Atomic force microscopy and energy dispersive X‐ray spectrophotometry analysis of reciprocating and continuous rotary nickel‐titanium instruments following root canal retreatment

The aim was to examine the effect of retreatment process on the surface roughness and nickel titanium (NiTi) composition of ProTaper Universal Retreatment (PTUR; consists of 3 files; D1, D2, D3) and WaveOne Gold (WOG) (primary) instruments. Twenty extracted mandibular molar teeth with severe curved (30–40°) mesial roots were selected and divided into two groups (n = 10) based on the instrument used for the removal of the root canal filling. Before and after using the instruments in two canals, they were subjected to atomic force microscopy (AFM) and energy dispersive X‐ray spectrophotometry (EDX) analysis. The EDX analysis data and roughness average (Ra) and root mean square (RMS) values were analyzed statistically using a one‐way analysis of variance and post hoc Tukey's test at the 5% significant level. There was no significant difference between the new and used D1 and D2 PTUR and WOG instruments in terms of the Ni composition (p > .05). The Ti contents of the used D2 and D3 PTUR instruments were lower those of the new instruments (p < .05). In both new and used instruments, PTUR and WOG have no difference in terms of Ra and RMS values. (p > .05). The Ra and RMS values of the PTUR and WOG systems significantly increased after removal of the root canal filling (p < .05). The use of PTUR and WOG instruments for removal of root canal filling in severely curved root canals affected the surface topography of the files. The NiTi composition of the WOG instruments was unaffected by the retreatment process.     

Efficacy of reciprocating systems for removing root filling material plus complementary cleaning methods in flattened canals: Microtomography and scanning electron microscopy study

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.     

Cyclic fatigue resistance of rotary NiTi instruments produced with four different manufacturing methods

The aim of this study was to compare the cyclic fatigue resistance of rotary NiTi files, produced with four different manufacturing methods on specially designed dynamic models that simulated clinical conditions. In this study, 120 files, consisting of 30 files for Typhoon, ProTaper Next, RaCe, and Twisted Files nickel titanium rotary systems were used. The 30 files of each group were divided into three subgroups to be used in artificial canals with a 60° angle of curvature and radii of curvature of 2, 5, and 8 mm (n = 10). All files were rotated in the artificial canals until fracture occurred and the number of cycles to fracture was calculated. The data were analyzed using one‐ and two‐way analyses of variance and Tamhane multiple comparison tests. In all three groups, Typhoon instruments had the highest number of cycles to failure than the RaCe, ProTaper Next, and Twisted Files instruments, and the difference statistically significant (p < .05). There were no significant differences between the RaCe, ProTaper Next, and Twisted Files groups (p > .05). The CM wire Typhoon system was significantly more resistant to cyclic fatigue compared to the other file systems in all three artificial canals. When the fracture resistance of an instrument in three different artificial canals was compared, the mean NCFs decreased as the radius of the curvature of the canal decreased from 8 to 2 mm. Manufacturing method is one of the most important factors on cyclic fatigue resistance, also the radius of curvature effects the cyclic fatigue.     

Quantitative evaluation of root canal surface roughness after filing with adaptive reciprocating and continuous rotary instruments

Obtaining clean and smooth root canal walls is the ideal clinical outcome of the cleaning and shaping stage in root canal treatment. This study compares the surface roughness of root canal surfaces instrumented with a NiTi filing system with either adaptive reciprocating (AR) or continuous rotation (CR). Root canal cleaning and shaping was carried out on the mesial canals of 24 extracted first molars roots with either AR or CR. Roots were split in half and the surface roughness of their canals was evaluated in 12 three dimensional roughness reconstructions using a scanning electron microscope. Rz (nm) values were calculated in three areas of each reconstruction and analyzed (α = 0.05). Mann‐Whitney tests showed that surface roughness was significantly higher overall in the AR group (Rz = 967 ± 250 nm) compared with the CR group (Rz = 739 ± 239 nm; p = 0.044). The roughness values generally increased from apical towards the coronal third in both groups. A less aggressive finishing file or a continuous rotary system to end the cleaning and shaping stage may be beneficial to reduce roughness of the root canal surface.     

Cyclic fatigue resistance and energy dispersive X‐ray spectroscopy analysis of novel heat‐treated nickel–titanium instruments at body temperature

The aim of this study was to evaluate the cyclic fatigue resistance of Dia‐X, WaveOne Gold and One Curve files in a water bath at intracanal temperature (35°C). Thirty‐nine instruments Dia‐X, WaveOne Gold, and One Curve systems (n = 13) were tested in an artificial canal with a curvature angle of 60° and a radius of 3 mm. A water bath setup at a temperature of 35°C was used to simulate the intracanal temperature and time to fracture (TTF) as seconds was recorded. The mean data were analyzed statistically using one‐way ANOVA, and post hoc Tukey test (p = .05). The fractured surface of the instruments was examined with scanning electron microscopy (SEM) and chemical composition of the instruments were investigated with energy dispersive X‐ray spectroscopy (EDS). Statistically significant differences were detected in TTF values of all the systems as follows: One Curve > WaveOne Gold > Dia‐X (p < .05). One Curve instruments demonstrated the highest TTF values in all the tested instruments. The EDS microanalysis revealed similar NiTi composition of on the surface of One Curve, WaveOne Gold, and Dia‐X instruments. The novel manufacturing process, including C‐wire heat treatment and the variable cross‐section of the One Curve files, could be the main factors affecting the fatigue life of the instruments.     

Percentage of gutta-percha in mesial canals of mandibular molars obturated by lateral compaction or single cone techniques

The aim of this study was to compare the percentage of gutta‐percha (PGP) in mesial root canals of mandibular molars obturated with LC (Lateral Compaction) or SC (Single Cone) ProTaper Universal System techniques at different levels of the root. Mesial root canals of 20 human permanent molars with similar anatomical characteristics were instrumented using the ProTaper Universal rotary system technique until the F2 instrument, with 20 canals filled by SC ProTaper Universal technique and 20 canals by the LC technique. The mesial roots were sectioned transversely to 3, 5, and 7 mm from the root apex. Digital images of specimens were obtained at MIC‐D digital microscope in increases of 30 to 35X. The gutta‐percha area was measured using ImageTool software. Data were analyzed using two‐way ANOVA and Bonferroni test (α = 0.05). The SC technique provided greater PGP than the LC technique in the apical third (3 mm) (P < 0.001). In the other thirds (5 and 7 mm) there was no statistical difference between the two techniques regarding the PGP (P > 0.05). There was no statistically significant difference between thirds of the root canal for both techniques (P > 0.05). It was concluded that SC technique provided greater PGP than the LC technique in the apical third of mesial root canals of mandibular molars. There was no difference between the two techniques regarding the PGP in the cervical and middle thirds. Microsc. Res. Tech. 75:1229–1232, 2012. © 2012 Wiley Periodicals, Inc.     

Clinical microscopic analysis of protaper retreatment system efficacy considering root canal thirds using three endodontic sealers

To evaluate the efficacy of ProTaper Universal rotary retreatment system and the influence of sealer type on the presence of filling debris in the reinstrumented canals viewed in an operative clinical microscope. Forty‐five palatal root canals of first molars were filled with gutta‐percha and one of the following sealers: G1, EndoFill; G2, AH Plus; G3, Sealapex. The canals were then reinstrumented with ProTaper Universal rotary system. Roots were longitudinally sectioned and examined under an operative clinical microscope (10×), and the amount of filling debris on canal walls was analyzed using the AutoCAD 2004 software. A single operator used a specific software tool to outline the canal area and the filling debris area in each third (cervical, middle, and apical), as well as the total canal area. Data were analyzed by Kruskal‐Wallis test and Tukey test at P < 0.05. Sealapex demonstrated significant differences in the average of filling debris area/canal among the 3 thirds. This group revealed that apical third showed more debris than the both cervical and middle third (P < 0.0001). Endofill presented significantly more filling debris than Sealapex in the cervical third (P < 0.05). In the middle (P = 0.12) and apical third (P = 0.10), there were no differences amongst groups. Debris was left in all canal thirds, regardless of the retreatment technique. The greatest differences between techniques and sealers were found in the cervical third. Microsc. Res. Tech. 75:1233–1236, 2012. © 2012 Wiley Periodicals, Inc.     

Cleaning capacity of octenidine as root canal irrigant: A scanning electron microscopy study

The aim of this study was to assess the cleaning capacity of the octenidine hydrochloride (OCT) used as root canal irrigant by scanning electron microscopy (SEM) analysis. Sixty human unirradicular extracted teeth were randomly distributed in 6 groups (n = 10) according to irrigant solutions which were used during root canal preparation: G1, 0.1% OCT; G2, 2% chlorhexidine (CHX); G3, 2.5% sodium hypochlorite (NaOCl); G4, OCT + 17% ethylenediaminetetraacetic acid (EDTA); G5, 2.5% NaOCl + 17% EDTA and G6, distilled water. All specimens were instrumented with ProTaper system up to F4. Teeth were sectioned and prepared for SEM. The smear layer was evaluated using a 5‐score system and the data were analyzed by Kruskal–Wallis and Dunn (α = 0.05). In all root canal thirds there was no significant difference between OCT, CHX, NaOCl, and water groups (p > .05), and these groups showed higher smear layer values than NaOCl + EDTA and OCT + EDTA groups (p < .05). There was no significant difference between NaOCl + EDTA and OCT + EDTA groups (p > .05). It was concluded that OCT used as a single root canal irrigant presented poor cleaning capacity and could be used in association with a final irrigation with EDTA to obtain smear layer removal.     

Evaluation of surface topography changes in three NiTi file systems using rotary and reciprocal motion: An atomic force microscopy study

Aim: To evaluate the surface topography changes in three nickel‐titanium (NiTi) file systems using either rotary or reciprocal motion using atomic force microscopy (AFM), and to determine the effect of scanning area on the AFM results in this study. Methodology: Five points on a F2 Protaper file, R25 Reciproc file, and a Primary file from WaveOne systems were scanned preoperatively in 1 × 1 and 5 × 5 µm² with an AFM device that can scan an intact (not sectioned) file. One standardized resin block was used for each instrument, according to the manufacturer's recommendations. Points were re‐scanned postoperatively using the same AFM and settings. Root‐mean‐square (RMS) and roughness average (Ra) values were obtained. The preoperative and postoperative surface topographies were compared separately in terms of RMS and Ra values. The surface topography change scores were analyzed using Kruskal–Wallis and Mann–Whitney U tests using a 0.10 significance level. Results: There were no significant differences preoperatively among the NiTi file systems in 1 × 1 or 5 × 5 µm² areas. Postoperatively, the WaveOne Primary had more surface irregularities (significant for 5 × 5 µm² scan in Ra evaluation). Conclusions: Three‐dimensional AFM images of instrument surfaces showed topographic irregularities preoperatively and postoperatively. AFM results differ depending on the scanning area and file used. Microsc. Res. Tech. 77:177–182, 2014. © 2013 Wiley Periodicals, Inc.     

Comparison between the use of thermoplasticized gutta‐percha and a polydimethyl siloxane‐based material in filling internal resorptive cavities using spiral computed tomography

To evaluate the fill of internal resorption cavities obturated with thermoplasticized gutta‐percha and GuttaFlow2 using CT scan. Twenty human maxillary anterior teeth were selected and root canals were prepared using ProTaper system to size F3. Irrigation was performed with 5 ml of 2.5% sodium hypochlorite (NaOCl) and 5 ml of 17% ethylenediaminetetraacetic acid (EDTA). Each root was then sectioned horizontally into two halves and semicircular cavities were prepared around the periphery of the root canal opening of each root half, using a round bur. Both the root halves were then fixed using cyanoacrylate glue. All the specimens were subjected to preoperative CT scan analysis to determine the volume of internal cavities. The samples were then randomly divided into two groups. In Group 1, the specimens were obturated with thermoplasticized gutta‐percha (E&Q system) and specimens in Group 2 were obturated using GuttaFlow2. All specimens were then subjected to postoperative CT scan analysis. The volume of voids in internal resorptive cavities were calculated, which was then used to estimate the amount of gutta‐percha filled. There was no significant difference in volume of internal resorptive cavities between thermoplasticized gutta‐percha and GuttaFlow2 groups before obturation (p = 0.466). However, after obturation there was a significant difference between both the groups, in which GuttaFlow2 demonstrated better fill (p = .014). Thermoplasticized gutta‐percha filled 81% of internal resorptive cavity while GuttaFlow2 filled 91%, respectively. GuttaFlow2 showed better fill than thermoplasticized gutta‐percha in the filling of internal resorptive cavities.     

Surface change of root canal dentin after the use of irrigation activation protocols: Electron microscopy and an energy‐dispersive X‐ray microanalysis

This study evaluated the mineral contents of root‐canal dentin after treatment with different irrigation activation protocols. One hundred and eight maxillary lateral incisor teeth were randomly divided into eight experimental groups and one control group. Root canals were prepared using ProTaper rotary files, with the exception of the Self‐Adjusting File (SAF) group. Canals were irrigated with 2 mL of 5% sodium hypochlorite (NaOCl) at each instrument change, and received a final flush with 10 mL of 17% ethylenediaminetetraacetic acid (EDTA) and 10 mL of 5% NaOCl for 1 min. The control group was irrigated with distilled water. Group I (GI): Needle syringe irrigation; Group II (GII): NaviTip FX; Group III (GIII): CanalBrush; Group IV (GIV): Manual dynamic activation with gutta‐percha; Group V (GV): Passive ultrasonic irrigation; Group VI (GVI): EndoActivator; Group VII (GVII): EndoVac; Group VIII (GVIII): SAF. The level of elemental composition was analyzed by a scanning electron microscopy and an energy‐dispersive spectrometer (EDS) system. The results were then statistically analyzed by one‐way ANOVA and Tukey tests. Ca/P ratio was changed after treatment with SAF and EndoActivator. The Ca, P, Mg, and S level changes were not statistically significant (P > 0.05). Final irrigation activation protocols did not alter the mineral level of root dentin surface. Microsc. Res. Tech. 76:893–896, 2013. © 2013 Wiley Periodicals, Inc.     

Effect of different irrigation protocols on the radicular dentin interface and bond strength with a metacrylate‐based endodontic sealer

This study assessed the influence of different endodontic chemical substances on the adhesion of the Epiphany SE/Resilon system (with and without resinous solvent) to radicular dentin walls, using the push‐out test and scanning electron microscopy (SEM). Forty‐eight root canals of human canines were prepared biomechanically with ProTaper rotary files (crown‐down technique) and the radicular dentin was treated with either 17% EDTA, 2% chlorhexidine gel (CHX) or 2.5% NaOCl (control). The root canals were filled with Resilon cones and Epiphany SE sealer with and without resinous solvent. Six groups of eight canals each had their roots sectioned transversally to obtain 1‐mm thick slices. Data were subjected to statistical analysis by ANOVA and Tukey's tests. The specimens treated with 17% EDTA (1.59 ± 0.91) presented higher bond strength (P < 0.05) than those treated with 2.5% NaOCl (0.93 ± 0.27) and 2% CHX (0.92 ± 0.22). Significantly higher bond strength (P < 0.05) was observed when the Epiphany SE was prepared with (1.37 ± 0.78) than without (0.92 ± 0.33) solvent. Adhesive failures were predominant in all groups. SEM analysis showed greater homogeneity of the filling mass when the solvent was added to the sealer. Treatment of root canal walls with 17% EDTA, and addition of a resinous solvent to Epiphany SE produced the highest adhesion to radicular dentin. Microsc. Res. Tech. 77:446–452, 2014. © 2014 Wiley Periodicals, Inc.     

Computed microtomography evaluation of calcium hydroxide‐based root canal dressing removal from oval root canals by different methods of irrigation

The aim of this study was to evaluate the capacity of conventional irrigation, passive ultrasonic irrigation (PUI), and Easy Clean for removing calcium hydroxide‐based root canal dressing from oval root canals. Thirty mandibular uniradicular incisors with oval canals were used, and subjected to chemical–mechanical preparation with Reciproc R40 instruments. The main canal was filled with a paste based on Ca(OH)₂ P.A., iodoform and propylene glycol in the ratio of 3:1:1. The teeth were stored in 100% humidity at a temperature of 37°C for 14 days. Afterwards, the teeth were divided into three groups (n = 10) according to the method of irrigation used (conventional irrigation, PUI, and Easy Clean). The specimens were analyzed by computed microtomography at three time intervals: before placing the root canal dressing, with the root canal dressing in place, and after application of the irrigation methods for removing it. The data were submitted to Kruskal–Wallis and Dunn tests for analyzing the canal as a whole, and Friedman and Dunn for analyzing the root thirds. The results showed that conventional irrigation was less efficient for removing the root canal dressing in comparison with the methods that agitated the irrigant solution (p < .05). When the root canal was analyzed as a whole, Easy Clean, and PUI were similar (p > .05). In analysis of the thirds, Easy Clean was more efficient than conventional irrigation in all the thirds, while PUI showed this behavior only in the cervical third (p < .05). The authors concluded that in oval canals, none of the irrigation methods were capable of removing all the root canal dressing, however, the methods that agitated the irrigant solution were more efficient than conventional irrigation.     

Effectiveness of different irrigation systems in the presence of intracanal‐separated file

The aim of this study was to evaluate conventional syringe irrigation and three different irrigant activation techniques' effectiveness for smear layer removal in the absence and presence of intracanal‐separated file (SF) fragment. Mandibular anterior teeth (160 total) with single canal were used and each root canal preparation was finished with the ProTaper Universal F1. The samples were randomly divided into eight equal groups with n = 20 in each group. The Protaper Universal F3 file was used to simulate intracanal file separation in four groups. To remove the smear layer, final irrigation for each group was performed with conventional syringe irrigation (CSI), EndoActivator, Vibringe, and passive ultrasonic irrigation (PUI). The roots were divided into two longitudinal parts and evaluated with scanning electron microscopy, and two observers scored smear layers at 1, 2, and 3 mm away from the minor foramen. The data were analyzed using the Kruskal–Wallis and Mann–Whitney U tests (p < .05). PUI significantly removed the smear layer better at all levels than other nonseparated file groups (p < .05). In the presence of intracanal SF, PUI had the most efficiency loss. Sonic techniques and CSI revealed statistically better smear layer removal efficiency than PUI at 3 mm level in the presence of SF (p < .05). The intragroup score analysis at all levels revealed that there were less smear layers at 3 mm than at 1 mm in all SF groups (p < .001). As a conclusion, sonic/ultrasonic methods did not yield better irrigant by‐passing than CSI in the presence of intracanal SF.     

Investigation of mineral content of root canal dentin after the application of various antibiotic paste using energy‐dispersive X‐ray detector

The purpose of this study was to evaluate mineral content of root canal dentin after treatment with different antibiotic pastes including the mixture of metronidazole, ciprofloxacin, doxycycline, cefaclor, amoxicillin, or minocycline. Fifty extracted maxillary canine teeth were randomly divided into five groups (n = 10 teeth for each group). Root canals were prepared Reciproc rotary files. Canals were irrigated using 5 ml 5% NaOCl and 1 ml 15% EDTA. Each tooth in all groups were longitudinally splitted into two pieces as a control and experimental samples. Each experimental group received following antibiotic paste; double antibiotic paste (DAP) and triple antibiotic paste with doxycycline (TAPd), TAP with cefaclor (TAPc), TAP with amoxicillin (TAPa), and TAP with minocycline (TAPm) for 21 days. The Ca, P, Mg, Ca, and K levels, and the Ca/P ratio was analyzed by a scanning electron microscope (SEM) equipped using a Bruker energy‐dispersive X‐Ray (EDX) detector. Data were analyzed with independent samples t‐test, one‐way anova, and Duncan tests. Ca and Ca/P ratio showed a statistically significant increase TAP with amoxicillin and cefaclor (p < .05). DAP, TAPd, and TAPm did not change the mineral levels (p > .05). TAPa and TAPc with increased the Ca level and Ca/P ratio of the root canal dentin which consequently positively influences the revascularization process.     

Comparison of influence of different manufacturing methods on the cleaning efficiency of rotary nickel–titanium files

The purpose of this study was to evaluate and compare cleaning effectiveness of TwistedFile, GT series X, Revo‐S, RaCe, Mtwo, and ProTaper Universal rotary files in curved canals. Seventy mesiobuccal canals of extracted human first maxillary molars were divided into seven groups of 10 samples each. Canals were prepared with six nickel–titanium (NiTi) rotary systems and manual K‐Flexofile. Irrigation was performed with 2 mL 2.5% NaOCl solution after each file, and 5 mL 2.5% NaOCl was used for the final flush. After the roots were split longitudinally, the presence of debris and smear layer was visualized using scanning electron microscopic photomicrographs taken at coronal, middle, and apical third. Mean scores for debris and the smear layer were calculated and statistically analyzed for significance between groups using the Kruskal–Wallis nonparametric analysis of variance (P < 0.05) and Mann–Whitney U test (P < 0.001). There was no significant difference among the groups in terms of debris and smear layer scores (P > 0.05). Without considering the preparation method used, while no statistically significant difference was found between the coronal third and the middle third (P > 0.05), higher amount of debris and smear layer were found in apical third (P = 0.001). The new generation of NiTi rotary files including the Twisted File and GT Series X presented similar cleaning effectiveness compared with traditionally ground NiTi rotary files. Microsc. Res. Tech. 76:231–236, 2013. © 2012 Wiley Periodicals, Inc.     

Residues of different gel formulations on dentinal walls: A SEM/EDS analysis

The aim of this study was to evaluate the presence of residues of sodium hypochlorite gel, chlorhexidine gel, and EDTA gel on dentinal walls after canal preparation through chemical SEM‐ elemental chemical microanalysis (EDS) analysis. Forty‐eight single‐rooted teeth were selected. They had their crowns sectioned and were instrumented with a reciprocating system. The canals were irrigated with 5 mL of saline solution during root canal preparation. After instrumentation, the root canals were irrigated with 3 mL 17% EDTA followed by 1 min of ultrasonic passive activation (3× 20 sec) to remove the smear layer, and then irrigated with 3 mL of saline solution. The specimens were randomized into three groups (n = 12) according to the chemical substance that filled the root canal for 30 min: GI: 5.5% sodium hypochlorite gel; GII: 2% chlorhexidine gel; GIII: 24% EDTA gel; Negative control group: no substance was used. Then, the root canals were irrigated with 6 mL of saline solution followed by 1 min of ultrasonic passive activation (3× 20 sec). After ultrasonic activation, the canals were irrigated with 2 mL saline. The roots were sectioned, and the percentage of each chemical element present in the samples was analyzed through chemical SEM‐EDS microanalysis. All experimental groups showed a significantly higher percentage of chemical elements (Na and/or Cl) than the control group (P < 0.03). This in vitro study has shown that, regardless of chemical solutions used even after the final irrigation protocol, chemical residues of different substances remained attached to the root canal walls. Microsc. Res. Tech. 78:495–499, 2015. © 2015 Wiley Periodicals, Inc.     

A cone‐beam computed tomography study of the anatomical relationships between mandibular teeth and the mandibular canal,with a review of the current literature

The purpose of this study was to evaluate age‐ and sex‐related changes in the anatomical relationships between the roots of the molars and premolars and the mandibular canal using cone‐beam computed tomography (CBCT) images. A total of 243 patients (116 males, 127 females) aged 16–83 years for whom previous CBCT scans were available were enrolled in this study. The patients were subcategorized by sex and age (Group I, <21 years; Group II, 21–40 years; and Group III, >40 years). The distances between the mandibular canal and the molars and premolars were measured. The mandibular canal was significantly closer to the root apices of the second and third molars than to the apices of other evaluated teeth (p < 0.05). All measurements were significantly higher in male than in female subjects (p < 0.05). Group I subjects exhibited significantly shorter distances between the mandibular canal and root apices of the first and second premolars, and the molars, than those of Group II and III subjects (p < 0.05). Direct contact relationships were found in 1.6%, 3.3%, 3.3%, 16%, and 32.2% of teeth (running from the first premolar to the third molar, respectively). Age and sex influenced the anatomical relationships between mandibular teeth and the mandibular canal, and these should be considered when planning endodontic and surgical procedures to avoid potential nerve injury.     

Efficacy of different final irrigant activation protocols on smear layer removal by EDTA and citric acid

The aim of this study was to evaluate the influence of different activation protocols for chelating agents used after chemo‐mechanical preparation (CMP), for smear layer (SL) removal. Forty‐five single‐rooted human premolars with straight canals and fully formed apex were selected. The specimens were randomly divided into three groups depending on the chelating agent used for smear layer removal: distilled water (DW, control group); 17% ethylenediaminetetraacetic acid (EDTA); and 10% citric acid (CA). Each group was further divided into three subgroups according to the activation protocol used: no‐activation (NA), manual dynamic activation (MDA), or sonic activation (SA). After CMP, all specimens were sectioned and processed for observation of the apical thirds by using scanning electron microscopy (SEM). Two calibrated evaluators attributed scores to each specimen. The differences between activation protocols were analyzed with Kruskal‐Wallis and Mann‐Whitney U tests. Friedman and Wilcoxon signed rank tests were used for comparison between each root canal third. When chelating agents were activated, either by MDA or SA, it was obtained the best cleaning results with no significant difference between EDTA and CA (P > 0.05). Sonic activation showed the best results when root canal thirds were analyzed, in comparison to MDA and NA groups (P < 0.05). The activation of chelating agents, independent of the protocol used, benefits smear layer removal from root canals. Microsc. Res. Tech. 76:364–369, 2013. © 2013 Wiley Periodicals, Inc.     

Dentinal tubule penetration of endodontic sealers after nonthermal plasma treatment: A confocal laser scanning microscopy study

One of the factors affecting the success of endodontic treatment is to fill the root canal system hermetically. The aim of this in vitro study was to evaluate the effect of nonthermal plasma (NP) on dentinal tubule penetration of root canal sealers using confocal laser scanning microscopy. Forty mandibular premolar teeth were selected and the root canals were prepared with large‐Waveone‐Gold rotary‐files. Specimens were divided into four experimental groups according to sealer and NP treatment (n = 10). G1: AH‐Plus (AH) G2: nonthermal plasma application + AH‐Plus(AH‐P) G3: Endosequence‐BC(BC) G4: nonthermal plasma application + Endosequence‐BC(BC‐P). Cold lateral‐condensation technique was used for the obturation of root canals. The roots were sectioned horizontally and the sections were examined under confocal laser scanning microscopy. The maximum tubule penetration and percentage of penetration values were obtained from the microscopy images and were statistically analyzed with repeated measurements‐ANOVA and the Tukey (HSD) test (p < 0.05). The percentages of dentinal tubule penetration of the groups were not statistically different. The maximum tubule penetration of the AH‐P was statistically lower than that of the BC‐P (p < 0.05). Plasma application had no affect on the percentage of dentinal tubule penetration. Under the conditions of this in vitro Endosequence‐BC sealer showed higher maximum tubule penetration values than AH‐Plus after NP treatment. Percentage of dentinal tubule penetration values of experimental groups was similar.