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

Isufi, Almira; Plotino, Gianluca; Grande, Nicola M.; Testarelli, Luca; Gambarini, Gianluca

doi:10.1016/j.joen.2020.07.015

Cited by 15 publications

(16 citation statements)

References 26 publications

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“…When only the crown was evaluated, the of hard tissue volume removed was higher in the TradAC-FP group than in the TradAC-CR group, showing that the fiber post promoted a higher percentage of dentine removal, in line with previous studies (Ikram et al 2009, Shaikh et al 2018. Moreover, a greater percentage volume of hard tissue was removed in the TradAC groups when compared to the ConsAC groups, in agreement with previous studies that evaluated traditional and conservative access cavities (Isufi et al 2020.…”

Section: Discussionsupporting

confidence: 91%

Influence of the endodontic access cavity design and restorative technique on hard tissue removal and fracture resistance of mandibular premolars

Boscatto

Prado

Silva

et al. 2022

RSD

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This study assessed the influence of traditional (TradAC) and conservative access (ConsAC) with different restorative techniques on the percentage of hard tissue removed (%HTR) and on the fracture resistance of mandibular premolars. 45 premolars were scanned in a micro-computed tomography and assigned into four groups according to access (TradAC or ConsAC) and restorative technique: composite resin (CR) or fiber post (FP) + CR. After post preparation, the teeth were rescanned to determine the volume enlargement and %HTR from the crown and root canal. After restoration, the load at fracture was recorded. Data were analyzed statistically by one-way ANOVA and Tukey’s post-hoc test, ANOVA repeated measure, and chi-square tests (P<0.05). TradAC (RC or FP) resulted in the increase (Δ%) of root canal volume and hard tissue removed up to 14 mm (%) in comparison with ConsAC (RC or FP). TradAC + FP removed a greater percentage of hard tissue from the crown when compared to TradAC + CR. The percentage of hard tissue removed in the crown in the ConsAC groups was statistically lower than in the TradAC groups. The control group showed higher fracture resistance than all experimental groups, with no differences among the latter. Restorable fracture patterns were more prevalent. Traditional endodontic access cavities removed a higher percentage of dentine than conservative endodontic access cavities. However, no differences in fracture resistance were observed. Restorations using composite resin or fiber post associated with composite resin showed similar results of fracture resistance.

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Section: Discussionsupporting

confidence: 91%

Influence of the endodontic access cavity design and restorative technique on hard tissue removal and fracture resistance of mandibular premolars

Boscatto

Prado

Silva

et al. 2022

RSD

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“…More recently, Isufi et al . (2020) proposed to categorise various access cavity formats based on the percentage of hard tissue removed after access preparation. According to the authors, for a given access cavity to be labelled as ‘traditional’ in mandibular molars, the percentage volume of dentine and enamel removed should be greater than 16% of the original volume of the crown.…”

Section: Discussionmentioning

confidence: 99%

“…2017, Isufi et al . 2020). In this context, the possibility to find a correlation between the fracture resistance and the volume of dentine and enamel removed after UltraAC and TradAC represents an unexplored line of investigation, essential to improve understanding of the impact of MIE on the preservation of tooth strength.…”

Section: Introductionmentioning

confidence: 99%

Preserving dentine in minimally invasive access cavities does not strengthen the fracture resistance of restored mandibular molars

Silva¹,

Lima²,

Barbosa³

et al. 2021

Int Endodontic J

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Aim To evaluate the correlation between the volume of dental hard tissues removed and the fracture resistance of mandibular molar teeth with ultraconservative (UltraAC) or traditional (TradAC) access cavity preparations. Methodology Sixty recently extracted and intact mandibular first molars were scanned in a microcomputed tomographic (micro‐CT) device, anatomically matched and assigned at random to 2 groups (n = 30), according to the access cavity type: UltraAC or TradAC. After access preparation, mesial and distal canals were prepared using Reciproc instruments and a new scan was taken. The volumes of pulp chamber and dental hard tissues in each specimen were measured before and after the experimental procedures, and the percentage volume reduction of hard tissues calculated for the entire tooth and for the crown separately. Teeth were then root filled, restored and subjected to fracture resistance tests in an universal testing machine. The force required to fracture was recorded in Newtons (N). The adherence of the variables to a Gaussian curve was verified using a Shapiro–Wilk test. Skewed data were analysed with nonparametric Wilcoxon signed rank or Spearman correlation tests, whilst the normally distributed data were analysed with a dependent samples Student t‐test. Level of significance was set at 5%. Results Pre‐operatively, no difference was observed between groups regarding the volume of pulp canal space or dental hard tissues (P > 0.05). After access preparation, volumes of the removed hard tissues from the entire tooth and from the crown were significantly greater in teeth prepared with TradAC than with UltraAC (P < 0.05). No significant difference was observed in the fracture resistance values between TradAC (902.9 ± 347.8 N) and UltraAC (948.7 ± 405.7 N) groups (P = 0.975). The Spearman test was unable to identify a correlation between fracture resistance and percentage volume of removed dental hard tissues in the entire root (P = 0.525, r = −0.084) or only in the crown (P = 0.152, r = −0.187). Conclusion The volume of hard dental tissues removed, although greater in teeth with TradAC compared to UltraAC, did not correlate with the fracture resistance results, indicating that a minimally invasive access cavity did not increase the resistance of restored mandibular first molars to fracture.

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“…Hence a major critical objective for any type of endodontic treatment; conventional or regenerative is to ensure optimal tooth survival and retention ( Elkholy et al, 2021 ). By minimizing tooth structure removal as we elaborated in this review, fracture resistance of such teeth can be maintained ( Isufi et al, 2020 ; Elkholy et al, 2021 ), at the same time, to avoid sacrificing disinfection for the sake of preserving tooth structure, we suggest an alternative enhanced disinfection protocol that would conserve sound tooth structure while at the same time maintain an appropriate level of disinfection to allow stem cell migration and success of the final regenerative treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the previous review of literature, the current review suggests the possible implementation of a new concept of minimally invasive regenerative endodontic procedures (MIREPs). Starting from the access cavity design, CEC for non-decayed traumatized teeth and caries-driven-access cavity for decayed teeth, would represent more suitable tooth preserving designs, where the volume of dentin and enamel removal in case of CEC designs was found to be less than 15% which was significantly less than enamel and dentin removal in TEC ( Isufi et al, 2020 ). Additionally, according to a recent systematic review and meta-analysis, a significant increase in fracture resistance was noted when CEC preparation was performed with preservation of tooth marginal ridges ( Ballester et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Regenerative Endodontics and Minimally Invasive Dentistry: Intertwining Paths Crossing Over Into Clinical Translation

Elnawam

Abdelmougod

Mobarak

et al. 2022

Front. Bioeng. Biotechnol.

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Regenerative endodontic procedures have been described for over a decade as a paradigm shift in the treatment of immature necrotic permanent teeth, owing to their ability to allow root maturation with subsequent enhancement of the tooth’s fracture resistance in addition to the potential for regeneration of vital intracanal tissues. Concomitantly, minimally invasive endodontics is another rising concept with the main concern of preservation of tooth structure. Stemming from their potential to preserve the original tooth structure, both regenerative and minimally invasive endodontics could be considered as two revolutionary sciences with one common goal. Achieving this goal would entail not only employing the appropriate strategies to recreate the ideal regenerative niche but modifying existing concepts and protocols currently being implemented in regenerative endodontics to address two important challenges affecting the outcome of these procedures; conservation of tooth structure and achieving effective disinfection. Therefore, the search for new biomimetic cell-friendly disinfecting agents and strategies is crucial if such a novel integratory concept is to be foreseen in the future. This could be attainable by advocating a new merged concept of “minimally invasive regenerative endodontic procedures (MIREPs),” through modifying the clinical protocol of REPs by incorporating a minimally invasive access cavity design/preparation and biomimetic disinfection protocol, which could enhance clinical treatment outcomes and in the future; allow for personalized disinfection/regeneration protocols to further optimize the outcomes of MIREPs. In this review, we aim to introduce this new concept, its realization and challenges along with future perspectives for clinical implementation.

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

Cited by 15 publications

References 26 publications

Influence of the endodontic access cavity design and restorative technique on hard tissue removal and fracture resistance of mandibular premolars

Influence of the endodontic access cavity design and restorative technique on hard tissue removal and fracture resistance of mandibular premolars

Preserving dentine in minimally invasive access cavities does not strengthen the fracture resistance of restored mandibular molars

Regenerative Endodontics and Minimally Invasive Dentistry: Intertwining Paths Crossing Over Into Clinical Translation

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