The Efficacy of Selected Sodium Hypochlorite Heating Methods for Increasing and Maintaining Its Intracanal Temperature—An Ex Vivo Study

Background: Enhancement of the temperature of sodium hypochlorite (NaOCl) solution would increase its cleaning potential and decontamination of the root canal system. Therefore, the aim of the present in vitro investigation was to compare the efficacy of different methods of NaOCl heating by evaluating the temperature profiles developed at different levels of the root canal system. Methods: Five thermocouples were applied at different levels of the root canal system of extracted human premolars. NaOCl solution was heated according to two methods: extraoral heating (50 °C, 60 °C, and 70 °C) using a magnetic hotplate heater and intracanal heating by F-06, XF-30/04, and ML-12 pluggers at 100 °C, 150 °C, and 180 °C. Results: The extraoral heating method was ineffective to produce a significant temperature increase at the root apex. Comparable results were obtained using the intracanal heating method through the ML-12 plugger that showed slightly better results only when set at 180 °C. On the other hand, negligible differences were observed in terms of temperature maintenance at several levels of the root between the F-06 and XF-30/04 pluggers, even though the time intervals were higher in case of XF-30/04. Conclusions: The intracanal heating method provided a better temperature persistence in the middle third of the root canal system. Conversely, extraoral heating was ineffective to produce a significant temperature increase at the apex of the root. Comparable results were obtained even using the ML-12 plugger.

Comparative Analysis of Ease of Removal of Fractured NiTi Endodontic Rotary Files from the Root Canal System—An In Vitro Study

This study aimed at analyzing and comparing the ease of removal of fractured nickel–titanium (NiTi) endodontic rotary files from the root canal system between the ultrasonic tips and the Endo Rescue appliance removal systems, as well as comparing the volume of dentin removed between ultrasonic tips and the Endo Rescue appliance using a micro-computed tomography (micro-CT) scan. Material and Methods: Forty NiTi endodontic rotary files were intentionally fractured in 40 root canal systems of 20 lower first molar teeth and distributed into the following study groups: A: Ultrasonic tips (n = 20) (US) and B: Endo Rescue device (n = 20) (ER). Preoperative and postoperative micro-CT scans were uploaded into image processing software to analyze the volumetric variations of dentin using an algorithm that enables progressive differentiation between neighboring pixels after defining and segmenting the fractured NiTi endodontic rotary files and the root canal systems in both micro-CT scans. A non-parametric Mann–Whitney–Wilcoxon test or t-test for independent samples was used to analyze the results. Results: The US and ES study groups saw 8 (1 mesiobuccal and 7 distal root canal system) and 3 (distal root canal system) fractured NiTi endodontic rotary files removed, respectively. No statistically significant differences were found in the amount of dentin removed between the US and ER study groups at the mesiobuccal (p = 0.9109) and distal root canal system (p = 0.8669). Conclusions: Ultrasonic tips enable greater ease of removal of NiTi endodontic rotary files from the root canal system, with similar amounts of dentin removal between the two methods.

Complexities in endodontics: A case series

There are cases in the endodontic treatment which are a real challenge. There are teeth with different anatomies of the root canals of different teeth and their treatment. There are most of the cases which are sevely carious and has lost more than 50% of the tooth structure. Patients usually lose their teeth because these problems. The aim of this study is to investigate several cases with different root canal anatomies like in open apex with blunderbuss canals in maxillary central incisors or mandibular premolar and molars with severly decayed crown tooth structures and their management. one case with severly decayed lower mandibular premolar i.e 45, one case of maxillary first molar with severly decayed crown structure i.e 16, a case of severly decayed mandibular first molar i.e 36, Three Cases of maxillary central incisors with immature open apex and blunderbuss canals w.r.t 21. Results are observed after several years. In performing a root canal treatment on such teeth, one should appreciate the complexity of the root canal system, canal obliteration and configuration, and the potential for regenerating the original anatomy of the tooth either Endodontic or Post Endodontic. Knowledge of the phenomenon of the complexity of the root canal system, canal obliteration and configuration, and the potential for regenerating tooth anatomies with the help of rebond fibres, MTA and Composite restorations, this will improve the medical practice of the general dental practitioner.

Antimicrobial and Antibiofilm Properties of Bioceramic Materials in Endodontics

Microbes are prevalent in the root canals of necrotic teeth, and they are the cause of primary and post-treatment apical periodontitis. Bacteria can dwell within the infected root canal system as surface-adherent biofilm structures, which exhibit high resistance to antimicrobial agents. Bioceramic materials, with their biocompatible nature and excellent physico-chemical properties, have been widely used in dental applications, including endodontics. This review focuses on the application of bioceramic technology in endodontic disinfection and the antibiofilm effects of endodontic bioceramic materials. Different bioceramic materials have shown different levels of antibiofilm effects. New supplements have emerged to potentially enhance the antibiofilm properties of bioceramics aiming to achieve the goal of microbial elimination in the root canal system.

Modern aspects of internal canal disinfection in treatment of complicated forms of caries

The widespread prevalence of pulp and periodontal diseases indicates the need for continuous improvement of the method of endodontic treatment and determines the relevance of the development of new methods of complex therapy. The primary etiologic agents of apical periodontitis are microorganisms and their by-products that have invaded the pulpal space and established multispecies biofilm communities in the root canal system. Biofilms are involved in all stages of root canal infection and can be found on root canal walls, in dentinal tubules, and on extraradicular surfaces. The success of endodontic dental treatment is determined by careful mechanical processing using modern instruments, drug treatment and subsequent three-dimensional hermetic obturation of the root canal. Only a high-quality and optimal solution to the three problems allows you to achieve high-quality long-term results of treatment. Instrumentation disrupts biofilms which colonize infected soft and hard tissues and provides access for irrigation and exposure to antimicrobial solutions for disinfection of the root canal system. Disinfection is achieved by the use of both antimicrobial agents and the mechanical flushing action of irrigation, with the goal being the disruption, displacement and removal of pulpal remnants, microorganisms, metabolic byproducts, debris and the smear layer created during instrumentation. The multistage, duration and laboriousness of drug treatment of root canals makes it not always effective, which can subsequently cause unsuccessful endodontic treatment. A practicing dentist should be able to rationally and efficiently utilize standard disinfection protocols in the irrigation and medication of root canal spaces.

Histological Evaluation of Multisonic Technology for Debridement of Vital and Necrotic Pulp Tissues from Human Molar Teeth. An Observational Study

Background: This study evaluated the efficacy of a multisonic technology for the debridement of vital and necrotic pulp tissues in freshly extracted human mandibular molar teeth. Methods: Twelve teeth with a diagnosis of symptomatic irreversible pulpitis (SIP) and twelve teeth with a diagnosis of pulp necrosis with symptomatic apical periodontitis (SAP) were extracted. The GentleWave® procedure was performed on 10 teeth from each group. Four non-treated teeth served as histologic controls. Histological consecutive 5 µm sections were obtained from the apical, middle, and coronal portion of the canals. The canals were evaluated for the presence of pulpal debris and bacteria. Results: In nine out of the ten specimens with SIP, no pulpal debris was detected in any portion of the canals. In the necrotic pulp group, eight out of the ten specimens had no detectable pulpal debris in any portion of the canal spaces. No bacteria were detected in the main canals, isthmuses, or lateral canals, but were detected deep within the dentinal tubules in 10 specimens. Conclusions: This study demonstrated that the multisonic technology was effective at removing vital and necrotic pulp tissue as well as bacteria from the root canal system, including inaccessible areas.

Disinfection of the root canal system: what should the protocol be?

The presence of micro-organisms within the root canal system is the critical aetiological factor in peri-radicular periodontitis. During root canal treatment (RCT) it is imperative that this infection and other organic debris are removed from the root canal system. This is challenging because complex tooth anatomy, the presence of a biofilm and the smear layer complicate the process. There are a number of irrigant chemicals and adjunctive systems available in contemporary endodontic practice that are used to disinfect the root canal system during root canal preparation. This article reviews the available evidence concerning these disinfection methods and concludes by presenting a clinical protocol supported by the literature. CPD/Clinical Relevance: A clinical protocol, supported by the literature, is presented for effective decontamination of the root canal system during root canal therapy.

Upright walking has driven unique vascular specialization of the hominin ilium

Background A novel physis in hominins modulates broadening and shortening of the ilium. We report analysis of a vascular canal system whose origin may be associated with this physis and which appears to be also unique to hominins. Its presence is potentially identifiable in the fossil record by its association with a highly enlarged foramen that is consistently present in modern humans and hominin fossils. Methods We measured the diameter of this foramen in humans, fossil hominins, and African great apes and corrected for body size. Results The mean relative human foramen diameter is significantly greater than those of either Pan or Gorilla. Moreover, eight of the nine values of the Cohen’s d for these differences in ratios are highly significant and support the ordering of magnitudes: Pan < Gorilla < Homo. The relative foramen diameter of A.L. 288-1 is above the 75th percentile of all other hominoids and at the high end of humans. The foramen is also present in ARA-VP-6/500. Conclusions We posit that the presence and significant enlargement of this foramen in fossils can reasonably serve as an indicator that its anterior inferior iliac spine emerged via the unique hominin physis. The foramen can therefore serve as an indicator of hominin iliac ontogenetic specialization for bipedality in fossil taxa.

What’s new for the clinician? - Excerpts from and summaries of recently published papers

Endodontic files are used to remove intracanal pulpal tissues, microbial biofilm, and toxic by-products and to develop a continuously tapering canal while maintaining the canal geometry that ultimately allows for the delivery of irrigating solutions and intracanal medicaments as well as the three-dimensional filling of the root canal system. Historically, stainless steel hand files have been used to perform canal shaping. However, these files are stiff and associated with increased operator fatigue, and when used in the preparation of curved root canals, the restoring forces of the files tend to return the file back to its original shape, resulting in canal transportation.