Morphologic Changes of Apical Foramen and Microcrack Formation after Foraminal Enlargement: A Scanning Electron Microscopic and Micro–computed Tomographic Analysis

Vieira, Maria do Socorro; Dantas, Hugo; Sousa, Frederico Barbosa de; Salazar-Silva, Juan Ramon; Silva, Emmanuel João Nogueira Leal; Batista, André Ulisses Dantas; Lima, Thiago Farias Rocha

doi:10.1016/j.joen.2020.07.017

Cited by 21 publications

(37 citation statements)

References 39 publications

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“…At first, this unexpected outcome produced great criticisms from some research groups as it went against the prevailing mainstream. As time went by, however, the main findings of De-Deus et al (2014) were supported by other independent groups (Aksoy et al, 2019;Arumugam & Yew, 2021;Aydin et al, 2014;Bayram et al, 2017aBayram et al, , 2017bCassimiro et al, 2017;Martins et al, 2021;Miguéns-Vila et al, 2017;Rödig et al, 2019;Vieira et al, 2020). At this point, it is important to highlight that microcracks visualized in sound teeth cannot be referred to as 'pre-existing' microcracks considering that there are no 'post-existing' microcracks.…”

Section: Micro-ct Workflow: Obtaining Cross-sectional Images To Evalu...mentioning

confidence: 79%

“…By using extracted/stored teeth, as in the first sectioning studies, this method was further improved through an in situ approach employing fresh cadaveric bone blocks. The best scientific evidence provided so far by these studies are summarized in the following list and shall be taken as the main conclusions of this narrative review: Micro‐CT is an accurate method to visualize dentinal microcracks previously observed in root cross sections under microscopic‐based magnification and illumination (De‐Deus et al, 2016); Using extracted teeth, no new dentinal microcrack is created after canal preparation since observed cracks are already present pre‐operatively; therefore, there is a lack of cause–effect relationship between root canal preparation procedures and dentinal defects (Aksoy et al, 2019; Arumugam & Yew, 2021; Aydin et al, 2014; Bayram et al, 2017a, 2017b; Belladonna et al, 2021; Cassimiro et al, 2017; De‐Deus et al, 2014, 2015, 2016, 2017b, 2017c; Martins et al, 2021; Miguéns‐Vila et al, 2017, 2021; de Oliveira et al, 2017a, 2017b; Rödig et al, 2019; Vieira et al, 2020; Zuolo et al, 2017); The number of dentinal microcracks has no correlation with the force required to fracture extracted teeth (Cavalcante et al, 2020); No dentinal microcrack is observed in situ neither in the baseline images nor after root canal preparation in fresh cadaveric bone blocks, suggesting that microcracks observed in extracted/stored teeth are a laboratory phenomenon, not reproduced in a clinical environment (De‐Deus et al, 2017b, 2019). …”

Section: Final Remarksmentioning

confidence: 99%

“…Currently, our digital search revealed 27 confirmatory studies using micro‐CT imaging technology to evaluate the frequency of dentinal microcracks after root canal preparation in extracted/stored teeth published in peer‐reviewed journals from research groups worldwide (Table 2). Eighteen of them found no new dentinal microcracks (Arumugam & Yew, 2021; Bayram et al, 2017a, 2017b; Belladonna et al, 2021; Cassimiro et al, 2017; De‐Deus et al, 2014, 2015, 2016, 2017c; Martins et al, 2021; Miguéns‐Vila et al, 2021; de Oliveira et al, 2017a, 2017b; Rödig et al, 2019; Stringheta et al, 2019; Ugur Aydin et al, 2019; Vieira et al, 2020; Zuolo et al, 2017), whilst nine studies reported the development of new defects after canal preparation (Aggarwal et al, 2021; Aksoy et al, 2019; Alkahtany & Al‐Madi, 2020; Çakici et al, 2019; Ceyhanli et al, 2016; Jain et al, 2018; Jamleh et al, 2021; Mandava et al, 2018; Tsenova‐Ilieva et al, 2019).…”

Section: Reviewmentioning

confidence: 99%

“…Since 2014, new findings from in vitro , ex vivo and in situ studies using micro‐computed tomographic (micro‐CT) imaging technology reshaped the overall panorama and understanding on the development of dentinal defects produced by root canal preparation and filling procedures (Aggarwal et al, 2021; Aksoy et al, 2019; Alkahtany & Al‐Madi, 2020; Arashiro et al, 2020; Arumugam & Yew, 2021; Aydin et al, 2014; Bayram et al, 2017a, 2017b; Belladonna et al, 2021; Çakici et al, 2019; Cassimiro et al, 2017; Cavalcante et al, 2020; Ceyhanli et al, 2016; De‐Deus et al, 2014, 2015, 2016, 2017b, 2017c, 2020; Jain et al, 2018; Jamleh et al, 2015, 2021; Mandava et al, 2018; Martins et al, 2021; Miguéns‐Vila et al, 2017; de Oliveira et al, 2017a, 2017b; Rödig et al, 2019; Shemesh et al, 2018; Stringheta et al, 2019; Vieira et al, 2020; Zuolo et al, 2017). The achievements from these studies identified that: (i) root dentinal microcracks observed in cross‐sectional images of extracted teeth are not caused by canal shaping procedures; (ii) dehydration often causes cracking of the dentinal tissue, regardless of canal instrumentation; (iii) dentinal microcracks do not predispose the root to fracture in a laboratory setting using extracted teeth; (iv) microcracks observed in root sections of extracted teeth ( in vitro ) cannot be confirmed in a fresh cadaver model ( in situ ); (v) dentinal microcracks caused by endodontic procedures and observed in cross‐sectional images of extracted roots are a phenomenon that has never been reported in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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A critical analysis of research methods and experimental models to study dentinal microcracks

Versiani¹,

Cavalcante

Belladonna

et al. 2021

Int Endodontic J

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The purpose of this narrative review was to discuss the scientific milestones that led to the current understanding of the root dentinal microcrack phenomenon based on the interplay between the usage of micro-computed tomography (micro-CT) as an analytical tool alongside a close-to-mouth experimental model. In 2009, reports on the development of dentinal microcracks in extracted teeth after root canal preparation triggered an awareness of the potential for vertical root fractures (VRFs) of endodontically treated teeth could be developed from defects created by the mechanical stress of nickel-titanium preparation systems on dentine. This assumption was taken for granted, even though no cause-effect relationship had been scientifically demonstrated. Since then, several studies using the sectioning method with extracted teeth have been published and the large discrepancy amongst their outcomes soon become evident. Moreover, the high frequency of reported dentinal microcracks largely contrasted with the clinical incidence of VRFs, raising doubts on their methodological reliability. Using micro-CT technology, it was demonstrated by several studies that, in extracted teeth, dentinal defects already existed before the endodontic procedures, indicating that the initial reports framed a non-existing cause-effect relationship between canal preparation and dentinal microcracks. Although these new findings contributed to a better comprehension of this phenomenon, the misconception that microcracks were the starting point for VRFs was only surpassed with a new in situ approach using fresh cadavers. Surprisingly, microcracks were not identified in sound teeth. As a conclusion, dentinal microcracks in extracted teeth can be considered a non-natural occurrence observed only in a laboratory set-up as a consequence of dehydration and storage conditions. Thus, dentinal microcracks shall not be considered as the starting point for VRFs as they do not manifest in nonextracted teeth. Identifying dentinal microcracks as a laboratory phenomenon highlights the impact of recent scientific developments to disclaim the clinical relevance of laboratory-obtained outcomes.

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Section: Micro-ct Workflow: Obtaining Cross-sectional Images To Evalu...mentioning

confidence: 79%

Section: Final Remarksmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A critical analysis of research methods and experimental models to study dentinal microcracks

Versiani¹,

Cavalcante

Belladonna

et al. 2021

Int Endodontic J

Self Cite

View full text Add to dashboard Cite

show abstract

“…This finding is in agreement with the results of the majority of previous studies that used micro-CT for the assessment of microcrack formation after root canal instrumentation. 9,10,12,[19][20][21][22][23][24][25] A study conducted in 2014 used micro-CT for the first time and showed no cause-and-effect relationship between dentinal microcrack formation and root canal instrumentation. 10 After that, many micro-CT studies confirmed this finding.…”

Section: Discussionmentioning

confidence: 99%

Micro-computed tomography assessment of dentinal microcracks after the preparation of curved root canals with rotary and reciprocal systems

Shantiaee¹,

Zandi²,

Shojaeian³

et al. 2021

Dent. Med. Probl.

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Background. Root canal preparation with nickel-titanium (NiTi) instruments may lead to the formation of microcracks in the root canal wall. Vertical root fractures may initiate from dentinal cracks, and eventually necessitate tooth extraction.Objectives. This study aimed to assess the effect of the instrumentation of curved root canals of mandibular molars with the 2Shape (2S) sequential rotary, EdgeFile ® X1 (EFX1) reciprocating and NeoNiTi (NN) rotational single-file systems on the formation of dentinal microcracks with the use of micro-computed tomography (micro-CT). Material and methods.Thirty curved mandibular molar root canals were instrumented with the 2S, EFX1 and NN systems (10 in each group). The teeth underwent micro-CT before and after instrumentation. Next, the pre-instrumentation and post-instrumentation cross-sectional images were evaluated and compared for the detection of dentinal microcracks. The number of microcracks in each group was calculated and reported as percentage. The data was analyzed using the McNemar's test with the IBM SPSS Statistics for Windows software, v. 25.0 (α = 0.05).Results. Out of the 29,280 cross-sectional images evaluated in this study, 11.5% showed dentinal microcracks (n = 3,362). On the post-instrumentation images, the frequency percentage of microcracks was 12.0% (n = 585) in the 2S group, 8.8% (n = 402) in the EFX1 group and 13.3% (n = 694) in the NN group. All of the microcracks detected on the post-instrumentation images were also present on the preinstrumentation images and no new microcracks were formed after root canal instrumentation with the aforementioned systems.Conclusions. Root canal instrumentation with the 2S, EFX1 and NN systems did not result in the formation of new dentinal microcracks.

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Clinical and radiological outcomes of dynamic navigation in endodontic microsurgery: a prospective study

Chen,

Zhang,

Zhang

et al. 2023

Clin Oral Invest

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Objectives This study was aimed at evaluating the clinical and radiological outcomes of novel dynamic navigation (DN)–aided endodontic microsurgery (EMS), with an analysis of potential prognostic factors. Materials and methods Forty-six teeth from 32 patients who received DN-aided EMS were included. Clinical and radiographic assessments were performed at least 1 year postoperatively. Two calibrated endodontists assessed radiological outcomes according to two-dimensional (2D) periapical radiography (PA) and three-dimensional (3D) cone-beam computed tomography (CBCT) imaging using Rud’s and Molven’s criteria and modified PENN 3D criteria, respectively. Fisher’s exact test was used for statistical analysis of the predisposing factors. Results Of the 32 patients with 46 treated teeth, 28 with 40 teeth were available for follow-up. Of the 28 patients, four (five teeth) refused to undergo CBCT and only underwent clinical and PA examinations, and the remaining 24 (35 teeth) underwent clinical, PA, and CBCT examinations. Combined clinical and radiographic data revealed a 95% (38/40) success rate in 2D healing evaluations and a 94.3% (33/35) success rate in 3D healing evaluations. No significant effect was found in sex, age, tooth type, arch type, preoperative lesion volume, preoperative maximum lesion size, presence/absence of crown and post, and the root canal filling state on the outcome of DN-aided EMS. Conclusions DN-aided EMS has a favorable prognosis and could be considered an effective and reliable treatment strategy. Further investigations with larger sample sizes are required to confirm these results. Clinical relevance DN-aided EMS could be considered an effective and reliable treatment strategy.

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Morphologic Changes of Apical Foramen and Microcrack Formation after Foraminal Enlargement: A Scanning Electron Microscopic and Micro–computed Tomographic Analysis

Cited by 21 publications

References 39 publications

A critical analysis of research methods and experimental models to study dentinal microcracks

A critical analysis of research methods and experimental models to study dentinal microcracks

Micro-computed tomography assessment of dentinal microcracks after the preparation of curved root canals with rotary and reciprocal systems

Clinical and radiological outcomes of dynamic navigation in endodontic microsurgery: a prospective study

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