Accessing root canal systems: requirements and techniques.
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Dental Pulp Cavity↗
Biomedical subjects
Ove A Peters
Publications and source records attributed to Ove A Peters.
Factors affecting the outcome of orthograde root canal therapy in a general dentistry hospital practice.
OBJECTIVE: The goal of this study was to weigh the impact of patient-related, tooth-related, and treatment-related factors on therapy outcome in a series of consecutive patients. STUDY DESIGN: Eighty-four patients were included. Of these, 66 (79%) were available for recall after > or = 30 months (mean = 46 months). Root canal treatments were performed using a standard protocol. At recall, teeth were scored by means of the periapical index (PAI), which was the dependent variable (dichotomized to sound/ unsound). Explanatory variables were patient age, integrity of the nonspecific immune system, smoking status, dichotomized PAI score before treatment, initial treatment versus retreatment, prior exposition of the root canal to saliva, stainless-steel hand versus NiTi rotary instrumentation, and quality of root filling. Unit of observation was the patient-individual. Data were analyzed using univariate tests and backward stepwise logistic regression analysis. RESULTS: After 5 steps with elimination of the least significant independent variable, status of the immune system (P = .05), initial PAI (P = .04), and root filling quality (P = .01) were found to be the indispensable predictors for treatment outcome. Using these 3 explanatory variables, the logistic regression model had a predictive value of 87%, compared to 91% with all 8 variables. Success rate at recall (PAI < or = 2 without symptoms) was 88% (95% CI = 78, 94). CONCLUSION: The integrity of a patient's nonspecific immune system, which has been neglected in earlier investigations, is a significant predictor for endodontic treatment outcome, and should receive more attention in future studies.
Adolescent↗
Analysis of torque and force with differently tapered rotary endodontic instruments in vitro.
The aim of this study was to compare torques and forces developed by two sequences of nickel-titanium rotary instruments, using only .04 taper instruments or a combination of .04 and .06 tapers, respectively. Curved canals in plastic blocks were shaped in a torque-testing device; torque, force, contact areas and numbers of working rotations were determined. Analysis of variance and Pearson correlation coefficients were used to compare the two sequences. Mean torque ranged from 0.2 +/- 0.03 to 3.19 +/- 0.28 Ncm and was higher for instrument sizes 25 to 45 in group A. Mean vertical forces ranged from 1.49 +/- 0.54 to 12.0 +/- 3.5 N; there were significant correlations between torque and force as well as between torque and contact areas. Numbers of rotations were lower in the combined .04 and .06 sequence. An instrumentation sequence encompassing various tapers seems to be safer regarding torsional and fatigue failure compared to a sequence that used one single taper. However, the former sequence requires the use of more instruments.
Analysis of Variance↗
Effect of cyclic fatigue on static fracture loads in ProTaper nickel-titanium rotary instruments.
The aim of the present study was to evaluate static fracture loads of ProTaper Nickel-Titanium instruments that had been subjected to various degrees of cyclic fatigue. Torque and angle at failure of new instruments and instruments that had been stressed to 30, 60, or 90% of their cyclic fatigue rotations in a simulated canal (90 degrees and 5 mm radius) were tested according to ISO 3630-1. With unused ProTaper instruments, resistance to cyclic fatigue decreased with diameter increase and ranged from 158 to 450 rotations. Torque at failure ranged from 0.5 to 2.1 Ncm and showed a strong linear relationship to instrument diameter (r = 0.9) while angle at failure was weakly related to diameter (r = 0.46). Cyclic prestressing significantly reduced torsional resistance in finishing files, while shaping files were largely unaffected. In conclusion, build-up of tension within NiTi rotary instruments depends on instrument diameter. Clinically, larger instruments that have been subjected to some cyclic fatigue should be used with great care or discarded.
Analysis of Variance↗
Current challenges and concepts in the preparation of root canal systems: a review.
Nickel-titanium rotary instruments are important adjuncts in endodontic therapy. This review attempts to identify factors that influence shaping outcomes with these files, such as preoperative root-canal anatomy and instrument tip design. Other, less significant factors include operator experience, rotational speed, and specific instrument sequence. Implications of various working length definitions and desired apical widths are correlated with clinical results. Despite the existence of one ever-present risk factor, dental anatomy, shaping outcomes with nickel-titanium rotary instruments are mostly predictable. Current evidence indicates that wider apical preparations are feasible. Nickel-titanium rotary instruments require a preclinical training period to minimize separation risks and should be used to case-related working lengths and apical widths. However, and despite superior in vitro results, randomized, clinical trials are required to evaluate outcomes when using nickel-titanium instruments.
Dental Alloys↗
Restoration of endodontically treated teeth without posts.
PURPOSE: To describe the treatment of a patient with a dismal oral situation after successful cure for drug addiction. METHODS: After root canal treatment and surgical pretreatment, four maxillary glass-fiber reinforced composite fixed partial dentures, anchored by endo-crowns instead of post and core, were fabricated (Targis & Vectris). Additionally, full crowns on four dental implants and an inlay were produced of non-reinforced composite (Targis). All restorations were luted adhesively to abutments with a three component adhesive system (Syntac Classic), light-curing composite (Tetric) and an ultrasonic insertion technique. RESULTS: An esthetic and functional acceptable result was achieved. Excessive removal of tooth structure by post preparation may weaken the root.
Adult↗
Engine-driven preparation of curved root canals: measuring cyclic fatigue and other physical parameters.
An increasing number of engine-driven rotary systems are marketed to shape root canals. Although these systems may improve the quality of canal preparations, the risk for instrument fracture is also increased. Unfortunately, the stresses generated in rotary instruments when shaping curved root canals have not been adequately studied. Consequently, the aim of an ongoing project was to develop a measurement platform that could more accurately detail physical parameters generated in a simulated clinical situation. Such a platform was constructed by fitting a torque-measuring device between the rotating endodontic instrument and the motor driving it. Apically directed force and instrument insertion depth were also recorded. Additional devices were constructed to assess cyclic fatigue and static fracture loads. The current pilot study evaluated GT rotary instruments during the shaping of curved canals in plastic blocks as well as "ISO 3630-1 torque to fracture" and number of rotations required for fatigue fracture. Results indicated that torques in excess of 40 Nmm were generated by rotary GT-Files, a significantly higher figure than static fracture loads (less than 13 Nmm for the size 20. 12 GT-File). Furthermore, the number of rotations needed to shape simulated canals with a 5 mm radius of curvature in plastic blocks was 10 times lower than the number of rotations needed to fracture instruments in a "cyclic fatigue test". Apical forces were always greater than 1 N, and in some specimens, scores of 8 N or more were recorded. Further studies are required using extracted natural teeth, with their wide anatomical variation, in order to reduce the incidence of fracture of rotary instruments. In this way, the clinical potential of engine-driven rotary instruments to safely prepare curved canals can be fully appreciated.
Analysis of Variance↗