Apical sealing using two thermoplasticized gutta-percha techniques compared with lateral condensation

This study was conducted to compare the apical sealing capacity of three filling techniques, a multiphase gutta-percha obturation technique, JS Quickfill, and lateral gutta-percha condensation. A four-stage stepback preparation was executed with circumferential filing in a total of 70 recently extracted permanent maxillary incisors and canines. Three experimental groups (20 teeth in each group) and two control groups (5 teeth in each group) were formed at random. Each experimental group was obturated with a different technique. The positive control group was not obturated. In the negative control group, the whole root was covered with two full nail varnish layers. Teeth were immersed in India ink for 48 h, demineralized, cleared with methyl salicylate, and examined with a stereomicroscope. None of the specimens obturated with the multiphase gutta-percha obturation system showed any penetration of India ink beyond the end of the preparation. In the groups of teeth obturated by JS Quickfill or lateral gutta-percha condensation, leakage was detected in one specimen from each group. No statistically significant differences were seen among groups. We conclude that the newer thermoplasticized filling techniques can be used successfully to obturate root canals in large, straight roots.     

Effect of two obturation techniques on the filling of lateral canals and the main canal

The three-dimensional obturation of the root canal system is widely accepted as a key factor for successful endodontic therapy. The purpose of this study was to evaluate the obturation of lateral canals and the main canal using cold lateral condensation versus the gutta-percha coated rigid carrier. Thirty epoxy blocks with five lateral canals placed at varying angles from the main canal were used. Each experimental group was obturated by a board certified endodontist with clinical experience in the respective obturation technique. The length of gutta-percha and sealer in the lateral canals was measured under a microscope (x30, Unitron) to the nearest 0.5 mm. The blocks were sectioned with an Isomet Plus precision saw (Buehler, Lake Bluff, IL) and copious water irrigation perpendicular to the main canal at the apex, the height of contour, and at 0.8, 1.6 and 2.4 mm from the canal apex. A microscope (x100, Leitz, Switzerland) was used to determine voids. There was significantly (p < .001) more gutta-percha in the lateral canals with the gutta-percha coated rigid carrier technique. In contrast, the cold lateral condensation technique had significantly (p < .001) more sealer in the lateral canals. However, there was no significant (p < .05) difference, in gutta-percha-plus-sealer filling of the lateral canals, between the two techniques. In the apical 1 mm of the main canal there were significantly (p < .011) fewer voids with the gutta-percha coated rigid carrier technique compared to the cold lateral condensation. In the model chosen, the gutta-percha coated rigid carrier technique and the cold lateral condensation technique were equally effective in filling lateral canals. In filling the main canal, however, the coated rigid carrier technique was more effective.     

Effect of post preparation on the apical seal of teeth obturated with plastic thermafil obturators

The effect of post canal preparation on the apical seal of endodontically obturated teeth with plastic Thermafil obturators was studied in vitro. Fifty-four extracted human maxillary anterior teeth were divided into four experimental and two control groups. Two groups were obturated with lateral condensation or plastic Thermafil obturator techniques; this was followed by post space preparation. Two groups were obturated as described above except that post space was not prepared. Apical leakage was determined with the use of 2% methylene blue dye solution at an absolute pressure of 75 mm Hg. There were no statistically significant differences between any of the groups. The clinical implication of these findings is discussed.     

Histological evaluation of the response of apical tissues to glass ionomer and zinc oxide-eugenol based sealers in dog teeth after root canal treatment

The object of the study was to compare two commercial root canal sealers: Ketac-Endo (a glass ionomer cement) and Fill Canal (a zinc oxide-eugenol cement). A total of 34 root canals from dog premolars with vital pulps were used. After instrumentation, the root canals were sealed with Ketac-Endo and Fill Canal cements using gutta-percha and a lateral condensation technique. After 270 days the animals were sacrificed with an anesthetic overdose and the maxillae and mandibles were removed and fixed in formalin for 48 h. After routine histological processing the sections were stained with hematoxylin-eosin and Mallory trichrome stains. Microscopic analysis revealed that Ketac-Endo cement presented better results than Fill Canal cement.     

Human saliva penetration of coronally unsealed obturated root canals

Studies have shown significant coronal dye and bacterial leakage following exposure of sealed root canals to artificial and natural saliva. The purpose of this study was to determine the time needed for bacteria in natural saliva to contaminate the entire length of root canals obturated by lateral and vertical condensation techniques. Forty root canals were cleaned and shaped using a step-back technique. Thirty root canals were obturated with gutta-percha and root canal sealer using either lateral or vertical condensation techniques. Forty root canals were obturated without a root canal sealer and served as positive controls. After obturation, the coronal 3 mm of five root canals were sealed with sticky wax and served as negative controls. The coronal portions of the filling materials were placed in contact with human saliva and the number of days required for bacteria in saliva to penetrate the entire root canals were determined. No bacterial leakage occurred in the negative control group. Complete bacterial leakage occurred within 2 days in the positive control group. All root canals were recontaminated in less than 30 days. No statistical significant difference was found between the two methods of obturation.     

Cloning and sequencing of part of the S10 operon from Actinobacillus actinomycetemcomitans FDC Y4

Linear dye penetration was evaluated in teeth with open apices in which calcium phosphate cement was used as an apical barrier to facilitate obturation. The apical foramens of 42 extracted single-rooted human teeth were opened to a size 90 file. Half the teeth received apical barriers consisting of calcium phosphate cement (CPC) followed by obturation using a customized gutta-percha cone/ lateral condensation technique. The other half were obturated without benefit of apical barriers. Linear dye penetration was measured after 48 h exposure to India ink. The teeth receiving apical CPC barriers before obturation had significantly less dye penetration than teeth without apical barriers. Based on its proven biocompatibility and osteconductive potential, calcium phosphate cement may serve well as a replacement for calcium hydroxide in a single-visit immediate apical barrier apexification technique.     

Comparative study of two filling techniques using glass-ionomer (Ketac-endo) root canal cement on fracture resistance of endodontically treated roots (in vitro)

Forty freshly single rooted teeth were selected for this study. The coronal part of teeth were decapitated and the root canals were prepared by modified step-back technique with K-flex files to size 35# at the apex, five ml of 5.25% NaOCl was used as irrigating solution. According to the dentin thickness at the mesio-distal direction of the prepared roots, roots were divided into two groups: Group (I), dentin and cementum thickness from 1.5-2 mm, and Group (II), dentin and cementum thickness 1 mm. According to the filling technique used the teeth were subdivided into four subgroups each of five teeth; Subgroup (A) single gutta-percha cone and Ketac-endo root canal sealer, Subgroup (B) lateral condensation technique with gutta-percha and Ketac-endo sealer, Subgroup (C) laterally condensed gutta-percha with Roth 801 cement and Subgroup (D) teeth left unfilled as negative controls. The prepared roots were placed into acrylic resin so that 10 mm of the root was exposed. A slowly increasing force was applied vertically using a blunt punch with 1 mm tip thickness attached to Instron testing machine. The results showed that group (I) with 1.5-2mm dentin thickness required greater force to fracture in all experimental groups, than that of group (II) with 1 mm dentin thickness. So the amount of remaining dentin thickness significantly affected the resistance to fracture of the prepared roots.     

Area-metric analysis of dye leakage for evaluation of sealing ability of root canal obturation techniques

Root canal sealing ability of obturation techniques has been assessed in vitro with various methods. The majority of the methods employ microleakage tracers and particularly dyes. In vitro measurements of dye penetration are either linear or volumetric. Area-metric analysis is a three dimensional registration method of dye leakage. The purpose of the present study was to evaluate in cleared teeth area-metric analysis as opposed to linear analysis of dye penetration. Forty freshly extracted single rooted human teeth were used. Instrumentation was carried out using Hedstroem files with a step back technique. The root canals were obturated using Roth sealer and qutta-percha cones and lateral condensation technique. The roots were then subjected to dye leakage tests under vacuum of 50 mmHg for 20 min. India ink was used as the tracer. The roots were randomly divided in two groups. In Group A the roots were cleared and linear measurements of the dye penetration were recorded The roots in Group B were ground stepwise transversally and subjected to area metric analysis. The results showed that area-metric analysis enabled sufficient recordings of the dye leakage patterns and the volume of the dye penetration could also be calculated.     

Problems with double-J stents and nephrostomy tubes

The aim of this study was to compare the backfilling capabilities of System B, Obtura II and Alphaseal. Forty-six lower premolar teeth were prepared chemomechanically and allocated to four experimental and two control groups. Ten were obturated using lateral condensation as a standard and 30 were obturated in the apical third using the System B. The latter 30 teeth were then backfilled using one of three techniques, System B, Obtura II or Alphaseal (n = 10 in each group). The remaining six teeth served as controls. Roots were radiographed from the proximal in order to evaluate voids and then placed in India ink for 65 h prior to being demineralized and rendered transparent, coronal leakage was quantified by linear measurement of ink penetration. No significant difference was found between the four groups with respect to the presence of voids radiographically (P < 0.05). The difference in leakage between the System B and Obtura II groups was not significant (P > 0.05). Both System B and Obtura II leaked significantly less than Alphaseal and lateral condensation (P < 0.001).     

Sealing properties of a new epoxy resin-based root-canal sealer

In this study a new epoxy-resin-based endodontic sealer, AH Plus, was tested in vitro for apical leakage. The conventional sealer AH26, for which information is already available, was used as the control. The root canals of 72 single-rooted teeth were prepared biomechanically using a stepback technique before lateral condensation of gutta-percha with one of the two sealers. Teeth were immersed in 5% methylene blue dye for 2, 4 or 10 days. The roots were split longitudinally so that the extent of dye penetration could be measured with a stereomicroscope. The mean extent at 2 days was 0.4 mm for AH26 and 1.4 mm for AH Plus. Neither material produced a complete apical seal and leakage increased with the duration of immersion in dye. The differences between observation periods as well as between materials with respect to dye penetration were statistically significant ANOVA, (P < 0.005).     

The role of the centrifugal pump in hemolysis during neonatal extracorporeal support

A study was conducted to evaluate coronal microleakage of Super EBA and Ketac-Endo when used as sealers with single-cone gutta-percha (GP) root canal obturation. The root canals of 24 extracted human teeth were instrumented with flared preparations to a minimum #40 master apical file size. Ten teeth were obturated with a single GP cone and Super EBA as the sealer and ten teeth were obturated with a single GP cone and Ketac-Endo as the sealer. Four teeth were used as controls. Salivary bacterial microleakage studies were conducted to determine whether these sealers could prevent coronal microleakage through the root canal in the absence of a coronal tooth restoration. There was no bacterial penetration through the apical foramen for either sealer tested during the 60-day test period.     

Strength of core build-up materials in endodontically treated teeth

PURPOSE: To compare the in vitro strength of a reinforced glass ionomer and a light-cured glass ionomer used as an alternative to amalgam in core construction to restore endodontically treated mandibular molar teeth. MATERIALS AND METHODS: The root canals of 120 extracted human mandibular molar teeth were prepared chemomechanically and obturated with laterally condensed cold gutta-percha. The crown of each tooth was sectioned leaving only one cusp standing. Gutta-percha was removed from the pulp chamber in all teeth. The volume of the pulp chamber was measured and the teeth ranked in ascending order of chamber volume. The specimens were divided into six groups of 20, allocating teeth with similar chamber volumes into each group. In three of the groups, gutta-percha was removed from the coronal 3-4 mm of each root canal. The teeth were restored with one of three materials, a cermet cement (Ketac-Silver), a resin-reinforced glass ionomer (Vitremer), or amalgam (Contour). Core preparation was carried out after 48 hours, reducing each core height to 6 mm. The specimens were thermocycled for 24 hours and then mounted in dental stone. A control group of 20 unrestored human mandibular molars was mounted in cold cure acrylic. Each tooth was tested in a Nene machine with a compressive load applied at 90 degrees to the occlusal surface at a crosshead speed of 5 mm/minute. RESULTS: There was no statistically significant difference between the experimental groups (P > 0.05), but the control group was significantly stronger (P < 0.001). Extension of core material into the coronal root canal system did not increase the fracture resistance of any of the experimental materials. Regression analysis of the results revealed no correlation between the volume of the pulp chamber and the load to fracture.     

Effect of mechanical versus thermal removal of gutta-percha on the quality of the apical seal following post space preparation

The objective of this study was to compare the effects of a flame-heated endodontic plugger, an electrically-heated endodontic spreader, Peeso reamers, and GPX burs on the apical seal when gutta-percha was removed from the root canal for post space preparation. Eighty-nine human canines were instrumented and obturated with gutta-percha and sealer to a standardized working length of 15 mm. An 11-mm segment of gutta-percha was removed from the roots in each of the four experimental groups of 20 teeth to simulate post space preparation. The teeth were immersed in India ink for 7 days and rendered transparent. The extent of linear dye leakage was measured with a stereomicroscope. There was no statistically significant difference in linear dye leakage among any of the experimental groups when 4 mm of gutta-percha remained.     

Incomplete calcium hydroxide removal from the root canal: a case report

This case demonstrates failure of root canal treatment of a maxillary central incisor following incomplete mechanical removal of a Ca(OH)2 intracanal dressing and subsequent resorption of the material from the apical portion of the root canal. Retreatment some 4 years later involved the removal of the contents of the root canal and permanent obturation by lateral condensation of cold gutta-percha with a sealer. Follow-up showed complete periradicular bone healing with a lamina dura evident. An explanation of the processes involved is offered, based upon histopathological and microbiological evidence in the literature.     

Assisted suicide in Switzerland: when is it permitted?

This study assessed in vitro apical leakage in root canals filled with gutta-percha and Ketac-Endo using different dentin conditioning and filling techniques. The root canals of 63 single-rooted teeth were instrumented and randomly divided into the following four groups: group A--canals were irrigated with 25% tannic acid and filled with Ketac-Endo and a standardized gutta-percha cone; group B--canals were irrigated with 1% NaOCl and filled as in group A; group C--canals were irrigated with 25% tannic acid and filled with Ketac-Endo and a chloroform-softened gutta-percha cone adapted to the canal walls; group D--canals were irrigated with 1% NaOCl and filled with Grossman's sealer and laterally condensed gutta-percha. After storage for 72 hours at 37 degrees C and 100% humidity, the gutta-percha was removed to a level 4 mm short of the working length, using a Peeso reamer. Teeth were immersed in India ink for 48 hours and cleared, and the coronal extent of dye penetration examined under a binocular dissecting microscope at x 15 magnification. The mean value of leakage for group A was 0.86 mm, for group B 2.23 mm, for group C 2.34 mm, and for group D 0.56 mm. Tukey's multiple comparison test disclosed significant differences (P < 0.05) between group A and groups B and C, and between group D and groups B and C. Differences between groups A and D, as well as between groups B and C, were not significant.     

Ultrasonic preparation and obturation of root-end cavities

This study evaluated the preparation of root-end cavities using an ultrasonically activated file, and the obturation of such cavities. In the first part, the root canals of 40 extracted teeth were prepared to size 40 and irrigated with NaOCl and EDTA. The root ends were resected and the teeth inoculated with Enterococcus faecalis, incubated for 10 days and divided into four groups: control; saline; irrigation; hand instrumentation performed via a retrograde approach up to size 50 using saline irrigant; ultrasonic instrumentation with prebent size 40 K-flex file inserted into a Piezon Master using saline irrigant. The teeth were fixed, sectioned longitudinally and viewed under scanning electron microscopy. Bacterial and smear layer scores were obtained at 1, 3, and 5 mm from the resected end. The bacterial scores for control and saline groups were similar; the scores for each instrumentation group were significantly lower than the control group (P<0.001). In addition, there were significantly fewer bacteria in the ultrasonic group compared with the hand instrument group (P<0.001). The smear layer scores for control and saline groups were similar, and significantly lower than in either instrumentation group (P<0.001). In the second part, root-end cavities were ultrasonically prepared in 20 extracted teeth. Ten cavities were filled with amalgam, and 10 with thermoplasticized gutta-percha and Grossman's sealer. After 24-h storage, the root ends were immersed in dye for 48 h. Cross-sectional slices of the obturated part of the root were evaluated using both light and confocal microscopy for dye leakage along the interface of filling material and dentine. There were no statistical differences between the leakage of amalgam and gutta-percha root-end fillings, nor between the two methods of microscopy.     

Influence of membrane oxygenators on the pulsatile flow in extracorporeal circuits: an experimental analysis

The vertical force applied to an endodontic spreader generates stress along the canal walls. Recognizing the potential for this stress may reduce the incidence of vertical root fractures. A photoelastic acrylic model was fabricated to exhibit the stress produced during obturation of curved canals using the lateral condensation technique. Twenty standardized models simulating curved canals (32 degrees) were formed within PL-2 photoelastic acrylic resin blocks. The canals were fitted with a gutta-percha point, and either a stainless-steel or nickel-titanium finger spreader was inserted. An Instron 4502 universal testing machine applied a vertical force of 20 Newtons to the spreader. Quarter wave and polarizing filters were used with backlighting to generate the fringe patterns in the models. Photographs of the resulting stress lines showed that the stainless-steel spreaders created three areas of concentrated stress. The nickel-titanium spreaders induced stress patterns spread out along the surface of the canals, thus reducing the concentration of stress and the potential for vertical root fracture.     

Obturation of a C-shaped canal using an improved method of warm lateral condensation

Pilot studies conducted by the authors seem to indicate that obturation of a root canal system by the lateral condensation of gutta-percha using an electrically heated spreader results in a more homogeneous mass of gutta-percha than standard lateral condensation. This article describes an improved variation which prevents inadvertent dislodgement of the mass of gutta-percha during the obturation. The authors refer to this technique as "zap and tap" and a case report describes its use to obturate a C-shaped canal system of a mandibular second molar.     

A comparative study on the effect of three methods of instrumentation on the shape of root canal (an in-vitro study)

This study compared the ability of three types of engine driven instrumentation techniques to negotiate and prepare small, slightly curved root canals. Forty five mesial roots of extracted maxillary and mandibular first permanent molars were classified into three groups. Group (I) was prepared by Canal Leader system, group (II) was prepared by Nickel Titanium files and group (III) was prepared by Canal Master technique. Radiographs of the root canal space before and after preparation was carried out by the aid of an experimental model. Enlarged photographic prints obtained from radiographs were scored for shaping effectiveness of the three techniques in respect to canal course, position & width of apical constriction and lack of ledge formation. The results indicated that the Canal Leader system was an efficient technique in maintaining canal curvature, absence of zipping, transportation or ledge formation in almost all of the specimen tested, followed by the Nickel Titanium files and then the Canal Master technique which produced more straightening and destruction of apical constriction.     

Scanning electron microscopic evaluation of two compaction techniques using a composite resin as a root canal filling material

The canals of 20 human dental roots were instrumented using a a step- back technique. The smear layer was removed, and the canals were obturated with composite resin. Two different techniques of compaction were used: either vertical or lateral motions were used to condense composite resin inside the root canal that was then photopolymerized layer by layer using the argon laser (488 nm). The beam was delivered into the root canal by means of an optical fiber 320 micrometers in diameter. Longitudinal and cross-sections of the samples and resin replicas of the root canals were examined using a light and scanning electron microscope. Scanning electron microscopic examination revealed that laterally compacted resin fillings showed fewer voids than those obtained by vertical compaction. In both experimental groups, adhesion of the resin to the dentin walls, pulled-out resin tags, microfailure, and resin fracture, leaving a layer of resin associated with the wall surface were observed.