Dental Operating Microscope Research Articles

Impact of Different Movement Kinematics on the Deformation of TF Adaptive Files

This study was designed to evaluate the effect of different movement kinematics on the deformation of TF Adaptive files using Dental Operating Microscope (DOM) and Scanning Electron Microscope (SEM). Materials and Methods: One hundred and eighty extracted human mandibular molars were selected with curved mesiobuccal canal (15o-35o). Thirty new sets of TF Adaptive files were divided into 3 groups according to the movement kinematics used (10 instruments each). Group I: 60 samples were instrumented with 10 TF Adaptive files in adaptive motion with TF Adaptive program Elements motor. Group II: 60 samples were instrumented with 10 TF Adaptive files in reciprocating motion with built-in reciprocating EndoEst motor mini, where the angle of reciprocation was set at 160° CCW and 41°CW. Group III: 60 samples were instrumented with10 TF Adaptive files in continuous rotation motion at 500rpm and torque 2 N/cm. Instruments were examined under DOM before usage and after each use for evaluation of deformation or fracture. Selected instruments from each group were evaluated using SEM. Results: there was no statistical significant difference among adaptive motion, reciprocating and continuous rotation motion in the mean deformation scores and percentage. The highest deformation scores and percentage was recorded in TF Adaptive instruments used with continuous rotation motion, however, there was no statistical significant difference. Conclusion: The innovated adaptive motion did not result in lower deformation of TF Adaptive files. Reciprocating motion produced less deformation in TF Adaptive files than did adaptive motion or continuous rotation motion, after preparing six root canals.

Evaluation of Apical Extent of Root Canal Instrumented Manually Using FlxoFile and Rotary Using ProTaper by the Aid of Dental Operating Microscope (An In Vitro Study)

Purpose: This study was designed to evaluate the influence of different apical limits of working lengths, electronic and radiographic methods of working length determination, maual and rotary root canal instrumentation on the apical extent of root canal filling material. Materials and Methods: Forty five roots of maxillary central incisors with mature apices were selected and divided into two groups: Group I ( 30 roots), and Group II (15 roots) according to the method of working length determination (electronic or radiographic respectively). Each main group was divided into three equal groups according to the apical limit of working Each group at main group (I) were subdivided into two equal subgroups: 1 and 2 (5 each) according to instrumentation system; rotary proTaper system or Flex-o-file while all roots at group (II) were cleaned & shaped with Flex-o-file. Each canal was obturated. The roots were longitudinally splitting .Under a surgical microscope, the integrity of apical constriction was observed and photographed. The distance between the apical terminus of the root canal filling and the apical foramen were measured and photographed by stereomicroscope. Results: ANOVA test revealed significant difference on the distance between the apical terminus of the root canal filling and the apical foramen were preserved at the three apical limits when working length and rotary canal preparation were carried by Tri Auto ZX headpiece, and when root canal were prepared by Flex-O-file after radiographic working length determination. Under different variables of this study, the integrity of apical constriction showed no significant difference. Conclusion: Electronic working length determination method is more accurate than radiographic method. Tri Auto ZX apex locating headpiece is a reliable method for electronic working length determination, and rotary root canal preparation.

Changes in anatomic position of root canal orifices in pluriradicular teeth following re-location during endodontic treatment

Direct access to the root canals in posterior teeth for endodontic treatment is most frequently facilitated by the straightening of the coronal parts of the root canals, having as a consequence the relocation of the canal orifices on the map of the floor of the pulp chamber (Christie and Thompson, 1994). This procedure intentionally moves the coronal aspect of a canal away from the center of the chamber, while simultaneously removing internal dentin from the pulp chamber walls. The aim of this study was to evaluate the displacement resulting from the relocation of root canal orifices during the initial phase of rotary root canal treatment in molars using the dental operating microscope (DOM) and digital image processing. Forty-three molars (17 maxillary and 26 mandibular) belonging to 43 patients (aged 18–62 years) with indications for root canal treatment were endodontically treated. The differences between the initial perimeter and the perimeter of the root canal orifices polygon after relocation varied between 2.7 and 3.4μm (mean 3.0μm), while the differences between the initial area and the area after relocation varied between 2,448,456.8 and 3,249,306.6μm2 (mean 2,848,881.7). The increase in access to the cavities and the alterations of the pulp chambers can be satisfactorily approximated by the variations of the perimeters and areas of the pulp floor polygons during root canal treatment. From a clinical perspective, these results indicate that there is a significant decrease in tooth substance in molars (except MB2).

Obturating the pink tooth: An in vitro comparative evaluation of different materials

Aim: The aim is to evaluate the obturating potential of thermoplasticized gutta-percha, mineral trioxide aggregate (MTA), and Biodentine in simulated internal resorption cavities. Materials and Methods: Thirty human extracted teeth with single canal and mature apex were collected for the study. Access cavity was prepared in each. For all the teeth, standardized instrumentation was done to apical size of ISO #50 K stainless steel hand file. Following instrumentation, at the length of 6 mm short of working length, internal resorption cavity was simulated using Gates–Glidden drill, as the canal of the selected teeth was wide enough and thus widening of the canal occurred only at the desired working length. The teeth were radiographed to check internal resorption cavity. The teeth were randomly divided into three groups; ten teeth in each group. Samples were obturated as follows: Group 1 – thermoplasticized gutta-percha, Group 2 – MTA, and Group 3 – Biodentine. Samples were stored at room temperature for 48 h. After 48 h, samples were evaluated radiographically and microscopically using Dental Operating Microscope. Statistical analysis of the results was performed using Kruskal–Wallis test. Results: Results obtained were statistically significant. Conclusion: MTA and Biodentine showed better sealing than thermoplasticized gutta-percha.

The use of Dental Operating Microscope for Retrieval of different types of Fractured Implant Abutment Screws: Case Reports

The use of Dental Operating Microscope for Retrieval of different types of Fractured Implant Abutment Screws: Case Reports

The Usage of the Dental Operating Microscope among Young Dentists in Tîrgu Mureș: A Questionnaire Survey

Abstract Introduction: In the last 15 years, the most important revolution in dentistry has been the introduction and then the widespread adoption of the dental operating microscope. The aim of this study was to evaluate the usage of the dental operating microscope among young specialized and general practitioner dentists in Tîrgu Mureș. Material and Methods: A 9-point questionnaire about dental microscope usage was distributed among endodontists, practitioners of other specialties, and general practitioners with less than 10 years of experience. Results: According to our results, the dental operating microscope is used mainly during root canal therapy by endodontists. Practitioners of other specialties (prosthetists, alveolar dental surgeons, and orthodontists) use the microscope in a small percentage during coronal restoration, prosthetics, or periodontal surgery. Most general practitioners are not interested in using magnification in their practice. Conclusions: Endodontists use the dental operating microscope when they face complicated cases and have access to it. Working under magnification is awakening the interest of doctors of other specialties also. Private practices should invest in acquiring a microscope, and young general practitioners should be motivated in using it during dental treatments.

The Effect of the Dental Operating Microscope on the Outcome of Nonsurgical Root Canal Treatment: A Retrospective Case-control Study

IntroductionThe aim of the current investigation was to assess the effect of the use of a dental operating microscope on the outcome of nonsurgical root canal treatment (NS RCT) while treating the mesiobuccal (MB) root of the maxillary first molar. MethodsThis retrospective investigation included endodontically treated maxillary first molars (ETMs) with apparent adequate previous NS RCT and restorations referred for endodontic retreatment at the endodontic graduate clinic. Inclusion criteria were ETMs that were diagnosed with irreversible pulpitis and normal periapical tissues before the initial NS RCT and ETMs that presented with a minimum of 1 identifiable periapical lesion (PAR) at 1 of the roots at the time of retreatment. One hundred ninety-five ETMs were included and divided into 2 groups:(1) the initial NS RCT had been performed using a microscope (n = 83) and(2) NS RCT had been performed without the use of a microscope (n = 112). Data extracted were whether the second MB (MB2) canal was located initially and the presence of an MB PAR at the time of retreatment. Data were statistically analyzed using binary logistic regression (α = 0.05). ResultsThe MB root was 3 times more likely to present with a PAR at the time of retreatment if the initial NS RCT was performed without the use of a microscope (P < .05, odds ratio = 3.1). There was a significant association between a missed MB2 canal and an MB PAR in the group in which the initial NS RCT was performed without the use of a microscope (P < .05, odds ratio = 5.1). However, in cases in which the initial NS RCT was performed using a microscope, a missed MB2 canal was not associated with the presence of an MB PAR. ConclusionsWith proper education, dentists can gain further insight into recognizing limitations in treating cases that require advanced training and advanced optics such as a microscope. Based on this strategy, it would appear that the outcome of NS RCT can be improved.

Comparison of different irrigation and agitation methods for the removal of two types of calcium hydroxide medicaments from the root canal wall: an in-vitro study.

Background and aimComparison of different irrigation and agitation methods for the removal of two types of calcium hydroxide medicaments from the root canal walls.MethodsFifty extracted single rooted teeth were selected for this study. After decoronation, the root canals of these teeth were prepared to the size F3 (30 no.) using rotary ProTaper file system. These samples were randomly divided into four groups. Group 1 (n=20) were filled completely with water based calcium hydroxide (CH), Group 2 (n=20) were filled with oil based CH using lentulo spiral, Group 3 (n=5) - the positive control group received the CH as intracanal medication, but no subsequent removal, Group 4 (n=5) - the negative control did not receive CH placement. Further on, Group 1 and Group 2 were divided into four sub-groups (n=5). In sub-group A we performed conventional syringe irrigation with side-vented needle sub-group B) manual dynamic agitation, sub-group C sonic agitation using endoactivator, sub-group D passive ultrasonic irrigation (PUI). Roots were split longitudinally into mesial and distal halves. Digital images of the root canal walls were acquired by a Dental Operating Microscope (DOM) and assessed by using a scoring criteria at different thirds (coronal, middle and apical) of the root canal as follows: score 1, score 2, score 3, and score 4. Data were analyzed applying one-way analysis of variance (ANOVA) and Tukey’s multiple comparison tests at a 95% confidence interval (P < 0.05).ResultsStatistically significant differences were not found between the experimental groups and the negative group in any one third of the root canal (P>0.05). However, a difference did exist between the experimental groups and the positive control group (P<0.05). None of the experimental groups totally removed CH substances from root canal walls.ConclusionAmong all experimental groups, removal of CH was best achieved by sonic agitation using endoactivator followed by passive ultrasonic irrigation (PUI), manual dynamic agitation and conventional syringe irrigation with side-vented needle.

Dental Operating Microscope: The Third Dimension in Dentistry

Dental Operating Microscope: The Third Dimension in Dentistry

Effect of the video output of the dental operating microscope on anxiety levels in a pediatric population during restorative procedures.

Adapting a child to the alien settings of a dental operatory is a major challenge to the dentist. Fear of the unknown and preconceived notions of dental pain causes anxiety in the pediatric patient. This often leads to disruptive and uncooperative behavior in the dental operatory. Many methods of behavior management have been described, of which the Tell-Show-Do (TSD) is an established and time-tested technique of behavior management. To determine if a live visual output of the dental operating microscope (DOM) could be used as an adjunct to the TSD technique, to involve the child more completely in the procedure and reduce the fear of the unknown. The study was a randomized, controlled, crossover, and cross-sectional clinical trial. Data were obtained from two visits. 90 children having carious lesions on both lower first molars, in the 7-9 years age group were selected and divided randomly into two groups. Restorative procedures were performed on one tooth per visit, with visits 1 week apart. Live display of the procedure was shown to the patient using video output of the DOM displayed on a 72 inch LCD monitor, angled for best visibility of the child. Anxiety levels were evaluated using Venhams picture selection test and pulse oximetry. Student's t-test was used to compare the anxiety scores obtained from the two groups. The results showed there was a decrease in the anxiety from the first visit to the second visit. (P = 0.05 for Group A and P = 0.003 for Group B). The patients preferred the visit in which the DOM was used. The operator reported an increased patient compliance and reduced patient movement in the visits in which the DOM was used. There is a reduction in anxiety from the first visit to the second visit for restorative treatment when the DOM is used.

Maxillary First Molar with One C-Shaped Fused Root Diagnosed with Cone-Beam Computed Tomography: A Case Report

Introduction:The root canal system of maxillary first molar is complicated. It is hard to master its variations. This case report showed a rare root canal configuration diagnosed with cone-beam computed tomography (CBCT). Methods :The dental operating microscope (DOM) and CBCT were used to search root canal orifices and confirm the rare root canal configuration. Results: CBCT images showed the maxillary first molar having 5 root canals in one C-shaped root with fusion of the mesiobuccal, distobuccal and palatal roots. Conclusions: The DOM and CBCT facilitated the diagnosis and treatment of a rare C-shaped fused root canal configuration in a maxillary first molar.

CBCT-Aided Microscopic and Ultrasonic Treatment for Upper or Middle Thirds Calcified Root Canals.

Root canal calcification is considered a great challenge during root canal treatment. Although the application of ultrasonic instruments and dental operating microscope (DOM) has advantages, dealing with calcified root canals still suffers a great risk of failure because of limited information about the location, length, and direction of obliteration on periapical radiographs. In this work, a cone-beam computed tomography- (CBCT-) aided method aimed at solving complicated calcified root canals in which conventional approaches could not work was proposed. Thirteen teeth with sixteen calcified canals (12 calcified in the upper third, 4 calcified in the middle third), which cannot be negotiated with conventional methods, were treated with the aid of CBCT. The location of calcification and depth of instrumentation and operating direction were calculated and assessed in three dimensions with ultrasonic instruments under DOM. In all thirteen teeth, canals with upper and middle thirds calcification were treated successfully. Finally, a guideline was proposed to help achieve consistent apical patency in calcified canals.

Frequency of middle mesial canals in mandibular first molars in North Indian population - An in vivo study

Objectives: The primary aim of the study was to determine the frequency of middle mesial (MM) canals in mandibular first molars in North Indian population. The secondary aim was to analyze whether an association exists between the detection rate of MM canals and age, gender, and number of distal canals. Materials and Methods: All mature mandibular first molars endodontically treated between March 2013 and March 2015 were included in the study. After instrumenting the main canals, the clinician inspected the mesial developmental groove under dental operating microscope (DOM) using ultrasonic tips and endodontic explorer to detect accessory mesial canals. The canal, if found, was negotiated, cleaned, shaped, and recorded. Results were analyzed using Chi-square test. Results: A total of 258 first molars from 243 patients were treated during the specified period, of which 28.3% had negotiable MM canals. The frequency of MM canals was 36.6% in patients 11-30 years old, 22.6% in patients 31-50 years old, and 18.4% in patients >50 years. Statistical analysis revealed a significant relationship of different age groups with the incidence of MM canals (P < 0.05). A significant relationship was also found between the detection rate of two canals in distal root and the presence of MM canals (P < 0.05) with gender having no influence. Conclusion: The presence of MM canals is quite high in North Indian population. Younger patients had a higher incidence of MM canals. Mandibular first molars with two separate distal canals showed a tendency to have MM canals.

Non-surgical endodontic treatment of premolars with three root canals: a case reports

To perform successful endodontic therapy, it is important to know the anatomy and morphology of the root canal system. Peculiarities with possible anatomic variations may lead to failure due to insufficient instrumentation and inadequate three-dimensional obturation of the root canal system.[1,2] Accurate radiographic examination using different horizontal angles is crucial for the endodontist to recognize the roots and root canals. Additionally, the observation of the pulp chamber anatomy during coronal access is an essential procedure for the correct clinical location of root canal orifices.[3] The high frequency of endodontic flare-ups and failures is associated with variation in root canal morphology. The factors that can contribute to observed differences in the anatomic study include ethnicity, age, gender and study design (in vitro versus in vivo).[4] The presence of three root canals in maxillary premolars of the Turkish population is a very rare occurrence as reported by several studies.[5–7] The presence of three root canals in mandibular premolars of the Turkish population is also a very rare occurrence as reported by Sert et al. and Ok et al. studies.[7,8] The use of magnification and fiber optic illumination, offers a tremendous advantage in locating and treating “extra” canals. Also the dental operating microscope (DOM), has been found to be particularly helpful. The efficient use of the DOM requires advanced training. Many endodontic procedures are performed at 10× to 15× magnification, and some require a magnification as high as 30×. The skillful use of a DOM entails its use for the entire procedure from start to finish. Working in such a way requires the endodontist to possess a high level of ergonomic and visual skills.[9] This paper reports the endodontic treatment of three cases of three-canalled maxillary premolars in different patients and the endodontic treatment of one case of threecanalled mandibular premolars in a different patient. An accurate diagnosis of the morphology of the root canal system is a prerequisite for successful root canal treatment. Some reports reveal a very rare occurrence of all types of premolar teeth in the Turkish population. Diagnostic tools such as preoperative radiography and examination of the pulp chamber floor facilitate the location of root canal orifices. The use of magnification tools, radiography exposed at two different horizontal angles, and their careful explication are important for successful endodontic therapy. This case report presents the successful endodontic treatment of three maxillary premolar teeth with three root canals and one mandibular premolar tooth with three root canals.

The Use of Dentascan to Diagnose and Treat Mandibular Premolar with Multiple Canals

Introduction: For successful endodontic therapy it is vital to have thorough knowledge of morphology of the root canal system and its variations besides proficient aseptic intraoperative condition. Mandibular second premolars are usually single rooted tooth with single root canal system. The incidence of the number of roots and the number of canals varies greatly in the literature. Methods and Results: This case report describes an unusual case of mandibular second premolar with two roots and five root canals. This was confirmed by radiographs, dentascan and dental operating microscope (DOM), and was successfully treated using K files system, guttapercha and AH plus sealer in lateral condensation manner. Conclusion: The clinical significance of this case report is that the precise awareness about the Case Report Yadav et al.; BJMMR, 7(4): 327-331, 2015; Article no.BJMMR.2015.339 328 aberrant morphologies of the root canal system can only be appreciated when advanced radiographic techniques, magnification and illumination are used to treat such type of cases.

The use of dental operating microscopes by endodontists in the Middle East: A report based on a questionnaire

Objectives: The purpose of this study was to determine how the Dental Operating Microscope (DOM) is currently being accepted for usage by endodontists in the Middle East. Materials and Methods: A one-page letter and auto-return upon completion computer-based questionnaires were e-mailed to most of the active members of the Middle Eastern endodontic associations. Results: Out of the 47% that are using the DOM, only 35% answered yes to using the DOM as much as anticipated. The reasons for not using the DOM as much as anticipated were positional difficulties (80%) and increased treatment time (75%). The majority of endodontists reported that they always use it during retrieval of separated instruments, negotiating calcified canals and surgical treatment. Conclusions: The findings revealed that endodontists in the younger age-groups are more accepting of the DOM. It was also found that the endodontists that are using the DOM in their practice are not using it as often as they anticipated.

Endodontic management of a maxillaryfirst molar with three palatal canals - A case report

This case report presents a successful endodontic management of left maxillaryfirst molar with three palatal canals. This rare root canal morphology was diagnosed using dental operating microscope (DOM) and confirmed with cone beam computed tomography (CBCT). Axial CBCT images confirmed that the palatal canals merged with each other in the apical third and exited through one apical foramen. This report highlights the importance of magnification (DOM) and advanced imaging techniques (CBCT) in better understanding of complex Root canal anatomy.

Endo- Perio management of maxillary first premolar with three distinct roots and three canals diagnosed with Cone Beam Computed Tomography– A rare case report

Many of the difficulties found in endodontic therapy are caused by variations in root canal anatomy. Any pre-assumptions regarding the root canal morphology will eventually lead to endodontic failure. Maxillary first premolars show a considerable variation in root canal morphology but the presence of three roots is rare. The incidence shown in the literature for three rooted maxillary first premolar is 0.5 to 6%. Endodontic–periodontal lesions offer a constant challenge to the clinician for diagnosis, treatment and prognosis. Treatment and prognosis of endodontic–periodontal diseases vary depending on the cause and the correct diagnosis of each specific condition. Management of such lesions needs a multidisciplinary approach. Use of three dimensional imaging technology like Cone Beam Computed Tomography (CBCT) has proven to be an essential tool for successful diagnosis of such lesion and higher magnification using the Dental Operating Microscope (DOM) should always be given preference during the clinical procedure. This case report describes the treatment performed on a maxillary first premolar having three independent roots and threedistinct root canals with furcation involvement. Special care needs to be taken during clinical examination, refining the access cavity, locating the orifices of the root canals on the pulpal floor and cleaning, shaping and obturating all identified root canals. The tooth was successfully managed by conventional endodontic treatment and regenerative periodontal surgical intervention.

Variant Anatomy of Mandibular First Permanent Molar: A Case Series

ABSTRACTThe advent of new dental imaging techniques and equipments, dental operating microscopes and loupes in endodontics have proved to be a boon for clinicians today. One of the causes of endodontic failure is missed canals. These technologies have greatly improved the ability to detect the presence of extra canals and thus seem to improve the success rate of endodontic treatment and the prognosis of endodontically treated tooth. The present article is a case series describing the endodontic management of two mandibular first permanent molars, one having two roots with six canals and other with three roots and five canals.How to cite this articleShenoi PR, Kubde R, Badole GP, Singare P. Variant Anatomy of Mandibular First Permanent Molar: A Case Series. J Contemp Dent 2015;5(2):113-117.

Detection of Second Mesio Buccal Canal in Maxillary First Molar with Unaided Eye, Surgical Loupes and Dental Operating Microscope: A Comparative Invivo Study

Detection of Second Mesio Buccal Canal in Maxillary First Molar with Unaided Eye, Surgical Loupes and Dental Operating Microscope: A Comparative Invivo Study