Quality of Root Canal Filling in Curved Canals Utilizing Warm Vertical Compaction and Two Different Single Cone Techniques: A Three-Dimensional Micro-Computed Tomography Study.

Statement of the Problem: Successful endodontic treatment depends on three-dimensional (3D) root canal filling to prevent the leakage of residual bacteria. Different obturation techniques with different sealers should be compared by employing advanced assessment tools. Purpose: This study compared the obturation quality of warm vertical compaction (WVC) and two different single-cone (SC) techniques using micro-computed tomography (micro-CT). Materials and Method: Thirty-three extracted maxillary molars with mesial root canal curvature of 20‒40º were prepared in vitro with One-Curve files and randomly assigned to three groups (n=11) for root canal obturation with WVC, SC technique with AH Plus sealer (SC-AH), or SC technique with SureSeal bioceramic (BC) sealer (SC-Su). The root canals underwent micro-CT examinations before and after obturation to determine the volume percentages (VPs) of voids and gaps at different distances from the apex (coronal, middle, and apical thirds). Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Results: The highest VP of voids and gaps was recorded in the SC-Su group, with no significant difference from other groups (p> 0.05). There were significant differences in VP of gaps at different distances from the apex (p<0.05). The VPs of gaps in the apical third of all the samples were significantly higher than in the coronal and middle thirds. However, the difference in VP of voids was not significant at different distances from the apex (p>0.05). Conclusion: None of the tested techniques could provide a void-free and gap-free filling. The apical third of the canals showed the highest VP of gaps in all obturation techniques.

Comparative Evaluation of Canal Transportation and Centering Ratio in Curved Canals: A Study of Cone-beam Computed Tomography and Micro-computed Tomography.

Introduction: This study aimed to compare the accuracy and agreement between cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT) in the assessment of canal transportation and centering ratio following root canal instrumentation with rotary files. Material and Methods: Twenty mesiobuccal canals of mandibular molars were prepared using the 2Shape sequential rotary system. CBCT and micro-CT scans were performed before and after instrumentation, and the magnitude of transportation and centering ratio were measured. The acceptable transportation was set at ≤0.15 mm. The accuracy and agreement between CBCT and micro-CT were calculated, and the intra-class correlation coefficient (ICC) and kappa coefficient were determined to assess the agreement between the two modalities. Statistical analyses were performed using repeated measures ANOVA. Results: Transportation was detected by both modalities at all distances from the apex after instrumentation. The agreement between CBCT and micro-CT in assessing canal transportation was observed in 80%, 85%, 75%, and 75% of specimens at 1-, 3-, 5-, and 7-mm from the apex, respectively. The ICC for transportation and centering ratio was much lower than 0.75, indicating poor agreement between the modalities. The kappa coefficient did not show acceptable agreement between the methods. Conclusions: CBCT and micro-CT demonstrated poor agreement in assessing canal transportation and centering ratio. Micro-CT remains the preferred modality for in vitro investigations, while CBCT should be limited to clinical settings.

Comparison of Canal Transportation and Centering Ability of One-G, EdgeGlidePath, and Neolix: A MicroComputed Tomography Study of Curved Root Canals.

AIMS: A glide path is created prior to root canal instrumentation by nickel-titanium (NiTi) rotary files to increase the efficiency and safety of cleaning and shaping. This study aimed to assess root canal transportation in use of different glide path files in curved canals. MATERIALS AND METHODS: 30 sound mesiobuccal root canals of mandibular molars with 20° to 40° curvature were selected and randomly assigned to 3 groups of EdgeGlidePath (EGP, EdgeEndo), One-G (Micro-Mega), and Neolix (Neoniti). The specimens were scanned before and after glide path creation by microcomputed tomography (micro-CT). The pre- and postoperative micro-CT scans were superimposed, and the degree of canal transportation and centering ratio were measured at 1, 3, 5, and 7 mm distances from the apical foramen. Statistical Analysis. The data were analyzed by two-way and one-way ANOVA. RESULTS: The effects of distance from the apical foramen and instrument type and the interaction effect of the two were not significant on the centering ability of the files or canal transportation. CONCLUSION: EdgeGlidePath, One-G, and Neolix files fabricated from the conventional NiTi alloy or heat-treated M-Wire alloy showed similar performance regarding centering ability and canal transportation in glide path preparation in curved canals.

Micro-computed tomography assessment of dentinal microcracks after the preparation of curved root canals with rotary and reciprocal systems.

BACKGROUND: Root canal preparation with nickel-titanium (NiTi) instruments may lead to the formation of microcracks in the root canal wall. Vertical root fractures may initiate from dentinal cracks, and eventually necessitate tooth extraction. OBJECTIVES: This study aimed to assess the effect of the instrumentation of curved root canals of mandibular molars with the 2Shape (2S) sequential rotary, EdgeFile® X1 (EFX1) reciprocating and NeoNiTi (NN) rotational single-file systems on the formation of dentinal microcracks with the use of micro-computed tomography (micro-CT). MATERIAL AND METHODS: Thirty curved mandibular molar root canals were instrumented with the 2S, EFX1 and NN systems (10 in each group). The teeth underwent micro-CT before and after instrumentation. Next, the pre-instrumentation and post-instrumentation cross-sectional images were evaluated and compared for the detection of dentinal microcracks. The number of microcracks in each group was calculated and reported as percentage. The data was analyzed using the McNemar's test with the IBM SPSS Statistics for Windows software, v. 25.0 (α = 0.05). RESULTS: Out of the 29,280 cross-sectional images evaluated in this study, 11.5% showed dentinal microcracks (n = 3,362). On the post-instrumentation images, the frequency percentage of microcracks was 12.0% (n = 585) in the 2S group, 8.8% (n = 402) in the EFX1 group and 13.3% (n = 694) in the NN group. All of the microcracks detected on the post-instrumentation images were also present on the preinstrumentation images and no new microcracks were formed after root canal instrumentation with the aforementioned systems. CONCLUSIONS: Root canal instrumentation with the 2S, EFX1 and NN systems did not result in the formation of new dentinal microcracks.

Effect of Root Canal Preparation Techniques on Crack Formation in Root Dentin.

INTRODUCTION: The aim of this study was to assess the frequency of root crack formation caused by the use of manual instrumentation, 2 rotary systems, and 1 reciprocating system using light-emitting diode transillumination. METHODS: One hundred fifty mandibular premolars were randomly divided into 5 groups (n = 30): control 1, no intervention; control 2, instrumented with hand files; group 3, instrumented with ProTaper Universal rotary files (Dentsply Maillefer, Ballaigues, Switzerland); group 4, instrumented with OneShape rotary files (Micro-Mega, Besancon, France); and group 5: instrumented with the WaveOne reciprocal system (Dentsply Maillefer, Ballaigues, Switzerland). After root canal preparations, the roots were sectioned at 3, 6, and 9 mm from the apex with water irrigation. The slices were inspected under a stereomicroscope with light-emitting diode transillumination from the buccal, lingual, mesial, and distal directions at ×40 magnification to determine the presence/absence of cracks (dentinal defects). The chi-square test was used to analyze the data. RESULTS: There was a significant difference among the groups in crack frequency (P < .05). The 2 single systems had significantly higher cracks than the other 3 groups. At 3 mm from the apex, there were significantly more cracks in groups 4 and 5 than in groups 1, 2, and 3 (P < .05). At 6 mm from the apex, no significant difference was noted (P > .05). At 9 mm from the apex, the frequency of cracks in group 3 was significantly higher (P < .05). CONCLUSIONS: According to the results, using rotary instrumentation can result in some dentinal defects, and single-file systems, regardless of motion type, can cause significantly higher crack formation in the apical third of root canals.

Cervical Dentin Changes in Curved Root Canals after Using WaveOne and Reciproc Files with Full Rotation versus Reciprocation Movement: An Ex vivo Study.

AIM: The aim of the current study was to compare the effect of WaveOne and Reciproc files in reciprocation versus reverse full rotation movements on cervical dentin thickness by virtue of cone beam computed tomography (CBCT) analysis in curved mesial canals of mandibular first molars. METHODS: Mesiobuccal canals of 60 mandibular molars were randomly divided into 4 groups (n = 15): Group 1; WaveOne/Reciprocation, Group 2; WaveOne/Full-Rotation, Group 3; Reciproc/Reciprocation, and Group 4; Reciproc/Full-Rotation. Pre- and post-instrumented CBCT scans were prepared for assessment of cervical dentin thickness changes (2 mm, 4 mm below the highest point of the root furcation) in both groups. Data statistically analyzed using two-way ANOVA test. RESULTS: There was no statistically significant difference between four experimental groups in terms of remaining dentin thickness at 2 and 4 mm levels below the highest point of the furcation (P > 0.05). No separation of instruments occurred in any group. CONCLUSION: WaveOne and Reciproc files with two different motions have similar effects on cervical of root canals in terms of dentin thickness changes.

Efficacy of preoperative ibuprofen and meloxicam on the success rate of inferior alveolar nerve block for teeth with irreversible pulpitis.

OBJECTIVE: The purpose of this study was to determine whether premedication with ibuprofen or meloxicam increases the success rate of anaesthesia in teeth with irreversible pulpitis. MATERIALS AND METHODS: In this parallel, double-blind clinical trial, 92 patients diagnosed with irreversible pulpitis were randomly divided into four groups of 23 patients. The first group (the no-premedication group) received no premedication, the second group (the meloxicam group) received 7.5 mg of meloxicam, the third group (the ibuprofen group) received 600 mg of ibuprofen, and the fourth group (the placebo group) received placebo 1 hour before intervention. Before taking the medication, electrical pulp testing (EPT) and the Heft-Parker visual analogue scale (VAS) were used to evaluate sensitivity and pain at baseline. Then, local anaesthesia was injected, and after 15 minutes, EPT was used again to evaluate tooth sensitivity. The pain during access preparation was also recorded using the Heft-Parker VAS. RESULTS: Ninety-two patients were analysed. The success rates of local anaesthesia were 21.7%, 34.8%, 78.3% and 73.9% in the no-premedication, placebo, ibuprofen and meloxicam groups, respectively, according to the EPT values. Considering the Heft-Parker VAS values, no premedication gave a 21.7% success rate, placebo gave a 34.8% success rate, ibuprofen gave an 82.6% success rate and meloxicam gave a 65.2% success rate. The ibuprofen and meloxicam groups showed significantly better results than the placebo and no-premedication groups (P < 0.001). However, the difference between meloxicam and ibuprofen groups was not significant. CONCLUSIONS: Premedication with meloxicam and ibuprofen significantly increased the success rates of inferior alveolar nerve block anaesthesia for teeth with irreversible pulpitis; however, neither drug provided profound anaesthesia.

Efficacy of Video-Assisted Instruction on Knowledge and Performance of Dental Students in Access Cavity Preparation.

INTRODUCTION: The conventional method of teaching endodontics has some drawbacks. Due to the small size of the oral cavity, students cannot closely observe the clinical procedure. Use of new teaching modalities such as the intraoral camera may obviate this problem. This study assessed the effect of video-assisted clinical instruction in dentistry (VACID) on dental student's knowledge and performance in access cavity preparation during endodontic treatment. METHODS AND MATERIALS: In this interventional study, twenty six undergraduate students were equally divided into two groups and received instructions on access cavity preparation via conventional demonstration (CD) or VACID using intraoral camera plus conventional demonstration. Students' knowledge was assessed before and after the demonstration. The scores obtained by students were compared between the two groups. Data were analyzed using the Mann Whitney U test. RESULTS: No significant difference was found between the two groups in knowledge and performance scores of students about pulp chamber removal, under-extension, over-extension, gouging, perforation or finding the main and extra canals. However, use of intraoral camera significantly reduced the number of student visits to instructors for problem solving (P=0.001). CONCLUSION: VACID is an effective educational method and as efficient as conventional demonstration in endodontics; as a result it can be used in combination with conventional teaching.

Alterations of the Danger Zone after Preparation of Curved Root Canals Using WaveOne with Reverse Rotation or Reciprocation Movements.

INTRODUCTION: The aim of this study was to compare the changes that occur in the danger zone (DZ) after preparation of curved mesiobuccal (MB) canals of mandibular first molars with WaveOne instruments in two different movements [reciprocation (RCP) and counter-clockwise rotation (CCWR)] by means of cone-beam computed tomography (CBCT). METHODS AND MATERIALS: MB canals of 30 mandibular molars were randomly divided into 2 groups (n=15); WaveOne/RCP and WaveOne/CCWR. Pre- and post-instrumentation CBCT images were assessed for changes in the dentin thickness in DZ (2 and 4 mm below the highest point of the root furcation) in both groups. Data was analyzed using the repeated measures ANOVA test. RESULTS: There was no statistically significant difference between two experimental groups in terms of remaining dentin thickness at 2 and 4 mm levels below the highest point of the furcation (P>0.05). CONCLUSION: The efficacy of WaveOne instrument on changes of the dentin thickness in the DZ was not affected by different file movements.

The Impact of Three Different Canal Lubricants on Fracture, Deformity and Metal Slivering of ProTaper Rotary Instruments.

INTRODUCTION: The aim of this in vitro study was to evaluate the effect(s) of three canal lubricants i.e. sodium hypochlorite, RC-Prep as the paste form of ethylenediaminetetraacetic acid (EDTA) and aqueous EDTA on the occurrence/incidence of fracture, deformity and metal slivering of ProTaper rotary instruments. METHODS: A total of 120 mesial canals (i.e. mesiobuccal and mesiolingual) of first mandibular molars or buccal canals (i.e. mesiobuccal and distobuccal) of first maxillary molars, with curvatures of 10-20 degrees were selected and randomly divided into three groups of forty samples each. These selected canals all had approximate 19-21 mm working length and apical diameter equal to a #15 K-file. In each group, the root canals were prepared using ProTaper rotary instruments with an electric motor using one of the three aforementioned irrigants. Subsequently, samples were compared to each other at different magnifications (16×, 20×, 40× and 57×) for any fracture, deformity or metal slivering, by the Cox regression analysis. RESULTS: The fractures rate of samples in RC-Prep group was significantly higher compared to other groups (P=0.01). No evidence of instrument deformity was detected in any groups. A statistically significant reverse relation between metal slivering and instrument fracture was observed. CONCLUSIONS: Application of aqueous EDTA and/or sodium hypochlorite as intracanal lubricants caused less fracture of ProTaper instruments compared to canal lubrication with RC-Prep.

Efficacy comparison of periapical infiltration injection of dexamethasone, morphine and placebo for postoperative endodontic pain.

OBJECTIVE: To evaluate the efficacy of periapical infiltration injection of dexamethasone and morphine in reducing postoperative endodontic pain. METHOD: Ninety patients participated in this double-blind randomised controlled clinical trial. They were referred to the dental school of Shahid Beheshti Medical University, Tehran, Iran for conventional endodontic treatment of molar teeth. The canals of each tooth were completely prepared with cleansing and shaping. The patients were randomly divided into three experimental groups to receive dexamethasone, morphine or normal saline (1 mL). Patients were then instructed to complete a pain diary 4, 8, 24 and 48 h after the appointment. Statistical analysis consisted of chi-squared test, analysis of variance and Kruskal-Wallis test. RESULTS: There was a statistically significant correlation between dexamethasone or morphine treatment and decreased levels and incidence of endodontic pain at 4, 8 and 24 h, but not at 48 h (P < 0.05). It was also observed that dexamethasone was significantly more effective (56.7% no pain) than morphine (43.3% no pain). CONCLUSION: Periapical infiltration of dexamethasone and morphine led to a considerable decrease in postoperative endodontic pain during the first 24 h after operation. Dexamethasone was more effective than morphine in pain reduction.

Comparing microleakage in root canals obturated with nanosilver coated gutta-percha to standard gutta-percha by two different methods.

INTRODUCTION: Favorable apical seal of root filling materials is a crucial factor for a successful root canal treatment. The aim of this in vitro study was to compare bacterial and dye microleakage of two root canal filling materials including standard gutta-percha and nanosilver coated gutta-percha, and to evaluate the agreement between results of these two methods. MATERIALS AND METHODS: Fifty-eight extracted single-rooted teeth were randomly divided into two experimental groups of 26 each, and two control groups of three each. After decoronation, root canals were instrumented by crown-down technique. Obturation was conducted using standard gutta-percha in one of experimental groups and nanosilver-coated gutta-percha in another group. AH26 sealer was used as the sealer in both experimental groups. Bacterial leakage was investigated after 60 days using Enterococcus (E.) faecalis microbial strains, and dye leakage was assessed during 72 hours using 1% methylene blue. The data were statistically analyzed by Chi-square test, Kaplan-Meier survival analysis, and Cohen's Kappa. RESULTS: There was 84% bacterial leakage in standard gutta-percha group and 76% in nanosilver gutta-percha group. Complete dye leakage occurred in 24% and 27% of standard and nanosilver gutta-percha groups, respectively. The above difference between groups was not significant. In the samples with leakage, recorded times of leakage were not significantly different. There was no significant measure of agreement between dye and bacterial penetration along root-end fillings. CONCLUSION: There was a poor agreement between dye and bacterial leakage methods. Leakage results produced by nanosilver gutta-percha were comparable to those by standard gutta-percha. Considering the antibacterial effects of nanosilver coated gutta-percha, use of this type of gutta-percha might be more efficacious in endodontic treatments.

In vitro evaluation of the antibacterial activity of three root canal sealers.

INTRODUCTION: Antibacterial activity is one of the desirable properties of an ideal sealer. This study aimed to compare the antimicrobial effect of three different sealers, i.e. resin (AH26), calcium hydroxide (Apexit) and zinc oxide eugenol (ZOE) based sealers. MATERIALS AND METHODS: Direct contact test with agar diffusion was used in this in vitro study. The freshly mixed sealers were AH26, Apexit and pure ZOE. They were prepared according to manufacturer's instruction and placed in prepared wells of 30 agar plates inoculated with Streptococcus (S) mutans and Prevotella (P) melaninogenicus (15 samples for each microorganism). All plates were incubated for 7 days (196 hours) at 37˚C under anaerobic conditions, and zones of inhibition were measured after 3 days, 5 days and 7 days. The data were analyzed using Kruskal-Wallis and Friedman tests. RESULTS: In all determined intervals, the antibacterial activity of AH26 was significantly greater than other test materials (P<0.001). ZOE sealer had moderate effect on test microorganisms, whilst Apexit showed the lowest antibacterial activity on S. Mutans and no antibacterial activity on P. melaninogenicus. CONCLUSION: The ascending sequence of bacterial growth inhibition zones was as AH26>Pure ZOE>Apexit.

Relation between pulpal neuropeptides and dental caries.

INTRODUCTION: Dental pulp has neural fibers that produce neuropeptides like Substance P (SP) and calcitonin gene-related peptide (CGRP). The inflammation of dental pulp can lead to an increase amount of SP and CGRP release, especially in symptomatic irreversible pulpitis. Therefore, it can be assumed that neuropeptides have some role in the progression of inflammation of the dental pulp. The aim of this study was to determine the relation between the presence and concentration of neuropeptides in dental pulps of carious teeth caries. MATERIALS AND METHODS: For this purpose, pulpal tissues were collected from 40 teeth (20 carious and 20 intact). Pulpal samples were cultured for 72 hours. ELISA reader was used for the detection of SP and CGRP in supernatant fluids. Statistical analysis was made by Mann-Whitney U and Chi square tests. RESULTS: SP and CGRP were present in 65% and 20% of inflamed pulpal samples, respectively and 40% and 5% of normal pulpal samples, respectively. Level of SP was significantly higher in inflamed pulp samples compared to intact pulps; however, there was no statistical difference when the other groups and neuropeptides were compared. The mean concentration of SP in normal pulps was 3.4 times greater than that of CGRP; interestingly in inflamed pulps the concentration of SP was 22.3 times greater than CGRP. CONCLUSION: We can conclude that in inflamed dental pulps, the concentration of SP is higher than CGRP. It can be hypothesized that CGRP has less effect on the inflammatory changes of dental pulps.