Materials for retrograde filling in root canal therapy.

BACKGROUND: Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination and obturation. It is conventionally performed through a hole drilled into the crown of the affected tooth, namely orthograde root canal therapy. For teeth that cannot be treated with orthograde root canal therapy, or for which it has failed, retrograde root filling, which seals the root canal from the root apex, is a good alternative. Many materials, such as amalgam, zinc oxide eugenol and mineral trioxide aggregate (MTA), are generally used. Since none meets all the criteria an ideal material should possess, selecting the most efficacious material is of utmost importance. OBJECTIVES: To determine the effects of different materials used for retrograde filling in children and adults for whom retrograde filling is necessary in order to save the tooth. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 13 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 13 September 2016); MEDLINE Ovid (1946 to 13 September 2016); Embase Ovid (1980 to 13 September 2016); LILACS BIREME Virtual Health Library (1982 to 13 September 2016); and OpenSIGLE (1980 to 2005). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We also searched Chinese BioMedical Literature Database (in Chinese, 1978 to 20 September 2016); VIP (in Chinese, 1989 to 20 September 2016); China National Knowledge Infrastructure (in Chinese, 1994 to 20 September 2016); and Sciencepaper Online (in Chinese, to 20 September 2016). No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) only that compared different retrograde filling materials, with reported success rate that was assessed by clinical or radiological methods for which the follow-up period was at least 12 months. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently and in duplicate. Original trial authors were contacted for any missing information. Two review authors independently carried out risk of bias assessments for each eligible study following Cochrane methodological guidelines. MAIN RESULTS: We included six studies (916 participants with 988 teeth) reported in English. All the studies had high risk of bias. The six studies examined five different comparisons, including MTA versus intermediate restorative material (IRM), MTA versus super ethoxybenzoic acid cement (Super-EBA), Super-EBA versus IRM, dentine-bonded resin composite versus glass ionomer cement and glass ionomer cement versus amalgam. There was therefore little pooling of data and very little evidence for each comparison.There is weak evidence of little or no difference between MTA and IRM at the first year of follow-up (risk ratio (RR) 1.09; 95% confidence interval (CI): 0.97 to 1.22; 222 teeth; quality of evidence: low). Insufficient evidence of a difference between MTA and IRM on success rate at the second year of follow-up (RR 1.06; 95% CI: 0.89 to 1.25; 86 teeth, 86 participants; quality of evidence: very low). All the other outcomes were based on a single study. There is insufficient evidence of any difference between MTA and Super-EBA at the one-year follow-up (RR 1.03; 95% CI: 0.96 to 1.10; 192 teeth, 192 participants; quality of evidence: very low), and only weak evidence indicating there might be a small increase in success rate at the one-year follow-up in favour of IRM compared to Super-EBA (RR 0.90; 95% CI: 0.80 to 1.01; 194 teeth; quality of evidence: very low). There was also insufficient and weak evidence to show that dentine-bonded resin composite might be a better choice for increasing retrograde filling success rate compared to glass ionomer cement at the one-year follow-up (RR 2.39; 95% CI: 1.60 to 3.59; 122 teeth, 122 participants; quality of evidence: very low). And there was insufficient evidence of a difference between glass ionomer cement and amalgam at both the one-year (RR 0.98; 95% CI: 0.86 to 1.12; 105 teeth; quality of evidence: very low) and five-year follow-ups (RR 1.00; 95% CI: 0.84 to 1.20; 82 teeth; quality of evidence: very low).None of these studies reported an adverse event. AUTHORS' CONCLUSIONS: Based on the present limited evidence, there is insufficient evidence to draw any conclusion as to the benefits of any one material over another. We conclude that more high-quality RCTs are required.

Influence of caries infiltrant contamination on shear bond strength of different adhesives to dentin.

OBJECTIVES: To analyze whether the contamination with a caries infiltrant system impairs the adhesive performance of etch-and-rinse and self-etching adhesives on dentin. MATERIALS AND METHODS: Dentin contamination with the caries infiltrant system (Icon, DMG) was simulated by applying either hydrochloric acid (15 % HCl, Icon Etch, 15 s), the resin infiltrant (Icon infiltrant, 4 min), or both prior to the application of the respective adhesives (each group n = 10). In the control groups, the etch-and-rinse adhesive (Optibond FL, Kerr) and the self-etching adhesive (iBOND Self Etch, Hereaus) were applied without former contamination with the infiltrant system. Additionally, the adhesive performance of the resin infiltrant alone was tested. Shear bond strength of a nano-hybrid composite was analyzed after thermocycling (5,000×, 5-55°C) of the specimens and analyzed by ANOVA/Scheffé post hoc tests (p < 0.05) and Weibull statistics. Failure mode was inspected under a stereomicroscope at × 25 magnification. RESULTS: Contamination with the resin infiltrant alone did not impair shear bond strength, while contamination with hydrochloric acid or with hydrochloric acid and the resin infiltrant reduced shear bond strength (MPa) of the adhesives (Optibond FL: 20.5 ± 3.6, iBOND Self Etch: 17.9 ± 2.6) significantly. Hydrochloric acid contamination increased the number of adhesive failures. The adhesive performance of the caries infiltrant system alone was insufficient. CONCLUSION: The contamination with the caries infiltrant system impaired the shear bond strength of conventional dental adhesives. CLINICAL RELEVANCE: Contamination of the caries infiltrant system on dentin should be avoided due to the detrimental effect of hydrochloric acid etching.

Effect of caries infiltrant application on shear bond strength of different adhesive systems to sound and demineralized enamel.

PURPOSE: To investigate the influence of caries infiltrant application on the shear bond strength of different adhesives on sound and demineralized enamel. MATERIALS AND METHODS: Sound and artificially demineralized (14 days, acidic buffer, pH 5.0) bovine enamel specimens were treated with a caries infiltrant (Icon, DMG), three different commercial adhesives (unfilled etch and- rinse adhesive: Heliobond, Ivoclar Vivadent; filled etch-and-rinse adhesive: Optibond FL, Kerr; or self-etching adhesive: iBOND Self Etch, Heraeus Kulzer) or a combination of caries infiltrant and adhesive. The shear bond strength of a nanohybrid composite was analyzed after thermocycling (5000x, 5° to 55°C) at a crosshead speed of 1 mm/min. Failure mode was inspected under a stereomicroscope at 25X magnification. RESULTS: In both sound and demineralized enamel, the shear bond strength of the caries infiltrant was not significantly different from the etch-and-rinse adhesives, while the self-etching adhesive showed significantly lower values compared to all other groups. Pretreatment with the caries infiltrant significantly increased the bond strength of the self-etching adhesive in both substrates and of the filled etch-and-rinse adhesive in demineralized enamel. While shear bond strength was not significantly different between the two substrates, cohesive failures were more likely to occur in demineralized than sound specimens. CONCLUSION: The shear bond strength of the caries infiltrant was similar to the etch-and-rinse adhesives. The caries infiltrant did not impair bonding to sound or demineralized enamel, and even increased adhesion of the selfetching agent.

[Shaping ability of multi-taper nickel-titanium files in simulated resin curved root canal].

OBJECTIVE: To compare the shaping ability of ISO standard stainless steel K files and multi-taper ProTaper nickel-titanium files in simulated resin curved root canals. METHODS Thirty simulated resin root canals were randomly divided into three groups and prepared by stainless steel K files, hand ProTaper, rotary ProTaper, respectively. The amount of material removed from inner and outer wall and canal width after canal preparation was measured, while the canal curvature before and after canal preparation and canals aberrations were recorded. RESULTS: The stainless steel K files removed more material than hand ProTaper and rotary ProTaper at the outer side of apex and inner side of curvature (P < 0.05). The mean degree of straightening in stainless steel K files group was significantly bigger than in ProTaper group (P < 0.05). The canals prepared by ProTaper had no evident aberration. CONCLUSION: The shaping ability of ProTaper is better than stainless steel K files.

[Radiographic anatomy of pulp chamber of Chinese permanent anterior teeth].

OBJECTIVE: The aim of this study was to measure and analyze the anatomic characteristics of the pulp chamber of Chinese permanent anterior teeth radiographically. METHODS: There were 137 human permanent anterior teeth to be used. The crown length, crown width and crown thickness were measured by vernier caliper. Labial-lingual and mesial-distal radiographs were obtained by parallel technique and Photoshop 8.0 was adopted for measuring the largest labial-lingual length, the largest mesial-distal length, the pulp chamber height and the distance between the lingual surface of the crown and the corresponding wall of the pulp chamber; the ratios of the largest labial-lingual length to the crown thickness, the largest mesial-distal length to the crown width and the pulp chamber height to the crown length were calculated. Finally the coefficients of variance were caculated. RESULTS: (1) The ratios of the largest mesial-distal length to the crown width of maxillary and mandibular canines were statistically different from those of the other anterior teeth. There was not statistically significant difference for those ratios either between maxillary and mandibular canines or among incisors. (2) Indexes of the pulp chamber had higher variance than those of the external morphology. (3) The distance between the lingual surface of the crown and the corresponding wall of the pulp chamber had the smallest coefficient of variance. (4) The largest mesial-distal length of the pulp chamber had the largest coefficient of variance, except for the mandibular canines. CONCLUSION: This study provided anatomical basis for clinical work; the distance between the lingual surface of the crown and the corresponding wall of the pulp chamber could be used as a depth reference for the endodontic access, and the access should not be extended excessively in mesial-distal direction.

[Difficulty assessment of root canal therapy in Chinese permanent maxillary anterior teeth].

PURPOSE: To assess the difficulty of root canal therapy in Chinese permanent maxillary anterior teeth by radiographic methods in vitro. METHODS: 80 maxillary anterior teeth including 27 maxillary central incisors, 22 maxillary lateral incisors and 31 maxillary canines were collected and X-rayed in 3 individual directions: labiopalatal projection, mesiodistal projection and the maximal angle shot. Three anatomic risk factors: root curvature, calcification and working length of root canal therapy were assessed by difficulty assessment standards and criterions. Kruskal-Wallis test was used to analyze the data. RESULTS: The results showed that the root canal therapy of 2 and 3 were significantly more difficult than 1, P < 0.05; while there was no significant difference between 2 and 3, P > 0.05. In 1, the results of difficulty assessment of root canal therapy were significantly different among 3 individual X-rays which were projected from 3 different directions (P < 0.05). The difficulty caused by root curvature was significantly greater than calcification and working length in labiopalatal X-ray in 1 (P < 0.05) and 2 (P < 0.01), while there was no significant difference among these 3 risk factors in 3 in labiopalatal projection (P > 0.05). CONCLUSIONS: The results suggest that the labiopalatal X-rays can be safely regarded as the reliable projection shot for difficulty assessment before endodontic procedures. Root curvature was by far the most important risk factor that affected the difficulty of root canal therapy in 1 and 2 while root curvature, calcification and working length played the same roles in root canal therapy of 3.

[Morphology of cross-sectioned root canal in Chinese mandibular permanent incisors].

OBJECTIVE: To identify morphological features of cross-sectioned root canal in Chinese mandibular permanent incisors. METHODS: Twenty mandibular permanent incisors were selected in this study. The tooth roots were embedded in resin and transversely sectioned with a low-speed diamond saw. The number of root canal and the morphology and isthmus of the root canal were observed under a stereo-microscope, which included the measure of the canal diameter. RESULTS: The double root canal comprised 22.5%, 30.0%, and 15.0% in crown third, middle third, and apical third root canals of the mandibular permanent incisors, respectively. The long oval canal comprised 44.8%, 77.0%, and 44.5% in crown third, middle third, and apical third root canals, respectively. The canal isthmus comprised 62.5%, 75.0%, and 48.7% in crown third, middle third, and apical third root canals, respectively. The diameter of buccal-lingual canal was at least 2 times of the diameter of mesial-distal canal. CONCLUSION: The cross-sectioned root canal morphology in Chinese mandibular permanent incisors varies considerably. But most have long oval and canal isthmus, which imposes a great challenge for root canal therapy.