Curved canals are a higher risk for instrument fracture than straight canals. In curved canals rotary instruments (including lentulo spirals) fractured more often than other instruments. In all, 87% of the fractured instruments were removed successfully. A decrease in success rate was evident with increasing treatment time. The use of an operating microscope was a prerequisite for the techniques used to remove the fractured instruments.

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The present study describes for the first time the changes of both AEFC thickness and the numerical density of collagen fibers inserting into AEFC at specified levels and sites of human premolars at different stages of development. The investigation was based on 45 premolars (25 maxillary, 20 mandibular; 25 first and 20 second), extracted from adolescents and young adults. All teeth were free of disease and presented with roots developed from 30-100% of their final length. They were prefixed in Karnovsky's fixative, decalcified in EDTA and subdivided into about 14 slices each, cut from mesial and distal root surfaces, vertical to and along the root axis. The slices were postfixed in OsO4, embedded in Epon and cut for light-microscopic study. AEFC thickness (4086 measurements) and the density of the collagenous fiber fringe (454 counts) inserting in AEFC were measured at 1, 3, 5 and 7 mm apical to the cementoenamel junction. The data obtained showed: AEFC thickness increased with age and varied between 0 and 57.5 microns. Between 9 and 17 years, cervical AEFC thickness increased in maxillary first premolars from an average of 5 to 30 microns, and in mandibular second premolars from 6 to 20 microns, i.e., AEFC grew at approximately the same rate as later in life. Depending on the differences in tooth development, AEFC on maxillary first premolars became thicker than that on mandibular second premolars. Due to the corono-apically decreasing gradient of AEFC development, its increase in mid-root regions lagged behind that in cervical regions of all teeth in people younger than about 14 yr.(ABSTRACT TRUNCATED AT 250 WORDS)

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R oot canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. Objectives: The objectives of this systematic review of randomized controlled trials were to determine the relative clinical effectiveness of hand instrumentation versus ultrasonic instrumentation alone or in conjunction with hand instrumentation for orthograde root canal treatment of permanent teeth. Material and Methods: The search strategy retrieved 226 references from the Cochrane Oral Health Group Trials Register (7), the Cochrane Central Register of Controlled Trials (CeNTRAL) (12), MeDLINe (192), eMBASe (8) and LILACS (7). No language restriction was applied. The last electronic search was conducted on December 13th, 2007. Screening of eligible studies was conducted in duplicate and independently. Results: Results were to be expressed as fixed-effect or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible randomized controlled trials were identified. Conclusions: This review illustrates the current lack of published or ongoing randomized controlled trials and the unavailability of high-level evidence based on clinically relevant outcomes referring to the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment. In the absence of reliable research-based evidence, clinicians should base their decisions on clinical experience, individual circumstances and in conjunction with patients' preferences where appropriate. Future randomized controlled trials might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis on not only clinically relevant, but also patient-centered outcomes.