Procedural errors detected by cone beam tomography in cases with indication for retreatment: in vivo cross-sectional study

Valverde Haro Henry Paul,Rupaya Carmen Rosa Garcia,Alves Flávio R. F. 대한치과보존학회 2024 Restorative Dentistry & Endodontics Vol.49 No.3

Objectives This study aimed to investigate the frequency and type of endodontic procedural errors in cases indicated for retreatment through cone-beam computed tomography (CBCT) analysis. Materials and Methods The sample consisted of 96 CBCT scans, encompassing 122 permanent teeth with fully formed roots. Errors included perforation, instrument fracture, canal transportation, missed canals, and inadequate apical limit of filling. Additionally, potential risk factors were analyzed and subjected to statistical modeling. Results The most frequent procedural error observed was the inadequate apical limit of filling, followed by canal transportation, perforation, missed canal, and instrument fracture. Statistically significant associations were identified between various procedural errors and specific factors. These include canal transportation and root canal wall, with the buccal wall being the most commonly affected; missed canal and tooth type, particularly the palatine and second mesiobuccal canal canals; inadequate apical limit of filling and root curvature, showing a higher deviation to the mesial direction in severely curved canals; inadequate apical limit of filling and the presence of calcifications, with underfilling being the most frequent; canal transportation and periapical lesion, notably with deviation to the buccal direction; and the direction of perforation and periapical lesion, most frequently occurring to buccal direction. Conclusions CBCT emerges as a valuable tool in identifying procedural errors and associated factors, crucial for their prevention and management. Objectives This study aimed to investigate the frequency and type of endodontic procedural errors in cases indicated for retreatment through cone-beam computed tomography (CBCT) analysis. Materials and Methods The sample consisted of 96 CBCT scans, encompassing 122 permanent teeth with fully formed roots. Errors included perforation, instrument fracture, canal transportation, missed canals, and inadequate apical limit of filling. Additionally, potential risk factors were analyzed and subjected to statistical modeling. Results The most frequent procedural error observed was the inadequate apical limit of filling, followed by canal transportation, perforation, missed canal, and instrument fracture. Statistically significant associations were identified between various procedural errors and specific factors. These include canal transportation and root canal wall, with the buccal wall being the most commonly affected; missed canal and tooth type, particularly the palatine and second mesiobuccal canal canals; inadequate apical limit of filling and root curvature, showing a higher deviation to the mesial direction in severely curved canals; inadequate apical limit of filling and the presence of calcifications, with underfilling being the most frequent; canal transportation and periapical lesion, notably with deviation to the buccal direction; and the direction of perforation and periapical lesion, most frequently occurring to buccal direction. Conclusions CBCT emerges as a valuable tool in identifying procedural errors and associated factors, crucial for their prevention and management.

Advances in Research on Stem Cell-Based Pulp Regeneration

Lee Hua-Nien,Liang Cheng,Liao Li,Tian Wei-Dong 한국조직공학과 재생의학회 2021 조직공학과 재생의학 Vol.18 No.6

Although root canal therapy is the most common and widely used treatment at clinical presentation, there are still some postoperative complications. As cell biology and tissue engineering techniques advance rapidly, the use of biological therapy to regenerate dental pulp has become a new trend; Relevant literatures in recent five years were searched using key words such as “root canal therapy”, “Dental pulp stem cells”, “Dental pulp regeneration”, and “Cell homing” in PubMed, Web of Science, etc; Dental pulp stem cells (DPSCs) have multi-differentiation potential, self-renewal capability, and high proliferative ability. Stem cell-based dental pulp regeneration has emerged as a new research hot spot in clinical therapy. Recently, dental pulp-like structures have been generated by the transplantation of exogenous DPSCs or the induction of homing of endogenous DPSCs. Studies on DPSCs are important and significant for dental pulp regeneration and dental restoration; In this review, the existing clinical treatment methods, dental pulp regeneration, and DPSC research status are revealed, and their application prospects are discussed. The stem cell-based pulp regeneration exerts promising potential in clinical therapy for pulp regeneration.

Treatment of horizontal root-fractured maxillary incisors

Sung-Hyeon Choi,Ji-Hye Yoon,이빈나,장훈상,황인남,오원만,황윤찬 조선대학교 치의학연구원 2019 Oral Biology Research (Oral Biol Res) Vol.43 No.3

Root fractures are defined as fractures that involve the dentin, cementum, and pulp, resulting in stretching or laceration of the pulp and/or periodontal ligament injury (rupture or compression). Two cases of horizontal root-fractured maxillary incisors are introduced in the present report. The first case is a middle third root-fractured maxillary incisor with root canal therapy in the coronal fragment, and the second case is a cervical third root-fractured maxillary incisor without root canal therapy. Both cases showed favorable results with a long-term follow-up period. In all traumatic injuries, early diagnosis and appropriate intervention dramatically enhance the outcome. The primary purpose of the treatment of root-fractured teeth is to maintain the vitality of the teeth. After an adequate observation period, if vitality control reveals non-vital pulp tissue, or if the patient complains of pain or discomfort in the tooth, endodontic therapy can be performed, usually to the coronal segment only.

근관확대 및 세척 주사바늘의 근관 내 위치가 치근단 3 mm 부위의 근관 세정에 미치는 영향

문호진,홍찬의 大韓齒科保存學會 2012 Restorative Dentistry & Endodontics Vol.37 No.1

Objectives: The aim of this study was to test the hypothesis, that the effectiveness of irrigation in removing smear layer in the apical third of root canal system is dependent on the depth of placement of the irrigation needle into the root canal and the enlargement size of the canal. Materials and Methods: Eighty sound human lower incisors were divided into eight groups according to the enlargement size (#25, #30, #35 and #40) and the needle penetration depth (3 mm from working length, WL-3 mm and 9 mm from working length, WL-9 mm). Each canal was enlarged to working length with Profile.06 Rotary Ni-Ti files and irrigated with 5.25% NaOCl. Then, each canal received a final irrigation with 3 mL of 3% EDTA for 4 min, followed by 5 mL of 5.25% NaOCl at different level (WL-3 mm and WL-9 mm) from working length. Each specimen was prepared for the scanning electron microscope (SEM). Photographs of the 3mm area from the apical constriction of each canal with a magnification of ×250, ×500, ×1,000, ×2,500 were taken for the final evaluation. Results: Removal of smear layer in WL-3 mm group showed a significantly different effect when the canal was enlarged to larger than #30. There was a significant difference in removing apical smear layer between the needle penetration depth of WL-3 mm and WL-9 mm. Conclusions: Removal of smear layer from the apical portion of root canals was effectively accomplished with apical instrumentation to #35/40 06 taper file and 3 mm needle penetration from the working length.

Combination of a new ultrasonic tip with rotary systems for the preparation of flattened root canals

Tavares Karina Ines Medina Carita,Pinto Jáder Camilo,Santos-Junior Airton Oliveira,Esteves Torres Fernanda Ferrari,Guerreiro-Tanomaru Juliane Maria,Tanomaru-Filho Mario 대한치과보존학회 2021 Restorative Dentistry & Endodontics Vol.46 No.4

Objectives This study evaluated 2 nickel-titanium rotary systems and a complementary protocol with an ultrasonic tip and a small-diameter instrument in flattened root canals. Materials and Methods Thirty-two human maxillary second premolars with flattened canals (buccolingual diameter ≥4 times larger than the mesiodistal diameter) at 9 mm from the radiographic apex were selected. The root canals were prepared by ProDesign Logic (PDL) 30/0.01 and 30/0.05 or Hyflex EDM (HEDM) 10/0.05 and 25/0.08 (n = 16), followed by application of the Flatsonic ultrasonic tip in the cervical and middle thirds and a PDL 25/0.03 file in the apical third (FPDL). The teeth were scanned using micro-computed tomography before and after the procedures. The percentage of volume increase, debris, and uninstrumented surface area were analyzed using the Kruskal-Wallis, Dunn, Wilcoxon, analysis of variance/Tukey, and paired and unpaired t-tests (α = 0.05). Results No significant difference was found in the volume increase and uninstrumented surface area between PDL and HEDM (p > 0.05). PDL had a higher percentage of debris than HEDM in the middle and apical thirds (p < 0.05). The FPDL protocol resulted in less debris and uninstrumented surface area for PDL and HEDM (p < 0.05). This protocol, with HEDM, reduced debris in the middle and apical thirds and uninstrumented surface area in the apical third (p < 0.05). Conclusions High percentages of debris and uninstrumented surface area were observed after preparation of flattened root canals. The HEDM, Flatsonic tip, and 25/0.03 instrument protocol enhanced cleaning in flattened root canals.

Effects of radiation therapy on the dislocation resistance of root canal sealers applied to dentin and the sealer-dentin interface: a pilot study

Yaduka Pallavi,Kataki Rubi,Roy Debosmita,Das Lima,Goswami Shachindra 대한치과보존학회 2021 Restorative Dentistry & Endodontics Vol.46 No.2

Objectives: This study evaluated and compared the effects of radiation therapy on the dislocation resistance of AH Plus and BioRoot RCS applied to dentin and the sealer-dentin interface. Materials and Methods: Thirty single-rooted teeth were randomly assigned to 2 groups (n = 15 each): AH Plus (Dentsply DeTrey) and BioRoot RCS (Septodont). Each group was subdivided into control and experimental groups. The experimental group was subjected to a total radiation dose of 60 Gy. The root canals of all samples were cleaned, shaped, and obturated using the single-cone technique. Dentin slices (1 mm) were sectioned from each root third for the push-out test and scanning electron microscopy (SEM) was done to examine the sealer-dentin interface. The failure mode was determined using stereomicroscopy. Bond strength data were analyzed by the independent t-test, 1-way analysis of variance, and the Tukey post hoc test (α = 0.05). Results: Significantly lower bond strength was observed in irradiated teeth than non-irradiated teeth in the AH Plus group (p < 0.05). The BioRoot RCS group showed no significant reduction in bond strength after irradiation (p > 0.05) and showed a higher post-irradiation bond strength (209.92 ± 172.26 MPa) than the AH Plus group. SEM revealed slightly larger gap-containing regions in irradiated specimens from both groups. Conclusions: The dislocation resistance of BioRoot RCS was not significantly changed by irradiation and was higher than that of AH Plus. BioRoot RCS may be the sealer of choice for root canal treatment in patients undergoing radiation therapy.

Revitalization of necrotic mature permanent incisors with apical periodontitis: a case report

Nagas, Emre,Uyanik, M. Ozgur,Cehreli, Zafer C. The Korean Academy of Conservative Dentistry 2018 Restorative Dentistry & Endodontics Vol.43 No.3

Despite considerable focus on the regenerative endodontic treatment of immature teeth with necrotic infected pulps and apical periodontitis, little data exist with regard to its possible implementation in necrotic permanent teeth with complete apical and radicular development. The present report describes the procedures and outcome of a regenerative endodontic treatment approach in 2 previously-traumatized incisors with closed apex with apical periodontitis. A 2-visit treatment procedure was employed. At initial visit, the root canals were copiously irrigated, followed by placement of a triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin into the root canals. After 4 weeks, the antibiotic paste was removed, and apical bleeding was initiated with size 10 hand files beyond the apices. The root canals were coronally sealed with mineral trioxide aggregate, and the access cavities were restored with bonded resin composite. At post-operative 60 months, both teeth were remained asymptomatic, with the recall radiographs showing complete resolution of apical radiolucency and reestablishment of periradicular tissues. In both teeth, the dimensions of root space remained unchanged as verified by image analysis. The revitalization protocol utilizing root canal disinfection and induced apical bleeding in necrotic, closed-apex incisors may offer a clinically acceptable alternative to conventional root canal treatment.

하악 전치부에서 발생한 치주-근관 복합 병소의 근관치료 후 조직 유도 재생술을 이용한 치료: 증례보고

권은영,정경화,김소연,전혜미,최윤경,주지영 대한턱관절교합학회 2019 구강회복응용과학지 Vol.35 No.1

When inflammatory products are found in both periodontal and pulpal tissues simultaneously, a periodontal-endodontic combined lesion is established. The treatment of periodontal-endodontic combined lesions includes root canal therapy and periodontal regenerative procedure for resolution of both the apical and marginal inflammatory lesions. The present study reports the treatment of periodontal-endodontic combined lesions in the mandibular anterior area with root canal therapy, followed by guided tissue regeneration therapy. Teeth with severe bone destruction in each case could be preserved, without extraction, over a 3-year period. Therefore, it appears that treatment of periodontal-endodontic combined lesions in the mandibular anterior area using guided tissue regeneration technique after root canal therapy may provide clinical advantages.

Revitalization of necrotic mature permanent incisors with apical periodontitis: a case report

Emre Nagas,M. Ozgur Uyanik,Zafer C. Cehreli 대한치과보존학회 2018 Restorative Dentistry & Endodontics Vol.43 No.3

Despite considerable focus on the regenerative endodontic treatment of immature teeth with necrotic infected pulps and apical periodontitis, little data exist with regard to its possible implementation in necrotic permanent teeth with complete apical and radicular development. The present report describes the procedures and outcome of a regenerative endodontic treatment approach in 2 previously-traumatized incisors with closed apex with apical periodontitis. A 2-visit treatment procedure was employed. At initial visit, the root canals were copiously irrigated, followed by placement of a triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin into the root canals. After 4 weeks, the antibiotic paste was removed, and apical bleeding was initiated with size 10 hand files beyond the apices. The root canals were coronally sealed with mineral trioxide aggregate, and the access cavities were restored with bonded resin composite. At post-operative 60 months, both teeth were remained asymptomatic, with the recall radiographs showing complete resolution of apical radiolucency and reestablishment of periradicular tissues. In both teeth, the dimensions of root space remained unchanged as verified by image analysis. The revitalization protocol utilizing root canal disinfection and induced apical bleeding in necrotic, closed-apex incisors may offer a clinically acceptable alternative to conventional root canal treatment.

Assessment of postoperative pain after single-visit root canal treatment using rotary and reciprocating file systems: an in vivo study

Reshma Parveen Shaik,Ram Sunil Chukka,Anila Bandlapally,Sayesh Vemuri,Nagesh Bolla,Ram Chowdary Basam,Sravanthi Tammineedi 대한치과마취과학회 2022 Journal of Dental Anesthesia and Pain Medicine Vol.22 No.4

Background: Various instrument kinematics used in single-visit endodontics influence the occurrence of pain after endodontic therapy. This study aimed to evaluate the occurrence of pain after mechanical instrumentation with Hyflex EDM (HEDM) and WaveOne Gold (WOG) during single-visit endodontic therapy. Methods: Sixty patients diagnosed with asymptomatic irreversible pulpitis and normal apical tissues in mandibular premolar teeth were included in the study for single-visit root canal therapy. The patients were divided into two groups (n = 30) according to the rotary instrument used during root canal preparation (group A [HEDM] and group B [WOG]). Pain was evaluated after endodontic therapy at 8, 24, and 48 h intervals using the visual analog scale (VAS). Data obtained were analyzed using the chi-square test, independent t-test, MannWhitney U test, and Wilcoxon matched-pairs test. Results: Statistically significant differences were observed between the two groups (P < 0.001) at 8, 24, and 48 h, with WOG exhibiting less pain than HEDM files. Conclusion: Postoperative pain was lower in the WOG file system than in the HEDM file system after single-visit root canal therapy at 8, 24, and 48 h.