Restorative Dentistry & Endodontics最新文献

Endodontic-periodontal lesions (EPLs) complicated by cemental tears present a diagnostic and therapeutic challenge. This case report describes the successful management of a 66-year-old male patient with a mandibular second molar (#18) exhibiting an EPL complicated by a cemental tear. Clinical examination revealed a draining sinus tract, deep periodontal pockets, and radiographic evidence of a "J-shaped" lesion and a radiopaque cemental fragment. The tooth had previously initiated endodontic treatment. A multidisciplinary approach involving endodontic treatment and surgical removal of the cemental tear was implemented. At 24-month follow-up, clinical and radiographic examination revealed significant improvement in periodontal health, bone regeneration, and resolution of the lesion. This case highlights the importance of considering cemental tears in the differential diagnosis of EPLs and demonstrates the efficacy of a combined endodontic-periodontal approach for achieving predictable outcomes.

Objectives: Endodontic retreatment aims to address treatment failure through the removal of root canal filling materials. This in vitro study evaluated the presence of filling material remnants in the mesial root canals, specifically focusing on the isthmuses, of mandibular molars after retreatment.

Methods: One hundred extracted mandibular molar mesial roots with isthmuses were prepared with an R25 file, obturated with one of five calcium silicate-based sealers (BioRoot RCS [Septodont], MTApex [Ultradent Products Inc.], EndoSequence BC Sealer HiFlow [Brasseler USA], Bio-C Sealer [Angelus]) or an epoxy resin-based sealer (AH Plus Jet [Dentsply Maillefer]), all stained with rhodamine B, and stored at 37ºC for 30 days to allow for setting. Retreatment was subsequently performed using R40 and XP-endo Finisher R instruments (FKG Dentaire) with 2.5% sodium hypochlorite irrigation. The presence of remaining filling material was then assessed using confocal microscopy, and setting times were tested per ISO 6876:2012.

Results: AH Plus Jet showed the most remnants at 2 mm and the longest retreatment time. Calcium silicate-based sealers exhibited prolonged setting times under dry conditions, with EndoSequence BC Sealer HiFlow showing a particularly extended setting period.

Conclusions: Despite retreatment, residues remained in all canals and isthmus regions, particularly Bio-C Sealer and AH Plus Jet in apical areas, emphasizing the difficulty of complete removal and the persistence of filling material.

Objectives: This study aimed to assess the influence of two endodontic sealers on the bond strength of glass fiber posts using conventional and self-adhesive resin cement through a push-out test.

Methods: Forty central human incisors were randomly divided into four groups (n = 10) based on sealer (epoxy resin- based or calcium silicate-based) and cement (conventional and self-adhesive resin) types: AH Plus (Dentsply De- Trey)/RelyX ARC (3M ESPE), AH Plus/RelyX U200 (3M ESPE), Bio-C Sealer (Angelus)/RelyX ARC, and Bio-C Sealer/RelyX U200. After canal filling and post cementation, roots were sectioned to obtain one specimen per root third. A pushout test and failure pattern assessment were conducted, with bond strength analyzed using the one-way analysis of variance and Tukey test.

Results: AH Plus/RelyX ARC showed the highest bond strength values, with a significant difference in the middle third. The most common failure was mixed (55%), while adhesive failures made up 45%, with 23.5% at the cement/post interface and 21.5% at the cement/dentin interface.

Conclusions: AH Plus/RelyX ARC provided the highest bond strength values for glass fiber posts to dentin.

Objectives: This study aimed to evaluate the influence of cone-beam computed tomography (CBCT) acquisition protocol, the presence of intraradicular metal post, and examiner experience on the detection of complete root fractures in multi-rooted teeth.

Methods: Twenty human molar teeth filled with gutta-percha were placed into artificial alveoli created in bovine ribs. The sample was divided into two groups based on the presence or absence of intraradicular posts in the distal roots. CBCT scans were obtained using four acquisition protocols with varying voxel sizes (0.28, 0.2, 0.125, and 0.80 mm). Following the creation of controlled fractures using a chisel and hammer, CBCT imaging was repeated, resulting in 160 images. Five examiners assessed the images using OnDemand software (KaVo Dental GmbH). Sensitivity, specificity, and accuracy were calculated for each examiner, CBCT protocol, and post-condition. Statistical comparisons were performed using Cochran's Q test and McNemar test, and a significance level of 5%.

Results: In teeth without metallic posts, sensitivity, specificity, and accuracy values exceeded 0.70, 0.70, and 0.80, respectively. However, the presence of metallic posts significantly reduced diagnostic performance, particularly in low-resolution protocols evaluated by less-experienced examiners.

Conclusions: CBCT acquisition protocols should be selected based on the presence of metallic posts to optimize root fracture detection in multi-rooted teeth. Examiner experience also plays a critical role in diagnostic accuracy.

Objectives: This study aimed to measure the dentin thickness of C-shaped canals in mandibular first and second premolars at coronal, middle, and apical root levels using cone-beam computed tomography (CBCT).

Methods: Dentin thicknesses of buccal, lingual, mesial, and distal root walls of 41 C-shaped premolars were measured at three different root levels on axial CBCT slices. The measurements were made at the midpoint of each third, along with 1 mm below and above the midpoint. C-shape configurations of the premolar root canals were also recorded. Analysis of variance, Kruskal-Wallis, and the independent samples t-tests were used for the comparisons (p = 0.05).

Results: The thickest walls for both premolars were buccal and lingual walls at all three root levels (p < 0.05). The thinnest walls for the first premolar teeth were mesial and distal walls of the lingual canal, while it was the mesial end of the buccal and lingual canals for the second premolars (p < 0.05). Dentin wall thicknesses at the mesial end of buccal and lingual canals of C1-shaped first premolars were thinner than C2-shaped first premolars at the apical level (p < 0.05).

Conclusions: Danger zones for C-shaped mandibular first and second premolars are predominantly mesial walls facing the radicular groove and distal wall of the lingual canal. CBCT imaging during endodontic treatment is recommended to avoid complications.

When root canal infections breach the maxillary sinus floor (MSF), maxillary sinusitis of endodontic origin (MSEO) can result. This case illustrates the surgical management of MSEO following the nonsurgical reestablishment of the MSF. A 55-year-old woman presented with left facial pain and was diagnosed with MSEO originating from the left upper first molar. Despite undergoing nonsurgical root canal treatment, there was no evidence of bony healing after 6 months. However, cone-beam computed tomographic (CBCT) scans revealed the reestablishment of MSF. Subsequently, surgical intervention was carried out using a dental operating microscope. Two years after surgery, CBCT images indicated that the mucosal edema had resolved, and the MSF was well reestablished. Preserving the MSF is crucial for the success of endodontic surgery. When MSEO is present, the integrity of the MSF must be assessed to determine appropriate treatment options.

Objectives: This study aimed to evaluate whether the agitation protocols using ultrasonic inserts or the XP-endo Finisher R file improved the removal of two different endodontic sealer remnants and the bond strength of fiberglass posts to dentin.

Methods: Seventy-two human teeth were selected. The canals were prepared with Reciproc 50 and Easy ProDesign 30/.10 and root filled according to the endodontic sealer groups: AH Plus or EndoSequence BC Sealer HiFlow. The samples were kept at 37ºC and 95% humidity for 28 days. During the post space preparation, the obturation was removed with Largo burs, and the groups were divided according to the irrigant agitation protocols (n = 12): no agitation, agitation with R1-Clearsonic associated with E1-Irrisonic ultrasonic inserts, or agitation with XP-endo Finisher R file. The fiberglass posts were cemented with RelyX ARC. The roots were sectioned into slices and submitted to the push-out test. Micro-computed tomography analysis was used to check the effectiveness of irrigating solution agitation in the elimination of remnants.

Results: The cleaning protocols with agitation were more effective in increasing the bond strength of posts to dentin for both sealer groups compared to non-agitation (p < 0.05). There was no difference between the same cleaning protocols for the different sealers. Among the different thirds, there was no statistical difference for the same sealer in the different cleaning protocols (p > 0.05).

Conclusions: Both agitation protocols effectively clean root-filled canals sealed with resin-based and calcium silicate-based sealers during fiberglass post space preparation. These protocols result in improved bond strength compared to non-agitation methods.

Objectives: This study aimed to evaluate the effects of two different file systems operated with three apical functions of an endodontic motor integrated with an electronic apex locator on debris extrusion.

Methods: Sixty single-rooted teeth were prepared and divided into two main groups and three subgroups based on the file system (OneShape [Micro-Mega SA] and WaveOne [Dentsply Maillefer]) and apical function of the endodontic motor used (auto apical stop [AAS], auto apical reverse [AAR], and auto apical slowdown [ASD]). The teeth were mounted in pre-weighed glass tubes filled with 0.9% sodium chloride to complete the circuit with the apex locator. Files were advanced until the respective apical function (stop, reverse, or slowdown) was activated. The extruded debris was collected, dried, and weighed by subtracting pre-weighed values from post-weighed values. Preparation time was also recorded. Statistical analyses were performed to compare the groups.

Results: OneShape was associated with significantly less debris extrusion compared to WaveOne, regardless of the apical function (p < 0.05). The ASD function resulted in the least debris extrusion compared to AAS and AAR (p < 0.05). Preparation time was significantly longer in the ASD function (p < 0.05), while no differences were observed between the file systems (p > 0.05).

Conclusions: The OneShape file system and the ASD function produced the least amount of apical debris. While the ASD function requires more preparation time, its potential to minimize debris extrusion suggests it may reduce postoperative symptoms.

Objectives: The study aimed to evaluate the effect of limonene extract (LE) on push-out bond strength (BS) to root dentin in endodontically treated teeth.

Methods: Single-rooted teeth were selected and instrumented using the reciprocating technique, then divided into three groups based on the final irrigating solution: 2.5% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), and 5% LE. The roots were further divided (n = 12) and obturated using the single-cone technique with epoxy resin-based (ERB) or bioceramic sealer (Bio-C). After 3 days, the roots were sectioned into 2-mm slices, obtaining two slices from each root third. Push-out BS testing was conducted at 0.5 mm/min, followed by failure pattern and adhesive interface analysis using scanning electron microscopy. Push-out BS data were analyzed by three-way analysis of variance and Tukey post-hoc test (p < 0.05).

Results: ERB showed higher BS when irrigated with EDTA (5.0 ± 2.3 MPa) compared to NaOCl (1.8 ± 1.1 MPa) (p = 0.0005), particularly in the cervical third. LE yielded intermediate values without significant differences from the other irrigants (3.5 ± 1.9 MPa) (p > 0.05). For Bio-C, the highest BS was observed in the apical third, especially with LE (9.4 ± 5.0 MPa), differing from other thirds and final irrigating solutions (p < 0.05). Mixed failure patterns were most prevalent, regardless of the irrigant solutions.

Conclusions: The combination of LE with Bio-C demonstrated superior BS in the apical third, suggesting its potential as a final irrigating solution in endodontic treatments.

Objectives: This study analyzed the stress distribution in a maxillary central incisor with external cervical resorptive defect restored with different restorative materials under normal masticatory and traumatic loading conditions using finite element analysis.

Methods: Cone-beam computed tomography of an extracted intact incisor and created resorptive models (Patel's 3D classification-2Bd and 2Bp) in the maxillary central incisor was performed for finite element models. The 2Bd models were restored either with glass ionomer cement (GIC)/Biodentine (Septodont) or a combination of both with composite resin. 2Bp models were restored externally with a combination technique and internally with root canal treatment. The other model was external restoration with GIC and internal with fiber post. Two masticatory loads were applied at 45˚ to the palatal aspect, and two traumatic loads were applied at 90˚ to the buccal aspect. Maximum von Mises stresses were calculated, and stress distribution patterns were studied.

Results: In 2Bd models, all restorative strategies decreased stress considerably, similar to the control model under all loads. In 2Bp models, the dentin component showed maximum stress at the deepest portion of the resorptive defect, which transfers into the adjacent pulp space. In 2Bp defects, a multilayered restoration externally and root canal treatment internally provides better stress distribution compared to the placement of a fiber post.

Conclusions: Increase in load, proportionally increased von Mises stress, despite the direction or angulation of the load. Multilayered restoration is preferred for 2Bd defects, and using an internal approach of root canal treatment is suggested to restore 2Bp defects.