A retrospective assessment of different endodontic treatment protocols

Evaluation by Scanning Electron Microscopy and Energy Dispersive X-Ray Spectroscopy of the Effects of Root Canal Instrumentation on the Radicular Dentine

One area of technological advancement has been the shift from stainless steel hand tools to nickel-titanium (Ni-Ti) rotary tools. This paper aims to perform an in vitro comparative study to evaluate the efficacy of five endodontic manual and rotary instruments such as Kerr files, Orodeka Plex V, ProTaper Flydent NiTi super files, and ProTaper Flydent NiTi super files in combination with an ultrasonic endodontic E3D Diamantata EMS scaler used for root canal shaping. The following aspects were highlighted: effective removal of smear layer (SL) from the dentinal tubules in the coronal 1/3, middle 1/3, and apical 1/3 of the root canal, appearance of cracks in the dentinal walls by SEM analysis, and highlighting of dentin mineral content and remnant debris by EDX analysis. In the study, 48 monoradicular, uninjured teeth were taken and divided into four groups, each with 12 teeth to be canal modeled, then longitudinally sectioned; the active surface was metallized for SEM-EDX analysis. From the SEM micrograph analysis, the morphology of the crystallites, the distribution of SL components, and the highlighting of instrumentation path traces/amplitudes were observed. By analyzing the SEM photomicrographs at 750 and 800× magnification, it was possible to highlight the cracks in the root dentinal walls. Thus, in comparison with Lots I and II which did not present cracks, in Lot III multiple cracks of the root dentinal walls were identified, especially in the coronal 1/3, and in Lot IV cracks were present with preponderance in the coronal and apical 1/3 of the root canals. The EDX images with atom mapping show very well the rather homogeneous elemental distribution for Ca, N, and P, respectively inhomogeneous for Na, Ca, Si, C, N, O, and P elements, as a result of the presence of remnant products from the processing of the root dentinal walls. Root canal instrumentation performed with both manual Kerr needle instrumentation by a convection technique and the rotary, Orodeka system, by crown-down technique, resulted in minimal SL formation in all three root canal areas, unlike the ProTaper FlyDent system. Most cracks were recorded in the case of the ProTaper Flydent rotary instruments and the one in which it was paired with a diamond ultrasonic scaler. The occurrence of dentinal cracks causes a decrease in dentinal microhardness, favoring the occurrence of root fractures.

Cauterization of Narrow Root Canals Untouched by Instruments by High-Frequency Current

The mechanical removal of bacteria is fundamental to the treatment of infected root canals, but complete sterilization of biofilms tends not to extend to uninstrumented areas. However, during electrical conduction to a root canal filled with a conductor, the higher impedance where the root canal is narrower generates Joule heat that may result in a large temperature increase and sterilization. The effect of a high-frequency electric current on the wall of a simulated narrow root canal was investigated by scanning electron microscopy (SEM) and energy dispersive X-ray spectrometry (EDS). Simulated root canals, 0.1 mm in diameter, were prepared in dentine blocks. The root canal wall was treated with Plank-Rychlo solution for 5 min to create a decalcified layer. The simulated root canal was filled with either saline or NaClO, and 150 or 225 V at 520 kHz was applied for 0 s, 1 s, or 5 s. As the conduction time increased, and when the saline was replaced with NaClO, the proportion with a flat decalcified surface decreased, dentinal tubules and a lava-like morphology were significantly more evident on SEM (p < 0.01), and EDS showed significant decreases in carbon and oxygen and increases in calcium (p < 0.01). It was concluded that filling uninstrumented root canals with NaClO and using electrical conduction for 5 s could incinerate and eliminate the organic material of the root canal wall. The application of high-frequency electric current may lead to the cure of many cases of persistent apical periodontitis.

Cone-beam computed tomographic evaluation of the root canal anatomy of the lower premolars and molars in a Brazilian sub-population

Purpose

This study evaluated anatomical variations in the root canals of the lower premolars and molars in a Brazilian sub-population using cone-beam computed tomography (CBCT).

Materials and Methods

In total, 121 CBCT images of patients were selected from a database. All images contained lower first and second premolars and molars on both sides of the arch, fully developed roots, and no treatment, resorption, or calcifications. In each image, the root canals of the lower premolars and molars were evaluated according to the Vertucci classification in On-Demand 3D software in the multiplanar reconstruction with dynamic navigation. Twenty-five percent of the images were re-assessed to analyze intraobserver confidence with the kappa test. Data were statistically evaluated with linear regression to evaluate the correlations of anatomic variations with age and sex, and the Wilcoxon test to analyze the laterality of variations, with a significance level of 5%.

Results

The intraobserver agreement (0.94) was excellent. In general, the root canals of lower premolars and molars showed a higher prevalence of type I than other Vertucci classification types, followed by type V in premolars and type II in molars. When the molar roots were evaluated separately, type II was more frequent in mesial roots and type I in distal roots. Although age showed no correlations with the results, sex and laterality showed correlations with tooth 45 and the lower second premolars, respectively.

Conclusion

The lower premolars and molars of a Brazilian sub-population showed a wide range of root canal anatomic variations.

Comparison of the Treatment Efficacy of Endo-Perio Lesions Using a Standard Treatment Protocol and Extended by Using a Diode Laser (940 nm)

Marginal and periapical periodontal diseases cause massive destruction of tooth tissues and surrounding tissues, such as alveolar bone and maxillary sinus floor, visible on radiographs. Lesions involving the apical and marginal periodontium are endo-perio (EPL) lesions. This study aimed to compare the treatment efficacy of endo-perio lesions using a standard treatment protocol and a standard diode laser-assisted treatment protocol. The 12 patients were divided into the study (a) and control (b) group. Periodontal indices, tooth vitality and mobility, occlusal status, and radiographic diagnosis were evaluated. Standard EPL treatment was then performed-without (a) and with (b) the use of diode laser (940 nm). Again, after six months, the above-mentioned parameters were evaluated and compared. The treatment of endo-perio lesions is a significant challenge for modern dentistry. Diode lasers are increasingly used in addition to traditional treatment methods. The conventional use of a 940 nm diode laser with an average power of 0.8 W in pulsed mode allows for the depth of periodontal pockets to be reduced. In addition, the use of a diode laser has a significant effect on tooth mobility and reduces bone loss.