Enhancing Coronal Adaptation of Root Canal Fillings with a Modified Single-Cone Obturation Technique: Two Case Reports.

The single-cone technique, also known as the hydraulic condensation technique, is widely employed in endodontics. However, the aforementioned method is presented with certain limitations; specifically concerning the coronal seal and the adaptation of the coronal third of a master gutta-percha (GP) with a round cross-section to the coronal dentinal walls of root canals with semi-round or oval cross-sections. Through two case reports, the current article introduces the coronal vertical condensation (CVC) technique; aiming to enhance GP adaptation to canal walls in similar scenarios. In fact, the coronal vertical condensation technique amalgamates the different aspects of warm vertical condensation and single-cone techniques. In CVC, following the placement of the master GP cone, an electrical heat carrier is inserted immediately a few millimeters apical from the canal orifice to remove the coronal portion of the master GP cone. Subsequently, a hand plugger is used to condense GP in the vertical dimension, and the coronal space is backfilled using melted GP. The implementation of CVC technique has demonstrated an improved coronal adaptation of GP with canal walls. The stated technique seems beneficial; especially in the obturation of severely curved canals or root canals with a final preparation shape of variable taper.

Micro-CT Evaluation of Four Root Canal Obturation Techniques.

PURPOSE: The aim of this in vitro study was to evaluate the quality of four root canal obturation techniques using microcomputed tomography (micro-CT). MATERIALS AND METHODS: A total of 36 mandibular first premolars with mostly round canals were decoronated, then instrumented up to a size F3 rotary file, and dressed with an epoxy resin-based sealer. Subsequently, they were divided into 4 different groups (n = 9) based on the method of obturation: lateral condensation using 0.02 tapered master cone (LC2), lateral condensation using 0.04 tapered master cone (LC4), matched single-cone technique (MS), and matched single cone-mediated ultrasonic activation (MSUA). All the teeth were scanned using micro-CT (resolution of 19 µm), and the percentage volume of voids was calculated. One-way analysis of variance and Tukey test were used to analyze the data (α = 0.05). RESULTS: The total percentage volume of voids was significantly lower in the MSUA group compared to all other groups (P < 0.05). The total percentage volume of voids was significantly lower in the MS group compared to the LC4 (P < 0.001) and LC2 (P < 0.001) groups. However, there was no significant difference between the LC2 and LC4 groups (P < 0.65). CONCLUSIONS: MSUA, significantly, showed the least root canal filling voids amongst all the obturation techniques studied. MSUA can be considered an effective method for the filling of the round root canals. In general, lateral condensation using either 0.02 or 0.04 tapered master cones had significantly the highest volume percentage of voids amongst the experimental groups.

Effect of calcium hydroxide on inflammatory root resorption and ankylosis in replanted teeth compared with other intracanal materials: a review.

Calcium hydroxide (CH) is the gold-standard intracanal dressing for teeth subjected to traumatic avulsion. A common complication after the replantation of avulsed teeth is root resorption (RR). The current review was conducted to compare the effect of CH with that of other intracanal medications and filling materials on inflammatory RR and replacement RR (ankylosis) in replanted teeth. The PubMed and Scopus databases were searched through June 2018 using specific keywords related to the title of the present article. The materials that were compared to CH were in 2 categories: 1) mineral trioxide aggregate (MTA) and endodontic sealers as permanent filling materials for single-visit treatment, and 2) Ledermix, bisphosphonates, acetazolamide, indomethacin, gallium nitrate, and enamel matrix-derived protein (Emdogain) as intracanal medicaments for multiple-visit management of avulsed teeth prior to the final obturation. MTA can be used as a single-visit root filling material; however, there are limited data on its efficacy due to a lack of clinical trials. Ledermix and acetazolamide were comparable to CH in reducing RR. Emdogain seems to be an interesting material, but the data supporting its use as an intracanal medication remain very limited. The conclusions drawn in this study were limited by the insufficiency of clinical trials.

Technical quality of root canal therapies performed by novice dental students in preclinical practice.

BACKGROUND: For improving the quality of endodontic performance of practitioners in clinical practice, their basic, preclinical performance and knowledge must be taken into consideration. This study aimed to radiographically evaluate the technical quality of preclinical molar root canal treatments (RCTs) performed by undergraduate dental students at a dental school in Iran. Further, the effect of using Gates-Glidden (GG) drills on the final quality of RCTs was evaluated. MATERIALS AND METHODS: In this retrospective cross-sectional study, 315 roots of 105 endodontically treated teeth in preclinical practice were evaluated radiographically. The analyzed quality parameters included length, taper and density of fillings, which were scored as S2 (adequate standard), the S1 (slight deviation), or S0 (considerable deviation). For all the parameters, acceptable, moderate and poor fillings received total scores of 6, 3-5 and 0-2, respectively. There were two groups of students: One group had used only K-files, and the other had used K-files along with GG drills. The quality of RCTs between these groups was evaluated using the aforementioned scoring protocol. The results were analyzed using Chi-square, Mann-Whitney and Fisher's exact tests (α = 0.05). RESULTS: Under-fillings (P = 0.001) and under-shapings (P = 0.007) occurred mostly in mandibular root fillings. A lower density was found in maxillary fillings (P < 0.001). No relationship was observed between the technique used (irrespective of GG drills usage) and length (P = 0.499) and taper of fillings (P = 0.238). The roots instrumented with GG drills had a higher filling density (P = 0.004). The quality mean score of RCTs was improved when GG drills were used (P = 0.008). CONCLUSION: The technical quality of preclinical molar RCTs performed by undergraduate dental students was considered acceptable in 35.6% of the cases. When GG drills were used along with K-files, the technical quality of RCTs was enhanced.

A 7-year study of 1,278 patients with maxillofacial trauma and cerebrospinal fluid leak.

BACKGROUND: A number of patients with facial fractures have cerebrospinal fluid (CSF) leak that may result in meningitis and other central nervous system complications. Commonly, CSF leak occurs following trauma, but the etiology and pattern of this disorder are different from region to region. This study aims to evaluate the distribution of CSF leak in patients with maxillofacial fractures in Isfahan province, Iran. PATIENTS AND METHODS: In this retrospective cross-sectional study, 1,287 medical files of patients admitted to a medical center with head and face injuries were evaluated during a 7-year period (2004-2010). Data was obtained using descriptive analysis. RESULTS: Of the 1,278 patients with head and maxillofacial fractures, 16 (1.25 %) males and one (0.07 %) female had CSF leak; all these cases had skull base fracture. Of these, 52.9 % had maxillary fracture, 23.5 % nasal fracture, 41.1 % orbital fracture, 11.7 % mandibular fracture, 23.5 % frontal fracture, and 41.1 % had more than one site of fracture. 58.8 % had rhinorrhea and 41.2 % otorrhea. Of all these patients with CSF leak, 8 (47 %), 2 (11.8 %), and 7 (41.2 %) cases were treated spontaneously, using lumbar drain placement, and by surgical intervention, respectively. CONCLUSIONS: Cerebrospinal fluid leak was observed most frequently in patients with fracture in the zygomatic and maxillary bone, and mostly exhibited itself as rhinorrhea and/or otorrhea. All cases with CSF leak had skull base fracture as well. However, post-traumatic CSF leaks are uncommon and are generally treated without surgical intervention (59 %). Distribution of CSF leak varies from one region to another and knowing this fact helps to manage the injury and prevent the complications.

Orthodontic Extraction of High-Risk Impacted Mandibular Third Molars in Close Proximity to the Mandibular Canal: A Systematic Review.

PURPOSE: Extraction of mandibular third molars (M3s) in close proximity to the mandibular canal has some inherent risks to adjacent structures, such as neurologic damage to teeth, bone defects distal to the mandibular second molar (M2), or pathologic fractures in association with enlarged dentigerous cysts. The procedure for extrusion and subsequent extraction of high-risk M3s is called orthodontic extraction. This is a systematic review of the available approaches for orthodontic extraction of impacted mandibular M3s in close proximity to the mandibular canal and their outcomes. MATERIALS AND METHODS: The PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), DOAJ, Google Scholar, OpenGrey, Iranian Science Information Database (SID), Iranmedex, and Irandoc databases were searched using specific keywords up to June 2, 2014. Studies were evaluated based on predetermined eligibility criteria, treatment approaches, and their outcomes. RESULTS: Thirteen articles met the inclusion criteria. A total of 123 impacted teeth were extracted by orthodontic extraction and 2 cases were complicated by transient paresthesia. Three types of biomechanical approaches were used: 1) using the posterior maxillary region as the anchor for orthodontic extrusion of lower M3s, 2) simple cantilever springs attached to the M3 buttonhole, and 3) cantilever springs tied to a bonded orthodontic bracket on the M3 plus multiple-loop spring wire for distal movement of the M3. Osteo-periodontal status of M2s also improved uneventfully. CONCLUSION: Despite the drawbacks of orthodontic extraction, removal of deeply impacted M3s using the described techniques is safe with regard to mandibular nerve injury and neurologic damage. Orthodontic extraction is recommended for extraction of impacted M3s that present a high risk of postoperative osteo-periodontal defects on the distal surface of the adjacent M2 and those associated with dentigerous cysts.

Can ambient orange fragrance reduce patient anxiety during surgical removal of impacted mandibular third molars?

PURPOSE: To investigate whether ambient orange fragrance, compared with no fragrance, can reduce patient anxiety before and during surgical removal of an impacted mandibular third molar. MATERIALS AND METHODS: In the present randomized clinical trial, the patients who required extraction of an impacted mandibular third molar and fulfilled the predetermined criteria were included. A dental anxiety scale (DAS) questionnaire was used to determine the anxiety level of the patients before surgery. Only patients with moderate and high anxiety levels (DAS scale ≥ 9 to ≤ 14) were included. The predictor variable was fragrance exposure. The fragrance group was exposed to orange fragrance, and the control group was exposed to no fragrance. The outcome variables were physiologic measures related to anxiety, including the mean blood pressure, respiratory rate, and pulse rate. The physiologic vital changes were determined before and during the surgical procedure. The data were analyzed using the independent t test, χ(2) test, and Mann-Whitney U test (Statistical Package for Social Sciences, version 16; α = 0.05). RESULTS: A total of 56 patients fulfilled the inclusion criteria (fragrance group, 19 males and 9 females; no-fragrance group, 12 males and 16 females). Before entering the waiting room, the patients' vital signs were recorded twice. No significant differences were found between the 2 groups. The mean blood pressure, pulse rate, and respiratory rate were significantly lower in the fragrance group during surgery (from sitting in the dental chair to the end of surgery; P < .05). CONCLUSIONS: The results of our study have shown that orange fragrance is effective in reducing the anxiety related to surgical removal of an impacted mandibular third molar.