Efficacy of different irrigant activation devices in removing dentin debris from an artificial isthmus connecting curved canals.

The aim of this study was to evaluate the debridement efficacy of sonic irrigation (EDDY; VDW, Munich, Germany and EndoActivator; Dentsply-Sirona, Ballaigues, Switzerland) and ultrasonically activated irrigation (Irrisafe; Satelec Acteon, Merignac, France) in a simulated canal isthmus connecting curved canals. Transparent resin blocks were produced containing two curved canals connected with an isthmus. The isthmus was then filled with dentin debris. Three irrigant activation cycles were performed and the amount of remaining debris was compared analysing pictures taken after each activation cycle. Data were statistically analysed using one-way ANOVA and post hoc Tukey tests at a significance level of p < 0.05. EDDY showed greater efficiency in removing dentin debris from the simulated isthmus than the other techniques tested. An increase in the activation time enhanced the efficiency of both EDDY and ultrasonically activated irrigation in debris removal.

[Preoperative dental screening in patients waiting for elective cardiovascular procedures: presentation of the SIC-ANMCO-SICCH-AIE-SIE-SidP intersociety consensus document]. / Lo screening dentale preoperatorio nei pazienti in attesa di interventi chirurgici cardiovascolari elettivi: presentazione del documento di consenso intersocietario SIC-ANMCO-SICCH-AIE-SIE-SidP.

The Italian scientific societies of cardiology (SIC and ANMCO), cardiothoracic surgery, endodontics, and periodontology realized that a specific protocol addressing preoperative dental/peri-dental screening in patients undergoing elective cardiothoracic surgery was lacking in the literature. As a consequence, they projected and then realized in 2019 a consensus document to establish the modalities for such a diagnostic and therapeutic screening, whose related options and timing depend on the patient's physical conditions as well as the time available before surgery. A high level of agreement was reached by the experts involved in the release of the consensus document and each clinical issue was addressed adequately. Three tables were released, with the aim of sharing a standardized protocol for the perioperative dental/peri-dental screening of patients who are waiting for elective cardiothoracic procedures. The authors of the consensus document, which has been widely diffused by all the involved scientific societies, hope that it can be largely accepted and applied, during the multidisciplinary phase preceding cardiovascular surgery the most.

Effect of different final irrigation protocols on pulp tissue dissolution from an isthmus model.

This study assessed the pulp tissue dissolution from isthmus of a two-rooted maxillary premolar using different final irrigation protocols. After root canal preparation, the surface of the tooth was reduced to an extent that the isthmus could be observed, and 1 mg of pulp tissue was introduced into the isthmus which was covered with a glass slide. Following six groups were tested: syringe and needle; subsonic activation; sonic activation; ultrasonic activation; heating followed by sonic activation; and heating followed by ultrasonic activation. Before and after each experiment a photograph of the isthmus was taken at 30× to register the area of the pulp tissue. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney tests (P < 0.05). Syringe and needle group showed the lower value of pulp tissue dissolution followed by subsonic irrigation procedures. Pulp tissue dissolution was significantly higher when heating was followed by sonic or ultrasonic activation.

Use of preoperative cone-beam computed tomography to aid in establishment of endodontic working length: A systematic review and meta-analysis.

PURPOSE: This study was performed to assess the accuracy of preoperative cone-beam computed tomography (CBCT), when justified for other reasons, in locating the apical foramen and establishing the working length. MATERIALS AND METHODS: Six electronic databases were searched for studies on this subject. All studies, of any type, were included if they compared measurements of working length with preoperative CBCT to measurements using an electronic apex locator (EAL) or histological reference standard. Due to the high levels of heterogeneity, an inverse-variance random-effects model was chosen, and weighted mean differences were obtained with 95% confidence intervals and P values. RESULTS: Nine studies were included. Compared to a histological reference standard, CBCT indicated that the apical foramen was on average 0.40 mm coronal of its histological position, with a mean absolute difference of 0.48 mm. Comparisons were also performed to an EAL reference standard, but the conclusions could not be considered robust due to high levels of heterogeneity in the results. CONCLUSION: A low level of evidence is produced suggesting that preoperative CBCT shows the apical foramen to be on average 0.40 mm coronal to its histological position, with a mean absolute difference of 0.48 mm.

Dentinal tubule penetration and root canal cleanliness following ultrasonic activation of intracanal-heated sodium hypochlorite.

This study investigated the effect of ultrasonic activation of intracanal-heated sodium hypochlorite (NaOCl) on its dentinal tubular penetration and root canal cleanliness in vitro. In experiment 1, mandibular premolars were randomly allocated to three groups (n = 8): group A, ultrasonic activation; group B, ultrasonic activation of intracanal-heated NaOCl and group C, syringe-and-needle irrigation. Penetration of the fluorescent-labelled NaOCl was investigated using light microscopy. In experiment 2, mandibular premolars were randomly allocated to group B or C (n = 10), for histological analysis of the remaining pulp tissue and debris. Data were statistically analysed using Kruskal-Wallis and Mann-Whitney tests (P = 0.05). The highest penetration of NaOCl was observed in group B, followed by group A (P < 0.05). Group B showed significantly less amount of debris than group C (P < 0.05). Dentinal tubule penetration of NaOCl and root canal cleanliness were significantly improved by ultrasonic activation of intracanal-heated NaOCl.

Influence of different motions on the cyclic fatigue resistance of Reciproc and Reciproc Blue endodontic instruments.

AIM: The aim of this study was to evaluate the cyclic fatigue resistance of Reciproc (RCP) and RPC Blue (RCPB) instruments used in continuous rotation, "RECIPROC" mode, and "WAVEONE" mode. MATERIALS AND METHODS: Sixty RCP and 60 RCPB R25 files were used. For each file type, three groups (n = 20) were defined depending on the used kinematics: continuous rotation, "RECIPROC" mode, and "WAVEONE" mode. A stainless-steel artificial canal with 60° angle and 5-mm radius of curvature was milled reproducing the size and taper of the used files. The test device was electrically heated to 35°C to simulate the clinical environment. All files were reciprocated or rotated until fracture. The time to failure and the length of the fractured fragments were measured. A fractographic examination was performed by scanning the electron microscopy to confirm the cause of fracture. Collected data underwent a two-way analysis of variance (α = 0.05). RESULTS: RCPB files exhibited better cyclic fatigue resistance than RCP. The "RECIPROC" motion yielded greater cyclic fatigue resistance than the "WAVEONE" movement; the least resistance was observed in the continuous rotation groups. No significant differences were found among groups in terms of length of the fractured fragment. The fractographic analysis confirmed that all scanned samples separated due to cyclic fatigue. CONCLUSIONS: Within the limitation of the present study, the "RECIPROC" mode increased the cyclic fatigue resistance of the tested instruments compared to "WAVEONE" mode and continuous rotation. To prevent RCP and RCPB file separation, motion kinematics other than the native "RECIPROC" movement should be discouraged in the clinical setting.

In vitro comparison of cyclic fatigue resistance of two rotary single-file endodontic systems: OneCurve versus OneShape.

The aim of the present study was to evaluate the difference in cyclic fatigue resistance between OneCurve (OC) and OneShape (OS) endodontic single-file NiTi systems in a severely curved artificial canal. After sample size calculation (α = 0.01; ß = 0.20; σ = 20.0; δ = 20.0), 25 OC and 25 OS files were used. An artificial canal with 60° angle and 5-mm radius of curvature was milled in a stainless-steel block reproducing the size and taper of the files used. The test device was electrically heated to maintain the environmental temperature at 37 °C. All files were rotated until fracture; the time to failure was recorded and the number of cycles to fracture (NCF) calculated. The length of the fractured fragments was measured too. Fractographic examination and cross-sectional area calculation were performed by scanning electron microscopy analysis (SEM). Data were statistically analyzed using an independent sample t test. The significance level was set at 0.01. Statistical analysis showed that OC files exhibited significantly greater cyclic fatigue resistance than OS (p < 0.001), with 721 ± 89 NCF and 301 ± 38 NCF, respectively. No significant difference was found in the length of the fractured fragments (p > 0.01). SEM fractographic analysis confirmed that all the scanned samples separated due to cyclic fatigue. Within the limitations of the present study, OC endodontic instruments resisted to cyclic fatigue better than OS. The improved mechanical resistance of OC could be related to new NiTi alloy used for their manufacturing.

Computed microtomography study of untreated, shaped and filled mesiobuccal canals of maxillary first molars.

This study assessed the effectiveness of modern endodontic shaping and filling procedures on mesiobuccal roots of maxillary molars with two canals. The canals of 20 mesiobuccal roots were treated with Mtwo rotary files, passive ultrasonic irrigation and Guttafusion obturators. X-ray computed microtomography analysis was carried out prior to treatment, after canal shaping and after canal filling to determine the alterations of the canal volume before and after the instrumentation, the volume of the hard tissue debris, and percentage of the volume occupied by filling materials. The shaping instruments and filling materials reached only partially the endodontic space of the second mesiobuccal canal and the accessory endodontic structures. Canal irregularities, ramifications, and interconnections were accumulation sites of hard tissue debris. This study demonstrated that rotary files, passive ultrasonic irrigation and carrier-based filling systems could be partially effective for the treatment of the mesiobuccal canals and their accessory endodontic structures.

Intracanal heating of sodium hypochlorite: Scanning electron microscope evaluation of root canal walls.

INTRODUCTION: The aim of this study is to evaluate the surface of root canals dentine using scanning electron microscope (SEM) after instrumentation with rotary Nickel-Titanium systems and two different protocols of activation of sodium hypochlorite (NaOCl) (extracanal heating at 50°C and intracanal heating at 180°C), to assess the presence/absence of smear layer and also the presence/absence of open dentinal tubules along the walls at the coronal, middle, and apical third of each sample. MATERIALS AND METHODS: Thirty-six single-rooted teeth were selected, divided into three groups and shaped with ProTaper Universal instruments following irrigation protocols with 5.25% NaOCl. At the end of the preparation, three different protocols of activation were used: nonheated NaOCl in Group A, extra-canal heated NaOCl at 50°C for Group B and intracanal heated NaOCl at 180°C for Group C. Specimens were cut longitudinally and analyzed by SEM at standard magnification of ×1000. The presence/absence of the smear layer as well as the presence/absence of open tubules at the coronal, middle, and apical third of each canal were estimated using a five-step scale for scores. Numeric data were analyzed using Kruskal-Wallis and Mann-Whitney U statistical tests and significance was predetermined at P < 0.05. RESULTS: Kruskal-Wallis analysis of variance (ANOVA) for debris score showed significant differences among the Ni-Ti systems (P < 0.05). Mann-Whitney test confirmed that Group A presented significantly higher score values than other Ni-Ti systems. The same results were assessed considering the smear layer scores. ANOVA confirmed that the apical third of the canal maintained a higher quantity of debris and smear layer after preparation of all the samples. DISCUSSION AND CONCLUSIONS: Intra-canal heating of NaOCl at 180°C proved to be more effective in obtaining clean canal walls. On the other hand, extra-canal heating at 50°C of NaOCl left a higher quantity of debris and the smear layer was widely represented.

Investigation on the shaping ability of nickel-titanium files when used with a reciprocating motion.

INTRODUCTION: The introduction of nickel-titanium (NiTi) files into clinical practice has improved the quality of canal shaping, but increasing the curvature of the root canal (or the diameter of the master instrument that prepares the full working length) could result in more transportation, straightening, and aberration of the canal. Nickel-titanium instruments are significantly safer and have an extended cyclic fatigue life when used with a reciprocating movement. The purpose of this study was to compare the shaping ability of FlexMaster NiTi instruments when used in either continuous or reciprocating movements. METHODS: Thirty-two Endo Training Blocks ISO 15, 2% taper, 10-mm radius of curvature, and 70° angle of curvature were prepared, according to the group, with FlexMaster NiTi instruments either in continuous rotation or in reciprocating (60° clockwise, 40° counterclockwise) movement. Preoperative and postoperative images of the simulated canals were taken under standardized conditions. The preoperative and postoperative images were combined exactly. The amount of resin removed was determined both for the inner (convex) and the outer (concave) sides of the curvature at 10 different points. RESULTS: In the most apical third of the canal, the Continuous group produced the largest enlargement of the canal as compared with the Reciprocating group (P < .05). In the apical third, the Continuous group displayed significantly greater enlargement of the canal at the external side. CONCLUSIONS: The shaping of simulated canals is more centered by using a reciprocating motion when compared with continuous rotation, but the reciprocating motion could be more time-consuming.

Removal of surgical smear layer.

INTRODUCTION: During apicoectomy and retrograde cavity preparation, a smear layer, which contains microorganisms and necrotic pulpal tissues, is formed on the dentinal surfaces cut by the instruments. Bacteria can survive and proliferate inside or below the smear layer. The purpose of this study was to evaluate in vitro two different procedures for the removal of the smear layer in retrocavities prepared with ultrasonic retrotips. METHODS: Twenty-eight single-rooted teeth were cleaned, shaped, and obturated with gutta-percha and sealer. The apical 3 mm of each root were cut with a carbide bur, and retrograde cavities were prepared with ProUltra ultrasonic retrotips (Maillefer Dentsply, Baillagues, Switzerland) at a depth of 3 mm. Teeth in group A were treated with a gel of 35% orthophosphoric acid for 15 seconds, and teeth in group B were treated with a gel of 24% EDTA at a neutral pH for 2 minutes. The samples were prepared for scanning electron microscopic observation and scored for the presence of the smear layer on the retrocavity walls. RESULTS: Eighty percent of the teeth in group A showed an optimal degree of cleanliness of the walls, with dentinal tubules completely open. The majority of analyzed samples coming from group B showed dentinal tubules covered with the smear layer. CONCLUSIONS: The analysis of the samples showed that orthophosphoric acid is more effective than EDTA in removing surgical smear layer even with less time of action.

Final rinse optimization: influence of different agitation protocols.

INTRODUCTION: This study examined the effect of different root canal irrigant agitation protocols in the penetration of an endodontic irrigant into dentinal tubules. METHODS: Fifty-six human single-rooted teeth were shaped with nickel-titanium instruments, and a final rinse of 5% sodium hypochlorite labeled with 0.2% alizarin red was performed. Specimens were assigned to 7 groups (N = 8) and submitted to the following rinse activation protocols: no agitation (control group), K-File or gutta-percha agitation, or different sonic (EndoActivator [Advanced Endodontics, Santa Barbara, CA] and Plastic Endo, Lincolnshire, IL) and ultrasonic (Satelec [Acteongroup, Merignac, France] and EMS, Nyon, Switzerland) agitations. Specimens were sectioned at 1, 3, and 5 mm from the apex in 1-mm-thick slabs, ground, and prepared for fluorescence microscopy at 100x with a wavelength of 450 milliseconds. Irrigant penetration into dentinal tubules was analyzed by using Kruskal-Wallis analysis of variance followed by post-hoc comparisons. RESULTS: Groups were ranked in the following order: control = K-file = gutta-percha < EndoActivator = Plastic Endo < Satelec = EMS. At 1 mm from the apex, the highest score was found for the EMS group compared with the control, K-file, gutta-percha, EndoActivator, and Plastic Endo groups, whereas no difference was found with the Satelec group. CONCLUSION: The results support the use of an ultrasonic agitation to increase the effectiveness of the final rinse procedure in the apical third of the canal walls.

Which osteotomy for a valgus knee?

A valgus knee is a disabling condition that can affect patients of all ages. Antivalgus osteotomy of the knee is the treatment of choice to correct the valgus, to eliminate pain in the young or middle age patient, and to avoid or delay a total knee replacement. A distal femoral lateral opening wedge procedure appears to be one of the choices for medium or large corrections and is particularly easy and precise if compared to the medial femoral closing wedge osteotomy. However, if the deformity is minimal, a tibial medial closing wedge osteotomy can be done with a faster healing and a short recovery time.

Osteotomies: the surgical treatment of the valgus knee.

Lateral compartment arthrosis from congenital valgus or the result of previous lateral meniscectomy can be a disabling condition. Realignment osteotomy, which may avoid or delay the need for a total knee replacement, is appropriate for young or middle-aged patients suffering from a painful valgus knee. Medium or large corrections can be managed with distal femoral lateral opening wedge osteotomy while minimal deformities are best treated with medial closing wedge tibial osteotomy.