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Aim: This study analyzed the two-dimensional (2D) and three-dimensional (3D) parameters and canal transportation using micro-CT in roots prepared with three instrumentation systems preceded or not by glide path. Materials and Methods: Sixty mesial canals of mandibular molars with severe curvature angles (≥25°) were divided randomly (n = 10): G1-Twisted-file-adaptive (TFA); G2-Reciproc (RC); G3-One-Shape (OS); G4-ProGlider (PG)+TFA; G5-PG+RC; and G6-PG+OS. Area, perimeter, circularity, and major and minor diameters at the apical 5 mm and volume and surface area and canal transportation were evaluated. Data were analyzed using two-way analysis and Tukey's test (α = 0.05). Results: RC showed significantly higher areas and lower perimeters and diameters than TFA (P

Morphology study of root canal systems is essential for a correct diagnosis, therapy and prognosis of root canal treatment. This study aimed to analyse the dental anatomy of the lower anterior teeth, using cone-beam computed tomography (CBCT). Lower anterior teeth were classified in terms of type, number and location of root canals, evaluating the bilaterality of anatomical occurrences and determining whether the gender and age influence the findings. We analysed 749 CBCT of patients attending the School of Dentistry for different reasons. Spearman's correlations and Wilcoxon signed-rank test were used to analyse data (α = 0.05). There was no significant correlation between gender (male and female) and anatomy of the canals 33 (P = 0.162), 32 (P = 0.815), 31 (P = 0.708), 41 (P = 0.422), 42 (P = 0.382) and 43 (P = 0.063). There was a significant correlation between age and anatomy of the canals 33 (P = 0.045), 32 (P = 0.033), 31 (P = 0.022), 41 (P = 0.000), 42 (P = 0.037) and 43 (P = 0.037). There was no significant correlation between gender and patients' age (P = 0.325). There was no anatomical difference between the bilateral pairs (right and left homologous teeth) (P > 0.05). The most common anatomical configuration was single-canal teeth (85.29%), followed by the configuration in which one canal leaves the chamber, divides into two and unite again (12.88%). Anatomy of the lateral incisors and lower canines does not change with the gender of patients. However, as age rises, single canals and the incidence of division into two canals ending in a single foramen also increases.

This study was designed to evaluate the effect of a final rinse with 0.2% chitosan solution on the adhesion in roots filled with gutta percha and an epoxy resin based sealer. Thirty extracted human maxillary canines selected to ensure specimen standardization were used in the study. After the coronal portion of each tooth was removed, the roots were instrumented and irrigated with 1% sodium hypochlorite (NaOCl). Roots were distributed into 3 groups according to the final rinsing solution (n = 10): 0.2% chitosan, 17% ethylenediaminetetraacetic acid (EDTA), or 1% NaOCl. The canals were irrigated with 5 mL of each solution for 5 minutes and then filled with gutta percha cones and the resin based sealer. Ten roots in each group were prepared, sectioned, and submitted to push-out testing. Data were analyzed with analysis of variance and Tukey test (P0.05). In the push-out test, final irrigation with chitosan (mean, 0.37 [SD, 0.12] MPa) or EDTA (0.38 [0.11] MPa) resulted in significantly greater bond strength of the sealer to the root canal (P0.05) than did irrigation with 1% NaOCl (0.13 [0.04] MPa). The cervical third had greater bond strength than the other thirds (P0.05). Adhesive failure was the most frequent type in all groups. A final rinse with 0.2% chitosan or 17% EDTA resulted in greater bond strength of root fillings to the root canal than did 1% NaOCl.

Aim: This study aimed to compare, through dentin microhardness and colorimetric analysis, the chelating effect of 0.2% chitosan solubilized in different acids. Materials and Methods: The second and third cuts of the cervical region of maxillary central incisors were divided into four quadrants, resulting in eight specimens, which were treated with 50 μL of solution for 5 min according to their group (n = 10): GI – 0.2% chitosan solubilized in 1% acetic acid; GII – 0.2% chitosan solubilized in 3.3% citric acid; GIII – 0.2% chitosan solubilized in 0.00145% hydrochloric acid; and GIV – 0.2% chitosan solubilized in 0.00112% nitric acid. A control was made from the chelating properties of the following acids: GV – 3.3% citric acid, GVI – 0.00145% hydrochloric acid, GVII – 0.00112% nitric acid, and GVIII – control (distilled water). Afterward, they were subjected to the Knoop microhardness tester with a load of 10 g for 15 s, resulting in three indentations of the root canal toward the cement. The measurements obtained were subjected to the one-way ANOVA test followed by Tukey's test (α =0.05). Subsequently dispensing the chitosan solutions, the same were subjected to colorimetric analysis. Results: Chitosan solubilized in acetic acid, followed by chitosan in citric acid, provided a greater reducing effect compared to the other groups. Similar results were observed in the colorimetric analysis. Conclusion: It was concluded that the chelating ability of the chitosan solution solubilized in acetic acid is higher than solubilization in citric, hydrochloric, and nitric acids.

To evaluate, by scanning electron microscopy (SEM), the efficacy of smear layer removal using chitosan compared with different chelating agents, and to quantify, by atomic absorption spectrophotometry with flame (AASF), the concentration of calcium ions in these solutions after irrigation.The root canals of twenty-five canines were prepared using a crown-down technique and irrigated with 1% sodium hypochlorite. The teeth were randomly divided into groups (n = 5), according to the type of final irrigation: 15% EDTA, 0.2% chitosan, 10% citric acid, 1% acetic acid and control (without final irrigation). The total volume of each chelating solution was collected from the canals and analysed by AASF for quantification of calcium ions in the solutions. Then, the roots were split longitudinally and examined by SEM for evaluation of smear layer removal in the middle and apical thirds. Cleaning scores were attributed and analysed statistically using the Kruskal-Wallis and Dunn tests. The AASF data were analysed by one-way anova and Tukey-Kramer test. A significant level of α = 0.05 was adopted.15% EDTA, 0.2% chitosan and 10% citric acid had similar smear layer removal capacity with a significant difference (P0.05) from 1% acetic acid and the control group. There was no significant difference (P0.05) between the smear layer remaining in the middle and apical thirds. The highest calcium ion concentration was observed with 15% EDTA (121.80 ± 5.13) and 0.2% chitosan (104.13 ± 19.23), with no significant difference. The lowest calcium ion concentration was obtained with 1% acetic acid (25.62 ± 7.68), whilst 10% citric acid (70.38 ± 11.15) had intermediate results, differing significantly from the other solutions (P0.01).15% EDTA, 0.2% chitosan and 10% citric acid effectively removed smear layer from the middle and apical thirds of the root canal. 15% EDTA and 0.2% chitosan were associated with the greatest effect on root dentine demineralization, followed by 10% citric acid and 1% acetic acid.

The effect of solutions of 0.2% chitosan, 15% EDTA and 10% citric acid on the microhardness of root dentin was evaluated comparatively in this study. Thirteen sound human maxillary central incisors were selected and decoronated at the cementoenamel junction. Ten roots were set into rapid polymerization acrylic resin and the root/resin block was fitted to the cutting machine to obtain slices from the cervical third. The first slice was discarded and the second slice was divided into four quadrants. Each quadrant was used to construct a sample, so that 4 specimens were obtained from each root slice, being one for each chelating solution to be tested: 15% EDTA, 10% citric acid, 0.2% chitosan and distilled water (control). The specimens were exposed to 50 μL of the solution for 5 min, and then washed in distilled water. A microhardness tester (Knoop hardness) with a 10 g load was used for 15 s. Data were analyzed statistically by one-way ANOVA and Tukey-Kramer test (α=0.05). The other 3 roots had the canals instrumented and irrigated at the end of the biomechanical preparation with the test solutions, and then examined by scanning electron microscopy (SEM) for qualitative analysis. All solutions reduced the microhardness of root dentin in a way that was statistically similar to each other (p>0.05) but significantly different from the control (p>0.05). The SEM micrographs showed that the three solutions removed smear layer from the middle third of the root canal. In conclusion, 0.2% chitosan, 15% EDTA and 10% citric acid showed similar effects in reducing dentin microhardness. Avaliou-se o efeito das soluções de quitosana 0,2%, EDTA 15% e ácido cítrico 10% sobre a microdureza da dentina radicular. Foram utilizados 13 incisivos centrais superiores humanos, os quais tiveram suas coroas seccionadas transversalmente e desprezadas. Dez raízes foram incluídas em resina acrílica de rápida polimerização e o bloco formado raiz/resina adaptado à maquina de corte. Desprezou-se o primeiro corte transversal da porção cervical e dividiu-se o segundo, em 4 quadrantes. Cada quarto foi destinado à confecção do corpo-de-prova obtendo-se 4 espécimes para cada raiz, um para cada solução (n=10): EDTA a 15%, ácido cítrico a 10%, quitosana a 0,2% e água destilada (controle). Os espécimes receberam 50 μ L da solução por 5 min, sendo em seguida, lavados com água destilada. Utilizou-se um microdurômetro (dureza Knoop) com carga de 10 g durante 15 s. Os dados foram avaliados por meio do teste ANOVA e Tukey-Kramer (α=0,05). Três incisivos centrais superiores foram instrumentados e irrigados, ao final da biomecânica, com uma das soluções estudadas. Os espécimes foram levados para MEV e posterior análise qualitativa. Todas as soluções avaliadas reduziram a microdureza da dentina radicular de forma semelhante entre si (p>0,05) e estatisticamente diferente do controle (p

Introduction The greatest reduction in microhardness of the most superficial layer of dentin of the root canal lumen is desired. The use of chelating agents during biomechanical preparation of root canals removes smear layer, increasing the access of the irrigant into the dentin tubules to allow adequate disinfection, and also reduces dentin microhardness, facilitating the action of endodontic instruments. This study evaluated the effect of different chelating solutions on the microhardness of the most superficial dentin layer from the root canal lumen. Methods Thirty-five recently extracted single-rooted maxillary central incisors were instrumented, and the roots were longitudinally sectioned in a mesiodistal direction to expose the entire canal extension. The specimens were distributed in seven groups according to the final irrigation: 15% EDTA, 10% citric acid, 5% malic acid, 5% acetic acid, apple vinegar, 10% sodium citrate, and control (no irrigation). A standardized volume of 50 μL of each chelating solution was used for 5 minutes. Dentin microhardness was measured with a Knoop indenter under a 10-g load and a 15-second dwell time. Data were analyzed statistically by one-way analysis of variance and Tukey-Kramer multiple-comparison test at 5% significance level. Results EDTA and citric acid had the greatest overall effect, causing a sharp decrease in dentin microhardness without a significant difference (p > .05) from each other. However, both chelators differed significantly from the other solutions (p .05) and did not affect dentin microhardness. Apple vinegar, acetic acid, and malic acid were similar to each other (p > .05) and presented intermediate results. Conclusion Except for sodium citrate, all tested chelating solutions reduced microhardness of the most superficial root canal dentin layer. EDTA and citric acid were the most efficient.

Horizontal root fractures are uncommon, mainly occurring on the cervical and middle third of the root of permanent upper incisors. The diagnosis is essentially radiographic and requires different healing patterns, depending on some pre- and postinjury factors. The aim of this article was to report the clinical management and different healing types in three cases of horizontal root fractures on permanent dentition. In case 1, the pulp tissue was vital and no treatment was necessary. In case 2, a root canal treatment of the cervical fragment was necessary and in case 3, pulpal necrosis was verified and an apical surgery was performed.

This paper reports a case of gemination in a maxillary lateral incisor with two root canals and crown-root dilaceration. A 16-year-old male patient was referred for endodontic treatment of the maxillary left lateral incisor and evaluation of esthetic and functional complaints in the anterior region. The patient reported trauma to the anterior primary teeth. There was no spontaneous pain, but the tooth responded positively to the vertical percussion test and negatively to the pulp vitality test. Clinical examination showed esthetic and functional alterations and normal periodontal tissues. CBCT imaging confirmed the suspicion of gemination and crown-root dilaceration and also revealed the presence of two root canals and periapical bone rarefaction. The root canals were instrumented with Reciproc R40 and 1% NaOCl irrigation and were filled by lateral condensation of gutta-percha and AH Plus sealer. The tooth was definitely restored with composite resin to recover esthetics. Continued follow-up over 6 months has shown absence of pain or clinical alterations as well as radiographic image suggestive of apical repair.

The aim of this study was to evaluate the influence of drying protocols (DP) on the apical sealing (AS) and on the bond strength (BS) of teeth filled with different sealers. The root canals of one hundred and fifty-six roots of maxillary canines were prepared with Reciproc rotary files (R50). The teeth were randomly divided into four groups (n = 39), according to the DP: GI–paper points; GII–70% isopropyl alcohol + aspiration with NaviTip points; GIII–95% ethanol + paper points; GIV–EndoVac + paper points. Each group was divided into subgroups, according to the sealer used: AH Plus, Sealapex and MTA Fillapex, using a single-cone technique. Evaluation of AS and BS was performed with fluid filtration (FF) and push-out (PO) methods, respectively. The PO test consisted of sectioning the roots, and subjecting a single slice from each third to testing and analysis for failure type. The data was submitted to two-way and three-way variance analysis (ANOVA) and Tukey (α = 5%). The AS showed no drying protocol influence. The FF results revealed a statistically significant difference between MTA and Sealapex (p < 0.05) sealers. The BS test values showed that there was no statistical significant difference among the canal thirds (p > 0.05), but that there was such a difference among the sealers (p < 0.05), among the protocols (p < 0.05), and in the interaction between sealers and protocols (p < 0.05). AH Plus revealed the highest BS values among the sealers; the highest BS results for the sealers occurred with the specimens used with isopropyl alcohol, compared with ethanol and EndoVac.

The purpose of this study was to evaluate, by scanning electron microscopy (SEM), smear layer removal and quantify, by atomic absorption spectrophotometry, the amount of calcium ion present in the chelating solutions after their use. Sixteen extracted canines were instrumented using the step-back technique and were assigned to 3 groups according to the irrigating solution used: G1: 1 mL 17% EDTAC between each file; G2: 1 mL 17% CDTA; G3: 1 mL 17% EGTA. The solutions were collected after use. The teeth were cleaved longitudinally, evaluated under SEM and assessed for smear layer by blinded examiners and scored from 1 to 4. In order to quantify calcium ion release, the collected solutions were examined by atomic absorption spectrophotometry. Freidman's test was used for statistical analysis of SEM values and showed that canals irrigated with 17% EDTAC and 17% CDTA had significantly less smear layer throughout the canals than 17% EGTA (p

This study evaluated the cleaning capacity of Profile .04 instruments with different concentrations of NaOCl solutions on flattened root canals. Twenty central mandibular incisors were divided into 4 groups: Group I: 0.5% NaOCl; Group II: 1% NaOCl; Group III: 5% NaOCl; Group IV: distilled and deionized water. After chemomechanical preparation, the teeth were submitted to histological preparation and morphometric analysis. Morphometric analysis showed that the 5% NaOCl was significantly more efficient in cleaning the root canal than 0.5% NaOCl and distilled water, which had the lowest levels of cleaning of the root canals (p

Baratto-Filho F, FariniukLF, Ferreira EL, Pecora JD, Cruz-Filho AM, Sousa-Neto MD. Clinical and macroscopic study of maxillary molars with two palatal roots. International Endodontic Journal, 35, 796^801, 2002. Aim To report an anatomical variation in maxillary first molars. Summary A case report is presented of a maxillary first molar requiring root-canal treatment that had two palatal roots with distinct canals and foramena at the apical level. Root-canal treatment was performed using mechanical instrumentation with NiTi files. An anatomical study on two extracted maxillary second molars with the same variation revealed their internal structure. This case demonstrates an uncommon anatomical condition and supplements previous reports of such cases affecting maxillary molars. Key learning points Clinicians should be aware of uncommon anatomical variations in maxillary molars. The majority of maxillary first molars have three roots and four canals. Maxillary molars may have two canals in the palatal root.

Introduction: This study evaluated dentin morphology and microhardness at the furcation area of mandibular molars. Methods: Toothsegmentsofmandibularmolars were embedded in resin blocks and bisected longitudinally (n = 20), and the furcation area was delimited by tracing 2 orthogonal lines from the most concave point of the outer surface of the furcation toward the mesial anddistalcanalentrances.Inhalfofthespecimens,Knoop microhardness was measured in 2 directions in the furcation area: vertically, parallel to the orthogonal lines and thebisectoroftheangleformedbythem;andhorizontally, inthe outer (closeto the pulpchamberfloor),inner (close to the cementum), and middle dentin layers. Data were analyzed statistically by one-way analysis of variance and Tukey-Kramer test (a = 0.05). The other half of the specimens were examined by scanning electron microscopy to evaluate dentin morphology and trajectory of thetubules. Results: Nostatisticallysignificantdifference (P>.05)wasfoundamongthemesial(46.56.4),central (47.3 8.1),and distal (49.7 6.5)orthogonal lines. The inner dentin layer (51.7 2.5) was statistically similar to the middle (46.3 2.9) (P > .05), which was similar to the outer layer (41.4 2.4) (P > .05). The inner layer was significantly harder than the outer layer (P < .05). The morphologicanalysis revealeda tendency ofcalcification of the tubules from the outer toward the inner layer. Conclusions: Dentin microhardness at the furcation area is uniform in its 3 vertical axes, but the inner dentin layer is harder than the outer layer. The dentinal tubules follow a centripetal direction toward the inner layer, in which dentin is much more mineralized. (J Endod 2014;40:129‐132)

The morphology of the supernumerary third root (radix) in mandibular first molars was examined by micro-computed tomography (μCT) scanning.Nineteen permanent mandibular first molars with radix were scanned in a μCT device to evaluate their morphology with respect to root length, root curvature direction, location of radix, apical foramen, accessory canals and apical deltas, and distance between canal orifices as well as 2- and 3-dimensional parameters of the canals (number, area, roundness, major/minor diameter, volume, surface area, and structure model index). Quantitative data were analyzed by 1-way analysis of variance and the Tukey test (α = 0.05).The mean length of the mesial, distal, and radix roots was 20.36 ± 1.73 mm, 20.0 ± 1.83 mm, and 18.09 ± 1.68 mm, respectively. The radix was located distolingually (n = 16), mesiolingually (n = 1), and distobuccally (n = 2). In a proximal view, most radix roots had a severe curvature with buccal orientation and a buccally displaced apical foramen. The spatial configuration of the canal orifices on the pulp chamber floor was mostly in a trapezoidal shape. The radix root canal orifice was usually covered by a dentinal projection. The radix differed significantly from the mesial and distal roots for all evaluated 3-dimensional parameters (P.05). The radix canal had a more circular shape in the apical third, and the mean size of the minor diameter 1 mm short of the foramen was 0.25 ± 0.10 mm.The radix root is an important and challenging anatomic variation of mandibular first molars, which usually has a severe curvature with a predominantly distolingual location, and a narrow root canal with difficult access.

Objectives Chitosan has been widely investigated and used. However, the literature does not refer to the shelf life of this solution. This study evaluated, through the colorimetric titration technique and an analysis of dentin micro-hardness, the shelf life of 0.2% chitosan solution. Materials and Methods Thirty human canines were sectioned, and specimens were obtained from the second and third slices, from cemento-enamel junction to the apex. A 0.2% chitosan solution was prepared and distributed in 3 identical glass bottles (v1, v2, and v3) and 3 plastic bottles (p1, p2, and p3). At 0, 7, 15, 30, 45, 60, 90, 120, 150, and 180 days, the specimens were immersed in each solution for 5 minutes (n = 3 each). The chelating effect of the solution was assessed by micro-hardness and colorimetric analysis of the dentin specimens. 17% EDTA and distilled water were used as controls. Data were analyzed statistically by two-way and Tukey-Kramer multiple comparison (α = 0.05). Results There was no statistically significant difference among the solutions with respect to the study time (p = 0.113) and micro-hardness/time interaction (p = 0.329). Chitosan solutions and EDTA reduced the micro-hardness in a similar manner and differed significantly from the control group (p < 0.001). Chitosan solutions chelated calcium ions throughout the entire experiment. Conclusions Regardless of the storage form, chitosan demonstrates a chelating property for a minimum period of 6 months.

The cleaning capacity of mechanical endodontic instruments activated by the ENDOflash system was evaluated by means of histologic and morphometric analyses. Twenty-two distobuccal roots of human maxillary molars from laboratory stock were randomly separated into four groups. Group 1 was instrumented with ENDOflash files, group 2 with ProFile taper .04 files, group 3 received instrumentation with Pow-R taper .04 files, and group 4 (positive control) was instrumented with Nitiflex files. After instrumentation, teeth were sectioned transversally and processed for microscopic evaluation to determine the amount of debris on root canal walls. Results obtained by morphometric analysis indicated significant statistical differences (p0.01) between groups. ProFile taper .04 files were significantly more efficient in cleaning the root canal, followed by Pow-R files, Nitiflex, and ENDOflash, which had the lowest levels for cleaning the root canals.

Complete debridement with smear layer removal are essential measures for achieving a successful outcome of root canal treatment. The aim of this study was to evaluate the effects of chitosan at different concentrations on the removal of the smear layer and on dentin structure after 3 and 5 min of application. Twelve recently extracted maxillary canine teeth were instrumented using the crown-down technique and irrigated with 1% sodium hypochlorite. The specimens were distributed according to the time and concentration of the final irrigating solution: G1: 0.1% chitosan for 3 min; G2: 0.2% chitosan for 3 min; G3: 0.37% chitosan for 3 min; G4: 0.1% chitosan for 5 min; G5: 0.2% chitosan for 5 min; G6: 0.37% chitosan for 5 min. All samples were prepared for SEM analysis. G1 exhibited removal of the smear layer, but not the smear plugs. G2 showed visible and open tubules with slight erosion of the peritubular dentin. Cleaning in G3 was similar to that in G2, however, the erosive effect was greater. There was expansion of the diameter of the tubules in G4; and in G5 and G6, there was severe erosion with deterioration of dentin surface. In conclusion, 0.2% chitosan for 3 min appeared to be efficient for removing the smear layer, causing little erosion of dentin. Completo debridamento dos canais radiculares com a remoção da smear layer são medidas essenciais no sucesso do tratamento endodôntico. O objetivo deste estudo foi avaliar os efeitos da quitosana, em diferentes concentrações, na remoção da smear layer e na estrutura da dentina, após 3 e 5 min de aplicação. Doze dentes caninos superiores, recém extraídos, foram instrumentados pela técnica crown-down e irrigados com hipoclorito de sódio 1%. Os espécimes foram distribuídos em seis grupos conforme o tempo e a concentração da solução irrigante final: G1: quitosana 0,1% por 3 min; G2: quitosana 0,2% por 3 min; G3: quitosana 0,37% por 3 min; G4: quitosana 0,1% por 5 min; G5: quitosana 0,2% por 5 min; G6: quitosana 0,37% por 5 min. Todas as amostras foram preparadas para avaliação em MEV. Os resultados mostraram que o G1 apresentou remoção da smear layer, mas não da smear plug. O G2 mostrou túbulos visíveis e abertos com ligeira erosão da dentina peritubular. A limpeza no G3 foi semelhante à do G2, no entanto, o efeito erosivo foi maior. No G4 houve ampliação do diâmetro dos túbulos e no G5 e G6, severa erosão com deterioração da superfície dentinária. Concluiu-se que a quitosana 0,2% por 3 min foi eficiente na remoção da smear layer, ocasionando pequena erosão

The effect of EDTAC (ethylenediamine tetra-acetic acid plus Cetavion, an ammonium surfactant), CDTA (cyclohexane-1,2-diaminetetra-acetic acid), and EGTA (ethylene glycol-bis-(beta-amino-ethyl ether) N,N,N',N'-tetra-acetic acid) on the microhardness of radicular dentin of the cervical third of human teeth was studied. Five newly extracted maxillary incisors were sectioned transversely at the cementoenamel junction, and the crowns were discarded. The roots were embedded in blocks of high-speed polymerized acrylic resin and cut transversely into 1-mm sections. The second slice of the cervical third of the root of each tooth was sectioned and divided into four parts. Each part was placed on an acrylic disc that was used as a base for microhardness measurement. Fifty microliters of 15% EDTAC, 1% CDTA, or 1% EGTA were applied to the dentin surface. Deionized and distilled water was used as control. Dentin microhardness was then measured with a Vicker's microhardness apparatus with a load of 50 g for 15 s. Statistical analysis showed that the three chelating solutions significantly reduced dentin microhardness when compared with water; however, there was no statistically significant difference among the three solutions.