Performance of obturation techniques in anatomical irregularities located at different thirds of the root canal system

Abstract This study aimed to compare the quality of root canal obturation (ratio of area occupied by gutta-percha (G), sealer (S), and presence of voids (V)) in different anatomical irregularities (intercanal communications, lateral irregularities, and accessory canals) located at different thirds of the root canal system of mandibular molar replicas. Sixty-seven 3D printed replicas of an accessed mandibular molar were prepared using ProGlider and ProTaper Gold rotatory systems. Three specimens were randomly selected to be used as controls and did not receive further treatment. The rest were randomly distributed in 4 experimental groups to be obturated using either cold lateral compaction (LC), continuous wave of condensation (CW), and core-carrier obturation (ThermafilPlus (TH) or GuttaCore (GC)) (n=16 per group). AHPlus® sealer was used in all groups. The three controls and a specimen from each experimental group were scanned using micro-computed tomography. The rest of the replicas were sectioned at the sites of anatomical irregularities and examined at 30× magnification. The G, S, and V ratios were calculated dividing the area occupied with each element by the total root canal area and then compared among groups using the Kruskal-Wallis test. Voids were present in all obturation techniques with ratios from 0.01 to 0.15. CW obtained a significantly higher G ratio in the irregularity located in the coronal third (0.882) than LC (0.681), TH (0.773), and GC (0.801) (p<0.05). TH and GC achieved significantly higher G ratios in those located in the apical third (p<0.05). The worst quality of obturation was observed in the loop accessory canal with all obturation techniques. Whitin the limitations of this study, it can be concluded that CW and core-carrier obturation are respectively the most effective techniques for obturating anatomical irregularities located in the coronal and the apical third.

Effect of different obturation techniques on sealer penetration into dentinal tubules after final irrigation with XP-Endo finisher file

The first objective of this research was to evaluate the effectiveness of XP-Endo Finisher on dentinal tubule penetration of irrigation solution using confocal laser scanning microscopy. The main purpose of this research was to compare the effect of cold lateral condensation, continuous wave obturation and core-carrier based techniques on sealer penetration. Sixty mandibular premolars were prepared and allocated into two experimental groups (n=30) as the final irrigation technique and obturation technique experiment. In the final irrigation technique experiment, final irrigation was performed with XP-Endo Finisher, passive ultrasonic irrigation (PUI) and conventional needle irrigation (CNI) (n=10). The roots in the obturation technique experiment were also assigned into 3 groups and obturated with cold lateral condensation, continuous-wave obturation and core-carrier techniques (n=10). The most effective activation method, which emerged as a result of the first part of this study, was used as the final irrigation method in the obturation technique experiment. Then, all roots were sectioned in 1-mm-thick slices at 3mm from the apex for scanning. In terms of depth and percentage of material penetration, CNI exhibited significantly the lowest values and no significant difference was found between others. Also, there was no significant difference among obturation methods. In conclusion, XP-Endo Finisher and PUI are more effective than CNI on irrigant penetration. Sealer penetration into dentinal tubules is independent of obturation techniques.

El objetivo principal de esta investigación fue evaluar la eficacia de XP- Endo Finisher en la penetración de la solución de irrigación en los túbulos dentinarios mediante microscopía de láser confocal. Se prepararon sesenta premolares mandibulares y se distribuyeron en dos grupos experimentales (n=30) según el tipo de método de evaluación utilizado. En el experimento de la técnica de irrigación final, la irrigación final se realizó con XP-Endo Finisher, irrigación ultrasónica pasiva (PUI) e irrigación con aguja convencional (CNI) (n=10). Las raíces en el experimento de la técnica de obturación también se asignaron en 3 grupos y se obturaron con técnicas de condensación lateral fría, obturación de onda continua y portador de núcleo (n=10). El método de activación más eficaz, que surgió como resultado de la primera parte de este estudio, se utilizó como método de irrigación final en el experimento de la técnica de obturación. Luego, todas las raíces se seccionaron en muestras de 1mm de espesor. En términos de profundidad y porcentaje de penetración del material, CNI exhibió significativamente los valores más bajos y no se encontraron diferencias significativas entre los demás. Además, no hubo diferencias significativas entre los métodos de obturación. En conclusión, XP-Endo Finisher y PUI son más efectivos que CNI en la penetración del irrigante. La penetración del sellador en los túbulos dentinarios es independiente de las técnicas de obturación.

Influence of root canal filling techniques on sealer penetration and gutta percha/sealer ratio: a confocal laser scanning microscopy analysis / Influência das técnicas de obturação do canal radicular na penetração do cimento e na relação guta-percha / cimento: uma análise por microscopia de varredura confocal a laser

Objective: The influence of four root canal filling techniques on the penetration of an endodontic sealer into dentinal tubules and the gutta percha/ sealer ratio (GP/SR) in root canals was evaluated using confocal laser scanning microscopy (CLSM). Material and Methods: Roots of the maxillary central incisors (n=40) were prepared with ProTaper Universal files up to file F5 and assigned to five groups: continuous wave condensation, lateral condensation, single cone, Thermafill®, and negative control group. After root canal filling with gutta-percha and AH26, along with the addition of 0.01% fluorescein, the roots were cut into 2-mm slices. Using CLSM, the specimens were transversely sectioned at 3, 6, and 10 mm from the apex. Results: Sealer penetration was deeper and more frequent at 10 mm than at the 6mm and 3mm for all obturation technique. Penetration was not significantly affected by obturation techniques except single master cone tecnique. Single cone technique demonstrated the lowest sealer penetration at all levels. However, sealer thickness was strongly dependent on obturation technique. Termafill® demostrated superior GP ratio followed by continuous wave condensation, lateral condensation and single cone. Conclusion: In conclusion, the single cone technique resulted in lower sealer penetration than the other techniques, which did not differ significantly from each other. However, sealer thickness was strongly dependent on obturation technique. Termafill® demostrated superior GP ratio followed by continuous wave condensation, lateral condensation and single cone. (AU)

Objetivo: A influência de quatro técnicas de obturação do canal radicular na penetração de um cimento endodôntico nos túbulos dentinários e a relação gutapercha / cimento (GP / CIM) em canais radiculares foram avaliadas por microscopia de varredura confocal a laser (MVCL). Material e Métodos: As raízes de incisivos centrais superiores (n = 40) foram preparadas com limas ProTaper Universal até a lima F5 e distribuídas em cinco grupos: condensação de onda contínua, condensação lateral, cone único, Thermafill® e grupo de controle negativo. Após o preenchimento do canal radicular com guta-percha e AH26, juntamente com a adição de 0,01% de fluoresceína, as raízes foram cortadas em fatias de 2 mm. Usando MVCL, as amostras foram seccionadas transversalmente a 3, 6 e 10 mm do ápice. Resultados: A penetração do cimento foi mais profunda e mais frequente em 10 mm do que nos 6 mm e 3 mm para todas as técnicas de obturação. A penetração não foi significativamente afetada pelas técnicas de obturação, exceto pela técnica de cone mestre único. A técnica de cone único demonstrou a menor penetração do cimento em todos os níveis. No entanto, a espessura do cimento foi fortemente dependente da técnica de obturação. O Termafill® demonstrou uma relação superior de GP, seguida por condensação de onda contínua, condensação lateral e cone único. Conclusão: Em conclusão, a técnica de cone único resultou em menor penetração do cimento do que as outras técnicas, que não diferiram significativamente uma da outra. No entanto, a espessura do cimento foi fortemente dependente da técnica de obturação. O Termafill® demonstrou uma relação superior de GP, seguida por condensação contínua das ondas, condensação lateral e cone único. (AU)

Evaluación radiográfica de los tratamientos realizados por alumnos de grado con dos técnicas de obturación endodóntica / Radiographic evaluation of the treatments performed by undergraduate students with two filling techniques

Objetivo: Evaluar radiográficamente, en dientes extraídos, el grado de homogeneidad y adaptación de las obturaciones endodónticas realizadas por alumnos de grado, comparando las técnicas de condensación lateral e híbrida. Materiales y métodos: Entre 2003 y 2017, los alumnos de tercer año de la Escuela de Odontología de la Universidad del Salvador / Asociación Odontológica Argentina realizaron 5.384 tratamientos endodónticos ex vivo empleando, para la obturación, las técnicas de condensación lateral e híbrida. En las radiografías posoperatorias, un docente especialista en endodoncia evaluó la homogeneidad y la adaptación de cada obturación para categorizarla como correcta o incorrecta. Para la comparación entre técnicas, dentro de cada año lectivo, se utilizó la prueba exacta de Fisher, y para el análisis porcentual de las observaciones, la prueba de Chi cuadrado. El nivel de significancia fue establecido en P<0,05. Resultados: Del total de 5.384 tratamientos, 4.970 (92,3%) mostraron obturaciones correctas. Con la técnica de condensación lateral, de los 1.741 tratamientos, 1.560 (89,6%) mostraron obturaciones correctas con la técnica híbrida, de los 3.643 tratamientos, 3.410 (93,6%) tuvieron obturaciones correctas. En función del tamaño total de las muestras, sumando todos los años, puede estimarse con 95% de confianza que la diferencia de obturaciones incorrectas entre ambas técnicas está entre el 2,3% y el 5,7%. Con la prueba del Chi cuadrado, se observa una diferencia significativa de obturaciones correctas a favor de la técnica híbrida (P<0,01) Conclusiones: La evaluación radiográfica de los tratamientos endodónticos realizados ex vivo por alumnos de pregrado mostró un alto porcentaje de obturaciones correctas. Así mismo, el empleo de la técnica híbrida dio, en general, mejores resultados de compactación de la masa del material obturador que la técnica de condensación lateral (AU)

Aim: To evaluate radiographically the degree of homogeneity and adaptation of endodontic obturations completed by undergraduate students in extracted teeth using lateral and hybrid condensation techniques. Materials and methods: Between 2003 and 2017, third year students of a the School of Dentistry of the Universidad del Salvador / Asociación Odontológica Argentina performed 5384 ex vivo endodontic treatments using lateral condensation and hybrid technique. In the postoperative radiographs, a specialist in endodontics assessed the homogeneity and adaptation of each obturation and categorize it as correct or incorrect. The data were submitted to statistical analysis to compare results obtained with the two techniques. Fisher and Chi-square tests were used and significance level was set at P<0.05. Results: Out of 5384 treatments, 4970 (92.3%) showed correct obturation. Within the 1741 treatments completed with the lateral condensation technique, 1560 (89.6%) were correct while within the 3634 where a hybrid technique was used, 3410 (93.6%) were correct. When the whole sample was considered (sum of treatment carried out during each of the academic years) a statistically significant difference (P<0.01) favoring the hybrid technique was found. The difference in incorrect cases can be estimated to be between 2.3% and 5.7% with 95% confidence. Conclusions: The radiographic evaluation completed by undergraduate students in extracted teeth showed a high percentage of correct fillings. The use of the hybrid technique showed, in general, better compaction of the obturation material than the lateral condensation technique (AU)

Various Obturation methods used in deciduous teeth.

Pulpectomy is one of the treatment options used to maintain primary teeth with radicular pulpal tissue inflammation or that have become nonvital, until normal exfoliation. The primary goal of this procedure is to maintain arch length and function by preserving primary teeth that are essential to proper guidance of the permanent dentition. Other objectives of preserving primary teeth are to enhance esthetics and mastication, prevent aberrant tongue habits, aid in speech, and prevent the psychological effects associated with tooth loss. The treatment consists of removing the pulp tissue associated with micro-organisms and debris from the canal and obturating with resorbable filling material. Familiarity with the complexity of primary tooth canal systems, their formation and resorption pattern dictates the parameters that affect the probability of success of root canal therapy. Moreover, the obturating material as well as obturation technique used that is capable of densely filling the entire root canal system and providing a fluid tight seal from the apical segment of the canal to the cavosurface margin in order to prevent reinfection also significantly influences the success rate of the endodontic therapy. Several methods have been used to deliver obturating materials into the root canals. The purpose of this article is to throw light on various obturation techniques used in deciduous teeth with their comparison, pros and cons.