Periradicular Surgery of Human Permanent Teeth with Calcium-Enriched Mixture Cement Evaluation of Marginal Adaptation of Root-End Filling Materials Using Scanning Electron Microscopy Endodontic surgery using 2 different magnification devices: preliminary results of a randomized controlled study. Periradicular regeneration after endodontic surgery with calcium-enriched mixture cement in dogs. Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite. A Randomized Controlled Study of Mineral Trioxide Aggregate and Super Ethoxybenzoic Acid as Root-end Filling Materials in Endodontic Microsurgery: Long-term Outcomes. Push-out bond strength of two root-end filling materials in root-end cavities prepared by Er,Cr:YSGG laser or ultrasonic technique. An ex-vivo comparative study of root-end marginal adaptation using grey mineral trioxide aggregate, white mineral trioxide aggregate, and Portland cement under scanning electron microscopy Comparison of Mineral Trioxide Aggregate and iRoot BP Plus Root Repair Material as Root‐end Filling Materials in Endodontic Microsurgery: A Prospective Randomized Controlled Study Hemostatic efficacy and cardiovascular effects of agents used during endodontic surgery. A prospective randomized controlled study of mineral trioxide aggregate and super ethoxy-benzoic acid as root-end filling materials in endodontic microsurgery. A prospective clinical study of Mineral Trioxide Aggregate and IRM when used as root-end filling materials in endodontic surgery. Effect of ultrasonic tip and root-end filling material on bond strength Assessment of hemostatic efficacy and osseous wound healing using HemCon dental dressing. Evaluation of the bond strength of root-end placed mineral trioxide aggregate and Biodentine in the absence/presence of blood contamination Super-EBA and IRM as root-end fillings in periapical surgery with ultrasonic preparation: a prospective randomized clinical study of 206 consecutive teeth. Dentine-bonded resin composite (Retroplast) for root-end filling: a prospective clinical and radiographic study with a mean follow-up period of 8 years. Periapical surgery using ultrasonic preparation and thermoplasticized gutta-percha with AH Plus sealer or IRM as retrograde root-end fillings in 160 consecutive teeth: a prospective randomized clinical study. Effect of dentinal tubules and resin-based endodontic sealers on fracture properties of root dentin. A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery. Evaluation of a mixture of zinc oxide, calcium hydroxide, and sodium fluoride as a new root canal filling material for primary teeth. Fracture resistance of roots endodontically treated with a new resin filling material. Investigation of the marginal adaptation of root-end filling materials in root-end cavities prepared with ultrasonic tips.
Introduction Root-end preparation and restoration with an endodontic material are required when nonsurgical endodontic retreatment has failed or is impossible . The present clinical study reports the treatment outcomes of periradicular surgery using calcium-enriched mixture ( CEM ) cement . Material s and Methods A prospect i ve outcome study of periradicular surgery using CEM was conducted on 14 permanent teeth with persistent apical periodontitis . Using a st and ardized surgical protocol , 2 - 3 mm of the root apex was resected ; approximately 3 mm deep root-end cavities were ultrasonically prepared and filled with CEM cement .  All patients were available for recall . Results Clinical and radiographic examination revealed complete healing of periradicular lesions , i.e. regeneration of periodontal ligament and lamina dura in 13 teeth ( 93 % success ) during a mean time of 18 months ; moreover , the teeth were functional and asymptomatic . Conclusion Favorable treatment outcomes in this prospect i ve clinical study suggested that CEM cement may be a suitable root-end filling bio material Introduction The importance of perfect apical seal in endodontics , more specifically in periradicular surgery , is the motivation/reason for development of root-end filling material s with favorable physical , chemical and biological characteristics . The aim of this in vitro study was to evaluate the marginal adaptation of root-end filling material s using scanning electron microscopy . Material s and Methods Twenty five human maxillary anterior teeth were prepared using a K-File # 50 to 1 mm short of the apical foramen and filled with gutta-percha and Sealapex using the lateral compaction technique . The apical 3 mm of the roots were sectioned perpendicularly to the long axis of the teeth . A 3-mm-deep root-end cavity was prepared using ultrasonic tips powered by an Enac ultrasonic unit . The teeth were r and omly assigned to five groups according to the material s tested including IRM , amalgam , ProRoot MTA , Super-EBA and Epiphany/Resilon . Root-end cavities were filled with the material s prepared according to the manufacturers ’ instructions . The root apices were carefully prepared for sputter coating and later evaluation using Scanning Electron Microscope ( SEM ) . The images of root-end fillings were divided into four quadrants and distributed into five categories according to the level of marginal adaptation between the root-end material and the root canal walls . The Fisher exact test with Bonferroni correction was used for statistical analysis . The level of significance was set at P = 0.005 . Results SEM images showed the presence of gaps in the root-end filling material s. No significant difference was observed between the tested material s ( P > 0.005 ) . Conclusion ProRoot MTA , IRM , amalgam , Super-EBA and Epiphany/Resilon showed similar marginal adaptation as root-end filling material PURPOSE The introduction of microsurgical instruments and magnification devices has brought advantages in root-end management and the application of root-end filling material s. The main purpose of this prospect i ve clinical study was to monitor the outcome of ultrasonic root-end preparation using magnification loupes or an endoscope . Tooth location and the presence of post restoration were also examined as potentially affecting the outcome . MATERIAL S AND METHODS Teeth treated surgically showed a periradicular lesion of strictly endodontic origin . A total of 59 patients were included in the study , according to specific selection criteria . Following the reflection of a full mucoperiosteal tissue flap , residual soft tissues were curetted , root ends were resected , and root-end cavities were prepared ultrasonically with a zirconium nitrate tip , and zinc oxide EBA-reinforced cement root-end fillings were placed . Thirty-two root-end management procedures were performed using magnification loupes and 39 using an endoscope . All cases followed for a period of 1 year were classified into 3 groups ( success , uncertain healing , and failure ) according to radiographic and clinical criteria . RESULTS Of the 71 teeth evaluated at 1-year follow-up , 67 teeth ( 92.95 % ) successfully healed , 3 teeth had uncertain healing , and 2 failed . In the group using endoscopy , 94.9 % of successful healing was achieved , while for the other group , 90.6 % was recorded . We found no statistically significant differences in treatment results related to the arch ( P = .20 ) , post restoration ( P = .21 ) , or type of magnification device ( P = .08 ) . CONCLUSIONS In the present study , adherence to a strict endodontic surgical protocol and the use of modern surgical endodontic procedures , together with visual magnifications , result ed in an overall high success rate INTRODUCTION The aim of this in vivo study was to compare the response of periradicular tissues to mineral trioxide aggregate ( MTA ) and calcium-enriched mixture ( CEM ) cement as root-end fillings and to analyze hard tissue healing after periradicular surgery . METHODS Intentional periradicular lesions were induced in 32 premolar teeth in 4 beagle dogs . The root canals were prepared , dried , and obturated with laterally condensed gutta-percha with sealer , and the coronal access cavities were filled with amalgam . After surgical exposure of the apices , 2 - 3 mm of the apical root was resected , and root-end cavities were ultrasonically prepared . The root-end cavities were r and omly filled with MTA or CEM cement . After 2 months , the animals were killed ; tissue blocks were removed and prepared for histologic examination . Hard tissue healing including cementum and new bone formation in addition to concentration and extent of inflammation were evaluated . RESULTS Eight sample s were excluded . The major finding was the cementum deposition adjacent to MTA in 11 of 12 sample s and CEM cement in 10 of 12 sample s. With one-way analysis of variance , no significant difference was observed between the periradicular tissue response to tested material s. CONCLUSIONS CEM cement and MTA were associated with regenerative periapical tissue response when used as root-end filling bio material INTRODUCTION The aim of apical surgery is to hermetically seal the root canal system after root-end resection , thereby enabling periradicular healing . The objective of this nonr and omized prospect i ve clinical study was to report results of 2 different root-end preparation and filling methods , ie , mineral trioxide aggregate ( MTA ) and an adhesive resin composite ( Retroplast ) . METHODS The study included 353 consecutive cases with endodontic lesions limited to the periapical area . Root-end cavities were prepared with sonic microtips and filled with MTA ( n = 178 ) , or alternatively , a shallow concavity was prepared in the cut root face , with subsequent placement of an adhesive resin composite ( Retroplast ) ( n = 175 ) . Patients were recalled after 1 year . Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete ( scar tissue ) healing of previous radiolucencies . RESULTS The overall rate of healed cases was 85.5 % . MTA-treated teeth demonstrated a significantly ( P = .003 ) higher rate of healed cases ( 91.3 % ) compared with Retroplast-treated teeth ( 79.5 % ) . Within the MTA group , 89.5%-100 % of cases were classified as healed , depending on the type of treated tooth . In contrast , more variable rates ranging from 66.7%-100 % were found in the Retroplast group . In particular , m and ibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast . CONCLUSIONS MTA can be recommended for root-end filling in apical surgery , irrespective of the type of treated tooth . Retroplast should be used with caution for root-end sealing in apical surgery of m and ibular premolars and molars INTRODUCTION The purpose of the present study was to evaluate the long-term clinical outcome of endodontic microsurgery when mineral trioxide aggregate ( MTA ) and super ethoxybenzoic acid ( Super EBA ; Harry J. Bosworth , Skokie , IL ) were used as root-end filling material s. Additionally , this study aim ed to compare the clinical outcome of endodontic microsurgery at the 1-year follow-up with that at the 4-year follow-up . METHODS Two hundred sixty teeth were r and omly assigned to either the MTA or Super EBA group in equal numbers using the minimization method . Endodontic microsurgery was performed according to the Yonsei protocol . The previous study of 192 teeth examined at the 1-year follow-up revealed a success rate of 95.6 % for MTA and 93.1 % for Super EBA . Patients were recalled 4 years after surgery , and treated teeth were classified as successes or failures with Molven 's criteria . The Pearson chi-square test and the McNemar test were conducted to analyze and compare the success rates . RESULTS A total of 182 teeth were examined at the 4-year follow-up . The success rate was 91.6 % for MTA and 89.9 % for Super EBA . Statistical analysis of the success rate did not show any significant difference between the 2 material s ( P = .8 ) . The overall success rate at the 4-year follow-up was 89.5 % , which was slightly lower compared with 94.3 % at the 1-year follow-up . However , there was no significant difference between the follow-up periods ( P = .063 ) . CONCLUSIONS This study identified no significant difference in the 4-year success rates of MTA and Super EBA as root-end filling material s in endodontic microsurgery . Additionally , compared with short-term outcomes , long-term follow-up outcomes were not significantly different This study compared the push-out bond strength of mineral trioxide aggregate ( MTA ) and a new endodontic cement ( NEC ) as root-end filling material s in root-end cavities prepared by ultrasonic technique ( US ) or Er , Cr : YSGG laser ( L ) .  Eighty single-rooted extracted human teeth were endodontically treated , apicectomised and r and omly divided into four following groups ( n = 20 ) : US/MTA , US/NEC , L/MTA and L/NEC . In US/MTA and US/NEC groups , root-end cavities were prepared with ultrasonic retrotip and filled with MTA and NEC , respectively . In L/MTA and L/NEC groups , root-end cavities were prepared using Er , Cr : YSGG laser and filled with MTA and NEC , respectively . Each root was cut apically to create a 2 mm-thick root slice for measurement of bond strength using a universal testing machine . Then , all slices were examined to determine the mode of bond failure . Data were analysed using two-way anova . Root-end filling material s showed significantly higher bond strength in root-end cavities prepared using ultrasonic technique ( US/MTA and US/NEC ) ( P < 0.001 ) . The bond strengths of MTA and NEC did not differ significantly . The failure modes were mainly adhesive for MTA , but cohesive for NEC . In conclusion , bond strengths of MTA and NEC to root-end cavities were comparable and higher in ultrasonically prepared cavities Context : Where nonsurgical endodontic intervention is not possible , or it will not solve the problem , surgical endodontic treatment must be considered . A major cause of surgical endodontic failures is an inadequate apical seal , so the use of the suitable substance as root-end filling material that prevents egress of potential contaminants into periapical tissue is very critical . Aims : The aim of the present ex-vivo study was to compare and evaluate the three root-end filling material s of mineral trioxide aggregate ( MTA ) family ( white MTA [ WMTA ] , grey MTA [ GMTA ] and Portl and cement [ PC ] ) for their marginal adaptation at the root-end dentinal wall using scanning electron microscopy ( SEM ) . Material s and Methods : Sixty human single-rooted teeth were decoronated , instrumented , and obturated with Gutta-percha .  After the root-end resection and apical cavity preparation , the teeth were r and omly divided into three-experimental groups ( each containing 20 teeth ) and each group was filled with their respective experimental material s. After longitudinal sectioning of root , SEM examination was done to determine the overall gap between retro grade material s and cavity walls in terms of length and width of the gap ( maximum ) at the interface . Descriptive statistical analysis was performed to calculate the means with corresponding st and ard errors , median and ranges along with an analysis of variance and Tukey 's test . Results : The least overall gap was observed in GMTA followed by PC and WMTA . While after statistically analyzing the various data obtained from different groups , there was no significant difference among these three groups in terms of marginal adaptation . Conclusion : GMTA showed the best overall adaptation to root dentinal wall compared to PC and WMTA . Being biocompatible and cheaper , the PC may be an alternative but not a substitute for MTA Introduction : This prospect i ve r and omized controlled study evaluated the clinical and radiographic outcome of endodontic microsurgery when using iRoot BP Plus Root Repair Material ( BP‐RRM ; Innovative BioCeramix Inc , Vancouver , BC , Canada ) or mineral trioxide aggregate ( MTA ) as the retro grade filling material and analyzed the relationship between some potential prognostic factors and the outcome of the surgery . Methods : By using strict inclusion and exclusion criteria , 240 teeth were successfully enrolled and r and omly and equally allocated to either the MTA or BP‐RRM treatment group . A st and ardized surgical procedure was performed by a single operator . The patients were followed up at 1 week , 3 months , 6 months , and 12 months ; follow‐up included clinical and radiographic examination . Clinical and radiographic evaluations acquired at the 12‐month follow‐up were taken as the primary outcome . For the identification of prognostic factors , the dichotomous outcome ( success vs failure ) was taken as the dependent variable . Results : A total of 158 teeth were analyzed at the 12‐month follow‐up , including 87 teeth in the MTA group and 71 teeth in the BP‐RRM group . The success rate in the MTA and BP‐RRM groups was 93.1 % ( 81/87 teeth ) and 94.4 % ( 67/71 teeth ) , respectively ( P > .05 ) . Three significant outcome predictors were identified : quality of root filling ( P < .05 ) , tooth type ( P < .05 ) , and size of the lesion ( P < .05 ) Conclusions : These results suggest that BP‐RRM is comparable with MTA in clinical outcome when used as root‐end filling material s in endodontic microsurgery The hemostatic efficacy , as well as the cardiovascular effects , of two hemostatic agents currently used during endodontic surgery was examined . The hemostatic agents used were epinephrine pellets ( Racellet pellets ) or 20 % ferric sulfate ( Viscostat ) .  Patients were assigned to one of two experimental groups .  Blood pressure and pulse rate were recorded pre- and postoperatively and at three additional times during the surgery ( root-end resection , root-end preparation , and filling ) . The adequacy of hemostasis was rated by the surgical operator . Results indicated that there is no significant change in cardiovascular effects when using either of these hemostatic agents . Except in one case where ferric sulfate was the agent , both agents produced surgical hemostasis that allowed for a dry field for root-end filling INTRODUCTION The purpose of the present study was to evaluate the clinical outcomes of endodontic microsurgery when super ethoxy-benzoic acid ( Super EBA ; Harry J. Bosworth , Skokie , IL ) and mineral trioxide aggregate ( MTA ) were used as root-end filling material s in a prospect i ve r and omized controlled study . METHODS Of the 388 teeth eligible for endodontic microsurgery , 128 teeth were excluded from the study , and 260 teeth were r and omly assigned to either the Super EBA group or the MTA group with equal numbers using the " minimization method . " Endodontic microsurgical procedures were performed according to the Yonsei protocol reported in a previous study and were carried out by a single operator . The patients were followed up at 3 , 6 , and 12 months . The primary outcome measure was the change in the apical bone density at 12 months , and the secondary outcome measures were the presence of clinical symptoms or abnormal findings at 12 months . RESULTS A total of 192 teeth were examined at the 12-month follow-up ; 102 teeth were in the Super EBA group , and 90 were in the MTA group . The overall success rate was 94.3 % , with a success rate of 95.6 % ( 86/90 teeth ) for MTA and 93.1 % ( 95/102 teeth ) for Super EBA . The statistical analysis of the success rate results did not show any significant difference between the groups ( P = .472 ) . CONCLUSIONS In this prospect i ve r and omized controlled study , there was no significant difference in the clinical outcomes of endodontic microsurgery when Super EBA and MTA were used as root-end filling material AIM To assess the success rate of the root-end filling material , Mineral Trioxide Aggregate ( MTA ) . METHODOLOGY Referred adult patients were recruited using strict entry criteria and r and omly allocated to receive MTA or IRM . A st and ardized surgical technique was employed : the root end was resected perpendicularly and a root-end cavity was prepared ultrasonically and filled . A radiograph taken immediately after surgery was compared with those taken at 12 and 24 months . Customised film holders and the paralleling technique were used ; radiographs were assessed by two trained observers using agreed criteria . The results from 122 patients ( 58 in IRM group , 64 in MTA group ) after 12 months and 108 patients ( 47 in IRM group , 61 in MTA group ) for the 24-month review period were analysed using the chi2 test . RESULTS The highest number of teeth with complete healing at both times was observed when MTA was used . When the numbers of teeth with complete and incomplete ( scar ) healing , and those with uncertain and unsatisfactory healing were combined , the success rate for MTA was higher ( 84 % after 12 months , 92 % after 24 months ) compared with IRM ( 76 % after 12 months , 87 % after 24 months ) . However , statistical analysis showed no significant difference in success between material s ( P > 0.05 ) at both 12 and 24 months . CONCLUSIONS In this study , the use of MTA as a root-end filling material result ed in a high success rate that was not significantly better than that obtained using IRM Objectives The objective of this study was to evaluate the bond strength of three root-end filling material s ( MTAA – MTA Angelus , MTAS – experimental MTA Sealer , and ZOE- zinc oxide and eugenol cement )  in retro grade preparations performed with different ultrasonic tips ( CVD , Trinity , and Satelec ) . Material s and method Ninety 2-mm root sections from single-rooted human teeth were used . The retro grade cavities were prepared by using the ultrasonic tips , coupled to a device for position st and ardization . The specimens were r and omly divided into nine groups : CVD MTAA ; CVD MTAS ; CVD ZOE ; Trinity MTAA ; Trinity MTAS ; Trinity ZOE ; Satelec MTAA ; Satelec MTAS ; Satelec ZOE . Each resin disc/dentin/root-end filling material was placed in the machine to perform the push-out test . The specimens were examined in a stereomicroscope to evaluate the type of failure . Data were su bmi tted to statistical analysis using ANOVA and Tukey tests ( α = 0.05 ) . Results The highest bond strength was observed for the CVD tip irrespective of the material used ( P < 0.05 ) . There was no significant difference for the Trinity TU-18 diamond and S12 Satelec tips ( P > 0.05 ) . MTAA and MTAS showed highest bond strength . The most common type of failure was adhesion between the filling material and dentin wall , except for ZOE , where mixed failure was predominant . Conclusions The CVD tip favored higher bond strength of the root-end filling material s. MTA Angelus and experimental MTAS presented bond strength to dentin prepared with ultrasonic tips . Clinical relevance Root-end preparation with the CVD tip positively influences the bond strength of root-end filling material s. MTA Angelus and experimental MTAS present bond strength to be used as root-end filling material INTRODUCTION Obtaining hemostasis in the surgical crypt during periradicular surgery is essential . It allows for improved visibility and contributes to a dry environment suitable for the placement of moisture-sensitive root-end filling material . Although current material s may not be moisture sensitive during setting , hemostasis is important for proper placement of root-end filling material s during apical surgery . A new hemostatic agent , HemCon dental dressing ( Patterson Dental , St Paul , MN ) , may improve upon the efficacy of wound healing and hemostasis both in extent and time . The aim of this study was to evaluate the hemostatic effect of HemCon in osseous wound sites and evaluate the wound healing potential and percentage of new bone formation in osseous crypts treated with HemCon . METHODS A split-mouth design was used with r and om allocation of sham and experimental sites in 12 rabbits . In experimental sites , either HemCon or 15.5 % ferric sulfate was applied to osseous crypts created with a round bur . Hemostatic efficacy was evaluated using predetermined scores . Rabbits were sacrificed at 21 days , and tissues were harvested and prepared for histologic evaluation . A blinded pathologist scored sample s relative to inflammation . The percentage of new bone deposition was calculated using NIS Elements software ( Nikon Instruments Inc , Melville , NY ) . RESULTS There was no statistical significant difference in hemostatic efficacy or wound healing between HemCon and ferric sulfate ( P > .05 ) . The HemCon group showed a significantly higher percentage of new bone deposition compared with the controls ( P < .01 ) . CONCLUSIONS HemCon shows promise as an adjunct to the endodontic surgical armamentarium Objective : Mineral trioxide aggregate ( MTA ) has been accepted as an appropriate root-end filling material in endodontic microsurgery because of setting ability in the wet environment . The aim of this study was to assess the bond strength of root-end placed MTA and Biodentine ( Septodont , Saint Maur des Fossés , France ) in the absence/presence of blood contamination . Material s and Methods : Forty-eight single-rooted maxillary incisors were used . subsequent to root-end resection and apical preparation using ultrasonic retro-tips , the specimens were r and omly separated into two groups according to the root-end filling material s : MTA ( Cerkamed Medical Company , Stalowa , Pol and ) or Biodentine . The specimens were then separated into two subgroups according to storage condition ( absence/presence of blood ) ( n = 12 ) . After obtaining 2.0 ± 0.1 mm slices , push-out tests were performed . Each slice was examined under a stereomicroscope to evaluate the failure mode . The data were analyzed using two-way analysis of variance and Tukey 's post hoc test for multiple comparisons . The failure modes were analyzed using the Chi-square test ( P = 0.05 ) . Results : The bond strength was significantly affected by the presence of blood contamination and root-end filling material type ( P < 0.001 ) . Biodentine had better bond strength than MTA ( P < 0.001 ) . The most common failure type was adhesive failure . According to the Chi-square test , there were no statistically significant differences among the groups ( P = 0.394 ) . Conclusions : Biodentine had better bond strength values compared to MTA , and the bond strength of both MTA and Biodentine as root-end filling material s was negatively affected by the presence of blood OBJECTIVE This study evaluated the treatment outcome after periapical surgery with the use of 2 different retro grade root-filling material s and the influence of 3 pre- and perioperative variables on the periapical healing . STUDY DESIGN Two hundred six teeth in 164 patients were r and omly allocated to receive either IRM or Super-EBA as a retro grade root-end seal . The teeth were review ed 12 months after surgery . The influence of lesion size , lesion type , and ortho grade root filling quality on healing was analyzed . RESULTS One hundred ninety-four teeth in 153 patients were review ed . Radiologic evaluation and clinical examination revealed 91 % success rate for the IRM group and 82 % for the Super-EBA group . There was no statistical significance in the healing outcome between the 2 groups ( Fisher exact test ) . The analyzed pre- and perioperative variables had no significant influence on the treatment outcome ( Z test ) . CONCLUSIONS Both retro grade material s tested in this study can serve as a root-end seal in periapical infected teeth , according to the results of the healing outcome after 12 months ' follow-up AIM To evaluate treatment outcome after using a resin composite ( Retroplast , RP ) in combination with a dentine-bonding agent ( GLUMA ) as root-end filling material after 1 year as well as after more than 5 years ( final examination ) . Also , the influence of various pre- , intra- and postoperative factors on the treatment outcome was studied . METHODOLOGY All patients ( 87 ) undergoing root-end resection consecutively treated by root-end filling with RP on an incisor , canine , pre-molar , or first molar ( 87 teeth , 118 roots ) were initially enrolled in the study .  RP was applied on the entire resected surface that was prepared to a slightly concave shape and after conditioning with EDTA and GLUMA . The treatment outcome involving subjective , clinical and radiographic parameters was evaluated after 1 year and at the final examination . A total of 27 patients ( 36 roots ) were excluded from the study because of unavailability of follow-up ( 19 ) and extraction of the operated tooth for reasons other than failed surgery ( 8) . Consequently , 60 patients ( 82 roots ) were included in the final material . The mean follow-up period at the final examination was 8 years ( range : 6.5 - 9 years ) . RESULTS The radiographic evaluation at the final examination revealed that 77 % , 5 % , 7 % and 11 % of the treated roots were characterized by complete , incomplete , uncertain and unsatisfactory healing , respectively . A total of 95 % of the roots classified as completely healed at the 1-year control were also completely healed at the final examination . Two roots ( 5 % ) showing complete healing at the 1-year control revealed unsatisfactory healing at the final examination because of displaced or lost RP-filling . Moreover , 60 % of the roots with uncertain healing at the 1-year control demonstrated complete or incomplete healing at the final examination . The classification according to subjective , clinical and radiographic parameters revealed that 78 % of the teeth were characterized by a successful treatment outcome at the final examination . Evaluation of the influence of various pre- , intra- and postoperative factors on the treatment outcome revealed that the radiographic classification at the final examination was exclusively influenced by the radiographic classification at the 1-year control ( P < 0.001 ) . CONCLUSIONS The present long-term study indicates that RP can be used for root-end filling with a successful treatment outcome OBJECTIVE The aim of this study was to evaluate the healing outcome after periapical surgery with an ultrasonic cleaning technique in conjunction with the use of either of 2 different retro grade root-filling material s in teeth with apical periodontitis . STUDY DESIGN One hundred sixty teeth in 139 consecutive patients were r and omly allocated into 2 groups receiving either IRM or thermoplasticized gutta-percha ( GP ) with AH Plus sealer as a retro grade root-end seal . The patients were review ed 12 months after surgery . The results were analyzed with Fisher exact test . RESULTS One hundred forty-seven teeth in 131 patients were review ed . Radiologic evaluation and clinical examination showed an 85 % success rate for the IRM group and 90 % for GP group . There was no statistical significance between the 2 groups . CONCLUSION Both tested material s , IRM and GP , are suitable as retro grade root-end filling material s in conjunction with ultrasonic root-end preparation according to the results of the healing outcome after 12 months follow-up OBJECTIVE To investigate the role of dentinal tubules in the fracture properties of human root dentin and whether resin-filled dentinal tubules can enhance fracture resistance . MATERIAL S AND METHODS Crack propagation in human root dentin was investigated in 200 microm thick longitudinal sample s and examined by light and scanning electron microscopy . 30 maxillary premolar teeth were prepared for work of fracture ( Wf ) test at different tubule orientations , one perpendicular and two parallel to dentinal tubules . Another 40 single canal premolars were r and omly divided into four groups of 10 each : intact dentin , prepared but unobturated canal , canal obturated with epoxy rein ( AH Plus/gutta percha ) , or with UDMA resin sealer ( Resilon/RealSeal . The sample s were prepared for Wf test parallel to dentinal tubules . Wf was compared under ANOVA with statistical significance set at p<0.05 . RESULTS Dentinal tubules influenced the path of cracks through dentin , with micro-cracks initiated in peritubular dentin of individual tubules ahead of the main crack tip . A significant difference ( p<0.001 ) was found between Wf perpendicular to tubule direction ( 254.9 J/m(2 ) ) vs. parallel to tubule direction from inner to outer dentin ( 479.4 J/m(2 ) ) . Neither canal preparation nor obturation using epoxy- or UDMA-based resins as sealer cements substantially influenced fracture properties of root dentin , despite extensive infiltration of dentinal tubules by both sealer cements OBJECTIVE R and omized clinical prospect i ve study to evaluate the application of MTA and IRM as retro grade sealers in surgical endodontics . STUDY DESIGN One hundred single-rooted teeth were surgically treated . After r and omization , MTA or IRM was used as a retrosealer . Radiographs were taken 1 week , 3 months , and 1 year postoperatively . Assessment was performed by 2 independent assessors 1 year after surgery . Both treatment groups were homogeneous in their composition , and clinical features and radiographic findings were classified according to Rud 's classification . RESULTS Complete healing was observed in 64 % of the MTA-treated teeth vs 50 % of the IRM-treated teeth . Incomplete healing was seen in 28 % ( MTA ) vs 36 % ( IRM ) , and unsatisfactory in 6 % ( MTA ) vs 14 % ( IRM ) . Only 1 failure was seen ( MTA ) . No statistically significant differences were found between the 2 retrofilling material s. CONCLUSION As root-end filling material s in this clinical prospect i ve r and omized design on single rooted teeth , MTA and IRM had the same clinical effectiveness Endodontic treatment was performed on 25 pulpally involved m and ibular primary molars in 4 to 9-year-old children ; the root canals were obturated with a new root canal filling material consisting of a mixture of calcium hydroxide , zinc oxide , and 10 % sodium fluoride solution , using h and -operated lentulo-spirals . All cases were evaluated clinical ly every 3 months and also radiographically every 6 months to assess the success of the treatment ; we also examined the resorption of the root canal filling material from the root canals and the status of overpushed material , if any , as the tooth resorbed with the passage of time . At 6 months , endodontic treatment in 2 of the 25 teeth had failed and one tooth had exfoliated ; the remaining 22 teeth were without any signs or symptoms . At the end of 2 years , 14 teeth could be evaluated ; out of these 12 had physiologically exfoliated . It was observed that the rate of resorption of this new root canal obturating mixture was quite similar to the rate of physiologic root resorption in primary teeth . In three cases , where there was an overpush of the mixture , a gradual partial resorption was noted BACKGROUND The authors evaluated the fracture resistance of endodontically treated teeth filled with either gutta-percha or a new resin-based obturation material .  METHODS The authors prepared and r and omly divided 80 single-canal extracted teeth into five groups : lateral and vertical condensation with gutta-percha , lateral and vertical condensation with the new resin-based obturation material , and a control group with no filling material . The specimens were stored in 100 percent humidity for two weeks , mounted in polyester resin and loaded to failure . RESULTS The authors found statistically significant differences among the experimental groups ( P < .05 ) . The groups with the new material displayed higher mean fracture loads and the gutta-percha groups lower mean fracture load values than the control unfilled group . However , the differences were not significant . The groups with the new material displayed significantly higher mean fracture loads than gutta-percha groups independent of the filling technique used . CONCLUSIONS Filling the canals with the new resin-based obturation material increased the in vitro resistance to fracture of endodontically treated single-canal extracted teeth when compared with st and ard gutta-percha techniques . CLINICAL IMPLICATION S ; If other properties of the new resin-based obturation material compare favorably with those of gutta-percha for filling the root canal , it should be considered as a replacement for gutta-percha , as the results of this study indicate that it could provide enhanced resistance to tooth fracture AIM To compare the surface topography of root apices following ultrasonic root-end preparation , and again after root-end fillings su bmi tted to three different finishing techniques . METHODOLOGY Eighty-one root-end cavities prepared ultrasonically in human canines , were divided at r and om into three test groups of 27 each . The cavities were filled with Super-EBA , IRM , or ProRoot-MTA and finished by ball burnishing . Eighteen roots from each group received a final finish with either a 30-fluted tungsten carbide finishing bur , or a Zekrya carbide 28 mm bur after storage in water at 37 degrees C for 24 h. The root-end surface topographies were reproduced by means of polyvinylsiloxane impressions and epoxy resin replicas . Scanning electron micrography ( SEM ) images of each replica were taken prior to and after root-end filling . An image analysis system was used to compare the alteration of the marginal chipping areas and to calculate the gaps located in the dentine/root-end filling interface . RESULTS When a bur was used to finish the set material s , a significant ( P < 0.05 ) area of marginal chipping was eliminated . The finishing technique did not significantly ( P > 0.05 ) affect the incidence of gaps in groups root-end filled with MTA or IRM . Super-EBA and IRM retrofillings finished with a ball burnisher or a Zekrya bur displayed a significantly ( P < 0.05 ) larger calculated gap area than roots filled with MTA . CONCLUSION Under this in vitro study , the marginal adaptation of MTA was good with or without finishing procedures . Applying a finishing bur over the condensed and set IRM and Super-EBA created better marginal adaptation
Conclusions : The probability for success for EMS proved to be significantly greater than the probability for success for RES , providing best available evidence on the influence of cavity preparation with ultrasonic tips and /or SuperEBA ( Keystone Industries , Gibbstown , NJ ) , IRM ( Dentsply Sirona , York , PA ) , MTA , or silicate cements as root‐end filling material instead of a shallow cavity preparation and placement of a resin‐based material .
HIGHLIGHTSEndodontic microsurgery ( EMS ) with the use of high‐magnification ultrasonic root‐end preparation and root‐end filling with SuperEBA , IRM , MTA , or other calcium silicate cements has a high probability of success .
Resin‐based endodontic surgery with the use of high‐magnification preparation of a shallow concave root‐end cavity with bonded resin‐based root‐end filling material performed less favorably than EMS
Introduction : The aim of the present study was to investigate the influence of root‐end preparation and filling material on endodontic surgery outcome .