The effect of an apex locator on exposure to radiation during endodontic therapy. In vivo determination of root canal length: a preliminary report using the Tri Auto ZX apex-locating handpiece. An in vivo evaluation of the ENDEX and RCM Mark II electronic apex locators in root canals with different contents. Accuracy of an electronic apex locator: a clinical evaluation in maxillary molars. Postoperative pain after the application of two different irrigation devices in a prospective randomized clinical trial. Comparison between two methods of working length determination and its effect on radiographic extent of root canal filling: a clinical study [ISRCTN71486641] Effect of working length measurement by electronic apex locator or radiography on the adequacy of final working length: a randomized clinical trial. Effect of apical size and taper on volume of irrigant delivered at working length with apical negative pressure at different root curvatures. Pulp Revascularization of Immature Dog Teeth with Apical Periodontitis Using Triantibiotic Paste and Platelet-rich Plasma: A Radiographic Study. Effect of apical preparation size and preparation taper on irrigant volume delivered by using negative pressure irrigation system. Sealing ability of ProRoot MTA and MTA-Angelus simulating a one-step apical barrier technique--an in vitro study. Effect of using electronic apex locators on selected endodontic treatment parameters. Cleaning efficacy of an apical negative-pressure irrigation system at different exposure times. 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 Treatment outcome in endodontics: the Toronto study--phases 3, 4, and 5: apical surgery. Postoperative pain after foraminal enlargement in anterior teeth with necrosis and apical periodontitis: a prospective and randomized clinical trial. Success rate of single- versus two-visit root canal treatment of teeth with apical periodontitis: a randomized controlled trial. Tissue response to root canal irrigation systems in dogs’ teeth with apical periodontitis Accuracy and reliability of apical S3 gallop detection Comparison of irrigant penetration up to working length and into simulated lateral canals using various irrigating techniques. The relationship of intracanal medicaments to postoperative pain in endodontics. Assessment of morphological changes and permeability of apical dentin surfaces induced by Nd:Yag laser irradiation through retrograde cavity surfaces. One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study
The objective of this study was to investigate whether the use of an electronic apex locator results in a reduction in X-ray exposure during endodontic therapy . Fifty , sound , extracted , single-rooted canine and incisor teeth were selected and r and omly divided into two groups ( A and B ) of 25 teeth . The working length was determined radiographically with ( group B ) and without ( group A ) adjunctive use of an apex locator by one operator . After working length determination , the teeth were sectioned and the actual working length measured for comparison . For group A , 14 retake radiographs were required to determine the working length , whereas group B required no retake radiographs ; this difference was highly significant ( p < 0.001 ) . The electronic apex locator was extremely accurate in locating the apical foramen with all teeth tested within 0.5 mm of the anatomical apex and 11 ( 44 % ) teeth at the apical foramen . In contrast , 15 ( 60 % ) teeth tested using radiographs alone were within 0.5 mm of the anatomical apex and only 4 ( 16 % ) teeth were actually at the anatomical apex . It was concluded that using an electronic apex locator as an aid to endodontic therapy could potentially reduce the number of diagnostic radiographs required for working length determination . Location of the apical foramen using a combination of an electronic apex locator and radiographs to determine working length is more accurate than using radiographs alone AIM The aim of this study was to assess the clinical perfomance of a cordless h and piece with a built-in apex locator - the Tri Auto ZX - design ed for root canal preparation with nickel-titanium rotary files . METHODOLOGY Twenty-five human maxillary incisor and canine teeth scheduled for extraction with mature apices were selected for the study . Informed written consent was obtained from each patient before treatment . After administration of local anaesthesia , the teeth were isolated and the pulp cavities accessed . The Tri Auto ZX along with a size 15 K-file was used in its electronic apex locating function based on the manufacturer 's recommendations . A periapical radiograph with the file at the electronically determined constriction was taken , the file removed and the measurement registered as the electronic length ( EL ) . To test the auto reverse function , a size 20 ProFile.04 taper NiTi rotary instrument was mounted in the h and piece . The point for the auto apical reverse function was preset on the panel at the 0.5 mm level . After the file was introduced into the canal and reached the predetermined level , the file automatically stopped and rotated in the opposite direction . A reference point was marked and this measurement was registered as the auto reverse length ( ARL ) . All measurements were made twice by two different investigators . Teeth were then extracted and immersed in a 20 % formalin solution for 48 h. After fixation , a size 15 file was inserted into the canal to measure the actual root canal length from the same reference point obtained with the Tri Auto ZX to the apical foramen , as seen in the stereo microscope . When the file tip was visible at the anatomical end of the canal it was withdrawn 0.5 mm and this measurement was registered as the actual length ( AL ) . All measurements were expressed in mm and the measuring accuracy was set to 0.5 mm . The significance of the mean differences between EL and ARL and between EL and AL measurements at the 5 % confidence level was evaluated . RESULTS EL measurements were coincident to ARL in all instances . EL and ARL were coincident to AL in 10 ( 40 % ) canals , in the remaining 15 canals ( 60 % ) the AL measurements were longer than EL and ARL ( + 0.5 mm ) in 14 instances and shorter ( -0.5 mm ) in one case . Overall , the AL was longer than the EL or ARL , the mean difference being -0.23 mm + /- 0.32 ( P < 0.05 ) . CONCLUSIONS It was concluded that the Tri Auto ZX was useful and reliable . The Tri Auto ZX measurements protected against overpreparation The accuracy of many apex locators is affected by electrolytes including sodium hypochlorite . According to the manufacturer a new device , the ENDEX , overcomes this problem . The purpose of this study was to assess the accuracy of the ENDEX in comparison with a traditional device , the RCM Mark II . The lengths of 61 canals with various contents ( vital pulp , necrotic pulp , pus/exu date , sodium hypochlorite , and water ) were determined in vivo . Files were cemented within the canals at lengths determined by the ENDEX . The teeth were then radiographed and extracted , and the distance between the file tip and apical foramen was recorded . Derived readings for the RCM Mark II were compared with the actual ENDEX reading and corresponding radiograph . The results indicated that most of the file tips that were at the radiographic apex actually extended through the apical foramen , and canal content had a varying effect on each device . The overall accuracy of the ENDEX  ( 71.7 % ) was higher than that of the RCM Mark II ( 43.5 % ) within 0.5 mm of the apical foramen . The ENDEX , unlike the RCM Mark II , proved accurate in the presence of sodium hypochlorite Identifying the point of apical termination in endodontic therapy is of indisputable importance . In this study , the accuracy of an electronic apex locator was clinical ly evaluated in 26 maxillary molar teeth , and comparisons were made to the radiographic and direct anatomical measurements of tooth length . The results indicated that a higher percentage of acceptable measurements were obtained by the radiographic method as compared with the electronic method ( 88.5 % to 73.1 % ) . Additionally , inaccurate electronic estimates were long in every instance . The results of this study do not support the replacement of radiographs with electronic devices in endodontic therapy INTRODUCTION The extrusion of irrigation solutions beyond the apical constriction may result in postoperative pain .  Sodium hypochlorite can cause severe tissue irritation and necrosis outside the root canal system if extruded into the periodontal ligament ( PDL ) space . Different delivery techniques were discussed to reduce this potential risk . The aim of this study was to compare the postoperative level of pain after root canal therapy using either endodontic needle irrigation or a negative apical pressure device . MATERIAL AND METHODS In a prospect i ve r and omized clinical trial , 110 asymptomatic single-rooted anterior and premolar teeth were treated endodontically with two different irrigation techniques . The teeth were r and omly assigned to two groups . In the MP group ( n = 55 ) , procedures were performed using an endodontic irrigating syringe ( Max-i-Probe ; Dentsply Rinn , Elgin , IL ) . The EV group ( n = 55 ) used an irrigation device based on negative apical pressure ( EndoVac ; Discus Dental , Culver City , CA ) . Postoperatively , the patients were prescribed ibuprofen 200 mg to take every 8 hours if required . Pain levels were assessed by an analog scale question naire after 4 , 24 , and 48 hours . The amount of ibuprofen taken was recorded at the same time intervals . RESULTS During the 0- to 4- , 4- to 24- , and 24- to 48-hour intervals after treatment , the pain experience with the negative apical pressure device was significantly lower than when using the needle irrigation ( p < 0.0001 [ 4 , 24 , 48 hours ] ) . Between 0 and 4 and 4 and 24 hours , the intake of analgesics was significantly lower in the group treated by the negative apical pressure device ( p < 0.0001 [ 0 - 4 hours ] , p = 0.001 [ 4 - 24 hours ] ) . The difference for the 24- to 48-hour period was not statistically different ( p = 0.08 ) . The Pearson correlation coefficient revealed a strongly positive and significant relationship for the MP group ( r = 0.851 , p < 0.001 ) and the EV group ( r = 0.596 , p < 0.0001 ) between pain intensity and the amount of analgesics . CONCLUSION The outcome of this investigation indicates that the use of a negative apical pressure irrigation device can result in a significant reduction of postoperative pain levels in comparison to conventional needle irrigation Background Obtaining a correct working length is critical to the success of endodontic therapy . Different methods have been used to identify this crucial measurement . The Aim of this clinical study was to compare the effect of working length determination using apex locator alone or in combination with working length radiograph on the apical extent of root canal filling . Methods A total number of 66 patients , 151 canals were r and omized into two groups , In group ( I ) working length was determined by apex locator alone , while in group ( II ) working length was determined by apex locator confirmed by working length radiograph , length of obturation was assessed , and the total number of radiographs was recorded . The data were analyzed using SAS system and T. tests were carried out . Statistical significance was considered to be P ≤ 0.05 . Results Sixty seven canals in group I were treated with a mean distance from the tip of root canal filling to radiographic apex -0.5 mm ± 0.5 and a mean of a total number of radiographs of 2.0 , while in group II eighty four canals were treated with a mean distance from the tip of root canal filling to radiographic apex -0.4 mm ± 0.5 and a mean of a total number of radiographs of 3.2 . There was no statistically significant difference in the mean distance from the tip of root filling to radiographic apex between group I and group II ( P > 0.05 ) . Conclusion The practice of using electronic apex locator in the determination of working length is useful and reliable with no statistical difference of the radiographic extent of root canal filling when using apex locator alone or in combination with working length radiograph . Under the clinical conditions of this study , it is suggested that the correct use of an apex locator alone could prevent the need for further diagnostic radiographs for determination of working length . This method can be useful in patients who need not to be exposed to repeated radiation because of mental , medical or oral conditions INTRODUCTION Obtaining a correct working length is critical to the success of endodontic therapy . The aim of this clinical study was to compare the effect of working length determination using electronic apex locator or working length radiograph on the length adequacy of final working length as well as the final obturation . METHODS A total of 84 patients with 188 canals were r and omized into two groups ; in group 1 , the working length was determined by working length radiograph , whereas in group 2 , it was determined by the Raypex5 electronic apex locator ( VDW , Munich , Germany ) . Length adequacy was assessed in each group for master cone and final obturation radiography and categorized into short , acceptable , and over cases . RESULTS There was no statistically significant difference between the rates of acceptable ( master cone radiography : group 1 = 82.1 % and group 2 = 90.4 % ; final radiography : group 1 = 85.7 % and group 2 = 90.4 % ) and short cases ( master cone radiography : group 1 = 7.1 % and group 2 = 8.7 % ; final radiography : group 1 = 1.2 % and group 2 = 1 % ) between the two groups . Over cases in master cone radiography were significantly more in group 1 ( 10.7 % ) than group 2 ( 1 % ) ( χ² , p = 0.00 ) . However , this category did not show a significant difference for final obturation between group 1 ( 13.1 % ) and group 2 ( 8.7 % ) . CONCLUSION The results of endodontic treatment using the Raypex5 electronic apex locator are quite comparable , if not superior , to radiographic length measurement regarding the rates of acceptable and short cases . Furthermore , in addition to reducing the radiographic exposure , electronic apex locators are superior in reducing overestimation of the root canal length INTRODUCTION The purpose of this investigation was to determine the effect that apical preparation size and preparation taper have on the volume of irrigant delivered at the working length for different canal curvatures using apical negative pressure irrigation . METHODS One hundred fifty-five human teeth ( 55 maxillary canines and 100 m and ibular molars ) were used in this study . Root canals were prepared with rotary instruments to a size 35.04 and separated into 3 experimental groups according to their degree of curvature : group A ( n = 50 ) included canal curvatures ranging from 0 ° to 10 ° , group B ( n = 50 ) from 11 ° to 30 ° , and group C ( n = 50 ) from 31 ° to 65 ° . Sample s of each curvature group were further r and omized to experimental subgroups according to the apical size and taper as follow : 35.06 , 40.04 , 40.06 , 45.04 , and 45.06 . The apical third was irrigated using a microcannula and the volume of NaOCl suctioned at the working length under negative pressure was measured over a period of 30 seconds using a fluid recovery trap . Positive controls consisted of measuring the maximum volume of 5.25 % NaOCl capable of being suctioned by the microcannula from an open glass vial over 30 seconds . Negative control was the volume of irrigant aspirated by the microcannula with a preparation size of 25.04 over 30 seconds . RESULTS The volume of irrigant was significantly greater when the apical preparation size increased from 35.06 to 40.04 . As the apical preparation taper increased further from 40.04 to 40.06 , the volume of irrigant significantly improved in group B , but it was not significant in group A. Apical preparation sizes greater than 40.06 did not show an increase of the volume of irrigant aspirated . CONCLUSIONS The degree of root canal curvature decreased the volume of irrigant at the working length for a given apical size and taper . An apical preparation of 40.06 significantly increased the volume and exchange of irrigant at the working length regardless of curvature INTRODUCTION This study evaluates radiographically the efficacy of 4 revascularization protocol s in necrotic-infected immature dog teeth with apical periodontitis ( AP ) . METHODS Forty double-rooted immature premolar teeth from 4 female beagle dogs aged 5 months were used . Four teeth were left untouched as negative controls ; the other 36 teeth were infected to develop pulp necrosis and AP following different treatment protocol s. Four teeth were left untreated and assigned to the positive control group , and the last 28 teeth were r and omly assigned into 4 experimental groups of 8 teeth : A1 , sodium hypochlorite ( NaOCl ) + a blood clot ; A2 , NaOCl + platelet-rich plasma ( PRP ) ; B1 , NaOCl + modified triantibiotic paste ( mTAP ) + a blood clot ; and B2 , NaOCl + mTAP + PRP . Teeth were monitored radiographically for 6 months regarding healing of periapical radiolucencies , thickening of the dentinal walls , and apical closure of roots . RESULTS Significant differences ( P < .05 ) between the 4 groups were evident in the percentage of teeth showing improvement of periapical radiolucencies ( 62.5 % ) , continued radiographic thickening of radicular walls ( 53.1 % ) , radiographic apical closure ( 43.8 % ) , and deposition of hard tissue on radicular dentin walls ( 53.1 % ) . Group B2 showed maximal improvement in the 3 variables assessed ( P < .05 ) . Group A1 showed the minimum percentages in the 3 parameters assessed ( P < .05 ) . CONCLUSIONS These results suggest that an intracanal dressing of mTAP and the use of PRP as scaffold improves the success rate of the revascularization procedure INTRODUCTION The purpose of this investigation was to determine the effect that apical preparation size and preparation taper had on the volume of irrigant delivered to the working length of a root canal preparation in a clinical ly relevant amount of time . METHODS Forty intact human single-rooted teeth were r and omly distributed into 2 separate phases . The first phase aim ed to determine the smaller apical size that will allow more volume of irrigant at working length . All sample s had the same taper and were sequentially instrumented to sizes of 30.06 , 35.06 , 40.06 , and 45.06 . The second phase aim ed to determine the taper that will allow more volume of irrigant at working length . Teeth were sequentially instrumented to 40.02 , 40.04 , 40.06 , and 40.08 . All sample s were irrigated by using the micro-cannula , and the volume of sodium hypochlorite suctioned at working length under negative pressure was measured during a period of 30 seconds by using a custom recovery device . RESULTS An increase in size from ISO # 35 to ISO # 40 result ed in a percentage gain of approximately 44 % in mean irrigant volume , whereas an increase in size from ISO # 40 to ISO # 45 result ed in a percentage gain of approximately 4 % . An increase in taper from 0.02 through 0.08 result ed in percentage gains of approximately 74 % , 5.4 % , and 2.4 % increase , respectively . CONCLUSIONS The data demonstrated that an increase in apical preparation size and taper result ed in a statistically significant increase in the volume of irrigant . In addition , an apical enlargement to ISO # 40 with a 0.04 taper will allow for tooth structure preservation and maximum volume of irrigation at the apical third when using the apical negative pressure irrigation system Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician due to lack of an apical stop against which to compact an interim dressing of calcium hydroxide , or the final obturation material . A one-visit apexification protocol with MTA ( Mineral Trioxide Aggregate ) has be seen as an alternative to the traditional treatment practice s with calcium hydroxide [ Ca(OH)2 ] . The aim of this study was to investigate the use of MTA as a 5 mm apical barrier by comparing sealing ability of ProRoot MTA to that of MTA-Angelus . 50 freshly extracted Maxillary and M and ibular single canal sound human incisor teeth were used in this study , which were decoronated to st and ardized 10 mm root lengths . The root segments were prepared to simulate the clinical situation of an open apex with Gates Glidden burs # 51 and r and omly assigned into 2 experimental groups of 20 sample s each ( Group A : ProRoot MTA , Group B : MTA-Angelus ) and 10 root segments were used as control ( Group C ) where no apical barrier was used . After obturation the coronal portion of all sample s were sealed with Glass Ionomer and stored at 37 degrees C and 100 % humidity for 4 weeks . The root segments were then double coated with nail varnish except for the apical 1 mm and apical ends of all root segments were suspended vertically in methylene blue dye for 48 hours at room temperature . After removal from the dye , the sample s were sectioned longitudinally and linear dye penetration was measured using a Grid and stereomicroscope . The measurements were tabulated and statistically analyzed . The mean percentage of dye leakage for Group A was 55.5 % and for Group B was 53.25 % . The results showed no statistically significant difference in the sealing ability of ProRoot MTA and MTA-Angelus when used as apical barriers The purpose of this study was to determine the effect of using electronic apex locators on the number of radiographs taken and the adequacy in length of the final obturation .  Patients in an undergraduate student endodontics clinic participated in the study . The working length ( WL ) was estimated by the authors for all cases ( 36 teeth ; 58 canals ) , using both a preoperative st and ardized radiograph and an electronic measurement . The students were then asked to place WL files to one of the estimates ( electronic or radiographic ; chosen by r and om assignment ) and take a WL radiograph . Neither the students nor their instructors knew which method was chosen for the estimates . Once treatment was completed , the total number of working radiographs was counted . The number of cases with acceptable ( 0 to 2 mm short of the apex ) or unacceptable obturation was also blindly registered . An electronic estimate of the WL improved length quality of the final obturation , compared with a radiographic estimate . The number of working radiographs taken was less in the electronic apex locator group in anterior and premolar teeth , but not in molars OBJECTIVE Recent studies have shown that the apical negative-pressure irrigation system EndoVac ( Discus Dental ) produces better disinfection and cleanliness at the apical third of root canals than current irrigation methods using positive pressure . The aim of this histologic study was to compare the EndoVac system at two different exposure times to the traditional positive-pressure irrigation technique for root canal cleaning efficacy and to measure the volume of irrigation at the apical third . METHOD AND MATERIAL S Fifty extracted human incisors , canines , and premolars ( with one canal ) were used . All teeth were stored in sterile saline and then r and omly assigned to one of three experimental groups of 15 each . All teeth were cleaned and shaped at working length using Profile Series 29 ( Dentsply Tulsa ) to a size 6 ( ISO size 36 ) or larger depending on the first instrument to bind at the apical third . After working length was reached with the master apical file , apical irrigation was accomplished with 6 % sodium hypochlorite ( NaOCl ) over a predetermined time for each group as follows : group 1 , EndoVac for 210 seconds ; group 2 , EndoVac for 150 seconds ; group 3 , traditional positive-pressure irrigation for 210 seconds . The amount of debris left in the canals was quantified at 1 and 3 mm from working length . RESULTS No statistical differences were found at 3 mm from working length . At 1 mm from working length , an overall test of association was significant when comparing across the three groups ( P = .03 ) . CONCLUSION The apical negative-pressure irrigation system EndoVac has the potential to achieve significantly better root canal cleaning at the apical third of root canals and in less exposure time than required with traditional positive-pressure irrigation 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 The long-term outcome of apical surgery performed on root-filled teeth presenting with post-treatment apical periodontitis has been the subject of debate ; therefore , current evidence is required to support the prognosis of this important procedure . The objectives of this study were ( 1 ) to assess the long-term outcome of apical surgery and ( 2 ) to identify significant outcome predictors in Phases 3 - 5 of the Toronto Study , pooled with the previously reported Phases 1 and 2 . METHODS The 4- to 10-year outcome of apical surgery was prospect ively assessed by a blinded , independent , calibrated examiner and dichotomized as " healed " ( periapical index score < or=2 or scar ; no signs or symptoms ) or " diseased . " Teeth presenting without signs or symptoms were classified as " functional . " Multivariate analysis was performed to investigate outcome predictors , pooling Phases 3 - 5 ( n = 40 ) with Phases 1 and 2 ( n = 94 ) for improved power . RESULTS Of 261 treated teeth in the pooled sample , 96 were lost to follow-up , and 31 were extracted . Of the remaining 134 teeth ( 85 % recall , excluding 66 teeth that could not be recalled ) examined for outcome , 99 teeth ( 74 % ) were healed , and 126 teeth ( 94 % ) were functional . Three significant ( P < .05 ) outcome predictors were identified : age ( odds ratio [ OR ] , 2.5 ; confidence interval [ CI ] , 1.01 - 6.00 ; healed : > 45 years , 84 % , < or=45 years , 68 % ) , preoperative root-filling length ( OR , 3.4 ; CI , 1.34 - 8.76 ; healed : inadequate , 84 % ; adequate , 68 % ) , and size of the surgical crypt ( OR , 1.9 ; CI , 1.19 - 3.16 ; healed : < or=10 mm , 80 % ; > 10 mm , 53 % ) . CONCLUSIONS In this 4- to 10-year cohort study , the outcome was better in subjects > 45 years old , teeth with inadequate root-filling length , and crypt size of < or=10 mm INTRODUCTION The aim of this r and omized , controlled , prospect i ve clinical study was to determine if foraminal enlargement instrumentation during endodontic treatment is associated with more postoperative pain compared with st and ard nonenlargement instrumentation . METHODS Forty volunteers with a single root canal were diagnosed with asymptomatic necrosis with apical periodontitis and r and omized into 2 experimental groups ( ie , the control group and the foraminal enlargement group ) . Endodontic treatment was performed in a single visit , and volunteers were instructed to record pain intensity ( ie , none , slight , moderate , and severe ) . Scores from 1 to 4 were attributed to each kind of pain after 12 , 24 , and 48 hours . The Kolmogorov-Smirnov and Student 's t tests were used to determine significant differences at P < .05 . RESULTS No statistically significant age difference was found between the groups ( P > .05 , Student 's t test ) . Postoperative pain showed no statistically significant difference between the groups at any observation period ( P > .05 ) . Also , no significant difference was observed in the mean number of analgesic tablets used between the groups ( P > .05 ) . CONCLUSIONS The foraminal enlargement and nonenlargement techniques result ed in the same postoperative pain and necessity for analgesic medication . This may suggest that the use of foraminal enlargement should be performed for endodontic treatment previsibility without increasing postoperative pain INTRODUCTION The aim of this study was to evaluate the outcome of single- versus 2-visit root canal treatment of teeth with apical periodontitis after a 2-year follow-up period . METHODS Three hundred maxillary and m and ibular nonvital teeth with apical periodontitis were treated in either a single visit or 2 visits . The main inclusion criteria were radiographic evidence of apical periodontitis ( minimum size ≥ 2.0 × 2.0 mm ) and a diagnosis of pulpal necrosis confirmed by a negative response to hot and cold tests . Radiographically , all teeth showed small and irregular periapical radiolucencies before treatment . The canals were enlarged with LightSpeedLSX ( Discus Dental , Culver City , CA ) root canal instruments to a final apical preparation size # 60 for anterior and premolar teeth and size # 45 to # 55 for molars . The EndoVac negative-pressure irrigation system ( Discus Dental ) was used for disinfecting irrigation , and all canals were filled by lateral compaction of gutta-percha and Sealapex sealer ( SybronEndo , Orange , CA ) . The healing results were clinical ly and radiographically evaluated 2 years postoperatively . RESULTS Of the 300 teeth treated , 18 were lost to follow-up , 9 in the 2-visit group and 9 in the 1-visit group . Of the 282 teeth studied , the r and omization procedure had allocated 146 teeth to 1-visit treatment and 136 teeth to 2-visit treatment . Teeth with symptoms of persisting periapical inflammation were scored as not healed . Teeth with a reduced periapical rarefaction were judged as uncertain . Teeth with complete restitution of the periodontal contours were judged as healed . In the 1-visit group , 141 of 146 teeth ( 96.57 % ) were classified as healed as compared with 121 ( 88.97 % ) of 136 teeth in the 2-visit group . Eleven cases were classified as uncertain in the 2-visit group ( 8.08 % ) compared with 4 ( 2.73 % ) in the 1-visit group . Two of 10 teeth in the 2-visit group presented with pain before the 2-year follow-up and were classified as not healed . The hypothesis tests were conducted at the 0.05 level of significance . Statistical analysis of the healing results did not show any significant difference between the groups ( P = .05 ) . CONCLUSIONS Several factors play an important role in the decision-making process of 1- versus 2-visit endodontics . Among these are objective factors like preoperative diagnosis , the ability to obtain infection control , root canal anatomy , procedural complications , and subjective factors like patients ' signs and symptoms . This study provided evidence that with a treatment protocol with instrumentation to predefined larger apical instrumentation sizes and irrigation with a negative apical pressure system can lead to healing in cases of apical periodontitis , which is a significant finding compared with more date d studies that showed average healing of apical periodontitis cases . With the given sample size , there was no statistically significant difference between the 2 treatment modalities Objectives The aim of this study was to compare the efficacy of apical negative pressure irrigation ( ANP ) and passive ultrasonic irrigation ( PUI ) with apical positive pressure irrigation ( PP — conventional irrigation ) in the periapical repair of dogs ’ teeth with apical periodontitis . Methods Forty-nine mesial and distal root canals of premolars of three dogs with experimentally induced periapical lesions were subjected to a single-session root canal treatment . The teeth were r and omly assigned to three groups : ANP , PUI , and PP ( control ) . After 180 days , the animals were euthanized , and the anatomic pieces were removed and subjected to histotechnical processing for morphological and morphometric histological analyses of hematoxylin and eosin (HE)-stained sections under conventional and fluorescence microscopy . Periapical lesion size before and 180 days after root canal treatment was measured by periapical radiographic examination . Tartrate-resistant acid phosphatase ( TRAP ) histoenzymology was performed for osteoclast counting and Brown and Brenn staining to assess bacteria . Data were analyzed statistically by the Kruskal-Wallis test ( α = 5 % ) . Result There were no statistically significant differences among the groups regarding periapical lesion size in the radiographic evaluation ( p = 0.91 ) . In the comparison of histopathological parameters , group ANP presented more homogeneous results . There was a statistically significant difference ( p = 0.02 ) between groups ANP and PP , with better results for group ANP in which milder infiltrate inflammatory was observed . No statistically significant difference ( p > 0.05 ) was found among the groups with respect to periodontal ligament space , presence of mineralized tissue resorption , size of the periapical lesions , and number of osteoclasts . Conclusion Although the three irrigation systems elicited similar periapical tissue response with respect to almost all evaluated parameters , ANP presented the mildest inflammatory infiltrate , suggesting an advantage over PP in the indication for clinical use . Clinical relevance Irrigation of the root canal systems is an extremely important step in root canal treatment . Therefore , it is of relevance to evaluate the efficacy of these systems by in vivo experimental models to provide scientific background for the clinical practice This study assessed  physician performance in detecting the apical S3 gallop using a cardiology patient simulator . Six physicians ( two cardiology fellows , two medicine residents , and two attending physicians ) performed two sets of 24 cardiac examinations that included the presence or absence of an apical S3 gallop . All the examiners were able to significantly alter the prior odds of an apical S3 gallop ’s being present , but the cardiology fellows had higher sensitivities . Sensitivity was lower for detecting soft S3 gallops , and specificity was lower when a diastolic murmur was also present . Physician performance in detecting apical S3 gallops is variable , but can be excellent AIM To evaluate the effect of an apical negative pressure system , a passive ultrasonic irrigation system and a combination of both apical negative pressure and passive ultrasonic irrigation on the penetration of the  irrigating contrast solution ( ICS ) up to working length and into simulated lateral canals . METHODOLOGY The root canals of 64 single-rooted teeth were instrumented using the ProTaper rotary system . In each sample , three simulated lateral canals were created at 2 , 4 and 6 mm levels from the root apex using a 06-size C+ file ( Dentsply Maillefer , Ballaigues , Switzerl and ) . Sample s were r and omly assigned into 4 experimental groups ( n = 16 ) : group I - conventional needle irrigation , group II - passive ultrasonic irrigation , group III - apical negative irrigation system and group IV - combination of passive ultrasonic irrigation and apical negative pressure irrigation system . To examine irrigating solution penetration , Indian ink was mixed with 5.25 % NaOCl and delivered into the root canals . Sample s were then assessed by direct observation of the images taken using Canon EOS rebel T3 . The depth of penetration of ICS up to the working length and into the simulated lateral canals was analysed using chi-squared tests . RESULTS The combination ( ANP and PUI ) and ANP group had significantly deeper ICS penetration up to the working length ( P < 0.001 ) . The combination ( ANP and PUI ) and the PUI group exhibited significantly greater ICS penetration into lateral canals at the 6 mm level ( P < 0.001 ) . At the 4 and 2 mm levels , the combination of ANP and PUI had significantly greater ICS penetration into the lateral canals than the other groups ( P < 0.001 ) . CONCLUSIONS The combination of ANP and PUI was the only group able to achieve irrigating contrast solution penetration both up to the working length and into lateral canals AIM To investigate the relationship of postoperative pain to three different medicaments placed in the root canal after a complete biomechanical debridement of the root canal system in patients presenting for emergency relief of pain . METHODOLOGY Two hundred and twenty-three teeth belonging to 221 patients presenting as emergencies to the Royal Dental Hospital of Melbourne were included in the study . Inclusion was limited to patients with a diagnosis of pulp necrosis and acute apical periodontitis . All teeth underwent conventional root canal treatment  , which involved the instrumentation to the apices of each canal at the first visit . Canals were instrumented using a stepback technique and h and -files along with irrigants using Milton 's ( 1 % sodium hypochlorite ) solution followed by 15 % EDTAC . The canals were dried and one of the following three medicaments was inserted into the canal in r and om sequence : Group 1 : Ledermix paste ( Lederle Pharmaceuticals , Division of Cyanamid , Wolfratshausen , Germany ) ; Group 2 : calcium hydroxide paste ( Calcipulpe , Septodont , France ) ; and Group 3 : no dressing . Before dismissal , the preoperative pain experienced on the previous night was recorded using a visual analogue pain scale . Patients were then instructed to record the degree of pain experienced 4 h after treatment and daily for a further 4 days . RESULTS The mean score pain for all three groups was between 42 and 48 prior to treatment being commenced . After 4 days , the pain score for Group 2 was 10 , for Group 3 was 7 and for Group 1 was 4 . Mean preoperative pain level was 44.4 ( of a maximum 100 ) for all groups , and declined by 50 % ( to 22.1 ) after 24 h. Patients in Group 1 ( Ledermix ) experienced significantly less ( P = 0.04 ) postoperative pain than those in the other two groups . There was no significant difference between Group 2 ( calcium hydroxide ) and Group 3 ( no dressing ) . CONCLUSION Under the conditions of this study , painful teeth with acute apical periodontitis that had been dressed with Ledermix paste gave rise to less pain than that experienced by patients who had a dressing of calcium hydroxide or no dressing at all . Ledermix is an effective intracanal medicament for the control of postoperative pain associated with acute apical periodontitis , with a rapid onset of pain reduction The purpose of this in vitro study was to observe the morphological changes and apical dye penetration at apical dentin surfaces induced by Nd : YAG laser irradiation at different power setting s with and without a laser initiator . Seventy five single rooted human maxillary anterior teeth were used . Following the establishment of the working lengths , the root canals were enlarged with step-back technique . The apex of each root was resected 3 mm perpendicular to its long axis . St and ard Class I cavities of 2 mm depth and 2 mm width were prepared . The teeth were r and omly divided into five groups with fifteen teeth in each . In Group 1 , the retro grade cavity preparations were lased with Nd : YAG laser at 2 W and those in Group 2 preparations were lased with Nd : YAG laser at 3.2 W. In Group 3 , the retro grade cavity surfaces were lased with Nd : YAG laser at 2 W following the application of India ink . Group 4 was lased with the same setting s of Group 2 after an absorbent cotton point soaked with India ink was inserted into the cut dentinal surfaces and the inner walls of the apical preparations . Group 5 served as control . Five teeth from each group were examined using scanning electron microscopy ( SEM ) . The amounts of smear layer , debris , and recrystalized dentin present were assessed and scored . Retro grade cavities of ten teeth from each group were filled with amalgam to examine apical dye penetration . The teeth were immersed in 2 % basic fuscin and kept for 48 hours . Dye penetration was evaluated by stereomicroscope at a magnification of X10 . The results showed the usage of India ink with Nd : YAG laser enhanced the amount of melting and recrystalization of dentin and the radiation and initiator increased the leakage Introduction and hypothesisIn a retrospective study , the sacrospinous hysteropexy was associated with a shorter recovery time compared to a vaginal hysterectomy with no differences in anatomical outcomes . No r and omized trials are performed . Methods Sixty-six women with stage 2–4 uterine descent were r and omized for vaginal hysterectomy(31 ) or sacrospinous hysteropexy(35 ) . Recovery time , anatomical outcomes , functional outcomes , and quality of life were measured . Results Length of time to return to work was shorter after a sacrospinous hysteropexy ( 43 versus 66 days , p = 0.02 ) . The difference in risk for recurrent prolapse stage 2 or more of the apical compartment at 1-year follow-up was 17 % ( 95 % confidence interval , 2 to 30 ) in favor of the vaginal hysterectomy . No differences in quality of life and urogenital symptoms were found . Conclusions The sacrospinous hysteropexy for uterine descent is associated with an earlier recovery time , more recurrent apical prolapses but no differences in functional outcomes , and quality of life
Although the available scientific evidence base is short and at considerable risk of bias , it is still possible to conclude that the apical locator reduces the patient radiation exposure and also that the electronic method may perform better on the working length determination .
INTRODUCTION Apical constriction has been proposed as the most appropriate apical limit for the endodontic working length .
Despite being the most used , some limitations are attributed to the radiographic method of working length determination .
It lacks precision because it is based on the average position of the apical constriction .
The electronic apex locators have been presented as an alternative to the odontometry performed by radiography .
These devices detect the transition of the pulp to the periodontal tissue , which is anatomically very close to the apical constriction and may perform with improved accuracy .