An international survey on the use of calcium silicate-based sealers in non-surgical endodontic treatment.

OBJECTIVES: To gain insight on the current clinical usage of bioceramic root canal sealers (BRCS) by general dental practitioners (GDPs) and endodontic practitioners (EPs) and to determine if BRCS clinical application is in accordance with the best available evidence. MATERIAL AND METHODS: An online questionnaire of 18 questions addressing BRCS was proposed to 2335 dentists via a web-based educational forum. Participants were asked about socio-demographic data, clinical practice with BRCS, and their motivation for using BRCS. Statistical analysis (chi-squared test or Fisher's exact test) was applied, as appropriate, to assess the association between the variable categories (p value < 0.05). RESULTS: The response rate was 28.91%. Among respondents, 94.8% knew BRCS (EPs more than GDPs, p < 0.05) and 51.70% were using BRCS. The primary reason for using BRCS was their belief of its improved properties (87.7%). Among BRCS users, single-cone technique (SCT) was the most employed obturation method (63.3%) which was more applied by GDPs (p < 0.05); EPs utilized more of the thermoplasticized obturation techniques (p < 0.05). A proportion of 38.4% of BRCS users indicated the usage of SCT with BRCS regardless of the root canal anatomy (GDPs more than EPs p < 0.05) and 55.6% considered that BRCS may influence their ability to re-establish apical patency during retreatment (GDPs more than EPs p < 0.05). CONCLUSIONS: This study highlights wide variation in the clinical use of BRCS which is not in accordance with the current literature. CLINICAL RELEVANCE: This inconsistency among EPs and GDPs on BRCS clinical application requires further clarifications to better standardize their use and improve their future evaluation.

Antibacterial efficiency of passive ultrasonic versus sonic irrigation. Ultrasonic root canal irrigation.

OBJECTIVES: To compare the antibacterial effect of the passive ultrasonic to passive sonic irrigation with a 5.25% NaOCI solution. METHODS: Sixty human teeth were used. The crowns were removed and the roots were instrumented prior to sterilization and incubation with Enterococcus faecalis. Five mL of 5.25% NaOCI were used during a 3 min final rinsing with: syringe irrigation (n = 20), passive ultrasonic irrigation with the Irrisafe (n = 20) and passive sonic irrigation with the Endo Activator (n = 20). A sterile file was used to remove dentine shavings at the apex and placed in BHI. After 72 h, this infusion was used to inoculate blood agar plates. The presence or absence of Enterococcus faecalis colonies was determined and statistically analyzed. RESULTS: No statistically significant difference was found among the 3 groups. None of the irrigation regimen permitted to obtain 100% of bacteria free teeth. CONCLUSION: The passive agitation of the irrigation solution did not increase its antibacterial efficiency. Longer irrigation times may be required.

Accidental ingestion and aspiration of root canal instruments and other dental foreign bodies in a French population.

AIM: To determine the incidence of aspiration and ingestion of endodontic instruments in France during root canal treatment without using rubber dam. METHODOLOGY: Data was provided by two insurance companies representing 24,651 French general dentists over 11 years. The type and number of accidents per year, the number of dental items involved and the percentage of occurrence of either aspiration or ingestion were reported. The incidence of accidental aspiration or ingestion was calculated. The need for hospitalization to remove the endodontic instruments and other dental items was reported and compared using chi square tests. RESULTS: One endodontic instrument was aspirated and 57 were ingested. Forty-three other dental items were aspirated and 409 were ingested. For the endodontic instruments: the incidence of aspiration was 0.001 per 100,000 root canal treatments and the incidence of ingestion was 0.12 per 100,000 root canal treatments. The aspirated endodontic instruments and dental items required statistically more frequent hospitalization than the ingested items (P < 0.0001). The endodontic instruments did not require more frequent hospitalization than other dental items when aspirated (ns) and when ingested (ns). No fatal outcome was reported. CONCLUSION: The incidence of ingestion or aspiration of endodontic instruments was low even thought most general practitioners do not routinely use rubber dam. Use of rubber dam by general practitioners for endodontic procedures should be encouraged by stressing its advantages rather than the fear factor of accidents.

Influence of the powder/liquid ratio on the properties of zinc oxide-eugenol-based root canal sealers.

OBJECTIVE: The purpose of this study was to investigate the effects of modifications of the powder/liquid ratio by endodontists on the physical properties recommended by ISO standards as well as on other clinically relevant properties of zinc oxide-eugenol-based root canal sealers. METHODS: The powder/liquid ratio of two zinc oxide-eugenol-based root canal sealers (Cortisomol and Pulp Canal Sealer EWT) was recorded by 10 endodontists. The materials, prepared according to the different consistencies, were tested according to ISO standards to evaluate their physical properties. Their sealing efficiency and the release of eugenol were also evaluated on 20 single rooted teeth. RESULTS: Some results varied according to the material. Nevertheless, for both cements, an increased powder/liquid ratio led to a decreased flow, an increased radiopacity and a decreased amount of eugenol released. The variations in the powder/liquid ratio did not influence the dimensional changes and the apical leakage of both cements. SIGNIFICANCE: Variations in the powder/liquid ratio of zinc oxide-eugenol-based root canal sealers have a limited influence on the properties of the sealers. The endodontists can prepare the zinc oxide-eugenol-based root canal sealers at their chosen consistency according to the filling technique they use.

In vitro apical leakage of system B compared with other filling techniques.

A fluid filtration system was used to compare the apical microleakage of roots filled with the system B (Analytic Technology), single-cone technique, lateral condensation, vertical condensation, and Thermafil (Caulk-Dentsply). After preparation of the canal system with a Profile (Caulk-Dentsply) five groups of 10 single-rooted teeth were randomly filled according to 1 of the 5 techniques. Phosphate-buffered saline was forced under a 15 cm H2O pressure, through the apex, toward the coronal part of the root. The filtration rate in L s(-1) Kpa(-1) was recorded 24 h after filling and after 1-month storage in phosphate-buffered saline. The 24 h results showed that the single cone technique provided the highest leakage (p = 0.001). At 1-month system B, Thermafil and vertical condensation had less leakage than the two other techniques (p = 0.0001): lateral condensation produced moderate apical leakage, whereas the single cone technique showed the highest leakage. Regardless of the technique the apical leakage increased after 1-month storage (p = 0.001 or p = 0.0001, depending on the technique).

Lack of correlation among three methods for evaluation of apical leakage.

The purpose of this study was to compare three methods of evaluation of the apical seal. Thirty-six teeth were prepared with a ProFile device and filled according to three filling methods: Thermafil (n = 12), warm vertical condensation (n = 12), and the single cone technique (n = 2). The apical seal was recorded with three methods, each successively used on the same teeth: a fluid filtration method, an electrochemical method, and a dye penetration study. The three methods of evaluation did not rank the apical leakage of the three filling techniques in the same order. The fluid filtration method showed that the vertical condensation was superior to Thermafil, which was in turn superior to the single cone technique (p = 0.04). The dye penetration study showed that the Thermafil was a better technique than the vertical condensation and the single cone technique (p = 0.005). The electrochemical method showed no statistical difference among the three filling techniques. No correlation was found among the results obtained with the three methods of evaluation. This study shows that several studies are necessary before comparing the apical seal obtained with various filling techniques.

Effects of pressure and measurement time on the fluid filtration method in endodontics.

The purpose of this study was to evaluate the influence of the measurement time and the pressure on the outcome of a fluid filtration test. Thirty-six roots were prepared with a Profile device and filled with Thermafil. The leakage along the filling material was recorded under a 15 cm H2O pressure (n = 18) or a 150 cm H2O pressure (n = 18) at 3 min, 1 h, and 24 h. The fluid flow expressed as microl min(-1) decreased with an increased measurement time (p = 0.001) and was higher in the high pressure group (p = 0.001). The fluid flow of this study, where all of the teeth were filled with the same technique, ranged from 3.8 x 10(-5) microl min(-1) cm H2O(-1) to 43 x 10(-5) microl min(-1) cm H2O(-1), depending on the pressure and measurement time. This shows the need for standardization to compare the results from various studies.

Concentration of eugenol apically released from zinc oxide-eugenol-based sealers.

This study investigated the amount of eugenol released from a zinc oxide-eugenol-based sealer at the apex of teeth filled according to two techniques: the single-cone and the Thermafil. The crown of 10 maxillary central incisors was removed, and the canal was prepared with ProFile to a size 30 under NaOCl irrigation. The patency of the apex was checked with a #8 K-file between each ProFile. Five roots were filled with a Thermafil #30 and 0.03 g of Sealite; five roots were filled using a Lentulo with 0.07 g of sealer and a gutta-percha cone #30. The powder/liquid ratio of the sealer was of 5/1. The concentration of eugenol released in phosphate-buffered saline was spectrofluorimetrically determined immediately after sealing, after 1 day, and after 1 month of storage. The roots filled with the single-cone technique released significantly more eugenol than these filled with Thermafil immediately after sealing (p = 0.002); but, after 1-day or 1-month storage, there was no difference. For both techniques, eugenol concentration decreased over time (p = 0.01): the immediate concentration was higher than the 1-day concentration (p = 0.04). Eugenol concentration after 1-month storage was undetectable. The results of this work show that the level of eugenol released from a zinc oxide-eugenol-based sealer beyond the apex is very low and decreases over time.