After cleaning and shaping of the root canal the final objective of the endodontic procedure is to obtain a three-dimensional obturation of the root canal space with a fluid-tight seal at the apical foramen. The objective of this in vitro study was to evaluate four different obturation techniques in respect of: • the radiographic quality of root canal obturation, • apical leakage and • the potential of these techniques to obdurate lateral canals One hundred and sixty canals were prepared by using RaCe nickel titanium rotary files to a size 30 with 6% taper. During preparation irrigation was done with TopClear Solution (17% EDTA and 0.2% cetremide) and ChlorXTRA (6% sodium hypochlorite). The canals were divided in four groups of forty canals each and were obturated using the Hybrid Root SEAL technique, the EndoREZ technique, the System B/Obtura technique and the Thermafil technique. The Radiographic Quality of Root Canal Obturation: Digital radiographs were taken of the four groups of obturated canals from a buccolingual and a mesiodistal direction. The quality of obturation was determined for the coronal and apical halves of each canal and scored according to radiographic appearances. The data was tabulated and statistically analyzed using the Mann- Whitney U test. The Hybrid Root SEAL technique demonstrated a statistically significant higher number of radiographic defects in the coronal aspects of the root canals when compared to the System B/Obtura and Thermafil techniques (p<0.05). There was no statistically significant difference between the radiographic defects in the coronal aspects of the root canals between Hybrid Root SEAL and EndoREZ techniques (p>0.05). The Hybrid Root SEAL technique demonstrated a statistically significantly higher number of radiographic defects in the apical aspects of the root canals compared to all the other groups (p<0.05). Apical Leakage: Twenty obturated canals of each of the four groups were processed for evaluation of apical leakage. The root surfaces were coated with nail varnish and sticky wax, leaving 4.0 mm around the apical foramen exposed. Specimens were immersed in 2% methylene blue dye for 48 hours, rinsed in distilled water and embedded in clear acrylic resin. Specimens were sectioned horizontally in 1 mm increments and the extent of dye penetration was measured to the nearest millimeter using a stereomicroscope. The data was tabulated and statistically analyzed using the Man-Whitney U test. The specimens that were obturated with the EndoREZ technique demonstrated the least apical leakage compared to all the other groups tested in this study. However, there was only a statistically significant difference when the EndoREZ technique was compared to the Hybrid Root SEAL and System B/Obtura techniques (p<0.05). The specimens that were obturated with the System B/Obtura technique demonstrated the most apical leakage compared to all the other groups tested in this study. However, there was only a statistically significant difference when the System B/Obtura technique was compared to the EndoREZ and Thermafil techniques (p<0.05). The Potential to Seal Lateral Canals: Twenty obturated canals of each of the four groups were processed for evaluation of the potential to seal lateral canals. The specimens were subjected to a clearing technique and a morphological analysis was performed using a stereomicroscope. Lateral canals were counted and graded within the coronal, middle and apical thirds of the roots. The data was tabulated and statistically analyzed using the Man-Whitney U test. The Thermafil technique demonstrated the greatest number of filled lateral canals. However, there was no statistically significant difference between the Thermafil technique and all the other techniques (p<0.05). / Dissertation (MSc)--University of Pretoria, 2009. / Odontology / unrestricted

Este estudo objetivou avaliar a influência do diâmetro do forame e do instrumento endodôntico na leitura odontométrica de dois aparelhos localizadores apicais eletrônicos. Foram utilizados 40 dentes incisivos inferiores, divididos em 4 grupos, de acordo com o diâmetro do forame apical (100, 200, 300 e 400 µm). Após a abertura coronária desses dentes e o acesso aos canais radiculares, realizou-se a medição do comprimento dos mesmos com auxílio de um microscópio clínico com ampliação de 7,8X, da incisal até que a ponta da lima surgisse no forame apical. Os dentes foram colocados em potes individuais contendo solução de ágar a 1% em solução salina de fosfato tamponado, mantendo-se cerca de 2/3 de suas raízes imersas na solução para que pudesse ser feita a leitura com o Root ZX® (J.Morita, Japão) e o NovApex® (Fórum, Israel). Os mesmos foram medidos com limas nº10 até que a distância de 0,5 mm do ápice fosse acusada no display dos aparelhos. Uma outra medida foi realizada nos dentes utilizando-se lima nº10 e limas com diâmetros correspondentes ao diâmetro dos forames (200µm, 300µm e 400µm). Para a análise estatística foi empregado o teste de Análise de Variância a dois critérios para o confronto global entre os aparelhos e o emprego da lima nº10 em todos os dentes e teste de Tukey para as comparações individuais. Os resultados demonstraram diferença estatística na precisão dos dois aparelhos com um resultado mais preciso para o Root ZX® (p<0,05). Dentes com forame, de menor diâmetro, apresentaram uma medida mais precisa com o localizador apical e dentes com forame de maior diâmetro apresentaram uma maior discrepância na medida. O emprego de limas tipo K nº10 nos dentes com forames de diâmetros maiores apresentaram maior precisão na medição quando comparadas às limas coincidentes aos diâmetros dos forames para o aparelho Root ZX®. Para o NovApex® esta correlação só passou a ocorrer a partir da lima nº40. / This study evaluated the influence of foramen diameter and endodontic instrument size on the odontometry reading of two electronic apical measuring devices. Forty mandibular incisors were used, which were divided into four groups according to the apical foramen diameter (100, 200, 300 and 400µm). After coronal opening of these teeth and access to the root canals, the root canal length was measured with aid of a clinical microscope with 7.8x magnification, from the incisal edge until the file tip reached the apical foramen. Ten teeth with 100-µm diameter were placed in individual jars containing 1% agar solution in phosphate-buffered saline, maintaining around 2/3 of their roots immersed in the solution to allow measurement with Root ZX (J. Morita, Japan) and NovApex (Forum, Israel). Teeth were measured with files n. 10 until the distance of 0.5mm from the apex was indicated by the device. Another measurement was performed on the other thirty teeth with files n. 10 and files with diameters corresponding to the foramen diameters (200µm, 300µm and 400µm). Statistical analysis was performed by two-way analysis of variance for overall comparison between the devices and employment of file n. 10 in all teeth, and Tukey test for individual comparisons. The results demonstrated statistical difference in the precision of both devices, with a more accurate result for Root ZX (p<0.05). Teeth with narrower foramina presented a more accurate measurement with the apical measuring device, and teeth with wider foramina presented larger discrepancy in the measurement. Utilization of K file n. 10 in teeth with wider foramina showed more accurate measurements compared to files with size corresponding to the foramen diameters with the Root ZX® device. With the NovApex® device, this correlation was only observed with file n. 40.

Este estudo objetivou avaliar a influência do diâmetro do forame e do instrumento endodôntico na leitura odontométrica de dois aparelhos localizadores apicais eletrônicos. Foram utilizados 40 dentes incisivos inferiores, divididos em 4 grupos, de acordo com o diâmetro do forame apical (100, 200, 300 e 400 µm). Após a abertura coronária desses dentes e o acesso aos canais radiculares, realizou-se a medição do comprimento dos mesmos com auxílio de um microscópio clínico com ampliação de 7,8X, da incisal até que a ponta da lima surgisse no forame apical. Os dentes foram colocados em potes individuais contendo solução de ágar a 1% em solução salina de fosfato tamponado, mantendo-se cerca de 2/3 de suas raízes imersas na solução para que pudesse ser feita a leitura com o Root ZX® (J.Morita, Japão) e o NovApex® (Fórum, Israel). Os mesmos foram medidos com limas nº10 até que a distância de 0,5 mm do ápice fosse acusada no display dos aparelhos. Uma outra medida foi realizada nos dentes utilizando-se lima nº10 e limas com diâmetros correspondentes ao diâmetro dos forames (200µm, 300µm e 400µm). Para a análise estatística foi empregado o teste de Análise de Variância a dois critérios para o confronto global entre os aparelhos e o emprego da lima nº10 em todos os dentes e teste de Tukey para as comparações individuais. Os resultados demonstraram diferença estatística na precisão dos dois aparelhos com um resultado mais preciso para o Root ZX® (p<0,05). Dentes com forame, de menor diâmetro, apresentaram uma medida mais precisa com o localizador apical e dentes com forame de maior diâmetro apresentaram uma maior discrepância na medida. O emprego de limas tipo K nº10 nos dentes com forames de diâmetros maiores apresentaram maior precisão na medição quando comparadas às limas coincidentes aos diâmetros dos forames para o aparelho Root ZX®. Para o NovApex® esta correlação só passou a ocorrer a partir da lima nº40. / This study evaluated the influence of foramen diameter and endodontic instrument size on the odontometry reading of two electronic apical measuring devices. Forty mandibular incisors were used, which were divided into four groups according to the apical foramen diameter (100, 200, 300 and 400µm). After coronal opening of these teeth and access to the root canals, the root canal length was measured with aid of a clinical microscope with 7.8x magnification, from the incisal edge until the file tip reached the apical foramen. Ten teeth with 100-µm diameter were placed in individual jars containing 1% agar solution in phosphate-buffered saline, maintaining around 2/3 of their roots immersed in the solution to allow measurement with Root ZX (J. Morita, Japan) and NovApex (Forum, Israel). Teeth were measured with files n. 10 until the distance of 0.5mm from the apex was indicated by the device. Another measurement was performed on the other thirty teeth with files n. 10 and files with diameters corresponding to the foramen diameters (200µm, 300µm and 400µm). Statistical analysis was performed by two-way analysis of variance for overall comparison between the devices and employment of file n. 10 in all teeth, and Tukey test for individual comparisons. The results demonstrated statistical difference in the precision of both devices, with a more accurate result for Root ZX (p<0.05). Teeth with narrower foramina presented a more accurate measurement with the apical measuring device, and teeth with wider foramina presented larger discrepancy in the measurement. Utilization of K file n. 10 in teeth with wider foramina showed more accurate measurements compared to files with size corresponding to the foramen diameters with the Root ZX® device. With the NovApex® device, this correlation was only observed with file n. 40.

Este trabalho teve como objetivo avaliar a influência da espessura de dentina radicular apical, da constrição apical e do diâmetro do forame apical na precisão de leituras realizadas com os localizadores foraminais eletrônicos Mini Apex Locator e Root ZX II®. Foram utilizados 30 incisivos inferiores permanentes unirradiculados de humanos, extraídos, com raízes íntegras e ápices completamente formados e portadores de um único canal. Por meio de um paquímetro, as espessuras radiculares dos dentes foram medidas, no sentido mésio-distal a 1,0 e a 4,0mm aquém do forame apical. Após a abertura coronária, uma lima tipo K no 10, munida de limitador de penetração, foi introduzida no canal radicular até que sua extremidade pudesse ser visualizada na altura do forame, com o auxílio de um microscópio óptico com aumento de 7,8X. Dessa medida, subtraiu-se 1,0mm, estabelecendo-se o comprimento de trabalho. A dilatação do canal radicular foi feita, inicialmente, com brocas de Gates Glidden, em ordem numérica decrescente, da número 5 até a número1, até 4,0mm aquém do forame apical. Os dentes foram fixados em um modelo experimental especialmente desenvolvido para permitir a medição com os localizadores foraminais eletrônicos. Tal modelo era constituído por dois segmentos de PVC: um de menor calibre, com diâmetro correspondente a meia polegada por 2,0cm de comprimento, com as duas extremidades abertas e outro, de maior calibre, com uma das extremidades fechada e com diâmetro interno equivalente ao diâmetro externo do primeiro segmento (3/4 de polegada). No segmento de maior diâmetro, foi feito um orifício lateral que permitiu o posicionamento do eletrodo labial do localizador foraminal eletrônico e, para a medição, no seu interior, foi colocado alginato e, então, encaixado o componente de menor diâmetro, fazendo com que o ápice radicular ficasse imerso no alginato. Foram realizadas as leituras com os localizadores, iniciando-se com a lima tipo K no 10 e seguindo-se a seqüência de instrumentação e medida até a lima tipo K no 130; a lima tipo K no 10 foi utilizada em todos os diâmetros. Terminada essa fase, os dentes tiveram os canais sobreinstrumentados, isto é, a ponta da lima ultrapassou o forame apical em 1,0mm, a partir da lima tipo K no 25 e seguindo até a lima tipo K no 130; novas medidas foram obtidas com cada lima que sobreinstrumentou o forame e a lima no 10 foi utilizada em todos os diâmetros. Em todos os casos o canal radicular estava preenchido com hipoclorito de sódio a 1%. Para a análise estatística foram empregados os testes de Análise de Variância a dois critérios e de Tukey. Os resultados indicaram que as variáveis capazes de influenciar a recisão das leituras com os localizadores foraminais eletrônicos foram a eliminação da constrição apical com o consequente aumento do diâmetro do forame apical, ao contrário da espessura da parede dentinária do canal radicular, que não interferiu significativamente na precisão das leituras. / This study evaluated the influence of the apical root dentin thickness, apical constriction and diameter of the apical foramen in the accuracy of readings obtained using the electronic apex locators Mini Apex Locator and Root ZX II ®. The study was conducted on 30 extracted human single-rooted permanent mandibular incisors, with intact and completely formed roots and presenting a single canal. The root thickness of the teeth was measured with a pachymeter in mesiodistal direction, at 1.0 and 4.0mm from the apical foramen. After coronal opening, a 10 K file with a stop was introduced in the root canal until its end could be observed at the level of the apical foramen, with aid of a light microscope with 7.8X magnification. One millimeter was subtracted from this measurement for establishment of the working length. Enlargement of the root canal was initially performed using Gates Glidden burs, in decreasing order, from number 5 to number 1, up to 4.0mm beyond the apical foramen. The teeth were fixated in an experimental model especially designed to allow the measurement with the electronic apex locators. This model was composed of two PVC segments: one smaller, with diameter corresponding to half inch with 2.0cm length, with both ends open; and the other, with larger diameter, with one end closed and internal diameter similar to the external diameter of the first segment (3/4 inch). In the segment with greater diameter, a lateral orifice was made to allow positioning of the lip electrode of the electronic apex locator. For the measurement, alginate was poured and the component with smaller diameter was fitted, so as the root apex was immersed in alginate. Readings were performed using the electronic apex locators, initiating with a 10 K file and following the sequence of instrumentation and measurement up to 130 K file. The 10 K file was used in all diameters. After this stage, the root canals were overinstrumented, i.e. the file tip was introduced until 1.0mm beyond the apical foramen, beginning with 25 K file up to 130 K file; new measurements were obtained with each file overinstrumenting the apical foramen, and the 10 K file was used in all diameters. In all cases, the root canal was irrigated with 1% sodium hypochlorite. Statistical analysis was performed by two-way analysis of variance and the Tukey test. The results indicated that the variables that may influence the accuracy of readings with the electronic apex locators were the elimination of apical constriction with consequent increase in the diameter of the apical foramen, different from the thickness of the root canal dentinal wall, which did not significantly influence the accuracy of readings.

Este trabalho teve como objetivo avaliar a influência da espessura de dentina radicular apical, da constrição apical e do diâmetro do forame apical na precisão de leituras realizadas com os localizadores foraminais eletrônicos Mini Apex Locator e Root ZX II®. Foram utilizados 30 incisivos inferiores permanentes unirradiculados de humanos, extraídos, com raízes íntegras e ápices completamente formados e portadores de um único canal. Por meio de um paquímetro, as espessuras radiculares dos dentes foram medidas, no sentido mésio-distal a 1,0 e a 4,0mm aquém do forame apical. Após a abertura coronária, uma lima tipo K no 10, munida de limitador de penetração, foi introduzida no canal radicular até que sua extremidade pudesse ser visualizada na altura do forame, com o auxílio de um microscópio óptico com aumento de 7,8X. Dessa medida, subtraiu-se 1,0mm, estabelecendo-se o comprimento de trabalho. A dilatação do canal radicular foi feita, inicialmente, com brocas de Gates Glidden, em ordem numérica decrescente, da número 5 até a número1, até 4,0mm aquém do forame apical. Os dentes foram fixados em um modelo experimental especialmente desenvolvido para permitir a medição com os localizadores foraminais eletrônicos. Tal modelo era constituído por dois segmentos de PVC: um de menor calibre, com diâmetro correspondente a meia polegada por 2,0cm de comprimento, com as duas extremidades abertas e outro, de maior calibre, com uma das extremidades fechada e com diâmetro interno equivalente ao diâmetro externo do primeiro segmento (3/4 de polegada). No segmento de maior diâmetro, foi feito um orifício lateral que permitiu o posicionamento do eletrodo labial do localizador foraminal eletrônico e, para a medição, no seu interior, foi colocado alginato e, então, encaixado o componente de menor diâmetro, fazendo com que o ápice radicular ficasse imerso no alginato. Foram realizadas as leituras com os localizadores, iniciando-se com a lima tipo K no 10 e seguindo-se a seqüência de instrumentação e medida até a lima tipo K no 130; a lima tipo K no 10 foi utilizada em todos os diâmetros. Terminada essa fase, os dentes tiveram os canais sobreinstrumentados, isto é, a ponta da lima ultrapassou o forame apical em 1,0mm, a partir da lima tipo K no 25 e seguindo até a lima tipo K no 130; novas medidas foram obtidas com cada lima que sobreinstrumentou o forame e a lima no 10 foi utilizada em todos os diâmetros. Em todos os casos o canal radicular estava preenchido com hipoclorito de sódio a 1%. Para a análise estatística foram empregados os testes de Análise de Variância a dois critérios e de Tukey. Os resultados indicaram que as variáveis capazes de influenciar a recisão das leituras com os localizadores foraminais eletrônicos foram a eliminação da constrição apical com o consequente aumento do diâmetro do forame apical, ao contrário da espessura da parede dentinária do canal radicular, que não interferiu significativamente na precisão das leituras. / This study evaluated the influence of the apical root dentin thickness, apical constriction and diameter of the apical foramen in the accuracy of readings obtained using the electronic apex locators Mini Apex Locator and Root ZX II ®. The study was conducted on 30 extracted human single-rooted permanent mandibular incisors, with intact and completely formed roots and presenting a single canal. The root thickness of the teeth was measured with a pachymeter in mesiodistal direction, at 1.0 and 4.0mm from the apical foramen. After coronal opening, a 10 K file with a stop was introduced in the root canal until its end could be observed at the level of the apical foramen, with aid of a light microscope with 7.8X magnification. One millimeter was subtracted from this measurement for establishment of the working length. Enlargement of the root canal was initially performed using Gates Glidden burs, in decreasing order, from number 5 to number 1, up to 4.0mm beyond the apical foramen. The teeth were fixated in an experimental model especially designed to allow the measurement with the electronic apex locators. This model was composed of two PVC segments: one smaller, with diameter corresponding to half inch with 2.0cm length, with both ends open; and the other, with larger diameter, with one end closed and internal diameter similar to the external diameter of the first segment (3/4 inch). In the segment with greater diameter, a lateral orifice was made to allow positioning of the lip electrode of the electronic apex locator. For the measurement, alginate was poured and the component with smaller diameter was fitted, so as the root apex was immersed in alginate. Readings were performed using the electronic apex locators, initiating with a 10 K file and following the sequence of instrumentation and measurement up to 130 K file. The 10 K file was used in all diameters. After this stage, the root canals were overinstrumented, i.e. the file tip was introduced until 1.0mm beyond the apical foramen, beginning with 25 K file up to 130 K file; new measurements were obtained with each file overinstrumenting the apical foramen, and the 10 K file was used in all diameters. In all cases, the root canal was irrigated with 1% sodium hypochlorite. Statistical analysis was performed by two-way analysis of variance and the Tukey test. The results indicated that the variables that may influence the accuracy of readings with the electronic apex locators were the elimination of apical constriction with consequent increase in the diameter of the apical foramen, different from the thickness of the root canal dentinal wall, which did not significantly influence the accuracy of readings.