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Research Articles
How do imaging protocols affect the assessment of root-end fillings?
Fernanda Ferrari Esteves Torres, Reinhilde Jacobs, Mostafa EzEldeen, Karla de Faria-Vasconcelos, Juliane Maria Guerreiro-Tanomaru, Bernardo Camargo dos Santos, Mário Tanomaru-Filho
Restor Dent Endod 2022;47(1):e2.   Published online December 15, 2021
DOI: https://doi.org/10.5395/rde.2022.47.e2
AbstractAbstract PDFPubReaderePub
Objectives

This study investigated the impact of micro-computed tomography (micro-CT)-based voxel size on the analysis of material/dentin interface voids and thickness of different endodontic cements.

Materials and Methods

Following root-end resection and apical preparation, maxillary premolars were filled with mineral trioxide aggregate (MTA), Biodentine, and intermediate restorative material (IRM) (n = 24). The samples were scanned using micro-CT (SkyScan 1272; Bruker) and the cement/dentin interface and thickness of materials were evaluated at voxel sizes of 5, 10, and 20 µm. Analysis of variance and the Tukey test were conducted, and the degree of agreement between different voxel sizes was evaluated using the Bland and Altman method (p < 0.05).

Results

All materials showed an increase in thickness from 5 to 10 and 20 µm (p < 0.05). When evaluating the interface voids, materials were similar at 5 µm (p > 0.05), while at 10 and 20 µm Biodentine showed the lowest percentage of voids (p < 0.05). A decrease in the interface voids was observed for MTA and IRM at 20 µm, while Biodentine showed differences among all voxel sizes (p < 0.05). The Bland-Altman plots for comparisons among voxel sizes showed the largest deviations when comparing images between 5 and 20 µm.

Conclusions

Voxel size had an impact on the micro-CT evaluation of thickness and interface voids of endodontic materials. All cements exhibited an increase in thickness and a decrease in the void percentage as the voxel size increased, especially when evaluating images at 20 µm.

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Porosity and pore size distribution in high-viscosity and conventional glass ionomer cements: a micro-computed tomography study
Aline Borburema Neves, Laísa Inara Gracindo Lopes, Tamiris Gomes Bergstrom, Aline Saddock Sá da Silva, Ricardo Tadeu Lopes, Aline de Almeida Neves
Restor Dent Endod 2021;46(4):e57.   Published online October 29, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e57
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to compare and evaluate the porosity and pore size distribution of high-viscosity glass ionomer cements (HVGICs) and conventional glass ionomer cements (GICs) using micro-computed tomography (micro-CT).

Materials and Methods

Forty cylindrical specimens (n = 10) were produced in standardized molds using HVGICs and conventional GICs (Ketac Molar Easymix, Vitro Molar, MaxxionR, and Riva Self-Cure). The specimens were prepared according to ISO 9917-1 standards, scanned in a high-energy micro-CT device, and reconstructed using specific parameters. After reconstruction, segmentation procedures, and image analysis, total porosity and pore size distribution were obtained for specimens in each group. After checking the normality of the data distribution, the Kruskal-Wallis test followed by the Student-Newman-Keuls test was used to detect differences in porosity among the experimental groups with a 5% significance level.

Results

Ketac Molar Easymix showed statistically significantly lower total porosity (0.15%) than MaxxionR (0.62%), Riva (0.42%), and Vitro Molar (0.57%). The pore size in all experimental cements was within the small-size range (< 0.01 mm3), but Vitro Molar showed statistically significantly more pores/defects with a larger size (> 0.01 mm3).

Conclusions

Major differences in porosity and pore size were identified among the evaluated GICs. Among these, the Ketac Molar Easymix HVGIC showed the lowest porosity and void size.

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Combination of a new ultrasonic tip with rotary systems for the preparation of flattened root canals
Karina Ines Medina Carita Tavares, Jáder Camilo Pinto, Airton Oliveira Santos-Junior, Fernanda Ferrari Esteves Torres, Juliane Maria Guerreiro-Tanomaru, Mario Tanomaru-Filho
Restor Dent Endod 2021;46(4):e56.   Published online October 27, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e56
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated 2 nickel-titanium rotary systems and a complementary protocol with an ultrasonic tip and a small-diameter instrument in flattened root canals.

Materials and Methods

Thirty-two human maxillary second premolars with flattened canals (buccolingual diameter ≥4 times larger than the mesiodistal diameter) at 9 mm from the radiographic apex were selected. The root canals were prepared by ProDesign Logic (PDL) 30/0.01 and 30/0.05 or Hyflex EDM (HEDM) 10/0.05 and 25/0.08 (n = 16), followed by application of the Flatsonic ultrasonic tip in the cervical and middle thirds and a PDL 25/0.03 file in the apical third (FPDL). The teeth were scanned using micro-computed tomography before and after the procedures. The percentage of volume increase, debris, and uninstrumented surface area were analyzed using the Kruskal-Wallis, Dunn, Wilcoxon, analysis of variance/Tukey, and paired and unpaired t-tests (α = 0.05).

Results

No significant difference was found in the volume increase and uninstrumented surface area between PDL and HEDM (p > 0.05). PDL had a higher percentage of debris than HEDM in the middle and apical thirds (p < 0.05). The FPDL protocol resulted in less debris and uninstrumented surface area for PDL and HEDM (p < 0.05). This protocol, with HEDM, reduced debris in the middle and apical thirds and uninstrumented surface area in the apical third (p < 0.05).

Conclusions

High percentages of debris and uninstrumented surface area were observed after preparation of flattened root canals. The HEDM, Flatsonic tip, and 25/0.03 instrument protocol enhanced cleaning in flattened root canals.

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Shaping ability and apical debris extrusion after root canal preparation with rotary or reciprocating instruments: a micro-CT study
Emmanuel João Nogueira Leal da Silva, Sara Gomes de Moura, Carolina Oliveira de Lima, Ana Flávia Almeida Barbosa, Waleska Florentino Misael, Mariane Floriano Lopes Santos Lacerda, Luciana Moura Sassone
Restor Dent Endod 2021;46(2):e16.   Published online February 25, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e16
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to evaluate the shaping ability of the TruShape and Reciproc Blue systems and the apical extrusion of debris after root canal instrumentation. The ProTaper Universal system was used as a reference for comparison.

Materials and Methods

Thirty-three mandibular premolars with a single canal were scanned using micro-computed tomography and were matched into 3 groups (n = 11) according to the instrumentation system: TruShape, Reciproc Blue and ProTaper Universal. The teeth were accessed and mounted in an apparatus with agarose gel, which simulated apical resistance provided by the periapical tissue and enabled the collection of apically extruded debris. During root canal preparation, 2.5% sodium hypochlorite was used as an irrigant. The samples were scanned again after instrumentation. The percentage of unprepared area, removed dentin, and volume of apically extruded debris were analyzed. The data were analyzed using 1-way analysis of variance and the Tukey test for multiple comparisons at a 5% significance level.

Results

No significant differences in the percentage of unprepared area were observed among the systems (p > 0.05). ProTaper Universal presented a higher percentage of dentin removal than the TruShape and Reciproc Blue systems (p < 0.05). The systems produced similar volumes of apically extruded debris (p > 0.05).

Conclusions

All systems caused apically extruded debris, without any significant differences among them. TruShape, Reciproc Blue, and ProTaper Universal presented similar percentages of unprepared area after root canal instrumentation; however, ProTaper Universal was associated with higher dentin removal than the other systems.

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A micro-computed tomographic study using a novel test model to assess the filling ability and volumetric changes of bioceramic root repair materials
Fernanda Ferrari Esteves Torres, Jader Camilo Pinto, Gabriella Oliveira Figueira, Juliane Maria Guerreiro-Tanomaru, Mario Tanomaru-Filho
Restor Dent Endod 2021;46(1):e2.   Published online December 8, 2020
DOI: https://doi.org/10.5395/rde.2021.46.e2
AbstractAbstract PDFPubReaderePub
Objectives

New premixed bioceramic root repair materials require moisture for setting. Using micro-computed tomography (micro-CT), this study evaluated the filling ability and volumetric changes of calcium silicate-based repair materials (mineral trioxide aggregate repair high-plasticity [MTA HP] and Bio-C Repair, Angelus), in comparison with a zinc oxide and eugenol-based material (intermediate restorative material [IRM]; Dentsply DeTrey).

Materials and Methods

Gypsum models with cavities 3 mm deep and 1 mm in diameter were manufactured and scanned using micro-CT (SkyScan 1272. Bruker). The cavities were filled with the cements and scanned again to evaluate their filling capacity. Another scan was performed after immersing the samples in distilled water for 7 days to assess the volumetric changes of the cements. The statistical significance of differences in the data was evaluated using analysis of variance and the Tukey test with a 5% significance level.

Results

Bio-C Repair had a greater filling ability than MTA HP (p < 0.05). IRM was similar to Bio-C and MTA HP (p > 0.05). MTA HP presented the largest volumetric change (p < 0.05), showing more volume loss than Bio-C and IRM, which were similar (p > 0.05).

Conclusions

Bio-C Repair is a new endodontic material with excellent filling capacity and low volumetric change. The gypsum model proposed for evaluating filling ability and volumetric changes by micro-CT had appropriate and reproducible results. This model may enhance the physicochemical evaluation of premixed bioceramic materials, which need moisture for setting.

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Micro-computed tomographic evaluation of a new system for root canal filling using calcium silicate-based root canal sealers
Mario Tanomaru-Filho, Fernanda Ferrari Esteves Torres, Jader Camilo Pinto, Airton Oliveira Santos-Junior, Karina Ines Medina Carita Tavares, Juliane Maria Guerreiro-Tanomaru
Restor Dent Endod 2020;45(3):e34.   Published online June 9, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e34
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated by using micro-computed tomography (micro-CT) the filling ability and sealer apical extrusion promoted by a new Sealer Injection System (SIS; Angelus) with side openings needle, in comparison with the conventional injection system, associated with a new ready-to-use calcium silicate-based sealer (Bio-C Sealer).

Materials and Methods

Acrylic resin models containing a main curved artificial canal and 3 simulated lateral canals in apical, middle and cervical thirds were used. The main root canals were prepared using a rotary system up to size 35.05. The canals were filled with Bio-C sealer by using a single cone technique and the conventional delivery system or SIS. Samples were scanned in micro-CT. The percentage of voids throughout the entire extension of the main root canal and in each third of the lateral canals, besides the apical extrusion of the sealer was calculated. Data were submitted to t-test (p < 0.05).

Results

There was no difference between both systems in the main root canals filling. Although the volume percentage of voids was similar in the apical and middle thirds of lateral canals, SIS had the greatest filling ability of the cervical third lateral canal. Moreover, the conventional system showed the highest apical extrusion of the sealer.

Conclusions

The conventional and SIS obturation systems had an appropriate filling ability of the main root canal. SIS had the best filling of the cervical third of the lateral canals, besides lower sealer apical extrusion, suggesting its clinical indication.

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Micro-computed tomographic assessment of the shaping ability of the One Curve, One Shape, and ProTaper Next nickel-titanium rotary systems
Pelin Tufenkci, Kaan Orhan, Berkan Celikten, Burak Bilecenoglu, Gurkan Gur, Semra Sevimay
Restor Dent Endod 2020;45(3):e30.   Published online May 22, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e30
AbstractAbstract PDFPubReaderePub
Objectives

This micro-computed tomographic (CT) study aimed to compare the shaping abilities of ProTaper Next (PTN), One Shape (OS), and One Curve (OC) files in 3-dimensionally (3D)-printed mandibular molars.

Materials and Methods

In order to ensure standardization, 3D-printed mandibular molars with a consistent mesiobuccal canal curvature (45°) were used in the present study (n = 18). Specimens were instrumented with the OC, OS, or PTN files. The teeth were scanned pre- and post-instrumentation using micro-CT to detect changes of the canal volume and surface area, as well as to quantify transportation of the canals after instrumentation. Two-way analysis of variance was used for statistical comparisons.

Results

No statistically significant differences were found between the OC and OS groups in the changes of the canal volume and surface area before and after instrumentation (p > 0.05). The OC files showed significantly less transportation than the OS or PTN systems for the apical section (p < 0.05). In a comparison of the systems, similar values were found at the coronal and middle levels, without any significant differences (p > 0.05).

Conclusions

These 3 instrumentation systems showed similar shaping abilities, although the OC file achieved a lesser extent of transportation in the apical zone than the OS and PTN files. All 3 file systems were confirmed to be safe for use in mandibular mesial canals.

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Micro-computed tomographic evaluation of the flow and filling ability of endodontic materials using different test models
Fernanda Ferrari Esteves Torres, Juliane Maria Guerreiro-Tanomaru, Gisselle Moraima Chavez-Andrade, Jader Camilo Pinto, Fábio Luiz Camargo Villela Berbert, Mario Tanomaru-Filho
Restor Dent Endod 2020;45(2):e11.   Published online January 8, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e11
AbstractAbstract PDFPubReaderePub
Objectives

This study compared the flow and filling of several retrograde filling materials using new different test models.

Materials and Methods

Glass plates were manufactured with a central cavity and 4 grooves in the horizontal and vertical directions. Grooves with the dimensions used in the previous study (1 × 1 × 2 mm; length, width, and height respectively) were compared with grooves measuring 1 × 1 × 1 and 1 × 2 × 1 mm. Biodentine, intermediate restorative material (IRM), and mineral trioxide aggregate (MTA) were evaluated. Each material was placed in the central cavity, and then another glass plate and a metal weight were placed over the cement. The glass plate/material set was scanned using micro-computed tomography. Flow was calculated by linear measurements in the grooves. Central filling was calculated in the central cavity (mm3) and lateral filling was measured up to 2 mm from the central cavity.

Results

Biodentine presented the least flow and better filling than IRM when evaluated in the 1 × 1 × 2 model. In a comparison of the test models, MTA had the most flow in the 1 × 1 × 2 model. All materials had lower lateral filling when the 1 × 1 × 2 model was used.

Conclusions

Flow and filling were affected by the size of the test models. Higher grooves and materials with greater flow resulted in lower filling capacity. The test model measuring 1 × 1 × 2 mm showed a better ability to differentiate among the materials.

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Micro-computed tomographic evaluation of canal retreatments performed by undergraduate students using different techniques
Emmanuel João Nogueira Leal Silva, Felipe Gonçalves Belladonna, Marianna Fernandes Carapiá, Brenda Leite Muniz, Mariana Santoro Rocha, Edson Jorge Lima Moreira
Restor Dent Endod 2018;43(1):e5.   Published online January 15, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e5
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated the amount of remaining root canal filling materials after retreatment procedures performed by undergraduate students using manual, rotary, and reciprocating techniques through micro-computed tomographic analysis. The incidence of instrument fracture and the instrumentation time were also evaluated.

Materials and Methods

Thirty maxillary single rooted teeth were prepared with Reciproc R25 files and filled with gutta-percha and AH Plus sealer by the continuous wave of condensation technique. Then, the specimens were assigned to 3 groups (n = 10), according to the retreatment technique used: manual, rotary, and reciprocating groups, which used K-file, Mtwo retreatment file, and Reciproc file, respectively. Retreatments were performed by undergraduate students. The sample was scanned after root canal filling and retreatment procedures, and the images of the canals were examined to quantify the amount of remaining filling material. The incidence of instrument fracture and the instrumentation time were recorded.

Results

Remaining filling material was observed in all specimens regardless of the technique used. The mean volume of remaining material was significantly lower in the Reciproc group than in the manual K-file and Mtwo retreatment groups (p < 0.05). The time required to achieve a satisfactory removal of canal filling material and refinement was significantly lower in the Mtwo retreatment and Reciproc groups (p < 0.05) when compared to the manual K-file group. No instrument fracture was observed in any of the groups.

Conclusions

Reciproc was the most effective instrument in the removal of canal fillings after retreatments performed by undergraduate students.

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Original Article
Three dimensional reconstruction of teeth using x-ray microtomography
Dong-Hoon Shin
J Korean Acad Conserv Dent 2003;28(6):485-490.   Published online November 30, 2003
DOI: https://doi.org/10.5395/JKACD.2003.28.6.485
AbstractAbstract PDFPubReaderePub

Complete understanding of the exterior and interior structure of the tooth would be prerequisite to the successful clinical results, especially in the restorative and endodontic treatment.

Although three-dimensional reconstruction method using x-ray microtomography could not be used in clinical cases, it may be the best way to reconstruct the morphologic characteristics of the tooth structure in detail without destructing the tooth itself. This study was done to three dimensionally reconstruct every teeth in the arch in order to increase the understanding about the endodontic treatment and to promote the effective restorative treatment by upgrading the knowledge of the tooth morphology.

After placing tooth between the microfocus x-ray tube and the image intensifier to obtain two-dimensional images of each level, scanning was done under the condition of 80 keV, 100 µA, 16.8 magnification with the spot size of 8 µm. Cross-section pixel size of 16.28 µm and 48.83 cross-section to cross-section distance were also used.

From the results of this study, precise three dimensional reconstructed images of every teeth could be obtained. Furthermore, it was possible to see image that showed interested area only, for example, enamel portion only, pulp and dentin area without enamel structure, pulp only, combination image of enamel and pulp, etc.

It was also possible to see transparent image without some part of tooth structure. This image might be used as a guide when restoring and preparing the full and partial crown by showing the positional and morphological relationship between the pulp and the outer tooth structure.

Another profit may be related with the fact that it would promote the understanding of the interior structure by making observation of the auto-rotating image of .AVI file from the various direction possible.

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