Root canal irrigants.

Regenerative endodontics: a review of current status and a call for action.

The hard tissue repository of the human dental pulp takes on numerous configurations and shapes. A thorough knowledge of tooth morphology, careful interpretation of angled radiographs, proper access preparation and a detailed exploration of the interior of the tooth are essential prerequisites for a successful treatment outcome. Magnification and illumination are aids that must be utilized to achieve this goal. This article describes and illustrates tooth morphology and discusses its relationship to endodontic procedures. A thorough understanding of the complexity of the root canal system is essential for understanding the principles and problems of shaping and cleaning, for determining the apical limits and dimensions of canal preparations, and for performing successful microsurgical procedures.

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Root canal morphology and its relationship to endodontic procedures

Ultrasonic irrigation of the root canal can be performed with or without simultaneous ultrasonic instrumentation. When canal shaping is not undertaken the term passive ultrasonic irrigation (PUI) can be used to describe the technique. In this paper the relevant literature on PUI is reviewed from a MEDLINE database search. Passive ultrasonic irrigation can be performed with a small file or smooth wire (size 10-20) oscillating freely in the root canal to induce powerful acoustic microstreaming. PUI can be an important supplement for cleaning the root canal system and, compared with traditional syringe irrigation, it removes more organic tissue, planktonic bacteria and dentine debris from the root canal. PUI is more efficient in cleaning canals than ultrasonic irrigation with simultaneous ultrasonic instrumentation. PUI can be effective in curved canals and a smooth wire can be as effective as a cutting K-file. The taper and the diameter of the root canal were found to be important parameters in determining the efficacies of dentine debris removal. Irrigation with sodium hypochlorite is more effective than with water and ultrasonic irrigation is more effective than sonic irrigation in the removal of dentine debris from the root canal. The role of cavitation during PUI remains inconclusive. No detailed information is available on the influence of the irrigation time, the volume of the irrigant, the penetration depth of the instrument and the shape and material properties of the instrument. The influence of irrigation frequency and intensity on the streaming pattern as well as the complicated interaction of acoustic streaming with the adherent biofilm needs to be clarified to reveal the underlying physical mechanisms of PUI.

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Passive ultrasonic irrigation of the root canal: a review of the literature.

Evaluation of the root canal configurations of the mandibular and maxillary permanent teeth by gender in the Turkish population.

Root canal morphology of human permanent teeth in a Turkish population.

Summary
When the root canals are instrumented during endodontic therapy, a layer of material composed of dentine, remnants of pulp tissue and odontoblastic processes, and sometimes bacteria, is always formed on the canal walls. This layer has been called the smear layer. It has an amorphous, irregular and granular appearance under the scanning electron microscope. The advantages and disadvantages of the prescence of smear layer, and whether it should be removed or not from the instrumented root canals, are still controversial. It has been shown that this layer is not a complete barrier to bacteria and if delays but does not abolish the action of endodontic disinfectants. Endodontic smear layer also acts as a physical barrier interfering with adhesion and penetration of sealers into dentinal tubules. In turn, it may affect the sealing efficiency of root canal obturation. When it is not removed, the durability of the apical and coronal seal should be evaluated over a long period. If smear layer is to be removed, EDTA and NaOCI solutions have been shown to be effective, among various irrigation solutions and techniques, including ultrasonics, that have been tested. Once this layer is removed, it should be borne in mind that there is a risk of reinfecting dentinal tubules if the seal fails. Further studies are needed to establish the clinical importance of the absence or presence of smear layer.

The smear layer: a phenomenon in root canal therapy.

The purpose of this study was to comparatively investigate the effect of antioxidant treatment and delayed bonding after bleaching with three different concentrations of carbamide peroxide (CP) on the shear bond strength of composite resin to enamel. One hundred flat buccal enamel surfaces obtained from bovine incisors were divided into three bleaching groups of 10, 16 and 22% CP (n = 30) and a control group. Each bleaching group was then divided into three subgroups (n = 10). Group 1 consisted of specimens bonded immediately after bleaching. Group 2 specimens were treated with antioxidant agent, 10% sodium ascorbate, while Group 3 specimens were immersed in artificial saliva for 1 week after bleaching. Specimens in the control group were not bleached. After the specimens were bonded with Clearfil SE Bond and Clearfil AP-X, they were thermocycled and tested in shear until failure. Fracture analysis of the bonded enamel surface was performed using scanning electron microscope. The shear bond strength data was subjected to one-way analysis of variance followed by Duncan's multiple range test at a significance level of P < 0.05. Shear bond strength of composite resin to enamel that was bonded immediately after bleaching with 10, 16 and 22% CP was significantly lower than that of unbleached enamel (P < 0.05). For all three bleaching groups, when the antioxidant-treated and delayed bonding (1 week) subgroups were compared with the control group, no statistically significant differences in shear bond strength were noted (P < 0.05).

Effect of 10% sodium ascorbate on the shear bond strength of composite resin to bleached bovine enamel.

Proper finishing of restorations is desirable not only for aesthetic considerations but also for oral health. The primary goal of finishing is to obtain a restoration that has good contour, occlusion, healthy embrasure forms and a smooth surface. This study investigated: 1) analyzing the surface roughness of three resin composites finished and polished with a new one-step and two conventional multi-step polishing systems and 2) evaluating the effectiveness of one-step polishing system and surface morphology using scanning electron microscope analysis (SEM). Specimens (N = 72) measuring 8-mm in diameter x 2-mm in thickness were fabricated in a plexiglass mold covered with a Mylar strip using three esthetic resin composites. After polymerization six specimens per resin composite received no finishing treatment and served as a control. Fifty-four specimens were randomly polished with Sof-Lex discs, Enhance disc with polishing paste or PoGo for 30 seconds after being ground wet with a 1200 grit silicon carbide paper. The average surface roughness of each polished specimen was determined with a profilometer (Surtronic 4). The data were analyzed using repeated measures ANOVA and Scheffe's post-hoc test of multiple comparisons (p or = 0.01). Among all the polishing systems tested, PoGo exhibited the smoothest finish for all resin composites. The combination of Enhance and Prisma Gloss polishing paste exhibited the highest roughness values for Filtek A110 and Clearfil ST; however, it gave the same Ra values as PoGo for Esthet-X (p < or = 0.01). SEM analysis of Esthet-X samples confirmed the profilometer's results. The surfaces of the Clearfil ST discs polished with PoGo resemble that of Mylar, while Enhance and Sof-Lex exposed and dislodged the filler particles. PoGo scratched in some places Filtek A110's surface, while Enhance produced mostly a Mylar-like surface with dislodged fillers in some places.

Murat Türkün

Papers

Root canal morphology of human permanent teeth in a Turkish population.

The smear layer: a phenomenon in root canal therapy.

Effect of 10% sodium ascorbate on the shear bond strength of composite resin to bleached bovine enamel.

The effect of one-step polishing system on the surface roughness of three esthetic resin composite materials.

Effect of an antioxidizing agent on the shear bond strength of brackets bonded to bleached human enamel.