Publications by authors named "Gianluca Gambarini"

103 Publications

Persistence of postoperative pain due to extrusion of endodontic obturator plastic carrier: A report of two cases treated with a periradicular microsurgical approach.

Dent Res J (Isfahan) 2021 24;18:34. Epub 2021 May 24.

Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Italy.

The aim of the present study was to describe two clinical cases showing postoperative pain associated with the use of plastic carrier obturation system and apical bone fenestration. The patients were treated by surgical access and apicoectomy through a modern technique (using magnification and microsurgical approach), thus removing the direct contact between obturation material and submucosal connective tissue. The surgical interventions were carried on without the occurrence of any complication. Postsurgical adverse sequelae were negligible. After few weeks from the surgery, all symptoms disappeared. Radiographic healing was observed after 48 months. The presence of apical bone fenestration could be the cause of persistent pain after root canal treatment. The contact between plastic carrier and submucosal connective tissue could be the direct cause of spontaneous pain even in absence of periapical infection. Since the clinical diagnosis could be difficult, the use of tridimensional radiology could be justified. Surgical approach, by the removal of the contact between the carrier and connective tissues, can be considered a viable option to treat these particular affections.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314973PMC
May 2021

Angle of Insertion and Torsional Resistance of Nickel-Titanium Rotary Instruments.

Materials (Basel) 2021 Jul 4;14(13). Epub 2021 Jul 4.

Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy.

Previously published studies have investigated the influence of instrument access on cyclic fatigue resistance. However, no studies have evaluated the relationship between angulated access and torsional resistance. The aim of this study was to investigate the influence of the angle of access on the torsional resistance of endodontic instruments. One hundred and eighty instruments were selected: 90 F-One Blue 25/04 and 90 HeroShaper 25/04 instruments. Three subgroups ( = 30) for each instrument type (A and B) were established according to the angle of insertion of the instruments inside the artificial canal (0°, 10° and 20°). The tests were performed using a custom-made device consisting of the following: a motor that can record torque values of 0.1 s; interchangeable stainless-steel canals with different curvature (0°, 10° and 20°) that allow the instrument's angulated insertion and keep it flexed during testing procedures; and a vise used to secure the instrument at 3 mm from the tip. Torque limit was set to 5.5 Ncm, and each instrument was rotated at 500 rpm until fracture occurred. Torque to fracture (TtF) was registered by the endodontic motor, and the fragment length (FL) was measured with a digital caliper. Fractographic analysis was performed using a scanning electron microscopy (SEM) evaluation to confirm the cause of failure. TtF values and fragment length (FL) values were statistically analyzed using one-way analysis of variance (ANOVA) test and the Bonferroni correction for multiple comparisons across the groups with significance set to a 95% confidence level. Regarding the F-One Blue instruments, the results showed a higher TtF for group A3 (20°) than for group A1 (0°) and group A2 (10°), with a statistically significant difference between group A3 and the other two groups ( < 0.05), whereas no statistically significant difference was found between group A1 and group A2 ( > 0.05). Regarding the HeroShaper instrument, the results showed the highest TtF for group B3, with a statistically significant difference between the three subgroups B1, B2 and B3 ( < 0.05). The results showed that the torsional resistance increases as the angle of instrument access increases with a varying intensity, according to the crystallographic phase of the instrument selected.
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http://dx.doi.org/10.3390/ma14133744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269838PMC
July 2021

Incidence of Different Types of Intracanal Fracture of Nickel-Titanium Rotary Instruments: A Systematic Review.

J Contemp Dent Pract 2021 Apr 1;22(4):427-434. Epub 2021 Apr 1.

Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy.

Aim: The aim of this systemic review is to investigate these parameters by analyzing the characteristics of fractured instruments to determine which is the most relevant mechanical stress that induces intracanal separation .

Background: The fracture of nickel-titanium (Ni-Ti) instruments is a result of flexural fatigue and torsional fatigue. An electronic search was conducted in MEDLINE database, Web of Science, and Cochrane following preferred reporting items for systematic reviews and meta-analyses guidelines. Data were collected and the key features from the included studies were extracted. Overview quality assessment questionnaire scoring assessed the quality of the articles. A total of 12 articles were selected, where the lowest score was 13.

Review Results: Considering Ni-Ti rotary instruments, this overall evaluation comprehends 939 broken instruments with an incidence of fracture of 5%. Out of the 12 selected articles, 10 studies revealed that flexural failure was the predominant mode (range of 62-92%). It appears that motion plays an important role when it comes to mechanisms of fracture. The majority of defects found in hand-operated instruments were in the form of torsional failure. Although the major cause of separation of rotary instruments is flexural fatigue, smaller instruments show more torsional fracture than the larger instruments. The average fragment length was found to be 2.5 mm and 3.35 mm, respectively, for torsional failure and flexural failure. The risk of bias depends on fractographic analysis.

Conclusion: Flexural fatigue is the predominant mode of fracture in rotary Ni-Ti instruments. The type of motion and size of the instrument seem to affect the mechanism of fracture. Fragment length may show a strong association with the type of fracture mechanism.

Clinical Significance: This systemic review found that flexural fatigue is the most relevant mechanical stress that induces intracanal separation . Moreover, in clinical practice, the fragment length might be an excellent indicator of the type of fracture.
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April 2021

Nickel-Titanium Rotary Instruments: An Comparison (Torsional Resistance of Two Heat-treated Reciprocating Files).

J Contemp Dent Pract 2021 Apr 1;22(4):361-364. Epub 2021 Apr 1.

Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy.

Aim And Objective: The present study aims to evaluate the difference in torsional resistance of two reciprocating nickel-titanium (Ni-Ti) rotary files: WaveOne Gold and EdgeOne Fire.

Materials And Methods: A total of 40 nickel-titanium rotary instruments ( = 40): 20 WaveOne Gold Small (WOGS) and 20 EdgeOne Fire Small (EOFS) were divided into two groups. Each instrument was tested using a torsional resistance device already validated in previous studies to evaluate and compare torsional resistance. The static torsional test was implemented by blocking each instrument at 3 mm from the tip and rotating it until fracture with a reciprocating motion. Torque to fracture (TtF) and fragment length (FL) were measured and statistically analyzed.

Results: Statistical analysis of TtF found significant differences between the two groups (<0.05). The EOFS showed higher TtF if compared to WOGS, with a mean value and a standard deviation of 3.05 ± 0.07 (N cm) against 2.97 ± 0.08 (N cm). Data for FL showed no significant differences (>0.05) between the two groups.

Conclusion: According to the results of this study, it is reasonable to assert that EOFS instruments showed a higher torsional resistance if compared to the WOGS.

Clinical Significance: As evidenced by this study, EOFS should be considered as a safer solution, in terms of torsional resistance, if compared to WOGS, reducing the risk of intracanal separation due to excessive torsional load.
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April 2021

Operative Torque Analysis to Evaluate Cutting Efficiency of Two Nickel-Titanium Rotary Instruments for Glide Path: An Comparison.

J Contemp Dent Pract 2021 Mar 1;22(3):215-218. Epub 2021 Mar 1.

Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy.

Aim And Objective: The aim and objective of this study was to evaluate and compare the cutting efficacy of two different nickel titanium rotary instruments by a novel methodology: the operative torque (torque and time needed to progress toward the apex).

Materials And Methods: Ten fresh extracted upper first premolars with two canals were instrumented with a KaVo (Biberach, Germany) and a KaVo 1:1 handpiece at 300 rpm with maximum torque set at 2 N. One canal was instrumented with ProGlider NiTi rotary instruments (Dentsply Sirona Endodontics, Ballaigues, Switzerland), with tip size of 16.02, and the other one with EgdeGlidePath rotary instrument (EdgeEndo, Albuquerque, New Mexico). Mean instrumentation time, mean torque values, and maximum torque values were evaluated for each instrument. The significance level was set at <0.05.

Results: EdgeGlidePath instruments reached the working length in significantly less time with a significantly smaller amount of torque when compared to ProGlider ( >0.05). No instruments exhibited flute deformation or underwent intracanal failure.

Conclusions: Operative torque is related to the capability to cut dentin and progress toward the apex: the smaller the torque values, the higher the cutting ability (and safety). Operative torque is also dependent on debris removal and irrigation techniques. Nevertheless, both operative torque and instrumentation time are clinically relevant parameters for evaluating instruments' performance (i.e., cutting ability).

Clinical Significance: Operative torque during endodontic instrumentation helps understanding the overall performance in terms of both cutting efficiency and safety.
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March 2021

Nuclear Magnetic Resonance Microimaging for the Qualitative Assessment of Root Canal Treatment: An Ex Vivo Preliminary Study.

Diagnostics (Basel) 2021 Jun 1;11(6). Epub 2021 Jun 1.

Department of Oral and Maxillo Facial Sciences, Sapienza Università di Roma, 00161 Rome, Italy.

Aim: To assess the potential ability of nuclear magnetic resonance micro-imaging (mMRI) to visualize and identify soft tissue debris and unfilled spaces inside radicular canals in endodontic treated extracted teeth, for understanding the causes of treatment failure. Toward this goal, multi-parametric mMRI and cone beam computed tomography (CBCT) were compared.

Methodology: A non-recoverable root treated human tooth was extracted due to endodontic failure and excessive mobility. It was examined with both CBCT and mMRI: CBCT was performed with 0.125 mm voxel size (GXCB-500, Kavo-Gendex, Brea, CA, USA) and mMRI was performed with a spectrometer operating at 9.4T magnetic field (Bruker Avance-400, Bruker, Billerica, MA, USA). The mMRI images were obtained with a microimaging probe. Relaxation times (T1 and T2) and diffusion-weighted acquisition sequences were used to obtain multi-parametric maps of the extracted tooth (slice thickness of 200 µm and in plane resolution of 30 × 30 µm).

Results: T1 and T2 maps identified unfilled spaces around and close to Gutta-percha cones instead of CBCT images that were not able to highlight this aspect. T1, T2 and apparent diffusion coefficient (ADC) assumed different values in dentine and in voids, characterized by different dimensions. Moreover, they were able to discriminate between infiltrations of water only and deposits of biological material. Because Gutta-percha cones are constituted of hard, non-porous material, they do not provide a signal and in mMRI images appear as zones of noise.

Conclusions: Unlike the CBCT exam, mMRI can detect soft tissue debris and unfilled spaces inside radicular canals. Therefore, this in vitro study showed the potential of mMRI to evaluate the quality of the root canal treatment, suggesting its potential benefit in determining the causes of endodontic failure, without the use of ionizing radiation.
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http://dx.doi.org/10.3390/diagnostics11061012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228494PMC
June 2021

A Paradigm Shift for Torsional Stiffness of Nickel-Titanium Rotary Instruments: A Finite Element Analysis.

J Endod 2021 Jul 27;47(7):1149-1156. Epub 2021 Apr 27.

Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy.

Introduction: The aim of this study was to investigate the influence of mass and the polar moment of inertia on the torsional behavior of nickel-titanium rotary instruments to understand which parameter of cross-sectional design had a key role in terms of torsional resistance.

Methods: Four different instrument models were designed and meshed using computer-aided engineering software (SolidWorks; Dassault Systems, Waltham, MA). Instrument models shared the same characteristics, except for cross-sectional design; triangle, rectangle, square, and hollow square geometry was selected. Finite element analysis was performed simulating a static torsional test using the FEEPlus internal solver (Solid Works). Von Mises stress and torsional load at fracture were calculated by the software. Linear regression analysis was performed to investigate the relationship of the polar moment of inertia, cross-sectional area, inner core radius, and mass per volume on the torsional resistance of nickel-titanium rotary instruments.

Results: The polar moment of inertia positively affected the maximum torsional load with the highest level of correlation (R = 0.917). It could be stated that the higher the polar moment of inertia is, the more maximum torsional load at fracture is present. Mass and cross-sectional area had a lower level of correlation compared with the polar moment of inertia (R = 0.5533). According to this, 2 instruments with the same mass/mm and/or cross-sectional area could have different torsional resistance.

Conclusions: The polar moment of inertia can be considered as the most important cross-sectional factor in determining the torsional resistance of rotary instruments over metal mass and cross-sectional area.
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http://dx.doi.org/10.1016/j.joen.2021.04.017DOI Listing
July 2021

Management of a Complex Case during COVID-19 Time Using One-day Digital Dentistry: A Case Report.

J Contemp Dent Pract 2020 Nov 1;21(11):1284-1292. Epub 2020 Nov 1.

Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy.

Aim And Objective: The aim of the present case report is to describe the digital management of an implant prosthetic rehabilitation performed by the use of different digital technologies, which allowed to successfully perform in 1 day both the surgical and the prosthetical stages with a minimally invasive approach and a high standard of care.

Background: Coronavirus disease-2019 (COVID-19) pandemic is affecting dental everyday practice. Clinicians have to reduce the number of patients per day and the time they spend in the dental office. Minimally invasive and digital approaches, with less possible exposure and interaction, are suggested to reduce the risk of infection.

Case Description: The failure of a short-span implant prosthetic rehabilitation combined with pain and mobility of the involved teeth was the main complaint reported by a 78-year-old male patient, who asked an urgent appointment to solve the problem. An intraoral scanner allowed the clinician to immediately take a preliminary digital impression of the arch to be treated. The resulting 3D files were sent by e-mail to the dental technician who provided a digital wax-up for the computerized workflow. Computer-aided implantology (CAI) performed using an in-office cone-beam computed tomography (CBCT) allowed clinician to guide the surgical approach in a prosthetic manner. Such an integration inside a well-defined workflow was the key for a successful and rapid treatment.

Conclusion: By using new innovative digital technology, the treatment was completed in 1 day, reducing the risk of COVID-19 by limiting the number of appointments and reducing contacts in confined environments like the dental office and public transportations. It also helped to reduce materials production and people movement in the treatment of dental emergency.

Clinical Significance: The possibility of performing an effective treatment saving time by using efficient technology and a minimally invasive procedure highlights the importance of digital planning in order to optimize every single step of the treatment. Digital workflow reduces also the movement of potentially infected materials from the office to the dental laboratory.
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November 2020

Nonsurgical Retreatment Using Regenerative Endodontic Protocols: A Case Report.

J Contemp Dent Pract 2020 Nov 1;21(11):1275-1278. Epub 2020 Nov 1.

Department of Oral and Maxillo-facial Sciences, Sapienza University of Rome, Rome, Italy.

Aim And Objective: The aim of this case report was to describe regenerative endodontic procedures (REPs) of the previously treated mature teeth with long-term results.

Background: Regenerative endodontic procedures are aimed to treat apical periodontitis and regenerate the pulp-dentin complex in necrotic teeth. However, there is no consensus in using REPs in the previously treated mature teeth. The aim of this case report was to describe REPs of the previously treated mature teeth with long-term results.

Case Description: A 25-year-old woman presented pain on chewing on 15 and swelling (WHO numbering system). The tooth had been endodontically treated and restored 4 years ago. After removing the old root canal filing, the roots were irrigated with 2.5% sodium hypochlorite and 17% EDTA using sonic activation. Calcium hydroxide (CH) was used as medicament for 3 weeks. At the second visit, CH was removed, and canals were irrigated as like as the first visit. Apical bleeding was induced, and concentrated growth factors (CGFs) were placed inside the root canal. The tooth has been followed up to 3 years.

Conclusion: The tooth was functional and asymptomatic at the recall visits. Since the first-year follow-up, the tooth responded to the electric pulp test and the thermal test. Radiological examinations revealed healing of apical lesion and hard tissue deposition.

Clinical Significance: Regenerative endodontic procedures can offer an advantage over traditional endodontic procedures in terms of tertiary healing, with a predictable, user-friendly procedure also for retreatment cases.
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November 2020

Influence of shaft length on torsional behavior of endodontic nickel-titanium instruments.

Odontology 2021 Jul 27;109(3):568-573. Epub 2020 Nov 27.

Department of Oral and Maxillo-Facial Sciences, "La Sapienza" University of Rome, Via Caserta 6, 00161, Rome, Italy.

Torsional stresses are one of the most frequent causes of intracanal separation of nickel-titanium endodontic instruments, which represents a great concern of endodontists. For this reason, torsional resistance of rotary instruments has been deeply investigated by determining all parameters that can influenced it, that can be summarized in: (1) Tooth-related factors, (2) Strategy-related factors and (3) Instrument-related factors. This study was conducted to examine the influence of shaft length on torsional resistance of a nickel-titanium rotary instrument and if it should be considered as an Instrument-related factor. With this aim, 120 Twisted Files Adaptive M-L (TFA M-L) NiTi instruments (SybronEndo, Orange, CA, USA) were divided into 6 experimental groups (n = 20), according to instruments length and size: Group 1, 20 TFA M-L1 25/08 23 mm; Group 2, 20 TFA M-L1 25/08 27 mm; Group 3, 20 TFA M-L2 35/06 23 mm; Group 4, 20 TFA M-L2 35/06 27 mm; Group 5, 20 TFA M-L3 50/04 23 mm; and Group 6, 20 TFA M-L3 50/04 27 mm. All instruments were submitted to a static torsional test, blocking each instrument at 3 mm from the tip and rotating it until its fracture. Torque to Fracture (TtF) and fragments length were registered and all data were statistically analyzed. Results showed that Groups 2, 4 and 6 had a higher TtF, respectively, than Groups 1, 3 and 5, which differ from the former just for shaft length. Group 6 showed the highest torsional resistance (1.31 ± 0.08 Ncm), whilst Group 1 the lowest (0.40 ± 0.08 Ncm). According to that, it can be stated that the longer the instrument, the higher the torsional resistance is, proving that shaft length should be considered as an important factor about torsional resistance.
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http://dx.doi.org/10.1007/s10266-020-00572-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178130PMC
July 2021

Correlation between endodontic pulpal/periapical disease and retrograde peri-implantitis: A case series.

Aust Endod J 2021 Aug 7;47(2):358-364. Epub 2020 Nov 7.

Endodontic Unit, Department of Oral and Maxillofacial Sciences, 'Sapienza' University of Rome, Rome, Italy.

Retrograde peri-implantitis is a symptomatic complication, characterised by radiographic detection of bone loss at the periapex of the implant. The aim of this study was to investigate the possible endodontic aetiology, evaluating the effectiveness of surgical treatment without endodontic therapy of adjacent teeth. In the 10-year interval, three patients reported symptoms of retrograde peri-implantitis after a mean period of 30.6 days from implant placement. Mean follow-up after surgical procedures was 8.66 years, with an implant survival of 100%. Retrograde peri-implantitis was probably caused by colonisation of the apical surface of the implant by bacteria persisting in the area after endodontic failure/apical periodontitis, reactivated by drilling in the site. In all cases, the adjacent teeth remained vital during the years, showing that a direct cause-and-effect relationship between pulpal/periapical disease of adjacent teeth and retrograde peri-implantitis was never present.
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http://dx.doi.org/10.1111/aej.12458DOI Listing
August 2021

Differences in endodontic emergency management by endodontists and general dental practitioners in COVID-19 times.

Braz Oral Res 2020 30;34:e122. Epub 2020 Oct 30.

Sapienza University of Rome , Department of Oral and Maxillo-Facial Sciences , Rome , Italy .

The aim of this study was to assess the differences, if any, between general dental practitioners (GDPs) and endodontists, in the diagnosis and treatment of endodontic emergencies during the worldwide outbreak of COVID-19. An online questionnaire was randomly sent by social media to clinicians in different countries from 24 April, 2020 to May 4, 2020. The survey consisted of a series of questions about demographic characteristics, endodontic emergency diagnoses, approaches to prevent aerosol formation, drug prescriptions in case of symptomatic irreversible pulpitis, and the ways in which dentists managed endodontic emergencies during the COVID-19 lockdown. A total of 1,058 dentists responded to the questionnaire; 344 (32.6%) of the participants were endodontists. Slightly less than half of the participants (n = 485, 45.8%) worked during the lockdown, but only 303 participants (28.6%) treated endodontic cases/emergencies. The responses showed agreement between endodontists and GDPs regarding the diagnosis of symptomatic irreversible pulpitis (SIP), symptomatic apical periodontitis (SAP), reversible pulpitis, and asymptomatic irreversible pulpitis (AIP). SIP and SAP were considered an emergency, whereas reversible pulpitis and AIP were not considered an emergency (p > 0.05). Non-aerosol-generating procedures and treatment approaches differed between the groups (p < 0.05). One-third of the participants did not use rubber dam (p > 0.05). Ibuprofen and amoxicillin-clavulanic acid were the most frequently prescribed drugs for pain associated with SIP. In conclusion, the most relevant findings in our survey were the differences between endodontists and GDPs in diagnosis, precheck triage, deep caries excavation procedures, and endodontic emergency pain relief strategies.
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http://dx.doi.org/10.1590/1807-3107bor-2020.vol34.0122DOI Listing
November 2020

Effect of Flexural Stress on Torsional Resistance of NiTi Instruments.

J Endod 2021 Mar 21;47(3):472-476. Epub 2020 Oct 21.

Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy.

Introduction: Previously published studies have deeply investigated the characteristics of flexural and torsional resistance of nickel-titanium rotary instruments, but none of them investigated the relationship between the 2 stresses. The objective of the present study was to evaluate the influence of flexural stresses over torsional resistance.

Methods: Sixty S-One 20.04 files (Fanta Dental, Shanghai, China) were used in the present study (N = 60) and divided into 3 test groups of 20 files. A customized device made of a mobile structure with a connection that holds the handpiece and the artificial canal was used for the experiment to make the measurements repeatable. The artificial canals were created with a 90° curvature, a 60° curvature, and lastly a straight canal. Each file was rotated at 300 rpm with a maximum torque value of 5.5 Ncm with the apical 2 mm firmly secured in a vise. The torque at fracture and the time to fracture were recorded by the software integrated in the handpiece and evaluated through statistical analysis.

Results: Statistical analysis found significant differences in the values of torque to fracture (TtF) between these 3 groups (P < .05). The 90° curved canal group showed the highest TtF value, and the 60° curved canal group showed a higher TtF value than the straight canal group.

Conclusions: The results of the present study demonstrated a positive influence of flexural stresses over torque at fracture of rotary files. When nickel-titanium instruments were used in a 90° or 60° curvature, the values of torque at fracture increased compared with the same instruments that rotated in the straight canal.
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http://dx.doi.org/10.1016/j.joen.2020.10.011DOI Listing
March 2021

Fine Aerosols and Perceived Risk of COVID-19 among Italian Dental Practitioners: An Experimental Survey.

J Contemp Dent Pract 2020 Jun 1;21(6):599-603. Epub 2020 Jun 1.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

Aim: The aim of the present study was to take a survey on Italian practitioners concerning the perceived risks of aerosol contamination in COVID-19 times and their attitude toward modifications of treatment protocols to reduce this risk.

Materials And Methods: Power analysis calculated a minimum sample size of 150 participants at 99% confidence level with a 5% margin of error. To homogenize responses elicited by different preventive measures by various national governments, only Italian dentists were included in the survey: overall 500 responses were collected.

Results: Of the 500 analyzed respondents, there were 266 females and 234 males; 379 practitioners were allocated in the more experienced groups, and the remaining 121 in the less experienced group based on less or more than 5 years of practice. The 70% of the dentists consider the dental practice more dangerous for the diffusion of COVID-19 than other social activities. The 5% consider dental practice more dangerous only for the patients. Aerosol contamination was perceived as a risk from the most dentist (70%), but there was agreement on the most dangerous way of cross infection in dental settings. Most of the dentists (55%) believed implementations in their protocols were needed to reduce the risk of COVID-19 infections. No significant differences were found within the groups: both women and men, as well as practitioners with different experience levels (younger or older than 35 years) perceived very similarly the problems related to COVID-19 in dentistry ( > 0.05).

Conclusion: The survey demonstrated that COVID-19 had a great impact on dental practitioners; it increased not only fear of aerosol contamination during dental treatments but also influenced the fear of close contacts.

Significance: Airborne and waterborne infections are related with dental treatments and considered the preferred ways of diffusion for COVID-19. The risk of aerosol-related infections could interfere with the clinical practice of the dentist, during the COVID-19 pandemic; the limitations that provided changes to everyday behavior could affect the perception of the safety of the operators, staff, and patient and this could also affect economically the dental office.
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June 2020

Academic Dental Activities and COVID-19 Pandemic.

J Contemp Dent Pract 2020 Jun 1;21(6):598. Epub 2020 Jun 1.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

COVID-19 pandemic has strongly and rapidly affected routine lifestyle and consequently, dental business, practice, and education. During the pandemic period, most Governments worldwide made specific regulations or recommendations to close practices, to avoid non-urgent dental therapies and treat only dental emergencies. Some recent surveys showed how dentists perceived the COVID-19 risk and how they reacted: by modifying their way of working, by reducing aerosol producing procedures, by improving staff and patient's safety with the increased use of personal protective equipment, environmental disinfection and limited access to dental offices, increasing use of remote consulting and triage.
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June 2020

Fatigue Resistance of Two Nickel-Titanium Rotary Instruments before and after Root Canal Treatment.

J Contemp Dent Pract 2020 Jul 1;21(7):728-732. Epub 2020 Jul 1.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

Aim: The aim of the present study is twofold: to evaluate cyclic fatigue resistance differences of two different nickel-titanium rotary instruments, brand new and after an instrumentation of single root extracted teeth.

Materials And Methods: Twenty new S One 20.06 were randomly divided into two groups. The first group ( = 10) was immediately subjected to a cyclic fatigue test (S One Group I). The second group ( = 10) (S one Group II) performed a cyclic fatigue test after three root canal treatment with a single-file technique. The same process has been carried out for 20 M-Two 20.06 instruments.

Results: Mean time to fracture (TtF) for Group I was 51.14 ± 1.28 for S One and 32.62 ± 0.17 for M-Two 20.06 and for Group II was 46.00 ± 0.99 for S One and 27.75 ± 1.58 for M-Two 20.06. The reduction in TtF values from Group I to Group II was 11% for S One and 15% for M-Two. Statistical analysis found significant differences in all the groups examined ( value < 0.05). Mean fragment length (FL) for Group I was 3.07 ± 0.17 for S One and 3.05 ± 0.14 for M-Two 20.06 and for Group II was 3.05 ± 0.07 for S One and 3.05 ± 0.14 for M-Two 20.06. Statistical analysis was pursued, and no significant difference was found ( value > 0.05).

Conclusion: The S-One showed significantly more resistance to cyclic fatigue stress than M-Two for both new and used instruments. This validates the hypothesis that the AF H wire enables the S One files to endure more the cyclic fatigue stresses.

Clinical Significance: This study demonstrates the cyclic fatigue resistance of a new endodontic instrument after repetitive usage.
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July 2020

A Survey on Perceived COVID-19 Risk in Dentistry and the Possible Use of Rapid Tests.

J Contemp Dent Pract 2020 Jul 1;21(7):718-722. Epub 2020 Jul 1.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

Aim: The present study was conducted to assess the perceived risk of COVID-19 transmission in dental professionals (DPs), that include dentists and dental auxiliary staffs, and whether rapid tests should be a recommended tool to constrain the transmission of the COVID-19, and who should be bearing their cost (governments, dentists, or patients) through an online survey.

Materials And Methods: A sample size of = 700 was recruited in the study. The study included DPs from all over the world. A randomized selection of samples was done through dental groups present on social networks. An online survey was conducted in April 2020, using the Google Form software to provide questions and collect and elaborate answers. Data were analyzed using the statistical software STATA and presented in terms of percentages.

Results: About 78% of the study participants perceived a very high risk of COVID-19 contamination in dental settings. Nearly 80% of the study participants were willing to be subjected to rapid tests and the same could be performed on patients visiting their dental clinics, which could prevent the spread of the disease. About 55% of the participants had reported that additional costs for the rapid tests should be borne by the governments.

Conclusion: The results of the present survey report that DPs do not feel safe and perceive a high risk of COVID-19 contagion and prevention of the disease could be done by performing rapid tests on dentists, dental staff, and patients visiting the dental clinics irrespective of age and gender of the participants.

Significance: Since all the dentists and allied staff have perceived increased risk for COVID-19 transmission, it is important that preventive measures are implemented through rapid test kits at the earliest.
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July 2020

Standardization of Endodontic Access Cavities Based on 3-dimensional Quantitative Analysis of Dentin and Enamel Removed.

J Endod 2020 Oct 25;46(10):1495-1500. Epub 2020 Jul 25.

Endodontics Unit, Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Rome, Italy.

Introduction: The aim of this study was to determine and compare the difference in the volume of dentin and enamel removed (DER) to prepare 3 different access cavities and to propose a standardization of the access cavities according to their volume of DER.

Methods: One hundred twenty maxillary and mandibular molars and premolars were assigned to 3 subgroups for each tooth type (n = 10): the traditional endodontic cavity (TEC) group; the conservative endodontic cavity (CEC) group with partial unroofing and convergent walls; and the ultraconservative endodontic cavity (UEC) group, preserving most part of the pulp chamber roof and the occlusal surface. The sliced image data of cone-beam computed tomographic images before and after access cavity preparation were exported as Digital Imaging and Communications in Medicine files and imported into the MeVisLab framework system (MeVis Research, Bremen, Germany). After segmentation, the volumes of coronal dentin and enamel were measured, and the difference in the percentage of volume of DER for endodontic access cavity preparation was calculated. The data were subjected to statistical analyses (analysis of variance) with a level of significance set at P < .05.

Results: The percentage of volume of DER was less than 6% for the UEC group, up to 15% for the CEC group, and more than 15% for the TEC group, with a statistically significant difference among all groups in all of the tooth types analyzed (P < .05).

Conclusions: The present study showed significantly different percentages of volume of DER among the groups analyzed (ie, UEC < CEC < TEC). A standardization of access cavity preparation was proposed according to the percentage of volume of DER.
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http://dx.doi.org/10.1016/j.joen.2020.07.015DOI Listing
October 2020

Centering Ability of a New Nickel-Titanium Rotary Instruments with a Peculiar Flat-side Design: An Study.

J Contemp Dent Pract 2020 May 1;21(5):539-542. Epub 2020 May 1.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

Aim: The aim of the present study was to investigate the role of the flat design compared with a non-flat designed instrument on the centering ability in a simulated root canal system.

Materials And Methods: Two file systems were chosen: the F-One (Fanta Dental, Shanghai, China) and a prototype with the same design but without the flat-side design. A total of 50 simulated L-shaped root canals in resin blocks were shaped with a new instrument each. Pre- and postcanal preparation images were captured and superimposed to measure and compare the canal transportation and evaluate the centering ability of each file. The test was performed and the level of significance was set at < 0.05.

Results: Prototype files removed significantly less resin from the inner and the outer parts of the canal and showed significantly higher mean transportation values.

Conclusion: It can be concluded that the F-One file system demonstrated better shaping ability compared with the prototype file system in L-shaped resin-simulated canals.

Clinical Relevance: The present study showed the safety of the flat-side design, minimizing the risk of iatrogenic errors such as ledging, perforation, or zipping of the root canal.
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May 2020

How to Improve Properties of Nickel-Titanium Rotary Instruments.

J Contemp Dent Pract 2020 Apr 1;21(4):351-352. Epub 2020 Apr 1.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy, Phone: +39 338 1504 134, e-mail:

In the last decades, the use of nickel-titanium (Ni-Ti) rotary instruments has become the most effective and popular method among endodontists for shaping root canals, even if there are still concerns regarding the increased risks of intracanal breakage or weakening of the instruments. So manufacturers started to modify the cross-sectional geometrical aspects of the files in order to improve their resistance to torsional and cyclic fatigue. Design is a major feature in determining instruments' properties including cutting efficiency, removal of debris, stresses generated during instrumentation, and the relative resistance to these stresses; however, a perfect design is not existing and any change in design is likely to provide some advantages but also some disadvantages..
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April 2020

Accuracy Evaluation of 14 Maxillary Full Arch Implant Treatments Performed with Da Vinci Bridge: A Case Series.

Materials (Basel) 2020 Jun 22;13(12). Epub 2020 Jun 22.

Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy.

The use of pterygoid implants can be an attractive alternative to sinus bone grafting in the treatment of posterior atrophic maxilla. This technique has not been widely used because of the difficulty of the surgical access, the presence of vital structures, and the prosthetic challenges. The use of dynamic computer aided implantology (DCAI) allows the clinician to utilize navigation dental implant surgery, which allows the surgeon to follow the osteotomy site and implant positioning in real time. A total of 14 patients (28 pterygoid implants and 56 intersinusal implants) were enrolled in the study for a full arch implant prosthetic rehabilitation (4 frontal implants and 2 pterygoids implants), using a dynamic navigation system. The reported accuracy of pterygoid implants inserted using DCAI was 0.72 mm at coronal point, 1.25 mm at apical 3D, 0.66 mm at apical depth, and 2.86° as angular deviation. The use of pterygoid implants in lieu of bone grafting represents a valid treatment opportunity to carry out a safe, accurate, and minimally invasive surgery, while reducing treatment time and avoiding cantilevers for a full implant prosthetic rehabilitation of the upper arch.
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http://dx.doi.org/10.3390/ma13122806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344455PMC
June 2020

Precision of Dynamic Navigation to Perform Endodontic Ultraconservative Access Cavities: A Preliminary In Vitro Analysis.

J Endod 2020 Sep 15;46(9):1286-1290. Epub 2020 Jun 15.

Department of Oral and Maxillo-Facial Sciences, University of Rome, Sapienza, Italy.

Introduction: Ultraconservative access cavities (UCACs) have been proposed to reduce crown weakening, but there is no consensus about their design and size and about their advantages and disadvantages, which are also related to how differently they are performed. The purpose of the present study was to evaluate the possible use of a novel Dynamic Navigation System (DNS) in planning and executing UCACs and its precision in vitro, compared with a manual approach (MA) without any guide.

Methods: Twenty radiopaque, artificial teeth replicas were randomly divided into 2 identical groups and scanned using cone-beam computed tomography. In the first group (MA) MB1 canal orifice was reached, starting from the central part of the molar occlusal surface, using a micro endodontic bur. In the second group, DNS allowed to plan and execute a more direct, straight-line truss access. After cavity preparation, teeth were scanned again, and cone-beam computed tomography images were compared. Data were statistically analyzed with analysis of variance test.

Results: Significant differences (P < .05) were found in the tested parameters between the 2 groups. The DNS group was significantly more precise, showing smaller mean values in the angulation (4.8°) and in the maximum distance from the ideal position (0.34 mm), when compared with MA group (mean values, 21.2° and 0.88 mm, respectively).

Conclusions: Hence, we may conclude that the use of DNS increased the benefits of UCACs by minimizing the potential risk of iatrogenic weakening of critical portions of the crown and reducing negative influences to shaping procedures.
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http://dx.doi.org/10.1016/j.joen.2020.05.022DOI Listing
September 2020

Potential of Operative Torque in Evaluating NiTi Instruments.

J Contemp Dent Pract 2020 Feb 1;21(2):113. Epub 2020 Feb 1.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy, Phone: +39 3381504134, e-mail:

The role of nickel-titanium (NiTi) in the production of endodontic instruments increased in the last few decades; therefore, the way of evaluation of its performance increased as well. Nowadays, there are several ways to evaluate NiTi instruments, divided into static and dynamic tests. The static ones are cyclic fatigue tests, torsional resistance tests, flexibility, and cutting efficiency tests. These methodologies have been deeply used to evaluate some of the metallurgical properties of the instruments on the market. Up-to-date, we know very well the behavior of NiTi under static conditions, but these knowledges are too fragmented to be relevant for understanding and evaluating the complexities of intracanal instrumentation. Starting from the purpose to introduce the variable of movement in the testing procedure, some dynamic tests have been proposed, such as dynamic cyclic fatigue test. Although these kinds of studies were capable of evaluating more precisely the behavior of rotary instruments inside the root canal, they could not take into account, at this moment, the complexities of stresses that instruments undergo during the shaping procedure. Therefore, some of these tests are not accepted anymore by the scientific community and on the contrary they do not help the general practitioner to orientate in the large amount of rotary instruments present on the market. This tends to withdraw the general dentistry from the scientific literature, wearing a groove between the practice and the science. Starting from these ideas, in the last couple of years some authors started to think the proper way to real-time evaluation of the performance of NiTi rotary instruments inside the root canal. To do so, a countable and repeatable measurement of instrument's developed stresses was needed. Setzer and Böhme first used the torque generated by Revo-S, Vortex, and ProFile to evaluate their performance during instrumentation. The so-called "operative torque" is the summation of torque generated in each point of the instrument during its simultaneous movement around its own axis and up and down inside the canal. The recorded values are influenced by both torsional and flexural stresses, becoming this way a reliable method to analyze, evaluate, and compare the performance of NiTi instruments inside the root canal. This methodology is applicable for not only but also measurement, as demonstrated by Gambarini et al. The main drawback of this kind of evaluation is the not well-determined correlation between the torsional and the flexural stresses; therefore, it is still unpredictable how each influence the other. In conclusion, the potential of real-time torque measurement is wide and still unexplored, but further studies are needed to better understand how torque is developed inside the root canal.
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February 2020

Future Trends in Endodontics: From the Virtual Assessment of the Anatomy to the Computer-driven Approach.

J Contemp Dent Pract 2020 Jan 1;21(1). Epub 2020 Jan 1.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy, Phone: +39 3381504134, e-mail:

Root canal treatment is one of the most challenging practices in dentistry as the complexity and the variability of the endodontic space can often lead the operator to create false trajectories or missing canals. The technical advances in the development of even more efficient and resistant endodontic instrument reached important results in the last few years with the adoption of NiTi alloys and thermal treatments, which could increase the flexibility and the resistance of the instruments..
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January 2020

Accuracy of a Novel Trace-Registration Method for Dynamic Navigation Surgery.

Int J Periodontics Restorative Dent 2020 May/Jun;40(3):427-435

A technology called Trace Registration (TR) has been introduced to allow dynamic navigation of implant placement without the need for a thermoplastic stent. This study was undertaken in order to validate the accuracy of the TR protocol for dynamically guided implant surgery. A retrospective, observational, in vivo study was performed using dynamic navigation via the TR protocol. The preoperative cone beam computed tomography (CBCT) plan was superimposed and registered (aligned) with the postoperative CBCT scan to assess accuracy parameters. A total of 136 implants were placed in 59 partially edentulous arches. Mean deviation between the planned and actual position for all implants was 0.67 mm at the coronal level (entry point), 0.9 mm at the apical level, and 0.55 mm in depth, with an angle discrepancy of 2.50 degrees. Tracing 5 to 6 teeth tended to improve accuracy results compared to tracing 3 to 4 teeth. TR is as accurate as traditional registration and statically guided methods for implant surgery.
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http://dx.doi.org/10.11607/prd.4420DOI Listing
April 2020

In Vivo Evaluation of Operative Torque Generated by Two Nickel-Titanium Rotary Instruments during Root Canal Preparation.

Eur J Dent 2019 Oct 31;13(4):556-562. Epub 2019 Dec 31.

Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy.

Objectives:  This study evaluated the operative torque and preparation time of ProTaper NEXT (Dentsply Maillefer; Ballaigues, Switzerland) and EdgeFile X7 (EdgeEndo; Albuquerque, New Mexico, United States) rotary systems during root canal preparation of maxillary premolars.

Materials And Methods:  Ten double-rooted maxillary premolars with independent canals were selected. Each canal in each tooth was prepared with one of the rotary systems ( = 10), ProTaper NEXT or EdgeFile X7. The instruments were rotated at 300 rpm with maximum torque set at 2 N.cm using an electric motor (KaVo; Biberach, Germany) that automatically recorded torque values at every 1/10th of a second (ds).

Statistical Analysis:  Operative torque (N.cm) and preparation time (s) of the first shaping instrument (size 17/.04) of both rotary systems were recorded and statistically compared using the Mann-Whiney test with a significance level set at 5%.

Results:  No instrument exhibited flute deformation or underwent intracanal failure. No differences were found between the instruments regarding the maximum (peak) torque values ( > 0.05). EdgeFile X7 17/.04 required significantly less preparation time (3.75 seconds interquartile range [IQR]: 3.2-9.0) than ProTaper NEXT X1 (15.45 seconds IQR: 8.35-21.1) ( < 0.05). The median operative torque values of ProTaper NEXT X1 (0.26 N.cm; IQR: 0.18-0.49) were significantly higher compared with EdgeFile X7 17/.04 (0.09 N.cm; IQR: 0.05-0.17) ( < 0.05).

Conclusions:  Although no difference was found between the median peak torque values of ProTaper NEXT X1 and EdgeFile X7 17/.04 instruments, the operative torque and instrumentation time results were impacted by their different designs and alloys during clinical preparation of root canals.
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http://dx.doi.org/10.1055/s-0039-1698369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938430PMC
October 2019

Root and Root Canal Morphology Differences Between Genders: A Comprehensive CBCT Study in a Saudi Population.

Acta Stomatol Croat 2019 Sep;53(3):213-246

Department of Restorative Dentistry and Endodontics, Sapienza University of Rome, Rome, Italy.

Objectives: To comprehensively explore the differences of all maxillary and mandibular permanent teeth in relation to number of roots, number of root canals, and root canal configuration between both genders in a Saudi Arabian population.

Methods: This retrospective radiographic study comprised 208 subjects (48% males and 52% females) with a mean age 28.74±9.56 years. The CBCT images of the recruited subjects were evaluated for all permanent teeth. A careful examination was obtained by optimal visualization using all the software features. The data were analyzed using SPSS software program. Cohen's Kappa test was used for reliability and the Chi-squared test of association was used for the differences between both genders in relation to the study variables. A P-value < 0.05 was considered significant.

Results: A total of 5254 maxillary and mandibular permanent teeth were evaluated. In relation to number of roots, there were no significant differences between both genders for all maxillary and mandibular teeth together (P= 0.064) as well as for maxillary and mandibular teeth separately (P= 0.315 and P= 0.100, respectively). A significant difference was found between males and females in relation to the number of canals of maxillary teeth (P= 0.014). For mandibular teeth, the significant level of difference was at the cut-off point (P= 0.050). For all maxillary and mandibular teeth together, the distribution among both genders was not significant (P= 0.082). The difference between both genders with regard to canal configuration of maxillary roots was highly statistically significant (P< 0.001). For mandibular teeth, the difference between males and females in relation canal configuration of anterior and premolar teeth was significant (P= 0.016) while, the difference was not significant when related to mesial roots of 1 and 2 molars (P= 0.205). However, the difference was highly significant when related to distal roots of 1 and 2 molars (P< 0.001).

Conclusion: No significant differences between both genders in relation to number of roots were found. Regarding the number of canals, significant differences were found only in three groups out of 14 groups of teeth with females who had a smaller number of canals than males. For canal configuration, two groups of maxillary teeth and three groups of mandibular teeth showed statistically significant differences between both genders.
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http://dx.doi.org/10.15644/asc53/3/5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820446PMC
September 2019

Anatomical variations and bilateral symmetry of roots and root canal system of mandibular first permanent molars in Saudi Arabian population utilizing cone- beam computed tomography.

Saudi Dent J 2019 Oct 6;31(4):481-486. Epub 2019 Apr 6.

Department of Restorative Dentistry and Endodontics, Sapienza University of Rome, Italy.

Aim: The aim of the study was to evaluate the anatomical variations of the roots and root canal system, and to determine the symmetry between right and left sides of mandibular first permanent molars in Saudi Arabian population using images derived from cone beam computed tomography (CBCT) scans.

Methods: The CBCT scans (with the following parameters: FOV 170 × 120 mm, 90 Kv, 5-8 mA, 17.5 s exposure time and 0.25 mm voxel size) were retrieved from the database and axial, coronal and sagittal sections of mandibular first molars were examined. The number of roots, canals and type of canal configuration based on Vertucci's classification were recorded. Bilateral symmetry between right and left side of the same individuals and differences between genders were investigated.

Results: Out of 174 mandibular first molars, 97.1% were two rooted and 2.9% were three rooted (distolingual root). In regards to the number of canals, 73% had three, 25.3% had four and 1.7% had two root canals. In teeth with four root canals, 90.9% of the extra canal was in the distal root, while 9.1% in the extra distolingual root. The most common canal configuration in mesial and distal root were type IV (64.9%) and type I (77%), respectively. Symmetrical analysis revealed 100% symmetry in number of roots and 56.4% in number of canals between right and left teeth in the same individual.

Conclusions: Within the limitation of this study, wide range of canals configurations were noted in mandibular first molars among the Saudi Arabian population. The prevalence of three rooted mandibular first molars was relatively low. Three canals were most commonly seen in mandibular first molars. Bilateral symmetry was varied in number of canals and canals configurations, which could be of clinical significance while performing root canal treatment on both side mandibular first permanent molars.
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http://dx.doi.org/10.1016/j.sdentj.2019.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823797PMC
October 2019

Differences in cyclic fatigue lifespan between two different heat treated NiTi endodontic rotary instruments: WaveOne Gold vs EdgeOne Fire.

J Clin Exp Dent 2019 Jul 1;11(7):e609-e613. Epub 2019 Jul 1.

Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy.

Background: Aim of this study is to investigate the cyclic fatigue resistance of the Gold treated WaveOne Gold and the Firewire treated EdgeOne Fire instruments. The null hypotesis was that there were no differences between the lifespan of Gold treated and FireWire treated instruments when subjected to cyclic fatigue tests.

Material And Methods: 40 new NiTi instruments with a length of 25 mm were tested: 20 Wave One Gold Medium (WOG), tip size 35 and variable taper (Dentsply Maillefer, Ballaigues, Switzerland) and 20 Edge One Fire (EOF) (EdgeEndo, Albuquerque, New Mexico) tip size 35 and the same variable taper. A mobile support for the electric handpiece and a stainless-steel block containing the artificial canals were used. The same artificial root canal with a 90 degrees angle of curvature and 2 mm radius of curvature was used for all the tested instruments and the WOG counter-clock wise reciprocating motion with an engaging angle of 150° and a disengaging angle of 30° at 300 rpm, was selected for the test. All instruments were inserted at the same length (18mm) and then rotated in the same reciprocating motion until fracture occurred: the time was stopped as soon as the fracture was visible and video-recorded with a 1/100 sec chronometer. Differences among groups were statistically evaluated with an analysis of variance test ANOVA (significance level was set at <0.05).

Results: Mean values of time to fracture (TtF) for EOF instruments were 28,00 seconds (SD +/- 2,64) and for WOG instruments were 14,67 seconds (SD +/- 2,41). Statistical analysis found significant differences between the TtF of the two instruments (<0,05).

Conclusions: Firewire instruments resulted to be about two times more resistant to cyclic fatigue when compared with identical instruments made with Gold treatment. Endodontics, NiTi, Waveone Gold, EdgeOne Fire, Cyclic Fatigue.
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http://dx.doi.org/10.4317/jced.55839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731004PMC
July 2019

Endodontic Microsurgery Using Dynamic Navigation System: A Case Report.

J Endod 2019 Nov 10;45(11):1397-1402.e6. Epub 2019 Sep 10.

Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

Dynamic navigation systems were introduced to facilitate dental implantology by improving the accuracy of dental implant positioning. Dynamic navigation integrates surgical instrumentation and radiologic images by using an optical positioning device controlled by a dedicated computerized interface. These features could help in reducing the risk of unintentional iatrogenic damage to nearby anatomic structures and perform minimally invasive or flapless surgery, leading to reduced patient postoperative discomfort and improved healing. The present case report showed the use of the Navident dynamic navigation system (ClaroNav, Toronto, Ontario, Canada) by an undergraduate student for bone cavity preparation and root-end resection in the surgical endodontic treatment of a lesion in an upper lateral incisor. The system allowed precise localization of the root and precise apicoectomy with a minimal invasive cavity. The dynamic navigation system allowed the student to precisely direct the bur in 3 dimensions. The osteotomy and root-end resection were easily and quickly performed by the undergraduate student with a minimally invasive approach without iatrogenic errors. The navigation system allowed the operator to precisely perform a minimally invasive osteoctomy and root-end resection during endodontic surgery. The development of dedicated surgical navigation systems for endodontic surgery could facilitate the operator's maneuvers and reduce the risk of iatrogenic errors.
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http://dx.doi.org/10.1016/j.joen.2019.07.010DOI Listing
November 2019
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