Dentin Removal Research Articles

Effect of Cavity Designs on Instrumentation, Obturation, and Fracture Resistance of Mandibular First Premolars With Vertucci V Canal.

This study aimed to assess the effect of cavity designs on instrumentation, obturation and fracture resistance for mandibular first premolars with Vertucci V canal. Mandibular first premolars with Vertucci V canal were scanned with microcomputed tomography. A total of 20 teeth with moderately curved canal were prepared with conservative endodontic cavity (CEC/M) or traditional endodontic cavity (TEC/M), and 30 with severely curved canal were prepared with CEC (CEC/S), modified CEC (MCEC/S) or TEC (TEC/S). CECs and MCEC were prepared using dynamic navigation systems. TECs were prepared freehand. Canals were prepared with WaveOne Gold, irrigated and then obturated with single-cone technique using iRoot SP sealer and WaveOne Gold gutta-percha cones. After restoration, all teeth were submitted to fracture resistance test. Removal of pericervical dentin, volume of dentin removal, area of untouched canal wall, accumulated hard tissue debris, centering ability, voids in canal filling, and load at fracture were evaluated. MCEC and CEC groups preserved more pericervical dentin above the alveolar bone level and more fracture resistance than TEC groups. At 3mm from apical foramen, lower centering ability in mesiodistal direction was found in buccal canal of CEC/S group. More voids were found in the lingual canal for CEC/S compared with TEC/S (P<.05). CEC and MCEC prepared with dynamic navigation system could preserve more dentin above the alveolar bone and fracture resistance than TEC prepared freehand. For teeth with severely curved V canal, MCEC showed similar ability in instrumentation and obturation as TEC.

Qualitative and quantitative assessment of solite RE black and HyFlex remover systems for endodontic retreatment - An in vitro nano-computed tomography analysis

Abstract Introduction: The successful outcome of endodontic retreatment heavily relies on the thorough removal of root canal filling materials. This study aimed to quantitatively and qualitatively assess the efficacy of various retreatment file systems using nano-computed tomography (nano-CT) imaging. Materials and Methods: Thirty recently extracted human mandibular molars with mesial roots having curvatures &lt;20° were chosen and sectioned to 16 mm in length. The root canals were prepared with the ProTaper Gold system up to size F2 and they were filled with gutta percha and AH Plus sealer. After obturation, all the samples were randomly assigned to two groups (n = 15 each) for retreatment: Group 1 utilized Solite RE Black retreatment files, while Group 2 employed Coltene HyFlex Remover files. Nano-CT imaging was employed to measure pre- and postoperative volumes of remaining filling material and remaining dentin thickness and the time taken for retreatment was measured in seconds. The obtained values were analyzed statistically (P &lt; 0.05). Results: Nano-CT analysis showed a significant difference (P &lt; 0.05) in the volume of remaining filling material between the Solite RE Black and Coltene HyFlex Remover groups. However, no significant difference was observed in the time required for gutta-percha removal. The Solite RE Black system showed comparatively less dentin removal than the Coltene HyFlex Remover system (P &lt; 0.05). Conclusion: The Solite RE Black retreatment file system demonstrated promising efficacy in removing filling material while preserving dentin integrity compared to the Coltene HyFlex Remover system. These findings support its potential as an effective tool for endodontic retreatment, emphasizing the need for further clinical trials to validate its performance across various clinical scenarios.

Accuracy of laser fluorescence in assessment of various caries removal techniques: an in vitro validation

BackgroundThis study aimed to evaluate the accuracy of laser fluorescence (LF) readings in detection of caries removal by various techniques (CRTs).MethodsA hundred and eighty extracted human molar teeth included in the study which were scored 3, 4, and 5 according to ICDAS. Each score group was randomly assigned to 4 subgroups according to CRT including ceramic bur (Group A), carbide bur (Group B), carbide bur with alumina abrasion (Group C), and carbide bur with bioactive glass (BAG) abrasion (Group D) (n = 15 for each group). A LF device (DIAGNOdent Pen, Kavo) was used to determine remaining caries. Histological sections of the teeth were examined under a dental operating microscope for validation. The data were analyzed using Fisher Freeman Halton, Fisher’s Exact, Pearson Chi-Square, Bonferroni Adjusted Z tests, ROC analysis, Kappa statistic and Binary Logistic Regression(p < 0.05).ResultsHistological examination revealed no significant differences among the CRTs and ICDAS scores (p > 0.05 for each). However, a significant difference was found between histological assessment and LF in ICDAS 5 score, specifically between Group B and Group D (p = 0.022), regarding caries presence. LF readings demonstrated over 0.9 area under curve (AUC) value regardless of CRT, except for ICDAS-4 score, and Group D in ICDAS-5 score. Overall, the AUC of LF was found to be 0.880 for the 38 cut-off point (p < 0.001), indicating a high level of accuracy. The univariate and multiple models showed the tested CRTs had no effect on the caries presence (p > 0.050).ConclusionsThe CRTs examined in this study demonstrated similar efficacy in terms of caries removal. However, the application of bioactive glass on caries-affected dentin may lead to overestimations in the LF readings. Additionally, LF on the cavity floor may not be clinically suitable for teeth with ICDAS 4 scores.Clinical relevanceThe clinical determination of caries removal endpoint is based on a multifactorial decision. However, when selective removal of soft dentin is performed, especially with bioactive glass abrasion in deep caries lesions, higher cut-off points might be determined in laser fluorescence readings to decide further operative intervention.

Microtomographic Analysis of the Biomechanical Performance of Thermally Treated Instruments in Flattened and Curved Root Canals.

This study aimed to evaluate, using micro-computed tomography (microCT), the impact of various mechanized systems on the geometry of the root canal system (RCS) and dentin thickness in mandibular first molars. The hypothesis proposed that different systems would produce significant variations in RCS preparation. Mesial and distal canals of mandibular molars were selected and divided into five groups (n=10) based on the system used: 2Shape (25.06), Reciproc Blue (25.08), ProTaper Ultimate (25.08), ProTaper Next (25.06), and Univy New (25.06). Biomechanical preparation was performed following each manufacturer's instructions. MicroCT scans were conducted before and after preparation to assess three-dimensional parameters (volume, surface area, SMI, and prepared root canal walls) and two-dimensional parameters (area, perimeter, diameters, roundness, and transportation). ProTaper Ultimate exhibited the greatest volume increase in mesial canals (1.73 ± 0.19), while ProTaper Next demonstrated the highest increase in distal canals (1.95 ± 0.25). Furthermore, ProTaper Ultimate resulted in the greatest dentin removal and the largest post-preparation area. Reciproc Blue achieved the best results for roundess and had the lower unprepared walls (15.3 ± 6.97). All systems produced comparable outcomes, with ProTaper Ultimate yielding the greatest volume increase and dentin removal, indicating a less conservative preparation. Reciproc Blue provided optimal roundness and minimized unprepared root canal wall surfaces.

Efficacy of chemo-mechanical caries removal: a 24-month randomized trial.

Chemo-mechanical caries removal (CMCR) offers an alternative to conventional drilling for carious dentin removal, but limited evidence exists on its long-term effects on treating caries in primary teeth. The primary aims of this study were to compare CMCR to drilling in terms of restoration status and the presence of secondary caries after 24 months. A randomized, parallel-group, single-blinded, controlled trial was conducted in Thailand. Participants were children aged 7-8 years with occlusal caries in second primary molars, randomly assigned to CMCR with Papacarie® (n = 242) or drilling (n = 246). All cavities were restored using glass ionomer cement. Completeness of caries removal was evaluated clinically by two blinded dentists, and patients' discomfort was measured using a facial visual analogue scale. Restoration status and development of secondary caries were assessed every six months clinically and every 12 months radiographically over a 2-year period. Both groups achieved complete caries removal, but the CMCR took significantly longer than the drilling method (9 vs. 2.3 min, p < 0.001). Children in the CMCR group reported significantly lower discomfort during treatment (p < 0.001). At 24 months, ten (4.6%) restorations in the CMCR group failed, compared to three (1.2%) in the drilling group. Clinically, four restorations (CMCR = 2, control = 2) exhibited secondary caries at the margin, while nine restorations (CMCR = 8, control = 1) showed radiographic evidence of secondary caries beneath the restoration. However, neither clinical nor radiographic evaluations revealed statistically significant differences in treatment outcomes at the two-year mark. CMCR demonstrated comparable efficacy to conventional drilling for complete caries removal and restoration success at 24 months in primary teeth. Despite a longer chair time, it resulted in less discomfort during treatment. https://clinicaltrials.gov/study/NCT01641861, identifier: NCT01641861.

The Effect of Silver Nano-Irrigant and Erbium Chromium: YSGG Laser on the Smear Layer Removal and Microhardness of Root Canal Dentine "In Vitro Study"

The Effect of Silver Nano-Irrigant and Erbium Chromium: YSGG Laser on the Smear Layer Removal and Microhardness of Root Canal Dentine "In Vitro Study"

Efficient Retrieval of Separated Endodontic Instruments: A Case Series Using the TS Infinite Loop System in the Coronal, Middle Thirds

Instrument separation during endodontic treatment presents a significant challenge, often leading to compromised treatment outcomes. This case series focuses on the successful retrieval of separated instruments from the root canal system using the TS Infinite Loop System. Three clinical cases involving separated instruments in the mesiobuccal canals of mandibular molars are presented, demonstrating the procedural approach and techniques used for retrieval. A combination of ultrasonic troughing and the TS Infinite Loop System enabled precise removal of fractured instruments without unnecessary dentin removal or canal enlargement. This series highlights the efficacy, precision, and potential of the TS Infinite Loop System as a reliable tool for managing instrument retrieval in challenging clinical scenarios.

Management of Deep Caries Lesions: A Study among Dentists in the Private Sector of Casablanca, Morocco.

To find out which management methods are preferred by dentists in the private sector of Casablanca for a deep carious lesion or a pulp exposure during carious tissue removal in adult patients. A questionnaire consisting of 25 questions was sent to 300 randomly sampled dentists in Casablanca. Only specialists in conservative dentistry and endodontics and general practitioners were included. There were three clinical scenarios allowing to approach the therapy recommended by each practitioner according to the proposed pulp diagnosis, these three different scenarios were based on preoperative symptomatology: Healthy pulp, reversible pulpitis, and irreversible pulpitis. Data entry and analysis were carried out using Epi7 and the results were statistically analyzed. The survey was answered by 214 dentists,145 women and 69 men. Approximately 74.3% of the respondents always establish a pulp diagnosis before carious tissue removal. Approximately 56.54% use partial carious tissue removal techniques. During pulp exposure, 79.25% of the practitioners opted, respectively, for a direct pulp capping (DPC) in the case of healthy pulp and 46.7% in the case of reversible pulpitis, while no practitioner chose DPC in the case of irreversible pulpitis. In addition, 3.31, 27.83, and 4.23% opted for pulpotomy in cases of healthy pulp, reversible and irreversible pulpitis, respectively. Glass ionomer cement (GIC) and calcium hydroxide (CH) are the materials of choice for dentists in cases of partial caries removal. In the case of DPC, dentists use CH and Biodentine™ in particular. Partial carious tissue removal techniques are not adopted by the majority of dentists. When faced with irreversible pulpitis, most dentists (93.33%) go directly to endodontic treatment in the case of deep carious lesion without pulp exposure. While 204 dentists (95.33%) preferred root canal treatment (RCT) too in the case of deep carious lesion with pulp exposure. The use of bioactive materials should be encouraged in the management of deep caries lesions and pulp exposure, Biodentine™ and MTA were chosen by 96 of the practitioners. Traditionally, the treatment of deep caries has been destructive, with removal of all carious dentin; however, the promotion of biologically based minimally invasive treatment strategies has been recommended to selectively (partially) remove caries and reduce the risk of pulp exposure. How to cite this article: Laslami K, Kharroubi SE, Moudrif M, et al. Management of Deep Caries Lesions: A Study among Dentists in the Private Sector of Casablanca, Morocco. J Contemp Dent Pract 2024;25(8):751-757.

Comparative evaluation of different endodontic access cavity designs on canal transportation and centering ability using bondent platinum file system on mandibular molar – An in vitro cone-beam computed tomography study

ABSTRACT Aim: This study aimed to compare the effects of different endodontic access cavity designs on canal transportation (CT) and centering ability (CA) using the bondent platinum file system on mandibular molars, utilizing cone-beam computed tomography (CBCT). Methodology: Thirty extracted human permanent mandibular molars which fulfilled the inclusion criteria were divided into three groups, Group 1 (TEC): Traditional endodontic access cavity (control group), Group 2 (CEC): Conservative endodontic access cavity, and Group 3 (TrEC): Truss endodontic access cavity. The teeth were scanned using CBCT initially followed by random allocation into three groups. Root canals were prepared using Bondent platinum file system in mesiobuccal and mesiolingual canals using #25.06 file and in distal canal #30.06 file. Postpreparation, CBCT scans to assess CT and CA at 3 mm, 5 mm, and 7 mm from the apex. Data analysis was performed using a one-way analysis of variance and Tukey’s post hoc test. Results: Significant differences (P &lt; 0.01) in mean CT and CA were observed between Group 1 (TEC) and Groups 2 (CEC) and 3 (TrEC). Dentin removal was highest at 3 mm, followed by 5 mm and 7 mm. The distal canal showed the greatest dentin loss compared to other canals. Conclusion: Minimal access cavity designs (CEC and TrEC) demonstrated less CT and improved CA compared to the traditional access cavity design (TEC). Study limitations acknowledged that conservative access cavity designs result in less deviation (CT) and better centering of the prepared canals compared to the traditional approach (TEC). These results imply the potential benefits of adopting less invasive access cavity designs in endodontic practice to enhance treatment outcomes.

Shaping ability of HyFlex EDM and ProTaper Gold files with or without using glide path files: An in vitro study

Abstract Introduction: The necessity of using a glide path before the canal preparation is inconclusive. Therefore, this study aimed to assess the shaping ability of two rotary systems in the maxillary first molars’ first mesiobuccal canal (MB1), with or without employing the glide path files. Materials and Methods: The MB1 canals of 100 extracted molars were randomly prepared using either HyFlex EDM (HEDM) or ProTaper Gold (PTG) systems (n = 50 each). Half of the samples in each group were prepared using ProGlider (PG) or HyFlex EDM Glide (HEG). The cone-beam computed tomography scanning was conducted before and after the instrumentation. The canal transportation, centering ability, and remaining dentin thickness were evaluated and compared between the groups using the independent sample t-test and Mann–Whitney U-test (α =0.05). Results: Using HEDM compared to PTG led to greater centering ability at the sub-furcation area (P &lt; 0.05), lower canal transportation at 2 mm below furcation (P = 0.025), and more dentin removed at the middle area (P = 0.011). The systems’ centering ability and canal transportation were comparable when path files were used. Utilizing HEG with HEDM decreased dentin removal at 2 mm below furcation (P = 0.045) and middle area (P = 0.008). Canal preparation with HEDM-HEG caused less dentin removal at 2 mm below furcation than PTG-PG (P = 0.007). Conclusions: The HEDM system outperformed PTG regarding centering ability in the sub-furcation areas and canal transportation 2 mm below the furcation. However, HEDM showed more dentin removal in the middle region than PTG, which was resolved when HEG was used. Therefore, using PathFile with the HEDM system might be suggested.

Metallurgical influence of separated endodontic instruments on the retrieval capability of katana-sword-like ultrasonic tip under different lubricants: In vitro study

Abstract Introduction: Ultrasonic retrieval is a time-consuming procedure sacrificing considerable amounts of dentin. This study aimed to assess the retrieval capability of katana tip on different alloys under different lubricants regarding dentin thickness and retrieval time. Materials and Methods: Extracted premolars were used to reach 40 samples. The apical 4 mm of X2 ProTaper Next and A1 Neoniti instruments were fractured, and katana tip was utilized for retrieval, using ethylenediaminetetraacetic acid or olive oil as intracanal lubricants. Dentin thickness was assessed using cone-beam computed tomography, and the time of retrieval was recorded. Results: There was no significant difference in the retrieval capability among the groups. Different alloys and lubricants had no significant effect on dentin thickness. However, olive oil significantly reduced the retrieval time. Conclusion: Katana tip proved to be efficient enough to retrieve apically separated instruments in curved canals, with instrument’s metallurgical makeup presenting minimal effect on its capability. Katana tip and high-viscosity lubricants reduced the retrieval time, which might reduce the dentin removal amount.

Endodontic Microsurgery Using Dynamic Navigation and Trephine Burs

Objectives: The use of the surgical operating microscope, CBCT imagining, biocompatible filling materials and ultrasonic instruments have improved the success and predictability of apical surgery. Despite these advances, more accurate and precise techniques for creating osteotomies and root-resections (apicoectomies) have not been widely adopted. This study highlights how dynamic navigation systems (DNS) can help avoid unnecessary dentin removal and “mitigate iatrogenic errors” such as root perforation. Methods: A total of 56 root-end resections were planned and completed on two sets of identical TrueJaw Endosurg models (DE Labs, Santa Barbra, CA, USA). One set of maxillary and mandibular jaws were used for 28 preparations, performed with a DNS (X-Guide, X-Nav Technologies, Lansdale, PA, USA). A second set of maxillary and mandibular jaws were used for 28 preparations executed freehand (FH), with pre-op measurements taken from a CBCT scan (CS 9600; Carestream, Atlanta, GA, USA). A Mann-Whitney test was used to compare the accuracy of the two groups Results: The average preparation depth was 10.77 mm. For the DNS group the average angular deviation was 2.35 degrees. The average deviation at the terminal end of the preparations was 0.96 mm (global apical deviation). For the freehand group average angular deviation was 13.55 degrees and the average global apical deviation was 2.62 mm. Significant differences were identified between the DNS and FH groups for angular deviation (p&lt;0.05), apical non-depth deviation (p&lt;0.05) and between the Global apical deviation(p&lt;0.05). Conclusion: Dynamic navigation demonstrated superior accuracy and precision over freehand in the context of apical microsurgery preparations. This study provides further proof of concept for the application of DNS in Endodontics. Clinical significance: Apical surgery can be a daunting task for an endodontist. Surgical guides can make the procedure easier, but they take time and money to make. DNS virtual planning can be completed rapidly and may be altered mid-procedure. This inherent flexibility makes same-day guided apical surgeries practical and predictable.

Evaluation of the shaping ability of different rotary file systems in severely and abruptly curved root canals using cone beam computed tomography

BackgroundWhen selecting an instrument for canal preparation, it is important to consider several parameters that influence the shaping efficiency, including instrument design, metallurgy, and operating motion. This study aimed to evaluate the shaping ability of the ProTaper Next (PTN), WaveOne Gold (WOG), and XP-endo Rise Shaper (XPRS) rotary systems in severely and abruptly curved root canals using cone beam computed tomography (CBCT) and ImageJ software. Materials and MethodsForty-eight mesial root canals of the mandibular first molars were assigned equally to three groups: PTN, WOG, and XPRS. Using ImageJ software, CBCT images were acquired pre- and post-instrumentation to assess dentin removal, remaining dentin thickness (RDT), canal transportation, and centering ratio at the coronal, middle, and apical levels. Statistical analyses were conducted on all numerical data. ResultsAll rotary systems removed significantly more distocoronal dentin in the danger zone (DZ), than the mesiocoronal area. PTN removed significantly more dentin and caused less RDT than XPRS (p < 0.05). However, there were no significant differences between PTN-WOG and WOG-XPRS. In the DZ, the highest percentage of specimens with an RDT < 0.5 mm was observed when using PTN (50%), followed by WOG (31.3%), and XPRS (6.3%). Compared with PTN and WOG, XPRS demonstrated less coronal transportation. Among all rotary systems, there was no significant difference in apical transportation or centering ratio. ConclusionsBased on our observations, all rotary instruments exhibited a tendency to remove dentin in the DZ, but to different degrees. XPRS demonstrated better results in terms of coronal transportation and dentin thickness in the DZ. Comparable centering abilities and minimal apical transportation were demonstrated using all rotary instruments.

A Fluorescence-based Method to Reaccess Root Canals in Endodontically Treated Teeth: A Micro–Computed Tomography Tridimensional Assessment

IntroductionThe aim of this study was to evaluate the volume of dentin removal and the volume of remnants of restorative material after the removal of an esthetic restorative coronal set and cervical barrier in endodontically treated mandibular molars with the aid of different magnification methods using 3-dimensional (3D) micro–computed tomographic (micro-CT) morphometric analysis. MethodsA sample of 30 mandibular first molars (N = 30) was used. All teeth were endodontically treated, and the specimens were initially scanned using micro-CT imaging and reconstructed. The molars were filled by a single-cone technique, and immediately the material at the initial 2-mm cervical level was removed. Cervical barriers were confected using ionomer glass cement with fluorescein 0.1%, filling the 2 mm at the cervical level of the canals and an additional 2 mm as the base. The coronal restoration set was performed using esthetic resin composites. A simulated tooth aging process was performed with 20,000 thermocycling cycles. The sample was distributed into the following 3 groups (n = 10) for the removal of the restoration set and cervical barrier with diamond burs based on the magnification aid: no magnification aid (naked eye), operative microscope aid, and REVEAL device (Design for Vision Inc, Bohemia, NY) aid. After removal, the final 3D micro-CT scanning and reconstruction were conducted with the same parameters as the initial scanning, and superposition of the final and initial scanning was performed. Morphometric analysis was conducted using CTAn software (Bruker microCT, Kontich, Belgium) to assess the volume of remnant restorative material (mm³), the volume of dentin removal (mm³), and the direction and site of dentin removal. Data were analyzed using 1-Way analysis of variance (P < .05). ResultsThe REVEAL group showed better results regarding the volume of remnant material (3.17 ± 1.65) and the percentage of dentin removal (2.56 ± 1.34). The microscope group showed no statistical difference compared with the REVEAL group regarding dentin removal (3.30 ± 1.48) and was statistically similar to the naked eye group in the volume of remnant material (9.63 ± 4.33). The naked eye group showed the worst results for the volume of remnant material (7.60 ± 2.68) and the percentage of dentin removal (6.60 ± 3.70). ConclusionsThe use of fluorescence associated with magnification was the method that presented the best results, with lower percentages of dentin removal and smaller volumes of remaining restorative material. This is an innovative technology in endodontics that shows potential to overcome the challenge of reaccessing root canals in the context of endodontic retreatment.

Traditional Versus Advanced Pulp Capping Materials in Primary Teeth.

In situations where pulp degeneration and carious lesions may coexist, pulp therapy is a regularly employed method. Mineral trioxide aggregate, a material that is now utilized for indirect pulp treatment (IPT), is nontoxic and nonmutagenic. There is proof that the restoration margin can be sealed to manage the caries lesion. In terms of the clinical and radiological outcome, it has been demonstrated that IPT is more effective and secure than direct pulp capping and pulpotomy. The pulp capping treatment's goal is to protect the pulp from microorganisms as well as from thermal, electrical, chemical, and physical stimulation. There is evidence that suggests targeted caries clearance and composite restoration may stop caries lesions more effectively than full dentin removal. Various pulp capping materials that are available in the market were highlighted in this review, and the discussion of each material was expanded to demonstrate its clinical efficacy. Articles were specifically selected and discussed for the materials used for the IPT in the primary teeth as very few studies have been done so far in relation to this subject. A literature search in various libraries, including PubMed, Cochrane, ResearchGate, Scopus, ScienceDirect, and other libraries, was done for several available materials that have been used for the IPT procedure in primary dentition in the last 20 years.

Inverted Layering Technique as a Biomimetic Procedure in a Multidisciplinary Resolution of Discolored Teeth: A Case Report.

The objective of this work is to report a restorative approach with composite resin applied in reverse in the aesthetic resolution of darkened anterior teeth. A 27-year-old female patient presented with the main complaint of dissatisfaction with the aesthetics of her smile due to dental darkening, a result of childhood trauma, without painful symptoms, pathological clinical signs or change in care. In the intraoral examination, a darkening of teeth 11 and 21 was observed, which radiographically showed thickening of the periodontal ligament, with disharmonious configuration of the marginal gingiva. From the clinical and radiographic characteristics, we opted for periodontal intervention for recovery and gingival levelling, followed by endodontic intervention and aesthetic restorative restoration. The restorative step was carried out sequentially by internal tooth bleaching, removal of dentin still pigmented after bleaching and enamel preservation. Soon after, it was restored in an alternative way and layered using a technique called reverse, using strips of polyethylene fiber over the dentin resin. The technique preserved the remaining enamel with the maintenance of the original remaining guides, proving to be a viable conservative alternative since of the diagnosis to the restorative conclusion in view of the longitudinal confirmation of the restorative efficacy after 1 year.

Clinical conduct of dentists in the treatment of deep dental carious lesions

Different techniques are employed to contain the carious process: non-invasive, microinvasive, and invasive, and with restorative needs. Thus, it is essential that dentists are duly updated regarding scientific evidence and perform with skill and precision the techniques proposed as treatment, being aware of the consequences and risks, and aiming at the most conservative therapy. Objective: To identify the clinical practices for the treatment of deep carious lesions used by dental surgeons of the Family Health Strategy (FHS) program of a Brazilian city. Material and methods: This was a quantitative and cross-sectional study carried out with 43 dental surgeons from the FHS program in the city of Sobral, State of Ceará, Brazil, using a Google Forms online questionnaire, containing questions related to the clinical criteria used during caries removal, deep dentin caries removal techniques, lining materials, survival rate of some treatments, in addition to sociodemographic data and questions regarding professional qualification. Results: Among those interviewed, 62.8% were aged between 25 and 30 years. Most dentists (58.7%) considered that the cavity floor should be hard at the end of the carious dentin removal, which demonstrates the non[1]adherence to Selective Carious Tissue Removal (SCTR) protocols. Only 25.6% considered SCTR a treatment with a chance of success and a 2-year survival rate greater than 80%. More than half of the interviewees (51.2%) disagreed with the maintenance of carious tissue in the axial/pulp walls of deep cavities to preserve pulp vitality. More invasive treatments were preferred in a greater proportion by dentists who work exclusively in the public sector (66.7%) compared to those who also work in the private sector (17.6%) [p=0.002], with an evident need for cariology education workshops and more studies on the topic. Conclusion: The dentists who participated in the study showed little adherence to less invasive techniques in the treatment of deep carious lesions.

Cone Beam Computed Tomography Analysis of Post Space in Bifurcated Premolars Using ParaPost and Peeso Reamer Drills

Introduction Core buildups are usually maintained by the usage of posts. Even so, in curved and narrow canals, such as bifurcated premolars, excessive dentin removal during post-space preparation can result in a vertical root fracture or perforation. In order to preserve root canal dentin during post-space preparation of bifurcated premolars, this study examined and analyzed the effects of two widely used drills: Peeso Reamer (Dentsply Maillefer, Ballaigues, Switzerland) and ParaPost (Coltene/Whaledent, Inc., Altstätten, Switzerland). We also examined the risks associated with using Cone-beam Computed Tomography (CBCT). Methods Three operators with varying levels of experience treated a total of 72 removed bifurcated premolars, dividing them into equal groups. The rotary ProFile system (Dentsply Sirona, Charlotte, NC) was utilized for root canal treatments, and gutta-percha size #30/0.4 was used for obturation. Peeso Reamer #2 and ParaPost #1 were then used to prepare the palatal canals. CBCT was used to assess the total mean intracanal spaces of 3 mm, 5 mm, and 7 mm that were measured both preoperatively and postoperatively. To compare the mean dentin thickness within the canal area across all groups, we used analysis of variance testing. We detected complications, like deviations or perforations, using mesiodistal periapical radiographs. Results When utilizing the Peeso Reamer, the mean dentin thickness (0.749 mm) was slightly more than when using the ParaPost (0.736 mm) with p=0.16. There was no significant difference in the mean dentin thickness of the canal area between the Peeso Reamer and the ParaPost drills. The Pesso Reamer drill had fewer complications since it matched the canal configuration, while the Parapost drill removed somewhat more dentin in the canal area. Only seven teeth with minimum deviation from the center of the canal during preparation were produced by the Peeso Reamer drill (20% of teeth having deviation), whereas twenty-one teeth had deviations (72.2% of teeth) and eight had furcal perforations generated by the ParaPost. Conclusion Within the limitations of our study, the Pesso Reamer drill caused little more dentin removal than the ParaPost drill. However, the Peeso Reamer had fewer risks and was safer to use in bifurcated premolars. The ParaPost drill is not recommended in bifurcated premolars due to the high risks of deviation and perforation because they have narrow canals. The selection of an appropriate drill for post-space use in bifurcated premolars is essential for successful patient outcomes.

Management of Separated Endodontic Instrument in Mandibular Second Molar with Bypass Technique

One of the most common mishaps in root canal treatment is a separated endodontic instrument. Bypass technique is an effective alternative besides file retrieval while clinical conditions have lack of access and visibility. Other than, this technique gives a more conservative outcome because it prevents more dentin removal. The aim of this case report was to describe management of separated endodontic instruments in the mandibular second molar with bypass technique during endodontic treatment. A 3,5 mm F1 ProTaper Hand Use file was separated in the mesiobuccal canal of the mandibular second molar. Radiograph examination was taken to make sure the level of fragment. Bypass was performed with #10 until #25 K-File to pass the separated instrument through the gap between it and the root canal wall. Obturation has been done with gutta percha and resin-based sealer using cold lateral condensation technique. Direct restoration was chosen as final restoration after 6 days follow up. Bypass technique can be performed as management of separated instrument considering the risks involved fragment extrusion to apical region, secondary separated instrument, and conservative aspect.

The use of the autofluorescence diagnostics device for controlled сaries excavation

The modern standard in dentistry is minimally invasive treatment, as it allows you to preserve the viability of teeth.&#x0D; The purpose of this study was to evaluate the possibility of using an autofluorescence diagnostic device (AFS) to determine the end-points of the carious cavity preparation.&#x0D; Material and methods. The study was conducted on ten third molars extracted for medical reasons. Autofluorescence with AFS device and caries-marker were used to visualize infected carious dentin at different stages of cavity preparation.&#x0D; Results. The method showed effectiveness for differentiating affected and infected dentin. Sound dentin, dense carious dentin, and soft infected dentin was characterized with green, orange, and red fluorescence, respectively. The data obtained from caries markers do not always coincide with the probing indicators and the AFS device. For the FACE method with AFS device sensitivity, specifity, and overall diagnostic accuracy were 81.8%, 88.9%, and 85%, respectively. For the caries-marker sensitivity, specifity, and overall diagnostic accuracy were 90%, 77.8%, and 80%, respectively.&#x0D; Conclusions. The AFS device allows selective removal of infected dentin more carefully compared to caries-marker staining as fluorescence allows us to visualize infected dentin and to preserve demineralized (affected) dentin.