Evaluation of two shaping systems and two sonic irrigation devices in removing root canal filling material from distal roots of mandibular molars assessed by micro CT.

AIM: To compare two preparation systems and two sonic irrigation devices during the removal of root filling material from oval distal canals of extracted mandibular molars. METHODOLOGY: The distal canals in 40 extracted mandibular molars were shaped using the ProTaper Next system (Dentslpy Sirona, Ballaigues, Switzerland), filled with Gutta Percha X2 (Dentsply Sirona), along with AH Plus sealer (Dentsply De Trey, Konstanz, Germany) and randomly divided into two groups (n = 20) according to volume of initial filling, preparation diameter and working length. One group was retreated using the Reciproc system (VDW, Munich, Germany), and the other using the 2Shape system (Micro-Mega, Besançon, France). A micro-CT scan was taken after the initial root filling and after retreatment to evaluate the volume of filling material remnants. The teeth were divided into four groups to test the supplementary effect of two sonic irrigation devices on removing filling material: Eddy (VDW) and MM1500 (Micro-Mega). In the first and second groups, 2Shape was followed subsequently by MM1500 and Eddy; in the third and fourth groups, Reciproc was followed by MM1500 and Eddy. A third micro-CT was taken to compare the remaining root filling material in all groups. Wilcoxon's signed rank tests, Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis. RESULTS: No significant difference was found for the volume of filling material removed between the Reciproc and 2Shape in the entire canal (P = 0.355). The volume dropped significantly from its initial value after removing the bulk of the root filling by 95.8% (from 4.71 to 0.22 mm3 ) with the 2Shape (P < 0.001) and by 94.0% (from 5.05 to 0.33 mm3 ) with the Reciproc (P < 0.001). Sonic activation significantly decreased the residual volume of filling material remnants by 3.21% (P = 0.013) in the first group, 1.38% (P = 0.012) in the second group, 1.83% (P = 0.008) in the third group and 1.83% (P = 0.012) in the fourth group. At the end, the percentage of residual material was not significantly different among the groups in the entire canal (P = 0.163). CONCLUSION: In the distal oval canals of extracted mandibular molar teeth, there was no significant difference between the 2Shape and Reciproc systems in removing gutta-percha/sealer. Sonic activation with MM1500 and Eddy significantly improved filling material removal.

Investigation of a novel mechanically mixed mineral trioxide aggregate (MM-MTA(™) ).

AIM: To characterize a novel mechanically mixed mineral trioxide aggregate product (MM-MTA, MicroMega, Besançon, France) and to investigate the physical and chemical properties in comparison with ProRoot MTA (Dentsply, Tulsa Dental, Johnson City, TN, USA) and MTA Angelus (Angelus, Londrina, Brazil). METHODOLOGY: The three materials were mixed according to manufacturer's instructions. Specimens 10 mm in diameter and 2 mm high were prepared and characterized by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and X-ray diffraction (XRD) analysis after 1-day and 28-day storage in physiological solution. Calcium ion leaching in solution and pH of the elution were also assessed. Furthermore, the setting time, radiopacity and material porosity were investigated. Statistical analysis was performed by anova and Tukey's post hoc tests. RESULTS: All the MTAs tested were composed primarily of tricalcium silicate and bismuth oxide. In addition, MM-MTA exhibited additional peaks for chlorine evident in the EDS analysis; calcium carbonate was present in the set material detected by XRD. Calcium hydroxide was present in the set ProRoot MTA and MTA Angelus. Calcium ion leaching and alkalization of the storage solution were demonstrated in all the materials. Both MM-MTA and MTA Angelus had a shorter setting time when compared to ProRoot MTA (P < 0.001). ProRoot MTA exhibited larger pores and more porosity than MTA Angelus and MM-MTA. All the materials exhibited radiopacity greater than the 3 mm aluminium thickness specified in ISO 6876 (2012). CONCLUSIONS: MM-MTA, ProRoot MTA and MTA Angelus are composed of Portland cement and bismuth oxide. In addition, MM-MTA contains calcium carbonate and a chloride accelerator. These additives affect the material hydration and the properties of the set material. The properties of MM-MTA are a result of a combination of factors, namely the particular cement mineralogy, radiopacifier loading, effective water-cement ratio and mechanical mixing.

Effects of three nickel titanium instrument systems on root canal geometry assessed by micro-computed tomography.

AIM: To compare and evaluate the shaping ability of several nickel titanium instrument systems with different motions: two reciprocating single-file systems (Reciproc and WaveOne) and one continuous rotation/reciprocation full-sequence system [Twisted File (TF) Adaptive] using micro-computed tomography. METHODOLOGY: A total of forty-eight mesial canals of mandibular molars with two separate root canals and severe angles of curvature were selected. Canals were divided randomly to one of three experimental groups: group 1, reciprocating instrumentation with Reciproc R25, group 2, reciprocating with the Primary WaveOne file and group 3 'Adaptive Rotary Motion' with Twisted Files. Each group consisted of 16 root canals. Canals were scanned before and after root canal preparation, with a resolution of 20 µm using a micro-computed tomography system. The following parameters were assessed: changes in dentine volume, percentage of unshaped canal walls, degree of canal transportation and centring ability. Data were analysed using analysis of variance and Tukey's post hoc tests test to explore a significant difference in mean dentine removal, mean percentage of noninstrumented canals, mean degree of canal transportation and centring ratio between groups in the apical third and along the entire root canal. The level of significance was set at α = 0.05. RESULTS: Preoperatively, there were no differences regarding root canal curvature and volume between experimental groups (P > 0.05). Overall instrumentation led to enlarged canal shapes with no evidence of preparation errors. None of the three groups was able to shape completely the root canal system. Mean dentine removal along the entire canal and in the apical third was significantly higher with Reciproc when compared with TF Adaptive and WaveOne (P = 0.013). Mean degree of canal transportation was significantly lower with TF Adaptive (P < 0.0001) followed by WaveOne and highest with Reciproc in the apical third and along the entire root canal. CONCLUSIONS: None of the NiTi systems was able to instrument completely the entire root canal. Reciprocation and Adaptive Motions were found to cut dentine efficiently to full working length, with no procedural errors. The TF Adaptive system maintained the original canal anatomy with less canal transportation and better centring ability.

Comparative micro-computed tomographic evaluation of two carrier-based obturation systems.

OBJECTIVES: The aim of the study was to measure the percentage of volume of voids and gaps in the apical third of root canals obturated with two techniques using micro-computed tomography. MATERIALS AND METHODS: Fifty-four single-rooted teeth were collected and root canal-prepared. The roots were randomly allocated into two groups; each group was obturated by using thermoplasticized technique with a different material (gutta-percha and Topseal for Thermafil, Resilon and RealSeal for RealSeal 1). Roots were then scanned, and volume measurements for voids and gaps in the obturated roots were carried out using specialized CT software. Percentage of gaps and voids was calculated. RESULTS: The present study showed that none of the root canal-filled teeth was gap free. Student t test was conducted. No significant difference was found between Thermafil and RealSeal 1 concerning percentage of voids in the apical third (P > 0.05). Both materials showed statistically significant difference between the levels where 1 mm showed the highest volume of voids (P < 0.05). CONCLUSIONS: Both carrier-based techniques allowed a good sealing ability in root canals but none of the materials was gap free. Statistically significant difference between the levels was found and 1 mm showed the highest volume of voids. CLINICAL RELEVANCE: This study shows the efficiency of carrier-based obturation systems in filling root canals hermetically. It compares new adhesive endodontic materials with the traditional gold standard gutta-percha. Results show the good sealing ability of both techniques making them appropriate to use in daily endodontic obturations.

Cyclic fatigue analysis of twisted file rotary NiTi instruments used in reciprocating motion.

AIM: To evaluate the cyclic fatigue fracture resistance of engine-driven twisted file (TF) instruments under reciprocating movement. METHODOLOGY: A sample of 30 size 25, 0.08 taper NiTi TF instruments was tested in a simulated canal with 60˚ angle of curvature and a 3 mm radius. During mechanical testing, different movement kinematics were used at a constant speed, which resulted in three experimental groups (each group n = 10). The instruments from the first group (G1) were rotated until fracture occurred. The instruments in the second (G2) and third group (G3) were driven under reciprocating movement with different angles of reciprocation. The time of fracture for each instrument was measured, and statistical analysis was performed using one-way analysis of variance followed by Tukey's Honestly Significant Different test. RESULTS: Reciprocating movement resulted in a significantly longer cyclic fatigue life (P < 0.0001) when compared with continuous rotation. No difference was found between reciprocation 150° clockwise/30° counterclockwise (CW/CCW) and 30° CW/150° CCW. CONCLUSIONS: The reciprocating movement was associated with an extended cyclic fatigue life of the TF size 0.25, 0.08 taper instruments in comparison with conventional rotation.

Influence of apical taper on the quality of thermoplasticized root fillings assessed by micro-computed tomography.

The objective of this study is to study the influence of final canal taper on the sealing ability of Real Seal 1 by using micro-computed tomography (micro-CT). Fifty-four single-rooted teeth were instrumented to apical size of 40 taper 4, 6, and 8. The teeth were divided into three groups. All teeth were filled with Real Seal 1 (RS1; SybronEndo, Orange, CA, USA). Roots were then scanned with mico-CT, and volume measurements of voids in the apical third and in sections at 1, 3, and 5 mm from the apex were calculated in the obturated roots using specialized CT software. Measurements were analyzed statistically by using ANOVA followed by Bonferroni multiple comparison correction. Data analysis showed that 0.08% and 0.06% apical tapered RS1 obturations provided better results than 0.04% tapered samples. The present study showed that none of the root canals filled teeth were gap free. Mean percentages of voids were significantly higher with Real Seal 1 taper 0.04% (P = 0.05).There was no significant difference with 0.06 and 0.08 final taper. For Real Seal 1 technique 0.06 and 0.08 tapered preparations seem to be more optimal. At 1 mm, final taper 0.08 showed less voids and gaps than the two other final tapers. In our daily practice, enlarging the apical third (last 3 mm) of root canals to an 8% taper is necessary to achieve a better sealing ability and thus long-term success for our root canal obturations.

In vitro evaluation of the reliability of the Root ZX electronic apex locator.

AIM: An experimental comparison of the Root ZX apex locator with the real measurement of the root canal length was carried out using a saline gel to simulate the periodontium. METHODOLOGY: Lengths were taken when the needle reached the 0.5 mark and the Apex mark on the meter. These measurements were then compared with a calculated reference length representing the real length of the root canal. Reliability was assessed using Student's t-test. Precision was assessed using the mean and standard deviation of differences. RESULTS: The Root ZX gave measurements within a range of 0.5 mm in 84.72% of the cases. The intra-operator and inter-operator variabilities were not statistically significant (P > 0.05). CONCLUSIONS: The Root ZX is not capable of detecting the '0.5 mm from the foramen' position and thus, should only be used to detect the foramen (major diameter).