Removal Of Filling Material Research Articles

Evaluation of apically extruded debris during root canal filling material removal in teeth with external apical root resorption: a comparison of different obturation techniques

BackgroundRoot canal retreatment is necessary when initial treatment fails. Nickel-titanium systems help remove filling materials; however, some methods can cause canal content extrusion, resulting in inflammation and delayed healing. This study aimed to examine the impact of different preparation techniques and endodontic file systems on apical debris volume to limit material dispersion to periradicular tissues.MethodsNinety extracted maxillary incisors were evaluated. Simulated apical root resorption was created by removing the apical 2 mm of the root. The teeth were divided into two groups: one filled with a single cone and the other with cold lateral compaction (CLC). Each group was further divided into three subgroups (n = 15 each): Subgroup 1 used Reciproc R25 for removal and R50 for final preparation; Subgroup 2 used ProTaper Universal Retreatment (PTUR) files D1, D2, and D3 for removal and ProTaper Next X5 for finalization; and Subgroup 3 used VDW.Rotate Retreatment (VDW.RotateR) for removal and VDW.Rotate 50.04 for completion. Debris from retreatment was collected in pre-weighed tubes to determine the amount. The apical extrusion data underwent a two-way analysis of variance.ResultsThe Reciproc group had a mean extruded debris weight of 0.54 ± 0.24 mg, higher than the PTUR (0.28 ± 0.15 mg) and VDW.RotateR (0.39 ± 0.29 mg) groups (p < 0.05). The single-cone technique (SCT) resulted in a mean debris weight of 0.34 ± 0.23 mg, lower than the CLC technique, which had a mean of 0.46 ± 0.27 mg (p < 0.05). SCT had a shorter retreatment duration (111.12 ± 33.46 s) compared to CLC (176.26 ± 52.26 s) (p < 0.05).ConclusionThe Reciproc file system and the CLC obturation technique resulted in greater apical debris extrusion than the other methods. SCT was quicker than CLC. The Reciproc groups are more susceptible to apex extrusion during retreatment.

Effect of the timing of primary endodontic treatment and dosage of radiation therapy on the filling material removal.

This study investigated the effect of the timing of primary endodontic treatment and dosage of radiotherapy on the remaining filling material (RFM) during endodontic reintervention. 60 single-rooted human mandibular premolars were distributed into five groups (n = 12), according to the timing and dosage of radiation (55Gy or 70Gy): NegativeCG-non-irradiated teeth; Endo-pre-RT55/70-obturation before irradiation (55Gy or 70Gy); Endo-post-RT55/70-obturation and reintervention after irradiation (55Gy or 70Gy). Roots were cleaved and analysed under stereomicroscope and Scanning Electron Microscope to quantify (%) the RFM. Experimental groups had a significantly greater amount (p < 0.05) of RFM in the middle and apical thirds than the control group, except for Endo-pre-RT55 in the middle third (p < 0.0001). The apical third had greater amount of RFM (p < 0.05). Radiation therapy, before and after primary endodontic treatment, increased the amount of RFM, regardless of the dose delivered. When necessary, reintervention preferably must be performed before radiation therapy.

The Efficacy of Different Retreatment Protocols in the Removal of Root Canal Filling Materials from Oval Root Canal (An In-vitro Study)

The Efficacy of Different Retreatment Protocols in the Removal of Root Canal Filling Materials from Oval Root Canal (An In-vitro Study)

Optimizing Non-surgical Endodontic Retreatment: A 3D CBCT Quantification of Root Canal Bioceramic Filling Material Removal

Optimizing Non-surgical Endodontic Retreatment: A 3D CBCT Quantification of Root Canal Bioceramic Filling Material Removal

Do Ultraconservative Access Cavities Hinder Endodontic Reintervention in Mandibular Incisors? A Laboratory Investigation.

This study assessed the influence of the type of endodontic access cavity on endodontic reintervention. Twenty mandibular central incisors were distributed into two groups (n = 10): TradAC group-traditional access cavities and UltraAC.Inc group-ultraconservative access cavities. After endodontic access, the root canals were prepared and obturated by the single cone technique. The filling material was removed with the Reciproc R25 instrument, followed by reinstrumentation with the R40 instrument. Images acquisition of each root canal hemisection was performed in a stereomicroscope to quantify the amount of remaining filling material. The amount of remaining filling material attached to the root canal walls was expressed in square millimeter (mm2). Data were statistically analyzed (one-way ANOVA and post hoc Student's t-tests). There was no statistically significant difference between TradAC and UltraAC.Inc groups (p > 0.05). None of the tested endodontics' access showed root canal walls completely free of filling material. Ultraconservative access cavities in mandibular incisors had no negative impact on the filling material removal.

Influence of sealer and supplementary approach on filling material removal during endodontic retreatment.

Both root canal sealer-based and supplementary protocols may influence removal of filling material during endodontic retreatment. Mesial root canals of extracted mandibular molars were prepared using HyFlex EDM 25/.08, and filled with a calcium silicate sealer (Bio-C Sealer), or an epoxy resin (AH Plus), using the single cone technique (n = 12). Retreatment was performed using ProDesign Logic (PDL) RT and PDL 35/.05. The specimens were randomly divided into two experimental groups (n = 12), and the sealers were distributed similarly. A supplementary protocol was performed with PDL 50/.01 or XP-endo Finisher. Root canal transportation and volume, in addition to the remaining filling material percentage were evaluated using high-resolution (5 µm voxel size) micro-CT. Statistical analysis was performed using t-tests (α = 0.05). Root canals filled with AH Plus presented high residual filling material (p < 0.05). Both protocols decreased residual volume of filling material in the apical third (p < 0.05). PDL 50/.01 increased the apical root canal volume (p < 0.05). No difference was observed between the systems regarding canal transportation (p > 0.05). In conclusion, AH Plus is more difficult to remove from the apical third than Bio-C Sealer. PDL 50/.01 and XP-endo Finisher enabled greater removal of filling materials in the apical third, in the retreatment of curved root canals, without promoting apical transport.

Efficacy of Multiple versus Single NiTi Rotary Systems for Removal of Root Canal Filling Material During Root Canal Retreatment (A Comparative in-vitro study)

Efficacy of Multiple versus Single NiTi Rotary Systems for Removal of Root Canal Filling Material During Root Canal Retreatment (A Comparative in-vitro study)

Endodontic retreatment of premolar with an impediment

Background: Root canal treatment can fail due to several causes. One of them is root canal calcifications. Purpose: To explain root canal retreatment technique in premolar with calcification. Case(s): A 65 years old female patient came to universitas airlangga dental hospital with a chief complaint of pain on tooth number 34 and 35. Tooth number 34 and 35 had an old restoration with secondary caries. Both teeth did not respond to vitality test. Both teeth were tender on percussion and bite test. Surrounding soft tissue was normal. Radiograph image reveals inadequate root canal obturations on both teeth and a periapical lesion on tooth 35. Case Management: Old restoration and root canal filling material was removed, then root canal retreatment was performed. Subsequently the tooth was restored with fiber post and zirconia crown. Discussion: old restoration has to be removed gently in order to prevent further damage to tooth structure. Root canal filling material can be removed with heated instruments, solvent, and rotary instruments. After root canal filling material removal, the remaining root canals need to be thoroughly shaped, cleaned, and sealed. Conclusion: root canal retreatment on premolar with an impediment can be successfully performed with appropriate instruments, materials, and technique.

In vitro evaluation of filling material removal and apical debris extrusion after retreatment using Reciproc blue, Hyflex EDM and ProTaper retreatment files

ObjectivesTo evaluate the amount of remaining filing material and apical debris extrusion after retreatment using Reciproc Blue, Hyflex EDM and ProTaper Retreatment Files.Materials and methodsThirty-six extracted permanent mandibular first molars with moderately curved mesial roots were selected. Mesiobuccal canals were prepared using the ProTaper Next system up to size X2 and filled using gutta-percha and Adseal sealer via cold lateral compaction. Teeth were randomly divided into three equal groups (n = 12): Group 1: Reciproc Blue (RB)(VDW, Germany), Group 2: Hyflex EDM (HEDM)(Coltene/Whaledent, Switzerland), Group 3: ProTaper Universal Retreatment file system + ProTaper Next file system (PTUR + PTN)( Dentsply Maillefer, Switzerland). Eppendorf tubes were used to collect the apically extruded debris. Cone-beam computed tomographic scans were taken prior to and after retreatment and the volume of remaining filling material was assessed at the coronal, middle and apical levels. Statistical analysis was performed using the Kruskal–Wallis test, Friedman's test and Wilcoxon Sign Rank test. Significance level was set at p value 0.05.ResultsThere were no statistically significant differences among the three groups in the reduction of the volume of the filling material or in the amount of apically extruded debris.ConclusionAll the tested filing systems showed similar efficacy in removing the filling material, however, none of them could achieve its complete removal. Apical extrusion of debris occurred with all the systems used with no significant difference between the three groups.

Intracanal removal and apical extrusion of filling material after retreatment using rotary or reciprocating instruments: A new approach using human cadavers.

This study compared intracanal removal of filling as well as the frequency and volume of extruded material after retreatment with either HyFlex or Reciproc instruments in mandibular teeth from cadavers. The root canals of 14 pairs of contralateral single-rooted teeth in mandibles of cadavers were instrumented with Reciproc R40 and filled using lateral compaction. The mandibles were scanned in a micro-computed tomographic (micro-CT) device before and after retreatment procedures. The contralateral teeth were assigned to two groups (n = 14) according to the retreatment protocol using either HyFlex or Reciproc instrument systems. In the HyFlex group, the HyFlex Remover instrument was worked 3 mm short of the working length (WL), followed by HyFlex CM 40.04 and 50.04 at the WL. In the Reciproc group, the R50 instrument was worked up at the coronal two thirds, followed by two more cycles until the WL was reached. Pre- and post-operative micro-CT images were analysed for extrusion and intracanal removal of filling material. After retreatment, extrusion of filling material occurred in 11 (78%) and 14 (100%) teeth from HyFlex and Reciproc groups respectively (p > .05). A similar volume of extruded material was observed after retreatment with both systems (p > .05). A significant decrease in the intracanal filling volume was verified after retreatment with both tested systems (p < .05). However, residual filling material was found in all root canals, regardless of the system. The amount of filling material removed (HyFlex = 80.8%; Reciproc = 65.9%) and the operation time was similar between systems (p > .05). A high frequency of filling material extrusion was observed after retreatment with the two systems in a cadaver model, with no significant difference between them. Both protocols obtained similar efficacy in filling material removal procedures, although none completely cleaned the canals.

Effectiveness of different supplementary protocols for remaining filling material removal in endodontic reintervention: an integrative review.

The aim of this study was to perform an integrative review to identify the most effective supplementary protocols used after filling material (FM) removal and root canal reinstrumentation, during endodontic reintervention. The literature search was performed on the electronic databases PubMed and Latin American and Caribbean Health Sciences Literature (LILACS), using a combination of specific scientific descriptors. Selection criteria accepted articles published in English, Spanish and Portuguese languages, up to August 2021, involving in vitro and ex vivo studies. After applying the eligibility criteria, 46 articles were included for qualitative analysis. The tool for qualitative analysis of quasi-experimental studies of the Joanna Briggs Institute was used to determine the risk of bias of the included articles. The selected articles provided important data regarding the following supplementary protocols: sonic and ultrasonic activation of the irrigating solution; the use of ultrasonic inserts, XP-endo system instruments, and photon-induced photoacoustic streaming for mechanical debridement; and new devices as GentleWave system, and the self-adjusting file. Overall, all supplementary protocols demonstrated efficacy in removing the remaining FM. The implementation of various supplementary protocols can effectively remove the remaining FM from the root canal walls, although complete removal is not always achieved. However, it was not possible to determine the most effective protocol. Conversely, their association can enhance remaining FM removal. Remaining FM attached to root canal walls hinders proper chemical-mechanical preparation during endodontic reintervention. Supplementary protocols optimize the remaining FM removal, enhancing cleaning and disinfection of root canal.

Modern supplementary strategies of filling material removal in non-surgical root canal retreatment

O retratamento não cirúrgico é atualmente a terapia mais afetada na Endodontia em termos de desfecho clínico. O presente estudo tem como objetivo avaliar estratégias modernas para abordagens complementares na remoção de material de obturador. Assim foi realizada uma revisão narrativa da literatura nas bases de dados PubMed. Cochrane Library e Web of Science com as seguintes palavras-chave em diferentes ordens: “root canal”, “filling material removal”, “non-surgical retreatment” e “supplementary”. Para o delineamento da seleção de estudos, após a triagem dos títulos, foi realizada a retirada das duplicatas e aplicados os critérios de inclusão, em seguida foi feita a análise dos resumos e, por fim, realizada a revisão dos textos completos para seleção final dos estudos. Pesquisas adicionais foram conduzidas manualmente sob demanda. Seis tipos de estratégias de limpeza foram identificados na literatura para abordagem complementar em retratamento não cirúrgico: ativação ultrassônica e sônica passiva, ativação ultrassônica ativa, instrumentos plásticos para agitação mecânica, instrumentos metálicos para agitação mecânica, ativação multissônica e ativação a laser. Aqueles abordados na literatura têm sido associados a desempenhos mais elevados de remoção de material de obturador em comparação com sistemas de instrumentação apenas. No entanto, nenhum deles foi capaz de remover completamente o material obturador dentro do sistema de canais radiculares. Estudos clínicos controlados e randomizados são necessários para entender a real influência dessas estratégias no retratamento não cirúrgico. Há uma discrepância notável entre o volume de estudos para cada estratégia, mais estudos são necessários em alguns sistemas já contemplados. Ainda existem sistemas de ativação das soluções irrigadoras não elucidados no retratamento não cirúrgico.

Innovative ex vivo exploration: A comparative study of novel approaches of root canal filling material removal efficiency.

Retention of the natural tooth without any symptoms in the oral cavity is one of the prime desires of endodontic treatment. Root canal therapy usually leads to failure when treatment is not up to the mark of acceptable standards. To address these deficiencies, non-surgical endodontic retreatment is the most accepted option with the success rate ranging from 65% to 83%. Forty-five single-rooted mandibular premolars with undeviated canals (as per Schneider's criteria) were obtained and divided further into three groups with 15 specimens along with resin-based sealer solvent in each group: Group 1 - Retreatment rotary file system, Group 2 - Ultrasonics, and Group 3 - Diode laser. Specimens were then evaluated under a stereomicroscope at ×10 after cutting in two halves followed by evaluation of the remaining filling material using Hulsmann and Bluhm criteria. Nonsurgical retreatment. The aim of the study was to evaluate and compare the efficacy of various retreatment techniques for the elimination of root canal filling material. The sample size was determined using the formula n = (Zα/2)2 s2/d2. The design of the study is in vitro experimental study. A sum of 45 single-rooted extracted human permanent mandibular premolars were included in this study. All teeth were biomechanically prepared and obturated followed by decoronating the samples. All specimens were randomly divided into 3 groups comprising 15 specimens along with solvent based on the technique for the filling material elimination from the root canal, i.e. Group I: retreatment rotary files, Group II: ultrasonics, and Group III: diode laser. The Tukey's post hoc tests and one-way analysis of variance were used for comparison of the study parameters among the groups. Results revealed that ultrasonics showed the least amount of remaining filling material within the root canal which had a significant difference from other groups, i.e. retreatment rotary files and diode laser. Ultrasonics with a resin-based sealer solvent can be considered a preferred option for nonsurgical retreatment. However, none of the groups shows complete elimination of filling material inside the root canal system.

Effectiveness of D-RaCe, SP1 and R-Endo Rotary Systems for Root Canal Filling Material Removal from the Human Mandibular Molars: A Micro-CT Study

Effectiveness of D-RaCe, SP1 and R-Endo Rotary Systems for Root Canal Filling Material Removal from the Human Mandibular Molars: A Micro-CT Study

Removal of the Previous Root Canal Filling Material for Retreatment: Implications and Techniques

Adequate removal of the previous filling material may be pivotal to a favorable outcome of root canal retreatment of teeth with post-treatment periodontitis in order to permit the access of irrigants and medicaments to persistent bacteria. However, even with recent technological advances, including the introduction of specially designed instruments, no technique has been shown to predictably promote complete filling removal. Supplementary approaches used after chemomechanical preparation, including the use of finishing instruments, ultrasonics and laser, have shown promising results in enhancing root canal cleaning and disinfection. This narrative review addresses the importance and implications of maximal filling removal during retreatment and discusses the effectiveness of different techniques and supplementary approaches used for this purpose.

Effect of Additional Apical Preparation on Retreatment of Curved Root Canals Filled with Different Sealers.

This study assessed the influence of additional apical preparation on material removal during retreatment of curved root canals filled with different sealers. Twelve mesial roots of mandibular molars with two separate canals and curvature between 25 and 35 degrees were selected. The working length was established 1-mm short of the apical foramen, and all the root canals were prepared using ProDesign R (PDR) 25/0.06. After preparation, the root canals were divided in two groups (n = 12) and filled by continuous wave condensation technique with NeoMTA Plus or AH Plus. All the root canals were retreated using rotary ProDesign Logic RT 25/0.08, reciprocating PDR 25/0.06 and apical preparation with PDR 35/0.05. Additional apical preparation was performed with ProDesign Logic (PDL) 50/0.01. The samples were scanned using a Skycan 1176 micro-computed tomography (micro-CT), voxel size 8.74 µm, before and after the retreatment procedures. Percentages of remaining filling material were evaluated. The data were submitted to paired and unpaired t-tests (α = 0.05). Percentage of remaining filling material was similar between the root canals filled with NeoMTA Plus or AH Plus sealer after retreatment using PDR 35/0.05, and after additional apical preparation using PDL 50/0.01 (p > 0.05). However, PDL 50/0.01 significantly decreased the percentage of remaining filling material in the apical third after the additional apical preparation for both sealers (p < 0.05). NeoMTA Plus or AH Plus did not influence the retreatment of curved root canals. ProDesign Logic 50/0.01 promoted greater filling material removal in the apical third.

Efficiency of Two Rotary Retreatment Systems with and without XP-Endo Finisher for the Removal of Root Filling Materials

Aims: To evaluate the volumetric amount of endodontic obturating materials remains after endodontic retreatment with and without complementary retreatment(XP-Endo Finisher) utilizing two retreatment rotary systems (R-Endo and EdgefileXR).Materials and Methods: Twenty human mandibular premolars with single straight root canals were prepared using a 2Shape endodontic rotary system with a file size of 25/0.04. Gutta-percha and T-Seal (Epoxy resin sealer) were used to obtain all the teeth using a single cone technique. Samples were then divided into two groups based on the retreatment system used (n=10). CBCT images of each sample were taken and analyzed in axial, coronal, and sagittal planes to determine the obturating material remnants after retreatment. Then, all samples retreated by two retreatment systems (R-Endo and EdgefileXR) were subjected to supplementary retreatment by the XP-Endo Finisher. Second CBCT evaluation were performed to determine the XP-Endp Finisher effect. The data were statistically analyzed using one-way ANOVA analysis of variance, independent t-test, and Duncan’s multiple analysis rang test. Results: EdgeFileXR and R-Endo were significantly different, EdgefileXR is more effective and XP-Endo Finisher improved removal of obturating materials in both groups. Conclusions: The retreatment system had a significant effect on the amount of endodontic obturating materials remnants, XP-Endo Finisher show a supplementary removal effect

Postoperative pain after endodontic reintervention: a randomized clinical trial

The present randomized clinical trial compared the prevalence and intensity of postoperative pain in cases of endodontic reintervention using manual or engine-driven reciprocating instruments. As secondary objectives, the analgesic intake and time required for the root canal filling removal and re-instrumentation were also evaluated. Forty-eight individuals with an endodontically treated single-rooted tooth diagnosed with asymptomatic apical periodontitis were included in the study. Patients were randomly assigned to two comparison groups (n=24/group): reintervention with stainless steel manual instruments or a nickel-titanium reciprocating system (Reciproc; VDW, Munich, Germany). The endodontic reintervention was performed in two sessions with a calcium hydroxide-based intracanal medication applied for 14 days before root canal obturation. Working time for the root canal filling removal and re-instrumentation was recorded with a digital stopwatch. After each visit, postoperative pain intensity was assessed at 12, 24, and 48 hours and seven days using the Numerical Rating Scale (NRS). The patients were also asked about analgesic intake. Data were analyzed using Pearson chi-square, T and Mann-Whitney U tests (α=0.05). No significant differences between groups were found regarding the prevalence and intensity of pain or the need for analgesic intake at any time point (P > 0.05). Working time was significantly shorter in the reciprocating group (18 versus 41 minutes). In conclusion, manual and reciprocating instruments achieved the same results in terms of prevalence and intensity of postoperative pain and analgesic intake. However, filling material removal and re-instrumentation of the root canals were more than twice as fast when using the reciprocating system.

Effectiveness of the REvision System and Sonic Irrigation in the Removal of Root Canal Filling Material from Oval Canals: An In Vitro Study.

This study aimed to evaluate the effectiveness of the Endostar REvision system (Poldent, Warsaw, Poland) in the removal of filling materials from oval root canals using sonic irrigation as an additional cleaning method. Thirty human-extracted mandibular premolars with oval canals were prepared using the ProTaper Universal system (Dentsply Maillefer, Ballaigues, Switzerland) up to instrument F1 (20/.07), and then filled by the continuous wave vertical compaction technique using pulp canal sealer EWT (Sybron Dental Specialties, Orange, CA, USA). The teeth were randomly divided into two groups (n = 15) according to the instrumentation system and the additional cleaning method, as follows: REvision (30/.08, 25/.06) with EQ-S sonic activation (Meta Biomed, Chungcheongbuk-do, Korea), REvision (30/.08, 25/.06) without additional activation. All specimens were sectioned longitudinally at 3 and 7 mm from the apex, and analyzed using digital microscopy (KEYENCE, Osaka, Japan) to measure the total area of the residual obturation materials, followed by SEM analysis. The data on the percentage of remaining filling material were analyzed by Kruskal–Wallis one-way Analysis of Variance on ranks. None of the retreatment protocols completely removed the filling material from the root canals (p > 0.05); the retreatment technique using sonic activation showed statistically less residual filling materials than the retreatment technique using irrigants without activation at the coronal third (p < 0.05), whilst no significant difference was found between both tested groups at the apical and middle thirds (p > 0.05). The REvision system showed promising results in the removal of filling materials from oval canals.

Comparative evaluation of different irrigating and irrigant activation system in removal of gutta-percha/sealer during retreatment: An in vitro Micro-CT study

BackgroundThe aim of the study was to compare the efficacy of different irrigation and irrigant activation system used as an adjuvant to retreatment rotary files in removal of gutta-percha and sealer from endodontic retreatment using Micro-CT. Method64 extracted permanent maxillary central incisor teeth with single canal, were collected and decoronated to standard length of 16 mm. Instrumentation was done using rotary files and obturation was performed using GuttaCore and AH plus sealer. After setting of sealer, initial removal of filling material was performed using ProTaper universal retreatment files (D1, D2, D3). All 64 sample were randomised into four groups (n = 16) Group1: Endodontic syringe irrigation, Group 2: Passive Ultasonic Irrigation (PUI), Group 3: EndoActivator, and Group 4: EndoVac. Micro-CT scanning was performed after obturation, initial removal of filling material by retreatment file and after using experimental protocols of each group, and volume of remaining filling material was calculated using Dolphin software. Statistical analysis performed with one-way ANOVA followed by Tukey's post hoc. ResultsA significant reduction in the volume of residual obturation material were found between each group. PUI was superior to the sonic (EndoActivator), negative pressure irrigation technique (EndoVac) and positive pressure irrigation at the coronal, middle third and apical third of the root canal. However, none of the supplementary techniques were able to completely remove the residual obturation material. ConclusionPUI and EndoActivator were found better in remaining filling material removal, demonstrating clinically useful as supplementary technique in removing remaining obturation material during endodontic retreatment.