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

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.

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.

Anestesia en la endodoncia de molares y premolares mandibulares con pulpitis aguda irreversible. Recomendaciones clínicas. Hacia una revisión sistemática / Anesthesia in the endodontic treatment of mandibular molars and premolars with acute irreversible pulpitis. Clinical recommendations. Towards to a systematic approach

Objetivo. El propósito de este trabajo es revisar el estado de la anestesia local odontológica en los pacientes con pulpitis aguda en los dientes posteriores mandibulares, para conocer los métodos más eficaces para lograr su anestesia antes del tratamiento endodóntico. Material y método. Se ha realizado una búsqueda bibliográfica de los ensayos clínicos sobre la eficacia de bloqueos mandibulares en pulpitis agudas de molares y premolares inferiores publicados desde el año 1987 hasta 2015. Resultados. La administración de un cartucho de 1,8 mL de la solución estándar de Lidocaína 2% con Adrenalina 1:100.000 (L- 100) o 1:80.000 (L-80), empleando la técnica de bloqueo mandibular, solo es efectiva en el 30% de los casos. En el caso de administrar dos cartuchos anestésicos, la eficacia aumenta al 45%. Si se administra un cartucho de 1,8 mL de Articaína 4% con adrenalina 1:100.000 (A-100) la eficacia es del 40% y, en el caso de administrar dos cartuchos, la eficacia aumenta hasta un 70%. Si se prescribe un antiinflamatorio no esteroideo (AINE) al paciente una hora antes de la intervención y se administra un cartucho de 1,8 mL de solución estándar L-80 o L-100, el porcentaje de casos con éxito alcanza el 55%. En el caso de prescribir paracetamol una hora antes, la eficacia se reduce al 50%. Si tras haber realizado el bloqueo mandibular con L-80 o L-100 se hace un refuerzo vestibular con otros 1,8 mL de A-100, la eficacia es del 65% y si se realiza un bloqueo mandibular de 1,8 mL de A-100 y refuerzo vestibular con otros 1,8 mL de A-100 la eficacia es del 85%. Conclusiones. Se recomienda la toma de AINES una hora antes de la intervención, efectuar un bloqueo mandibular con 3,6 mL deA-100 y refuerzo por vestibular con 1,8 mL deA-100 (AU)

Aim. The purpose of this paper is to review the state of the dental local anesthesia in patients with acute irreversible pulpitis in mandibular posterior teeth, to find out the most effective methods to achieve anesthesia prior to the endodontic treatment. Materials and methods. A literature review was conducted searching for clinical trials on the efficacy of the mandibular block technique in lower molars and premolars with acute irreversible pulpitis, published from 1987 to 2015. Results. The administration of one cartridge of 1,8 mL standard solution of Lidocaine 2% with Adrenalin 1:100.000 (L-100) or 1:80.000 (L-80) with the mandibular block technique is only effective in 30% of the cases. If administering two cartridges, the effectiveness increases to 45%. One cartridge of 1,8 mL Articaine 4% with Adrenalin 1:100.000 (A-100) is effective in 40% of the cases, increasing to 70% when adding a second cartridge. If prescribing a nonsteroidal anti-inflammatory drug (NSAID) one hour before the treatment and injecting one cartridge of 1,8 mL standard solution L-80 or L-100, the percentage of successfully anesthetized cases reaches 55%. In case of prescribing acetaminophen one hour before treatment, the efficacy is reduced to 50%. If following the mandibular block technique with L-80 or L-100, a buccal reinforcement is made with 1,8 mL A-100, the effectiveness is 65%. If such blockage is made with 1,8 mL of A-100 and the buccal reinforcement with 1,8 mL A-100, the effectiveness is 85%. Conclusion. The recommendations to achieve the highest effectiveness of anesthesia are taking NSAIDs one hour before treatment and performing a mandibular block technique with 3,6 mL of A-100 and buccal reinforcement with 1,8 mL of A- 100 (AU)