Abstract
This study is aimed at comparing the efficacy of heat softening and ultrasonic removal of root-end gutta-percha during retrograde preparation for root apical microsurgery. Recently extracted single-rooted premolars (n = 40) were prepared with standardized endodontically treated and root-end resection and then randomly divided into four groups that received root-end cavity preparation using four different instruments: a diamond-coated ultrasonic tip (AS3D; SACTEON, Paris, France), AS3D with the modified plugger of cordless heat carrier (MSE; B&L Biotech, Bala Cynwyd, PA, USA), stainless steel ultrasonic tip (Jetip-2; B&L Biotech, Bala Cynwyd, PA, USA), or Jetip-2 with MSE. The time required for root-end preparation was recorded. The root apex samples were examined by scanning electron microscopy to assess root surface microcracks and marginal integrity. The remnants of gutta-percha on the cavity walls were evaluated using a stereomicroscope. Statistical analysis was performed using Student's t-test and Wilcoxon rank-sum test (P < 0.05). Usage of MSE with Jetip-2 significantly reduced preparation time from 99.8 ± 6.8 s to 32.4 ± 1.0 s (P = 0.009), the number of microcracks from 42 to 13 (P = 0.036), and the remnants of gutta-percha from 80% to 20% (P = 0.041). Similar results were observed for AS3D with MSE. The heat softening of MSE was effective in cleaning gutta-percha, thus greatly improving the efficiency of the root-end preparation, thereby producing a root-end cavity with fewer microcracks and better marginal integrity.
Highlights
Despite adequate endodontic treatment, failure may occur because of complex canal anatomy, apical cysts, and extraradicular infections [1]
Some studies have reported that apical microcracks appear during root-end preparation with ultrasonic tips [9,10,11,12,13], which increase the risk of apical leakage, reduce the mechanical properties of the root-end, and negatively affect the longterm outcomes of endodontic microsurgery [14]
There was no significant difference in the time requirements and features of apical cavity preparation performed with the AS3D and Jetip-2 ultrasonic tips (Table 2)
Summary
Failure may occur because of complex canal anatomy, apical cysts, and extraradicular infections [1]. Endodontic microsurgery is a reliable treatment approach with a success rate of 95.2% for teeth in which conventional endodontic treatment has failed [2,3,4] It can facilitate the complete debridement of the root canal and ensure adequate sealing of the root canal apex. Ultrasonic tips have been gaining more extensive application than conventional rotary burs because of their unique advantages when used for root-end preparation [7, 8]. They allow safe access to the long axis of the root canal, decreasing the risk of lateral perforation and preserving an adequate environment for retrograde obturation. Some studies have reported that apical microcracks appear during root-end preparation with ultrasonic tips [9,10,11,12,13], which increase the risk of apical leakage, reduce the mechanical properties of the root-end, and negatively affect the longterm outcomes of endodontic microsurgery [14]
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