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The ultimate challenge for successful endodontic therapy is to establish a homogenous unit of the root canals which requires a hermetic seal. Adhesion of root canal sealers to dentin is important to seal the root canal system thoroughly and to prevent microleakage. Bonding of root filling materials to the radicular dentin is known as ‘monoblocks’ which has become more popular after introduction of bonding concept in the root canal system. The aim of this review highlights on newer materials and different concepts in rehabilitation of root canal space. Thus the potential of these monoblocks is discussed with the possibility of their application in endodontics in future. Keywords: Monoblocks, MTA, Fibre posts, Bonding to root canal.

Aim This study aimed to evaluate the effect of the prior application of intracanal medicaments on the bond strength of OrthoMTA (mineral trioxide aggregate) and iRoot SP to the root dentin. Materials and methods Thirty single-rooted mandibular premolars were standardized and prepared using ProTaper rotary files. The specimens were divided into a control group and two experimental groups receiving Diapex and Odontopaste medicament, either filled with iRoot SP or OrthoMTA, for 1 week. Each root was sectioned transversally, and the push-out bond strength and failure modes were evaluated. The data were analyzed using Kruskal Wallis and Mann-Whitney U post hoc test. Results There was no significant difference between the bond strength of iRoot SP and OrthoMTA without medicaments and with the prior placement of Diapex (p value > 0.05). However, iRoot SP showed significantly higher bond strength with the prior placement of Odontopaste (p value 0.05) and between failure mode and root filling materials (p value > 0.05). The prominent failure mode for all groups was cohesive. Conclusion Prior application of Diapex has no effect on the bond strength of iRoot SP and OrthoMTA. However, Odontopaste improved the bond strength of iRoot SP. Clinical significance Dislodgment resistance of root canal filling from root dentin could be an indicator of the durability and prognosis of endodontic treated teeth.

A 27-year-old male patient complained of dental pain on previously root-treated tooth #17. Intentional replantation (IR) was performed. However, the symptoms returned at 10 months of follow-up, and a sinus tract was detected on the buccal gingiva of tooth #17. The patient refused extraction of the tooth and tooth was scheduled for non-surgical retreatment. Root canal retreatment was initiated with the removal of the previous root filling material while leaving the retrograde filling in situ. After 1 month of intracanal medication, the tooth became asymptomatic with complete healing of the sinus tract and the root canal filling was completed. Clinical and radiographic examination at 1 year follow-up revealed endodontic success with complete resolution of periapical radiolucency. This case report shows that non-surgical retreatment could be a viable alternative for failed IR.

To evaluate the influence of ultraconservative endodontic cavities (UEC) on canal shaping and filling ability, cleaning of the pulp chamber, time required to perform root canal treatment and fracture resistance of 2-rooted maxillary premolars in comparison with traditional endodontic access cavities (TEC) in extracted teeth placed in a phantom head to simulate clinical conditions.Twenty extracted intact 2-rooted maxillary premolars were scanned in a micro-computed tomographic device, matched based on similar anatomical features of the canals and assigned to UEC or TEC groups (n = 10). Then, teeth were mounted on a mannequin head and their pulp chamber accessed. After canal preparation, filling and cavity restoration, the time required to perform root canal treatment was recorded and the specimens were loaded to fracture in a universal testing machine. The maximum load at fracture was recorded. The sample was scanned after root canal instrumentation, filling and restoration procedures. Untouched canal areas, accumulation of hard-tissue debris (AHTD), voids in root fillings and cleaning of the pulp chamber were analysed. Data were analysed statistically using Shapiro-Wilk and Student's t-tests with a significance level of 5%.The percentage of untouched canal area did not differ significantly between UEC and TEC groups (P 0.05). However, UECs were associated with a greater percentage of AHTD after canal preparation (P 0.05). No differences were observed in terms of voids in root fillings between the groups (P 0.05). Nonetheless, UEC had a greater percentage of root filling remnants in the pulp chamber after cleaning procedures (P 0.05). The time required to perform root canal treatment was significantly longer in the UEC group (P 0.05). There was no difference regarding the mean load at fracture between the groups (P 0.05). Unrestorable fractures were observed in all specimens of both groups.There was no true benefit associated with ultraconservative endodontic cavities. UEC resulted in more AHTD remaining inside the root canals. UEC did not influence the quality of root fillings; however, UEC made the cleaning procedure of the pulp chamber more difficult, thus increasing the total time required to perform root canal treatment. Moreover, UEC were not associated with an increase in fracture resistance of root filled 2-rooted maxillary premolars.

The aim of this study was to compare, by micro-computed tomography (micro-CT) analysis, the obturation quality of two filling methods: the single-cone technique with the bioceramic EndoSequence BC sealer and the continuous wave technique with the resin-based AH Plus sealer. Twenty mandibular molars were divided into two groups (n = 10) according to the sealer used. Only the mesial roots, which are known to have mostly two canals, were used. The specimens were scanned before and after instrumentation and after obturation. Root canal volume after instrumentation and filling volume were calculated to obtain the percentage volumes of filling, voids and gaps. All specimens presented final volumes that were smaller than the initial volumes (P 0.05). There was no significant difference between groups for filling volume, voids and gaps (P 0.05). Using two filling methods, EndoSequence BC and AH Plus promoted a similar root filling quality in mesial roots of mandibular molars. Neither sealer was able to fill the root canal system completely.

The purpose of this study was to evaluate the ability of the XP-endo Shaper instrument (FKG Dentaire, La Chaux-de-Fonds, Switzerland) during the removal of root fillings from oval-shaped canals. M-Wire Reciproc and Reciproc Blue systems (VDW, Munich, Germany) were used as reference instruments for comparison, and micro-computed technology was used as an analytical tool.Thirty mandibular incisors with oval-shaped canals were matched based on similar anatomic features of the canal (eg, volume, aspect ratio, and 3-dimensional configuration) after scanning procedures. The canals were prepared with M-Wire Reciproc R25 instruments and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using the continuous wave of condensation technique. Then, the sample was allocated into 3 experimental groups (n = 10) according to the retreatment protocol used: M-Wire Reciproc, Reciproc Blue, and XP-endo Shaper. M-Wire Reciproc R25, Reciproc Blue R25, and XP-endo Shaper instruments were used to remove the root fillings. Apical enlargement was performed with M-Wire Reciproc R40, Reciproc Blue R40, and BioRace BR5 (FKG Dentaire) instruments. Each sample was scanned after each endodontic procedure. The volume of remaining root filling material was quantified before and after apical enlargement. The percentage volumes of root filling reduction in relation to the instrumented canals at both time points (before and after apical enlargement) were calculated and considered for statistical analysis. Data were analyzed statistically with a significance level of 5%.Reciproc Blue presented significantly lower removal of filling material compared with the XP-endo Shaper (Tukey test, P.05). No difference was detected either between M-Wire Reciproc and Reciproc Blue (Tukey test, P.05) or M-Wire Reciproc and XP-endo Shaper (Tukey, P.05). The increase of apical enlargement significantly improved the removal of root fillings from the root canals (P.05); this effect was similar for all systems (time point × file system, P.05).The XP-endo Shaper instrument showed a higher percentage of root filling removal, but no differences were observed comparing M-Wire Reciproc with the XP-endo Shaper or Reciproc Blue. The increase of apical enlargement improved the removal of root fillings in all groups. None of them was able to render root canals completely free from root fillings.

Root canal treatment (RCT) is a procedure to eliminate pulpal diseases with the aim to promote healing of the periradicular tissue. The RCT conducted must be of high technical standard and achieve a good quality endodontic work (GQEW) to ensure successful outcome and prolonged retention of the teeth in oral cavity. Previous studies reported poor outcome of RCT conducted by the undergraduate dental students. There is limited report documented on the quality of RCT performed by the dental students in Malaysia. The aim of this study was to identify the technical standards of the RCT and types of post-endodontic restoration placed by USIM undergraduate dental students. The radiographic obturation quality from 274 root filled teeth were evaluated against several indices. The data were analyzed using SPSS version 21. Post treatment radiographs indicated that 84.62% of the RCT have adequate density indicating good apical seal. Meanwhile, for obturation level, the root canal filling that ends 0-2mm (optimal), >2mm away (inadequate), and beyond apex (extrusion) were 84.59%, 5%, and 10.77%, respectively. Teeth with GQEW, having both adequate root filling length and complete obturation were found in 194 (74.6%) teeth. McNemar’s test revealed significant reduction in post-treatment periapical index (p

Zinc oxide eugenol (ZOE) has traditionally been used as a root filling material in primary teeth pulpectomy. Calcium hydroxide and iodoform (Ca(OH)2/iodoform) may have advantages as a root canal filling material to evaluate treatment success of Ca(OH)2/iodoform pulpectomy in primary teeth compared with ZOE based on clinical and radiographical criteria. All human clinical studies reporting clinical and radiographical outcomes of Ca(OH)2/iodoform compared with ZOE in primary teeth pulpectomy were identified in digital bibliographic databases. Two authors independently selected studies and extracted relevant study characteristics. Success of treatment was based on an accomplishment of specific clinical and radiographical criteria. Meta‐analyses were performed to appraise study heterogeneity and aggregated statistics. Out of 5,000 articles identified in initial search, 15 articles met all inclusion criteria, while 10 were included in the meta‐analyses. At 6‐ and 12‐month follow‐up, there were no statistically significant differences in the clinical and radiographical success rates of Ca(OH)2/iodoform and ZOE. However, ZOE was shown to have statistically significant higher success rates at ≥18‐month follow‐up. On the basis of the findings of this systematic review, we recommend that Ca(OH)2/iodoform be utilized for pulpectomy in primary teeth nearing exfoliation; conversely, ZOE should be utilized when exfoliation is not expected to occur soon. Future randomized control clinical trials with a long‐term follow‐up are needed before a reliable conclusion can be drawn as to the best pulpectomy material. The success of pulpectomy in primary teeth depends on selecting the ideal root canal filling material. It is challenging to select the appropriate filling materials for primary teeth. ZOE or ZOE/iodoform combined with Ca(OH)2 appears to be the materials of choice if primary teeth are not nearing exfoliation. More high‐quality randomized control clinical trials with a long‐term follow‐up period are needed before a reliable conclusion can be drawn as to the best pulpectomy material in primary teeth (systematic review registration number: CRD42016037563).

The aim of this study was to evaluate the influence of final irrigation protocols and endodontic sealer on bond strength of root filling material on root dentin previously treated with photodynamic therapy (PDT).One hundred root canals were prepared up to #F3 file of Pro-Taper system to receive the root filling material. All samples were submitted to PDT and randomly divided into five groups (n = 20) according to final irrigation protocols: Group 1-distilled water + ultrasonic activation (US); Group 2-17% EDTA; Group 3-QMix; Group 4-17% EDTA + US; Group 5-QMix + US. Each group was randomly divided into two subgroups (n = 10), according to the endodontic sealer used for cementation of gutta-percha points: AH Plus or MTA Fillapex. The bond strength was evaluated by a push-out test. The patterns of failure were observed under optical microscopy. The bond strength was evaluated using a two-way Anova followed by the Tukey post-hoc test, and the failure mode was evaluated using the chi-square test (α = 5%).The use of 17% EDTA and QMix associated or not to US improved the bond strength of root filling material with either endodontic sealer (p 0.05). AH Plus showed higher bond strength than MTA Fillapex (p 0.05). There was a higher predominance of cohesive failure in all groups, regardless of the tested final irrigation protocols and endodontic sealer (p 0.05).The use of 17% EDTA and QMix, regardless of association with US, and the use of AH Plus improve the bond strength of the root filling material on root dentin previously treated with PDT.

Objective The aim of this work is to correlate between endodontic case complexities and treatment quality outcomes. Methods Three hundred and forty nine radiographs of patients who had received endodontic treatment at a postgraduate dental institute in Dubai were retrieved from the Institute's data base. The majority of the cases were referred by in house general dental practitioners (GDPs). Unreadable radiographs were all excluded. From the original sample of 349,in total 51 radiographs were discarded. The final sample thus consisted of 298 root canal fillings of 211 patients treated by the endodontic postgraduate students. All radiographs were individually evaluated following the American Association of Endodontic Case Difficulty Assessment Form. Based on this, the technical quality of the root filling was evaluated for each individual case. Results The sample consisted of 53% high,35% moderate and 12% minimal difficulty cases. Adequate homogeneity of root canal fillings were found in 93% of the cases. This compared with 90% of cases with adequate length of root fillings. There were statistically significant differences between the length of root canal filling and level of difficulty (p = 0.016) but, no statistically significant difference between homogeneity of root canal filling and case difficulty (p = 0.794). Conclusion Eighty four percent (0.93 × 0.90 = 0.84) of the cases treated proved to be adequate in terms of length and homogeneity which is in line with published work of Endodontic treatment carried out by specialists. Clinical Significance GDPs require robust guidelines to help with appropriate referral of patients to Endodontic specialists.

Objective The aim of this study was to compare the fracture resistance of immature bovine roots when using ProRoot MTA, CEM Cement, and Biodentine as root filling materials. Materials and Methods An immature bovine tooth model was developed by removing the coronal and apical portions of 70 bovine incisors 8 mm above and 12 mm below the cementoenamel junction (CEJ). The specimens were then divided into five groups: ProRoot MTA, CEM Cement, Biodentine, gutta-percha/AH26 sealer, and control. All groups received a 5-mm apical plug with a temporary restorative material. Then, the remaining root canal space was filled with one of the afore-mentioned materials. After setting, the specimens were mounted in acrylic resin. Then, 3 mm coronal to the CEJ from the buccal side of the teeth and at a 135°angle to the long axis, the specimens were loaded until fracture. Results The specimens in the Biodentine (2196 N) and ProRoot MTA (2103 N) groups had significantly greater fracture resistance in comparison to the control group (p = 0.01). No significant difference was found between CEM Cement, gutta-percha and sealer AH26, and control groups. No significant differences occurred between the four experimental groups (p = 0.45). Conclusion Filling the root canal space with ProRoot MTA and Biodentine contributed to higher fracture resistance values.

The aim of this study was to evaluate three reciprocating systems and complementary cleaning methods on filling material removal during retreatment of flattened canals. Thirty-six mandibular incisors were prepared using rotary instruments up to size 25.08 and filled using the single-cone technique. Subsequently, the teeth were divided into three groups (n = 12) according to retreatment procedures: Reciproc Blue (RB): 25/0.08 and 40/0.06; ProDesign R (PDR): 25/0.06 and 35/0.05; and WaveOne Gold (WOG): 25/0.07 and 35/0.06. The remaining filling volume materials were assessed by means of micro-CT imaging before and after retreatment. After this, the specimens were subdivided into three groups according to complementary cleaning methods: XP-Endo Shaper (30/0.01); passive ultrasonic irrigation (PUI); 60° oscillatory instrumentation with #30 H-file, and micro-CT scan was taken. Then, the roots were cut in half and the samples were analyzed by scanning electron microscope (SEM). The data were analyzed statistically using Kruskal-Wallis and Dunn's Multiple Comparison test with significance level of 5%. None of the reciprocating files promoted complete removal of filling material and there was no statistical difference between the groups, regardless instrument size (p 0.05). Complementary cleaning methods increased remnant filling removal (p 0.05). XP-endo Shaper significantly reduced the amount of filling material in the apical and middle thirds, compared with H-files (p 0.05), with no difference with PUI. In the SEM, there was no statistical difference among the instruments (p 0.05). The reciprocating systems showed similar effectiveness in removing root filling material. Complementary cleaning method with the XP-Shaper enhanced filling material removal.

Aim To evaluate the performance of XP-endo Finisher R instruments when removing root filling remnants from oval-shaped canals using microcomputed tomographic (micro-CT) imaging as the analytical tool. Passive ultrasonic irrigation (PUI) was used as a reference technique for comparison. Methodology Twenty mandibular incisors with oval-shaped canals were matched based on similar anatomic features of the canal (volume, aspect ratio and 3D configuration) after scanning procedures. The canals were prepared with Reciproc R25 instruments, filled with gutta-percha and AH Plus sealer using the single-cone technique and retreated up to a Reciproc R40 instrument. After retreatment procedures, the specimens were rescanned, and the homogeneity between the specimens, the oval-shaped anatomy and the remaining filling material were confirmed. The pair-matched samples were assigned to two experimental groups (n = 10), according to the supplementary approach used: XP-endo Finisher R or PUI. Each sample was scanned after each endodontic procedure. The volume of remaining root filling material was quantified before and after the use of each supplementary approach. This analysis was performed considering the total canal (Student t-test) and also by thirds (anova procedure followed by a Bonferroni correction). Data were analysed statistically with a significance level of 5%. Results The volume of root filling material at baseline was similar between the groups (t-test, P = 0.787). XP-endo Finisher R removed significantly more root filling material compared to PUI (t-test, P = 0.015), as it removed a mean of ≅32% material compared to 12% for the PUI. There was no difference in the amount of root filling material removed in the root canal thirds after using both supplementary approaches (one-way anova, P = 0.07 for XP-endo Finisher R and P = 0.886 for PUI). Conclusions Both supplementary approaches significantly reduced the volume of remaining root filling material from oval-shaped canals. The XP-endo Finisher R instrument removed significantly more root filling material than PUI. None of the supplementary approaches was able to render oval-shaped canals completely free from remaining root filling material.

This study aimed to compare the efficacy of XP-endo Finisher R and IrriSafe, with a solvent mixture of Methyl ethyl ketone/Tetrachloroethylene (MEK/TCE), in the removal of root filling residues. Twenty-four human mandibular incisors were pair-matched by micro-computed tomography according to volume and aspect ratio. After retreatment, specimens were allocated to two experimental groups (n = 12), according to the supplementary instrument used. The volume of residual filling material after each irrigating step and the time for retreatment was calculated. Statistical analyses were carried out using Mann–Whitney test, with a significance level of 5%. The volume of initial root canal filling material between the groups was similar (p > 0.05). With the final irrigation protocol (NaOCl and EDTA) the volume of the filling remnants decreased significantly (p 0.05). The additional solvent mixture MEK/TCE increased the efficiency of filling materials reduction, regardless of the agitating instruments employed, IrriSafe or XP-endo Finisher R (p

Background The understanding on how well GuttaFlow Bioseal (GFB) conforms to the root canal irregularities is unclear and requires further investigation. Purpose This study compared the obturated surface area, the extrusion of root filling material and the duration of obturation procedure between GFB and monocone. Methodology The root canal of twenty single-rooted mandibular premolars were prepared using Hyflex CM rotary files (Coltene/Whaledent). The samples were equally divided into two groups; GFB and monocone. The duration of obturation procedure was evaluated using a digital timer and a radiograph was taken to assess the presence of extrusion. The roots were sectioned perpendicularly to obtain 3 root segments; apical 1/3, middle 1/3 and coronal 1/3. All resected roots were mounted on brass stubs, sputter-coated with thin gold coating and observed under scanning electron microscope (Zeiss EVO50, Germany) at 20x magnification. The images were transferred to the SketchAndCalc Area Calculator software for evaluation of obturated surface area. The data was analysed with SPSS version 25.0. Results The median score of obturated surface area between GFB and monocone at the apical 1/3 was 86.51 and 83.00, at the middle 1/3 was 90.48 and 87.35 and at the coronal 1/3 was 93.00 and 83.39 respectively with statistically significant difference at the coronal 1/3. The extrusion of root filling material between GFB and monocone did not show statistically significant difference. The mean score of duration of obturation procedure between GFB and monocone was 149.50 and 137.60 respectively with statistically significant difference. Conclusion The obturated surface area at the apical 1/3 and middle 1/3 between GFB and monocone was comparable but at the coronal 1/3 the former showed 11.5% better. The extrusion of root filling material between GFB and monocone was equivalent. The obturation procedure with GuttaFlow Bioseal required 8.6% longer than the monocone obturation technique.

Objectives There has been a marked improvement in dental health in Norway during the last few decades. What effect has this had on provision of dental services, and how has private dental practitioners’ assessment of their workload changed? Methods The data were from 2 large surveys of private dental practitioners carried out in 1992 (n = 1056) and 2015 (n = 1237). An analysis of nonresponders showed that they were evenly distributed according to their age, gender, and the region in which their practice was located. Thus, the samples were representative of private dental practitioners. For 1 representative week in practice, the practitioners were asked to report the number of visits and the number of patients who received 1 or more of the following items of treatment: filling, crown, bridge, denture, root filling, extraction, and periodontal treatment. As a measure of patient supply, the responses from the following questions were used: “Based on an overall assessment of economy, workload, and other personal factors, is the number of regular patients adequate? If not, do you wish to have more patients or fewer patients?” Results From 1992 to 2015, the annual number of visits per practitioner decreased by 23%. The number of patients per practitioner who received fillings, crowns, bridges, dentures, root fillings, or extractions decreased by 50% or more. The decrease was largest for practitioners younger than 35 years and for men. The proportion of practitioners who reported a deficit of patients increased from 20% to 37%. Conclusions Many dentists will have too few patients and a fall in income in the years to come is expected.

Introduction The purpose of this study was to compare endodontic treatment factors, treatment difficulties, and oral health–related quality of life (OHRQOL) between elderly and young patients. Methods A total of 150 adults, 75 elderly (≥65 years) and 75 young patients (18–64 years), were recruited. Operators enumerated difficulties associated with communication, diagnosis, rubber dam application, access cavity preparation, canal localization, working length determination, instrumentation, and obturation after root canal treatment. The number of treatment visits, maxillary first molars with a second mesiobuccal canal, and the technical quality of the root filling were registered. Patients filled out questionnaires on pain, attendance of regular dental visits, esthetics, and masticatory function and the Oral Health Impact Profile-14. Results Significantly more elderly had necrotic pulp (P < .001) and needed root canal treatment on teeth with full-coverage crown/bridge abutment (P < .001). It was significantly difficult to perform access cavity preparation and localize root canals on the elderly and on teeth with a full-coverage crown/bridge abutment. In regression analysis, the elderly presented with difficulties only during canal localization (P < .05). Second mesiobuccal canals were obturated in 43.5% of the young patients and 23.1% of the elderly patients. There were no significant differences in the number of treatment visits or the technical quality of root filling between the 2 groups. There were no significant differences in pain sensation, esthetics, masticatory function, or regular dental visits between the 2 groups. Elderly patients reported a significantly better OHRQOL (P < .05). Patients experiencing pain, patients needing treatment on anteriors/premolars, and females reported a significantly poorer OHRQOL (P < .05). Conclusions The elderly presented with treatment difficulty during canal localization and had better OHRQOL compared with young patients. publishedVersion

The aim of this study was to evaluate the influence of pozzolan sealers used for apexification in immature permanent teeth on the root fragility using a performance simulation in sheep teeth in vitro. The fracture resistance of 125 incisor teeth from 38 domestic sheep was evaluated by filling the root canals with AH Plus, ProRoot MTA, and the Biodentine and Pozzolan MTA-based materials EndoSeal MTA and Endocem MTA after performing immature, permanent tooth simulations. The highest fracture resistance was obtained in a negative control group where no treatment was administered. The lowest resistance was found in a positive control group where no canal filling was performed. A significant difference between these groups was found (p < 0.001). The median fracture value of the AH Plus experimental group (934.14 + 95.38 Newtons (N)) was higher than both the Endocem MTA (893.87 +125.41 N) and the EndoSeal MTA groups (869.08 + 91.49 N). However, the differences between these groups were not statistically significant (p > 0.05). The results of the simulations indicate that the Pozzolan MTA-based EndoSeal MTA and Endocem MTA increase the fracture resistance of immature permanent teeth.

AIM To evaluate the influence of ultraconservative access cavities (UltraAC) on canal shaping and filling ability and load capacity of mandibular molars after root canal preparation with XP-endo Shaper (XP) or Reciproc (RC), under simulated clinical conditions. Traditional access cavities (TradAC) were used for comparison. METHODOLOGY Forty extracted mandibular molars were scanned by micro-computed tomographic and, based on similar anatomical features, were divided into four groups (n = 10), according to the type of access cavity and canal instrumentation protocol: TradAC/RC, TradAC/XP, UltraAC/RC and UltraAC/XP. All root canal procedures were performed with the teeth placed in a dental mannequin. Teeth were scanned after root canal instrumentation and filling. Unprepared canal area, dentine removed, accumulated hard tissue debris (AHTD), canal transportation, presence of voids and filling material remnants within the pulp chamber were analysed. After restorative procedures, the teeth were subjected to thermomechanical cycling and to a load capacity test. Statistical analyses were performed using two-way anova test, considering the randomized blocks design (P

Instrumentation creates space for root canal irrigation, disinfection and root filling. All of these phases have an impact on the method and size of instrumentation, depending on the philosophy of the dentist and the limitations and requirements set by the equipment used in each phase, especially in root filling phase. The shrinkage of root canal sealers and instability in tissue fluids has necessitated a thin layer of the sealer and has resulted in instrumentation techniques with large tapers primarily directed to thermoplastic obturation methods and warm vertical condensation techniques. In many cases these access cavity and endodontic preparation techniques have led to excessive removal of dentin on the coronal and middle third of the root canals, making the coronal part and root more susceptible to fracture. New technologies on root canal preparation using low taper NiTi conforming files to conservatively prepare the root canals maintaining as much sound peri-cervical dentin as possible have gained a large attention on the last years. These instrumentation methods combined to new calcium-silicate-based hydraulic endodontic cements that can predictably fill the root canal space on a more biological and conservative setting fit on the minimally invasive root canal filling phase. This chapter presents a panorama of presently available material and methods suggested for root canal filling to adapt to the minimally invasive preparation concept.

Background: This study aims to analyze the use of contemporary technologies and materials in undergraduate endodontic teaching in Spain. Material and Methods: The survey was sent to the undergraduate endodontic programme leads in the 23 Spanish dental schools. The survey asked about the use of magnification, ultrasonic devices, electronic apex locator, rotary instruments, root-filling techniques, and bioceramic cements in the teaching of endodontics. Results: The response rate was 91%, and the final number of schools included in the study was twenty. Only two schools (10%) used magnification (loupes or operative microscope). Five schools (25%) used ultrasonic devices to prepare the access cavity, and four (20%) to activate the irrigation solution. In 14 dental schools (70%) no type of ultrasonic instrument was used. Electronic apex locators in working length determination was used in 19 schools (95%). All schools used rotary instrumentation in the teaching of endodontics, and 45% of schools used reciprocating instruments. Five schools (25%) used warm vertical compaction technique, four (20%) single cone gutta- percha technique, and four (20%) thermoplastic injection techniques. No school used carrier-based gutta-percha. Bioceramic cements were used in 19 of the schools (95%).Conclusions: Spanish dental schools have incorporated some of the new endodontic technologies and materials, including the electronic apex locator, rotary instruments, and the new bioceramic cements; however, the modern root filling techniques, magnification, and ultrasonic instruments are not yet used in most dental schools.

This study aimed to investigate the real-time nanoleakage and flow characteristics of calcium silicate-based (Ca–Si) root canal filling materials. Extracted human teeth (n = 30) were decoronated and standardized in their inner and outer dimensions. After root canal enlargement, the roots were filled with gutta-percha (GP) and AH26 sealer, GP and EndoSeal MTA sealer, or Biodentine. The roots were connected to a Nanoflow device (IB Systems) under hydrostatic pressure (40 cm∙H2O) and fluid flow was traced through the filled roots. Data were detected at the nanoscale twice per second and automatically recorded in units of nL/s. Leakage was quantified as the mean slope until the curve plateaued over time, and all static flow intervals lasting longer than 1 s were analyzed to identify any increase in flow and duration. Data were statistically analyzed using the Kruskal-Wallis test. The calculated leakage values were 0.0670 ± 0.0516 nL/s for GP/AH26, 0.1397 ± 0.1579 nL/s for GP/EndoSeal MTA, and 0.0358 ± 0.0538 nL/s for Biodentine, with no statistically significant differences among the root filling materials (P > 0.05). An analysis of real-time flow data for 1000 s to identify spot trends and the overall tendency of flow until a plateau was reached revealed a stepwise increase in the roots filled with Ca–Si material, whereas the GP/AH26-filled roots showed a linear increase. Real-time measurements under hydrostatic pressure with the Nanoflow device enabled precise fluid flow tracing through the root canal filling material. In terms of nanoleakage, the tested root canal filling materials showed no significant differences, while the real-time flow patterns of roots filled with Ca–Si material showed different characteristics from those of GP/AH26-filled roots.

We investigated differences in the technical quality of root fillings according to socioeconomic status. In the Finnish Health 2000 Survey, which comprised a sample of 8,028 adults aged over 29 yr, 6,115 underwent panoramic radiography. A total of 7,986 endodontically treated teeth were detected among 3,095 participants. The criterion for a technically inadequate root filling was a distance from the root filling to the root apex of over 3 mm or a filling extruding beyond the apex. Educational level, employment status, and income were the measures of socioeconomic status. Differences in the frequency of inadequate root fillings according to socioeconomic status were investigated using a multilevel logistic mixed-effects model taking into account age, gender, number of teeth, and type of root filled tooth. Almost half (46%) of the root fillings were inadequate. Among the over 64-yr-olds, higher education and higher income were associated with a higher probability of having an inadequate root filling. Among the under 65-yr-olds, socioeconomic status was not associated with root filling quality. Contrary to expectation, lower socioeconomic status was not associated with poorer endodontic treatment quality; however, higher income and higher education was associated with higher odds for inadequate root fillings among the over 64-yr-olds.

AIM The aim of this study was to in vitro evaluate the apical sealability of mineral trioxide aggregate (MTA) when used as an orthograde root filling material, and to evaluate whether smear layer removal has any influence on the apical seal of this material. MATERIALS AND METHODS Forty single-rooted human mandibular premolars were selected in this in vitro study. The selected teeth were randomly divided into two equal groups (n = 20) based on the irrigation type. Group 1 was irrigated using distilled water to keep the smear layer intact, and group 2 was irrigated using NaOCl 5.25% and ethylenediaminetetraacetic acid (EDTA) 17% to remove the smear layer. All teeth were instrumented using a step-back technique and obturated using white MTA. Microleakage of 0.2% rhodamine B solution at the tooth-material interface was evaluated to assess the apical seal of MTA. The data were analyzed statistically using Mann-Whitney test U-test (p = 0.05). RESULTS When the smear layer was present, MTA revealed less leakage compared to the group of MTA without smear layer with statistically significant difference (p

This study evaluated by the efficacy of rotary and reciprocating systems to remove filling material by micro-CT. Sixty human canines were instrumented up to F3 by ProTaper Universal system and filled with AH Plus/ gutta-percha. Specimens were submitted to 1,200 thermal cycles, scanned by microCT SkyScan 1176 and randomly distributed in groups according to the filling material removal protocol (n = 10): ProTaper Universal, ProTaper Universal/xylol, ProTaper Next, ProTaper Next/xylol, Reciproc and Reciproc/xylol. After filling removal, specimens were analyzed by microCT to separately verify the presence of gutta-percha and sealer remnants. The data (mm3) were analyzed by two way ANOVA and Tukey´s test (5%). For the remaining gutta-percha, the use of xylol provided the highest values for Reciproc (7.60 ± 0.73), which was statistically different from the other groups (p < 0.05) that presented lower values and were statistically similar to each other (p > 0.05). For the remaining sealer, xylol provided the highest values (21.25 ± 6.94) different (p < 0.05) from the use of instruments alone (11.47 ± 9.45). ProTaper Next presented the lowest values (8.16 ± 1.37) for the remaining sealer, different (p < 0.05) from that of Reciproc (24.67 ± 6.32). The qualitative analysis revealed that all groups presented some remaining root filling material, with the highest volumes presented by Reciproc and Reciproc/xylol. In conclusion the rotary systems provided greater removal of filling material regardless of the use of xylol. The use of xylol negatively interfered with the action of the reciprocating system in the removal of the gutta-percha and sealer.

To assess the impact of conservative endodontic access cavities (CEC) and truss access cavities (TAC) during root canal treatment performed on mandibular molars in terms of: ability to shape and fill root canals, microbial reduction in canals, and cleaning of the pulp chamber. In addition, the fracture resistance of the teeth after coronal restoration was assessed. Traditional endodontic cavities (TEC) were used as a reference technique for comparison.Thirty extracted intact mandibular molars were scanned in a microcomputed tomography device (micro-CT), matched based on similar anatomical features and assigned to TEC, CEC or TAC groups (n = 10). The specimens were accessed accordingly, and root canals were contaminated with bacterial suspensions of Enterococcus faecalis (21 days). Subsequently, the first microbial sample was collected from root canals (S1). The canals were initially prepared with Reciproc Blue R25 instrument followed by a second instrumentation using Reciproc Blue R40. Eight mL of 0.5% NaOCl were used as an irrigant for each instrument. A final irrigation protocol was performed with 2 mL of 0.5% NaOCl, 2 mL of 17% EDTA and another 2 mL of 0.5% NaOCl. Microbial samples were collected from root canals after R25 (S2), R40 (S3) and final irrigation (S4). The teeth were rescanned after S4. Then, root canals were filled, rescanned, restored and the teeth subjected to fracture resistance tests. The statistical analysis was performed with type I negative binomial and beta 0-1 inflation regression models for microbiological analysis. Instrumentation, filling and resistance to fracture results were subjected to anova and Tukey tests (P 0.05).S4 revealed no significant variations in microbial reduction amongst the groups (P 0.05). TEC had a significantly lower percentage of unprepared surface area than CEC (P 0.05). No differences were found regarding the percentage of dentine removed, transportation, centring ability and filling voids amongst the groups (P 0.05). The TEC group had a significantly lower volume of remaining root filling material within the pulp chamber than CEC and TAC groups (P 0.05). There was no difference regarding fracture resistance amongst the groups (P 0.05).Conservative access cavities did not offer any advantage in comparison with the traditional endodontic cavities in any of the parameters considered. Furthermore, conservative methods were associated with larger percentages of unprepared canal surface area and larger volumes of remaining root filling material within the pulp chamber.

Aim To evaluate the extraradicular peroxide release from sodium percarbonate compared to sodium perborate as an intracoronal bleaching agent. Methodology Sixty mandibular single-rooted premolars with intact CEJ were selected. After root filling, gutta-percha was removed 4 mm apical to CEJ and 2 mm of GIC was condensed over the root filling. Intracoronal bleaching agents were placed into six groups of teeth (n = 10): sodium perborate with distilled water (SPW); sodium percarbonate with distilled water (SPCW); sodium perborate with 30% hydrogen peroxide (SPHP); sodium percarbonate with 30% hydrogen peroxide (SPCHP); 30% hydrogen peroxide as positive control (HP) and distilled water as negative control (CL). The teeth were then mounted in vials filled with distilled water, kept in an incubator and taken out at 1, 3 and 6 days for spectrophotometric analysis. Extraradicular peroxide release was quantified by the ferrothiocyanate method. Statistical analysis was undertaken with one-way anova and Scheffe post hoc tests. Results The greatest peroxide release occurred in the HP group, followed by the SPCHP and SPHP groups, and then by the SPCW and SPW groups. Intergroup comparison revealed that there was no significant difference in peroxide release among the groups SPCW and SPW on days 1, 3 and 6 (P > 0.05). Similarly, no significant difference was found between the SPCHP and SPHP treated groups on days 1, 3 and 6 (P > 0.05). Conclusion Extraradicular peroxide release from sodium percarbonate was comparable to that of sodium perborate, as the differences were not significant.

AIM To compare the efficiency of M-Wire Reciproc and Reciproc Blue instruments in the removal of root filling material and in their ability to regain apical patency through micro-computed tomographic (micro-CT) analysis. METHODOLOGY Ten anatomically matched pairs of teeth, with a single oval-shaped straight canal, were selected and scanned in a micro-CT device. The root canals were prepared with M-Wire Reciproc R25 instruments and filled with gutta-percha and AH Plus sealer. The root canals were then randomly allocated into two groups (n = 10), according to the instrument used: M-Wire Reciproc and Reciproc Blue. The canals were retreated up to instrument sizes 25 and then 40 in both groups. The surface area and volume of residual filling material were assessed using micro-CT imaging after the retreatment procedures. The time required to remove the root fillings was recorded. Data were analysed statistically using t-test with a significance level of 5%. RESULTS No significant difference (P > 0.05) was observed between the instruments in terms of the volume of residual root filling material. Apical enlargement from size 25 to 40 significantly improved the removal of filling materials (P

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.

Objective: This study evaluated the cleanliness of root canals and the adaptability of root canals filling material after using the XP Endo finisher (XP-F) and passive ultrasonic irrigation (PUI) during retreatment. Methods: 53 recently extracted mandibular premolars were used that were instrumented to a size 50 then blocks were grouped into; G1: Cleanliness (Cl) group and G2: Adaptability (Ad) group. The blocks in Cl group were sectioned longitudinally then reassembled and reinstrumented to a size 50. Then the canals in Cl & Ad groups were obturated then the root filling material was removed and canals were cleaned with XP-F or PUI. Furthermore, specimens in Cl group were evaluated using a digital microscope to image the remnants while canals in Ad group were reobturated and sectioned horizontally that were examined using push out test to evaluate adaptability and data were statistically analyzed. Results: When compared cleanliness of canals from remnants, there was no significant difference between subgroups. Furthermore, the AdXP-F and Adc subgroups had significantly higher values than AdPUI subgroup. Conclusions: Both XP-F and PUI perform the same with regards to removing of remnants. When using the XP-F instrument, the adaptability of the root canal filling material to the root canal walls improved.

The main goal of root canal therapy is to eliminate the pathogenic effects of bacteria from the root canal system and that through chemomechanical debridement followed by inert root filling to prevent microorganisms from infecting or reinfecting root canals and the periradicular tissues. Defining clinical healing of apical periodontitis after endodontic treatment is very difficult especially finding a relevant radiologic examination method for accurate observation. Therefore, various radiologic techniques were used among which we site the periapical x-rays, the orthopantomogram, the cone beam computed tomography, and that depending on the size and the localization of the pathological entity. The aim of the present paper was to show the treatment outcome and the healing of large periapical radiolucency controlled with CBCT. Resume Le principal objectif du traitement canalaire est d’eliminer les bacteries pathogenes du systeme radiculaire. Cela est accompli par le debridement chimio-mecanique suivi d’une obturation hermetique et inerte des racines pour empecher les micro-organismes d’infecter ou de reinfecter les canaux radiculaires et les tissus periradiculaires. Il est tres difficile de definir la guerison clinique de la parodontite apicale apres un traitement endodontique, en particulier de trouver une methode d’examen radiologique pertinente pour une evaluation precise. Par consequent, differentes techniques radiologiques ont ete utilisees, parmi lesquelles on trouve la radiographie periapicale, la panoramique, la tomodensitometrie a faisceau conique, le choix de la technique etant en fonction de la taille et de la localisation de l’entite pathologique. Le but de cet article etait de montrer le resultat du traitement et la cicatrisation dans le temps d’une lesion radioclaire periapicale importante, le controle etant radiologique.

Introduction This study aimed to assess whether the method of teaching endodontology influenced the quality of root fillings made by undergraduate students. Materials and methods The method of teaching endodontology at our institution was revised. Changes concerned: the programme (ie method of clinical training and summative assessment), and the supervision whilst performing root canal treatment on patients. An intermediate cohort (N=91) comprised partly students attending the former programme (involving patients) and partly students attending the revised programme (without patients). After succeeding in the summative assessment, the quality of the first root filling made by the student in a patient under supervision of either a general dental practitioner or an endodontist was evaluated according to pre-determined criteria. Data were analysed using Cohen's Kappa, Chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests. Results Sixty-two per cent (47 of 76) of root fillings made by students who attended the revised programme were of good quality, in comparison with 47% (seven of 15) of those made by students who attended the former programme (P=.274). Less complex treatments had better quality root fillings if students were supervised by endodontists (88% (14 of 16) good quality) than supervised by general dental practitioners (59% (22 of 37) good quality) (P=.045). Complex treatments did not differ in quality of root fillings for the supervision types (P=.825). Conclusion The quality of root fillings made by students who attended the revised programme seems at least as high as that of those who attended the former programme. Higher quality root fillings might be obtained under supervision of endodontists than under supervision of general dental practitioners.

Aim To study the demographics of Swedish adults who had received a root filling, followed by extraction during the following 5-6 years in comparison with subjects who had undergone a corresponding root filling with an uneventful outcome. Methodology The root filled maxillary first molar was chosen as the comparison model. The Swedish Social Insurance Agency provided data on all teeth reported as root filled in Sweden during 2009. A comparison group, equally large as the study group, was constructed by randomly selecting subjects with root filled maxillary first molars, which had not subsequently been extracted, that is, an uneventful outcome. Demographic data on the subjects were obtained from Statistics Sweden: country of birth, disposable income, educational level, age, civil status and gender. Chi-square, t-tests and logistic regression were used for statistical analyses. Results In the year 2009, 36 139 maxillary first molar teeth were reported to have been root filled, 4362 (12.1%) of which were then recorded as extracted during the following 5-6 year period. Only minor intergroup differences were noted: 86.5% of the study group were Swedish-born, compared with 84.4% of the comparison group (P = 0.007). Women comprised 53.2% of the study group and 50.5% (P = 0.01) of the comparison group. There was an association between extractions and gender as well as age; men had a lower odds ratio (OR) for extraction OR, 0.87; confidence interval (CI), 0.80-0.95. For every additional year, the chance for extraction was higher OR, 1.01; CI, 1.01-1.01. No other significant differences were detected. Conclusions There was only little or no demographic differences between the study group, comprising Swedish adults who had undergone root filling of one of their maxillary first molars in 2009 and subsequent extraction during the following 5-6 years, and the comparison group, with uneventful outcomes after a corresponding root filling.

Objective: This study aimed to evaluate the relationship between the quality of the coronal restoration and the root canal filling on the periapical status of endodontically treated teeth using CBCT. Materials and Methods: CBCT data were obtained from the records of patients who deny any dental treatment in the 2 years prior to the CBCT examination. CBCT images (90 kVp and 7 mA, exposure time of 23 s, and a voxel size of 0.2 mm, with a field of view of 13 cm x 13 cm) of 1011 endodontically treated teeth were observed. A score was given to the quality of the root filling and the quality of the coronal restoration. Statistical Analysis Used: Data were statistically analyzed to correlate the periapical status with gender, dental group. and quality of endodontic treatment and restoration (Chi-square test with a significance level of P < 0.001). Results: Absence of periapical periodontitis was found in 54.9% of the cases. The periapical outcome was not related to gender or dental group (P > 0.05). A statistically significant factor (Chi-square test, P < 0.0001) resulted when different qualities of sealing were compared. Conclusions: CBCT showed that high-quality root canal treatments followed by an adequate coronal sealing restoration avoid the presence of periapical periodontitis in time.

In dental root canal treatment, failure is due to incomplete Obturation. These are formation of voids, under-filling & over-filling of Gutta Percha (GP) material (rubbery, biocompatible and inert material used in sealing canals against bacterial infection.) More studies are required to evolve with properties of GP material after loading. Compaction Force during obturation, Method and Techniques of Root filling are considered important factors. Root canal was modeled in ANSA 15.1.2 and FEA tool as LS DYNA R 7.11 was used to get stress distribution and energy consumed after loading the GP with time. Von Mises stress in the dentine (123.2 MPa) and in the GP present in the Coronal 1/3 rd of root canal (13.04 MPa) was observed.

To investigate the effectiveness of XP-endo Shaper (XPS) and XP-endo Finisher R (XPFR) instruments in removing aged root filling material from root-treated mandibular molars.Thirty mandibular molars were instrumented and divided into three groups: single-cone obturation using AH Plus sealer (AHS) or EndoSequence BC sealer (BCS), and warm vertical compaction using AH Plus sealer (AHW). The specimens were stored at 100% humidity and 37 °C for 54 months. Retreatment was performed using XPS and XPFR. Micro-computed tomography was used to scan the specimens after 54 months, after XPS retreatment and after the supplementary approach using XPFR.The XPS removed more filling material in the BCS and AHS groups, compared with the AHW group (P 0.05). After supplementary instrumentation XPFR, the proportion of the remaining filling material decreased significantly in all groups (P 0.05). The XPFR instruments were more efficient in removing filling material in the BCS group than in the AHS or AHW group (P 0.05). The combined use of XPS and XPFR instruments efficiently removed filling material in the BCS group, followed by the AHS and AHW groups (P 0.05).Although the combined use of XPS and XPFR instruments helped remove the bulk of aged root filling material from mandibular molars, material removal from canals filled using warm vertical condensation in the critical apical area remains a concern.Removal of the aged filling materials using XP-endo instruments from the apical area is challenging when instrumented root canals are filled using warm vertical condensation.

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 &gt, 0.05). Similarly, specimens treated with TotalFill BC sealer with different obturation techniques showed statistically similar outcomes (p &gt, 0.05). It was also observed that specimens in groups 3, 4, 5 and 6 demonstrated comparable outcomes of fracture strength (p &gt, 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).