Root canal preparation using micro-computed tomography analysis: a literature review

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Abstract

Abstract: This literature review has critically analyzed the published research related to the biomechanical preparation of root canals with three-dimensional analysis using micro-computed tomography (micro-CT). In December 2017, six databases (PubMed, Cochrane, Web of Science, Embase, Scopus, and Science Direct) were accessed using keywords to find articles including the use of the micro-CT analysis in biomechanical root canal preparation. There were 60 full articles that were selected, which were screened and read by two authors. The research that was reviewed and analyzed included root canal anatomy and sample selection, changes in canal shape and untouched canal areas, canal transportation and centering ability, and kinematics (motion). Of the studies selected, 49.18% discussed anatomical characteristics, with 54.1% of these studies describing mesial roots of mandibular molars with moderate curvature. Only 35% used a stratified distribution based on root canal system morphology and quantitative data obtained by micro-CT. The analysis of canal transportation and centering ability showed that transport values in the apical third exceeded the critical limit of 0.3 mm in mesial roots of mandibular molars with moderate curvature, especially in the groups in which a reciprocating system was used. In relation to kinematics, 91.70% of the reviewed studies evaluated continuous rotating instruments, followed by reciprocating rotation (38.33%), vibratory (15%), and the adaptive kinematics, which was in only 8.33%. The reciprocating kinematics was associated with higher canal decentralization and transportation indexes, as well as a greater capacity for dentin removal and debris accumulation. This literature review showed that the anatomy, the type of design and kinematics of instruments, and the experimental design are factors that directly influence the quality of biomechanical preparation of root canals analyzed in a qualitative and quantitative manner by micro-CT.

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Clinical implications and microbiology of bacterial persistence after treatment procedures.

José Siqueira, Isabela Rôças (2008)

Apical periodontitis is an infectious disease caused by microorganisms colonizing the root canal system. For an optimal outcome of the endodontic treatment to be achieved, bacterial populations within the root canal should be ideally eliminated or at least significantly reduced to levels that are compatible with periradicular tissue healing. If bacteria persist after chemomechanical preparation supplemented or not with an intracanal medication, there is an increased risk of adverse outcome of the endodontic treatment. Therefore, bacterial presence in the root canal at the time of filling has been shown to be a risk factor for posttreatment apical periodontitis. About 100 species/phylotypes have already been detected in postinstrumentation and/or postmedication samples, and gram-positive bacteria are the most dominant. However, it remains to be determined by longitudinal studies if any species/phylotypes persisting after treatment procedures can influence outcome. This review article discusses diverse aspects of bacterial persistence after treatment, including the microbiology, bacterial strategies to persist, the requisites for persisting bacteria to affect the outcome, and future directions of research in this field.

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Mechanical preparation of root canals: shaping goals, techniques and means

Michael Hulsmann, Ove Peters, Paul Dummer (2005)

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Root and canal morphology of Burmese mandibular molars.

K Gulabivala, T H Aung, A Alavi … (2001)

To study the root canal morphology of Burmese mandibular molars using a canal staining and tooth clearing technique. Mandibular molars (331) were collected from indigenous Burmese patients and designated; first (139), second (134), third (58) molars. Following pulp tissue removal and staining of the canal systems with Indian ink, the teeth were decalcified and rendered clear with methyl salicylate. Under magnification (x3), the following features were evaluated: (i) root number and morphology, (ii) number of canals per root, (iii) root canal configuration (Vertucci's classification), (iv) number of apical foramina per root, (v) number and location of lateral canals and (vi) the presence of intercanal communications. Most of the mandibular molars had two separate roots (90% in first molars, 58% in second molars, 53% in third molars) and three-rooted teeth were (10%) confined to first molars. C-shaped roots occurred in 22.4% of mandibular second molars and a further 14.9% had two fused roots. The majority (81-100%) of conical distal roots possessed a simple type I (single canal) configuration. Whilst the canal system of mesial roots was more complex: 52-85% contained two canals, of which type II (two orifices, one foramen) and type IV (two separate canals) were the most prevalent. A broad range of 6.5-70% had intercanal communications. Fused/single-rooted molars had a wide variety of canal system types but intercanal communications were rare except in C-shaped roots (33%) of second molars. The majority of roots of all molars contained one or two apical foramina (91-96%) and the apical third had the highest prevalence of lateral canals. There was a high prevalence of three-rooted mandibular first molars and C-shaped roots/canals in mandibular second molars from a Burmese population. Conical roots tend to have simple canal systems, whilst flatter/broader roots have more complex canal systems.