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Morphometric analysis of the working zone for endoscopic lumbar discectomy.

OBJECTIVE: Our study's purpose was to analyze the working zone for the current practice of endoscopic discectomy at the lateral exit zone of the intervertebral foramen (IVF) and to define a safe point for clinical practice. METHODS: One hundred eighty-six nerve roots of the lumbar IVFs of cadaveric spines were studied. Upon lateral inspection, we measured the distance from the nerve root to the most dorsolateral margin of the disc and to the lateral edge of the superior articular process of the vertebra below at the plane of the superior endplate of the vertebra below. The angle between the root and the plane of the disc was also measured. RESULTS: The results showed that the mean distance from the nerve root to the most dorsolateral margin of the disc was 3.4 +/- 2.7 mm (range 0.0-10.8 mm), the mean distance from the nerve root to the lateral edge of the superior articular process of the vertebra below was 11.6 +/- 4.6 mm (range 4.1-24.3 mm), and the mean angle between the nerve root and the plane of the disc was 79.1 degrees +/- 7.6 degrees (range 56.0-90.0 degrees ). CONCLUSIONS: The values of the base of the working zone have a wide distribution. Blind puncture of annulus by the working cannula or obturator may be dangerous. The safer procedure would be the direct viewing of the annulus by endoscopy before annulotomy; the working cannula should be inserted into the foramen as close as possible to the facet joint.

Adolescent↗

Analysis of the film thickness of a root canal sealer following three obturation techniques.

The aim of this study was to obtain a quantitative analysis of the film thickness of a root canal sealer formed after filling by three different techniques. Thirty human maxillary incisors were selected and access cavities were prepared using high-speed diamond stones and water spray. A size #15 K-Flexofile was introduced in the canal of each specimen until it was seen just at the apical foramen. The working length was determined to be 1 mm short of that position and the canals were prepared to an apical size of #45 K-Flexofile. Copious irrigation with 5.25% NaOCl (sodium hypochlorite) was used during and after instrumentation. The samples were divided into three groups and obturated as follows: G1 - lateral condensation, G2 - lateral condensation with an accessory cone, and G3 - continuous wave of condensation. The samples were evaluated in the cervical, middle and apical thirds. The film thickness of the root canal sealer was measured through a microscopic evaluation. Statistical analysis was obtained using the Wilcox test. Statistical analysis showed significant differences between G3 and G1, G3 and G2 (p < 0.05). In general, the lowest film thickness was observed in the continuous wave of condensation (G3). Lateral condensation with an accessory cone (G2) and lateral condensation (G1) demonstrated poorer results in this study, showing a higher film thickness. The small film thickness of the sealer obtained by the continuous wave of condensation technique may increase the clinical performance of this technique.

Dental Cements↗

Tissue reaction to endodontic materials: methods, criteria, assessment, and observations.

The purpose of this study was to develop methods and criteria for the testing of the biocompatibility of endodontic materials. One hundred twenty-one teeth from 12 baboons (Papio anubis) were used to test three sealers: AH26, Kerr pulp canal sealer, and Kloroperka N.O. Gutta-percha cones were used as solid core in all cases. Under disinfected conditions, access preparation was performed, and with working length approximately 1.0 mm short of the foramen, the instrumentation of the root canal was started, using sodium hypochlorite (1%) for irrigation. After the root canals were cleaned and shaped, they were obturated with gutta-percha cones and the sealer, and by lateral condensation technique. Histologic periapical reactions were evaluated at 1, 7, 30, 365, 730, and 1095 days. The methods and criteria used were adequate for ranking of the biocompatibility of the tested materials in the short and long periods. At short observation periods (1 to 7 days) AH26 caused severe reactions, and Kerr pulp canal sealer and Kloroperka N.O., moderate and mild reactions, respectively. At 2- and 3-year observation periods the ranking was AH26, mild; Kerr pulp canal sealer, moderate; and Kloropercha N.O., severe.

Animals↗

Comparison of a warm gutta-percha obturation technique and lateral condensation.

This study was designed to compare a warm gutta-percha obturation technique, Thermafil Plus (Tulsa Dental, Tulsa OK), with lateral condensation for the ability to adapt gutta-percha to the walls of a root canal system. An extracted sectioned and mounted maxillary central incisor had canal irregularities created and was subsequently subjected to multiple obturations using both techniques. Length of fill, replication to working length, number of artificial depressions replicated, quality of replications, number of voids, and general appearance of obturation were all evaluated using standardized criteria. Data evaluation consisted of a one way analysis of variance on the same type defects between obturation groups followed by a Scheffé post-hoc test. A statistically significant difference was found between the groups in each category of evaluation. Gutta-percha using Thermafil was better able to flow into lateral spaces, had fewer voids, and replicated the surface of the root better. It also, however, was extruded out the apical foramen more than in the lateral condensation group.

Analysis of Variance↗

Leakage evaluation with and without vacuum of two gutta-percha fill techniques.

Two sets of 30 roots were obturated either with lateral condensation or a halothane dip technique. Fifteen roots from each group were immersed in India ink with vacuum and 15 without vacuum. Each root was coated with nail polish and wax, leaving only its apical end open for ink penetration. The roots were cleared and three linear measurements were made: distance of ink penetration coronal to the gutta-percha apical tip; distance from the gutta-percha tip to major foramen; and distance from the major foramen to anatomical apex. The average length of ink penetration coronal to the apical extension of the gutta-percha for the lateral condensation groups combined was 1.33 mm and for the halothane groups combined was 2.15 mm. There was no significant difference between vacuumed and not vacuumed for degree of ink penetration. The gutta-percha of the halothane-dipped groups advanced significantly closer to the foramen than the lateral condensation groups (0.38 mm versus 0.65 mm).

Cuspid↗

An in vitro evaluation of coronal microleakage in obturated root canals without coronal restorations.

A study was conducted to evaluate coronal microleakage of Super EBA and Ketac-Endo when used as sealers with single-cone gutta-percha (GP) root canal obturation. The root canals of 24 extracted human teeth were instrumented with flared preparations to a minimum #40 master apical file size. Ten teeth were obturated with a single GP cone and Super EBA as the sealer and ten teeth were obturated with a single GP cone and Ketac-Endo as the sealer. Four teeth were used as controls. Salivary bacterial microleakage studies were conducted to determine whether these sealers could prevent coronal microleakage through the root canal in the absence of a coronal tooth restoration. There was no bacterial penetration through the apical foramen for either sealer tested during the 60-day test period.

Dental Leakage↗

Two canals in mesiobuccal roots of maxillary molars.

The purpose of this study was to examine extracted root canal treated maxillary molars cleared for: (i) the presence of a mesiopalatal (MP) canal in both first and second molars, (ii) the extension of MP canal from the pulp to the apical area, and (iii) the incidence of two foramina in the MB root. Seventy-two extracted maxillary molars (42 first and 30 second molars) were root canal treated by graduate students. The mesiobuccal (MB) roots of these samples were rendered transparent using a clearing technique. The results demonstrated that 52.3% of first and 40% of second molars had two canals obturated in the MB root. After clearing the same roots, the presence of MP canals rose to 80.9% and 66.6%, respectively. The MP canals were root canal treated as far as the foramen in 35.2% of first and 35% of second molars. However, after making them transparent, 91.1% and 90% showed the presence of this canal to the anatomical apex. The MB roots of the root canal treated first molars showed the presence of two foramina in 47% of cases but in 88.2% after clearing. The second molars showed 50% and 70%, respectively. The differences between root canal treated teeth before and after clearing were significantly different in almost all comparisons in both first and second molars. The only exception was when the presence of two foramina was compared before and after the clearing process in second molars (McNemar test P < 0.05).

Coloring Agents↗

Apical extrusion of thermoplasticized obturating material in canals instrumented with Profile 0.06 or Profile GT.

The purpose of this in vitro study was to compare the extrusion of thermoplacticized gutta-percha in teeth instrumented with Profile 0.06 or Profile GT, and obturated with Thermafil Plus and Thermafil GT, respectively. A total of 120, extracted, human maxillary central incisors were divided into four equal groups. Group 1 was instrumented with Profile 0.06 and obturated with Thermafil Plus. Group 2 was instrumented with Profile 0.06 and obturated using warm vertical condensation (negative control). Group 3 was instrumented with Profile GT and obturated with Thermafil GT. Group 4 was instrumented with Profile GT and obturated like Group 2 (negative control). Extrusion was graded as present or absent. Results found 9 of 30 extruded for group 1, 1 of 30 for group 2, 15 of 30 for group 3, and 2 of 30 for group 4. The results suggest that, in vitro, Thermafil GT may be more prone to extruding gutta-percha past the apical foramen than Thermafil Plus.

Chi-Square Distribution↗

[Obturator dislocation of the hip joint].

Luxatio obturatoria may occur in the case of a trauma affecting the hip joint when the latter is in a position of flexion, abduction and external rotation. The femoral head dislocates anteriorly and caudally towards the foramen obturatum. A recent case will be presented with a discussion of the general aspects of this injury, with special emphasis on concomitant injuries and their significance of the long-term prognosis.

Femur Head↗

The effect of varnish and pit and fissure sealants on the sealing capacity of retrofilling techniques.

Freshly extracted teeth with single canals were instrumented and filled with laterally condensed gutta-percha and sealer. After obturation, the tooth apices were treated with various retrograde techniques. The sealing ability of these techniques, namely laterally condensed gutta-percha, heat-sealed gutta-percha, and silver amalgam retrofilling, was compared on the basis of dye penetration. The apical foramen of the treated canals was then coated with different sealing materials--HelioSeal (light-activated sealant), Delton pit and fissure sealant (chemically activated sealant), and varnish--to examine their effect on the leakage resistance of these materials. Statistical analysis indicated that laterally condensed gutta-percha, as well as retrograde amalgam filling, produced a statistically significantly better seal than heat-sealed gutta-percha. Coating of the apical foramen with different sealing materials showed that HelioSeal had significantly improved the sealing capacity of all the materials tested at each time period. Delton pit and fissure sealant did not increase the sealing ability in the first week. However, this material has significantly improved the sealing ability after the first week. On the other hand, sealing of the apical foramen with varnish did not produce any significant change in the sealing capacity of the filling materials. Finally, dye penetration around all the filling and retrofilling materials, in the presence or absence of the apical seal, continued and increased with time. However, root canals sealed with Helioseal consistently showed the least amount of apical leakage of all the canals tested.

Apicoectomy↗

[Study on obturating efficiency of Gutta-percha point as a root canal filler. Difference in results among combinational usages of hand reamers and files].

The last treatment step followings extirpation of pulp from an infected root canal is root canal filling. Before root canal filling is done, however, the canal must be enlarged enough and the infected dentin and debris removed thoroughly from the canal. Furthermore, re-infection from the apical foramen at the apex of the root canal should be prevented. In this study, we examined the root apex sealing ability of gutta-percha points applied by the lateral condensation method and the vertical condensation method, as well as the difference in root canal sealing ability of gutta-percha points when either a hand reamer or file or their combination was used for root canal enlargement. Extracted human upper incisors were used for root canal enlargement. The condition of the root canal wall after enlargement was observed by scanning electron microscope. The fitness between the wall and gutta-percha was determined by observation of replicas filled with gutta-percha. Furthermore, to assess the degree of apex sealing after root canal filling, we immersed the extracted teeth in Indian ink for 1 day, 3 days, 1 week, 2 weeks, or 4 weeks (Indian ink permeation test). The results obtained were as follows: 1. Reamer and K-file could smooth the root canal wall more than H-file by the scratch-up method. And also the instruments used by the rotation method formed a sure apical seat, which resulted in film apex filling. 2. By the observation of gutta-percha point-filled replicas we noted a border line between the apical seat and apical foramen when the lateral condensation method was used, whereas the line was not observed with the vertical condensation method. 3. Between the 2 filling methods there was no difference in the ink permeation by Indian ink permeation test, but high sealing ability was observed in the root canal in which a sure apical seat had been formed.

Gutta-Percha↗

In vitro evaluation of apical microleakage following canal filling with a coated carrier system compared with lateral and thermomechanical Gutta-Percha condensation techniques.

AIM: The apical sealing ability of a coated carrier system was evaluated in extracted human teeth and compared with lateral and thermomechanical condensation techniques using dye penetration. METHODOLOGY: Sixty-four extracted single-rooted teeth were instrumented to an apical size 30 using 4% taper Hero 642 trade mark instruments (Micromega, Besançon, France). The sample was divided into three experimental groups. Twenty teeth were randomly obturated with lateral condensation, 20 with thermomechanical compaction and 20 teeth with the Herofill trade mark Soft-Core system. Four teeth were used as positive and negative controls. The teeth were covered with nail varnish up to 2 mm from the apical foramen and immersed in a 2% aqueous methylene blue dye solution for 1 week and then washed, dehydrated and embedded in resin. The apical 1 mm of each tooth was removed to reveal the apical limit of the preparation. Transverse sections of the teeth were taken at 500, 1000 and 1500 micro m from this point and evaluated for apical leakage. Significant differences between the preparations were analysed with a semiautomatic analyser and the ratio of the dye-penetrated surface to the total dentinal surface was calculated. RESULTS: Statistical analysis of the results demonstrated significantly less leakage for the Herofill trade mark Soft-Core system compared to lateral condensation in terms of total mean dentinal surface and at the 500 micro m level. No other differences were noted between Herofill trade mark Soft-Core and thermomechanical or lateral condensation, either for the total mean value or at each level. CONCLUSIONS: The Herofill trade mark Soft-Core system was a reliable obturation system in the apical portion and compared favourably with other gutta-percha filling techniques.

Coloring Agents↗

Calcium ion diffusion from calcium hydroxide-containing materials in endodontically-treated teeth: an in vitro study.

The aim of this in vitro study was to determine the amount and duration of diffusion of calcium ions from both a calcium hydroxide-containing root canal sealer and an intracanal medicament, through the apical foramen and the dentinal tubules of endodontically-treated teeth. The root canals of 88 freshly extracted single-rooted teeth were prepared using the modified double flared, balanced force technique with patency filing. The teeth were divided into four test groups of 20 teeth each and a control group of eight teeth. One group was dressed with a non-setting calcium hydroxide while the other was obturated using cold lateral condensation of gutta-percha with a calcium hydroxide-containing sealer. An artificial root defect was created in the apical third of the root of the teeth in the other two groups and the root canals were either dressed or obturated in the same way as the first two groups. All groups were incubated at 37 degrees C and were sampled for calcium diffusion after 1, 2 and 3 days and 1, 2, 3, 4 and 8 weeks. There was statistically significantly more calcium diffusion with the non-setting groups compared with the sealer groups (P < 0.05). There was more calcium ion diffusion from teeth with a patent apical foramen than those with an artificial resorptive root defect (P < 0.05).

Analysis of Variance↗

Electrical impedance measurements of root canal length.

Electronic methods are now widely used during endodontic treatment for the assessment of root canal length. These commonly measure the electrical resistance or impedance between the root canal and the buccal mucosa. A number of studies have been undertaken to determine the accuracy of commercially available instruments. The aims of this investigation were to determine the electrical impedance characteristics of the root canal and periapical tissues in vivo, measure the changes relative to the distance of an endodontic instrument from the apical constriction and propose an equivalent circuit modelling the periapical tissues. The length of the root canals of 20 previously untreated teeth were determined using radiographic and electronic methods. Minimal canal preparation was carried out and measurements were made with a size 10 K-Flex file. A microprocessor-controlled LCR analyser was used to measure the electrical impedance characteristics of each root canal. The instrument measured the series and parallel resistive (RS, RP) and capacitance (CS, CP) component of the tissues at two test frequencies, 100 Hz and 1 kHz. Measurements were made for each root canal when the diagnostic file was placed at the apical constriction and repeated when the file was withdrawn to -0.5, -1.0, -1.5, -2.0 and -5.0 mm from the foramen. Readings were taken for each canal after the canal had been dried with paper points, and flooded first with deionised water and then with sodium hypochlorite. The root canals were then prepared, cleaned and obturated using standard endodontic procedures. The LCR analyser selected the series resistance component as the major measurement parameter. There was a clear increase in series resistance (RS) with increasing distance from the radiographic apex for dry canals and those containing deionised water and sodium hypochlorite. The mean resistance for dry canals was markedly higher than for those containing fluid, ranging from 22.19 k omega to 92.07 k omega in comparison with 9.32 k omega to 12.10 k omega for deionised water and from 7.46 k omega to 8.92 k omega for canals containing sodium hypochlorite. There was a marked change in the series and parallel resistive component with distance from the apex, suggesting a complex relationship between the impedance of the smear layer and bulk dentine. The impedance characteristics of a root canal were a complex electrical network comprising resistive and capacitive series and parallel elements.

Dental Pulp Cavity↗

An in vitro study of the comparative effectiveness of obturating curved root canals with gutta-percha cones, silver cones, and stainless steel files.

The quality of apical seal obtained with gutta-percha cones, silver cones, and stainless steel files was assessed in 120 freshly extracted teeth with moderately or severely curved root canals. Teeth were coated with wax, except in the apical foramen area, and immersed in 2 percent methylene blue solution for 48 hours. Apical leakage was quantitated by a linear measurement of the distance that the dye penetrated along the root canal and by a volumetric measurement of the quantity of dye within the root. There was a highly significant (p less than 0.001) correlation between the two measurements. Root canals filled with silver cones showed significantly less apical leakage than those filled with gutta-percha or stainless steel files, regardless of degree of curvature. For both silver cones and stainless steel files, leakage was less in severely curved roots than in moderately curved roots.

Dental Bonding↗

Risk assessment of the toxicity of solvents of gutta-percha used in endodontic retreatment.

Three randomly assigned groups of single-canaled extracted teeth obturated with gutta-percha were retreated using controlled application of one of three organic solvents: chloroform, xylene, or halothane. Two additional groups of teeth served as positive and negative controls. Residual volume of solvent expressed through the apical foramen during retreatment was determined by the difference of pretreatment and posttreatment weights of hermetically sealed receptacles attached to the root surface of the teeth. Results indicate that the amount of solvent that has been determined to have leached out through the apical foramen is several orders of magnitude below the permissible toxic dose. Thus, it is proposed that the use of any of the aforementioned solvents used in the retreatment of root canals would pose negligible risk to the patient.

Chloroform↗

The risk of intentional dissolution of the smear layer after mechanical preparation of root canals.

The root canals of 27 caries-free human cuspids were divided into 3 groups of 9 teeth each. Group I was mechanically prepared with reamers and files. Alternate irrigation with 5.25% NaOCl and 3% hydrogen peroxide was used between each instrument. The group II root canals were prepared with the use of alternate irrigation with the same concentrations of NaOCl and hydrogen peroxide and finally flushed with 17% EDTA and NaOCl solution. Group III was prepared mechanically with the use of sterile distilled water as an irrigant followed by a final flush with 17% EDTA solution. The root canals of all specimens were obturated with gutta-percha points and Tubliseal by means of the lateral condensation technique. After the root canals were obturated, samples of each of the three groups were immersed in separate flasks containing Streptococcus mutans, Staphylococcus epidermidis, and Corynebacterium hofmannii. All the microorganisms tested invaded the coronal dentin--where the access cavity had been sealed with Fynal--and/or the main foramen.

Adult↗