An Update on Root Canal Preparation Techniques and How to Avoid Procedural Errors in Endodontics

Background: Effective root canal treatment involves cleaning and shaping root canals using a range of instrumentation procedures and techniques. The aim of this review was to provide an update on root canal hand instrumentation techniques and how to overcome iatrogenic errors. Methods: A comprehensive search was carried out using multiple databases, PubMed, Medline, Google scholar, and Scopus, to identify relevant studies addressing the objective of this study and to summarize the current evidence to readers. Keywords, i.e., endodontics, root canal preparation, hand instrumentation, techniques and procedural errors, as well as, MeSH terms, i.e. “endodontics”, “instrumentation”, “root canal preparation” were used to conduct our comprehensive search. Results: The hybrid technique is a commonly-used approach that combines the benefits of both the crown-down and step-back techniques and was reported to be one of the best techniques to produce an optimal root canal preparation outcome. Hand-instrument manipulation using the balanced forced technique is also favoured as it rapidly and safely permits removal of canal contents allowing irrigants and medications to reach deep inside canal spaces. Conclusion: The use of hand files is still recommended for initial canal negotiation and preparation and is essential for the correction of procedural errors. This study provided an update on several hand instrumentation techniques commonly used in endodontics. The correct and safe application of these techniques can prevent iatrogenic procedural errors from occurring which optimizes the quality of treatment outcome.

“Air Polishing and CHX Effects in Addition to Subgingival Ultrasonic Instrumentation on Clinical Periodontal Parameters: A Randomised Clinical Trial”

Objectives: This study was performed to investigate the efficacy of using glycine powder air-polishing (GPAP) or antiseptics (CHX) adjunctively to scaling and root planing (SRP) in the treatment of periodontitis. Methods: In this trial, ninety patients (between 28-80 years old) who had at least three teeth with 3 to 7- mm periodontal pockets, were ıncluded from the Department of Periodontology. The patients were divided into three groups randomly. In the control group ultrasonic instrumentation was performed with distilled water and hand instrumentation, in the CHX group ultrasonic instrumentation was performed with CHX and hand instrumentation, in the GPAP group in addition to SRP with ultrasonic performed with distilled water and hand instrumentation, GPAP was performed for 10 seconds per periodontal pocket using a Perio-Flow device. All treatments were performed in one session. Resuls: The scores of plaque index(PI),gingival index (GI), probing depth (PD), bleeding on probing (BOP) and clinical attachement level (CAL) were decreased in all groups after 1 month and the results were statistically significant in intergoup comparisions. PI and CAL scores were statistically significant in intragroup comparisions in GPAP group. Altough GI, PD and BOP scores were lower in the GPAP group than CHX and control group, the differences after 1 month were not statistically significant. Conclusion: Within the limits of this study, it was seen that SRP was effective alone in the treatment of periodontitis. However, using a CHX with ultrasonic devices has little beneficial effects on periodontal parameters when compared with control and GPAP groups. GPAP groups was found more effectively in PI and CAL scores.

Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations

Objective In the era of SARS-CoV-2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies. Study Design Prospective quantification of airborne aerosol generation during surgical and clinical simulation. Setting Cadaver laboratory and clinical examination room. Subjects and Methods Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation. Results Hand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 μm. Suction drilling at 12,000 rpm, high-speed drilling (4-mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols ( P < .001). In clinical simulations, nasal endoscopy ( P < .05), speech ( P < .01), and sneezing ( P < .01) generated 1- to 10-μm airborne aerosols. Significant aerosol escape was seen even with utilization of a standard surgical mask ( P < .05). Intact and VENT-modified (valved endoscopy of the nose and throat) N95 respirator use prevented significant airborne aerosol spread. Conclusion Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 μm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT-modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not.

EFFICACY OF TWO PIEZOELECTRIC ULTRASONIC SCALERS WITH HAND INSTRUMENTATION: A PROFILOMETRIC AND SEM STUDY

Background: The goal of the present study was to compare the efficacy of two piezoelectric scalers with hand instrumentation in calculus removal, loss of tooth substance and roughness created on root surface. Methods: 90 freshly extracted non-carious, non-restored single rooted teeth with hopeless periodontal prognosis were included in the study. They were divided into three groups of 30 teeth each i.e. Group 1,Group 2 and Group 3 where instrumentation was done using two piezoelectric scalers- Piezoelectric scaler A & Piezoelectric scaler B and Gracey curette respectively. Specimens were subjected to Scanning Electron Microscopy (SEM) & Profilometric analysis to evaluate the root surface roughness created by these three instruments. Results: Statistically significant difference was observed in Remaining calculus index (RCI) in the three experimental groups with hand instrument being least effective in removing calculus when compared to the piezoelectric scalers(p≤0.05). There was significant difference in mean Loss of tooth substance index(LTSI) and Roughness loss of tooth substance index (RLTSI) scores when compared in the three groups (p value =0.002). Both SEM and profilometric analysis showed that Piezoelectric scaler A and Piezoelectric scaler B caused less root surface roughness compared to hand instruments. Conclusion: The findings of the present study suggest that scaling and root planing using both piezoelectric scalers and hand instruments were effective in mechanical debridement of the root surface. However, piezoelectric instruments gave smoother root surface than hand instruments and were also more efficient in calculus removal. Key words: Dental scaling, Root planing, Ultrasonics, Scanning Electron Microscopy, Dental calculus

Apically extruded debris and irrigants during root canal filling material removal using Reciproc Blue, WaveOne Gold, R-Endo and ProTaper Next systems

Background. The present study aimed to compare the amount of apically extruded debris and irrigants produced by various nickel-titanium instruments. Methods. A total of 100 single-rooted mandibular premolar teeth were root canal treated and prepared for agar gel model. The root canal fillings were removed using Reciproc Blue, ProTaper Next, R-Endo, WaveOne Gold systems or hand instrumentation. The mean weights of apically extruded materials were calculated. Data were statistically analyzed using one-way ANOVA and post hoc Bonferroni tests. Results. Hand instrumentation resulted in significantly more debris and irrigants than other systems (P<0.05). The mean amount of apically extruded debris and irrigants produced by Reciproc Blue system was significantly greater than motordriven instruments (P<0.05). No significant difference was detected between ProTaper Next and WaveOne Gold systems (P>0.05), while they both produced significantly less apically extruded material than R-Endo system (P<0.05). Conclusion. All the instruments caused apical extrusion. ProTaper Next and WaveOne Gold systems were associated with significantly less apical extrusion.