Evaluation of Root Canal Obturation Quality in Deciduous Molars with Different Obturation Materials: An In Vitro Micro-Computed Tomography Study

Assessment of Root Canal Filling Capacity and Quality of the Root Canal Pastes

Background

The complex anatomy of root canals in primary teeth makes root canal treatment and canal filling difficult. Root canal filling materials should meet the basic requirements for hermetic filling in terms of their physicochemical properties, such as radiopacity and viscosity, which might be affected by heat.

Objectives

The aim of this study was to investigate the effect of different temperatures on the filling quality and hermetic obturation ability of primary root canal filling pastes.

Materials and Methods

Primary root canal filling pastes containing calcium hydroxide with barium sulphate and calcium hydroxide with iodoform were heated to four different temperatures (4°C, 23°C, 39°C and 55°C). After instrumentation, 80 endodontic blocks were filled with the heat-treated sealers. Digital radiographs were taken and analysed. The results were analyzed using Tukey's HSD, two-way Robust ANOVA, and the Bonferroni test for multiple comparisons.

Results

The results of this study, the obturation radiopacity values of calcium hydroxide paste containing barium sulphate showed significant differences at different temperature values. Paste at 4°C showed significantly higher radiopacity (p<0.001). Paste at 55°C showed both significantly higher radiopacity (p<0.001), and the total unfilled area values obtained at 55°C was found to be significantly lower than the other temperatures (p=0.025).

Conclusion

It was observed that the preheating process had a positive effect both on the filling quality and hermetic obturation capacity of primary root canal sealants at high temperatures.

Micro-CT Analysis of Apical Plug Using Various Premixed Bio-ceramic Putties: An In Vitro Study

OBJECTIVE

Root growth and apical closure continue after tooth eruption. Root growth may cease if pulp viability is lost due to caries or trauma during this period. Successful endodontic treatment is challenging in these cases due to wide root canals and lack of apical stops. New premixed bioceramic root repair putties offer superior handling and healing properties. The aim of this study is to evaluate the filling ability and volumetric changes of three bioceramic putties (BIO-C Repair, NeoMTA Putty, and EndoSequence BC RRM Fast Set Putty) using micro-CT analysis.

METHODS

Thirty-six freshly extracted single-rooted teeth with straight root canals were used, divided into three groups based on the materials. Immature teeth were simulated. Pre- and post-obturated micro-CT images were taken for each root. Voids were calculated as the percentage difference between canal space volume and repair material volume. The data were then analysed statistically using one-way analysis of variance (ANOVA) with the level of significance set at α=0.05.

RESULTS

All groups showed marginal gaps and/or internal voids after root-end filling. No significant difference between groups in canal and material volumes was detected at 3 mm (p>0.05). However, void percentage differences were significant (p=0.003); Bio-C Repair (9.28+-3.27%) and EndoSequence BC RRM (6.7+-2.72%) were significantly higher with no difference between them, while NeoMTA Putty (3.73+-1.69%) was significantly lower.

CONCLUSION

NeoMTA Putty exhibited the least volumetric alterations after setting, compared to EndoSequence BC RRM and BIO-C Repair. Enhanced long-term stability as a minimal dimensional change contributes to the material's durability and effectiveness over time, potentially leading to better treatment outcomes making NeoMTA Putty a reliable choice for various endodontic applications, potentially leading to improved success rates and patient outcomes. (EEJ-2024-07-114).

Teaching pulpectomy in paediatric dentistry: A national cross-sectional survey of dental schools in Brazil

BACKGROUND

Pulpectomy is used to treat primary teeth with irreversibly inflamed or necrotic pulp tissue. There is, however, a lack of consensus on clinical protocols for teaching pulpectomy at dental schools.

AIM

To determine what faculty members at Brazilian dental schools are teaching about pulpectomy in primary teeth.

DESIGN

A cross-sectional, observational study was conducted using a 39-question survey available via the Google Forms® platform. A snowball sampling strategy was used for recruitment. Invitations to participate were sent via e-mail, WhatsApp® and Instagram®. The data were analysed descriptively.

RESULTS

A total of 177 (58.4%) responses were obtained. Most faculty members recommended the use of Kerr hand files (66.1%), and 1% sodium hypochlorite was the most common choice for the irrigating solution (35.3%). Iodoform pastes were the first choice of faculty members (41.6%), and 60.5% of the faculty members recommended composite resin as the definitive restoration.

CONCLUSION

Similarities were found in the teaching of pulpectomy for primary teeth among faculty members at dental schools in Brazil.

Comparative Evaluation of the Quality of Obturation Between Three Obturation Techniques in Primary Canines: An In Vitro Study

Aims This study compares three obturation techniques (rotary lentulo spiral, handheld lentulo spiral, and pressure syringe) for the quality of two filling pastes (zinc oxide eugenol (ZOE) paste and Metapex (Meta Biomed Co., Ltd., Chungcheongbuk-do, Korea). Methods and materials Sixty extracted primary canines were instrumented and obturated by filling materials. The obturation techniques were divided into three groups according to different obturation techniques. Obturation quality was evaluated for length, density, and presence of voids by using digital radiography. Results This study showed that the handheld lentulo spiral technique using Metapex and ZOE exhibited more optimal fillings for obturation length. The highest density obturation was achieved using the syringe injection approach with Metapex and ZOE. The highest incidence of both external and internal voids was observed in the group using ZOE with the handheld lentulo spiral technique Conclusions Based on the findings of this study, for both filling materials, the handheld lentulo spiral technique had the greatest number of optimal lengths but there were also more voids.

Hydraulic (Single Cone) Versus Thermogenic (Warm Vertical Compaction) Obturation Techniques: A Systematic Review

Root canal treatment (RCT) involves cleaning and shaping of the root canal system before filling the canals with obturating materials, often gutta-percha (GP). The two primary obturation techniques are the thermogenic (warm vertical compaction, WVC) and hydraulic (single cone, SC) techniques. The objective of this study is to compare the clinical results and effectiveness of thermogenic and hydraulic obturation procedures in endodontic therapy to provide clinicians with evidence-based recommendations. Search strategies were conducted on February 01, 2024 and involved the databases Web of Science, PUBMED, Google Scholar, Scopus, Medline, Embase, NCBI, and Cochrane Library. The current systematic review included systematic reviews; meta-analyses; cohort studies; randomized controlled trial (RCT) studies; studies involving the comparison between single cone and warm compaction techniques; studies involving outcomes that include advantages, disadvantages, and complications associated with single cone or warm compaction techniques; and studies published within the last seven years. The selected studies were restricted to those with insufficient data, review articles without authentic references, publications in a language other than English, animal studies, and studies not involving SC or WVC. Out of 2300 studies registered, only 12 studies were included in the review. Both WVC and SC techniques showed satisfactory root canal fillings. However, five studies showed differences in the filling quality, four studies assessed the sealing ability and the dentinal tubule penetration of sealers, one study compared dentinal cracks, one study evaluated the amount of debris excluded apically, and one study compared the post-operative pain while using both techniques. The WVC and SC obturation techniques offer advantages and disadvantages in endodontic treatment. SC obturation is a simple and efficient procedure that is particularly suitable for situations with uncomplicated canal structures. The WVC obturation approach provides superior flexibility and sealing capability, especially in the complex root canal system. When choosing the method of treatment, it is important to take into account the patient's preferences, the clinician's experience, and unique considerations related to the situation. This systematic review highlights the important recommendations to healthcare professionals in selecting the most suitable obturation procedure based on the specific requirements of each clinical scenario. Research involving long-term follow-ups is required to get a better understanding of the outcomes of long-term goals. Clinical relevance: ability to educate clinicians regarding the best obturation technique between thermogenic and hydraulic. It directs the treatment decisions to maximize patient's comfort, minimize post-operative complications, and improve efficacy in endodontic practice.

Comparison of Endoflas and Zinc Oxide Eugenol as Root Canal Filling Materials for Pulpectomy in Deciduous Teeth: a Systematic Review and Meta-Analysis

Objectives

To evaluate and compare the effectiveness of Endoflas and Zinc Oxide Eugenol (ZOE) as root canal filling materials (RCFMs) for the pulpectomy of deciduous teeth by analyzing multiple clinical and radiographic success and failure follow-ups in previously published studies.

Data

All clinical studies that investigated the pulpectomy of the deciduous teeth of children aged 3-9 years.

Sources

The databases used for source identification included MEDLINE (via PubMed), Scopus, Web of Science, and the Cochrane Library. No limitations were imposed on the publication year or language. The selection of studies and extraction of relevant study characteristics were conducted from December 26, 2021, to September 7, 2023. Additionally, the risk of bias (RoB) in the included studies was evaluated by using a RoB instrument (RoB 2). Eligible studies were then combined, and a random-effects model was applied by using the maximum likelihood estimations of log risk ratios and their corresponding 95% confidence intervals.

Study selection

Of the 3913 records found in the abovementioned databases, nine were eligible for systematic review and eight were eligible for meta-analysis. The studies included 628 pulpectomies of deciduous molar teeth in children. The overall results showed that compared with Endoflas, ZOE was associated with a higher risk ratio for clinical evaluation (LOG[RR] = 0.06, CI 0.03-0.09, p-value 0.001) and radiographic evaluation (LOG[RR] = 0.68, CI 0.35-1.00, p-value 0.001). This association was highly significant at 6- and 9-month follow-ups.

Conclusion

Compared with ZOE, Endoflas was associated with a lower risk of the clinical and radiographic failure of deciduous teeth pulpectomy and a 6%-6.8% higher risk ratio, especially at 6- and 9-month follow-ups.

Clinical significance

This study suggests the superiority of Endoflas over ZOE as an RCFM for deciduous teeth.

Evaluation of the efficacy of the Lentulo spiral filler operated at four different speeds and with two different techniques in cadaveric canine teeth of dogs

This study evaluated the effect of filling technique and rotational speed on the efficacy of sealer cement placement using the Lentulo spiral filler. Cadaveric maxillary and mandibular canine teeth (n = 74) from age and breed matched fresh-frozen adult canine cadaver heads were utilized. Following routine mechano-chemical preparation, teeth were randomly divided into 8 treatment groups with varying rotational speeds [250-2,000 revolutions per minute (RPM)] and fill techniques (backfill technique versus pumping technique). The quality of the sealer cement fill was evaluated radiographically before and after master gutta percha cone placement. Percentage of voids present in the apical, midbody, and coronal portions of the tooth were subjectively scored as: no voids present, voids present in less than 25% of the area, voids present in 25-50% of the area, voids present in greater than 50% of the area. The apex was also scored as underfilled, adequately filled, or overfilled. Operating the Lentulo spiral filler at 2,000 RPM resulted in the best quality fill regardless of filling technique. The pumping technique with placement of the master gutta percha cone had a higher probability of success as compared to the backfill technique, but this finding lacked significance. Regardless of speed or technique, the apical region had the highest quality of fill. The addition of the master gutta percha cone improved the quality of fill. Therefore, we recommend using the Lentulo spiral filler at higher speeds with a pumping technique (followed by addition of a master gutta percha cone) to improve the quality of epoxy resin-based sealer cement placement.

The Contribution of Various In Vitro Methodologies to Comprehending the Filling Ability of Root Canal Pastes in Primary Teeth

A void-free obturation during root canal treatment on primary teeth is currently very difficult to attain. In this study, the pulpectomy filling abilities of Bio-C Pulpecto (Angelus, Basil, Londrina, Paraná, Brazil) and of zinc oxide eugenol, or "ZOE" (DenPro, Prevest, New York, NY, USA), were compared using several in vitro techniques. Therefore, 30 primary anterior teeth were used in the present in vitro study. Analysis of variance (ANOVA), including a multiple comparison procedure (Holm-Sidak method, Dunn's Method, or Tukey test), was used. On micro-CT, Bio-C Pulpecto exhibited higher void percentages than did ZOE (10.3 ± 3.8%, and 3.5 ± 1.3%), respectively (p < 0.05). With digital microscopy, higher total void percentages were found in the BC (13.2 ± 26.7%) group compared to the ZOE (2.7 ± 2.8%) group (p < 0.05). With the CLSM, mean tubular penetration depths were higher for Bio-C Pulpecto than for ZOE in all canal thirds (p < 0.05). SEM images demonstrated no tags into dentinal tubules in either group throughout the three thirds. Moreover, higher statistically significant flowability was found for Bio-C (2.657 ± 0.06 mm) compared to ZOE (1.8 ± 0.13 mm) (p < 0.05). The findings of this study indicate that neither ZOE nor Bio-C Pulpecto appears to meet the criteria for an ideal root canal filling paste for primary teeth. This study laid the groundwork for future research by determining how micro-CT, digital microscopy, SEM, and CLSM contribute to our understanding of the filling process of primary teeth. More thorough research on the mechanism of root canal obturation on primary teeth is required to achieve a long-term successful root canal therapy in young children.