Context:During biomechanical preparation, a smear layer is formed which occludes the openings of dentinal tubules and disfavors the penetration of irrigants. Hence, such layers should be removed. It becomes more challenging when we approach the apical third of the root canal.Aim:The aim was to compare the efficacy of different irrigants including ethylenediaminetetraacetic acid (EDTA), EDTA along with ultrasonication, citric acid, and mixture of tetracycline isomer, an acid, and a detergent (MTAD) as final irrigants where sodium hypochlorite (NaOCl) was used in each experimental group during root canal preparation with special emphasis on the apical third.Settings and Design:Forty-five human upper anterior teeth were selected and divided into one control group (group 1) and four experimental groups (group 2 to group 5), each containing nine teeth. All the four experimental groups were irrigated with 5.25% NaOCl solution during preparation, whereas test irrigants (5 mL) as the final solution used in each experimental group were 17% EDTA, 17% EDTA along with ultrasonication, 25% citric acid, and MTAD, respectively. The samples were prepared and observed under a scanning electron microscope (SEM). The photomicrographs were recorded and evaluated with a scoring system.Statistical Analysis Used:Data were analyzed using Kruskal-Wallis test and Dunn's test (P = 0.05).Results:None of the combined irrigants was found completely effective. All the test irrigants including MTAD worked well in the middle and cervical third, whereas MTAD showed excellent results in the apical third as compared to the other groups.
Context:Where nonsurgical endodontic intervention is not possible, or it will not solve the problem, surgical endodontic treatment must be considered. A major cause of surgical endodontic failures is an inadequate apical seal, so the use of the suitable substance as root-end filling material that prevents egress of potential contaminants into periapical tissue is very critical.Aims:The aim of the present ex-vivo study was to compare and evaluate the three root-end filling materials of mineral trioxide aggregate (MTA) family (white MTA [WMTA], grey MTA [GMTA] and Portland cement [PC]) for their marginal adaptation at the root-end dentinal wall using scanning electron microscopy (SEM).Materials and Methods:Sixty human single-rooted teeth were decoronated, instrumented, and obturated with Gutta-percha. After the root-end resection and apical cavity preparation, the teeth were randomly divided into three-experimental groups (each containing 20 teeth) and each group was filled with their respective experimental materials. After longitudinal sectioning of root, SEM examination was done to determine the overall gap between retrograde materials and cavity walls in terms of length and width of the gap (maximum) at the interface. Descriptive statistical analysis was performed to calculate the means with corresponding standard errors, median and ranges along with an analysis of variance and Tukey's test.Results:The least overall gap was observed in GMTA followed by PC and WMTA. While after statistically analyzing the various data obtained from different groups, there was no significant difference among these three groups in terms of marginal adaptation.Conclusion:GMTA showed the best overall adaptation to root dentinal wall compared to PC and WMTA. Being biocompatible and cheaper, the PC may be an alternative but not a substitute for MTA.
Conventional root canal treatment (RCT) of the teeth has long shown high success rate. However, the endodontic treatment of a pulpless tooth with periapical radiolucency of a considerable size always has a question of success. In modern days, surgical exploration is avoided, especially in the posterior teeth. These types of cases may be successfully managed by orthograde Mineral Trioxide Aggregate (MTA) placement in the apical third of the root followed by proper obturation. The objective of our present case reports was to evaluate the periapical pathology of posterior teeth clinically and radiographically by using MTA in orthograde way and avoiding traumatic surgical exploration. In the first case, the patient reported with intraoral sinus and pus discharge related to tooth #45. On radiograph, open apex (blunderbuss) was found along with periapical radiolucency. In the second case, the patient reported with pain and swelling related to tooth #26, having large periapical radiolucency related to the palatal canal. On vitality test, both the teeth responded negative, i.e., non-vital. Conventional RCT was planned in both the cases with orthograde MTA- Angelus (Angelus, Londrina, PR, Brazil) apical plug followed by the proper obturation with gutta-percha (G.P.), and after that the patients were kept on periodic follow-up and the outcome-based clinical and radiographic criteria were assessed. The post-obturation assessment at 1-month interval showed changes in the size of radiolucency with a gradual decrease, and after 6 months a remarkable decrease of radiolucency or the defect was almost filled with bone formation visible around the roots.
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