• Restorative Dentistry and Endodontics
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• v.23 no.2
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• pp.537-549
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• 1998

The purpose of this study was to evaluate the influence of root resection and retrograde cavity preparation methods on the apical leakage in endodontic surgery. To investigate the effect of various root resection and retrograde cavity preparation methods on the apical leakage, 71 roots of extracted human maxillary anterior teeth and 44 mesiobuccal roots of extracted human maxillary first molars were used. Root canals of the all the specimens were prepared with step-back technique and filled with gutta-percha by lateral condensation method. Three millimeters of each root was resected at a 45 degree angle or perpendicular to the long axis of the tooth according to the groups. Retrograde cavities were prepared with ultrasonic instruments or a slow-speed round bur, and occlusal access cavities were filled with zinc oxide eugenol cement. Three coats of clear nail polish were placed on the lateral and coronal surfaces of the specimens except the apical cut one millimeter. All the specimens were immerged in 2% methylene blue solution for 7 days in an incubator at $37^{\circ}C$. The teeth were dissolved in 14 ml of 35% nitric acid solution and the dye present within the root canal system was returned to solution. The leakage of dye was quantitatively measured via spectrophotometric method. The obtained data were analysed statistically using two-way ANOVA and Duncans Multiple Range Test. The results were as follows: 1. No statistically significant difference was observed between ultrasonic retrograde cavity preparation method and slow-speed round bur technique, without apical bevel (p>0.05). 2. Ultrasonic retrograde preparation method showed significantly less apical leakage than slow-speed round bur technique, with bevel (p<0.0001). 3. No statistically significant difference was found between beveled resected root surface and non-beveled resected root surface, with ultrasonic technique (p>0.05). 4. Non-beveled resected root surface showed significantly less apical leakage than beveled resected root surface, with slow-speed round bur technique (p<0.0001). 5. No statistically significant difference in apical leakage was found between the group of retrograde cavity prepared parallel to the long axis of the tooth and the group of one prepared perpendicular to the long axis of the tooth (p>0.05). 6. Regarding isthmus preparation, ultrasonic retrograde preparation method showed significantly less apical leakage than slow-speed round bur technique, in the mesiobuccal root of maxillary molar, without bevel (p<0.0001).

• Restorative Dentistry and Endodontics
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• v.35 no.6
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• pp.436-444
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• 2010

Objectives: This study aimed to assess prospectively the clinical outcome of nonsurgical endodontic treatment and identify patient- and tooth-related factors, rather than treatment-related factors, that were the best predictors of this outcome. Materials and Methods: The inception cohort comprised 441 teeth (320 patients) and 175 teeth (123 patients) were followed up for 1-2 years. Age, gender, presence of medical disease, number of canals, previous endodontic treatment, presence of sensitivity and pain, pulp vitality, swelling or sinus tract of pulpal origin on the gingiva, periapical radiolucency and tendency of unilateral bite on the affected tooth were recorded at treatment start. Results: The outcome was classified on the basis of periapical radiolucency as healed or non healed. The overall healed rate in these cases, including nonsurgical retreatment, was 81.1%. Four tooth-related factors had a negative impact in the bivariate analysis: previous endodontic treatment, necrotic pulp, preoperative gingival swelling or sinus tract of pulpal origin, and preoperative periapical radiolucency. Stepwise logistic regression analysis including patient-, tooth-related factors and level of the root canal filling as a treatment-related factor showed that preoperative gingival lesion (odds ratio [OR]: 4.4; p = 0.005), preoperative periapical radiolucency (OR: 3.6; p = 0.011), and $\leq$ 1-2 mm under root filling length (OR: 9.6; p = 0.012) were significant predictors of failure. Conclusions: A preoperative gingival lesion of pulpal origin can influence the outcome of nonsurgical endodontic treatment in addition to preoperative periapical radiolucency.

• Restorative Dentistry and Endodontics
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• v.24 no.1
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• pp.166-179
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• 1999

Apical sealing is essential for the success of surgical endodontic treatment. Root-end cavity is apt to be contaminated with moisture or blood, and is not always easy to be dried completely. The purpose of this study was to evaluate the influence of dry methods of retrocavity on the apical seal in endodontic surgery. Apical seal was investigated through the evaluation of apical leakage and adaptation of filling material over the cavity wall. To investigate the influence of various dry methods on the apical leakage, 125 palatal roots of extracted human maxillary molar teeth were used. The clinical crown of each tooth was removed at 10 mm from the root apex using a slow-speed diamond saw and water spray. Root canals of the all the specimens were prepared with step-back technique and filled with gutta-percha by lateral condensation method. After removing of the coronal 2 mm of filling material, the access cavities were closed with Cavit$^{(R)}$. Two coats of nail polish were applied to the external surface of each root. Apical three millimeters of each root was resected perpendicular to the long axis of the root with a diamond saw. Class I retrograde cavities were prepared with ultrasonic instruments. Retrocavities were washed with physiologic saline solution and dried with various methods or contaminated with human blood. Retrocavities were filled either with IRM, Super EBA or composite resin. All the specimens were immersed in 2% methylene blue solution for 7 days in an incubator at $37^{\circ}C$. The teeth were dissolved in 14 ml of 35% nitric acid solution and the dye present within the root canal system was returned to solution. The leakage of dye was quantitatively measured via spectrophotometric method. The obtained data were analysed statistically using one-way ANOVA and Duncan's Multiple Range Test. To evaluate the influence of various dry methods on the adaptation of filling material over the cavity wall, 12 palatal roots of extracted human maxillary molar teeth were used. After all the roots were prepared and filled, and retrograde cavities were made and filled as above, roots were sectioned longitudinally. Filling-dentin interface of cut surfaces were examined by scanning electron microscope. The results were as follows: 1. Cavities dried with paper point or compressed air showed less leakage than those dried with cotton pellet in Super EBA filled cavity (p<0.05). However, there was no difference between paper point- and compressed air-dried cavities. 2. When cavities were dried with compressed air, dentin-bonded composite resin-filled cavities showed less apical leakage than IRM- or Super EBA-filled ones (p<0.05). 3. Regardless of the filling material, cavities contaminated with human blood showed significantly more apical leakage than those dried with compressed air after saline irrigation (p<0.05). 4. Outer half of the cavity showed larger dentin-filling interface gap than inner half did when cavities were filled with IRM or Super EBA. 5. In all the filling material groups, cavities contaminated with blood or dried with cotton pellets only showed larger defects at the base of the cavity than ones dried with paper points or compressed air.

• Restorative Dentistry and Endodontics
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• v.31 no.3
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• pp.186-191
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• 2006

This study evaluated the effect of two different calcium hydroxide ($Ca(OH)_2$) paste removal techniques on the apical leakage of canals obturated with gutta percha cones and sealer after removing a $Ca(OH)_2$ dressing using an electrochemical method. Seventy extracted single-rooted teeth were instrumented on with Profile rotary files under NaOCl irrigation. Fifty-eight canals were filled with calcium hydroxide paste, which was then removed using one of the following two techniques. In group A, calcium hydroxide was removed using only NaOCl irrigation, and in group B, the canals were re-prepared with a Profile rotary files-one size larger than the previous instrument and were irrigated with NaOCl. In both groups, the root surfaces were coated twice with nail varnish from CEJ to an area 4 mm away from the apex after canal obturation. Apical leakage was measured using an electrochemical method for 24 days. All the specimens showed leakage that increased markedly in the first three days. There was no significant difference between the two groups (p>0.05). The effect of two calcium hydroxide paste removal techniques on the apical leakage was not different during a short period.

• Restorative Dentistry and Endodontics
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• v.27 no.3
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• pp.277-283
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• 2002

The purpose of this study is to evaluate the two warm gutta-percha filling techniques by measuring the weight changes of resin blocks before and after canal filling in ribbon shaped canal. Simulated ribbon shaped root canals in 30 transparent resin blocks were instrumented to #40 using .06 taper Profile. 15 resin blocks were obturated with gutta-percha using cold lateral condensation. Warm lateral condensation using the Endotec II was then accomplished on the same 15 blocks. Another 15 resin blocks were obturated using the System B. All canals were obturated without sealer. The resin blocks were weighed after canal preparation and after each subsequent obturation, and then weight changes of the resin blocks were calculated The results were as follows. 1. Warm lateral condensation using Endotec II and continuous wave of condensation using System B produced a denser obturation of gutta-percha compared with conventional cold lateral condensation (p<0.01). 2. There was no significant difference between warm lateral condensation and continuous wave condensation. In conclusion, the warm gutta-percha condensation techniques like warm lateral condensation and continuous wave condensation can be expected to bring favorable canal obturation results in ribbon shaped canals.

• Restorative Dentistry and Endodontics
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• v.35 no.5
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• pp.335-343
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• 2010

Objectives: To compared the effect of different levels of moisture of root canal on the sealing ability after filling with four different types of sealer. Materials and Methods: Single-rooted teeth (n = 90) instrumented to and apical size of 0.06 / 45 were randomly assigned to 12 experimental groups (n = 7 per group), positive/negative control groups (n = 3 per group). The teeth of the experimental groups (a. DRY; b. PAPER POINT DRY; c. WET) were obturated with sealer (Group 1-3: Sealapex; Group 4-6: AH plus; Group 7-9: Tubuli-seal; Group 10-12: EndoRez) and warm vertical compaction method. After 7 days in $37^{\circ}C$, 100% humidity, the coronal-to-apical microleakage was evaluated quantitatively using a glucose leakage model. The leaked glucose concentration was measured with spectrophotometer at 1, 3, 7, 14, 21, and 30 days. Data were recorded ad mmol/L and statistically analysed with the two-way ANOVA and Duncan test (p = 0.05). Results: Throughout the experimental period Tubuli-seal/WET (Group 9) showed the highest mean cumulative glucose penetration (178.75 mmol/L), whereas AH plus/DRY (Group 4) had the least (20.78 mmol/L). Conclusions: The results of this study demonstrated that the moisture condition of root canals at the time of obturation and the type of sealer that was used had a significant effect on leakage and sealing ability. Thus drying procedure according to sealer types is a critical step and should not be missed in endodontic treatment.

• Korean Journal of Dental Materials
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• v.46 no.1
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• pp.1-10
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• 2019

There are several causes of tooth discoloration following root canal treatment. In this study, we evaluated the effects of sealers on tooth discoloration and internal bleaching. Twenty-four teeth were divided into 4 groups: control group, AH plus, Endosequece BC, and MTA fillapex group. Root canal filling was performed using each sealer conventionally and non-vital bleaching was performed with sodium perborate. The L, a, and b values were measured using Vita easyshade. Tooth discoloration after root canal treatment occurs irrespective of the type of sealers and may cause discoloration with only gutta-percha cone. The effect of non-vital bleaching following the use of calcium silicate-based sealers such as Endosequece BC and MTA fillapex was higher than that of AH plus. Therefore, it needs careful use of sealers in endodontics and calcium silicate-based sealers have advantages of bleaching in case of discolored tooth.

• Restorative Dentistry and Endodontics
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• v.33 no.2
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• pp.107-114
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• 2008

This study was performed to assess the radiopacity of a variety of canal filling and retrograde root-end filling materials according to the specification concerning root canal obturation materials. Ten materials including Gutta-percha pellets, amalgam, Fuji II LC, $Dyract^{(R)}$ AP, Super $EBA^{(R)}$, $IRM^{(R)}$, AH $26^{(R)}$, $Sealapex^{TM}$, Tubli-$Seal^{TM}$, and dentin were evaluated in this study. In the first part, densitometric reading of an each step of aluminum step wedge on occlusal film were performed at 60 kVp (0.2, 0.3, 0.4 s), 70 kVp (0.2, 0.3, 0.33 s) to decide appropriate voltage and exposure time. In the second part, ten specimens which are 5 mm in diameter and 0.5, 1.0, 1.5, 2.0, 2.5, 3.0 mm in thickness, were fabricated from each material studied. The specimens were radiographed simultaneously with an aluminum step wedge under decided condition (60 kVp, 0.2 s). The mean radiographic density values of the materials were transformed into radiopacity expressed equivalent thickness of aluminum (mm Al). The following results were obtained. 1. Among the various conditions including 0.2 s, 0.3 s, 0.4 s at 60 kVp and 0.2 s, 0.3 s, 0.33 s at 70 kVp, the appropriate voltage and exposure time that meet the requirement of density from 0.5 to 2.0 was 0.2 s at 60 kVp. 2. All of the materials in this study had greater radiopacity than the minimun level recommended by ISO No. 4049 standards. 3. Most of the materials had greater radiopacity than 3 mm Al requirement of ANSI/ADA specification No. 57 (2000) and ISO No. 6876 (2001) standards except for Fuji II LC and Dyract. It suggests that all experimental canal filling and retrograde root-end filling materials have a sufficient radiopacity that meet the requirement concerning root canal obturation materials except for Fuji II LC and Dyract.

• Restorative Dentistry and Endodontics
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• v.33 no.5
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• pp.435-442
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• 2008

Type II root canal was defined that two canals leave the chamber and merge to form a single canal at short of the apex. The aim of this study was to analyse the master apical file (MAF) size according to various instrumentation techniques in the type II root canal when each canal was enlarged to working length. Eighty mesial roots of molar with ISO #15 initial apical file (IAF) size in type II root canals were randomly divided into four experimental groups with 20 teeth each. According to enlarging instruments, four groups are: K-$FLEXOFILE^{(R)}$ (KF), engine-driven Ni-Ti $P_{RO}T_{APER}{^{(R)}}$ (PT), HERO $Shaper^{(R)}$ (HS), $K^{3\;TM}$ (K3). All canals were enlarged to each working length with ISO #30 size: #30 in KF, F3 in PT, .04/30 in HS, and .06/30 in K3. The master apical file (MAF) size was confirmed by tactile sensation and universal test- ing machine (EZ test, Shimadzu Co., Kyoto, Japan). The mean MAF size was statistically compared using one-way ANOVA and Tukey HSD test at the 0.05 probability level. These results show that the MAF size was appeared one or two sizes larger than the final enlarging instrument when all canal in type II configuration were enlarged to each working length. Therefore, the clinician have to confirm the apical stop once more after instrumentation of type II root canal.

• Journal of the korean academy of Pediatric Dentistry
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• v.46 no.3
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• pp.255-264
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• 2019

Endodontic treatment of primary molars is a great challenge to the dentists because of their complex morphology. However, there have been limited controlled in vivo studies about filling materials for primary teeth. Hence, the aim of this study is to evaluate and compare histologic responses of different calcium hydroxide canal filling materials that are used in daily clinical practice. Pulpectomies were performed in 132 teeth of the dogs. The root canals were randomly filled with either $Vitapex^{(R)}$ (n = 44), $Metapex^{(R)}$ (n = 44), or $Metapaste^{(R)}$ (n = 44). After 4 or 13 weeks, respectively after operation, the dogs were sacrificed, and teeth were processed for histologic examinations. Inflammatory reaction was evaluated and scored in a blind manner. The Fisher's exact test and Kruskal-Wallis test were used to compare the tested groups. In 4-week-group, all inflammatory responses were in normal range except for fibrosis. In 13-week-group, increased response to various inflammation reaction was shown compared to the 4-week-group. However, there were no statically significant differences between the tested groups in all inflammatory reaction. Overall, there were no significant differences among three materials in responses of apical tissues and all of them showed favorable tissue responses.