Apical Foramen Area Research Articles

Evaluation of apical transportation and apical root sealing in root canals prepared with mtwo rotary system with and without apical enlargement – an in vitro study

The aim of this study was to evaluate apical transportation and apical root canal sealing after root canal filling in human teeth prepared with MTwo® Rotary System with and without apical foramen enlargement. Twenty mandibular premolars were divided into two groups (n=10). Group 1 had root canals prepared 1mm beyond the apical foramen. Group 2 had root canals prepared 1mm below the root canal length. After chemo-mechanical preparation, samples were submitted to scanning electronic microscopy. Apical foramen images had 75x magnification at standardized positions, allowing measurements from the apical foramen area before and after root canal preparation, and after root canal filling. Apical foramen shape and apical transportation, as well as its level of circumferential filling after root canal preparation were accessed using the Image Subtraction System. Scanning electronic microscopy analysis demonstrated that samples of Group 1 showed larger foraminal diameter than samples of Group 2 (p<0.05). Apical foramen transportation was statistically different between Groups 1 and 2 (p=0.0108). Furthermore, the apical foramen sealing also differed statistically between groups 1 and 2 (p=0.0007) and 100% of samples of Group 1 showed apical root canal sealing. Apical root canal sealing was more effective when the root canal was prepared with apical foramen enlargement, even when the apical transportation was detected.

Use of CBCT Guidance for Tooth Autotransplantation in Children

Tooth autotransplantation (TAT) offers a viable biological approach to tooth replacement in children and adolescents. The aim of this study was to evaluate the outcome of the cone-beam computed tomographic (CBCT)–guided TAT compared to the conventional TAT protocol and to assess the 3-dimensional (3D) patterns of healing after CBCT-guided TAT (secondary aim). This study included 100 autotransplanted teeth in 88 patients. Each experimental group consisted of 50 transplants in 44 patients (31 males and 19 females). The mean (SD) age at the time of surgery was 10.7 (1.1) y for the CBCT-guided group. This was 10.6 (1.3) y for the conventional group. The mean (SD) follow-up period was 4.5 (3.1) y (range, 1.1 to 10.4 y). Overall survival rate for the CBCT-guided TAT was 92% with a success rate of 86% compared to an 84% survival rate and a 78% success rate for the conventional group (P > 0.005). The following measurements were extracted from the 3D analysis: root hard tissue volume (RV), root length (RL), apical foramen area (AFA), and mean and maximum dentin wall thickness (DWT). Overall, the mean (SD) percentage of tissue change was as follows: RV gain by 65.8% (34.6%), RL gain by 37.3% (31.5%), AFA reduction by 91.1% (14.9%), mean DWT increase by 107.9% (67.7%), and maximum DWT increase by 26.5% (40.1%). Principal component analysis (PCA) identified the mean DWT, RV, and maximum DWT as the parameters best describing the tissue change after TAT. Cluster analysis applied to the variables chosen by the PCA classified the CBCT group into 4 distinct clusters (C1 = 37.2%, C2 = 17.1%, C3 = 28.6%, C4 = 17.1%), revealing different patterns of tissue healing after TAT. The CBCT-guided approach increased the predictability of the treatment. The 3D analysis provided insights into the patterns of healing. CBCT-guided TAT could be adopted as an alternative for the conventional approach. (Clinical trial center and ethical board University Hospitals, KU Leuven: S55287; ClinicalTrials.gov Identifier: NCT02464202)

Localization and identification of root canal bacteria in clinically asymptomatic periapical pathosis

Twenty-one teeth with clinically asymptomatic periapical pathosis (class 3) were extracted and the isolation, identification, and localization of bacteria in the root apex were examined. Mixtures involving several bacteria were isolated from more than 60% of the cases. Scanning electron microscopy revealed bacterial masses to be associated with the apical part of the root canal, but not with the area of apical foramen or on the surface of root apex. Our results indicate that the bacteria in class 3 cases may be derived from organisms which colonized before or during endodontic treatment, but not from anachoresis. The bacteria-positive cases of asymptomatic periapical pathosis have the potential to progress to symptomatic periapical pathosis.

歯根嚢胞の細菌学的研究

This paper examined bacteriological study of 69 contents, which were classified based upon property of asymptomatic and few-symptomatic radicular cysts. Bacteria were isolated from 100% of 14 purulent cases (Group I), but only from 14. 5% of 55 serous cases (Group II). From Group I, anaerobes, especially Gram-negative rods such as Fusobacterium necrophorum were predominantly isolated, as facultative viridans type streptococci from positive culture cases of Group I, MIC values of the anaerobic isolates against various antibiotics were higher than those of bacteria indigenous to oral cavity. Many isolates from contents of radicular cyst showed various enzymatic activities thought to be toxic to periodontal tissue. In Group I and positive culture cases of Group II, scanning electron microscopic study revealed bacterial mass clumping in both the upper part of root apex and the area of apical foramen, but not in the area of apical foramen in negative culture cases of Group II. These results suggested that anaerobic isolates from contents of radicular cyst had ability to remain after antibiotic administration and to assist growth of radicular cyst. Anaerobic bacteria persisting in the upper part of root apex might proliferate and extend to contents of radicular cyst through apical foramen when host defence mechanisms decreased.

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 < 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.