Using 3-dimensional printing to create presurgical models for endodontic surgery.

Advances in endodontic surgery--from both a technological and procedural perspective-have been significant over the last 18 years. Although these technologies and procedural enhancements have significantly improved endodontic surgical treatment outcomes, there is still an ongoing challenge of overcoming the limitations of interpreting preoperative 2-dimensional (2-D) radiographic representation of a 3-dimensional (3-D) in vivo surgical field. Cone-beam Computed Tomography (CBCT) has helped to address this issue by providing a 3-D enhancement of the 2-D radiograph. The next logical step to further improve a presurgical case 3-D assessment is to create a surgical model from the CBCT scan. The purpose of this article is to introduce 3-D printing of CBCT scans for creating presurgical models for endodontic surgery.

Remedying and preventing endodontic rotary nickel-titanium (NiTi) file breakage.

Of all the procedural problems that can occur when practicing dentistry, endodontic file breakage is one dilemma that not only can lead to extreme stress for the clinician, but can cause great anxiety for the patient as well. Separated rotary nickel-titanium (NiTi) files can also pose an increased risk of post-endodontic complications. Understanding why and how endodontic file breakage occurs, including the two main factors that contribute to this type of incident, can help clinicians employ prevention strategies and overcome this predicament if it does occur. The purpose of this article is to discuss the causes of separated endodontic rotary NiTi files, explain how to prevent this problem from happening, describe the removal of a broken file, and discuss the prognosis for instances where the separated file cannot be removed.

An in vitro comparison of bond strength of various obturation materials to root canal dentin using a push-out test design.

The purpose of this in vitro study was to compare the bond strength of various obturation materials to root canal dentin by using a push-out test design. Twenty-five single-rooted extracted human teeth were used in this study. The crowns were removed, and root canal instrumentation was completed by using Endogel-coated 0.06 EndoSequence rotary files (Brasseler, Savannah, GA) and appropriate irrigation with 5.25% NaOCl and a final rinse with 17% EDTA. After instrumentation, the roots were randomly divided into five single-matched cone obturation groups (n = 5 roots/group), as follows: group 1, gutta percha with Kerr EWT (Kerr Corp, Romulus, MI); group 2, gutta percha with AH Plus (Dentsply, DeTrey, Germany); group 3, Resilon (Pentron Clinical Technologies, Wallingford, CT) and Epiphany (Pentron); group 4, Activ GP (Brasseler) obturation system; and group 5, EndoREZ obturation system (Ultradent, South Jordan, UT). The obturated roots were cut perpendicular to the long access to create 1-mm thick slices from the apical, middle, and coronal thirds. The bond strength was measured for each test slice with a push-out testing machine. Statistical analysis was completed by using a two-way analysis of variance and the post hoc Tukeys test with significance set at p < 0.05. Group 2 showed a significantly (p < 0.05) greater bond strength compared with all other groups. Also, groups 1 and 4 had significantly (p < 0.05) higher bond strengths compared with groups 3 and 5.

Integrating ultrasonic tips into the endodontic treatment armamentarium.

The integration of ultrasonic tips in conventional and surgical endodontic treatment can be useful for the clinician. An ultrasonic tip is used in conventional endodontic treatment to remove or bypass a separated instrument or a post within a canal, and can replace a slow-speed handpiece and round bur to detect or provide better access to a canal. In endodontic surgery, the replacement of the slow-speed or miniature handpiece with an ultrasonic tip will allow for better instrument ergonomics and depth of a root-end preparation. When used in conjunction with magnification and illumination, visualization for the clinician is markedly improved. In addition, advancements in polymer science have allowed for the development of plastic ultrasonic tips.

An in vitro comparison of the antimicrobial effects of various endodontic medicaments on Enterococcus faecalis.

The purpose of this in vitro study was to investigate the antimicrobial action of Dermacyn (Oculus Innovative Sciences, Petaluma, CA), BioPure MTAD (Dentsply Tulsa Dental, Johnson City, TN), 2% chlorhexidine (CHX; Ultradent, West Jordan, UT), and 5.25% sodium hypochlorite (NaOCl) against Enterococcus faecalis (American Type Culture Collection 4082). Eighteen Petri dishes of BHI agar were inoculated with E faecalis. Each Petri dish had five saturated paper disks placed. Four of the disks were saturated with a different test solution, and the last paper disk served as the control and was saturated with sterile distilled water. The plates were randomly distributed into two groups. Group one (n=9) was incubated aerobically and group 2 (n=9) was incubated anaerobically for 48 hours at 37 degrees C. The largest diameter of the zones of microbial inhibition was measured in millimeters and recorded. Statistical analysis was performed with repeated-measures analysis of variance. BioPure MTAD showed significantly (p<0.05) more zones of microbial inhibition than 5.25% NaOCl, 2% CHX, and Dermacyn. Sodium hypochlorite and CHX showed significantly (p<0.05) more zones of microbial inhibition than Dermacyn. The zone of inhibition between NaOCl and CHX was not significant (p>0.05). The control group showed no microbial inhibition.

Clinically enhancing the connection between endodontic and restorative treatment for better case prognosis.

This article focuses on the endodontic-restorative interface. The reduction of bacterial contamination via chemical-mechanical debridement during conventional endodontic treatment, in conjunction with canal obturation and timely restorative treatment using a rubber dam to prevent the microbial recontamination of the canal system, will significantly improve the clinical outcome.

An in vitro comparison of the intraradicular dentin bond strength of Resilon and gutta-percha.

The purpose of this study was to compare the micropush-out bond strength of Resilon to that of gutta-percha. Extracted human anterior teeth were used for evaluation. The crowns were removed and the root canals were instrumented with Gates Glidden drills and 0.06 Profile rotary files. Instrumentation was performed with 5.25% sodium hypochlorite irrigation and a final rinse of 17% EDTA. The teeth were randomly divided into two groups. Gutta-percha group: obturation with gutta-percha and Kerr Pulp Canal Sealer EWT. Resilon group: obturation with Resilon points, Epiphany Primer, and Root Canal Sealant. The teeth were cut perpendicular to their long axis to obtain a series of 1.0 mm thick disks (n = 15 per group). Micropush-out bond strengths to root canal dentin were measured. The results show that the mean bond strength to root canal dentin was significantly higher (p < 0.05) in the Resilon/Epiphany group as compared to the gutta-percha/Kerr Pulp Canal Sealer EWT group.

A comparison of thermal properties between gutta-percha and a synthetic polymer based root canal filling material (Resilon).

A new polymer-based obturating material, Resilon, has been developed but there have been no studies identifying its thermal properties. The purpose of this study was to compare the melting point, specific heat, enthalpy change with melting and heat transfer between gutta-percha (GP) and Resilon (R). The first three tests were determined using a differential scanning calorimeter and the heat transfer test was determined using a split-tooth model. Results show no significant difference (t test, p > 0.05) between gutta-percha and Resilon for the melting point temperature (GP: 60.01 degrees C; R: 60.57 degrees C). There was a significant difference (t test, p < 0.05) in specific heat capacity (GP: 0.94 J/g degrees C, R: 1.15 J/g degrees C) and endothermic enthalpy change (GP: 10.88 J/g, R: 25.20 J/g) between the two materials. The heat transfer test showed a significant difference (Mann-Whitney, p < 0.05) in temperature increase between gutta-percha and Resilon within 3 mm of the heat source.

In vitro evaluation of the antimicrobial effects of a root canal sealer-antibiotic combination against Enterococcus faecalis.

The purpose of this in vitro study was to evaluate the antimicrobial effects of five antibiotics when added to Kerr Pulp Canal Sealer EWT against Enterococcus faecalis. Five antibiotics: amoxicillin, penicillin, clindamycin, metronidazole, and doxycycline, were added separately to Kerr sealer. Thirty brain heart infusion agar plates were inoculated with E. faecalis and sterile paper discs containing a sealer-antibiotic combination were randomly assigned to the inoculated plates. Kerr sealer on a sterile paper disc and a blank sterile paper disc served as the controls. Fifteen plates were incubated aerobically and the remaining 15 plates were incubated anaerobically at 37 degrees C. The zones of inhibition were measured at 48 hours. No significant differences (p > 0.05) were found between aerobic and anaerobic groups. The groups were combined and data analysis using a one-way ANOVA and Tukey's post hoc test was performed. Results revealed that sealer-antibiotic combinations containing amoxicillin, penicillin, clindamycin, and doxycycline had a significant difference (p < 0.001) in the mean zones of inhibition when compared to Kerr EWT sealer alone. No significant differences (p > 0.05) were found between the metronidazole-sealer combinations and Kerr EWT sealer alone.

The causes, prevention, and clinical management of broken endodontic rotary files.

Complications can occur during many dental procedures. The prepared clinician responds by either correcting the problem during treatment, or, ideally, preventing the problem from occurring in the first place. In endodontic treatment separated rotary Ni-Ti files are a common procedural problem. Through understanding that the main causes of file breakage are cyclic fatigue and torsional stress, a dentist can best prevent this occurrence by using hand files before rotary files, creating a straight-line (glide path) access into a canal, and preflaring the coronal portion before using rotary files in the apical third of the canal. In addition, using an up and down motion with the electric slow-speed handpiece (not allowing the file to bind within the canal) will significantly reduce the incidence of file breakage. If a file does break, successful removal primarily depends on the location of the file in the canal rather than the specific technique employed for removal. A case does not necessarily fail if the separated file cannot be removed. The prognosis when file separation occurs can still be favorable, especially if care was taken to reduce the critical concentration of canal debris with hand instrumentation and chemical irrigation prior to rotary file insertion. In addition, the introduction of a new CS file design will help the dentist increase the chance of removing the file in the event of breakage.

Low carb endodontics.

The field of endodontics has seen great technological advances and changes in thought processes over the last decade. Unfortunately, with these advances and changes has come an overload of information (too many carbs!). This article will help to reduce your intake of carbohydrate information and provide you with what you need to know about conventional endodontic treatment.

An in vitro comparison of the rake angles between K3 and ProFile endodontic file systems.

The purpose of this study was to compare rake angles of the ProFile and K3 file systems. Twenty-five 40/0.06 taper files were obtained for each system. Five files from the same manufacturer were placed perpendicularly into a vial of Epoxicure Resin and left to set for 24 h. The set-ups were removed from the vials and each were sectioned 5 mm from the tip of the files and polished. A photomicrograph was taken of each file with 100x magnification. Five sets of ProFile and five sets of K3 files were processed in this manner. Images were captured digitally, and rake angles of each file were measured. Multivariate ANOVA found a significant difference (p < 0.001) among the three negative rake angles of the ProFile system compared with the K3 system.