Root canal treatment of three-rooted maxillary second premolars: Report of four cases

The aim of this report is to contribute to a better understanding of the radiographic, clinical and anatomic findings in maxillary second premolars. This paper reports the endodontic treatment of two cases of three-rooted three-canal maxillary second premolars in different patients, and two sound maxillary second premolars also with three canals and three independent roots in a sibling of one of the patients. Although the presence of maxillary second premolars with one or two canals and one root is much more common, other anatomic conditions can be found. A correct clinical and radiographic diagnosis based on knowledge of root canal anatomy and critical interpretation of radiographs is necessary for a safer and successful endodontic treatment of these teeth.

Effects of chlorhexidine and sodium hypochlorite on the microhardness of root canal dentin

Objective. The purpose of this study was to evaluate the effects of endodontic irrigants on the microhardness of root canal dentin.Study design. Thirty extracted single-rooted human teeth were used. The crowns were sectioned at the cementoenamel junction. Each root was transversely sectioned into cervical, middle, and apical segments, resulting in 90 specimens. The 3 sections of each root were separately mounted in an individual silicon device with acrylic resin. The specimens were randomly divided into the following 3 groups (n = 30), according to the irrigant solution used: (1) group 1, control (saline solution); (2) group 2, 2% chlorhexidine gluconate solution; and (3) group 3, 1% sodium hypochlorite (NaOCl). After 15 minutes of irrigation, dentin microhardness was measured on each section at 500 mu m and 1000 mu m from the pulp-dentin interface with a Vickers diamond microhardness tester in Vickers hardness number (VHN).Results. Data obtained were analyzed using analysis of variance and the Tukey test (5%). Specimens irrigated with 2% chlorhexidine (group 2) or 1% NaOCl (group 3) presented lower values of dentin microhardness, with significant difference in relation to the control group (P < .05).Conclusion. It could be concluded that chlorhexidine and NaOCl solutions significantly reduced the microhardness of root canal dentin at 500 mu m and 1000 mu m from the pulp-dentin interface.

IN VITRO INCIDENCE of ROOT CANAL BIFURCATION IN MANDIBULAR INCISORS BY RADIOVISIOGRAPHY

Objective: The aim of this study was to verify, in vivo and in vitro, the prevalence of root canal bifurcation in mandibular incisors by digital radiography. Material and Methods: Four hundred teeth were analyzed for the in vivo study. Digital radiographs were taken in an orthoradial direction from the mandibular incisor and canine regions. The digital radiographs of the canine region allowed visualizing the incisors in a distoradial direction using 20 degrees deviation. All individuals agreed to participate by signing an informed consent form. The in vitro study was conducted on 200 mandibular incisors positioned on a model, simulating the mandibular dental arch. Digital radiographs were taken from the mandibular incisors in both buccolingual and mesiodistal directions. Results: The digital radiography showed presence of bifurcation in 20% of teeth evaluated in vitro in the mesiodistal direction. In the buccolingual direction, 17.5% of teeth evaluated in vivo and 15% evaluated in vitro presented bifurcation or characteristics indicating bifurcation. Conclusions: Digital radiography associated with X-ray beam distally allowed detection of a larger number of cases of bifurcated root canals or characteristics of bifurcation.

The adhesive system and root canal region do not influence the degree of conversion of dual resin cement

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of Nd : YAG and Er : YAG lasers on the sealing of root canal fillings

Objective: the ability of the laser irradiation to promote the cleaning and disinfection of the radicular canal system has become this type of treatment in a viable and real alternative in endodontics. The purpose of this study was to evaluate the apical marginal sealing of root canal fillings after the irradiation with the laser of Nd:YAG or of Er:YAG. Materials and Methods: Forty-two human, extracted single-rooted teeth had their crowns sectioned and the root canals prepared with a no. 70 K-file. Then, they were dried and divided into three groups according to canal wall treatment: group 1: the canals were filled with EDTA for 3 min, followed by irrigation with 1% sodium hypochlorite solution; group 2: the canal walls were irradiated with Nd:YAG laser; and group 3: the canal walls were irradiated with Er:YAG laser. Afterwards, the root canals were obturated by the lateral condensation technique. The roots were externally waterproof, except in the apical foramen and immerged in 2% methylene blue aqueous solution during 48 hours. Results: the results showed that the largest infiltrations happened in the group 3-Er:YAG (7.3 mm), proceeded by the group 1-EDTA (1.6 mm) and by the group 2-Nd:YAG (0.6 mm). The group Er:YAG differed statistically of the others (p < 0.05). Conclusion: It was concluded that the Er:YAG laser intracanal irradiation previously to the root canal filling must be used with caution until future research is define the best parameters for it's use.

Scanning electron microscope evaluation of chlorhexidine gel and liquid associated with sodium hypochlorite cleaning on the root canal walls

Objective. The aim of this study was to evaluate, by scanning electronic microscopy (SEM), the cleaning of the root canal walls after instrumentation and irrigation with 2.5% sodium hypochlorite (NaOCl) associated with 2% chlorhexidine (CHX) gel or liquid, combined or not with 17% ethylenediamine tetra-acetic acid (EDTA).Study design. Sixty single-root human teeth were subjected to standardized root canal instrumentation with different irrigants (n = 10): G1) NaOCl + CHX liquid; G2) NaOCl + CHX liquid + EDTA + saline solution; G3) NaOCl + CHX gel; G4) NaOCl + CHX gel + EDTA + saline solution; G5) saline solution; G6) saline solution + EDTA. After instrumentation, the teeth were prepared for SEM analysis (x500 and x2,000) to evaluate the cleaning of the cervical, middle, and apical thirds. The area analyzed was quantified according to the percentage of open and closed tubules, and data were statistically analyzed by analysis of variance and Tukey tests (P = .05).Results. The number of open tubules was highest in G4 in all root thirds, showing statistically significant difference from G1, G2, and G5 (P < .05). G1 presented higher quantity of closed tubules significant than G2.Conclusion. Irrigation with NaOCl and CHX gel followed by EDTA and saline solution produced greater cleaning of the root canal walls. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e82-e87)

Assessment of external root temperature during root canal irradiation by Nd:YAG and Er:YAG lasers

Different types of laser have been widely studied for applicability in the oral health area. In the endodontic area, investigations with some types of laser have been conducted to establish safe parameters for clinical application in root canals. However, it has not been duly explained whether the temperature increase caused by laser irradiation could cause alteration in the temperature on the external surface of the root and, consequently, alterations in the cells of the periodontal ligament, causing resorption and even loss of the dental element. The proposal in this paper was to gauge the external root temperature in the apical and cervical regions of the roots of human teeth during root canal irradiation with Nd:yttrium aluminum garnet (YAG) and Er:YAG lasers using different parameters. The novel approach of this paper is the use of the technique of laser applications along the total length of the root canal with series of repetitive irradiation, however, using time of 1 s of irradiation associated with 1 s off to avoid cumulative thermal effects. Experimental results confirm the accuracy of the parameters and exposure regimen obtained. All the parameters used in this paper are acceptable from a clinical as well as a biological point of view. (C) 2009 Laser Institute of America.

Scanning electron microscopic study of the cleaning ability of chlorhexidine as a root-canal irrigant

Aim To evaluate in vitro the cleaning of root-canal walls after irrigation with different irrigants.Methodology A total of 36 recently extracted human teeth were divided into four experimental groups according to the irrigating solution used: saline; 2% chlorhexidine; 2.5% sodium hypochlorite; and 2.5% sodium hypochlorite + EDTA. The cleaning of the apical, middle and coronal thirds of the root canals was evaluated by scanning electron microscope examination using a 4-point scoring system.Results the best cleaning was obtained using 2.5% sodium hypochlorite and EDTA, followed by 2.5% sodium hypochlorite only (P < 0.05), whose cleaning was similar to chlorhexidine only in the cervical third. Cleaning by saline and 2% chlorhexidine was worse than the other two groups and was similar in all thirds. Better cleaning was found in the cervical and middle thirds for all groups with the worst results in the apical third.Conclusions the apical third of the root canals was not cleaned as well as the middle and coronal thirds. Cleaning by chlorhexidine and saline was inferior compared to the cleaning by sodium hypochlorite with and without EDTA.

Effect of irrigating solution and calcium hydroxide root canal dressing on the repair of apical and periapical tissues of teeth with periapical lesion

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

In vitro evaluation of root canal preparation using oscillatory and rotary systems in flattened root canals

Objective: the aim of this study was to evaluate the biomechanical preparation of flattened root canals using the following systems: Endo-Eze AET stainless steel oscillatory instruments (Ultradent) and RaCe rotary NiTi instruments (FKG Dentaire). Materials and Methods: Twenty extracted human mandibular incisors were randomly assigned to two groups: Group I Instrumentation with oscillatory Endo-Eze AET files (oscillatory technique); Group 2 - Instrumentation with rotary NiTi RaCe files (rotary technique). The teeth were decoronated, had their apices and coronal openings sealed with sticky wax and were embedded in crystal-clear orthophtalic polyester resin. The roots were sectioned transversally with diamond discs at 10 mm (middle third) and 5 mm (apical third) from the apex and the segments were reassembled for instrumentation. The sections were photographed before and after root canal instrumentation and evaluated with respect to whether the original root canal shape was modified by instrumentation. To evaluate the differences in the root canal shape before and after biomechanical preparation, scores were given regarding the instruments touch on the intracanal walls. Results: In middle third of the root canals instrumented with the rotary system, there was a change in the original canal anatomy (p < 0.05), with formation of a protuberance in the mesiodistal direction. This protuberance did not occur when the oscillatory instrumentation was used. The oscillatory system had better results in the middle and apical thirds as evaluated by Dunn's multiple-comparison test (p > 0.05). Conclusion: Under the tested conditions, Endo-Eze oscillatory system yielded the instrumentation of all flattened oot canal walls, maintaining the canal original shape throughout the biomechanical preparation, and was more effective than RaCe rotary system.