Evaluation of apical preparations performed with ultrasonic diamond and stainless steel tips at different intensities using a scanning electron microscope in endodontic surgery

Abstract

Objective: The objective of our study is to analyse (with the help of scanning electron microscopes) the quality of the dental root surface and the appearance of dental cracks after performing apical preparations using two diffe-rent types of ultrasonic tips. Study design: We used 32 single-rooted teeth that underwent a root canal and apical resection. Afterwards, the teeth were divided into 4 groups of 8 teeth each, with preparations of the apical cavities in the following manner: Group 1: stainless steel ultrasonic tip at 33KHz. Group 2: stainless steel ultrasonic tip at 30KHz. Group 3: diamond ultrasonic tip at 30KHz. Group 4: diamond ultrasonic tip at 33 KHz. The quality of the root surface and the presence of cracks were evaluated by one single observer using a scanning electron microscope. Results: All of the teeth in our study had cracks after the apical preparations. The mean number of cracks per tooth ranged between 6.1±1.9 (group 1) and 3.5±2.4 (group 4), with a significantly higher number found in the groups that used stainless steel tips (P=.03). The types of cracks produced involved: 8 complete cracks (4.5%), 167 incomplete cracks (94.4%), and 2 intradentinal cracks (1.1%), with no significant differences observed between the different frequencies used for each group. Conclusions: Stainless steel ultrasonic tips provoked a larger number of cracks than diamond tips. The frequency of vibration used did not have any effect on the number of cracks found. Key words:Apicoectomy, scanning electron microscope, therapeutic ultrasound, endodontic surgery, dentinal crack.

Rehabilitation of surgically failed anterior teeth using bioactive material and monoblock effect

“…Apicoectomy/root end resection is a procedure where the apical 3 mm of the root canal is resected during periradicular surgery to include most accessory and lateral canals and thus eliminate most residual microorganisms and irritants. 4 In the present case, as the resected root apices (the source of infection) were left behind from the previous periapical surgery, a surgical approach was considered to eliminate the pathology.…”

Apicoectomy of Perforated Root Canal Using Bioceramic Cement and Photodynamic Therapy

“…The apical third was retroinstrumented using the ultrasonic tip which is an effective method resulting in additional disinfection of the surgical site [ 44 ]. A diamond ultrasonic tip was used as it provokes a minimal number of postoperative cracks when compared to stainless steel tips [ 45 ].…”

Ultrasonics in endodontics

“…There was also no difference found in the number of cracks created when comparing ultrasonic retropreparation to the use of high‐speed burs for similar retropreparation , and ultrasonically prepared cavities were able to achieve an effective seal when filled with MTA, and even improved the sealing ability of inferior retrofilling materials . Diamond‐coated retropreparation tips, which are widely used, also do not appear to cause significant root‐end cracks , while stainless‐steel tips are able to cause a larger number of cracks than diamond‐coated tips . This, too, has been disputed, with a different study reporting stainless‐steel ultrasonic tips to produce no root‐end fractures .…”

“…One concern with the use of ultrasonic retrotips for cavity preparation is the possible creation of cracks at the root‐end, although the clinical impact is not exactly clear . It is possible that cracks may promote leakage, perhaps resulting in failure of apical surgery procedures .…”