JOURNAL CLUB: Terminology of Dental Caries and Dental Caries Management: Cons...Urvashi Sodvadiya
Vita Machiulskienea, Guglielmo Campusb, c Joana Christina, Carvalhod Irene, Digee Kim, Rud Ekstrandf, Anahita Jablonski-Momenig, Marisa Maltzh, David J. ,Mantoni Stefania, Martignonj, k E. Angeles, Martinez-Mierl, Nigel B., Pittsj Andreas G., Schultem Christian, H. Spliethn, Livia Maria, Andaló Tenutao, Andrea Ferreira Zandonap, Bente Nyvade
CARIES RESEARCH; OCT 2019
JOURNAL CLUB: Terminology of Dental Caries and Dental Caries Management: Cons...Urvashi Sodvadiya
Vita Machiulskienea, Guglielmo Campusb, c Joana Christina, Carvalhod Irene, Digee Kim, Rud Ekstrandf, Anahita Jablonski-Momenig, Marisa Maltzh, David J. ,Mantoni Stefania, Martignonj, k E. Angeles, Martinez-Mierl, Nigel B., Pittsj Andreas G., Schultem Christian, H. Spliethn, Livia Maria, Andaló Tenutao, Andrea Ferreira Zandonap, Bente Nyvade
CARIES RESEARCH; OCT 2019
Comparative evaluation of treatment of noncarious cervical hypersensitivity b...DR.AJAY BABU GUTTI M.D.S
Comparative evaluation of treatment of noncarious
cervical hypersensitivity by a fluoride varnish, a
dentin bonding agent, and Er, Cr:YSGG laser: An
in vivo study JCD 2020
Evaluation of Marginal integrity and Depth of Cure for three ‘bulk fill’ comp...pratiklovehoney
Evaluation of Marginal integrity and Depth of Cure for three ‘bulk fill’ composites : SDR, Tetric Evoceram Bulk Fill Composite and EverX Posterior Bulk Fill Composite - An In Vitro study
The bond strength of endodontic sealers to root /prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Vital pulp therapy plays important role in preserving tooth and tooth vitality in both primary and permanent teeth.
Direct pulp capping, indirect pulp capping, pulpotomy has been covered in this presentation. All materials possibly useful in vital pulp therapy as well as recent advances have been included with all the evidences.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Intentional replantation of maxillary second molar; case report and 15-year f...Abu-Hussein Muhamad
Abstract: Intentional reimplantation is a procedure in which tooth extraction is performed followed by reinsertion of the extracted tooth into its own socket after performing the desired procedure. In this article, intentional reimplantation is described and discussed as a treatment approach for aperiapical lesion that is in maxillary second molar. After 15 years, the patient was asymptomatic, the tooth was still functional and a recall intraoral periapical radiograph showed an intact periodontal ligament space and lamina dura with no evidence of gross root resorption or ankylosis.
Keywords: Intentional replantation, calcified canals, mineral trioxide aggregate
MANAGEMENT OF OPEN APEX IN PERMANENT TEETH WITH CALCIUM HYDROXIDE PASTEAbu-Hussein Muhamad
Calcium hydroxide is a multi purpose agent, and there have been an increasing number of indications for its use in endodontics. Some of its indications include inter-appointment intracanal medicaments, endodontic sealers, pulp capping agents, apexification, pulpotomy and weeping canals. The aim of this study was to report the 10 year follow-up data of an apexification treatment applied to a permanent incisor of a young patient treated with calcium hydroxide.
Minimally invasive dentistry (MID) is an evidence based intervention approach supported internationally that aims to do the least harm to effected and surrounding tissues
DENTAL AVULSION- IMMEDIATE REPLANTATION: 8- YEAR FOLLOW UP CASEAbu-Hussein Muhamad
Avulsion of permanent front teeth is a rare accident , mostly affecting children between seven and nine year s of age.
Replanted and splinted, these teeth often develop inflammat ion, severe resorption or ankylosis affect ing alveolar bone
development and have to be extracted sooner or later . This repor t proposes a discussion on the var ious pecul iar ities of a
tooth avulsion case with immediate replantation, such as a long retent ion per iod, root canal fil ling with MTA, or thodontic
treatment.
The permanent teeth with open apex and large periapical lesion are diffcult to treat as a traditional root canal procedure, therefore calcium hydroxide place an important role in reducing the periapical infl ammation. Management of open apex can be done using mineral trioxide aggregate (MTA) which can be placed in apical 3-4 mm. The aim of this This case report describes the use of mineral trioxide aggregate (MTA) for management of a periapically compromised immature tooth.
Comparative evaluation of treatment of noncarious cervical hypersensitivity b...DR.AJAY BABU GUTTI M.D.S
Comparative evaluation of treatment of noncarious
cervical hypersensitivity by a fluoride varnish, a
dentin bonding agent, and Er, Cr:YSGG laser: An
in vivo study JCD 2020
Evaluation of Marginal integrity and Depth of Cure for three ‘bulk fill’ comp...pratiklovehoney
Evaluation of Marginal integrity and Depth of Cure for three ‘bulk fill’ composites : SDR, Tetric Evoceram Bulk Fill Composite and EverX Posterior Bulk Fill Composite - An In Vitro study
The bond strength of endodontic sealers to root /prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Vital pulp therapy plays important role in preserving tooth and tooth vitality in both primary and permanent teeth.
Direct pulp capping, indirect pulp capping, pulpotomy has been covered in this presentation. All materials possibly useful in vital pulp therapy as well as recent advances have been included with all the evidences.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Intentional replantation of maxillary second molar; case report and 15-year f...Abu-Hussein Muhamad
Abstract: Intentional reimplantation is a procedure in which tooth extraction is performed followed by reinsertion of the extracted tooth into its own socket after performing the desired procedure. In this article, intentional reimplantation is described and discussed as a treatment approach for aperiapical lesion that is in maxillary second molar. After 15 years, the patient was asymptomatic, the tooth was still functional and a recall intraoral periapical radiograph showed an intact periodontal ligament space and lamina dura with no evidence of gross root resorption or ankylosis.
Keywords: Intentional replantation, calcified canals, mineral trioxide aggregate
MANAGEMENT OF OPEN APEX IN PERMANENT TEETH WITH CALCIUM HYDROXIDE PASTEAbu-Hussein Muhamad
Calcium hydroxide is a multi purpose agent, and there have been an increasing number of indications for its use in endodontics. Some of its indications include inter-appointment intracanal medicaments, endodontic sealers, pulp capping agents, apexification, pulpotomy and weeping canals. The aim of this study was to report the 10 year follow-up data of an apexification treatment applied to a permanent incisor of a young patient treated with calcium hydroxide.
Minimally invasive dentistry (MID) is an evidence based intervention approach supported internationally that aims to do the least harm to effected and surrounding tissues
DENTAL AVULSION- IMMEDIATE REPLANTATION: 8- YEAR FOLLOW UP CASEAbu-Hussein Muhamad
Avulsion of permanent front teeth is a rare accident , mostly affecting children between seven and nine year s of age.
Replanted and splinted, these teeth often develop inflammat ion, severe resorption or ankylosis affect ing alveolar bone
development and have to be extracted sooner or later . This repor t proposes a discussion on the var ious pecul iar ities of a
tooth avulsion case with immediate replantation, such as a long retent ion per iod, root canal fil ling with MTA, or thodontic
treatment.
The permanent teeth with open apex and large periapical lesion are diffcult to treat as a traditional root canal procedure, therefore calcium hydroxide place an important role in reducing the periapical infl ammation. Management of open apex can be done using mineral trioxide aggregate (MTA) which can be placed in apical 3-4 mm. The aim of this This case report describes the use of mineral trioxide aggregate (MTA) for management of a periapically compromised immature tooth.
Similar to JOURNAL CLUB: Impact of Access Cavity Design and Root Canal Taper on Fracture Resistance of Endodontically Treated Teeth: An Ex Vivo Investigation
Ortho endo-prostho relationship /certified fixed orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Determination of root canal working length /certified fixed orthodontic cours...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
With increasing stress on preventive
prosthodontics, the use of overdentures has
reached a point where it is now a feasible
alternative to most treatment plan outlines in
the construction of a prosthesis for patients
with remaining teeth
Single-Step Apexification with Mineral Trioxide Aggregate (MTA) –Case ReportsAbu-Hussein Muhamad
The completion of root development and closure of the apex occurs up to 3 years after the eruption of
the tooth. The treatment of pulpal injury during this period provides a significant challenge for the clinician.
The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has
been expressed in the use of mineral trioxide aggregate (MTA). We report a case with MTA were used
successfully for one step apexification in teeth with open apex
Single step apexification with mineral trioxide aggregateAbu-Hussein Muhamad
Abstract: The completion of root development and closure of the apex occurs up to 3 years after the eruption of the tooth. The treatment of pulpal injury during this period provides a significant challenge for the clinician. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate (MTA). We report a case with MTA were used successfully for one step apexification in teeth with open apex. Key words: Immature teeth, one visit apexification, Mineral Trioxide Aggregate, monoblock, artificial barrier
Similar to JOURNAL CLUB: Impact of Access Cavity Design and Root Canal Taper on Fracture Resistance of Endodontically Treated Teeth: An Ex Vivo Investigation (20)
Introduction
History
Mechanism of action
Antimicrobial effect
Tissue dissolving efficacy
NaOCl and bioflim
Factors affecting Antimicrobial and tissu
e dissolving efficacy
Haemostatic property
Buffered NaOCl
Effect of increasing temperature on NaOCl
NaOCl and dentin
Effect of NaOCl on resin-dentin interface
Effect of NaOCl on endodontic instruments
Combination of NaOCl with different irrigants
Commercially available NaOCl based irrigants
Sodium Hypochlorite accidents
Hulsman’s criteria
Clinical manifestation
Management
Prevention
Conclusion
References
As an intracanal medicament
Definition
Clinical application
Mechanism of action
Vehicles
Placement of Calcium hydroxide paste
Dentin and Calcium hydroxide
Effect of Calcium hydroxide on clinical outcome
Calcium hydroxide and Chlorhexidine
Calcium hydroxide and Sodium Hypochlorite
Removal of Calcium hydroxide from the canal
When to replace Calcium hydroxide dressing?
Calcium hydroxide and CO2
Toxicity
As a Root canal Sealer
Clinical significance
Classification
Composition
Properties
Leakage
Solubility
- In tissue fluids
- In chemical solvent
Biocompatibility
Antimicrobial
Toxicity
Conclusion
References
Introduction
Basic chemistry
Properties
Manufacture
In dentistry…
History
Calcium hydroxide as a liner
Traditional versus current concept in
Mechanism of action
Antimicrobial
Biological
Bridge formation
Choices of materials as liner
Classification
Conventional Calcium Hydroxide liners
Light cured Calcium Hydroxide liners
Calcium hydroxide as a base
Comparative evaluation of properties
Calcium release
Alkalizing activity
Porosity, Water sorption and solubility
Antibacterial property
Cytotoxicity
Bridge formation
Effects of acid etching on properties of CH
Pulpal inflammation
Drawbacks of Calcium Hydroxide
Calcium hydroxide versus MTA
Conclusion
References
Introduction
Principles of tooth preparation
Preservation of tooth structure
Retention form
taper
Surface area
Freedom of movement
Length
Resistance form
Height/width ratio
path of insertion
Structural durability
Occlusal reduction
Functional cusp bevel
Axial reduction
Preservation of periodontium
Types of margin
Biological consideration
Conclusion
References
Introduction
Prevention of caries
Brief introduction about types of Immunity
Causative factors of dental caries
Virulance of S mutans
Natural immune barriers
Salivary secretion and its composition
Natural barriers
Innate immune responses of dental pulp to caries
Acquisition of oral microbes
Factors affecting oral microbial colonization
Innate salivary factors found in oral cavity
Adaptive immunity
Secretary IgA
Types of Immunization
Routes of Immunization
Conclusion
Introduction
Classification of endodontic emergency
According to P Carrotte
According to Walton and Torabinejad
According to Weine
Importance of diagnosis in endodontic emergency
Types of diagnostic Aids needed
Emergency treatment of pulp and periapical related diseases
Acute pulpitis
Acute pulpitis with apical periodontitis
Pulp necrosis
Acute periapical abscess
Emergency treatment of traumatic injuries
Crown fracture
Root fracture
Avulsion
Andreasen’s criteria
Summer’s criteria
Emergency therapy for intratreatment pain
Endodontic emergency after treatment
Medication in endodontic emergency
Conclusion
References
Introduction
Portals of entry to the pulp
Concepts of infection
Focus of infection
Zones of Fish
Kronfeld’s mountain pass theory
Older v/s Newer Concepts in endodontics
Endodontics: When to do and When not to do?
Vital pulp therapy
Rationale of Pulpotomy
Vital pulp therapy over root canal therapy
Root canal therapy over vital pulp therapy
Rationale of Apexification
Conclusion
References
Introduction
Clinical application of images
+ Case documentation
+ Laboratory communication
+ Patient education
+ Dental education
Dental photography
Preoperative photography
+ Extraoral photography
# Full face- front and profile
# Dentofacial smile
# Close-up lip photographs
Intraoral photography
# Occlusal photographs
# Full dentition retracted view (Front & Lateral)
- Teeth slightly open & in occlusion
# Maxillary Anterior teeth
Postoperative photography
Features of camera
+ Lenses
# Close-Up photography lenses (Macro lenses)
# Alternatives to Macro lenses
+ Focal length
+ Working distance
+ Magnification ratio
Principle-based photography concepts
+ Exposure control
# Factors affecting exposure control
# Exposure modes
+ White balance
+ Depth of field
Camera system equipment
+ Classification of camera based on a recording of the image
+ Most common types of camera currently available
# Digital Single-lens reflex camera (DSLR)
# Pocket-sized cameras
# Portable electronic devices
How to select a camera
Important features in choosing an SLR camera
+ Lenses
+ Number of pixels
+ Functions
+ Available cameras for dental photography
Understanding lighting
+ Flashes
# Ring flash versus Point source flash
+ Accessories for Smartphone
+ How to modify the light system?
+ F-Stop and Flash setting
Accessories for Intraoral photography
+ Retractors
+ Photographic mirror
+ Contrasters
Basic general photographic technique
Technical problems area
+ Camera
+ Film
+ Developing
Image management
+ File format and compression
Summery
Conclusion
References
- Introduction
- Development
- Epithelial enamel organ
- Amelogenesis
The life cycle of ameloblast
Morphogenic stage
Organizing stage
Formative/ secretary stage
Development of Tome’s processes
Maturation stage
Stages of maturation
- Difference between hypoplastic and hypo mineralized enamel
-Molar-incisor hypomineralization (MIH)
-Amelogenesis imperfecta
-Dental fluorosis
-Protective stage
-Importance of reduced enamel epithelium
-Desmolytic stage
-Chemical properties
Inorganic part
Structure of hydroxyapatite
Clinical significance
Organic part
Types of protein
Water
-Basic Structural elements of enamel
Rods
Direction of rods
Interrod enamel
Rod sheath
Enamel crystals arrangement and its importance
Rodless enamel
-Physical characteristics
Density
Thickness
Hardness & Strength
Compressive and tensile strength of enamel
Brittleness
Factors associated with attrition
Enamel and ceramic restoration
Solubility
-Acid etching of enamel
-Factors affecting the acid etching
-Contamination of surface
-Concentration and time of acid etching
-Type of enamel
-Effect of bleaching and bleaching agents on Physical properties of enamel
-Comparison between physical properties of tooth structure and restorative material
-Translucency
-Specific gravity
-Permeability
-Permeability and structure of enamel
-Factors affecting permeability
-Colour
-Factors affecting color
-White spot lesion
-Deep dentinal caries
-Histology
-Hunter- Schreger bands
Types and its clinical significance
Incremental lines of Retzius
-Enamel lamellae
-Enamel spindles
-Enamel tufts
-Neonatal line
-Gnarled enamel
-Dentinoenamel junction
-Cementoenamel junction
-Difference between Deciduous and Permanent enamel
-Repair of Enamel
-Surface structure
-Prismless enamel
-Perikymata
-Rod ends
-Pits Surface elevation
-Enamel caps
-Enamel brochs
Enamel cuticle
Primary enamel cuticle/ Nasmyth’s membrane
Secondary enamel cuticle
Pellicle
Age changes
Conclusion
Previously asked questions
References
- Introduction
- Normal anatomy of kidney
- Nephron
- Juxtaglomerular apparatus
- Clearance
- tubular function
- Regulation of water and ion reabsorption
- Types of water reabsorption
- Mechanism of urine concentration and dilution
- Countercurrent mechanism
- Definition
- Uses of culture media
- Basic composition of culture media
- Types of culture media
--Based on physical state
----solid medium
----semi solid medium
----liquid medium
--Based on ingredients
----Simple or basal medium.
----Complex medium.
----Synthetic or defined medium.
----Semisynthetic medium.
--Special medium
----Enriched media
----Enrichment media
----Selective media
----Differential media
----Indicator media
----Transport media
----Anaerobic media
-Media preparation
-Culture method
--Streak culture
--Lawn culture
-references
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Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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JOURNAL CLUB: Impact of Access Cavity Design and Root Canal Taper on Fracture Resistance of Endodontically Treated Teeth: An Ex Vivo Investigation
1. IMPACT OF ACCESS CAVITY DESIGN AND ROOT
CANAL TAPER ON FRACTURE RESISTANCE OF
ENDODONTICALLY TREATED TEETH: AN EX
VIVO INVESTIGATION
Mohammad Sabeti, DDS, MS,* Majid Kazem, DDS, MS,†‡ Omid
Dianat, DDS, MS,‡§ Nazanin Bahrololumi, DDS, Amirreza Beglou,
DDS, Kasra Rahimipour, DDS, and Farshad Dehnavi, DDS
1
2. • Tooth fracture is one of the most undesirable phenomena in
endodontically treated teeth (ETT) and usually leads to tooth
extraction.
• It is mainly associated with the loss of tooth structure because of
dental carries or the therapeutic endodontic procedures such as access
cavity and root canal preparation.
• The endodontic access cavity is considered an important step in
endodontic treatments.
INTRODUCTION
2
3. • New concept of a conservative access cavity (CAC), inspired by
concepts of minimally invasive dentistry, has been designed and
developed in order to minimize the removal of the chamber roof and
pericervical dentin .
• For instance, newly developed ultraflexible canal preparation
instruments make straight-line access to the canals less important;
also, the progress in visual magnification makes it easier to find canal
orifices without the need for excessive expansion of access cavity
walls.
• However, inadequate access cavity also increases the prevalence of
iatrogenic complications during endodontic procedures.
3
4. • The higher instrument tapers lead to superior canal and canal wall
cleanliness, excessive removal of radicular dentin because of increased
instrumentation taper.
• Accordingly, the aim of the present study was to evaluate and compare
the effect of access cavity preparation and 3 different root taper
preparations on ETT fracture resistance of maxillary molars.
4
5. Sample Preparation
• 78 sound maxillary first and second molars were collected based on the
inclusion and exclusion criteria.
• 30 maxillary first molars were similarly decoronized. Three roots of each tooth
were divided by burs (ISO no. 806 104 199 544 016; NTI, Kahla, Germany) under
sufficient water cooling. The distobuccal roots were randomly assigned to 1 of
3 groups (n = 10) for tapering evaluation (ie, a .04 taper, a .06 taper, or a .08
taper).
• Roots with more than 20% deviation were replaced. 5
Materials and Methods
6. • All specimens of the tapering groups were prepared for endodontic
treatment.
• After establishing the working length, canals were instrumented up to an
apical size of 25; instrumentation was performed with the Twisted Files
rotary system (taper .04, .06, and .08; Kerr Co, Glendora, CA) according to
the manufacturer’s instructions.
• Intermittent irrigation with 5 mL 2.5% sodium hypochlorite was applied
with 30-G needles.
6
7. • The another 48 teeth, which were similar in buccolingual and mesiodistal
size, were randomly assigned to 1 of 3 groups (n = 16):
• Group 1: Intact teeth; no treatment (negative control)
• Group 2: Traditional access cavity (TAC, positive control)
• Group 3: Conservative access cavity (CAC, experimental)
• Access cavities were prepared using coarse, flat-end diamond burs (ISO
no. 806 104 199 544 016, NTI) in a high-speed handpiece with sufficient
water cooling.
• In the TAC group, traditional endodontic access cavities were prepared
following conventional guidelines.
7
8. • In the CAC group, in order to determine the outlines of the access
cavity and locate the pulp chamber and canals, they used 2 periapical
radiographs made from buccal and mesial aspects as a guide.
• Then starting from central fossa, cavities were extended only as
necessary to visualize and locate canal orifices while taking care to
preserve pericervical dentin.
8
Conventional
access cavity
Conservative
access cavity
9. • To simulate the periodontal ligament space, roots were covered before
acrylic embedment with a uniformly thin 0.2-mm layer of light body
silicone impression material.
• For both experimental groups (ie, the tapering and cavity preparation
groups), a fracture resistance test was conducted.
• To analyze the results, statistical software (SPSS 17; SPSS
Inc,Chicago, IL) was used
9
12. • Endodontic procedures encompass various steps such as access cavity
preparation and root canal preparation, which may result in the loss of
excessive tooth structure, weakening of the tooth, and a subsequent reduction
in the tooth’s capability to resist forces
• conservative approaches have gained attention for the restoration of tooth
stability.
• As shown in a study by Krishan et al , minimal access cavities were
associated with compromised canal instrumentation in the distal canals of
mandibular molars. Moreover, the lack of straight-line access because of
inadequate tooth tissue removal may compromise the delivery of irrigants to
the apical portion of the roots because it avoids the needle reaching further
into the canal
12
Discussion
13. • However, some researchers believe that conventional access preparation
removed unnecessary sound dentin and can decrease resistance to tooth
fracture.
• In agreement with the results, Moore et al reported that the fracture
strength in maxillary molars with CACs and TACs was remarkably lower
than that of intact molars.
• Although the CAC’s fracture strength was 23% greater than that of
TAC, this difference was not statistically significant; this finding
suggests that, in comparison with TAC preparation, CAC preparation
provides insignificant advantages with regard to fracture strength.
13
14. • The removal of the pulp chamber roof and the disruption of tooth
integrity may have been responsible for the substantial reduction in
fracture resistance of the ETT of both groups in comparison with the
intact teeth, which is supported by the finding of many other studies.
• Rover et al, suggested a reduced possibility of canal orifice detection
in the CAC group in comparison with the TAC group. They also
observed an increased possibility of canal transportation associated
with CACs.
14
15. • The primary aim of endodontic treatment is to eliminate
microorganisms. Research has established that bacteria can penetrate
into and colonize almost half the length of dentinal tubules
• Accordingly, inadequate removal of infected dentin within the canals
can decrease the prognosis and lead to posttreatment failures.
• For root canal shaping, the current study showed no significant
reduction of the fracture resistance of the root by .06 taper
instrumentation compared with .04, whereas preparation with the .08
taper showed a significant decrease in fracture resistance.
15
16. • In agreement with our results, a previous study has shown that during
instrumentation, maintaining the natural geometry of the root canals is a
paramount stabilizing factor for the tooth.
• Possibly, in their study, the decrease in fracture resistance that followed .08
taper instrumentation might have been the result of geometric alterations
of the root canals because .08 taper files are more rigid and less adaptable.
• Root fracture occurs as a result of propagation of microcracks created in the
root canal shaping process with occlusal forces . Thus, they suggest that the
increased risk of fracture with the .08 taper in this study might be
associated with the greater number of craze lines and the greater degree of
imposed stress in root dentin
16
17. • 1 limitation of the present study is that the variability of the tested teeth
may have confounded the results. In addition, preparing the conventional
and conservative access cavities with the same degree of accuracy in all
teeth is difficult.
• They suggest that in order to achieve experimental conditions that are
more similar to clinical conditions, subsequent studies should use finite
element analysis.
• The data achieved in this ex vivo study provide insight into the fracture
resistance of different access designs and root canal tapers in the clinical
setting. However, for more certain results, clinical trials with long-term
follow-ups are required.
17
Limitation
18. 18
Conclusion
• The following can be concluded:
1. Increasing the tapering of root canal preparation can
detrimentally affect tooth fracture resistance
2. Conservative endodontic access in maxillary molars was not
shown to significantly increase fracture resistance over traditional
access
19. 19
References
• Lam PP, Palamara JEA, Messer HH. Fracture strength of tooth roots following canal preparation by hand and
rotary instrumentation. J Endod 2005;31:529–32.
• . Al Amri MD, Al-Johany S, Sherfudhin H, et al. Fracture resistance of endodontically treated mandibular first
molars with conservative access cavity and different restorative techniques: an in vitro study. Aust Endod J
2016;42:124–31.
• Lang H, Korkmaz Y, Schneider K, Raab W-M. Impact of endodontic treatments on the rigidity of the root. J Dent
Res 2006;85:364–8.
• Boveda C, Kishen A. Contracted endodontic cavities: the foundation for less invasive alternatives in the
management of apical periodontitis. Endod Topics 2015;33:169–86.
• 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;42:1779–83.
• . Clark D, Khademi JA. Case studies in modern molar endodontic access and directed dentin conservation. Dent
Clin North Am 2010;54:275–89.
• Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent Clin North Am
2010;54:249–73.
20. • Gluskin AH, Peters CI, Peters OA. Minimally invasive endodontics: challenging prevailing paradigms.
Br Dent J 2014;216:347–53.
• Patel S, Rhodes J. A practical guide to endodontic access cavity preparation in molar teeth. Br Dent J
2007;203:133–40.
• 0. Capar ID, Altunsoy M, Arslan H, et al. Fracture strength of roots instrumented with self-adjusting file
and the ProTaper rotary systems. J Endod 2014;40:551–4.
• Harvey TE, White JT, Leeb IJ. Lateral condensation stress in root canals. J Endod 1981;7:151–5.
• Schroeder KP, Walton RE, Rivera EM. Straight line access and coronal flaring: effect on canal length. J
Endod 2002;28:474–6.
• 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;40:1160–6.
• Shahrbaf S, Mirzakouchaki B, Oskoui SS, Kahnamoui MA. The effect of marginal ridge thickness on the
fracture resistance of endodontically-treated, composite restored maxillary premolars. Oper Dent
2007;32:285–90.
20
21. • Toure B, Faye B, Kane AW, et al. Analysis of reasons for extraction of endodontically treated
teeth: a prospective study. J Endod 2011;37:1512–5.
• Assif D, Nissan J, Gafni Y, Gordon M. Assessment of the resistance to fracture of
endodontically treated molars restored with amalgam. J Prosthet Dent 2003;89: 462–5.
• Linn J, Messer HH. Effect of restorative procedures on the strength of endodontically treated
molars. J Endod 1994;20:479–85.
• Cobankara FK, Unlu N, Cetin AR, Ozkan HB. The effect of different restoration techniques on
the fracture resistance of endodontically-treated molars. Oper Dent 2008;33:526–33.
• Bremer BD, Geurtsen W. Molar fracture resistance after adhesive restoration with ceramic
inlays or resin-based composites. Am J Dent 2001;14:216–20.
• Soares CJ, Pizi ECG, Fonseca RB, Martins LRM. Influence of root embedment material and
periodontal ligament simulation on fracture resistance tests. Braz Oral Res 2005;19:11–6.
• Tzimpoulas NE, Alisafis MG, Tzanetakis GN, Kontakiotis EG. A prospective study of the
extraction and retention incidence of endodontically treated teeth with uncertain prognosis
after endodontic referral. J Endod 2012;38:1326–9
21