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Bacterial coronal leakage after obturation with three root canal sealers.

The purpose of this study was to compare the bacterial leakage of root canals obturated with three root canal sealers, using Endodontalis faecalis as a microbial tracer to determine the length of time for bacteria to penetrate through the obturated root canal to the root apex. Seventy-five, single-rooted teeth with straight root canals had the crown cut off at the cementoenamel junction. Root canals were instrumented by a step-back technique. The prepared teeth were randomly divided into 3 groups of 19 teeth each and another 2 groups as positive and negative controls (9 teeth each). The experimental groups were dependent on the sealer used: AH-Plus, Apexit, and Ketac-Endo. The root canals were obturated using a lateral condensation technique. After 24 h the teeth were attached to microcentrifuge tubes with 2 mm of the root apex submerged in Brain Heart Infusion broth in glass test tubes. The coronal portions of the root canal filling materials were placed in contact with E. faecalis. The teeth were observed for bacterial leakage daily for 30 and 60 days. With the chi2 test for comparing pairs of groups at the 0.05 level (p < 0.05), there was no statistical difference between Ketac-Endo and AH-Plus (p > 0.06), but Apexit had significantly higher leakage (p < 0.05) at 30 days. After 60 days there was no statistical difference between Ketac-Endo and Apexit (p > 0.05), but Apexit leaked more than AH-Plus. The conclusion drawn from this experiment was that epoxy resin root canal sealer was found to be more adaptable to the root canal wall and filling material than a calcium hydroxide sealer when bacterial coronal leakage was studied.

Calcium Hydroxide↗

[Results of a survey on the usefulness of adding corticoids to root canal obturation pastes].

500 questionnaires were sent out. The statistical survey was carried out on 116 replies. It emerges from this survey that 81% of our colleagues who answered use a canal filling paste containing a corticoid. The reason for its use is the prevention of fairly serious medicamentous arthritis. A small number (5 colleagues) had complications which they ascribed to the associated corticoid. A few use a non-hardening paste containing a corticoid as a temporary canal filling.

Adrenal Cortex Hormones↗

[The possibility of a standardization of clinical trials concerning materials for root canal obturation].

Clinical trials constitute epidemiologic experiments, in comparable groups of human populations designed to assess the preventive of curative effects of agents or measures. International organizations (FDI, WHO, CIOMS, ISO) have been instrumental in creating uniform methods, so that the findings from different sources can be validly compared. The need for a standardization of clinical trials in dentistry is particularly felt: - by the dental profession in order to make the choice of materials with the best clinically proven qualities - by the manufacturers in order to develop materials of improved clinical quality - by the public health administrators (or social security agencies), in order to either evaluate the benefit of instituted preventive and curative measure or to ascertain the best possible services A centennial history of efforts is shown to have resulted today in a broad international understanding (Table III). 1. The first chapter of this paper presents a review of the principal requirements for controlled clinical trails [8] such as officially adopted by FDI (Table V). 2. The second chapter offers a first-hand apercu of impending recommendations proposed by COMIET in two protocols [11] for the uniform conduct and evaluation of clinical trials of restorative techniques and materials. 2.1 Three standardized forms (A, B: Table IX, and C) serve to uniformly record data of the operative procedures. 2.2 The proposed standardized criteria (Tables X, XI) for the clinical appraisal of distinct materials give the advantage of having been tested already very extensively. 3. A critical review of the proposed protocols [11] reveals the necessity of: 3.1 referring to and coordinating with the already adopted principal requirements for controlled clinical trials. 3.2 generally adopting the excellent guidelines for the conduct of the study and the evaluation of observations (Tables X, XI) 3.3 taking advantage of the possibilities for reducing the recommended sample of 100 paired restorations (200 cavities)--difficult to implement in many countries--by certain measure such as preliminary in-vitro experiments, consideration of results already reported in the literature and a more systematic use of a standardized photographic serial documentation, a topic which will be the object of an ensuing paper.

International Cooperation↗

Diagnostic accuracy of endoscopy in periradicular surgery - a comparison with scanning electron microscopy.

AIM: To compare the accuracy of endoscopic diagnostics with the scanning electron microscope (SEM) in evaluating elements of periradicular surgery. METHODOLOGY: The material consisted of 22 extracted human molars, which were subjected to the following treatments: orthograde root-canal obturation, root-end resection and root-end cavity preparation with diamond-coated sonic microtips. After each step, the cut root face was inspected with an endoscope, and subsequently, the roots were duplicated for SEM evaluation. Endoscope findings were compared to those obtained with SEM serving as the 'gold standard' with a blinded observer. The presence of the following structures was assessed including specificity and sensitivity: isthmuses, accessory canals, obturation gaps, microfractures and chipping of cavity margins. RESULTS: The specificity and sensitivity of the identification of isthmuses or accessory canals was 100% each for the endoscope compared to SEM. The sensitivity of identification of obturation gaps, crack formation or chipping ranged between 73 and 95% (except intradentine cracks with only 36% sensitivity). The specificity of the same parameters ranged between 77 and 100% for the endoscope compared to SEM. CONCLUSIONS: With the exception of intradentine cracks, the endoscope accurately identified microstructures following root-end resection and root-end preparation. The endoscope could be considered for use during intraoperative diagnostics in periradicular surgery.

Apicoectomy↗

Radiographic evaluation of periapical healing after obturation of infected root canals: an in vivo study.

AIM: To radiographically compare periapical repair of roots with infected root canals obturated in one-step or with calcium hydroxide (Ca(OH)2) intracanal medication in two steps. METHODOLOGY: Standardized preoperative periapical radiographs were taken of 72 roots of vital dogs' teeth. All roots were then aseptically instrumented to ISO size 45. As negative controls, 12 roots were aseptically obturated. The remaining roots were infected with dental plaque and closed. Six weeks later, apical periodontitis was radiographically confirmed in the infected roots. The roots were divided into the following groups: group 1, one-step (n = 24); roots were irrigated with 10 cc saline, obturated, and permanently restored. Group 2, Ca(OH)2 (n = 24); roots were treated as in group 1, except that after saline irrigation Ca(OH)2 medicament was placed in the canal 1 week before obturation. Group 3, positive control (n = 12); the roots were irrigated with saline, access permanently closed but canals not obturated. Group 4, negative control (n = 12); previously aseptically obturated roots were permanently restored. After 6 months, standardized postoperative radiographs were obtained. Three independent evaluators blinded to the treatment groups evaluated the preoperative and postoperative radiographs. The evaluators were instructed to rate each root, based on changes on the radiographs, as failed, improved or healed. RESULTS: Radiographically, the percentage of cases that completely healed were similar for the one-step and Ca(OH)2 groups (35.3% vs. 36.8%). However, the Ca(OH)2 group had fewer failed cases (15.8% vs. 41.2%) and more improved cases (47.4% vs. 23.5%) than the one-step group. CONCLUSION: Power statistics demonstrated that at 43 cases per group, Ca(OH)2 treatment would be statistically superior to one-step treatment. We consider this number to be clinically important.

Animals↗

[Evaluation of two root canal preparation and obturation methods: the Mc Spadden method and the use of ProFile-Thermafil].

BACKGROUND: In endodontic field different instruments and techniques have been suggested for the preparation and filling or radicular bent canals. The purpose of this study is to compare two different cleaning and canal filling methods: preparation and filling technique, according to Mc Spadden's method, instrument technique and the closing of the canal system according to ProFile-Thermafil method. METHODS: In this study ten molars divided into two groups of five elements each were used. The five molars of the first group were prepared according to the "crown-down" technique with nickel-titanium instruments by NT Engine Files Quantec 2000 series. The 18 canals found out in the five molars have been filled with Pac Mac and gutta-percha preheated. The five molars of the second group have 17 radicular canals which, firstly, have been cleaned with ProFile .04 and .06 taper fitted to a manipulator at 220 revolutions per minute and then filled by Thermafil n. 30 with plastic carrier. All ten molars were X-rayed first, during and after the treatment. All teeth were soaked into polymerised resin, dissected into three different points and observed through Optical Microscope. RESULTS: Both cleaning techniques succeed in being efficient in bent canals. The instruments made by Mc Spadden highlight a greater preservation of canal dentine than the ProFile. In samples of the first group there is an excellent adaptation of multiphase gutta-percha to the canal walls and a correct relationship between the filling material and the apical foramen. In filling with Thermafil the adaptation of gutta-percha inside the radicular canal shows outstanding differences in relation to sections taken into account. Actually, while in portion of the crown the filling can be considered satisfactory towards the canal walls, in apical sections there is a decrease in the quantity of gutta-percha step by step, while a contact of plastic carrier with dentine walls is highlighted. CONCLUSIONS: Wheter in the shaping or in the canal filling phase, the two methods are efficient and conservative towards dental structure at the same time. These methods, have an outstanding reduction in dental weakening and in times of the endodontic treatment performance.

Dental Instruments↗