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ENDODONTICS: CLINICAL SOLUTIONS

III SIE INTERNATIONAL CONGRESS 2018

This event is CME certified - CIC Provider N° 696

Patronised by

ABSTRACT BOOKSan Raffaele Congress CenterDibit 1Via Olgettina, 58 - 20132 Milan

MILAN 8th - 10th NOVEMBER 2018

SOMMARIO

THURSDAY 8th NOVEMBER

PRE-CONGRESS COURSE 3

FRIDAY 9TH NOVEMBER

SESSION I 4

SESSION II 6

SESSION III - SPONSORED MASTER CLINICIAN SESSION 9

SESSION IV - SPONSORED MASTER CLINICIAN SESSION 11

RICCARDO GARBEROGLIO AWARD 13

GIORGIO LAVAGNOLI AWARD 21

FRANCESCO RIITANO AWARD 27

THE BEST POSTER SIE AWARD 33

POSTER SESSION 53

SATURDAY 10TH NOVEMBER

SESSION V 71

SESSION VI 73

RESEARCH SESSION - PART I 76

RESEARCH SESSION - PART II 84

CLINICAL THEATER I 90

CLINICAL THEATER II 93

CLINICAL THEATER III 95

SPONSORED TABLE CLINICS 98

SPONSORS 105

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THURSDAY 8th NOVEMBERLECTURE ROOM CARAVELLA/SANTA MARIA

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PRE-CONGRESS COURSE

PROBLEM SOLVING WITHIN THE SCOPE AND CHALLENGES OF ENDODONTIC PROCEDURESLA SOLUZIONE DI CASI COMPLESSI IN ENDODONZIA CLINICA E CHIRURGICA

Augusto Malentacca, Arnaldo Castellucci

✎ ABSTRACT

In recent years in Endodontics there has been a true explosion of new technologies, new instruments and new materials, which made predictable many procedures that before were considered impossible or just made by chance. The most important revolution has been the intoduction of the surgical operating microscope. Before the introduction of the operating microscope we could “feel” the presence of a problem (a ledge, a perforation, a blockage, a broken instrument), and the solution of that problem was never predictable. With the use of the operating microscope everithing is changed both in non-surgical and in surgical endodontics. In non-surgical endodontics, every challenge existing in the straight portion of the root canal system, even if located in the most apical part, can be easily seen and then solved under the microscope, with magnification and coaxial illumina-tion. In surgical endodontics, today it is possible to make class I cavity preparations perfectly along the axis of the root canal, three dimensionally cleaned and obturated, in a total respect of the root canal anatomy. Thanks to the use of the microscope (magnification and coaxial illumination) our success rate is higher after non-surgical and surgical endodontics and our procedures are much more predictable.Another recent revolution has been the introduction of the Cone Beam Computed Tomography in our practice. Thanks to the CBCT, dentistry is moving away from “radiographic interpretation” into “desease visualization”.Thanks to all these revolutionary progresses, the long term success rate of root canal treatments is higher and endodontic therapy today is more predictable and even more fun!

AUGUSTO MALENTACCA Received his degree in medicine in 1976 and specialized in dentistry in 1979. He has worked in his own office in Rome since 1980 practic-ing on the whole in restorative and endodon-tic dentistry but also dedicates his time to

teaching, holding private courses at the office. He was president of SIE (Italian Society of Endodontists) from 1999 to 2001. He is an active member of A.I.C. (Italian Academy of Restorative dentistry) and was the founder member and president of AIOM (Italian Society of Microscopic dentistry).

ARNALDO CASTELLUCCIGraduated in Medicine at the University of Florence in 1973 and he specialized in Dentist-ry at the same University in 1977. From 1978 to 1980 he attended continuing education courses on Endodontics at Boston University School of Graduate Dentistry with Prof. Herbert

Schilder. As well as running a practice limited to Endodontics, Dr. Castellucci is Past President of the Italian Society of Endodontics SIE, Past President of the International Federation of Endodontic Associations I.F.E.A., Active Member of the European Society of Endodontology E.S.E., Active Member of the American Association of Endodontists A.A.E. He is Assistant Professor of Endodontics at the University of Cagliari Dental School and Professor of Micro-Sur-

gical Endodontics at the Specialty of Oral Surgery of the University Federico II of Naples. He is a very well known international lecturer and gave lectures all around the world. He has been Editor of “The Italian Journal of Endodontics” and of “The Endodontic Informer”, now he is the Editor in Chief of Endo Tribune, Founder and President of the “Warm Gutta-Percha Study Club” and of the Micro-Endodon-tics Training Center, where he teaches and gives hands-on courses. He published articles on Endodontics in the most prestigious End-odontic Journals. He is the author of the textbook (3 volumes) “End-odonticS”, which is now available in English. He lives and practices in Florence where he has his private practice and his Micro-End-odontics Training Center.

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FRIDAY 9TH NOVEMBERLECTURE ROOM CARAVELLA/SANTA MARIA

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OPENING CEREMONY AND WELCOME ADDRESSES BY THE AUTHORITIESEnrico Gherlone | President of CDUO “Collegio dei Docenti Universitari di Discipline Odontostomatologiche”Gerhard Konrad Seeberger | Elected President of FDI “Fédération Dentaire Internationale”Dag Ørstavik | President of ESE “European Society of Endodontology” Clara Spatafore | on behalf of President of AAE “American Association of Endodontists”Roberto Carlo Rossi | President of OMCeOMI “Ordine dei Medici Chirurghi e Odontoiatri di Milano”Raffaele Iandolo | President of CAO NAZIONALECarmelo Pulella | Vice Presidente Vicario CIC “Comitato Italiano di Coordinamento delle Società Scientifiche Odontostomatologiche”Carlo Ghirlanda | President of ANDI “Associazione Nazionale Dentisti Italiani”Fausto Fiorile | President of AIO “Associazione Italiana Odontoiatri”Francesco Riccitiello | President of SIE “Società Italiana di Endodonzia”

SESSION ILECTURE ROOM CARAVELLA/SANTA MARIA

Chairmen: Daniele Angerame - Dag Ørstavik

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OPERATIVE FIELD ISOLATION IN ENDODONTICS: RATIONALE OF USE AND MANAGEMENT OF COMPLEX CASES L’ISOLAMENTO DEL CAMPO OPERATORIO IN ENDODONZIA: LA GESTIONE DEI CASI COMPLESSI

Filippo Cardinali

✎ ABSTRACT

Barnum introduced the isolation technique to improve procedural quality, giving the dental profession a method to access the site of operation, to give the maximum protection to the soft tissues and to create an optimal field of vision that is still unsurpassed by any other technique. After more than 150 years, Barnum’s vision is still vivid and effective and the benefits deriving from this technique have been recognized, approved and well document-ed in the literature. There is no conservative or endodontic dentistry textbook where the usage of the rubber dam is described as an optional treatment step; comprehensive operative field isolation is considered as one of the key steps for a predictable clinical result.Lecture’s aim is to demonstrate that rubber dam application is an easy, essential and accessible step for all prac-titioners who want work according to correct biological and ethical guidelines.In complex cases, isolation ought to be carefully planned, and will allow the practitioner to achieve a totally stable and leakage-free field for the whole treatment. Nevertheless, it’s important to highlight that once the field is isolated, the clinical case will be transformed from complex to simple with noticeable benefits for the operative pro-cedures to follow.When it comes to isolation of complex cases in Endodontics, one of the most discussed and controversial topics is the opportunity or not of a pre-treatment. The aim of the lecture is to deeply analyze the role of the pre-treatment in End-odontics and how its execution is not always mandatory, and how it depends on many factors that will be analyzed.

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FILIPPO CARDINALIGraduate in Dentistry and Dental Prosthesis at the University of Ancona in 1992. Active Member of the Italian Society of Endodontics. Certified Member of the European Society of Endodontology. Associate Member of Ameri-can Association of Endodontists. In the Italian

Society of Endodontics (SIE) currently holds the position of Treasurer and of Country Representative of the Italian Society of Endodontics at the ESE. Co-author of the book “Text atlas of anatomy endodon-tic” published by Tecniche Nuove in 2011. Co-author of the book “Isolation of the operative field: how to streamline the clinical and

improve their professional quality life” published by ANDI Servizi in 2013. Co-author of the book “Manuale di Endodonzia” published by Elsevier Masson Italy in 2013. Co-author of the iBook “The Isolation Game: rubber dam use in endodontics and restorative” published and available on Apple iBook Stores. Lecturer in theoretical and practical courses on subjects related to the isolation of the opera-tive field and endodontics, has participated as a speaker at courses and conferences in Italy and abroad. Private practice, concentrating mainly endodontics and restorative and author of publications on journals of national and international sector.

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CLINICAL APPROACH TO WORKING LENGHTS UN APPROCCIO CLINICO ALLE LUNGHEZZE DI LAVORO

Vittorio Franco

✎ ABSTRACT

Endodontic treatments are currently based on changes in the shape and contents of what is known as the end-odontic space: it is difficult to distinguish the point, or, better, the so called passage plan between ‘‘in’’ and ‘’out’’.In addiction new alloys or better, new thermomechanical treatments changed the behaviour of the shaping in-struments in the root canals as well some new device for the activation/agitation of the irrigating solutions could change our habits during the cleaning phase. The purposes of this presentation are:- to establish how to use the modern endodontic tools in order to identify the end of the root canal space;- to focus on the management of various working lengths and on the impact that our choices could have on our results, in other words, how the different working lengths interact between themselves.

VITTORIO FRANCOHe graduated from the University of Rome “La Sapienza” in 1991. Since 1997 Dr. Franco has been an active member of the SIE (Italian So-ciety of Endodontics) and at present, he is the society president elected. He is an active mem-ber of the Italian Academy of Dental Microsco-

py and certified member of the European Society of Endodontology. Dr. Franco is also the Italian representative at the general assembly of the European Society of Endodontology (ESE) and member of the ESE membership committee. Dr. Franco has in the past served on the Editorial Board of the Giornale Italiano di Endodonzia, has re-

viewed articles for a number of international journals and has per-sonally authored many scientific articles published in peer review journals. He has written book chapters for Endodontic textbooks. Dr. Franco is a well-known opinion leader and he cooperates as trainer, developer and tester with a number of leading manufac-turers of Endodontic materials and instruments. He lectures na-tionally and internationally and he is a visiting professor at many postgraduate courses in Endodontics. Dr. Franco has been work-ing in Rome and London exclusively in Endodontics and Endodon-tic Surgery under microscopic magnification on referred patients.

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A NEW INSTRUMENTATION APPROACH FOR THE MANAGEMENT OF COMPLICATED CANAL SYSTEMSUN NUOVO APPROCCIO PER LA STRUMENTAZIONE ED IL MANAGEMENT DEI SISTEMI CANALARI COMPLESSI

Antonios Chaniotis

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✎ ABSTRACT

The root canal system is often a highly complicated canal network of multi-planar curvatures and anastomoses. Reaching the biological and design objectives of instrumentation in severely curved canals, deep apical splits and complicated canal systems can be an extremely challenging aspect of root canal treatment. The aim of this lecture is to introduce a novel instrumentation concept with for the predictable and safe enlargement of extreme-ly challenging root canal systems.Learning objectives - Upon completion of this course the participant should be able to :1. Understand the design and biological objectives of canal instrumentation2. Understand the anatomical complexity of the root canal systems3. Investigate the minimum instrumentation requirements for effective disinfection4. Implement a new instrumentation method for the predictable management of challenging anatomies.

ANTONIOS CHANIOTISGraduated from the University of Athens Den-tal School, Greece (1998). In 2003 he complet-ed the three-year postgraduate program in Endodontics at the University of Athens Dental School. Since 2003, he owns a limited to mi-croscopic Endodontics private practice in Ath-

ens, Greece. For the last ten years, he served as a clinical instructor affiliated with the undergraduate and postgraduate programs at the University of Athens, Athens Dental School, Endodontic depart-

ment, Greece. From 2012 to 2014 he served as Clinical fellow teach-er at the University of Warwick, Warwick dentistry UK. He lectures nationally and internationally and he has published articles in In-ternational peer review Journals and textbooks. He currently serves as an active member of the Hellenic Society of Endodontology (ESE full member society), a certified member of the European Society of Endodontology (ESE) and international member of the American Association of Endodontists (AAE).

SESSION IILECTURE ROOM CARAVELLA/SANTA MARIA

Chairmen: Michele Simeone - Carlo Prati

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BEYOND THE CONSERVATION: THE SECOND LIFE FOR TEETH AND ROOTS OLTRE LA CONSERVAZIONE: LA SECONDA VITA DELLE RADICI DEI DENTI NATURALI

Pio Bertani

✎ ABSTRACT

Endodontics therapy aims to save teeth, and saving teeth worth every effort. Teeth even compromised because of periodontal disease or endodontic problems may have a longevity that surpasses by far that of the average implant (Carnevale et al. 1998; Hardt et al. 2002; Lang and Zitzmann 2012; Salvi et al. 2014; Klinge et al. 2015). Sound tooth survival after 50 years of function ranged from 99.5% for teeth without gingiva inflammation to 94% for teeth with occasional inflammation and 64% for teeth with continuous inflammation (Schaetzle et al 2004). Endodontically treated teeth shoved normal periapical conditions in the 95.5% of cases after a 20-27 years ob-servation. (Fristad et al 2004). Oral health may affect self-esteem and physical appearance. Killingsworth (2007) demonstrates a positive asso-ciation between number of teeth at each age and earnings. People who lack teeth may have trouble finding jobs (Shipler 2004, Eckholm 2006). A low number of teeth increases the risk of higher prevalence and incidence of dementia (Sparsk Stein et al. 2007). Even compromised teeth can have a second life. Autotrasplantation of misplaced teeth can solve easily difficult clinical problems; interim endodontic therapy of hopeless teeth can regenerate apical bone for primary implant stability (Abou Rass 2010); recently, some techniques collectively termed “Partial Extraction Therapies” have been proposed, using the tooth itself for ridge preservation in implant therapy (Gluckman 2016). The presenta-tion will show various techniques used to give the chance of a “second life” even to hopeless teeth.

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PIO BERTANIGraduated in Medicine and Surgery, Special-ized in Odontostomatology. Guest Professor of Restorative dentistry, University of Modena and Reggio Emilia, Italy, 2003-2008; Lecturer, postgraduate course of restorative dentistry, University of Modena and Reggio Emilia, Italy,

2004-2005; Lecturer, postgraduate course of prosthetic dentist-

ry, University of Bologna, Italy, 2009-2013; Teaching Professor of Endodontics at the University of Parma. Past President of Società Italiana di Endodonzia, Active member of the European Society of Endodontics, Active member of Accademia Italiana di Odontoiatria Estetica. Co-Author of books “Manuale Illustrato di Endodonzia” (Masson, Bologna, 2003) and “Manuale di Endodonzia” (Elsevi-er, 2013). International speaker, author of several publications.

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REGENERATIVE ENDODONTICS, A CURRENT STATUSENDODONZIA RIGENERATIVA, LO STATO ATTUALE

Mohammad Hossein Nekoofar

✎ ABSTRACT

Various methods and different materials have been suggested to deal with teeth having immature apices and necrotic pulp. In most of these treatment modalities root length and root dentin thickness remain unchanged and consequently such teeth are susceptible to root fracture. The aim of regenerative endodontics procedures (REPs) in treatment of teeth with incomplete root formation and necrotic pulp is to replace the irreversibly inflamed pulp tissue with newly regenerated tissue in an attempt to stimulate root maturation.The principle of REPs is based on the tissue engineering triad: • Stem cell• Scaffold• Signal molecules The prerequisite of REPs is chemical disinfection of the root canal system that achieves through profuse irriga-tion using sodium hypochlorite and the placement of an antibacterial paste inside the root canal system without mechanical instrumentation to avoid smear layer formation that may block the release of growth factors from root dentin. In addition it has been suggested to use the triantibiotic paste as an intracanal medication between the first and the second appointment. At the second appointment a blood clot is induced inside the canal to act as a scaffold for regeneration and then the coronal access cavity is sealed with a bioactive calcium silicate cement to prevent bacterial penetration and to allow regeneration in a bacteria free environment. The material used to provide the bacteria tight seal in this context is important as it should ideally have the ability to up-regulate signaling molecules and provoke regen-eration. Moreover, since it is not practical to avoid blood contamination the sealing ability and basic physical properties of the material should not be jeopardized by moisture and/or blood exposure.More recently, the use of platelet-rich plasma and/or platelet-rich fibrin rather than blood clot has been suggested. In this presentation the clinical consideration of REPs by emphasizing on the clinical outcome will be reviewed and the recent published evidence about REPs will be critically appraised.

MOHAMMAD HOSSEIN NEKOOFARHe is an academic member of Endodontics department in Tehran University of Medical Sciences (TUMS) where he received his DDs (1989). For his M.Sc, he worked on Electron-ic Root Canal Length Measurement Devices (1993, TUMS). In 1994, he became a Diplomate

of the Iranian board of Endodontics. His PhD projects were focused on investigating Calcium Silicate cements and lead to his gradua-tion in 2011 from Cardiff University, UK. Working on Regenerative Endodontics and Stem Cells, he is already responsible for teaching in department of Tissue Engineering and Applied Cell Sciences in TUMS. Simultaneously he is an honorary Senior Lecturer in Endodon-tics and Dental Biomaterial in Cardiff University and teaches post-graduate courses such as surgical endodontic courses, biomaterial endodontics. Dr. Nekoofar also has a strong sense of leadership

and management. He has been the president of Iranian Associa-tion of Endodontics since 2013 and the Group Leader of Endodon-tolgy Research Group in Cardiff University since 2004 up to now. He has written more than 60 papers, published in peer-reviewed journals which have been cited more than 1700 times. He has been invited as a keynote speaker internationally to give lectures in dif-ferent professional dental/endodontics congresses or Universities around the world such as Irish Endodontics Society (Dublin 2008), American Association of Endodontics (Vancouver 2008), European Society of Endodontology (Rome 2011), Turkish Endodontic Society (Istanbul 2012 & 2014), NIVVT symposium (Ghent, Belgium 2014), University of Illinois at Chicago (Chicago, USA 2015),  Indiana Uni-versity/School of Dentistry  (Indiana, USA 2015),  International As-sociation of Dental Research CED (Antalya, Turkey 2015), Biennial European Society of Endodontology Congress (Brussels 2017), The

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19th Scientific Congress of Asian Pacific Endodontic Confederation, (Delhi 2017), Eurasia Endodontic Symposium (Cyprus, 2017), 19th Indian Association of Conservative Dentistry and Endodontics & IES PG Convention (Gulbarga, India 2018). He is a member of the edi-torial board of the International Endodontic Journal and also acts as a scientific reviewer for a series of endodontics/dental journals.

His research interests mainly focus on Electronic Root Canal Length Measurement Devices, Calcium Silicates, Post-operative Pain in Endodontics, Treatment of Immature Root Canals, Automated Root Canal Preparation, Physiopathology of Periapical Lesions and Re-generative Endodontics.

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CALCIUM-SILICATE BASED MATERIAL: A NEW WAY FOR RESTORATIVE AND ENDODONTICS FILINGSMATERIALE A BASE DI SILICATO DI CALCIO: UNA NUOVA POSSIBILITÀ PER LA RESTAURATIVA E L’OTTURAZIONE ENDODONTICA

Stephane Simon

✎ ABSTRACT

Interest for endodontists for pulp vitality conservation therapeutics is growing up. Better Knowledge on behavior of pulp inflammation response and pulp healing processes allow us now to better anticipate short term and long term success of pulp capping therapies.One of the keys for long term success is the choice of biomaterial used for pulp capping.Calcium Hydroxide has been considered as the gold standard material for many years. Mineral Trioxide aggregate have shown better results than calcium hydroxide into the literature.Few years ago, a new family of hydraulic cements called “bioceramics”, enriched the list of materials dedicated to pulp capping procedures.Hydraulic cements family also includes flow materials which are dedicated to the root canal filling. Even if their use is highly controversy by practitioners, we should accept that endodontic root canal filling concepts may change in the future.In this presentation, we will describe several situations where hydraulic cements can be used in endodontics from pulp capping to root canal filling, either surgical a retro obturation. We will also discussed the pros and cons of their use.

STEPHANE SIMONHe has been qualified as Doctor in Dental Surgery in 1994 at the University of Reims. He completed in 2009 his PhD in Pulp Biology in the frame of a co-supervised Thesis between the University of Paris 7 and the University of Birmingham. To date he is full time academic

teacher/researcher and his clinical practice is limited to Endodon-tics. He has been graduated as a Professor in restorative dentistry and endodontics. He is the director of the European Postgraduate Endodontic Program at Paris Diderot University (3 years full time

program). His time is 50% devoted to the clinical practice and 50% to Basic Science/clinical research about Tissue engineering and dental Pulp healing. He works as a Researcher in Paris and as Asso-ciate Researcher in Birmingham. Today, his main interest is about Tissue engineering, cell and molecular Biology of pulp tissue (Basic science and clinical prac-tice), and is highly involved into development of new techniques and concepts for graduate and postgraduate teaching (E learning, flipped classroom, MOOCs, etc.).

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SESSION III SPONSORED MASTER CLINICIAN SESSION

LECTURE ROOM CARAVELLA/SANTA MARIAChairman: Maria Teresa Sberna

DENTALICA/MICROMEGA

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HEAT TREATMENT AND ITS IMPLICATIONS FROM A CLINICAL POINT OF VIEWIL TRATTAMENTO TERMICO E LE SUE IMPLICAZIONI DA UN PUNTO DI VISTA CLINICO

Walid Nehme

✎ ABSTRACT

Major changes in the field of shaping instrumentation have set a new course for endodontics in the last decade. Newer instruments are generating predefined and more conservative canal shapes with respect to canal anatomy.In this presentation we will describe recent advancements in shaping instruments designs and thermomechan-ical treatments. The features of the new heat-treated files from Micro Mega will be highlighted. The implementa-tion of these enhancements to meet the requirements for each clinical scenario will be explained and endorsed through an extensive literature review, experimental studies and clinical cases. Moreover, the concepts behind modern endodontics, will be revisited accordingly from a practical point of view. Does coronal flaring comply with the minimal invasive requirements? Do we still apply the shaping techniques principles? Do modern files affect our shaping procedures? At conclusion participants should be able to list the different thermomechanical treatments of the endodontic files, acknowledge the new properties and limitations of new Micro Mega files, enhance clinical performance to safer endodontics.

WALID NEHMEHe is a clinical professor at the Endodontic department of Saint Joseph University of Bei-rut where he received his DDS (1988) and MSc (1994). His academic activities lie within the field of undergraduate and postgraduate end-odontic education and emphasizes on clinical

training and conduction and surveillance of research projects. Pr Nehme has published scientific, and clinical articles in peer-re-viewed journals nationally and internationally on subjects includ-ing Root canal anatomy, instrumentation techniques, NiTi files, Irrigation procedures, obturation and retreatment. He is an interna-

tional member of the American Association of Endodontists (AAE). He served as President of the Lebanese Society of Endodontology (LSE). He is a founder member and former president of the Arab Endodontic Society (AES). He is an analyst and opinion leader for clinical trials for endodontic manufacturers and have contributed to the elaboration of new devices in endodontics. He runs postgrad-uate endodontic courses and hands on in the Middle East, Africa and Europe and Canada. He works in a referral-based practice lim-ited to endodontics in Beirut, Lebanon and Abu dhabi, United Arab Emirates.

SWEDEN & MARTINA

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THE MTWO SYSTEM: UNALTERED OVER THE YEARS BUT EVER-EVOLVING IN CLINICAL USEIL SISTEMA MTWO: IMMUTATO NEGLI ANNI MA SEMPRE IN EVOLUZIONE NELL’UTILIZZO CLINICO

Vito Antonio Malagnino

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✎ ABSTRACT

The Mtwo system was designed and launched on the market some 15 years ago, and since then there has been a ceaseless finding of new ways to use it, both by increasing its role in root canal preparation and by simplifying and making it increasingly safe to use.By now an extraordinary role of the 10/.04 instrument is consolidated in the initial phase of root canal treatment (scouting) during which the need to use steel instruments has become really rare and confined to some retreat-ment cases; there are various ways of benefiting from the positive characteristics of this instrument in the various clinical cases, by varying the depth of advancement and the rotational speed. With regard to rotational speed, with the Mtwo system this can be used in many ways by varying it depending on the complexity of the case, on the preparation phase and also on the operator’s skills; the instrument remains effective also if the rotational speed is decreased significantly, thereby allowing maximum control and complete safety. The possibility of determining the preparation and cleaning standards simply by observing the material (dentin, blood or necrotic material) that remains in the sulcus of the instruments is another peculiarity strictly related to the way in which the Mtwo work; together with proper compliance with the other preparation rules this possibility allows to complete the fit-to-size preparation of every canal.

VITO ANTONIO MALAGNINOHe was born in S. Marzano di S.Giuseppe (TA) Italy on May 15th 1955. He graduated in Med-icine and Surgery with the maximum of votes at the University of the Studies of Perugia in 1980. He specialized in Odontostomatologia at the University of the Studies of Rome “La

Sapienza”, with the experimental thesis on “Working length and filling limits in endodontics”, then published on “L’Intervento” sup-plement to the n.3, 1983 of Convivia Medica. Visiting Professor of the Integrative Course of “Pediatric endodontics” at the Course of Degree in Dentistry and Dental Prosthesis of the University of the Studies of Rome “La Sapienza”, for the academic year 1987-88. Vis-iting Professor in Endodontics at the Course of Degree in Dentistry and Dental Prosthesis of the University of the Studies of Rome “La Sapienza” from 1988 to 1995. Extra-Ordinary Professor in Pedodon-tics in the Academic years 1997-98 and 1998-99. From the year 1997

is Professor of “Endodontics” at the Course of Degree in Dentistry and Dental Prosthesis of the University of the Studies of Chieti “G. D’Annunzio”. Secretary of the Italian Endodontic Association SIE from 1990 to 1995. Vice President of the Italian Endodontic Associa-tion SIE from 1995 to 1997. President of the Italian Endodontic Asso-ciation SIE from 1997 to 1999. In 1995 he organized the World Wide Conference of International Federation of Endodontic Associations IFEA. Editor of the Italian Journal of Endodontics from 2002 to 2004. Secretary-Treasurer of the Italian Association of Conservative Den-tistry SIDOC from 1988 to 1998. President of the Italian Association of Conservative Dentistry SIDOC from 2002 to 2004. From 2003 he is Co-Editor of the Italian Journal of Operative Dentistry. Member of Honour of the French Association of Endodontcs. He is Author of more than 100 publications in endodontic speaker in numerous international congresses. It carries out profession with limited prac-tice in endodontics in Rome from 1982.

DENTSPLY SIRONA

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BUBBLES IN ENDODONTICS: A NEW SONIC TIP FOR ACTIVATING IRRIGATING SOLUTIONSBOLLICINE IN ENDODONZIA: UNA NUOVA PUNTA SONICA PER L’ATTIVAZIONE DELLE SOLUZIONI IRRIGANTI

Vittorio Franco

✎ ABSTRACT

The key to the health of endodontically treated teeth, is the eradication of bacteria from inside the endodontic space and the complete removal of pulp tissue and debries: this goal is difficult to achieve and it is currently assigned to irrigation and disinfection protocols. Sodium hypoclorite as well as EDTA are efficient irrigating solu-tions; nevertheless, accessory anatomies and the shape of the canals interfere in their action avoiding a correct contact and a sufficient shear stress.Enhanced irrigation strategies have been explored as advanced antibiofilm strategies, with the aim of improved clinical treatment outcomes.A new sonic tip seems giving promising results. The Aim of this presentation is to introduce to participants, with the help of a live demo, a very feasible and safe way to improve cleaning of the endodontics space.

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VITTORIO FRANCO He graduated from the University of Rome “La Sapienza” in 1991. Since 1997 Dr. Franco has been an active member of the SIE (Italian So-ciety of Endodontics) and at present, he is the society president elected. He is an active mem-ber of the Italian Academy of Dental Microsco-

py and certified member of the European Society of Endodontology. Dr. Franco is also the Italian representative at the general assembly of the European Society of Endodontology (ESE) and member of the ESE membership committee. Dr. Franco has in the past served on the Editorial Board of the Giornale Italiano di Endodonzia, has re-

viewed articles for a number of international journals and has per-sonally authored many scientific articles published in peer review journals. He has written book chapters for Endodontic textbooks. Dr. Franco is a well-known opinion leader and he cooperates as trainer, developer and tester with a number of leading manufactur-ers of Endodontic materials and instruments. He lectures nationally and internationally and he is a visiting professor at many postgrad-uate courses in Endodontics. Dr. Franco has been working in Rome and London exclusively in Endodontics and Endodontic Surgery un-der microscopic magnification on referred patients.

SESSION IV SPONSORED MASTER CLINICIAN SESSION

LECTURE ROOM CARAVELLA/SANTA MARIAChairman: Alberto Rieppi

SIMIT NEXT

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ENDODONTICS AND FUTURE OF TREATMENT AND RETREATMENTENDODONZIA E IL FUTURO DEL TRATTAMENTO E RITRATTAMENTO

Marco Martignoni

✎ ABSTRACT

Endodontics today means complete understanding of the clinical situation via imaging and planning the treat-ment eventually through the use of dedicated software.Still the importance of having a clear view of the treatment before and during the treatment is crucial for good results.On the endo file side today we can count on new designs associated with new metallurgic approach for reaching unique results.New generation glider uses similar approach than in the past but now can offer breakthrough features. Flexibility and resistance are the key words for the future. Reduction of fatigue, control of torque and constant monitoring of the working length will be all controlled and directed with a totally new digital and interactive device that will become a personal partner able to guide and support the endodontist in his daily practice increasing safety and consciousness.Re treatment will take advantage of the increase of control expressed by software coupled with the new designs.Systems for obturation are simpler and more friendly turning treatment or retreatment in a basic daily practice.

MARCO MARTIGNONIHe is graduated cum laude at University of Chieti-Italy in 1988. He leads a private clinic in Rome Italy and dedicates his practice mainly to endodontics, pre-prothesic core buil-up, re-storative procedures and prothodontics under operatory microscope. He has published re-

search on post endodontic core build up and, as speaker, and gives numerous lectures and practical workshops in Italy and worldwide on endodontics, on core build up and restorative procedures and

on the use of operatory microscope in dentistry. He is past-presi-dent of the Italian Society of Endodontics. Has been president of the congress ESE-Rome 2011 (European Society of Endodontology). He is founder of the Italian Accademy of Microscopic Dentistry and honorary member of the French Society of Endodontics. Part-time Professor a Steinbeis Transfer Institute Hochschule Berlin Master of Science in Interdisciplinary Dentistry. Visiting Professor to the International Master in Endodontics and Restorative Dentistry, Uni-versity of Siena.

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FOTONA

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LASER ACTIVATED IRRIGATION: EVOLUTION OF BUBBLES FROM PIPS TO SWEEPSIRRIGAZIONE LASER ATTIVATA: EVOLUZIONE DA PIPS A SWEEPS

Giovanni Olivi

✎ ABSTRACT

Disinfection and elimination of the microbial flora from the root canal system is one of the main goals of end-odontic treatment. In recent years a novel application of laser activated irrigation named PIPS™ (Photon-induced photoacoustic streaming) was introduced. This method uses Er:YAG laser with a wavelength of 2940 nm which is delivered to the irrigant in the access cavity with a conical and stripped fiber tip. Since Er:YAG laser light is highly absorptive in water it causes boiling and micro-explosions in the irrigant solution, which induces cavita-tion bubbles. Further research in this field led to the development of SWEEPS® (Shock Wave Enhanced Emission Photoacoustic Streaming), whisch is a revolutionary method for cleaning and disinfecting the root canal system, utilizing the power of the Er:YAG laser to create powerful deeply penetrating shockwaves within the cleaning and debriding solutions. In that way irrigants penetrate deep into lateral canals and microscopic dentinal tu-bules to deeply disinfect dentinal walls by removing tissue, debris, biofilm and bacteria. An important advantage of the SWEEPS® laser endodontic treatment is that it cleans and disinfects root canal systems more effective-ly compared to conventional treatments. … SWEEPS® promises to represent an entirely new way of thinking about root-canal therapy. With SWEEPS®, practitioners are able to offer patients faster, safer and more effective root-canal treatments.

GIOVANNI OLIVIGraduated cum laude in Medicine and Surgery and in Dentistry at the University of Rome, It-aly. He has lectured in the  past twelve years as a visiting professor in several European universities and is currently focused on his private practice in Endodontics, Aesthetic and

Pediatric Dentistry in Rome. Dr. Olivi completed the postgraduate laser course at the University of Florence in 2002 and achieved the laser certification from ISLD in 2004. He also obtained his Ad-vanced Proficiency from the Academy of Laser Dentistry in 2006

and achieved the Master status from ALD in 2009. In 2007 he re-ceived the “Leon Goldman Award” for clinical excellence from ALD. Dr. Olivi is an active member of the Italian Academy of Microscope Dentistry (AIOM), the Italian Society of Endodontics (SIE), the Ital-ian Society of Pediatric Dentistry (SIOI) as well as an active member of the Academy of Laser Dentistry (ALD). He lectures about laser dentistry worldwide and is the author of over 60 peer-reviewed ar-ticles and several textbook chapters on dentistry topics. He is also the author of 4 books on laser dentistry.

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RICCARDO GARBEROGLIO AWARD LECTURE ROOM NEWTON

RESEARCH COMMITTEE

Coordinator: Giuseppe CantatoreCommittee: Daniele Angerame, Elisabetta Cotti, Simone Grandini, Vassilios Kaitsas, Carlo Prati, Stefano Salgar-ello, Michele Simeone.

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VARIATION OF VASCULAR AND BLOOD INDICATORS OF EARLY ENDOTHELIAL DYSFUNCTION AFTER ROOT CANAL THERAPY: A CLINICAL AND BIOMOLECULAR STUDYVARIAZIONI DEGLI INDICATORI VASCOLARI ED EMATOCHIMICI DI DISFUNZIONE ENDOTELIALE PRECOCE DOPO TERAPIA ENDODONTICA: STUDIO CLINICO E BIOMOLECOLARE

Beatrice Giuggia*, Loredana Bergandi, Allegra Comba, Mario Alovisi, Giorgia Carpegna,

Damiano Pasqualini, Nicola Scotti, Elio Berutti.

INTRODUCTIONCardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Chronic inflammation as uncon-ventional risk factor and endothelial dysfunction (ED) have been correlated to atherosclerosis and CVD. Apical periodontitis (AP), as an inflammatory response to root canal infection, has been associated with an in-creased risk of CVD. Recently, it has demonstrated an association between AP and ED, however there is no evi-dence of an improvement of ED after root canal treatment (RCT) of patients with AP.

AIMThe aim of the study was to evaluate the effects of RCT in patients with lesion of endodontic origin (LEO) on endo-thelial and related vascular/biochemical dysfunction markers, before and after 2 months after treatment.

MATERIAL AND METHODS A case-control clinical trial was designed and approved by Ethical Committee with the following inclusion criteria:Age (25-40 years) and normal weight (BMI< 25 Kg/m2)Absence of CVD, diabetes, systemic, oncologic, immunologic or inflammatory chronic diseases, immunosup-pressive or cortisone therapy Absence of generalized or localizated chronic periodontitisPresence of at least one periradicular lesion of endodontic originAbsence of radiolucency not of endodontic origin.Study power was set at 80% with a p = 0.05 for sample size calculation (n=25)Patients were divided into 3 groups:Healthy subjects (CONTROL) (n=25)LEO patients (LEO) before the endodontic treatment (n=25)LEO treated patients (LEO TREATED), the same patients of LEO group re-evaluated 2 months after treatment.An endothelial functional test using ENDO-PAT2000 to assess endothelial flow reserve (EFR) was performed. Blood sampling was used to evaluate the levels of Endothelin-1, ICAM-1, sVCAM-1, E-selectin, TNF-α, IL-6, IL-1, and sCD14. One-way ANOVA and post-hoc Bonferroni test were used for data analysis (p<0.05) comparing the studied indi-cators in CONTROL vs LEO patients and LEO TREATED vs LEO. Spearman rank correlation coefficient and linear regression analysis (*, p<0.05) were utilized to assess correlation between variables.

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RESULTSIn table 1 are summarized descriptive statistics and inferential analysis of the tested variables (*means statisti-cally significant). EFR values, measured with ENDO-PAT, did not show statistically significant differences (p=0.18). Endothelin-1, ICAM-1 and E-selectin levels were statistically higher in LEO group than CONTROL group, with a re-turn to lower levels comparable to the CONTROL subjects after endodontic treatment. The levels of sVCAM were equal in all the three groups. Inflammatory cytokines IL-1 and sCD14 levels were significantly higher in LEO pa-tients, whereas after root canal treatment a decrease of these values was evident. On the contrary, TNF-alpha and IL-6 levels were within physiological range in all groups and with no significant difference.

DISCUSSIONExperimental and clinical data have implicated the endothelin system contributing in early stages to ED. An in-crease of ADMA, an endogenous inhibitor of NO synthase, together with IL-2 levels in patients with AP has been demonstrated, suggesting the existence of an early ED. ED is a disease most likely to be reversible at an early pre-clinical stage, through life style modifications, pharmacological therapy, and reversal of CVD risk factors. There is no evidence whether endodontic treatment may improve endothelial function in AP patients. In this study patients with peri-radicular lesions of endodontic origin exhibit early endothelial dysfunction and inflammatory status with higher levels of endothelin-1, ICAM-1, E-selectin, IL-1 and sCD14 in LEOs group than healthy subjects, with a return to levels of healthy subjects after endodontic treatment, even with no correlation with the macro-scopical evidence of a reduction of EFR.

CONCLUSIONEndodontic treatment of AP may improve ED markers, thus lowering the risk of CVD.

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MICROCT STUDY ON CADAVER OF MICROCRACKS FORMATION AFTER ULTRASONIC PREPARATION OF THE RETROCAVITY IN MICROSURGICAL ENDODONTICSSTUDIO MICROCT SU CADAVERE DELLA FORMAZIONE DI MICROCRACKS DOPO PREPARAZIONE ULTRASONICA DELLA CAVITÀ RETROGRADA IN ENDODONZIA MICROCHIRURGICA

Mario Solavagione*, Elio Berutti, Damiano Pasqualini, Mario Alovisi, Nicola Scotti, Giorgia Carpegna

INTRODUCTIONNew ultrasonic root-end preparation devices permit the preparation of conservative and straight cavities. Howev-er, microcracks can occur due to the vibratory action of such instruments.

OBJECTIVE OF THE STUDY The purpose of this study was to evaluate the relationship between retrograde preparation and microcracks ap-pearance and propagation on root-end surfaces scanned by microCT.

MATERIALS AND METHODSFourteen human anterior teeth were collected from cadaver mandibles to avoid bias caused by extraction alveo-lar bone was preserved around the teeth. The treatment consisted in: I) Root-end resection making a bevel with a Lindemann surgery FG 26mm bur and subsequent microCT evaluation; II) Ultrasonic preparation with Pro-Ultra retrotip followed by microCT scans. Different tips were used in order to avoid eccessive usury which can cause itself micro-cracks creation and propagation. Furthermore the order of instrumentation was randomly determined and registered due to evaluate the relationship between tip consumption and micro-cracks appearance. Data distribution was analyzed with Shapiro-Wilk normality test, Chi-square was used in order to evaluate the differ-ence between Post-bevel and Post retrocavity groups. Level of significance used was P<0.05. All statistical analy-sis were executed with SPSS 24.0 software (IBM, Endicott, USA). RESULTS: 2158 slices were analyzed in order to evaluate formation and propagation of microcracks: new micro cracks were find in 62 slices (2.87%) caused by

15

bevel creation, increased to 94 (4.35%) after ultrasonic preparation, One-Way ANOVA test showed statistically significant differences among initial, after bevel and after ultrasonic preparation specimens (p < 0.001) with a 51.6% increase from pre to post ultrasonic preparation. However quantity of specimens with microcracks resulted the same. No statistically significant differences were observed between usury and cracks appearance. 

DISCUSSIONThe analysis based on anatomic specimen from cadavers and the observation of microCT scans is considered the most reliable method for the analysis of root fractures because tooth extraction and sections are avoided. Statis-tically significant micro-cracks increase from pre to post ultrasonic preparation was found in specimens with pre-existent micro fracture, while no micro cracks were found in specimens without micro cracks at the initial stage.

CONCLUSIONSSince ultrasonic tips seem to create multi axial stresses on root-end surfaces, the evaluation of their influence on microcracks creation due to optimize surgical instrument design results fundamental. For this reason a larger study will be necessary to confirm the preliminary findings.

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COMPARATIVE STUDY OF THE BIOCOMPATIBILITY OF BIOCERAMICS SEALERS IN ENDODONTICSSTUDIO COMPARATIVO DELLA BIOCOMPATIBILITÀ DEI CEMENTI BIOCERAMICI IN ENDODONZIA

Virginia Mola*, Mario Alovisi, Giorgia Carpegna, Allegra Comba, Damiano Pasqualini, Nicola Scotti, Elio Berutti

INTRODUCTION Bioceramic materials are typically used in dentistry for apexifications or to repair root defects and perforations. New bioceramic materials have been recently introduced in the endodontic proposal. They are offered in a pre-mixed formula, in a jar or a syringe, and promise to be biocompatible as well as MTA or Biodentine. Moreover the Fast Setting Putty (FSP) formula has a quicker hardening time. In the present study we investigated the biocom-patibility and mineralization of these new materials. The materials analyzed were: Mineral Trioxide Aggregate (MTA) which is the current gold standard in clinical practice, Biodentine™ and three new bioceramic calcium phosphate silicate cements with a different composition but the same clinical indications. In particular, we test-ed: Root Repairing Material Putty (RRMPU), Root Repairing Material Paste (RRMPA) and Root Repairing Material Putty Fast Set (FSP).

OBJECTIVES OF THE STUDY This study aimed to compare the biocompatibility and the osteogenic potential of different bioceramic materials in vitro using the same human cell line model and to investigate their effect on cells differentiation.

MATERIALS AND METHODSFor each material 1 mm-thick and 5 mm in diameter discs were prepared and sterilized through UV exposure for 2 hours. MG-63 human osteoblastic-like cells were cultured with the bioceramics (15 days) and tested for: bio-compatibility (evaluation of any morphological changes and of cells survival), ALP activity assay and Alizarin Red Staining (ARS) to detect mineralization nodule deposition both to evaluate the osteogenic differentiation. Unex-posed cells acted as the control group. The cells were monitored and photographed with a microscope Evos fl at different times: the biocompatibility was evaluated at T0, 24 and 48 hours, while the ostogenic differentiation was assessed every 24 hours for 15 days. Statistical analysis was carried out using the ordinary one-way ANOVA test (Tukey’s multiple comparisons test). Significance has been defined as NEJM: 0.12 ns (not significant), 0.033, 0.002 e <0.001.

RESULTS All materials tested had suitable biocompatibility and bioactivity, without inducing significant morphological changes of cells. The ALP activity level increased in all cements inducing mineralization nodule deposition, es-

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pecially in RRMPU (p< 0.001) and FST (p< 0.001) compared to MTA. ARS revealed a significant potential to induce mineralization in vitro for RRMPU (p<0.0001), FSP (p= 0.0003) and Biodentine™ (p< 0.0001).

DISCUSSION Wang’s review describes the characteristics of an ideal material: absence of contraction, inflammation and toxic-ity and biocompatibility. Many authors have evaluated biocompatibility using the MG-63 human osteoblastic-like cells. The biocompatibility of the MTA is well-known and it is used as a reference to evaluate the biocompatibility of the new bioceramics. Nowadays, studies on bioceramics evaluate the biocompatibility using different cells and the results are difficult to compare. According with our results, previous studies evaluated ALP and Alizarin red and showed that the biomineralization and the activity of alkaline phosphatase had higher value for the new bioceramics compared to MTA.

CONCLUSIONS The data obtained in this in vitro study are in agreement with those described in the literature both for mineraliza-tion nodule deposition and for osteogenic differentiation. Further analysis will be needed to confirm the results. However, we can conclude that the tested bioceramics showed good level of biocompatibility and bioactivity, even higher than the materials currently used in contemporary clinical practice. Furthermore, these new ceramic sealers resulted cheaper than MTA.

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BIOACTIVITY (APATITE FORMING ABILITY) OF COMMERCIAL AND EXPERIMENTAL POLYSILOXANE-GUTTAPERCHA ENDODONTIC SEALERS. CALCIUM RELEASING, ALKALINIZING ACTIVITY, ESEM-EDX MORPHOLOGICAL ANALYSISBIOATTIVITÀ (CAPACITÀ DI FORMARE IDROSSI-APATITE) DI CEMENTI ENDODONTICI COMMERCIALI E SPERIMENTALI A BASE DI POLIVINILSILOSSANI E GUTTA-PERCA. RILASCIO DI CALCIO, ATTIVITÀ ALCALINIZZANTE, ANALISI MORFOLOGICA ESEM-EDX

Carlo Prati, Teo Renzi*, Fausto Zamparini, Luigi Generali, Maria Giovanna Gandolfi

INTRODUCTION There is a growing interest in sealers with bioactive (apatite forming) and biointeractive (release of biologically relevant ions) properties, especially when dealing with wide apices of immature and retreated teeth, root internal resorptions, blood contamination and refractory periapical lesions with large bone defects.

OBJECTIVES The aim of this study was to assess the chemical properties (alkalinizing activity, calcium release) and the bioac-tivity (apatite forming ability) of experimental Polysiloxane-guttapercha Calcium Silicate-containing cements in simulated wet root canals. The ability to nucleate calcium phosphate on their surface upon immersion in a simulated body fluid (SBF) has been evaluated using Environmental Scanning Electronic Microscopy (ESEM) and Energy-dispersive X-ray analy-sis (EDX).

MATERIALS AND METHODSA polysiloxane-guttapercha based sealer (GuttaFlow 2, Coltène/Whaledent Inc.) was mixed with three different calcium silicates materials, namely Calcium Silicates and Di Calcium Phosphate (CaSi/DCPD), Calcium Silicates (CaSi) and Hydroxyapatite (CaSi/HA) and Bioroot RCS (Septodont, Saint-Maur-de-Fosses, France).4 experimental formulations were obtained: GuttaFlow 2 + 20% CaSi/DC GuttaFlow 2 + 20% CaSi/HA

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GuttaFlow 2 + 20% BioRoot RCS GuttaFlow 2 + 30% BioRoot RCSMaterials were compacted into polyvinylchloride molds (8 mm diameter, 1.6 mm height; n=8 per group), imme-diately immersed in 10 mL of deionized water (pH 7.18) into polypropylene sealed containers and stored at 37°C. The soaking water was replaced at each endpoint (3 h and 1,3,7,14,28 days) and analyzed for pH and calcium content. Analyses were carried out under magnetic stirring at room temperature (24°C) by using a multiparameter laboratory meter (inoLab 750, WTW, Weilheim, Germany) connected to a selective electrode (Sen Tix Sur; WTW) for pH measurements or a calcium probe (Calcium ion electrode, Eutech Instruments Pte Ldt, Singapore.ESEM (Zeiss EVO 50; Carl Zeiss, Oberkochen, Germany) connected to a secondary electron detector for energy dispersive X-ray analysis (EDX; Oxford INCA 350 EDS, Abingdon, UK) was used to investigate apatite forming abil-ity on samples immediately immersed in Hank Balanced Saline Solution (HBSS), after 3 and 28 days.

RESULTS All the materials demonstrated the ability to alkalinize the pH from 3 hours to 24 hours. These values were con-stant until 28 days. Calcium release demonstrated a progressive increase from 3 hours to 28 days. After 28 days immersion in HBSS, a layer of CaP was detected on all the experimental samples.

DISCUSSION Conventional Guttaflow 2 does not release calcium ions, nor proved to alkalinize the local environment. Sealers with bioactive (apatite forming) and biointeractive properties may represent a new frontier for endodontic ther-apy. Release of biologically relevant ions (i.e Ca++ and OH-) may be useful for mineralizing cells activation and proving a slight antibacterial activity. Moreover, an alkaline environment favours apatite precipitation. All these conditions may allow a faster healing of the periapical bone.

CONCLUSION Nano spherulites particles were detected in all formulations. Their composition was mainly calcium-phosphate and apatite. EDX confirmed the presence of calcium and phosphate.

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DENTIN EROSION CAUSED BY DIFFERENT ENDODONTIC IRRIGATION SOLUTIONS: A NANOFOCUS CONFOCAL MICROSCOPY STUDYEROSIONE DENTINALE CAUSATA DA DIFFERENTI SOLUZIONI IRRIGANTI: UNO STUDIO AL MICROSCOPIO CONFOCALE

Shlomo Elbahary, Igor Tsesis, Eyal Rosen, Suhad Haj-Yahya*, Majd Khawalid, Rachel Sarig

INTRODUCTION Current methods of cleaning and shaping root canals produce a smear layer that covers the instrumented areas of the walls. Irrigation is considered the best method for the removal of tissue remnants and the smear layer. Complete removal of the smear layer requires the use of a chelating agent or other demineralizing agent and a soft-tissue solvent because no single solution is capable of providing both effect. Although the combination of EDTA and sodium hypochlorite (NaOCl) have been advocated as an effective irrigation regimen to remove the organic and inorganic matter, there is no clear consensus regarding the ideal irrigation sequence, volume, and application time in the literature. Root canal irrigations can lead to structural changes, as evidenced by the re-duction of dentin strength, microhardness, and changes in surface roughness. Many studies have suffered from specific limitations, such as qualitative evaluation based on nonrandomized selection of the observation areas and analysis done by scores. This lack makes it difficult to fully understand the effect of irrigation sequences on dentin surface.

OBJECTIVES To examine the effect on root canal wall dentin by immersion in different irrigate solutions in alternative sequenc-es and to quantify and compare the level of erosion (measured by roughness) caused by the chemical treatments using novel optical topography.

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MATERIALS AND METHODS Fifty human fully developed permanent anterior teeth were used, the tooth crowns were removed at the cemen-toenamel junction. Each root was sectioned perpendicular to the long axis of the root under water cooling with a diamond saw, this cut will result in 3 slabs of the root 1 mm thickness each the 150 dentin samples were ran-domly divided into 5 groups of 30 samples each and prepared as follows: group 1 (N=30), treatment with 17% EDTA for 10 minutes group 2 (N=30), treatment with 5.25% NaOCl for 10 minutes group 3 (N=30), treatment with 17% EDTA for 10 minutes and then with 5.25% NaOC for 10 minutes group 4 (N=30), treatment with 5.25% NaOCl for 10 minutes and then treatment with 17% EDTA for 10 minutes group 5 (control), treated with deionized and distilled water for 10 minutes. The surface roughness was measured according to Description of surface texture parameters in ISO 25178 with a Nanofocus confocal microscope Roughness values were statistically analyzed by one-way Anova. Statistical significance was set at P <.05 - RESULTS the roughness values were significantly affect-ed by the different irrigation solutions and combination tested comparing mean values of the control group. The EDTA 17% group and the combined EDTA 17% & NaOCl 5.25% showed significantly higher roughness properties comparing the NaOCl 5.25% group (P<0.05), control group (P<0.05). Adding NaOCl 5.25% after 10 minutes of EDTA 17% significantly raised the roughness properties comparing the adding of EDTA 17% after 10 minutes of NaOCl 5.25% (P<0.05).

DISCUSSION The present study shows that the sequence of use of the common endodontic irrigants, hypochlorite, and the demineralizing agents (EDTA) is a key factor in determining the level of erosion in root canal wall dentin. Is not known presently whether such erosion is harmful for the root dentin and the tooth. It is well known that the mineral component in hard connective tissues contributes to strength and elastic modulus, whereas collagen is responsible for toughness. Theoretically, the observed erosion could be a contributing factor in vertical root fracture depending on the depth of erosion, thickness of the root, and the amount of sclerotic dentin in the root.

CONCLUSION Nanofocus confocal microscope is an efficient method to evaluate the level of erosion on root canal wall dentin The use of EDTA 17% on dentin discs significantly (P<0.05) raised the roughness level in dentin regardless the order or combination with NaOCL 5.25%.

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EVALUATION OF THE CONTAMINATION POTENTIAL OF ENDODONTIC HAND INSTRUMENTSVALUTAZIONE DEL POTENZIALE DI CONTAMINAZIONE DEGLI STRUMENTI ENDODONTICI MANUALI

Giovanni Schianchi*, Luca Testarelli, Dario Di Nardo, Federico Valenti Obino,

Gianfranco Gaimari, Gianluca Gambarini, Claudio Passariello

INTRODUCTION The onset of degenerative processes and the need for rehabilitative procedures can justify the execution of root canal treatment also in the absence of an infection. Although an inadequate procedure is the most frequent cause of failure of endodontic treatment, in some cases failure occurs even if the highest technical standards have been followed. Among factors associated with these failing treatments microbial ones must be includ-ed. Endodontic treatment is not classified as an aseptic surgical procedure and endodontic instruments can be commercialized in non-sterilized packages and used without preliminary sterilization. The use of non-sterilized instruments could potentially cause the introduction of dangerous microorganisms within root canals.

OBJECTIVES This work was aimed at evaluating qualitatively and quantitatively the microbial contaminants present at the sur-face of endodontic hand instruments, as they are delivered in their original packages from different manufacturers.

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MATERIALS AND METHODS Seven groups (24 instruments for each group) of K-files (size 25, length 25 mm) from different manufacturers, aseptically taken from their original packages, were tested for bacterial contamination. Each instrument was transferred into a sterile 5 ml conical tube containing 2 ml of sterile PBS and vortexed for 5 minutes to detach eventual adherent bacteria. The washing buffer was then centrifuged and 0.2 ml of sterile PBS were added to each tube to re-suspend bacteria. Bacterial contaminants were counted by plating on BD Columbia Agar supplemented with 5% Sheep Blood after incubation for up to 5 days at 37°C. Bacterial colonies were counted and analysed for identification by standard microbiological methods. Significance of differences in the amounts of bacteria de-tected for the different tested instruments was evaluated through the one-way analysis of variance (ANOVA) for dependent samples. The Turkey HSD test was performed as post hoc test to detect differences between groups of instruments. Differences were considered significant when values of P were in the range <0.05>0.01 and highly significant when values of P were ≤0.01.

RESULTS No bacterial colonies were detected from instruments delivered in sterile packages. All instruments delivered as non-sterilized gave rise to the development of bacterial colonies. Bacterial counts obtained from instruments commercialized as non-sterilized in not-sealed plastic boxes resulted significantly higher than those obtained from instruments commercialized as non-sterilized in sealed boxes. No potentially pathogenic species were de-tected among bacterial contaminants grown from instruments commercialized in sealed boxes; on the contrary, some potentially pathogenic species were detected among bacterial contaminants grown from instruments de-livered non-sterilized in not-sealed boxes.

DISCUSSION The eventuality that endodontic instruments introduce potentially dangerous bacteria into the root canal system deserves consideration, since many operators prefer to use new instruments directly taken from their original packaging. In the light of our experimental results this is a potentially dangerous behaviour, particularly when instruments delivered in not-sealed boxes are used. It is interesting that packaging modalities significantly influ-ence contamination, both quantitatively and qualitatively, suggesting that contamination occurs during storage and manipulation of packages.

CONCLUSION These data suggest that instruments delivered sterilized or packaged in sealed boxes should be preferably used and that, when instruments packaged in not-sealed boxes are used, a preliminary decontamination/sterilization phase in the dental office is recommended.

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PHYSICAL PROPERTIES AND SEALING ABILITY OF EXPERIMENTAL POLYSILOXANE-GUTTAPERCHA CALCIUM SILICATE-CONTAINING ENDODONTIC SEALERSPROPRIETÀ FISICHE E CAPACITÀ DI SIGILLO DI CEMENTI ENDODONTICI SPERIMENTALI A BASE DI POLIVINILSILOSSANO E GUTTA-PERCA CONTENENTI CALCIO SILICATI

Carlo Prati, Luca Raimondi*, Fausto Zamparini, Maria Giovanna Gandolfi

INTRODUCTION Obturation of root canals during endodontic treatment is critical for preventing leakage from the oral cavity and periodontal tissues. In order to design a new endodontic sealer with bioactive and physical properties for the apical bone regeneration, Polysiloxane-guttapercha sealer doped with experimental calcium silicate fillers have been developed to create a satisfying sealing ability, hence dramatically reducing the risk of any residual gap/void that the root filling material might have left.

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OBJECTIVES The aim of this study is to assess the physical properties (i.e. setting times, solubility, porosity, and radiopacity) and the sealing ability in simulated wet root canals of novel polysiloxane-guttapercha calcium silicate-containing cements for root canal sealing.

MATERIALS AND METHODSA polysiloxane-guttapercha based sealer (GuttaFlow 2, Coltène/Whaledent Inc.) was mixed with three experi-mental calcium silicates powders, namely Calcium Silicates and Di Calcium Phosphates (CaSi/DC), Calcium Sil-icates (CaSi) and Hydroxyapatite (CaSi/HA) or BioRoot RCS (Septodont, Saint-Maur-de-Fosses, France) powder.4 experimental formulations were obtained: GuttaFlow 2 + 20% CaSi/DC GuttaFlow 2 + 20% CaSi/HA GuttaFlow 2 +20% BioRoot RCS GuttaFlow 2 +30% BioRoot RCS Initial and final setting times, were evaluated according to ASTM C266-03 and ADA specification.Porosity, solubility, water sorption and radiopacity were evaluated following ISO 6876/2012.Sealing ability was evaluated by using fluid filtration rate on root samples previously instrumented single-canal root.Briefly, roots were prepared to obtain an apical diameter #40 using nickel-titanium rotary files (HyFlex EDM, Col-tene/Whaledent Inc.), each root was filled with single cone technique and immediately immersed in simulated body fluid. A 18-gauge needle was inserted across a plexiglass support into the coronal third of the filled root (5 mm) and the coronal side of the root was fixed to the plexiglass support with cyanoacrylate. The external surface of root was coated with nail varnish to seal the root surface except for the apical orifice (2 mm apical free from varnish). A high-precision device (digital fluid flow meter) able to detect micrometric fluid movements through the apical system was used for fluid flow rate measurements at 1, 14, 28 days.

RESULTSAll the materials showed final setting times adequate for the clinical practice (TABLE 1). Porosity, water adsorp-tion and solubility values are shown in TABLE 2. The tested materials showed different apparent porosity values, being significantly higher for GuttaFlow 2 + 20% CaSi/DC and GuttaFlow 2 +30% BioRoot RCS. Interestingly, fluid filtration rate outcomes revealed a reduction from 24 hours to 28 days, revealing an improved sealing ability.

DISCUSSION Materials having appropriate physical properties, as low porosity and solubility and adequate setting time may represent the gold standard for the optimal root canal sealing. In this prospective, low soluble bioactive (apa-tite-forming) calcium silicate-containing sealer may be extremely attractive, as these materials may also induce dentin remineralization and apatite nucleation, allowing to increase sealing efficiency and reduction of root ca-nal voids.

CONCLUSION The experimental materials showed good setting time and sealing abilities which increased during time, making them attractive materials for root canal filling.

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GIORGIO LAVAGNOLI AWARD LECTURE ROOM NEWTON

CULTURAL COMMITTEE

Coordinator: Massimo GiovarruscioCommittee: Mauro Cabiddu, Claudia Dettori, Francesco Maggiore, Carmelo Pulella, Giovanni Schianchi, Carlo Tocchio

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INTENTIONAL REPLANTATION AND 3D OBTURATION WITH BIODENTINE OF A RESORBED ROOTREIMPIANTO INTENZIONALE CON RICOSTRUZIONE TRIDIMENSIONALE IN BIODENTINA DI RADICE RIASSORBITA

Giovanni Messina*, Luigi Stagno D’Alcontres, Enrico Cassai, Maria Elena Cipollina

INTRODUCTIONReferred patient of 14 years old (in orthodontic treatment) for a suspected resorption on a 2.1 that was exposed to a trauma. After an apical x ray, a cone beam was performed to have a complete diagnosis.

OBJECTIVESThe treatment’s goal is to stop the root resorption, removing all the resorbing tissue and rebuild the root by bio-dentine’s use. Replant the tooth also using the orthodontic’s guide.

MATERIALS AND METHODSThe cone-beam confirmed the resorption so, after achieving the parents’s consent to the treatment, was planned an intentional replantation and a retrograd approach. After an autramatic extraction the root was cleaned from all the resorbing tissue with an ultrasonic handpiece. After the tissue removal the root was rebuilded by the use of Biodentine and then replanted and splinted to the ortho appliance that allowed a precise position of replantation X ray control confirmed the correct rebuilding of the root anatomy.

RESULTS6 days after the session the patient came to observation referring no pain or swelling after the treatment. After 6 months the patient has completed the ortho treatment and the x ray control revealed a good response and the biodentine’s stability and no sign of tissue inflammation.

DISCUSSIONSince the good preliminary results at six months of the intentional replantation with Bio dentine root rebuilding, these treatment, in young patient, can be considered as a good option to the maintainability of the tooth till the adult age and to long lasting prosthetic treatments. In November 2018 for the SIE we will got 15 months follow up, a good period for a follow up and we’ll find three possible results: - A good healing - The ankyloses that in these case could be considered also as a success too - in case of a new spot of resorption since the treatment session was really fast (30 minutes) and with a really good compliance by the patient a referred low morbidity of post operation syntomphs, we could consider to repeat the same treatment for another session and gain more time in a young patient.

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HOT MODIFIED TECHNIQUE WITH A NEW BIOSEALER: CASE SERIESTECNICA MODIFICATA A CALDO CON UN NUOVO CEMENTO BIOCERAMICO: CASE SERIES

Dina Abdellatif*, Alfredo Iandolo, Massimo Calapaj

INTRODUCTIONThe long-term success of endodontic treatment is basically based on adequate 3D Cleaning followed by 3D obtu-ration of the complex root canal system. 

OBJECTIVESThe goal of this work is to discuss and demonstrate a modified warm filling technique using this new biosealer, the Guttaflow Bioseal.

MATERIALS AND METHODSFor the current warm modified technique we’ll use System-B heat source or any similar device. After choosing the correct gutta percha master cone, we prepare the biosealer and insert it into the root canal with the proper tip. Then we insert the gutta percha cone to the working length and begin the three-dimensional obturation technique. To reach our aim, we decrease the heat carrier temperature to 130-150 degrees instead of the average 200-250 degrees, as this is completely sufficient. Penetration depth is reduced to 3 seconds as compared to the usual 5 seconds and the heat carrier is inserted till only 4 mm short from working length. Traditionally, to dissolve the gutta percha in the apical third the heat carrier has to reach 3 mm from working length. But, with this modified technique the heat carrier can be stopped also at 6-10 mm from working length. With this modified technique the gutta percha itself does not have to get inside the accessory canals, as the bioceramic sealer will already flow into any hidden canals. In the following in-vitro tests, it’s manifested that the modified obturation technique al-lowed the sealer to advance deeper inside lateral canals in comparison to the traditional single cone technique. By increasing the penetration speed of the heat carrier, we increase the pressure and this is needed to make the biosealer penetrate throughout the endodontic space. The clinician doesn’t have to reach the desired working length in one stroke, but can use another stroke until the desired length is reached. With the new warm modified technique, the biosealer sets only around 2 minutes earlier than the normal technique. This happens with using the reduced heat settings and fast penetration.

RESULTSSeveral clinical cases with periapical lesions are shown with follow-ups using this technique.

DISCUSSIONNowadays, we have many presented sealers, the biosealers, even if they have some disadvantages such as: be-ing used only with cold techniques and they harden to a great deal. To guarantee a secure obturation we must try to fill the endodontic space as much as possible and achieving this with cold techniques is not possible. Instead, with the benefit of a new biosealer, bioseal guttaflow, we can also obturate three-dimensionally.

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IS TRANSIENT RED DISCOLORATION A GOOD INDEX OF PROGNOSIS FOR THE PULP AFTER DENTAL TRAUMA? A CASE REPORT WITH 7 YEARS FOLLOW-UPLA DISCOLORAZIONE ROSSA TRANSITORIA POST-TRAUMATICA È UN INDICE DI BUONA PROGNOSI PER LA SOPRAVVIVENZA PULPARE? CASO CLINICO CON 7 ANNI DI CONTROLLO

Luca Casula

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INTRODUCTIONCoronal discoloration is a common event observed following trauma in primary and permanent teeth. The clini-cian choose between immediate endodontic treatment or follow-up, waiting for clear evidence of pulpal necrosis. The discoloration of the crown can change from a lack of translucency to pink, bluish or grey. Pink or red discolor-ation that occurs shortly after injury, can be reversible. In this case it is advisable not to treat the pulp of the tooth immediately, but wait for its color return to normal and can thus maintain its pulp vitality.

OBJECTIVESThe purpose of this case report is to evaluate if there are any type of discolorations that indicate a good prognosis for the pulp and not the need to endodontically treat the tooth.

MATERIALS AND METHODSA 35 years old female patient, showed the concussion of the element #21, the sub-luxation of the element #11 and the concomitant coronal fracture of both. The crown fractured of both elements was rebuilt three days after the trauma. Two weeks after the trauma the element #11 was negative to the sensibility test, had coronal discol-oration (red) and it was painful to percussion. Althought there were several signs which indicated the possible pulpal necrosis, root canal therapy has not been performed on the tooth. After two months the symptoms had returned to normal, as well as the color of the tooth. Seven years after the trauma, the tooth responds positively to the cold test, is asymptomatic and has a normal color.

RESULTSThe last control at 7 years after the dental trauma and the red discoloration, highlights the good condition of the restoration: the patient is still asymptomatic, both elements have a positive cold test and x-rays show that there were no pathologic changes.

DISCUSSIONAccording to the Internal Association of Dental Traumatology guidelines 2012, at least two signs and symptoms are necessary to make the diagnosis of necrotic pulp. Andreasen states that the diagnosis of pulp necrosis should be based on primarily two or more of the following signs: crown discoloration, negative sensibility testing and periapical radiolucency, but the importance of transient negative sensibility testing should be considered (mini-mum of 2-3 month’s observation). Some authors, support the existence of a traumatic transient pathology, where in the tooth, after discoloration, returns to normal spontaneously. This approach allowed to avoid the eradication of the pulp, preserving the functionality and integrity of the teeth at 7 years. However, controls are necessary over time to identify any complications like root resorption or pulp canal obliteration, which may rarely occur in this case.

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UNUSUAL CONFIGURATION OF IPERDENSE PERIRADICULAR NEOFORMATION OF UNCERTAIN ORIGIN: DIFFERENTIAL DIAGNOSIS AND CLINICAL TREATMENTCONFIGURAZIONE ATIPICA DI UNA NEOFORMAZIONE PERI RADICOLARE IPERDENSA DI ORIGINE INCERTA: DIAGNOSI DIFFERENZIALE E TRATTAMENTO CLINICO

Giorgia Carpegna*, Allegra Comba, Mario Alovisi, Damiano Pasqualini, Nicola Scotti, Elio Berutti

INTRODUCTIONOdontomas are a commonly defined as a tumor that produces mature enamel, dentin, cementum and pulp tis-sue. The majority of odontomas are asymptomatic, but they can provocate swelling, bone expansion, displace-ment of teeth. The treatment is usually referred to the dentists due to the associated dental problems. A 36 year-old female arrived in 2014 to the Endodontic Department of Dental School in Torino reporting pain referred to the maxillary left lateral incisor and canine. The clinical exam didn’t shows any decay neither filling nor periodontal probing. The buccal gum showed some swelling. The patient report any traumatic accident in the past. Both

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thermic and electric tests gave a negative response. The periapical x-rays showed a radiopaque lesion around 22 and 23 root; the lesion was confirmed by the Cone Beam Computed Tomography (CBCT) which also showed some area of root resorption. The first diagnosis was pulp necrosis of the element, due to the presence of the lesion that affected the vascular nervous bundle. The differential diagnosis for the lesions were: odontoma, periapical cemented dysplasia or florid cements-osseous dysplasia.

OBJECTIVESThis case report want to explain the decisional treatment plan of a complex odontoma.

MATERIALS AND METHODSAfter the first visit the treatment plan was made. First of all the orthograde therapy was performed. After six months there was no changement on the X-rays findings. The clinic decided to perform a retrograde microsurgery. After local anesthesia (articaine with 1: 100.000 adrenaline and lidocaine 1: 50.000), a gingivobuccal mucoperi-osteal flap was elevated. The neoformation was exposed and removed by cutting was around the healthy bone tissue. Then the soft tissue, granulomatous like, was enucleated. Both bone and tissue were send to histologic analysis. The canine radicular apex showed sign of pathologic resorption. The retrograde filling was made with Super Eba cement. Antibiotic and analgesic therapy was given.

RESULTSSigns and symptoms were solved after surgery. X-rays controls were performed at 1 month, 6 month, 1 year and 3 years after surgery and showed a complete healing of the lesion. The histologic report showed amorphous ce-ment-like material and fibrous stroma confirming the suspect of odontoma.

DISCUSSIONOdontomas are usually clinically asymptomatic, but in this case the patient experienced pain in the upper max-illa, in absence of any trauma, decay or retained teeth. In most cases odontomas are detected as incidental find-ings on routine radiographs but the diagnosis can be confirmed only by hystopatology. CBCT can aid the surgical planning and can show the precise relationship between the lesion and the surrounding tissue.

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CAD CAM RESTORATION FOR AN ENDODONTICALLY TREATED TOOTHRICOSTRUZIONE CAD CAM DI UN ELEMENTO TRATTATO ENDODONTICAMENTE

Noushad Rahim*, Francesco Mannocci

INTRODUCTIONFull crowns have long been considered the gold standard for restoring endodontically treated teeth. A recent study by Al Nuaimi et al highlighted the importance of preserving tooth to the outcome of root canal treatment. CBCT is gaining wider acceptance as part of an endodontists armamentarium. Patel et al has shown that CBCT is more sensitive at detecting periapical pathosis compared to a periapical radiograph. Advances in materials and clinical techniques, along with the increased demands from the patients have meant that we are now able to fab-ricate the ceramic restorations, in one visit using CAD CAM technology and 3D Scanning instead of impressions.

OBJECTIVESThis case report demonstrates the use of CBCT for endodontic diagnosis and treatment planning and using CAD CAM technology to restore the endodontically treated tooth

MATERIALS AND METHODSA 42 year old male patient was referred by her GDP for completion of root canal treatment due to pulp canal obliteration. On presentation, the patient was reporting of discomfort especially to biting pressure. His medical history is unremarkable. Clinical examination revealed a moderately restored permanent dentition. The UR6 was mildly tender to palpation and percussion. All the neighbouring teeth responded positively to the pulp sensi-bility test using Endo Ice® (Hygenic®, The Hygenic Corporation, Akron, USA). With the consent of the patient,

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a small FOV CBCT scan (Planmeca Promax 3D®, Planmeca, Helsinki, Finland) was taken with exposure settings at 80 Kv, 3 mA and 17.5 s. A periapical radiolucency was evident on the CBCT scan on the MB root but not in the periapical radiograph. The cross sectional image confirmed the presence of 4 canals. A diagnosis of apical peri-odontitis was made for the UR6. After discussing various treatment options, the patient agreed to have root canal treatment and an overlay restoration. Endodontic treatment was completed in two visits under rubber dam and local anaesthesia with the aid of an operating microscope. A onlay was fabricated using the Planmill (Planmeca, Helsinki, Finland).

RESULTSThis case report highlights the benefit of using a small FOV CBCT scan to help in diagnosis as well as treatment planning. The CAD CAM restoration was fabricated in one visit eliminating the need for an impression or an ad-ditional visit.

DISCUSSIONA small FOV CBCT scan is specifically designed to capture information from a small region. In this case, it was able to detect a periapical changes in the MB root while the periapical radiograph did not. A CAD CAM overlay restoration is more conservative to a full crown and requires just one visit to complete the restoration.

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ENDODONTIC PAIN MANAGEMENT WITH SINGLE TOOTH ANESTESIA PROVIDED BY A COMPUTER-CONTROLLED LOCAL ANESTHETIC DELIVERY. A CASE SERIESGESTIONE DEL DOLORE IN ENDODONZIA MEDIANTE ANESTESIA DEL DENTE SINGOLO EFFETTUATA TRAMITE UN DISPOSITIVO COMPUTERIZZATO DI EROGAZIONE DELL’ANESTETICO. UNA CASE-SERIES

Francesca Cerutti*, Riccardo Tonini, Massimo Giovarruscio, Fabio Gorni

INTRODUCTIONPerforming pain-free root canal treatment in patients is not always achievable, above all in case of acute pulpits. 85 cases of pulpitis were confirmed by diagnostic tests and radiography. A standard protocol for anesthesia was followed, then endodontic treatment was performed. Patients and practitioners were interviewed immediately after the treatment and one week later for evaluating the efficacy of the anesthesia and the pain felt by the patient (VAS).

OBJECTIVESAim of this study was to test the efficacy of The Wand-Single Tooth Anesthesia System (Milestone Scientific, Inc., Livingston, NJ) in providing pain-free and effective anesthesia in patients with acute pulpitis. The Authors wanted to test the capability of the CCLAD to go beyond the limits of the intraligamentary technique (difficulty of finding the desired location, controlling the placement of the needle throughout the administration phase of anesthesia, increased pain perception reported by patients due to high syringe pressure and consequent tissue damage) and the feedback of patients and clinicians after its employment.

MATERIALS AND METHODSAnesthesia was provided using the CCLAD in STA mode according to the manufacturer’s instructions (2 injection sites in multi-rooted teeth, 1 site in single-rooted teeth) and using 3% mepivacaine without adrenaline. After placing the rubber dam, endodontic therapy was executed with Ni-Ti mechanical instruments, sodium hypochlo-rite irrigation activated by US-tips and warm gutta-percha filling. Patient were interviewed about: pain during the injection, pain during the therapy, post-operative pain, preference of STA with respect to classical anesthesia. The clinicians were asked about: anesthesia effectiveness, need for additional anesthesia, patient compliance and presence of post-operative complications. 

RESULTSIn a 0-10 scale, average pain during the injection was 1,7; average pain during the therapy was 1,9; average

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post-operative pain was 1,1. 64,75% of the patients preferred STA to the traditional anesthesia. According to the practitioners, the average anesthesia effectiveness and the average patient compliance were 8.26 cases out of 85 required additional anesthesia and 11 patients reported post-op complications.

DISCUSSIONWithin the limitations of this study, CCLAD seems to be effective in treatment of acute pulpitis and patients prefer it. The absence of vasoconstrictor may have provided shorter duration of anesthesia which may influence the results and justify the need for additional injection. Post-operative complications were generally localized inflammation of the peridontium that spontaneously healed within few days.

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IMMEDIATE CROWN REPLACEMENT: REPORT OF EXTENSIVE RADICULAR FRACTURE CASE SERIES WITH INTRA-CANAL ANCHORAGECASE SERIES RELATIVO ALLA CEMENTAZIONE ADESIVA IMMEDIATA, CON ANCORAGGIO INTRA-CANALARE, DI CORONA NATURALE IN SEGUITO A FRATTURA RADICOLARE

Davide Guglielmi

INTRODUCTIONManagement of traumatic dental injuries (TDI) involves a multidisciplinary approach to maximize healing while maintaining function and esthetics. The challenge is to identify the most suitable treatment for a given patient using a combination of evidence-based guidelines and clinical experience.

OBJECTIVESComplicated crown-radicular fractures, account for up to 20% of all TDI with the majority in the maxillary anterior region. The treatment of root fractures depends on the location of the fracture itself and can also vary from crown lengthening (orthodontic dental extrusion or osseous resective periodontal surgery) to the extraction of the root followed by implant placement. In this case series we will report 4 cases of new conservative approach passing by the natural crown’s reattachment associated to root canal therapy and a clinical crown exposure, followed by fixing with a post.

MATERIALS AND METHODSIn all fractured elements we noticed bleeding of the gingival sulcus, sensibility testing was negative and mobility was present. The preoperative radiographs shows the horizontal root fractures that entered the pulp chamber. The portion of fractured tooth was removed and the fracture lines, once exposed, showed implication of the bio-logic widh. For that, we raised a intra-sulcular flap, and performed a osseous resective surgery (ORS) in order to have at least 2 mm circumferentially of exposed root coronally to the alveolar crest. After placing rubber dam the root canal treatments were performed and the posts space were prepared. Afterward the teeth crowns had to be prepared by removing the remains of the pulpal chamber in order to receive the coronal part of post and to avoid future discolorations. Subsequently the adhesive passages were carried out and the crowns luted. In conclusion after removed all excess material, placed sutures a peri-apical X-Ray were performed.

RESULTSFollow-up visits confirmed the success of treatments based on clinical (probing depth, bleeding on probing, mo-bility, dyschromia) and radiographic evaluations (absence of apical radiolucency, thickening of the periodontal ligament). The patient remained pain-free with good function and aesthetics during a follow-up period between 2 and 8 years.

DISCUSSIONManagement of complicated crown fragments has undergone major changes in recent years. The remarkable advances in adhesive systems and resin-based composites have made reattachment procedures all the more achievable. This minimally invasive approach seems to be predictable, managing to reduce costs and the num-ber of interventions for the patient while satisfying function of the treated elements and high aesthetic standard.

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FRANCESCO RIITANO AWARD LECTURE ROOM NEWTON

CULTURAL COMMITTEE

Coordinator: Massimo GiovarruscioCommittee: Maria Giovanna Barboni, Enrico Cassai, Renato Gullà, Roberto Mancini, Luigi Scagnoli, Umberto Uccioli

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DENTINAL MICROCRACK FORMATION AFTER USING NEW RECIPROCATING AND ROTARY NICKEL-TITANIUM INSTRUMENTS: A MICRO-COMPUTED TOMOGRAPHIC EVALUATIONFORMAZIONE DI MICROCRACK DENTINALI DOPO L’UTILIZZO DI NUOVI STRUMENTI RECIPROCANTI E ROTANTI AL NICKEL-TITANIO. VALUTAZIONE ALLA MICRO-TC

Taha Özyürek*, Mustafa Gündoğar, Simone Staffoli, Gianluca Plotino

INTRODUCTIONIn recent years, the occurrence of root fracture in endodontically treated teeth has become a major concern in endodontics. Root fracture has been defined as a devastating clinical event, and it is currently one of the leading causes of tooth loss. There are many studies in the literature that evaluates and compares the effect of nickel-ti-tanium files on dentinal microcrack formation. However, according to the authors’ knowledge, there is no scien-tific literature that compares the dentinal microcrack formation preparation after One Curve, HyFlex EDM, T-endo MUST and Genius files using micro-computed tomography (micro-CT).

OBJECTIVESThe aim of the present study was to evaluate the frequency of dentinal microcracks observed after root canal prepa-ration with One Curve, HyFlex EDM, T-endo MUST and Genius files using micro-CT analysis. The null hypothesis of the present study that there would be no significant difference among the groups in term of dentinal crack formation.

MATERIALS AND METHODSForty human mandibular molar mesial roots with moderate curvatures (between 10°-20°) and two separate ca-nals were included in the present study and roots with abrupt apical curvatures were also excluded from the study and replaced. Mesial root with 2 canals were randomly assigned to 4 experimental groups (n = 10) for root canal preparation: Group 1, One Curve; Group 2, HyFlex EDM; Group 3, T-endo MUST; and Group 4, Genius. The specimens were scanned using high-resolution micro-CT imaging before and after root canal preparation. After-ward, preoperative and postoperative cross-sectional images of the teeth were screened to identify the presence of dentinal defects. The number of microcracks was determined as a percentage for each group.

RESULTS AND DISCUSSIONA total of 70214 cross-sectional images were examined. Fourteen thousand nine hundred twenty-two (42.51%) dentinal defects were observed. No new microcracks were observed after root canal instrumentation with the tested systems. The presence of dentinal microcracks was observed in 40.03%, 40.19%, 45.58% and 44.21% of the cross-sectional images in the One Curve, HyFlex EDM, T-endo MUST, and Genius groups, respectively. Accord-ing to the present study results, in all groups, all dentinal microcracks observed in the postoperative cross-sec-tional images already existed in the corresponding preoperative images. Therefore, mechanical enlargement procedures could not be associated with the formation of new dentinal cracks. This result agrees with several previous micro-CT studies that have shown no correlation between root canal preparation and the initiation and/or propagation of dentinal microcracks.

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MICRO-CT STUDY ON CADAVER OF MICRO-CRACKS FORMATION AFTER ROTARY AND RECIPROCATING INSTRUMENTATIONSTUDIO MICROCT SU CADAVERE DELLA FORMAZIONE DI MICROCRACKS DOPO STRUMENTAZIONE ROTANTE E RECIPROCANTE

Roberto Tassone*, Mario Alovisi, Giorgia Carpegna, Damiano Pasqualini, Nicola Scotti, Elio Berutti

INTRODUCTIONMany studies investigated the potential causal relationship between canal shaping and the micro-cracks forma-tion in the canal walls. Cracks are considered predisposing factors for vertical fractures, that represent one of the most common cause of endodontic failure.

OBJECTIVESThe aim of this micro-CT study is to describe the micro-cracks formation using a traumatic methods, in cadaver lower incisors during glide path and shaping with rotary and reciprocating instruments.

MATERIALS AND METHODSTwenty-one cadaver lower incisors surrounded by alveolar bone were collected. After a periapical radiography, teeth were opened with a diamond bur. The canal scouting with a 10 K-file and a second control radiography were done. Fourteen elements were divided in two groups of 7 elements: REC and CONT. In the REC group, the glide path and shaping were performed with reciprocating instruments: Wave One Gold Glider and Wave One Gold Primer. In the CONT group with continuous rotary instruments: Proglider and Protaper Next X1-X2. Three micro-CT acquisition were done for each tooth: pre instrumentation, after glide path and after shaping. Four specialists ob-served 10908 slices obtained during the post shaping acquisition and noted the position of the micro-cracks and the number of slices with cracks. Micro-cracks were researched in pre treatment and post glide path acquisition. A descriptive analysis for all the variables was done and the Chi-square test was used to evaluate the difference between the two groups (p < 0.05).

RESULTS AND DISCUSSIONOur study analyzed 10908 slices for every phase of instrumentation (initial, post glide path and post shaping). On average, 780 slices for every sample were observed from the cemento-enamel junction to the apex. Twenty seven cracks were found: 8 before treatment, 3 after glide path and 19 post shaping. In pre-treatment acquisi-tions 36 slices showed cracks (0.33%), 29 in the REC group and 7 in the CONT group. At the end of shaping phase 114 slices presented micro-cracks (1,05 %): 37 slices after glide path, 11 in the REC group and 26 in the CONT group. 77 slices showed dentinal defects after shaping phase, 39 in the REC group and 38 in the CONT one. There wasn’t a statistically significant difference between the two groups (Chi square test 3,44) (P=0,06). Methods used in this study, based on cadaver teeth with surrounding bone analysis by the micro-CT, is considered the most accurate to avoid bias caused by the element extraction and section. The endodontic instruments motion, rotary or reciprocating, didn’t influence the micro-cracks formation.

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COMPARISION OF STERILIZATION METHODS FOR GUTTAPERCHA FILLED TEETHCONFRONTO TRA DIVERSE TECNICHE DI STERILIZZAZIONE PER DENTI OTTURATI CON GUTTA-PERCA

Annamaria Pascarella*, Nicola Maria Grande, Raffaella Castagnola, Simona Antetomaso, Luca Marigo

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INTRODUCTIONSeveral authors evaluated the bacterial leakage resistance of root canal filling. These studies need sterile samples but no works have been performed to assess the efficacy of cold sterilization and its effect on the endodontic sealing.

OBJECTIVESThe aim of this study is to compare the efficacy of 3 sterilization techniques to sterilize gutta-percha (GP) filled teeth and their ability to preserve the quality of the filling materials and the sealing of root canal.

MATERIALS AND METHODSThe study consists of two phases. For the first part 34 single root extracted teeth were selected and divided in 3 experimental groups (n=10) and 1 control group (n=4). After the chemo-mechanical preparation (Mtwo files) the specimens were filled with GP and AH plus sealer using a single cone technique. The samples (n=30) were divided in 3 groups: GroupA1 sterilized with plasma sterilization, GroupB1 with beta ray sterilization and GroupC1 with an autoclave. After the sterilization procedures 6 samples of each experimental group and 2 samples of the control group were subjected to viable counts to evaluate the presence of microorganisms. 4 samples of the experimental groups and 2 samples of the control group were sectioned and analyzed with a light microscope. For the second part of the experiment were used 14 GP pellets and 8 guttacore obturators divided into three ex-perimental groups (n=4 pellets, n=2 guttacore) and one control group (n=2 pellets, n=2 guttacore). Each sample was marked with a longitudinal pen line and its length and diameter measured with a digital gauge. GroupA2 was sterilized with plasma sterilization, GroupB2 with beta ray sterilization and GroupC2 with autoclave. After the sterilization procedures the samples length and diameter were measured. The data were analyzed using a non parametric Kruskal Wallis test (p<0.05).

RESULTS AND DISCUSSIONMicrobiological analysis results were evaluated as positive or negative depending on the presence or absence of any bacteria. All the experimental samples were negative, the samples of the control group were positive. The assessment of the quality of the sealing with a positive or negative result was made with a light microscope. Only the GroupC1 had negative results. In the second part of the study GroupC2 showed a statistically significant difference with both GroupA2 and GroupB2, while no statistically significant difference has been found between GroupA2 and GroupB2. Beta ray sterilization and plasma sterilization can both be viable sterilization methods for teeth that have been sealed. According to our study this low temperatures sterilization techniques do not damage the GP and the quality of the sealing remains unchanged.

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CUTTING EFFICIENCY OF NICKEL-TITANIUM RECIPROCATING INSTRUMENTS MANUFACTURED WITH DIFFERENT HEAT-TREATMENTSEFFICIENZA DI TAGLIO DI STRUMENTI RECIPROCANTI IN NICHEL-TITANIO PRODOTTI CON DIFFERENTI TRATTAMENTI TERMICI

Pietro La Paglia*, Giusy Rita Maria La Rosa, Silvia Rapisarda, Eugenio Pedullà

INTRODUCTIONNumerous variables influence cutting efficiency of Nickel-Titanium (NiTi) files, including design, instrument mo-tion as well as manufacturing processes.

OBJECTIVESThe purpose of this study was to compare the lateral cutting efficiency of two single file systems, Reciproc R25 (REC) (VDW, Munich, Germany) and Reciproc blue R25 (REB), with identical design but manufactured with differ-ent heat-treatments. 

MATERIALS AND METHODS60 new Reciproc R25 and new Reciproc R25 blue files were divided into 6 groups (n = 10) on the basis of different

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cutting inclination: groups 1, 2, 3 included, respectively, Reciproc tested at 90°, 70° and 45° of inclination respect to the sample; groups 3, 4 and 5 formed by Reciproc blue tested at 90°, 70° and 45°, respectively. Cutting test was performed using a customized testing apparatus containing a standard gypsum sample with a 1.5 mm thickness (Zeus Dental Stone IV, Zingardi, Italy) against which the cutting efficiency of the instruments was tested. This cus-tomized device allowed to test files with different cutting inclinations respect to gypsum sample. All instruments were activated in reciprocating motion (150CCW - 30CW at 300 rpm) performed via a computing platform (Ardui-no; Smart Project Srl, Strambino, Italy), connected to a step-by-step motor, which allowed to set up all movement parameters. The loss of weight of the gypsum blocks was directly proportional to the cutting efficiency of the instrument. The weight loss of the block cut in two minutes was measured by an analytical balance with a sensi-tivity of ±1 X 10^-4 g (Balance E42-B, Gibertini, Italy). Means and standard deviations of each group were recorded and data were statistically analyzed with two-way analysis of variance and Bonferroni post-hoc test (P < .05).

RESULTS AND DISCUSSIONNo difference was observed for REC among 90°, 70° and 45° (P>.05). REB had no statistical difference between 90° and 70° (P>.05), however its cutting efficiency significantly increased at 45° (P<.05). No significant difference was observed between REC and REB at 90° and 70° (P>.05). This result could be explained by the same design of REC and REB considering that cutting efficiency of NiTi files is connected to design of files. However, REB exhib-ited higher cutting efficiency than REC at 45°(P<.05) probably due to their specific metallurgical properties that resulted in more flexible and softer cutting edges allowing more evenly distributed contact areas with the sub-strates. Increased file inclination (as 45°) and heat-treatment (as blue) improved cutting efficiency of NiTi files.

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SHAPING ABILITY OF NICKEL-TITANIUM ROTARY INSTRUMENTS AND SONIC INSTRUMENTS IN SIMULATED CURVED CANALSCONFRONTO DELLA CAPACITÀ DI SAGOMATURA DI UNO STRUMENTO ROTANTE IN NICHEL-TITANIO ED UNO STRUMENTO SONICO

Sophie Sinato*, Carlo Tocchio

INTRODUCTIONRoot canal preparation with NiTi rotary instruments results in faster, more consistent preparations than stainless steel hand instruments. NiTi instruments are able to maintain the original canal shape without creating severe canal aberrations. Despite these advantages, unexpected instrument fracture is not uncommon. Recently devel-oped Sonic files are characterized by unique design properties in terms of shape. These instruments, due to the typical sonic movements are believed to reduce the incidence of fractures respecting the original anathomy.

OBJECTIVESAim of the study was to compare the shaping ability of PT Next, and GF instruments in simulated canals with a single curvature. Several investigations on the shaping ability of root canal instruments have been performed by using simulated curved root canals in resin blocks, because they allow standardization of degree, length, and radius of curvature.

MATERIALS AND METHODSSimulated canals have been shaped using both NiTi rotary instrumentation (PT Next) and Sonic Files (GF). All the samples have been filled with dye (Pelikan 4001). Pre and post preparation images were taken using digital technique and processed with DraftSight software. The internal and the external radius have been measured. Analysis of variance and post hoc Student test were used for statistical analysis.

RESULTS AND DISCUSSIONProTaper Next instruments caused more pronounced canal transportation in the curvature (P < .01) than sonic instruments. Sonic GentleWave instruments seem to be favorable when preparing curved canals in simulated curved canals.

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MICRO-COMPUTED TOMOGRAPHY EVALUATION OF PROTAPER NEXT AND WAVEONE GOLD GLIDE PATH AND SHAPING OUTCOMES IN MAXILLARY FIRST MOLAR CURVED CANALSVALUTAZIONE ALLA MICRO-CT DEGLI ESITI DI GLIDE PATH E SHAPING EFFETTUATI CON PROTAPER NEXT E WAVEONE GOLD IN CANALI CURVI DI PRIMI MOLARI SUPERIORI

Fabio Tutino*, Mario Alovisi, Giorgia Carpegna, Damiano Pasqualini, Nicola Scotti, Elio Berutti

INTRODUCTIONPrevious studies reported that ProGlider (PG) glide path single instrument seemed to improve ProTaper Next (PTN) performance by positively influencing geometrical shaping outcomes. WaveOne Gold Glider (WOGG) is a single reciprocating glide path file, which was recently proposed in combination with WaveOne Gold (WOG). No comparison is available about the geometrical shaping outcomes of these different rotary and reciprocating glide path and shaping systems.

OBJECTIVESThe aim of this study is to evaluate the shaping ability of the rotary instrumentation system ProGlider and Pro-Taper Next (X1, X2) compared to the reciprocating system WaveOne Gold Glider and WaveOne Gold Primary.

MATERIALS AND METHODSFifty extracted maxillary first permanent molars were selected. After a traditional access cavity creation, canal scouting was accomplished in all specimens in the MB1 canal with #10 K-file at working length (WL). The samples were randomly assigned to the groups: ProGlider and ProTaper Next (X1, X2) rotary shaping system (group PG-PTN) (n=25) and WaveOne Gold Glider and WaveOne Gold Primary reciprocating shaping system (group WOGG-WOG) (n=25). The selected samples were scanned at high-resolution before preparation, after glide path and after shaping. Subsequently, the images were reconstructed with the NRecon and DataViewer softwares (Bruker-mi-croCT). Surface area, canal volume, root canal centring ability (centroid shift), canal geometry enlargement (RDR and RA ratios) and thickness of dentinal wall at inner curvature were assessed in the apical and coronal levels and at the point of maximum canal curvature.

RESULTS AND DISCUSSIONPost glide path analysis showed that the increase in root canal volume is not different between groups (P> 0.05). In the coronal third the canal widening is inferior with the use of PG. In the apical third the difference of centroid shift is statistically significant (P = 0.020) with reduced values for the WOGG. WOGG removed more dentine in the root canal coronal and middle third accordingly with its higher conical shape. Post shaping analysis revealed that the volume and increase in the surface area of the canal are significantly different and that the removal of dental tissue is reduced for the PTN group (P = 0.003). The percentage of dentin removed on the furcation side is on average 19.6% for the WOG group and 11.2% for the PTN group (P = 0.016). Between the two groups there are no significant differences regarding the displacement of the centroid in any of the three levels (P> 0.05).

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ELECTRONIC WORKING LENGHT VARIATION DURING ENDODONTICAL TREATMENT: A RANDOMIZED CLINICAL TRIALLA VARIAZIONE DELLA LUNGHEZZA ELETTRONICA DI LAVORO DURANTE IL TRATTAMENTO ENDODONTICO: UNO STUDIO CLINICO RANDOMIZZATO

Davide Mirra*, Giorgia Carpegna, Mario Alovisi, Allegra Comba, Damiano Pasqualini, Nicola Scotti, Elio Berutti

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INTRODUCTIONThere are no studies in the literature, nor are the causes clear, that may lead to variations in the electronic working length (EWL) measurement between an operating session and the next, related to inflammatory apical remodeling phenomena.

OBJECTIVESA randomized clinical trial was designed to evaluate the change of EWL during endodontic treatment between the end of the shaping and the canal filling performed in the second session (after seven days).

MATERIALS AND METHODSThe canal scouting was performed with a manual k- file # 10 (Dentsply Maillefer, Ballaigues, Switzerland), the glide path was created mechanically with Proglider (Dentsply) or manually. The shaping has been completed with one of these three systems: ProTaper Universal, ProTaper Next or MTwo. The EWL was detected four times, always with k-file # 20 Nitiflex: the first during the canal scouting and confirmed at the end of the glide path, the second after S1-S2 Protaper Universal or X1 Protaper Next (Dentsply) or Mtwo # 3 (Sweden & Martina, Padua, Italy), the third at the end of the shaping. The last EWL was performed at 7/10 days before canal’s filling. The apex locator used was Morita Root ZX (J Morita Corp. Kyoto, Japan). We investigated whether this variation was related to the type of tooth (single or multiple canal teeth) with preoperative pulp status (vital or necrotic teeth), with acute apical periodontitis (PAA) and with endodontic lesion (LEO).

RESULTS AND DISCUSSION106 teeth were subjected to statistical analysis. The EWL variation observed between the end of the shaping and the filling session was 34% of the cases. The EWL variation in multiple canal teeth was 41%, in single canal teeth 17%. The EWL variation for necrotic teeth was 25%, for the vital ones 45.5%. The variables that showed a statistically significant impact on EWL variation were PAA (p = 0.0110) and the type of canal instrumentation (p = 0.0006). To justify this variation we supposed an inflammatory status that can induce an acute inflammatory pro-cess that changes the physiological state of periapical tissues, so a variation in the environmental conditions in which the apex locator was working. Another hypothesis is that there may be a slight change in the architectural pattern of the root apex capable of providing such a 0.5 mm variation. To sum up the operator has to re-check the EWL before proceeding with canal filling.

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THE BEST POSTER SIE AWARD

}11.30 - 13.30 EXHIBITION AREA

}14.30 - 16.30 / 17.00 - 18.30 LECTURE ROOM VETRI

Poster Committee: Marco Colla, Stefano Gaffuri, Manuele Mancini, Riccardo Tonini

1 }14.30

OPERATIVE TORQUE MEASUREMENT OF TWO DIFFERENT INSTRUMENTMISURAZIONE DEL TORQUE OPERATIVO DI DUE DIFFERENTI STRUMENTI

Marco Seracchiani*, Antonio Morese, Andrea Del Giudice, Federico Valenti Obino,

Dario Di Nardo, Luca Testarelli, Gianluca Gambarini

INTRODUCTIONIn the last twenty years introduction of Nickel Titanium Rotary (NTR) instruments have been introduced in end-odontic practice, increasing the quality of endodontic treatments while reducing the instrumentation time. How-ever, the clinical performance of NTR instruments involve a complex interrelationship of several factors such as cross-sectional, flute and tip design, metallurgical properties of the alloy including heat and surface treatments, motor settings of speed and torque. All these factors may influence the way the NTR instruments cut dentin and the torsional and bending stresses, deriving from canal instrumentation. A few custom designed torque plat-forms were proposed in the last decades to analyze and compare in vitro performance of NTR instruments. More recently, the progress in technologies allowed to build new endodontic motors, which can visualize and record instrumentation torque.

OBJECTIVE Aim of this study was to compare the efficacy and safety of two different NTR instruments used for the shaping of a three dimensional resin root canal and record mean torque and instrumentation time. 

MATERIAL AND METHODSForty resin root canal models were instrumented with a K-15, to check the apical patency and randomly divided in two group. Each group was shaped using a different instrument: S ONE 25.06 (Fanta Dental, China) and F2 Protaper Universal (PTU, Dentsply Maillefer, Switzerland). All the canals were shaped by the same operator, to avoid errors due to different operator sensitivity. All instruments were rotated at 300 rpm with maximum torque set at 2,5 N using a prototype endodontic motor provided by Kavo (Biberach, Germany) and a Kavo 1:1 Handpiece. The 1:1 reduction was selected, being mandatory to ensure precise torque control measurements in the range of 0,05N. The following data recorded in 20 canals were statistically analysed: mean instrumentation time and mean torque values. T-test was used to assess differences between the two groups for the above-mentioned pa-rameters. The significance level was set at P < 0.05. 

RESULTSTable 1 shows mean torque values recorded in the artificial canal used in the present study. In both cases, low standard deviation values indicated that the mean values were consistent and provided predictable torque mea-surements. Overall, the F2 PTU instruments reached the working length in significantly more time (69,03 vs 33,17 s), but with a significantly smaller amount of mean torque value (0.50 vs 0.66 N/cm) than those registered for S One 25.06 instruments. No instrument showed sign of deformation.

DISCUSSIONNTR instruments must reach the working length, and consequently are necessarily subjected to higher instru-mentation stress while working in. This concept of a low torque instrumentation technique was proposed years ago, with the development of torque control motors. However, in many cases the torque settings were not based on precise scientific data.The too higher torque set values did not decrease the risk of intracanal breakage and

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the lower did not provide easy progression of the NTR instruments inside canals. The results show a significant difference for both instrumentation time and mean torque. The results can be explained by the different cross section of the two instruments, that can affect how the instrument engage the root canal walls. The mean torque of the instrument was lower, although the increased taper of the F2 PTU in the coronal part should increase the engagement of the cutting blades in the resin. This could be explained by the higher cutting efficiency of the instrument. 

CONCLUSIONThe analysis of torque set could be an useful tool for the analysis of instruments and preparation techniques. Clinically, a lower mean torque provide lower torsional stress and minimize the intracanal breakage risk, at least for torsional stress. Changing the Torque set to a more proper value can increase the clinical safety without af-fecting the cutting efficacy.

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EVALUATION OF THE APICAL SEAL OF ROOT CANAL FILLINGS WITH TWO DIFFERENT METHODS OF IRRIGATION USING CHITOSAN - AN IN VITRO STUDYVALUTAZIONE DEL SIGILLO APICALE IN OTTURAZIONI CANALARI ESEGUITE CON DUE DIVERSI METODI DI IRRIGAZIONE CHE UTILIZZANO CHITOSAN - UNO STUDIO IN VITRO

Elvira Gyulbenkiyan*, Angela Gusiyska, Radosveta Vassileva

INTRODUCTIONThe success of endodontic treatment depends on thorough disinfection and debridement of the root canal sys-tem for achievement and maintenance of a hermetic seal chemically and or micromechanically, along canal sys-tem. Ideally, the root canal sealer should be non-toxic and have a positive effect on the healing of periapical lesion. AH Plus is epoxy resin-based sealer considered as a “Gold Standart” due to its exellent properties, such as low solubility, small expansion, adhesion to dentin, and very good sealing ability. TotalFill BC siller is a pre-mixed, hydrophilic bioceramic saealer consists of calcium silicate, calcium hydroxide, calcium phosphate and zirconium oxide. Different solutions are used to prepare the root canal wall for better adhesion and most of them were reported to exhibit cytotoxicity when injected into periradicular tissue and there is no solution at present capable of acting simultaneously on the organic and inorganic elements of the smear layer. Chitosan is a natural polysaccharide obtained by the deacetylation of chitin, which has attracted a great deal of attention in dental research because of its broad spectrum of antibacterial properties, high chelating ability, biocompatibility, bio-degradability, bioadhesion and lack of toxicity. Previous research demonstrated its ability to enhance the me-chanical properties of dentin collagen and to reinforce collagen constructs.

OBJECTIVESThe aim of this in vitro study was to evaluate the sealing properties of epoxy resin-based sealer and bioceramic sealer using conventional protocol of irrigation and modified included chitosan-citrate solution 0,6%. 

MATERIALS AND METHODSA total of twenty extracted single-rooted human teeth were used for the purpose of this in vitro assessment. The teeth were extracted due to orthodontic or periodontal reasons and were instrumented with rotary crown-down technique - № F4 (ProTaper Universal, Dentsply, Maillefer, Switzerland). The teeth were allocated to each group: Group I (n=5) - irrigation with classical protocol (NaOCl 2,0%, EDTA 15%, distilled water) and root-canal obtu-ration with AH Plus (Dentsply, Maillefer, Switzerland), Group II (n=5) - irrigation with modified protocol (NaOCl 2,0%, chitosan-citrate 0,6%, distilled water) and root-canal obturation with AH Plus (Dentsply, Maillefer, Switzer-land), Group III (n=5) - irrigation with classical protocol and root-canal obturation with TotalFill BC (FKG Dentaire SA, Switzerland), Group IV (n=5) - irrigation with modified protocol and root-canal obturation with TotalFill BC (FKG Dentaire SA, Switzerland). All teeth were separated longitudinally. Half of teeth from each group was scan-ning electron microscopy (SEM) observed, the other half from each group was examined using light microscope.

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RESULTSAll teeth irrigated with modified protocol included chitosan-citrate solution showed SEM less apical microleakage (Mean in Group II and IV - 7.94 µm and 4.33 µm) than these irrigated with conventional protocol (Mean in Group I and III - 12,51 µm and 11,96 µm). There is not presence of statistically significant difference (p < 0.05) between teeth obturated with AH Plus (Dentsply, Maillefer, Switzerland) and TotalFill BC (FKG Dentaire SA, Switzerland).

DISCUSSION Of paramount importance is the root filling to prevent bacterial penetration. Conditioning of the dentin wall is essential for adhesion of sealers thus minimize microleakage. Conventional irrigation with NaOCl and EDTA could cause erosive effect on dentin which weakens the bond between the filling material and the dentin.

CONCLUSION The effective irrigation is one of the most important part of endodontic treatment and chitosan-citrate solution showed good results for conditioning dentine walls for sealing and preventing apical microleakage.

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IN VITRO STUDY ON THE CLINICAL EFFICACY OF OPTIMUM GLIDE PATH AND OPTIMUM TORQUE REVERSE OF THE NEW ENDODONTIC ENGINE TRI-AUTO ZX2 (MORITATM)STUDIO IN VITRO SU EFFICACIA CLINICA DI OPTIMUM GLIDE PATH E OPTIMUM TORQUE REVERSE DEL NUOVO MOTORE ENDODONTICO TRI-AUTO ZX2 (MORITATM)

Luca Simone*, Katia Greco, Maria Teresa Sberna, Sabrina Dababou, Giuseppe Cantatore

INTRODUCTION A fundamental turning point in Endodontics was brought about by the introduction of the Ni-Ti instruments. These need to be used in continuous rotation in order to activate the alloy to use its properties.The contin-uous rotation in the root canals, however, involves risks related to torsional stress and cyclic fatigue. The fracture is still a very fearsome event. In order to use the instruments in greater safety, new endodontic mo-tors have been introduced with alternative movements. These include the Tri Auto ZX2 cordless motor (Mor-itaTM) with different programs for safe instrumentation dedicated to each instrument. The innovations intro-duced are the movement OGP (Optimum Glide-Path) and OTR (Optimum Torque Reverse). OGP is a clockwise / counterclockwise alternating movement of 90°-90 ° or 90°-180 ° dedicated to instruments for the Glide-path that wants to reproduce the manual watch-winding movement respecting the technique of balanced forces. OTR instead allows a variation of the rotation of files from continuous to alternate in the presence of excessive tor-sional stress. The “theoretical” advantage of this engine is that these movements will be usable on all instruments.

MATERIALS AND METHODS The aim of this study is to evaluate, “ex-vivo” on extracted teeth, if the use of this new motor brings advantages in terms of resistance of endodontic instruments, quality of the results obtainable and reduction of the work timing. In the study conducted on 4 experimental groups of extracted molars, the pulp chambers were opened, the probing and subsequent shaping of the root canals. The Tri Auto ZX2 cordless motor (MoritaTM) instrumented a first group of straight channels (angle of curvature <30°) and a second of curved channels. All root canals were instrumented with Proglider (Dentsply) and OGP function, subsequently they were shaped with ProTaper Next evaluating OTR. The other two comparable groups were prepared with the same instruments and different engine: X Smart Plus (Dentsply); considered today among the Gold Standards in the sector. 

RESULTS In this study, 7 signs of deformation found in microscopes were recorded in the data; these led to 2 fractures of a Pro-glider and a ProTaper Next X1 respectively. The fracture index was therefore 3.03% higher than that considered an ac-ceptable fracture index of 2.5%. What appears from statistical data is that during the creation of Glide-path with the

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use of Proglider and Tri Auto ZX2 MoritaTM engine with active OGP no sign of failure and fracture has ever occurred.  On the other hand, there were no advantages in using the OTR function in the shaping phases with ProTaper Next instruments.

DISCUSSIONStatistical analysis showed advantages in terms of safety in the creation of Glide-Path with active OGP function. 63% probability of being significant. The OTR function did not lead to any advantage in the use of the instrumen-tation in question. 

CONCLUSION Both types of endodontic motors are clinically valid in the instrumentation of both straight canals and curved canals, using both Glide-path and Preflaring instruments in the preliminary phases of the endodontic treat-ment, and in the use of shaping instruments in the subsequent phases. In the analysis of data obtained, the X-smart IQ (Dentsply Maillefer TM) endodontic motor proved to be significantly faster than its rival Tri Auto ZX2.  There were no advantages in using the OTR function while the use of the OGP function seems to lead to the cre-ation of a good sliding path, with Glide-Path instruments, in greater safety than other endodontic motors with standard movements.

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MORPHOLOGY OF ROOT APEX BEFORE AND AFTER SINGLE-INSTRUMENT TECHNIQUE WITH RECIPROC BLUE. AN ENVIRONMENTAL SCANNING ELECTRON MICROSCOPY STUDYMORFOLOGIA DELL’APICE RADICOLARE PRIMA E DOPO STRUMENTAZIONE CON RECIPROC BLUE SINGLE INSTRUMENT. STUDIO AL MICROSCOPIO ELETTRONICO A SCANSIONE AMBIENTALE

Andrea Spinelli*, Fausto Zamparini, Chiara Pirani, Francesco Iacono, Maria Giovanna Gandolfi, Carlo Prati

INTRODUCTIONThe apical morphology is greatly influenced by several clinical conditions, such as presence of a periapical le-sion, inner dentin sorption, occlusal stress and orthodontic movement. All these conditions may affect the mor-phology and the diameter of the apex. New NiTi Reciprocating instruments have been recently introduced to shape and finish all root canal dentinal walls. Reciproc Blue (VDW, Munich, Germany) is a new generation of “single reciprocating instrument”. The clinical technique requires the use of a single instrument in straight roots and 5% NaOCl in addition to 10% EDTA solution.

OBJECTIVESThe aim of the study was to analyze apex modification induced by instrumentation with single Reciproc Blue on apical morphology and apex diameter under Environmental Scanning Electron Microscopy (ESEM) and energy dispersive x-ray spectroscopy (EDX).

MATERIALS AND METHODSTwenty extracted human upper premolars and incisors from patients (30-40 year olds) were used in the study. Af-ter extraction teeth were cleaned and immersed in distilled water and 1% NaOCl for 10 days. Each tooth was care-fully examined under ESEM and EDX at room temperature under controlled pressure to measure apex diameter, presence of root cement, chips, fracture and smear layer/debris pits and grooves. Each tooth was then treated to create a standard crown access and glyde path and scouting was performed with a manual #10 stainless steel file to establish WL. Reciproc Blue (VDW, Munich, Germany) was used according to manufacturer’s directions. Roots were shaped using Reciproc blue # 25 (N=3), Reciproc #40 (N=3) or #50 (n=3) for 15 minutes using a Silver Re-ciproc Endomotor (VDW, Germany). Each root was gently irrigated alternating with 5 ml 5% NaOCl (Ogna, Italy) and 10% EDTA (Ogna, Italy) during root canal preparation. The teeth were then sectioned. Files were used with a short gentle pressure to the apex. ESEM and EDX were used to evaluate the presence of dentinal grooves, tips and chips

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along the external marginal of the apex and the morphology of accessory apexes, foramina and cement erosion. 

RESULTSBefore instrumentation, all apexes demonstrated the presence perimarginal erosion with only few is-lands of cement. Some external chips were detected frequently connected with grooves (15-30 µm depth). After instrumentation, some dentin grooves resulted filled with smear layer produced by the instrument. All the apexes appeared more regular and with a more defined circular morphology. Few chips were still detected while no dentin fractures were observable. A larger diameter was observed after use of #40 and #50.

DISCUSSION ESEM-EDX may give us important information’s of organic and inorganic content using a non destructive process. To the best of our knowledge, no studies have previously investigated apex morphology using this technique. A recent study analyzed the shape of previously instrumented apexes, using optical microspcope, revealing that both reciprocating and traditional Niti lead to apical foramen deformation.

CONCLUSIONThe use of Reciproc Blue may represent a new safe approach for the maintenance of an adequate morphology of mature apex.

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EFFECTIVENESS OF THE ONE FLARE AND 2SHAPE SYSTEMS COMPARED WITH THE RECIPROC SYSTEM IN REMOVING ROOT CANAL FILLING MATERIAL FOLLOWED BY ULTRASONIC PASSIVE IRRIGATION: A MICRO COMPUTED TOMOGRAPHIC STUDYEFFICACIA DI ONE FLARE E 2SHAPE VERSUS RECIPROC NELLA RIMOZIONE DEL MATERIALE DI OTTURAZIONE CANALARE SEGUITO DALL’IRRIGAZIONE PASSIVA AD ULTRASUONI: STUDIO ALLA MICRO-TC

Marc Krikor Kaloustian*, Alfred Naaman, Walid Nehme, Franck Diemer, Issam Khalil

INTRODUCTIONRemoving all previous filling materials that may harbor bacteria and thus jeopardize the sealing ability of the new root filling is an essential step in the retreatment procedure. Several rotary files have been proposed for retreat-ment. Nevertheless, no sole system has been able to clean completely the canal walls. Additional methods such as ultrasonic activations have been suggested to fulfill this objective.

OBJECTIVESTo determine a proper retreatment system and an irrigation technique that are able to eliminate the maximum amount of obturation debris with minimum canal transportation using a Micro CT scan.

MATERIALS AND METHODS40 mandibular molars with separate canals of mesial roots were selected, shaped and filled with Gutta percha and Cement. A first Micro CT scan was taken. Teeth were then allocated to 2 groups according to the retreatment system used. In the first group, One Flare and 2Shape from Micro Mega, France were used. In the second group, Reciproc R25 from VDW, Germany was used. After instrumentation, a second Micro CT scan was conducted to evaluate the quantity of obturation debris left on the canal walls and the canal transportation. This procedure was followed by irrigant activation using two passive ultrasonic irrigation systems. The EndoUltra wireless device from Micro Mega and the Irrifase from Acteon. A third Micro CT scan was taken and images were superimposed. Repeated measure analysis of variance followed by univariate analyses and Bonferroni multiple post hoc tests were used for statistical comparison. 

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RESULTSNone of the retreatment protocols completely removed the filling material from the root canals (P > .05). Also, no sig-nificant difference was observed between the additional cleaning methods in any of the root canals assessed (P > .05).

CONCLUSIONSThe One Flare and 2Shape system compared to the Reciproc system were equivalent with respect to effectiveness in removing filling material and canal transportation regardless of the additional cleaning method used.

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DIABETES MELLITUS TYPE 1 AND ENDODONTIC LESIONS: INCIDENCE, FREQUENCY E PREVENTIONDIABETE TIPO 1 E LESIONI ENDODONTICHE: INCIDENZA, FREQUENZA E PREVENZIONE

Silvia Maria Massaglia*, Giuseppe Cantatore, Katia Greco, Maria Teresa Sberna, Nicola Cantile, Gaetano Paolone

INTRODUCTIONDiabetes mellitus type 1 (DM) is an autoimmune syndrome that destroys insulin-producing beta cells in the pan-creas causing the decrease of the production of insulin. The deficiency of this hormone brings to a condition of hyperglycaemia, wound healing difficulties, systemic and oral manifestation. The causes are unknown. Treat-ment with insulin is required for survival. Several clinical studies have demonstrated that patients with untreated and uncontrolled DM (A1C6.5%) have more periapical lesions due to the effects of hyperglycaemia on the blood circulation. 

OBJECTIVESThe aim of this review is to compare several articles in order to understand the correlations between diabetes mellitus and the endodontic treatment outcome, the prevalence and the incidence. 

MATERIALS AND METHODSA systematic literature research was conducted on PubMed Library, MEDLINE, Cochrane using the keywords “Di-abetes, diabetes mellitus, apical periodontitis, Endodontics, Endodontics Pathologies, Endodontic Treatments, endodontic lesions”. The inclusion criteria were: 1) clinical studies or review on endodontic patients with un-controlled Diabetes (A1C>6.5%) with periapical lesions 2) comparison between patients with or without DM 3) scientific works from January 2000 to January 2018. The other articles were not included in the review because not suitable for this study. 

RESULTSAfter the study selection, only 8 of 154 articles fulfilled the inclusion criteria. There is a scientific evidence that Diabetes increases the endodontic treatment failure and the healing of periradicular lesions due to the compli-cations of hyperglycaemia. For these reasons patients with DM should be rigidly controlled with check ups, with professional oral hygiene to reduce the risk of failure. Moreover they should keep under control Glycated haemo-globin (A1C <5.7%). 

DISCUSSIONDiabetes is one of the most diffuse disease in the world. Therefore it’s fundamental to focus on its implications in other field of medicine and dentistry. Regarding to endodontics, patients with DM, especially with periradicular lesions, have a lower treatment success. The prognosis depends on the differential diagnosis, the general state of the patient, the endodontic involvement. Blood sugar should be check regularly. 

CONCLUSIONSAll these studies demonstrated that there is a correlation between the higher root canal treatment failure and DM uncontrolled patients. Patients with diabetes have more endodontic complications than patients without

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diabetes. According to the limits of this study, results show that if the DM is treated and kept under control, the endodontic treatment could be considered a safe and predictable procedure.

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APICAL CYST ETIOPATHOGENY - CASE REPORTEZIOPATOGENESI DI UNA CISTI APICALE: CASE REPORT

Teodora Stefanescu, Viorel Miclaus, Stefan Vasile Stefanescu*, Aranka Ilea

INTRODUCTIONApical lesions are very common in dentistry practice. Nowadays, there are two major root related apical lesions: the periapical granuloma and the radicular cyst or periapical cyst. Both, granulomas and apical cysts, may develop in the periodontal tissue in response to intracanal antigenic content through immune-pathological mechanisms. 

CASE REPORTA 51-years-old female patient referred to our dental office accusing a dull pain, paraesthesia in the right area of the chin, tenderness to pressure located at tooth 4.4, that had extensive carious lesions, open pulp chamber and inert during pulp sensitivity tests, no fistula and no pathological mobility presented. Radiographic examinations revealed a large radiolucency, a cyst-like lesion of 12mm in the lower jaw.

MATERIALS AND METHODSAfter extraction, tooth along with the cystic lesion were immersed for fixation in a Stieve mixture for 24 hours, than in 10% formalin for 7 days. The so conserved histologic piece was decalcified in 5% trichloroacetic acid for 21 days. Then, the sample was cut in 4 mm thick slices and dehydrated in ethylic alcohol, clarified with n-butanol and paraffin included.

RESULTSHistological analysis presented a large cystic formation which spreads from the disto-cervical area to the apical region, surrounding the apex. This lesion presents a large cavity in the apical region, limited by the root surface and the epithelial layer Cavity is lined with stratified squamous non-keratinized epithelium, consisting of squa-mous (flattened) epithelial cells arranged in layers, which sends epithelial extensions of variable lengths (some very long) having comparable structure. An epithelial canal links the cyst cavity to the marginal epithelium all along the distal side of the root.

DISCUSSION Radiographically it is virtually impossible to differentiate granuloma from a cyst. It’s generally accepted that peri-apical lesions larger than 10 mm were considered as apical cysts whilst smaller ones were considered as granu-lomas. In order to differentiate radicular inflammatory periapical lesions an accurate histopathological analysis of lesions is required. The reported incidence of cysts among periapical lesions varies from 6 to 55%. While Paul S and et al. found that 92% of the cyst-like lesions are real cyst, Ramachandran Nair PN et al. found that 15% of a sample of 256 periapical lesions were cysts. Although the mechanisms related to cystic cavity and epithelial lin-ing formation are not clear, these cells seem to prevent healing, leading to an inefficient orthograde endodontic therapy. Seeing this case, we are able to emit 2 hypothesess related to cyst formation: 1. by marginal epithelium cells invading the periodontium along a thin fracture line not visible with bare eyes.2. or, following the drainage of an apical pus collection through a sinus tract formed out of epithelial cells,

where the resistance of the surrounding tissues was the lowest, e.g. periodontal ligament, sinus tract that served as a path for epithelial cell invasion.

CONCLUSIONThis case is special due to one individual feature that could overturn concepts about cysts, namely the epithelial canal that links the apical lesion to the cervical margin of the tooth. Based on our findings we can conclude that:1. cyst lining epithelium resembles that of sulcular epithelium of the gingiva2. radicular cyst is an inflammatory cyst formed by inclusion of the gingival epithelium 3. there is a continuity between the cystic lumina and the periodontal pocket

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4. the pathogenesis suggests periodontal pocket-involved mechanism5. neither Malassez epithelial rest nor reduced enamel epithelium or dental lamina remnants cannot form by

themselves such well organized base membrane for epithelial lining in a cyst, without sulcular epithelial inclusion

6. the features of the epithelium varies from one area to another depending on the local conditions.

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EVALUATION OF THE PERCENTAGE OF TOTAL CHLORINE AND DISSOLUTION TIME OF THE PULP USING DIFFERENT FORMULATIONS OF NAOCLVALUTAZIONE DELLA PERCENTUALE DI CLORO TOTALE E TEMPO DI DISSOLUZIONE DELLA POLPA CON DIFFERENTI FORMULAZIONI DI NAOCL

Alfredo Iandolo, Alberto Dagna*, Mariano Malvano, Dina Abdellatif

INTRODUCTION The goal of root canal treatment is to shape and clean the endodontic space, lowering the bacterial load and removing the pulp tissue. 

OBJECTIVES The aim of this study is to evaluate the effective concentration of different commercial formulas of sodium hy-pochlorite, by evaluating the percentage of total chlorine in each product. The dissolution capacity of the pulp tissue of each of the tested products was then analyzed by measuring the required time.

MATERIALS AND METHODSThree commercial types of sodium hypochlorite were selected for this study: 5% NaOCl (ACE, Procter & Gamble), 5% NaOCl (N5, Simit Dental) and 6% NaOCl (CanalPro, Coltene). For each product, 10 packages were used, from which samples of the product were taken and 30 x 5 ml tubes were filled. All samples were analyzed using the DIN EN ISO 7393-2 method and the percentage of total chlorine (expressed as a percentage) was calculated. 40 sam-ples of vital pulp were produced, obtained from dental elements just extracted for periodontal reasons, stored in physiological solution. In order to unify size and weight of the samples (0.001 mg), a microtome and a precision balance (Pro Explorer Ohaus) were used. Each sample, carefully examined by stereomicroscope (40x), was placed in artificial plastic containers and submerged in 0.1 ml of irrigating solution at room temperature (26 ° C). A fourth control group used saline solution as irrigant. Simultaneously with the insertion of the irrigating solution, a digital stopwatch was activated and the time necessary for the complete dissolution of the pulp sample was measured. The data obtained were subjected to statistical analysis using the Stata 12 software (StataCorp. 2011. Stata Sta-tistical Software: Release 12. College Station, TX: StataCorp LP.). The Pearson correlation index was calculated between the percentage values of total chlorine present in each irrigant and the time values necessary for the complete dissolution of the pulp. The dissolution time values were analyzed with the Kruskal-Wallis non-para-metric ANOVA test to evaluate any statistically significant differences between the different commercial formula-tions of sodium hypochlorite (P <0.05).

RESULTS AND DISCUSSION The Kruskal-Wallis test showed statistically significant differences between the different commercial formula-tions of hypochlorite (P <0.05). CanalPro showed the lowest values, while ACE showed the highest values of dissolution time of the pulp.

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THREE-DIMENSIONAL ANALYSIS OF ENDODONTIC ANATOMY IN LOWER FIRST MOLAR’S MESIAL ROOTS: AN IN VIVO STUDYANALISI TRIDIMENSIONALE DELL’ANATOMIA ENDODONTICA DELLE RADICI MESIALI DI PRIMI MOLARI INFERIORI: UNO STUDIO IN VIVO

Antonio Morese*, Giovanni Schianchi, Valerio Ferri, Alessandro Mazzoni, Alessio Zanza,

Luca Testarelli, Gianluca Gambarini

INTRODUCTIONMissed canals and anatomical complexities are two of the main causes of root canal treatment’s failure. The recent development of low-dose, detailed three-dimensional radiological examination (CBCT) allowed a better understanding of the anatomy of the root canal system. Not all the canal systems could be appreciated with peri-apical 2D radiographs due to the overlapping of dento-alveolar structures. Even if images are not always easy to be interpreted by clinicians, CBCT allows a valid and repeatable evaluation of the number, shape and trajectory of the endodontic canals. Therefore, new innovative software have been recently developed to allow better visu-alization and understanding of the root canal system.

OBJECTIVEThere are numerous studies in the literature concerning the anatomy of the endodontic system, but none have evaluated confluences in vivo. The aim of this study was to evaluate the three-dimensional anatomy of the end-odontic system and its complexity in the mesial roots of lower first molars in an Italian population by the use of Cone Beam Computed Tomography (CBCT). 

MATERIALS AND METHODSA total of 50 molars were examinated, selected by the CBCT of 40 patients who required this type of radiological study as part of the dental, surgical and implant treatment plan. These parameters have been considered: num-ber of canals, presence of apical confluences, distance between confluences and apical foramen. To evaluate the parameters of interest, the three-dimensional reconstructions were analyzed using the iCatVisionTM software (Imaging Sciences International; Hatfield, PI, USA).

RESULTSAll the roots (100%) examinated showed two canals. We observed a Vertucci type IV configuration in 59% of cases and a Vertucci type II configuration in 41% of cases. There were apical confluences in 41% of cases. The mean distance between the point of confluence and the apical foramen was 2.85 mm. 

DISCUSSIONConfluences can be a challenging situation for endodontic instrumentation, because the joining of two canals always results in abrupt dangerous curvature and lead to intracanal fracture. The majori-ty of such confluences are not visible by traditional radiography. In the present study results showed that confluences are often frequent in the mesial root of molars; moreover they are located main-ly in the last apical millimeters which increases the risk of intracanalar breakage due to metal fatigue.  The preoperative recognition can eliminate this potential risk. As Vertucci suggested when a confluence is present the clinician should not instrument both canal to the apex, but only one; in the other one it is recommended to stop the shaping at the joining point. The solution is easy, but it’s not as simple as the recognition of such complexities.

CONCLUSIONSThe pre-operative recognition of particular anatomical configurations of the endodontic system, like confluences in the mesial root of the first lower molar, could provide to the clinician fundamental informations for a more predictable and safer treatment, preventing the onset of iatrogenic errors.

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CYCLIC FATIGUE RESISTANCE OF ROTARY INSTRUMENTS WITH NEW ALLOYPROVE DI RESISTENZA A FATICA CICLICA DI STRUMENTI ROTANTI CON NUOVE LEGHE

Simone Coppola*, Valentina Di Giacinto, Orlando Donfrancesco, Michela De Lucenti,

Gabriele Miccoli, Luca Testarelli, Gianluca Gambarini

INTRODUCTION AND OBJECTIVESThe aim of the present study is to compare the resistance to cyclic fatigue of two rotary instruments different design and different thermal treatments: AF Blue S ONE 25.06 (Fanta Dental Materials, Shangai, China) and Pro-Taper Next X2 (Dentsply, Maillefer, Ballaigues, Svizzera).

MATERIALS AND METHODS20 different rotatory endodontic instruments 25mm long and tip size #25 were randomly divided in two groups and rotated until fracture occurred in an artificial steel canal with a 90° curvature and a 5mm radius, already validated in several studies. The tested instruments are: 10 AF Blue S ONE tip size #25 and taper 0.06 and Pro-Taper Next tip size #25 and variable taper. Cyclic fatigue testing was performed in artificial canal manufactured by reproducing the instrument size and taper. The instruments were inserted in the artificial root canal for 18mm and (rotated) until 300 rpm with 2.0 Ncm of torque. Both groups have been rotated until fracture and the time to fracture (TtF) has been recorded4. The data were collected and mean and standard deviations were calculated. Differences among groups were statistically evaluated with an analysis of variance test (significance level was set at P < 0.05). Data was statistically analyzed using the SPSS 17.0 software (SPSS Incorporated, Chicago, IL, USA). The broken fragment was analyzed and its length recorded (FL). The average values and the SD of TtF and FL were calculated and the recorded data were used in the Test T Student (P<0.05).

RESULTSMean values for time to fracture for S ONE instruments were 109.2 seconds (SD +/- 3.34) and for ProTaper Next instruments were 25.7 seconds (SD +/- 3.65). Statistical analysis found significant differences between the two instruments (p >0,05). S ONE exhibited superior cyclic fatigue resistance compared with ProTaper Next. Mean values for fragment length, showing no statistically relevant differences (p >0,05). 

DISCUSSION These new instruments were manufactured with a special type of alloy. It is peculiar for its martensitic features which make the instrument more flexible and resistant to cyclic fatigue. Moreover, further evaluations should be pursued regarding the cutting ability and the torsional resistance. Both instruments are clinically used for the root canal shaping. So the cyclic fatigue analysis becomes an important parameter in the evaluation of these instruments mainly because they work for their whole length. 

CONCLUSIONIn conclusion the blue alloy is peculiar for its martensitic features which gives the instrument higher resistance to cyclic fatigue, allowing us to use them safely in curved root canals.

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ENDODONTIC RETREATMENT AND MICROSURGERY WITH PERFORATION REPAIR AND SEPARATED FILE RETRIEVAL OF A MAXILLARY MOLARRITRATTAMENTO ORTOGRADO E MICROCHIRURGICO CON RIPARAZIONE DI UNA PERFORAZIONE E RIMOZIONE DI UN FILE DI UN MOLARE MASCELLARE

Mariano Malvano*, Alfredo Iandolo, Elio Farina, Leandro Palma

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INTRODUCTIONNowadays, with the presence of modern technologies as operative microscope, ultrasonic tips, devices to ac-tivate irrigation and three-dimensional obturation performed with thermo plasticized gutta-percha; excellent results can be obtained. When the orthograde treatment or retreatment fail to achieve this, microendodontic surgery can be used to save the tooth.

OBJECTIVESThe purpose of our therapy is to perform endodontic retreatment of tooth number 2.6, removing the improper ob-turation on the MB and palatal root canals, find and do a root canal treatment of DB root canal which was missed in the previous treatment, removing the cause of the parodontal pocket in the vestibular side (presumably a per-foration on the chamber floor) and surgically remove the fractured instrument in the maxillary bone.

MATERIALS AND METHODSAfter removing the temporary obturation, a perforation was found, we proceeded, to the removal of the gutta percha present in the two partially treated canals using protaper retreatment kit. Once the disto-buccal canal has also been found, we proceeded to root canal preparation, first with manual instruments, and then with Protaper Gold and obturation with continuous wave tecnique (System-B). The perforation on the chamber floor was closed using theracal. We have therefore shifted our attention to the surgical removal of the fractured instrument, locat-ed behind the MB apex. By performing an apicectomy of the affected root, the removal of the instrument and a retrograde filling with super eba sealer. Finally we proceeded to the coronal restoration of the tooth.

RESULTSClinical and x ray follow up show the complete healing of the tooth from both the endodontic and periodontal point of view.

DISCUSSIONThe positive results manifested by this clinical case demonstrate how the use of modern technologies is essen-tial to avoid iatrogenic damage and to gain safe and reproducible results.

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NON SURGICAL MANAGEMENT OF DENS INVAGINATUS: A CASE REPORTAPPROCCIO NON CHIRURGICO IN UN CASO DI DENS INVAGINATUS

Nicola Cantile*, Giuseppe Cantatore, Gaetano Paolone, Maria Teresa Sberna, Katia Greco, Luigi Chiodo, Silvia Massaglia

INTRODUCTION Dens invaginatus is a developmental anomaly, resulting in an enamel-lined cavity, that invades the crown or root before mineralization phase. Several theories have been proposed to explain the etiology of these malformation: a defect in growth timing by the internal enamel epithelium, a deformation of the enamel or-gan during tooth development. Despite the different hypotheses, the process by which dens invaginatus oc-curs remains unclear.  The classification proposed by Oehlers (1957) is the most commonly used, proba-bly because of its simple nomenclature and easy clinical application.  Invaginations are classified as follows Type1: Invagination ends as a blind sac within the crown;Type2: Invagination extends apically beyond the CEJ, and a connection between invagination and pulp is possible; Type3: Invagination extends beyond the CEJ, and a second apical foramen is evident.The reported prevalence for dens invaginatus ranges from 0.04% to 10%. Such a wide range is explained by heterogeous nature of inclusion and exclusion criteria. The most affected teeth are permanent maxillary lateral incisors. Bilateral occurrence is not uncommon as it happens in 43% of all cases. About diagnosis, the CBCT is now considered a useful tool for various complex endodontic treatment of root canal system anomalies such as dens invaginatus.

OBJECTIVESTo report the use of cone beam computed tomography (CBCT) in the treatment of dens invaginatus II types.

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MATERIALS AND METHODSPeriapical X-ray revealed a large periapical lesion which extended from lateral incisors to the apical area of cen-tral incisors. CBCT shows diagnosis of “dens invaginatus” type II for the tooth 1.2 and a large bone loss which interested also the apical area of tooth 1.1. The diagnosis is an acute apical periodontitis originally caused by the invagination in tooth 1.2 and extended to tooth 1.1. Therapy: access cavity preparation in the tooth 1.2 based on the CBCT scans. Removal of the “Dens Invaginatus” was obtained using ultrasonic tips and operating micro-scope. The apical third was cleaned with and instrumented with reciprocating files. After a 2 week intra-canal medication with calcium idroxide the tooth 1.2 was root filled using warm vertical compaction of gutta-percha for the apical third and 2 guttacore obturators for the coronal and middle third.

RESULTAccording to the case report outcomes and Oehler’s classification, each different type of invagination requires a different planning treatment, and any therapeutic approach aims primarily at preserving the pulp, when possible. Type II: a CBCT examination and use of magnification is often essential in this kind of invagination to evaluate a possible communication between invagination and principal root canal. Type III: a CBCT examination and use of magnification is essential, there are several therapeutic treatment and some authors describe also a surgical approach.

DISCUSSION Non surgical root canal treatment should be the first treatment alternative before turning to endodontic surgery, intentional replantation or extraction. The use of CBCT revealed with accuracy the anatomy of the root canal, the size of the invagination, its depth, and the size of the periradicular lesion. A considerable interest has been ex-pressed by literature in the use of other materials such as MTA or Biodentine.

CONCLUSIONThe management of dens invaginatus remains an endodontic challenge, especially because of the complex root canal morphology and the difficulty accessing the irregular and invaginated canals. In Oehlse’s cases of I and II class it’s primarily important to remove invagination if the root anatomy allow if the root anatomy allow to do it. In conclusion a well understanding of the anatomy, a complete analysis of the problem, using different device like CBCT scans, or microscope, and the application of well standardized protocol, can ensure predictable and successful results.

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SHAPING ABILITY OF TWO NICKEL-TITANIUM INSTRUMENTATION TECHNIQUES ANALYSED BY MICRO-COMPUTED TOMOGRAPHYCAPACITÀ DI SAGOMATURA DI DUE TECNICHE DI STRUMENTAZIONE AL NICHEL-TITANIO ANALIZZATE MEDIANTE MICRO-TC

Stephanie Tarek Araji*

INTRODUCTION A proper Cleaning and shaping of root canal space enhances the disinfection of the root canal system and facil-itates a three dimensional obturation needed for long term success of root canal therapy. Since the Introduction of NiTi numerous improvements in design, and raw materials have been advocated to increase its performance and safety. Applying various thermomechanical treatment procedures by dental manufacturers aims to enhance its mechanical behavior such as flexibility and resistance to fatigue. In 2014 Protaper Gold (Dentsply Maillefer, Ballaigues, Switzerland) was introduced by Dentsply in order to replace the Protaper Universal and increase the flexibility and cyclic fatigue resistance. In 2017 Two Shape (Micro-Mega, Besançon, France) was introduced by Mico-Mega. The aim of this study was to evaluate the shaping ability of the Two Shape and to compare it with the ProTaper Gold system using micro-CT imaging system. The null hypothesis was that no difference could be detected in the analysed parameters between the two preparation techniques.

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OBJECTIVEThe objective of this research was to study the impact of heat treatment on the instruments’ performance. 

MATERIALS AND METHODS32 mandibular molar teeth with fully formed apices were selected and scanned. They were then randomly as-signed to two experimental groups and instrumented with either the Protaper Gold or the Two Shape. After in-strumentation, teeth were scanned again. The following parameters were assessed: changes in dentine volume, percentage of unshaped canal walls, degree of canal transportation and centring ability. Statistical analyses were performed using the Kolmogorov-Smirnov and the One-Sample T-tests.

RESULTSThere was no significant difference in the mean canal transportation and the mean centering ratio between Pro-taper Gold and Two Shape in the three thirds, but there was significant difference between section levels for Pro-taper Gold and Two Shape. The mean percentage of non-instrumented area was not significantly different among groups. However, The instrumentation time including irrigation and recapitulation, was significantly different between the two groups.

DISCUSSION These results were attributed to the new manufacturing method, which resulted in increased phase transforma-tion temperature and increased flexibility of the new files. This was in agreement with a previous study showing that Protaper Gold are significantly more flexible than the Protaper Universal. The use of the multiple file system can also be an important factor in reducing the amount of transportation, as proved in a study comparing the TF system and Wave One. However, the close results of transportation between Protaper Gold and Two shape is jus-tified by the way the Two shape is used. It is inserted multiple times in the canal, ensuring a progressive prepara-tion that substitutes the number of instruments in the Protaper Gold system. Canal scouting and preliminary cre-ation of a glide path also decreased the amount of canal deviation as shown in a study comparing the WaveOne Primary instrument that produced less modification in the canal curvature if used with a glide path. According to a study comparing progressive and constant tapered shaft design of instruments, the protaper instrument provided a good centered apical preparation due to its progressive tapered shaft design. The two shaping systems weren’t able to instrument completely the entire canal system, 30-37% of the canal surface was found untouched in the two groups after preparation, which is similar to the results of other studies. In the present study, the Two Shape system was faster than the Protaper Gold files, which was probably related to the number of files used in each system.

CONCLUSION Within the limitations of this study, there was no significant difference between the instrumentation techniques.

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PRE AND PER OPERATIVE STRATEGIES FOR POST ENDODONTIC PAIN MANAGEMENT IN SYMPTOMATIC IRREVERSIBLE PULPITIS AND APICAL PERIODONTITIS AFTER ROOT CANAL THERAPY - SYSTEMATIC REVIEW AND META ANALYSISSTRATEGIE PRE E POST-OPERATIVE PER LA GESTIONE DEL DOLORE ENDODONTICO IN CASI DI PULPITI IRREVERSIBILI SINTOMATICHE E PERIODONTITI APICALI DOPO TERAPIA CANALARE: REVIEW SISTEMATICA E METANALISI

Suneelkumar Chinni*, Subha Anirudhan

INTRODUCTIONPatients with severe pre-operative pain tend to have more severe post endodontic pain than patients with mild or no preoperative pain. 

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OBJECTIVESThe main objective of this study is to assess the effect of pre-operative use of corticosteroids on post endodontic pain in patients with symptomatic pulpitis who underwent root canal treatment in a single visit and the effect of cold saline as final irrigant on post endodontic pain in patients with symptomatic apical periodontitis who underwent root canal treatment.

MATERIALS AND METHODSThe study was carried out in two different parts namely pre operative analysis, where in the effect of pre operative corticosteroid on post endodontic pain was evaluated, and per operative analysis that assessed the effect of cold saline as final irrigant on post endodontic pain.PRISMA guidelines were followed in conducting this systematic review. ANALYSIS OF PRE OPERATIVE INTERVENTIONSPICO ANALYSISPopulation: Patients with symptomatic pulpitisIntervention: Pre-operative medication with corticosteroids and single visit root canal treatmentComparison: Pre-operative medication with placebo/other drugs and single visit root canal treatmentPrimary outcomes: 1) Percentage of patients reporting clinically significant reduction in pain (as defined by study authors)2) Difference in pain scores between groups measured using validated pain scale and percentage of patients requiring rescue analgesic medicationANALYSIS OF PER OPERATIVE INTERVENTIONPICO ANALYSISPopulation: Patients with symptomatic pulpitis and symptomatic apical periodontitisIntervention: Cold Saline as a final endodontic irrigantComparison: Normal Saline or any other irrigant as final endodontic irrigantPrimary Outcomes1) Percentage of patients reporting clinically significant reduction in pain (as defined by study authors)2) Difference in pain scores measured using validated pain scale3) Percentage of patients requiring rescue analgesic medication.

RESULTSANALYSIS OF PRE OPERATIVE INTERVENTION AND PER OPERATIVE INTERVENTIONThe characteristics of the selected studies, risk of bias assessment for pre operative analysis, Me-ta-analysis. Forest plots of Prednisolone versus placebo at 6 hours, Prednisolone versus placebo at 12 hours, and Prednisolone versus placebo at 24 hours were presented in the Pre Operative analysis image. The characteristics of the studies included in per operative analysis and risk of bias assessment for per operative analysis were presented in the Per operative analysis image.

DISCUSSION Paucity of studies in the literature related to this topic and small sample size of most of the studies included was a limitation in this review. Further studies on the effect of corticosteroids such as prednisolone and dexamethasone in symptomatic pulpitis cases when given preoperatively through different routes of administration need to be done. All the trials agreed to the postoperative pain reduction with the use of cold saline as final irrigant. Due to hetero-geneity of the data, meta-analysis could not be done for the studies. It is therefore indicated to conduct further studies to assess the role of intracanal cold saline in reducing postoperative pain.

CONCLUSIONIt can be concluded that preoperative administration of a single dose corticosteroids such as prednisolone and dexamethasone in symptomatic pulpitis may reduce the incidence of postoperative pain after single visit root canal therapy in the short-term. Similarly, use of cold saline as a final irrigant in symptomatic teeth undergoing root canal therapy may reduce the incidence of postoperative pain.

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AN IN VITRO EVALUATION OF THE DEGREE OF PULP TISSUE DISSOLUTION THROUGH DIFFERENT ROOT CANAL IRRIGATION PROTOCOLSVALUTAZIONE IN VITRO DEL GRADO DI DISSOLUZIONE DEL TESSUTO PULPARE ATTRAVERSO DIFFERENTI PROTOCOLLI DI IRRIGAZIONE

Alfredo Iandolo*, Dina Abdellatif, Giuseppe Pantaleo, Massimo Gagliani, Massimo Amato

INTRODUCTION The goal of root canal treatment consists in the complete removal of all the damaged tissues, bacteria and their toxins, from the complex radicular system. The endodontic space should not be considered in a single dimen-sion, the main canal, but it must be considered as a complex of structures and ramifications on three dimensions. 

OBJECTIVES The aim of this study is to evaluate in vitro, using artificial lateral canals, the rate of dissolution of the pulp tissue through different protocols of canal irrigation. 

MATERIALS AND METHODS 100 artificial canals provided with lateral canals have been used. Each lateral canal was filled with pulp tissue and calibrated to 0002 mg. All canals were irrigated using 5 different protocols. 5 groups have been used for the experiment: Group A, distilled water (control); Group B, preheated NaOCl; Group C, NaOCl heated inside the canal; Group D, NaOCl ultrasonically activated; Group E, NaOCl heated inside the canal with ultrasonic activation. All samples were weighed through professional microbalance in three different phases: before insertion of the pulp tissue into the lateral canal, after insertion of the pulp tissue and, finally, after different protocols of irriga-tion. A statistical analysis with Kruskal-Wallis test and Mann-Whitney test was performed.

RESULTS AND DISCUSSION The partial dissolution of the pulp tissue inside the artificial lateral canal occurs only using the protocol with NaOCl heated inside the canal with ultrasonic activation. Other irrigation protocols are not able to dissolve the pulp tissue. The main objective of endodontic therapy is the removal of damaged tissues and bacteria. Modern literature highlights that is impossible to remove all the pulp tissue and bacteria from the whole endodontic space. So, to achieve excellence and get positive results in the short and long term, it is necessary to use techniques and technologies that may increase the degree of root canal detersion.

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EVALUATION OF CYCLIC FATIGUE AND WEAR ANALYSIS OF ONESHAPE AND ONECURVE INSTRUMENTSCARATTERISTICHE SUPERFICIALI E RESISTENZA ALLA FATICA CICLICA DI STRUMENTI ONESHAPE E ONECURVE

Arash Azizi*, Chiara Pirani, Francesco Iacono, Fausto Zamparini, Riccardo Schiavon,

Cesare Nucci, Filippo Cardinali, Maria Giovanna Gandolfi, Carlo Prati

INTRODUCTIONNickel titanium (NiTi) rotary instruments has semplified endodontic procedures by minimizing procedural errors associated with hand instrumentation and reducing time for chemo-mechanical preparation. Despite many ad-vantages of NiTi instruments, unexpected intracanal separation due to torsion or flexural fatigue of the instru-ments is still a major concern.

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OBJECTIVESThis study compared cyclic fatigue resistance and wear analysis of OneShape and OneCurve (Micromega, Besan-con, France) in vitro.

MATERIALS AND METHODSCyclic fatigue tests were performed on 40 brand new OneCurve 25.06 (n = 20) and OneShape 25.06 (n = 20) using an artificial stainless steel canal with 5.0 mm radius of curvature, 90° angle of curvature and the center of the curvature at approximately 5.0 mm from the tip of the instrument and an overall length of 18.0 mm. A stainless steel apparatus provided a standardized placement of the NiTi instruments in the ar-tificial canal6. All the files were rotated until the fracture and time was visually recorded. The number of cy-cles to fracture (NCF) was calculated using the following formula: NCF = time (s) failure rotational speed/60. Four brand new OneCurve (n=2) and OneShape (n=2) were subjected to in vitro wear tests. Tests were performed using straight canals selected from a pool of extracted human teeth according with Kosti et al. 7 Once that ca-nal patency was verified with a #10 K-file, the working length was determined by subtracting 1 mm. Instruments were used with a 16:1 reduction handpiece X-Smart (Dentsply Maillefer, Baillagues, Switzerland) following the manufacturer’s recommendation, at 350 rpm and 2.5 N cm, in pecking motion. Access cavity preparation was achieved with OneFlare and Glidepath has been achieved with OneG. Irrigation was performed with 3 ml of 5% NaOCl (Niclor 5, Ogna, Muggio`, Italy) and 3 ml of 10% EDTA (Tubuliclean, Ogna, Muggio`, Italy). Each instrument was used in 5 canals, washed in an ultrasonic bath containing detergent for 10 min and then autoclaved at 134.8 C. Scanning electron microscope (JSM-5200, JEOL, Tokyo, Japan) was used to evaluate brand new OneCurve and OneShape instruments, and the same samples after canals instrumentation at same points and with same angu-lations to identify the wear features. Micrographs were taken at increasing magnification from 35 to 5000, on the tip of the instruments, and on cutting edges at 5 mm from the tip. The wear degradation was evaluated comparing the pre- and post-operative micrographs, in order to verify fractures and the presence of unwinding, microcracks, blade disruption and tip deformation. As statistical analysis Mann-Whitney was performed.

RESULTSOneCurve files exhibited a statistically higher cyclic fatigue resistance compared with OneShape (p≤0.05). No instrument fracture during wear evaluation was registered. Slight plastic deformations observed in few instru-ments. Spiral distortions and microcracks were absent in both instruments.

DISCUSSIONOneCurve instruments were introduced recently and there is no study evaluating their wear and cyclic fatigue resistance. This instrument is heat treated for increasing flexibility with variable asymmetrical cross-section al-lowing for safe, effective debris removal. Both instruments are designed for a single-file instrumentation in clock-wise rotation. Oneshape in past studies showed a faster preparation of root canals, safe to use and presented less apicaly extruded debris.

CONCLUSIONWithin the limitation of this study, it can be concluded that OneCurve instruments were more fatigue resistant compared with conventional OneShape instruments. Both instruments showed a high wear resistance.

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NONSURGICAL MANAGEMENT OF A LARGE PERIAPICAL LESION EXTENDING TO THE MAXILLARY RIGHT SINUS: A CASE REPORTTRATTAMENTO NON-CHIRURGICO DI UNA GRANDE LESIONE ESTESA FINO AL SENO MASCELLARE DESTRO: CASE REPORT

Belgacem Mohamed Aziz*, Aguir Najet, Bhouri Lotfi

INTRODUCTIONApical periodontitis is an inflammatory reaction of the immune system to the presence of infection in or around the root canal system. This inflammation is associated with an alteration in the periapical bone, that can be iden-

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tified on periapical radiograph. The anatomic proximity of the maxillary premolars and molars apices (in order of frequency: the second molar followed by the first molar then the second premolar and finally the first premolar) offers a sinus propagation route of dental origin infection.

OBJECTIVES The aims of this work are to show: - The importance of CBCT in the assessment of periapical lesions and the precision of their relationship with the anatomical structures particulary the maxillary sinus.- The crucial role of chemomechanical endodontic infection control in the management of a large periapical le-sion extending to the maxillary right sinus.

MATERIALS AND METHODS A 43 Year male patient with no medical history was referred to the Department of conservative dentistry and end-odontics with the chief complaint of feeling of heaviness, cacosmia, in-orbital pain, a unilateral nasal obliteration on the right side.The endobuccal examination revealed a poorly made access cavity on 1.4 tooth. The axial percussion and buccal apical palpation were slightly sensitive on 1.4 and 1.3 teeth. The cold test performed on the 1.4 and 1.3 was neg-ative. A periapical radiograph centered on the maxillary right canine, premolars and first molar revealed a large periapical lesion around the 1.4 tooth and extremely close to the distal side of the 1.3 tooth.The patient was advised a CBCT. The CBCT image revealed:- The presence of a unilateral radiolucent lesion involving the 14 and the 13 maxilary teeth. - This lesion invaded the right sinus, which had an intrasinusal polyp.- The axial sections confirmed the presence of three root canals on the 1.4 tooth.At the first appointment, an access cavity was correctly realised on 1.3 tooth and rectified on 1.4 tooth.Root canal preparation was managed with Reciproc files (VDW) alternated with a copious irrigation us-ing 3.5% sodium hypochlorite solution. Final irrigation was performed with 3.5% sodium hypochlorite and EDTA 17% and a calcium hydroxide dressing was given for 10 days. Root Canal filling was performed with thermomechanical gutta condensation using Revo-condensor system(MM) on 1.3 tooth and with later-al cold condensation of gutta percha on 1.4 tooth. BioRoot RCS (Septodont) was used as endodontic sealer.  The coronal obturations were carried out with (3M) composit resin.

RESULTSRegular clinical follow ups revealed a clear improvement in clinical symptoms. A six months radiological mon-itoring carried out through a CBCT showed an early radiologically resolution of the periapical radiolucency and intrasinusal polyp. 

DISCUSSIONThe diagnosis of chronic sinusitis of endodontic origin is based on the unilateral signs and will be confirmed by the radiographic (CBCT) and its treatment is based essentially on the etiological treatment.As mentioned in previous studies, in the cases of periradicular radiolucent lesions, sufficient biomechanical cleaning of the root canal system is the most critical factor for healing.It has been demonstrated that in these cases, non-surgical root canal therapy should be the first line of treatment. Indeed, Caliskan observed a complete healing in 73.8% and incomplete healing in a further 9.5% of periapical lesions cases with non-surgical treatment. In our case the shaping and disinfection of root canal system followed by a sealed coronal obturations allowed the healing of the periapical lesion as well as sinusitis without surgery.

CONCLUSIONEndodontic therapy should protect or heal inflamed periapical tissue. Even in large periapical lesions, non surgi-cal endodontic treatment may lead to a complete healing.

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A SURVEY AMONG DENTAL STUDENTS ON THEIR KNOWLEDGE ON THE INDICATIONS FOR ANTIBIOTIC THERAPY OF ENDODONTIC INFECTIONUN SONDAGGIO TRA GLI STUDENTI IN ODONTOIATRIA RELATIVAMENTE ALLA LORO CONOSCENZA SU INDICAZIONI PER LA TERAPIA ANTIBIOTICA IN CASO DI INFEZIONE ENDODONTICA

Elka Radeva*, Mirela Marinova-Takorova, Marian Radev

INTRODUCTIONThe ESE guidelines state that dental students in Europe should have basic knowledge on the pharmacology and therapeutics that could be applied on patients with endodontic infections, use of antibiotics and antimicrobial resistance. The dental curriculum in Sofia University includes study of antimicrobial drugs in several different subjects.

OBJECTIVE The objective of the presented study was to collect information about the knowledge of last year dental students on the indications for the usage of antibiotics in endodontic infection.

MATERIAL AND METHODSLast year dental students from Medical University - Sofia were asked to fill a questionnaire, which included ques-tions concerning the indications for usage of antibiotics in endodontic infections. In addition, information about respondents’ age and gender was collected. The data was analysed using descriptive and graphical statistics.

RESULTS 99 replies were analysed. The majority of the respondents (53.5%) chose 5 days as the duration of antibiotic ther-apy. As a first choice of antibiotic, 56.57% chose Amoxicillin 500 mg and 23.23% - in combination with Clavulanic acid. For patients with penicillin allergy 72.73% chose Clindamycin. Over 90% of the respondents would pre-scribe antibiotics for cases of periapical abscess with deterioration of the general condition, periapical abscess in patients with systemic diseases and persisting endodontic infection. 59.57% would prescribe antibiotic for cases with exacerbating chronic periodontitis. 28% would choose antibiotic for irreversible pulpitis and 10.53% - for necrotic pulp with asymptomatic apical periodontitis. For a standard prophilaxis in patients with systemic diseases 61.62% would prescribe Amoxicillin 2g, 47.47% of students would prescribe antibiotic one hour before the medical procedure and 47% - one day before the medical procedure.

CONCLUSIONS The survey shows that most dental students have basic understanding about the usage of antibiotics; however their in-depth knowledge of different cases with endodontic infections can be further improved.

KEYWORDS Antibiotic therapy, dental students, endodontic infection.

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THE ROLE OF CONE BEAM COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF COMPLEX ENDODONTIC CASESRUOLO DELLA CONE BEAM CT NELLA DIAGNOSI DI CASI ENDODONTICI COMPLESSI

Hamdan AlSereidi*, Samira Kathryn Al-Salehi

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INTRODUCTIONCone beam computed tomography (CBCT) represents a major advance in the imaging of the dental and maxillo-facial region. The limitations of conventional intraoral radiography in endodontic practice, relative to CBCT, have been highlighted 1. Conventional intraoral radiographs are cheap, have a low radiation dose, higher resolution than CBCT and may often be sufficient for diagnosis. CBCT is expensive, invariably gives a higher radiation dose than conventional radiographs and suffers from artefacts. When considering using CBCT the benefits must be carefully balanced against the extra radiation dosage and cost. 

OBJECTIVESTo evaluate the impact of CBCT upon diagnosis as part of endodontic management of posterior teeth. The null hypothesis that CBCT does not make any difference in endodontic diagnosis was tested.

MATERIALS AND METHODSFive patients, referred to a specialist Endodontic unit in a teaching hospital,were selected from a large pool of referred patients. Three of these were complex retreatment cases one of which was also associated with sinus problems, a hyperplastic resorption case and a Perio/Endo lesion. Ten Endodontic specialists were selected to act as assessors. As well as a full clinical history,a high quality colour photographic intraoral image, two parallel-ing technique periapical radiographs and limited volume CBCT examination were carried out for each patient. All components, except the CBCT dataset, were combined into a Powerpoint presentation. A questionnaire was also designed for the 10 assessors. The case scenarios, for the 5 patients were examined by each assessor individu-ally on two dates three months apart. On one date, all the information including CBCT images was given to each assessor but,on the other date, the CBCT images were with held. 

RESULTSThe initial provisional diagnosis and that after 3 months were in close agreement with each other, Kappa values ranging from 0.7 to 1.0 for both intra/inter assessor reliability. Wilcoxon Signed Rank Test was used for data anal-ysis. For final diagnosis,six of the assessors changed their diagnosis in the resorption case with the availability of CBCT. There was a significant improvement in their confidence level (p=0.027). The corresponding figures for the Perio/Endo case were 70% and p=0.007. For the retreatment case with associated sinus problems the figures were 60% and p=0.007. However, for the other two retreatment cases although some assessors changed their diagnosis (20% and 40%) the improvement in their confidence level was not statistically significant (p=0.059 and p=1.00). Similar trends were also recorded for helpfulness of the images in making a diagnosis with some 10% to 80% changing their image findings with the availability of CBCT and this was significant in only two cases.

DISCUSSION The 5 cases selected were likely to be representative of those more challenging treatments seen by a hospi-tal-based specialist in endodontics. Other studies in the literature which have addressed diagnostic thinking efficacy of CBCT in an endodontic context 7,8,9 have used different case selection processes which, in some cases, are unclear or which may lead to selection bias. The ten assessors were all Endodontic specialists with a minimum of 3 years experience. The Kappa values confirmed the reliability of the assessors. In the resorption case,60% of the assessors changed their diagnosis with the availability of CBCT. However, all assessors failed to identify a second resorptive lesion which was also present. Also in one of the three retreatment cases,thickening of the lining of the sinus,relevant to the diagnosis,was missed by all assessors.

CONCLUSIONAvailability of CBCT images significantly increases clinician’s confidence in reaching a final diagnosis. Radio-graphic reporting on CBCT images by Maxillofacial Radiologists in secondary referral centres is important as some clinicians could, on occasions, miss important pathology.

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EFFICACY OF ULTRASONIC AND SONIC ACTIVATION IN HEALING PROCESS OF PERIODONTAL LESIONS OF ENDODONTIC ORIGINEFFICACIA DELL’ATTIVAZIONE SONICA ED ULTRASONICA NEL PROCESSO DI GUARIGIONE DI LESIONI PARODONTALI DI ORIGINE ENDODONTICA

Daniela Kirilova Sultova*

INTRODUCTIONThe long-term success of endodontic treatment is closely linked to adequate cleansing of the endodontic space after root canal shaping, and then proceed to a complete obturation of the complex root canal system. Root canal shaping is not able to reach all areas of the root canal system, regardless of the technique used; then a part of the canal is not treated.It is therefore necessary to carry out the endodontic biochemistry cleansing for accessible and not accessible spaces. Blank-Goncalves et al. showed that sonic and ultrasonic irrigation resulted in better removal of the smear layer in the apical third of curved root canals than conventional irrigation. Lateral canals and isthmuses that are part of the root canal system can also harbor biofilm and dentin debris and should be cleaned as well.Use of ultrasonic and sonic activation improves the exchange of substances in the canal, permits heating of the irrigating solution, eliminates dentin debris and thereby achieving greater cleaning.35 years old man with sharp pain,tooth mobility, severe pain to percussion,periapical radiolucency on the X-ray came in the office. The diagnose was symptomatic apical periodontitis.The prognosis for healing is guarded.

OBJECTIVES This clinical case may prove that appropriate endodontic therapy is sufficient to result in bone healing of a lesion from endodontic origin. This report also shows the role of calcium hydroxide in a case with a bone loss. Souza et al suggested that the action of calcium hydroxide beyond the apex may be four-fold anti-inflammatory, neutral-ization of acid products, activation of the alkaline phosphatase, antibacterial action.

MATERIALS AND METHODSA 35 years old man with a sharp pain and tooth mobility came in the office.Endodontic treatment was done with hand files and rotary system 2 Shape; Ca(OH)2 was placed for 7 days. Permanent filling was done with hydrolic condensation with bioceramic sealer. Irrigation-heated 2.5% NaCLO, citric acid and activation with Endoactivator and Endoultra.

RESULTSTooth appeared asymptomatic during follow-up examinations. Radiographs show gradual disappearance of the apical and lateral lesions after 6 months and 1 year respectively.

DISCUSSIONAdvancement in clinical shaping instruments and techniques have led to a much greater emphasis on root ca-nal irrigation protocols. Activation, high volume and frequent exchange of sodium hypochloride throughout the cleaning and shaping procedure is acknowledged to be essential to success.

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POSTER SESSION EXHIBITION AREA

}11.30 - 13.30

Poster Committee: Marco Colla, Stefano Gaffuri, Manuele Mancini, Riccardo Tonini

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PULP CAPPING WITH ADHESIVE RESIN-BASED COMPOSITE VS CALCIUM HYDROXIDEINCAPPUCCIAMENTO PULPARE CON COMPOSITO ADESIVO A BASE DI RESINE VERSUS IDROSSIDO DI CALCIO

Fadwa Chtioui*, Ines Kallel, Nabiha Douki

INTRODUCTION The results of some short-term experiments suggest that capping of a vital pulp with the modern adhesive resin systems may be as effective as capping with calcium hydroxide.

OBJECTIVES Describe our clinical experience about the utility of adhesive resins on pulp capping and compare short-term effects of the bonding resin and those of pulp capping with calcium hydroxide in a review of the literature.

MATERIALS AND METHODS Vital, healthy pulp of two patients were exposed mechanically during a cavity preparation. The first underwent capping with bonding resin and the second with calcium hydroxide. Then both teeth were restored with compos-ite resin. Clinical evaluations such as percussion test, ice test, EPT, were recorded and also before - and after - standard x-ray films were compared and evaluated to decide whether the case was successful or not. Evaluation was performed at least 3 months after the capping materials.

RESULTS AND DISCUSSION Clinical follow-up revealed that there was no difference in pulp response with signs of bridge formation. The ap-plication of calcium hydroxide or bonding resin in direct contact with the mechanically exposed pulp of healthy human teeth can lead to acceptable repair of the dentine-pulp complex, such as wound healing with tertiary dentine bridge formation. The success rate however is dependent on the proper pulpal diagnosis. However further studies for maintaining long-term pulp vitality after indirect and direct pulp-capping would be necessary.

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MINERAL TRIOXIDE AGGREGATE: DIRECT PULP CAPPING, CLINICAL CASE AND EXAMINATION AFTER 2 YEARSINCAPPUCCIAMENTO DIRETTO DELLA POLPA CON MINERAL TRIOXIDE AGGREGATE, FOLLOW UP A 2 ANNI

Federico Ceroni*

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INTRODUCTIONClinical case of a young caries-prone patient. After a full-mouth series of radiographs and bite-wings we find ev-idence of carious lesions, 3 of these on teeth 25,15, and 26, particularly advanced and in close proximity to the dental pulp. The patient does not relate any symptoms in these teeth and the pulp vitality test is positive and within normal limits. Also present are a root-canal treatment and filling on 24 with evident secondary caries due to leakage. The treatment plan consists of a prophylaxis; direct composite fillings of the decayed teeth; direct pulp-capping of teeth 25,16, and 26 with mta (mineral trioxide aggregate) and direct composite reconstruction; endodontic re-treatment, fiber post build-up and seating of an overlay on 24.

OBJECTIVESThe objective is to maintain vital the 3 decayed teeth with pulp exposure, with the intent of following a mini-in-vasive approach respecting the biology and dental tissues. Today this is possible thanks to the use of materials e.g. mta, capable of giving us a highly predictable result.

MATERIALS AND METHODSAfter positioning a dental dam the carious lesion is removed and having evaluated the type of pulp exposure, we wait for the bleeding to stop. The pulp is then covered with a thin layer (1-2mm) of mta, followed by the placement of a cotton pellet and temporary filling material. After at least 48 hours the hardening of the mta is verified; the tooth is then reconstructed permanently with direct adhesive composite resine technique.

RESULTSOver a period of time the 3 teeth treated with direct pulp- capping were checked radiographically and clinically. The results after 2 years confirm that mta proves to be an excellent material. It demonstrates good physical and chemical properties, is biocompatible and has excellent sealing properties. The teeth remain vital and asymp-tomatic and no pulp calcifications or reabsorptions are observed.

DISCUSSIONAt a time in which medicine, dentistry in particular, is increasingly evolving toward a mini-invasive concept, safeguarding the pulp organ and maintaing its vitality in cases of caries and trauma, seems to be the objective of research.

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INVASIVE CERVICAL RESORPTIONRIASSORBIMENTO CERVICALE INVASIVO

Luca Venuti*

INTRODUCTIONThe external cervical root resorption it can be classified between resorption of inflammatory origin. It is generally presented as a complex of clinical situation both in diagnosis than a predictable prognosis. It’s often associated with loss of calcified tissue: dentin, cementum, alveolar bone. The pulp vitality is often compromised. Etiological factors are vague and not closely associated with the onset of the disease. Prevention is often impossible and treatment modalities not so simple. Key points to get a favorable prognosis of this elements are: early detection, accurate removal of tissue resorp-tion, endodontic and restorative phases with accurate isolation of the operative field.

OBJECTIVES The report highlighted the importance of therapeutic procedures designed to preserve as much healthy tooth tis-sue as possible, respect the biological periodontal width, conservative procedures observing the best isolation of the operating field in order to implement the correct adhesive techniques. Case reports show an operating sequence that respects the anatomical substrates can be considered effective and predictable.

MATERIALS AND METHODSIn clinical cases presented the operative sequence is common:1st appointment: surgical exposure of the lesion with sulcular full thickness mucogingival flap incision. Possible

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osteotomy and remodeling of periodontal structrue surrounding the lesion, mechanical debridement of resorp-tion tissue. Pulpotomy if necessary and medication with temporary sealing the endodontic space with Cavit. Mounting the rubber dam in open flap condition in order to obtain correct adhesive procedures to make a defin-itive restoration. Three passage adesive system is used. Microibrid composite material, such as flow materials can be stratified to make the restoration. Suspended suture at the end of the finishing and polishing procedure.2nd appointment: suture removal, root canal therapy if necessary.In case of endodontic treatment is carried out by the open pulp chamber, a further control the infiltrate resorption in order to eliminate all the infiltrated tissue.Final direct restoration with all adesive procedure made under rubber dam protection.

RESULTSThe protocol presented tends to immediately assess the prognostic ability of the item being resorpted and sug-gests a conservative maintenance of the element, in order to don’t invest time and money in elements where the prognosis is still uncertain. Composite restorations with adhesive technique performed under the dam show excellent behaviour.

DISCUSSIONThis therapeutic procedure (periodontal treatment, endodontic, restorative) in two sessions should be consid-ered the protocol treatment.

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DIFFERENCES ON CYCLIC FATIGUE RESISTANCE BETWEEN TWO SIMILAR ROTARY INSTRUMENTSDIFFERENZE SULLA RESISTENZA ALLA FATICA CICLICA TRA DUE SIMILI STRUMENTI ROTANTI

Valerio Ferri*, Marco Seracchiani, Orlando Donfrancesco, Michela De Lucenti,

Gabriele Miccoli, Luca Testarelli, Gianluca Gambarini

OBJECTIVESThe aim of this study is to evaluate the cyclic fatigue resistance of two rotary files with different pattern and ther-mical treatment used for glidepath, as first rotary instrument during the canal shaping. 

MATERIAL AND METHODSAll the instruments was at their own first utilization. The rotary instruments used were tested using a clinical equipment valuated in several studies on artificial steel canals with a 90° curvature and 5 mm of radius. The tested rotary instruments were ProtaperNext X1 (DentsplySimit, Switzerland) and EdgeFileX7 17.04 (EdgeEn-do, USA). The instruments have been rotated until a visible fracture sign at 300 Rpm and 3 Ncm Torque. Statistical analysis was provided using the SPSS 17.0 software (SPSS Incorporated, Chicago, IL, USA). Statistical relevance level was set at p<0,05. 

RESULTS The EdgeFiLe X7 17.04 had statistically relevant higher resistance to cyclic fatigue than ProTaper Next X1, p<0,05. No difference was found on the lenght of the fragment between Protaper Next X1 and EdgeFile X7.

DISCUSSIONNew instruments EdgeFile X7 are made with a special alloy, with well-developed martensitic characteristic, which let the instrument being more flexible and resistant to the cyclic fatigue. This difference could depend, other than on the martensitic behavior, also on the increased taper of the Protaper Next, that, while increasing the shaping taper and easing the progression of the second instrument of the sequence, reduce the cyclic fatigue resistance of the instrument. 

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CONCLUSIONThis test is clinically relevant because of the clinical usage of these two instruments, being the first NTR instru-ments to be introduced in the canal. Therefore they have to resist several mechanical stress while reaching the apex, even against curvature in the apical zone. However, Further evaluations should be made regarding other properties of instruments such as cutting and torsion resistance.

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CENTERING ABILITY OF THREE NITI FILES WITH A SINGLE STEP VERSUS THREE STEP SHAPING PROCEDURECAPACITÀ DI CENTRATURA DI TRE FILE NITI CON UN SINGOLO PASSAGGIO RISPETTO ALLA PROCEDURA DI TRE FASI DI SAGOMATURA

Maria Moukarzel*, Walid Nehme

INTRODUCTIONEffective cleaning and shaping of the root canal system are essential to achieve biological and mechanical ob-jectives of endodontic treatment. In conjunction to these objectives, achieving an adequate shaping should facilitate irrigation and 3D obturation. Nevertheless these objectives might be hindered in curved canals due to stripping or zipping. Reciprocating motion has been taking over continuous rotation since manufacturers seek to meet all these objectives, including simplifying instrumental sequences. Studies have already shown that shaping ability of contemporary reciprocating files while preserving the original shape mainly is a result of the interplay of 3 main factors: the reciprocation kinematics, the file cross section, and the alloy. Also, it would be appropriate to add another factor: the shaping technique and sequence adopted by the clinician since its causal effect influence the canal architecture. Yared in 2008 reported promising and good clinical results of reciprocat-ing movement with a single step shaping technique, while others defend and emphasize the interest and virtues of the crown down technique.

OBJECTIVES The aim of the study is to evaluate the centering ability in curved canals of Reciproc® (VDW), Wave One® (Dentsply, Maillefer) and the 2 Shape from MicroMega, in two shaping techniques: One step versus three steps crown down.

MATERIALS AND METHODS90 resin blocks (Maillfer, Dentsply) were divided into three groups of 30. The first group was negotiated with Re-ciproc®, the second with Wave One® and third with the 2Shape. Each group was divided into two subgroups of 15 blocks each: in the first sub-group each third was prepared separately from coronal, to apical. In the second sub group the blocs were shaped in a single step directly to the apical third. Pictures of the blocs were taken be-fore and after shaping and superimposed in the digital program Photoshop. For each bloc, 15 sections at 0.5mm respectively were drawn away from the foramen, using the AutoCad program. For each section, two measure-ments were taken in the direction of the curvature and in the opposite direction. The total of 2700 Values were collected and analyzed with an ANOVA , a paired student test and a Fischer’s test with an alpha risk fixed at 5%.

RESULTSAll groups showed a significant difference in both techniques (p<0,0001) and the 2Shape revealed less deviation when compared to other instruments (p<0,0001). Comparing the two shaping techniques in each group, results of Reciproc® and2 Shape showed significant difference when the instrument was used in three stages in the canal (p<0,0001). The Student Test confirmed these observations. Whereas the results for WaveOne® showed a tendency to cut toward the external wall of the curvature (p>0,0001).

CONCLUSION Instruments behavior is technique sensitive. The three steps procedure enlarge the outer wall With Reciproc® and WaveOne® and the inner wall with 2Shape.

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COMPARISON OF TWO SONIC AND ULTRASONIC DEVICES IN THE REMOVAL OF DENTINAL DEBRIS FROM LATERAL CANALSCONFRONTO DI DUE DISPOSITIVI SONICI E ULTRASONICI NELLA RIMOZIONE DEI DETRITI DENTINALI DAI CANALI LATERALI

Sirine El-Khoury*, Gaby Haddad, Walid Nehme

INTRODUCTIONPulpal pathologies are caused by the presence of bacteria in the canal, as well as by the toxins they emit. How-ever, several recent studies proved that canal shaping leaves at least 35% of the canal surface uninstrumented. The role of canal shaping would be then to clear a passage to the irrigation solution so it can reach the uninstru-mented canal walls. The real difficulty of canal irrigation resides in regions with difficult access, such as isthmus, apical deltas, grooves, as well as lateral and accessory canals.

OBJECTIVESTo compare the efficacy of two devices in the removal of dentinal debris of artificially created lateral canals, start-ing from a null hypothesis that there is no significant difference between these two activation methods.

MATERIALS AND METHODS12 single-rooted mandibular premolars were instrumented using the 2Shape system to a size 35/.04. They were then imbedded in resin blocs and cut in half. Lateral canals were created at 2, 4 and 6 mm from the apex and filled with dentinal debris. Teeth were used 3 times each in the 3 groups (n=36) and were irrigated with EDDY®, EndoUltra® or conventional irrigation. A total of 324 lateral canals were studied. Pre- and post-irrigation images were taken under microscope and a cleaning score was set by 2 observers. Mann-Whitneytests were used to compare the scores between the 3 irrigation methods.

RESULTSAt 2 and 4 mm, ultrasonic activation resulted in significantly cleaner lateral canals than sonic activation and con-ventional irrigation (P = 0.01). At 6 mm, ultrasonic activation and sonic activation resulted in significantly cleaner lateral canals than conventional irrigation (P < 0.01).

DISCUSSIONThe literature does not reach a conclusion regarding the effectiveness of ultrasonic and sonic activation with respect to each other. Classic laboratory techniques for the cleaning of dentinal debris include the creation of grooves in teeth and filling them with debris, and it recreates similar lateral canals as those of other studies. These results reflect those found in the study of Karade and al. where there was no significant difference between EndoUltra and EndoActivator in the elimination of smear layer in the oronal and middle thirds, but in the apical part EndoUltra showed significantly cleaner canals than EndoActivator. The difference between ultrasonic and sonic activation in the apical third could be due to the fact that penetration of the irrigating solution to the apical part of the canal is not affected by the taper of the preparation with ultrasonic activation, whereas sonic activa-tion showed a lesser penetration of the solution with smaller tapers. However, when it comes to sonic activation with EDDY, studies showed better results than previous experiments with the EndoActivator.

CONCLUSIONThe null hypothesis was rejected. Ultrasonic activation showed significantly better results in the apical third of the canal. There was no significant difference between sonic and ultrasonic activation in the middle third.

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INFLUENCE OF PHOTON-INDUCED PHOTOACOUSTIC STREAMING (PIPS) ON ROOT CANAL DISINFECTION AND POST-OPERATIVE PAIN: A RANDOMIZED CLINICAL TRIALINFLUENZA DELLA METODICA PIPS (PHOTON-INDUCED PHOTOACOUSTIC STREAMING) SULLA DISINFEZIONE CANALARE E SUL DOLORE POST-OPERATORIO: STUDIO CLINICO RANDOMIZZATO

Francesca Bonino*, Elena Gianello, Mario Alovisi, Giorgia Carpegna, Damiano Pasqualini, Nicola Scotti, Elio Berutti

INTRODUCTIONQuality of endodontic treatment is the most important factor to achieve high success rate. PIPS device was in-troduced as method to improve efficiency of cleaning. It implies the use of Er:YAG laser and irrigating solutions. Potential risk of apical extrusion of infected debris during endodontic treatment, correlated with use of laser, can produce an acute inflammatory response, with postoperative pain.

OBJECTIVESThis clinical study evaluates ability of PIPS device to reduce the bacterial count in root canals in vivo compared to traditional technique, by collecting intracanal bacterial samples. In addition, the study aims to evaluate extent of postoperative pain after therapy, through a questionnaire filled in by patients.

MATERIALS AND METHODS28 patients with apical periodontitis diagnosis, associated with pulp necrosis, of multiple or single root canal teeth were selected for endodontic treatment and assigned by randomization to a group: group A (n=14) with tra-ditional irrigation and group B (n=14) with PIPS method applied according to protocol. Irrigation was carried out with NaOCl 5% and EDTA 10% solutions. Intracanal samples were taken before and after endodontic treatment with sterile paper points and were subjected to culture test. Values of microbical analysis were evaluated with Kolmogorov-Smirnov normality test and Mann-Whitney test (p<0,05). Self-assessment questionnaire was given to patients to evaluate postoperative pain in the first 7 days after therapy. Variation of quality of life’s indicators was assessed with a form of analysis of variance for repeated measurements and the Student’s T-test. Endoral periapical radiographies were performed after 6 and 12 months from treatment to evaluate the healing.

RESULTS AND DISCUSSIONIrrigation with PIPS device is more effective than conventional irrigation in reducing intracanal bacterial count in vivo. This reduction is statistically significant in the non-selective, medium, suitable for isolation and culture of obligate anaerobes. Within necrotic teeth’s root canals, a bacterial count consisting specially in anaerobic bacteria is expected. PIPS method does not adversely affect postoperative pain perceived by patients. There are not statistically significant differences between the groups for quality of life’s indicators, except the amount of painkillers recruited, which results to be lower for the traditional method. Therefore PIPS device could represent a promising aid to root canals disinfection, specially in case of simplified operative protocols and reduced times of instrumentation.

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BONDING IN THE ROOT CANAL: POST-SPACE SANDBLASTING, TECHNIQUE PRESENTATIONADESIONE NEL CANALE RADICOLARE: SABBIATURA DEL POST-SPACE, PRESENTAZIONE DELLA TECNICA

Manuel Tinto*, Daniela Toich, Matteo Sartori, Salvatore Longoni

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INTRODUCTION After root canal filling and post space preparation, the root canal walls are coated with sealers remnants and gut-ta-percha, as well as smear layer and dentin debris. Cleaning the post space prior to the application of adhesive techniques is of great importance for gaining optimal adhesion.

OBJECTIVES Post-space cleaning protocols proposed in Literature include: mechanical removal with burs, brushing with al-cohol or detergent, or irrigation with EDTA/hypochlorite or 37% orthophosphoric acid with or without ultrasonic activation. The best seems to be mechanical cleaning with dedicated drills associated with irrigation with EDTA and the use of ultrasound. These methods, however, are indaginous and also require the use of microscope (or magnification in general) to control better the cleaning of post-space. Sandblasting/Airborne Particle Abrasion/Micro-etching with alumina particles using an intra-oral sandblaster, could be a good way to clean post space and improve bond strenght.

MATERIALS AND METHODSThe technique proposed in this paper involves the use of sandblasting with Al2O3 50µm to clean the post-space and to create an high energy surface ideal for adhesion.Technique is divided into 4 main phases. All procedure must be done under dental dam isolation.Phase 1- After temporary filling removal, post space is created with dedicated drills. Phase 2- Post space and pulp chamber sandblasting with intra-oral sandblaster (15/20s) with Al2O3 50 µm. - Wash out of all debris with physiologic saline - Fiber post sandblasting Phase 3- Post space and pulp chamber etching with 37% ortophosphoric acid (60s) + wash all (60s). - Chlorexidine 2% (CHX 2%) application for 60s.- Dry 

RESULTS AND DISCUSSIONPost space sandblasting was proposed for the first time in 1995 by with encouraging results: micro-etching in-creases retention between luting composite, post core and tooth structure. Despite this, the technique has not taken hold.Dentin sandblasting seems to offer better results in terms of bond strength increasing compared to other tech-niques; various papers have demonstrated beneficial effects of sandblasting on dentine adhesion. The high shear bond strength observed in sandblasted dentin could be attributed to the micro-roughness that increase the wettability. Dentin sandblasting also eliminates smear layer and seems to opens dentinal tubules. Post-space sandblasting is a simple, conservative, fast and economical method to eliminate all products and de-bris that could interfere with adhesion. High energy surface is achieved, adhesion is enhanced and bond strenght is increased.

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APICAL PERIODONTITIS AS A POSSIBLE CAUSE OF DEEP CERVICAL INFECTIONS: CASE REPORTSPERIODONTITE APICALE COME CAUSA DI INFEZIONI CERVICALI PROFONDE: PRESENTAZIONE DI CASI CLINICI

Sabrina Dababou*, Katia Greco, Luca Simone, Gaetano Paolone, Maria Teresa Sberna, Giuseppe Cantatore

INTRODUCTIONPeriapical lesions are often the consequence of pulpal involvement of tooth cavity. These entities con-tain bacterial products and immune system cells which aim is to bound the infection and avoid its dif-

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fusion. If the infection has a great bacterial load and/or it’s not treated and/or the patient has an impaired health, the endodontic infection may spread and reach other tissues, organs and/or anatomical spaces. This is a rare but possible complication of endodontic lesions which could develop into oro-facial abscess, cellulitis, deep cervical infection, mediastinitis, cavernous sinus thrombosis and/or acute osteomyelitis. Immediate and specific diagnosis and a multi-specialist treatment of these conditions is mandatory to avoid life-threatening complications.

MATERIALS AND METHODSWe have collected five clinical cases reporting a periapical lesion due to an endodontic disease which is wors-ening in to a so-called odontogenic infection, i.e. infection of oro-facial and cervical spaces. These patients were mostly redirect from the emergency room to the otorhinolaryngology department for an immediate treatment of the infection (drainage and antibiotic therapy) and for medical support (hydratation, nutrition, control of fever). Secondly the patient underwent to dental treatment (extraction or root canal treatment) to eradicate definitively the foci of the infection. The treatment was always chosen after a correct diagnosis attained with specific medical history collection and instrumental investigation.

RESULTSAll five patients presented with severe odontogenic infection, in particular way a submandibular abscess, that resolved after appropriate emergency and dental treatment. In all cases antiobiotic therapy joined with tooth extraction were perfomed, while the drainage was necessary in just 3 cases.In the majority the faringeal space was implicated resulting in impaired breathing, and often the patient reported an acute lockjaw, the typical signs of masticatory space involvement.All patients underwent to instrumental examinations, i.e. OPT, CBCT and ecography to ascertain and check the extention, limits and cause of the infection allowing the administration of the correct and effective treatment.

DISCUSSION Odontogenic infections are potentially severe complications consequent to an untreated dental pathologies or incorrect dentistry procedures. They are often underestimated but may involve cervico-fascial spaces in the head and neck area, even the paranasal sinuses. Their diagnosis is mostly challenging because signs and symptoms can be non-specific or misleading and often the odontogenic cause is not clear.

CONCLUSIONSTime in these cases can save patient’s life. For this reason, it’s highly recommended to stay always on alert and recur to an effective collaboration between the dental and the ENT specialists to prompt not only the diagnosis but also the treatment of these complications. Antibiogram-driven therapies and multiportal approaches are essential elements of the current therapeutic strategy.

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ENDO-PERIO LESIONS: DIAGNOSIS AND CLINICAL CONSIDERATIONSLESIONI ENDO-PERIO: DIAGNOSI E CONSIDERAZIONI CLINICHE

Emna Hidoussi*, Wael Batbout, Hana Sarraj, Neila Zokkar, Lotfi Bhouri

INTRODUCTIONEndo-perio lesion is a clinical manifestation of the pathologic inflammatory intercommunication between pulpal and periodontal tissues via open structures such as apical foramina, dentinal tubules, and lateral accessory ca-nals. The success of a combined periodontal and endodontic lesion depends on the elimination of both of these disease processes. 

OBJECTIVESThis clinical case report demonstrates the successful management of a endodontic-periodontal lesion following a critical evaluation and decision-making process with interdisciplinary treatment strategies.

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MATERIALS AND METHODSA 36-year-old male patient with an endo-perio lesion in the right mandibular first incisor was initially treated with endodontic therapy. Access prepared with endodontic access bur and the canal was cleaned and shaped. Canal was irrigated with 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid (EDTA). The canal was dried with paper points and filled with calcium hydroxide, Ca(OH)2. After 2 weeks, the patient presented to continue root canal treatment. He reported no more pain and that he felt much better. Obturation was completed using warm vertical compaction of gutta percha with Acroseal sealer. The periodontal therapy is performed comprising the root planing and scaling to control the periodontal infection.

RESULTSThis case report show a combined endo-perio lesions which were first treated with conventional endodontic ther-apy and then followed by periodontal surgery. After 1 year the radiograph show positive lesion healing and good bone regeneration. 

DISCUSSION Generally, in a case of combined endo-perio lesion, an adequate endodontic therapy would result in healing of the endodontic component and the periodontal repair/regeneration would finally depend on the periodontal prognosis. Prognosis of endodontic and periodontal therapies primarily depends upon the severity of periodon-tal disease and the response to periodontal treatment.

CONCLUSIONEndo perio lesions present challenges to the clinicians in their proper diagnosis, treatment and prognosis of the involved teeth. They have a varied pathogenesis which ranges from quite simple to relatively complex. Knowl-edge of these diseases is essential in coming to the correct diagnosis and proper treatment plan.

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ASSESSMENT OF THE QUALITY OF ENDODONTIC RETREATMENT ON A POSTGRADUATE ENDODONTIC CLINIC IN DUBAI, UAEVALUTAZIONE DELLA QUALITÀ DI UN RITRATTAMENTO ENDODONTICO IN UNA CLINICA ENDODONTICA PER POSTGRADUATE A DUBAI (UAE)

Reem Mohamed, Jafar Alharmoodi*, Samira Kathryn Al-Salehi

INTRODUCTIONRoot canal therapy outcome is predictable usually with a high degree of success. Nonetheless, failures can oc-cur after treatment (14%-16% failure rate) primarily due to poor quality root canal treatment. Clearly in such cases endodontic retreatment or endodontic surgery become necessary. Endodontic retreatment always poses a challenge from a technical and biological perspective. Most retreatment cases are referred by General Dental Practitioners (GDPs) to Endodontic specialists because GDPs do not normally have the specialist skills nor the necessary equipment, for example, surgical microscopes often needed to enable a successful outcome. Even amongst specialists, a success cannot always be guaranteed. Good quality obturation will result in a good apical seal increasing the likelihood of periapical healing thus ensuring a successful outcome. 

OBJECTIVESThe aim of this study was to assess endodontic retreatment outcomes based on quality of obturation and healing.

MATERIALS AND METHODSA total number of 223 radiographs of patients who had received endodontic retreatment during the period (2008-2015) at a postgraduate teaching clinic were selected. Unreadable radiographs were all excluded. From the orig-inal sample of 223 in total 24 radiographs were discarded. The final sample thus consisted of 199 root canal fillings of 140 patients treated by endodontic postgraduates. All radiographs were individually evaluated for the density of the root filling as well as the distance between the end of the root canal filling and radiographic apex based on a six-point scoring system. Subsequently, patients were reviewed and follow up periapical radiographs

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were exposed. The outcome of healing was assessed using the Periapical Index (PAI) scoring system. The data were analysed using Chi Square test (p<0.05).

RESULTSThe study revealed that 78.9% of the endodontic retreatments were both homogeneity and length acceptable. The corresponding figure was only 13.1% before endodontic retreatment. Conversely, homogeneity and length unacceptable before endodontic retreatment was 47.2% reducing to a mere 2.5% after retreatment. The results were statistically significant (P<0.001). There was over 80% improvement in periapical healing following end-odontic retreatment and this was also statistically significant (P<0.001).

DISCUSSION The study showed that the category homogeneity acceptable, length acceptable (optimal techni-cal outcome) to be 78.9% compared with only 13.1% recorded before endodontic retreatment on the postgraduate clinic. This finding was statistically significant (P<0.001). To our knowledge, the near-est good technical outcome, for endodontic re-treatment, found in the literature was that of an Austra-lian study giving 74% of cases (n=100) with 1mm short of the radiographic apex. The overall picture sug-gests that the quality of work carried out on our postgraduate clinic is of an exceptionally high standard. More than half of the original sample (55%) attended follow up sessions and appropriate radiographs were taken for this subsample. It was noted that 88 out of 109 patients showed periapical healing. The figure for healing re-ported in a systematic review by Ng and Gulabivala 2011 showed the healing to be in the range 70% -80% which is in agreement with the findings in this report.

CONCLUSIONThere was a significant improvement in outcome after endodontic retreatment on the postgraduate endodontic clinic. The success rate of endodontic retreatment was over 70% which is in line with the endodontic literature. Radiographic follow up confirmed some 81% improvement in healing rate following endodontic retreatment.

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B.P.F.C.® BIO-PLASMA® WITH PURE GROWTH FACTORS (BIOPLASMA®) FOR THE TREATMENT OF A PERIAPICAL LESION OF AN HOPELESS ENDODONTICALLY TREATED TOOTH: A NEW THERAPEUTIC OPTION?USO DI B.P.F.C. CON FATTORI DI CRESCITA PURI (BIOPLASMA®) PER IL TRATTAMENTO DI UNA LESIONE PERIAPICALE DI UN ELEMENTO FORTEMENTE COMPROMESSO E GIÀ TRATTATO ENDODONTICAMENTE: UNA NUOVA OPZIONE TERAPEUTICA?

Raffaello Viganò, Riccardo Botta*, Luca Viganò, Cinzia Casu

INTRODUCTIONRecent literature reviews have shown that the survival of endodontically treated teeth is very high. Some studies reported that the success rate for endodontic surgery is between 82 and 94%, and is considered an effective treatment before the replacement by a single-tooth implant.

OBJECTIVESThe aim of this case report was to evaluate the efficacy of a new platelet-rich plasma preparation and its regener-ative capacity of bone periapical tissue for the treatment of an hopeless endodontic treated tooth, using a pure platelet concentrate. This is made without the use of anticoagulant nor any type of activator eg: bovine thrombin, calcium chloride. For this reason it has been called “Pure”, it is the B.P.F.C.® Bio-Plasma® with Pure Growth Factors (BioPlasma®) designed and developed by Dr. Raffaello Viganò (Varese Italy 2010), to promote the bone healing process. 

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MATERIALS AND METHODSA 20 years old female patient went to our attention for the evaluation of the previous treated element 2.2. She reported good health without systemic disease. She presented a fistula in correspondence of the tooth 2.2 and with an x- ray was possible to see a previous endodontic treatment and a radiolucent lesion great-er than 1,5 cm in diameter. A diagnosis of periapical lesion was made. It was decided to maintain the den-tal element through an endodontic retreatment with hand instruments, of the element and then an end-odontic surgery with the positioning of the B.P.F.C. The patient have read and signed a written consent form. The study protocol was approved by the Ethics Committee for Human Studies, University of Varese. The phases of the surgical treatment were: taking blood from the patient with Vacuette 9 ml; centrifugation and fractionation of the blood material; creation of the membrane with a mixture of fibrin and poor plasma; prepa-ration of rich gelled plasma; preparation of the surgical flap; removal of 3 mm of the root infected and seal with MTA; debridement of the infected bone; positioning of the rich plasma and then the membrane; final suture with minimal exposure of the membrane. 

RESULTSAfter 2 months the apical lesion completely healed. Follow up at 6 months, 1 year and 3 years demonstrated the success of treatment. 

DISCUSSIONOur case report showed that the Bio-Plasma® with Pure Growth Factors, inserted in the bone cavity after re-moval of periapical lesion could be an interesting therapeutic proposal for hopeless retreated elements instead of implantology. The limits of this protocol are related to the skill in carrying out the blood sample required. Further clinical trials, are needed to validate this starting result.

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HEALING OF A MAXILLARY BONE-PERFORATING LESION AFTER NON-SURGICAL RETREATMENT: A CASE REPORTGUARIGIONE DI UNA LESIONE OSSEA PERFORANTE MASCELLARE DOPO RITRATTAMENTO NON CHIRURGICO: CASE-REPORT

Marc Habib*

AIMTo report clinical and radiographic treatment outcome describing the use of cone beam computed tomography (CBCT) in the diagnosis and management of a maxillary lateral incisor with perforating lesion following calcium hydroxide dressing.

SUMMARYA 43-year-old female patient presented for endodontic examination with a palatal gum swelling on her maxillary incisors. The chief complaint was a persistent protuberance in the labio-gingival aspect of maxillary right lateral incisor. An intraoral examination revealed no significant mobility on tooth number 12. Radiographic examination showed straight root with discontinued filling in the middle part of the canal, extensive bone loss associated with the apex of the maxillary lateral right incisors. The data collected from the diagnostic cone beam computed tomography scan revealed bone destructive lesion perforating both buccal and palatal plates with no evidence of fracture. It was decided to treat this tooth with nonsurgical retreatment. After removing the old endodontic filling, pus was observed flooding the access cavity of the shaped canal. Calcium Hydroxide dressing was then applied and renewed 3 times over a period of 3 weeks. Palatal protrusion gradually diminished then obturation was performed. At eight months recall, the tooth was asymptomatic and x-ray showed bone healing. Then the patient came back for her eighteen months recall, the CBCT confirmed re-construction of both buccal and palatal alveolar bone. Key learning points -Periapical lesion may perforate bone plate, and this may not be detectable using conventional radiographic techniques.

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-CBCT provides additional relevant information on the location and nature of bone defects when compared with that provided by conventional radiographs.-In some retreatment cases, chemo-mechanical debridement and the use of calcium hydroxide paste can induce bone repair and healing of large lesions.

KEYWORDSMaxillary lateral incisor, calcium hydroxide, perforating lesion, non-surgical retreatment, CBCT.

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BENEFITS OF BIOCERAMIC SEALERS FOR THE SINGLE CONE TECHNIQUE AFTER SINGLE-FILE CANAL PREPARATION: A WIN-WIN GAME?BENEFICI DEI SEALER BIOCERAMICI NELLA TECNICA DEL CONO SINGOLO DOPO PREPARAZIONE CANALARE CON FILE SINGOLO: UN VANTAGGIO RECIPROCO?

Daniele Angerame, Matteo De Biasi, Massimiliano Lenhardt*, Rossella Bedini, Raffaella Pecci, Vittorio Franco

INTRODUCTIONBioceramic materials are ceramics designed for use in medicine and dentistry. Bioceramic sealers have become popular among the endodontists because they are biocompatible, non-toxic, antibacterial, and stable within the biological environment. Bioceramic sealers slightly expand during setting and are capable of a tight seal with the root dentin; furthermore, they endure moisture and blood contamination and, therefore, are less technique-sen-sitive than other materials.

OBJECTIVESTo highlight the potential advantages deriving from the use of a bioceramic sealer used in different technical variants of the single cone obturation in canals shaped with a single-file system.

MATERIALS AND METHODSA preliminary computed microtomographic (µCT) analysis was conducted on single rooted teeth to assess the quality of root canal filling after shaping with a R25 Reciproc Blue file (VDW). A bioceramic sealer (BioRoot RCS, Septodont) was used for cold single cone filling. Three variants of the single cone technique were considered: dedicated R25 gutta-percha cone to working length; trimmed dedicated R25 gutta-percha cone 1 mm short of working length; non-standardized gutta-percha cone fitted to working length. The voids formed along canal walls and inside the filling materials were qualitatively evaluated after the analysis of image stacks and three-dimen-sional reconstructions.

RESULTS AND DISCUSSIONAll three considered technical variants led to satisfactory root canal filling with even distribution of the bioceram-ic sealer, which surrounded the gutta-percha cone with minimal microscopic voids formation. Our results confirm the effectiveness of the single cone technique already demonstrated in previous µCT studies with traditional sealers. As expected, greater amounts of sealer were observed around non-standardized gutta-percha cones. Differently from the case of eugenol-based sealers, the dimensional stability of a bioceramic sealer is not influ-enced by a sealer excess and does not appear capable of constituting a clinically relevant problem. Trimming the cone 1 mm short of the working length left the most apical portion of the canal filled exclusively by sealer. With this approach, the bioceramic material is likely to express its full potential of tight seal, antibacterial and biomin-eralizing action, whose actual effects deserve to be investigated in the clinical setting.

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REVIEW AND CLASSIFICATION OF HEAT TREATMENT PROCEDURES AND THEIR IMPACT ON MECHANICAL BEHAVIOR OF ENDODONTIC FILESREVISIONE E CLASSIFICAZIONE DELLE PROCEDURE DI TRATTAMENTO TERMICO E DEL LORO IMPATTO SUL COMPORTAMENTO MECCANICO DEI FILES ENDODONTICI

Christia Maroun Aoun*, Walid Nehme, Alfred Samir Naaman, Issam Khalil

INTRODUCTIONThe nickel-titanium alloys used in root canal treatment contain approximately 56% (wt) nickel and 44% (wt) tita-nium. The two unique features of relevance to clinical dentistry are termed shape memory (SM) and super-elas-ticity (SE). Those properties are attributed to the reversible, stress-induced martensitic transformation driven by stress and influenced by the temperature. Changes in the transformation behavior, via heat treatment, have been used to reorganize the crystallographic structure of the alloy to enhance their properties.

OBJECTIVESThe article presents an updated literature review on NiTi endodontic instruments in order to explain and analyze the influence of heat treatment process on mechanical properties of Niti shape memory alloys. The reader should understand the clinical implications of thermal heating of endodontic intruments such as enhanced flexibility and safety.

MATERIALS AND METHODSThe literature concerning the influence of heat treatment on mechanical properties of NiTi alloy has been an-alyzed using selected criteria. A closer look at multiple patents was important to understand the effects of heating on crystalline microstructure and phase transformation properties.

RESULTSThe main advantage gained by heat treatment process is the increase of Af (Austenite finish) temperature of the alloy. If “Af” is superior to body temperature, the file will be in a mixed martensitic, R-phase and austenitic struc-ture in intracanal temperature. Therefore, heat treated instruments showed a significant increase in flexibility and flexural fatigue resistance. Only few reports describe the mechanical behavior under torsional loads. Interesting-ly, modifications in crystalline structure seem to have an influence on angle of deflection and torque load, which are two determinant parameters of torsional fracture.

RESULTS AND DISCUSSIONAn analysis of the different effects of heat treatment on Niti instruments is presented, thus enabling an easier understanding of mechanical properties of new thermomecanically treated alloys.

CLINICAL RELEVANCEThe theme is relevant for clinical Endodontics since the variety of instruments is great and clinicians need a better understanding of the different ways of their manufacturing for a better use during endodontic treatment.

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THE CHALLENGE OF ENDODONTIC RETREATMENT: CASE REPORTLA SFIDA DEL RITRATTAMENTO ENDODONTICO: CASE REPORT

Hana Bougatef*, Imen Gnaba, Rim Ragoubi, Mahmoud Smaoui, Sonia Zouiten, Abdelatif Boughzela

INTRODUCTION The primary goal of non-surgical endodontic retreatment is to relieve patient symptoms and reestablish healthy

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periapical tissues following failure of initial therapy by achieving access to the root canal system, complete re-moval of previous filling material, followed by canal cleaning, shaping, refilling and if present, addressing defi-ciencies of pathological or iatrogenic origin.There are two therapeutic steps of endodontic retreatment: - The coronary time that provides canal access.- The root time which makes it possible to reach the apex.

OBJECTIVES The purpose of this work is to explain the eventual causes of endodontic treatment failure, how to take the deci-sion of endodontic retreatment and to study its feasibility by describing its protocol through a case report. 

MATERIALS AND METHODS A patient consults for a faulty amalgam on the 46. The radiological examination revealed an insufficient root fill-ing, a periapical lesion related to both the mesial and distal roots of the tooth. The indication and the feasibility of the endodontic retreatment was studied. After opening the access cavity and performing a pre-endodontic reconstitution, a rectification of the access cav-ity was performed and revealed a second distal canal stuffed with necrotic tissue. A very small amount of gutta percha at the first third of roots was removed by the H file. The rest of the roots had ledges.To gain access to the entire root, more time was spent using pre-bent and lubrificated 06 and 08 K files with Chelating gel (EDTA) associated with sodium hypochlorite irrigation. Finally a complete shaping using manual protaper was carried out followed by root filling using lateral condensation technique.

RESULTSOutcomes assessment of retreatment is traditionally based on clinical findings and radiographs. A 5 months clinical follow-up shows the disappearance of the periapical lesion. 

DISCUSSION Retreatment is clearly indicated when a periapical lesion, clinical signs and/or symptoms are present, the pres-ence of an inadequate root filling or coronal seal. Additionally, if the initial obturation permits coronal leakage, elective retreatment may be necessary before non-vital bleaching to minimise risks of root resorption.In addition to the diagnostic and technical problems, other characteristics of practitioners (age, clinical experi-ence, confidence, specialty training) may influence their decision so they must study the possible causes of the primary treatment failure. First, gutta percha length and condensation’s quality, are considered features that help determine if the initial treatment was completed to a satisfactory standard. Root fillings do not extend to the apex as in our clinical case can still harbour residual bacteria that escaped initial chemo-mechanical debridement. This lack of disinfection tends to be the most common cause to persistent apical disease. In addition, quality of the coronal seal, which is consistently demonstrated to be a prognostic factor in both primary and secondary root treatment must be well examined. Second, resistant microorganism can lead, even with adequate obturation and coronal seal, to an apical disease persistence. Finally, as extra radicular sources, extrusion of root filling material into periapical tissues and aggressive instrumentation can also maintain or induce apical infections.

CONCLUSIONManagement decisions are an indispensable part of the clinical process. Whilst the choice the clinician makes from the range of available retreatment options is strengthened by an evidence-based approach, the way in which he evaluates the available information in a given situation plays an important role in the decision-making process.

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EVALUATION OF THE ACCURACY OF APICAL GAP FOR MTA: AN IN VITRO STUDYVALUTAZIONE DELLA PRECISIONE DEL GAP APICALE DELL’MTA: UNO STUDIO IN VITRO

Maurilio D’Angelo*, Francesca Savo, Orlando Donfrancesco, Michela De Lucenti,

Alessio Zanza, Gianluca Gambarini, Luca Testarelli

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INTRODUCTIONRoot canal treatment of teeth with necrotic pulps and apical periodontitis may be complicated by limited access to the root canals due to restorations and dystrophic calcifications, an alternative approach is to use a surgical procedure to perform retrograde root canal treatment.In recent years, mineral trioxide aggregate (MTA) is often advocated as the material of choice for root-end filling in endodontic surgery. MTA would improve healing due to its favourable tissue response and sealing properties over time.Clinical studies have shown that apical leakage is one of the main causes of failure of endodontic treatment. On the other hand, several studies have highlighted the importance of dimensional stability as one of the essential characteristics for the root filling material. 

OBJECTIVEEvaluating the dimensional stability of Aureosel MTA (OGNA, Italy) measuring the gap between the sealer and the dentine walls after apicectomy and his variation in time. 

MATERIALS AND METHODSApproximately 2 mm of the root tip was removed, and the canal was identified and explored with a size 10 K-file (Dentsply DeTrey, Germany) and an ultrasonic root-end preparation (Sybron Endo, CA, USA) was created. The canal was irrigated with sodium hypochlorite. Afterwards the canal was dried with paper points and filled with Aureoseal MTA. The samples were kept in incubator at 37°C with 100% humidity. In order to evaluate marginal ad-aptation the roots were cut by diamond disc horizontally with plenty of water to obtain a 1mm thickness sample.The samples were analyzed by scanning electron microscope (SEM) after 24 h for the first evaluation and 1 week for the second one. The obtained images were measured by relevant software and the data statistically analyzed to asses significant difference between the mean gap. The significant level was set at P<0,05.

RESULTSTable 1 shows the amount of gap for the two different evaluation time. The MTA gap between plug and dentin wall of the canal is higher after one week. Although these differences were not statistically significant.

DISCUSSIONThe lack of dimensional stability, and subsequently the loss of marginal adaptation through creating a path for microorganisms’ penetration can cause microleakage and disruption of sealing ability of the material. As previously mentioned, the results of this study demonstrate a direct correlation between the marginal adap-tation and the sealing ability. The results of this study can be attributed to the properties of the used material. MTA is an hydrophilic material that can absorb liquids while setting process and acquire the ability to penetrate into dentinal tubules and gaps. These characteristics, along with a slight expansion during setting process and production of crystalline hydroxyapatite in the border of material and dentin walls can provide an excellent seal-ing and marginal adaptation. However, considering the disagreements among reported results, it is necessary to take the limitations of this study into account. The study of marginal adaptation only shows the gap between the plug and the dentin wall while microleakage occurs both inside of the apical plug and in the boundary between the plug and dentine wall.

CONCLUSIONSConsidering the obtained results and the condition of this study it seems that there is not a statistically difference in the gap at 24 hours and one week after the treatment. However, in order to confirm these results, further stud-ies using other methods of gap evaluation seem necessary.

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EFFECTIVENESS OF ULTRASONIC TIPS IN THE RETREATMENT OF TEETH FILLED WITH GUTTA-PERCHA AND BIOCERAMIC BASED SEALEREFFICACIA DELLE PUNTE ULTRASONICHE NEL RITRATTAMENTO DI DENTI OTTURATI CON GUTTA-PERCA E CEMENTO BIOCERAMICO

Mirela Marinova-Takorova*, Elka Radeva, Emilia Naseva

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INTRODUCTIONDespite of the high success rate of endodontic treatment there are still cases, when failure occurs. The aim of the presented study was to evaluate the effectiveness of ultrasonic tips in the retreatment of teeth filled with gutta-percha and bioceramic based sealer.

MATERIAL AND METHODSTwenty-two extracted single rooted teeth were used. They were enlarged to size F2, using Pro Taper Universal files. The teeth were then randomly assigned into two groups (n=11). Group one was filled using cold lateral com-paction technique and group two - using single cone technique with matched-taper single cone technique. Both groups were retreated using ultrasound tips. Time needed for the removal of root canal filling was recorded. The teeth were sectioned longitudinally and the amount of the residual filling material was evaluated.

RESULTSThere was no significant difference in the time needed for the retreatment of both groups. 59% of the samples had no residual material in the apical part, compared to 45.4% for both the coronal and middle part. When com-paring the different filling techniques, best removal was achieved in the apical part for the lateral compaction technique (68,2% with no residual filling material) and in the coronal for the single cone technique (54,5% with no residual material). In the middle part the results were comparable.

CONCLUSIONSComplete removal of filling material was not achieved in any part of the root canal. The time needed for the retreatment of both filling techniques was comparable. Least remnants of filling material were observed in the apical part of the root canal.

KEYWORDSRetreatment, ultrasonic tips, bioceramic based sealer.

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AN ENDODONTIC RETREATMENT OF A CROWNED TOOTH WITH FISTULARITRATTAMENTO ENDODONTICO DI UN DENTE PROTESIZZATO CON FISTOLA

Rim Ragoubi*, Iméne Gnaba, Hana Bougatef, Sonia Zouiten, Abdelatif Boughzela

INTRODUCTIONThe failure of primary endodontic treatment is manifested by various clinical and/or radiographic symptoms. Orthograde endodontic retreatment is the method of choice for a prolonged and conservative therapy. The proce-dure requires completing removal of the filling material from the canal system to allow effective cleaning shaping and re-filling.

OBJECTIVES This work describes a case of an endodontic retreatment through a crowned tooth:25 with fistula and periapical lesion.

MATERIALS AND METHODSA female patient 41 years old presented at the Dental Clinic with mycosis fistula related with a metallic crowned tooth: 25. A retrograde retreatments were indicated. The access cavity was opened into the crown with a trans-met-al bur because the tooth presents a mobility degree > 1 the Gutta Percha was removed by using Protaper reverse sequence and the tooth was obturated with Thermafil system. A 6 month clinical follow-up will be shown. 

RESULTSDisappearance of the fistula in 7 days. Periapical healing, physiological mobility and normal periodontal probing after 6 months. 

DISCUSSIONTo identify the source of the fistula, a guttapercha cone is carefully placed through the stoma until it stops and a radiograph is taken.

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In front of clinical symptoms (fistula) and radiographic signs (periapical lesion) tooth, the diagnostic of a chronic apical abscess with fistula was mad.The orthograde endodontic retreatment is highly indicated in front of a conservable tooth.The access cavity is made through the crown so as not to increase the mobility which is already greater than 1 degree. One of the difficulties that one may have is the risk of not finding the axis of the tooth and creat-ing perforation. Orthograde retreatment is based on the combined use of chemical solvents and mechan-ical rotary or manual endodontic instruments. In this case we used a protaper reverse sequence but many systems could be used like: R endo de Micro-Méga, Protaper Universal retreatment de dentsply maillefer, the ProFile (Dentsply) a mechanical push-pull, quarter-turn file system and retreatment files (Dentsply). The solvents are always used with the mechanical action of manual or mechanized instruments. Various sol-vents can be used for Eugenate-sealer: products based on xylene-tetrachlorethylene, ethylene acetate or nat-ural solvates (lemon, orange, eucalyptus)which are less cytotoxic. The use of chloroform now is banned. The rules of the orthograde retreatment consist in renewing the solvent, checking for the presence of the filling ma-terial in the turns of the instrument and finally check the position of the instrument by a radiograph per_oper-atoire. After the gutta Percha removalwe realised disinfection, shaping and obturation of the canal finally we must insist on the importance of a well established coronary obturation to ensure the healing of the fistula. Clinical studies have shown that if the previously described clinical steps are not respected the therapeutic success rate decreases by up to 40 percent in chronic apical periodontitis compared with that observed without apical periodontitis.

CONCLUSIONSIn general, nonsurgical retreatment will be the preferred choice, because it seems to provide the most benefit with the lowest risk. It has the greatest likelihood of eliminating the most common cause of posttreatment dis-ease, which is intra radicular infection. The preliminary evaluation of the feasibility of reprocessing the acquisi-tion of adequate equipment and the respect of Shilder’s objectives are fundamental elements in the success of such treatment.

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3D RECONSTRUCTION OF INSTRUMENTED C SHAPED CANALS WITH WAVE ONE GOLD SYSTEMRICOSTRUZIONE 3D DI UN CANALE A “C” STRUMENTATO CON IL SISTEMA WAVE ONE GOLD

Georgette Arce Brisson, Ana Cecilia Boetto*

INTRODUCTIONThe C-shaped root canal is describing as a single canal having a tapered shape, which connects one or more ca-nals to each other in its cross-section, forming an arc of 180° or more. It is an anatomical variation that appears frequently in the second lower molar. Preoperative diagnosis and radiographic interpretation of the C shape root canal morphology can be difficult, so the use of ocular magnification is recommended to improve clinical procedures. The aim of this study was to assess ex vivo the effectiveness of the reciprocating System Wave One Gold, in C-shaped root canal, Through the three-dimensional reconstruction of scanned images with Computed Tomography Cone Beam (CBCT).

MATERIALS AND METHODTwelve seconds mandibular molars were selected with fused roots with a lingual or buccal groove. Periapical ra-diography was taken follow by a Cone Beam tomography, in which 4 teeth were placed in a silicon bloc (Speedex condensation silicon, Coltene) The silicon blocs were placed on the CBCT support, at a distance of 1.20 m, which was respect in the CBCT PRE and POST instrumentation. The CBCT parameter were, isotropic voxel size 90 μm, in an acquisition with 80 KV and 5 mA. The images were then three-dimensionally reconstructed using Mimics Innovation Suite Software Version 16. Three-dimensional classification of the C-shaped root canal. Type I Type II Type III was carried out. The percentage of the unaffected area of the root canal was calculated.

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Results when applying the Kruskal-Wallis test the differences between Type I with Type II and III were statistically significant (p = 0.003). Differences between thirds between the 3 types were not statistically significant.

DISCUSSIONYin et al. They studied with computed micro-tomography, they showed that the non-instrumented surface with Pro-Taper was 59.6% whereas with manual instrumentation it was 41.6%. Solomonov et al. When comparing SAF and ProTaper in the instrumentation of C Shape, describe that the percentage of non-instrumented surface with ProTaper was 66% and with SAF 41%. In this pilot study the percentage of non-instrumented surface with WOG was 74.3%.

CONCLUSIONThis implemented method, three-dimensional reconstruction of images obtained before and after treatment al-lows to determine the percentage of the canal area unaffected with CBCT to observe the surface instrumented or not in C shape root canals, without altering the samples. The instrumentation of the C-shaped molars with Wave One Gold system left surface areas non-Instrument, with a higher percentage in Type I, where the continuous C is presented.

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SURGICAL ENDODONTICSENDODONZIA CHIRURGICA

Luca Giovinazzo*

INTRODUCTIONThe presence of a buccal fistula on the alveolar mucosa, with evident suppuration, establishes a failure of the orthograde treatment of the tooth 26. The radiography shows a small transparent radio area on the mesial buccal root and configures the obligatory nature of surgical endodontics. The Parodonto is in the norm and the perfect coronal seal gives confidence in the choice of the therapeutic path.

AIMSWeine and Gerstein attest to the need to remove as much as possible the previous inadequate root canal obtu-ration and replace it with well-compacted gutta-percha, hoping to fill lateral channels, accessory channels pre-viously forgotten. Sometimes this practice improves the clinical and radiographic conditions making the surgery no longer necessary.

MATERIALS AND METHODSAn anesthesia is performed with 2% lidocaine with 1: 50,000 epinephrine. The incision is performed with a 15c blade with an optical magnification of 3.6x. The cortical bone appears to be fenestrated near the apical portion of the vestibular mesio root, and the bone breccia extends with sonic bur. The following phases will be managed with the Leica M400 Operating Microscope with 180W xenon light. The lumen and isthmus are prepared for a 3 mm canal tract with an ultrasonic diamond tip kis 1D Kerr on the EMS handpiece. After drying the inside of each lumen with 4 mm long sterile paper cones, the MTA bio material is prepared as indicated and deposited on a steel dispenser. The material is collected by the MAP Sistem, conveyed and compacted inside the lumen, thanks to the piston placed inside the cannula that acts as a plugger. Reposition the flap on the bed and fix it with a 5/0 PTFE suture with simple knots.

RESULTSThe patient performed radiographic and clinical recalls after 6 months, 2 years and finally at 4 years. The final ra-diograph shows the complete healing of hard tissues, the complete conjunction of gutta percha with MTA without the presence of root canal voids. In this case we highlight the preservation of the papilla with incision of mesial and distal retraction to 26. This technique of incision of soft tissues has led to an optimal healing without evident scarring outcomes.

CONCLUSIONThe use of microscopy and sonic instruments have been effective not only in the management of the apical third but to preserve the integrity of the sinus membrane.

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SATURDAY 10TH NOVEMBER

SESSION VLECTURE ROOM CARAVELLA/SANTA MARIA

Chairmen: Paul Dummer - Sandro Rengo

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ENDODONTIC TREATMENT IN THE TEETH WITH INCOMPLETE ROOT DEVELOPMENTIL TRATTAMENTO ENDODONTICO NEI DENTI CON SVILUPPO RADICOLARE INCOMPLETO

Francesco Riccitiello, Katia Greco

✎ ABSTRACT

Pulpotomy should be considered the elective treatment to be performed in case of traumatic, iatrogenic or cari-ous pulp exposures in dental elements whose root formation has not completely occurred, in order to preserve pulpal vitality.The residual pulp abutment and, in particular, the stem cells, which will be transformed into odontoblast-like cells, will perform their main function, that is to produce dentinal tissue, allowing the physiological root growth, the thickening of the canal walls and the closure of the root apex.The scientific-mercelogical innovation of the last few years provides a continuous marketing of new materials useful in the clinical-odontological routine, placing, sometimes, the same operators facing difficulties or prob-lems of choice.In particular, for pulpotomy, the dichotomy is between calcium hydroxide, universally recognized material, reli-able and effective in the production of dentine bridge, and Mineral Trioxide Aggregate (MTA), a new biocompati-ble material with multiple applications in endodontics.From our clinical experience, the use of the MTA does not find its maximum indication for pulpotomy since the formation of the dentinal bridge requires a period of time equal to or greater than that induced by calcium hydrox-ide. Moreover, the same formation of the dentinal bridge by the MTA turns out to be more apical than the location where the material is placed and probably this is due to the persistent alkanity in the time of the MTA.In conclusion, calcium hydroxide is still the material of choice for pulpotomy, while the elective field of applica-tion of MTA is related to the repair of perforations of the floor of the pulp chamber or root canals.

FRANCESCO RICCITIELLOBorn in Naples in 1958, in 1982 he graduated in Medicine and Surgery at University of Na-ples “Federico II”. In 1985 he postgraduated in Odontostomatology at the same University. In 1989 he was contract professor in Restorative Dentistry at University of L’Aquila. In 1990 he

graduated in technician and clinical assistant at University of Na-ples “Federico II”. Since 2000 he was Researcher at university of Naples “Federico II”. In 2001 he has been elected as delegate of researchers to the Faculty Advice. Since 1985 he is active member

of SIDOC (Italian Society of Restorative Dentistry), founding mem-ber of SIDT (Italian society of dental traumatology) of which he was president since 2005, he was President of the Italian Academy of Microscopic Dentistry (AIOM), he is President of SIE (Società Itali-ana di Endodonzia). Author of numerous national and international publications, mainly in the field of conservative dentistry and end-odontics. He is co-author of some books of restorative dentistry and dental traumatology. From 2010 he is Associate Professor of Den-tistry at the Faculty of Medicine of Naples University “Federico II”.

KATIA GRECOGratuated with honor at University of Rome “La Sapienza” in Dentistry and Dental Prosthetics. She has been ordinary member of the SIE since 2001 and active member since 2004. Worked as contracted professor of Endodontics at the

“Magna Grecia” University of Catanzaro from 2010 to 2015. She has been working as contracted Endodontics professor at the “Vita Sa-lute” University of San Raffaele in Milan since 2016. Regular speak-er in national and international conferences and author of many articles focused on Clinical Endodontics.

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MODERN CLINICAL ENDODONTOLOGY: A NUMBERS GAME - FAKE NEWS OR NEW FAKES?MODERNA ENDODONZIA CLINICA: UN GIOCO DI NUMERI - FAKE NEWS O NUOVI FAKES?

Patrick Sequeira-Byron

✎ ABSTRACT

When Altman wrote that much medical research was ‘seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis and faulty interpretation’, it set wheels in motion that touched even the realms of the endodontium. But now, 22 years later, how do we match up to the task - and what is our prognosis?At the core of our discussions will be a portfolio of Cochrane reviews in endodontology, interspersed with clinical tenets. The aim, as suggested by the title is to map out the landscape of current endodontology knowledge and the research required to fill in the gaps.This will be made with special reference to current activity in surgical science, of which clinical endodontology is a part, and will include the IDEAL collaboration, the COMET initiative and the EBM Manifesto.(Altman DG. The scandal of poor medical research. BMJ 1994;308:283-4)

PATRICK SEQUEIRA-BYRONHe is a Swiss Certified Endodontologist and Senior Lecturer at the University of Berne, where he leads the undergraduate and post-graduate teaching of evidence-based dentist-ry. He spends four days a week in frontline, wet-fingered, independent, clinical practice,

receiving endodontic referrals from colleagues. Previous clinical work includes posts in London, Berne, Zürich and Zug, including an instructor role in field surgery with the Swiss Army. He is a Swiss Certified Endodontologist (re-certified until 2022). His academic qualifications subsequent to BDS from Guy’s Hospital count an MSc in Evidence-Based Health Care (Green-Templeton College, Oxford) in 2002, Doctorate in Dental Medicine (Zurich) in 1992 for histo-

logical studies of human cementum and several other postgradu-ate qualifications in clinical dentistry. Increasingly he works as a research methodologist and medical statistician. Current research interests encompass surgical clinical trials methodology, spanning placebo control designs, outcome measurement in oral health, and a variety of dental intervention studies, mostly in endodontology. He is an advocate for appropriate research synthesis and Cochrane Clinical Advisor for Endodontology, always using systematic review technology and sometimes meta-analysis. He has served in many roles on the Executive, Scientific and Examination Committees of the Swiss Society for Endodontology and is past Chair of the ESE Membership Committee.

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THE OUTCOME OF ROOT CANAL TREATMENTS AND RETREATMENTS ASSESSED WITH CBCT: WHAT IS CHANGING IN EVERY DAY’S CLINICAL PRACTICE? IL RISULTATO DEI TRATTAMENTI E RITRATTAMENTI CANALARI VALUTATI CON L’USO DELLA CBCT: CHE COSA E CAMBIATO NELLA PRATICA CLINICA?

Francesco Mannocci

✎ ABSTRACT

The outcome of endodontic treatments is conventionally assessed using periapical radiographs, however in the last 6 years at least 6 outcome studies have used Cone Beam Computed Tomography (CBCT) for the same pur-pose. These studies have shown a significantly lower success rate compared to that normally observed with periapical radiographs.This lecture will summarize the finding of the CBCT outcome studies published so far and will also include some in press data on outcome studies comparing different endodontic instrumentation techniques and single vs two visit endodontics in relation to primary treatments and retreatments.

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The factors associated with the failure of root canal treatments including the presence of residual bacteria, coro-nal leakage, micro-cracks development will be discussed.In press data on the survival of root canal re-treated teeth will also be presented.

FRANCESCO MANNOCCIHe is a Specialist in Endodontics and Restor-ative Dentistry.  He obtained his MD (Pisa, Italy, 1986) and DDS (Pisa, 1990) in Italy, and  his  PhD in Clinical Dentistry from King’s College London in 2001. After having worked in private practice in Pisa for 18 years while

collaborating with the University of Siena as a Visiting Professor he  became Lecturer in Endodontology at King’s College London in 2004,  Senior lecturer/Honorary Consultant in 2006, Head of

Endodontology in 2008, and Professor of Endodontology at King’s College London in 2011. Prof. Mannocci has authored more than 120 papers in international peer reviewed journals. Prof. Mannoc-ci is Associate Editor of the International Endodontic Journal. Prof. Mannocci has done research work on subjects including restoration of endodontically treated teeth, instrumentation techniques, den-tal anatomy, histology, endodontic radiology and endodontic mi-crobiology. Prof. Mannocci maintains a private practice limited to Endodontics in Central London.

SESSION VILECTURE ROOM CARAVELLA/SANTA MARIA

Chairmen: Clara Spatafore - Mauro Rigolone

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PROCEDURES AND PROTOCOLS FOR SUCCESSFUL ROOT CANAL RETREATMENTSPROCEDURE E PROTOCOLLI PER IL SUCCESSO NEI RITRATTAMENTI CANALARI

Walid Nehme

✎ ABSTRACT

Root canal retreatments are a challenge, with a level of difficulty dictated by the different filling materials that may vary by nature or position and by previous mishaps such as root perforations, canal transportation, canal ob-structions. These factors might hinder the clinician from achieving a thorough cleaning and shaping of the whole canal system and can make retreatment a stressful and time-consuming procedure. In this presentation, a large number of techniques and procedures will be reviewed and Clinical mishaps will be addressed, with an active and cognizant approach during the various phases of the treatment, with an emphasis on prevention, which will allow the clinician to conclude a successful treatment. A didactical description of clinical procedures used for a complete disassembly; the removal of root filling materials, separated instruments and posts; and the localiza-tion of untreated canals. Multiple representative clinical cases will be reviewed for discussion.At conclusion, participants should be able to: - Describe and perform several methods for coronal disassembly and canal exploration upon non-surgical re-

treatment. Describe and perform post removal of Pre-formed SS, gold, ceramic and fiber. - Describe and perform a wide range of clinical techniques to safely remove different root canal pastes, carriers,

separated instruments and silver points without compromising the outcome of the retreatment procedures with clinical mishaps.

- Evaluate the risks and prognosis of each treatment option.

WALID NEHMEHe is a clinical professor at the Endodontic de-partment of Saint Joseph University of Beirut, where he received his DDS (1988) and MSc (1994). His academic activities lie within the field of undergraduate and postgraduate end-odontic education and emphasizes on clinical

training and conduction and surveillance of research projects. Pr Nehme has published scientific, and clinical articles in peer-re-viewed journals nationally and internationally on subjects includ-ing Root canal anatomy, instrumentation techniques, NiTi files,

Irrigation procedures, obturation and retreatment. He is an interna-tional member of the American Association of Endodontists (AAE). He served as President of the Lebanese Society of Endodontology (LSE). He is a founder member and former president of the Arab Endodontic Society (AES). He is an analyst and opinion leader for clinical trials for endodontic manufacturers and have contributed to the elaboration of new devices in endodontics. He runs postgrad-uate endodontic courses and hands on in the Middle East, Africa and Europe and Canada. He works in a referral-based practice limited to endodontics in Beirut, Lebanon and Abu dhabi, United Arab Emirates.

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CLINICAL STRATEGIES IN TEETH WITH ENDODONTIC COMPLEX ANATOMY: WHAT IS BEST AND WHY STRATEGIE CLINICHE IN DENTI CON ANATOMIE ENDODONTICHE COMPLESSE: QUALI SOLUZIONI PREFERIRE E PERCHÉ

Giuseppe Cantatore

✎ ABSTRACT

Today, too many teeth are extracted in favor of implants, since extraction is perceived as easier and more lucra-tive than saving a natural tooth, which may require more knowledge for proper periodontal and endo-restorative treatment planning. Extraction and implant placement have been recommended for periodontally compromised teeth, in esthetically challenging situations, or when an endodontic retreatment is needed.However, endodontic therapy per se has proven to be highly favorable. Indeed Endodontic treatments and even retreatments, correctly carried out, show long term success rate comparable or higher than that of implants. This lecture will be dedicated to the Dentist and Specialist who still believe that saving our patient’s teeth should be our duty and our mission. The lecture will focus on the following topics: - Treatment planning in endodontic complex cases: criteria to evaluate their feasibility and long term prognosis. - The importance of CBCT for correct diagnosis, treatment planning, early evaluation of periapical radiolucencies

and follow-up. - Why is important to have a CBCT scanner in our Clinics. Clinical tricks and new softwares to get more useful

informations from a CBCT scan. - New technologies to improve shaping and disinfection of the root canal system. - Erbium YAG laser and their use in infected canals: advantages and limits. - Endodontic Retreatments and their limits: Orthograd or Surgical Retreatment?

All topics will be treated with the help of a rich visual documentation based on CBCT Scans and HD “in vivo” videos.

GIUSEPPE CANTATOREHe graduated in Medicine in 1980 at the Uni-versity of Rome “La Sapienza”. In 1983 he specialized in General Dentistry at the same University. Prof. Cantatore taught Endodontic at the University of L’Aquila from 1987 to 1991 and of Rome “La Sapienza” from 1992 to 1998.

From 2000 to 2014 he has been Associate Professor of Endodontics at the University of Verona-Italy. From 2014 he is Professor of End-odontics and Restorative Dentistry at the University San Raffaele in Milan. In the same University Professor Cantatore is Coordinator of the Deparment of Carious Pathology. Dr. Cantatore is Author of more than 100 articles mostly related to Endodontics published on

National and International Dental Magazines. As an International Speaker Dr. Cantatore gave Precongress Courses, Workshop and Presentations during the most important International Meeting; among them the American Association of Endodontists, the IFEA (International Federation of Endodontic Associations), and the Eu-ropean Association of Endodontists (ESE). At the present moment Dr. Cantatore is Past-President of the European Society of Dental Microscopy (EFAM), Past-President of the Italian Society of Endo-dontists (SIE), Past President of Italian Association of Dental Mi-croscopy (AIOM), and honorary member of the Libanese Society of Endodontics. Dr. Cantatore lives and works in Rome with clinical practice limited to Endodontics.

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CAD CAM SOLUTIONS FOR POST-ENDODONTICS RESTORATIONS SOLUZIONI DIGITALI PER I RESTAURI POST-ENDODONTICI

Massimo Gagliani

✎ ABSTRACT

The importance of the coronal seal have been already demonstrated by several studies and it should be consid-ered a fundamental phase of the endodontic treatment itself. The reconstruction of endodontically treated teeth should be routinely accomplished by adhesive procedures, both in direct and in indirect ways; these procedures represent a challenge for the clinician. In these cases, most of the time, the residual tooth structure is very lim-ited and a careful attention should be paid to the type of hard tissue available and to all the surrounding peri-

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odontal tissues. Many studies advocated a superior performance of complete vs. partial restorations, but many of these reports should be reviewed and no conclusive data are yet available.Inlay, onlay or overlays are the most recognized type of indirect partial reconstructions; they are made by dif-ferent materials. Composite, glass and feldspatic ceramics are now available for modern CAD/CAM chairside devices and all of them are suitable to make indirect restoration; longitudinal studies report excellent outcome results and, the improvement of these techniques might encourage further types of reconstruction, particularly those named “endocrowns”.A comprehensive and fully documented overview on indirect partial extensive adhesive restorations, with or without intracanal adhesive endo-posts, will be illustrated and proposed as a reliable alternative to complete prosthetic crowns in all posterior teeth, to induce the clinicians to preserve sound tooth structure and to supply a better interface with all the periodontal tissues.

MASSIMO GAGLIANI Born in Milan on November 12, 1958, he got the Degree in Medicine on 1983. Specialty in Dentistry on 1987, Specialty in Orthodontics in 1989. He devoted his research activity on Restorative Dentistry and Endodontics since 1990, he became Researcher at the University

of Milan in 1992; in the same University was upgraded to Associate Professor in 2000. Actually he is the chief of the Restorative & End-odontics Dept. at the Dental School “Giorgio Vogel”, DDBS, Univer-sity of Milan. He is an Active Member of the major international and national Society on Restorative & Endodontics such as: ESE, AAE,

AIC, SIE, SIDOC. He is one of the five founders of the Digital Dental Academy (DDA). He published in all the major international journals several papers on Restorative & Endodontics topics. He, also, pub-lished chapters and was Editor in several books on Restorative and Endodontics topics. He is Member of the Editorial Board in some of the most respected italian journals and Scientific Coordinator for Editorial Group EDRA (active also in Poland and Spain) publisher of: Dental Cadmos (the oldest journal in Dentistry published in Italy) and of the website www.Odontoiatria33.it; formerly he was Editor in Chief of the Italian Journal of Endodontics (Giornale Italiano di Endodonzia).

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ADHESIVE POST-ENDODONTIC RESTORATIONS: RESEARCH CONCEPTS TRANSLATED TO DAILY CLINIC SCENARIOS RESTAURI ADESIVI DIRETTI POST-ENDODONTICI: DAL LABORATORIO ALLA CLINICA

Massimo Giovarruscio, Salvatore Sauro

✎ ABSTRACT

Materials used for restorations of endodontically treated teeth such as composites, cements and bonding sys-tems have improved considerably over the last ten years. Nevertheless, shortcomings such as biocompatibility, premature bond reduction, interface and marginal degradation (i.e. gaps) are still considered important issues that may increase the risk for root canal retreatments. Enzymatic degradation of collagen fibrils within the restoration interface, along with hydrolysis of polymers are the important factors thought to jeopardise the durability of adhesive post-endodontic restorations. However, when bioactive restoration approaches are performed in combination with “smart” restorative materials, these may interact therapeutically with dental hard tissues and reduce the degradation processes at the interface via remineralisation, so improving the durability of the bonding and sealing of adhesive post-endodontic resto-rations. This may also play an important role in caries prevention as well as in reducing the risk for endodontic retreatment due to root canals reinfection via the marginal gaps of post-endo restorations. The use of innovative therapeutic approaches able to “repair” fractures and gaps through remineralisation processes, might increase the survival rate of restorations performed in compromised clinical situations. Innovative “bioactive strategies” able to induce mineral deposition at the interface between materials and dental substrates or fibres-reinforced posts will be proposed as possible alternative to common “passive” restorative procedures. Thus, it is time for academic dental research, clinicians and dental industry to cooperate in the development and application of smart and more biocompatible therapeutic materials and clinical approaches that may enhance the longevity of adhesive post-endodontic restoration, rather than attempting to improve “passive” restorative approaches and materials. These latter are also frequently characterised by important toxicity due to elution of components con-tained in the light-curable resin-based materials, especially when these materials are not appropriately handled.

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MASSIMO GIOVARRUSCIOHe is highly skilled professional, with exten-sive experience in Endodontics, Restorative and Aesthetic Dentistry. With over 20 years’ experience in dentistry, he has developed his reputation within the profession as an excellent clinician and endodontist. He is

accredited Specialist in Endodontics and he is a Clinical Teacher in Endodontics at King’s College London Dental Institute to both Undergradute and Postgraduate students. Visiting Professor at Universidad CEU Cardenal Herrera Valencia, Master Internacional en Odontologia Restauradora y Endodoncia. He works in Rome, Bristol and London, specialising in Endodontic Treatment and Res-

toration of Endontically Treated Teeth and is regarded as an World Opinion Leader in Endodontics and restorative procedures related to the endodontically treated tooth. He lectures world-wide and has published many articles in International journals, and wrote several endodontic chapter and manuals recognized and used by the Uni-versity. Active member of the European Society of Endodontology, British Academy of Aesthetic Dentistry, Italian Society of Endodon-tics. Massimo is also a member of Styleitaliano Endodontics, the largest Dental Study Group in the web, with the mission of setting excellence standards while simplifying protocols in this vast world of Endodontics.

SALVATORE SAUROCurrently professor in dental biomaterials and minimally invasive dentistry, coordinator of the “Dental Research” and Director (Principal Investigator) of the research group “In Situ Dental Tissues Engineering and Minimally In-vasive Therapeutic Adhesive Rehabilitation”

at the University CEU Cardinal Herrera of Valencia. Professor Sauro is also honorary senior lecturer, Biomaterials, Biophotonics and Tissue Engineering, King’s College London Dental Institute (KCLDI) at Guy’s Hospital, London (UK) and Visiting Professor, Federal Uni-versity of Ceará, School of Dentistry, Fortaleza, Brazil. He obtained his Ph.D (2009) in “Dental Biomaterials Research Pre-clinical Den-tistry”, and then continued with a position of post-doctorate/re-search associate in “Dental Biomaterials/Pre-clinical Dentistry” at King’s College London Dental Institute, London. He also worked for

2 years as research assistant in “Dental Biomaterials and Adhesive Dentistry” at the University of Granada, Spain. Professor Sauro has been working in dental biomaterials, preventive and minimally in-vasive dentistry research for approximatively 15 years achieving a H-Index in JCR of 25. He collaborates with internationally renowned researchers, and he has published more than 100 articles in inter-national peer-review journals with high impact in the dental field, more than 150 abstracts of research in international conferences, two international patents and 3 chapters in scientific books. Pro-fessor Sauro is also part of the “editorial board” of the Internation-al Journal of Adhesion and Adhesive, Oral Clinical Investigation, International Journal of Endodontics, Journal of Endodontics and the Journal of Dentistry and a member of the “IADR - Internation-al Association of Dental Research” and “AMD - Academy of Dental Materials”.

RESEARCH SESSION

Part 1

LECTURE ROOM NEWTONChairmen: Eva Amoroso D’Aragona - Stefano Salgarello

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PUSH-OUT BOND STRENGTH TO RADICULAR APICAL-THIRD DENTINE OF DIFFERENT RETRO-FILLING MATERIALSVALUTAZIONE QUANTITATIVA DELLA FORZA DI ADESIONE ALLA DENTINA RADICOLARE DEL TERZO APICALE DI DIFFERENTI MATERIALI DA RETROFILLING

Valentina Eva Biesuz, Giuseppe Merlati, Valeria Edefonti, Marco Bucci*, Dino Re

INTRODUCTIONMineral trioxide aggregate (MTA) is a Portland cement-derived hydraulic material that has been widely used in a variety of applications in endodontics as supported by a broad body of evidence. MTA has excellent physical and biological properties such as biocompatibility, bioactivity, and sealing ability. Biodentine® is defined as a special micronized concrete derived from the main component of Portland cement, tricalcium silicate. With phys-ical properties far superior to those of MTA, especially in terms of setting time and compressive strength, it exhibits the same characteristics of biocompatibility and sealing ability, after setting in an alkaline pH, with controlled (size and spatial organization) formation of calcium salts. The present study aimed to investigate the bond strength to root dentin of a retro-filling canal sealer (Biodentine®) by using Pro-Root™ as control material for comparison. 

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OBJECTIVETo evaluate push-out bond strength to radicular canal dentine of BioDentine® (BD) as compared with Pro-Root™ (WPR-MTA). In particular researchers want to evaluate the bonding’s success and, in case of failure, to deepen these topics: 1. adhesive failure between sealer and dentin. cohesive failure within sealer. mixed failure when both cohesive and adhesive failures were observed. 

MATERIALS AND METHODS80 dentinal slices obtained from the apical third of freshly extracted single and multi-rooted human teeth were randomly divided into two groups (n=40) according to the used test material: Biodentine (BD) or ProRoot White MTA (PR-WMTA). After canal space preparation the test materials were placed into the lumen of the slices. After that the samples were thermocycled (5.000 cycles) and so they underwent push-out test. During the test the maximum force applied to the materials at the time of dislodgment was recorded and the slices were then exam-ined under a stereomicroscope at x24 magnification to determine if bond failure took place and its nature. Data were subjected to: 1) Shapiro-Wilk normality test and 2)Mood’s median test to compare means of push out bond strength; 3) Chi-square test to determine if there is significant association between the type of material and the type of failure. 

RESULTSThe mean push-out bond in N of BD and PR-WMTA were 13,7 and 7,3 respectively. There was significant difference between the means with the results of the first material overtaking the other of more than 40%. Under stereo-microscope PR-WMTA showed a majority of adhesive failure; BD showed the same result, but the percentage of cohesive fracture was higher than PR-WMTA’s. We observed mixed failure in both groups.

DISCUSSIONThe bond strength of endodontic materials is a very important factor in clinical practice. These materials used to seal the external surface of the roots should be able to prevent bacterial leakage between the pulp and the periradicular tissues, remaining in place under dislodging forces. To assess bond strength, the push-out test has been shown to be efficient and reliable. The published literature on the bond strength of both BD an WMTA is limited, there is only another recent study that compares the push-out bond strength between these materials. A previous study by Gusner et al (2013) showed significantly higher retention in BD than WMTA. In this study like in Gusner›s one samples were exposed to saline solution before testing and this, according to Gusner›s findings, may have greatly increased BD push-out bond strength. Moreover BD seems to perform a little flexibility before being pushed out. There are no findings in the literature about this behavior.

CONCLUSIONMTA based materials performed a revolution in endodontics. Their properties provided a higher percentage of success in surgery and retreatments. Evolutions of this material seems to achieve higher performances in han-dling, setting time and adhesion. Further studies will deepen the elastic properties of these materials.

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BACTERIAL COLONIZATION IN FURCAL PERFORATION SEALED BY DIFFERENT MATERIALS: A CONFOCAL LASER SCANNING MICROSCOPY STUDYCOLONIZZAZIONE BATTERICA IN PERFORAZIONE DELLA FORCAZIONE SIGILLATA CON DIVERSI MATERIALI: UNO STUDIO AL MICROSCOPIO LASER CONFOCALE

Shlomo Elbahary*, Sohad Haj-Yahya, Eyal Rosen, Cemre Koç, Igor Tsesis

INTRODUCTION Furcal perforation may be the consequence of procedural error or a pathologic process such as caries and root resorption. Understanding of the pathological process following perforation repair requires an experimental model, which should enable not only to assess the ability of the repair material to prevent bacterial migration through the filled root but also to track and quantify the microbial colonization within the root canal space, at the filling-dentine interfaces and in the dentinal tubules.

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OBJECTIVESThe aim of the present study was to evaluate Enterococcus faecalis colonization of furcation perforations re-paired with different materials by using confocal laser scanning microscopy.

MATERIALS AND METHODSFifty-five extracted human mandibular molars with closed apex and completely distinct roots were selected. Teeth with cracks, carries or resorptions were excluded from the study. The occlusal surface of the crowns and 5 mm of the apical portion of the roots were cut, perforation defect was created on the furcation area. The samples were randomly divided into five experimental groups, in each one different repair material (MTA-Angelus, MTA Cem, Biodentin) has been used. Each specimen was filled from the coronal part of the root canal with the freshly prepared E. faecalis bacterial suspension, After 21 days of incubation, the specimens were cut perpendicular to the long axis of the root. The samples were stained using LIVE/DEAD BacLight BacterialViability for staining of the biofilm. Immediately after the staining procedure, fluorescence from the stained bacteria was observed under a confocal laser scanning microscope (CLSM). The mesial, distal, buccal, and lingual areas of the specimens were evaluated by the software as follows:1. The size of fluorescent staining within the evaluated areas, as calculated by the software.2. The viability of the colonized bacteria evaluated as the proportion of live and dead bacteria: the values of

green fluorescence (live cells) and red fluorescence (dead cells) 3. The depth of bacterial colonization into the dentinal tubules was measured and recorded considering the

perforation wall as the starting point.

RESULTS There were not significant difference Between the stained areas (buccal, lingual, mesial and distal directions), in all groups (p >0.05) There was no significant difference (P>0.05) between different materials and stained area both Total and in Dead: Live ratio where performed. There were significantly more dead bacteria than live bacte-ria on filling surface (p < 0.05) and significantly more live bacteria than dead bacteria around the filling (buccal, lingual, mesial and distal directions) (p < 0.05) in all the experimental groups. Live: Dead bacteira ratio was sig-nificantly bigger in the MTA Angelus comparing the other groups (P<0.05). No significant differences were found regarding the depth of bacterial colonization into the dentinal tubules between the evaluated materials.

DISCUSSIONSPrevious studies were limited since they were using indirect models, incapable of evaluating the actual routes of bacterial penetration and colonization. To our knowledge, this is the first study that evaluated the bacterial colonization in Perforation site in extracted human teeth following the placement of repaier material, using CLSM which considered as useful as the traditional microbiological histological standard electron microscopy and as PCR-based techniques and along with the live/dead staining method, it provides also information the vitality of bacteria in the infected dentinal tubules in situ.

CONCLUSIONSFrom the perspective of statistical analysis, there was no significant difference in terms of microleakage, but descriptively the colonization area scores distribution obtained by the Biodentine sample group was better than the MTA Angelus and CEM groups. The depth of bacterial penetration into the dentinal tubules was not affected.

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THE EVALUATION OF POST-OPERATIVE PAIN AFTER MULTIPLE-VISIT ROOT CANAL TREATMENTS WITH 2 DIFFERENT ROTARY NI-TI INSTRUMENT TYPES: A CLINICAL PROSPECTIVE STUDYVALUTAZIONE DEL DOLORE POST-OPERATORIO DOPO IL TRATTAMENTO CANALARE IN PIÙ SEDUTE UTILIZZANDO DUE DIFFERENTI STRUMENTI ROTANTI NI-TI: UNO STUDIO CLINICO PROSPETTICO

Chiara Pirani, Ashkan Karami Shabankare*, Francesco Iacono, Luigi Generali,

Fausto Zamparini, Maria Giovanna Gandolfi, Carlo Prati

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INTRODUCTIONThe post-operative pain (PP) of mild intensity is a common consequence of root canal preparation and is con-sidered a complex multifactorial process. Many factors inherent to patients, to the tooth and to the skills of the operator can influence the prevalence of PP.

OBJECTIVES OF THE STUDYTo investigate the incidence of and the factors influencing the PP after root canal treatments (RCT) associated to 2 different NiTi rotary instruments and to test the study method on a pilot sample.

MATERIALS AND METHODSThis observational prospective study was conducted in the Endodontic Department, University of Bologna. Thir-ty-three consecutive patients requiring management of endodontic disease and responding to the inclusion cri-teria were selected. Written informed consent was obtained from every involved patient. RCT were performed in multiple-visit, avoiding the risk that post-obturation pain could alter the results. Patients were given a ques-tionnaire to record the intensity and duration of post-endodontic pain, to be returned during the following set-ting. The enrolled clinicians were both endodontists (n=2) and postgraduate master’s students (n=14) operating under the supervision of trained tutors. The patient was questioned about the presence of preoperative pain in the previous 24 hours. The presence of Peri-Apical Lesion was assured by a value of Peri-Apical Index (PAI) ≥ 3, following Ørstavik et al. directives. The Curvature Radius was divided in 3 groups (straight, moderate or severe). After gaining straight access and removing interferences, the working length was electronically established and confirmed by an intraoperative radiograph. A manual glide path was then achieved using K-files up to 20 size. Mechanical preparation was performed using 2 different NiTi rotary systems with rotational speed and torque value adjusted according to manufacturer instructions. Used irrigant solutions were 5% NaOCl alternated with 1 to 3 mL of 10% EDTA. Obturation of the canal space with resin cement and carrier-based system was performed after 7 days and the PP was recorded as described. Both demographic and clinical variables were recorded in order to study their correlation in the aetiology of PP: patient, shaping and tooth-related factors were registered and statistically analysed. Distribution, intensity and duration of PP were evaluated with the aid of a 100 mm Visual Analogue Scale (VAS) at 24, 48, 72 hours and 7 days after initial appointment. Mean value or frequency distribution were carried out to describe quantitative or categorical parameters. Friedman test and Wilcoxon tests were used in comparison of VAS among time and between values (instrumentation and obturation at each time). Kruskal-Wallis test was performed aiming to compare VAS among curvature degree. α level was set at 0.05.

RESULTSMean value of preoperative VAS was equal to 3.4±3.5 cm. Preoperative visual analogue scale measurements were always significantly different from Vas instrumentation and for obturation at each time (p=0.001), except at 24h. Significant differences were observed concerning the presence of pre-operative pain among the PP curvature (p=0.02). As for VAS relative to instrumentation in comparison with obturation, the only significant difference was observed at 24h, being the first higher than the second (p=0.024). Generally VAS mean values relative to instrumentation are higher than those of obturation. No significant differences were observed in VAS among dif-ferent curvature degrees.

DISCUSSIONThe VAS is commonly used to represent pain intensity because of its reliability and validity. The use of more flex-ible NiTi instruments can be considered an important factor in determining a lower incidence and intensity of PP, by reducing apical transportation and by avoiding to push debris apically.

CONCLUSIONThe prevalence of PP after RCT was significantly affected by the presence of pre-operative pain.

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INFLUENCE OF DIFFERENT OPERATIVE PROTOCOLS ON TWO IRRIGANT ACTIVATION TECHNIQUES OF CANAL CLEANLINESS: A SCANNING ELECTRON MICROSCOPE EVALUATIONINFLUENZA DI DIVERSI PROTOCOLLI OPERATIVI IN DUE TECNICHE DI ATTIVAZIONE DELL’IRRIGANTE SULLA DETERSIONE CANALARE: VALUTAZIONE AL MICROSCOPIO ELETTRONICO A SCANSIONE

Daniele Angerame, Matteo De Biasi*, Laura Morelli, Lorenzo Bevilacqua, Vittorio Franco

INTRODUCTION The removal of pulp tissue remnants, microorganisms, and their toxins from the endodontic space is a prerequi-site for healing of lesions of endodontic origin. Sodium hypochlorite and ethylenediaminetetraacetic acid (EDTA) solutions are two of the most widespread irrigants and are often used in combination because they have different action on organic and inorganic matter. Canal cleanliness can be optimised by various irrigant activation sys-tems; passive ultrasonic irrigation (PUI) is surely one of the most tested and effective. The XP Endo Finisher (XPEF; FKG) is a recently developed nickel-titanium instrument specifically designed to clean the endodontic space after shaping, whose action on smear layer and debris removal has been studied preliminarily.

OBJECTIVESTo evaluate the influence of different protocols for irrigant solution activation on the removal of smear layer and debris.

MATERIALS AND METHODS Fifty-six single-rooted extracted teeth were decoronated with a cutting disc. The root canal was scouted and working length determined with a #10 stainless-steel manual file. Canal shaping was performed with BT Race files (FKG) up to size 40/.04. The canals were continuously rinsed with 2 ml of 5% sodium hypochlorite; then, a final irrigation with 3 ml of distilled water was performed. The roots were randomly attributed to a control and six experimental groups (n=8). In the control group, canals were rinsed with 17% EDTA for 3 minutes and 5% sodium hypochlorite for 3 minutes. The same irrigation protocol was carried out in the following six test groups, which entailed the use of either the XPEF or an ultrasonic tip (Irrisafe, Satelec Acteon): G1, EDTA with XPEF + NaOCl; G2, EDTA + NaOCl with XPEF; G3, EDTA + NaOCl, both with XPEF; G4, EDTA with PUI + NaOCl; G5, EDTA + NaOCl with PUI; and G6, EDTA + NaOCl, both with PUI. Smear layer and debris formation was scored at the scanning electron microscope referring to the Hülsmann scale. Non-parametric statistical analyses were conducted for the compar-ison of smear layer and debris scores both between and within the groups (p<0.05).

RESULTSCanal cleanliness was suboptimal irrespective of the considered group. Smear layer was predominantly observed in the middle and apical thirds; debris accumulated in the canal wall irregularities of the coronal and middle thirds. The coronal third showed better canal cleanliness followed by the middle and apical thirds. Fewer debris particles were detected in the coronal and middle thirds of the XPEF groups, while PUI yielded better smear layer removal. Sodium hypochlorite activation alone or in combination with EDTA activation led to worse smear layer and debris scores compared to the control group and EDTA activation groups.

DISCUSSIONThe action of XPEF appeared to be more effective in removing debris of larger size, probably because of its contin-uous bumping action against canal walls. PUI agitation mainly improved smear layer removal by heating, acoustic streaming and cavitation, but was less effective in debris removal due to the lack of a vigorous mechanical action. EDTA is generally considered effective in the removal of the smear layer in comparison with other substances; accordingly, our study confirmed that EDTA activation can improve canal cleanliness in comparison to sodium hypochlorite, given its incapability to dissolve inorganic substrates.Conclusion: XPEF and PUI improved canal cleanliness in different ways but could not remove the smear layer and debris completely. The sole activation of EDTA appears preferable over the other protocols tested.

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SMEAR LAYER REMOVAL ABILITY OF FOUR DIFFERENT IRRIGATION SYSTEMS. FESEM EVALUATION IN AN EX VIVO STUDYABILITÀ DI RIMOZIONE DELLO SMEAR LAYER CON QUATTRO DIFFERENTI SISTEMI DI IRRIGAZIONE. ANALISI FESEM IN UNO STUDIO EX VIVO

Manuele Mancini, Pietro Palopoli*, Loredana Cerroni, Giovanni Olivi, Matteo Olivi, Cristiano Buoni, Luigi Cianconi

INTRODUCTIONShaping the endodontic space produces a thin amorphous layer, known as the smear layer. Its persistence after root canal instrumentation may jeopardize the clinical result. For its removal, a post-shaping alternating irriga-tion with EDTA and NaOCl is recommended. To enhance these irrigants’ distribution and effectiveness in areas difficult to access, such as the apical area, several activation techniques have been developed. Keeping the apical preparation as wide as possible was once suggested to increase the cleanliness of the canal’s apical third. Today, instead, great importance is given to dentin preservation. In fact, new instruments have been designed in order to better respect the tooth structure, such as TRUShape files (Dentsply). 

OBJECTIVESThe aim of this study was to compare the smear layer removal in the apical third after final irritants activation with Sonic [EndoActivator, (EA)], Ultrasonic [EndoUltra, (PUI)] and Laser (PIPS and SWEEPS) activation in mini-mally shaped canals. This is the first study testing SWEEPS, a novel laser technique which, differently from PIPS delivers pairs of individual pulses, aiming to increase the turbulent photoacoustic agitation. Moreover, to date, no study tested TRUShape in relation to smear layer removal.

MATERIALS AND METHODSEighty-five single-rooted human teeth were selected for the study. Only teeth with intact and mature root apices and similar length were selected. After an access cavity was created, a #10 K-file was inserted into the canal until the instrument tip was visible at the apical foramen. The root lengths were standardized to 20 mm by grinding of the crowns. To simulate clinical conditions, apices were sealed with composite. Specimens were shaped to TruShape 25/.06 and irrigated with 5.25% NaOCl, and then divided into 5 groups: (1 control [n=5] and 4 tests groups [n=20]) according to the final activation technique (EA, PUI, PIPS and SWEEPS). EDTA followed by NaOCl and then again EDTA was activated for each test group. Specimens were then split longitudinally and observed by Field Emission Scanning Electron Microscopy. Blinded evaluation of the presence of smear layer at 1, 3, 5 and 8 mm from the apex was performed at 1000X magnification. Cleanliness was evaluated according to a 5-score index system codified by Hulsmann. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests.

RESULTSEndoActivator was as efficient as EndoUltra in removing the smear layer at 1, 3, 5 and 8 mm from the apex. When the samples were exposed to irrigants with laser activation, their effect on the dentinal surface was enhanced. In fact, PIPS and SWEEPS removed significantly more smear layer than PUI and EA at 1 mm from the apex, although no statistically significant differences were found between the two systems’ effectiveness. Every technique per-formed better than the control group. As expected, all groups showed increased smear layer removal, moving apically to coronally. No technique was able to completely remove the smear layer in any sample.

DISCUSSIONDifferently from other studies, apical preparation was not specifically extended in order to allow ade-quate flow of irrigants to the apex. Canal enlargement may compromise the integrity of the tooth while ram-ifications may still remain untouched. Thus, in our investigation, canal shaping was kept minimal (25, .06).  This minimally invasive shaping may be considered too small for syringe irrigation to be effective, enlightening the need for irrigants’ activation.

CONCLUSIONThe challenge for future Endodontics is to provide enhanced cleanliness while saving as much restorable tooth as possible. In our study none of the activation systems completely removed the smear layer from the endodontic space. Nevertheless, PIPS and SWEEPS showed the best results in conservative canal preparations.

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ENDODONTICS OR IMPLANTS? 4 YEARS RESULTS FROM A CLINICAL “BEST PRACTICE” COHORT STUDY. TRATTAMENTO ENDODONTICO O IMPIANTO? RISULTATI A 4 ANNI DA UNO STUDIO CLINICO “BEST PRACTICE”

Fausto Zamparini*, Andrea Spinelli, Chiara Pirani, Paul Dummer, Maria Giovanna Gandolfi, Carlo Prati

INTRODUCTION The survival rate of endodontically treated premolars is still a great clinical challenge. Anatomical conditions, root canals or periapical infections are clinical limits and may represent clinical criteria to replace teeth with osseointegrated implants. On the other hands, surgical and economic problems may force to keep premolar and preserve their function.

OBJECTIVES This longitudinal “best practice” retrospective clinical study was designed to evaluate the critical steps in the de-cisions to treat or replace compromised premolars and molars affected by periapical lesions and/or deep carious lesions. Survival rate and other critical parameters were evaluated after 4 years.

MATERIALS AND METHODS Patients (n=53) treated from January 2007 to December 2014 in the Clinical Endodontic Section of the School of Dentistry. Preoperative periapical status (periapical radiographs and clinical symptoms/signs) scored as peri-apical index (PAI), crown condition, post presence, periodontal parameters and condition of crown tissue were obtained by the medical record of each patient. The reasons to extract or to perform endodontic treatment/retreatment was recorded. Teeth were endodontically treated (group EnT; n=34) or extracted and replaced by im-plant (group ImP; n=38). Each patient was recalled after 6 months to monitor the therapy and re-evaluated after 4 years for survival rate of tooth/implant, bone defects around tooth/implant, periodontal parameters around tooth/implant, secondary caries. Time to complete the therapy and cost for the entire treatment (endodontic treatment/post/provisional and definitive crown versus extraction/implant placement, provisional and definite crown) were calculated by the university price list.

RESULTS One patient was excluded from the study as not able to attend the recall program. At 4 years, survival rate was 91.2% for EnT group and 97.3% for Imp group. One patient in ImP group lost the implant after 9 months. In one case implant abutment resulted unscrewed after 4 years, that was replaced with a new one within 15 days. No coronal chipping or other complications occurred.Three patients in EnT group had root fractures, 1 after 10 and 2 after 48 months from the root canal treatment, respectively. Three patients showed an asymptomatic periapical lesion at 4 years. The cost for the entire therapy was 2.410 Euro for group ImP versus 1.660 Euro for EnT. The number of appoint-ments was 13±3 for ImP versus 10±3 for EnT. The mean time to complete the rehabilitation was 7±2 months for ImP group versus 6±8 months for EnT. The clinical and radiographic healing time for ImP group was 6 months versus 9 months for EnT group.

DISCUSSION Under ideal conditions, both root canal treatments and implant rehabilitation shows comparable long term re-sults in terms of survival rate. When considering complications/events occurred, root canal treatments may re-sults with greater number of complication during the operative phases (i.e missed canals, root perforations, post misplacements, instrument separation). Implants, on the other hand may present more complications in the long term (i.e abutments unscrewed, coronal chipping, internal screw fracture).

CONCLUSION After 4 years both treatments showed similar results and showed a reduced number of clinical problems. Implant therapy may reduce healing time but requires a greater number of appointments and higher cost.

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A COLD ATMOSPHERIC PLASMA (CAP) PROTOTYPAL DEVICE TO ASSIST ENDODONTIC TREATMENTS: PERFORMANCE ANALYSISDISPOSITIVO PROTOTIPALE BASATO SU TECNOLOGIA DI PLASMI FREDDI ATMOSFERICI PER TRATTAMENTI ENDODONTICI: STUDIO SPERIMENTALE DELLE PERFORMANCE

Emanuele Simoncelli*, Augusto Stancampiano, Michele Manzini, Diletta Forgione,

Matteo Gherardi, Vittorio Colombo, Riccardo Tonini

INTRODUCTION Cold Atmospheric Plasma (CAP) - an ionized gas where the temperature of heavy particles is lower than the electronic temperature - has shown great potential as a new technology for dental applications, thanks to its capability of producing reactive species, radiation and electromagnetic fields while maintaining environmental temperatures. In air, the reactive oxygen and nitrogen species (RONS) produced by CAP have been shown to have high antibacterial properties against the microorganism mainly involved in root canal infections and to be able to activate (bio-)surfaces such as enamel/dentin for the enhancement of the conservative adhesive restoration. As a gaseous medium, CAP can penetrate irregular cavities, such as in dentinal tubules or apical regions.

OBJECTIVES Following these considerations, a compact CAP device, able to propagate plasma through a dielectric capillary directly to the oral cavity of the patient, was developed based on a plasma source configuration that allows to decou’ple the region of plasma generation from the one in which plasma interacts with the targeted tissue, im-proving the patient safety. Its performances were investigated in terms of antibacterial efficacy and enhancement of adhesion between dentin and the adhesive system (AS) for the coronal region and endodontic sealer (SEA) + guttapercha (GUT) for the apical region.

MATERIALS AND METHODS The evaluation of the antibacterial efficacy of plasma treatment driven by the CAP prototype was carried out on tooth models with standardized root canal, contaminated with Enterococcus faecalis (in vitro). By means of con-focal analysis, the inactivation of 24h E. faecalis biofilm was investigated along the whole length of root canals of extracted teeth. On the other hand, concerning the plasma assisted restoration of root canal, the enhancement of adhesion performances was investigated for both coronal and apical restoration of extracted teeth. The increase of bonding strength between the plasma activated dentin and the filling materials used in conventional proce-dures was quantitatively evaluated through pushout tests. SEM and confocal analyses were carried out to study the behavior of fillers interacting with the CAP treated dentin.

RESULTS Regarding bacterial inactivation, 5 minutes of CAP treatment led to a bacterial load log-reduction higher than 4 in in vitro conditions; confocal analysis also showed the plasma treatment effectiveness in reducing the biofilm along the whole length of the root canal. Concerning adhesive restoration, the pushout analysis highlighted an increase of adhesion performances for both coronal (+130%) and apical restoration (+50%). SEM and confocal images showed a deeper penetration of filling materials in the CAP treated dentin.

DISCUSSION CAP treatment can effectively inactivate bacteria, both in planktonic and biofilm state, also in the apical region, thanks to its ability to produce RONS in gas phase. The results suggest the possibility of introducing a treatment with the CAP prototype as a new step in an innovative endodontic (plasma assisted) procedure aimed at increas-ing the overall antibacterial efficacy. Also, the promising results obtained exposing the dentin to plasma before the conventional obturation procedure are directly related to the activation of dentin surface. After the correct removal of the smear layer, the plasma induced increase of wettability favors a deeper penetration of both AS and GUT in the dentinal tubules.

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CONCLUSION A CAP prototype was designed and developed as a multi-functional device for dental applications. Its efficacy was tested for both the disinfection and the restoration of the root canal, with the added value of working in the same treatment conditions. The introduction of a CAP-assisted endodontic procedure in the conventional clinics appears more and more probable, although future clinical in vivo studies are still required.

RESEARCH SESSION

Part 2

LECTURE ROOM NEWTONChairmen: Elisabetta Cotti - Vassilios Kaitsas

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THE INFLUENCE OF ULTRASONICATED OBTURATION ON THE DEPTH OF SEALER PENETRATION INTO DENTINAL TUBULES: A CONFOCAL MICROSCOPIC STUDY AND DIGITAL IMAGE PROCESSINGINFLUENZA DELL’APPLICAZIONE DI ENERGIA ULTRASONICA ALL’OTTURAZIONE CANALARE CON GUTTAPERCA VEICOLATA DA CARRIER SULLA PROFONDITÀ DI PENETRAZIONE DEL CEMENTO ENDODONTICO NEI TUBULI DENTINALI: ANALISI AL MICROSCOPIO CONFOCALE

Marco Bartoli*, Roberto Bresciani, Diletta Forgione, Mohannad Nassar, Stefano Salgarello, Riccardo Tonini

INTRODUCTIONA successful endodontic treatment depends on the elimination of pulp tissue, bacteria and their byproducts and necrotic debris from the root canal system, in addition to the entombment of any residual bacteria and the creation of an adequate seal to prevent reinfection of the root canal space and thus inducing healing of the peri-apical area. To achieve the goal of a three-dimensional canal obturation the filling materials and techniques used to place them must achieve a high level of adaptability to the cleaned root canal space and dentin walls, includ-ing penetration into the dentinal tubules if possible. The adequate penetration of the sealer inside the dentinal tubules and its adaptation to the dentinal walls may prevent leakage and entrance of inflammatory exudate, bacteria, saliva and chemical fluids to the interior of the canal. The sealer’s penetration and its antibacterial ac-tivity might also help eliminate the entombed bacteria. Ultrasonication can be applied during obturation and this might positively affect sealer penetration because the constant energy provided to the carrier by the ultrasonic handpiece push the obturation materials deep into the microscopic spaces such as the dentinal tubules. To the best of our knowledge there is no study that evaluated the effect of ultrasonication of the carrier based-obtura-tion on the sealer penetration inside the dentinal tubules.

OBJECTIVESThe aim of this study was to compare the depth of sealer penetration into dentinal tubules during obturation using three different root filling techniques and in particular to see if the application of ultrasonic energy to the carrier based guttapercha technique could improve this distinctive feature and how.

MATERIALS AND METHODSThirty single-rooted dental elements with single root canal were randomly divided in three equal groups, pre-pared and then obturated using three different filling techniques (n=10): carrier based GP (Group 1), continuous wave of condensation (Group 2) and carrier based GP technique with ultrasonic application (Group 3). The roots were sectioned at 3 and 6 mm from the apex, the samples were examined at 10x magnification from coronal to apical using a confocal laser scanning microscope. Using the a software, depth of sealer penetration was mea-sured and recorded. The canal wall served as the starting point, and sealer penetration into dentinal tubules was

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measured by 50 measurements for each section, From the 3 groups, 60 sections were evaluated at the 3 and 6 mm levels, for every single section, getting 3000 measurements, a statistical analysis was performed using Kru-skal Wallis test and Dunn post hoc Test (P<.05).

RESULTSThe ultrasonicated obturation showed the deepest sealer penetration at both levels evaluated (P<.05). A statis-tical significance between all of the techniques was found at the 3 and 6 mm levels (P≤.05; Kruskal Wallis-Dunn tests). There was statistical significance in the depth of sealer penetration between all of the groups at both levels evaluated P≤.05).

DISCUSSIONIn some papers the ultrasonication of a file to place the sealer resulted in a low penetration showing that ultra-sonic energy has the ability to create several nodes along the length of file. The differences between our study and that one is the timing of ultrasonication and the fact that in our study it was applied during the obturation phase in which a thermoplasticized guttapercha was used and not through a rigid file. Other published papers disagree, the ultrasonication method of sealer placement resulted in deeper penetration of the sealer and it was stated that it causes acoustic microstreaming of the sealer when activated giving credit to our study.

CONCLUSIONS The use of ultrasonication during obturation results in deeper penetration of the sealer in the dentinal tubules which might be eflected clinically as better sealing when compared to the other tested techniques.

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SURGICAL ENDODONTIC TREATMENT AND PERFORATION REPAIR OF A MAXILLARY SECOND PREMOLARENDODONZIA CHIRURGICA DELLO STREEPPING DI UN SECONDO PREMOLARE MASCELLARE

Massimo Calapaj*, Alfredo Iandolo, Dina Abdellatif

INTRODUCTIONThis Case Report describes the healing of a large periapical lesion related to a maxillary premolar (tooth number 2.5) that was presented 10 years ago to have endodontic treatment and prosthetic rehabilitation. The 52-year-old patient who complained of pain and mobility at chewing showed a large periapical lesion, 3rd degree mobility (Miller), a buccal fistula at the level of the middle third of the root was present clinically. Given the absence of periodontal probing, of retentive system (not caused by root fracture but due to a stripping perforation) it was inclined to a diagnosis of endodontic failure. Therefore treatment of surgical endodontics was planned with the aid of a new sealer based on MTA, which, offers reduced setting times and ease of manipulation compared to previous formulas, permitting repairing the dental elements with extensive root lesions while maintaining a high prognostic predictability.

OBJECTIVESThe aim of this case report is to evaluate the healing potential of the new MTA-based sealers used for the repair of a large root lesion (middle and apical 3°), of the distal wall of 2.5. The studies presented in the literature about the new sealers based on MTA describe an optimal marginal adaptation guaranteeing a constant seal over time, with formation of bio-reactive surfaces and deposition of apatite.

MATERIALS AND METHODSThe treatment protocol included the following phases: Antibiotic prophylaxis (Augmentin 1x2 for 6 days), anes-thesia with vasoconstrictor 1: 50.000, access to the lesion with paramarginal flap, removal of granulation tissue, cleansing and shaping of the apex and of the root stripping with ultrasonic tip (ProUltra Surgical), three-dimen-sional obturation with MTA Sealer (Tech Biosealer RootEnd Portland cement + calcium chloride + a phyllosilicate whose function is to improve the plasticity of the material and modify the sliding values mixed with Dulbecco

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solution) and positioning of equine collagen (Condress). The patient was recalled after 48 hours for control and sutures removal.

RESULTSThe patient performed follow-up radiograph at 1, 3, 6, 12 and 18 months, almost immediate lessening of pain and mobility. The patient regained the masticatory function while maintaining the prosthetic crown.

DISCUSSIONThe analysis of the results at the given time seems to demonstrate how the therapeutic choice applied has been effective given the absence of painful symptoms and dental mobility. The MTA cement used showed simplicity of manipulation in comparison to the previous formulas confirming what is present in the literature.

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POST-OPERATIVE QUALITY OF LIFE FOLLOWING CONVENTIONAL ENDODONTIC INTRA-CANAL IRRIGATION AND PIPS: A PROSPECTIVE RANDOMIZED CLINICAL STUDYQUALITÀ DELLA VITA NEL POST-OPERATORIO IN SEGUITO AD IRRIGAZIONE ENDODONTICA CONVENZIONALE E PIPS: UNO STUDIO CLINICO PROSPETTICO RANDOMIZZATO

Jessica Dagher*, Carla Zougheib

AIMThe aim of this randomized clinical study was to evaluate the effect of laser-activated irrigation by Photon-In-duced Photoacoustic Streaming (PIPS) on postoperative pain after final root canal obturation.

MATERIALS AND METHODSFifty-six patients enrolled this prospective randomized clinical trial. The 56 teeth were mechanically prepared and divided into 2 groups. In the positive control group G1, the final irrigation with 2 cc of 5.25% sodium hypochlorite (NaOCl) was done using a 27G syringe at 5mm from the determined working length. In the experimental group G2, the root canals were irrigated with 17% EDTA and 5.25% NaOCl following the PIPS protocol using an Er:YAG laser (2940 nm) with a 600µm diameter tip at 20mJ, 15 Hz, 0.3 W average power and a 50-microsecond pulse duration. Postoperatively, the patients were advised to take a minor analgesic (400mg of Ibuprofen) in case of pain percep-tion. Pain levels were assessed by a self-explanatory Visual Analogue Scale (VAS) questionnaire after 24, 48, 72 hours and 7 days. Statistical analysis was performed using a software program (SPSS for Windows, Version 18.0, Chicago, IL). The level of significance was set at α = 0.05.

RESULTSThere was no significant difference between the laser irradiated group and the control group (p<0.5). Laser acti-vation of irrigating solutions did not increase post-operative pain.

CONCLUSIONThe outcome of this investigation indicated that PIPS was as effective as conventional irrigation in relation to postoperative pain making this activation technique interesting to use for supplementary root canal disinfection.

KEYWORDSEndodontic treatment, post-operative pain, debris, irrigating solutions, laser activation, PIP.

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3D OBTURATION USING A NEW HEAT SOURCE DEVICE, THE MB SYSTEM: CASE SERIESOTTURAZIONE TRIDIMENSIONALE UTILIZZANDO UN NUOVO DISPOSITIVO DI RISCALDAMENTO, SISTEMA MB: CASI CLINICI

Marino Borrelli*, Alfredo Iandolo

INTRODUCTIONHeating devices have been produced to warm the gutta-percha during root canal obturation, and this step is an important factor for guaranteeing the hermetic seal of the root canal according to the continuous wave technique.

OBJECTIVESThe aim of this work is to demonstrate scientifically and clinically the advantages of a new heat source device.

MATERIALS AND METHODSTeeth were instrumented using K-type thermocouples, and the roots were filled with thermoplastic gutta-percha. Vertical compaction was achieved through the heat sources System B and System MB, and temperature profiles were detected by means of NI Dac Interface controlled by the LabView System. With both heat sources, higher temperature levels were recorded in the region of the root far from the apex. When the warm plugger tip was positioned at a distance of 3 mm from the root apex, temperature levels of about 180°C were used to soften gut-ta-percha, and no statistically significant differences were observed between peak temperatures developed by the two heating sources at the root apex. However, a temperature level higher than 40°C was maintained for a longer time with System MB. Several clinical cases will be presented which was done using this new heat source.

RESULTSUsing MB system a temperature level higher than 40°C was maintained for a longer time with System MB, thus, providing an adequate time for warm compaction of the gutta-percha.

DISCUSSIONThe results of this work suggest that, during clinical procedures, if a heated plugger is positioned at a distance of 3 mm from the root apex, both the heating sources tested in this in vitro study might allow for a temperature sufficiently high to soften gutta-percha. However, compared with System B equipment, a temperature level high-er than 40°C is maintained for a longer time when System MB is used, thus providing an adequate time for the clinician to perform the warm compaction of apical gutta-percha.

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A COMPARISON OF CANAL TRANSPORTATION AND CENTERING ABILITY OF ONE SHAPE AND ONE CURVE BY USING COMPUTED TOMOGRAPHYCONFRONTO NEL TRASPORTO DEL CANALE ED ABILITÀ DI LAVORARE CENTRATO DI ONE-SHAPE E ONE-CURVE CON L’UTILIZZO DI TOMOGRAFIA COMPUTERIZZATA

Walaa Awada*, Fabienne Perez, Issam Khalil

INTRODUCTIONRoot canal shaping remains one of the most important procedures in endodontic treatment.Advanced root canal preparation techniques with nickel-titanium (NiTi) rotary instruments offer the potential to avoid some of the major drawbacks of traditional instruments and device. Attempts to develop better performing NiTi instruments have included modifications in design, mode of action, and treatment of the NiTi alloy. Recently,

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thermal treatment of NiTi alloys has been used to optimize their mechanical properties, and several studies have shown this to increase the flexibility of NiTi instruments.

OBJECTIVESThe purpose of this study was to compare canal transportation and centering ability, of One Shape and a new heat treated instrument: The One curve, by using Micro CT on root canals with a severe curvature.

MATERIALS AND METHODS24 root canals with severe curvature and short radius were selected. Canal curvature was calculated by using Schneider’s technique. Canals were divided randomly into 2 groups of 12 each. After preparation with One Shape, One Curve, the amount of transportation that occurred was assessed by using Micro CT. Three sections from api-cal, mid-root, and coronal levels of the canal were recorded. Amount of transportation and centering ability were assessed. To compare the degree of canal transportation, a technique developed by Gambill et al was used.The 2 groups were statistically compared with analysis of variance and Tukey honestly significant difference test.

RESULTS AND DISCUSSIONThe canal transportation was not significantly different between the two shaping techniques in the third apical and third median, although it was significantly high with One Shape at the coronal level. The heat treatment pro-cess provides the One Curve a higher flexiblility that allows it to respect the canal anatomy better, as reflected in this study, at the coronal third. Other studies showed that instruments with high flexibility, gained after a heat treatment process, allow better respect of canal anatomy. One Shape and One Curve showed no differences in canal transportation, except for the One Curve that showed better results in the coronal level.

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THE IG-FILE USE TO GAUGE THE APICAL DIAMETER IN ENDODONTICS: AN IN VITRO STUDYIG-FILE USATO PER MISURARE IL DIAMETRO APICALE IN ENDODONZIA: STUDIO IN VITRO

Alfredo Iandolo, Dina Abdellatif, Giuseppe Pantaleo*, Michele Simeone, Sandro Rengo, Massimo Amato

INTRODUCTIONTo obtain a predictable apical sealing becomes mandatory to detect the apical diameter of the shaped canal, in order to choose the more suitable obturation tecnique (gutta-percha tips, heat carriers, thermafil obturators), and to optimize the condensation forces. Apical gauging is an essential step to obtain certain and reproducible results. Moreover, the knowledge of the right apical diameter would avoid the overfilling of root canals.

OBJECTIVESThe aim of this study is to evaluate the efficacy of the IG-File (Iandolo Gauging File), a new instrument designed for apical diameter gauging.

MATERIALS AND METHODSAfter shaping with F1 Universal Protaper, 60 roots were randomly divided into two groups and assigned to two operators, one expert in endodontics (EO) and one unexpert (UO). In each sample, after canalar curvatures had been individuated, the apical diameters were measured with the IG-File and the K-NiTi. The results were com-pared with the reference value obtained by retrograde apical gauging. The data were statistically analyzed. The statistical analysis consisted of the elaboration of categorical variables (operator experience, tooth type and presence of curvatures) frequence and percentage. Numerical variables were described as average, median and standard deviation. Statistical analysis was based on experimental questions about measurement accuracy. Re-sults were analyzed with Chi-squared test of Pearson and Fisher’ exact test to individuate variables that influence measurements accuracy (type of instrument, experience of operator and canal curvatures).

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RESULTS AND DISCUSSIONAmong 60 samples, 10% of errors were recorded when the IG-Files was used; in the K-NiTi group the incorrect measurements were 70%. In both groups (expert and unexpert) the IG-File measurements were more accurate than the K-NiTi (90 Vs 33 and 90 vs 26,7). The differences were statistically significant. In curved canals the dif-ference between measurement rates performed with both instruments was statistically significant (85,7% IG File vs 28,6% K-NiTi) as well as in the samples without curvatures (92,3% IG file vs 30,8% NiTi file). In root canals without curvatures overestimation errors in K-NiTi File group are more frequent than underestimation errors. This difference was statistically significant. A proper gauging of the apical diameter has a key role in endodontic therapy; an incorrect measurement can lead to clinical failures. This “in vitro” study highlights that IG File im-proves measurement accuracy independently from clinician experience. Furthermore, in curved canals the IG-File is more accurate than K-NiTi.

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INFLUENCE OF DIFFERENT ANGLES OF FILE ACCESS ON CYCLIC FATIGUE RESISTANCE OF RECIPROC AND RECIPROC BLUE INSTRUMENTSINFLUENZA DI DIFFERENTI ANGOLI DI INSERZIONE SULLA RESISTENZA ALLA FATICA CICLICA DI RECIPROC E RECIPROC BLUE

Giusy Rita Maria La Rosa*, Oriana Gaetana Rinaldi, Simona Boninelli,

Ernesto Rapisarda, Hyeon-Cheol Kim, Eugenio Pedullà

INTRODUCTION The inclination of file into the canal can induce a supplementary curvature in addition to anatomical ones, in-creasing fracture risk of Nickel-Titanium (NiTi) instruments due to cyclic fatigue. 

OBJECTIVESTo compare the cyclic fatigue resistance of two single file systems, Reciproc (VDW, Munich, Germany) and Recip-roc blue (VDW) with different angles of file access.

MATERIALS AND METHODS120 new Reciproc R25 (REC) and Reciproc blue R25 (REB) were divided into 8 groups on the basis of the angle of access inside the artificial canal tested (n=15): groups 1, 2, 3 and 4 included REC tested at 0°, 10°, 20°, 30° respectively and groups 5, 6, 7 and 8 consisted of REB tested at 0°, 10°, 20° and 30° respectively. Resistance to cyclic fatigue was determined by recording time (sec) to fracture (TtF) in a stainless steel artificial canal (60° an-gle of curvature and 5 mm radius), using a customized device that allows to test files with different inclinations re-spect to the standard position. The instruments were activated by a 6:1 reduction handpiece (Sirona, Bensheim, Germany) powered by a torque-controlled endodontic motor (Silver; VDW, Munich, Germany) using the presetting programs “RECIPROC ALL”. Data were analyzed by two-way analysis of variance (ANOVA) and Tukey post-hoc test with P< .05. The fracture surface of fragments was examined with a scanning electron microscope (ZEISS Supra 35VP; Oberkochen, GmBH, Germany). 

RESULTS AND DISCUSSIONCyclic fatigue resistance of REB was higher than REC at 0° and 10° (P < .05) while there was no difference for an-gle of 20° (P>.05). REC had higher TtF than REB at 30° (P < .05). Moreover, a significant difference was observed between 0° and other tested angles (P < .05) for REC instruments. Regarding REB, no statistically difference was observed between 0° and 10° (P > .05), while there was among 10°, 20° and 30° as well as among 0°, 20° and 30° (P < .05). A typical pattern of cyclic fatigue fracture was observed for all fractured files. The results of the cyclic fatigue tests are strictly related with the flexibility of the instruments tested and confirmed previous studies in which NiTi blue alloy showed enhanced mechanical properties than M-Wire NiTi. In the meanwhile, a major incli-nation of file insertion reduces cyclic fatigue of Rec blue. Consequently, it is possible to hypothesize that when the file inclination is low, metallurgical properties of blue files have a major influence on cyclic fatigue resistance while when the inclination is increased the benefits provided by the thermal treatment are reduced by the highly stress environment.

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CLINICAL THEATER I

Complex Endodontic treatment: solutions and tricks

Trattamenti Complessi: Soluzioni ed espedienti

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CAMERAL AND ENDOCANAL CALCIFICATIONS: TREATMENT APPROACH CALCIFICAZIONI PULPARI CAMERALI ED ENDOCANALARI: APPROCCIO DEL TRATTAMENTO

Lucio Daniele, Massimo Calapaj

✎ ABSTRACT

Endodontic calcifications represent an alteration of the pulp tissue that the tooth uses as a defense response to stimuli of different nature. The calcifications can be present in various degrees and at different levels of the root ca-nal: from pulpulite of the pulp chamber to complete chamber obliteration and of the root canal system, to cement calcifications. Calcifications represent often very complex clinical situations that the endodontist has to face. After briefly referring to the mechanisms of formation of endodontic calcifications and to their classification, the present work describes, using video sequences taken from a microscope, the operating sequences that the clinician must put into practice to solve these complex cases with a orthograde approach. Particular attention is given to the finding of important anatomical references that allow to avoid possible iatrogenic damages, to the respect for the original anatomy and the choice of the correct instruments.The clinical cases presented demonstrate how the use of the microscope and ultrasound are indispensable for the safe removal of pulp and endocanal calcifications and allow to tackle even the most complex clinical cases in a predictable and safe manner.

LUCIO DANIELEUniversity degree in Dentistry and partial den-ture at the University of L’Aquila (1994). Since 1999 he is active member of SIE (Italian So-ciety of Endodontology) and of AIOM (Italian Academy of Microscope Dentistry). Since 2003 he is active member of E.S.E. (European Soci-

ety of Endodontology) with the qualification of Certified Member. For the fourth time he is Cultural Secretary of the Abruzzo Section of SIE (Italian Society of Endodontology). He was Cultural Secretary (2004-2010), Treasurer (2004-2007) and then President for two terms (2010-2018) of the A.N.D.I. Section of the province of L’Aquila, organisation for which he has organised 62 scientific conferences and several cultural events. He won the Giorgio Lavagnoli Award as best clinical presentation on “Saving Teeth: the Endo Challenge” at the International Congress of SIE, held in Rome in 2016. He has attended the basic and advanced training courses held by Dr. Clif-ford Ruddle (USA - California). Speaker at many national and inter-national congresses on topics of endodontics, surgical micro-end-odontics, microscopic and conservative dentistry, he taught at the

Master’s Degree in Endodontics of the University of Siena in 2016, 2017 and 2018, at the Master in Endodontics of G. D’Annunzio Uni-versity of Chieti-Pescara in 2003 and 2004, at the update courses of the Medical Register of Rome for many years and to the ASO courses for the preparation of Dental Assistants and Dental Hygienists. He is the author of the chapter “The odontogenic pain” of the textbook “Manual of Endodontics” (Elsevier, 2013). He wrote case reports for the “Atlas of Endodontic Anatomy” (New Techniques, 2011). He is the author of numerous scientific articles and monographs, and coauthor of the text “Endodontics in the third millennium: safe, re-liable and predictable - from research to clinics” (Aries Due, 2007) namely of the chapter on endodontic retractions. He teaches basic and advanced Endodontics, Endodontics Surgery and Conservation in theoretical and practical courses in Italy and abroad. He has a dental surgery in L’Aquila with his brother Lorenzo and he works also in other dental surgeries, dealing exclusively with endodon-tics, microscopic orthograde and surgical endodontics and aes-thetic restorative.

MASSIMO CALAPAJActive Member SIE (Italian Society of Endodon-tic) since 2004. Master in Implantoprotesi at the University of Genoa in 2005. Active Mem-ber AIOM (Italian Academy of Microdentistry) since 2006. Cultural Secretary SIE of Sicily 2010-2012. Prof. Adjunct of Endodontology at

the Messina University 2015-2018. Active Member EFAM (European Federation Associations Microdentistry). Member ESE (European Society of Endodontology). National Vice President AIOM Italian Academy of Microdentistry. Member WEB Commission of the SIE. Active Member AIC-Osstem. Directive Council Member ANDI Messi-

na . Member of Cultural Commission CAO Messina. Lecturer, Master II level for Conservative and Endodontics at the University of Messi-na. Voluntary work in developing countries with the AMSES Onlus. It is part of the study group in periodontics Dr. Roberto Pontorie-ro. President from 2012 AMBRE Onlus Association Mediterranean Children Rheumatic. More than 100 times speaker at national and international conferences and training courses in Endodontics. He invented and patented the Endodontic Fiber Post “TecHole” mar-keted by Isasan in Italy and in the world. Since 2004 deals on scien-tific research to Conservative and Endodontics at the University of Messina. Author of research papers in international journals.

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DECISION MAKING TO APPROACH A LEDGE OR A BLOCK DURING A RETREATMENTCRITERI DECISIONALI NELL’AFFRONTARE GRADINI E BLOCCHI DURANTE UN RITRATTAMENTO

Manuele Mancini, Flavio Palazzi

✎ ABSTRACT

Endodontic mishaps or procedural accidents are unfortunate outcomes that can occur during root canal treat-ment. They are sometimes unpredictable, but often due to incorrect operating strategies or more simply to an ap-proximate or distracted application of correct ones. A conservative but functional access cavity, a safe and effec-tive scouting phase, apical patency and glide path at full working length are critical issues in determining ledges and blocks. The latter result when a deviation occurs from the original canal curvature and anatomy without com-munication with the periodontal ligament, during root canal instrumentation. The operator works the files short of the full canal length, and the root canal becomes blocked at that “short point”. A block can be propaedeutic to a ledge formation when the working length can no longer be negotiated and the original pathway of the canal has been lost. However, obstructed access to the root canals and the accumulation of dentine mud resulting from the dentine and organic components detached during the apical progression of the scouting file can be the first causes of blockage. The presence of a ledge might exclude the possibility of achieving an adequately shaped canal preparation that reaches the ideal working length, and this can result in incomplete instrumentation and disinfection of the root canal system as well as incomplete filling of the canal. Decision making on blocked canals and ledges as tips and tricks for their prevention and clinical management will be faced during the session.

MANUELE MANCINIHe received his DDS degree cum laude from the University of Rome “Tor Vergata”, Rome, Italy. Tutor of dental materials course at the same University, where he also received his PhD. He is certified-active member of: the Ital-ian Society of Conservative Dentistry (SIDOC),

the Italian Society of Endodontics (SIE), the Italian Academy of Mi-croscopic Dentistry (AIOM). Member of Culture Commission of the

Italian Society of Endodontics (SIE). Member of Editorial Commis-sion of the Italian Academy of Microscopic Dentistry (AIOM). He is Certified Dentsply-Sirona official trainer in Endodontics and Restor-ative Dentistry. Author of more than fifty papers on national and in-ternational journals with impact factor. He is peer-reviewer of inter-national journals. Lecturer in national and international congresses on endodontics and restorative dentistry. His private practice is in Rome, Italy.

FLAVIO PALAZZIHe received summa cum laude honors degree in Medicine (1996) and summa cum laude honors degree in Dentistry (2000), from the University of Naples Federico II, Naples, Italy. He is Certified Member of the European Soci-ety of Endodontology (ESE), Active Member

and Head of Culture Commission of the Italian Academy of Micro-scope Dentistry (AIOM), Active Member of the Italian Society of Endodontics (SIE), Active Member and Board Member of the Italian Academy of Endodontics (AIE), Coordinator and Author of National

and International Research Projects, Author of publications in Na-tional and International Journals with impact factor, peer-reviewer of International Journals and Lecturer in National and International Conferences on Endodontics and Restorative Dentistry. He is Cer-tified Dentsply Sirona Official Educator for training in Endodontics and Restorative Dentistry and Member of the Zeiss Academy. Head teacher of Private Courses in Endodontics, Restorative, Prosthetic and Microscope Dentistry, He is Private practice in Naples, Italy, with special dedication to Endodontics, Restorative Dentistry, Re-habilitation and Prosthetics.

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HOW TO ACHIEVE THE THERAPEUTIC SUCCESS IN CASE OF PERFORATION COME OTTENERE IL SUCCESSO TERAPEUTICO IN CASO DI PERFORAZIONI

Riccardo Tonini, Denise Irene Karin Pontoriero

✎ ABSTRACT

It’s not important how skilled and performing you are while doing an Endodontic treatment, sooner or later, you’ll have to face a iatrogenic damage.It could be a mistake you did, it could be a mistake someone else did, anyways, you have to find a way to solve and fix it. Typical iatrogenic damages are perforations. They are communications between the root canal system and the attachment apparatus that may compromise the prognosis of the tooth. A perforation may occur during access cavity preparation, calcified and curved canals negotiation and during post space preparation.During this lecture, speakers will explain step by step, with videos and simple slides, how to repair different kind of perforations, giving all the necessary tips and tricks in order to make this easier and repeatable. Only predict-able techniques will be presented and explained and a selection of the most modern materials will be suggested. Following the guidelines proposed by the lecturers, the attendants will be able to reproduce them successfully in their daily practice.

RICCARDO TONINIHe graduated from dental school of University of Brescia (Italy) at 2004. At 2007 he carried out his Master degree from university of Vero-na (Italy) in Endodontics. His scientific work includes publications, continuous participa-tions in national and international meetings

and teaching experience in Italy (University of Brescia). Since 2010

he is an active member of the Italian Society of Endodontics and the Italian Society of Microscopic dentistry. He is also a member of Style Italiano study club. He is the inventor of ProTrain®, and has collaborated for several other innovations in dental industry. Dr Tonini maintains Private Practice limited in Endodontics for the last five years in Brescia, Italy.

DENISE IRENE KARIN PONTORIEROShe graduated in Dentistry, summa cum laude, at the University of Brescia (Italy) in 1997. Ac-tive Member of the Italian Society of Endodon-tics (SIE) since 2000, International Specialist Member of the American Association of Endo-dontists (AAE), Active Member of the Italian

Academy of Microscopic Dentistry (AIOM) , Member of the European Society of Endodontology (ESE). SIE’s Regional Cultural Secretary from 2013 to 2017. Fellow of the International Academy for Dento

Facial Esthetics (IADFE). She is Adjunct Professor of Endodontics at University of Genoa (Italy) and she is teacher for the International Fellowship of Advanced Endodontics. She has been lecturing for national and international congresses and courses regarding End-odontics and she participated as Visiting Professor for the Master in Periodontology at the University of Genoa in 2011, and for the University of Pennsylvania, Philadelphia U.S.A. in 2012. She man-tains private practices limited to Endodontics and Micro-dentistry in Brescia and Genoa, Italy.

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CLINICAL THEATER II

Endocanal Posts: an overview

Overview sui perni endocanalari

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POST SPACE: UNPREDICTABILITY OF SEAL AND CORRELATED PARAMETERSIMPREDICIBILITÀ DI CEMENTAZIONE E PARAMETRI CORRELATI

Umberto Uccioli, Alberto Mazzocco

✎ ABSTRACT

In scientific studies the restoration of endodontically treated teeth is a topic that is extensively studied and yet re-mains controversial from many perspectives. The autors discuss the major pertinent literature on this topic, with an emphasis on major decision-making elements in post cementation while restoring of endodontically treated teeth. Recommendations are made for treatment planning, materials, and clinical practices from restorative and endodontic perspectives. The purpose of this lecture is to organize this topic into its component parts and provide evidence-based prin-ciples that are sound from a restorative as well as an endodontic perspective. The autors will focus primarily on recent publications, although some of the classic literature also is discussed.

UMBERTO UCCIOLIBorn in Rome, in 1967, graduated with Laude in dentistry and dentures at the “La Sapienza” University in Rome, in 1994. The Endodontics, the Conservative practice and in general the microscopic dentistry are the specialties fields in which, over the years, he has dedicated its

activity. In fact, he is an active member of the “Italian Society of Endodontics” from 1999, for which from 2009 to 2013 he is mem-ber of the acceptance committee and since 2014 he is also member of the Cultural Commission. During his membership within the SIE, from 2005 to 2007 he was Cultural Secretary of the Roman section

of Endodontics (eminence). Since 2001 he is active member of the Italian Academy of Microscopic Dentistry (AIOM) and ordinary mem-ber of the Italian Academy of Conservation (A.I.C.). Speaker in sev-eral national Congresses (SIE, Eminence, A.I.O.M, mediator, order of the Medici of Rome, Andi of Naples and L’Aquila) and internation-al (3rd Saudi Endodontic Society an 1st Italian Professional Expert Group Scientific Conference). He is the author of publications for national and international scientific journals. He has collaborated in the drafting of the “Italian Handbook of endodontics” by the Ital-ian Society of Endodontics (SIE).

ALBERTO MAZZOCCOGraduated with honors in Dentistry and Den-tal Prosthetics at the University of Verona, he is an active member of the Italian Society of

Endodontics, of which he has held the position of regional secre-tary from 2014 to 2018, active member of the Italian Academy of Endodontics. He works as a private dentist in Verona.

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INDICATIONS AND MANAGEMENT FOR FIBER POST INSERTION INDICAZIONE E GESTIONE DI UN PERNO IN FIBRA IN FASE DI INSERZIONE

Andrea Polesel, Alfio Pappalardo

✎ ABSTRACT

Restoration of the endodontically treated tooth is a key factor for long term success in saving heavily compro-mised teeth. If sufficient healthy coronal dental tissue is present, post-endodontic restoration can be achieved with a conservative technique (direct, but more often indirect) and does not require the use of endodontic posts. In cases with severe loss of dental substance it is often impossible to achieve sufficient anchorage of a resto-ration in the remaining dentin. In such situations, a root canal-retained restoration is a predictable solution. On

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one side the full crown with an endodontic post is considered by the international literature as the gold standard in case of teeth heavily weakened by dental caries, fractures or previous conservative-prosthetic preparations. On the other side many factors are not completely clear: 1) when use a post? 2) which material is preferred when selecting the post? 3) how large should the post be? 4) how deep the post should be inserted? 5) how many posts should be used in posterior teeth? 6) how should be prepared the post space? 7) which instruments should be used to guarantee a conservative procedure? 8) which protocol of adhesion should be chosen to cement the fiber posts? 9) are the occlusal load and the ferrule two mandatory key-factors in prognosis of endodontically treated teeth, restored with posts and full crowns? The objective of the presentation is to show the clinical-practical strategies to obtain predictable results when using endodontic posts. The protocols proposed will be showed by using clinical cases and videos.

ANDREA POLESELHe graduated in Dentistry, summa cum laude, at the University of Genoa (Italy) in 1995. Active Member of the Italian Society of Endodontics (SIE) since 2001, Active Member of the Italian Academy of Restorative Dentistry (AIC) since 2014, Certified Member of the European Soci-

ety of Endodontology (ESE), International Member of the American Association of Endodontists (AAE). Since 2014 he has been a Mem-ber of the Admission Committee of the SIE. Regional Cultural Secre-tary for the SIE (2009-2013) in Liguria (SEL). Since 2015 he is a Mem-ber of the Editorial Board of the AIC. Coordinator and responsible of hAICarie-project in Liguria (2016-17-18) carried out by AIC. Since 2016 he is a Member of the Cultural Committee of the AIOM. Since

the academic year 2007, he is an Adjunct Professor of endodontics at the University of Genoa and since 2015, he is teacher for the In-ternational Fellowship of Advanced Endodontics in this University. He gave courses in Egypt, Dubai, Bahrain, Lebanon, South Arabia, and he was a lecturer in many European cities. Author of national and international articles on endodontics, aesthetics and adhe-sive restorative, he has also published two chapters in endodontic books. He is co-author of the AIC-book “Esthetic restorative dentist-ry” edited by Quintessence (in press). International and National lecturer on various topics and teacher in educational programmes and courses in Italy and abroad. Private practice in Endodontics, Restorative Dentistry and Surgery in Arenzano and Genoa, Italy.

ALFIO PAPPALARDOGraduated in Dentistry (DDS) from the Uni-versity of the Study of Catania, Italy, in 2000. Second level Master of Advanced Endodontics at the University of the Study of Chieti,Italy, in 2004. Active member of the Italian Society of Endodontics (SIE) Active member of the Ital-

ian Society of Conservative Dentistry (S.I.D.O.C.) Active member of the Italian Academy of Endodontics (A.I.E.) Ordinary member of the Italian Academy of Conservative (A.I.C.) Member of the American Association of Endodontists (A.A.E.) Member of the Italian Society of dental traumatology (S.I.T.D.) Since 2010 - Tutor for Dentistry and Dental Prosthesis degree course at the University of the Study of Catania. Since 2014 - Odontostomatological Clinic Professor for the Dentistry and Dental Prosthesis degree course at the Univer-sity of the Study of Catania. Since 2016 - Regional Cultural Segre-tary (S.S.E.) Sicilian Section of the Italian Society of Endodontics.

From 2016 to 2017 - Responsible for the Sicilian Region for the proj-ect “hAICarie” carried out by the Italian Academy of Conservative (A.I.C.). He cooperated with Prof. V. Malagnino on the realization of the root canal instruments MTwo. He carried out clinical activity mainly dealing with Endodontics, Conservative, fixed Prosthesis, Endodontic Microscopy and Oral Surgery. He teaches Endodontics and Conservative at several training courses. He has been speak-er and tutor at important National conferences in the field of End-odontics and Restorative dentistry. He is author and co-author of scientific and clinical articles in the field of Endodontics and Con-servative published by several specialized national and interna-tional journals. He keeps constantly updated in particular in the Endodontics and Restorative dentistry, taking part to the most im-portant congresses and training courses and costantly reading all the main books and journals on the clinical filed. He practices in Catania where he has his private surgery.

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POST REMOVAL DURING A RETREATMENT RIMOZIONE DI UN PERNO ENDOCANALARE DURANTE UN RITRATTAMENTO

Stefano Vecchi, Cristian Coraini

✎ ABSTRACT

The dental elements endodontically treated that have endo-canal posts internally, and that require an endodon-tic retreatment, represent a real daily challenge for endodontics.Various factors have to be considered when a post is to be removed successfully and safely. Endodontics must be aware of the variety of posts available on the market, regarding both their shape and the material they are made of. It is of course also helpful to know or to intuit the type of cement used to fix them inside the root canal sys-tem. A careful study of the radiographic surveys will allow endodontics to become aware also of the anatomical aspects that may complicate or advise against the removal phases. The purpose of the clinical roundtable is to highlight the techniques that are suitable to remove the most com-

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monly used endodontic posts in a simple, effective, safe and predictable way, comparing these techniques with the most recent scientific literature on this topic. We shall understand if and in which way the methods using ul-trasonic sources may cause damage to the dental and periodontal structures adjacent to the root canal. We shall follow video demonstrations and clinical cases that will guide participants in the procedures that most commonly present themselves in the normal endodontic routine, with the intent to provide operating systematics suited to the removal of any type of endodontic posts present, melted and cemented in a conventional, threaded, or adhe-sive way (glass, carbon, silica fibres).

CRISTIAN CORAINIDental technician qualification and diploma (1990-1991), degree in dentistry “cum Laude” at Milan-University (1996), international cer-tificate post-graduate in implantology and esthetic dentistry (New York University 2003-2005). Goer from 1998 at the Istituto Stomato-

logico Italiano of Milan in all departments, from 2012 head of the perio-implants and CAD-CAM department in the same Institut. In 1998 winner of the italian national price “The clinical case I’ll never forget” (UTET editions, Rimini, Amici di Brugg), and in 2013 with his technician Mr. Luca Vailati of the price on the occlusion at the International College of Prosthodontists World Congress (Turin). Ac-

tive member of: SIE (Italian Society of Endodontics), AIOM (Italian Academy of Microscope Dentistry), AIG (Italian Association of Gna-tology), member of the editorial board of “Italian Journal of End-odontics”. Currently, italian national secretary of AIOM, from 2017 Adjunct Professor in Prosthesis at the “Statale” University of Milan. Author of 60 peer-reviewed articles on national and international journals, author and co-worker of several chapters in many books about endo, perio, implants and prosthetical issues. Invited lectur-er in many italian universities, private practice in Milan, he focuse his work in the treatment of endodontic, perio-implants, prosthet-ic, esthetic and micro-dentistry cases with a multi-disciplinary ap-proach.

STEFANO VECCHIDegree cum laude in dentistry at “Catholic Uni-versity” of Rome “Agostino Gemelli”, in 1990. He attended the annual course-session held by Dr. Samuele Valerio, Dr. Parma Benfenati, Dr. Stefano Patroni. Endodontics improve-ments thanks to Dr. Stephen Buchanan, Dr.

Cliff Ruddle and professor Vinio Malagnino. Ordinary member Si-doc, active member Sie, Italian Society of Endodontics, currently “marche-regional secretary”. Lecturer as far as endodontics and restorative dentistry domains at national conferences. Private prac-tice into his dental clinic in Serra de’ Conti (Ancona).

CLINICAL THEATER III

Decision Making for canal obturation

Otturazione canalare: criteri decisionali

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WARM GUTTAPERCHA AND CARRIER-BASED SYSTEM: COMPARISON TECHNIQUESCARRIER-BASED: COMPARAZIONE DELLE TECNICHE

Mauro Cabiddu, Francesco Portulano

✎ ABSTRACT

The technique of Dr. Schilder, based on the vertical condensation of hot gutta-percha, is unanimously consid-ered one of the best methods of root canal obturation for the quality and predictability of the results it allows to obtain. Unfortunately, the Schilder technique has a slow learning curve and is very sensitive to the operator’s manual skill.As a consequence, alternative root canal obturation techniques were introduced, which simplified the original Schilder method without changing the basic principles and without compromising the quality of the final results.Among these will be discussed in this presentation the technique conveyed by carrier designed by Dr. WB John-son. The technique of root canal obturation carried by carriers has reached a good spread and popularity in recent years because it is easy to learn and allows, even for the less experienced, a rapid improvement in the average quality of endodontic cases. The Thermafil system, however, is only apparently an easy technique as it requires an operational sequence to be scrupulously penalized by a drastic decrease in the success rate obtainable and a high risk of significant extrusions of gutta percha and / or cement.

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Recently, the Guttacore, a new corecarrier system, was introduced in which the polysulphone plastic carriers in Thermafil were replaced by cross-linked gutta-percha, which enables the carrier (obturator) to be removed more easily during retreatment. The Guttacore carrier does not melt by heat used in an obturator oven and is insoluble in common organic solvents employed for root canal treatment.In this report we will illustrate the clinical variables that can influence the quality of the Thermafil and Guttacore fillings. In particular, the effects of shutter speed, cement quantity, cement application modalities, removal of a gutta-percha portion from the tip of the shutter and the position of the carrier with respect to the working length will be examined.

MAURO CABIDDUMD - University of Turin (Italy), 1991. DDS - University of Sassari (Italy), 1994. Assistant Professor at University of Turin, Depart. of Endodontics and Restorative Dentistry, Master in Micro- Endodontics and Micro-Endodon-tic Surgery (2009-present). Active Member of

SIE (Italian Endodontic Society. Active Member of AIOM (Italian Micro-Dentistry Academy). Associate Member of AAE (American

Association of Endodontists). Runs seminars in Endodontics at University of Cagliari Depart. of End. and Rest. Dent. Master in End-odontics, Lecturer on endodontics and post endo restorative den-tistry at national and international congresses. Runs private post graduate courses and workshops on Micro-endodontics and post endo restorat. Dentistry. Private practice limited to Endodontics and Restorative Dentistry with the aid of the Operative Microscope.

FRANCESCO PORTULANOHe was born in Taranto on 10/11/1969. En-rolled in the “Ordine Provinciale di Roma dei Medici Chirurgic” (Provincial Order of Medi-cal Surgeons of Rome), order number 3325. Licenced in dentistry in the first session of the year 1995—May 1996. “Laurea” degree

in Dentristry and Dental Prosthetics at the University of Rome “La Sapienza” . 1 April 1996 with a vote of 110/110. Degree thesis:

Chronic Peripical Lesions of Endodonic Origins and Their Cure with Endodonic Treatment Without Surgeory. Tutor: Prof. Giuseppe Can-tatore, Department of Endodontics 2000-2017 Clinical research col-laboration with Giuseppe Cantatore, Associate Professor. Qualifica-tion as Active Member of the Italian Society of Endodontics, 2004. Participation in the national conferences of the Italian Society of Endodontics 1996-2016 clinical Endodontic. Department in dentist-ry and dental prosthetics at the University of Verona.

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SINGLE CONE AND BIO-ACTIVE CEMENTS: NEW CONCEPT OR REVIVAL? TECNICA DEL CONO SINGOLO CON CEMENTI BIO-ATTIVI: NUOVO CONCETTO O RIVISITAZIONE?

Emanuele Ambu, Francesco Iacono

✎ ABSTRACT

Various methods and materials have been used to approach a three-dimensional root canal filling during end-odontic procedures. The application of bioceramic technology has changed both surgical and non-surgical end-odontic treatment, providing a promising direction for the preservation of natural teeth. New bio-active sealers have demonstrated the ability to overcome some of the significant limitations of earlier generations of endodon-tic materials due to their physic-chemical and biological properties. The lecture will summarize the literature background and the potential clinical advantages in the use of bioceramic materials. Characteristics of the new pre-mixed formulations and their current association with single-cone technique will be discussed through clin-ical cases to clarify how to perform an adequate obturation of the root canal system with this technique. The lecture will deeply investigate the current debate about potential of the new bioceramic sealers discussing actual limitations and misconceptions still existing on the routinely use of the presently available bioceramic sealers. Future perspectives of bioceramics materials and their potential improvements will be discussed.

EMANUELE AMBUBorn in Bologna (Italy), 1962, April 7th. Graduated in Medicine and Surgery (6 years) in 1989, University of Bologna. Mas-ter in Endodontics in 1998, University of Florence. Professor of Endodontics (2002-2011), Dental School, University of Modena

and Reggio Emilia. Chairman of Post-graduate course of End-odontics in 2003-2004, University of Modena and Reggio Emilia.

Visiting Professor of Post-graduate course of endodontics from 2006 to 2008, Dental School, University of Bologna. Visiting Pro-fessor of Post-graduate course of endodontics since 2011, Tuscan School of Dental Medicine, University of Siena. Clinical Assistant Professor (Endodontic Surgery) of Graduate School since 2014, Tuscan School of Dental Medicine, University of Siena. Visiting Pro-fessor of Post-graduate course of endodontics since 2012, Dental School, University of Cagliari. Visiting Professor of Post-graduate

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course of endodontics since 2013, Dental School, Universitad de Valencia, Spain. Co-director of “Diploma di Microendodonzia”, Uni-versitat de Valencia since 2015. Active Member of the Italian End-odontic Society (SIE) since 1999, Member Officer of the Committee of Active Members (2009-2013). Certified Member of the Europe-

an Society of Endodontology since 2001. Active Member of Italian Academy of Endodontics since 2013, now Member Officer of the Cultural Committee. Reviewer of the “European journal of Pediatric Dentistry” and “Advances in Radiology”.

FRANCESCO IACONOGraduated at the University of Catania and in 2008 completed a Master in Endodontology at University of Bologna. In 2008 and 2011 he was visiting scholar at the Department of Oral Biology of the Medical College of Georgia,

US. Actually he is adjunct professor of Endodontics at the Master of Endodontology at the University of Bologna and adjunct profes-sor at the University of Modena and Reggio Emilia. He published in peer-reviewed endodontic journals with particular interest in calci-um-silicate cements and endodontic NiTi instruments.

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CANAL OBTURATION AND ENDODONTIC FAILURE: PROBLEM SOLVINGOTTURAZIONE CANALARE E FALLIMENTI ENDODONTICI: PROBLEM SOLVING

Enrico Carmignani, Luca Venuti

✎ ABSTRACT

The first priority of effective endodontic therapy is to enter, shape and clean the root canal system in a manner that will allow efficient and total filling of the root canal space. The objective of any (endodontic) technique used should be to apply a biocompatible hermetically sealing canal filling that obturates the prepared canal space from pulp chamber just to its apical termination. If the final objective of root canal therapy is to render the root canal space impervious to leakage and microbial recontamination, then the sealing of the space becomes an important consideration in the long-term healing outcomes and the health and safety of the patient. Assuming that persistent intraradicular infection is the most common cause of failure, appropriate measures for the control and prevention of infection are essential to maximize the success of treatment; including strict asepsis, complete chemomechanical preparation using antimicrobial irrigants, intracanal medication, adequate root canal filling, and proper coronal sealing. The topics of the report will focus on all the problems that we can find during canal obturation. Strategies to avoid errors that could lead to failure of endodontic therapy will be suggested. It will be examined how to deal with various clinical situations that in the finalization phase could lead to a missed apical seal. The presence of irregularities in the preparation with risk of kneeling of the gutta percha cone, the early cooling of a carrier based method, the management of a very wide apex, the difficulty in determining a proper drying of the canal befor sealing, a difficult vertical compaction in case of a complex anatomy, the presence of lateral canal, will be some of the problems addressed.

ENRICO CARMIGNANIBorn in Messina (Italy) on May 3rd 1970. De-gree in Dentistry on April 1994 at the Univer-sity of Messina achieving 110/110 cum laude. Member of Italian Society of Endodontics since 1999. Active Member of Italian Society of Endodontics since November 2005. Member

of Italian Academy of Microscopic Dentistry. In 1997/98 attends the Master’s degree in Endodontics at “Sapienza” University of Rome, directed by Professor G.Goracci and Professor G. Cantatore. Lectur-er at several National and Regional Congresses of the Italian Soci-ety of Endodontics (SIE) Lecturer at the European Congress of the European Society of Endodontology (E.S.E.) in Istanbul - 2007 and

in Rome - 2011. Cultural regional Secretary in Sicily of the Italian Society of Endodontics since 2013 to 2015. Organizer of “Monothe-matic Seminar on Endodontic retreatment” of SIE at the University of Messina - May 2013. Organizer of the Regional Congress of SIE in Sicily on 2014, titled “Excellence in Endodontics within the reach of a General Dental Practicioner” - Palermo 03 Maggio 2014. Co-au-thor of scientific publications in the field of Endodontics. Official certified Trainer Endo-Resto Dentsply Sirona. Works as a consultant in Rome, North and South of Italy, focusing mainly on Endodontics, Surgical Endodontics, Restorative Dentistry and Microscopic oper-ative dentistry.

LUCA VENUTIBorn in Bologna 01/07/1970. Became dental thecnichian in L. Dehon school Bologna 1989. Graduated in Dentistry at the University of Bo-logna (Italy) in 1996. Active Member of the Ital-ian Society of Endodontics (SIE)  since 2003. Ordinary Member of the Accademia italiana di

Conservativa (AIC) since 2004. Author of national articles on end-

odontics. National lecturer on various topics and teacher in educa-tional programs and courses in Italy. Cultural regional Secretary in Emilia Romagna of the Italian Society of Endodontics 2017/2018. Private practice in Endodontics,  Restorative Dentistry and Prost-odontics in Bologna, Italy. Partner of the Centro Odontoiatrica Stor-ni - Venuti since 2000.

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SPONSORED TABLE CLINICS

A - DENTSPLY SIRONA

TABLE CLINIC 1

MODERN ENDODONTIC TREATMENT: RECIPROC® BLUE E GUTTAFUSIONENDODONZIA MODERNA: RECIPROC® BLUE E GUTTAFUSION

Lucia Reggio

✎ ABSTRACT

Today it is possible to achieve success in endodontics with a fast, simple and repeatable protocol, which is well suited to different canal anatomies and performs well both in treatments and re-treatments.Reciproc® Blue files are highly performing and safe tools; they are the perfect union between a shape specifically designed to work with the reciprocating movement and the physical characteristics of elasticity and resistance of the innovative NiTi alloy with Blue heat treatment. During the meeting, it will also be described how to obtain a per-fect three-dimensional obturation of the canal system with the thermoplastic gutta-percha of Guttafusion system.

LUCIA REGGIOShe graduated with honors in 2008 from the University of Turin. From 2014 to 2015, she is holder of the integrative didactic of surgical endodontics at the Specialty Surgery Schools of Turin University. In 2016, she is co-holder of

the theoretical and practical annual course of endodontic treatment and retreatment at the S. Luigi Gonzaga Hospital. She exercise the private practice in her own clinics dedicating mainly to endodontic, adhesive e restorative dentistry. She is aggregate member of SIE - Italian Society of Endodontics.

TABLE CLINIC 2

NEW OPPORTUNITIES IN ENDODONTIC TREATMENTS: R-PILOTTM AND EDDY®NUOVE OPPORTUNITÀ IN ENDODONZIA: R-PILOTTM ED EDDY®

Enrico Cassai

✎ ABSTRACT

Which are main challenges that dentists meet in endodontic field today? To reduce the risk of instruments frac-ture inside canals with complicated anatomies and an effective cleaning of the full canal system.R-Pilottm is the new file for reciprocating movement that creates a glide path and reduces the risk of instrument fracture caused by taper-lock or torsional stress; R-Pilottm can be integrated in every canal shaping system, preceding and speeding up this procedure. EDDY® is the new polyamide sonic powered tip for the activation of irrigant solutions that enhance their effectiveness in terms of penetration, organic tissues dissolution and debris removal. During the workshop, lecturer will present the protocol for the glide path creation with R-Pilottm and the suggested sequence for the activation of irrigant solution with the sonic tip EDDY®.

ENRICO CASSAIHe graduated cum laude in Dentistry and Den-tal Prosthetics at University of Ferrara in 1999. He is active member of the Italian Society of Endodontology (SIE) and the Italian Associ-ation of Microscopic Dentistry (AIOM). He is associate member of the American Associa-

tion of Endodontists (AAE) and European Society of Endodontology (ESE). He is secretary of SERE the Emilia Romagna section of SIE for the year 2015-2017. He is member of the cultural commission of SIE for the year 2017-2019. In 2004 Dr. Cassai was Preceptor at the Endodontics Department of Loma Linda University (California). He attended Dr. M.Torabinejad’s ward, Dr. Cliff Ruddle’s course center

and Dr. Stephen Buchanan’s course center in Santa Barbara (Cali-fornia). He is member of the Scientific Committee of the scientific magazine “L’Informatore Endodontico”. He lectured in courses and conventions both in Italy and abroad as lecturer and he is author of several publications on international scientific journals. Dr. Cassai is also a contract professor for Endodontology at University of Fer-rara (AY 2004-2010 and 2013-2018). He is editor in Endodontology for www.seligomedical.it. He is active member of Style Italiano End-odontics. He works in private practice in Ferrara, particularly com-mitted to clinical endodontics, microscopic surgery and aesthetic restorative dentistry.

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B - DENTALICA / MICROMEGA

NEW CONCEPTS FOR A SAFE, EFFICIENT AND PREDICTABLE ENDODONTICSNUOVI CONCETTI PER UN’ENDODONZIA SICURA, EFFICACE E PREDICIBILE

Simone Staffoli, Fabio Piccotti

✎ ABSTRACT

The continuous development of modern Endodontics impose the clinicians higher levels of quality. Success depends on a number of factors, including appropriate instrumentation, successful irrigation and de-contamination of the root canal space. The new techniques and technologies allow the practitioner to tackle the endo practice without any anxiety achieving very good results in terms of safety and predictability. Thanks to the new instruments, the operative techniques have evolved rapidly, ensuring a higher level of safety and reducing the working time. The aim of the workshop is to present a protocol of canal shaping that is safe, fast and reliable. The new Micro-Mega systems, 2Shape and One Curve, meet all these requirements: they are easy to use and allow a safe canal preparation since they can easily adapt to all anatomies. During the workshop the participants will have the opportunity to test the instruments and to evaluate their ef-fectiveness in combination with EndoUltra, the first cordless ultrasonic device for activation of irrigant solutions.

SIMONE STAFFOLIDental Degree (DDS). Postgraduate Clinical Fellowship in Oral Implantology. Chairman Prof. Carlo Ercoli Eastman Insitute for Oral Healt, Strongh Memorial Hospital, Rochester, NY,USA. Postgraduate Master Program in End-odontics”. (MSC) Dept of Dentistry, University

“La Sapienza” of Rome, director Prof. Livio Gallottini. Didactic &

Scientific Coordinator at Postgraduate Master Program in “End-odontics” chairman, Prof. Gianluca Gambarini, Sapienza, Univer-sity of Rome. Assistant Professor in Endodontics. Phd student in “Innovative Technologies in Disease of the Skeleton, of the Skin and of the Oro-MaxilloFacial District” chairman Prof.ssa Antonella Polimeni “Sapienza” University of Rome.

FABIO PICCOTTIGraduate in Dentistry and Dental Implant at the University of Pisa, Italy in 2008. 2009: Endodontic course of Dr. Andrea Gesi in Vi-areggio - Pisa, Italy. 2010: Hands-on seminar about Microendontic Surgery of Dr. Arnaldo Castellucci. Florence, Italy. 2014: Postgraduate

course advanced endodontics - non-surgical retreatment continu-ing education of Cliff Ruddles DDS. Santa Barbara - California. USA. 2013: Prosthetic course of Dr. Piero Simeone. Rome, Italy. 2015: Prosthetic course of Dr. Enrico Manca. Milan, Italy. 2016: Prosthetic course of Dr. Domenico Massironi. Melegnano - Milan, Italy. From 2014 to Present: Clinical Manager of IMIEDN in Florence, Italy. From 2004 to 2010: Collaborating with Dr. Daniele Manfredini on current

issues such as the role of occlusion, evidence based dentistry and gnatology. From 2009 to 2010: clinical team of Art Dental Studio in Massa, Italy. From 2015 to Present: Annual Endodontic Seminar in Tirana for Italian Dental Education (IDI). From 2018 to present: Annual seminar about Endo management in periopatiens in Tirana for Italian Dental Education. From 2010 to Present: member of Edi-torial Board of International Journal of Experimantal Dental Science (IJEDS) From 2015 to Present: Reviewer for Journal of Oral & Facial Pain Headache. From 2018 to Present: Hands on Laser in Dentistry. Istituto Stomatologico Italiano - Milan, Italy. 2018: Laser Endodon-tic Disinfection. San Raffaele - Milan, Italy. From 2013 to 2016: An-nual seminar in Endodontic Protocols. Florence, Italy.

C - SIMIT NEXT

R2C PROTOCOL: THE ROOT TO CROWN SOLUTIONIL PROTOCOLLO R2C - THE ROOT TO CROWN SOLUTION

TABLE CLINIC 1

WAVE ONE GOLD VS PROTAPER NEXT IN THE COMPLEX ANATOMIES SUPPORTED BY 3D TECHNOLOGY ENDO SOFTWARE WAVE ONE GOLD VS PROTAPER NEXT NELLE ANATOMIE COMPLESSE SUPPORTATA DALLA TECNOLOGIA 3D ENDO SOFTWARE

Giuseppe Carrieri

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TABLE CLINIC 2

NEWS ON OBTURATION: THE NEW GUTTA PERCHA MASTER CONES WITH CONFORM FIT TECHNOLOGY. POST-ENDODONTIC RESTORATION: GUIDE LINES NOVITÀ IN TEMA DI OTTURAZIONE: LA NUOVA TECNOLOGIA DI GUTTA PERCHA MICRONIZZATA (GUTTA PERCHA CONFORM FIT). LA RICOSTRUZIONE POST ENDODONTICA: PROTOCOLLI OPERATIVI

Davide Fabio Castro

✎ ABSTRACT

The new protocol called R2C “The Crown Root Solution” explains to the clinicians how to maximize their treat-ment and how to reach the state of art in Endodontics and Restorative with Dentsply Sirona Solution.During the workshop it will be explained in which clinical cases is better use the instruments ProTaper NEXT or WaveOne Gold supported by 3D Endo Software, the first CBCT based software designed to improve endodontic treatment planning for more predictability.The new Gutta-percha master cones with Conform Fit technology are the first to feature a variable taper to precise-ly match your corresponding file. A perfect endo need a perfect resto: direct and indirect tooth Restoration. It will be described how and why you need to insert a fiber post. In situations where not enough hard tissue remains, a post is placed in order to provide sufficient retention for the core build-up and coronal restoration.

GIUSEPPE CARRIERIGraduated in Dentistry and Dental Prosthetics at the University of Chieti in 1999. Trainee of Prof. De Fazio, he attended the specialization courses of Dr. C. Ruddle and Dr. S. Buchanan. Specialized in Clinical and Surgical Endodon-tics that he practiced exclusively with micros-

copy. Active Member of the Italian Society of Endodontics (SIE).

Author of the chapter: “The operating microscope in endodontics”, of the book: “Illustrated manual of endodontics” by Dr. Emanuele Ambu. He holds courses of Endodontics at the University of Bari. Lecturer at the master of “Clinical and Surgical Endodontics” for the year 2004, at the University Modena. Founder of the “RadioEndo” study group. Freelancer in Bari.

DAVIDE FABIO CASTROGraduated magna cum laude in Dentistry in 1998, S.Raffaele Hospital, Milano, Italy. Active Member of the Italian Society of Endodontolo-gy (SIE). Active Member of the Italian Academy of Microscopy (AIOM, 2006-2014). Member of Executive Council and Acceptance Mem-

ber Commission of Italian Academy of Microscopy (2008-2010). Member of Acceptance Member Commission of Italian Society of Endodontology (SIE, 2010-2015). Member of the Editorial Com-mittee of Endodontic Italian Journal. Joint Author in “L’endodonz-

ia nel III millennio sicura , affidabile e predicibile: dalla ricerca alla clinica” (2007, Arisdue, Litograf Editor). Author of the “Dental morphology and Endodontic space access” section in Manuale di Endodonzia (SIE, Edra, 2013). Dentsply-Maillefer Opinion Lead-er from 2006. University Tutor in Endodontic teaching in S. Paolo Hospital. (2006-2009). University professor on contract in Dental School, Post-Graduated II Level Master in Clinical and Surgical Mi-croendodontics- Lingotto, Torino since 2011. International speak-er, author of several publications focused on Endodontics. Pri-vate Practice limited to Microendodontic and Restorative Therapy.

D - FOTONA d.o.o

NEXT LEVEL ENDODONTICS: THE EVOLUTION OF BUBBLESENDODONZIA DEL FUTURO: EVOLUZIONE DELL’ATTIVAZIONE LASER DEGLI IRRIGANTI

Giovanni Olivi

✎ ABSTRACT

Disinfection and elimination of the microbial flora from the root canal system is one of the main goals of end-odontic treatment. In recent years a novel application of laser activated irrigation named PIPS™ (Photon-induced photoacoustic streaming) was introduced. This method uses Er:YAG laser with a wavelength of 2940 nm which is delivered to the irrigant in the access cavity with a conical and stripped fiber tip. Since Er:YAG laser light is

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highly absorptive in water it causes boiling and micro-explosions in the irrigant solution, which induces cavita-tion bubbles. Further research in this field led to the development of SWEEPS® (Shock Wave Enhanced Emission Photoacoustic Streaming), whisch is a revolutionary method for cleaning and disinfecting the root canal system, utilizing the power of the Er:YAG laser to create powerful deeply penetrating shockwaves within the cleaning and debriding solutions. In that way irrigants penetrate deep into lateral canals and microscopic dentinal tu-bules to deeply disinfect dentinal walls by removing tissue, debris, biofilm and bacteria. An important advantage of the SWEEPS® laser endodontic treatment is that it cleans and disinfects root canal systems more effective-ly compared to conventional treatments. … SWEEPS® promises to represent an entirely new way of thinking about root-canal therapy. With SWEEPS®, practitioners are able to offer patients faster, safer and more effective root-canal treatments.

GIOVANNI OLIVIGraduated cum laude in Medicine and Surgery and in Dentistry at the University of Rome, It-aly. He has lectured in the  past twelve years as a visiting professor in several European universities and is currently focused on his private practice in Endodontics, Aesthetic and

Pediatric Dentistry in Rome. Dr. Olivi completed the postgraduate laser course at the University of Florence in 2002 and achieved the laser certification from ISLD in 2004. He also obtained his Ad-vanced Proficiency from the Academy of Laser Dentistry in 2006

and achieved the Master status from ALD in 2009. In 2007 he re-ceived the “Leon Goldman Award” for clinical excellence from ALD. Dr. Olivi is an active member of the Italian Academy of Microscope Dentistry (AIOM), the Italian Society of Endodontics (SIE), the Ital-ian Society of Pediatric Dentistry (SIOI) as well as an active member of the Academy of Laser Dentistry (ALD). He lectures about laser dentistry worldwide and is the author of over 60 peer-reviewed ar-ticles and several textbook chapters on dentistry topics. He is also the author of 4 books on laser dentistry.

E - SWEDEN&MARTINA

USE OF MTWO INSTRUMENTS AT DIFFERENT RPM ACCORDING TO THE CLINICAL NEEDSL’USO DEGLI MTWO A DIVERSE RPM A SECONDA DELL’ESIGENZA CLINICA

Antonio Malagnino

✎ ABSTRACT

With the coming of NiTi alloy, modern endodontics has evolved, improving the practice of the dentist and reduc-ing working times. Nevertheless, the endodontist has kept some old habits belonging to the steel period. Other dogmas have added to the dogmas of the past, deriving from the perception that endodontics is not completely a surgical branch of dentistry. The aim of the meeting is to detect the objectives of the single steps of an endodon-tic treatment and, according to the logic of propedeuticity, provide different solutions, so as to gain the goal of an endodontic treatment: the tridimensional filling of the radicular canal with an apical seal.

ANTONIO MALAGNINOMaster Degree in Dentistry at Chieti University in 2002. “Comparison between Niti Spread-ers and steel Spreaders”, master thesis pub-lished on the Italian Journal of Endodontics (n. 4/2002). Attended the annual course of End-odontics of Prof. Vito Antonio Malagnino in

2003. Member of the Endodontics Department at Clinical University

of Chieti. Specialisation course in Clinical Endodontics at Bologna University with Prof. Carlo Prati in 2005-2006. Chair professor in Endodontics at University of Chieti from 2006 to 2017. Active mem-ber of SIDOC from 2008. Private practice as consultant, specialised in clinical and surgical endodontics and post-endodontic conserva-tive treatment.

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F - SEPTODONT

USES OF BIOCERAMICS IN ENDODONTICS: TECHNICAL ASPECTSUSI DELLE BIOCERAMICHE IN ENDODONZIA: ASPETTI TECNICI

Emanuele Ambu, Fabio Rovai, Francesco Bellucci

✎ ABSTRACT

The introduction of MTA™ by Torabinejad, in 1995, marked a turning point for the prognosis of therapies that often led to results which were not always predictable and satisfying.Management of perforation, open apexes, hooding and closure of retrograde cavities was carried out by using different materials which, most of the time, were not fit for the purpose.At this point, the solution to these problems relied on each individual clinician’s experience, knowledge and skills, which made therapy outcomes not always reproducible. In 2009, Biodentine™, born as a proper dentinal substitute, was launched on the market by Septodont. Its I physiochemical properties give it a higher perfor-mance, compared to MTA and, above all, make it easier to use.Easy mixing and manipulation make it usable in all the above mentioned fields, therefore it is definitely first choice material for daily clinical practice.The more than encouraging results from using “repair” bioceramics reported in literature (Root Repair Materi-al), have led companies to produce an endodontic sealer which could contain the chemical properties of Bio-dentine™, and overcome the limitations of traditional endodontic cements. The outcome of this research has brought about the birth of Bioroot™ a proper endodontic sealer which enables exploiting the excellent proper-ties of bioceramics.This formulation offers the ability to seal the root canal in an extremely easy way, overcoming the limitations of the techniques used so far.Lectures will examine the clinical applications of these materials and will provide participants with the best in-structions for use on the basis of their own experience.

EMANUELE AMBUBorn in Bologna (Italy), 1962, April 7th. Graduated in Medicine and Surgery (6 years) in 1989, University of Bologna. Mas-ter in Endodontics in 1998, University of Florence. Professor of Endodontics (2002-2011), Dental School, University of Modena

and Reggio Emilia. Chairman of Post-graduate course of End-odontics in 2003-2004, University of Modena and Reggio Emilia. Visiting Professor of Post-graduate course of endodontics from 2006 to 2008, Dental School, University of Bologna. Visiting Pro-fessor of Post-graduate course of endodontics since 2011, Tuscan School of Dental Medicine, University of Siena. Clinical Assistant Professor (Endodontic Surgery) of Graduate School since 2014,

Tuscan School of Dental Medicine, University of Siena. Visiting Pro-fessor of Post-graduate course of endodontics since 2012, Dental School, University of Cagliari. Visiting Professor of Post-graduate course of endodontics since 2013, Dental School, Universitad de Valencia, Spain. Co-director of “Diploma di Microendodonzia”, Uni-versitat de Valencia since 2015. Active Member of the Italian End-odontic Society (SIE) since 1999, Member Officer of the Committee of Active Members (2009-2013). Certified Member of the Europe-an Society of Endodontology since 2001. Active Member of Italian Academy of Endodontics since 2013, now Member Officer of the Cultural Committee. Reviewer of the “European journal of Pediatric Dentistry” and “Advances in Radiology”.

FABIO ROVAIDegree in dentistry obtained on 23/07/1993 with vote 110/110 at the University of Perugia. Licence to practice obtained in the year 1993, session of November, at the University of Pe-

rugia. Registration at the register of Surgeons of the province of Pe-rugia from 23 February 1994 at number 00473. Practice focuses on Microscopic endodontics.

FRANCESCO BELLUCCIHe graduated cum laude in 1996 at the Univer-sity of Naples “Federico II” in Dentistry, per-fecting at the same university in oral surgery. Later he attended specialization courses in endodontics, periodontal surgery and implan-tology In 2015 obtained a Diploma in “Micro-

scopic-Endodontics” at the University of Valencia with Dr. E. Ambu and Prof. L. Forner, and in 2016 is tutor at the same University for the second edition of the course. Publishes on the International blog

“Zerodonto” two articles with the collaboration of Prof. Z. Metze-ger (2015) and of Dr. E. Ambu (2017) on the “expansive endodon-tic instruments”, and collaborates with the “Bioteck Academy” by publishing two case-reports of periodontal regenerative therapy. He’s been active member of the Italian Accademy of Endodontics (AIE) since 2018, and is ordinary member of Sidp and AIOP. Re-ported and published on topics of oral surgery and endodontics. To date, he perform his private practice in Avellino, and collabo-rates with other studies in Campania as consultant in endodontics.

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G - J. MORITA EUROPE GMBH

STEP DOWN TECHNIQUE AND SHAPING COMPLETELY MECHANIC AND CONTROLLEDSTEP DOWN TECHNIQUE E STRUMENTAZIONE COMPLETAMENTE MECCANICA E CONTROLLATA

Federico Michelini

✎ ABSTRACT

In recent years, endodontics has had a great development from the point of view of techniques and instruments. All the procedures as glide path, preflaring and shaping have a great evolution: from steel to NI-TI, from manual technique to mechanical technique.Now we can start to talking about completely mechanical and controlled Endodontics. Can we have a real total mechanic shaping of root canals? Can the length of the root canal be always under control? Which protocol is the best choice for this type of technique? Morita has the definitive solution.

FEDERICO MICHELINIGraduated in Dentistry and Dental Prosthet-ics at the University of Valencia in 2015, and received his master’s degree in Clinical End-odontics at the University of Bologna. From 2017 tutor of the Master of Endodontics and of the course of dentistry and dental prosthesis

in the endodontic field of the University of Bologna. In 2017 and 2018 took part in the Closed Meeting of the Italian Endodontic So-ciety (SIE) and in 2017 took part at the AIC Continuing Education. Member of the Italian Society of Endodontics, of the Italian Acad-emy of Endodontics and of the European Society of Endodontolo-gy. Author and speaker in national and international conferences.

H - KOMET ITALIA

THE ENDODONTIC RETREATMENT WITH ENDO RESTART KOMETIL RITRATTAMENTO ENDODONTICO CON ENDO RESTART KOMET

Giuseppe Squeo

✎ ABSTRACT

Endodontic failures can be attributable to inadequacies in shaping, cleaning and obturation, iatrogenic events, or reinfection of the root canal system when the coronal seal is lost after completion of root canal treatment. The goals of nonsurgical retreatment are to remove materials from the root canal space. Nonsurgical endodontic re-treatment procedures have enormous potential for success if the guidelines for case selection are respected and the most relevant technologies, best materials and precise techniques are utilized. Endo Re-Start by Komet is a new instruments made for removal seal and guttaperca inside the endodontic canals. In this course the unique characteristics of these tools will be described. There is also a practical part on extracted teeth.

GIUSEPPE SQUEOGraduate in Dentistry at the University of Bari in 2000. AC Professor of Restorative Den-tistry at the University of Foggia. He is Active member of the Italian Society of Endodontics (SIE) and the Italian Academy of Microscop-

ic Dentistry (AIOM). Inside the SIE he is Secretary of the Puglia Section (SEP). Speaker in Italy and abroad in numerous courses and conferences. He wrote some publications in national and in-ternational journals. He carries on his private practice in Bari, fo-cused on the clinical fields of clinical and surgical endodontics.

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I - ACTEON

THE USE OF 3D TECHNOLOGIES FOR THE DIAGNOSIS AND THE CORRECT TREATMENT PLAN IN ENDODONTICSL’USO DELLE MODERNE TECNOLOGIE 3D PER LA DIAGNOSI E IL CORRETTO PIANO DI TRATTAMENTO IN ENDODONZIA

Fabio Gorni

✎ ABSTRACT

The choise to keep or remove a dental element is one of the most demanding decisions that we have to make during our professional activity, we should therefore arrive at this decision only after a certain diagnosis and a complete evaluation of the different therapeutic possibilities.When we have to deal with complex cases it is essential to have access to different exams than normal 2D X ray images, then use more deeply examination such as CBCT, which has now become a diagnostic and operative standard even in the case of endodontic treatment. The correct use of this technology, especially in endodontics, is linked to the quality of the images we can read and the specificity of the software we use, that is strategic in the endodontic field. The clinical table will illustrate the cases in which the CBCT is useful and the cases in which, thanks to this technology, the treatment plan has changed according to the data obtained with the 3D technology. It will also show the functionality of the AIS 3DAPP software by ACTEON, the heart of the X-MIND TRIUM, the ACTEON’s CBCT.

FABIO GORNIGraduated from the Milan Dental School in 1984. Visiting professor for the dept of End-odontics of the S. Paolo Hospital in Milan. Ac-tive member of the Italian Society of Endodon-tics, of the Italian Accademy of Microscopic dentistry, Specialist Member of the European

Society of Endodontology and member of the American Associa-tion of endodontists, from 1994-1998 he was a member of the ad-mission committee of the SIE. From 1998-2001 he was the cultural secretary of the Italian Society of endodontics, the president from 2003 to 2005. At the moment he is the past-president of the SIE. He has lectured on various endodontic topics all over the world he has also published on many national and international jour-

nals and he has also produces scientific videos. With C.J. Ruddle he has published a series of videos called “The endodontic game” distributed in Europe, USA, Canada, Australia, and Asia. He is visit-ing Professor, head of the Peri-oral Aesthetics Course at the facul-ty of Odontology of the Università Vita Salute San Raffaele - Milan Founder of Style Italiano Endodontics. He has written chapters for 5 different endodontics books, he is one of the maximum expert in the world on the recovering of compromised teeth and in end-odontic surgery. Innovator in endodontics field and in the use of the microscope in dentistry. He has is own private practice in Milan and he is specialized mainly in endodontics, surgical endodontics and implants with particularly focusing for the micro dentistry.

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