AIM:To compare in vivo the accuracy of two electronic apex locators (EALs) by means of digital radiographic imaging system.METHODOLOGY:Electronic working lengths of 831 canals were determined with the DentaPort ZX and Raypex 5 apex locators and confirmed radiographically. The radiographic images acquired with the aid of a digital radiographic imaging system (VisualiX eHD; Gendex Dental Systems, Des Plaines, IL, USA) were blindly analysed by two independent evaluators. The distance between the file tip and the radiographic apex was measured using dedicated software (VixWin Pro, Gendex Dental Systems, Des Plaines, IL, USA) and the mean distance achieved between different tooth type and EALs were compared statistically. Statistical analyses were performed using the t-test for independent samples and one-way anova with the null hypothesis set as 5%. Positive or negative values were recorded when the file tip was detected beyond or short of the radiographic apex, respectively.RESULTS:The mean distance between file tip and radiographic apex were -1.08 +/- 0.73 and -1.0 +/- 0.67 mm considering DentaPort ZX and Raypex 5 groups, respectively, with no significant differences (P > 0.05). No statistically significant differences were found amongst the same tooth type when comparing both groups (P > 0.05) or amongst different teeth type in the same group (P > 0.05).CONCLUSIONS:Within the limitations of this in vivo study, the DentaPort ZX and Raypex 5 were similar in terms of accuracy.

Objective. The purpose of this study was to evaluate 50 human periapical lesions for bacteria and epithelium in a case study in dental practice.Study design. Specimens were obtained front the extraction of 50 untreated teeth that had lesions attached to their apices. The specimens were histologically evaluated using serial sections.Results. Bacteria were found in all teeth, colonizing necrotic tissue in the main canal, dentinal tubules, or apical ramifications, and in the body of the periapical lesion in 18 abscesses or cysts. Twenty-one lesions were epithelialized; 14 abscesses, 20 granulomas, and 16 cysts were distinguished. In 18 root canals inflamed tissue was found in the apical part of the canal. A single foramen was present in 13 cases while apical ramifications were found in 37 cases.Conclusions. Granulomas were most common, and most epithelialized lesions were cysts. Bacteria were only detected periapically in abscesses or cysts. Inflamed tissue was present in the apical root canal in one third of. cases.

AIM:To evaluate setting time, solubility and disintegration, flow, film thickness, and dimensional change following setting in a dual-cured resin root canal sealer Epiphany compared with an epoxy-resin-based sealer AH Plus.METHODOLOGY:The experiments were performed according to ANSI/ADA Specification 57 which tests the physicochemical properties of endodontic sealing materials. Five samples of each material were tested for each of the properties. In addition, deionized distilled water from the solubility test of Epiphany was submitted for analysis of the cations Fe, Ni, Ca, Mg, Zn, Na, and K in an atomic absorption spectrometer. Three samples were analysed.RESULTS:There were no statistical differences (P>0.05) in flow (AH Plus: 38.57 mm; Epiphany: 35.74 mm) and film thickness (AH Plus: 10.6 microm; Epiphany: 20.1 microm). The solubility (AH Plus: 0.21%; Epiphany: 3.41%) and dimensional alterations following setting (AH Plus: expansion of 1.3%; Epiphany: expansion of 8.1%) were statistically different (P<0.05). The setting times of both sealants were in accordance with ANSI/ADA requirements.CONCLUSIONS:Setting time, flow, and film thickness tests for both cements conformed to ANSI/ADA standards. Dimensional alteration test for both cements were greater than values considered acceptable by ANSI/ADA. Epiphany values regarding solubility were also greater than values considered acceptable by ANSI/ADA.

AIM:To report two cases in which calculus-like material was found on external root surfaces of (i) an extracted root and (ii) an apicected part of a root, both of which were removed due to post-treatment refractory apical periodontitis.SUMMARY:In each case, there was a fistulous tract, which did not heal after conventional root canal treatment. The first case did not heal even after apical surgery, and subsequent tooth extraction revealed calculus-like material on a root surface of complex anatomy. The second case showed radiographic signs of healing after apicectomy. Histology of the apical biopsy revealed a calculus-like material on the external surface of the root apex. It is suggested that the presence of calculus on the root surfaces of teeth with periapical lesions may contribute towards the aetiology of failure.KEY LEARNING POINTS:Biofilm on the external root surface has been implicated in the failure of apical periodontitis to heal, despite adequate root canal treatment. Calculus-like material was found, in two cases, on the root surface of teeth with post-treatment apical periodontitis, where the only communication externally was a sinus tract.

AIM To evaluate the biological properties of a variety of materials that could be used in apical surgery. METHODOLOGY The intraosseous implant technique recommended by the FDI (1980) and ADA (1982) was used to test the following materials: zinc oxide-eugenol (ZOE), mineral trioxide aggregate (MTA), and Z-100 light-cured composite resin. Thirty guinea-pigs, 10 for each material, divided into experimental periods of 4 and 12 weeks, received one implant on each side of the lower jaw symphysis. The connective tissue response alongside the lateral wall outside the cup served as a negative control for the technique. At the end of the observation periods, the animals were killed and the specimens prepared for routine histological examination to evaluate their biocompatibility. RESULTS The reaction of the tissue to the materials diminished with time. The ZOE cement was highly toxic during the 4-week experimental period, but this profile changed significantly after 12 weeks, when it showed biocompatible characteristics. MTA and Z-100 showed biocompatibility in this test model at both time periods. CONCLUSIONS MTA and Z-100 composite were biocompatible at 4 and 12 weeks in this experimental model.

Three cases of mandibular second molars with C-shaped root canal morphology are described, Two of these molars did not radiographically show the usual anatomic configuration of two separated roots, but rather had a single conical root, Only two root canals orifices were observed in the pulp chamber floor: a mesial-lingual orifice in its normal position and a buccal C-shaped fissure that was continuous from the normal location of the mesiobuccal canal to that of the distal canal, The fissure became smaller in the apical third, ending in a distal direction, The third case, a second molar extracted because of severe periodontal involvement showed, after sectioning, a C-shaped root with connections between all three canals.

One hundred fifty cases of endodontic treatment failures were studied clinically, radiographically, and histologically. Fifty-seven percent of the teeth were asymptomatic. Pain alone and/or associated with swelling was present in 21% of the teeth. There was no correlation between the size of periradicular rarefaction and the occurrence or severity of clinical signs and/or symptoms. Stainable bacteria were demonstrated in 69% of the teeth and were present mostly in the canal. The severity of periradicular inflammation was related to presence of stainable bacteria in the canal. Swelling and pain or a draining sinus tract was often associated with stainable bacteria inside the canal. The development of a radicular cyst associated with an endodontically treated tooth that has failed is not necessarily the cause of endodontic treatment failure.

The purpose of this study was to develop methods and criteria for the testing of the biocompatibility of endodontic materials. One hundred twenty-one teeth from 12 baboons (Papio anubis) were used to test three sealers: AH26, Kerr pulp canal sealer, and Kloroperka N.O. Gutta-percha cones were used as solid core in all cases. Under disinfected conditions, access preparation was performed, and with working length approximately 1.0 mm short of the foramen, the instrumentation of the root canal was started, using sodium hypochlorite (1%) for irrigation. After the root canals were cleaned and shaped, they were obturated with gutta-percha cones and the sealer, and by lateral condensation technique. Histologic periapical reactions were evaluated at 1, 7, 30, 365, 730, and 1095 days. The methods and criteria used were adequate for ranking of the biocompatibility of the tested materials in the short and long periods. At short observation periods (1 to 7 days) AH26 caused severe reactions, and Kerr pulp canal sealer and Kloroperka N.O., moderate and mild reactions, respectively. At 2- and 3-year observation periods the ranking was AH26, mild; Kerr pulp canal sealer, moderate; and Kloropercha N.O., severe.