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Adaptation of thermafil components to canal walls.

The desired result of the Thermafil system is described as a centered carrier encased by gutta-percha in apposition to the canal walls. This study examined, in curved canals, the intracanal relationships of: (a) the metal carrier; (b) the surrounding gutta-percha; and (c) the sealer. Following the manufacturer's recommended techniques, 20 resin blocks that had canals prepared with conservative flaring were obturated. Cross-sections were made in the cervical, middle, and apical thirds and were evaluated with a stereomicroscope and scanning electron microscope to determine the location of the Thermafil components. In an additional 20 resin canal preparations obturated with the Thermafil system, the sealer was stained with dye to evaluate coating patterns. Then, these blocks were sectioned at the apex and examined under the stereomicroscope for adaptation at the apical extent of the preparation. In most preparations, the carrier abutted the canal wall in the cervical and middle sections but was usually surrounded by gutta-percha in the apical one third. The adaptation of components showed the most variability at the most apical extent of the preparation; complete encasement of the carrier did not occur in any specimen. Sealer distribution was variable throughout, usually being absent in the apical canal.

Dental Pulp Cavity↗

Comparison of root canal preparation using different automated devices and hand instrumentation.

The pre- and postinstrumentation degree of curvatures in curved mesial root canals of mandibular molars were compared after preparation with eight automated devices and hand instrumentation. The straightening of the root canal was measured before preparation and after preparation to size 25 and 35. Procedural mistakes such as loss of working length or file fractures were also recorded. Following preparation to ISO 25, only the Endoplaner and the Canal Finder system showed significantly more straightening than hand instrumentation. After preparation to ISO 35, the Endoplaner and the Intra-Endo 3-LDSY showed significantly more straightening than hand instrumentation. Mecasonic, Excalibur, and the Canal Finder system also straightened the root canal more than hand instruments, but the results did not differ significantly. The best results with only moderate straightening and few cases of loss of working length were obtained by the Endolift and Giromatic handpieces, which both were comparable to hand instrumentation.

Dental Cavity Preparation↗

Radiovisiography versus conventional radiography for detection of small instruments in endodontic length determination. II. In vivo evaluation.

Radiovisiography was compared clinically to conventional D-speed and E-speed radiographs viewed with X 2 magnification using the mesiobuccal root of maxillary molars of 22 patients. Clarity of size 8 and 10 endodontic file tips in relation to the radiographic apex was the object of comparison. Five images of radovisiography, (original, enhanced, negative-to-positive mode), were compared to D-speed and E-speed radiographs. D-speed radiographs were also compared to E-speed radiographs. D-speed radiographs were statistically superior to all five radiovisiography images. Four of the radiovisiography images were equivalent to E-speed radiographs. D-speed radiographs provided superior recognition of small file tips when compared to E-speed radiographs 100% of the time. Accurate identification of the small file tips was achieved on 95% of D-speed and 70% of E-speed radiographs. With radiovisiography, identification was achieved on 95% of the zoom images in the negative-to-positive mode, 86% of enhanced, 82% of standard zoom, and 77% of the images in negative-to-positive conversion.

Adult↗

Obturation of a C-shaped canal using an improved method of warm lateral condensation.

Pilot studies conducted by the authors seem to indicate that obturation of a root canal system by the lateral condensation of gutta-percha using an electrically heated spreader results in a more homogeneous mass of gutta-percha than standard lateral condensation. This article describes an improved variation which prevents inadvertent dislodgement of the mass of gutta-percha during the obturation. The authors refer to this technique as "zap and tap" and a case report describes its use to obturate a C-shaped canal system of a mandibular second molar.

Adult↗

An in vivo evaluation of Endex electronic apex locator.

Because of technical problems and hazards of radiation, dentists have desired alternative ways to determine the working length during root canal therapy. Attention has turned to electronic devices for measuring root canal length. Several such devices are now available. They show promise but their accuracy is hampered because moisture in the root canal can result in inaccurate responses. Recently, a new device, Endex, has been introduced, claiming ease of operation and accuracy in moist environments. Ten operators used the Endex to measure 185 root canal lengths (in 99 teeth). Endex measurements were compared with radiographic measurements. The Endex located the apical constriction accurately within +/- 0.5 mm in 89.64% of moist canals.

Adolescent↗

Evaluation of root thickness in curved canals after flaring.

Root thickness in the mesial canals of lower first and second molars was compared before and after flaring by using a muffle system. Gates Glidden burs or M-Series Canal Openers were used with either a straight up-and-down motion or with an anticurvature motion. It was found that Gates Glidden burs used straight up and down removed statistically more dentin at the level of the furcation than Canal Openers used straight up and down or in an anticurvature fashion. At a level 2 mm apical to the furcation, Gates Glidden burs used in an anticurvature fashion removed statistically more dentin than any other method tested.

Analysis of Variance↗

Redemption of a perforated furcation with a multidisciplinary treatment approach.

A long-standing lesion associated with an undetected perforation of the furca in a mandibular molar was successfully managed using a multidisciplinary treatment approach. The sequence of therapeutic procedures involved conventional endodontic retreatment, an initial orthograde sealing of the perforation, guided tissue regeneration, and a subsequent orthograde resealing of the perforation with Ketac-Endo and Intermediate Restorative Material.

Adult↗

Apical sealing ability of metal versus plastic carrier Thermafil obturators.

Sixty straight maxillary canines, 40 straight mandibular incisors, and 40 curved mesial canals of 27 mandibular molars were instrumented and randomly assigned to one of seven groups of 20 canals. Experimental groups were obturated with metal or plastic carrier Thermafil obturators. Control groups were obturated using the lateral condensation technique. An additional group of 20 unobturated curved molar canals served as positive controls. Kerr Pulp Canal Sealer was used in all obturation groups. The presence or absence of apical extrusion of gutta-percha was recorded. Teeth were suspended in black India ink for 2 wk, cleared, and then examined under a dissecting microscope at x20 magnification. No leakage was found in any of the obturated canals, whereas unobturated controls showed total dye penetration. Plastic carrier Thermafil and metal carrier Thermafil groups produced a significantly greater incidence of apical extrusion of gutta-percha compared with lateral condensation groups (p < 0.001). Extrusion for Thermafil groups occurred significantly more frequently in straight compared with curved canals (p = 0.002). The Thermafil groups showed a higher frequency of filled lateral and accessory canals than in the lateral condensation group; however, this was statistically insignificant (p = 0.48).

Chi-Square Distribution↗

Effect of preflaring on tactile detection of the apical constriction.

The efficacy of tactile detection of the apical constriction in flared and nonflared root canals was examined in 120 root canals of adult patients. In 68 nonflared (group 1) root canals, a #15 or #20 K-file was used to detect ("feel") the apical constriction. In 52 teeth (group 2), Hedstrom files, Gates Gliden drills #2 to #4, and ultrasonic files were used to enlarge the canal orifice and flare the coronal portion of the root canals before testing the apical constriction. After placing a #15 or #20 file in each root canal, a radiograph was taken, and the distance between the tip of the file and the radiographic apex was measured. The location of the file tip was classified into three categories: (a) within 1 mm short of the radiographic apex; (b) underextended, more than 1 mm short of the radiographic apex; and (c) overextended beyond the radiographic apex. In group 1 (nonflared), 32.3% of the root canals were classified in category a, as compared with 75.0% in group 2 (preflared). Over 26% of the root canals in group 1 and approximately 4% of the canals in group 2 were included in category b. Files inserted in preflared root canals had a significantly lower incidence of overextension than those placed in nonflared canals (21% versus 41%). The ability to determine the apical constriction by tactile sensation was significantly increased when the canals were preflared (p < 0.0001).

Adult↗

A radiographic comparison of two root canal instrumentation techniques.

The ability of two instrumentation techniques to negotiate and enlarge small curved canals was com-compared radiographically. Fifty canals in extracted human molar teeth were instrumented by the progressive enlargement (PE) technique, a form of step-back preparation using standard K files, or by the balanced force (BF) technique using K files whose tips had been specially modified. By using drawings and projected radiographic images of the files, the position of the largest file used in the apical preparation, #30 or #35 for the PE technique and #45 for the BF technique, was compared with the position of a small file placed in the canal before instrumentation. The PE and BF techniques were equally capable of instrumenting small curved canals to their respective largest apical preparation sizes. However, at sizes equivalent to the largest apical preparation sizes used in the PE technique, the BF technique produced significantly less deviation from the center of the original canal.

Dental Cavity Preparation↗

Comparison of apical leakage in teeth obturated with a polyamide varnish or zinc oxide and eugenol cement using lateral condensation.

The sealing ability of copal varnish has been investigated when used as an adjunct in restorative procedures, retrofilling procedures, and dontic obturation procedures. Barrier, a polyamide-type polymer cavity varnish, has been compared with copal varnishes in restorative dentistry. This investigation compared the apical sealing properties of a zinc oxide and eugenol sealer (Roth) with a polyamide varnish (Barrier). Twenty-four teeth were instrumented and divided into two groups, one obturated with gutta-percha and Roth sealer and one with gutta-percha and Barrier, using submersion in methylene blue dye to demonstrate apical leakage. Roth sealer exhibited less dye penetration than Barrier when used as an endodontic sealant (p < 0.02).

Dental Cavity Lining↗

Experimental apical sealing with a new canal obturation system.

Twenty-seven root canals were obturated by the Thermafil system after conventional preparation. The lateral condensation technique was used as a control in 11 other canals. All specimens were immersed passively in India ink for 3 days at 37 degrees C. After rendering all roots transparent, no statistically significant differences (p < 0.4) were seen in apical leakage as determined stereomicroscopically. Like-wise, no relationship was noted between leakage and the last apical file size used to prepare and clean the canals.

Dental Leakage↗

Modified endodontics for lengthy canals.

A review of the dental literature concerning lengths of maxillary cuspids and reports of cuspid gigantism are presented. Endodontic therapy in these cases requires variations and modifications in conventional therapy for successful treatment. A case report is presented which illustrates some of these treatment modifications.

Cuspid↗

Histological evaluation of therapy using a calcium hydroxide dressing for teeth with incompletely formed apices and periapical lesions.

Periapical tissue response was evaluated histologically in teeth of 6-month-old dogs with incomplete root formation and periapical lesions in order to compare the effects of two calcium hydroxide-containing pastes prepared with different vehicles on induced root apex formation and repair of the periapical region. A group of teeth with no root canal dressing was used as control. After induction of the periapical lesion, the root canals were instrumented and filled with one of the two pastes (Calen and Calasept), which were renewed monthly for 90 days. At the end of the follow-up period (3 months), the animals were killed. Block sections from the actual areas were dissected free and prepared for histopathological analysis. Both calcium hydroxide pastes helped induce apical sealing and repair of the region, but the Calen paste yielded better results than Calasept. The induced mineralized tissue was predominantly of the cementoid type after the use of both pastes, but the inflammatory infiltrate was significantly less intense with the use of the Calen paste. In the control group, the absence of a root canal dressing impaired the process of periapical repair and yielded no apical root closure in any of the cases analyzed.

Animals↗

Remaining dentin/cementum thickness after hand or ultrasonic instrumentation.

A quantitative study was undertaken to measure remaining dentin/cementum thickness after using step-down, step-back hand instrumentation or ultrasonically energized instrumentation techniques. A model system was used which enabled the same canal system of extracted human mandibular molars to be accurately evaluated and measured before and after instrumentation. Although no statistical difference was demonstrated in the encroachment upon the furcal aspect of mesial roots of mandibular molars, both techniques came dangerously close to creating stripping and perforations in a high percentage of cases.

Dental Cementum↗

Comparison of mechanical and standard hand instrumentation techniques in curved root canals.

The original and postinstrumentation shapes of the mesial root canal system of 12 mandibular molars were compared after being instrumented with a mechanical handpiece and a hand instrumentation technique. Area of dentin removed and amount and direction of transportation were evaluated in relation to degree of root canal curvature. Pre- and postinstrumentation measurements were taken of the root canal system in the cervical, middle, and apical thirds. The mechanical handpiece removed dentin and transported the root canal more than the hand instrumentation in the cervical and apical thirds. Both techniques transported to the distal in the cervical third and to the mesial in the apical third. In the middle third, the mechanical handpiece transported more to the mesial and the hand instrumentation more to the distal. Degree of root canal curvature had no influence on the amount of dentin removed or transportation of the root canal.

Dental Pulp Cavity↗

Endodontic retreatment in small and large curved canals.

This study used a special jig system, photography, and a sonic digitizer to evaluate the change in canal size and location after retreatment in 20 teeth with small or large curved canals (greater than 23 degrees). During initial instrumentation, small canals enlarged twice as much as large canals in the coronal and middle areas. During retreatment, small and large canals showed 30 to 85% enlargement compared with that of the initial instrumentation. There was a trend, primarily during retreatment, for small canals to deviate more than large canals away from the original canal location.

Dental Pulp Cavity↗

Failure of endodontically treated teeth: classification and evaluation.

All endodontically treated teeth that were extracted over a 1-yr period in a busy group practice were evaluated for cause of failure. The 116 teeth collected were classified into major failure categories of prosthetic, periodontic, and endodontic origin. Of the teeth, 59.4% were prosthetic failures which were due primarily to crown fracture. Teeth that had been crowned had greater longevity than uncrowned teeth. Periodontal failures constituted 32% of the study. Only 8.6% of the failures were due to endodontic causes, but these failures became evident more quickly than those in the other categories. A classification of failures is presented, and the results are analyzed.

Alveolar Bone Loss↗