Fracture Strength of Endodontically Treated Teeth with Different Access Cavity Designs

Plotino, Gianluca; Grande, Nicola M.; Isufi, Almira; Ioppolo, Pietro; Pedullà, Eugenio; Bedini, Rossella; Gambarini, Gianluca; Testarelli, Luca

doi:10.1016/j.joen.2017.01.022

Cited by 232 publications

(271 citation statements)

References 30 publications

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“…Consequently, conservative access and canal preparations have been suggested to preserve tooth structure in this area (Clark & Khademi , Plotino et al . ).…”

Section: Discussionmentioning

confidence: 97%

Micro‐CT analysis of danger zone thickness in the mesiobuccal roots of maxillary first molars

et al. 2018

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Aim To evaluate dentine thickness from both distal (‘danger zone’) and mesial (‘safety zone’) aspects of the MB1 and MB2 canals of maxillary first molars at the furcation level using micro‐CT imaging. Methodology One hundred maxillary first molars with two canals in the MB root were selected from a Brazilian subpopulation and scanned at a resolution of 19.6 μm in a micro‐CT device. From each specimen, two axial cross‐sectioned images were selected at 2 and 3 mm apical to the furcation level of the MB root and evaluated for the smallest dentinal thickness. Measurements were made from the outer perimeter of the MB1 and MB2 canals towards the external root surface from both distal (danger zone) and mesial (safety zone) aspects of the root. The influence of an isthmus was also considered in the analysis, and samples were classified according to the presence or absence of an isthmus in the axial sections. Non‐parametric Wilcoxon signed‐rank tests were used to compare dentinal thickness between MB1 and MB2 canals with a significant level set at 5%. Colour‐coded 3D models of dentine thickness throughout the MB root were created and evaluated qualitatively. Results At both levels, median dentine thickness of the MB2 canal was significantly lower in both distal and mesial aspects of the root in comparison with the MB1 canal (P < 0.01). The presence of an isthmus was not a variable that influenced dentinal thickness. Colour‐coded models indicated that dentine thickness was dependent on the cross‐sectional shape of the MB root. At least 50% of the sample had <1 mm of dentine thickness at the danger zone of the MB2 canal. Conclusions Danger zones in the MB roots of maxillary first molars were not symmetrical. MB2 canals had less dentine thickness on both aspects of the root compared to the MB1 canal.

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“…Consequently, conservative access and canal preparations have been suggested to preserve tooth structure in this area (Clark & Khademi , Plotino et al . ).…”

Section: Discussionmentioning

confidence: 97%

Micro‐CT analysis of danger zone thickness in the mesiobuccal roots of maxillary first molars

et al. 2018

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“…That said, studies do not seem to demonstrate a significant benefit of contracted access cavities from the mechanical standpoint (Plotino et al . ). Indeed, this is valid, considering that greater tapered instruments resulted in loss of tooth structure in the root canal, specifically the pericervical dentine (Clark et al .…”

Section: Introductionmentioning

confidence: 97%

“…With the advent of activated irrigation strategies such as ultrasonically activated irrigation, it remains unknown whether smaller apical preparation sizes will result in canals that are as clean as canals prepared to larger sizes, when the taper is standardized. This is critical and timely, with the increasing trend towards minimally invasive root canal treatment, where sizes of access cavities are constricted, with the claim of conserving tooth structure, and an overarching aim of preventing fractures of teeth (Krishan et al 2014, Plotino et al 2017, Rover et al 2017. That said, studies do not seem to demonstrate a significant benefit of contracted access cavities from the mechanical standpoint (Plotino et al 2017).…”

mentioning

confidence: 99%

“…This is critical and timely, with the increasing trend towards minimally invasive root canal treatment, where sizes of access cavities are constricted, with the claim of conserving tooth structure, and an overarching aim of preventing fractures of teeth (Krishan et al 2014, Plotino et al 2017, Rover et al 2017. That said, studies do not seem to demonstrate a significant benefit of contracted access cavities from the mechanical standpoint (Plotino et al 2017). Indeed, this is valid, considering that greater tapered instruments resulted in loss of tooth structure in the root canal, specifically the pericervical dentine (Clark et al 2013, Huynh et al 2018, Silva et al 2018.…”

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confidence: 99%

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Influence of apical preparation size and irrigation technique on root canal debridement: a histological analysis of round and oval root canals

Lee

Khan

et al. 2019

Int Endodontic J

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Aim To examine the debridement of round and oval root canals prepared to two apical sizes with and without ultrasonically activated irrigation. Methodology Mandibular premolars with round (n = 48) and oval (n = 48) root canals were pair‐matched after microCT scanning and randomly divided into two experimental groups (n = 20): group 1, rotary NiTi to size 20, .04 taper; group 2, rotary NiTi to size 40, .04 taper. Specimens were subdivided into two subgroups (n = 10): subgroup A, syringe and needle (SNI); subgroup B, ultrasonically activated irrigation (UAI). Untreated canals (eight oval and eight round) served as controls. Specimens were processed for histological evaluation for measurement of the remaining pulp tissue and debris (RPT), and the perimeter percentage of root canal area untouched by the instruments (PRAU). Following assessment of normality, multiple‐way anova models were used to study the effects of preparation size, irrigation technique and canal cross‐sectional shape, and their interactions on the RPT and PRAU (α = 0.05). Results All experimental groups had significantly less RPT than the control (P < 0.05). Both the preparation size (20 vs. 40) and the irrigation technique (SNI vs. UAI) had a significant effect on RPT (P = 0.006 and P < 0.001, respectively). Groups irrigated with SNI always had significantly greater RPT than those irrigated with UAI, irrespective of the preparation size (P < 0.001). Canals prepared to size 20 had significantly greater RPT than those with size 40 in the SNI subgroup (P < 0.001), but there was no significant difference in the UAI subgroup (P = 0.481). Conclusions Root canals prepared to a larger size (40) were cleaner than those prepared to a smaller size (20), when irrigation was performed with a syringe and needle. When the irrigant was ultrasonically activated, smaller preparations resulted in canals that were as clean as larger preparations. This finding was common to both round and oval canals of freshly extracted premolars with vital pulp tissue.

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“…A conservative endodontic cavity preparation (Plotino et al . ) was performed to access the pulp chamber, and if bleeding pulp was confirmed, the tooth was included in the study. In the absence of pulp haemorrhage, the tooth was excluded.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of complementary irrigation routines in debriding pulp tissue from root canals instrumented with a single reciprocating file

et al. 2018

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Aim To compare histologically the debridement efficacy of four irrigation techniques in root canals instrumented with a reciprocating single file. Methodology From recently extracted premolars with vital pulp, 68 were selected and classified as having round canals (mesiodistal diameter similar to buccolingual) or oval‐shaped canals (mesiodistal diameter 2.5 times larger than buccolingual) (n = 32, each) by means of bidirectional radiographs. Four additional uninstrumented samples served as histological controls. The root canals of the specimens were accessed and then instrumented with Reciproc R25® and further assigned to one of four experimental groups according to the complementary irrigation technique: Group I, conventional syringe; Group II, passive ultrasonic irrigation; Group III, manual dynamic activation (MDA); and Group IV, EndoActivator®. Roots were then demineralized and the apical 3 mm was multi‐sliced and processed for histologic examination. The percentage of residual pulp tissue was calculated at each cross section. Kruskal–Wallis and Mann–Whitney tests were used to evaluate the effects of irrigation technique, root canal shape and level of cross section on the percentage of residual pulp tissue (P < 0.05). Results Irrigation technique and root canal shape significantly influenced the percentage of residual pulp tissue (P < 0.05) of canals instrumented with the R25 instrument. Percentage of residual pulp tissue was significantly less using ultrasonic irrigation (P < 0.05), but there was no difference between other irrigation techniques (P > 0.05). Round canals retained significantly less percentage of residual pulp tissue compared to oval‐shaped canals (P = 0.001). At 3 mm, there was less pulp tissue compared to levels 2 and 1 mm (P < 0.05). Conclusions In canals instrumented with R25 files, ultrasonic irrigation was more effective in removing pulp tissue in the apical level, especially for the debridement of oval‐shaped canals.

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Fracture Strength of Endodontically Treated Teeth with Different Access Cavity Designs

Cited by 232 publications

References 30 publications

Micro‐CT analysis of danger zone thickness in the mesiobuccal roots of maxillary first molars

Micro‐CT analysis of danger zone thickness in the mesiobuccal roots of maxillary first molars

Influence of apical preparation size and irrigation technique on root canal debridement: a histological analysis of round and oval root canals

Effectiveness of complementary irrigation routines in debriding pulp tissue from root canals instrumented with a single reciprocating file

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