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Introduction Limited field of view cone-beam computed tomography (LFOV CBCT) is the primary imaging modality recommended for treatment planning before endodontic microsurgery (EMS). Persistent apical periodontitis, often treated with EMS, results in changes in the buccal cortical plate that may detrimentally impact prognosis. The accuracy of a preoperative LFOV CBCT to predict intraoperative findings is unclear. Methods Electronic health records (EHRs) of EMS performed at 2 endodontic offices between 2016 and 2018 were reviewed retrospectively. EHR data extracted were documented for surgical findings of intact buccal cortical plate, fenestration, dehiscence, and height of remaining buccal collar of bone. Two calibrated, independent reviewers evaluated presurgical LFOV CBCTs in the multiplanar paraxial and parasagittal planes at 2 different reconstructed viewing plane thicknesses. Reviewer findings were compared with EHR documentation. Data were analyzed by using χ2, logistic regression, and multivariable analysis. Significance was set at P Results Within the 125 EMS cases included in the study, the EHR prevalence of intact buccal cortical plate was 49%, dehiscence 7%, and fenestration 44%. The imaging predictive value, whether it was negative (NPV) or positive (PPV), was higher when predicting presence of buccal bone (PPV of intact buccal cortical plate = 86.5%; NPV of dehiscence = 96%; NPV of fenestration = 89%). Sensitivity and specificity ranged from 80%–90%. Accuracy in prediction was high for all variables, exceeding 80%. Accuracy was not significantly influenced by reconstructed viewing slice thickness, viewing plane, or reviewer. Conclusion Preoperative LFOV CBCT was highly discriminatory and accurately predicted intraoperative buccal cortical bone status, especially intact buccal cortical plate and fenestration.

Introduction Nonsteroidal anti-inflammatory drugs (NSAIDs) have been commonly used to treat endodontic postoperative pain. The purpose of this study was to address the following Population, Intervention, Comparator, Outcome, Timing, Study design and setting question: in patients with preoperative pain who undergo initial orthograde endodontic treatment, what is the comparative efficacy of NSAIDS compared with non-narcotic analgesics or placebo in reducing postoperative pain and the incidence of adverse events. Methods Ovid MEDLINE (1946–December 15, 2015), the Cochrane Database of Systematic Reviews (2005–December 15, 2015), and the Cochrane Central Register of Controlled Trials (to December 15, 2015) were searched using included drugs, indications, and study designs as search terms. Hand searches in texts were also conducted. Two independent reviewers assessed eligibility for inclusion, extracted data, and assessed quality using the risk of bias tool. L'Abbe plots were used for qualitative review. Where applicable, meta-analysis was conducted on the pooled effect size (ES). Results Two thousand two hundred eighty-four studies were identified through the database searches; 405 full-text articles were assessed. Fifteen articles met the inclusion criteria; qualitative analysis revealed all studies had a moderate to high risk of bias. Ibuprofen was the most studied NSAID. The L'Abbe plots showed that NSAIDS are effective at relieving postoperative endodontic pain overall. Meta-analysis showed that ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively (ES = 10.50, P = .037), and ibuprofen 600 mg + acetaminophen 1000 mg combination is more effective than placebo (ES = 34.89, P = .000) but not significantly different than ibuprofen (ES = 13.94, P = .317). Five studies reported patients experiencing adverse events such as drowsiness, dizziness, nausea, and emesis; 2 studies reported that patients experienced no adverse events. Conclusions A combination of ibuprofen 600 mg and acetaminophen 1000 mg is more effective than placebo but not significantly different than ibuprofen 600 mg at 6 hours postoperatively. Ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively; however, there are insufficient data to recommend the most effective NSAID, dose amount, or dose interval for the relief of postoperative endodontic pain of longer duration in patients with preoperative pain.

Introduction: The purpose of this study was to compare the accuracy of working length (WL) measurements by using the Root ZX II, Apex NRG XFR, and Mini Apex Locator with rotary nickel-titanium (NiTi) instruments. Methods: Twenty-eight teeth had their WLs determined with each electronic apex locator (EAL) by using 0.04 taper ProFiles sizes 40–20 in a crown-down technique until WL was reached. Four control teeth had their WL determined by using stainless steel hand files. The files were cemented at WL, and the teeth were extracted. The apical 4 mm of each root was shaved to the apical constriction, exposing the file. Photographs were taken under 15 and 30 magnification and projected at 360 and 720 for evaluation. Results: The accuracy of the Root ZX II, Apex NRG XFR, and Mini Apex Locator in locating the minor diameter within 0.5 mm was 50%, 46.43%, and 39.29%, respectively. There was no statistically significant difference between the EALs in locating the minor diameter. The determination of WL by using hand files in the control teeth was more accurate. Conclusions: The Root ZX II, Apex NRG XFR, and Mini Apex Locator used with rotary NiTi files were able to locate the apical constriction within 0.5 mm only 50% or less of the time. (J Endod 2009;35:962–965)

The purpose of this study was to compare the flow of GuttaFlow (Coltène/Whaledent Inc, Cuyahoga Falls, OH) and gutta-percha into lateral grooves and depressions in the apical 7 mm of the root canal system. A maxillary canine was used to fabricate a split-tooth model with depressions and lateral grooves placed in the canal walls at 1 mm, 3 mm, 5 mm, and 7 mm from the working length. The model was obturated with GuttaFlow or gutta-percha and Roth's 801 sealer (Roth International, Chicago, IL). Obturations with gutta-percha were performed by using warm vertical compaction with the System B plugger (Analytic Endodontics, Orange, CA) advanced to 5 mm, 4 mm, or 3 mm from the working length. All obturations with GuttaFlow showed extrusion of material beyond the apex. GuttaFlow completely obturated the grooves and depressions at all levels from the working length, and, at the 1-mm level, GuttaFlow flowed significantly better into grooves. GuttaFlow flowed better than gutta-percha into depressions at the 1-mm level when the System B plugger was inserted to 5 mm and 4 mm from the working length, but no significant differences were seen when the System B plugger was inserted to 3 mm from the working length. Gutta-percha flowed significantly better into grooves and depressions at the 1-mm level when the System B plugger was inserted 3 mm from the working length compared with 5 mm and 4 mm from working length.

The purpose of this study was to evaluate the hemostatic efficacy and systemic cardiovascular effects of CollaCote™ collagen sponges saturated with 2.25% racemic epinephrine during endodontic surgery. A total of 48 patients participated in the study. Patients received CollaCote-saline or CollaCote-epinephrine placed in the bony crypt, after which hemostatic efficacy was evaluated. Blood pressure and pulse rate was recorded before and after administration of the local anesthetic, after the application of the test solutions, and before the patient's dismissal. Results showed no significant difference in blood pressure or pulse rate between the experimental and control groups. In the CollaCote-saline group, five of six cases failed to achieve hemorrhage control. In the CollaCote-epinephrine group, 1 of 42 cases had no hemorrhage control. Two patients had slight but apparent intermittent bleeding. Complete hemostasis was achieved in 39 of 42 cases. In conclusion, the results suggest that CollaCote collagen sponges saturated with 2.25% racemic epinephrine provide excellent hemostasis with no evident changes in blood pressure or pulse rate.

The purpose of this study was to evaluate the effect of preparation taper using size #20 or size #40 ProFile GT files on the ability to introduce irrigant and remove debris from root canals. Forty-eight bilaterally matched pairs of extracted teeth were instrumented using .04-, .06-, .08-, and .10-tapered files with one tooth of each pair enlarged to size #20 and the other to size #40. The teeth were sectioned at 1 mm and 3 mm from the apex, and the amount of remaining debris was calculated as a percentage of the total lumen area. The following variables were evaluated: apical preparation size, preparation taper, total volume of irrigation, depth of irrigation needle penetration, and number of instrument changes needed to reach working length. Compared with the size #40 preparations, a significantly greater percentage of remaining debris was observed in the size #20 preparations at the 1-mm level for all tapers except the .10 taper group in which there was no significant difference (p = 0.982). There were no significant differences between any groups at 3 mm. Results suggest that debris is more effectively removed using .04, .06, and .08 ProFile GT instruments when the apical preparation size is larger (size #40) compared with size #20 apical preparations. When a taper of .10 can be produced at the apical extent of the canal, there is no difference in debris removal between the two preparations sizes.

The purpose of this study was to compare the accuracy of a two-frequency (Root ZX) and a five-frequency (Endo Analyzer Model 8005) electronic apex locator under clinical conditions. Thirty-two teeth planned for extraction were used. The coronal portion of each canal was flared using Gates Glidden drills and Orifice Shapers. The canals were irrigated with 2.6% sodium hypochlorite. A K-type file was used to determine a separate working length in each canal using the electronic apex locators. The teeth were extracted and the apical 4 mm of each root canal was exposed along the long axis of the tooth. Photographic slides of each canal were projected and the file position in relation to the minor diameter was determined by two investigators. The mean distance between the electronic apex locator working length and minor diameter was 1.03 mm for the Endo Analyzer and 0.19 mm for the Root ZX. A paired sample t test showed that the Endo Analyzer had significantly longer readings beyond the minor diameter than the Root ZX (p0.0001). The ability to locate the minor diameter (+/- 0.5 mm) was 90.7% for the Root ZX and 34.4% for the Endo Analyzer Model 8005.

The purpose of this in vivo study was to evaluate root-ends for cracks after root resection and again after ultrasonic root-end preparation in patients undergoing endodontic surgery. Endodontic surgery was performed on 25 roots from 20 patients. In vivo vinyl polysiloxane impressions were made after root resection and again after ultrasonic root-end preparations. Epoxy resin casts were made from the impressions and scanning electron micrographic examination of the root-end replicas was performed. There was no evidence of cracks after root resection. One incomplete canal crack was evident after ultrasonic root-end preparation.

The purpose of this study was to compare ultrasonic and high-speed-bur root-end preparations. Seventy-six roots from 29 bilaterally matched pairs of human teeth in cadavers were used in this study. In group 1 ultrasonic preparations were made in 38 roots and filled with amalgam. In group 2 high-speed bur preparations were made in 38 roots and filled with amalgam. The size of the bony crypt was measured and the teeth were extracted and radiographed mesial-distally and buccal-lingually. None of the root-end preparations resulted in root perforation. The mean mesial-distal minimum depth of ultrasonic and high-speed bur preparations were 2.11 mm and 1.39 mm, respectively. The mean buccal-lingual minimum depth of preparation was 2.51 mm for the ultrasonic and 2.05 mm for the high-speed bur preparations. The depth of the ultrasonic preparations was significantly greater for both measurements. A significantly greater bevel angle was associated with the bur preparations, 35.1 degrees versus 16.0 degrees for the ultrasonic preparations. The incidence of ultrasonic root-end preparations deviating from the uninstrumented canal spaces was found to be 2.6%. All bur root-end preparations were at an acute angle to the long axis of the root. The bony crypt size for bur preparations was significantly greater than that for ultrasonic preparations.

The purpose of this study was to evaluate gray mineral trioxide aggregate (MTA), white MTA, and Fuji II LC cement as coronal barriers to bacterial leakage. Seventy-eight, matched, human teeth were obturated with gutta-percha. In group I, 18 pairs received a 3-mm barrier of gray or white MTA. In group II, 18 pairs received a 3-mm barrier of gray MTA or Fuji cement. Three pairs were used as positive (obturated without barrier) and negative (covered with epoxy resin) controls. A dual-chamber leakage model utilizing salivary microbes was used for the evaluation. Leakage was recorded when turbidity was observed. All controls behaved as expected. In group I, three gray MTA and three white MTA samples leaked. In group II, one gray MTA and three Fuji samples leaked. There was no statistically significant difference in leakage between gray and white MTA or gray MTA and Fuji at 30, 60, or 90 days. Gray and white MTA or Fuji II can be recommended as a coronal barrier for up to 3 months.

Files of Greater Taper (GT) are rotary nickel-titanium files of three tapers (0.06, 0.08, 0.10) with file tips of sizes 20, 30, and 40. The purpose of this study was to compare in an in situ model the efficacy of root canal debridement in the apical 3 mm when instrumenting to a GT size 20 or a GT size 40 at working length. Twenty matched human cadaver teeth with 32 canals were decoronated at the cementoenamel junction and instrumented with rotary Files of GT to either GT size 20 or GT size 40. Sodium hypochlorite, EDTA, and RC Prep were chemical aids for debridement. The teeth were extracted; decalcified; sectioned at 0.5 mm, 1.5 mm, and 2.5 mm from the apex; and prepared for histologic examination and quantification of remaining debris. No differences were found between each level within each apex size group; however, the GT size 20 group left significantly more debris in the apical third compared with the GT size 40 group. A regression analysis showed that the apical third cleanliness could be predicted mainly by instrument size and to a lesser extent by the canal length. Irrigant volume, number of instrument changes, and depth of penetration of irrigation needle were not likely to explain differences in debridement.

The purpose of this study was to evaluate the efficacy of a handpiece-mounted irrigation device and compare it to irrigation with a syringe and needle in the apical 5 mm of the root canal system. Twenty matched pairs of extracted teeth were used. The only variable within each matched pair was the method of irrigation. A syringe and needle were used in group A and the handpiece-mounted system in group B. Sections 1, 3, and 5 mm from the working length were examined microscopically, and images of the slides were digitized. The percentage of canal space occupied by pulpal and dentinal debris was calculated to be 6% +/- 12.7% in group A, versus 3.8% +/- 7% in group B (p = 0.264). The percentages at each level were as follows: 1 mm from the working length, 14.1% +/- 19% for group A and 5% +/- 7.5% for group B; 3 mm from working length, 1.8% +/- 5.4% for group A and 3.9% +/- 6.9% for group B; and 5 mm from working length, 3.1% +/- 7.7% for group A and 2.6% +/- 7.3% for group B. In group A, there was significantly more debris in the 1-mm section than in the 3- or 5-mm sections. In group B, the differences between levels were not significant. There was no significant difference in the amount of debris remaining in the apical 5 mm of canals when comparing the handpiece-mounted irrigation device to irrigation with a syringe and needle. The average times for instrumentation in group A (needle irrigation) and group B (Quantec-E irrigation system) were 8.7 +/- 2.7 min and 6.5 +/- 1.9 min, respectively. Group B was associated with statistically significant shorter instrumentation time (p0.0005). An average of 12.5 +/- 4.9 ml of irrigant was used in group A and 17.3 +/- 4.8 ml in group B. The difference was statistically significant (p0.0005).

Coronal leakage has been recognized as a cause of pulpal and periradicular disease. Although cleaning and shaping of the root canal system is considered paramount, obturation of the system is an important step in endodontic success. The purpose of this study was to evaluate coronal bacterial leakage in teeth obturated with the System B continuous wave of condensation technique, followed by an Obtura II backfill, versus teeth obturated using the lateral condensation technique. Sixty single-rooted bilaterally matched teeth were evaluated in this study. An anaerobic bacterial leakage model was used. Results indicate that microbial coronal leakage occurs more quickly using lateral condensation than with the System B continuous wave of condensation and Obtura II backfill. This difference was statistically significant (por = 0.05). However, there was no statistical difference between groups 1 and 2 in the numbers of teeth that demonstrated bacterial leakage at the end of the study.

Intracanal mineral trioxide aggregate (MTA) may provide an alternative to calcium hydroxide in the treatment of external inflammatory root resorption. This in vitro study using human matched pairs of teeth compared white ProRoot MTA (WMTA; (Dentsply Tulsa Dental Specialties, Tulsa, OK) and an alternative material with purportedly improved handling properties, EndoSequence Root Repair Material (ES; Brasseler USA, Savannah, GA), by measuring pH in simulated root surface resorptive defects after intracanal placement. The null hypothesis tested was that there is no difference between WMTA and ES.Bilaterally matched pairs (n = 24) of extracted, human, single-rooted teeth were instrumented to apical size 50/.06, and root surface cavities were prepared at 5 mm and 2 mm from the apex. Root canals of experimental matched pairs (n = 20) were filled with WMTA or ES; control pairs (n = 4) were filled with calcium hydroxide (positive control [POS]) or saline (negative control [NEG]). Teeth were sealed coronally and apically and immersed in saline. The pH in root surface cavities was measured at 20 minutes, 3 hours, 24 hours, 1 week, 2 weeks, 3 weeks, and 4 weeks.The pH at 5 mm when compared with the 2-mm level was significantly higher for the WMTA, ES, and POS groups (P.05, paired t tests); therefore, each level was analyzed separately. At both the 2-mm and 5-mm levels, significant pH changes occurred over time in the WMTA, ES (both P.0001, repeated-measures analysis of variance), and POS (P.0001, Friedman test) groups and not in the NEG group (mean pH = 7.32 ± 0.04, P .05). There were no differences between WMTA and ES at 20 minutes and 3 hours at both levels or at 24 hours at 5mm. The pH of WMTA was higher than ES by 24 hours at the 2-mm level (8.79 vs 8.56, P.05, paired t test) and after 1 week at the 5-mm level (8.91 vs 8.05, P.0001) and was thereafter always significantly higher in WMTA compared with ES (P.0001). The null hypothesis was rejected.In matched pairs of teeth, intracanal placement of WMTA compared with ES resulted in a higher pH in simulated root resorption defects that was time and root level dependent.

The purpose of this study was to compare the flow of gutta-percha and Resilon (RealSeal; SybronEndo, Orange, CA) into lateral grooves and depressions in the apical 7 mm of a root canal by using warm vertical compaction. A split-tooth model was constructed with lateral grooves and depressions prepared at 1, 3, 5, and 7 mm from working length (WL). Groups A, B, and C were obturated with gutta-percha with a System B plugger placed 5 mm, 4 mm, and 3 mm from WL. Groups D, E, and F were obturated with Resilon with a System B plugger placed 5 mm, 4 mm, or 3 mm from WL. Gutta-percha and Resilon showed similar movement into lateral grooves and dentin depressions, with a significant difference found only with increased flow of gutta-percha into depressions at the 1-mm level when the System B plugger was placed 3 mm or 4 mm from WL (p

One hundred six patients with pretreatment pain presenting for endodontic treatment participated in a controlled double-blind study of dexamethasone use. Endodontic therapy was performed and, after controlling for use of nonuse of dexamethasone, patient variables and treatment factors were evaluated for their effects on endodontic posttreatment pain. Patients with no radiographic periapical lesions had significantly more pain than patients with periapical lesions at 8-, 24-, 48-, and 72-h posttreatment regardless of whether they received placebo or dexamethasone. No other patient or treatment factors correlated with posttreatment pain. Twenty-two patients in the subgroup receiving placebo reported an 81% incidence of posttreatment pain, 73% of them required posttreatment pain medications. By 72-h posttreatment, the incidence and severity of pain in the placebo group was minimal.

Ultrasonic instrumentation has been associated with cracking of the dentin in the area of the root-end preparation. The purpose of this study was to evaluate root-end preparations for cracking and to describe cavosurface morphology after the use of diamond-coated instruments. Forty teeth were inspected for intradentin cracks, incomplete canal cracks, and complete canal cracks before and after preparation with a stainless steel CT-5 ultrasonic instrument and again after root-end preparation with an S12D/90 degrees diamond-coated instrument. Six teeth had polyvinylsiloxane impressions taken of the root ends after preparation with the CT-5 and again after preparation with the diamond-coated instrument. Replicas were made, split, sputter-coated, and inspected using the scanning electron microscope. This study indicates that use of the diamond-coated instrument for root-end preparation does not result in significant root-end cracking and that it can remove cracks created by a prior instrument's use. The use of the diamond-coated instrument resulted in a heavily abraded, debris-covered cavosurface that may affect the apical seal.

A technique is presented for the expedient placement of interim buildups of type II glass ionomer cement as an aid for endodontic isolation of broken down teeth. The bond strength of glass ionomer cement to tooth structure is sufficient to withstand the forces of endodontic manipulation without the need for reinforcing pins. The material also shows promise as an intermediate endodontic seal. Variations of this technique are presented to address some other common isolation problems and the esthetic needs of the patient.

Fifty patients participated in this controlled double-blind study. The results showed that, when compared with a placebo, injection of the steroid (dexamethasone, 4 mg) significantly reduced both the incidence and severity of pain at 4 h posttreatment and reduced pain at 24 h posttreatment. Other patient and treatment factors such as age, sex, tooth number, pulp and periapical status, and number of appointments had no effect on posttreatment pain. However, posttreatment pain did correlate with the presence of pretreatment pain in both incidence and severity.