POLISH JOURNAL OF ENVIRONMENTAL STUDIES Vol. 25, No. 6A (2016) 1. Evaluation of Adult Body Posture According to Pain Symptoms and Parafunctions Present in the Stomatognathic System ALICJA STACHURA-PUŻYŃSKA, PIOTR CZYRSKI, WIESŁAW KULEJ, KRZYSZTOF DUDEK, MAREK PUŻYŃSKI, KAMIL NELKE... 5 2. The Relation of Sex, Age, Body Stature and Body Posture Stability Among Adults ALICJA STACHURA-PUŻYŃSKA, PIOTR CZYRSKI, WIESŁAW KULEJ, KRZYSZTOF DUDEK, MAREK PUŻYŃSKI, NATALIA MANDZIOS, KATARZYNA STASZAK... 10 3. Three Dimensional Quality Evaluation of Root Canals Preparation with TiLOS System ŁUKASZ ZADROŻNY, KAROL SZLĄZAK, LEOPOLD WAGNER, WOJCIECH ŚWIĘSZKOWSKI... 18 4. Three Dimensional Quality Evaluation of Root Canals Filled with Thermal Technique ŁUKASZ ZADROŻNY, KAROL SZLĄZAK, LEOPOLD WAGNER, WOJCIECH ŚWIĘSZKOWSKI... 21 5. Oral Health Status and Selected Saliva Parameters in Children under Antineoplastic Treatment DARIA PIETRASZEWSKA, LIDIA POSTEK-STEFAŃSKA, ANNA JODŁOWSKA, AGNIESZKA WACŁAWCZYK, GRAŻYNA SOBOL-MILEJSKA... 24 6. Effectiveness of the ICON Product in the Treatment of Initial Caries in Permanent Teeth in Developmental Age LIDIA POSTEK-STEFAŃSKA, IWONA WYSOCZAŃSKA-JANKOWICZ, ANNA BEYGA, GRZEGORZ OGIŃSKI, LECH BORKOWSKI, AGNIESZKA WACŁAWCZYK, ANNA JODŁOWSKA... 28 7. Tooth Germ Development Impairment after Antineoplastic Treatment in Childhood Cancer ANNA JODŁOWSKA, LIDIA POSTEK-STEFAŃSKA, DARIA PIETRASZEWSKA, GRAŻYNA SOBOL-MILEJSKA, IWONA WYSOCZAŃSKA-JANKOWICZ... 32 8. Progression of Erosive and Carious-like Lesions in Human and Bovine Enamel - A Comparative Microhardness Study TOMASZ STEFAŃSKI, LIDIA POSTEK-STEFAŃSKA, PIOTR MALARA, ANNA KLOC-PTASZNA... 37 9. Indirect Effect of 2,3,7,8-Tetrachlorodibenzo-P-Dioxin Conjugated with Tocopherol or Acetylsalicylic Acid on Zinc and Iron Concentration in Hard Tissues of Rats ALEKSANDRA SKALEC, MACIEJ DOBRZYŃSKI, KATARZYNA HERMAN, MAŁGORZATA KOWALCZYK-ZAJĄC, AGNIESZKA CZAJCZYŃSKA-WASZKIEWICZ, KAROL KIRSTEIN, MAGDALENA SZKLARZ, KATARZYNA FITA, ALEKSANDER CHRÓSZCZ, MACIEJ JANECZEK, ZBIGNIEW RYBAK, IRENEUSZ CAŁKOSIŃSKI... 42 10. Dioxin Influence on the Masticatory Apparatus in Clinical and Experimental Research ALEKSANDRA SKALEC, MACIEJ DOBRZYŃSKI, KATARZYNA HERMAN, MAŁGORZATA KOWALCZYK-ZAJĄC, AGNIESZKA CZAJCZYŃSKA-WASZKIEWICZ, KAROL KIRSTEIN, MAGDALENA SZKLARZ, KATARZYNA FITA, ALEKSANDER CHRÓSZCZ, MACIEJ JANECZEK, IRENEUSZ CAŁKOSIŃSKI OLGA PARULSKA, PIOTR MALEC, GRZEGORZ TERLECKI, ALEKSANDA KUMALA... 49
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18 Pol. J. Environ. Stud. Vol. 25, No. 6A (2016), 18-20 Three Dimensional Quality Evaluation of Root Canals Preparation with TiLOS System Łukasz Zadrożny 1, Karol Szlązak 2 *, Leopold Wagner 1, Wojciech Święszkowski 2 1 Department of Dental Propaedeutics and Prophylaxis, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warszawa 2 Faculty of Materials Science and Engineering, Warsaw University of Technology, Wołoska 141, 02-507 Warszawa Abstract Endodontic therapy depends on complete removing of the pulp tissue, the removal of microorganisms and their degradation products, and on giving the appropriate shape to the root canals with finally filling them. Canal shaping and mechanical preparation enlarge initial canal space and provide condition for proper rinsing and chemical preparation of canal space. This step is crucial for general treatment outcome. Only property shaped and well irrigated canal can be filled properly. The aim of this study was three dimensional analysis of quality of root canals preparation with oscillatory mechanical files. Evaluation was done on the basis of micro CT scanning of human teeth. 25 teeth were selected for this study. Root canals of each tooth were prepared with hand K-files up to ISO number 15. After hand instrumentation mechanical, oscillatory files TiLOS was used. Chemical irrigations were done with NaOCl, EDTA and CHX with syringe and endodontic double side port needle up to working length of each canal. Each sample was scanned two times in SkyScan 1172 micro CT device. Comparison of initial and final scans after mechanical preparation was done in SkyScan software. Applied analysis provides three dimensional examination of tooth tissues before and after instrumentation with accuracy of 20 μm. Initial and final volume of each canal was calculated respectively from the micro CT reconstruction of the pre-treatment and after instrumentation scans. Calculations were done for canal range from 2 mm from the tip of the root and up to 2 mm apical to the cemento-enamel junction. Applied imagination technique shows differences in canal shape after mechanical preparation with endodontic instruments. Unfortunately none of the analyzed canals was completely prepared. Lack of preparation can be found on the entire canal length. The most difficult to prepare are buco-lingual aspects of oval canals. Keywords: microtomography, ednodontics, root canal preparation, TiLOS *e-mail: karolszlazak@wp.pl
Three Dimensional Quality Evaluation... Introduction According to general teeth anatomy, clinicians should apply a proper technique of canals preparation during endodontic therapy. There are two main alloys (stainless steel and Nickel-Titanium) for endodontic instruments and a few groups of endodontic instruments (Fig. 1). Each group and alloy features different properties. Stainless steel (SS) are more rigid than Nickel-Titanium (Ni-Ti) files, and work better in straight and narrow canals. Ni- Ti files have shape memory and are advised for curved canals. Both SS and Ni-Ti files can be hand and mechanical driven. Most of mechanical files are Ni-Ti, but all of mechanical files systems require initial hand instrumentation [1-4]. For initial preparation SS files are more recommended as they are more wear resistant in sizes less than 20 ISO. Moreover, the first file placed into canal check patency and measure working length (WL) with apex locator which works more precisely with SS alloy. There are no universal and ideal endodontic files system. It is reasonable to combine alloys, movement and project based properties of files applied clinically to achieve best shaping results [5, 6]. Computed microtomography (μct) has a very good accuracy and allows to show three dimensional reconstructions of canals system, in details with resolution up to 4-5 μm. It is a superior tool to visualize teeth in-vitro using samples of extracted teeth as well as three dimensional analysis of canals shaping and filling quality [7]. Experimental Procedures Materials contain 25 single root teeth. Freshly extracted human teeth were radiovisiographed and those with a single, oval canal were selected for the study. Oval canals were defined as those that have a long to short diameter ratio of 2.5 or greater at 5 mm from the root apex. All teeth after extraction were cleaned, disinfected and installed in polystyrene foam block. Polystyrene foam block ensure the marked orientation of tooth for initial scanning, easy removal for shaping procedure and the same as initial installation for second μct scanning. Access to the pulp chamber of each tooth was prepared according to endodontic standards. Root canal of each tooth was prepared with hand K-files (Ultradent Products, USA) up to ISO number 15/02. After hand instrumentation mechanical, oscillatory files from TiLOS Redi Pack (Ultradent Products, USA) were used. Mechanical files were driven with dedicated contra-angle handpiece providing back and forth 19 oscillations in range of 30 (Ultradent Products, USA). Micro motor was set on 20000 rpm and with handpiece 4:1 reduction it gives 5000 oscillations per minute. The sequence of files was: hand K-files (SS) up to 15/02, mechanical (SS) #1 file 13/02, K-file (SS) 20/02, mechanical Ni-Ti file 25/04, hand K-files (Ni-Ti) 25/02, 30/02, 35/02, 40,02. Each file was used until being completely loose in canal space. Chemical irrigations included syringe rinsing of 2% NaOCl (Cerkamed, Poland) with endodontic double sideport needle (Ultradent Products, USA) up to working length. 5 ml of NaOCl was used between each file in sequence. Final rinsing of each canal was performed using 5 ml of 18% EDTA (Cerkamed, Poland) and 5 ml of 2% Chlorhexidin (Cerkamed, Poland). After final irrigation canals were dried with paper points. Each specimen was scanned twice with SkyScan 1172 (Bruker, Belgium) μct scanner with the X-ray tube working at 100kV and 100 μa using an aluminum filter of 0.5mm. The samples were rotated over 180 degrees with the rotation step of 0.5 degree and the pixel size was 20 μm. First (initial) scanning was done before and second (final) was done after instrumentation. Comparison of initial and final scans was done in SkyScan software. Applied analysis provided three dimensional examination of tooth structure before and after instrumentation with accuracy of 20 μm. Initial and final volume of each canal was calculated respectively from the μct reconstruction of the pre-treatment and after instrumentation scans. Calculations were done for canal range from 2 mm from the tip of the root and up to 2 mm apical to the cemento-enamel junction. Results In the conditions of this study none of analyzed oval canals was completely prepared. Lack of preparation can be found on the entire canal length and the lower quality of dentin removal was found on buccal and lingual canal aspects. The best canal preparation left 43% of canal walls untouched (Fig. 2). Mean value of canal preparation was calculated as 54% with SD = 12.6. Fig 1. Available endodontic instruments. Fig. 2. 3D reconstructions of canal preparation accuracy. Orientations: 0 a), 90 b) 180 c) i 270 d); Grey- canal before preparation, Red- untreated surface.
20 Zadrożny Ł., et al. Discussion of Results Oval canals are most difficult to prepare especialy with rotary files. Despite using in this study a combination of hand and mechanical endodontic instruments made both with stainless steel and nickel-titanium alloys, it was impossible to prepare root canals evenly and completely. Prepared canal walls surface was between 42% to 67%. Paqué in μct study with lower accuracy at the level of 34 μm found mean values of untreated dentin in the range of 59.6% to 79.9% depending on applied file sequence. In another study, analyzing 6 instruments systems on the last 4mm of canals the same author found untreated areas ranged from 4% to 100%. De Deus found percentage of untouched canal area ranging from 27.68% to 60.77% underlines the less-than-ideal shaping ability of the available instruments to prepare the root canal space. Also Versiani checked 4 endodontic systems in terms of shaping quality of oval canals and found none of them able to completely prepare canal space. Conclusions Results of this study and findings of other authors shows weakness of mechanical canal preparation. None of authors found significant difference in shaping quality depending on applied endodontic system including rotary, oscillatory/reciprocating and SAF. Both own results and literature review emphasize the key role of irrigation and intracanal dressing materials in an attempt to compensate the suboptimal status of the mechanical debridement, acting throughout the untouched canal areas [10-15]. Acknowledgements The work was partially financed by the program: Development of Science the Development of the Region, a project of the Masovian Province Self-government System, implemented under the Operational Program Human Capital 2007-2013, Priority VIII Regional Human Resources, Measure 8.2 Transfer of knowledge, Submeasure 8.2.2 Regional Innovation Strategies, supported by European Union. Used Abbreviations μct: Computed microtomography SS: Stainless steel Ni-Ti: Nickel- Titanium References 1. ZADROŻNY Ł., WAGNER L., FITAK E. Use of TiLOS endodontic system, based on selected clinical cases. Magazyn Stomatologiczny. 9, 169, 2011 [In Polish]. 2. LEONARDO R. DE T. The Endo-Eze TiLOS system. Dent Today. 29 (2), 74, 2010. 3. RIITANO F. Anatomic Endodontic Technology (AET) a crown-down root canal preparation technique: basic concepts, operative procedure and instruments. Int Endodontic Journal, 38, 575, 2005. 4. METZGER Z., TEPEROVICH E., ZARY R. The Selfadjusting File (SAF). 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