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Does the Orifice-directed Dentin Conservation Access Design Debride Pulp Chamber and Mesial Root Canal Systems of Mandibular Molars Similar to a Traditional Access Design?

Published:December 19, 2017DOI:https://doi.org/10.1016/j.joen.2017.10.010

      Highlights

      • For the first time, the debridement of an orifice-directed access cavity design (truss access) was compared with a traditional access cavity.
      • The pulp chamber was significantly cleaner in a traditional access compared with the orifice-directed access.
      • The root canals and isthmus showed a similar amount of remaining pulp tissue immaterial of the access cavity design.

      Abstract

      Introduction

      Despite the increasing reports on mechanical aspects of contracted endodontic access cavities (CECs), we believe that the biological aspects (debridement) have not been adequately investigated. This study examined if 1 type of CEC (orifice-directed dentin conservation [DDC] access) was able to debride the pulp chamber, root canals, and isthmus of mesial roots of mandibular molars similar to a traditional endodontic access cavity (TEC).

      Methods

      Mandibular molars (N = 32) were selected and divided randomly into 2 experimental groups (n = 12) after micro–computed tomographic scanning (group 1: TEC and group 2: DDC) and histologic controls (n = 8). After instrumentation to a size 30/0.06 taper using 3% sodium hypochlorite as irrigant, specimens were processed for histologic evaluation, and the remaining pulp tissue (RPT) was measured from the pulp chamber, root canal, and isthmus at all root thirds. Data were analyzed using 1-way analysis of variance, Kruskal-Wallis, and appropriate post hoc tests (P = .05).

      Results

      The RPT in the pulp chamber was significantly higher in DDC compared with TEC (P < .05). Comparing the root thirds in each group, there was no significant difference in the RPT within the root canals or the isthmus (P > .05). The RPT within the root canals and isthmus was not significantly different between the 2 access cavity designs at any root third (P > .05).

      Conclusions

      Debridement of the pulp chamber was significantly compromised in DDC. The type of access cavity did not influence the amount of RPT in the root canals and isthmus.

      Key Words

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      References

        • Trope M.
        • Bergenholtz G.
        Microbiological basis for endodontic treatment: can a maximal outcome be achieved in one visit?.
        Endod Topics. 2002; 1: 40-53
        • Kishen A.
        Mechanisms and risk factors for fracture predilection in endodontically treated teeth.
        Endod Topics. 2006; 13: 57-83
        • Zadik A.
        • Sandler V.
        • Bechor R.
        • Salehrabi R.
        Analysis of factors related to extraction of endodontically treated teeth.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: e31-e35
        • Moore B.
        • Verdelis K.
        • Kishen A.
        • et al.
        Impacts of contracted endodontic cavities on instrumentation efficacy and biomechanical responses in maxillary molars.
        J Endod. 2016; 42: 1779-1783
        • Uzunoglu E.
        • Yilmaz Z.
        • Erdogan O.
        • Gorduysus M.
        Final irrigation regimens affect fracture resistance values of root-filled teeth.
        J Endod. 2016; 42: 493-495
        • Clark D.
        • Khademi J.
        Modern molar endodontic access and directed dentin conservation.
        Dent Clin North Am. 2010; 54: 249-273
        • Aminoshariae A.
        • Kulild J.C.
        Master apical file size - smaller or larger: a systematic review of healing outcomes.
        J Endod. 2015; 41: 999-1007
        • Aminoshariae A.
        • Kulild J.C.
        Master apical file size - smaller or larger: a systematic review of microbial reduction.
        J Endod. 2015; 48: 1007-1022
        • Patel S.
        • Rhodes J.
        A practical guide to endodontic access cavity preparation in molar teeth.
        Br Dent J. 2007; 203: 133-140
        • Clark D.
        • Khademi J.
        Modern endodontic access and dentin conservation, part 1.
        Dent Today. 2009; 28: 86-90
        • Clark D.
        • Khademi J.
        Modern endodontic access and dentin conservation, part 2.
        Dent Today. 2009; 28: 86-90
        • Plotino G.
        • Grande N.M.
        • Isufi A.
        • et al.
        Fracture strength of endodontically treated teeth with different access cavity designs.
        J Endod. 2017; 43: 995-1000
        • Boveda C.
        • Kishen A.
        Contracted endodontic cavities: the foundation for less invasive alternatives in the management of apical periodontitis.
        Endod Topics. 2015; 33: 169-186
        • Khademi J.
        • Trudeau M.
        • Narayana P.
        • et al.
        Image-guided endodontics: the role of the endodontic triad.
        Dent Today. 2016; 35: 94
        • Narayana P.
        Access cavity preparations.
        in: Schwartz R.S. Canakapalli V. Best Practices in Endodontics: A Desk Reference. 1st ed. Quintessence Publishing, Chicago, IL2015: 89-104
        • Krishan R.
        • Paque F.
        • Ossareh A.
        • et al.
        Impacts of conservative endodontic cavity on root canal instrumentation efficacy and resistance to fracture assessed in incisors, premolars and molars.
        J Endod. 2014; 40: 1160-1166
        • Rover G.
        • Belladona F.G.
        • Bortoluzzi E.A.
        • et al.
        Influence of access cavity design on root canal detection, instrumentation efficacy, and fracture resistance assessed in maxillary molars.
        J Endod. 2017; 43: 1657-1662
        • De-Deus G.
        • Souza E.M.
        • Barino B.
        • et al.
        The self-adjusting file optimizes debridement quality in oval-shaped root canals.
        J Endod. 2011; 37: 701-705
        • Neelakantan P.
        • Devaraj S.
        • Jagannathan N.
        Histologic assessment of debridement of the root canal isthmus of mandibular molars by irrigant activation techniques ex vivo.
        J Endod. 2016; 42: 1268-1272
        • Siqueira Jr., J.F.
        • Araujo M.C.
        • Garcia P.F.
        • et al.
        Histological evaluation of the effectiveness of five instrumentation techniques for cleaning the apical third of root canals.
        J Endod. 1997; 23: 499-502
        • Susin L.
        • Liu Y.
        • Yoon J.C.
        • et al.
        Canal and isthmus debridement efficacies of two irrigant agitation techniques in a closed system.
        Int Endod J. 2010; 43: 1077-1090
        • Molina B.
        • Glickman G.
        • Vandrangi P.
        • Khakpour M.
        Evaluation of root canal debridement of human molars using the GentleWave system.
        J Endod. 2015; 41: 1701-1705
        • Ingle J.I.
        Endodontic cavity preparation.
        in: Ingle J. Tamber J. Endodontics. 3rd ed. Lea & Febiger, Philadelphia1985: 102-167
        • Rodrigues R.C.V.
        • Zandi H.
        • Kristoffersen A.K.
        • et al.
        Influence of the apical preparation size and the irrigant type on bacterial reduction in root canal-treated teeth with apical periodontitis.
        J Endod. 2017; 43: 1058-1063
        • Siqueira Jr., J.F.
        • Alves F.R.
        • Almeida B.M.
        • et al.
        Ability of chemomechanical preparation with either rotary instruments or self-adjusting file to disinfect oval-shaped root canals.
        J Endod. 2010; 36: 1860-1865
        • Siqueira Jr., J.F.
        • Perez A.R.
        • Marceliano-Alves M.F.
        • et al.
        What happens to unprepared root canal walls: a correlative analysis using micro-computed tomography and histology/scanning electron microscopy.
        Int Endod J. 2017 17 Mar; ([Epub ahead of print])https://doi.org/10.1111/iej.12753
        • Ahmed H.M.
        • Neelakantan P.
        • Dummer P.M.H.
        A new system for classifying accessory canal morphology.
        Int Endod J. 2017 31 Jul; ([Epub ahead of print])https://doi.org/10.1111/iej.12800
        • Benenati F.W.
        • Khajotia S.S.
        A radiographic recall evaluation of 894 endodontic cases treated in a dental school setting.
        J Endod. 2002; 28: 391-395
        • Lloyd A.
        • Uhles J.P.
        • Clement D.J.
        • Garcia-Godoy F.
        Elimination of intracanal tissue and debris through a novel laser-activated system assessed using high-resolution micro-computed tomography: a pilot study.
        J Endod. 2014; 40: 584-587
        • Azim A.A.
        • Deutsch A.S.
        • Solomon C.Z.
        Prevalence of middle mesial canals in mandibular molars after guided troughing under high magnification: an in vivo investigation.
        J Endod. 2015; 41: 164-168
        • Card S.J.
        • Sigurdsson A.
        • Orstavik D.
        • Trope M.
        The effectiveness of increased apical enlargement in reducing intracanal bacteria.
        J Endod. 2002; 28: 779-783
        • Coldero L.G.
        • McHugh S.
        • MacKenzie D.
        • Saunders W.P.
        Reduction in intracanal bacteria during root canal preparation with and without apical enlargement.
        Int Endod J. 2002; 35: 437-446
        • Khademi A.
        • Yazdizadeh M.
        • Feizianfard M.
        Determination of the minimum instrumentation size for penetration of irrigants to the apical third of root canal systems.
        J Endod. 2006; 32: 417-420
        • Johnson M.
        • Sidow S.J.
        • Looney S.W.
        • et al.
        Canal and isthmus debridement efficacy using a sonic irrigation technique in a closed-canal system.
        J Endod. 2012; 38: 1265-1268
        • Koch J.D.
        • Smith N.A.
        • Garces D.
        • et al.
        In vitro particle image velocity measurements in a model root canal: flow around a polymer rotary finishing file.
        J Endod. 2014; 40: 412-416
        • Niemi T.K.
        • Marchesan M.A.
        • Llloyd A.
        • Seltzer R.J.
        Effect of instrument design and access outlines on the removal of root canal obturation materials in oval-shaped canals.
        J Endod. 2016; 42: 1550-1554
        • Connert T.
        • Zehnder M.S.
        • Weigner R.
        • et al.
        Microguided endodontics: accuracy of a miniaturized technique for apically extended access cavity preparation in anterior teeth.
        J Endod. 2017; 43: 787-790