Distal Root Research Articles

Endodontic management of perforating internal resorption in a mandibular molar using sandwich technique

Internal inflammatory root resorption is an uncommon pathology that can progress to the periradicular vicinity. It is frequently asymptomatic and only discovered during a radiological screening. Appropriate and timely diagnosis is extremely crucial in tackling these cases. A perforating internal resorptive cavity in the distal root of the mandibular first molar was successfully managed using a sandwich concept of sectional apical obturation with gutta-percha and Bioceramic sealer followed by the placement of mineral trioxide aggregate in the resorptive cavity.

Immediate implant placement in conjunction with guided bone regeneration and/or connective tissue grafts: an experimental study in canines.

PurposeThis study was conducted to assess the effect of hard and/or soft tissue grafting on immediate implants in a preclinical model.MethodsIn 5 mongrel dogs, the distal roots of P2 and P3 were extracted from the maxilla (4 sites in each animal), and immediate implant placement was performed. Each site was randomly assigned to 1 of the following 4 groups: i) gap filling with guided bone regeneration (the GBR group), ii) subepithelial connective tissue grafting (the SCTG group), iii) GBR and SCTG (the GBR/SCTG group), and iv) no further treatment (control). Non-submerged healing was provided for 4 months. Histological and histomorphometric analyses were performed.ResultsPeri-implant tissue height and thickness favored the SCTG group (height of peri-implant mucosa: 1.14 mm; tissue thickness at the implant shoulder and ±1 mm from the shoulder: 1.14 mm, 0.78 mm, and 1.57 mm, respectively; median value) over the other groups. Bone grafting was not effective at the level of the implant shoulder and on the coronal level of the shoulder. In addition, simultaneous soft and hard tissue augmentation (the GBR/SCTG group) led to a less favorable tissue contour compared to GBR or SCTG alone (height of peri-implant mucosa: 3.06 mm; thickness of peri-implant mucosa at the implant shoulder and ±1 mm from the shoulder: 0.72 mm, 0.3 mm, and 1.09 mm, respectively).ConclusionSCTG tended to have positive effects on the thickness and height of the peri-implant mucosa in immediate implant placement. However, simultaneous soft and hard tissue augmentation might not allow a satisfactory tissue contour in cases where the relationship between implant position and neighboring bone housing is unfavorable.

Passive ultrasonic irrigation, EndoActivator system and XP-endo Finisher R as additional cleaning techniques to remove residual filling materials from flattened root canals.

Background:The effectiveness of endodontic retreatment essentially depends on the cleaning and/or disinfection processes. In this context, the removal of root canal filling materials plays a crucial role.Aims:To assess the efficacy of passive ultrasonic irrigation (PUI), EndoActivator system (EAS), and XP-endo Finisher R (XPEFR) as additional cleaning techniques to remove the remaining root canal filling materials from flattened root canals.Subjects and Methods:Thirty-six similar flattened distal root canals of extracted human first lower molars were selected by micro-computed tomography (micro-CT) and then instrumented and filled. After the initial retreatment procedures, the residual volume of root canal filling materials was assessed by micro-CT (V1). Then, the specimens were divided into three groups (n. 12), according to the additional cleaning technique and submitted to another micro-CT scan (V2).Statistical Analysis Used:Analysis of variance and Games-Howell tests (P < 0.05).Results:The percentage reduction in the residual volume of root canal filling materials reached by PUI, EAS, and XPEFR was 28.38%, 28.12%, and 43.52%, respectively, considering the total space of the root canal (P > 0.05). In the apical third, these values were 20.05%, 21.54%, and 48.82% (P < 0.05).Conclusions:Additional cleaning techniques enabled removing a greater amount of root canal filling material from flattened distal root canals of extracted human first lower molars. Considering the total space of the root canal, there were no statistically relevant differences among the groups. In the apical third, XPEFR performed better.

A micro-computed tomographic assessment of oval-shaped root canals obturated with bioceramic sealer using different obturation techniques

Background/Aim: To evaluate void volumes in oval-shaped root canals obturated with three different obturation systems using microcomputed tomography (micro-CT). Material and Methods: Twenty-four distal roots of mandibular molar teeth canals were prepared and randomly divided into three groups (n = 8 in each group). The canals were obturated using single cone (SC), GuttaCore (GC), and warm vertical compaction (WVC) techniques. Each specimen was scanned using a micro-CT device. The volumes of the voids were calculated, and the data were statistically analyzed using a one-way analysis of variance and post hoc Tukey's (P &lt; .05). Results: The void volumes in the WVC group were significantly lower than those in the other groups (P &lt; .05). When different root canal parts were examined, the void volumes increased significantly from the apical to the coronal level in the GC and SC groups (P &lt; .05). In the WVC group, most voids were observed in the middle part (P &lt; .05), whereas there was no significant difference in void volumes in the coronal and apical parts (P &gt; .05). Conclusions: None of the systems provided void-free root filling. However, the void volume using the WVC system was significantly lower than that observed using the other systems.

Comparative evaluation of the effect of hand file, different nickel-titanium retreatment files, and self-adjusting file system on the incidence of dentinal microcrack formation during the removal of root canal filling material: An in vitro stereomicroscopic study

Aim: The aim of the study is to evaluate the effect of hand files, rotary nickel-titanium files, and self-adjusting file (SAF) on the incidence of crack formation during retreatment. Materials and Methods: Eighty extracted human mandibular molar teeth with intact mesial roots were selected. They were divided into 8 groups of 10 teeth each; Group 1: Control, Group 2: Obturated control, Group 3: Hand files, Group 4: ProTaper Universal Retreatment, Group 5: Twisted File Adaptive, Group 6: Reciproc Blue, Group 7: XP-endo Finisher R, Group 8: SAF system. All teeth had the coronal portions and distal roots removed by a diamond-coated disc with water cooling, leaving roots approximately 13 mm in length. Except for Group 1, all canals were similarly instrumented and obturated at an apical size of 40.02. Retreatment was performed in each group according to manufacturer's recommendations except for Groups 1 and 2. The roots were sectioned horizontally at 3, 6, and 9 mm from the apex with a low-speed saw. Stereomicroscopic evaluation of the sections was done to assess the presence or absence of defects. Results: The groups that were not retreated (Groups 1 and 2) showed no defects. Hand files showed the least number of defects followed by the SAF. Reciproc Blue showed the most dentinal defects. Conclusion: All NiTi instruments tend to induce various degrees of dentinal damage during retreatment procedures. The SAF and hand instrumentation presented satisfactory results with minimal dentinal microcracks.

USE OF TOOTH CLEARING TECHNIQUE TO DETERMINE ROOT AND CANAL MORPHOLOGY OF PERMANENT MANDIBULAR THIRD MOLARS IN POPULATION OF PESHAWAR: AN IN VITRO CROSS-SECTIONAL STUDY

OBJECTIVE: To find out number of roots, root-canals and canal configuration in permanent mandibular third molars through tooth clearing technique. METHODS: In this cross-sectional study, 193 extracted human mandibular permanent third molars with completely formed apical foramen and intact roots were collected from both genders treated at dental hospitals in Peshawar, Pakistan from 1st July to 31st December 2019. After collection teeth were visually inspected to count number of roots, followed by access cavity preparation, pulp extirpation and canal staining with black Indian ink. Decalcification was done by placing teeth in nitric acid for 5 days followed by dehydration in ascending concentrations of alcohol. Complete transparency was achieved by immersing teeth in methyl-salicylate for 72 hours. Transparent teeth were inspected again for number of roots and root-canals. RESULTS: Among 193 extracted mandibular third molars, (n=161; 83.4%) had two-roots and (n=24; 12.4%) were single-rooted. Two-canals were present in vast majority (n=142; 73.6%) whereas three and one-canal were seen in (n=37; 19.2%) and (n=13; 6.7%) teeth respectively. Most common type of root canal pattern was Vertucci’s Type-I in mesial-roots (n=79; 63.7%) and distal-roots (n=120; 96.8%). Vertucci’s Type-II and Type-IV were (n=15; 12.1%) and (n=12; 9.7%) in the mesial-roots respectively. Mandibular third molars didn’t present with any configurations that didn’t fullfill Vertucci’s criteria. Correlation between number of roots and root-canals of mandibular third molars was non-significant. CONCLUSION: Two-roots and two-canals were common patterns for mandibular third molars. Mesial and distal roots were predominant in Type-I followed by Type-II and Type-IV Vertucci’s classification.

Crown root fracture imaging on Cone Beam Computed Tomography

Objectives: This case report is aimed to describe the features of CBCT in assessing tooth fracture.&#x0D; Case Report: A 50-year-old man came with complaints of discomfort in the right lower jaw area, especially when used for chewing. The results of the percussion test were positive. CBCT examination showed that there was a radiolucent image of the enamel in the middle of the crown root to the 1/3 apical of the mesial and distal roots of tooth 47 which resembled a fracture line. The fracture line also appears to have reached the pulp. In addition, there is a well-defined radiolucent appearance with an irregular shape along the root from the buccal to lingual alveolar crest and accompanied by a decrease in the alveolar crest. The fracture that occurred in this case was from the enamel to the apical and involved the pulp, thus the radiodiagnosis on tooth 47 was a complicated crown root fracture with lateral periodontal cyst.&#x0D; Conclusion: CBCT can be used to help identify tooth fractures by obtaining a more accurate and useful value in differentiating conditions associated with fractures. CBCT provides data on the size and length of the fracture line and the size of the lesion.

Assessment of Mandibular Molar Root Morphology Using Cone‑Beam Computed Tomography in Periodontitis Patients From Eastern Province: A Cross-Sectional Study

BackgroundThe aim of this study was to assess the root morphology of mandibular molar teeth using cone‑beam computed tomography (CBCT) in patients with periodontal disease.MethodsIn total, 88 patients were included in this study (70 patients with periodontitis and 18 patients with non-periodontitis). This cross-sectional study involved CBCT images taken for patients who visited the dental clinic of Imam Abdulrahman Bin Faisal University (IAU) from January 2019 to March 2021. The following data were analyzed on the mandibular molars: root length, number of root canals, root trunk, distance between roots, accessory canals in the furcation area (ACF), bone loss, and furcation involvement.ResultsThe mesial root was longer than the distal root in the mandibular molars of periodontitis and non-periodontitis patients. A statistically significant difference was observed between non-periodontitis and periodontitis patients regarding the number of mesial root canals of the mandibular first molar; 70% had two root canals in non-periodontitis patients, compared with 86.1% in periodontitis patients (p = 0.04). First molars of non-periodontitis patients had significantly longer root trunks than periodontitis patients (4.65 ± 0.90 compared with 4.09 ± 1.02, p = 0.007). There was a statistically significant difference in bone loss between non-periodontitis and periodontitis patients (0% and 25% for first molars, and 2.8% and 23.6% for second molars, respectively). Accessory furcation canals were 2.9 % in second molars and 7.1 % in first molars in periodontitis patients, which were higher compared with non-periodontitis patients.ConclusionsThe first molar showed a longer root trunk in non-periodontitis patients than in periodontitis patients. The mean mesial and distal root lengths were also greater in the first than the second molar. Accessory canals in the furcation area were more observed in first molars than in second molars in periodontitis patients compared with non-periodontitis patients.

Three-dimensional inlay-guided endodontics applied in variant root canals: A case report and review of literature

BACKGROUNDRoot canal retreatment is common after root canal therapy in clinical situations. Especially, completing the retreatment of variant root canals can be challenging. This is particularly true for the molars located at the end of the dental arch. However, advancements in digital dental diagnosis and treatment techniques can solve these problems. Here, we describe a case of a maxillary second molar with a variant distobuccal root canal treated via a novel “inlay-guided endodontics” technique based on improved computer-generated programs. CASE SUMMARYA 63-year-old man complained of a defect in the maxillary left second molar. The tooth, diagnosed with post-treatment endodontic disease, was initially treated by conventional methods, which were ineffective. Our “inlay-guided endodontics” technique was subsequently adopted, with the establishment of a precise integrated three-dimensional (3D) plate model of cone-beam computed tomography data and a digital impression of the dentition. An optimal root canal approach was generated for the “virtual file” in the 3D model. The plate data were imported into a 3D printer and printed. With the help of the guide plate, the file was accurately placed into the cervical third of the distal root canal. The root canal and prosthodontic treatments successfully proceeded subsequently. CONCLUSIONOur newly developed inlay guide plates may facilitate individualized and minimally invasive root canal treatment.

Effect of RaCe, ProTaper, and V-Taper rotary systems on dentinal crack formation during endodontic treatment: An in vitro study.

Background. Prevention of dentinal crack formation is of utmost importance in endodontic treatment. This study aimed to evaluate the effect of RaCe, ProTaper, and V-Taper rotary systems on dentinal crack formation in three root regions during endodontic treatment. Methods. Seventy human mandibular first molars were selected randomly, and their distal roots were used. Ten samples were assigned to the control group, and sixty samples were assigned to three groups (n=20). Each group was prepared with RaCe, ProTaper, or V-Taper rotary files according to the manufacturers’ instructions. A stereomicroscope was used to view cracks at ×40 magnification. Friedman’s, chi-squared, and Kruskal-Wallis tests were used for statistical analysis of data (P < 0.05). Results. A comparison of the three rotary systems did not reveal any significant differences in the number of cracks between the three root thirds evaluated (P > 0.05). A comparison of the number of cracks in the coronal, middle, and apical thirds in each rotary system showed that the number of cracks in the middle third was fewer than that in the two other thirds only in the V-Taper group (P < 0.05), with no significant differences in the ProTaper and RaCe groups between the different root regions (P > 0.05). Conclusion. The application of RaCe, ProTaper, and V-Taper rotary files resulted in a similar rate of crack formation in endodontic treatment. V-Taper files created the minimum number of cracks in the middle third.

The C-shaped root canal systems in mandibular second molars in an Emirati population

Our study aimed to describe the root and canal morphology of mandibular second molars in Emirati population and to study the prevalence and types of morphological change in C-shaped canal configuration along the root length in an effort to describe C-shaped molars as a unit. Cone beam computed tomography (CBCT) scans of Emirati patients were analyzed in multiple plans and root and canal configuration of mandibular second molars were evaluated. Moreover, specific types of morphological change in C-shaped canal configuration along root length were studied and reconstructed using 3D reconstruction software. A total of 508 mandibular second molars were evaluated. Among the non-C-shaped mandibular second molars, two separate roots were the most prevalent root morphology (78.3%). The mesial root's most common root canal configuration was Vertucci Type II (46.5%), and in the distal root, Vertucci Type I (90.5%). The prevalence of C-shaped mandibular second molars was 17.9% and was significantly prevalent (P < 0.001) in females. Specific types of morphological change in C-shaped molars along the root length were observed and described for the first time, in which the most common types of morphological change were C1-C2-C3d (18%), C1-C3c-C3d (15.4%), C4-C3c-C3d (7.7%), and C3c-C3c-C3d (7.7%). This study showed wide variations in the root and canal morphology in mandibular second molars in Emirati population with a relatively high prevalence of C-shaped canal configuration (17.9%). Moreover, specific types of morphological change in C-shaped configuration were detected and described for the first time in this population.

Impact of Mesioangular Mandibular Impacted 3rd Molar on Peridontal Health of Adjacent Tooth

Objective: The aim of this study is to determine the impact of mesioangular mandibular 3rd molar impaction on periodontal health of adjacent tooth in patients. Study Design: Retrospective/observational study Place and Duration: Department of Oral &amp; Maxillofacial Surgery, MMDC Multan, during from Oct 2020 to September 2021. Methods: Total of seventy patients of both genders was presented in this study. Detailed demographic data of enrolled cases age, sex, body mass index, symptoms and complications were recorded after taking informed written consent. All the patients had mesioangular impactions of mandibular third molars. The impaction depth, relationship with ramus, and angulation of 70 IMTMs and their association with 2nd molar distal caries and root resorption, pathological states, and closeness to the mandibular canal were assessed on panoramic radiographs. Pell and Gregory classification was used to determine position of impacted third molar. The odds ratio (OR) and 95% confidence interval (CI) of IMTM's position on the related complications (credible interval for Bayesian models). Statistical significance was defined as a two-tailed p-value 0.05. SPSS 24.0 version was used to analyze complete data. Results: There were 42 (60%) males and 28 (40%) females with mean BMI 23.13±6.46 kg/m2. Most of patients 31 (44.3%) were aged between 20-35 years. Mean attachment level was 3.03±2.34 and probing depth was 3.34±3.35. Caries, pain and swelling were the most common symptoms found among cases. Distal second molar root caries 21 (30%) and pocket formation 17(24.3%) were the most common pathologies. As per histological findings periapical inflammation was majority found in 37 (52.9%) cases followed by dental follicle in 19 (27.1%) and cyst in 11 (15.7%). Conclusion: In this study, we found that the impacted mandibular third molar was most linked with distal second molar root caries and the creation of a pocket between the impacted tooth and the second molar tooth. The most common pathology associated with the impacted molar was distal second molar root caries and the creation of a pocket between the affected tooth and the second molar. Keywords: Mesioangular, Impacted mandibular third molar, Pathology, Complication

Impact of the Mesioangular Mandibular on the Peridontal Health of Adjacent Tooth by the Third Molar

Objective: The purpose of this study is to assess the impact of mesioangular mandibular 3rd molar impaction on the periodontal health of neighbouring teeth in patients. Study Design: Dental College HITEC-IMS Taxilla/Gulraiz Dental Clinic Quaid Avenue Main Road, Gulraiz 3, Rawalpindi. Jan 2021-Aug 2021 Place and Duration: Methods: Total of ninety patients of both genders was presented in this study. After receiving informed written consent, detailed demographic information about the recruited cases was collected, including age, gender, body mass index, symptoms, and complications. All of the patients experienced mesioangular third molar impactions on their mandibular teeth. A total of 90 IMTMs were evaluated using panoramic radiographs to determine their impaction depth, relationship with the ramus, and angulation, as well as their association with 2nd molar distal caries and root resorption, pathological states, and proximity to the mandibular canal. The position of the impacted third molar was determined using the Pell and Gregory categorization system. The odds ratio (OR) and 95 percent confidence interval (CI) of IMTM's position on the associated problems are shown in the table below (credible interval for Bayesian models). P-values with two-tailed confidence intervals of less than 0.05 were considered statistically significant. SPSS 27.0 version was used to analyze complete data. Results: There were 55 (61.1%) males and 35 (38.9%) females with mean BMI 24.61±5.22 kg/m2. Most of patients 41 (45.6%) were aged between 20-35 years. Mean attachment level was 2.99±4.74 and probing depth was 3.78±4.61. Caries, pain, and swelling were the most often reported symptoms, according to our research. The most common diseases were distal second molar root caries, which accounted for 30 (33.3%) of all cases, and pocket development, which accounted for 21 (23.3%). According to histological findings, periapical inflammation was the most common finding in 46 (51.1%) of the cases, followed by dental follicle in 24 (26.7%), cyst in 16 (17.8%), and other malignancies in 4 (4.4%) cases. Conclusion: According to the findings of this study, the impacted mandibular third molar was most closely associated with distal second molar root caries and the formation of a pocket between the impacted tooth and the second molar tooth in the lower jaw. Most common pathology linked with the impacted molar was distal second molar root caries and the formation of a pocket between the affected tooth and the second molar. Keywords: Mesioangular, Impacted mandibular third molar, Pathology, Complication

Worldwide Assessment of the Mandibular First Molar Second Distal Root and Root Canal: A Cross-sectional Study with Meta-analysis

IntroductionThis study assessed the prevalence of radix entomolaris and 2 canals at the distal aspect of mandibular first molars among different geographic regions by means of cone-beam computed tomographic imaging. MethodsPrecalibrated observers from 23 worldwide geographic locations followed a standardized screening protocol to assess 5750 cone-beam computed tomographic images of mandibular first molars (250 per region), gathering demographic data and recording the presence of radix entomolaris and a second canal at the distal aspect of teeth. Intra- and interrater reliability tests were conducted and comparisons among groups were performed using proportions and odds ratio forest plots. The significance level was set at 5%. ResultsThe results of intra- and interrater tests were above 0.79. The prevalence of radix entomolaris varied from 0.9% in Venezuela (95% confidence interval [CI], 0%–1.9%) to 22.4% in China (95% CI, 17.2%–27.6%). Regarding the proportion of a second distal canal, it ranged from 16.4% in Venezuela (95% CI, 11.8%–21.0%) to 60.0% in Egypt (95% CI, 53.9%–66.1%). The East Asia subgroup was associated with a significantly higher prevalence of an extra distolingual root, whereas the American subgroup, the American native ethnic group, and elderly patients were linked to significantly lower percentages of a second canal at the distal aspect of teeth. No significant differences were noted between male or female patients. ConclusionsThe overall worldwide prevalence rates of radix entomolaris and a second canal at the distal aspect of the mandibular first molar were 5.6% and 36.9%, respectively. The East Asia geographic region and Asian ethnic group had a higher prevalence of a second distal root.

Miniscrew insertion sites of infrazygomatic crest and mandibular buccal shelf in different vertical craniofacial patterns: A cone-beam computed tomography study.

ObjectiveTo identify optimal areas for the insertion of extra-alveolar miniscrews into the infrazygomatic crest (IZC) and mandibular buccal shelf (MBS), using cone beam computed tomography (CBCT) imaging in patients with different craniofacial patterns.MethodsCBCT reconstructions of untreated individuals were used to evaluate the IZC and MBS areas. The participants were divided into three groups, based on the craniofacial pattern, namely, brachyfacial (n = 15; mean age, 23.3 years), mesofacial (n = 15; mean age, 19.24 years), and dolichofacial (n = 15; mean age, 17.79 years). In the IZC, the evaluated areas were at 11, 13, and 15 mm above the buccal cusp tips of the right and left first molars. In the MBS, the evaluated areas were at the projections of the first molars’ distal roots and second molars’ mesial and distal roots, at a 4- and 8-mm distance from the cementoenamel junction. Intergroup comparisons were performed with analysis of variance and the Tukey test.ResultsThere was no statistically significant difference in the IZC bone thickness among the groups. For MBS bone availability, some comparisons revealed no difference; meanwhile, other comparisons revealed increased MBS bone thickness in the brachyfacial (first molars distal roots) and dolichofacial (second molars mesial and distal roots) patterns.ConclusionsThere was no significant difference in the IZC bone thickness among the groups. The facial skeletal pattern may affect the availability of ideal bone thickness for the insertion of extra-alveolar miniscrews in the MBS region; however, this variability is unlikely to be clinically meaningful.

Do we pay for maxillary protraction? Evaluation of the effects of Alt-RAMEC protocol and face mask treatment on root development.

To evaluate root development of pediatric patients treated with Alt-RAMEC + Face mask therapy. The 19 subjects (9 girls, 10 boys; mean age: 8.6 ± 1.1years) treated with Alt-RAMEC and a Petit-type face mask were included to the study. The cone-beam tomography (CBCT) records of these patients were used to quantify the root length. The root length measurements of 456 permanent teeth (maxillary-mandibular incisors, canines, premolars, and first molars) were performed at the beginning of the treatment (T0), after the Alt-RAMEC protocol (T1), and at the end of the face mask treatment (T2) using Planmeca Romexis software. Tooth length values increased significantly in the maxillary teeth except the central incisors, left lateral incisor, the palatal root of the right first molar, and distal and palatinal roots of the left first molar (p < 0.05). Mandibular teeth also showed significant increase in the root length except mandibular central incisors and the distal root of left first molar (p < 0.05). The change in tooth lengths from T0 to T1 showed positive delta values. The comparison of the change in tooth lengths after the Alt-RAMEC protocol and after the face mask therapy showed that ∆T2-T1 was statistically significantly higher compared with ∆T1-T0 (p < 0.05). Alt-RAMEC + Face mask therapy seem not to inhibit root development of maxillary and mandibular teeth in the mixed dentition. These findings suggest that early Alt-RAMEC + Face mask interventions have not played a negative role in root development. However, further studies involving a control group need to be performed.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine.

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine.

Nerve Root Sparing En Bloc Resection of Sacral Chondrosarcoma: Technical Note and Review of the Literature.

Total en bloc sacrectomy provides the best long-term local control for large primary bony sacral tumors, but often requires lumbosacral nerve root sacrifice leading to loss of ambulation and/or bowel, bladder, and/or sexual dysfunction. Nerve-sparing techniques may be an option for some patients that avoid these outcomes and accordingly improve postoperative quality of life. To describe the technique for a posterior-only en bloc hemisacrectomy with maximal nerve root preservation and to summarize the available literature. A 38-yr-old woman with a 7.7×5.4×4.5 cm biopsy-proven grade 2 chondrosarcoma involving the left L5-S2 posterior elements underwent a posterior-only left hemisacrectomy tri-rod L3-pelvis fusion. A systematic review of the English literature was also conducted to identify other descriptions of high sacrectomy with distal sacral nerve root preservation. Computer-aided navigation facilitated an extracapsular resection that allowed preservation of the left-sided L5 and S3-Co roots. Negative margins were achieved and postoperatively the patient retained ambulation and good bowel/bladder function. Imaging at 9-mo follow-up showed no evidence of recurrence. The systematic review identified 4 prior publications describing 6 total patients who underwent nerve-sparing sacral resection. Enneking-appropriate resection was only obtained in 1 case though. Here we describe a technique for distal sacral nerve root preservation during en bloc hemisacrectomy for a primary sacral tumor. Few prior descriptions exist, and the present technique may help to reduce the neurological morbidity of sacral tumor surgery.

Guided Endodontics in Root Canals with Complex Access: Two Case Reports

This article reported two clinical cases in which the guided endodontics was used to perform the access to the root canals. The first case presents a 40-year-old female with a history of pain related to the left maxillary canine. After radiographic examination, the presence of severe calcification up to the apical third of the root canal, associated with a periapical radiolucency, was noted. In the second case, an 85-year-old male was referred to our service with pain upon palpation, at the right mandibular first molar. The radiographic images revealed the presence of endodontic treatment and a fiberglass post in the distal root canal, which was associated with extrusion of the filling material and a periapical lesion. The 3D-guides were planned based on cone beam computed tomography and intraoral digital scanning, which were aligned using a specific software. Therefore, implant drills could be guided up to the root canal length required for each case. In the first case, a surgical root canal was created and the patient was free of signs and symptoms after the treatment was completed. In the second case, it was observed that the fiber post was worn by the drill, allowing free access to the filling material. It was possible to perform the endodontic reintervention in a more predictable way and in less time. In both cases, the use of the guided endodontics allowed the preservation of a large part of the dental structure. The procedures were performed faster, without the occurrence of fractures and perforations.

Influence of apical preparation size and final irrigation protocol on the debridement of oval root canals.

This study assessed the influence of apical preparation size and final irrigation protocol on the debridement of the apical third of oval root canals of mandibular molars. Seventy-seven distal roots were divided into 7 groups (n = 11): Control: without instrumentation or irrigation; Group 30CI: ProTaper Next (up to size 30; PTN) + conventional irrigation (CI); Group 30UAI: PTN + ultrasonically activated irrigation (UAI); Group 30XPF: PTN + XP-endo Finisher (XPF); Group 40CI: PTN + ProDesign Logic (up to size 40; PDL) + CI; Group 40UAI: PTN + PDL + UAI; and Group 40XPF: PTN + PDL + XPF. The total volume of irrigating solutions used per root canal in all the experimental groups was 33 mL of 2.5% sodium hypochlorite (NaOCl) and 6 mL of 17% ethylenediaminetetraacetic acid (EDTA). After specimen processing and histological analysis under a digital microscope (100x), the percentages of untouched canal walls (UCW) and remaining debris (RD) were assessed using Image J software. A descriptive and exploratory analysis was conducted, indicating that the data failed to meet the assumptions of an analysis of variance. Therefore, generalized linear models were used to assess the effects of the different instrumentation and irrigation protocols, as well as the interaction among them, on the percentage of UCW and RD. No significant difference was found among the irrigation protocols regarding the percentage of UCW, irrespective of apical preparation size (p>0.05). However, UCW and RD were significantly lower in groups 40CI, 40UAI and 40XPF than in groups 30CI, 30UAI and 30XPF (p<0.05). The percentage of RD was significantly lower in the UAI and XPF groups than in the CI groups, irrespective of apical preparation size (p<0.05). The difference between preparation sizes 30 and 40, with respect to RD, was higher when CI was used (p<0.05). In conclusion, instrumentation up to apical preparation size 40 resulted in lower percentages of UCW and RD than up to apical preparation size 30. Use of UAI or XPF resulted in lower percentages of RD than CI.