A Retrospective, Radiographic Outcomes Assessment of 1960 Initial Posterior Root Canal Treatments Performed by Endodontists and Dentists.

INTRODUCTION: The Air Force Dental Service has established evidence-based treatment standards for endodontics, including 3-dimensional filling of the canal system, cuspal coverage restoration of endodontically treated posterior teeth, and use of rubber dam. The purpose of this retrospective study was to determine the effect of these standards on outcomes of initial posterior root canal treatments (RCTs) completed by Air Force (AF) and civilian dentists with and without accredited postgraduate training. METHODS: Treatment and follow-up radiographs of AF members who had an initial posterior RCT completed in 2011 were evaluated. A survey of all radiographs was performed to determine the (1) RCT obturation quality, (2) healing of periapical pathosis, and (3) presence and quality of cuspal coverage restorations. RESULTS: A total of 2262 RCTs were examined, with 1960 RCTs meeting inclusion criteria for at least 1 evaluation category. For RCT obturation quality, 1810 RCTs were evaluated, and 96.0% were considered adequate. For cuspal coverage restorations, 1856 RCTs were evaluated, and of these 2.7% were inadequately restored. Healing of periapical pathosis was 91.5% and 85.7% for AF and referred civilian providers, respectively. Survivability was 94.4% for endodontists, 95.3% for AF general dentists with additional training, 87.9% for AF general dentists without additional training, and 78.4% for civilian general dentists. Overall, survivability was 94.1% for a follow-up period ranging up to 47 months, with a mean of 27 months. CONCLUSIONS: In this retrospective, radiographic analysis, evidence-based practices as followed in the Air Force Dental Service and accredited postgraduate training resulted in improved treatment outcomes.

The effect of 8.25% sodium hypochlorite on dental pulp dissolution and dentin flexural strength and modulus.

INTRODUCTION: The purpose of this study was to evaluate the effect of various concentrations of sodium hypochlorite (NaOCl), including 8.25%, on dental pulp dissolution and dentin flexural strength and modulus. METHODS: Sixty dental pulp samples and 55 plane parallel dentin bars were retrieved from extracted human teeth. Five test groups (n = 10) were formed consisting of a pulp sample and dentin bar immersed in various NaOCl solutions. The negative control group (n = 5) consisted of pulp samples and dentin bars immersed in saline. The positive control group (n = 5) consisted of pulp samples immersed in 8.25% NaOCl without a dentin bar. Every 6 minutes for 1 hour, the solutions were refreshed. The dentin bars were tested for flexural strength and modulus with a 3-point bend test. The time until total pulp dissolution and any changes in dentin bar flexural strength and modulus for the different NaOCl solutions were statistically analyzed. RESULTS: An increase in NaOCl concentration showed a highly significant decrease in pulp dissolution time. The pulp dissolution property of 8.25% NaOCl was significantly faster than any other tested concentration of NaOCl. The presence of dentin did not have a significant effect on the dissolution capacity of NaOCl if the solutions were refreshed. NaOCl concentration did not have a statistically significant effect on dentin flexural strength or modulus. CONCLUSIONS: Dilution of NaOCl decreases its pulp dissolution capacity. Refreshing the solution is essential to counteract the effects of dentin. In this study, NaOCl did not have a significant effect on dentin flexural strength or modulus.

A panoramic survey of air force basic trainees: how research translates into clinical practice.

INTRODUCTION: The purposes of this study were to examine the following in young adults residing in the United States: (1) the prevalence of teeth with root canal therapy (RCT) and teeth in need of RCT, (2) how frequently treatment practices associated with success as cited in the literature are found in posterior teeth with RCT, and (3) which treatment practices are associated with periradicular pathology. METHODS: Panoramic radiographs taken of all basic trainees entering the US Air Force in 2011 were evaluated in a 2-part review. A general survey of all radiographs was performed to determine the prevalence of teeth with and teeth in need of RCT. All panoramic radiographs that showed a posterior tooth with RCT were evaluated in detail to consider the presence and quality of cuspal coverage restorations, the quality of RCT, and the presence of periradicular pathology. RESULTS: A total of 35,811 panoramic images were evaluated. Ten percent of basic trainees had existing RCT, whereas 5% showed a need for RCT. The total number of posterior teeth with RCT was 3,455. Nearly half of these teeth had either no cuspal coverage or an unacceptable cuspal coverage restoration. Almost one third of the existing RCT was considered inadequate based on best treatment practices. Approximately 25% of teeth with RCT had periradicular pathology present. A strong correlation was found between the quality of RCT and the absence of periradicular pathology. Of RCT teeth deemed hopeless, 97.5% had no cuspal coverage restoration present. CONCLUSIONS: Factors cited in the literature as being associated with success are lacking in the dental treatment of young adults residing in the United States.

Comparação da resistência à fadiga por torção das limas de níquel-titânio PathFile com outras limas pequenas de conicidade de 0, 02mm / Comparison of the torsional fatigue resistance of PathFile nickel-titanium files with other small 0.02 mm taper files

Esse estudo teve por objetivo comparar a resistência à fadiga por torção das seguintes limas de conicidade de 0,02mm: PathFile #13, #16 e #19; ProFile #15 e #20; K3 #15 e #20; Quantec LX #15 e #20; e Liberator #15 e #20. Métodos: foram testados 11 grupos, com 20 limas cada. As limas foram fixadas a um torcímetro e submetidas a rotação até fraturar. O torque máximo e o grau de rotação antes da fratura foram registrados. Limas com tamanhos de ponta semelhante foram comparadas entre si para identificar diferenças significativas. O teste ANOVA de uma via e o teste post hoc de Tukey foram usados para identificar diferenças estatisticamente significativas (p < 0,05) entre os grupos. Resultados: as limas Liberator #15 e #20 tiveram fraturas ao torque significativamente mais baixas do que todas as outras limas semelhantes, enquanto a PathFile #16 teve fratura ao torque significativamente mais alta do que as limas #15 com as quais foi comparada. Conclusão: os resultados do teste de resistência à fadiga por torção das limas Path File foram comparativamente melhores do que os de outras limas pequenas com conicidade de 0,02mm.

In vitro canal and isthmus debris removal of the self-adjusting file, K3, and WaveOne files in the mesial root of human mandibular molars.

INTRODUCTION: The purpose of this study was to compare the effectiveness of debris removal between the Self-Adjusting File (SAF), WaveOne, and K3 file systems in the mesial roots of mandibular molars. In addition, the SAF was tested as a potential adjunct after instrumentation with other systems. METHODS: The mesial roots of 30 extracted mandibular molars were mounted in resin by using the K-Kube, sectioned at 2 and 4 mm from working length, and randomly placed into 3 groups: K3 group, sequential preparation with K3 files to an apical size of 35/.04; WaveOne group, preparation with WaveOne primary file; and SAF group, preparation with SAF. Images were taken before instrumentation, after instrumentation, after final irrigation, and after SAF adjunct irrigation. A cleanliness percentage was calculated by using interactive software. Comparisons between groups were analyzed with repeated-measures analysis of variance and post hoc tests (P < .05). RESULTS: There was no significant difference in canal cleanliness among the groups, but the WaveOne was significantly worse for isthmus cleanliness. Use of the SAF as an adjunct only significantly improved canal cleanliness in the K3 group at the 2-mm level by an average of 1.7%. CONCLUSIONS: There was no difference in canal cleanliness between the 3 file systems; however, the SAF and K3 files performed significantly better than the WaveOne with respect to isthmus cleanliness. When used as a final irrigation adjunct device after instrumentation, the SAF provided a significant improvement only in a subset of the K3 group.

Reinforcement of simulated immature roots restored with composite resin, mineral trioxide aggregate, gutta-percha, or a fiber post after thermocycling.

INTRODUCTION: The purpose of this study was to evaluate the fracture resistance after thermocycling of simulated immature teeth restored with composite, a fiber post, mineral trioxide aggregate (MTA), or gutta-percha. METHODS: Eighty-four primary bovine mandibular incisors were divided into 7 groups (n = 12). Negative controls received no treatment. Teeth in all other groups were prepared to an internal diameter of 1.75 mm. After placement of 4-mm apical barrier of MTA, the canals were filled with their respective test materials to the facial cementoenamel junction. For the fiber post group, a fiber post was fitted to extend from the MTA barrier to 2 mm below the incisal edge and was cemented with Build-It FR. The positive controls were left unfilled. The access openings were filled with BisFil II composite. All teeth were then thermocycled for 500 cycles at 5 °C and 55 °C with a 30-second dwell time and 5-second transfer time. Each root was horizontally fractured through the test material by using an Instron Universal Testing Machine, and the peak load to fracture was recorded. The data were analyzed with analysis of variance and Tukey post hoc tests (P < .05). RESULTS AND CONCLUSIONS: Thermocycled composite was not significantly stronger than gutta-percha and MTA. The only material that significantly strengthened the simulated immature teeth was the fiber-reinforced composite with a fiber post.

Comparison of debris removal with three different irrigation techniques.

INTRODUCTION: The purpose of this study was to compare the effectiveness of debris removal between EndoVac, PiezoFlow, or needle irrigation (Max-i-Probe) in mandibular molars. METHODS: The mesial roots of 30 extracted mandibular molars were mounted in resin by using the K-Kube and then sectioned at 2 and 4 mm from the apex. The specimens were reassembled and instrumented to size 40/0.04. A standard irrigation protocol was used during instrumentation in the PiezoFlow and Max-i-Probe groups. During instrumentation of teeth in the EndoVac group, the manufacturer's recommendations for irrigation were followed. Images of the canals and isthmuses were taken before final irrigation. The percentage of cleanliness for each canal and isthmus was calculated by using interactive software. The specimens were reassembled for final irrigation with EndoVac, PiezoFlow, and Max-i-Probe by using similar volumes of irrigants. Images were again used to calculate cleanliness. Comparisons of canal and isthmus cleanliness before and after final irrigation were made by using paired t tests, and the groups were compared with repeated-measures analysis of variance (P < .05). RESULTS: There were no statistically significant differences in canal and isthmus cleanliness among all 3 groups at 2 and 4 mm from working length before or after final irrigation. Canal and isthmus cleanliness significantly improved at all levels after the final irrigation regimen in each group. CONCLUSIONS: Final irrigation by using EndoVac, the PiezoFlow, or Max-i-Probe with similar volumes of irrigants significantly improved canal and isthmus cleanliness.