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PubMed2006

How does signal fade on photo-stimulable storage phosphor imaging plates when scanned with a delay and what is the effect on image quality?

OBJECTIVE: The goals of this in vitro study were to determine the effect of signal fading of DenOptix photo-stimulable storage phosphor imaging plates scanned with a delay and to determine the effect on the diagnostic quality of the image. In addition, we sought to correlate signal fading with image spatial resolution and average pixel intensity values. STUDY DESIGN: Forty-eight images were obtained of a test specimen apparatus and scanned at 6 delayed time intervals: immediately scanned, 1 hour, 8 hours, 24 hours, 72 hours, and 168 hours. Six general dentists using Vixwin2000 software performed a measuring task to determine the location of an endodontic file tip and root apex. One-way ANOVA with repeated measures was used to determine the effect of signal fading (delayed scan time) on diagnostic image quality and average pixel intensity value. RESULTS: There was no statistically significant difference in diagnostic image quality resulting from signal fading. No difference was observed in spatial resolution of the images. There was a statistically significant difference in the pixel intensity analysis of an 8-step aluminum wedge between immediate scanning and 24-hour delayed scan time. CONCLUSION: There was an effect of delayed scanning on the average pixel intensity value. However, there was no effect on image quality and raters' ability to perform a clinical identification task. Proprietary software of the DenOptix digital imaging system demonstrates an excellent ability to process a delayed scan time signal and create an image of diagnostic quality.

Analysis of Variance↗

PubMed2006

Evaluation of canal filling after using two warm vertical gutta-percha compaction techniques in vivo: a preliminary study.

AIM: To evaluate the quality of root canal filling when comparing two warm gutta-percha filling techniques in vivo. METHODOLOGY: Human teeth were randomly divided into two equal groups, with 30 canals each. The root canals were shaped by hand and ProFile 0.04 rotary instruments to size 20-40 at the end-point and then filled with gutta-percha cones and AH-Plus. In group A, a traditional warm vertical compaction technique was performed using the Touch'n Heat, and back-filling with the Obtura II. In group B, a modified warm vertical compaction technique was used: small amounts of gutta-percha were removed, and the remaining most apical 3 mm were compacted with a 1 mm movement; then thermomechanical back-filling was performed. The teeth were extracted, stored in dye, cleared, and the distance between the apex and apical limit of the filling, linear dye penetration, and voids were measured from the buccal, lingual, mesial and distal perspective. The homogeneity of variance and means was verified using Levene's test and t-test. ANOVA and Dunnett post hoc test were used to establish the significance and to analyse the effects through multiple comparisons. RESULTS: Compared with the specimens of group A, the specimens of group B exhibited less mean linear dye penetration (P < 0.05), smaller void length (P < or = 0.05) and maximal width (P < or = 0.05) when examined in all four views, and a more precise filling when viewed from the buccal aspect (P < 0.05). CONCLUSIONS: The modified warm vertical compaction technique with apical back-filling produced a more effective and precise three-dimensional filling.

Cermet Cements↗

PubMed2002

Impact of dental devices on cochlear implants.

A cochlear implant (CI) converts mechanical sound energy into electrical signals that can be delivered to the cochlear nerve of profoundly deaf patients. The purpose of this study was to investigate whether electromagnetic interference with the CI occurs during the operation of the electric pulp tester, apex locator, electrocautery unit, electrosurgery unit, or panoramic radiograph machine. A mastoidectomy and cochleostomy were performed on a cadaver, and a CI was implanted. The dental devices were used intraorally, and the implant's circuitry was tested after each trial. A second CI was implanted in a human skull, which was then exposed to 50 panoramic radiographs, testing the implant's circuitry after each exposure. The probability of damage to the CI by any of the devices was negligible, except for the electrosurgery unit operated at level 7, which destroyed the CI's circuitry. Therefore, although the other devices seem safe, it is recommended that the electrosurgery unit not be used on a CI patient.

Cadaver↗

PubMed2004

Comparative study of white and gray mineral trioxide aggregate (MTA) simulating a one- or two-step apical barrier technique.

This study investigated the use of Mineral Trioxide Aggregate (MTA) as an apical barrier by comparing the sealing ability and set hardness of white and gray MTA. Forty-four root segments were prepared to simulate an open apex. Apical barriers of white and gray MTA were placed to a thickness of 2 mm or 5 mm. The samples were obturated immediately (one-step) or after the MTA set for 24 h (two-steps). After placement in methylene blue dye for 48 h, the samples were sectioned for leakage analysis and microhardness testing of the barrier. Gray MTA demonstrated significantly less leakage than white MTA (p < 0.001), and the two-step technique showed significantly less leakage than one-step (p < 0.006). The 5-mm thick barrier was significantly harder than the 2 mm barrier, regardless of the type of MTA or number of steps (p < 0.01). Results suggested that a 5 mm apical barrier of gray MTA, using two-steps, provided the best apical barrier.

Aluminum Compounds↗

PubMed2000

Radiation dose reduction during endodontic therapy: a new technique combining an apex locator (Root ZX) and a digital imaging system (RadioVisioGraphy).

This study was undertaken on 14 teeth in order to evaluate a new technique for radiation dose reduction during endodontic therapy. After examination of the preoperative film, usually available in the patient file, an apex locator (Root ZX) was used to measure the working length. Complete chemomechanical debridement was then performed, and the master cone was evaluated by a digital imaging system (RadioVisioGraphy (RVG)). Obturation was performed when measurements of the electronic device and RVG were comparable. A postoperative image was made by the RVG system to evaluate the final obturation. A clinical and radiographic follow-up examination (follow-up period: 6 to 8 months) revealed satisfactory apical healing. These results indicated that a successful obturation technique can be performed by a single radiation exposure, using the RVG unit for master cone evaluation. This technique may be useful in medically compromised patients who need not to be exposed to excessive or repeated radiation during endodontic therapy.

Bismuth↗

PubMed2006

Accuracy of root length determination using Tri Auto ZX and ProTaper instruments: an in vitro study.

The accuracy of the electronic apex locator feature of Tri Auto ZX was assessed. Twenty distobuccal roots were selected and, after endodontic access, placed in plastic cylinders filled with 2% agar until completely covered. The roots were divided in two groups according to the calibration of the automatic apical reverse mechanism of Tri Auto ZX, at 1 and 2 mm from the apical foramen. Preparation was performed with ProTaper instruments connected to the device. Afterwards, the last file used was introduced into the canal and fixed in place with acrylic resin. The roots were removed from the agar and ground until exposure of the file. The distances between file tip and apical foramen were submitted to statistical analysis. The distances reached were actually shorter than the preset distances in every case, however, they were considered clinically acceptable. Setting the reverse mechanism at 1 mm was more reliable than at 2 mm.

Dental Instruments↗

PubMed2006

The ability of two apex locators to locate the apical foramen: an in vitro study.

The objective of this study was to compare the accuracy of the Root-ZX and Novapex electronic apex locators (EALs) in locating the apical foramen. Forty extracted human teeth were used. The coronal portion of each canal was flared using Gates Glidden drill. Canals were irrigated with 2.5% sodium hypochlorite. The actual length (AL) and electronic length (EL) measurements were made on each specimen separately with both devices with an aid of a K-type file. The results obtained with each EAL were compared with the corresponding control length. The statistical analysis of the results showed EAL reliability in detecting the apical foramen to 89.7% for the Root-ZX and 82.1% for the Novapex, taking the tolerance of +/-0.5 mm into account. A paired sample t test showed that there was no statistically significant difference between the accuracy of the devices (p = 0.4305). The results of this study indicate that the Root-ZX and Novapex are useful and accurate devices for the apical foramen location.

Dental Instruments↗

PubMed2006

Ex vivo evaluation of the ability of four different electronic apex locators to determine the working length in teeth with various foramen diameters.

BACKGROUND: The aim of this ex vivo study was to evaluate the accuracy of four electronic apex locators (EALs) to determine the working length in teeth with various foramen diameters. Our previous study revealed that electronically measured canal length was influenced by the root canal diameter. It is not known whether foramen size would interfere with the reading accuracy of an EAL. METHODS: A total of 36 extracted human lower single rooted premolar teeth were divided into four groups of nine teeth each. In groups A, B and C, the root canals were instrumented using #10-80, #10-100 and #10-120 K-files, and the tip of size #80, #100 and #120 K-files were permitted to pass through the apical foramen to a length of 1mm, respectively. In group D, the teeth were instrumented using #10-140 K-files and the tip of #140 K-file was permitted to pass through the apical foramen to a length of 5 mm. Thus, the average apical foramen diameters in groups A, B, C and D were approximately 0.82 mm, 1.02 mm, 1.22mm and 1.5 mm, respectively. The teeth were then mounted in 1% agar and four EALs were used: Root ZX, Foramatron D10, Apex NRG and Apit 7. For electronic measurement, sizes #10 and #80, #10 and #100, #10 and #120, and #10 and #140 K-files were used for groups A, B, C and D, respectively. During electronic measurement the canals were flushed with 6% sodium hypochlorite solution. RESULTS: Three-way ANOVA and Bonferroni test showed that EAL, file size and foramen size all had a significant influence on the measurement error (P<0.0001), with all the interactions between these three factors being significant (P<0.0001). CONCLUSIONS: The four EALs were unreliable to determine the working length of teeth with a wide apical foramen, when using a small size file. The Root ZX and Foramatron D10 showed significantly better scores than the other two EALs and may be more reliable to determine the working length of teeth with a wide apical foramen, if a tight-fit file is used.

Bicuspid↗

PubMed1993

Periodontal cell migration into the apical pulp during the repair process after pulpectomy in immature teeth: an autoradiographic study.

The migration of dental papilla cells into the periodontium during the process of root development may occur as part of the process involved in the formation of the periodontal tissues. The question posed is whether such cells under pathological conditions could retromigrate from periodontium into dental pulp and together with other apical pulp cells of immature teeth, take part in the production of additional dental tissue, e.g. 1) the tertiary/dentine under deep carious lesion where odontoblasts had been destroyed 2) the dentine bridge on an amputation wound and 3) calcified tissue which closes an apex during the apexification process in immature teeth. The migration of periodontal cells locally marked by H3 thymidine immediately after partial pulpectomy in immature dog's teeth was analysed at observation periods of 2, 24 and 50 h and also without H3 thymidine labelling of periodontal cells 8 weeks after pulpectomy. The marked cells were found in the early observation periods after pulpectomy just in the places where the hard tissues were formed in the later observation period of 8 weeks. They were found in large numbers just around the coagulated necrotic foci. The finding supports the assumption that firm necrotic masses are a very important stimulative factor in the reparation process in pulp and periodontium. The experiment also corroborated the existence of periodontal cell retromigration into apical dental papilla of immature teeth. Future research should assess the possible role of the pathological condition in the determination of undifferentiated odontogenic ectomesenchymal periodontal cells into odontoblasts.

Animals↗

PubMed2006

Comparison in vivo of the first tapered and nontapered instruments that bind at the apical constriction.

OBJECTIVE: To compare sizes of the first instrument with or without taper that binds to the narrow apical diameter of the root canal after coronal flaring. STUDY DESIGN: For the study, 388 canals were examined in patients with intact apices. A standard endodontic access cavity was prepared and the coronal third flared using standardized K-files, Gates Glidden reamers, or Profile rotary instruments. Apical patency was established using K-file size 10 and working length determined using an apex locator and radiographs. Standardized K-file hand instruments were gently introduced to working length beginning with size 15. The first K-file to bind to the canal walls and reach the working length was recorded as FKFB. Nontapered instruments (Lightspeed) were then gently introduced by hand to each canal in ascending order beginning with size 20 to working length. The first instrument to bind to the canal walls and reach the working length was recorded as FLSB. Statistical analysis was carried out using univariate analysis of variance. RESULTS: The average size of FLSB was approximately 2 ISO sizes larger than FKFB (P < .001). Minimal differences were found in the maxillary central incisors (6.7 +/- 3.0) and maximal differences in canals from maxillary lateral incisors (15.4 +/- 3.5). CONCLUSIONS: The first nontapered instruments to bind at the apical constriction were larger and reflected the actual narrow apical diameter of the canal better than the tapered instruments.

Dental Instruments↗

PubMed2002

A simple model to demonstrate the electronic apex locator.

AIM: To describe and evaluate a newly developed model for demonstrating and teaching the use of electronic apex locators. SUMMARY: A phantom model, master jaw model and extracted human teeth were used to construct the demonstration model with alginate impression material as the periapical conductive medium. The model was validated in a series of length determinations with apical foramina enlarged to 0.20, 0.30 and 0.45 mm diameter, and the stability of the model was evaluated up to 45 h after construction. All evaluations were conducted with the Root ZX apex locator with 2.65 and 5.25% NaOCl in the canals. Most length measurements were within 1 mm of actual root length (range: -2.2 to +0.21 mm) and did not change significantly over 45 h for teeth with foramina of 0.3 mm or less. Measurements for teeth with wide (0.45 mm) apices were stable up to 28 h. NaOCl concentration did not significantly affect the readings. KEY LEARNING POINTS: A simple, inexpensive model can be manufactured from plastic dental jaws, natural teeth and alginate impression material to demonstrate electronic working length measurement. The model is stable for many hours and provides consistent results with different concentrations of NaOCl in the canal and various apical diameters. The model is a useful teaching aid but needs further evaluation and refinement before use in research applications.

Alginates↗

PubMed2000

Quality of apical seal in curved canals using three types of spreaders.

The aim of the present study was to evaluate the influence of spreader shape on the quality of obturation. Forty-five single canal teeth with varying degrees of apical curvature were used throughout. The canals were prepared using the step-back technique and obturated with lateral condensation. The teeth were classified into three groups (A, B, and C) and treated as follows. Group A was treated with markedly conical, flat-ended spreaders (A to D; Dentsply-Maillefer, Ballaigues, Switzerland). Group B was treated with slightly conical (15 to 40) sharp-pointed CC-cord spreaders. Group C was treated with CC-cord, slightly conical but flat-ended spreaders. The obturated teeth were decalcified in 7.5% nitric acid to obtain four cross-sections: the first at 2 mm from the apex and then the following three sections at 1-mm intervals. Section thickness was approximately 1 mm. Each section was photographed under a stereoscopic microscope. The following areas were measured on each of the microphotographs using a planimeter: (a) gutta-percha mass, (b) mass of sealer, (c) foreign bodies, and (d) empty spaces. These four areas were added to determine total cross-sectional canal area and then the percent of that area attributable to a and to b + c + d was calculated. The statistical analysis of the data (parametric Student's t test for independent groups) revealed that only in group B was the area occupied by a, the gutta-percha mass, significantly greater at all levels than the area occupied by b + c + d. Next in obturation effectiveness was group C, followed by group A.

Decalcification Technique↗

PubMed2001

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↗

PubMed2002

A scanning electron microscopic study of dentinal erosion by final irrigation with EDTA and NaOCl solutions.

AIM: The purpose of this in vitro study was to examine dentinal erosion caused by final irrigation with EDTA and NaOCl. METHODOLOGY: Twenty-five single-rooted human teeth were instrumented with rotary nickel-titanium Series 29 Profile Instruments. The teeth were divided into five groups and subjected to final irrigation as follows: group A, irrigated with 6% NaOCl (3 mL) for 2 min; group B, 15% EDTA (3 mL) for 1 min; group C, 15% EDTA (3 mL) for 1 min, followed by 6% NaOCl (3 mL) for 2 min; group D, 15% EDTA (3 mL) for 3 min and group E, 15% EDTA (3 mL) for 3 min, followed by 6% NaOCl (3 mL) for 2 min. Photomicrographs of dentinal walls were produced using a scanning electron microscope (3000 x) at 1, 3 and 6 mm from the apex. The amount of debris and dentinal tubule diameter were evaluated, and values were statistically analysed using one-way ANOVA and Fisher's PLSD test. RESULTS: When the root canal was irrigated with 15% EDTA alone, the dentine had a smooth and plane appearance, and dentinal tubule orifices were regular and separated. When the root canal was irrigated with EDTA followed by NaOCL the dentine was eroded and the dentinal tubule orifices were irregular and rough. Dentinal tubule diameter increased to 3.43 +/- 0.23 microm in group C and to 3.93 +/- 0.44 microm in group E. Significant differences were observed between groups B and C, and between groups D and E (P < 0.05). However, more debris was removed by irrigation with EDTA followed by NaOCl than with EDTA alone (P < 0.05). CONCLUSIONS: Final irrigation with 6% NaOCl accelerates dentinal erosion following treatment with 15% EDTA.

Analysis of Variance↗

PubMed2003

Percentage of filled canal area in mandibular molars after conventional root-canal instrumentation and after a noninstrumentation technique (NIT).

AIM: To compare the percentage of filled canal area in mandibular molar roots after using conventional root-canal hand instrumentation or after a noninstrumentation technique (NIT). METHODOLOGY: Forty mandibular molars were used shortly after extraction. The root canals of 20 molars in the manual group were conventionally prepared using hand instruments and then filled with warm vertical compaction of gutta-percha. The 20 teeth in the second group were cleaned and obturated by NIT. In each case, the entire molar, including the crown and the roots, was embedded in an acrylic resin cylinder before NIT. Horizontal sections were cut at 2, 4, 6 and 8 mm from the apex. Images of the sections were taken using a microscope at x40 magnification and a digital camera; the images were scanned as Tagged Image File Format (TIFF) images into a PC. The cross-sectional area of the canal with the filling materials was measured using an image analysis programme. The percentage of filled area was calculated. The difference in the percentage of filled canal area between the two groups was analysed using a Student's t-test. RESULTS: At all levels, 93-100% of the canal area was filled in both groups. No significant difference was found between the manual technique and the NIT technique at any level (P>0.05). CONCLUSIONS: Within the limitations of this study, following the cleaning and filling of root canals using NIT, the percentage of filled root canal was similar to that using warm vertical compaction of gutta-percha after conventional root-canal instrumentation.

Adult↗

PubMed2002

Patency file and apical transportation: an in vitro study.

The purpose of this study was to evaluate the transportation produced at the apical foramen by the use of stainless steel and nickel-titanium K-files #10, #15, #20, and #25 as a patency file. Thirty human maxillary lateral incisors were transversally cut at 4 mm from the apex and mounted in square pieces of silicone with special marks to ensure repositioning of the specimens. The specimens were randomly divided in two equal groups of 15. In group A, stainless steel K-files #10, #15, #20, and #25 were used as a patency file. In group B, a stainless steel K-file #10 followed by nickel-titanium K-files #15, #20, and #25 were used as in group A. Sodium hypochlorite was used as the irrigating solution. Photographic slides of the apical foramen of each specimen before instrumentation and after the use of each file size were taken. The photographic slides of each specimen were mounted in slide mounts, projected onto the same drawing paper, and superimposed according to the peripheral shape of the root. Transportation of the apical foramen was determined comparing the five drawings of each specimen. Transportation was detected in 18 of the 30 specimens; 9 in group A and 9 in group B. No statistically significant differences were seen between groups (p = 1.00).

Dental Alloys↗

PubMed2006

Sliding window adaptive histogram equalization of intraoral radiographs: effect on image quality.

OBJECTIVES: To investigate whether contrast enhancement by non-interactive, sliding window adaptive histogram equalization (SWAHE) can enhance the image quality of intraoral radiographs in the dental clinic. METHODS: Three dentists read 22 periapical and 12 bitewing storage phosphor (SP) radiographs. For the periapical readings they graded the quality of the examination with regard to visually locating the root apex. For the bitewing readings they registered all occurrences of approximal caries on a confidence scale. Each reading was first done on an unprocessed radiograph ("single-view"), and then re-done with the image processed with SWAHE displayed beside the unprocessed version ("twin-view"). The processing parameters for SWAHE were the same for all the images. RESULTS: For the periapical examinations, twin-view was judged to raise the image quality for 52% of those cases where the single-view quality was below the maximum. For the bitewing radiographs, there was a change of caries classification (both positive and negative) with twin-view in 19% of the cases, but with only a 3% net increase in the total number of caries registrations. For both examinations interobserver variance was unaffected. CONCLUSIONS: Non-interactive SWAHE applied to dental SP radiographs produces a supplemental contrast enhanced image which in twin-view reading improves the image quality of periapical examinations. SWAHE also affects caries diagnosis of bitewing images, and further study using a gold standard is warranted.

Algorithms↗

PubMed2006

Safety of electronic apex locators and pulp testers in patients with implanted cardiac pacemakers or cardioverter/defibrillators.

The purpose of this study was to determine if electronic apex locators (EAL) or electric pulp testers (EPT) interfere with the function of implanted cardiac pacemakers (ICP) or cardioverter/defibrillators (ICD). Twenty-seven patients with ICPs or ICDs had continuous electrocardiogram monitoring and device interrogation to detect interferences during the use of two types of EALs and one EPT. No interferences were detected by any ICP or ICD. In six patients, with intermittent pacing, a significant increase in pacing was observed during EAL/EPT stimulation (p < 0.05). Examination of RR intervals (a measure of intrinsic heart rate) demonstrated significantly longer RR intervals (slower intrinsic heart rate) during EAL/EPT stimulation (p < 0.05). Evaluation of the electrocardiograms for each patient failed to show any abnormalities in pacing during testing. These findings led us to conclude that the increased pacing frequency observed was related to a slower intrinsic heart rate and not electrical interference with the cardiac devices. In conclusion, the two EALs and one EPT used in this study did not interfere with the functioning of any of the cardiac devices tested.

Analysis of Variance↗