Cleanliness Of Root Canal Walls Research Articles

EFFICACY OF 70% ETHANOL IN REMOVAL OF CALCIUM HYDROXIDE INTRACANAL MEDICAMENT WITH TWO TYPES OF VEHICLES WITH AND WITHOUT PASSIVE ULTRASONIC IRRIGATION: AN IN-VITRO STEREOMICROSCOPIC STUDY

Aim: To assess efcacy of 70% ethanol in removal of aqueous-based (Ultracal) and oil-based (Metapex) calcium hydroxide intracanal medicament(CaOH2) with/without passive ultrasonic irrigation (PUI). After root Materials And Methods: canal instrumentation, forty-eight tooth samples were randomly divided into two groups(n=24) and lled with either Ultracal or Metapex, 3mm short of working length. Samples were incubated at 37°C, 100% humidity for 7 days. The root canal was initially irrigated with 10mL saline and reinstrumented with master apical le to remove bulk of placed CaOH2. Samples in each group were then further randomly assigned into 2 subgroups(n=12) for irrigation using 70% ethanol with/without PUI, and 5mL saline nal ush. Samples were sectioned longitudinally and stereomicroscope images at 80X magnication were obtained. Cleanliness of root canal walls was scored according to a scoring system by Kuga et al(2010). Data were analysed by Kruskal–Wallis test, Mann–Whitney U test, Friedman's test and Wilcoxon tests at p≤0.05. Inter and intragroup comparisons reveal 70% Results: ethanol irrigation effectively removed Ultracal from root canals regardless of activation(P<0.05). In Metapex group, 70% ethanol irrigation with PUI showed signicantly better cleaning efciency than non-activated irrigation(P<0.05). Use of 70% ethanol for removal of Conclusions: aqueous-based CaOH2 showed good cleaning efcacy in all thirds of the root canal regardless of irrigant activation. Remnants of oil-based CaOH2 were present with non-activated 70% ethanol irrigation but better cleanliness was seen with PUI. Removal of oil-based CaOH2 from root canal system is enhanced with 70% ethanol with PUI.

Age and experience with dental operating microscope: Do these factors influence on the post space preparation and adhesion of glass fiber posts?

This study evaluated the influence of operator's age and experience with dental operating microscope (DOM) on the cleaning of post space walls and on bond strength of glass fiber posts associated with self-adhesive resin cement. Sixty bovine roots were selected. Root canal preparation was performed and roots were filled using gutta-percha/AH Plus. For post space preparation, specimens were divided into four groups (n=15), according to operator's age and the use of DOM: (1) ≥40 years; (2) ≥40 years with magnification; (3) <40 years; (4) <40 years with magnification. Next, a high-speed bur of the post system and torque-controlled round burs were used for cleaning of post space. Five roots in each group were evaluated for the degree of cleanliness under a stereo microscope using a scoring system. In the remaining 10 specimens from each group, glass fiber posts were cemented with RelyX U200. Two slices (1 ± 0.1 mm) prepared on each root third of all specimens were evaluated by push-out analysis. The scoring system was analyzed using Kruskal-Wallis and push-out data using ANOVA. Significance level was set at 5%. No significant difference was observed in cleaning scores among groups (p > .05). There was no significant difference when comparing the groups and the root thirds (p > .05). The adhesive failure between dentin, cement, and post predominated in all groups. Operator's age and experience with DOM did not influence the cleanliness of root canal walls or the bond strength of glass fiber posts associated with self-adhesive resin cement for post space preparation. RESEARCH HIGHLIGHTS: Although magnification is considered part of Endodontics, little is known about the variables associated. Operator's age and experience with microscope on cleaning of canals and on push-out of posts with self-adhesive resin cement were evaluated.

In vitro evaluation of root canal wall cleanliness in primary molars after preparation with Self-Adjusting-File (SAF) or Mtwo NiTi-instruments and final irrigation.

In vitro evaluation of cleanliness of root canal walls of primary molars after preparation with the Self-Adjusting-File and Mtwo-instruments and final irrigation with citric acid and sodium hypochlorite. s Study Design: In 23 matched pairs, teeth were prepared either with SAF or with Mtwo NiTi-instruments, and final irrigation was performed with 2 mL citric acid and 4 mL NaOCl. Roots were split longitudinally, SEM-images were taken, and smear layer was evaluated by two blinded observers using a four-grade score. Statistical evaluation was performed with Mann-Whitney-U-Test and Wilcoxon Signed Rank Test (P<0.05). No significant difference between SAF and Mtwo (P=0.9454) was observed. Overall removal of the smear layer was significantly better in the coronal part of the root canal than in the apical one (P=0.0004393). Mtwo showed no significant difference in cleanliness when comparing the coronal and apical part of the root canal (P=0.1089), whereas SAF cleaned the coronal part of the root canal significantly better than the apical part (P=0.00108). None of the two instruments was superior concerning cleanliness in root canals of primary molars. Both show good cleaning ability when using an irrigation protocol with citric acid and sodium hypochlorite.

Final Endodontic Irrigation with 70% Ethanol Enhanced Calcium Hydroxide Removal from the Apical Third

IntroductionThe purpose of this study was to evaluate the cleanliness of root canal walls and dentinal tubules after attempting to remove the calcium hydroxide dressing with different irrigant solutions and the use of nonactivated irrigation or passive ultrasonic irrigation (PUI). MethodsAfter root canal instrumentation, 80 single-rooted teeth were filled with calcium hydroxide mixed with propylene glycol and 0.1% rhodamine B dye and inserted into canals with a Lentulo spiral. The calcium hydroxide dressing was initially removed with 10 mL saline solution and reinstrumentation with the master apical file. Then, the samples were randomly assigned into 8 experimental groups (n = 10) according to the irrigant solution with or without PUI: 2.5% sodium hypochlorite, 17% ethylenediaminetetraacetic acid + 1.25% sodium lauryl ether sulfate (EDTA-T), 37% phosphoric acid, or 70% ethanol. A final flush with 5 mL saline solution was performed. The percentage of clean root canal walls and the depth of clean dentinal tubules were measured with images of confocal laser scanning microscopy. The groups were compared using the 2-way analysis of variance test with the Bonferroni post hoc test for depth analysis and the Kruskal-Wallis with Dunn post hoc test for the perimeter analysis. ResultsIrrigation with 70% ethanol presented a significantly higher percentage of clean root canal walls and a higher depth of clean dentinal tubules when compared with irrigation with 2.5% sodium hypochlorite and 17% EDTA-T for both irrigation methods (P < .05). No differences were observed between nonactivated irrigation or PUI protocols (P > .05). ConclusionsSeventy percent ethanol enhanced calcium hydroxide removal from the apical root third compared with 2.5% sodium hypochlorite or 17% EDTA-T.

The differences between mangosteen peel extract irrigant and NaOCl 2.5% on root canal cleanliness

Background: Preparation, one of the stages in root canal treatment, always producesdebrisas aresultof instrumentation onroot canalwalls. Debrisconsistsoforganicand inorganicmaterials. Irrigation need to be performed in every preparation so that debrisandmicroorganisms can be removed from root canal wallsthrough flushingmechanism. NaOCl 2.5% is the most popular irrigant used in root canal treatment. However, NaOCl2.5% onlyworks onorganic tissue. Mangosteenpeel extractcontainsvariousactive compounds, such as saponin. Saponin acts assurfactantso as tolower thesurface tension and remove debris from the root canalwalls. Purpose: to compare the cleanliness of root canal walls following irrigation with NaOCl 2.5% and mangosteen peel extract. Method: Eighteen mandible premolar extracted for orthodontics necessity were used in this study. The teeth were divided into three groups, in which each group consists of six teeth. All of them were instrumented with ProTaper for Hand Use and irrigated. Group 1 used aquadest as irrigant, group 2 used NaOCl 2,5%, and group 3 used mangosteen peel extract 400 ug/ml. The roots were split longitudinally into halves and in 1/3 of apex. The surface of the canal walls were examined using scanning electron microscope. Photomicrographs were scored by three independent observers and statistically tested. Result: There were significant differences between three groups (p&lt;0.05). Group 3, irrigated with mangosteen peel extract 400 ug/ml, had the smallest median score that was 1. Conclusion: Mangosteen peel extract is moreeffective thanNaOCl 2.5% incleaningroot canalwall from debris.

Comparison of root canal walls cleanliness obturated with two commercially available; calcium silicate sealers and a resin sealer after retreatment

Background: Despite improvements and advances in materials and methods, root canal treatment is not always satisfactory. After completing the obturation procedures, retreatment might be mandatory in cases of reinfection or inappropriately cleaned root canal. Retreatment strategy involves elimination of the obturating material, and then the whole mechanical and filling procedures are repeated again. Thus, root canal sealers removal shouldn’t represent an obstacle. Objective: The current study aimed is to investigate and observe the cleanliness of root canal walls that were previously obturated with two types of calcium silicate bioceramic sealers compared to a resin sealer. Materials and Methods: 21 single-rooted premolars were utilized. After complete removal of the obturating materials using Protaper retreatment universal system, the roots were cut by the use of a hammer and a chisel, then the middle third of the retreated canals were observed under a scanning electron microscope at magnification 1000x, the amount of clear, opened dentinal tubules was compared. Results: Among the three investigated sealers, ADSEAL showed the largest number of clear dentinal tubules while, a fewer open dentinal tubule were observed with Well Root and Ceraseal. Conclusions: None of the investigated sealers could be totally removed from root canal walls. However, the quantity of remnants of root filling material with well root and ceraseal were significantly more, compared to ADSEAL.

Efficacy of protaper next and protaper universal retreatment systems in removing gutta-percha in curved root canals during root canal retreatment.

The aim of this study was to compare the cleanliness of root canal walls after retreatment using ProTaper Next (PTN), ProTaper Universal Retreatment (PTR) nickel-titanium (NiTi) systems and Hedström hand files in curved mesial canals of mandibular molar teeth and the time required for gutta-percha and sealer removal. Ninety mandibular molar teeth with curved mesial roots were instrumented up to #35.04 with Mtwo NiTi rotary instruments and obturated using the continuous wave of condensation technique. Removal of gutta-percha and sealer was performed using one of the following: PTN and PTR NiTi systems and Hedström hand files. Samples were placed on the VistaScan phosphor plates in the mesio-distal direction and the radiographs were taken. The digital radiographs were analyzed using AutoCAD software. Also, the total time required for gutta-percha removal was calculated by a chronometer. The total retreatment time was significantly shorter in the PTN and PTR groups compared with the manual group (p<0.05). There was a significant difference between the groups according to the total residual gutta-percha and sealer (p<0.05). The PTN and PTR groups left significantly less gutta-percha and sealer remnant than the manual group (p<0.001). Within the limitations of this study, the PTN and PTR groups showed less residual gutta-percha and sealer than the manual group. The NiTi rotary systems were significantly faster than the manual group in the time required for gutta-percha and sealer removal.

What happens to unprepared root canal walls: a correlative analysis using micro‐computed tomography and histology/scanning electron microscopy

To microscopically examine the cleanliness of root canal walls that remained unprepared as revealed by micro-CT. The root canals of 10 freshly extracted mandibular premolars with necrotic pulps and apical periodontitis along with the mesiobuccal canals of 11 mandibular molars with vital pulps were prepared using Reciproc instruments R40 and R25, respectively, and 2.5% sodium hypochlorite irrigation. Specimens were scanned in micro-CT before and after preparation, and the unprepared areas were identified. The outer root surface corresponding to the untouched areas was marked on each root third to guide further analysis using histological (for teeth with vital pulps) and scanning electron microscopic (SEM; for necrotic teeth) examination. In the teeth with vital pulps, the root canal area occupied by tissue remnants was calculated. In SEM analysis of teeth with necrotic pulps, scores were attributed for the amount of debris on the untouched areas. The proportion of unprepared areas in the mesiobuccal molar canals was 18.1% and 9.6% over the full canal length and apical canal, respectively. In premolars, corresponding figures were 34.6% and 17.6%, respectively. Histological analysis of canals with vital pulps revealed tissue remnants over the untouched walls almost exclusively in the apical canal. SEM analysis of the canals with necrotic pulps revealed debris along the untouched walls in all root canal thirds. The areas that remain untouched by Reciproc instruments used with 2.5% NaOCl irrigation as revealed by micro-CT analysis were usually covered with debris, in the form of pulp tissue remnants, bacteria and dentine chips, especially in the apical root canal.

Efficacy of Different Nickel-Titanium Instruments in Removing Gutta-percha during Root Canal Retreatment

IntroductionThe aim of this study was to compare the cleanliness of root canal walls after retreatment using ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), Twisted File Adaptive (TFA; Axis/SybronEndo, Orange, CA), Reciproc (PRC; VDW, Munich, Germany), and ProTaper Universal retreatment (PTR, Dentsply Maillefer) nickel-titanium systems and the time required for gutta-percha and sealer removal. MethodsEighty human maxillary central incisors with single and straight root canals were instrumented up to #40.02 with manual K-files (Dentsply Maillefer) and obturated using the continuous wave of condensation technique. Removal of the gutta-percha and sealer was performed using 1 of the following nickel-titanium systems: PTN, TFA, RPC, or PTR. The teeth were sectioned, and digital images were captured. The photographs were analyzed using AutoCAD software (Autodesk, San Rafael, CA). Also, the total time required for gutta-percha removal was calculated by a chronometer. ResultsThe total retreatment time was significantly shorter in the PTR group compared with the other groups (P < .05). There was a significant difference between the groups according to the total residual gutta-percha and sealer (P < .05). The PTN and PTR groups left significantly less gutta-percha and sealer remnant than the TFA and RPC groups (P < .05). ConclusionsWithin the limitations of this study, the PTN and the PTR groups showed less residual gutta-percha and sealer than the TFA and RPC groups. The time required for gutta-percha and sealer removal was similar for all the groups, except for the PTR group.

Cleaning Effectiveness of Three NiTi Rotary Instruments: A Focus on Biomaterial Properties.

Nickel-titanium (NiTi) instruments are commonly used for shaping the root canal system in endodontic practice. They are more flexible and have better cutting efficiency than conventional stainless steel files. The superelasticity of NiTi rotary files allows the clinicians to produce the desirable tapered root canal form with a reduced tendency to canal transportation and instrument fracture. HyFlex CM instruments are new NiTi rotary instruments with shape memory produced by an innovative methodology (patent pending) that uses a complex heating and cooling treatment that controls the material’s memory. The aim of the present study was to compare the cleaning efficacy of two conventional (Mtwo, Revo-S) Ni-Ti rotary instruments with HyFlex CM. 30 single-rooted freshly extracted teeth were divided into three groups. Root canals were shaped with three NiTi instruments (Mtwo, Revo-S and HyFlex CM) using 5.25% NaOCl and 17% EDTA solutions. Specimens were fractured longitudinally and prepared for SEM analysis at standard magnification of 1000×. The presence/absence of debris smear layer and the presence/absence of smear layer at coronal, middle, and apical third of each canal were evaluated using a 5-step scale for scores. Numeric data were analyzed using Kruskall-Wallis and Mann-Whitney U statistical tests and significance was predetermined at P < 0.05. This study revealed significant differences among the various groups. Despite some minor differences, all instruments removed smear layer and debris produced during instrumentation. HyFlex CM seem to be not so effective in promoting cleanliness of root canal walls and in removing smear layer from dentine if compared to Mtwo and Revo-S.

Removal of Gutta-Percha/Zinc-Oxide-Eugenol Sealer or Gutta-Percha/Epoxy Resin Sealer from Severely Curved Canals: An In Vitro Study

The aim of this study was to compare the cleanliness of root canal walls after retreatment using two rotary retreatment files to hand instruments in severely curved canals obturated with gutta-percha and two different sealers. Single rooted mandibular premolars (n = 90) with root curvatures were instrumented and obturated with gutta-percha and an epoxy resin (Group 1, n = 45) or zinc oxide eugenol sealer (Group 2, n = 45). Following retreatment of the specimens (n = 15 ProTaper Universal Retreatment Files (Subgroup B) or R-Endo retreatment files (Subgroup C) after 1 month, split specimens were examined under a stereomicroscope and the percentage of remaining root filling material was statistically compared using one way ANOVA with Bonferroni adjustment for multiple comparisons (P = 0.05). The R-Endo system performed significantly better than the other two file systems (P < 0.05). None of the systems used in this study cleaned root canals thoroughly. The R-Endo system did provide cleaner walls when compared to the other instruments used. The type of root filling materials had an impact on the outcomes with all techniques.

SEM Evaluation of the Root Canal Walls after Treatment with Tetraclean

In this ex vivo study, the surface cleanliness of root canal walls after shaping with Ni-Ti instruments and irrigating with different endodontic solutions was evaluated by SEM. 50 single-rooted teeth were divided into 5 groups. All root canals were shaped with Revo-S™ (MICRO-MEGA®, Besancon, France) rotary Ni-Ti instruments and irrigated with NaOCl, varying the final rinse: NaOCl, Tetraclean, 17% EDTA, Cloreximid, Tetraclean liquid not mixed with powder. Specimens were fractured longitudinally and prepared for SEM analysis in order to evaluate the presence/absence of smear layer and the presence/absence of open tubules at the coronal, middle, and apical third of each canal, using a 3-step scale for scores. Numeric data were analyzed using Kruskall-Wallis test and Mann-Whitney U test and significance was predetermined at p<0.05. This study showed significant differences between the various groups. The 5.25% NaOCl + Tetraclean and 5.25% NaOCl + 17% E.D.T.A. groups had significantly lower scores than other groups (p<0.001), with no significant difference between them. Final rinse with Tetraclean is effective in removing the smear layer, leaving a high number of opened dentin tubules.

Effectiveness in cleaning oval‐shaped root canals using Anatomic Endodontic Technology, ProFile and manual instrumentation: a scanning electron microscopic study

To compare in vitro the cleanliness of root canal walls in oval-shaped root canals following automated or manual instrumentation. Forty-five oval-shaped single-rooted maxillary and mandibular premolars with straight canals were divided into three groups of 15. Automated canal preparation was performed using Anatomic Endodontic Technology (AET, group 1) and the ProFile system (group 2). Manual instrumentation (group 3) was performed with K-Flexofiles. Irrigation was performed using alternately 5.25% NaOCl and 17% EDTA, followed by rinsing with saline. The roots were split longitudinally into halves and the canals examined at x200 and x400 in a scanning electron microscope. The presence of debris and smear layer was recorded at distances of 1, 5 and 10 mm from the working length using a three-step scoring scale and a 300 mum square grid. Mean scores for debris and smear layer were calculated and statistically analysed for significance (P < 0.05) between and within groups, using the Kruskal-Wallis nonparametric anova and Dunn's tests. At 1, 5 and 10-mm levels the root canals prepared with AET had significantly less surface debris and smear layer on the canal walls compared with canals prepared with ProFile or manual instrumentation. For all three groups significantly lower mean smear layer scores (P < 0.05) were recorded at 5 and 10-mm levels compared with the 1 mm level. Significantly lower mean debris scores (P < 0.05) were also recorded at 5 and 10-mm levels for the AET group whereas no significant differences were found between the three levels for the ProFile and manual instrumentation groups. Although better instrumentation scores were obtained in canals prepared with AET, complete cleanliness was not achieved by any of the techniques and instruments investigated.

Surface debris of canal walls after post space preparation in endodontically treated teeth: a scanning electron microscopic study

Purpose To evaluate surface cleanliness of root canal walls along post space after endodontic treatment using 2 different irrigant regimens, obturation techniques, and post space preparation for adhesive bonding. Study design Forty teeth, divided into 4 groups, were instrumented, using Ni-Ti rotary files, irrigated with NaOCl or NaOCl + EDTA and obturated with cold lateral condensation (CLC) or warm vertical condensation (WVC) of gutta-percha. After post space preparation, etching, and washing procedure, canal walls were observed using a scanning electron microscope (SEM). Amount of debris, smear layer, sealer/gutta-percha remnants, and visibility of open tubules were rated. Results Higher amounts of rough debris, large sealer/gutta-percha remnants, thick smear layer, and no visibility of tubule orifices were recorded in all the groups at apical level of post space. At middle and coronal levels areas of clean dentin, alternating with areas covered by thin smear layer, smaller debris, gutta-percha remnants, and orifices of tubules partially or totally occluded by plugs were frequently observed. Conclusions After endodontic treatment, obturation, and post space preparation SEM analysis of canal walls along post space shows large areas (covered by smear layer, debris, and sealer/gutta-percha remnants) not available for adhesive bonding and resin cementation of fiber posts.