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This study aimed to evaluate the use of a single-file reciprocating system on the technical quality of root canal filling and treatment by radiographic assessment of cases treated by undergraduate dental students. This was a retrospective cross-sectional clinical study of endodontically treatments conducted by fourth-year undergraduate students during the academic year 2021–2022. Root canal preparation was performed using the WaveOne Gold system with matching single-cone gutta-percha. The collected data included sex, tooth position, number of canals, and treatment time (first or second semester). The quality of the root canal filling was assessed based on the root canal filling length, density, and taper. The presence of ledges, apical transportation, perforation, and instrument separation were recorded. Data were analyzed using SPSS version 28. Chi-square tests were used, and the statistical significance level was set at P < 0.05. A total of 601 teeth were included. The length of the root canal filling was adequate in 93.51 % of the teeth, underfilled in 2.82 %, and overfilled in 3.66 %. The density and taper were adequate in 96.5 % and 98.16 % of the teeth, respectively. There were no significant differences among the parameters of length, taper, density, or procedural errors relative to the arch type. However, there was a significant difference between the anterior and premolar teeth in terms of taper, density, and overall quality of the root canal filling. The overall quality of root canal treatment was acceptable in 527 teeth (87.68 %), with no significant difference between teeth (P = 0.256). The quality of root canal treatment performed by undergraduate students using a single-file reciprocating system is good or acceptable. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess whether calcium silicate root fillings prevent bacterial penetration and to determine how bacteria penetrate roots. Extracted single‐rooted, single‐canal human teeth were decoronated, prepared and filled with ProRootMTA or Biodentine (n = 12 each). Positive and negative (n = 2 each) controls were not filled. A two‐chamber model was used with Streptococcus gordonii. The lower compartment was evaluated for turbidity over 150 days. Roots were split and examined for bacteria via SEM. The chi‐squared test was used for comparisons (α = 0.05). Experimental groups had bacteria in their coronal thirds. Tubules contained bacteria in 90.9% and 91.7% of areas examined in the Biodentine and ProRootMTA groups, respectively, with no significant difference (p = 0.914). Experimental and negative roots had no turbidity with no significant difference between Biodentine and ProRootMTA (p = 1.000). Positive controls had turbidity. Bacteria penetrate roots via dentine tubules of root‐filled teeth. Biodentine was comparable to ProRoot MTA. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables. Methods: This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected. Results: The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome. Conclusions: The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it. [ABSTRACT FROM AUTHOR]

To investigate the quality of root canal fillings and frequency of apical periodontitis (AP) in root canal filled teeth in a Swedish population. This study used data from a cross-sectional survey conducted in 2013. The root canal filling quality and periapical status were assessed in 491 root canal filled teeth in 196 individuals aged 20–70 years, randomly selected from the population of Jönköping, Sweden. All root canal filled teeth were examined with periapical radiographs. Three calibrated observers recorded length and density in root canal fillings as well as periapical status according to the Periapical Index. A root filling ending within 0.5–2 mm from the radiographic apex without lateral or apical voids was considered adequate. Data were analyzed in a generalized estimating equation (GEE) model with AP as dependent variable and gender, age, number of teeth, number of root filled teeth, tooth type, and root filling quality as independent variables. Teeth with technically inadequate root fillings were associated with AP in a simple GEE-analysis. In the multiple GEE-model, the association between technical quality and apical peridontitis was nonsignificant when controlling for tooth type and gender. The quality of root canal fillings is poor and the prevalence of AP in root canal filled teeth is high, particularly in molar teeth, in a Swedish population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables. Methods: This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected. Results: The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome. Conclusions: The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it.

Aim: To document treatment outcomes and related resources, in patients undergoing root canal treatment (RCT) in county public dental clinics, by monitoring patient records for 12 months from treatment start. Methodology: The subjects comprised 243 patients starting RCT at 20 public dental clinics in Västra Götaland county, Sweden. Their computerized dental records were monitored prospectively for a year after starting their endodontic treatment. Treatment was completed with either a root filling or extraction. The following treatment‐specific variables were registered: number of appointments and days until treatment was completed, possible complications and prescriptions for antibiotics, and for the root filled teeth: type of coronal restoration and further procedures undertaken within the year. The treatment outcomes were compared with the preoperative variables and in a logistic regression analysis. Results: Complete data were available for 240 patients (98.8%): 128 women and 112 men, with a mean age of 48.5 years (SD = 16.3). Molar teeth predominated (n = 113, 47.1%). Most cases were completed with a root filling (n = 169, 70.4%). The remainder were extracted (n = 32, 13.3%) or were still uncompleted (n = 39, 16.3%). On average, a root filling was completed in 2.4 (SD = 0.9) appointments, or extraction at the third appointment (SD = 1.6). The molars were less often completed and often predominant among the extracted teeth. The indication for extraction was often for endodontic or RCT‐related reasons. Most complications were registered in the molars and antibiotics were prescribed in 20 cases. Most root filled teeth were restored with a direct restoration. Four root filled teeth (2.4%) were extracted within the time period. Conclusions: Patient records, followed from the start of treatment, show that 12 months on, the root filling had not been completed in just under 30% of the teeth. Of these, about half were extracted. Of particular concern is the outcome for endodontic treatment of molar teeth. In the general practice setting, molar endodontics are not only technically challenging but also very demanding in terms of chairside resources. In the present study, a successful outcome was achieved in just over half the cases. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine the vertical root fracture (VRF) resistance of roots obturated with TotalFill BC Sealer and AH Plus sealer using lateral condensation and single cone techniques in comparison to untreated controls. Sixty single rooted mandibular premolars were sectioned and divided into six groups. Ten teeth were left untreated (positive control-Gp 1) and fifty teeth were cleaned and shaped. Ten root specimens were left unfilled (negative control-Gp 2) and the remaining roots were divided into 4 groups. Gp 3, GP and AH Plus sealer (AH Plus) using the cold lateral compaction (LC) technique; Gp 4, GP and AH Plus using the Single Cone (SC) technique; Gp 5: TotalFill GP and TotalFill BC sealer using the LC technique; Gp 6: TotalFill GP and TotalFill BC sealer with SC. VRF was performed for all specimens using a universal testing machine. Analysis of variance (ANOVA) and Tukeys post-hoc multiple comparison test was used to compare the means among tested study groups. Group 1 (positive control) displayed the highest fracture resistance (946.61 ± 166.465 N); however, the lowest fracture strength was demonstrated by the specimens in group 2 (negative control) (433.31 ± 129.350 N). Specimens treated with AH plus using different obturation techniques (group 3 and 4) showed comparable outcomes (p > 0.05). Similarly, specimens treated with TotalFill BC sealer with different obturation techniques showed statistically similar outcomes (p > 0.05). It was also observed that specimens in groups 3, 4, 5 and 6 demonstrated comparable outcomes of fracture strength (p > 0.05). The use of TotalFill-BC sealer showed similar vertical root fracture resistance as AH plus sealer in root canal treated teeth. Use of total fill-BC and AH Plus sealer in root canal treatment showed vertical root fracture resistance comparable to untreated natural teeth (positive controls). [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the sealing ability of different root canal cement: resin AH Plus®, calcium hydroxide Sealapex®, and eugenol zinc oxide Pulp Canal Sealer® by measuring the apical penetration of a dye. Methods: One hundred straight single-canal teeth were biomechanically prepared to 0.5 mm of the apical foramen. The teeth were divided into four groups, three experimental groups, with thirty teeth in each group, and a control group, with ten teeth. The following sealants were selected: AH Plus®, Sealapex®, and Pulp Canal Sealer®. The root canal was not sealed in the control group. Lateral condensation was performed on the experimental groups using gutta-percha. The teeth were immersed in Indian ink to determine leakage. Results: In the experimental groups, ink penetration was observed in about 50% of the teeth. The lowest mean penetration was observed in the AH Plus® group (30.9 (±42.9)), and the highest was observed in Pulp Canal Sealer® (94.35 [±79.9]), (P < 0.001). Sealapex® (42.7 [±56.3]) had lower ink penetration than Pulp Canal Sealer® (P < 0.005). No statistically significant difference was observed in dye penetration between AH Plus® and Sealapex® (P = 0.2931). Conclusion: Low dye periapical penetration was observed using AH Plus and the calcium hydroxide cement (Sealapex®), while higher penetration was observed in Pulp Canal Sealer®.

The goal of endodontic treatment is the removing of pathological tissues and bacterias from the root canal system. The major obstacle is achieving this goal is represented by branched root canal systems, sometimes this is more difficult due to atypical tooth anatomy or tooth anomaly. This article presents a complex case of a lower premolar with multiple root canals and a dental anomaly.

Related to endodontic literature, mandibular incisors seem to be infrequently treated from an endodontic point of view, excepting third molars. The low percentage of endodontically treated mandibular incisors can be related to many causes, such as: low prosthetic value, difficult endodontic approach and, a more or less, good endodontic predictability due to intracanalar morphology.

The aim of the present study was to determine the vertical root fracture (VRF) resistance of roots obturated with TotalFill BC Sealer and AH Plus sealer using lateral condensation and single cone techniques in comparison to untreated controls. Sixty single rooted mandibular premolars were sectioned and divided into six groups. Ten teeth were left untreated (positive control-Gp 1) and fifty teeth were cleaned and shaped. Ten root specimens were left unfilled (negative control-Gp 2) and the remaining roots were divided into 4 groups. Gp 3, GP and AH Plus sealer (AH Plus) using the cold lateral compaction (LC) technique; Gp 4, GP and AH Plus using the Single Cone (SC) technique; Gp 5: TotalFill GP and TotalFill BC sealer using the LC technique; Gp 6: TotalFill GP and TotalFill BC sealer with SC. VRF was performed for all specimens using a universal testing machine. Analysis of variance (ANOVA) and Tukeys post-hoc multiple comparison test was used to compare the means among tested study groups. Group 1 (positive control) displayed the highest fracture resistance (946.61 ± 166.465 N); however, the lowest fracture strength was demonstrated by the specimens in group 2 (negative control) (433.31 ± 129.350 N). Specimens treated with AH plus using different obturation techniques (group 3 and 4) showed comparable outcomes (p > 0.05). Similarly, specimens treated with TotalFill BC sealer with different obturation techniques showed statistically similar outcomes (p > 0.05). It was also observed that specimens in groups 3, 4, 5 and 6 demonstrated comparable outcomes of fracture strength (p > 0.05). The use of TotalFill-BC sealer showed similar vertical root fracture resistance as AH plus sealer in root canal treated teeth. Use of total fill-BC and AH Plus sealer in root canal treatment showed vertical root fracture resistance comparable to untreated natural teeth (positive controls).

Objective: The objective of this study was to determine the association between periapical health status with the quality of the root filling and was the coronal restoration and identify the predictors of periapical lesion. Subjects and Methods: It was conducted among 197 adult patients who visited Kuwait University. Periapical status was measured by periapical index. The presence or absence of periapical lesions was evaluated using panoramic radiographs. Statistical Analysis: Data were analyzed using the Statistical Package for Social Sciences. Chi-square tests were performed to assess associations between categorical variables. Results: Of the 4,841 teeth examined, 2.7% were root-filled (n = 130). Thirty-four percent of the root-filled teeth (n = 44), and 3% of the nonroot-filled teeth (n = 141 of 4711) exhibited periapical radiolucency. Of the root filled teeth, 49% were judged to be inadequate (n = 64) and 91% of the inadequate ones had short root filling (n = 58). The presence of periapical lesion was significantly predicted by inadequate coronal restoration, dental caries, periodontal bone loss, and the presence of post crown. Conclusion: This study demonstrated a large number of untreated teeth with periapical pathology. The quality of root fillings in this population appeared to be poor and was significantly associated with a high prevalence of apical periodontitis.

Objectives: This study aimed to present the results and analyses of clinical trials, including updates on the different functions of root canal sealers., Materials and Methods: In June 2023, we performed a comprehensive search of ClinicalTrials.gov to identify interventional clinical trials pertaining to root canal sealers. In total, 23 clinical trials conducted up to June 2023 were included in this study., Results: Approximately half of the trials (11 out of 23) were completed, while none were terminated or withdrawn. Each included trial had a minimum of 10 participants, with 11 trials having more than 100 participants. None of the assessed trials provided outcomes, and the majority (17 out of 23) lacked associated publications. In terms of geographic distribution, the USA and Canada did not contribute to any root canal sealer trials., Conclusions: This study highlights the lack of diversity in trial locations, the absence of reported results, and a scarcity of clinical trials examining the physicochemical properties of different sealers. Most published trials primarily focused on assessing the post-operative pain effect of these sealers, but no significant difference was found regarding post-operative pain control., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2024. The Korean Academy of Conservative Dentistry.)

Introduction There is limited literature on the impact of testing variables on the push-out bond test (POBT). This review identified designs of the POBT used in the endodontic literature and aimed to determine which experimental variables may influence the push-out bond strength (POBS). Methods A systematic review based on PRISMA guidelines was performed by searching the PubMed, SCOPUS, and Cochrane library databases using terms including push-out and dislocation resistance and descriptions of endodontic materials. Test variables assessed included method of root preparation, timing of sectioning compared with filling, thickness, diameter and taper of sections, and plunger size and velocity. The POBS of 3 common materials (gutta-percha and AH Plus, mineral trioxide aggregate, and Biodentine) were collected from investigations, and a comparison was attempted. Results One hundred thirty-three studies assessed the POBS of root-filling materials, 68 assessed root repair cements/root-end filling materials, and 16 assessed orifice barrier materials other than mineral trioxide aggregate. There was significant variation in all of the assessed variables, resulting in a large range of reported values for the POBS of the various materials. Because of this heterogeneity in study design, no further statistical analysis of the impact of the test variables on POBS was possible. Conclusions There was considerable variation in the POBT design used in endodontic research. Greater standardization is required for future research as well as accurate reporting for all test variables to assess the impact of specific design variables on POBS. [ABSTRACT FROM AUTHOR]

Successful root canal treatment depends critically on controlling pulp-space infection. Three dimensional filling with gutta percha results in a uniformed smooth surface and least observable space between gutta-percha and canal walls especially in middle and apical region of the root canal. The aim of this study was to evaluate the success rate of three dimensional root filling with gutta percha. Among the 71 study teeth filling using three dimensional guttapercha, 67 were clinically sound and did not have signs and symptoms suggesting failure at the evaluation. The success rate was thus 94.4%. An ideal root canal filling three-dimensionally fills the entire root canal system as close to the cemento-dentinal junction as possible. Three dimensional filling with gutta percha are effective in filling canals with a high rate of success. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To evaluate radiographically the technical quality of root fillings performed by undergraduate dental students and to assess whether students were exposed to an appropriate endodontic case mix during their clinical training. Methodology: A retrospective audit was undertaken evaluating the clinical records of patients who underwent endodontic procedures during the period from September 2015 to June 2016 in the Dental School at Queen's University Belfast, UK. Two final‐year dental students were trained and calibrated to evaluate postoperative intra‐oral periapical radiographs of completed root canal treatments using specific assessment criteria. Data were presented as frequencies, percentage and mean ± standard deviation (SD). Comparisons of treatment outcomes between groups (posterior and anterior teeth) were calculated using Fisher's exact test, and the level of significance was set at P < 0.05. Intra‐ and interexaminer reproducibility was assessed by Kappa statistics. Results: A total of 222 teeth and 381 canals were assessed, and of those, 253 (66%) of the root fillings were found to be acceptable in all the assessment parameters, namely taper, length and lateral adaptation of the root filling. Subanalysis of individual root filling parameters revealed that 372 canals (97%) exhibited good taper, and 275 canals (72%) were considered to be of an appropriate length, with 89 canals (23%) found to be underfilled and 17 canals (5%) overfilled. Overall 346 (91%) of canals had good lateral condensation. Students treated both single and multirooted teeth, and there was no significant association between tooth type and the quality of root filling provided (P > 0.05). Conclusions: In the majority of the teeth treated by undergraduate students at Queen's University Belfast, the technical quality of the root filling was acceptable and students were exposed to an appropriate case mix for endodontic training. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to measure the time consumed preparing retrograde cavities in root canals of maxillary molars filled using the GuttaCore (Dentsply Tulsa Dental Specialties, Tulsa, OK) technique and the cold lateral condensation technique (CLC) and to examine the quality of the root-end cavity preparation by ultrasonic tips using micro–computed tomographic (micro-CT) scanning. Methods A total of 24 maxillary molars were included; distobuccal and palatal canals were instrumented to size #40 and size #50, respectively. Teeth were randomly distributed into 2 experimental groups; half of the samples were filled with CLC, and half were filled with the GuttaCore technique. After 2 months, the apical 3 mm of each root apex was resected. A retrograde cavity was then prepared 3 mm deep into the root-end–filled canals using ultrasonic tips. The quality of the preparation was first confirmed by a surgical stereomicroscope, and the time required for the root-end preparation was recorded. After root-end cavity preparation, all samples were scanned by micro-CT scanning. Results There was no significant difference between the palatal and distobuccal canals in the time required to prepare a retrograde cavity. Less time was required in the GuttaCore group to remove all root filling material and finish the cavity preparation than in the CLC group ( P < .05), especially in the palatal canals. Micro-CT results confirmed that all material was removed from the root-end cavities and the absence of microcracks. Conclusions GuttaCore was removed in less time from root-end cavities than root filling performed with the CLC technique. No damage to the surrounding dentin was detected by micro-CT scanning in the 2 groups. [ABSTRACT FROM AUTHOR]

Abstract: Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root‐end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium‐enriched mixture cement, Endo‐CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick‐Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root‐end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the association between periapical health status with the quality of the root filling and was the coronal restoration and identify the predictors of periapical lesion. Subjects and Methods: It was conducted among 197 adult patients who visited Kuwait University. Periapical status was measured by periapical index. The presence or absence of periapical lesions was evaluated using panoramic radiographs. Statistical Analysis: Data were analyzed using the Statistical Package for Social Sciences. Chi-square tests were performed to assess associations between categorical variables. Results: Of the 4,841 teeth examined, 2.7% were root-filled (n = 130). Thirty-four percent of the root-filled teeth (n = 44), and 3% of the nonroot-filled teeth (n = 141 of 4711) exhibited periapical radiolucency. Of the root filled teeth, 49% were judged to be inadequate (n = 64) and 91% of the inadequate ones had short root filling (n = 58). The presence of periapical lesion was significantly predicted by inadequate coronal restoration, dental caries, periodontal bone loss, and the presence of post crown. Conclusion: This study demonstrated a large number of untreated teeth with periapical pathology. The quality of root fillings in this population appeared to be poor and was significantly associated with a high prevalence of apical periodontitis. [ABSTRACT FROM AUTHOR]

To evaluate the bioactivity and the cytocompatibility of experimental Bioglass-reinforced polyethylene-based root-canal filling materials. The thermal properties of the experimental materials were also evaluated using differential scanning calorimetry, while their radiopacity was assessed using a grey-scale value (GSV) aluminium step wedge and a phosphor plate digital system. Bioglass 45S5 (BAG), polyethylene and Strontium oxide (SrO) were used to create tailored composite fibres. The filler distribution within the composites was assessed using SEM, while their bioactivity was evaluated through infrared spectroscopy (FTIR) after storage in simulated body fluid (SBF). The radiopacity of the composite fibres and their thermal properties were determined using differential scanning calorimetry (DSC). The cytocompatibility of the experimental composites used in this study was assessed using human osteoblasts and statistically analysed using the Pairwise t-test (p<0.05). Bioglass and SrO fillers were well distributed within the resin matrix and increased both the thermal properties and the radiopacity of the polyethylene matrix. The FTIR showed a clear formation of calcium-phosphates, while, MTT and AlamrBlue tests demonstrated no deleterious effects on the metabolic activity of the osteoblast-like cells. BAG-reinforced polyethylene composites may be suitable as obturation materials for endodontic treatment. Since their low melting temperature, such innovative composites may be easily removed in case of root canal retreatment. Moreover, their biocompatibility and bioactivity may benefit proliferation of human osteoblast cells at the periapical area of the root. [ABSTRACT FROM AUTHOR]

Introduction The aim of the present study was to evaluate both survival and failure rates of endodontically treated teeth restored with or without fiber post–retained restorations after a mean observation period of at least 5 years. Methods A total of 144 single-rooted and multirooted teeth in 100 subjects were endodontically treated following a predetermined aseptic protocol and restored with either a fiber post and a composite core or a composite filling without intraradicular retention. A fiber post was cemented when the teeth presented with only 1 wall and/or less than one third of the remaining height of the clinical crown. After a comprehensive treatment plan, the teeth were restored with either a direct composite restoration or a single-unit crown. Endodontically treated teeth supporting fixed and removable dental prostheses and telescopic crowns were excluded from the analysis. Success was defined as tooth survival without any treatment of biological and/or technical complications. Results The overall tooth survival rate was 89.6% after a mean observation time of 8.8 ± 2.3 years. The survival rate of teeth with a fiber post amounted to 94.3%, and for teeth without a post, it was 76.3% ( P < .001). The main reason for tooth loss was root fracture (9.7%). No loss of post retention was observed. Successfully treated teeth without any biological and/or technical complications and requiring no additional treatment during the entire observation period amounted to 79.9%. Conclusions Endodontically treated teeth restored with fiber posts and either a direct composite restoration or a single-unit crown yielded higher survival and success rates compared with teeth restored without fiber posts. Vertical fractures of roots not containing a post represented a frequently encountered and serious problem. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the effect of the quality of the coronal restoration and the root filling on the success of endodontic treatment. Patients treated at Kuwait University Dental Clinics (KUDC) from 2003 to 2014 were contacted by telephone calls. Demographic data and clinical records of patients, including age, gender, the tooth number, and medical history were recorded. Each patient received clinical examination for all teeth, including assessment of the coronal filling (type, quality), root- and/or coronal fracture, and the periodontal condition around the tooth (e.g., probing depth, gingival recession); percussion and mobility tests. A periapical radiograph of the endodontic treated tooth was taken to determine the health of the periapical tissues using the periapical index. The quality of the root filling was assessed by length and density of the root filling. The mean follow-up period was 4.8 years. The overall success rate of endodontic treatment was 86%; teeth without any initial periapical lesion had a success of 93%, whereas those with such lesion had a success rate of 80%. Periapical healing was not significantly associated with either the length of root filling (p = 0.40) or the density of root filling (p = 0.099), but was statistically significantly associated with the presence of coronal filling defects (p = 0.001). This study demonstrated that inadequate coronal filling but not the quality of root filling was associated with a higher prevalence of periapical lesions. [ABSTRACT FROM AUTHOR]

Aim of the study The study aimed to determine the influence of root filling and coronal restorations quality on prevalence and severity of chronic apical periodontitis (CAP). Materials and method The study was performed on 126 patients (age 20-50), with a total number of 299 teeth with finished endodontic treatments and amalgam and composite resins restorations. The assessment of root fillings was performed on periapical radiographs and coronal restorations were assessed using clinical examination and byte-wing radiographs. The periapical status was analysed using P.A.I. indices. Results The study proves the high prevalence of chronic apical periodontitis (73.6%). High prevalence of C.A.P. (94.1%) and P.A.I. indices (4.06) are present for teeth with coronal restoration with poor marginal integrity and short root fillings. Conclusions Both the quality of the coronal restoration and the quality of the root filling (length and density) are correlated with the presence and severity of chronic apical periodontitis.

Introduction: The aim of this study was to evaluate the apical and coronal sealing of endodontic fillings promoted by the associations of Sealer 26/Gutta-percha, Endofill/Gutta-percha and Resilon/ Epiphany. Materials and Methods: It was used 38 human canines, 10 teeth for each test group and 4 teeth for each control group. After teeth conventional endodontic treatment, they were immersed in saline solution for thirty days, sealed and stored in India ink for seven days. Then were submitted to a clearing technique and evaluated for infiltration by stereoscopic microscope. The data were statistically analyzed by ANOVA and Bonferroni tests. Results: The results showed no significant differences (p> 0.05) between the three groups of filling materials used. Conclusion: Considering the limitations of this in vitro study, it seems that no material showed superiority related to the ability of apical and coronary sealing.

Introduction: Endodontic-periodontal (EP) lesions require both endodonticand periodontal therapies. Impermeable sealing of the root canal system after cleaning and shaping is essential for a successful endodontic treatment. However, complete healing of the hard and soft tissue lesions takes time, and diseased bone, periodontal ligament, and tooth fibrous joints are reported to have an increased failure risk for a given load. Considering that EP lesions may affect the biomechanics of teeth, this finite elemental analysis study aimed to test the effect of root fillings on stress distribution in premolars with EP lesions. Methods: Three finite elemental analysis models representing 3 different types of EP lesions (primary endodontic disease [PED], PED with secondary periodontic involvement, and true combined) were created. The root canals were assumed as nonfilled or filled with gutta-percha, gutta-percha/apical mineral trioxide aggregate (MTA) plug, and MTA-based sealer. Materials used were assumed to be homogenous and isotropic. A 300- N load was applied from the buccal cusp of the crown with a 135° angle. The Cosmoworks structural-analysis program (SolidWorks Corp, Waltham, MA) was used for analysis. Results were presented considering von Mises criteria. Results: Stresses at the root apex increased with an increase in lesion dimensions. Root filling did not affect stress distribution in the PED model. An MTA plug or MTA-based sealer created more stress areas within the root compared with the others in the models representing PED with periodontic involvement and true combined lesions. Conclusions: Stresses at the apical end of the root increase with increases in lesion dimensions. MTA-based sealers or an MTA plug creates more stresses when there is periodontic involvement or a true combined lesion. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the effect of the quality of the coronal restoration and the root filling on the success of endodontic treatment. Patients treated at Kuwait University Dental Clinics (KUDC) from 2003 to 2014 were contacted by telephone calls. Demographic data and clinical records of patients, including age, gender, the tooth number, and medical history were recorded. Each patient received clinical examination for all teeth, including assessment of the coronal filling (type, quality), root- and/or coronal fracture, and the periodontal condition around the tooth (e.g., probing depth, gingival recession); percussion and mobility tests. A periapical radiograph of the endodontic treated tooth was taken to determine the health of the periapical tissues using the periapical index. The quality of the root filling was assessed by length and density of the root filling. The mean follow-up period was 4.8 years. The overall success rate of endodontic treatment was 86%; teeth without any initial periapical lesion had a success of 93%, whereas those with such lesion had a success rate of 80%. Periapical healing was not significantly associated with either the length of root filling (p = 0.40) or the density of root filling (p = 0.099), but was statistically significantly associated with the presence of coronal filling defects (p = 0.001). This study demonstrated that inadequate coronal filling but not the quality of root filling was associated with a higher prevalence of periapical lesions.

Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings: a. They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusion b. They may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin. The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The purpose of this study was to assess the prevalence of apical periodontitis in root canal–treated teeth from the Korean population and to evaluate the relationship between the quality of root canal fillings and coronal restorations and the periapical status of these teeth. Methods: Full-mouth periapical radiographs at the Dental Hospital of Yonsei University, Seoul, South Korea, were examined. A total of 1030 endodontically treated teeth restored with full veneer crown–type restorations were evaluated by 2 independent examiners. Teeth were classified as healthy or diseased according to the periapical status. The quality of endodontic treatment and coronal restorations were also classified via radiographic and clinical evaluation. The data were analyzed using the chi-square test and logistic regression. Results: Forty-one percent of all endodontically treated teeth were classified as diseased. Approximately 35.6% of the teeth had endodontic treatments that were rated as adequate. The diseased teeth rate for cases with adequate endodontic treatment was 24.5%, which was significantly lower when compared with teeth with inadequate endodontic treatment (49.9%). The number of teeth with adequate coronal restorations was 706 (68.5%). Teeth with adequate coronal restorations had a significantly decreased prevalence of diseased teeth (34.7%) compared with teeth with inadequate coronal restorations (54.3%). Teeth with both adequate root fillings and restorations showed a significantly better outcome (82.3%) than the others, and teeth with both inadequate root fillings and restorations showed a significantly worse outcome (41.2%) than the others. Conclusions: Data from this Korean population showed a relatively high prevalence of apical periodontitis. The quality of endodontic treatment and coronal restorations were of equal importance and were strong independent predictors of the periapical status. [Copyright &y& Elsevier]

Introduction: The retreatability of recent calcium silicate or mineral trioxide aggregate (MTA) sealers has not yet been assessed. The aim of this study was to evaluate the removal of 2 MTA-based sealers (MTA Fillapex [Angelus Soluções Odontológicas, Londrina, PR, Brazil] and MTA Plus [Prevest-Denpro, Jammu City, India]) using a rotary retreatment system, considering an epoxy resin sealer (AH Plus [Dentsply Maillefer, Ballaigues, Switzerland]) as the standard for comparison. Methods: Root canals in 45 single-rooted teeth were instrumented using a rotary nickel-titanium system (MTwo; VDW GmbH, Munich, Germany) and obturated with gutta-percha using one of the following sealers (n = 15): group 1, MTA Fillapex; group 2, MTA Plus; and group 3, AH Plus. The teeth were scanned using a cone-beam computed tomography scanner. After 2 months, the root canals were retreated with a rotary retreatment system (ProTaper Universal Retreatment; Dentsply Maillefer, Ballaigues, Switzerland) and a second cone-beam computed tomography scan was performed to assess the amount of remaining root filling material (in percentage) and dentin removal (in cubic millimeters). The time taken to reach the working length was calculated in minutes. Group comparisons were performed using 1-way analysis of variance and the Student-Newman-Keuls post hoc test (P = .05). Results: There was a significant difference in the amount of remaining root filling material between the 3 groups (P < .05), with group 1 showing the least amount of root filling material (1.8% ± 0.22%) and group 3 showing the highest (10.4% ± 0.71%). The amount of dentin removal and the time taken to reach the working length was significantly higher in group 3 than in groups 1 and 2 (P < .05). There was no significant difference between groups 1 and 2 in these outcome variables (P > .05). Conclusions: The rotary retreatment system evaluated was not able to completely remove any of the sealers. MTA Fillapex showed less remaining root filling material than MTA Plus. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: This study aimed to compare the filling ability of carrier-based thermoplasticized gutta-percha in flat-oval canals prepared using either rotary ProTaper files (Dentsply Maillefer, Ballaigues, Switzerland) or the Self-Adjusting File system (SAF) (ReDent-Nova, Ra''anana, Israel). Methods: Thirteen pairs of mandibular incisors were selected from a random collection. The teeth in each pair had single root canals with a flat-oval cross-section and similar sizes and dimensions. Teeth from each pair were randomly assigned to 1 of 2 experimental groups. One group was instrumented using the ProTaper NiTi system, whereas the SAF system was used in the other. Root filling was performed with Thermafil obturators (Dentsply Tulsa Dental Products, Tulsa, OK), and teeth were sectioned at 6, 5, 4, and 3 mm from the apex; the cut surface was subjected to morphometric measurement to establish the percent gutta-percha–filled area (PGFA) for each section. The Wilcoxon matched-pairs signed rank test was used to assess the effect of the 2 preparation methods on the PGFA. Results: The median PGFA in the ProTaper group was 77.5%, whereas the median PGFA was 90.5% in the SAF group (P < .05). In the SAF-instrumented group, 17.8% of the specimens had a PGFA ≥95% compared with only 5.8% of the ProTaper-instrumented specimens (P < .05). Conclusions: Instrumentation of the flat-oval canals with the SAF system led to a significantly higher PGFA compared with ProTaper instrumentation with syringe and needle irrigation. [Copyright &y& Elsevier]

von See C, Rücker M, Koch A, Kokemueller H, Schumann P, Ziebolz D, Gellrich N-C. The influence of pressure changes on endodontically treated teeth during simulated dives. International Endodontic Journal, 45, 57-62, 2012. Abstract Aim To measure and evaluate pressure changes in the pulp chambers of extracted teeth exposed to hyperbaric conditions during root canal treatment. Methodology A pressure sensor was inserted and sealed into the pulp chambers of extracted human molars ( n = 6). The teeth were subjected to simulated dives to 4.5 bar in a diving chamber. During the simulated ascents and descents, the pressure within the pulp chamber was measured, and the difference between the pressure inside the pulp chamber and the pressure in the diving chamber was calculated. Each tooth underwent two dives with an intact pulp chamber, with a calcium hydroxide dressing, after root canal filling, and after adhesive sealing of the pulp chamber floor with a composite. Differences were analyzed statistically ( P < 0.05) using one-way analysis of variance ( anova). Results There were no significant pressure differences in teeth with an intact pulp chamber and teeth with a calcium hydroxide dressing. After root filling, however, the increase in pressure inside the pulp chamber was significantly lower ( P < 0.05) than that in the diving chamber. After adhesive sealing of the pulp chamber floor with a composite, the pressure inside the pulp chamber was significantly lower ( P < 0.05) than the pressure in the diving chamber. Conclusions In root canal treatment, canal orifices should be sealed with an adhesively bonded composite filling before a dive. The use of a calcium hydroxide dressing after root canal preparation does not disqualify patients from diving. [ABSTRACT FROM AUTHOR]

Aim To investigate a possible relationship between apical root impedance and canal anatomy. Methodology Twenty-three roots from human extracted teeth with different apical anatomy (classified by number of apical canal exits) were selected. After impedance measurements, the root canals were stained and the teeth cleared to confirm their division into simple (S - Vertucci type 1; n =12) and complex (C - various Vertucci canal types with multiple exits; n = 11) root types. Impedance measurements were taken using a frequency response analyser at seven apico-coronal levels in each root (0.0, 0.5, 1.0, 2.0, 3.0, 4.0, 5.0 mm short of the apical terminus) at 14 frequencies ranging from 1120 to 100 000 Hz. Potential confounding factors were controlled. The impedance characteristics of individual roots were compared with 37 equivalent circuits to select best fit. The association between impedance characteristic (described by the selected equivalent circuit) and canal anatomy (S/C) was investigated using logistic regression with robust standard error to account for multiple data-sets from the same root. Results Canal anatomy had a significant (P = 0.046) effect on the equivalent circuit model. One circuit (model 10) occurred significantly more commonly in the simple canals. The odds of selecting circuit-model- 10 were 2.2 times (odds ratio 2.17, 95% confidence interval 1.01-4.63) higher in canals with simple anatomy compared to those with complex anatomy. Conclusion Canal anatomy had a significant effect on the equivalent circuit describing its impedance characteristics. It is theoretically possible to use impedance spectroscopy to clinically predict and image apical canal complexities. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of this study was to obtain a three-dimensional analysis of the isthmus area of the mesiobuccal root canal system in mandibular molars using high-resolution micro–computed tomography (μ-CT) scanning and to measure the amount of debris and root filling material in the isthmus after instrumentation/irrigation and root filling. Methods: Mandibular molars with two separated mesial root canals (10 teeth) were scanned by using the Skyscan 1172 μ-CT system (Skyscan, Aartselaar, Belgium) before and after instrumentation and after filling using the Thermafil root filling technique. An isthmus was defined as the ribbon-shaped or thin connecting structure between two root canals after instrumentation. The characteristics of the isthmuses were quantitatively monitored during the whole treatment. The images were segmented and quantified. The surface area of the isthmus, volume of debris after rotary instrumentation, and volume of the filled space in the isthmus after obturation were evaluated. Results: Of the seven mesial roots, two had isthmus/anastomoses somewhere along its length in the apical 5 mm, and five had an isthmus that was continuous all the way from the coronal part to the apical part. The average percentage of isthmus surface area and isthmus volume after instrumentation was 21.4% and 9.4% of the whole root canal system, respectively. About 35.2% of the isthmus volume was filled with apparent hard tissue debris after instrumentation/irrigation. The average percentage of volume of filling material in the isthmus areas was significantly lower (57.5%) than in the main root canals (98.5%, p < 0.001). Conclusions: A considerable amount of dentin debris is produced and packed into the isthmus area during rotary instrumentation of mesial canals of lower molars despite continuous irrigation during and after instrumentation. The debris may partly prevent penetration of the filling material and sealer into the isthmus area. [Copyright &y& Elsevier]

Khabbaz MG, Protogerou E, Douka E. Radiographic quality of root fillings performed by undergraduate students. International Endodontic Journal, 43, 499–508, 2010. Aim To evaluate the radiographic technical quality of root fillings and the incidence of iatrogenic errors in treatment provided by undergraduate students. Methodology Endodontic records and periapical radiographs of 759 root filled teeth were selected following exclusion of 25 (3.3%). A final total of 734 cases were used to assess the technical quality of root fillings in 1109 root canals performed by 4th and 5th undergraduate students. Two variables were examined: the length and the density of the fillings, categorized as acceptable and non-acceptable. The presence of ledges, root perforation, foramen perforation and fractured instruments were also investigated. Chi-square tests were used for statistical analysis. Results Acceptable root fillings were found in 55% of canals. More `acceptable' root fillings occurred in maxillary compared to mandibular teeth (58 and 51% respectively) ( P < 0.05) and in anterior compared with premolar (71 and 61%) and molar root canals (39% respectively) ( P < 0.05). Insignificantly more (5.4%) acceptable root fillings were provided by 5th year students. Most of the underfillings and iatrogenic errors were detected in molars for both academic years (53 and 65% respectively). Ledges were noted in 55% of cases treated by both academic years and significantly more foramen perforations were detected in the 5th compared with the 4th year students ( P < 0.05). Conclusions There is a need to improve the technical quality of root fillings performed by the undergraduate students, especially in molar teeth. [ABSTRACT FROM AUTHOR]

Roggendorf MJ, Legner M, Ebert J, Fillery E, Frankenberger R, Friedman S. Micro-CT evaluation of residual material in canals filled with Activ GP or GuttaFlow following removal with NiTi instruments. International Endodontic Journal, 43, 200–209, 2010. Aim To assess the efficacy of removing Activ GP or GuttaFlow from canals using NiTi instruments. Methodology Root canals in 55 extracted pre-molars were prepared to apical size 40, 0.04 taper. The teeth were imaged with micro-CT, and 30 teeth selected that had consistent apical size and taper of the shaped canals. They were randomly assigned to root filling with either the glass-ionomer-based ActivGP system ( n = 15) or the polyvinylsiloxane-based GuttaFlow system ( n = 15). After 2 weeks, canals were retreated stepwise with size 40–50 EndoSequence 0.04 taper instruments. Micro-CT scans (8 μm) were taken after use of each instrument to detect root filling residue in the coronal, middle and apical segment, and the retreatment time recorded. Residue, expressed as percentage of canal surface area, was compared between groups with t-tests, and within groups with repeated measuresanova and Bonferroni-adjusted pairwise comparisons. Retreatment time was analysed with one-wayanova. Results The percentage of sealer residue-coated canal surface was consistently highest ( P < 0.001) in the apical third of canals, and it did not differ significantly between the two root filling groups. Stepwise enlargement from size 40 to 50 significantly decreased the amount of sealer residue in both groups ( P < 0.001). Retreatment time did not differ significantly between groups. Conclusions Both root fillings with ActivGP and GuttaFlow were removed with nickel-titanium rotary instruments. Enlargement of canals up to two sizes beyond the pre-retreatment size was necessary to minimize the amount of sealer remaining. [ABSTRACT FROM AUTHOR]