Evaluation with Micro-CT of the Canal Seal Made with Two Different Bioceramic Cements: GuttaFlow Bioseal and BioRoot RCS.

AIM: The aim of this work is to investigate the quality of root canal seals obtained by comparing two bioceramic cements, GuttaFlow bioseal and BioRoot RCS, focusing on the presence of voids created during the canal obturation procedure. MATERIALS AND METHODS: The voids are analyzed using a micro-computed tomography (micro-CT) device. The study will be performed using images of the endodontic space before and after filling of a selected group of elements. Furthermore, the average thickness of the cement, the average quantity of gutta-percha compared to the total shaped volume, and the average quantity of the two cements, GuttaFlow bioseal and BioRoot RCS, with respect to the total shaped volume were considered. The apical, middle, and coronal thirds have been investigated in a sectorial manner. Images have been analyzed using a CT-An™ software and visualized through a three-dimensional (3D) reconstruction of the slices by the software CT-Vol™. Shapiro-Wilk test/Test D'Agostino-Pearson/Kolmogorov-Smirnov test were used to ensure the reliability of results. RESULTS: No significant differences were observed in the amount of gutta-percha compared to the shaped volume between the GuttaFlow bioseal group and BioRoot RCS. No statistically significant difference was observed between the two groups in terms of voids. CONCLUSION: The data obtained from this study allowed to conclude that the samples filled with GuttaFlow bioseal and BioRoot RCS have a similar seal capacity since no statistically significant differences were observed between the two groups. No sample showed the absence of voids within the root canal obturation. CLINICAL SIGNIFICANCE: Even if the two cements tested showed differences in terms of void volume and ability to fill thin spaces, they should be considered both acceptable and equivalent in terms of clinical sealing ability.

Cone-beam computed tomography accuracy in pulp chamber size evaluation: An ex vivo study.

This study aimed to assess ex vivo the accuracy of cone-beam computed tomography (CBCT), as compared to operative microscope, for evaluating pulp chamber size. A total of forty teeth were extracted for periodontal reasons and a horizontal section was done at the most apical level of the cement-enamel junction. The pulp chamber was photographed using a digital camera connected to an optical microscope. Then, the tooth was scanned with CBCT and the horizontal slide matching the anatomical section of pulp chamber was digitally stored. The pulp chamber section area was measured through image analysis software. The two methods provided similar results, either for monoradicular (P = 0.14) or multiradicular teeth (P = 0.93). Correlation was statistically significant (P < 0.0001), being the coefficient r = 0.89 and 0.94 for monoradicular and multiradicular teeth, respectively. Conclusively, CBCT is suitable for pulp chamber morphology evaluation. However, it has limitations in detecting the anatomical variability of small branches in root canal system.

Digital Orthopantomography vs Cone Beam Computed Tomography-Part 1: Detection of Periapical Lesions.

AIM: Digital orthopantomography (OPT) is usually the first examination step in supervising an incoming patient. Cone beam computed tomography (CBCT) is the most refined and affordable method to search for different dental lesions. The aim of this paper is to evaluate the effectiveness of OPT and CBCT in detecting periapical lesions in different dental groups. MATERIALS AND METHODS: An OPT and a CBCT scan of the dental arches of 45 patients were examined. The presence of AP was pointed out for OPT and CBCT. Sensitivity, specificity, predictive values, and accuracy were calculated for OPT, using CBCT as the reference standard. RESULTS: OPT showed low sensitivity (40.0), positive predictive value (90.4), negative predictive value (90.0), accuracy (90.0), and high specificity (99.2). It was found to have higher sensitivity in the lower front and premolar areas, while the lowest was found in the upper molar area. CONCLUSIONS: OPT can be used for endodontic diagnosis in the lower central and premolar sections, but CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between apex and important anatomical structures exists. CLINICAL SIGNIFICANCE: CBCT exposes the patient to higher doses of radiations when compared with OPT, but CBCT, with its more selective sensitivity and the possibility to offer a three-dimensional (3D) rendering of dental and periodontal structures, is an elective choice for uncertain cases and for specific dental areas.

Digital Orthopantomography vs Cone Beam Computed Tomography-Part 2: A CBCT Analysis of Factors Influencing the Prevalence of Periapical Lesions.

AIM: Cone beam computed tomography (CBCT) is the most refined and affordable method available today for the examination of an incoming patient for different dental pathologies. The aim of this paper is to evaluate the significance of some factors influencing the prevalence of apical periodontitis. MATERIALS AND METHODS: An ortopantomography (OPT) and CBCT scan of the dental arches were examined for each of the selected 45 patients. The presence of apical periodontitis (AP) was compared for CBCT and OPT examination. Sensitivity, specificity, predictive values, and accuracy were calculated for CBCT, using OPT as a reference. The impact of protective/risk factors on the development of AP was examined. RESULTS: CBCT showed higher sensitivity (250%), predictive values (111%), accuracy (111%), and specificity (101%) than OPT. It was found to have higher sensitivity in all the dentition areas, especially where empty anatomical spaces or more radiotransparent structures have a strict relationship with the tooth apex and periapical structures like upper front area, premolar areas, and, especially, in the upper molar area. The prevalence of AP increased from 16 to 17% in the case of insufficient conservative restoration or 25% in the case of microleakage, 35-42% in the case of prosthetic restoration, 56-67% for posts, and 60 and 85%, respectively, for inadequate endodontic treatment and missed canals. CONCLUSION: CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between the apex and important anatomical structures exists. Different risk factors with different relevance are identified. CLINICAL SIGNIFICANCE: As CBCT-examined results show, coronal restorations are moderate-risk factors, while insufficient endodontic treatments and posts are high-risk factors for the development of AP.

A Micro-computed Tomography Evaluation of the Shaping Ability of Two Nickel-titanium Instruments, HyFlex EDM and ProTaper Next.

INTRODUCTION: The aim of this study was to evaluate and compare, by means of micro-computed tomography imaging, the shaping ability of ProTaper Next (PTN) and the novel HyFlex EDM (HFEDM) instruments. METHODS: Forty teeth were randomly divided into 2 groups and prepared with PTN or HFEDM. Root canal transportation and centering ratio were evaluated in mesiodistal and buccolingual directions at 5 levels (at the midpoint of the apical, middle, and coronal thirds and at the boundaries between them). Variations in volume, surface, and cross-sectional shape were measured for the apical, middle, and coronal thirds. The null hypotheses were that no differences existed between the 2 groups. The D'Agostino-Pearson test (α = .05) was conducted to assess the normality of the data sets. The distributions were compared by using the Mann-Whitney test (α = .05). RESULTS: Statistically significant differences (P < .005) were recorded only for buccolingual canal transportation and centering ratio at the section between the middle and coronal thirds, where HFEDM files were superior. CONCLUSIONS: HFEDM and PTN files were similarly effective, and both safely prepared the root canals, respecting their original anatomies. HFEDM files performed better in terms of buccolingual canal transportation and centering ratio at the section between the middle and coronal thirds.