Determining the Correct Course of Endodontic Retreatment With No Patient History Available.

Forensic endodontics is an empirical concept that has a clinical application. By definition, forensic endodontics is the determination of the diagnosis and etiology of a patient's tooth pain and/or periradicular radiographic lesion on a tooth that has been previously endodontically treated. Forensic endodontics diverges from conventional endodontic retreatment in that the patient has no recollection of when the tooth was treated or by whom, and the clinician has no access to any past radiographs to assess the healing progression of the previous endodontic treatment. To determine the correct course of endodontic therapy, the clinician needs to make a proper pretreatment diagnosis and determine the etiology despite the absence of a treatment history. In forensic endodontic case scenarios, the retreatment options are conventional nonsurgical endodontic retreatment, surgical endodontics, or extraction. An intentional replantation surgical case is presented as a clinical example of performing forensic endodontics.

The Importance of Obtaining a Pulpal and Periradicular Diagnosis Prior to Restorative Treatment.

Maintaining dental pulp vitality should be among the clinical goals of any restorative treatment. By obtaining a pretreatment pulpal and periradicular diagnosis before performing restorative treatment, the clinician will be better able to proceed with treatment of the pulp, especially if it is exposed during caries excavation. A pretreatment pulpal and periapical diagnosis may be effectively attained by performing five objective clinical tests: pulp sensibility, percussion (which may include bite testing), palpation, periodontal probing/ tooth mobility, and updated radiography. This article provides a description of these five clinical tests and gives an overview of current terminologies used when obtaining a pulpal and periradicular diagnosis.

Clinically Enhancing Local Anesthesia Techniques for Endodontic Treatment.

Local anesthesia is one of the most important drugs given to patients who undergo endodontic treatment. Yet, clinicians often do not view local anesthetic agents as drugs and, therefore, struggle clinically to consistently achieve profound pulpal anesthesia. To improve the clinical effects of local anesthesia for endodontic treatment, in conjunction with selecting the correct type of local anesthesia, clinicians need to thoroughly understand how the local anesthetic process works and how to objectively test for clinical signs of pulpal anesthesia and integrate supplemental anesthesia when appropriate.

Using 3-dimensional printing to create presurgical models for endodontic surgery.

Advances in endodontic surgery--from both a technological and procedural perspective-have been significant over the last 18 years. Although these technologies and procedural enhancements have significantly improved endodontic surgical treatment outcomes, there is still an ongoing challenge of overcoming the limitations of interpreting preoperative 2-dimensional (2-D) radiographic representation of a 3-dimensional (3-D) in vivo surgical field. Cone-beam Computed Tomography (CBCT) has helped to address this issue by providing a 3-D enhancement of the 2-D radiograph. The next logical step to further improve a presurgical case 3-D assessment is to create a surgical model from the CBCT scan. The purpose of this article is to introduce 3-D printing of CBCT scans for creating presurgical models for endodontic surgery.

Remedying and preventing endodontic rotary nickel-titanium (NiTi) file breakage.

Of all the procedural problems that can occur when practicing dentistry, endodontic file breakage is one dilemma that not only can lead to extreme stress for the clinician, but can cause great anxiety for the patient as well. Separated rotary nickel-titanium (NiTi) files can also pose an increased risk of post-endodontic complications. Understanding why and how endodontic file breakage occurs, including the two main factors that contribute to this type of incident, can help clinicians employ prevention strategies and overcome this predicament if it does occur. The purpose of this article is to discuss the causes of separated endodontic rotary NiTi files, explain how to prevent this problem from happening, describe the removal of a broken file, and discuss the prognosis for instances where the separated file cannot be removed.

An in vitro comparative study of intracanal fluid motion and wall shear stress induced by ultrasonic and polymer rotary finishing files in a simulated root canal model.

Objective. This in vitro study compared the flow pattern and shear stress of an irrigant induced by ultrasonic and polymer rotary finishing file activation in an acrylic root canal model. Flow visualization analysis was performed using an acrylic canal filled with a mixture of distilled water and rheoscopic fluid. The ultrasonic and polymer rotary finishing file were separately tested in the canal and activated in a static position and in a cyclical axial motion (up and down). Particle movement in the fluid was captured using a high-speed digital camera and DaVis 7.1 software. The fluid shear stress analysis was performed using hot film anemometry. A hot-wire was placed in an acrylic root canal and the canal was filled with distilled water. The ultrasonic and polymer rotary finishing files were separately tested in a static position and in a cyclical axial motion. Positive needle irrigation was also tested separately for fluid shear stress. The induced wall shear stress was measured using LabVIEW 8.0 software.

An in vitro comparison of torsional stress and cyclic fatigue resistance of ProFile GT and ProFile GT Series X rotary nickel-titanium files.

The purpose of this in vitro study was to compare the torsional stress and cyclic fatigue characteristics of ProFile GT (Dentsply Tulsa Dental, Tulsa, OK) and ProFile GT Series X (Dentsply Tulsa Dental). Files of 0.04 and 0.06 taper, 25 mm in length, and ISO sizes of 20 and 30 tips were compared (n = 25 per test group). Torque stress resistance was evaluated by measuring the torque in gram-centimeters (g-cm) and angle of deflection (degrees of rotation) required for instrument separation with use of a torsiometer instrument. Cyclic fatigue was determined by recording the time until breakage of a file rotating in a simulated canal with an applied 45 degrees or 60 degrees curve. The files were operated in a cyclic fatigue instrument that simulated clinical rotary file usage with a constant cyclical axial motion. There was no statistical difference (p > 0.05) when comparing the torque (g-cm) required to induce a torsional failure of ProFile GT and ProFile GT Series X files of identical file sizes. The angle of deflection (degrees of rotation) of ProFile GT was significantly greater (p < or = 0.001) before separation than ProFile GT Series X for all file sizes tested except 20/.04 (p > 0.05). There was no statistical difference (p > 0.05) in cyclic fatigue failure for ProFile GT and ProFile GT Series X in a canal with a curvature of 45 degrees . In the 60 degrees canal curvature, ProFile GT was found to be significantly more resistant (p = 0.005) to fracture because of cyclic fatigue than ProFile GT Series X for file size 30/.06 and significant (p < or = 0.001) for files sizes 20/.06 and 30/.04. There was no difference (p > 0.05) in cyclic fatigue resistance in the 60 degrees canal for ProFile GT and ProFile GT Series X for file size 20/.04.

An in vitro comparison of bond strength of various obturation materials to root canal dentin using a push-out test design.

The purpose of this in vitro study was to compare the bond strength of various obturation materials to root canal dentin by using a push-out test design. Twenty-five single-rooted extracted human teeth were used in this study. The crowns were removed, and root canal instrumentation was completed by using Endogel-coated 0.06 EndoSequence rotary files (Brasseler, Savannah, GA) and appropriate irrigation with 5.25% NaOCl and a final rinse with 17% EDTA. After instrumentation, the roots were randomly divided into five single-matched cone obturation groups (n = 5 roots/group), as follows: group 1, gutta percha with Kerr EWT (Kerr Corp, Romulus, MI); group 2, gutta percha with AH Plus (Dentsply, DeTrey, Germany); group 3, Resilon (Pentron Clinical Technologies, Wallingford, CT) and Epiphany (Pentron); group 4, Activ GP (Brasseler) obturation system; and group 5, EndoREZ obturation system (Ultradent, South Jordan, UT). The obturated roots were cut perpendicular to the long access to create 1-mm thick slices from the apical, middle, and coronal thirds. The bond strength was measured for each test slice with a push-out testing machine. Statistical analysis was completed by using a two-way analysis of variance and the post hoc Tukeys test with significance set at p < 0.05. Group 2 showed a significantly (p < 0.05) greater bond strength compared with all other groups. Also, groups 1 and 4 had significantly (p < 0.05) higher bond strengths compared with groups 3 and 5.

An in vitro comparison of bacterial leakage of three common restorative materials used as an intracoronal barrier.

The purpose of this in vitro study was to evaluate quantitatively the effectiveness of three different restorative materials used as an intracoronal barrier to prevent microleakage of endodontically treated teeth. Fifty-five extracted human single-canal teeth were used in this study. The teeth were endodontically prepared and obturated. Forty-five teeth were randomly assigned to three experimental groups: group 1: sealed with Ketac-Cem (3M ESPE, St Paul, MN) (n = 15), group 2: sealed with Clearfil Protect Bond/Clearfil AP-X (Kuraray, New York, NY) (n = 15), and group 3: sealed with Maxcem (Kerr, Orange, CA) (n = 15). Ten teeth were also randomly assigned to a negative control group (n = 5) and a positive control group (n = 5). Microleakage was tested by using a sterile two-chamber bacterial method and Enterococcus faecalis was used as a microbial marker. Samples were incubated aerobically at 37 degrees C for 120 days. Bacterial leakage was determined by change in turbidity in the medium. Statistical analysis was performed using a Wald chi-square test. No significant difference (p > 0.05) in bacterial leakage was found between the three experimental groups tested. All positive controls leaked within 60 days and broth of the negative control group remained clear throughout the entire experimental period.

Integrating ultrasonic tips into the endodontic treatment armamentarium.

The integration of ultrasonic tips in conventional and surgical endodontic treatment can be useful for the clinician. An ultrasonic tip is used in conventional endodontic treatment to remove or bypass a separated instrument or a post within a canal, and can replace a slow-speed handpiece and round bur to detect or provide better access to a canal. In endodontic surgery, the replacement of the slow-speed or miniature handpiece with an ultrasonic tip will allow for better instrument ergonomics and depth of a root-end preparation. When used in conjunction with magnification and illumination, visualization for the clinician is markedly improved. In addition, advancements in polymer science have allowed for the development of plastic ultrasonic tips.

An in vitro comparison of the antimicrobial effects of various endodontic medicaments on Enterococcus faecalis.

The purpose of this in vitro study was to investigate the antimicrobial action of Dermacyn (Oculus Innovative Sciences, Petaluma, CA), BioPure MTAD (Dentsply Tulsa Dental, Johnson City, TN), 2% chlorhexidine (CHX; Ultradent, West Jordan, UT), and 5.25% sodium hypochlorite (NaOCl) against Enterococcus faecalis (American Type Culture Collection 4082). Eighteen Petri dishes of BHI agar were inoculated with E faecalis. Each Petri dish had five saturated paper disks placed. Four of the disks were saturated with a different test solution, and the last paper disk served as the control and was saturated with sterile distilled water. The plates were randomly distributed into two groups. Group one (n=9) was incubated aerobically and group 2 (n=9) was incubated anaerobically for 48 hours at 37 degrees C. The largest diameter of the zones of microbial inhibition was measured in millimeters and recorded. Statistical analysis was performed with repeated-measures analysis of variance. BioPure MTAD showed significantly (p<0.05) more zones of microbial inhibition than 5.25% NaOCl, 2% CHX, and Dermacyn. Sodium hypochlorite and CHX showed significantly (p<0.05) more zones of microbial inhibition than Dermacyn. The zone of inhibition between NaOCl and CHX was not significant (p>0.05). The control group showed no microbial inhibition.

Clinically enhancing the connection between endodontic and restorative treatment for better case prognosis.

This article focuses on the endodontic-restorative interface. The reduction of bacterial contamination via chemical-mechanical debridement during conventional endodontic treatment, in conjunction with canal obturation and timely restorative treatment using a rubber dam to prevent the microbial recontamination of the canal system, will significantly improve the clinical outcome.

An in vitro comparison of the intraradicular dentin bond strength of Resilon and gutta-percha.

The purpose of this study was to compare the micropush-out bond strength of Resilon to that of gutta-percha. Extracted human anterior teeth were used for evaluation. The crowns were removed and the root canals were instrumented with Gates Glidden drills and 0.06 Profile rotary files. Instrumentation was performed with 5.25% sodium hypochlorite irrigation and a final rinse of 17% EDTA. The teeth were randomly divided into two groups. Gutta-percha group: obturation with gutta-percha and Kerr Pulp Canal Sealer EWT. Resilon group: obturation with Resilon points, Epiphany Primer, and Root Canal Sealant. The teeth were cut perpendicular to their long axis to obtain a series of 1.0 mm thick disks (n = 15 per group). Micropush-out bond strengths to root canal dentin were measured. The results show that the mean bond strength to root canal dentin was significantly higher (p < 0.05) in the Resilon/Epiphany group as compared to the gutta-percha/Kerr Pulp Canal Sealer EWT group.

A comparison of thermal properties between gutta-percha and a synthetic polymer based root canal filling material (Resilon).

A new polymer-based obturating material, Resilon, has been developed but there have been no studies identifying its thermal properties. The purpose of this study was to compare the melting point, specific heat, enthalpy change with melting and heat transfer between gutta-percha (GP) and Resilon (R). The first three tests were determined using a differential scanning calorimeter and the heat transfer test was determined using a split-tooth model. Results show no significant difference (t test, p > 0.05) between gutta-percha and Resilon for the melting point temperature (GP: 60.01 degrees C; R: 60.57 degrees C). There was a significant difference (t test, p < 0.05) in specific heat capacity (GP: 0.94 J/g degrees C, R: 1.15 J/g degrees C) and endothermic enthalpy change (GP: 10.88 J/g, R: 25.20 J/g) between the two materials. The heat transfer test showed a significant difference (Mann-Whitney, p < 0.05) in temperature increase between gutta-percha and Resilon within 3 mm of the heat source.

In vitro evaluation of the antimicrobial effects of a root canal sealer-antibiotic combination against Enterococcus faecalis.

The purpose of this in vitro study was to evaluate the antimicrobial effects of five antibiotics when added to Kerr Pulp Canal Sealer EWT against Enterococcus faecalis. Five antibiotics: amoxicillin, penicillin, clindamycin, metronidazole, and doxycycline, were added separately to Kerr sealer. Thirty brain heart infusion agar plates were inoculated with E. faecalis and sterile paper discs containing a sealer-antibiotic combination were randomly assigned to the inoculated plates. Kerr sealer on a sterile paper disc and a blank sterile paper disc served as the controls. Fifteen plates were incubated aerobically and the remaining 15 plates were incubated anaerobically at 37 degrees C. The zones of inhibition were measured at 48 hours. No significant differences (p > 0.05) were found between aerobic and anaerobic groups. The groups were combined and data analysis using a one-way ANOVA and Tukey's post hoc test was performed. Results revealed that sealer-antibiotic combinations containing amoxicillin, penicillin, clindamycin, and doxycycline had a significant difference (p < 0.001) in the mean zones of inhibition when compared to Kerr EWT sealer alone. No significant differences (p > 0.05) were found between the metronidazole-sealer combinations and Kerr EWT sealer alone.

The causes, prevention, and clinical management of broken endodontic rotary files.

Complications can occur during many dental procedures. The prepared clinician responds by either correcting the problem during treatment, or, ideally, preventing the problem from occurring in the first place. In endodontic treatment separated rotary Ni-Ti files are a common procedural problem. Through understanding that the main causes of file breakage are cyclic fatigue and torsional stress, a dentist can best prevent this occurrence by using hand files before rotary files, creating a straight-line (glide path) access into a canal, and preflaring the coronal portion before using rotary files in the apical third of the canal. In addition, using an up and down motion with the electric slow-speed handpiece (not allowing the file to bind within the canal) will significantly reduce the incidence of file breakage. If a file does break, successful removal primarily depends on the location of the file in the canal rather than the specific technique employed for removal. A case does not necessarily fail if the separated file cannot be removed. The prognosis when file separation occurs can still be favorable, especially if care was taken to reduce the critical concentration of canal debris with hand instrumentation and chemical irrigation prior to rotary file insertion. In addition, the introduction of a new CS file design will help the dentist increase the chance of removing the file in the event of breakage.

Low carb endodontics.

The field of endodontics has seen great technological advances and changes in thought processes over the last decade. Unfortunately, with these advances and changes has come an overload of information (too many carbs!). This article will help to reduce your intake of carbohydrate information and provide you with what you need to know about conventional endodontic treatment.

An in vitro comparison of the rake angles between K3 and ProFile endodontic file systems.

The purpose of this study was to compare rake angles of the ProFile and K3 file systems. Twenty-five 40/0.06 taper files were obtained for each system. Five files from the same manufacturer were placed perpendicularly into a vial of Epoxicure Resin and left to set for 24 h. The set-ups were removed from the vials and each were sectioned 5 mm from the tip of the files and polished. A photomicrograph was taken of each file with 100x magnification. Five sets of ProFile and five sets of K3 files were processed in this manner. Images were captured digitally, and rake angles of each file were measured. Multivariate ANOVA found a significant difference (p < 0.001) among the three negative rake angles of the ProFile system compared with the K3 system.