Root Canal Obturation Research Articles

Ex-vivo evaluation of clinically-set hydraulic sealers used with different canal dryness protocols and obturation techniques: a randomized clinical trial

ObjectivesThis 2-part randomized parallel triple-blind clinical trial adopts a unique model assessing clinically-set hydraulic calcium silicate-based sealers (HCSBS) after different root canal dryness protocols and obturation techniques.MethodsFor the first phase of the study, 24 teeth scheduled for orthodontic extractions were allocated into four groups according to the canal dryness protocol and the obturation technique. G1 (CLC-AHP): cold lateral compaction (CLC) with AH Plus sealer, G2 (CLC-ES-SD): CLC with Endosequence (ES) after standard canal(s) dryness (SD); G3 (SC-ES-SD): matching single-cone (SC) with ES after SD; G4 (SC-ES-PD): as G3 but after partial canal(s) dryness (PD). Teeth were extracted after one month of clinical service and examined for intracanal voids by micro-CT (2D & 3D). For the 2nd phase, another 24 teeth were allocated into four groups according to the root canal dryness protocol and the HCSBS used (ES or CeraSeal (CeS)). Teeth were extracted after one month and sectioned vertically for energy dispersive X-ray (EDX)/scanning electron microscope (SEM) examination. One-way ANOVA with Games-Howell post-hoc test and Chi-square test with multiple z-tests were used for statistical analysis.ResultsSC-PD showed the highest percentage of voids (p < 0.05). MicroCT scans as well as EDX/SEM examination showed that PD resulted in significantly larger interfacial gaps (p < 0.001) with more hydration products at the sealer/dentin interface than SD.ConclusionsBoth tested dryness protocols allowed the hydration of HCSBS and the formation of hydration products, thus standard dryness is recommended to reduce the incidence of intracanal voids.Clinical relevanceWhen using the single-cone obturation technique, intentional root canal moisture negatively affects the performance of HCSBS.Protocol Registrationhttp://www.clinicaltrials.gov, ID: NCT05808062.

Clinical outcomes of nonsurgical root canal treatment using NeoSealer Flo and Endosequence BC Sealer: A retrospective analysis with short-term follow-up.

Sealers are an important component in root canal obturation to provide the seal of the root canal system. In recent years, there has been an increase in the use of hydraulic silicate sealers, commonly referred to as bioceramic sealers, due to their many advantageous properties. NeoSealer Flo (NS; Avalon Biomed USA, Houston TX) is a recently introduced premixed bioceramic sealer. There is limited evidence on its properties and clinical performance. Therefore, the purpose of this study was to evaluate the outcome of root canal treatment using NS in a sealer-based obturation technique. The records of patients in a private practice between 2017 and 2022 were analyzed to identify both initial and retreatment cases obturated with either EndoSequence BC sealer or NS using sealer-based obturation with a minimum of one-year follow-up. Treatment outcome between NS and BC was compared with chi-square test. Logistic regression was used to identify additional prognostic factors. Six hundred and eighty-seven teeth met the inclusion criteria for the study. The success rate of cases obturated with BC was 94.9% and 96.5% for the cases obturated with NS.No statistically significant differences were found between the two sealer types. Presence of a periapical radiolucency or periapical radiolucency > 5.00mm were statistically significant prognostic factors. Endodontic treatment using BC or NS with sealer-based obturation method is a viable treatment option. Root canal obturation with bioceramic sealers, such as NeoSealer Flo and Endosequence BC sealer, provide favorable clinical outcomes.

Analysis of errors in endodontic treatment according to cone-beam computed tomography

AIM. The aim of the study was to study the frequency of errors in endodontic treatment according to cone beam computed tomography.MATERIALS AND METHODS. 71 cone beam computed tomography (CBCT) scans of patients treated by random sampling who sought treatment and consultation in the period 2022–2023 were studied. 256 teeth previously subjected to endodontic treatment with the presence or absence of radiological signs of chronic apical periodontitis were examined. The assessment of the quality of root canal obturation and the features of the anatomical structure of teeth was carried out. The data of the «Ray RAYSCAN alpha 3D» cone beam computed tomograph were studied using the OnDemand3DDental program. The results were considered statistically significant at p&lt; 0.05.RESULTS. In 57.42% of cases, there were no signs of periapical pathology, and in 42.58%, foci of bone destruction in the periapical region were observed. Homogeneously, 58.59% of root canals were sealed to the apex. In 16.79% of cases, the removal of filling material outside the root canal was noted. 10.54% of teeth with insufficient root canal filling depth and 6.64% of teeth with a missing root canal were also identified.CONCLUSIONS. There is a decrease in the incidence of the most common errors of endodontic treatment. The method of cone beam computed tomography is important at the stage of diagnosis and planning of endodontic treatment to assess the features of the internal structure of the tooth.

Longitudinal tooth fracture indicating a questionable prognosis for an endodontist

Introduction and Objectives: Longitudinal fracture or vertical fracture of a tooth occurs at any level in the root and extends vertically. It has a high incidence of occurrence in the first molars. The most frequent sites to occur are the buccolingual surface and proximal surfaces of teeth. The etiology of fracture involves different factors in endodontically treated and non-endodontically treated teeth. Longitudinal fractures become the most challenging to diagnose and treat. This paper reviews these aspects of challenges and discusses the advantages and limitations of dental materials used for the treatment. Review Methods: PubMed and Google Scholar databases were searched for articles on longitudinal tooth fractures between 2007 and 2022. The 16 current articles were selected. Brief Description of the State of Knowledge: As per the review of the literature, longitudinal fracture of the tooth is the most common fracture to occur due to excessive forces on the root canal-treated tooth. This occurs in endodontically treated teeth due to long-term application of calcium hydroxide, cracks caused during root canal preparation extended by the pressure of root canal obturation, and in non-endodontically treated teeth due to cyclic and heavy masticatory stress, and habitual chewing of hard food especially in males. Summary: Functional and esthetic outcomes following longitudinal fracture treatment are important considerations in the case of anterior teeth. Longitudinal fracture or vertical fracture of a tooth occurs mostly in the first molars. It is crucial to identify and manage actors for good prognosis, as restoration at a time can reduce fracture extension prevent microleakage.

Evaluation of root canal obturation in permanent teeth

Evaluation of root canal obturation in permanent teeth

Influence of occlusal surface reduction on post endodontic pain following instrumentation and obturation: A randomized double blinded clinical study.

The purpose of this randomized clinical study was to investigate the influence of occlusal surface reduction on postendodontic pain. Sixty patients were included with a diagnosis of acute irreversible pulpitis and acute apical periodontitis and divided randomly into two groups. In the intervention group, occlusal surfaces were reduced and left intact in the control group. Postoperative pain was evaluated at the 6th, 12th, 24th, and 48th h after the root canal instrumentation and 6th and 12th h following obturation using visual analog scale. Data were evaluated using the Chi-square test, t-test, Friedman test, Mann-Whitney U-test, and Wilcoxon rank test. Postoperative pain levels in both groups were reduced significantly over the time period evaluated, however, between the two groups, there was no difference evident. Occlusal surface reduction did not influence the pain following root canal instrumentation and obturation.

Evaluation of the Quality of Root Canal Obturation Using Resin and Silicon-Based Sealers: A Randomized Clinical Trial

Evaluation of the Quality of Root Canal Obturation Using Resin and Silicon-Based Sealers: A Randomized Clinical Trial

Chitosan nanoparticles, Rose Bengal-chitosan activated photodynamic therapy as final irrigant on pushout bond strength, smear layer removal efficacy and antibacterial effectiveness against E.faecalis

AimImpact of final root canal disinfectants diode laser (DL), Rose Bengal photosensitizer (RBP), Chitosan Nanoparticles (CNPs), and CNPs modified RBP on Enterococcus faecalis (E.faecalis) survival rate, smear layer (SL) removal efficacy and push out bond strength (PBS) of resin sealer to the radicular dentin. Material and methodSingle rooted seventy-five human mandibular premolar teeth were sectioned at a level of cementoenamel (CEJ) and root canal treatment was performed using a ProTaper rotary instrument. To assess the antibacterial efficiency E.faecalis inoculation was performed using a pour plate method. The samples were arbitrarily allocated into five groups based on the final disinfectant received (n = 15) Group-1 (NaOCl+17 % EDTA), Group-2 (NaOCl+DL), Group-3 (NaOCl+CNPs), Group-4 (NaOCl+RBP activated by DL) and Group-5 (NaOCl+CNPs-RBP activated by DL). SEM analysis for SL removal was performed on five specimens from each group. Root canal obturation and sectioning were performed at cervical, middle, and apical levels. PBS and failure mode were analyzed using a universal testing machine (UTM) and stereomicroscope respectively. The data was subjected to analysis using one-way analysis of variance (ANOVA) and Tukey's post hoc test. ResultGroup 1 (NaOCl+17 % EDTA) (0.36 ± 0.01 CFU/mL) unveiled the maximum survival rate of tested bacteria. However, Group 5 (NaOCl+CNPs-RBP activated by DL) (0.11 ± 0.01 CFU/mL) displayed minimum survival of E.faecalis. The highest SL removal (1.44 ± 0.11) and bond integrity scores (12.23 ± 0.24 MPa) were recorded in the coronal section of Group 5 (NaOCl+ CNPs-RBP activated by DL) treated roots. However, the lowest removal of SL (3.15 ± 1.09) and PBS (7.24 ± 0.09 MPa) were recorded in Group 4 (NaOCl+RBP activated by DL) treated canals. CONCLUSIONCNPs-RBP activated by DL as the final irrigant provided satisfactory antibacterial activity, SL removal, and bond strength outcomes compared to other tested groups.

Clinical outcome of non-surgical root canal treatment using different sealers and techniques of obturation in 237 patients: A retrospective study

ObjectivesThe aim of this retrospective study was to compare the clinical results of two root canal sealers and three obturation techniques used for non-surgical root canal treatment.Materials and methodsA total of two hundred eighty-three root canal treated teeth in two hundred thirty-seven patients with minimum a 6-month follow-up was included for this study. The canals were filled with three different modes: 1) cold lateral condensation (CLC) and AH Plus Sealer; 2) continuous wave condensation technique (CWC) and AH Plus Sealer, and 3) sealer-based obturation technique (SBO) and AH Plus Bioceramic Sealer. The treatment outcome was analysed based on clinical signs and symptoms, and periapical radiograph (periapical index, PAI).ResultsThere were no significant differences in treatment outcome between various sealers and filling techniques applied. The sealer extrusion was found most frequently in the CWC group (60.67%), followed by SBO (59.21%) and CLC (21.19%) with statistically significant differences (p < .05). The initial diagnosis, previous treatment and sealer extrusion (p < .05) were prognostic factors that affected treatment outcome.ConclusionsBased on the findings of this study, neither the sealer type nor the filling technique affected the treatment success while preoperative diagnosis, previous treatment and sealer extrusion had significant effect on the outcome.Clinical relevanceA bioceramic sealant applied along with the single-cone technique might be considered as an alternative method in root canal obturation.

Effectiveness of therapy of complicated forms of dental caries using an Er,Cr:YSGG laser with a wavelength of 2780 nm

BACKGROUND: The use of laser technologies in the treatment of complicated forms of dental caries is promising in dentistry. However, the available literature does not fully cover the use of the Er,Cr:YSGG laser (wavelength: 2780 nm) in the treatment of purulent pulpitis and pulp necrosis. AIM: To determine the effectiveness of therapy for complicated forms of dental caries using an erbium–chromium laser with a wavelength of 2780 nm for biomechanical treatment of root canals. MATERIALS AND METHODS: Overall, 106 patients were examined and divided into three groups: group 1 (control), 15 patients whose treatment was performed using a generally accepted method; group 2, 50 patients who were treated with erbium–chromium laser radiation at the second visit, immediately before root canal obturation; and group 3, 41 patients who were treated in one visit and divided into two subgroups. In group 3-A (n=18), the root canal was irradiated with a laser with factory settings, and in group 3-B (n=23), the frequency and power of the laser were increased from 20 to 40 Hz and from 1.25 to 1.5 Watts, respectively. RESULTS: In group 1, 59 microorganisms from all 17 strains were seeded before the treatment of the root canal system of teeth with chlorine-containing disinfectants. Moreover, the proportion of seeded microorganisms in each strain was 6.6%–40% (average value: 23.1%). After treatment, the seeding rate of Streptococcus mitis decreased from 40% to 13%, Streptococcus intermedius from 20% to 6.6%, Enterococcus spp. from 33.3% to 13.3%, and Candida spp. from 33.3% to 20%. In group 2, after complex biomechanical treatment of root canals and the use of a hydrokinetic laser, none of the 17 strains sown before treatment were observed. The Candida spp. (5.5%) were not neutralized due to the use of a hydrokinetic laser with a wavelength of 2780 nm in the factory settings in group 3-A (power, 1.25 W; pulse frequency, 20 Hz; air, 10%; water, off). The combined use of the traditional protocol and hydrokinetic Er,Cr:YSGG laser in group 3B enabled complete elimination of microorganisms from those sown before treatment (p 0.001). CONCLUSION: Treatment of purulent pulpitis and pulp necrosis in one visit using a hydrokinetic Er,Cr:YSGG laser with a wavelength of 2780 nm with increased parameters (i.e., power, 1.5 W; frequency, 40 Hz; air, 35%; water, 25%) is recommended.

Pre-Sealing of Endodontic Access Cavities for the Preservation of Anterior Teeth Fracture Resistance.

Sodium hypochlorite solution (NaOCl) is an effective canal irrigant but interferes with the mechanical features of dentin and the bonding capability of adhesives when restoring endodontically treated teeth. This study evaluated whether access cavity resin sealing before using canal irrigant would augment the resistance of endodontically treated anterior teeth against fracture. Sixty maxillary incisors underwent endodontic treatment in five groups (n = 12). Irrigation with 5.25% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA) was performed in all groups except for Group 5. After root canal obturation, in Group 1, the access cavity was kept unrestored. In Group 2, immediate restoration after obturation was achieved. For Group 3, delayed restoration after 1 week was provided. In Group 4 (pre-sealed), before canal irrigation, the dentin surface of access cavities was sealed using self-adhesive composite resin (Vertise Flow) and then restored after obturation. In Group 5, which was saline irrigated, immediate restoration was performed. After storage and thermal cycling for 5000 cycles at 5°C-55°C with a dwell time of 15 s and a transfer time of 5 s, teeth were statically loaded by a universal testing machine until a fracture occurred. Data were collected as the fracture resistance (FR) and analyzed using the one-way analysis of variance and Tukey's tests. FR significantly differed between all groups (p < 0.001). The lowest FR was recorded in the unrestored group (284 ± 86 N), which was not statistically different from the immediately restored group (p = 0.065). The pre-sealed group exhibited the highest FR value (810 ± 127 N, p ≤ 0.02 vs. other groups). The FR of the saline-irrigated and delayed restored groups was almost similar (p = 0.13). NaOCl/EDTA irrigation resulted in an adverse effect on FR. Delayed restoration could reduce this adverse effect. Access cavity pre-sealing with flowable composites led to a higher FR than conventional methods and may be considered an effective step during treatment procedures.

Comparative evaluation of postoperative pain after root canal obturation using resin-based sealer (AH plus) and bioceramic sealer (IROOT SP) in adult mandibular molars: A double blinded randomized controlled trial

ABSTRACT Aim: The aim of this randomized clinical trial was to compare the occurrence and intensity of postoperative pain following root canal obturation using a bioceramic (IROOT SP, Innovative BioCeramix, Inc.,) and a resin-based endodontic sealer (AH plus) using visual analog scale (VAS). Methods: A total of 40 subjects with chronic irreversible pulpitis needing root canal treatment were included in this double blinded randomized clinical trial. Randomization was done using manually generated sealed envelopes. According to the sealers used, the patients were divided into 2 groups where in Group 1 (n = 20): AH plus sealer and Group 2 (n = 20): Bioceramic sealer. Postoperative pain was assessed using VAS scale. Mann–Whitney U test was used for statistical analysis. Results: The occurrence of postoperative pain was similar in both groups. Postoperative pain intensity decreased in both the groups after 48 h. No statistically significant difference was found in the occurrence of postoperative in either group (P &gt; 0.05). Conclusion: AH Plus and bioceramic sealer perform similarly in terms of the occurrence and intensity of postoperative pain with no significant difference. The average pain levels and number of rescue medication taken were similar in both the groups.

Comparative evaluation of Postoperative Pain following Ultrasonic activation and Root Canal Obturation with Bioceramic Sealers versus Epoxy-Resin in Partially Edentulous Patients Rehabilitated with Tooth-Supported Overdentures : RCT

Comparative evaluation of Postoperative Pain following Ultrasonic activation and Root Canal Obturation with Bioceramic Sealers versus Epoxy-Resin in Partially Edentulous Patients Rehabilitated with Tooth-Supported Overdentures : RCT

Comparing Warm and Cold Gutta-Percha Techniques for Root Canal Filling: An In Vitro Study

ABSTRACT Background: Gutta-percha is commonly used in endodontic therapy for obturating root canals after cleaning and shaping procedures. Warm and cold gutta-percha techniques are two common methods employed for obturation, each with its own advantages and limitations. Materials and Methods: Twenty extracted human teeth with single-rooted canals were selected and divided into two groups: warm gutta-percha obturation and cold gutta-percha obturation. In the warm gutta-percha group, gutta-percha was heated to a predetermined temperature using a warm gutta-percha heating device and injected into the root canal using a heated carrier. In the cold gutta-percha group, gutta-percha was applied directly to the root canal without prior heating. Root canal obturation quality was assessed using radiographic imaging to evaluate the presence of voids, completeness of obturation, and adaptation to the canal walls. Micro-computed tomography (micro-CT) analysis was also performed to quantify the volume of obturating material and assess the three-dimensional distribution of gutta-percha within the root canal space. Results: Both warm and cold gutta-percha techniques demonstrated effective obturation of root canals, with comparable outcomes in terms of void formation, completeness of obturation, and adaptation to canal walls. However, micro-CT analysis revealed differences in the volume and distribution of gutta-percha within the root canal space. Warm gutta-percha obturation exhibited more uniform distribution of gutta-percha material and higher volumetric filling compared to cold gutta-percha obturation. Additionally, the warm gutta-percha technique demonstrated superior flowability and adaptation to irregularities within the root canal system. Conclusion: In this in vitro study, warm gutta-percha obturation demonstrated advantages over cold gutta-percha obturation in terms of volumetric filling, distribution within the root canal space, and adaptation to canal irregularities.

The Effect of The Ultraconservative Access Cavity on The Homogeneity of Root Canal Obturation

The Effect of The Ultraconservative Access Cavity on The Homogeneity of Root Canal Obturation

Effect of root canal obturation using resin and bio-ceramic sealers on reinforcement of endodontically treated teeth.

Effect of root canal obturation using resin and bio-ceramic sealers on reinforcement of endodontically treated teeth.

Evaluation of the Sealing Ability of Various Root Canal Obturation Techniques in Permanent Molars: An In vitro Study.

Achieving a reliable seal in root canal obturation is essential for the success of endodontic treatment. Despite the availability of multiple techniques, the comparative sealing abilities of these methods remain a topic of investigation, particularly in permanent molars. This in vitro study involved 60 extracted permanent molars, divided randomly into three groups: Group A (lateral compaction), Group B (thermoplasticized gutta-percha), and Group C (single cone). After instrumentation and obturation, the sealing ability was assessed using a dye penetration method. Arbitrary values were assigned to quantify the extent of dye penetration. The mean dye penetration values were as follows: Group B (thermoplasticized gutta-percha) had the lowest penetration (2.1 ± 0.3 mm), followed by Group A (lateral compaction) (3.5 ± 0.4 mm), and Group C (single cone) exhibited the highest penetration (5.2 ± 0.6 mm). In this study, thermoplasticized gutta-percha demonstrated superior sealing ability compared to lateral compaction and single cone techniques in permanent molars. These findings underscore the importance of selecting an effective obturation technique to ensure optimal seal integrity in root canal therapy.

Exploring Undergraduate Students' Perspectives on Endodontic Treatment: A Cross-Sectional Study in Makkah.

Background Students at two universities in Saudi Arabia found endodontics or root canal treatment (RCT) difficult due to challenges in the procedures. Until now, there has been no evidence that Umm Al-Qura University students face difficulties when performing RCT. Therefore, this study aims to explore students' perceptions of the critical steps in RCT. Methods A survey was conducted among 146 dental students at Umm Al-Qura University, Makkah, Saudi Arabia to assess their perceptions and challenges during RCT. Demographic information was collected in the first section, while the second section focused on identifying difficulties encountered during endodontic treatment stages. All participants provided signed electronic consent, and the study was approved by the university's institutional review board. Chi-squared tests were used to analyze the results. Results In a survey of 123 students, 94 (76.2%) found the endodontic specialty acceptable compared to other dental specialties (P < 0.001). Eighty-eight (71.5%) found RCT on the molars difficult (P < 0.001). Most students, 104 (84.6%), chose to have more clinical training to improve their clinical endodontic skills, and 77 (62.6%) chose to increase the number of instructors per student in the clinic (P < 0.05). Difficulties in performing RCT on premolars and during root canal obturation were statistically correlated with the academic year of the student (P < 0.05). Conclusion Dental students often struggle when performing RCT on molars. Some difficulties during RCT are correlated with the academic year of the student. Finally, from the students' perspective, improving endodontic skills involves providing better clinical training opportunities and increasing instructor-to-student ratios.

Optical microscopy evaluation of root canal filling removal by beginner operators in posterior teeth.

This study analyzed the effectiveness of root canal filling removal in lower molars performed by beginner operators using optical microscopy. A total of 55 mandibular first and second molars with mesial roots exhibiting an average curvature of 10-20° were selected based on preoperative radiographs. Instrumentation was done with ProTaper Gold (Dentsply Sirona) up to F2 (25/.08), using 2ml of 2.5% NaOCl irrigation solution after each file. Root canal obturation was performed using gutta-percha points with cold lateral condensation and Sealapex (Kerr Dental). Coronal fillings were made with composite resin and stored in distilled water for two years. Removal of the root canal fillings was performed with AF Retreatment Rotary (AFRR) and AF Blue R3 (AFBR3) (Fanta Dental Materials) under reciprocating motion with 2.5% NaOCl irrigation. Cross-sections of the coronal, middle, and apical thirds were analyzed at 40x magnification using a STEINDORFF POL microscope with a digital camera. Image analysis was conducted using Image J software, version 1.54, to determine the efficiency of root canal filling removal by percentage. Statistical analysis via one-way ANOVA revealed significant differences between distal and mesial roots (P < 0.05). Specifically, for mesial roots, the removal efficiency was 70.65% in the coronal third, 54.66% in the middle third, and 21.32% in the apical third. Significant difficulties were noted due to fractured files, calcifications, and debris accumulation in the isthmuses. The study concluded that the protocol using Fanta files demonstrated significant differences in removal efficiency correlated with root curvature, compounded by the inexperience of beginner operators. The findings highlight the challenges faced by novice practitioners in achieving effective root canal filling removal.

In Vitro Cone Beam CT Analysis of the Efficacy of Three Supplementary Steps In the Removal of Obturation Material in Endodontic Retreatment.

To evaluate and compare the efficacy of XP-endo Finisher R (FKG Dentaire, Le Locle, Neuchatel, Switzerland), EDDY (VDW Dental, Munich, Germany), and passive ultrasonic irrigation (PUI) as supplementary steps following the D-RaCe retreatment file system (FKG Dentaire) in the removal of root canal obturation material using cone beam CT. A total of 45 two-rooted permanent maxillary first premolars were selected. Following access preparation, cleaning, and shaping with Hero Shaper (Micro Mega,Besançon, BFC, France)rotary file up to 25/04%, thermoplasticized obturation was performed with TotalFill BC sealer (FKG Dentaire) and gutta-percha. The specimens were subjected to routine retreatment using the D-RaCe retreatment file system. Cone beam computed tomography (CBCT) and volumetric analysis were performed before and after this procedure. The samples were divided into group A (XP-endo Finisher R: n=15), group B (EDDY: n=15), and group C (PUI: n=15). Finally, a third CBCT was taken and a volumetric analysis was done. Statistical analysis was done using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). The lowest mean residual volume of obturation material was seen with XP-endo Finisher R (1.6 mm3), followed by PUI (1.7 mm3). The EDDY showed the least efficiency in complete debridement of the root canals (3.6 mm3). This difference in values was statistically significant. The XP-endo Finisher R and PUI showed superior performance than EDDY in the removal of remaining obturation material from the root canal system after retreatment with the D-RaCe retreatment file system. However, none of the systems were able to completely remove the root canal obturation materials.