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Liu Y, Huang X, Ke H, Song X, Huang X, Sun S. Influence of Access Cavities on Maxillary Central Incisor Fracture Resistance: Finite Element Study. Int Dent J 2024:S0020-6539(24)00121-7. [PMID: 38692963 DOI: 10.1016/j.identj.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION AND AIMS Altering the position and orientation of the root canal access cavity passway, or modifying the reduction of dentin volume, can influence the strength of dentition. This study aimed to compare the effects of different access cavities on the biomechanical performances of maxillary central incisors with a finite element analysis. METHODS Based on the micro-computed tomography (CT) scan of a maxillary central incisor, the finite element models of the intact tooth and teeth with 4 access cavity designs: conservative incisal access cavity, incisal access cavity, conservative access cavity, and traditional access cavity were generated. Simulated occlusal forces were applied at the incisal edge of the incisor in the finite element analysis procedure. RESULTS The maximum von Mises stress and maximum principal stress in the cervical area are highest in the traditional access cavity group, followed by the conservative access cavity group, incisal access cavity group, and conservative incisal access cavity group. CONCLUSION The conservative access cavities minimise the extent of dentin removal from the cervical region, protecting the mechanical behaviour of the incisor. Moving the access cavity entry point to the incisal edge also improves the fracture resistance of the incisor. CLINICAL RELEVANCE This study's findings would help clinicians select the most appropriate endodontics access cavity method when performing the root canal on maxillary central incisors.
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Affiliation(s)
- Yujiang Liu
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Xinyao Huang
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Haoyu Ke
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Xinyi Song
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Xinmeng Huang
- Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Shufen Sun
- Hospital of Stomatology, Jilin University, Changchun, PR China.
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Yu D, Guo L, Gao J, Liu J, Yang D. Evaluation of apical extrusion of debris and centering ability in different nickel-titanium files during curved root canal preparation. BMC Oral Health 2023; 23:395. [PMID: 37322508 PMCID: PMC10273756 DOI: 10.1186/s12903-023-03070-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Curved root canals lead to difficulties in cleaning, shaping and filling the root canal system. Apical extrusion of debris and root canal transportation are important factors causing postoperative complications. In clinical practice, commonly selected instruments include multifile NiTi systems, such as M3-Pro PLUS (M3-PRO), Orodeka Plex 2.0 (ODP), Rotate (ROT), and Protaper Gold (PTG), as well as single-file NiTi systems, such as M3-L Platinum 2019 (M3L), Waveone Gold (WOG), and Reciproc Blue (RCB). This study aimed to comprehensively evaluate the differences in the apical extrusion of debris and centering ability of the above NiTi files. METHODS Seventy 3D-printed resin teeth were used (n = 10). The apically extruded debris was collected in a preweighed centrifuge tube. The resin teeth with or without root canal preparation were cut into separate cross sections at 1 mm, 3 mm, 5 mm, and 7 mm away from the root apex, and then the root canal transportation and centering ratio of each cross section were calculated. RESULTS Apical extrusion of debris was highest in RCB but lowest in OD-P (P < 0.05). Root call deviation was lowest in ROT at the 3 mm level, in PTG at the 5 mm level, and in PTG and ROT at the 7 mm level (P < 0.05). The centering ratio of NiTi files was highest in the RCB group at the 3 mm level, in the PTG group at the 5 mm level, in the ROT group at the 7 mm level (P < 0.05). CONCLUSIONS For NiTi files with the same system, the cross-sectional design is the greatest factor affecting the extrusion of debris, and motion mode is the second. In addition, the multifile system could reduce the degree of root canal transportation.
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Affiliation(s)
- Dongsheng Yu
- Northern Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, 404100, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 404100, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 404100, China
| | - Li Guo
- Northern Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, 404100, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 404100, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 404100, China
| | - Jing Gao
- Northern Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, 404100, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 404100, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 404100, China
| | - Jie Liu
- Northern Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, 404100, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 404100, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 404100, China
| | - Deqin Yang
- Northern Department of Endodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, 404100, China.
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, 404100, China.
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, 404100, China.
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Vasudevan A, Sundar S, Surendran S, Natanasabapathy V. Tooth substance loss after incisal endodontic access and novel single-tooth template-guided endodontic access in three-dimensional printed resin incisors with simulated pulp canal calcification: A comparative in vitro study. J Conserv Dent 2023; 26:258-264. [PMID: 37398863 PMCID: PMC10309124 DOI: 10.4103/jcd.jcd_3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 07/04/2023] Open
Abstract
Context Background Guided endodontics has various applications, one of which is for calcified canal negotiation. Recently, a new single-tooth template has been fabricated to overcome the drawbacks of bulky guides, which are difficult to use with rubber dam isolation. Aim This study aimed to assess the efficacy of the novel single-tooth template for negotiation of pulp canal calcification (PCC) in three-dimensional (3D)-printed resin incisors by comparing substance loss and time taken between incisal endodontic access (IEA) and single-tooth template-guided endodontic access (SGEA). Methods Forty-two resin incisor teeth having patent canal in the apical third were used (N = 21/group). They were subcategorized based on operator's experience into senior endodontist (SE), postgraduate (PG), and undergraduate (UG) (n = 7/operator). Canals were negotiated conventionally for IEA and using the single-tooth template for SGEA. Substance loss was calculated from the volume difference between pre- and postoperative cone-beam computed tomography scans. The time taken was also recorded. Statistical Analysis Used Statistical analysis was performed using unpaired t-test and one-way analysis of variance test. Results Canals were successfully negotiated in 100% and 95% of teeth in the SGEA and IEA groups, respectively. Overall substance loss and time taken were significantly lesser for SGEA for all operators (P < 0.001). In the IEA group, post hoc test showed statistical significance between SE and UG for substance loss (P < 0.05) and SE-UG and PG-UG for time taken (P < 0.05). No significant difference among operators was noted for both parameters in SGEA. Conclusions SGEA resulted in significantly lesser substance loss and time taken for canal negotiation in 3D-printed resin incisors with simulated PCC. This was independent of the experience levels of the operator.
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Affiliation(s)
- Aishwarya Vasudevan
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Sathish Sundar
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Smita Surendran
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research University, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
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Tang Y, Wu Y, Pei F, Liu C, Qiu Y, Yang T, Gu Y. A micro-computed tomographic analysis of the root canal systems in the permanent mandibular incisors in a Chinese population. BMC Oral Health 2023; 23:129. [PMID: 36890470 PMCID: PMC9996864 DOI: 10.1186/s12903-023-02830-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Comprehensive understanding of the root canal system complexity is critical important for successful root canal therapy. A double root canal system may be present in permanent mandibular incisors with a variable incidence in different ethnic populations. Ignorance or improper management of this canal variation can lead to treatment failure. This in vitro study aimed to identify the anatomic features of root canal systems in the mandibular incisors in a Chinese population by using micro-CT. METHODS A total of 106 permanent mandibular incisors (53 central incisors and 53 lateral incisors) were collected from a native Chinese population. The teeth were scanned by a micro-CT scanner and then reconstructed three-dimensionally. The canal configurations were detected by Vertucci's classification, and the number and location of the accessory canals were also identified. The long (D) and short diameters (d) of the main and accessory canals were measured and D/d ratio was calculated at different root levels (cemento-enamel junction [CEJ] level, mid-root level and 1, 2, 3 and 4 mm from the apex). The root canal curvatures in the double-canaled mandibular incisors were measured at the proximal view by using modified Schneider's method. Chi-square test or Fisher's exact test was used for comparison of occurrence rates. Comparison of means from multiple groups was performed by using one-way ANOVA and LSD post-hoc test. RESULTS In regard to the occurrence of double root canals, gender difference was neither detected in the mandibular central (16.0% [male] vs 14.3% [female]; p = 0.862), nor in the mandibular lateral incisors (26.9% [male] vs 33.3% [female]; p = 0.611). Age group difference was also not detected in the mandibular central (p = 0.717) and lateral incisors (p = 0.521). The incidence of double root canals was 15.1% (8/53) in the central incisors, and 30.2% (16/53) in the lateral incisors, but the difference did not reach statistical significance (p = 0.063). The most frequent non-single canal type was the type III (1-2-1) (18.9% [20/106]), and the other types identified included 1 case of type II (2-1) and 3 cases of type V (1-2). The incidence of accessory canals was 17.9% (19/106), with a mean level of 1.92 ± 1.19 mm from the apex. The frequency of long-oval (2 ≤ D/d < 4) and flattened canals (D/d ≥ 4), as well as the mean value of D, d and D/d ratio increased from the apical 1 mm to the apical 4 mm level (the D/d ratio increased from 1.9 to 2.9 for the single canals, from 1.4 to 3.3 for the buccal canals and from 1.2 to 2.3 for the lingual canals), and the D/d ratio reached the peak at the mid-root level. Double curvatures were detected in 33.3% (8/24) of the buccal canals and 37.5% (9/24) of the lingual canals, and the difference has no statistical significance (p = 0.063). The degrees of the primary curvatures were 21.5 ± 7.1 degrees for the buccal and 30.1 ± 9.2 degrees for the lingual canals, and the degrees of secondary curvatures were 27.0 ± 11.4 degrees for the buccal and 30.5 ± 12.5 degrees for the lingual canals in the double curvatures. The degrees of the single curvatures were 14.2 ± 6.3 degrees for the buccal and 15.6 ± 6.0 degrees for the lingual canals. Significant difference was detected among above 6 groups of canal curvatures (p = 0.000), and severe curvatures (≥ 20 degrees) were more frequently detected in the double curved canals. CONCLUSIONS Double-canaled mandibular incisors were not uncommon in the Chinese population, and type 1-2-1 was the most frequent non-single canal type. Gender and age did not significantly impact the occurrence of a second canal in mandibular incisors. Long-oval and flattened canals were very common at different root levels and their incidence increased from apex to the mid-root level. Severe curvatures were frequently detected in the double canal systems, especially in those canals with double curvatures.
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Affiliation(s)
- Ying Tang
- Department of Central Laboratory and Pathology, Ninth People's Hospital of Suzhou, Soochow University, Suzhou, China
| | - Yihan Wu
- Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist., 215200, Suzhou, China
| | - Fan Pei
- Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist., 215200, Suzhou, China
| | - Chao Liu
- Department of Central Laboratory and Pathology, Ninth People's Hospital of Suzhou, Soochow University, Suzhou, China
| | - Yinfeng Qiu
- Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist., 215200, Suzhou, China
| | - Tao Yang
- Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist., 215200, Suzhou, China
| | - Yongchun Gu
- Department of Central Laboratory and Pathology, Ninth People's Hospital of Suzhou, Soochow University, Suzhou, China. .,Department of Central Laboratory and Dentistry, Ninth People's Hospital of Suzhou, Soochow University, Ludang Road 2666#, Wujiang Dist., 215200, Suzhou, China.
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Tang Y, Zhang Y, Meng Z, Sun Q, Peng L, Zhang L, Lu W, Liang W, Chen G, Wei Y. Accuracy of additive manufacturing in stomatology. Front Bioeng Biotechnol 2022; 10:964651. [PMID: 36051587 PMCID: PMC9424550 DOI: 10.3389/fbioe.2022.964651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
With the rapid development of the three-dimensional (3D) printing technology in recent decades, precise and personalized manufacturing has been achieved gradually, bringing benefit to biomedical application, especially stomatology clinical practice. So far, 3D printing has been widely applied to prosthodontics, orthodontics, and maxillofacial surgery procedures, realizing accurate, efficient operation processes and promising treatment outcomes. Although the printing accuracy has improved, further exploration is still needed. Herein, we summarized the various additive manufacturing techniques and their applications in dentistry while highlighting the importance of accuracy (precision and trueness).
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Affiliation(s)
- Yao Tang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Yunfan Zhang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Zhaoqiang Meng
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qiannan Sun
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Liying Peng
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Lingyun Zhang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Wenhsuan Lu
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
| | - Wei Liang
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
- *Correspondence: Wei Liang, ; Gui Chen, ; Yan Wei,
| | - Gui Chen
- Department of Orthodontics, Cranial Facial Growth and Development Center, Peking University School and Hospital of Stomatology, Beijing, China
- NMPA Key Laboratory for Dental Materials, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, Beijing, China
- *Correspondence: Wei Liang, ; Gui Chen, ; Yan Wei,
| | - Yan Wei
- Department of Geriatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
- *Correspondence: Wei Liang, ; Gui Chen, ; Yan Wei,
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Comparison of Er:YAG laser and ultrasonic in root canal disinfection under minimally invasive access cavity. Lasers Med Sci 2022; 37:3249-3258. [PMID: 35854018 DOI: 10.1007/s10103-022-03613-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Abstract
The disinfection of root canal through minimally invasive access cavity remains questionable. This in vitro study compared the effectiveness of three disinfection measures including conventional irrigation, ultrasonic assisted irrigation, and erbium:yttrium-aluminum-garnet (Er:YAG) laser assisted irrigation through conventionally or minimally invasive access. Sixty-six extracted maxillary first molars were randomly divided into group 1 conventionally invasive access group (CIA) and group 2 computer-guided minimally invasive access group (MIA). Each group was further randomly divided into three subgroups, (A) conventional irrigation (CI), (B) passive ultrasonic agitation (PUI), and (C) Er:YAG laser activated irrigation (LAI). Enterococcus faecalis (E. faecalis) infection model was established inside all root canals after instrumentation was performed up to ProTaper Universal F2. After various disinfection methods, microbial samples were collected from root canals by paper tip method and cultured, and colony forming units (CFU) values of each sample were calculated. Then the root canals were enlarged to the size of F3, after which dentin debris was collected from the F3 file. After dilution and culturing, the CFU value was calculated for each group. Two-way analysis of variance (ANOVA) was performed to test the interaction. The results revealed a significant antagonism (F = 3.394, P = 0.043). The bacterial CFU counts of group B and group C were significantly less than that of group A (P < 0.05), and there was no significant difference between group B and C (P > 0.05). Additionally, group 2A was better than group 1A (P < 0.05); there was no significant difference between group 1B and group 2B, group 1C and group 2C (P > 0.05). Comparison of the bacterial CFU counts in dentin debris after disinfection, the results revealed a significant antagonism (F = 7.224, P = 0.002), and group C had the least. The disinfection effect of Er:YAG laser or ultrasonic assisted computer-guided minimally invasive access is similar to conventionally invasive access, and Er:YAG laser is better than ultrasonic in removing bacteria from dentinal tubules and is easy to operate, which is more suitable for minimally invasive root canal treatment.
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Rahbani Nobar B, Dianat O, Rahbani Nobar B, Kazem M, Hicks ML. Influence of minimally invasive access cavities on load capacity of root‐canal‐treated teeth: A systematic review and meta‐analysis. AUST ENDOD J 2022; 49:213-236. [PMID: 35665985 DOI: 10.1111/aej.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 01/20/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022]
Abstract
This systematic review (PROSPERO-CRD42020147333) aimed to compare the effects of conservative, ultraconservative and truss access cavities with traditional access cavities on the load capacity of root-canal-treated teeth. Online databases were searched until December 2021, and 25 ex vivo studies in which the effects of different access cavities on load capacity of permanent teeth had been investigated were included. Quality assessment was completed using a modified risk of bias tool for in vitro studies adapted from previous studies. Meta-analysis was performed using the maximum-likelihood-based random-effects model with similar groups. Conservative access cavities significantly improved the load capacity of maxillary premolars (p < 0.01 [-1.32, -0.028]) and molars (p < 0.05 [-0.89, -0.02]) compared to traditional access cavities. Additionally, truss access cavities significantly improved the load capacity of mandibular molars with (p < 0.05, [-1.18, -0.02]) mesio-occluso-distal cavity preparations. Higher levels of evidence are needed to determine the long-term implications of minimal preparations for treatment outcomes.
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Affiliation(s)
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of DentistryUniversity of MarylandBaltimoreMarylandUSA
| | - Behnam Rahbani Nobar
- Department of Endodontics, School of DentistryAlborz University of Medical SciencesKarajIran
| | - Majid Kazem
- Department of Endodontics, School of DentistryShahid Beheshti University of Medical SciencesTehranIran
| | - M. Lamar Hicks
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of DentistryUniversity of MarylandBaltimoreMarylandUSA
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Silva EJNL, De-Deus G, Souza EM, Belladonna FG, Cavalcante DM, Simões-Carvalho M, Versiani MA. Present status and future directions - Minimal endodontic access cavities. Int Endod J 2022; 55 Suppl 3:531-587. [PMID: 35100441 DOI: 10.1111/iej.13696] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
In the last decades, the move of Medicine towards minimally invasive treatments is notorious and scientifically grounded. As Dentistry naturally follows its footsteps, minimal access preparation also became a trend topic in the endodontic field. This procedure aims to maximize preservation of dentine tissue, backed up by the idea that this is an effective way to reduce the incidence of post-treatment tooth fracture. However, with the assessment of the body of evidence on this topic, it is possible to observe some key-points (a) the demand for nomenclature standardization, (b) the requirement of specific tools such as ultra-flexible instruments, visual magnification, superior illumination, and three-dimensional imaging technology, (c) minimally invasive treatment does not seem to affect orifice location and mechanical preparation when using adequate armamentarium, but it (d) may impair adequate canal cleaning, disinfection, and filling procedures, and also (e) it displays contradictory results regarding the ability to increase the tooth strengthen compared to the traditional access cavity. In spite of that, it is undeniable that methodological flaws of some benchtop studies using extracted teeth may be responsible for the conflicting data, thus triggering the need for more sophisticated devices/facilities and specifically designed research in an attempt to make it clear the role of the access size/design on long-term teeth survival. Moreover, it is inevitable that a clinical approach like minimal endodontic access cavities that demands complex tools and skilled and experienced operators bring to the fore doubts on its educational impact mainly when confronted with the conflicting scientific output, ultimately provoking a cost-benefit analysis of its implementation as a routine technique. In addition, this review discusses the ongoing scientific and clinical status of minimally invasive access cavities aiming to input an in-depth and unbiased view over the rationale behind them, uncovering not only the related conceptual and scientific flaws, but also outlining future directions for research and clinical practices. The conclusions attempt to skip from passionate disputes highlighting the current body of evidence as weak and incomplete to guide decision making, demanding the development of a close-to-in-situ laboratory model or a large and well-controlled clinical trial to solve this matter.
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Affiliation(s)
- Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Department of Endodontics, School of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão
| | | | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Xu F, Zhang Y, Gu Y, Ping Y, Zhou R, Wang J. Shaping ability of four single-file systems in the instrumentation of second mesiobuccal canals of three-dimensional printed maxillary first molars. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1425. [PMID: 34733977 PMCID: PMC8506727 DOI: 10.21037/atm-21-3855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022]
Abstract
Background This study evaluated and compared the shaping ability of four advanced single-file nickel-titanium (NiTi) systems during the preparation of curved second mesiobuccal (MB2) canals in maxillary first molar replicas fabricated by three-dimensional (3D) printing via micro-computed tomography (Micro-CT) imaging. Methods A total of 60 3D-printed maxillary first molar replicas were constructed from one extracted tooth, with an angle of curvature ranging from 15° to 25°. The MB2 canals from these 60 replicas were divided into 4 groups of 15 replicas according to the canal instrumentation system used, namely, Waveone gold (WOG), Reciproc blue (RCB), XP-endo shaper (XPS) and M3-L. The specimens were scanned before and after preparation using Micro-CT. The pre- and post-instrumentation images of each specimen were superimposed, and the amount of resin removed, the change in surface area, the canal transportation, and centering ability were assessed using the Mimics software. Instrumentation time was also recorded. One-way analysis of variance and least significant difference (LSD) tests were used to statistically compare the groups. The significance level was set at 5%. Results Instrumentation time with M3-L was significantly longer than the other systems (P<0.05). The amount of resin removed and the change in surface area generated by the 4 systems were different at the apical, middle, and coronal thirds, and the total canal (P<0.05). Overall, WOG and XPS resulted in the less change than RCB and M3-L. There was no significant difference among the groups at the middle third regarding canal transportation and centering ability (P>0.05). However, a significant difference was found at the apical level (P<0.05), where RCB showed the poorest centering ability and the highest canal transportation (P<0.05). In addition, XPS resulted in the least canal transportation (P<0.05) at the coronal level, while there was no significant difference between the four groups in terms of centering ability. Conclusions The M3-L instrument required more time to prepare the curved MB2 canals compared with the other systems. Overall, WOG and XPS showed the least resin removal and surface area change. M3-L, XPS, and WOG instruments respected the original canal curvature better than RCB files.
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Affiliation(s)
- Fulu Xu
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.,Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Yuerong Zhang
- Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China.,Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
| | - Yongchun Gu
- Department of Dentistry, The Ninth People's Hospital of Suzhou, China
| | - Yifan Ping
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.,Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Ruyu Zhou
- Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
| | - Juan Wang
- Department of Endodontics and Operative Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.,Jiangsu Province Key Laboratory of Oral Diseases, Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, China
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Shabbir J, Zehra T, Najmi N, Hasan A, Naz M, Piasecki L, Azim AA. Access Cavity Preparations: Classification and Literature Review of Traditional and Minimally Invasive Endodontic Access Cavity Designs. J Endod 2021; 47:1229-1244. [DOI: 10.1016/j.joen.2021.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 12/18/2022]
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A Critical Review of Methods for Quantitative Evaluation of Root Canal Transportation. J Endod 2021; 47:721-731. [PMID: 33587997 DOI: 10.1016/j.joen.2021.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A comparison between root canal transportation studies is nearly impossible because of nonstandardized transportation evaluation methods. The aim of the present review was to search, compare, and critically discuss transportation evaluation methods. METHODS A search of PubMed, Web of Science, Scopus, ScienceDirect, and reference lists of articles was conducted up to March 2020 using appropriate key words to identify transportation evaluation methods. The methods in the included articles were extracted, compared, and categorized. RESULTS Seventy-four articles using original methods were selected. All studies share 3 main steps: image acquisition, image measurements, and calculation of parameters. Images were acquired by photography, radiography, and computed tomographic imaging. Two types of measurements were used: the amount of removed material and the canal center point distance. The parameters were calculated and reported as distance or ratio. Relationships between the different transportation parameters were found and confirmed with mathematical simulation. CONCLUSIONS Although methods were proposed as being novel, similarities between them were found, enabling the classification of the methods and identifying correlations. The canal center point distance is the most suitable for the description of canal transportation because it is comprehensible and it relates to the mathematical concept of translation. Removed material-based measurements are double the value of the canal center point distance. Ratio parameters are not suitable for reporting transportation.
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Chamberless Endodontic Access for Treatment of Calcified Anterior Central Incisors. J Endod 2020; 47:322-326. [PMID: 33129898 DOI: 10.1016/j.joen.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Modern techniques for treating maxillary anterior central incisors with calcified canals emphasize maintaining coronal dentin with small crown access. Alternatively, traditional retrograde surgical procedures are focused on creating an apical seal predominately limited to the remaining resected apical one third of the root canal space. A treatment option for calcified anterior teeth, with avoidance of traditional orthograde access, is presented. Chamberless endodontic access (CEA) to the canal is chosen in this case, leveraging a previous surgical treatment and osseous defect to create straight line canal access. METHODS A tooth presenting with a chronic apical abscess and an apparent previous apical surgery was instrumented and obturated using a CEA avoiding the traditional orthograde approach to the root canal system. Straight line approach was achieved retrograde and canal instrumentation was performed using ultrasonic activated U-files. Canal obturation was accomplished with warm vertical condensation technique followed by placement of an apical retroseal. RESULTS A successful 52-month outcome demonstrated the viability of CEA facilitating retrograde instrumentation and obturation. CONCLUSIONS Use of CEA simultaneously protected the clinical crown and provided a successful clinical outcome. A viable option for treatment of an anterior calcified canal and abscess due to dental trauma, CEA mitigates many of the risks associated with the treatment of calcified root anatomy.
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Spicciarelli V, Marruganti C, Marzocco D, Martignoni M, Ounsi H, Grandini S. Influence of Endodontic Access Cavity Design on Fracture Strength of Maxillary Incisors and Premolars and on Fatigue Resistance of Reciprocating Instruments. FRONTIERS IN DENTAL MEDICINE 2020. [DOI: 10.3389/fdmed.2020.575010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Silva EJNL, Oliveira VB, Silva AA, Belladonna FG, Prado M, Antunes HS, De‐Deus G. Effect of access cavity design on gaps and void formation in resin composite restorations following root canal treatment on extracted teeth. Int Endod J 2020; 53:1540-1548. [DOI: 10.1111/iej.13379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Affiliation(s)
- E. J. N. L. Silva
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
- Department of Endodontics Fluminense Federal University NiteróiBrazil
| | - V. B. Oliveira
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
| | - A. A. Silva
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
| | - F. G. Belladonna
- Department of Endodontics Fluminense Federal University NiteróiBrazil
| | - M. Prado
- Department of Endodontics Veiga de Almeida University Rio de Janeiro Brazil
| | - H. S. Antunes
- Department of Endodontics Grande Rio University Duque de CaxiasBrazil
| | - G. De‐Deus
- Department of Endodontics Fluminense Federal University NiteróiBrazil
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Rover G, Lima CO, Belladonna FG, Garcia LFR, Bortoluzzi EA, Silva EJNL, Teixeira CS. Influence of minimally invasive endodontic access cavities on root canal shaping and filling ability, pulp chamber cleaning and fracture resistance of extracted human mandibular incisors. Int Endod J 2020; 53:1530-1539. [DOI: 10.1111/iej.13378] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 01/11/2023]
Affiliation(s)
- G. Rover
- Department of Dentistry Federal University of Santa Catarina Florianópolis SCBrazil
| | - C. O. Lima
- Department of Endodontics State University of Rio de Janeiro Rio de JaneiroRJBrazil
| | - F. G. Belladonna
- Department of Endodontics Fluminense Federal University NiteróiRJBrazil
| | - L. F. R. Garcia
- Department of Dentistry Federal University of Santa Catarina Florianópolis SCBrazil
| | - E. A. Bortoluzzi
- Department of Dentistry Federal University of Santa Catarina Florianópolis SCBrazil
| | - E. J. N. L. Silva
- Department of Endodontics State University of Rio de Janeiro Rio de JaneiroRJBrazil
- Department of Endodontics Fluminense Federal University NiteróiRJBrazil
- Department of Endodontics Grande Rio University Duque de Caxias RJ Brazil
| | - C. S. Teixeira
- Department of Dentistry Federal University of Santa Catarina Florianópolis SCBrazil
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Silva EJNL, Rover G, Belladonna FG, De-Deus G, da Silveira Teixeira C, da Silva Fidalgo TK. Impact of contracted endodontic cavities on fracture resistance of endodontically treated teeth: a systematic review of in vitro studies. Clin Oral Investig 2017; 22:109-118. [PMID: 29101548 DOI: 10.1007/s00784-017-2268-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This systematic review was performed to answer the following question: do contracted endodontic cavities (CECs) increase resistance to fracture in extracted human teeth compared to traditional endodontic cavities (TECs)? METHODS A literature search without restrictions was carried out in PubMed, Science Direct, Scopus, Web of Science, and Open Grey databases. Articles were selected by two independent reviewers. In addition, a reference and hand search was also fulfilled. All included in vitro studies evaluated the influence of CECs on strength to fracture in extracted human teeth and compared to TECs. The quality of the selected studies was evaluated and they were classified as having a low, moderate or high risk of bias. RESULTS A total of 810 articles were obtained in the electronic search. After the application of the eligibility criteria, reference and hand search, and duplicate removal, six studies were included in this systematic review. All included studies evaluated the influence of CECs on strength to fracture in extracted human teeth and compared to TECs. Characteristics investigated in the selected articles included the sample size and tooth type, access cavity design, filling and restoration procedures, load at fracture test characteristics, and results. The studies demonstrated large variability among the fracture resistance values and standard deviations and low power. Three of the reviewed studies presented low risk of bias and the other three showed medium risk of bias. CONCLUSION Overall, this systematic review of in vitro studies showed that there is no evidence that supports the use of CECs over TECs for the increase of fracture resistance in human teeth. CLINICAL RELEVANCE Recently, CECs have gained attention in endodontics due to maximum tooth structure preservation including the pericervical dentin, which could improve the strength to fracture of endodontically treated teeth. However, the influence of access cavity design on fracture resistance remains limited and controversial.
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Affiliation(s)
- Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil. .,Department of Endodontics, Grande Rio University (UNIGRANRIO), Duque de Caxias, RJ, Brazil.
| | - Gabriela Rover
- Department of Endodontics, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | | | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University (UFF), Niterói, RJ, Brazil
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