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ANTIBACTERIAL EFFECT OF ROOT CANAL FILLING MATERIALS
Get PDFSvrha istraživanja bila je ispitati antibakterijski učinak MTA, Endosequence, AH Plus i Endo N2 materijala za punjenje korijenskih kanala na bakterije Streptococcus mitis i Streptococcus oralis. Pri tome su korištena dva testa: test difuzije u agaru (ADT) i test izravnog dodira (DCT). Kod ADT-a suspenzija svake bakterijske vrste nanesena je na površinu krvnog agara, gdje su potom dodani materijali za punjenje korijenskih kanala. Nakon inkubacije od 24 sata, izmjeren je promjer zone inhibicije rasta oko svakog materijala. Kod DTC-a u zdence su postavljeni materijali na koje su dodane mikrobne suspenzije. Nakon 1 sata, u svaki je zdenac dodano BHI bujona te su uzorci inkubirani tijekom 1, 6, 20 i 24 sata. Pri završetku svakog vremenskog razdoblja napravljena su razrjeđenja koja su nasađena na krvni agar te je sljedeći dan određen broj bakterijskih kolonija (CFU/ml). Najveći antibakterijski utjecaj na Streptococcus mitis, prema ADT-u, imao je Endo N2, uz širinu zone inhibicije rasta od 15 mm. Na Streptococcus oralis najveći je antibakterijski utjecaj imao Endosequence, uz širinu zone inhibicije rasta od 14 mm. DCT-om najveći je antibakterijski utjecaj na Streptococcus mitis pokazao AH Plus, gdje je nakon inkubacijskog razdoblja od 24 sata broj bakterija bio 1.45x10. Najveći antibakterijski utjecaj na Streptococcus oralis imao je MTA, gdje je broj spomenutih bakterija nakon inkubacijskog razdoblja od 24 sata bio 1.89 x 10. Najveću zonu inhibicije rasta ispitivanih bakterija pokazali su Endosequence i Endo N2. Kod DCT-a za Streptococcus mitis, AH Plus i MTA pokazali su se djelotvornijim u usporedbi s Endosequence i Endo N2 materijalima, dok je najbolji antimikrobni učinak za Streptococcus oralis postignut s MTA-om.The aim of this study was to examine the antibacterial effect of MTA, Endosequence, AH Plus and Endo N2 root canal filling materials, on bacteria Streptococcus mitis and Streptococcus oralis. Therefore, two tests were used, the agar diffusion test (ADT) and the direct contact test (DCT). For ADT, a suspension of each bacteria was applied onto the surface of the blood agar plate. Then, the root canal filling materials were added. After 24h of incubation, the diameter of growth inhibition zone around each of the materials was measured. For DCT, materials were placed into the wells, onto which afterwards, microbial suspensions were added. After one hour, BHI broth was added into each of the wells. Subsequently, the samples were incubated for 1, 6, 20 and 24 hours. Then, dilutions, plated on blood agar, were made after each time period. The number of bacterial colonies (CFU/ml) was determined the next day. According to ADT, Endo N2 had the biggest antibacterial effect on Streptococcus mitis, with a zone width of 15 mm, while Endosequence had the best effect on Streptococcus oralis, with a zone width of 14 mm. For DCT, AH Plus had a major antibacterial effect on Streptococcus mitis, where, after 24h of incubation, the number of bacteria was 1.45x10. As for Streptococcus oralis, the greatest antibacterial effect was caused by MTA, after the same time period, having a number of bacteria of 1.89 x 10. Endosequence and Endo N2 displayed the biggest growth inhibition zone of the bacteria examined. For DCT, AH Plus and MTA were more efficient on Streptococcus mitis compared to Endosequence and Endo N2, while MTA had the best antibacterial effect on Streptococcus oralis
Advantages of fiber-reinforced composite materials for direct restorations
No full textSvrha ovog rada je prikazati na kliničkom slučaju prednosti i mogućnosti primjene vlaknima
ojačanih kompozitnih materijala za izradu direktnih restauracija. Kod pacijenta muškog spola i
starosti 27 godina koji je upućen na Zavod za endodonciju i restaurativnu stomatologiju
Stomatološkog fakulteta Sveučilišta u Zagrebu zbog revizije endodontskog liječenja donjeg
lijevog drugog kutnjaka, provedena je revizija te se pristupilo izradi direktne restauracije kako
bi se nadoknadila izgubljena zubna tkiva te povratila zubu morfologija i funkcija. Prilikom
izrade restauracije, za dentinsku bazu korišten je kratkim staklenim vlaknima ojačan
kompozitni materijal GC everX Posterior u kombinaciji sa standardnim kompozitom (Essentia
Universal) pomoću kojeg je rekonstruirana morfologija zuba. Staklenim vlaknima ojačani
kompoziti imaju mehanička svojstva koja odgovaraju svojstvima dentina, povećavaju otpornost
zuba na loma, a mogu i spriječiti napredovanje frakture zuba ili ispuna prema dubljim
dijelovima zuba i/ili korijena zuba. U prikazanom kliničkom slučaju, postavljena je direktna
restauracija kombinacijom staklenim vlaknima ojačanog kompozita i standardnog kompozita
budući da je zub endodontski liječen te je bio prisutan opsežan gubitak tvrdih zubnih tkiva, a
osim toga, zub je u regiji kutnjaka gdje se očekuju najače sile tijekom funkcije te se odabranim
materijalima pokušala smanjiti mogućnost loma i vertikalne frakture korijena te posljedično
gubitak zuba.The aim of this thesis is to present a clinical case in order to show the advantages and
possibilities for use of fiber-reinforced composite (FRC) materials for direct restoration. A male
27-year-old patient was referred to the Department of Endodontics and Restorative Dentistry,
School of Dental Medicine University of Zagreb for an endodontic retreatment of his left
mandibular second molar. Following the retreatment, a direct restoration was planned in order
to restore tooth morphology and function. During restorative procedure, GC everX Posterior
short glass fibre-reinforced composite was used as dentin base, in combination with a standard
composite (Essentia Universal) for final reconstruction of tooth morphology. Mechanical
properties of glass FRC match the properties of dentin, improve tooth fracture resistance, and
can help prevent propagation of fracture line in hard dental fissures or filling. The clinical case
presented, direct restoration was placed using combination of FRC and standard composite
since the tooth was endodontically treated with extensive loss of hard dental tissue. Moreover,
the tooth in question was a molar, therefore, as one can expect the highest occlusal forces in the
posterior region, the materials chosen were used in order to minimise the possibility for
infractions, fractures and vertical root fracture and consequently, prevent tooth loss
Microlaminated glass ionomer cements
Get PDFStaklenoionomerni cementi imaju kemijsku adheziju za tvrda zubna tkiva, tolerantni su na prisutnost vlage, koeficijent termalne ekspanzije odgovara istome tvrdih zubnih tkiva, biokompatibilni su, bioaktivni te jednostavni za uporabu što im omogućuje široku primjenu u modernoj dentalnoj medicini. Mikrolaminirani SIC-i predstavljaju novu generaciju cemenata koji imaju poboljšana fizičko-mehanička svojstva te se mogu rabiti za izradu trajnih ispuna u stražnjoj regiji.
Nakon primjene lokalne anestezije za donji desni prvi kutnjak, karijesna lezija je otvorena okruglim dijamantnim svrdlom uz vodeno hlađenje. Zub je izoliran gumenom plahticom, a za uklanjanje karijesne lezije, odabran je modificirani atraumatski tretman (ARTm). Okruglim čeličnim svrdlom, bez vodenog hlađenja, uklonjena je karijesna lezija u području caklinsko – dentinskog spojišta, a parapulpno je karijesni dentin uklonjen ručnim instrumentima. Nakon kondiciniranja kaviteta 10%-tnom poliakrilnom kiselinom (Dentin conditioner, GC, Tokio, Japan) kroz 20 sekundi, ispiranja vodom i sušenja sterilnom vaticom, kavitet je zatvoren kapsuliranim SIC-om EQUIA Forte Fil (GC, Tokio, Japan). Nakon usklađivanja okluzije i artikulacije, na površinu je nanesen premaz EQUIA Forte Coat (GC, Tokio, Japan) koji je osvijetljen LED polimerizacijskom lampom.
U opisanom prikazu slučaja, kod pacijenta s visokim rizikom od nastanka karijesa i uznapredovalom karijesnom lezijom na donjem desnom prvom kutnjaku, modificiranim ART-om uklonjen je vanjski, inficirani dio karijesne lezije kako se ne bi ugrozio vitalitet pulpe. Zatim je na unutrašnji, demineralizirani dentin postavljen trajni ispun od mikrolaminiranog SIC-a zbog svojstva bioaktivnosti materijala i mogućnosti interne remineralizalizacije demineraliziranog dentina. Na kontrolnom pregledu nakon 6 mjeseci zub je asimptomatski, a ispun zadovoljava estetske, funkcionalne i biološke zahtjeve.Glass ionomer cements have chemical bonding to hard dental tissues, they are moisture tolerant, coefficient of thermal expansion is similar to hard dental tissues coefficient, they are biocompatible, bioactive and simple for use, which allows them to be widely used in modern dental medicine. Microlaminated GICs represent a new generation of cements that have improved physico-mechanical properties and can be used as permanent fillings in the posterior region.
After applying local anesthesia for the lower right first molar, caries lesion was opened with a round diamond drill with water cooling, the tooth was isolated with a rubber dam, and the modified atraumatic treatment (ARTm) was performed for the removal of caries lesion. Carious tissue at dentin-enamel junction was removed with round steel burs, without water cooling and, on the parapulpal wall, carious dentin was removed with hand instruments. After conditioning the cavity with 10% polyacrylic acid (Dentin conditioner, GC, Tokyo, Japan) for 20 seconds, rinsing the cavity with water and drying it with sterile cotton pellet, the cavity was filled with capsulated GIC EQUIA Forte Fil (GC, Tokyo, Japan). After checking occlusion and articulation, the surface was coated with EQUIA Forte Coat (GC, Tokyo, Japan), which was light-cured with a LED polymerization lamp.
In this clinical case, in a patient with high caries risk and advanced caries lesion on the lower right first molar, the external infected layer of caries lesion was removed using modified ART, in order to preserve the vitality of the pulp. On the inner layer of demineralized dentin, due to the bioactivity of the material and the ability for internal remineralisation, a permanent filling of the microlaminated GIC was placed. At follow-up visit after 6 months, the tooth is asymptomatic and the filling fulfills the aesthetic, functional and biological requirements
Bioactive materials for retrograde filling
No full textEndodontsko liječenje terapijski je postupak kojim tretiramo ireverzibilno promijenjenu pulpu zuba i osiguravamo uvjete za cijeljenje periapikalne lezije. U slučaju neuspjeha primarnog endodontskog liječenja, indicirana je revizija koja se može provoditi na ortogradni nekirurški i retrogradni kirurški način. Kirurška revizija uključuje resekciju vrška korijena s uklanjanjem patološki promijenjenog periapikalnog tkiva, izradu retrogradnog kaviteta i postavljanje materijala za retrogradno punjenje korijenskih kanala. Tijekom godina u kliničku praksu uvedeni su brojni materijali za retrogradno punjenje korijenskog kanala kao što su amalgam, cink-oksid eugenolni cementi, staklenoionomerni cementi, gutaperka, kompozitne smole, a na tržištu se sve više razvijaju bioaktivni materijali za punjenje korijenskih kanala. Pojavili su se sredinom 1990-ih godina s ciljem da nadvladaju ograničenja dotadašnjih materijala, a u endodontskoj kirurgiji bioaktivni materijali koji se koriste za retrogradno punjenje korijenskih kanala su MTA, Biodentine i biokeramika. Bioaktivni materijali ostvaruju kemijsku vezu s tvrdim zubnim tkivima, biokompatibilni su, djeluju antimikrobno, osteokonduktivno i osteoinduktivno, posjeduju sposobnost indukcije dentinogeneze, cementogeneze te regeneracije periapikalnih tkiva.Endodontic treatment is a therapeutic procedure which aims to treat irreversibly altered pulp and provide conditions for the healing of periapical lesions. In case of primary endodontic treatment failure, an endodontic retreatment is indicated, which can be performed as orthograde nonsurgical or retrograde surgical retreatment. Surgical retreatment consists of removing the root apex and the pathologically altered periapical tissue, preparation of the root-end cavity and applying materials for the retrograde filling of root canals. Over the years, a number of materials for retrograde filling of root canals have been introduced into clinical practice, such as amalgam, zinc oxide eugenol cements, glass ionomer cements, gutta-percha and composite resins. Additionally, bioactive materials are increasingly being developed on the market. Bioactive materials appeared in the mid1990s with the aim of overcoming the limitations of earlier used materials. In endodontic surgery, the most commonly used bioactive materials are MTA, Biodentine and bioceramics. Bioactive materials form a chemical bond with hard dental tissues, are biocompatible, have antimicrobial, osteoconductive and osteoinductive effects, and have the ability to induce dentinogenesis, cementogenesis and regeneration of periapical tissues
Fiber reinforced composite bridges- possibilities and limitations
No full textVlaknima ojačani kompozitni materijali sastoje se od vlakana i smolaste organske matrice, a imaju
bolja fizičko–mehanička svojstva u usporedbi s klasičnim kompozitnim materijalima. Svrha ovog
diplomskog rada je prikazati postupak izrade kompozitnog mosta ojačanog vlaknima te opisati
indikacije, mogućnosti i ograničenja spomenutog terapijskog rješenja.
Prikazana su dva klinička slučaja kod kojih je izrađen kompozitni most ojačan staklenim vlaknima
direktnom metodom, u jednoj posjeti. Palatinalna ploha zuba nosača najetkana je ortofosfornom
kiselinom tijekom 60 sekundi, zatim se temeljito isprala vodom i posušila sterilnom vaticom. Nanio
se adheziv G-Premio Bond (GC, Tokio, Japan) te se posvijetlio LED polimerizacijskom lampom
(>500 mW/cm2) 20 sekundi. Na palatinalnoj plohi krune kojom će se nadograditi zub koji
nedostaje napravila se preparacija, zatim je nanesen adheziv i isti je posvijetljen polimerizacijskom
lampom. Odredila se dužina vlakna (everStick C&B, GC, Tokio, Japan). Zatim se postavio tekući
kompozit G-aenial Universal Injectable (GC, Tokio, Japan) na palatinalnu površinu zuba nosača i
u području preparacije na odabranoj kruni zuba. Vlakno se postavilo u područje preparacije na
kruni zuba te je adaptirano prstima na zub nosač uz polimerizaciju lampom. Na kraju se tako
izrađen most ojačan staklenim vlaknima završno oblikovao te su se uklonili prerani kontakti.
Kompozitnim mostovima ojačanim vlaknima moguće je estetski i funkcionalno uspješno
nadoknaditi gubitak zuba u prednjoj ili stražnjoj regiji. Spomenuti radovi mogu poslužiti kao
privremena ili dugotrajna terapijska opcija te su u skladu s filozofijom minimalne intervencije jer
ih je moguće postaviti bez preparacije susjednih zuba ili uz minimalno invazivne preparacije.Fiber - reinforced composite materials consist of fibers and organic matrix, and they have better
physical - mechanical properties compared to conventional composite materials. The purpose of
this thesis is to present the procedure of fabrication of fiber reinforced composite bridges and to
describe the indications, possibilities and limitations of this treatment option.
Two clinical cases were presented with a fiber reinforced composite bridge fabricated using a direct
method, in one visit. The palatal surface of the abutment tooth was etched with orthophosphoric
acid for 60 seconds, then rinsed thoroughly with water and dried with a sterile cotton pellet.. GPremio Bond adhesive (GC, Tokyo, Japan) was applied and polymerized using a LED curing lamp
(> 500 mW / cm2) for 20 seconds. Preparation was performed on the palatal surface of the crown
that would be used to replace the missing tooth, then adhesive was applied o the surface and it
polymerized with a curing lamp. The required length of the fiber (everStick C&B, GC, Tokyo,
Japan) was determined. Afterwards, flowable composite G-aenial Universal Injectable (GC,
Tokyo, Japan) was placed on the palatal surface of the adjacent tooth and in the prepared groove
on the palatal surface of the selected crown. The fiber was placed into the groove of the crown,
adjusted using fingers to the adjacent tooth and polymerized with a curing lamp. In the end, the
fiber reinforced composite bridge was finished and premature contacts were removed.
Fiber-reinforced composite bridges can be used in order to aesthetically and functionally replace a
missing tooth in the anterior or posterior region. These bridges can serve as a temporary or longterm treatment option which is in accordance with the philosophy of minimal intervention because
it is possible to place this bridge without any preparation of adjacent teeth or by performing
minimally invasive preparation
Indikacije i kontraindikacije za endodontsku kirurgiju
No full textSvrha je ovog diplomskog rada sistematično prikazati indikacije i kontraindikacije endodontske kirurgije kako bi se utvrdili svi čimbenici koji utječu na odluku o primjeni kirurškog zahvata kao terapijske opcije za pacijente s endodontskim problemima. Endodontska je kirurgija indicirana za liječenje periapikalnih bolesti endodontskog porijekla u slučaju neuspjeha ortogradnog endodontskog liječenja zuba ili ukoliko ortogradni pristup nije moguć. Zahvati koji se provode u okviru endodontske kirurgije obuhvaćaju inciziju i drenažu, periapikalnu i korektivnu kirurgiju. Periapikalna kirurgija, odnosno apikotomija, najčešće je izvođeni zahvat endododntske kirurgije. Uključuje kirurgiju mekih tkiva, osteotomiju, resekciju vrška korijena, izradu i punjenje retrogradnog kaviteta. Materijal izbora za punjenje retrogradnog kaviteta danas su, zbog svoje biokompatibilnosti i bioaktivnosti, kalcij silikatni cementi. Endodontska je kirurgija indicirana u slučaju perzistentne ili rekurentne infekcije, anatomskih čimbenika, periapikalne patologije, frakture korijena zuba, resorpcije korijena, neodgovarajućeg cijeljenja nakon ortogradnog endodontskog liječenja, prisutnosti stranih tijela te nejasnih dijagnostičkih kriterija. Kontraindikacije mogu biti opće/sistemske i lokalne te uključuju sistemske bolesti koje ometaju ili usporavaju cijeljenje, pacijente na antikoagulantnoj terapiji, alergije na lokalne anestetike ili materijale za punjenje, trudnoću, psihološke čimbenike, lošu kontrolu oralne higijene, nedovoljnu količinu koštanog tkiva, specifičnosti anatomije korijena zuba i susjedne anatomske strukture te otežani kirurški pristup. Uspješnost endodontske kirurgije iznosi 88% do 96%, a ovisi o korištenim tehnikama, instrumentima i spretnosti kliničara. Budućnost endodontske kirurgije donosi napredak u digitalnim tehnologijama, modernom instrumentariju, biokompatibilnim materijalima i regenerativnom pristupu. Takav napredak obećava veću preciznost, učinkovitost i predvidivost endodontske kirurgije, što će rezultirati većom uspješnosti i boljim ishodom liječenja te samim time većim zadovoljstvom pacijenata.The purpose of this thesis is to systematically present the indications and contraindications of endodontic surgery in order to identify all factors influencing the decision to use surgical intervention for patients with endodontic problems. Endodontic surgery is indicated for treating periapical diseases of endodontic origin when orthograde endodontic treatment fails or is not feasible. Procedures include incision and drainage, periapical surgery (apicoectomy), and corrective surgery. Apicoectomy is the most common procedure and involves soft tissue surgery, osteotomy, root apex resection, and preparation and filling of a retrograde cavity. Calcium silicate cements are preferred for retrograde root canal filling due to their biocompatibility and bioactivity. Endodontic surgery is indicated for persistent or recurrent infection, anatomical factors, periapical pathology, root fracture, root resorption, inadequate healing after orthograde endodontic treatment, presence of foreign bodies, and unclear diagnostic criteria. Contraindications include systemic diseases that hinder or slow down healing, patients on anticoagulant therapy, allergies to anesthetics or retrograde root canal filling materials, pregnancy, psychological factors, poor oral hygiene, insufficient bone tissue, specific root anatomy and adjacent structures, and restricted surgical access. The success rate of endodontic surgery ranges from 88% to 96%, depending on techniques, instruments, and skills of the clinician. The future of endodontic surgery includes advances in digital technologies, modern instruments, biocompatible materials, and regenerative approaches, promising greater precision, efficiency, and predictability. These advancements are expected to result in higher success rates, better treatment outcomes, and increased patient satisfaction
Efficiency of a novel laser-activated irrigation in retreatment of bioactive root canal sealer
No full textSvrha istraživanja bila je mikro CT analizom ispitati učinkovitost nove SWEEPS tehnike laserski
aktiviranog ispiranja u uklanjanju punjenja korijenskih kanala nakon revizije endodontskog
punjenja. Korijeni 76 humanih zubi nasumično su podijeljeni u četiri skupine (n = 19) ovisno o
vrsti punila (epoksi smola i gutaperka, biokeramičko punilo i biokeramičke gutaperke) i tehnici
punjenja (hladna ili termoplastična tehnika). Tehnika jedne gutaperke korištena je kao izabrana
tehnika punjenja za dvije skupine: u jednoj skupini, korijenski kanali punjeni su kombinacijom
gutaperke i AH Plus punila, dok je druga skupina punjena u kombinaciji TotalFill punilom i
TotalFill gutaperkom. U skupinama punjenim termoplastičnom tehnikom s nosačem korištena je u
jednoj skupini kombinacija AH Plus i Guttafusion gutaperki za punjenje kanala, a u drugoj skupini
MTA Filaplex i Gutafussion gutaperki. Punjenje u korijenskim kanalima je zaštićeno
postavljanjem kapsuliranog SIC ispuna te su uzorci pohranjeni na tjedan dana u fiziološku otopinu
kako bi se omogućilo stvrdnjavanje materijala. Nad svim uzorcima provedena je revizija
endodontskog punjenja Reciproc instrumentima R25. Nakon revizije, korijenski kanali dodatno su
tretirani auto SWEEPS protokolom. Razlika u volumenu zaostalog punila analizirana je pomoću
mikro CTa. Uzorci su skenirani nakon inicijalnog punjenja, nakon revizije Reciproc instrumentom
i nakon dodatnog tretmana SWEEPSom. Statistička analiza razlike u volumenu provedena je
analizom varijance (ANOVA) (p < 0,05). Rezultati istraživanja pokazuju kako dodatni tretman
SWEEPSom značajno smanjuje volumen zaostalog punila u svim skupinama u usporedbi sa
skupinama koje su tretirane isključivo Reciproc instrumentom; iako punilo u potpunosti nije
uklonjeno ni u jednoj skupini. Iz ovog istraživanja može se zaključiti kako SWEEPS modalitet
povećava učinkovitost u uklanjanju zaostalog punila na bazi epoksi smole i biokeramičkog punila
punjenog tehnikom jedne gutaperki i termoplastičnom tehnikom s nosačem.The main reason for endodontic failure is the persistence or regrowth of microorganisms that have
a high affinity for root canal filling materials and sealers, especially guttapercha. The reasons for
these microbial issues range from inadequate control of aseptic conditions and overlooked root
canals to improper instrumentation and complications during root canal treatment occurring in the
form of perforations, broken instruments, short or overextended root canal fillings, and
microleakage of temporary or longterm restorations. Endodontic failure may require either
nonsurgical or surgical retreatment, where nonsurgical root canal retreatment is the preferred
option whenever possible. Proper retreatment can be challenging and timeconsuming; however,
removing the old root canal filling is essential as it acts as a mechanical barrier to the irrigating
solution used in the retreatment process. Depending on their chemical composition, sealers can be
classified as either zincoxide eugenol, epoxy resin, silicon, calcium hydroxide, glass ionomer,
methacrylate resin, or calcium silicate types. In 2007, bioceramic sealers were introduced as a new
sealer type. The chemical reaction of bioceramic sealers utilizes the moisture in dentine tubules to
form a calcium silicate hydrate gel and portlandite, which reacts with the moisture in dentine
tubules forming calcium silicate hydrate gel and portlandite. The result is a taglike structure
providing adhesion of bioceramic materials to the root canal dentine. This interaction facilitates
successful sealing, but it may also hinder the complete removal of the root canal filling if
retreatment is needed. Different techniques have also been developed to improve the sealing of the
endodontic space. Single cone and carrierbased techniques have been developed to offer a possible
solution to cold lateral compaction where vertical fractures can occur due to forces applied during
obturation. Both techniques are usually used after root canal instrumentation with NiTi enginedriven files, and both techniques have several advantages, including simplicity and small time
expenditures, while also eliminating the requirement for accessory cones or time spent on lateral
condensation. A recently introduced obturation technique is GuttaFussion (VDW, Munich,
Germany). It consists of a plastic core coated with crosslinked thermoset guttapercha that does
not melt at the temperatures generated by the special oven.
Irrigation after mechanical debridement is a crucial step in the retreatment process and has been
improved by introducing various irrigation activation techniques. The philosophy behind this
approach is that increasing the turbulence of the irrigating solution improves the debridement of
the root canal system and thereby improves the penetration of the fluid to enhance antibacterial
action. The use of lasers has been shown to achieve a similar effect. Laseractivated irrigation (LAI)
is based on the creation of intracanal cavitation as a result of photoacoustic and photomechanical
effects. This effect is linked to the absorption of the energy emitted by erbium lasers, as it agitates
the waterbased solutions in the intracanal space. More recently, Er:YAG laser modality, SWEEPS
(Shock Wave Enhanced Emission Photoacoustic Streaming), was launched to improve the cleaning
and disinfecting efficacy of LAI. However, to date, little information is available regarding the
effectiveness of removing root canal filling material during retreatment using SWEEPS. The
available literature contains no research on the effectiveness of SWEEPS in removing epoxy resin–
based and bioceramic sealers in combination with single cone and corecarrier obturation
techniques. Therefore, the present study aimed to use microcomputed tomography (microCT)
analysis to evaluate the efficacy of shock wave–enhanced emission photoacoustic streaming
(SWEEPS) in the retreatment of epoxy resinbased and bioceramic sealers used in combination
with singlecone and carrierbased obturation techniques.
Methodology:
This study included 76 singlerooted extracted human teeth with single canals, and intact and
mature root apices were selected. After removing the contaminated tissue on the outer specimen
surfaces, the working length of each root canal was determined by inserting a size #15 K file. The
crowns were sectioned using a watercooled diamond drill to obtain roots with a standardized
length of 17 mm. The root canals were instrumented using a size R25 Reciproc instrument and a
VDW Gold endo motor according to the manufacturer’s instructions. During instrumentation, the
canals were irrigated with 2.5% NaOCl solution using a 27gauge needle and a 2 mL syringe. The
smear layer was removed by rinsing the root canals with 2 mL of 17% EDTA for 1 min, followed
by a final rinse with saline solution. The canals were dried using size R25 Reciproc paper points.
All specimens were randomly divided into four experimental groups according to the root canal
obturation technique and the type of root canal sealer. For one of the singlecone groups (n = 19),
a Reciproc R25 guttapercha cone was dipped into the AH Plus sealer and then placed slowly, in
an upanddown motion, until it reached the entire working length. For the other singlecone group
(n=19), a combination of bioceramic guttapercha and bioceramic sealer was used for root canal
filling. The TotalFill BC sealer was syringed into the canal, and TotalFill guttapercha was placed
in the canal up to the working length. The coronal excess of the master cone was cut to the coronal
orifice using a flameheated hand plugger. For one corecarrier group (n = 19), the root canal walls
were coated with AH Plus sealer using a size #25 reamer in a counterclockwise motion. For the
other corecarrier group (n = 19), MTA Fillapex sealer was used to coat the root canal walls.
Guttafusion R25 was heated in a special oven during the coating of the canal with the root canal
sealer. The heated guttapercha was then slowly inserted to the working length without twisting or
forcing. The excess material in the canal orifice was then extruded by bending the corecarrier to
the right and left until separation took place, and the core material was condensed with a plugger
by the same researcher. The access cavity in all specimens was sealed with glass ionomer cement.
All specimens were stored at 37°C for one week to allow sufficient time for the sealer to set. After
one week and complete setting of the sealer, the root canal retreatments were performed on all
specimens (n = 76) using R25 Reciproc instruments in a VDW Gold endo motor according to the
manufacturer’s instructions, without the use of any solvent. The root canals were rinsed with 2 mL
of 2.5% NaOCl solution. The criteria for the completion of the retreatment procedure were smooth
canal walls and no presence of root canal filling material on the Reciproc instruments. At the end
of the retreatment procedure, root canals were rinsed with 2 mL of 17% EDTA for 1 min, followed
by a final rinse with saline solution. The canals were then dried using size R25 Reciproc paper
points. Auto SWEEPS protocol (50 μs, 15 Hz, 20 mJ, and 0.3 W) was performed for LAI using an
Er:YAG laser with a 2940 nm wavelength. The pulp chamber was reconstructed using
thermoplastic materials and served as a reservoir for the irrigation solution. The tip was submerged
in saline and hovered above the orifice in the cervical region rather than inserting the tip into the
canal. After retreatment using Reciproc instruments and additional SWEEPS treatment using
microCT, each tooth was scanned after root canal filling. Once scanning was done, the images
were reconstructed to determine the residual volume of the sealer. The results for the volumes of
root canal filling after retreatment with the Reciproc instruments and the additional use of SWEEPS
were subjected to linear transformation to remove the influence of the initial root canal filling
volume. The differences between the four experimental groups were tested using analysis of
variance.
Results and discussion:
The volume of root canal filling materials decreased significantly in all four experimental groups
after retreatment with Reciproc instruments (p<0,05), however, none of the teeth showed complete
removal of the root canal filling materials. No statistically significant difference was observed
between the groups regarding the volume of root canal filling remnants after retreatment only with
Reciproc instruments (p > 0,05). Additional treatment with SWEEPS significantly reduced the
volume of root canal materials in all experimental groups compared to retreatment with Reciproc
instruments alone (p < 0,05). However, none of the teeth, even with the SWEEPS treatment,
showed complete removal of the material from the root canal. Statistical analysis of the
effectiveness of SWEEPS according to the root canal filling technique or the root canal filling
materials revealed a statistically significant difference for the singlecone group treated with the
combination of AH Plus and guttapercha, given that a higher volume of root canal filling remnants
was observed in that group than in the other groups (p < 0,001). The findings of this study also
reveal a more effective removal of a combination of bioceramic sealer and bioceramic guttapercha
than of the combination of epoxy resinbased sealer and guttapercha after SWEEPS treatment of
root canals obturated using the singlecone technique. Comparing the effectiveness of SWEEPS in
the corecarrier groups did not show any statistically significant difference between the AH Plus
and the bioceramic sealers. A comparison of AH sealer used with corecarrier and single cone
techniques revealed a smaller residual volume in the core carrier after retreatment with SWEEPS.
The groups treated with the bioceramic sealer combined with different obturation techniques
showed no statistically significant differences in the root canal filling after SWEEPS treatment (p
> 0,05). The results of this study show that the root canal filling materials were not completely
removed from the root canal walls in any of the samples, regardless of the retreatment technique
or irrigant agitation using SWEEPS.
Conclusion:
The results of this in vitro study indicated that none of the materials were completely removed from
the root canal after an additional SWEEPS treatment. However, SWEEPS can be used to enhance
the removal of both epoxy resinbased and bioceramic sealers in combination with singlecone and
carrierbased obturation techniques. This information may be important for clinical use, given that
reducing the root canal filling remnants to a minimum may be beneficial for the success of
endodontic retreatment
Direct restorations of front teeth
No full textSvrha ovog rada je prikazati na kliničkom slučaju izradu direktnih restauracija na zubima u prednjoj regiji. Pacijent muškog spola u dobi od 25 godina dolazi na Zavod za endodonciju i restaurativnu dentalnu medicinu Stomatološkog fakulteta Sveučilišta u Zagrebu zbog traumatske ozljede uslijed pada i nekomplicirane frakture na gornjim desnim sjekutićima. S obzirom na to da se ne radi o opsežnom gubitku tvrdog zubnog tkiva, kao odgovarajuća terapija odabrana je direktna restauracija kompozitnim materijalima čime je omogućen minimalno invazivan pristup uz dobivanje zadovoljavajuće estetike i funkcije. U prikazanom slučaju korištene su različite boje kompozitnih materijala: caklinska boja za izradu palatinalne stijenke, dentinska boja za izradu dentinskih jezgri te standardna boje za izradu aproksimalnih i labijalnih stijenki. Zahvaljujući tehnici slojevitog nanošenja kompozitnog materijala, krajnji rezultat prikazanog kliničkog slučaja su prirodan oblik i boja restauriranih zuba te zadovoljan pacijent.The aim of this thesis is to present a clinical case in order to demonstrate placement of direct restoration on teeth in the anterior region. A 25-year-old male patient was admitted to the Department of Endodontics and Restorative Dentistry at the School of Dental Medicine of the University of Zagreb because of a traumatic injury caused by falling and uncomplicated
fractures of the upper incisors. Given that it was not an extensive loss of hard dental tissue, direct restoration using composite materials, which enables a minimally invasive approach while obtaining satisfactory aesthetics and function, was chosen as the appropriate therapy. In the presented case, different colours of composite materials were used: enamel colour for the
palatal wall, dentin colour for mamelons, and standard colours for the proximal and labial walls. Due to layering of the composite material, the end result of the presented clinical case was a natural shape and colour of the restored teeth and a satisfied patient
Direct and indirect restorations of endodontically treated teeth
Get PDFRestauracija endodontski liječenih zuba i dalje predstavlja izazov. Uspjeh terapije i preživljavanje zuba najviše ovisi o kvaliteti restauracije. Kod izbora vrste restauracije glavni čimbenik trebala bi biti količina preostalog zubnog tkiva.
Direktne restauracije uglavnom su jednostavnije. Potreban je jedan posjet liječniku i jeftinije su za pacijenta. Indirektne restauracije imaju bolja fizičko-mehanička svojstva te, za razliku od direktnih restauracija, polimerizacijsko skupljanje kompozita ne dovodi do razvoja stresa na stijenkama kaviteta.
U ovom radu prikazana su tri klinička slučaja izrade restauracija kod endodontski liječenih zuba. U prvom slučaju prikazana je izrada direktnog kompozitnog ispuna s dentinskom jezgrom od kompozita ojačanog vlakima kako bi se ojačala preostala struktura zuba te spriječio lom krune i/ili korijena koji bi mogao dovesti do gubitka zuba. Drugi slučaj prikaz je otvorene “sandwich” tehnike za koju su korišteni kombinacija staklenoionomernog cementa i kompozita. Otvorena “sandwich” tehnika korištena je zbog subgingivnog smještaja ruba preparacije, tj. zbog nemogućnosti osiguravanja suhog radnog polja. Treći slučaj prikazuje izradu kompozitnih mostova na distalnim zubima te nadogradnju prednjih zuba. Kompozitni mostovi ojačani su staklenim vlaknima te im je jezgra izraĎena od kompozita ojačanog vlaknima kako bi im se poboljšala fizičko-mehanička svojstva.
Razvoj materijala i nove spoznaje o svojstvima endodontski liječenih zuba otvaraju nove mogućnosti u restauraciji endodontski liječenih zuba. U prikazanim kliničkim slučajevima odabrani su materijali i tehnike za izradu direktnih i indirektnih restauracija kako bi se osigurali uspjeh i dugotrajnost restauracija te preživljavanje endodontski liječenih zuba.The restoration of endodontically treated tooth still remains a challenge. The success of therapy and tooth survival depend primarily on the quality of restoration. The most important factor for choosing the type of restoration should be the quantity of the remaining tooth structure.
Direct restorations are more easily made, only one visit is required and they are cheaper for the patient. Indirect restorations have better physico-mechanical properties, and, in comparison to direct restorations, polymerization shrinkage of composites does not produce stress on cavity walls.
In this case report, three clinical cases of restoring endodontically treated teeth are shown. In the first case, a direct composite restoration with fiber reinforced composite core is shown. The fiber reinforced composite was used to reinforce the remaining tooth structure and reduce the possibility of crown and/or root fracture, that could lead to tooth loss. In the second case, open “sandwich” technique is shown, where a combination of glass ionomer cement and composite is used. Open “sandwich” technique is used, because preparation of the cavity was under gingival margin and dry working field could not be ensured. In the third case, composite bridges in the posterior region and a restoration of the frontal teeth are shown. The composite bridges are fiber reinforced and their base is made from fiber reinforced composite to enhance their physico-mechanical properties.
Development of materials and new findings about properties of endodontically treated teeth open up new possibilities for restoration of endodontically treated teeth. In the presented clinical cases, materials and techniques were used for direct and indirect restorations in order to ensure the success and longevity of the restoration as well as the survival of endodontically treated teeth
How to prevent complications and errors during endodontic treatment
No full textPrimarni cilj endodontskog liječenja je sačuvati zub kao funkcijsku jedinicu. Iako je terapija
korijenskih kanala uglavnom rutinska, zbog nepredvidivih okolnosti ili nedovoljnog opreza
kliničara mogu nastati određene pogreške i komplikacije. Svrha ovog rada je pregledno opisati
moguće pogreške i komplikacije tijekom endodontskog liječenja, načine kako iste spriječiti, a
ukoliko ipak dođe do pogreške i komplikacije, opisat će se mogućnosti njihovog liječenja i
utjecaj istih na ishod terapije. Pogreške i komplikacije endodontskog liječenja mogu se
podijeliti na pogreške vezane za izradu trepanacijskog kaviteta, pogreške tijekom
instrumentacije korijenskih kanala, pogreške tijekom irigacije korijenskih kanala i pogreške
tijekom punjenja korijenskih kanala. U ostale pogreške spadaju terapija pogrešnog zuba,
gutanje ili udisanje instrumenta, parestezija živca, neodgovarajuće koronarno brtvljenje te
nezgode prilikom preparacije ležišta za intrakanalne kolčiće. Prije svega, važno je potencijalne
pogreške prevenirati, a ukoliko nastanu znati ih prepoznati, kako bi se mogle sanirati na
odgovarajući način i kako bi se procijenio njihov utjecaj na dugoročno preživljenje zuba. Prvi
izbor za zbrinjavanje pogreški je nekirurška metoda, a ako ona nije dovoljna, potreban je
kirurški pristup. Dobrim poznavanjem anatomije zuba i morfologije endodontskog prostora te
pridržavanjem svih pravila dijagnostike i plana terapije većina pogreški i komplikacija se može
izbjeći te se time poveća vjerojatnost pozitivnog ishoda i uspjeha endodontskog liječenjaThe primary goal of endodontic treatment is to preserve the tooth as a functional unit. Although
root canal therapy is mostly routine, certain mishaps and complications can occur due to
unpredictable circumstances or insufficient caution of the clinician. This thesis aims to describe
possible mishaps and complications during endodontic treatment, ways to prevent them, and if
mishaps and complications do occur, the possibilities of their treatment and their influence on
the outcome of therapy. Errors and complications of endodontic treatment can be classified into
mishaps related to access cavity preparation, mishaps during root canal instrumentation,
mishaps during root canal irrigation, and errors during root canal filling. Other mishaps include
therapy of the wrong tooth, foreign body ingestion or aspiration, nerve paresthesia, inadequate
coronary sealing, and mishaps related to preparation for intracanal posts. Above all, it is
important to prevent potential mishaps, and if they do occur, to know how to recognize them,
so that they can be treated appropriately and that their impact on the longterm survival of the
tooth can be assessed. The first choice for dealing with mishaps is a nonsurgical method, and
if that is not sufficient, a surgical approach is required. By having good knowledge of the
anatomy of the tooth and the morphology of the endodontic space, and by following all the
rules of diagnosis and the treatment plan, most mishaps and complications can be avoided,
thereby increasing the probability of a positive outcome and success of endodontic treatment
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