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ESE ROME 2011 NOT ONLY ROOTS 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L POSTERS ESE ROME 2011 NOT ONLY ROOTS THURSDAY, 15TH SEPTEMBER 2011 Chairpersons: Ove Peters, Johannes Klimscha Session T1 – 13.30 T1 - 1 Proposal for a clinical practice guide in endodontology in Romania, according to the AGREE guidelines Adrian Bacila, Alexandru Bucur, Stefan-Ioan Stratul, Doina Onisei, Emilia Ianes, Luminita Nica Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania Abstract AIM. The last two decades witnessed major changes in the dental care providers system in Romania: the overwhelming establishment of private practices and dental health insurances; the establishment in 2010 of the dental specialties of endodontology, periodontology, prosthodontics and their national recognition; the developments and advances in the fields of clinical dentistry. These changes have led to the identification of the need for the regulation of the clinical practice in the most important dental specialties. METHODOLOGY. In November 2010, following the call of the Professional-Scientific Commission of the Romanian College of Dentists CMDR, professors and experts in endodontology from 7 leading Romanian dental schools have been invited to join a consensus team, which aim is to produce the first Clinical Practice Guide in Endodontology. According to the requests of CMDR, this first Guide is intended for general practitioners, while a next extended Guide will be issued to regulate the activity of specialists in endodontology. RESULTS. On this occasion, several proposals of consensus processes were issued. The poster presents one of the proposals based on the 21 universal criteria of the AGREE (Appraisal of Guidelines Research and Evaluation) collaboration (www.agreecollaboration.org), gathered under the headlines: 1. Definition of the scope and purpose 2. The stakeholder involvement 3. The rigour of development 4. The clarity and presentation 5. The applicability and 6. The editorrian independence. CONCLUSION. To date, a first draft of Clinical Practice Guide in Endodontology has been distributed nationwide to be commented and amended. The draft and the ammendements are currently under evaluation by the CMDR ruling bodies. T1 - 2 Influence of root canal treatment on leukocytes and neutrophils count: a case report Iman Hassanzadeh, T. Charles Université Libre de Bruxelles, Brussels, Belgium Abstract The goal of the endodontic therapy is to eliminate the pulpal tissue, to prevent or heal an infection of the root canal system. In case of an unsuccessful treatment of infected teeth, bacteria’s endotoxins will create a periradicular inflammatory lesion. The mediators of this local inflammation can generate an inflammatory syndrom with impacts on systemic diseases, which can induce or complicate many cardiac pathologies like arrhythmia or high blood pressure. This case report will illustrate this fundamental aspect of the endodontic therapy. A 72 years old woman was referred by her cardiologist for a persistent inflammatory systemic syndrom. The patient presents a weakened general health with histories of cardiac surgery (myxome), high blood pressure, arrhythmia (atrial fibrillation) and an important leucocytosis of unknowed origin. A scintigraphy had been realized without any result on the source of the chronic infection. The last blood test www.eserome2011.com before the endodontic retreatments showed pathologic results with a leukocytes count of 11070 (normal count : 4000-11000) and a neutrophils count of 8944 (normal count : 1400-6700). New blood tests were realized in collaboration with her cardiologist during the period of the endodontic treatment and showed a significant improvement of the hyperleucocytosis. A decrease of the leukocytes and neutrophils was observed: from 11070 (one month before treatment) to 6200 (one month after treatment) for the leukocytes, from 8944 (one month before treatment) to 3577 (one month after treatment) for the neutrophils. In the same time, the clinical symptoms like the arrhythmia have been reduced. In conclusion, this case report shows the influence of endodontic treatment on the general health and cardiovascular state. Such an inflammatory syndrome caused by unsatisfactory root treatment can produce harmful and even lethal effect. T1 - 3 Long -term bone mass evaluation after endoperiodontal therapy in woman receiving hormon replacing therapy Leusic Temmer Jelka, Vera Njemirovskij Dental Polyclinic Zagreb, Crotia School of Dental Medicine University of Zagreb, Croatia Abstract The aim of this study was to examine the bone mass of the mandible incisal region after endo-eriodontal treatment in woman receiving hormon replacing therapy determinated with densitometric measurement..The patient was age 55 with diagnosis of osteoporosis treated during 9 years with hormon replacing therapy.The reason of visiting was compromised periodontitis and endodonticaly treated tooth 41. After endodontic treatment and fixation with extracoronar splint ,aproached densitometric measurment using” TROPHY-RWG -UI” digital X- ray system.assesed by following the gray scale principle.The first stage of periodontal treatment included initial therapy I ,followed by initial therapy II, root scalling. Reevaluation followed by regenerative and surgical treatment. A “Biooss”xenogenic osseus implant and non-resorbic Biogide(Geisslich) membrane was used.Computer assistted radiodensitometric measurment of surgical region were carried out prior to surgical treatment , six months,a year and three years after treatment. The results confirmed that hormon replacement therapy assosiated with endoperiodontal therapy did not damage bone mass of mandible. T1 - 4 Main reasons for endodontic treatment in a population of Pancevo, Serbia Kolak Veljko, Dragana Pesic, Irena Melih, Milica Popovic, Ankica Jakovljevic, Faculty of Stomatology, Pancevo, Serbia Abstract AIM. The aim of this epidemiological study was to evaluate the prevalence of endodontically treated teeth and teeth needing endodontic treatment, as well as to investigate the frequency of different indications for this therapy in an adult population of the municipality of Pancevo, Serbia. METHODOLOGY. An epidemiological study was conducted at the Institute of Stomatology, Faculty of Stomatology in Pancevo during 2009 and 2010. The study included 148 randomly chosen male and female patients, aged over 20 years from Pancevo, Serbia. Clinical and radiographic examination on each patient was performed. Radiographic examination included panoramic and periapical radiographs. The periapical region of the teeth included in this study was examined using the Periapical index scoring system ( PAI). Data were statistically analyzed using Chi-Square and Mann-Whitney tests. RESULTS. Of the 3168 teeth that were examined, 208 (7%) were endodontically treated and 314 (10%) were indicated for endodontic treatment. The most frequent indication for therapy was apical periodontitis (51%), which showed statistically significant difference 1 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY (p<.001) in relation to other reasons for treatment. Between different age groups, the largest number of teeth indicated for endodontic treatment : 86 (27%) were in the group of patients 20-30 years old. Anterior teeth were significantly more often indicated for treatment (47%), (p<.001), compared to premolars and molars. CONCLUSION.The results of this study show a high prevalence of apical periodontitis, and a high need for endodontic treatment in Pancevo. Furthermore, it indicates a lack of culture in terms of oral health care, and lack of regular habits of oral hygiene, bad attitude to dental treatment and low level of preventive care in Pancevo. R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L T1 – 5 Results: In the retreatment group, 77% of lesions healed, whereas the root canal treatment group had a 100% healing rate. Patients suffering from post extraction ONJ showed periradicular lesions in 57% of extracted teeth. Conclusion: This preliminary short-term study suggests that patients taking endovenous bisphosphonates may expect a satisfying outcome of conventional root-canal treatment or re-treatment, with satisfactory periradicular healing, and that there is a higher possibility of presenting ONJ if the tooth extracted was already affected by a periradicular lesion. Thus, root canal treatment may be considered a safe and realistic alternative to extraction in patients following bisphosphonate therapy. Determination of mercury in hard tissue of the teeth T1 - 7 Nexhmije Ajeti, Veton Hoxha, Xhevdet Elezi, Tringa Kelmendi, Violeta Vula Operative Dentistry and Endodontology, University of Prishtina, Kosovo University of Prishtina, Faculty of Agronomy Abstract The aim of this study was to determinate the mercury in hard tissue of the teeth. Materials and methods: 30 human single root human teeth were tested. They were extracted for different reasons. Depends of preparation of cavity teeth were divided in three experimental group with 10 teeth.Group 1-10 teeth were prepared in occlusal surface,group 2-10 teeth were prepared in approximal-oclusal surface and group 3-10 teeth were prepared in MOD. All of them were filled with amalgam and after 24 hours, and five teeth of each group were polished. After 9 months the examples were tested. Before chemical analysis tooth were irrigated four times for 10 minutes in ultrasonic bath.Tooth were grind in size less than in grinder with sphere (Retch, Germany. After grinder tooth were dry in thermostat on 105°C temperatures, for 3 hours. Every tooth was weight with weight machine (Kern, Germany). From each tooth was taken 250 mg dust and was mineralized with royal water (HCl+HNO3 in ration 1:3) in microwave oven (Bergenhof, Germany). After mineralization examples were filtered and were analyzed in ICP-OES (Perkin Elmer, USA, Optima 2100 DW). Results: There were significant differences in the amount average of mercury in both groups polished (One Way Anova, F=110.54, p<0.001), and unpolished groups (One Way Anova, 69.54, p<0.001). Conclusions: It may be concluded that mercury was released more in unpolished amalgam fillings than polished amalgam fillings. T1 – 6 Endodontic implications in patient taking intravenous bisphosphonates Paolo Ambrogio, Paola Franco, Damiano Pasqualini, Nicola Scotti, Elio Berutti Department of Endodontics, Prof. E. Berutti University of Turin Dental School, Turin, Italy Abstract Introduction: Bisphosphonates are pharmacological compounds whose most important biological effect is to reduce bone remodelling. They are associated with a rare adverse event, known as osteonecrosis of the jaws (ONJ). The impact of endovenous bisphosphonates on periradicular healing, and the correlation between ONJ and periradicular lesions, are yet to be determined. This study evaluated the healing of periradicular lesions after root canal therapy in patients taking endovenous bisphosphonates, and assessed the correlation between ONJ and periradicular lesions. Methods: Teeth with or without preoperative periradicular radiolucency were identified in patients undergoing endovenous bisphosphonate therapy. Each case was examined clinically and radiographically to determine treatment outcome. Non-surgical root canal treatments and re-treatments were performed by a single endodontist at the Lingotto Dental School of Turin, using non-standardized protocols. 2 Hepatitis and dentists: our experience F Shllaku, M Kelmendi, Donika Bajrami, Miranda Stavileci Faculty of dentistry, University Children’s Hospital, Prishtina, Kosovo Abstract AIM. There are many reports which document that dentists, especially oral surgeons are a “high risk” group for developing hepatitis. The presence of serum markers in dentists is about 16.0% in relation to other population ( 9.0%). B hepatitis is considered very important for dentists, because of its frequency and the severity of its clinical picture. The aim of this study was to determine: 1. The incidence of hepatitis and 2. To focus on the role of preventive measures in decreasing the prevalence of hepatitis in dentists and other health workers. METHODOLOGY. The investigation sample consists of two groups: 1. 20 dentists employed at the Dental Clinic in Prishtina and. 2. 124 dentists from Kosova cities. Using radioimmuno assay technique, HBS antigen was “screened” in the first group, whereas information about hepatitis was obtained from the second dentists group. RESULTS. 11 of 20 dentists were HBS positive (55.0%) and 9 HBS negative ( 45.0%). Such a high percentage of positive HBS antigen in dentists is probably due to the small sample size. 13 out of the 124 questioned dentists showed a history positive for hepatitis ( 10.5%), with a prevalence significantly higher in Prishtina’s dentists. The prevalence of hepatitis in these dentists is probably higher due to anicteric forms. CONCLUSION. Our results confirm the well known phenomenon of high prevalence of hepatitis in dentists. Preventive measures are needed for health workers, including dentists, with a anti hepatitis vaccine as the best solution. T1 - 8 Clinical approach of radix entomolaris cases Petridis Xenos, Georgios P. Dechouniotis, Vasiliki Kondylidou, Maria K. Georgopoulou Greece Abstract The importance of familiarization with the variations of the tooth and root canal anatomy is unquestionable in order to achieve an optimal endodontic treatment outcome. Mandibular molars constitute a group of teeth that shows deviations of varying frequency from the expected tooth and canal morphology. Pre- and/ or intra- operative incognizance of such anatomical characteristics may invite treatment failure. Studies have shown that the first mandibular molars may display deviations from the two-rooted norm that is usually encountered. Additional roots that are located either disto-lingually or mesio-buccally have been reported, assigning the terms radix entomolaris and paramolaris respectively. A strong correlation between the incidence of these supernumerary roots and the studied ethnic groups seems to appear, with Asian populations exhibiting higher frequencies than the Caucasians. The external morphological characteristics and the corresponding internal anatomical features of these additional roots are not easily distinguishable. Angled periapical radiographs may raise suspicions ESE ROME 2011 NOT ONLY ROOTS regarding the existence of a supernumerary macrostructure, but more advanced means of radiographic visualization, such as conebeam computed tomography (CBCT) offer more precise anatomical information. Also, means of enhanced magnification as well as endodontic instruments of Ni-Ti manufacture constitute valuable aids in identifying and preparing the morphologically variable canals of the radix entomolaris/ paramolaris mandibular molars. The purpose of this study is to present clinical cases of radix entomolaris first mandibular molars and describe via radiographic and dental operating microscope images the steps for identifying and treating such cases. T1 - 9 Evaluation of the knowledge and attitude of martial art female masters about encountering to tooth avulsion and factors related to that in stadiums of the capital city of Iran posed pulp were capped with zinc-oxide as control. In group II ,the exposed pulp were capped with capsaicin as experimental group .All access cavities were sealed with glass inomer cement (Fuji IX).The animals were sacrificed at,1,2 and 4 weeks after the procedure. The specimens were stained with H& E and studied by light microscope. Results: Inflammatory response including intensity and signs of necrosis decreased significantly during first to fourth week in group I.(P=0.029,P=0.026) In capsaicin group hyperaemia decreased significantly during first, second and fourth week.(p=0.019) In comparison of the effect of two drugs on pulp in 4 weeks sign of necrosis increased significantly in capsaicin group.(p=0.029) Two groups showed difference in dental barrier formation, type of inflammatory response and soft tissue changes but these differences were not statistically significant.(p>0.05) Conclusions: according to findings of this study capsaicin could decrease the intensity of inflammation. Rezvani Yasaman, Peyvand Moeeni, Mehrnaz Rafe ee Anaraki Tehran azad dental school pediatrics, Tehran, Iran Chairpersons: Hani Ounsi, Roberto Fornara Abstract Aim: Trauma to primary and permanent teeth and supporting structures is one of the common problems in children.Avulsion is one the most complicated cases of trauma that contains1-16% of trauma in the children at the age of 7-11 years old. Physical education teachers are the first people who face children have the most time opportunity to put back the avulsed tooth in the Regarding to the lack of knowledge in physical education teachers from the treatment of tooth avulsion, we decided to survey the women masters of martial arts in the capital of Iran and educate them how to handle correctly with dental traumas. Methodology: In the present descriptive analytic research,first we divided Tehran into four parts. 112 masters answered our questionnaires that included 26 questions.7 questions about personal information .9 question about the knowledge of dental traumas emergencies There were 10 questions about trainers consideration in the field of dental traumas emergencies. Results: Among 112 people in the survey, 34 people (30.3%) had good knowledge, 58 people (51.6%) had average knowledge and 20 people (17.1%) had weak knowledge. There is a significant relation between knowledge & working experience (P.value= 0.033<0.05) & educational level (P.value= 0.002<0.05), Among the teachers who were surveyed 33 people (27.6%) had good consideration, 67 people (54.8%) had average consideration & 14 people (12.6%) had week consideration, Between attitude & age (P.value= 0.004<0.05) & working experiment level (P.value= 0.001<0.05) & educational level (P.value= 0.002<0.05) & significant relation. Conclusions: Most of the masters had weak knowledge about replanting the avulse tooth .The conclusion shows that to promote the knowledge of the martial art masters, the training courses in the field of dental trauma emergencies is necessary. Session T2 – 13.30 T1 - 10 Histopathologic evaluation of capsaicin on cat dental pulp Madani Zahra Sadat, Maryam Seyed Majidi, Aliakbar Moghaddamnia, Amir Zahed pasha Babol university of medical sciences-dental school Endodontics, Babol, Iran Dental school Oral patholog, Babol, Iran Babol university of medical sciences-Pharmacology, Babol, Iran Abstract Aim: The aim of this study was evaluating anti-inflammatory effect of local administration of capsaicin on cat dental pulp. Methodology: Twenty four canine teeth of six cats were selected for this experimental study. after cats had been anesthetized the crown of were cut three mm upper than CEJ and exposed under sterile condition. The teeth were divided in to two groups .in group I , the ex- www.eserome2011.com T2 - 1 Endodontic microsurgery: prognostic factors for clinical outcomes Kim Hyun-Joo, Sung-Ju Moon, Minju Song, Euiseong Kim Dept. of Conservative Dentistry, Yonsei University, Seoul, Korea Abstract Introduction: This study examined the potential prognostic factors on the outcome after endodontic microsurgery. In addition, the predictors of an isolated endodontic lesion were compared with those of both an isolated endodontic and endodontic-periodontal lesion. Methods: The data was collected for patients with a history of endodontic microsurgery performed between August 2004 and December 2008, at least 1 year before being evaluated. Surgical procedures were carried out by the endodontic faculty and residents. After surgery, an operation record form was made with the preoperative, intraoperative and postoperative factors from clinical and radiographic measures. For statistical analysis of the predisposing factors, the dependent variable was the dichotomous outcome, i.e. success versus failure. Results: Of 907 cases, 491 were retained at follow-up. At the 0.05 level of significance, age, gender (female), tooth position (anterior), root length filling(adequate), lesion type (endodontic lesion), root-end filling material (MTA and Super EBA) and restoration at follow-up appeared to have a positive effect on the outcome. On the other hand, with the isolated endodontic lesion, the tooth position (anterior), root length filling(adequate), and restoration at follow-up were found to be significant at the 95% confidence level. Conclusion: Under the control of significant variables in logistic regression, the potential prognostic factors on the outcome were gender, tooth position, lesion type and root-end filling material. On the other hand, the tooth position was found to be pure predictor of an endodontic lesion affecting the clinical outcome. T2 - 2 Endodontic treatment of first and second lower molar with a massive abscess: nine years control Marco Capecchi, V Bongiorno, Enrico Semenzato, Ilves Bottion, Kevin Steffan, Carlo Tocchio Italy Abstract A patient with a massive endodontic abscess, has been visited in our departement in 2002. After an antibiotic therapy and an exudate 3 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY drainage the theet had been treated with a temporary dressing and two weeks after they had been filled and restored. A nine years control is presented to underline the good outcome rate of the endodontic therapy. T2 - 3 Outcome assessment of the endodontic retreatment of teeth with chronic apical periodontitis: a longitudinal study Mihaela Grigorie, A Iliescu, L Nica, SI Stratul, M Voiculeanu, AC Didilescu Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania Abstract Aim: Assessment of success rate in endodontic retreatment of teeth with chronic apical lesions, by using three different techniques. Material and method: Seventy-one teeth with periapical lesions were included in the study. Incomplete root-canal fillings were removed with rotary instruments. Treatment protocol included irrigation with 2.5% sodium hypochlorite, and intracanal medication with calcium hydroxide. The following filling techniques were used: lateral compaction (n=20), Thermafil (n=24), and vertical condensation (n=27). The outcome was assessed after two years based on radiographic and clinical findings, as follows: complete healing, incomplete healing or failure. Data distributions were expressed as percentages; possible associations between outcome and filling techniques, sealer extrusion, or transportation, were tested using Pearson Chi-squared Test. A value of p < 0.05 was considered statistically significant. Results: The healed cases counted for 4% of the total number, healing cases 86%, and 10% had not healed. Among the teeth with complete healing, 2 were filled with Thermafil, whilst 1 was treated by vertical condensation. Failures were recorded as follows: Thermafil 57%, lateral condensation 29%, and vertical condensation 14%. No statistical significant associations were recorded. Conclusions: Overall, although the outcome was favorable (healed and healing cases), the healing cases were more numerous than healed cases. Longer periods are needed to observe the evolution of healing cases. T2 - 4 Success rate and tooth localization of endodontic treatment in dental-school outpatients Ines Willershausen, Adriano Azaripour, L. Weimer, B. Briseño, B. Willershausen Institute for Dental Material Sciences and Technology - Operative Dentistry University of Mainz Abstract Aim: Besides morphological characteristics, the endodontic techniques and the use of a microscope determine the success rate of endodontic treatments. The aim was to examine endodontic treatment outcome from outpatients of a dental school, treated either by dental students (62%) or by dentists (38%). Methodology: A total of 1124 endodontically treated teeth were investigated in adult patients (n=745) over a period of 5 years. The patients’ age ranged from 18 to 87 years (54% male and 46% female). Success was defined as no loss or extraction of the teeth within five years. Results: The study showed that more teeth were located in the maxilla (55.2% male, 57.3% female) than in the mandible (44.8% male, 42.7% female), but there was not difference between left and right side. Exemplarily for both genders, the following frequencies of allocation of the endodontically treated teeth concerning the tooth group in the maxilla was found: second right premolar 11%, second left premolar 9.7%, first and second left molars each 9.4%, first left premolar 7.9%, first right molar 7.6%, second right molar 7%, and 4 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L the first left incisor only in 2.9%. For the mandible, a slightly different situation was detected: first left molar 16.5%, first right molar 13.5%, second right molar 12.8%, second left premolar 11.7%, first right premolar 9.0%, second left molar 8.6%, second right premolar 8.3%, and the incisors each 0.8-1.5%. Most endodontic treatments were carried out in patients aged 21-55 years (67%). After the 5-yearobservation time, the success rate of the endodontic treatments done by students was 91%, whereas it was only 80.2% for the treatments done by trained dentists. Conclusions: A possible explanation for this result might be the fact that the students only treated easy cases with fewer complications, while difficult and problematic teeth were treated by the dentists. T2 - 5 Randomized clinical study on patients’ quality of life after emergency endodontic treatment Ivan Naymo, Paolo Ambrogio, Nicola Scotti, Damiano Pasqualini, Elio Berutti Department of Endodontics, Prof. E. Berutti, University of Turin Dental School, Turin, Italy Abstract INTRODUCTION: Emergency treatment for irreversible pulpitis comprises pulpotomy or pulpectomy. The study evaluated the effectiveness of these emergency treatment protocols in reducing postoperative complications, their influence on patient satisfaction with treatment, and the consequent impact on their quality of life. MATERIALS AND METHODS: The first 86 consecutive patients entering the Endodontic Emergency Service, Turin Lingotto Dental School, during September-October 2010, were recruited who were aware, collaborative, and suffering from irreversible pulp disease of molar teeth, without apical periodontitis. Patients were randomly assigned, by sealed envelope, to one of two study protocols, pulpotomy or pulpectomy, after completion of the access cavity. Postoperatively, patients received instructions, the medical report, and a VAS evaluation questionnaire to be returned at 7-day follow-up. The following were investigated: curves of pain scores expressed through the VAS scale, percentage distribution of scores for bleeding in the pulpotomy group, mean number of analgesic tablets taken in pulpectomy and pulpotomy, subdivided by bleeding score, days to pain stop. The time required to perform the procedure was recorded. RESULTS: Analysis of pain expressed on the VAS scale showed a statistically significant decrease (p = 0.004) after emergency treatment. The distribution of bleeding scores in the pulpotomy group showed that the largest number had score 0, followed by scores 1 and then 2. Mean analgesic consumption was higher in the pulpotomy group. Time to pain stop was lower in the pulpectomy group. The mean time required to perform pulpotomy was 15 minutes, whereas for pulpectomy it was 25 minutes. CONCLUSIONS: This randomized clinical trial showed the significant impact irreversible pulpitis has on patients’ quality of life, and that appropriate treatment for this disease significantly improves all components of patients’ quality of life that we considered. T2 - 6 Patient satisfaction with endodontic treatment Nenad Baltić , Simeon Paris, Jurica Matijević, Dario Repić , Zoran Karlović , Silvana Jukić Krmek Croatia Abstract Aim: The aim of this study was to evaluate the level of patient satisfaction with endodontic treatment. Methodology: Sample consisted of 214 endodontic patients treated in five general dental practices in Zagreb and at the Department of Endodontics and Restorative Dentistry at School of Dental Medicine, ESE ROME 2011 NOT ONLY ROOTS University of Zagreb, during two months. Survey was conducted through specially designed questionnaire with five groups of questions which encompassed general data, the experience with former endodontic treatment, the attitude towards following endodontics, and the source of payment. Fifth group of questions, related to the experience with just finished treatment, was answered on the end of treatment. Level of satisfaction was expressed in grades from 1 to 5 (from 1- not satisfied to 5- very satisfied). Data were analyzed with Student-t test and Spearman’s rho correlation. Results: Half of male examinees (50.0%) were satisfied, while 51.2% of females were very satisfied with just performed endodontic treatment. The level of satisfaction positively correlated with lover pain experience and the greater level of satisfaction with prior endodontic therapy, positive patient attitude towards success of actual treatment and willingness to recommend that treatment to others (Spearman’s rho, p<0.05). Negative correlation was associated with the negative experience with prior treatment, the loss of the priory treated tooth, and the fear and the level of stress before the actual treatment (Spearman’s rho, p<0.05). Conclusions: Considering that half of male endodontic patients were satisfied and half of female patients were very satisfied, therefore we can conclude that endodontic part of dental service is acceptable for patients. T2 - 7 Non-surgical management of large periapical lesions using conventional endodontic treatment Emre Ovsay, RF Kaptan, G Bayer Yeditepe University Fakulty Of Dentistr, Istanbul, Turkey Abstract Surgery as a treatment method for periapical lesions is usually rejected by patients because of it’s complicated procedure and major complications.Patients prefer to heal in a more simple way.The nonsurgical way includes the conventional endodontic method for healing patients. According to technolocigal changes in endodontics patients prefer to get treated in a single visit.Non-surgical endodontic therapy is a way to treat teeth with large periapical lesions.Usually large periapical lesions can be recognized during radiographic examination.They can only diagnosed by histologic examination.All periapical lesions should be initially treated with convential endodontic therapy.This case reports three teeth with apical periodontitis (including two molars and a premolar) with large periaical lesions and their (1-3 year) follow ups which are healed with conventional endodontic therapy.In these cases the healing of large periapical lesions with non-surgical endodontic therapy is critisized and treatment steps are considered.The periapical radiographs showed us that the lesions can be treated without surgery. T2 - 8 The success and quality of endodontic treatment under NHS: a retrospective study J. Sobocinski Pawel, SJ Hayes Cardiff University Postgraduate Medical and Dental Dep., Cardiff, UK Abstract Aim: To assess the success of endodontic treatment carried out under NHS contract by one dentist. To assess the quality of root filling using ESE Guidelines and highlight the most common reasons of marking filling as unsatisfactory. Methodology: All root canal treatments carried out by one dentist between July 2007 and December 2009 were reviewed. The treatment outcome and quality of root fillings were decided based on the clinical notes and radiographs. The treatments carried out under NHS contract with minimum 12 months observation were examined for the purpose of this study. Failure was classified when the tooth was extracted or there were any symptoms reported by the patient or signs (swelling, erythema, tooth mobility, tenderness to percussion, sinus www.eserome2011.com tract or pus discharge) or the periapical radiolucency was equal or larger than original area. The success cases were classified either as definite success or as probable success. The quality of root filling was classified as satisfactory or unsatisfactory using ESE Guidelines. Results: Out of 186 endodontic procedures carried out, 99 procedures on 97 teeth qualified for further studies. Out of the 99 fillings 49 (49%) were classified as satisfactory and 50 (51%) as unsatisfactory. The most common faults of root filling for all procedures were: incomplete apical filling and overfilling. Among the failed treatments: incomplete apical filling and missed canal. 18 treatments were classified as failures. 16 had unsatisfactory fillings and 2 satisfactory. Out of 97 teeth, 9 were or are going to be extracted (9%), five teeth (5%) had re-treatment either in the surgery (4) or by the specialist (1) three teeth (3%) are under observation and one awaits re-treatment. Conclusions: Most of the failures were associated with unsatisfactory root filling. Incomplete apical filling and missing the canal are most likely to have serious consequences. T2 - 9 The root canal treatment of teeth associated with a large periapical lesion: three case reports Umut Tunga, Ersan Clcek, Ondokuz Mays University, Faculty of Dentistry, Depertmant of Endodontics, Samsun, Turkey Abstract Treatment options to heal large periapical lesions range from non-surgical root canal treatment and/or apical surgery to extraction. Current philosophy in the treatment of teeth with large periapical lesions includes the initial use of conventional orthograde root canal treatment. Radiographic differentiation of periapical cysts and granulomas is difficult. If the lesion is separate from the apex with an intact epithelial lining it may have developed into a self-perpetuating entity that may not heal when treated non-surgically. On other occasions, a periapical lesion may have a direct communication with root canal system and respond favorably to ortograde root canal treatment. The purpose of these two cases was to demonstrate the need for conservative endodontic management of chronic periapical infections. The following case reports describe the endodontic treatment of single rooted central and lateral incisors teeth which were associated with a large periapical lesion. In this case report; orthograde root canal treatment provided a successful healing of a large periapical lesion in three separate cases. This confirms that, large periapical lesions can respond favorably to non-surgical treatment. T2 - 10 Biocompatibility of AH plus jet and Epiphany sealers in rat periapical tissue Noriko Mutoh, Nobuyuki Tani-Ishii Division of Endodontics, Department of Oral Medicine, Kanagawa Dental College, Yokosuka Japan Abstract Introduction: The purpose of this study was to evaluate the biocompatibility of resin-based root canal sealer in periapical tissue of rat. Methods: Four-week-old female Wistar rats (n=60) were used for tooth replantation to reproduce the periapical tissue response with root canal sealers. The resin-based root canal sealer Epipany , AH plus jet, and a eugenol sealer Canals were used in this experiment. The upper right first molar was extracted and applied with a root-canal sealer on the root apex of the extracted tooth. The tooth was then replanted in the original socket. Jaws were collected from groups of 10 rats at 7 days and 14 days after tooth replantation. After histological processing, sections were stained with hematoxylin-eosin. Results: Mild inflammation occurred in the periapical tissue of the replanted teeth with both Epiphany and AH plus jet sealers on day 7, whereas the eugenol sealer induced severe, oderate inflammation. On day 14, the lesions induced by all types of sealers were healed and replaced predominantly by fi- 5 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY brous connective tissue. Thus, all materials showed high biocompatibility, although the extent of inflammatory reactions during the early stages varied depending on the types of materials. Conclusions: This study demonstrated that Epiphany and AH plus jet were biocompatible materials, and our animal model was useful for the assessment of the biocompatibility of endodontic sealers. Chairpersons: Edgar Schäfer, Roberto Sammarco Session T3 – 13.30 T3 - 1 Increase in interleukin-8 in teeth with irreversible pulpitis Alireza Adl, Mohammadyar Mosavi, Zahra Amirghofran, Shohreh Ravanshad Endodontist, Assistant Professor of Shiraz Dental School Endodontist, Professor of Immunology, Shiraz University of Medical Science Associate Professor of Shiraz Dental School Abstract Statement of the Problem: As a Chemokine from C-X-C family, Interleukin-8 has a strong activity for Neutrophiles and Lymphocytes. In addition, it causes Neutrophile granules to release and the release of enzymes leads to the destruction of tissues. A recent study has shown that IL-8 increases in Gingival Cerevicular fluid of teeth with symptomatic irreversible pulpitis. This study was an attempt to investigate and compare the amount of increase in Interleukin-8, in Gingival Crevicular Fluid of teeth with Symptomatic and Asymptomatic inflammated Irreversible Pulpitis. Method and Materials: For this study, 40 patients (suffering from Symptomatic and Asymptomatic Irreversible Pulpitis) were selected from among those patients referred to Endodontics Department of Shiraz Dental School. In order to collect the Gingival Crevicular Fluid, the target zones were isolated and cleaned with cotton roles and suction. Next, 3 paper points were put in the sulcus of selected teeth alternatively, each of which lasted for 1 minute. Then, the samples (paper points) were put into Ependorf tubes. The tubes were placed into ice boxes and sent to Immunology Department of Shiraz Medical School in order to continue the treatment. The level of IL-8 was measured using Elisa test. Results: The results indicated that there was not a significant difference between the levels of Gingival Crevicular Fluid in teeth with Symptomatic and Asymptomatic Irreversible Pulpitis Conclusion: Disregarding the symptoms, it was concluded that the levels of Interleuki -increased in teeth with Irreversible Pulpitis; however the increase was n( statistically significant. Key words: Interleukin-8, Irreversible Pulpitis, Symptom. T3 - 2 Presence of biofilm in the transition zone in combined endo-perio lesions. A low-vacuum SEM study. Darian Rusu, Luminita Nica, Andreea Didilescu, Cosmin Locovei, Aurel Raduta, Alexandru Ogodescu, Adrian Kasaj, Holger Jentsch, Stefan-Ioan Stratul Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania Politechnical University Traian Vuia Timisoara, Romania University Johannes Gutenberg Mainz, Germany University of Leipzig, Germany Abstract Introduction: Presence of bacterial biofilms on the external surface of apex of teeth with pulp necrosis has been previously investigated using SEM. Conventional SEM requires a complicate procedure, consisting in fixation of samples, dehydration, and coating (sputtering) of biofilm with conductive materials.Aim:Evaluation of the morphology 6 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L of biofilm of the transition zone between apical lesions and periodontal pockets in combined endo-perio lesions with a modified protocole involving a simplified histologic sample preparation and low-vacuum SEM examination.Materials&Methods:21 teeth with combined endo-perio lesions, diagnosed clinically and radiographically, were extracted and washed with saline, underwent fixation in modified Karnovsky solution and were dehydrated in alcohol series. The transition zone was located and examined under low-vacuum SEM (INSPECT S-FEI,Hillsboro,OR,USA), at 80-250Pa and 15kV.The presence of established biofilm, isolated glycocalyx strands, isolated bacteria, nude cement areas, periodontal ligament fibers, resorbtions, calculus, unstructured debris, and the type of microorganisms (cocci, rods, filaments, spirils) was assessed on each sample. Results were quantified and expressed as percentage.Results:The transition zones displayed established biofilms in 38% of the cases, isolated glycocalix strands in 9.5%, resorbtive areas in 28.5%, scattered bacteria in 24%, nude cement areas in 71%, calculus deposits in 24%, unstructured debris in 28.5%, and periodontal ligament fibers in various degrees of destruction in 24% of the samples, respectively. When present, cocci were found in 57%, bacilli in 14%, and filaments in 24% of the samples.No spirils were found.Conclusion:The transition zone between the apical lesion and the periodontal pocket in combined endo-perio lesions displays a relatively low incidence of established biofilm. When present, coccoid forms were predominant, while bacilli and filamentous forms were rather seldom observed. Rezorbtive areas appeared in only one third of samples.The low-vacuum SEM method is simple, cost-saving, results in excellent biofilm images, avoids sputtering and destruction of samples and electrostatic charges. T3 - 3 The role of TGF-β1 in matrix remodeling in periapical granuloma Andreea Diaconu Oana, M Banita, L Gheorghita, M Tuculina, C Pisoschi, P Surlin Department of Endodontics, School of Dentistry, University of Medicine and Pharmacy, Craiova, Romania Abstract AIM: Periapical granuloma represents a chronic lesion of the periapical tissues due to pulpal inflammation induced by the persistent presence of microorganisms. Granulomatous inflammation is considered a protective host response to limit periapical tissue damage through the inflammatory response. The histological feature of periapical granuloma is an onion leaf-like appearance, the external leaf being a dense connective structure. TGF-β1 is a family of multifunctional cytokines known to be involved both in the inflammatory response - inhibiting the proliferation of Tlymphocytes and deactivated macrophages - and in wound healing and fibrosis by inhibiting metalloproteinases synthesis and promoting collagen deposition. The aim of our study was to assess the expression of TGF-β1 isoform in periapical granuloma in relation with matrix remodeling (examined through MMP-2 and TIMP-2 expression) and its role in activation of myofibroblasts, cells known for their involvement in collagen deposition. METHODOLOGY: Formalin-fixed paraffin-embedded sections from 7 periapical granulomas were used to performe immunohistochemical reactions in order to assess the localization of TGF-β1, α-SMA - a specific marker for myofibroblasts, MMP-2 and TIMP-2. RESULTS: We noted a concentric distribution of morphological structures within the granuloma, the core being formed by proinflamatory cells with many new vessels TGF-β1 positive. On serial sections we noted some α-SMA and TIMP-2 positive pericytes. Macrophages and plasma cells express also TGF-β1. The edge of the structure was formed mainly by a dense tissue with fibroblasts and α-SMA positive cells myofibroblasts. Some peripheral cells with epithelial features (Mallassez epithelial rests) displayed discrete positive reaction for MMP-2. CONCLUSION: These data suggest that TGF-β1 could have a dual action in periapical granuloma: to induce the decrease of extracellular matrix breakdown and to activate fibroblasts towards a myofibroblast phenotype. ESE ROME 2011 NOT ONLY ROOTS T3 - 4 Evaluation of five periopathogens in endo-periodontal lesions A.C. Didilescu, D. Rusu, M. Greabu, A.A. Iliescu, G. Bancescu, A. Anghel, L. Nica, F. Leghel, S-I. Stratul Department of Dental Anatomy and Embriology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Department of Periodontology, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Department of Biochemistry, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Department of Oral Rehabilitation, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Department of Oral Microbiology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Department of Biochemistry, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Department of Endodontology, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Department of Biochemistry, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Department of Periodontology, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Abstract Aim: To evaluate five periopathogens: Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td), Prevotella intermedia (Pi), in samples from endo-periodontal lesions. Subjects and Methods: Forty-one patients were investigated. A clinical examination was performed, together with periapical radiographs and microbiological investigation of the endodontic and periodontal biofilms. Qualitative and semi-quantitative evaluation of the bacteria was performed using a commercially available kit (micro-IDent®, Hain. Lifescience GmbH, Nehren, Germany). The Spearman’s rank correlation coefficient was used to test possible associations between pathogen detections, as well as between bacterial scores and clinical parameters. A value of p < 0.05 was considered statistically significant. Results: The most prevalent species found in endodontic samples were: Tf (66% of the cases), Pg (61%), and Pi (46%). Both Tf and Pi had a positive correlation (r = 0.52, p < 0.01, n = 41), as well as Tf and Pg (r = 0.47, p < 0.01, n = 41) in endodontic samples. Positive correlations were also found between Tf and Pg (r = 0.53, p < 0.01, n = 41) in periodontal samples. Abnormal mobility was positively associated with detection of Pg (r = 0.37, p < 0.05, n = 41) and Tf (r = 0.43, p < 0.01, n = 41) in periodontal samples. Conclusion: The findings suggest that at least three of the five investigated species may play specific roles in the pathogenesis of endo-periodontal lesions: Pg, Tf, and Pi, respectively. This study was funded by the Romanian Council of Scientific Research (CNCSIS) and the European Society of Endodontology (ESE). T3 - 5 Selective detection of viable Enterococcus faecalis using propidium monoazide in combination with real-time PCR Kim Sin-Young, Jung IY Department of Conservative Dentistry, Seoul St. Mary’s Dental Hospital, Catholic University of Korea, Seoul, Korea Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Korea Abstract Polymerase chain reaction (PCR) can detect bacteria more rapidly than conventional plate counting. However, DNA-based assays cannot distinguish between viable and dead cells due to persistence of DNA after cells have lost their vitality. Recently, propidium monoazide (PMA) treatment has been introduced. The purpose of this study is to evaluate the applicability of the PMA treatment and real-time PCR method for cell counting in comparison with plate counting and to evaluate the antibacterial efficacy of 2% CHX on E. faecalis using PMA treatment in combination with real-time PCR. Firstly, to elucidate the relationship between the proportion of viable www.eserome2011.com cells and the real-time PCR signals after PMA treatment, mixtures with different ratios of viable and dead cells were used. Secondly, relative difference of viable cells using PMA treatment in combination with real-time PCR was compared with CFU by plate counting. Lastly, antibacterial efficacy of 2% CHX on E. faecalis was measured using PMA treatment in combination with real-time PCR. The results were as follows : 1. Ct value increased with decreasing proportion of viable E. faecalis. 2. There was correlation between viable cells measured by real-time PCR after PMA treatment and CFU by plate counting. 3. Relative difference of viable E. faecalis decreased more after longer application of 2% CHX. T3 - 6 Rezorbtion pattern analysis of radicular tips involved in combined endo-perio lesions: a low-vacuum SEM study Nica Luminita Maria, Alexandru Ogodescu, Stefan-Ioan Stratul, Darian Rusu, Rodica Jianu, Cosmin Locovei, Aurel Raduta, Mircea Nicoara, Camil Ianes, Andreea Didilescu Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania Politechnical University Traian Vuia Timisoara, Romania Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania Abstract Introduction:The rezorbtion lacunae of the root tip area of teeth involved in chronic apical lesions has been recently investigated (Felippe et al. 2009) using conventional SEM, which requires a complicate procedure, consisting in fixation of samples, dehydration using either critical point drying with liquid CO2 or alcohol series, and coating (sputtering) of biofilm with conductive material (Au,Pa or Carbon). Aim:Evaluation of the resorbtion pattern of the root tip surface in teeth with combined endo-perio lesions with a modified protocole involving a simplified histologic preparation and a lowvacuum SEM examination method.Materials&Methods:21 teeth with combined endo-perio lesions, diagnosed clinically and radiographically, were extracted and washed with saline solution, underwent fixation in modified Karnovsky solution (2.5% glutaraldehyde,4% paraformaldehyde,0.1M sodium cacodilate,pH7.2-7.4) and were dehydrated in alcohol series. The presence of rezorbtion lacunae and their pattern (isolated, multiple and merging, generalized, apparently deep, apparently shallow, the presence of isolated bacteria or established biofilm) was examined and assessed under the low-vacuum SEM (INSPECT S-FEI,Hillsboro,OR,USA), at 80-250 Pa and 15kV. Results:Cemental rezorbtive lacunae were observed in 18 of the evaluated samples (85.7%). Out of these, 7 (33%) displayed isolated patterns, 7 (33%) were multiple and merging, while 8 (38%) were generalized, involving the entire apical periforaminal area. Most of the rezorbtive areas displayed a honeycomb-type of lacunae. Established biofilms were found in 24% of the samples, while scattered free bacteria in only 29%. Conclusion: The rezorbtion area patterns of radicular tips involved in combined endo-perio lesions observed under low-vacuum SEM are relatively similar to those observed in apical lesions. They decrease in number and surface coverage towards the transition zone to the periodontal pocket, where the cement tends to be covered with calculus deposits. When present, bacteria (cocci better represented than bacilli) are either organized in biofilms, sheltered by resorbtive lacunae, or isolated. T3 - 7 Mast cells in periapical lesions: comparative study in non-diabetic versus diabetic population Sanchez Perez Rosa, Francisco J. Vera, Leopoldo Forner, Beatriz Vera, Carmen Llena Department of Stomatology, University of Valencia, Spain Department of Pathology, University of Valencia. Molecular Biology Laboratory, University Hospital “La Fe”, Valencia, Spain Abstract Introduction: Diabetic patients often show different changes in inflammatory reaction. Aim of our study is to detect the presence of mast 7 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY cells in periapical lesions in both diabetic and non-diabetic patients. Methods: Two groups (n=10 each) of periapical lesions from type II diabetic and non-diabetic patients were immunohistochemically studied by using CD117 (c-kit) monoclonal antibody. Cytometry was made under 40x magnification. Anova test was made. Results: Diabetic and non-diabetic lesions showed a mean of 31.4 and 36.9 mast cells/HPF respectively. In diabetics patients, 44, 23 and 10 mast cells/HPF in cyst, granuloma and scar tissue were founded respectively, and in the non-diabetic group, 28, 29 and 47 mast cells/ HPF were observed at the same lesions. The higher incidence of mast cells was seen in scar tissue of non-diabetic group (47/HPF) and periapical cysts of diabetic group (55/HPF). Mast cells are spread all over the different areas in the non-diabetic group, but in the diabetic one, mast cells are highly predominant at the fibrous areas without statistical significance (p>.05). Conclusions: In our study CD117 appears with a predominant presence of mast cells in fibrous lesions of the diabetic group, and mainly related to cystic lesions. T3 - 8 In vitro ameloblast differentiation affected by wnt signaling Takahashi Satomi, N Kawashima, K Katsube, T Sugiyama, H Suda Tokyo Medical and Dental University Pulp Biology and Endodontics, Tokyo, Japan Tokyo Medical and Dental University Oral Pathology, Tokyo, Japan Akita University School of Medicin Department of Biochemistry, Akita, Japan Tokyo Medical and Dental University Global Center of Excellence (GCOE) Program; International Research Center for Molecular Science in Tooth and Bone Diseases, Tokyo, Japan Abstract Aim. Ameloblast differentiation is initiated and maintained by the epithelial-mesenchymal interaction, where various growth factors are synthesized, and they are believed to be related to differentiation of ameloblasts. Wnt signaling is reported to be involved in the development and differentiation of many cells, including ameloblasts. We found that expressions of Wnt-related genes were up-regulated following the ameloblast differentiation in vitro. The objective of this study was to evaluate the effects of up- and down-regulation of Wnt signaling on ameloblast differentiation. Methodology. Ameloblast-like cells (ALC) were cultured in spinner modified MEM supplemented with 10% FBS and antibiotics. Wnt signaling was modified by LiCl (50mM), an inhibitor of GSK3, and Axin, a negative regulator of the Wnt signaling pathway, RNAi. Presence of LiCl activates the Wnt signaling, and knock-down of Axin prohibits the Wnt signaling. mRNA expressions of Wnt-related signaling molecules and ameloblast differentiation markers were analyzed by real-time RT-PCR using specific primers. Results. Ameloblastic marker expression was up-regulated in the presence of LiCl and down-regulated by Axin RNAi in ALC. These results suggest that Wnt signaling may accelerate the ameloblast differentiation. Conclusion. Up- and down-regulation of Wnt signaling increased and decreased the expression of ameloblast differentiation markers in ALC, respectively. T3 - 9 Biofilm morphology of the internal wall of the cemental cone in combined endo-perio lesions. A low-vacuum SEM study. Stratul Stefan Ioan , Darian Rusu, Doina Onisei, Mircea Nicoara, Luminita Nica, Ciprian Sarbu, Mihaela Grigorie, Andreea Didilescu Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, Romania Politechnical University Traian Vuia Timisoara, Romania Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania Abstract Introduction:While bacterial biofilm of the terminal root canal and of the periforaminal external area has been extensively described us- 8 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L ing conventional SEM (Kishen et al.2005, Richardson et al.2009), the biofilm on the intraforaminal walls (the “cemental cone” described by Kuttler) is relatively unknown.Aim:evaluation of the biofilm morphology on the internal wall of the cemental cone in combined endoperio lesions lesions with a modified protocole involving a simplified histologic sample preparation and a low-vacuum SEM examination method.Materials & Methods: 21 teeth with combined endo-perio lesions, diagnosed clinically and radiographically, were extracted and washed with saline solution, underwent fixation in modified Karnovsky solution (2.5% glutaraldehyde, 4% paraformaldehyde, 0.1M sodium cacodilate, pH7.2-7.4) and were dehydrated in alcohol series. The structures found on the internal walls of the cemental cone were examined and assessed under the low-vacuum SEM (INSPECT SFEI,Hillsboro,OR,USA), at 80-250Pa and 15kV. The presence of established biofilm, isolated glycocalyx areas, isolated bacteria, nude cement areas, resorbtion areas, filling materials, unstructured debris, and the type of microorganisms (cocci, rods, filaments, spirils) was assessed on each of the samples and the results were quantified and expressed as percentage.Results:Low-vacuum inspection resulted in electrical charge-free images of the non-conductive or contaminated surfaces. The internal walls of the cemental cone displayed established biofilms in 24% of the cases, isolated glycocalix strands in 14%, resorbtive areas in 14%, scattered bacteria in 9.5%, nude cement areas in 76%, filling material in 9.5%, and unstructured debris in 33%, respectively. When present, coccii were found in 38%, bacilli in 5%, and no filaments or spirils.Conclusions:Structured bacterial biofilm was found present in the majority of samples; when present, the morphology of the intraforaminal biofilm resembles to the biofilm in periodontal pockets. However, a continuity between the intraforaminal biofilm and the periforaminal and pocket biofilm could not be testified in the present study. Chairpersons: Carsten Appel, Michael Hülsmann Session T4 – 13.30 T4 - 1 The modern endodontic surgery: microscope, ultrasounds, and Mta. An evaluation of clinical and radiographic success after 2-years follow-up. Lorenzo Comin Chiaramonti, Alessandro Cucchi, Giacomo Cavalleri Departement of Endodontics, Verona University, Italy Resident, Institute of Oral Surgery and Dentistry, University of Milan, Italy Abstract INTRODUCTION: An endodontic treatment performed according to “ideal” protocol allows to achieve a long-term success rates of 90%. In recent years, endodontic surgery has increased its predictability by introducing new tools and materials: operative microscope for magnification and illumination;micro-curettes, micro-mirrors, microopeners or micro-carriers for easy access and manoeuvrability; ultrasonic tips for preparing mini-invasive cavity; and MTA to a perfect apical seal. This study aims to evaluate the clinical and radiographic success of endodontic cases treated with surgical approach, using modern technologies that were introduced in endodontic surgery in order to ensure greater predictability of the result. MATERIALS AND METHODS: 39 patients underwent endodontic surgery between January 2006 and July 2007, using a protocol based on the principles of “modern” endodontics. This protocol has been standardized in order to provide the use of operative microscope, the removal of endodontic lesions with micro-curette, the apicoectomy through progressive abrasion of root apex, the retrograde instrumentation with ultrasonic tips, and the 3-D apical seal with MTA. All intra-and post-operative complications, reported by patients and/ or highlighted by clinicians, were recorded. Patients were clinically and radiographically evaluated at 6, 12 and 24 months, in order to determine the clinical and radiographic success rates based on preestablished success criteria. ESE ROME 2011 NOT ONLY ROOTS RESULTS: The 2 years follow-up: 29 teeth (74.4%) showed clinical and radiographic complete healing; 4 teeth (10.3%) showed a clinical healing, but an incomplete radiographic healing (scar); and 2 teeth (5.1 %) showed a clinical healing, but uncertain radiographic healing; in addition, four teeth (10.3%) were extracted because of vertical root fractures (FVR), that were visible only at the time of surgery. DISCUSSION AND CONCLUSIONS: The success rates of this study demonstrate the effectiveness and validity of “modern” surgical endodontics, which allows to reach very predictable results. This surgical protocol was applied in other scientific studies, in which success rates were between 88% and 97%. Others authors have reached more or less different percentages by applying more or less different surgical protocols. Using operative microscope, ultrasounds, and MTA seems to be the most important factor to have a more predictable result. This study demonstrated that the “modern” endodontic surgery can achieve high success rates, minimizing intra-and postoperative complications. T4 - 2 Surgical endodontics. Report of a case Alonso Ezpeleta Luis Oscar, Nieto De Pablos Jose Maria, Piñero Yébenes Rafael, Del Valle Alexandre Beatriz University of Zaragoza, Zaragoza, Spain University of Alfonso X el Sabio, Madrid, Spain Abstract Introduction: Prognosis of endodontic surgery has been often considered more questionable. However, the development of new instrumentation and obturation techniques using ultrasounds and MTA, allows the procedure to be more predictable as well as a reliable option to preserve the tooth. A literature review about endodontic surgery will be presented, with a clinical case of apical surgery. The endodontic treatment of a three-rooted bicuspid was accomplished through a combined orthograde and retrograde approach. The case report will show how apical surgery represents an effective and predictable technique when orthograde tretament is not feasible. A correct diagnosis, treatment plan and correct surgical approach with a three-dimensional shaping and filling of the retrograde cavity are crucial for successful clinical outcomes. T4 - 3 Autotransplantation of an ectopic impacted premolar with sinus lift and allogenic bone graft Bo-hyun Ban, Ji Yau Sun, Se young hwang, Bock young Jung, KeeDeog Kim, Nan sim Pang South Corea Abstract Aim: This paper presents a case report of autogenous tooth transplantation to a site which had insufficient bone volume using sinus lift and allogenic bone graft. Summary: An ectopic, fully impacted premolar tooth was autotransplanted from its ectopic impaction site into its original site, where there was insufficient recipient vertical bone volume due to sinus pneumatization. The deciduous tooth was extracted from recipient site and the sinus membrane detached and elevated via the alveolar socket. Allogenic bone grafting was performed, and the impacted premolar was transplanted into the prepared site. To improve the adaptation, the recipient site was prepared using a rapid prototype (RP) tooth model, a replica tooth which allowed complete socket preparation in advanced of the actual removal of the donor tooth. The donor tooth was fixed with sutures and maintained for 17 days to allow physiologic movement. Rootcanal treatment was initiated 24 days after autotransplantation, and MetaPaste medicament was used for 4 months. Canal filling was completed 5 months after autotransplantation. There was no root resorption of the transplanted too! th and the grafted bone was well preserved and had no signs of infection until 2 year check up. www.eserome2011.com T4 - 4 Cause of failure in non-surgical endodontic treatment through the endodontic microsurgery Bona Kim, Hyun Kim, Minju Song, Euiseong Kim Dept. of Conservative Dentistry, Yonsei University, Seoul, Korea Abstract Aim: The purpose of the study was to investigate the clinical causes of failure and the limitation of the previous endodontic treatment by inspection of the root apex and resected root surface at 26x magnification during endodontic microsurgery of failed teeth with previous endodontic treatment. Methodology: The data was collected from patients in the Department of Conservative Dentistry at the Dental College, Yonsei University in Seoul, Korea between March 2001 and January 2011. All rootfilled cases with symptomatic or asymptomatic apical periodontitis were included in this study. All surgical procedures were performed using an operating microscope(OPMI R PICO; Carl Zeiss, Göttingen, Germany), and the surface of the apical root to be resected or resected root surface after Methylene blue staining were examined during the surgical procedure and recorded carefully with 26x magnification to determine the state of previous endodontic treatment by using an operating microscope. Results: Among 557 cases with periapical surgery, 493 teeth were included in this study. With exclusion of unknown cases, the most common possible causes of failure was leaky canal(30.4%), followed by missing canal(19.7%), underfilling(14.2%), anatomical complexity(8.7%), overfilling(3.0%), iatrogenic problem(2.8%), periodontal problem(1.8%) and crack(1.2%). The frequency of possible failure causes was different among the tooth position statistically (p<0.001). Conclusion: Appreciation of root canal anatomy using an operating microscope in non-surgical endodontic treatment can make the prognosis enhance more predictable and favorable considerably. T4 - 5 Immediate post extractive implant rehabilitation of an endodontic failure: a case report Nadia Medea Ferrarese, Nicolà Maria Balzano, T Costa, E Bressan, Carlo Tocchio University of Padua. Italy Abstract BACKGROUND: Post extractive implant rehabilitation give a solution in case of endodontic failure or the impossibility of rebuilding the tooth. MATERIALS AND METHODS: tooth 36 have been extracted for an endodontic failure. A post extractive treatment using astra-tech implant (h 11, ø 4,5) have been done. Implant have been loaded after two month with a conical abutment cement-retained restoration. RESULTS: the case present a post extractive implant placement. Conical abutment have been used for the connection between the fixture and the crown. DISCUSSION: Rehabilitation of single tooth could be done with different therapeutic possibilities: conventional fixed prosthesis, removable prosthesis or implant solution. In case of vitality and integrity of contiguous teeth implant therapy is suggested. CONCLUSIONS: Single implant placement with conical connection is a valid option for single tooth rehabilitation, maintaining the integrity of contiguous teeth. T4 - 6 Endodontic and surgical treatment of a maxillary central teeth with expansive internal resorption Ö. Genc, T.B. Özkan, Devrim Akyol Gulter, V. Kaplan Yuzuncuyıl University, Faculty of Dentistry, Van, Turkey Abstract This case presents the endodontic and surgical treatment of a maxillary central tooth with extensive internal root resoption. A 33-year- 9 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY old patient was referred to our clinic with the complaint of a discoloration on the maxillary right central tooth. Radiographs were taken and a large internal resoptive defect was detected in the apical and middle thirds of the canal. Endodontic access cavity was opened and 30# K file was inserted into the canal. At the time severe bloody exudate was started to drain from the canal orifice. Drainage lasted for half an hour time and, then calcium hydroxide dressing was placed. Dressing was changed for six times in two months period but no signs of healing was observed. Therefore, an obturation was performed using an MTA based root canal paste and gutta percha, and, in the same visit apical surgery was initiated. Unhealty situation of the periodontium was observed during the surgical treatment, therefore it was decided to extract and reimplant the tooth, to allow curetage. Apical part of the root was sealed with amalgam. Tooth was put again in the socket in infra-occlusion after alveoler bone was shaped . then it was fixed to adiacent teeth for three weeks. After 1 month the mobility was class 1. After 2 months there was no mobility. A zirconium crown was prepared for the tooth. Follow up radiographs over 12 months demonstrated the maintenance of a functional tooth. T4 - 7 A longitudinal retrospective study on the success rate of endodontic microsurgery Lui Jeen-Nee, Ma-Ma Khin, Benny Goh, Leslie Ang, Nah-Nah Chen National Dental Centre of Singapore Abstract Aim: The aim of this study was to evaluate the outcome of endodontic microsurgery and variables related to success. Method: Clinical records of all patients who had undergone an endodontic microsurgery by endodontists over a 6-year period (19972003) in the National Dental Centre of Singapore were examined. Anterior and posterior permanent teeth with a recall period of 1-2 years were selected for the study. All surgical procedures, except for flap raising and suturing, were performed using a surgical operating microscope. After root resection and retro-preparation with ultrasonic tips, root end cavities were filled with either Intermediate Restorative Material or Mineral Trioxide Aggregate. Periapical radiographs were taken after surgery and every 6 months subsequently. Teeth were evaluated for clinical signs and symptoms at each post-surgery visit. Pre-operative and post-operative radiographs were evaluated independently by 2 endodontists in a blinded manner and categorized into complete healing, incomplete healing, uncertain healing and failure. For analysis, teeth with complete and incomplete healing was grouped together and defined as “success”. Results: 264 apical surgeries had been performed over the 6 year period. 101 teeth were eligible for the study and subjected to further analysis. The percentage of complete healing, incomplete healing, uncertain healing and failure was 61.4%, 11.9%, 15.8% and 10.9% respectively. Overall, the success rate was 73.3% and failure was 26.7%. A multivariable logistic regression model (c-statistic=0.74) showed that females had a higher likelihood of success compared to males (OR=5.6, 95% CI 1.3-24, p=0.02). When detected intra-operatively, presence of an isthmus (OR=0.24, 95% CI 0.05-1.19, p<0.1) or crack (OR=0.20, 95% CI 0.04-0.98, p<0.1) was associated with a higher risk of failure. Conclusions: A success rate of 73.3% was achieved in teeth with a recall period of 1-2 years after endodontic microsurgery. Gender, presence of isthmus and crack are possible prognostic determinants of the outcome. T4 - 8 Management of a large endodontic lesion by means of decompression and endodontic surgery Meire Maarten , Filip L. Calberson, Roeland J. G. De Moor Department of Operative Dentistry and Endodontology, Dental School, Ghent University, De Pintelaan 185/P8, B9000 Gent, Belgium Abstract Although evidence suggests that the size of an apical lesion does not affect the prognosis of orthograde root canal treatment, the clinician 10 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L is sometimes faced with large cyst-like periapical lesions that do not respond to non-surgical root canal treatment. A such situation is presented in this case report. A 28 year old caucasian female was referred to the Endodontic Department for treatment of a large radiolucency surrounding the apex of tooth 12. This lesion was discovered after an episode of acute pain in that area. Orthograde endodontic treatment was initiated and a calcium hydroxide intracanal dressing was placed for several months and refreshed regularly. After six months, the patient was symptom free and the canal was filled with gutta percha and sealer. Four months later, symptoms reappeared and radiographic evidence of reduction of the lesion size was lacking. The patient agreed upon a decompression procedure, in order to limit the risk of damage to the vascular supply to neighboring teeth or encroachment into the nasal antrum with a surgical enucleation. After six months of decompression, only minor decrease in lesion size was noted and it was decided to perform endodontic surgery. A full thickness flap was raised followed by curettage of the lesion. The root end of 12 was resected and a retrocavity was prepared with ultrasonic tips and filled with MTA. The bone lesion was packed with absorbable gelatine sponges and covered by a collagen membrane before suturing the flap. Fifteen months later, the patient remains symptom-free, the soft tissues are healthy and apart from a small apical scar, the lesion is completely healed. T4 - 9 Healing of periapical lesion after retrograde mta obturation Burcu Serefoglu, U. Tekin, B. Yildirim Ege University School of Dentistry, Izmir, Turkey Abstract Objective: To present the healing of a large periapical lesion after the second surgical endodontic treatment of a 63 years old male patient who had received surgical management 27 years ago. Methodology: The patient referred to our clinic with complaint of swelling in the labial vestibule of maxillary anterior region and pain. A large radiolucent lesion around the maxillary left central and lateral teeth was seen on radiographic examination. The adopted treatment protocol was started with drainage and only posts were removed from the teeth. Although filling material was tried to removed, it couldn’t achieved. As a result, surgical endodontic treatment was decided to perform. Before the surgery, the teeth were restored with fiber post and composite. At the surgery stage, apical piece of the root filling material removed with an ultrasonic and MTA was used as a retrograde sealing material. After surgical treatment, the teeth were restored with metal reinforced full porcelain crown. Results: Clinic and radiographic examinations at 24 months followup revealed healthy apical healing. Conclusion:This case report demonstrated that previously treated teeth that exhibit large periapical lesions can be retreated by using MTA as a retrograde sealing material to achieve periapical healing. T4 - 10 The influence of different bevels of root-end resections and burs in the exposure of dentinal tubules. An ex-vivo study. Lyssaris Vasileios, CH Beltes, N Economides Aristotle University Thessaloniki Department of Endodontology, School of dentistry, Thessaloniki, Greece Abstract Aims. The purpose of the present study has two-folds: a) to evaluate how the apical root resection angle may influence the overall number and type of exposed dentinal tubules, b) to compare different types of burs in relation with the exposure of dentinal tubules after root-end resections. Methods. Sixty single-rooted extracted human teeth, endodontically ESE ROME 2011 NOT ONLY ROOTS treated, were included in this study. The teeth were divided into three groups of twenty each. In the first group the apical 3mm of the roots were resected perpendicular to the long axis of the roots, whereas in the second and the third group apicectomies of 20 and 45 degrees were performed respectively. Each group was subdivided according to the type of the bur and the application of EDTA solution on roots surface. All specimens were examined under scanning electron microscope. Results. Dentinal tubules were not exposed in the specimens without EDTA preparation, regardless the bevel of resection and the type of bur. Only in the specimens with EDTA preparation pores and tubes of dentinal tubules were exposed. The amount and the type of exposure were influenced by the handling of the burs during root-end resections. Conclusions. Based on the findings of this study, the influence of exposed dentinal tubules during periapical surgery in relation with the overall success is possibly overestimated. The root surfaces seem to be covered with the products of bur cutting during root-end resections. Chairpersons: Jean Yves Cochet, Katia Greco Session T5 – 13.30 T5 - 1 Apexification with calcium oxide: three case reports Bodrumlu Emre, Ersan Clcek , Bura Güler Samsun University, faculty of dentistry, department of endodontics, Turkey Abstract AIM. Calcium oxide, available for decades as a root canal filling material, has not been frequently used in recent years due to its lack of radiopacity, and due to the expectation that it would lead to an excess of root fractures. These case reports were performed to determine the clinic and radiographic success of calcium oxide in the apexification treatment. METHODOLOGY. This clinical report describes an apexification procedure on three maxillary central incisors presenting with chronic apical periodontitis. The pulp of the teeth had become necrotic following a traumatic injury. According to the treatment procedure the root canals were biomechanically prepared, medicated and filled with calcium oxide to stimulate hard tissue barrier formation. RESULTS. Follow-up clinical and radiographic examinations confirmed apical barrier at 6 months. CONCLUSION It is concluded that calcium oxide may be considered a safe and viable alternative to other current methods of apexification. homogeneous root canal filling extended beyond the apical constriction. A CBCT was used as an additional diagnostic tool to assess the relevant area more accurately. An extensive iatrogenic perforation on the labial site was detected. Retreatment of the root canal filling was performed using the operating microscope and ultrasonic instruments. After disinfection of the root system, the perforation and the apical 2 mm of the root canal were sealed with MTA. The remaining root canal system was obturated with warm vertically compacted gutta-percha. The access cavity was sealed with composite. For aesthetic reasons, both central incisors were restored using a polychromatic composite layering approach. RESULTS.Follow-ups up to 24 months showed an asymptomatic tooth and a completely healed periradicular lesion. CONCLUSION. For treatment of complex endodontic problems, sophisticated equipment such as Cone Beam Computed Tomography, the operating microscope and biocompatible endodontic materials may be essential in order to obtain favourable results. T5 - 3 Intentional replantation Mario Castro, J Reichsthaler, M Lee, Justo Sosa Private Practice Vienna, Austria Private Practice Los Angeles, USA Private Practice Tenerife, Spain Abstract AIM “Intentional Replantation” is the intentional removal of a tooth and its re-insertion into the socket after endodntic manipulation or obturation of the canals or both. According to the AAE (American Association of Endodontists) it is the insertion of a tooth into its alveolus after the tooth has been extracted for the purpose of performing a treatment such as a root end filling or perforation repair. METHODOLOGY There are several indications for this treatment option as: limited accessibility, close proximity to critical anatomical structures, detection and treatment of perforation, treatment of failed apical surgery. As every procedure it has its contraindications such as: moderate to severe periodontitis, furcation involvement, severely dilacerated roots, inability to remove the tooth atraumatically, vertical root fracture, non-restorable tooth/extensive caries and large restoration. When performing an “Intentional Replantion” every effort should be made to replant the tooth within 10-15 minutes in order to achieve proper periodontal ligament and bone healing. There are only a few steps to follow for this procedure: extraction, resection, MTA fill and replantation. RESULTS. According to Kratchman et al., the procedure is reliable and predictable and should be considered as treatment option. CONCLUSION. It is our conclusion that “Intentional Replantation” is an excellent endodontic treatment option with a predictable and successful prognosis. It should be considered as an alternative treatment option, when microsurgical root end surgery can not be performed. T5 - 2 Non-surgical management of a traumatized central incisor with apical root perforation and large periapical lesion Leodard Buttel, Roland Weiger, Gabriel Krastl Department of Periodontology, Endodontology and Cariology, Institute of Dentistry, University of Basel, Switzerland Abstract AIM. Root perforations are undesired complications that may impede endodontic therapy and jeopardize the treatment outcome. Cone Beam Computed Tomography (CBCT) has proved to be a useful tool to properly assess the size and location of the perforation. METHODOLOGY. A 14-year-old boy was referred to the clinic for endodontic treatment due to pain on his upper left central incisor. He gave a history of trauma with crown fractures on both maxillary central incisors 4 years ago. The clinical examination revealed the presence of a sinus tract. The periapical radiograph showed a large periapical lesion and an in- www.eserome2011.com T5 - 4 The vital treatment of hyperplastic pulpitis with MTA and Ca(OH)2: two case reports Clcek Ersan, Bura GÜler, Hikmet Aydemr Ondokuz mays university, faculty of dentistry, depertmant of endodontics, Samsun, Turkey Abstract AIM. Vital pulp therapies are the treatment of choice for pulp exposures in immature/mature teeth with hyperplastic pulpitis and/or traumatic injuries. The procedure is primarily based on the healing ability of the healthy pulp. Two well-established methods for pulp preservation are direct pulp capping and pulpotomy. Pulpotomy involves the partial or total coronal pulp amputation and capping the wounded surface with a suitable material. METHODOLOGY. In these case reports, two different materials were used for coronal pulp amputation in maxillary and mandibular first molars with hyperplastic 11 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY pulpitis in separate patients. White mineral trioxide aggregate (MTA) was used in the first case. In the second case, calcium hydroxide (Ca(OH)2) was used and these cases were controlled after the treatment through one years with three months period. RESULTS. Any symptoms and pathologies were not observed in the both cases end of the one year. T5 - 5 Iatrogenic dentistry: case presentation Dragidella Fatmir, Metush Disha, Blerim Kamberi University of Prishtina, Medical Faculty, School of Dentistry, Kosovo Abstract Introduction: iatrogenic dentistry is disease-inducing dentistry or dental procedures which reduce natural resistance to disease. Objectives: the aim of this paper is to present a very unusual placement of gutta-percha points during endodontic treatment. Material and methods: patient N.N., 42 years old came to our department for the reason of pain and swelling in region of right mandibular second premolar. After clinical and radiological examination we found three gutta-percha points placed outside of root canal anatomy. Results: A minor periodontal surgery has been performed to remove gutta-percha points.Discussion and conclusions: the dentist play an important role in maintaining the health of oral tissues. On the other hand the dentist can cause damage to the tissues as result of inappropriate dental therapy. T5 - 6 Tooth saving Jeong Hye Jeon, JS Kim Hallym university Department of conservative dentistry Seoul Republic of Korea Abstract Introduction: Endodontics as a discipline has offered patients the opportunity to maintain the nature teeth. Occassionally, we meet the very difficult cases nevertheless do our best. Management of failing endodontic treatment may present significant challenges. The following case report describes successful treatment these challenging cases. Case Presentation Case1: Use of Mineral trioxide aggregate(MTA): in case of invasive external root resorption on Lt. Mandibular premolar. Case2: Hemisection on Mandibular first molar tooth and amputation of mesial root combined bridge restoration. Case3: Intentional Replantation: Extraction and replantation with 180-degree rotation of traumatic abulsive anterior tooth. Conclusions: This case report demonstrate the importance of establishing a multidisplinary approach for a successful dental trauma management. Although this case reports present a favorable clinical outcome, further studies are necessary to provide more efforts about tooth savings. T5 - 7 Endodontic management of external apical pulpal infection root resorption. A case-series study Konstantinos Ioannidis, Georgios Tsombanides, Konstantinos Mastoras, Christos Gogos, Theodoros Lambrianidis Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Greece Abstract AIM. External root resorption varies in etiology and can be classified in two major categories, including inflammatory and replacement resorption. However, the variations among the two main categories should be identified according to the existing local or systemic stimulation and aetiological factors, in order to diagnose, reverse and treat the process successfully. In the presence of external apical pulpal infection root resorption it is critical to control the biofilm formation within the root canal sys- 12 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L tem and especially in the distorted apical terminus. In this study, the patients’ records with diagnosed external apical pulpal infection root resorption that presented in a post-graduate clinic in a three-year period are described. METHODOLOGY. The management of all affected teeth included conservative endodontic treatment or re-treatment. Therapeutic procedures included chemomechanical preparation of the root canal system (hand files / ultrasound activation of NaOCl 2.5%, EDTA 15%, chlorhexidine 2%), and application of inter-appointment medication (Ca(OH)2) from 1 week up to 3 months. Several obturation methods were used for the resorbed root canals including thermo plasticized gutta-percha, MTA apical plugging and back-filling with gutta-percha or entire filling with MTA. All patients were scheduled for a 6 to 12 months follow-up examination cons ecutively. RESULTS. In the majority of the cases the healing outcome was evaluated as favorable with clinical and radiological criteria. T5 - 8 Intentional replantation of C-shaped mandibular second molars: case reports Lim Ji Hyui, Chang SW, Yoo HM, Park DS, Oh TS Department of Conservative Dentistry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Abstract Although nonsurgical endodontic treatment usually has high success rates, it may fail eventually. These can be managed by alternative treatments, such as intentional replantation. Intentional replantation is indicated for limited access, anatomic limitations, failed periapical surgery, persistent chronic pain, or patient management. However, in case of mandibular second molar, there are many root canal variations including C-shaped canal. C-shaped canal systems have complicated canal configuration, so conventional root canal treatment can be easily failed. Also, the mandibular second molar has anatomic limits to perform periapical surgery. Two clinical case reports present the intentional replantation of Cshaped mandibular second molars with previously failed nonsurgical endodontics. In both cases, the molar was extracted, and the root appeared to be C-shaped. The root apices were resected extra-orally, retrograde cavities were prepared, and retrofilled with Super EBA (Harry J. Bosworth Co., Skokie, IL). Then the tooth was replanted. The patient returned for follow-up at 1 month, 3 months, 6 months, and once yearly thereafter. At the last visit, the patient was asymptomatic and periapical radiograph showed no evidence of root resorption or peripaical lesion. In conclusion, the presented cases show that intentional replantation may be a reliable procedure. Intentional replantation should be considered as a viable treatment option to preserve the natural dentition, in situations where other procedures would likely to fail. T5 - 9 Endodontic management of internal root resorption. A case series study Konstantinos Mastoras, Konstantinos Ioannidis, Georgios Tsombanides, Christos Gogos, Theodoros Lambrianidis Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Greece Abstract AIM. The hard tissues (dentin, cementum and enamel) of permanent teeth do not normally undergo resorption. Tooth resorption may occur as a result of inflammatory conditions, mechanical stimulation, or neoplastic processes. The resorption may occur in bone, dentin or cementum but the process is similar. The key cells involved in resorption are multinucleated giant cells, called osteoclasts, cementoclasts, or dentinoclasts depending on the tissue being resorbed. The aetiology of internal root resorption varies and may occur as a result of chronic inflammation/infection in the vital pulp secondary to caries, trauma, pulpotomy, restorative procedures, orthodontic movement and herpes zoster. In this study, the patients’ records with diagnosed internal inflammatory root resorption that presented to ESE ROME 2011 NOT ONLY ROOTS post-graduate clinic in a three-year period are described. METHODOLOGY.The management of all affected teeth included conservative endodontic treatment or re-treatment. Therapeutic procedures included chemomechanical preparation with hand and rotary files, ultrasound activation of NaOCl 2.5%, EDTA 17%, chlorhexidine 2% and Ca(OH)2 as inter-appointment medicament from 10 days up to 1 month. Different obturation techniques were performed, including warm vertical compaction, continuous wave vertical condensation and carrier-based systems. All patients were scheduled for follow up examination from 6 to 12 months. RESULTS. The healing outcome was evaluated as favorable with clinical and radiological criteria. T5 - 10 Intentional replantation of a vertically fractured lateral incisor, reconstructed with dentin – bonded resin. Case report. Michael Ioannou, AA Iacovidou Private Dental Practices, Nicosia, Cyprus Abstract Intentional replantation of a vertically fractured root after reconstruction with dentin – bonded resin could be an alternative treatment rather than extraction or root resection. In our case a lateral incisor #22, which was retreated 5 years ago, came back with sensitivity on palpation and positive percussion. A new retreatment was decided. During the observation on the walls of the canal, with the operating microscope, an incomplete vetrical root fracture was noticed. It was extended from the middle to, probably, the apex of the root. An intentional replantation and a reconstruction of the root with dentin bonded dentin were decided. Consent of the patient was obtained, explaining the nature of the procedure and the possible risk benefits. The tooth was extracted with special caution to avoid damaging the periodontium. The tooth was observed with an operating microscope (OPMI PICO MORA, Carl Zeiss) at 8,5x and 13,6x magnification to examine the extension of the fracture line and the condition of the fractured surface. The incomplete fracture was detected and could be characterized a thin, one surface fracture. It was sealed with dentin – bonded resin, after a shallow preparation of the fracture line with a fine diamond, on a high torque handpiece. During the reconstruction, the tooth was kept under moisturizing condition with saline. Care was taken to touch the periodontal ligament as little as possible. The socket was gently curetted to remove inflamed tissue and debris. Then the tooth was replanted into the socket with gentle finger pressure. Enamel matrix proteins contained in Emdogain ( Biora AB ) was used for augmentation of periodontal tissue regeneration. The tooth was splinted with 0.9mm wire for three months. The tooth was followed up based on a protocol used at the University of Athens (Dr. Siskos G.). For the last 2,5 years the tooth is symptom free and the radioqraphical status is fine. Under specific circumstances, intentional replantation is an optional treatment. Even if we don’t have a lot of evidence for the value of this technique, we may conclude that this technique has the potential to become a basic treatment in specific cases, to preserve vertically fractured teeth. Chairpersons: Sashi Nallapati, Frank Paqué Session T6 – 13.30 T6 - 1 Increase of the temperature during the ultrasonic removal of endodontic posts Nadia Medea Ferrarese, Giulia Carli, Nicolò Maria Balzano, Carlo Tocchio School of Dentistry , University of Padua, Italy Abstract The literature suggests the reduction of the temperature during the www.eserome2011.com removal of endodontic posts using ultrasonic devices. The heat’s control is important to avoid damages to periodontal ligament, i.e. external gingival recession. The aim of this study is the comparison, in vitro, of different techniques and materials used in retreatment of endodontically treated teeth restored with custom or preformed posts. Several artificial canals have been constructed using epoxy resin. An internal and an external thermo-probe have been connected to a thermocouple that measured the increases of the temperature when ultrasonic tip is applied to remove the post. Six groups have been analyzed with three types of posts removed with cooled and not cooled ultrasonic tip. Group A1: cast metal post removed with not cooled ultrasonic tip Group A2: cast metal post removed with cooled ultrasonic tip Group B1: glass-fiber post removed with not cooled ultrasonic tip Group B2: glass-fiber post removed with cooled ultrasonic tip Group C1: retractable glass-fiber removed with not cooled ultrasonic tip Group C2: retractable glass-fiber removed with cooled ultrasonic tip Results demonstrate that the use of a cooled tip is important to remove all types of posts. Retreatment of glass-fiber posts with soft core showed much less increase of temperature if compared with all other posts. Conclusions: considering the limits of this in vitro study, it can be concluded that using retractable posts removed by cooled ultrasonic tips is the best condition in retreatment to avoid excessive heating of the root surface. T6 - 2 Use of calcium silicate cements as root canal sealer in endodontics: a clinical trial Livio Gallottini, Konstantinos Besharat Laith, Guido Migliau Department of Dental and Maxillo Facial Sciences, School of Dentistry, Master’s Degree in Endodontics, La Sapienza University of Rome, Italy Abstract AIM. To evaluate from a clinical point of view the new calcium silicate cements proposed for endodontic application as root canal sealers associated with gutta-percha orthograde obturation techniques. METHODOLOGY. 105 adult patients who presented a mandibular molar to be treated endodontically, where divided into 3 groups of 35 patients (30 teeth presenting periapical lesion ,10 previous root canal treatments and 5 widened periodontal ligament). Endodontic single visit treatments were performed by the same operator. Working length was determined by the joint use of an electronic apex locator (PROPEX II-DENTSPLY MAILLEFER,Ballaigues,CH) and an intraoral radiograph. Cleaning and shaping was performed using the simultaneous technique with Mtwo NI-TI rotary files and Mtwo Apical NI-TI rotary files (Sweden & Martina SPA,Padova,IT) for the preparation of the apical area. Alternated irrigation of 5% NaOCl and 2.5% EDTA was used after each instrument. In cases of retreatment, Mtwo R 25/05 file(Sweden & Martina SPA,Padova,IT) was used to remove filling materials. The obturation of the root canal system of all teeth was done using the Domino system(Sweden & Martina SPA,Padova,IT). A different endodontic sealer was used for each group: -Group I Epiphany (Pentron Clinical Tecnologies,Orange CA,USA) -Group II Top Seal (DENTSPLY MAILLEFER,Ballaigues,CH) -Group III Tech BIOSEALER ENDO (Isasan srl,Rovello Porro,IT) Follow-ups were carried out 3 and 6 months after treatment. Results were analysed using the software Statistical Package for Social Sciences (SPSS Inc, ver. 13.0, Chicago, IL, USA), chi-squared test was used for statistical evaluation of proportions. Treatment success was assessed by the healing of periapical tissues and no response to percussion. RESULTS. Success rate in Group I was 77.14%; in Group II was 80% and in Group III was 94%.The difference between the first two groups and the third one is statistically significant(p=0.03933). CONCLUSION. Tech BIOSEALER ENDO exhibited promising results and a good biocompatibility. It shows all the advantages of calcium silicate cements (excellent antibacterial properties) being at the same time more fluid and offering a suitable working time. 13 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY T6 - 3 Different healing results of the M1 superior depending on using a microscope during treatment Herman M Kostelijk, G Slaus, P Bottenberg Dept.of conservative dentistry, Free University of Brussels, Belgium Abstract Aim: to compare the long term healing results after endodontic treatment of the M1 superior with or without microscope and to establish a relation between healing results, the use of a microscope in endodontic treatment and the number of canals found and treated. Methodology : in 2006, 90 upper first molars were treated endodontically in a dental office in Tilburg, the Netherlands by four different dentists. Patients were not preselected and treated at random by one of the practitioners involved. This also applied for the use of a dental microscope. All treatments were done mechanically using NaOCl as the main cleaning liquid and a guttapercha or resilon canal filling was placed. After treatment a final x-photo was taken. After at least one year a control x-photo was taken. Both photos were digitally recorded on Phosphor plates and read by a Digora Optime reader (Soredex, Finland). In 2011 a panel of three dentists compared the initial and control x-photo, projected side by side on a large screen and gave a verdict about the healing, being successful, or failing. Success was defined as the absence of apical periodontitis, failure as the presence of apical periodontitis on the control x-foto (no matter if it was present on the initial x-foto). Data were analyzed using the Chi2- test. Results: 92 % of the 60 molars treated with the aid of a microscope showed healing, whereas 63% of 30 molars treated without a microscope had a successful outcome. This was significant according to the Chi-square test (p= 0.0025). Nevertheless, The Chi-square test showed no significance (p=0.18) concerning the number of treated canals: 48 molars with four canals were treated and showed a successful healing result in 88% of the cases, and 42 molars with three canals treated had a successful outcome for 76%. Conclusions: sing a microscope in the endodontic treatment of first upper molars had a positive effect on the healing of apical periodontitis, irrespective of slight differences in treatment procedures caused by the individual practitioner. At the same time, the finding and treating of a fourth canal had a positive, but not significant effect on the healing of apical periodontitis. The use of a microscope reduces the number of not found and treated fourth canals in such a way that there is no significant difference in long term healing results left between molars with four or three canals treated. Therefore it is important to use a microscope in the endodontic treatment of the M1 superior. T6 - 4 Micro-tomographical evaluation of mesiobuccal root canal system in maxillary molars among the Turkish population Kerem Askin¸ M. Ozgur Uyanik, Fugen Comert Turkey Abstract Aim: The aim of this study was to invastigate root canal morphology of mesiobuccal root canal system of three-rooted maxillary first molar teeth by using micro-computed tomography (μCT) scans. Methods: 30 freshly extracted maxillary first molar teeth were selected and scanned with μCT device. (SkyScan 1074, Aartselaar, Belgium). These images were reconstructed by using NRecon software programme (SkyScan 1074, Kontich, Belgium) in order to obtain two-dimensional cross-sectional slices of the root structure. After constructing two individual 3Dimages exhibiting the shape of the root by using 3D-Doctor software programme (v.3.5 Able Software Corp, Lexington, MA).The morphology and frequency of second mesiobuccal root canal was investigated by this model. Results: Second mesiobuccal root canal was detected in 76,6% 14 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L (23/30) of the samples analyzed. Single mesiobuccal root canal was only detected in 7 of the teeth investigated. (23,4%). Conclusion: Morphology of the mesiobuccal root canal system in maxillary molar teeth generally present a more complex structure than the other root canals. Based on the results of this study, it can be concluded that care should be taken during preparation of maxillary molar teeth due to the high frequency of second root canal. T6 - 5 Endodontic treatment of C-shaped mandibular molars. Report of five cases. Theodora Zarra, Z Psimma, C Boutsioukis Department of Endodontology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece Abstract Aim: The aim of this work was to describe the endodontic management of five C-shaped mandibular molars. Summary: Five cases of C-shaped mandibular molars in Caucasian patients were referred to the Postgraduate Clinic of the Department of Endodontology over the last year. Pulp necrosis and/or periapical lesions were identified in all cases. The presence of C-shaped root canals was suspected during routine pre-treatment radiographic examination and was verified clinically during probing and scouting of the canals with small hand-files and the aid of an operative microscope. A single C-shaped root canal was only found in one case, while slightly varying canal configurations were evident in the other four cases. Root canals were instrumented using Hedstroem files in a circumferential filing manner and obturated using warm lateral or vertical condensation. All teeth received permanent restorations and were followed for up to 12 months. None of the cases presented signs of failure within this period. Conclusions: The C-configuration is one of the most common variations of root canal anatomy in mandibular molars. Identification and successful treatment of such cases pose a challenge to the clinician. Implications of this anatomical variation may also extend to the prosthetic rehabilitation of these cases. T6 - 6 Acute pain of the trigeminal nerve due to amalgam in the mandibular canal Georgios Mikrogeorgis, O Pantelidou, V Thomaidis, Kleoniki Lyroudia Department of Endodontology, Dental School, Aristotle University of Thessaloniki, Greece. Department of Medicine, Democritus University of Thrace, Alexandroupoli, Greece Abstract Aim: This is a rare case of amalgam allocation in an alveolar cavity of an extracted third molar. This case report has an educational value and it is presented in order to be avoided such a traumatic injury in the future. Case presentation: A 36 years old woman went to a private practice for a regular examination. The dentist decided at that time to make an extraction of the tooth #38. During the extraction tooth #37 was broken. The dentist decided that an amalgam filling had to be done to the tooth #37 directly after the extraction and during the same appointment. The patient showed an acute continuous pain of the whole facial region innervated from the trigeminal nerve that was imitated endodontic pain. A panoramic radiograph of the patient after three days showed a large piece of amalgam near or inside the mandibular canal. A surgery was followed at the region. Amalgam was removed from the mandibular canal and as a result acute pain disappeared during the post operative days. Conclusion: Restoration with amalgam has to be avoided during a post– extraction time. Amalgam can appear toxic effects to the mandibular nerve that can transferred to the whole trigeminal nerve as well. ESE ROME 2011 NOT ONLY ROOTS T6 - 7 Endodontic treatment of an unusual maxillary dens invaginatus with sinus tract: 5 year follow-up Steffen Heike, A Eltahir University School of Dentistry, Greifswald, Germany Abstract A healthy 11-year-old girl was referred by an orthodontist to maintain the affected tooth because the left lateral incisor and the left canine were missed and the right lateral canine showed an atypical anatomy. On presentation the maxillary right lateral incisor showed a nearly destroyed clinical crown and a sinus tract in the buccal area releasing pus. The tooth responded to vitality tests. The radiograph showed a dens invaginatus, and an extended area of radiolucency. The patient received local anaesthesia, rubber dam was placed, and adequate access under the microscope was provided. Approximately 4-5 mm below the level of the gingival margin, a wide Cshaped canal with vital tissue and a second very narrow necrotic canal were detected. Bleeding pulp was removed and both canals were prepared using combined hand and rotary instrumentation after establishing the working length. A passive irrigation with hypochlorite and CHX by the use of ultrasonic was used, calcium hydroxide was inserted and the tooth was temporarily sealed. Four month later the sinus tract had disappeared. After removal of medication an apical barrier to the wide opened apex with collacote was created and a plug of ProRootMTA was condensed; the apical part of the tooth was filled by vertical compaction and AH plus (Dentsply/ DeTrey, Konstanz, Germany). To prevent a fracture a fiber post was inserted and the crown was completely restored with light-cured composite. The patient returned for clinical and radiographic follow-ups after 1 and 5 years. Apical repair was observed, as well as absence of clinical symptoms. This case show the long-term success for a combined therapy with MTA, vertical compaction, fiber post and composite to maintain teeth with an anusual anatomy to maintain the tooth until orthodontic therapy is finished and an implant is possible. Chairpersons: Sema Belli, Mario Lendini Session T7 – 13.30 T7 - 1 Comparison of different solutions for final rinse optimization Raffaele Paragliola, Vittorio Franco, Cristiano Fabiani, Luciano Giardino, Simone Grandini Tuscan School of Dentistry, Dept of Endo/Restorative, University of Siena, Italy Abstract Introduction: The purpose of this study was to assess the penetration of a new modified sodium hypochlorite solution labelled with 0.2% alizarin red into dentinal tubules when used in root canals with PUI activation. Materials and Methods: 32 extracted human single-rooted teeth were selected for the study. Crowns were at 2 mm above the CEJ. 30.06 was the last file used at the WL. The teeth were randomly divided into four groups (N=8). A final rinse of each canal was performed with different agitation procedure: control, NaOCl+PUI, Hypoclean, Hypoclean+PUI. Specimen was cut at 1, 3, and 5 mm from the apex and were examined with a fluorescence light microscope at 100X. Images were evaluated following a set of scores used to assess the penetration of solution into the dentinal tubules. Statistical analysis was performed by using Kruskal-Wallis analysis. Results: Differences were found among groups in relation to the irrigation regimen used. Groups were ranked in the following order: control<Hypoclean<NaOCl+PUI= Hypoclean+PUI Group. At 1 mm www.eserome2011.com from the root apex, the Hypoclean+PUI group exhibited the highest score. Discussion: In the present study Hypoclean was compared to 5.25% NaOCl. The two irrigant were tested without activation into root canal and in association with PUI. Hypoclean showed a better result when was used without activation, but no differences were found when was used in combination with PUI. T7 - 2 In vitro comparison of antimicrobial activity of calcium hydroxide with different vehicles and ready-to-use calcium hydroxide against enterococcus faecalis and candida albicans Ali Çan YÜcel, Ertan Emek Onuk, Evren Sariyilmaz, Bekir Krarbucak Ondokuz Mays University, Faculty of Dentistry, Department of Endodontics, Turkey Ondokuz Mays University, Faculty of Veterinary Medicine, Division of Preclinic Science, Turkey University of Pennsylvania, School of Dental Medicine, Department of Endodontics, USA Abstract One of the goals of root canal treatment is to eliminate bacteria and their by-products from the roor canal system before filling. Resistant microorganisms, such as Enterococcus faecalis and Candida albicans, can remain in the root canals even after thorough mechanical instrumentation and irrigation procedures because of the complex anatomy of the root canal system and the ability of microorganisms to survive under adverse conditions. The use of intracanal medication has been advocated in the treatment of infected root canals. The aim of the present study was to evaluate the antimicrobial efficiency of calcium hydroxide (CaOH2) mixed with different vehicles: saline, glycerin+CMCP, CHX and proprietary brands of CaOH2 pastes: Calcicur, MM paste, Metapaste and to determine the most appropriate treatment for endodontic infections caused by Enterococcus faecalis and Candida albicans. An agar diffusion method was used to investigate the antimicrobial activity of calcium hydroxide mixed with different vehicles, %2 water based CHX, sterile saline, Glycerin+CMCP, and proprietary brands of calcium hydroxide pastes: Metapaste, Calcicur, MM paste. Enterococcus faecalis and Candida albicans were used as the standard test organisms. Data were analyzed using the statistical software package SPSS. One way analysis of variance (ANOVA) and Duncan’s test were performed for C. albicans whereas t test was performed for E. faecalis, with the level of significance set as p =.05. When the antibacterial effects of the CaOH2 pastes were compared the highest inhibition zones were observed in CHX- CaOH2 and Glycerin+CMCP- CaOH2, the difference between them was not statistically significant (P>.05). When comparing antifungal effects the highest inhibition zone was observed in glycerin+CMCP- CaOH2 group and it was significantly higher than CHX- CaOH2 and Calcicur. T7 - 3 Root canal disinfection with 6% NaOCl at different exposure times using two irrigation techniques Carrillo Vasquez Ana Gabriela, Leticia Reyes University of Baja California, Tijuana, Mexico Abstract The purpose of this study was to evaluate disinfection of the root dentin using 6% sodium hypochlorite, by observing effectiveness at different exposure times and using two irrigation techniques: conventional (syringe) and passive ultrasonic irrigation (PUI). 70 freshly extracted teeth were used in the present study. After cleaned and shaped of the root canal using the Crown Down technique with ProTaper (Dentsply Maillefer, Switzerland) rotary NiTi files. The smear layer was removed and teeth were sterilized. The teeth were divided into four groups of 15 teeth each (A, B, C and D) were contaminated with E. Faecalis. The remaining 10 served as positive and negative control groups. Groups A and B were irrigated using a conventional technique 15 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L and 6 % NaOCl, which was left for 10 (group A) and 15 minutes (group B). After irrigation regimen a hedstrom file (Sybron) number 25 was introduced to file the dentin walls to produce dentin shavings and paper points were use for debri collection. The other 2 groups were irrigated as previously shown for 9 (group C) and 14 minutes (group D), with the last minute of passive ultrasonic irrigation. Then the teeth and the paper points were placed in a brain heart infusion (BHI) broth and were incubated for 24 hrs. Disinfection of the samples was determined by the presence or absence of turbidity in the broth. Data were collected and statistically analyzed (Chi Square test). Presence of infection was observed in group A and B. In groups C and D there was no presence of turbidity. A statistically significant difference was noted between all groups A, B, C and D (p <0.05) Hence, we may conclude that 6 % NaOCl passive ultrasonic irrigation is more effective than conventional irrigation, regardless of different exposure times. 3% NaOCl (1:3 ratio). 100Ð of each experimental solution was placed in micro-tube which contained 900 Ð of PBS for dilution. Autoclaved filter paper disk of 8 mm diameter was soaked in the E.faecalis cultured solution. The infected filter paper disk was placed into the experimental antimicrobial solutions. After 3, 30, and 300 minutes of incubation period, the filter paper disks were transferred in the micro-tube containing 1ml PBS. E. faecalis fallen from the filter paper disk was serially diluted with PBS (10-1~10-12). After spreading was performed in the BHI agar media in anaerobic condition at 37Ð for 24 hours, the total number of CFUs was measured. Results: 3 minute soaking of HEBP13 group and 30 minute soaking of HEBP11, 12, 13 groups were capable of killing 100% of E. Faecalis, while EDTA group showed no antimicrobial effect. Conclusions: 9% HEBP/NaOCl solution in 1: 3 ratio is recommended for antimicrobial effect. T7 - 4 The tissue dissolving and smear layer removal performance of HEBP/NaOCl solution in different temperatures Cleaning of root canals with the combination of passive ultrasonic irrigation and different irrigating solutions F Haznedaroglu, Helin Ozkan, G. Barut Istanbul University, Department of Endodontics, Istanbul, Turkey Abstract Aim:To evaluate the efficacy of passive ultrasonic irrigation (PUI) with sodium hypochlorite individually or in combination with different irrigation solutions in removing debris and smear layer. Methodology: A total of 45 single-rooted teeth were divided into four experimental groups, each containing 10 teeth and one positive control group containing 5 teeth. The canals of all the teeth were prepared biomechanically with hand instruments using a step- back technique . The control group was not instrumented. The four irrigation sequences used in this study were performed (total 30 ml) as follows: Group 1: irrigation manually with 3% NaOCl. Groups 2, 3 and 4: in all groups PUI with 3% NaOCl during biomechanical preparation and the final irrigation was done with PUI using 3% NaOCl, 15% EDTA followed by PUI using 3% NaOCl or 10% citric acid followed by PUI using 3% NaOCl, respectively. The remaining debris and smear layer were evaluated by SEM photomicrographs taken from the coronal, middle, and apical thirds of the canals. A 5-grade scoring system for remaining debris and smear layer was used. Statistical analysis was carried out using the Mann-Whitney U tests. Results: Statistical analysis showed that in group 2 debris and smear layer at the middle and coronal thirds were removed more effectively than in group 1( p<0.05). Groups 3 and 4 were found to be more effective in removing debris and smear layer in apical, middle and coronal thirds than groups 1 and 2 (p<0.05). There was no statistically significant difference between groups 3 and 4. Conclusion: The use of PUI with EDTA and citric acid as the final irrigation was effective in cleaning the canals, especially at the middle and coronal thirds. T7 - 5 Assessment of the mixture of 9% HEBP/NaOCl solution for antimicrobial activity Lee Ji Hae, GW Choi, W Nam School of dentistry, Kyung Hee university Department of conservative dentistry, Seoul, Republic of Korea Abstract Aim: The aim of this study is to assess the antimicrobial activity of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP)/ Sodium hypochlorite (NaOCl) solution in different composition ratio. Methodology: Enterococcus faecalis (ATCC 4083) cells were cultured in 10ml Brain Heart Infusion Broth in anaerobic condition (85% N2, 10% H2, 5% CO2) at 37Ð for 24 hours. Experimental antimicrobial solutions were prepared according to different composition of HEBP/ NaOCl as follows: Control, Distilled water; NaOCl, Distilled water and 3% NaOCl (1:1 ratio); ethylenediaminetetraacetic acid(EDTA), 17% EDTA and 3% NaOCl (1:1 ratio); H11, 9% HEBP and 3% NaOCl (1:1 ratio); H12, 9% HEBP and 3% NaOCl (1:2 ratio); H13, 9% HEBP and 16 T7 - 6 Kim Kun Young, GW Choi, HR Kang School of dentistry, Kyung Hee university Department of conservative dentistry, Seoul, Republic of Korea Abstract Aim: The aim of this study is to assess the tissue dissolving and smear layer removal performance of various irrigation solution in different temperatures. Methodology : 1. Tissue dissolving assay Pulp tissue was obtained from extracted bovine incisors. Initial weight of each specimen was measured and recorded. Specimens were randomly divided into 9 groups. Specimens were placed into propylene tube which contained various kinds of solution: NaOCl alone, NaOCl in combination with either Ethylenediaminetetraacetic acid(EDTA) or 1-hydroxyethylidene-1,1-bisphosphonate(HEBP). Specimens were then incubated at 22Ð, 45Ð and 60Ð. After an incubation period of 0, 15, 30, 60, 90, and 120 min at each temperature, the weight of pulp tissue was measured. The weight loss of pulp tissue of each group was expressed as percentage of initial weight of the pulp tissue. 2. Smear layer removal effect test One hundred mandibular incisor teeth of young bovine were used. Cylindrical specimen (a height of 5±0.1mm) was fabricated by cutting away the crown portion at the CEJ and mid-root portion. Pulpal lumen was drilled around with high-speed #2 round bur and instrumented with rotary K3TM rotary Ni-Ti files. The lumen was irrigated with one of three experimental solutions. Specimens were then longitudinally sectioned and evaluated by SEM. Results: As the temperature of experimental solution rises, the tissue solubility increases accordingly (p<0.05). At same temperature, the tissue solubility of NaOCl is the highest followed by HEBP and EDTA in order (p<0.05). In the smear layer removal test, NaOCl group did not remove the smear layer. EDTA group and HEBP group efficiently removed the smear layer and the EDTA group was most efficient (p<0.05). Conclusion: with certain temperature limit, NaOCl/HEBP in higher temperature is recommanded as an irrigant in endodontic treatment in order to increase the tissue dissolving effect. T7 - 7 Effects of passive and ultrasonic irrigation on push-out bond strength of two different luting cement Akyuz Sefika Nur, A Erdemir, A Turkyilmaz, AU Eldeniz Kirikkale University Department of Endodontics, Kirikkale, Turkey Selcuk University Department of Endodontics, Konya, Turkey Abstract Aim To evaluate the effects of passive and ultrasonic smear layer removal techniques on the push-out bond strength of a glass fiber post adhesively luted with self-etching and self-adhesive luting cements. ESE ROME 2011 NOT ONLY ROOTS Methodology Thirty maxillary incisor roots were endodontically treated. After post space preparation, they were assigned to 5 groups: group 1 was served as control. The smear layer was removed passively (5.25% NaOCl and 18% EDTA in group 2 and 5.25% NaOCl and 20% citric acid in group 3) or ultrasonically (5.25% NaOCl and 18% EDTA in group 4 and 5.25% NaOCl and 20% citric acid in group 5). Each group was divided according to the adhesive approach, into the two categories. Posts (FRC Postec Plus) were luted with either a self-etch (Panavia F 2.0, Kuraray Medical, Japan) or self adhesive (G-Cem Automix, GC Corp., Japan) cement. Luting agents were then light-activated using a blue light–emitting diode curing unit. Roots/ cemented posts were transversally sectioned. Push-out tests were performed using a Universal Testing Machine at a crosshead speed of 1 mm min-1. The data were calculated as MPa and analyzed by using two way analysis of variance and Tukey tests. Results Push-out bond strengths were significantly affected by the smear layer removal techniques (p<0.05) and the type of luting agent (p<0.05). The use of ultrasonic system in removal of the smear layer was significantly increased push-out bond strength (p<0.05). The bond strength of the self-etch resin cement (Panavia F) was significantly higher than that of the self adhesive resin cement (G-Cem Automix) (p<0.05). Conclusions Within the limits of this in vitro study, the use of ultrasonic system in removal of the smear layer and the choice of selfetch resin cement can be increased the push-out bond strength of the glass fiber posts. T7 - 8 Assessment of mixture of HEBP/NaOCl solution for smear layer removal and tissue dissolving capacity Nam Wook, GW Choi School of dentistry, Kyung Hee university Department of conservative dentistry, Seoul, Republic of Korea Abstract Aim: To evaluate the capacity of smear layer removal and tissue dissolving with the mixture of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) and NaOCl solution. Methodology: 1. Smear layer removal test Cylindrical root segments of bovine incisors were irrigated as follows(n=20 per groups): NaOCl group, 3% NaOCl during and after instrumentation; Ethylenediaminetetraacetic acid(EDTA) group, 3% NaOCl during, 17% EDTA after instrumentation; HEBP11 group, 1:1-mixture 9% HEBP and 3% NaOCl during and after instrumentation; HEBP12 group, 1:2-mixture of 9% HEBP and 3% NaOCl during and after instrumentation; HEBP13 group, 1:3-mixture of 9% HEBP and 3% NaOCl during and after instrumentation. Irrigant volume and contact time were 15ml/15min during and 5ml/2min after instrumentation. Specimens were evaluated by SEM. 2. Tissue dissolving assay Bovine pulp specimens were previously weighed and immersed in each experimental solution. Experimental solutions were prepared as follows: NaOCl group, 1:1-mixture of distilled water and 3% NaOCl; EDTA group, 1:1-mixture of 17% EDTA and 3% NaOCl; HEBP11 group, 1:1-mixture of 9% HEBP and 3% NaOCl ; HEBP12 group, 1:2-mixture of 9% HEBP and 3% NaOCl; HEBP13 group, 1:3-mixture of 9% HEBP and 3% NaOCl. After an incubation time of 0, 15, 30, 60, 90, 120 minutes, the specimens were weighed. Results are expressed as percentage of the remaining tissue weight to the original tissue weight. Results :In the smear layer removal test, EDTA group and HEBP groups showed favorable ability to remove the smear layer, the EDTA group was most effective (p<0.05). No significant difference was found among HEBP groups (p>0.05). In the tissue dissolving test, the tissue solubility of NaOCl group is the highest followed by HEBP and EDTA groups in order. HEBP12 and HEBP13 group dissolved the tissue more effectively than HEBP11 group (p<0.05). Conclusions: The 1:2 and 1:3-mixture of 9% HEBP/NaOCl is recommended for the smear layer removal and tissue dissolving. www.eserome2011.com T7 - 9 Prevention of precipitate formation between CHX and NaOCl in curved canals: an in-vitro study Yaylali Ibrahim Ethem, K. Demirkaya, Y.M. Tunca Gülhane Military Medical Academy, Centre of Dentistry Science, Department of Endodotics, Ankara, Turkey Abstract Aim: To compare prevention of precipitation formation between Chlorhexidine and Sodium hypocholorite solutions by using traditional irrigating needles and Passive Ultrasonic Irrigation (PUI) in curved root canals. Material and Method: Thirty extracted maxillar first molar with curved palatinal roots were selected and sectioned palatal roots. The roots were divided in 3 groups (n=10). Apical foraminas were sealed with composite resin. WL was determined as 16 mm. and were sectioned from coronal parts. All root canals were prepared and irrigated with EDTA % 5 , NaOCL % 5 and Chlorhexidine % 2 sequently in according to irrigation protocol. Distilled water was used prior to Chlorhexidine to remove NaOCl. Traditional irrigation needles were used as 5 ml. to deliver distilled water in Group T. Distilled water was activated ultrasonically as 5 cc. / 20 sec. in Group U. None distilled water was performed in Group C as control group. Each roots were sectioned in 3 parts apicocoronally and then mesiodistall . Each part of root were examined and the results were subjected to Mann–Whitney U test. Results: The coronal and medial thirth of roots had no precipitation in two techniques. In apical parts of the roots, Group U had lesser precipitation areas than Group T (p<0,05). Conclusions : In our study we used distilled water as 5 ml. for both techniques. If the durations and/or amounts of irrigation is much more than 5 ml. and / or 20 second, the beter results can be taken. T7 - 10 Antimicrobial effectiveness of 2% Chlorhexidine liquid and Ca(OH)2 in root canals infected with E. faecalis (ex vivo) Konstantinos Kalogeropoulos, G Khabbaz Marouan Dpt. of Endodontics, Athens Dental School, University of Athens, Athens, Greece Abstract Aim of this investigation was to compare the antimicrobial effectiveness of 2% CHX liquid with that of Ca(OH)2 as intracanal medicaments against E. faecalis. Methods: 80 human intact freshly extracted single rooted teeth were prepared to apical size 50. Smear layer was removed and the specimens were immersed in BHI broth and underwent a sterilization process. Sterility was checked by the absence of turbidity. Infection of the specimens was done by a microbial suspension of E. faecalis renewed every second day. After 4 days the specimens were assessed for bacterial growth and divided into 4 groups of 15 each and 2 control groups of 10 each. The tested intracanal medications were commercially available Ca(OH)2 paste and liquid 2% Chlorhexidine solution. The medications were inserted in the root canals and infection was evaluated after three and seven days. Fisher’s Exact test and Bonferroni–Holmes post hoc test were used for the statistical analysis. Results: The infected specimens in the 2% CHX liquid group were found to be 5/15 (33.33%) and 4/14 (28.6%) for the 3 and 7 days period respectively whilst the infected specimens in the Ca(OH)2 group were found to be 13/15 (86.67%) and 11/15 (73.33%) respectively for the same period of time. The difference in antibacterial activity between the two medicaments was statistically significant in all the test periods. Conclusion: Under the limitations of the present investigation 2% liquid CHX seems to be an effective alternative intracanal medicament against E. faecalis, compared to Ca(OH)2 in three and seven days period of time. 17 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY Chairpersons: Ashraf El Ayouti, Francesco Riccitiello Session T8 – 13.30 T8 - 1 Effect of different irrigation solutions on shear bond strength of composite resin to dentin Sefika Nur Akyuz, A Erdemir, K Altinoluk, B Kalaycioglu Kirikkale University, School of Dentistry, Kirikkale, Turkey Abstract Aim: To evaluate the effect of endodontic irrigation solutions on shear bond strength of composite resin to dentin. Methodology: Sixty extracted mandibular molars were sectioned parallel to the occlusal surface to expose midcoronal dentin. The dentin surfaces were polished with waterproof-polishing papers. The specimens were randomly divided into six groups of 10 each. While Group 1 served as a control, the specimens in groups 2 to 6 were treated with a different irrigation solution respectively that included 5.25% NaOCl, 18% EDTA (Ultradent, South Jordan), 15% EDTA gel (SurePrep, Diadent, Korea), 2% Chlorhexidine solution (Drogsan, Turkey), 1% Chlorhexidine gel (Drogsan, Turkey). The Clearfil SE Bonding system (Kuraray, Japan) was applied to dentin surfaces and the composite (Clearfil photo-posterior, Kuraray, Japan) build ups were created. After the specimens were stored in an incubator for 24 h, the shear bond strength was measured at a cross-head speed of 1 mm/min and calculated as MPa. The data were analyzed using one way ANOVA and Tukey tests. Results: There was a statistically significant decrease on shear bond strength of composite resin to dentin associated to irrigation with NaOCl, EDTA or EDTA gel (p<0.05), whereas chlorhexidine and chlorhexidine gel irrigation had no effects on adhesion (p>0.05). Conclusions: It was concluded that the use of NaOCl, EDTA or EDTA gel in endodontic treatment affected adversely shear bond strength of composite resin to dentin. Further studies are still needed to solve any negative effect of these solutions on dentin. T8 - 2 PerioFilm preparation in the complicated endodontic and orthodontic therapy of the tooth with apical resorption Banaszek Katarzyna Department of Endodontics, Medical University of Lodz, 92-231 Lodz, ul. Pomorska 251, Poland Abstract The article presents the use of the PerioFilm adhesive dressing containing antibiotic piperacillin and biodegradable resins (Italmed, Italy, Firenze and Laboratorios Inibisa, S.A. Spain, Barcelona) in the complicated endodontic retreatment of tooth 11 with advanced apical resorption in an eighteen-year-old female patient during orthodontic therapy. Orthodontic treatment caused the shortening of 1/3 of the original root length, alveolar bone loss to 2/3 of the root length, pathological pockets on the mesial and distal side of the root, purulent exudate from the pockets, tooth mobility of degree 3 and the presence of chronic apical periodontitis with active fistula at the bottom of the pocket. Exacerbations resulted in periapical abscess formation, and oedema of the oral mucosa, lips as well as subnasal area. Standard endodontic and periodontal therapy was performed. Endo-perio lesions were treated with PerioFilm because of its wide spectrum of action against anaerobic bacteria in pathological pockets and a longlasting release of piperacillin. The dressing was prepared according to the manufacturer’s recommendations and applied to the dried canal and the bottom of the pockets by a syringe with a blunt needle (1-2 drops delicately blown up with the air spray). The product hardened in contact with air. After 1 min the canal was obturated and the patient was asked not to drink 18 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L or eat for the next 3 hours. PerioFilm was applied 4 times in 7-10 day intervals. After the last application, the root canal was filled with calcium hydroxide-based non-hardening material and the cavity in the tooth crown was tightly sealed. Forty days after the beginning of therapy the radiograph showed decreased inflammation around tooth 11; the clinical examination revealed the tooth stabilisation, reduction in tooth mobility (degree 2), lack of marginal periodontitis and decrease in pocket depth. The fistula closure occurred after the first application of PerioFilm. T8 - 3 Experimental study on the use of diode laser in endodontic resistant infections by Enterococcus faecalis Gilda Cretella, M Inchingolo, L Marigo, Daniele Angerame, Francesco Somma Università Cattolica del Sacro Cuore, Rome, Italy Università degli Studi di Trieste, Trieste, Italy Abstract Background: The aim of this study was to evaluate the bactericidal effect of diode laser irradiation against intracanal Enterococcus faecalis by colony counts and SEM analysis. Methods and Materials: 160 extracted single-rooted and monocanalar teeth were treated with ProTaper instruments (Dentsply Maillefer, Ballaigues, Switzerland). 152 root canals were inoculated with Enterococcus faecalis for 21 days, 8 teeth were not contaminated and their canals were irrigated with saline solution. The samples were randomly divided into 3 groups: group A (n=48) was irrigated with saline solution colored with methylene blue activated by diode laser ENJOY5 (Sweden & Martina, Padova, Italy); group B (n=48) was irrigated with saline solutions activated by diode laser; Group C (n=48) was treated with 5.25% sodium hypochlorite activated by diode laser. 8 teeth were used as positive control and 8 were used as negative control. Results: ANOVA test and Bonferroni’s test were used for statistical analysis. A statistically significant reduction of bacterial count was observed using the Uro-Quick system in all groups. Starting from an initial charge an average of 5 x 106 CFUs / ml, a final average charge of 30 x 103 CFUs / ml was reached for group A, 57 ◊ 103 CFUs/ml for group B, while the samples of group C were completely decontaminated. The SEM analysis confirmed the results obtained by the plate count: significant differences, regarded to the presence of biofilm, are observed from group B to group C. The samples of group C have an almost complete absence of biofilm, compared to those of group B in which the dentinal wall is mostly covered by bacterial mat. Conclusions: The diode laser has been effective in reducing both the free bacteria and the biofilm of root canal system, especially when it is used in association with sodium hypochlorite. T8 - 4 Effect of superoxidised water on debris and smear layer removal in the root canals of ex vivo human teeth Saulius Drukteinis, Daiva Sabakiauskiene, V Peciuliene, R Maneliene Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania Abstract Aim. The aim of this study was to measure and compare the root canal cleanliness and smear layer removal effectiveness of superoxidised water (Sterilox) when used as an endodontic irrigating solution in comparison with sodium hypochlorite and ethylenediaminetetraacetic acid. Methodology. Forty single-rooted human teeth were distributed randomly into two groups of 20 teeth each. Root canals were shaped with ProTaper rotary nickel-titanium instruments. The irrigation treatments investigated were superoxidised water (Group 1) and 3.0% sodium hypochlorite + 17% ethylenediaminetetraacetic acid (Group 2). Roots were splited longitudinally and subjected to scanning elec- ESE ROME 2011 NOT ONLY ROOTS tron microscopy. The presence of debris and smear layer at coronal, middle and apical thirds was evaluated by using a 5-grade scoring system with 200X and 1000X magnification, respectively. Results. Concerning debris and smear layer removal, the irrigation with NaOCl and EDTA was slightly superior to superoxidised water, but no significant differences among groups were detected. Conclusions. Irrigation with electrochemically activated water cleaned root canal walls and may be a possible alternative to NaOCl and EDTA in conventional root canal treatment. Further investigation of superoxidised water solution as root canal irrigant is warranted. T8 - 5 Antibacterial activity of propolis extract as a vehicle of calcium hydroxide Erdemir Ali, S.N. Akyuz, A. Turkyilmaz, N. Unal Kirikkale University, Faculty of Dentistry, Kirikkale, Turkey Kirikkale University, Faculty of Veterinary Medicine, Kirikkale, Turkey Abstract Aim: To evaluate antibacterial activity of propolis extract as a vehicle of calcium hydroxide using agar diffusion and direct contact tests. Methodology: Calcium hydroxide combinations were prepared by adding calcium hydroxide powder into either distilled water (Group 1), glycerin (Group 2), 1% chlorhexidine gel (Group 3), or 10% dimethyl-sulfoxide (DMSO) extract of propolis (Group 4). Antibacterial activities of the calcium hydroxide combinations were evaluated using Staphylococcus Aureus (ATCC 6538), Escherichia Coli (ATCC 25922), Candida Albicans (ATCC 10231) and Enteroccocus Faecalis (ATCC 29212). For ADT, the freshly mixed calcium hydroxide combinations were placed into the prepared wells of agar plates inoculated with the test microorganisms. After varying periods of incubation (24, 48 and 72 hours, 7 and 10 days), the zones of growth inhibition were measured. For DCT, two microtiter plate wells were used. The freshly mixed calcium hydroxide combinations were placed on the walls of microtiter plate wells. 10 μL bacterial suspensions were allowed to directly contact the prepared materials for 1 hour and 24 ! hours at 37oC. Fresh media were added and 15 μL were transferred from these plates to another plates containing fresh medium. Bacterial growth was then spectrophotometrically measured every 1 hour for 16 hours. Results: ADT results indicated that Calcium hydroxide combinations with chlorhexidine gel and DMSO extract of propolis were significantly higher antibacterial activity than the other combinations (p<0.05). In DCT results, although one hour direct contact was enough to kill all test bacteria when Calcium hydroxide combinations with chlorhexidine gel and DMSO extract of propolis were used, 24 hours were needed for the other combinations. Conclusions: The results of this in vitro study indicated that Calcium hydroxide combinations with chlorhexidine gel and DMSO extract of propolis showed better antimicrobial activity than calcium hydroxide manipulated with distilled water and glycerin. T8 - 6 Chlorhexidine effectiveness against Enterococcus faecalis, when associated or not to calcium hydroxide as intracanal medication CXM Ferreira, FRF Alves, LS Gonçalves, Julio Cezar Machado Oliveira Estácio de Sá University, Graduate Program in Dentistry, Rio de Janeiro, Brazil Abstract Several agents have been proposed to be employed as intracanal medicaments, among them calcium hydroxide and chlorhexidine have been reported to offer effectiveness without side effects. However, the combination of these two antimicrobial agents has not been deeply evaluated and the aim of this study was to compare the an- www.eserome2011.com tibacterial effect of seven different formulations based on calcium hydroxide and/or chlorhexidine against four endodontic isolates and a standard strain of Enterococcus faecalis. The tested formulations were 0.12%, 0.2% and 2% chlorhexidine gluconate associated to zinc oxide or calcium hydroxide, and calcium hydroxide associated to glycerin. The negative control as tested by a paste composed by zinc oxide and glycerin, and the positive control group by a 2% chlorhexidine gel. All the formulations were prepared in creamy consistence. The agar diffusion test was used to evaluate the antibacterial effect of the medicaments. There was no significant statistical difference amongst the inhibition zones growth presented by the seven different formulations and the positive control group (p>0.05), when the action against the four wild strains was compared to that against the ATCC reference strain of E. faecalis. When comparing medicaments in which chlorhexidine was combined with zinc oxide or calcium hydroxide, statistical difference was observed only between medications containing 2% chlorhexidine, where the combination of chlorhexidine with zinc oxide was more effective than the combination of chlorhexidine with calcium hydroxide (p<0.05). Calcium hydroxide mixed with glycerin was significantly less effective than pastes prepared with chlorhexidine, but more effective than the negative control group (p<0.05). Considering the limitations of the method employed in this study, our results suggest that calcium hydroxide seemed to jeopardize the antibacterial activity of chlorhexidine against E. faecalis, and accordingly chlorhexidine should be employed as intracanal dressing combined with some neutral powder agent as zinc oxide, mainly in retreatment cases. T8 - 7 Laser as an adjunct to chemo-mechanical disinfection of infected root canals. A systematic review KM Larsson, Eva Wolf, H Fransson Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden Abstract Aim Laser devices for endodontic purposes are suggested to reduce bacterial load when used as an adjunct to conventional root canal treatments. The aim of this study was to evaluate the efficacy of laser as an adjunct to chemo-mechanical disinfection of infected root canals with the end-point measures healing of apical periodontitis or reduction of the microbial load. Methodology A PubMed and CENTRAL literature search with specific indexing terms and a subsequent hand search were made with stated limits and criteria. Relevant publications were retrieved, followed by interpretation. The three authors independently assessed level of evidence of the studies that fulfilled the inclusion criteria. Level of evidence for each included publication was assessed as high, moderate or low. Results The initial search process yielded 211 publications. All abstracts of these publications were read, and the reference lists of relevant publications were hand searched. Ten articles were read in full text and interpreted according to a data extraction form. Five were included in the systematic review and assessed with a level of evidence. Four of the five included studies reported a positive effect when laser treatment was used as an adjunct to conventional chemomechanical treatment of infected root canals. A meta-analysis was impossible to perform, as the included studies were heterogeneous regarding study designs, treatment and end-point measures. Each included study was assigned a low level of evidence, primarily due to lack of a power analysis, blinding and reproducibility. Conclusions The evidence grade for whether laser can be recommended as an adjunct to chemo-mechanical disinfection of infected root canals was insufficient. This does not necessarily imply that laser should not be used as an adjunct to root canal treatment but instead underscores the need for future high-quality studies. 19 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L T8 - 8 Chairpersons: Hagay Shemesh, Giovanni Cavalli Effectiveness of EDTA and MTAD on Debris and Smear Layer Removal using a Self-Adjusting File Session T9 – 13.30 Adiguzel Ozkan, Senem, T ÖZER, Sadullah Kaya, Zeki Dicle University, Faculty of Dentistry, Department of Operative Dentistry and Endodontics, Diyarbakir, Turkey Dicle University, Faculty of Medicine, Department of Statistical Analysis, Diyarbakir, Turkey Abstract Introduction: In this study, we evaluate the cleaning ability of a selfadjusting file (SAF) system in terms of debris and smear layer removal using EDTA or MTAD. Methods: In total, 45 root canals were randomly divided into two irrigation groups of 20 canals each and a negative control group of five canals. The canals in each of the irrigation groups were irrigated using sodium hypochlorite (2.6%) as an initial irrigant following 17% EDTA or MTAD in a continous flow with SAF for 2 min in a closed system. The roots were split longitudinally and subjected to scanning electron microscopy (SEM). The presence of debris and smear layer in the coronal, middle, and apical thirds of the canal was evaluated using a 5-grade scoring system with 200X and 2000X magnification, respectively. Results: The SAF operation with continuous irrigation using MTAD resulted in 85%, 70%, and 60% of the coronal, middle, and apical thirds of the root canal, respectively. The SAF operation with continuous irrigation using EDTA resulted in 85%, 60%, and 50% of the coronal, middle, and apical thirds of the root canal, respectively. Evaluation by SEM showed no significant difference between tested irrigants in removing the smear layer among the different regions of the root canal. Conclusions: When using the SAF, the protocols used in this study were effective for debridement of all parts of the root canal. T8 - 9 In vitro comparison of the Vibringe system with conventional syringe in root canal debridement Raffaella Castagnola, Valentina Aprile, L Marigo, Daniele Angerame, Francesco Somma Università Cattolica del Sacro Cuore, Rome, Italy Università di Trieste, Trieste, Italy Abstract Background The aim of this in vitro study was to compare the efficacy of root canal wall debridement using either conventional syringe irrigation or a sonic device (Vibringe). Methods and Materials 136 extracted monoradicular and monocanalar teeth were randomly divided into two equal groups. The canals of the teeth in each group were instrumented with ProTaper Universal rotary files (Dentsply Maillefer, Switzerland). Final irrigation was performed with either conventional syringe in group 1 or Vibringe system (BV Corp Vibringe, Amsterdam, Netherlands) in group 2. The teeth were then decoronated and each root split longitudinally into two halves to be examined in the apical, middle, and coronal thirds using the scanning electron microscope (SEM). The presence of smear layer was evaluated by a standardized 4-point scoring system, and the resulting scores submitted to Chi-square statistic test. Results The apical thirds of the root canals in group 1 showed lower smear layer removal than those in group 2, and the difference was statistically significant (P < 0.05). There was no significant difference in the coronal and middle score between the groups (P > 0.05). Conclusions In conclusion, the protocol used in this study was not efficient to completely remove the smear layer, but the Vibringe System demonstrated significantly better results than syringe irrigation in the apical root canal third. 20 T9 - 1 An endodontic lesion or not? An uncommon case presentation of an odontogenic keratocystic tumor S.O. Basoudan, H.A. Balto, A.S. Al-Rasheed College of Dentistry, King Saud University. Riyadh, Saudi Arabia Abstract A 34-year old female patient presented with symptoms, mostly pus discharge, that had not subsided after root canal treatment, and retreatment, over the last 4 years. Radiographs showed a very large periradicular lesion related to tooth 12 (FDI) and involving the proximal area between teeth 12 and 13. The root canal treatment on 12 seemed adequate. Clinically, the tooth was mobile with an isolated 10-mm pocket distolingually. The initial differential diagnosis was mainly a periapical lesion related to root fracture/crack or abnormality of the tooth, or a lateral periodontal cyst (possibly infected). Endodontic surgery was initiated, there were no signs of fractures or cracks or abnormalities on #12. Only soft tissue debridement was performed. The histopathology report of the soft tissue indicated an odontogenic keratocystic tumor. A 2-year follow up shows absence of the patient’s symptoms, no recurrence and bone healing of the whole periapical area. Diagnosis of odontogenic keratocystic tumors prior to intervention is advantageous because this tumor requires special management. Reports in the literature show high recurrence rates of odontogenic keratocystic tumors. Recent systematic reviews have suggested a relationship between treatment modalities and the recurrence rates. Resection shows nearly no recurrence and enuclation alone shows the highest rates. The use of Carnoy’s solution is a conservative approach with lower recurrence rates than enuculation alone. Taking a biopsy prior to surgery is valuable. But where not possible, complete and careful curettage of the lesion is very important. In addition, the patient should be kept under follow-up for long terms. T9 - 2 A study of endodontic practice amongst Turkish dentists Kaptan Figen, F Haznedaroglu, MB Kayahan, H Ozkan Yeditepe University faculty of dentistry, Turkey Istanbul University faculty of dentistry, Turkey Abstract Aim: The purpose of this study was to gather information on routine endodontic treatment performed by Turkish dentists. Methodology: 47 questions with multiple-choise answers were given to 1400 dentists either at the Turkish Dental Association Congress where they attended or were reached by e-mail. Basic information (age, gender, year ofgraduation, practice profile) and information of various issues relating to the cleaning, shaping and obturation of root canals was collected. Results: Of 1400 questionnaires a total of 602 were returned, 589 (42%) of which were valid. The majority (84%) of respondents categorized themselves as general practitioners. 9.4% mentioned a clinical interest or speciality in practice and 7.3% were postgraduate students. Most practitioners (72.3%) did not use rubber-dam. A vast majority of respondents (90.2%) used sodium hypochlorite as an irrigant, but 7% did not know the concentration they used; EDTA was used in 44.1% of the practices. The majority of respondents (77.8%) took a radiography with an instrument of known length in situ to gauge the working length; electronic root canal length determination was often used (41.1%); 17.1% relied on tactile sense. Among the respondents 21.1% didn’t perform retreatment. The majority of respondents (95.7%) used hand instruments (H-file or combined with K-file) to prepare root canals, 58.1% used ni-ti rotary inrtruments. 81.5 percent of participants attended postgraduate continuing edu- ESE ROME 2011 NOT ONLY ROOTS cation seminars, while only 32.4% attended an endodontic congress. Among the respondents 33.8% used cold lateral condensation as root canal obturation technique. The most popular sealer was AH Plus 46.2%. According to the results of this study, Turkish dentists are aware of current trends in endodontics, but incapable of bringing these into everyday practice. T9 - 3 Combined endodontic and surgical treatment of extensive maxillary frontal teeth crown destruction: case presentation Disha Metush, Fatmir Dragidella, Kastriot Meqa, Zana SllamnikuDalipi, Teresa Disha, Saranda Disha, Donika Disha, Burim Gutiqi, Melisa Disha Dentistry School, Medical Faculty, University of Prishtina, Prishtina, Kosovo Private Dentistry Clinic “Dental- D”, Peja , Kosovo Abstract Extensive carious lesions, especially in the maxillary frontal teeth represent not only functional and esthetic problems, but also psychosocial discomfort due to an “awkward appearance”. A case report will be presented of a a patient KB, age 16, with extensive destruction of maxillary teeth 12, 11, 21, 22, and periapical lesions of 21 and 22, with intraoral vestibular sinus tract. The periapical involvement has been documented with intraoral radiography. After the removal of carious lesions of the abovementioned teeth and endodontic treatment of 21 and 22,a full crown composite restoration of 12, 11, 21 and 22 was carried out. The periapical lesions in 21 and 22 were surgically removed with surgically . The reconstruction of the maxillary frontal teeth has restored functionality and esthetics, and satisfactory pshycological impact to the patient. T9 - 4 Endodontic treatment of a maxillary first molar tooth with a C-shaped canal morphology: case report Dincol Muzaffer Emir, Handan Ersev, Bülent lmaz Research assistant, Istanbul University, Faculty of Dentistry, Department of Endodontics, Istanbul, Turkey Abstract This clinical report presents the endodontic treatment of a maxillary first molar with a C-shaped distopalatally located root canal system. According to the endodontic literature, the C-shaped root canal is most frequently seen in the mandibular second molar. However, occurence of this unusual morphology in maxillary first molars has only been described in a limited number of case reports. A 16-year-old male patient presented to our clinic with the complaint of discoloration in his left maxillary first molar. Radiographic examination revealed two distinct roots (palatal and mesio-buccal) and as well as a periapical radioluceny associated with the mesio-buccal root end. The disto-buccal root end was not identified and it was believed to be superimposed on the palatal root. Upon completion of the access cavity, only one canal orifice was found in the mesio-buccal root as well as a deep semilunar groove which extended from the palatal to the disto-buccal aspects of the cavity. Neither the palatal, nor the disto-buccal root canal orifices were identified and whenever an instrument was inserted into any side of the Cshaped canal, it was always ended in the disto-palatal foramen of the tooth. The clinical conclusion was that the palatal and the disto-buccal canals were merged in a C-shaped single canal and that there was only one canal in the mesio-buccal root. The two root canals were rinsed with copious amounts of 2.5% sodium hypochlorite solution and shaped with stainless-steel K-type files by using the step-back technique. Obturation was performed with laterally condensed gutta-percha and AH-Plus sealer. A 6-months follow-up radiograph showed complete resolution of the periapical lesion. www.eserome2011.com T9 - 5 Surgical extrusion of a crown-root fractured tooth: 3-year follow-up Onay Emel Olga, M Ungor, B Kaya, F Veziroglu Baskent University School of Dentistry, Ankara, Turkey Abstract AIM. Different treatment approaches are indicated for fractured teeth. Although it is suggested that using orthodontic forces is a biological way of extruding teeth, surgical extrusion is a one-step procedure which is simpler and less time-consuming than orthodontic extrusion. A case is presented. METHODOLOGY. A 50 year-old female was referred for treatment with the primary complaint of discomfort in her maxillary left second premolar, which was reported to have been traumatized 1-week previously while chewing on hard food. The intra-oral examination revealed an oblique crown-root fracture on the tooth. Following the extraction of the mobile fractured palatal fragment under local anesthesia, temporary endodontic treatment was initiated. The surgical procedure involved careful mobilization of the tooth with elevator and cutting of the marginal periodontal fibers with a sharp scalpel. The tooth was extruded for 4 mm using extraction forceps. Stabilization of the root in its new position was achieved with an orthodontic archwire (Nitinol; 3M-Unitek, Monrovia, CA, USA) and Edgewise brackets (Clarity; 3M-Unitek, Monrovia, CA, USA) for 4 month-period. Ten days following the extraction root canal therapy was completed. The root canal was instrumented with ProTaper rotary files (Dentsply-Maillefer, Ballaigues, Switzerland). One ml. of 5.25% NaOCl was used for irrigation between instruments. The root canal was filled with gutta-percha (Diadent, Chongju, Korea) and AH Plus sealer (Dentsply, Konstanz, Germany) using lateral condensation technique. The tooth was temporarily restored with glass ionomer cement (IonofilU; Voco, Cuxhaven, Germany). After the resolution of the periapical radiolucency, the tooth was restored with porcelain fused to metal crown. RESULTS. Three years follow-up examination showed that there were no radiographic and clinical signs of progressive root resorption, marginal bone loss or periapical disease. CONCLUSION. The favorable results of this case demonstrate that surgical extrusion may be an alternative treatment to orthodontic extrusion. T9 - 6 Re-attachment of fractured anterior tooth Seo-Ryeong Kim, Jiwan Yum, Jeong-Kill Park, Bock Hur, HyeonCheol Kim Department of Conservative Dentistry, Pusan National University, Yangsan, Korea Abstract I. Introduction Crown fractures or crown-root fractures of anterior teeth are the most frequent form of acute dental injury that mainly affects children and adolescents. Today, restoration of such traumatized incisors by reattachment of the original tooth fragment appears to be the most conservative treatment approach. Reattachment of the fractured fragment is currently the preferred technique representing a simple and low cost method, which allows the maintenance of incisal function in dental structure, provides better esthetic results, maintains the tooth form and color. Following case reports present clinical cases of tooth reattachment performed in a fractured upper incisor with pulp exposure or crownroot fracture, which was restored with an original crown fragment. II. Case Presentation < Case 1 > 1. Sex/age : F/15 2. Chief Complaint(C.C) : Crown fracture of #11 3. Past Dental History(PDH) : N-S 4. Present Illness(P.I) : #11- Crown fracture with pulp exposure 5. Impression : Complicated crown fracture with pulp exposure of #11 6. Tx plan : Cvek pulpotomy and crown re-attachment on #11 21 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY < Case 2 > 1. Sex/age : M/13 2. Chief Complaint(C.C) : Tooth mobility and cold sensitivity of #21 3. Past Dental History(PDH) : 35 days ago, #21 was fractured by fist trauma 4. Present Illness(P.I) : #21- Cervical crown-root fracture(extended subgingivally on the palatal area), apical horizontal root fracture, per(+), mob(+), cold(+) 5. Impression : Complicated crown-root fracture of #21 6. Tx plan : Fragment re-attachment on #21 III. Conclusion Reattachment of the intact fractured segment can be considered as a conservative method for aesthetic rehabilitation. This procedure was useful to preserve a natural tooth structure. T9 – 7 Managment of endo-perio lesion in first upper incisor: a case report Sepic Matanovic Branka Mikica, M Molnar, B Pazin Department of Endodontics, Oral Medicine and Periodontology, Dental Clinic Zagreb, Zagreb, Croatia Abstract The relationship between periodontal and endodontic disease brings speculation, confusion, and controversy. Pulpal and periodontal problems are responsible for more than 50% of tooth mortality today. Diagnosis is difficult since these diseases have been studied primarily as separate entities. The infection of the pulp may initiate periodontal defects through canal ramifications and dentinal tubules, impairing wound healing in regenerative procedures. Although no studies exist addressing the direct effect of pulpal infection on the outcome of guided tissue regeneration (GTR) procedures, several studies indicate that pulpal status may play a significant role toward the end results of GT and periodontal treatment A 42-year old female was referred for the periodontal treatment, during which a translucency around intact first anterior incisor 21 was discovered. The patient was unaware of it and had no previous symptoms. Vital response was missing so we preformed a root canal treatment with ProTaper Universal System (Maillefer, Baillaigues, Switzerland). After one week of calcium hydroxide (Ultracal SX, Ultradent Products, South Jordan, UT) the root canal was finished with ProTaper gutta percha points. A surgical periodontal treatment started with a full thickness flap. Intra operationem we observed a significant bone loss on the medial aspect of tooth 21 going from the upper third to the periapical aspect of the root. We did not observed a root fracture even with the size and a position of the radiographed bone loss indicating it. The bone defect was filled with natural bone substitute material Bio-Oss (Geistlich, Geistlich Pharma AG) and the defect was later covered with a collagen membrane Bio-Gide (Geistlich, Geistlich Pharma AG). One, three and six months follow up radiographs and clinical examinations were done after the periodontal surgery. T9 – 8 An interdisciplinary approach to treating a severely discoloured central incisor with gingival recession Babur Taner, C Walter, H Hecker, R Weiger, G Krastl Switzerland Abstract Background: Discoloured teeth and uneven gingival contours may pose a considerable challenge for the dental clinician. Case: This report presents the case of a 39-year-old female patient exhibiting a distinct discoloration and a gingival recession on her upper left central incisor. She presented a history of trauma to the upper anterior region 25 years ago. The patient’s desire was to keep the tooth and to improve the appearance of her front teeth. The clinical examination revealed a severe internal staining and an exposed root surface (Miller class 1) on tooth 21 (FDI). The periapical radiograph showed an insufficient root canal filling but no visible apical periodontitis. 22 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L Treatment: After endodontic retreatment internal bleaching was performed with sodium perborate according to the walking bleach method. Despite five bleaching sessions, a complete metamorphosis of the discoloured tooth could not be achieved. The access cavity was sealed with composite. A coronally positioned flap technique was chosen for root coverage of the recession defect. The tooth was restored with a bonded all-ceramic crown six months later. At the 5-year follow-up an apical periodontitis was diagnosed on the periapical radiograph. Apical surgery was performed. The root-end cavity was filled with MTA cement. Follow up: At the 7 years follow-up (2 years after surgery) the aesthetic appearance was satisfying. Clinical examination revealed no mobility of the tooth, probing depths up to 3mm, and normal function without any symptoms. The radiograph revealed a reduced radiolucency and provided evidence of ongoing healing of the periapical pathology. Conclusion: The present case demonstrates the challenging synoptic treatment of an upper incisor. The combination of endodontic treatment, the walking bleach method, periodontal plastic surgery and reconstruction with an all ceramic crown creates a sufficient aesthetic result that may not have been obtained with either treatment alone. T9 – 9 Efficiency and duration of anaesthesia with Ubistesin (Articaine 1:400.000) during outpatient dental treatment in a dental school Hassan Muhamed, Adriano Azaripour, M. Försch, M. Daubländer, B. Willershausen Departments of Operative Dentistry, Dental Surgery University of Mainz, Mainz, Germany Abstract Aim To test the efficiency and duration of anaesthesia with Ubistesin (Articaine 1:400.000 adrenalin; 3M ESPE, Neus Germany) during dental treatments such as restorations, endodontic treatments or root planing. Methodology A total of 380 patients (52.1% female, 47.9 % male) with an age range from 18 to 78 years were included. Overall 515 maxillary teeth and 311 mandibular teeth underwent treatment and had to be anaesthetized. In total 287 patients were treated with a block (conduction) anaesthetic (1.7 mL) and in 97 cases an infiltration anaesthetic (1-1.7 mL) was used. The dental treatment included tooth preparation, restorations as well as periodontal therapies such as scaling and root planing and other minor dental procedures. All patients received a questionnaire to indicate the duration of anaesthesia. Results In 327 (86%) patients it was not necessary to give a supplementary injection during the dental treatment; for 369 patients it was possible to complete the dental treatment and most of the patients (377) had no after-pain. In most cases the treatment involved removal of caries (42%), root canal access (8%), scaling and root planing (17%), restoration (11%) and others (22%). The average time course of the treatments was: commencing 5 min after the anaesthesia, repeat injection after 54 min, to finish the dental treatment within 90 min. The mean time for normal sensation to return was 164 min. All patients had satisfactory anesthesia following Articaine (1:400.000), although the individual sensation of pain constituted a factor that was not easy to estimate. Conclusions In this study population; satisfactory local anaesthesia was achieved using Articaine with only 1:400,000 epinephrine. Dentists should justify the use of agents with higher vasoconstrictor concentration on a case by case basis. ESE ROME 2011 NOT ONLY ROOTS friDAY, 16TH SEPTEMBER 2011 Chairpersons: Ivana Miletic, Etienne Deveaux Session F1 – 13.30 F1 - 1 Chronic maxillary sinusitis and pulpal complication: a case report Bulent Yilmaz, H Ersev, ME Dinçol Istanbul University, Faculty of Dentistry, Department of Endodontics, Istanbul, Turkey Abstract Maxillary sinusitis of dental origin has extensively been investigated by various researchers. It usually occurs when the integrity of the sinus floor membrane is disrupted by iatrogenic complications, trauma, or pathological causes such as periapical or periodontal diseases of the adjacent maxillary teeth and odontogenic cysts. However, to the best of our knowledge, there is no information about chronic rhinogenic maxillary sinusitis causing pulpal complication in the literature. The aim of this report is to present a case of periapical lesion supposedly evolved secondary to the chronic rhinogenic maxillary sinusitis. A 30-year-old male patient was referred for dental consultation by an otorhinolaryngologist who stated that chronic maxillary sinusitis might have eroded sinus floor. Computed tomography showed sinus membrane thickening and a close anatomical relationship between the sinus floor and the molar teeth. Oral examination was noncontributory, but a sinus tract located at the buccal mucosa overlying the left first molar tooth was observed. Adjacent teeth to the sinus were intact. Periodontal probing did not show any attachment loss. Periapical radiograph revealed that mesiobuccal root of the first molar has periapical radiolucency. This tooth was negative to vitalometric test. Any etiological factor other than sinusitis could not be found for pulp infection. A nonsurgical endodontic treatment was initiated. Root canals were shaped by using ProTaper instruments (Dentsply Maillefer, Ballaigues, Switzerland). As an interappointment medicament, calcium hydroxide was applied for a period of eight-month. Then the root canals were obturated by using AH Plus sealer (Dentsply, DeTrey, Konstanz, Germany) and lateral condensation of gutta-percha cones. At this visit, it was detected that the periapical lesion and the membrane thickening were significantly resolved. In conclusion, this report presents a case in which chronic maxillary sinusitis might have caused a retrograde pulpal infection in the adjacent tooth. F1 - 2 Root canal retreatment of a mandibular first molar with five root canals: a case report Anais Ramirez, José Antonio González, Francesc Abella, Fernando Durán Sindreu, Miguel Roig Cayón Universitat Internacional de Catalunya, Barcelona, Spain Abstract A third middle root canal was found between mesiobuccal and mesiolingual root canals during a root canal retreatment. This report shows a very rare configuration with separate apical terminations of the three distal root canals and the importance of looking for additional canals when we are in front of a retreatment. F1 - 3 Endodontic treatment of the first and second maxillary premolars with unusual anatomy Boris Pazin, Marijana Molnar, Branka Mikica Sepi, Matanovi Ljiljana Pater Henigsman, Ana Mal Department of Endodontics, Periodontology and Oral medicine, Dental Clinic, Zagreb, Croatia Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Croatia Abstract The main objectives of endodontic treatment are the elimination of microorganism from the root canal system and prevention of reinfec- www.eserome2011.com tion of the system. Inability to find and properly clean root canals may be the cause of treatment failure. These case reports show endodontic therapy of the first and second maxillary premolars with three root canals. According to Ingle and Bakland, only 6% of the first and 1% of the second maxillary premolars have three root canals. The first patient, aged 35, was referred to the Department of Endodontics, Periodontology and Oral Medicine for endodontic therapy by his general dentist. The chief complaint was persistent pain in relation to upper right first premolar, not decreasing despite chemomechanical preparation. Intraoral exam and radiographic analysis showed second buccal root canal that was not treated. Treatment consisted of chemomechanical preparation of all three root canals using the step-back technique. Root canals were filled by using cold lateral condensation technique. All symptoms were relieved and the tooth was reconstructed using Filtek Supreme XT composite material (3M ESPE, St. Paul, USA). The second patient, aged 28, was referred to our Department for endodontic or periapical surgical therapy of the second left upper premolar. Intense spontaneous and percussion pain was relieved after locating the third, distobuccal root canal. The treatment consisted of chemomechanical preparation of three root canals by using Ni-Ti rotary system ProTaper (Sx, S1, S2, F1) and filling with ProTaper (Dentsply, Tulsa, USA) Gutta Percha cones (F1) and AH+ sealer (Dentsply, DeTrey, Zurich, Switzerland). The six-month follow-up showed periapical osseus healing and fully functional asymptomatic teeth. F1 - 4 Treatment of inflammatory gingival lesion caused by vertical root fracture (case report) Esnaashari Ehsan, Arezou Pezeshkfar, Hamid Moghadas Iran Abstract Treatment of a tooth with vertical root fracture can be difficult and unpredictable. Quite often, the most predictable treatment possible is simply extraction. This article presents a patient with an inflammatory gingival lesion on the labial aspect of the maxillary right central incisor due to vertical root fracture. This diagnosis confirmed during surgery. There was also a super contact on the mentioned tooth. Root canal therapy was done and super contact eliminated. After 5 weeks the gingiva gained normal appearance. 12 months follow up showed that the results remained stable and the tooth treated remained asymptomatic. It is necessary to emphasize that, it is not possible to extend the result of this treatment to all patients with vertical root fracture and at the present there is no predictable treatment for such teeth and extraction may be the only choice of treatment. F1 - 5 Management of taurodontism of maxillary first molar Jeon Hyo Jin, Bock Hur, Hyeon-Cheol Kim, Jeong-Kil Park Department of conservative dentistry, Pusan National University School of Dentistry, Yangsan, Korea Abstract A 16-years-old patient was referred from local dental clinic for the management of maxillary left first molar. On radiographic view, access cavity of maxillary left first molar was prepared. The apex of tooth was opened and taurodontism was observed. On panoramic view, all first and second molars were taurodontism. On his medical history, lupus was suspected. The canal of left maxillary first molar was cleaned and shaped and filled with MTA. On 4 month follow-up, periapical lesion of left maxillary first molar was healed. 23 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY F1 - 6 Detection of fractured endodontic files and simulated external root resorptions with three types of lcd monitors using three different imaging receptors and cbct: an exvivo study Kaan Orhan, Atakan Kalender, Umut Aksoy, Fatma Basmaci Near East University, Department of Oral, Teeth and Jaw Radiology, Mersin 10, Turkey, Near East University, Department of Endodontics, Mersin 10, Turkey Abstract Aim: Careful reading of diagnostic radiographs and other images to prevent misdiag¬nosis is crucial before and after endodontic treatment. They must optimize their viewing conditions, regardless of whether they use film, the gold standard for image quality, particularly for spatial resolution. Thus, the aim of this study is to compare different LCD monitors in order to detect simulated external root resorptions and fractured endodontic files in mandibular molar teeth at three different tube potential settings using two phosphor plate systems (SPP), a charge-coupled device (CCD) and a CBCT unit. Methods: Fifty extracted human mandibular molars were used for this study. 30 root canals were prepared for simulation of fractured endodontic file. External root resorption defects in different locations were simulated in 40 human mandibular molar root surfaces.. All teeth were then were placed in a cadaver mandible and radiographed with four different imaging modalities- Newtom 3G-CBCT (6 inch) scanner, Digora-Optime SPP system, VistaScan-Perio, Planmeca CCD,-at 60-, 66-, and 70-kV tube potentials, different angles and exposure-times. Three observers scored the resultant images using one LCD monitor and two medical monitors (1.5mp and 3mp) for the presence or absence of fractured files and resorptions. The diagnostic accuracy for each imaging modality was expressed as the area under the ROC curves (Az). Results: Inter and Intra-observer agreement were higher for CBCT than three digital imaging receptors for detecting simulated external root resorptions and fractured endodontic files. Medical monitors exhibited better performance than LCD monitor (p>0.05). Conclusions: Resolution, contrast ratio, and luminance are different between the LCD and medical monitors which may be related to higher diagnostic accuracy for endodontic imaging. Despite the high cost, medical monitors can be recommended for the imaging interpretation in endodontics. F1 - 7 Study of the internal anatomy of upper molars, in vitro and in vivo comparison Benages Hernica Meritxell, Guillermo Topham, Fernando DuranSindreu, Rufino Bueno, Miguel Roig Spain Abstract Comparative study between in vitro and in vivo results of the internal anatomy of first and second molars using diafanization technique (clearing technique). After a literature review we found no previous studies where in vitro and in vivo are compared in the same population. Our objetive is to verify that the internal anatomy of maxillary molars observed in in vitro studies match those when working in vivo. The study was carried out in a population of Gran Canaria, Canary Islands, Spain, Europe. The inhabitants of these islands are Caucasian. The upper molars to study in the in vitro part are classified at the time of extraction as 1st and 2nd molars. The teeth were disinfected and stored in wet condition. We perform the cameral opening and classify them according to the number of canals located. We apply the protocol technique of diaphanisation, used in previous studies at our university. Once transparent, teeth are injected India ink and photographed. Then they are sorted according to the Vertucci classification. Clinical cases of the in vivo are made, all from a single dentist, with an MSc in Endodontics. Working conditions are the same in all 24 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L cases and they are sorted according to the Vertucci classification. The statistics we get are descriptive. We carry out a comparative study between in vitro and in vivo. The conclusion we get from this comparison is that the most common internal anatomy observed in vitro is not the same as the one observed in vivo. F1 - 8 A case of extraordinary resilience of the human body after a dental trauma Rafael Michiels, RJG De Moor Department of Operative Dentistry and Endodontology, Dental School, Ghent University Hospital, Ghent University, Gent, Belgium Private Practice limited to Endodontics, Hasselt, Belgium Abstract A 9-year-old girl was referred for a second opinion after traumatic injury of the upper right central incisor. Since the tooth showed a vertical crown fracture with pulpal exposure and with the fracture extending into the root, it was decided to extract the tooth. A temporary replacement by means of a spoon denture was planned, until an implant could be placed at appropriate age. At the moment of the first appointment i.e. 1 month after the trauma, no clinical complaints were present. The tooth was temporarily restored with Fuji IX GP Extra A1 (GC Europe, Belgium) by the referring dentist. An open apex and a vague apical radiolucency was seen. All sensibility and clinical tests indicated a vital pulp without acute/persisting peri-apical pathology. The performed tests included: palpation, percussion, cold testing, determining possible probing defects and electric pulp testing. It was decided not to perform a root canal treatment, but to conduct a systematic follow-up. A first follow-up visit after 10 weeks showed the persisting vague apical reaction, but no clinical symptoms and all sensibility and clinical tests were normal. Further follow-up was advised. Six months after the initial trauma the tooth remained free of clinical symptoms and responded normally to all sensibility and clinical tests, furthermore the vague apical reaction seemed to have disappeared. During this visit, a permanent coronal restoration with Herculite XRV A2 enamel (Kerr, USA) was made. Twelve months after the initial trauma the tooth remained free of clinical symptoms and responded normally to all sensibility and clinical tests. Further apexogenesis is to be expected. Conclusion: Non surgical root canal treatment or extraction may be avoided in certain cases of severe dental trauma. Proper selection and good follow-up are key factors contributing to the success of these cases. F1 - 9 Incidence of teeth with endodontic disease in patients presenting to general dentists in Norway S. Bjørntvedt, G.J. Debelian, L. Døving, Gerner Nina Wiencke, E. Lange, I. Pedersen, J. Ulstad, T. Willumsen Dental Health Services’ Competence Centre for Eastern Norway, TK, Endodontic private practice, Norway, Department of Endodontics, School of Dentistry, University of Oslo, Norway, Institute for Clinical Dentistry, School of Dentistry, University of Oslo, Norway Abstract Aim: The aim of the present study was to identify the incidence of teeth with endodontic disease, factors causing disease, the frequency of symptomatic cases, selected therapy and the number of cases referred to a specialist in endodontics. Methodology: 316 randomly selected dentists were invited to participate to this study. All selected dentists received an electronic form containing 20 questions concerning clinical practice related to endodontics obtained from one selected week. Results: Ninety-five dentists returned the questionnaire where 87 where selected for analysis. Three hundred and two teeth were diagnosed with endodontic disease ranging from 0 to 16 cases per dentist in one week (mean 3.5). The major causative factor was caries ESE ROME 2011 NOT ONLY ROOTS (40.4%) and apical periodontitis was present in 183 teeth (60%). Two hundred and eleven teeth (70%) were symptomatic (including teeth sensitive to percussion, palpation and spontaneous pain). 76.5% of the diagnosed teeth were rescheduled for conventional endodontic therapy where 6.9% were referred to an endodontist. Conclusions: The result of this study shows a high incidence of teeth needed for endodontic therapy in patients presenting to a randomly selected group of Norwegian general dentists. Apical periodontitis was the predominant endodontic disease. F1 - 10 Comparision of three digital imaging receptors and cbct for detection of simulated external root resorptions: an ex-vivo study Aksoy Umut, Atakan Kalender, Kaan Orhan, Fatma Basmaci Near East University, Department of Endodontics, Mersin 10, Turkey Near East University, Department of Oral, Teeth and Jaw Radiology, Mersin 10, Turkey Abstract Aim: The diagnosis of external root resorption is often based on radiographic and clinical examinations. The usefulness of standard radiographs in endodontics, conventional radiographic techniques do not provide a safe method for identifying and locating external root resorptions. Thus, the aim of this study is to evaluate the diagnostic ability of cone-beam computed tomography (CBCT) to detect simulated external root resorptions in mandibular molar teeth at three different tube potential settings using two phosphor plate systems (SPP), a charge-coupled device (CCD) and a CBCT unit. Methods: External root resorption defects in different locations were simulated in 40 human mandibular molar root surfaces in 50 teeth. Of all these 50 teeth, 30 had endodontic treatment while 20 had no treatment. 200 root surfaces in 50 teeth were served as control group. All teeth were then were placed in a cadaver mandible and radiographed with four different imaging modalities- Newtom 3G-CBCT (6 inch) scanner, Digora-Optime SPP system, VistaScanPerio, Planmeca CCD,-at 60-, 66-, and 70-kV tube potentials, different angles and exposure-times. Three observers scored the resultant images for the presence or absence of fractured files. The diagnostic accuracy for each imaging modality was expressed as the area under the ROC curves (Az). Results: Inter and Intra-observer agreement were higher for CBCT than three digital imaging receptors. Highest correct readings were obtained at the proximal regions for intra-oral imaging modalitie (p>0.05). Conclusions: These results suggest that the CBCT radiographic method is more sensitive than conventional radiography to detect simulated external root resorption cavities. Chairpersons: Yuan Ling Ng, Panos Panapoulos Session F2 – 13.30 F2 - 1 The assessment of the histomorphometric cementum layer in patient with chronic periodontitis N. Keklikoglu, S. Asçı Kaan, H.A. Balcıoglu, I. Bolat, S. Yesil Isık, M. Gerek, Eli Defne Tacettinoglu, D. Erdilek, E. Fıratlı Division of Basic Science, Faculty of dentistry, University of Istanbul Department of Endodontology, Faculty of Dentistry, University of Istanbul Department of Periodontology, Faculty of Dentistry , University of Istanbul Department of Endodontology, Faculty of Dentistry , University of Yeditepe, Istanbul Department of Cariology and Restorative , Faculty of Dentistry, University of Istanbul Abstract Aim: Periodontal diseases may cause alterations in the structural integrity and the biochemical structure of cementum. Alterations www.eserome2011.com occuring in the morphology of cementum in the advanced ages and the effects of periodontal diseases have an importance in terms of various clinical applications. The aim of this study is to determine the difference on the thickness of cementum in two different age groups over 45 year-old (aged between 45-50 and over 50 year-old) diagnosed with chronic periodontitis. Methodology : Following the extraction, teeth were placed in a 10% buffered neutral formaldehyde solution for fixation for 24 hours. After fixation, teeth were decalcified in 8% formic acid solutions. Crosssections of 5-7 microns were prepared in the longitudinal axis of parafin embedded teeth. The sections were stained with hematoxylin and eosin. Measurements and histological examination were performed with light microscopy (X100, with immersion oil) (Olympus CH20) and metric oculars (oculometer). Results: No statistically significant difference was detected between the two groups in the comparison of the mean of the thickness of cementum acquired from the measurements. Conclusion: Further research is required on how periodontal diseases effect the cementum morphologically and development of cementum with regenerative techniques. F2 - 2 Retreatment in a patient with rheumatoid arthritis: a case report A. El Ayouti, T. Connert, Nadia Medea Ferrarese, Giulia Carli, Balzano Nicolò Maria, Carlo Tocchio University of Padova School of Dentistry Abstract Rheumatoid arthritis is an autoimmune disease with an unknown etiology. A female patient affected by R.A.,had been visited in 2005. She was taking Azathioprine (an Immunosoppressive drug) and corticosteroid. She needed an endodontic retreatment of a second lower molar with an extensive bone resorption. The rapid periapical bone destruction that occurred during the endodontic treatment of a rheumatoid arthritis patient taking azathioprine and a corticosteroid has been descrive in the literature and the cause of the rapid destruction is unclear nd may be related to the drugs. Despite the assumption of azathioprine and corticosteroid, the endodontic treatment led to a successful conclusion. A five years control is presented. F2 - 3 Root canal anatomy of Korean mandibular first molars by cone-beam computed tomography Sun Ji Yau, Bo hyun Ban, Se Young Hwang, Bock Young Jung, KeeDeog Kim, Nan Sim Pang Abstract This study investigated canal curvatures in Korean mandibular first molars by using cone-beam computed tomographic (CBCT) images. Methods: 320 mandibular first molars from 165 Korean patients were scanned by CBCT and their canals were reconstructed by 3D modeling software. Three dimensional CBCT images were analyzed to measure the direction and radius of the curvature of the canals by using V-Works software and Kappa software. The degrees of canal curvatures measured by Schneider method in periapical radiographic views were compared with those from CBCT. Results: The average angles of primary curvatures were 25.3 degrees for the mesiobuccal canal, 27.8 degrees for the mesiolingual, 20.2 degrees for the distobuccal and 38.6 degrees for the distolingual canal. The direction of each curvature was distobuccal for the mesiobuccal and mesiolingual canals and distolingual for the distobuccal and distolingual canals. Conclusions: For successful endodontic outcomes, the precise and reliable anatomic information of root canal system is essential. The CBCT-aided method is available for determination of 3 dimensional canal curvatures. 25 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY F2 - 4 Distribution of root resorptions in patients referring to department of endodontics Merve Ozgul, S. Ascı Kaan Istanbul University, Faculty of Dentistry, Department of Oral Medicine and Surgery, Istanbul, Turkey Istanbul University, Faculty of Dentistry, Department of Endodontics, Istanbul, Turkey Abstract Aim. This research has been designed to analyse the distribution and etiologic factors of external root resorption diagnosed through radiographic examination of the patients referring to the Deparment of Endodontics, Faculty of Dentistry in Istanbul University. Methodology. Periapical radiographs of 170 patients , (100 women, 70 men) aged between 13-81 years (median age:40 years) were evaluated. The study was performed on 3850 teeth. A detailed medical history, including systemic diseases and history of trauma were recorded. The previous root canal treatments were evaluated clinically and radiographically. Patients undergoing orthodontic treatment were excluded from the study. A grading scale for root resorption 0-4 (Levander at al.,1998), was made with the help of graph paper by comparing symmetrical teeth: 0= regular root contour; 1= Irregular root contour; 2= Apical Root resorption,(< 2 mm); 3= Apical Root resorption , ( 2 mm to 1/3 of original root length); 4= Root resorption (> 1/3 of original root length). RESULTS. The prevalence of external root resorption was 7.84% on females and 9.43% on males. The distribution of external root resorption was 55% ( mandible) and 45% (maxilla). Resorptive defects were distributed mostly in the apical region of the root, followed by lateral and cervical regions respectively. Root canal treatments had been performed in 108 (35%) of 308 root resorbed teeth. Unsuccessful treatments were observed in 80% of the endodontically treated and root resorbed teeth. CONCLUSION. Infection and failed root canal treatment are considered as the most important etiologic factors of external root resorption. Trauma is also an important etiologic factors. To determine the etiology and distribution of root resorptions long-term clinical studies are needed. F2 - 5 Frequency of different indications for endodontic retreatment in population of Pancevo, Serbia Dragana Pesic, V. Kolak, I. Melih, M. Popovic, A. Jakovljevic Faculty of Stomatology, Pancevo, Serbia Abstract Aim. The aim of this study is to determine the prevalence of different indications for endodontic retreatment, and the influence of specific factors on this frequency. Matherial and methods. For this study 3168 teeth from 148 patients, from both genders and different ages, who came to receive dental care at the Department of Endodontics, Faculty of Stomatology in Pancevo during the years 2009-2010 were examined. The sample of this investigation was selected randomly and data were collected using clinical and radiographic examination of patients. Different indications for root canal retreatment were investigated: underfilled canal; overextension of filling material; voids or unfilled regions in a canal; fractured instruments; untreated canal; adequate endodontic treatment with presence of radiolucency. The influence of different factors on retreatment frequency was also examined: age of patients, functional group of teeth, restorative material. PAI index was determined on each tooth that required retreatment. Data were statistically analyzed using Chi-Square and Mann-Whitney tests. Results. Of the 3168 teeth examined, 208 were endodontically treated. In 126 teeth (60%) the necessity for endodontic retreatment was determined. The most frequent reason for retreatment was the presence of underfilled canals: 71 cases (56 %) with a statistically significant difference (p<.001) to other reasons for retreatment. ChiSquare test showed significant difference (p<0.001) when teeth with 26 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L different restorative material and need for root canal retreatment were compared. Endodontic retreatment was significantly most frequently needed in anterior teeth ( p<0.05). Conclusion. The need for retreatment among endodontically treated teeth had an incidence of 60 %. The most frequent reason was due to underfilled canals, and the most frequently involved teeth were in the anterior group. The study indicates that the approach to initial endodontic therapy needs improvement with implementation of contemporary concepts of working length determination. F2 - 6 Long-term clinical evaluation of Thermafil and warm gutta-percha techniques. A retrospective investigation Chiara Pirani, G.L. Acquaviva, F. Iacono, S. Chersoni, C. Prati Department of Odontostomatological Sciences, Endodontics Unit, University of Bologna, Italy Abstract Aim. To compare the long-term clinical outcome of endodontic treatments performed with Thermafil (TH) plus AH Plus or with warm gutta-percha (WG) and AH Plus. Methodology. A total of 143 endodontically treated teeth (67 patients) were evaluated. For each tooth included following data have been collected: initial pathology, initial treatment or retreatment, diameter of periapical radiolucency before treatment, endodontic obturation technique (WG or TH) and quality of obturation. Patients were examined during control sittings for at least 4 years. For every case symptomatology and periapical radiographic status have been evaluated and compared with preoperative status. Results. Total success rate was 88% (79% healed, 9% incomplete healing cases), failure rate was 12%. Kruskal-Wallis analysis showed no statistically significant differences between TH technique (88%) and WG technique (87%). The success rate for initial treatments resulted meaningfully higher than the one for retreatments both in TH group and in WH group. Initial treatments presented a total success rate of 87% in TH group and of 91% in WG group. Retreatments showed a total success rate of 78% in TH group and of 73% in WG group. Treatments without initial periapical radiolucency showed a significantly higher success rate than treatments with periapical radioluncency (96% vs. 88%, p<0.01). Obturation classified as “adequate” showed a meaningfully higher success rate than “inadequate” obturation cases (90% vs. 79%, p<0.05). Conclusions. The present study indicated that success probability of endodontic therapy performed with TH or WG is superimposable. Independently from the obturation technique, the present study confirmed the quality of obturation as the main prognostic factor both for initial treatments and for retreatments. F2 - 7 Endodontic pain or TMD - case report Goranka Prpic Mehicic, M Valentic-Peruzovic, Z Blazic-Potocki School of Dental Medicine, University of Zagreb, Croatia Dental Clinic, Zagreb, Croatia Abstract The problem of differential diagnosis in patients coming with referred pain into the office of general dental practitioners is often very complex and demanding. Case report: A fourthy eight year old male patient was referred to the Department of Endodontics with a chief complaint of mild to severe pain in the left part of the mandible spreading to the area of the left TMJ, left ear and left temporal area. Previously he was examined by his GDP, who didn’t detected dental course of pain and patient was sent to the neurologist with suspicion on trigeminal neuralgia. He was treated with the Tegretol and acupuncture for six months. During the treatment the intensity of pain decreased from time to time, but it was constantly present. During the period of pharmacological treatment his quality of life was poorer, and he was asking for sec- ESE ROME 2011 NOT ONLY ROOTS ond opinion. He was sent for examination to the Centre for TMD, examination and functional analysis did not confirm any muscular or intracapsular disorder, and he was sent to the Dept. of Endodontics. Thorough examination and radiographs revealed periapical lesion on 37 and a caries lesion under filling on 36. After endodontic treatment was completed the patient was finally relived from pain and his quality of life came back to normal. Because of diffuse spreading of pain it is sometimes difficult for patient to identify the origin of pain, and differential diagnosis should be very carefully provided to avoid unnecessary treatments. In this time of very sophisticated technological and scientific advances, it has become more important than ever, that a careful and well thought communication exists between practitioner, specialist and patient, in order not only to provide the best available treatment, but also to give the patient realistic expectations on the decisions that he will be required to make. Chairpersons: Domenico Ricucci, Roeland De Moor F2 - 8 Session F3 – 14.00 Immediate implant placement in endodontically infected sites: an alternative to secondary endodontic treatment F3 - 1 Stefano Corbella, Silvio Taschieri, Igor Tsesis, Luca Francetti, Massimo Del Fabbro Department of Health Technologies, Milan University, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel Abstract Scientific literature suggested that in case of failure of primary endodontic treatment or both surgical and non-surgical retreatment, the only alternative is tooth extraction and replacement with dental implants. Although the presence of active infection has long been considered a major contraindication to the insertion of implants immediately after tooth extraction, several articles reported excellent results with the latter therapeutic alternative. The aim of this literature review is to evaluate and discuss the clinical outcomes of restorations supported by implants placed immediately after extraction in endodontically infected sockets. A Medline and EMBASE search was performed on articles published from 1966 to April 2009 using the terms “dental implants”, “immediate implant*”, “extraction socket*”, “infected teeth”, “infected site*”, “infected socket*”. No restriction was placed regarding the study design or the species involved. For clinical articles at least 6 months of follow-up was required for inclusion. Data analysis of the selected articles showed that immediate implant insertion in endodontically infected sites after careful debridement of the socket, could be a viable technique with success rates comparable to those of secondary endodontic treatment. Since the clinical reports on this topic are scarce, the level of evidence is low and the followup period is limited, more well-designed studies are required in order to assess relevance of this treatment alternative. In vitro comparison of antimicrobial activity of calcium hydroxide against enterococcus faecalis and candida albicans Ali Cagin Yücel, Ertan Emek Onuk, Evren Sariyilmaz, Bekir Karabucak Ondokuz Mays University, Faculty of Dentistry, Department of Endodontics Ondokuz Mays University, Faculty of Veterinary Medicine, Division of Preclinic Science University of Pennsylvania, School of Dental Medicine, Department of Endodontics Abstract Aim: The aim of the present study was to evaluate the antibacterical efficiency of calcium hydroxide mixed with different vehicles: saline, glycerin+CMCP, CHX and proprietary brands of CH pastes: Calcicur, MM paste, Metapaste and to determine the most appropriate treatment for endodontic infections caused by Enterococcus faecalis and Candida albicans. Methodology: Standard holes in the cultivated agar plates were filled with one of the CH pastes and control agents. The zones of microbial inhibition were measured after incubation period. Results: The CH pastes could be ranked from strongest to weakest as follows CHX-CH, Glycerin+CMCP-CH. Sterile saline-CH, Calcicur, MM paste, Metapaste study groups did not demonstrated any antibacterial effect against E. faecalis. The antifungal effects of the CH pastes were ranked from strongest to weakest as follows: Glycerin+CMCP -CH, CHX-CH, Calcicur, Sterile saline-CH, Metapaste, MM paste. Conclusion: When various medicaments! added to CH pastes, antimicrobial efficiency of CH pastes might seem to enhance in this study but it should be confirmed by in vivo studies. This knowledge should be used to improve ready-to-use CH pastes which has an increasing usage in endodontic recently. F3 - 2 F2 - 9 Best treatment is the best treatment planning: case report Effect of vehicle on diffusion of calcium hydroxide paste through dentinal tubules: in vitro study Yalcin Turgut Yagmur, Gozde Acar Istanbul University Faculty of Dentistry, Department of Endodontics Donika Bajrami, V Hoxha, B Kamberi, L Istrefi, A Dragidella Department of Dental Pathology and Endodontics, Faculty of Medicine, School of Dentistry, Prishtina, Kosovo Abstract The purpose of this case demonstrate the importance of treatment planning. Endodontic therapy has advanced to provide long-term clinical success, and preservation of the natural dentition is a primary goal of dentistry. Dentistry is restoratively driven, supplemented by endodontic and surgical components. When a tooth cannot be restored, then it does not matter whether endodontic treatment can be or is rendered. Treatment planning decisions need to focus on the restorability of the tooth when deciding what treatment will provide reasonable long-term success. If the tooth can be restored, then pursuing endodontic treatment is the best treatment decision. But when this cannot be accomplished or the restorative prognosis cannot provide reasonable long-term success, then extraction and implant placement is the more prudent treatment option. Abstract The purpose of this study was to compare the pH changes of calcium hydroxide mixed with different vehicles. We used 30 single rooted human extracted teeth. Crowns were sectioned transversally at cement-enamel junction and teeth were instrumented manually with step-back technique using K files ( K-files Niti-Flex, Dentsply, Maillefer,Switzerland), irrigation regimen was performed using NaCl 0.9% and EDTA 17 % (Calasept, EDTA, Nordiska Dental, Sweeden) for 3 min. Specimens were divided in 5 groups of 6 teeth each, based on the vehicle used to mix calcium hydroxide paste (Calcium Hydroxide U.S.P, Vision, Henry Schein, Made in Germany): group 1 - distilled water; group 2- anesthetic solution; group 3- chlorhexidine 0.2% (diluted from CHX 2%); group 4 - chlorhexidine 2% (Calasept, CHX 2%, Nordiska Dental, Sweeden); group 5 - MTAD (Bio Pure MTAD, Dentsply Tulsa Dental). PH was measured after 1, 3, 7, 15 and 30 days www.eserome2011.com 27 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY with pH meter (Ecoscan, Eutech Instruments, Singapore). The data were analyzed and compared statistically with Tukey test. All groups showed similar pH values, but group III, IV and V presented a better diffusion capacity through dentin than group I and II. Our results suggests that CHX and MTAD are efficient vehicle in calcium hydroxide paste. R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L F3 - 5 The sealing ability of AH plus jet and Epiphany to Resilon by thermoplastic obturation Tani-Ishii Nobuyuki, Noriko Mutoh Division of Endodontics, Department of Oral Medicine, Kanagawa Dental College, Yokosuka Japan F3 - 3 Comparison of ProRoot MTA, Geristore and Retroplast on attachment of human gingival fibroblast Banafsheh Amani, Ehsan Esnaasharl Azad dental school Endodontic department tehran iran Abstract Aim :this study compared the effect of three root end filling materials: mineral tioxide aggregate ,Geristore,Retroplast on human gingival fibroblast adhesion. Methodology : human gingival fibroblasts were incubated on set materialspeciments,and the number of cells adhered to each material was counted at 24,72 hours and 1 week by using sem and observing the surfaces of disks. Results result showed that cell count was higher for retroplast than other material at all times,and ccultured cells adhered to retroplast significantly increased with time.MTA was significantly better than Geristore. Conclusions retroplast have good biocompatibility which enhance apical tissue regeneration. F3 - 4 Antibacterial activity evaluation of various root canal sealers with a direct contact test AU Eldeniz, Nur Mutlu Seref, I Capar, H Ari Faculty of Dentistry, Selcuk University, Konya, Turkey Abstract AIM: The purpose of this study was to evaluate the antibacterical activity of leachable components of a new glass ionomer sealer Activ GP in comparison with six resin-based sealers; Acroseal-Septodont, France, AH Plus-Dentsply DeTrey, Germany, EndoREZ-Ultradent, USA, RealSeal-SybronEndo, USA, MMSeal, MicroMega, France, Hybrid Root SEAL-Sun Medical, Japan, Apexit Plus-Ivoclar Vivadent, LS, Sealapex-Kerr, MI, GuttaFlow-Roeko, Germany and RoekoSealRoeko, Germany using a modified direct contact test using E. faecalis (A197A), C. albicans (ATCC 90028) and S. mutans (NTCT 10449) as test microorganisms. Methodology: The materials were tested immediately after application to the microtiter wells (n=6) (fresh samples) and after setting for 3 days (set samples). Ten microliters of bacterial suspension was added to each well for direct contact with each material for 1 h at 37°C. Growth of surviving bacteria was then measured in a microplate spectrophotometer hourly at 600 nm for 24h. Twelve uncoated wells using identical inoculum size served as positive controls. Results: Direct contact test results indicated that Hybrid Root SEAL is more potent bacterial growth inhibitor than the other resin based sealers. ActiV GP sealer was more potent growth inhibitor on S. mutans than C. albicans and E. faecalis. Silicone based RoekoSeal and GuttaFlow sealers had very little antibacterial activity when compared with other sealers except Apexit Plus. Calcium hydroxide based Sealapex sealer demonstrated better antibacterial activity on tested bacteria than Apexit Plus. Generally, all the sealers were less effective in inhibiting E. faecalis than C. albicans and S. mutans. Conclusion: Apexit Plus, GuttaFlow and RoekoSeal were less potent bacterial growth inhibitors than the other tested sealers on all test microorganisms. 28 Abstract Aims. The present study assessed the warm vertical obturation and evaluate the sealing ability of canals filled with resin-based sealer and Resilon by thermoplastic obturation. Methods. The total of 72 plastic standard teeth (Dentsply-Maillefer,) were used and divided into 2 group of 36 teeth. In group 1 root canals were filled with Resilon (Pentron) / Epiphany (Pentron) and in group 2 with Resilon / AH plus jet (Dentsply-Maillefer,) sealer by Obturator beta (Pentron). The canal walls were throughly coated with AH plus jet or Epiphany by using a sterile paper point, and Resilon was obturated by Obturator beta. The mean penetration of Resilon was measured until root apex by Olympus microscope SZX16 with a digital camera DP71. The sealing ability of obturation was evaluated by dye leakage test. All canals were obturated, and the teeth were sectioned horizontally at 1,3, and 5 mm from the root apex. Sections were taken by a digital microscope, and quantified the proportion of core material in each canal. A one-way analysis of variance (ANOVA) and Scheffe testing were used to compared and identify any statistically significant differences at p<0.05. Results. The result indicated that the both Resilon penetration was perfectly until root apex, and the sealing ability of both Epiphany and AH plus jet was significantly high in both groups. The proportion of the both Resilon was more than 91 % at level of 1 mm, and more than 96% at level of 3 and 5 mm from apex. Conclusions. It was conclude that Resilon / Epiphany and Resilon / AH plus jet obturation were showed significantly less leakage with warm vertical obturation. F3 - 6 Clinical applications of new calcium-silicate cements for root perforation repair: 12-24 months follow-up Francesco Iacono, C. Pirani, S. Chersoni, M.G. Gandolfi, Carlo Prati Endodontics Unit, University of Bologna, Italy Abstract Introduction New formulation of calcium-tetrasilicate cements (CS) have been recently proposed for different clinical applications such as root perforation repair cement. Objective of this clinical study was to evaluate a 12-24 months follow-up. Methods Six case reports are presented documenting clinical outcomes after the application of new CS as root perforation repair material. Under rubber dam isolation, perforation site was cleaned, sealed with a CS and covered with a CVI layer. A composite material was used to restore the teeth. A follow-up of 12-24 months was performed. Results and Conclusions The procedure was shown to be successful in five cases of this series demonstrating the effectiveness of the new CS in resolving apical periodontitis in case of root perforation. One case of root perforation did not show the complete radiographic resolution but it does not present clinical symptoms. ESE ROME 2011 NOT ONLY ROOTS F3 - 7 A comparative study on effects of adding CaCl2 & K-YJelly on solubility of MTA Mohebbi Pooneh, Hengameh Akhavan, Nazanin Aryan, Azin Sedighnia Tehran azad dental school endodntics, Tehran, Iran Shahid Beheshti dental school, Tehran, Iran Abstract Aim: Mineral Trioxide Aggregate(MTA), mixed with water has a short working time, delayed setting time and poor consistency. A preliminary study, suggested that substituting K-Y Jelly and/or CaCl2 5% as a mixing vehicle decreases the setting time of MTA. An adequate solubility is an important property of root end filling materials ,that can affect the result or root canal therapy. The present study compared the solubility of ProRoot MTA mixed with water to that of mixed with K-Y Jelly and of CaCl2 5%. Methodology In this experimental study all the materials were mixed following mixing procedure which advised based on manufactures and researches. The standardized samples,(n:5 per group), Stain less Steel matrices(20±1 diameter, 1.5±0.1 height) were filled with Pro Root MTA +distilled water, Pro Root MTA + CaCl2 5%, Pro Root MTA + K-Y Jelly. These samples were immersed in double-distilled water for 24h, 7 days, 28 days. Mean loss of weight was determined and analyzed statistically using a one way ANOVA and paired Tukey test for all pair- wise comparisions. Result : Pro Root MTA + CaCl2 5% , showed the best results after 28 days but difference among Pro Root MTA + water& Pro Root MTA + Ca Cl2 5%, was not statistically significant after 24h and 7 days.( P Value:0.413, .0918). K-Y Jelly + Pro Root MTA showed the worst result after 28 days. Conclusions All the materials had acceptable solubility but based on the finding of this study, we can conclude that MTA mixed with CaCl2 5%, has shown better solubility than MTA mixed with water & K-Y. technique and the continuous wave technique. Material and method: Forty single rooted extracted teeth of similar size and root shape were selected. Biomechanical preparation was performed with rotary instrumentation, using NiTi Twisted Files (SybronEndo, CA, USA). The apical portion of all roots was prepared at the working length to a size 35/06. Irrigation was performed with NaOCl 5% (Chlorax, P.P.H. Cerkamed, Poland) after each file, EDTA 17% (META Biomed, Korea) and Clorhexidine 2% (Gluco-Chex, P.P.H. Cerkamed, Poland) as final rinse. The specimens were randomly divided into four groups of ten samples each and root canal fillings were performed using gutta-percha (SybronEndo, CA, USA) /Sealapex (Kerr, Italya) and Resilon (RealSeal, SybronEndo, CA, USA) /Epiphany (SybronEndo, CA, USA) with lateral condensation and continuous wave technique. Apical leakage was estimated using a dye penetration test with 2% methylene blue. Next, the teeth were cleared in order to observe and compare the dye penetration. The transparent specimens were examined with a digital camera mounted on a binocular microscope, recording only the largest measurement in millimeters. Results: Dye penetration was inhomogeneous within and between the four groups. The Resilon/Epiphany groups displayed significantly more dye penetration than the gutta-percha/Sealapex groups. Specimens filled with Resilon/Epiphany leaked to an extent that could be easily measured using the current setup. Conclusion: Under the condition and within the limitations of the current study it was shown that Resilon/Epiphany root fillings showed significantly more dye penetration compared with gutta-percha/Sealapex counterparts with regard to obturation method. Chairpersons: Maria Giovanna Barboni, Davide Castro F3 - 8 Session F4 – 13.30 Thermal characterization by DSC of a new endodontic cement F4 - 1 Benedetta Tosini, Stefano Pagano, Alessandro Conversini, Guido Lombardo, Potito D’Errico Faculty of Medicine and Surgery, Department of Odontostomatological Sciences, University of Perugia, Italy Abstract In the reconstruction endodontic, the cement dentin adhesion is a critical factor .That can cause detachment system. The purpose of the study was to evaluate, by means of differential thermal analysis, the degree of polymerization of a new endodontic cement, subjected to several cycles of treatment by car or light curing . The data showed a higher polymerization obtained by curing with respect to autopolimerization. Differential thermal analysis is a predictable method for the determination of the degree of care of different materials. Its use in root canal area could be a great help in clinical. F3 - 9 Gutta-percha versus Resilon root fillings: an apical microleakage analysis Timis Lucia Iacobina, Dragan Oana Carmen, Cimpean Sanda Faculty of Dentistry, University of Medicine and Pharmacy, Cluj-Napoca, Romania Abstract One of the keys to success of root canal therapy is to obtain a root filling that will prevent penetration of fluids and microorganisms. The aim of this study was to investigate apical microleakage of root canals filled with Resilon or gutta-percha using lateral condensation www.eserome2011.com Comparison of vertical forces generated during root canal filling Anja Baraba, I. Katalinic, I. Anic, I. Bago, S. Segovic, I. Miletic School of Dental Medicine Department of Endodontics and Restorative Dentistry, Croatia Abstract Aim: To examine vertical forces exerted during root canal obturation with three techniques, cold lateral condensation, ProTaper thermoplasticized and ProTaper Single-cone technique. Also to evaluate vertical forces exerted during root canal obturation with the cold lateral condensation technique performed by undergraduate students, dentists on specialty training in endodontology and specialists of endodontology. Methodology: Fourty-five single-rooted permanent teeth were used for the first part of the study. All specimens were instrumented using the ProTaper technique to F2 instrument and were randomly divided into three experimental groups (n=15 per group), obturated using the cold lateral condensation technique, ProTaper thermo-plasticized and ProTaper Single-cone technique. Ten single-rooted permanent teeth were used for the second part of the study. All specimens were instrumented using the step-back technique to master apical file size #25. Three groups of operators: 1) undergraduate students (n=10); 2) dentists on specialty training in endodontology (n=10) and 3) specialists of endodontology (n=10) obturated the root canals using the cold lateral condensation technique. Vertical forces were measured using the force measurement device, developed for simulation of endodontic treatment. Results: When cold lateral condensation obturation technique was used, vertical force of 1.21±0.24 kg was measured which was statistically significantly different in comparison to other techniques 29 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L (p=0.0001). Vertical force recorded during root canal obturation by undergraduate students was 1.54±0.47 kg, 1.65±0.46 kg by dentists on specialty training in endodontology and 1.32±0.41 kg by specialists of endodontology. The results showed no statistically significant difference (p>0.05) between three groups of operators. Conclusions: The cold lateral condensation technique exerted higher vertical forces in comparison to the ProTaper thermo-plasticized and ProTaper Single-cone technique. There was no difference between vertical forces exerted by undergraduate students, dentists on specialty training in endodontology and specialists of endodontology during root canal obturation using cold lateral condensation technique. respective of the section level. In contrast, group III proved to have significantly (p<0.05) superior gutta-percha percentages, both at 6 and 8 mm compared to the other two groups. Accordingly, radiological examination proved the superiority of group III that had significantly better scores. Conclusion: within the limits of the present study, the thermomechanical condensation has been shown to be a better alternative to the traditional root filling techniques. F4 - 2 CBCT to Evaluate Tridimensional Obturation of Endodontic System Comparison of obturation density of cold lateral compaction versus BeeFill in vitro Amir Abbas Moshari, Arjang Falahdoust, Rezvan Nasiri Tehran azad dental school endodntics, Tehran, Iran Abstract Aim: The most important failure of obturation is non efficiency and low density of obturation material.A maximum volume of gutta-percha and a thin layer of sealer are preffered. Different techniques have been introduce. Purpose of this study was to compare the density of BeeFill system and cold lateral compaction technique. Methodology: In this experimental study sixty transparent acrylic blocks with thirty degree curves were instrumented. The blocks were weighed and randomly divided into two groups. Group A was obturated with cold lateral compaction. Group B was obturated with BeeFill system. Each block was reweighed and difference calculated. Independent sample t –test were used as statistical method of evaluating the results. Results and Conclusions: The mean density of cold lateral group was 0.0297273 gr and for Beefill group was 0.0322687 gr. Independent sample t-test showed that density between the groups significant. (P<0.001) F4 - 3 Radiological and microscopic assessment of the root filling quality by three filling techniques Gabriela Chiriac, M. Bud, C. Culic, Dana Hrab, Sanda Cimpean Department od Cariology&Endodontics, Faculty of Dentistry,University of Medicine and Pharmacy “I.Hatieganu” Cluj-Napoca, Romania Abstract The final goal of a successful endodontic treatment is a three dimensional filling of the root canal system by maximizing the gutta-percha and minimizing the sealer quantity. In the present study we aimed at comparing the results obtained through three different endodontic filling techniques. Material and methods: 30 extracted teeth with oval-shaped root canals (long:short ratio >2:1 at a distance of 5 mm from the root apex) were included into the study. Initial radiographs of the specimens were realized using a CCD sensor (RVG Visiodent, France). The root canals were prepared afterwards with a rotative technique- Twisted files (SybronEndo, Orange, CA, USA). The samples were randomly distributed in one of the following groups receiving different root fillings: I. Group I (n=10), cold lateral condensation technique II. Group II (n=10), continuous wave of condensation filling technique III. Group III (n=10), thermomechanical technique The root filling quality was evaluated initially by the radiological method by 5 observers who gave scores to the analyzed images. The voids along the root filling were hereby assessed. Consecutively, roots were sectioned horizontally at 3, 6 and 8 mm from the apex and micro-photographs taken. Using imaging software, gutta-percha percentage at each level was calculated. Results: Within each group, there were no significant differences ir- 30 F4 - 4 Leila Mihaela Gheorghita, O. Diaconu, A. Camen, M. Tuculina, I. Moraru University School of Dentistry, Craiova, Romania Abstract Aim. This study aims to evaluate tridimensional root canal obturation using CBCT. Matherial and methods. 40 maxillary and 40 mandibular premolars extracted for orthodontic reasons were studied. Preoperative radiographs were taken, pulp tissues were removed and chemomechanical treatment was performed using ProTaper System, sodium hypoclorite 5% and EDTA. Root canal obturation was performed using cold lateral condensation of gutta-percha. Postoperatives radiographs and CBCT was made after root canal obturation in order to evaluate tridimensional obturation of the endodontic system. Results. The postoperative radiographs analysis showed in 87,6% of the cases correct tridimensional obturation. On the other hand analizing CBCT data only 67,8% of the cases presented correct tridimensional obturation, because of lack of instumentation of the second root canal in lower premolars, the third root canal in upper first premolars and type V Vertucci canals. Conclusions. CBCT offers an important aid in evaluating endodontic treatment, especially in cases of complex endodontic anatomy. CBCT has become over the last years an important investigation tool that offers important information about root canal anatomy, intercanalar communications, supplementary canals. The comprehension of root canal morphology clearly improves therapeutical perspective and leads to a more successful endodontic treatment. Key words. CBCT, endodontic system, tridimensional obturation. F4 - 5 New sealer based on MTA: report of three cases Jose Antonio Gonzalez Sanchez, F. Abella Sans, A. Ramirez Sebastia, S. De Noé Hernandez, J. Tomas Aliberas, R. Bueno Martínez University International of Catalunya, Barcelona, Spain Abstract A new sealer based on mineral trioxide aggregate, Fillapex (Angelus®, Brazil), has been recently developed. It consists of two biocompatible components: Mineral Trioxide Aggregate and Salicylate Resin. Its MTA-based composition provides sealing integrity (due to the low solubility of MTA), biological regeneration and antibacterial properties (due to high Ph). The features of this sealer are an excellent radiopacity, easy handling, adequate working time (35 minutes) and adequate setting time (130 minutes). Moreover has been described as the only root canal sealer that promotes cementum regeneration. The aim of this poster is to review clinical case reports in which the new sealer based on MTA was used in root canal obturation. Conclusion: sealer based on mineral trioxide aggregate was found to be successful when used as root canal sealer. Further histological and biological investigations are needed to support these clinical results. ESE ROME 2011 NOT ONLY ROOTS F4 - 6 F4 - 8 An evaluation of the use of different sizes and techniques of thermoplasticized obturators on the apical seal: a comparative study Comparing the ability Gutta-Percha, Resilon and a New Thermoplastic Carrier to obturate a simulated apical lateral canal when using two different apical sizes preparations Al-Huwaizi Hussain , Th. Neama College of dentistry, University of Baghdad - Ministry of Health, Conservative dentistry, Iraq Abstract Aim Thermoplasticized gutta-percha is molded into the intricacies of the root canal walls and seals the root apex more tightly than cold gutta-percha. The objective of this in vitro study was to evaluate and compare the apical microleakage of root canals filled with a cold lateral condensation, thermafil obturators size(35,40), soft core(low heat, regular heat)size(35,40) obturations. Methodology Seven groups of eighty four extracted human teeth of single and straight root canals (twelve samples were used for each group).The teeth were instrumented by protaper files (hand use). Groups(1, 3, 5 and 7) obturated with size (40) (matched size) while group( 2, 4 and 6) had been obturated with a master cone size (35). All the samples were sealed coronally then stored in normal saline at 37ºC for one week then all the roots were submerged in Indian ink for one week. The roots were cleared and the degree of linear dye penetration was measured in millimeter by stereomicroscope under 40X magnification and calibrated grid. Results The result showed that the group of lateral condensation leaked apically significantly higher than thermoplasticized obturator techniques while the group of Soft core (low heat) obturator size (40) exhibited the least value of apical microleakage. Conclusions Lateral condensation had the highest leakage value of dye penetration, Soft core low heat showed better apical sealing than soft core regular heat and the obturators size (40) showed less apical leakage than size (35). Nogueira Paulo, D. Duggan, E. Rivera University of North Carolina Endodontics, Chapel Hill, US Abstract Aim of this study is to compare the ability Gutta-Percha, Resilon and a New Thermoplastic Carrier to obturate a simulated apical lateral canal when using two different apical sizes preparations. Methodology: Sixty epoxy resin blocks with simulated single root canals and one apical lateral canal were used for this study (Tulsa Dental Products, Tulsa). Each canal has the original dimension of a ISO # 10 K file, 12 mm in length with a curvature of approximately 30 degrees. Each block was prepared using rotary Profile Vortex M-wire Nickel Titanium Rotary files 21 mm in length, (Dentsply Tulsa Dental Products, Tulsa. The resin blocks were divided into six groups (n=10). The groups A, B and C were instrumented up to size ISO # 25, taper .06, while the groups D, E and F were be instrumented up to size ISO # 45, taper .06. Obturation: Group A: Calamus Singles, Group B: Calamus Singles Resilon, Group C: Guttacore size # 25 Obturators, Group D: Calamus Singles, Group E: Calamus Singles Resilon and Group F: Guttacore size # 45 Obturators. Data: Digital photography exported as jpeg images were evaluated into the AutoCAD 200 program (Autodesk Inc, San Rafael, CA) to measure the depth of penetration of the filing obturation material into the lateral canals. Results: The results are being recorded and a multiple-comparison analysis of variance test followed by a Tukey post hoc test will be used to compare filling material flow into lateral canals of each of the experimental groups (p< 0.05). Conclusions: The conclusions will be write after the statistical analyse is concluded. F4 - 9 F4 - 7 In vitro apical Leakage evaluation of straight root canals filled using protaper Gutta-Percha Jose Maria Nieto De Pablos, Luis Oscar Alonso Ezpeleta, Alexandre Beatriz Del Valle, Jose Grabiel Diaz Martín, Alvarez Jesus Mena University of Alfonso X el Sabio, Madrid, Spain University of Zaragoza, Zaragoza, Spain Abstract The achievement of hermetic root canal filling is essential in endodontics considering that more than 58,66% failures depend on unproper obturation of the root canal system. 60 single rooted teeth and bicuspids with straight root canals have been shaped using NiTi Protaper rotary instruments and filled according to the lateral condensation technique. Teeth were sealed using two coats of nail varnish exposing only 5 mm of the apical area. Specimens were immersed in 0,5% methylene blue solution, and centrifuged during 72 hours to facilitate dye penetration. Apical microleakage was evaluated using a digital caliper under a stereomicroscope (at 40 x magnification). In 80% of the tested specimens, less than 1 mm of apical leakage was recorded. 15,4% of specimens recorded an extent of leakage between 1 and 2 mm and only 3,8% of cases leakage was higher than 2 mm. According to the achieved results, it can be concluded than the tested filling technique is fast and safe in terms of in vitro resistance to dye leakage, although it is more expensive than conventional lateral technique. www.eserome2011.com An evaluation of four thermoplastic gutta-percha techniques Sinziana Adina Scarlatescu, A. Iliescu, D.S. Stefan, B. Dimitriu Faculty of Dental Medicine, “Carol Davila” University, Bucharest, Romania, “Politehnica” University of Bucharest, Romania Abstract Aim: To assess the quality of root fillings by using four methods of thermoplastic gutta-percha techniques. Methodology: Forty extracted mandibular incisors and premolars were treated with ProTaper Universal instruments (Dentsply-Maillefer, Switzerland) and randomly divided into four groups, ten teeth per group. Four techniques were used for root canal filling: Group A - continuous wave of condensation, Group B - warm vertical condensation, Group C - thermomechanical compaction and Group D - a hybrid technique: warm vertical condensation in the apical third followed by thermomechanical compaction. In each group the obturation was performed using ProTaper Universal gutta-percha points corresponding to the size of the latest instrument and Tubliseal EWT (Kerr, USA) as a sealer. Sealer and gutta-percha extrusions were observed. Radiographic assesment of obturations was done using the following scores: 1: well-condensed and adapted filling; 2: imperfectly condensed filling with irregularities less than 1 mm in adaptation; 3: irregularities more than 1 mm but less than 2 mm; 4: irregularities more than 2 mm. Results: At radiographic evaluation, thermocompaction presented score 1 in 95% of teeth, score 2 in 5%; hybrid technique: score 1 - 65%, score 2 - 35%; continuous wave: score 1 - 45%, score 2 - 30%, score 3 - 15%, score 4 - 10%, while multiple waves showed score 1 - 10%, score 2 - 50%, score 3 - 25%, and score 4 - 15%. Sealer/gutta-percha extrusions were absent in 85% of cases filled by multiple waves, 80% - continuous wave, 70% - hybrid techniques, and 50% - thermocom- 31 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY paction. Conclusions: Overall, the techniques analyzed presented good results. The hybrid, thermocompaction and continuous wave of condensation techniques showed more precision of filling, fewer voids and good penetration into lateral canals, than warm vertical condensation did. F4 - 10 Applications of Cone-Beam Computed Tomography in Dental Practice: A Literature Review Alamri Hadi, Alshalhoob Mazen, Alshehri Mohammed Intern, Riyadh Colleges of Dentistry and Pharmacy Consultant, Restorative and Implant Dentistry at Riyadh Military Hospital Abstract Objectives.This article presents a review of the clinical applications of cone-beam computed tomography (CBCT) in different dental disciplines. Methods. A literature search was conducted via PubMed for studies on dental applications of CBCT published between 1998 and 2010. The search revealed a total of 540 results, of which 130 articles were clinically relevant and were analyzed in detail. Results. The results of this systematic review show the different applications of CBCT imaging in dental practice, 36 articles (27.7%) related to applications in oral and maxillofacial surgery (OMFS), 33 articles (25.4%) related to endodontic clinical applications, 22 articles (16.9%) related to clinical applications in implant dentistry, 15 articles (11.5%) related to orthodontic clinical applications, 10 articles (7.7%) about clinical applications in general dentistry, 8 articles (6.2%) about the temporomandibular joint (TMJ), 5 articles (3.8%) related to applications in periodontology, and 1 article (0.8%) about CBCT applications in forensic dentistry. 36 articles (27.7%) related to applications in oral and maxillofacial surgery (OMFS), 33 articles (25.4%) related to endodontic clinical applications, 22 articles (16.9%) related to clinical applications in implant dentistry, 15 articles (11.5%) related to orthodontic clinical applications, 10 articles (7.7%) about clinical applications in general dentistry, 8 articles (6.2%) about the temporomandibular joint (TMJ), 5 articles (3.8%) related to applications in periodontology, and 1 article (0.8%) about CBCT applications in forensic dentistry. Conclusions. The majority of CBCT applications in the practice of dentistry are found in the specialties of OMFS, endodontics, implant dentistry, and orthodontics. Future research should focus on obtaining accurate data regarding the radiation doses of CBCT systems and the clinical of CBCT applications in forensic dentistry and prosthodontics. Chairpersons: Francesco Mannocci, Miguel Miñana Session F5 – 14.00 F5 - 1 Working length variation during mechanical preparation of curved root canals using rotary instruments Arkadiuz Dziedzic, T. Piekarz, E. Michalak, B. Mosler, M. Tanasiewicz Department of Conservative Dentistry with Endodontics, Medical University of Silesia, Bytom, Poland Abstract Aim: An in vitro comparison of endodontic working length (WL), measured at different stages of mechanical preparation of severly curved root canals using sequences of new type S5 nickel-titanium rotary instruments. Methodology: The material consisted of 17 selected root canals of extracted molars and premolars with curvature more than 20 degrees defined by the radiological Scheider’s method. Horizontally sectioned roots were cemented in the mass of acrylic in order to obtain mechanical resistance. Intracanal spaces were prepared in vitro using crown-down technique and sequence of five rotary instruments S5 (Poldent) and a dedicated cordless endodontic S5 Endo Motor with the 32 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L speed ranged 150 rpm-300 rpm. A solution of sodium hypochlorite 2% and Filecare EDTA compound (VDW, Germany), a chemical adjunct to mechanical debridement, were applied to remove the organic remnants and inner smear layer. Initial and subsequent working length measurements were determined by means of ‘C’ File size ISO 08 or 10 (VDW, Germany) and electronic caliper with an accuracy 0.01mm. An undoubtful reference point was set for the anatomical opening of the root canal (mechanical resistance due to acrylic mass), the second point was on the bottom edge of the silicone stopper sidewall. Results: The average working length of initially nagotiated intracanal spaces was 15.34mm (+/-1.38SD), while the final WL after full chemo-mechanical preparation was established with the value 15.05mm (+/-1.4SD). The average reduction of WL after completed process for all measurements was 0.28mm with respect to the initial value. The biggest average variation in WL (0.07mm) was observed after third S5 instrument with 4% taper and 30 ISO size. The differences were not statistically significant. Conclusions: Mechanical root canal preparation using S5 Ni-Ti rotary instruments with increased taper and crown-dawn technique can affect and slightly decrease the final working length of severly curved root canals in clinical settings. F5 - 2 Comparison of two techniques for assessing the shaping efficacy of repeatedly used nickel-titanium rotary instruments Hani F. Ounsi, Giovanni Franciosi, Raffaele Paragliola, Khalid Al Huzaimi, Ziad Salameh, Franklin R. Tay, Marco Ferrari, Simone Grandini Tuscan School of Dental Medicine Abstract Introduction: The shaping capacity of nickel-titanium (NiTi) rotary instruments is often assessed by photographic or micro–computed tomography (micro-CT) measurements, and these instruments are often used more than once clinically. This study was conducted to compare photographic and micro-CT measurements and to assess if the repeated use of NiTi instruments affected the shape of canal preparation. Methods: Ten new sets of ProTaper Universal instruments (Dentsply-Maillefer, Ballaigues, Switzerland) were used in 60 resin blocks simulating curved root canals. Groups 1 to 6 (n = 10) represented the first to sixth use of the instrument, respectively. Digitized images of the prepared blocks were taken in both mesiodistal (MD) and buccolingual (BL) directions and area measurements (mm2) were calculated using AutoCAD (Autodesk Inc, San Rafael, CA). The volumes of the same prepared canals were measured using micro-CT (mm3). Statistical analysis was performed to detect differences between photographic and volumetric measurements and differences between uses. Results: Two-way repeatedmeasures analysis of variance revealed significant differences between groups (P < .001). Regarding measurement type, there were no significant differences between BL and MD measurements, but there were significant differences between micro-CT and BL measurements (P < .001) and micro-CT andMD measurements (P = .001). Significant differences were also noted between uses. Conclusions:Within the limitations of the present study, micro-CT scanning is more discriminative of the changes in canal space associated with repeated instrument use than photographic measurements. Canal preparations are significantly smaller after the third use of the same instrument. F5 - 3 Postoperative pain following glide path: manual vs mechanical with pathfile Mario Alovisi, Luca Cerrato, Damiano Pasqualini, Nicola Scotti, Elio Berutti Department of Endodontics – Prof. E. Berutti, University of Turin Dental School, Turin, Italy Abstract Introduction: Rotary Ni-Ti instruments prevent expulsion from the apical foramen of infected debris, produced during shaping; their ESE ROME 2011 NOT ONLY ROOTS introduction into endodontics has thus greatly reduced patient perception of postoperative pain. However, the need for manual creation of a glide path before rotary instruments may be used, to prevent torsional stresses, means that some debris is expelled from the foramen during this phase. In 2008, Maillefer introduced a system of rotary instruments, the Pathfile system, with which to create the glide path mechanically. This study evaluates postoperative pain in patients in whom the glide path was created mechanically using the PathFile system, versus others in whom it was done by manual preflaring with stainless steel K-Files. Materials and methods: 295 patients requiring endodontic treatment were subdivided into two groups. In group 1 (n=149) the glide path was created mechanically using the new PathFile instruments; in group 2 the glide path was created manually with traditional kfiles. The presence and intensity of postoperative pain were evaluated through a questionnaire, in which each patient recorded symptoms twice daily for seven days after treatment on a VAS scale. The results were analyzed statistically with the ANOVA model (p<0.05). Results: The distribution of postoperative pain in the two groups produced two curves. The curve for group 1 (Pathfile) showed a more favorable trend for variation of pain over time than the curve for group 2 (k-files), the difference being statistically significant (p<0.001). In the ANOVA model, adjusted for analgesic ingestion, this significance was attenuated, though still present (p = 0.039). Conclusions: Use of the new PathFile system of rotary instruments to create the glide path produced a statistically significant reduction in postoperative pain (p < 0.001) perceived by patients after endodontic treatment. F5 - 5 F5 - 4 F5 - 6 An evaluation of root canal treatment: in vitro study Conservative endodontics-a savior in a lost case: case report M. Chirila, G.F. Moldoveanu, N. Maru Carol Davila University Endodontics Bucharest Romania Carol Davila University Clinical and Topographical Anatomy Bucharest Romania Abstract Aim. To assess the performances of root canal treatment using three different techniques: step-back, manual and rotary ProTaper. Methodology. We divided 45 extracted single rooted teeth, preserved in saline solution, into 3 groups for each technique. Root canal instrumentation was done during endodontic practice, together with our group of students and according to the protocol specified from the beginning. For rotary ProTaper we needed a low speed torque motor X-Smart (Dentsply, Maillefer, Switzerland). After finishing all endodontic treatments, the teeth were sectioned at 3 mm from the apex, the sections were stereomicroscopically analyzed and then pictures were taken. Results. On the resulted sections we analyzed the reports between the surfaces of shaped and non-shaped root canals and the concordance between root canals morphology and post shaping design. Distribution depending on apical master file was: 20% F1, 20% F2, 60% F3 for rotary ProTaper technique, 7% F1, 13% F2, 80% F3 for manual ProTaper technique and 27% ISO 40, 20% ISO 35, 20% ISO 20, 13% ISO 25, 6% ISO 50, 7% ISO 30, 7% ISO 45 for step-back technique. Regarding the analyzed sections we found out that for the step-back technique 62% were regular surfaces and 38% irregular, for manual ProTaper 67% regular and 33% irregular and for rotary ProTaper 75% regular and 25% irregular. The dentinal detritus was: 20% out of all the surfaces analyzed for step-back, 10% for manual ProTaper and 13% for rotary ProTaper. Some teeth were not shaped at the level of our sections: 3% of the teeth instrumented with step-back techniques and 6% for manual ProTaper. Conclusions. All three techniques had questionable performances especially for wide root canals of upper central incisors and upper canines and for oval root canals. The step-back technique proved to be more efficient when used for oval root canals. The rotary ProTaper technique reduced the operating time and simplified the instrumentation procedure. www.eserome2011.com Comparison of apically extruded debris between Mtwo and ProTaper systems Henhameh Akhavan, Masoumeh Dibaj, Mohamadreza Fouladloo, Peyman Mehrvarzfar, Azin Sedighnia, Mohebbi Pooneh Tehran azad dental school endodntics, Tehran, Iran Shahid Beheshti dental school, Tehran, Iran Abstract Aim: The purpose of this in vitro study was to determine the quantity of extruded apically debris using the proper rotary system compared to Mtwo rotary system. Methodology: In this experimental study, forty disto-buccal root canals of human maxillary first molars were selected and divided into two groups of twenty canals. One group was instrumented with Mtwo rotary system and the other with ProTaper rotary system according to the manufacturer. A standard amount of irrigant was used for each canal. Apically extruded debris and irrigant were collected in pre-weighted vials. Then the vials were located in the desicator and after removing the irrigant ,the weight of dry debris was estimated. The mean weight of the extruded debris for each group was analysed using one sample Kolmogorov smirnov test and independent sample test. Results: Both instrumentation systems produced extruded debris and irrigant. There was no difference between two groups. Apically extruded debris for ProTaper was 0.0008195 and for mtwo was 0/.0008010(p=0.104) Conclusions: Both of the systems had the same level of extrusion debris. Mtwo had no advantage to the ProTaper. Marijana Molnar, B.M. Sepic Matanovic, B. Pazin, M Klemencic Department of Endodontics Oral Medicine and Periodontology, Dental Clinic Zagreb, Zagreb, Croatia Abstract Children and adolescents are subject to several periodontal diseases. Although there is a much lower prevalence of destructive periodontal diseases in children than in adults, children can develop severe forms of periodontitis. Aggressive periodontitis AP is characterized by severe and rapid loss of periodontal attachment often commencing at or after the circumpubertal age. Since early diagnosis ensures the greatest chance for successful treatment, it is important that children receive a periodontal examination as part of their routine dental visits. In 2006 a 12-year-old boy presented with generalized gingival inflammation, extensive localized bone loss, and mobility of 32,31,41,42, as well as the beginning of bone loss in the first molars. Neither unusual infection, nor traumas were detected. The presence of Actinobacillus actinomycetemcomitans was detected. Other specialists have recommended extraction and removable prosthesis, but in view of his young adolescent age we advise a different approach. Treatment consisted of supragingival and subgingival debridement, devitalizing and splinting mobile teeth, root scaling and planing combined with 10 days prescription of Amoxicillin and Metronidazole. Clinical follow-up was to be continued over next year but patient quit therapy. Next we saw him was in 2011, now 18-year with a full-blown AP. Intraoral examination revealed severe gingival inflammation, dental abscesses, pathological tooth mobility, bleeding upon probing and attachment loss around first and second molars, also premolars. Radiographs revealed severe horizontal and vertical bone loss. The only unchanged part was a lower front block and with that in mind and with insufficient bone amount for implants conservative endodontic therapy coupled with initial and surgical periodontal therapy with antibiotics is the only option. 33 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY F5 - 7 Cyclic fatigue resistance of three different nickel-titanium instruments after immersion in sodium hypochlorite Eugenio Pedullà, Nicola Maria Grande, Gianluca Plotino, Alfio Pappalardo, Ernesto Rapisarda Surgery Department, University of Catania Odontostomatology Department, “La Sapienza” University of Rome Abstract Aim: To assess resistance to cyclic fatigue of three brands of NiTi files after immersion in NaOCl solutions in conditions similar to those used in clinical practice. Methodology: A total of 150 new Twisted File (SybronEndo, Orange, California), Revo S SU (Micro Mega, Besançon, France) and Mtwo (Sweden&Martina, Due Carrare - Padova, Italy) endodontic NiTi rotary files size 25.06 taper were used. The fifty files of the same brand were randomly assigned to five different groups of 10 each. Group 1 (control group) was composed of new instruments not immersed in solution. Instruments of groups 2, 3, 4 and 5 were immersed in 5% NaOCl (Niclor, OGNA laboratory, Muggiò - Milano, Italy) at 37 °C for 16 mm. Files of Group 2 and 3 were statically immersed in NaOCl solution for 5 and 1 minutes respectively; instruments of Group 4 and 5 were dynamically (300 rpm/min) immersed in solution for 5 and 1 minutes respectively. All files were submitted to cyclic fatigue test and numbers of cycles to failure (NCF) were recorded. Data were analysed by Two way ANOVA (P < 0.05). Results: There’s not statistical differences between the five groups of the same brand but Post-hoc analysis revealed a significantly higher resistance to cyclic fatigue in all groups of Twisted File when compared to respective groups of Revo S SU (P < 0.001 for each comparison). The comparison between the same groups of Twisted File and Mtwo or Mtwo and Revo S did not show statistically significant differeces (P>0.05). Conclusions: In our experimental conditions immersion in sodium hypochlorite as in clinical practice not significatively reduce the cyclic fatigue resistance of nickel-titanium instruments. However, the cyclic fatigue changes with the type of instruments. In particular, Twisted File were more resistant. Furthermore static or dynamic immersion did not reduce significatively the cyclic fatigue resistance of the same endodontic file. F5 - 8 Working with considerations of the apical third J. Reichsthaler, G. Castro Mario, M. Lee, Justo Sosa Private Practice, Vienna, Austria Private Practice, Los Angeles, USA Private Practice Tenerife, Spain Abstract The main goal of endodontics is to diagnose, treat and prevent the bacteria that is responsible for the development of periapical changes in the root canal system. Chemomechanical preparation and obturation of the root canal is the protocol to attain these goals. In order clean and shape the apical third of the root canal system, Anatomical consideration, proper clinical determination of the apical size, and concept of bacterial reduction are important concepts that need to be incorporated to the root canal therapy by the clinician. Considerations for widening the apical third are: To remove bacteria and their substrates, to remove dead pulp tissue,to increase the capacity of the root canal to retain a larger amount of sterilizing agent,to prepare the tooth to receive the canal filling. Understanding of the importance of the apical size or “the forgotten dimension” is important in performing the root canal treatment with a biological aim of anatomical considerati! on and the concept of bacterial reduction. F5 - 9 Shaping root canals using only two files in reciprocating motion E. Semenzato, I. Bottion, K. Steffan, N.M. Ferrarese, P.O. Carli, C. Tocchio University of Padova School of Dentistry Abstract The the aim o the sudy is to investigate if it is possible to prepare root 34 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L canals using only two rotary files in a reciprocating motion. 38 teeth extracted for periodontal reasons have been used . The elements have been inserted in high-density silicons blocks. X-rays images have been taken using the parallel technique and classified in base to the radius of curvature. They was endodontically shaped according to the technique proposed by the dott. Yared in 2008 modified using a K file #10 used in combination with the reciprocating handpiece M4 (SybronEndo) and the rotating file NiTi RevoS #0.06 taper called SU (MicroMega, France). At the end of the preparation, the canals have been irrigated with mean of contrast based of iomeprolo, and X ray exams have been taken using parallel technique. The images have been overlapped in order to appraise if the preparation had maintained the original trajectory. The maintenance of the anatomy has been possible. F5 - 10 Management of fusuion of maxillary second molar and third molar Jang Soon Ham , Bock Hur, Hyeon-Cheol Kim, Jeong-Kil Park Department of conservative dentistry, Pusan National University School of Dentistry, Yangsan, Korea Abstract This poster presents the management of fusion of maxillary left second molar and third molar. The patient was referred from local clinic for the morphologic abnomality of maxillary left second molar. The tooth was prepared for full veneer crown and access cavity was formed. The tooth was symptommatic and perforation of pulpal floor was observed. Using dental CT, 4 canals of fused second molar were cleaned, shaped and filled. The perforated floor was treated with MTA. Chairpersons: Mohammad H. Nekoofar, Lise Lotte Kirkevang Session F6 – 14.00 F6 - 1 Effect of three glide path preparation techniques on maintenance of curvature in simulated curved canals Hofmann Norbert, J. Grote, B. Klaiber Department of Operative Dentistry and Periodontology, University of Wuerzburg, Wuerzburg, Germany Abstract The study compares the influence of three glide path preparation techniques on maintenance of curvature in simulated curved root canals. Plastic training blocs featuring curved canals (angulation: 60°; radius: 5mm; VDW, Munich, Germany) were used. Glide path was prepared using: 1) carefully pre-bent stainless steel hand instruments (K-FlexoFile, Maillefer, Ballaigues, Switzerland) sizes 010 to 020; 2) NiTi rotary instruments sizes 013, 016 and 019 taper 0.02 (PathFiles, Maillefer); 3) NiTi rotary instruments sizes 010 to 020 (MTwo, VDW). Final instrumentation was performed using NiTi rotary instruments up to size 040 (MTwo, VDW). Instrumentations were performed by undergraduate students, each preparing one canal with each technique at random sequence respectively. Reproducible photographs of the specimens were taken before instrumentation, after glide path and after full preparation. The contours of the canals were traced using an image analysis software (SigmaScan Pro 5, SPSS Inc., Chicago IL, USA), and a custom-made software was used to determine the deviations from ideal preparations defined according to the geometry of the instruments and initial curvature. Differences were tested for significance using the Friedman test (SPSS). After glide path preparation, over-instrumentation was observed at the outer curvature between 0 and 4mm short of WL. Between 0 and 1.5mm, the over-instrumentation was significantly higher with hand instruments (P<0.001). An under-instrumentation of the outer curva- ESE ROME 2011 NOT ONLY ROOTS ture was found with MTwo between 4.5 an 6mm short of WL. At the inner curvature, over-instrumentation was seen between 2 and 6.5mm short of WL with hand instruments and between 3.5 and 6mm with PathFiles and MTwo. Over-instrumentation was more pronounced in hand instruments. After full canal instrumentation, similar results were observed irrespective of the type of glide path preparation. During glide path preparation, straightening of the canal was more pronounced with hand instruments, whereas the NiTi rotary instruments produced similar results. F6 - 2 Comparison of the centering ability of the twisted filet and revo-s® by using cone beam computed tomography Menezes Aguiar Carlos, Camille Gomes Faria, Andréa Cruz Câmara Universidade Federal de Pernambuco, Brazil Abstract The aim of root canal preparation is to form a continuously tapered shape with the smallest diameter at the apical foramen and the largest at the orifice to allow effective irrigation and filling without deviating from the original trajectory. By means of the cone beam computed tomography, the present study aims to determine the centering ability of the Twisted FileT rotary system compared with the Revo-S® rotary system. Twenty mesiobuccal canals of human maxillary first molars whose curvature ranged from 50° to 60° were divided into two groups with 10 root canals each according to the instrument used: Group 1, Revo-S® Rotary System; Group 2, Twisted FileT Rotary System. All teeth were scanned by cone beam computed tomography to determine the root canal shape before and after instrumentation. The exposure time was 26.9 seconds, operating at 120kV and 7mA. The images were sectioned into four points, located respectively at 15 mm, 9 mm, 3mm, and 1mm from the apex. The images were captured digitally for further analysis using the Image Tools Software. The results were statistically analyzed using the Kruskal-Wallis and Student’s t test. A level of significance of .05 was adopted. F6 - 3 Curved root canals: CT-based assessment of root canal geometry after preparation using 3 techniques Sanda Ileana Cimpean, Gabriela Chiriac, C. Culic, M. Hedesiu, R. Savu, D. Lazar Department of Cariology&Endodontics, Faculty of Dentistry, University of Medicine and Pharmacy `Iuliu Hatieganu’ Cluj-Napoca, Romania Department of Radiology, Faculty of Dentistry, University of Medicine and Pharmacy `Iuliu Hatieganu’ Cluj-Napoca,Romania Private dental office, Bucharest, Romania Private dental office, Oradea, Romania Abstract The accomplishment of a tapered, uniform root canal preparation is a great challenge in endodontics. Therefore the establishment of a gold standard preparation technique, with the occurrence of fewest procedural errors and their sequels has been the subject to numerous research studies. The aim of the current study was to investigate the changes in root canal volume and surface area in moderately curved root canals, following preparation with hand Vs rotary instrumentation using CT measurements. Material and Methods: 45 moderately curved (10-30°) mesio- and distobuccal roots of extracted maxillary molars were included in the study. After preparation of the access cavity, initial radiograph and determination of the root canal curvature, the specimens were randomly distributed into one of the following groups: 1. Group I (n=15) included manually prepared root canals (Kerr files, SybronEndo, Orange, USA) 2. Group II (n=15), consisted in root canals prepared with K3 (SybronEndo, Orange, USA) 3. In Group III (n=15), Twisted files (SybronEndo, Orange, USA) were utilized for preparation. www.eserome2011.com Pre instrumentation and post instrumentation three dimensional CT images were obtained from root cross sections starting at 1mm from the apex up to the coronal orifice. Nine levels were chosen for CT evaluation. Scanned images were superposed and compared. The investigated parameters were the remaining dentine thickness, canal transportation and centering ability. The results indicate a comparable centering ratio of the K3 and Twisted files groups, superior to the one observed in the manual preparation technique. Furthermore, no significant difference between the groups was noticed with regard to canal transportation and remaining root dentine at apical levels. Conclusion: Rotary instruments can be successfully used in the treatment of moderately curved root canals, if judiciously utilized. F6 - 4 The effect of working length and root canal preparation technique on root fracture resistance of maxillary premolars Davut Çelik, Ahmet Serper, Tamer Tademir, Küat Er, Kahraman Saime Asl Department of Endodontics, Karadeniz Technical University, Trabzon, Turkey Department of Endodontics, Hacettepe University, Ankara, Turkey Abstract Aim: To evaluate the effect of two different rotary instruments on root fractures in maxillary premolars with different root lengths. Methodology: Two groups of teeth were selected from a pool of freshly extracted human maxillary premolars. The first group of 56 teeth had root canal working lengths of 16 mm and the second group of 56 teeth had root canal working lengths of 14 mm which were measured after crowns were sectioned at the cementoenamel junction. Each group was assigned into 3 subgroups: canals prepared with ProTaper to F3 file (n=16), canals prepared with GTX to .06/30 file, canals prepared with manuel K-flexofiles to a size 30 file; the remaining eight teeth were used as the control group. After preparation, root tips were embedded in acrylic resin blocks exposing coronal 9 mm of each root. A steel tipped rod attached to an Instron testing machine was positioned against the orifice of each canal and applied vertical force with a constant speed of 1mm min-1 until root fracture occurred. Results: Data were analysed using the Kruskal-Wallis and Dunn tests. Control groups were more resistant than all experimental groups (p<0.01). 16 mm group which was prepared with ProTaper instruments was found less resistant to breakage than other groups (p<0.01) whereas no statistically significant differences were found between the other experimental groups (p>0.05). Conclusions: For the maxillary premolar roots with 16 mm working lengths, the use of ProTaper instruments at full working length, decreased fracture resistance. F6 - 5 Endodontic treatment of a C-shaped maxillary first molar: a case report Emir Dincol Muzaffer, H. Ersev, B. Imaz Istanbul University, Faculty of Dentistry, Department of Endodontics, Istanbul, Turkey Abstract This clinical report presents the endodontic treatment of a maxillary first molar with a C-shaped disto-palatally located root canal system. According to the endodontic literature, the C-shaped root canal is most frequently seen in the mandibular second molar. However, occurence of this unusual morphology in maxillary first molars has only been described in a limited number of case reports. A 16-yr-old male patient presented to our clinic with the complaint of discoloration in his left maxillary first molar. Radiographic examination revealed two distinct roots (palatal and mesio-buccal) and as well as a periapical radioluceny associated with the mesio-buccal root end. The distobuccal root end was not identified and it was believed to be superim- 35 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY posed on the palatal root. Upon completion of the access cavity, only one canal orifice was found in the mesio-buccal root as well as a deep semilunar groove which extended from the palatal to the disto-buccal aspects of the cavity. Neither the palatal, nor the disto-buccal root canal orifices were identified and whenever an instrument was inserted into any side of the C-shaped canal, it was always ended in the disto-palatal foramen of the tooth. The clinical conclusion was that the palatal and the disto-buccal canals were merged in a C-shaped single canal and that there was only one canal in the mesio-buccal root. The two root canals were rinsed with copious amounts of 2.5% sodium hypochlorite solution and shaped with stainless-steel K-type files (Dentsply Maillefer) by using the step-back technique. Obturation was performed with laterally condensed gutta-percha and AH-Plus (De Trey, Dentsply, Konstanz, Germany) sealer. A 6-months follow-up radiograph showed complete resolution of the periapical lesion. Whereas C-shaped root canal morphotypes are clasically reported in mandibular molars, the present case has demonstrated this configuration in a maxillary first molar. R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L of each type were sectioned transversely at 1mm, 3mm, 6mm and 10mm from the tip and also were examined by scanning electron microscopy at the magnification ×150. All images were captured digitally and the following design parameters were assessed by a direct measurement technique: tip angle, helical angle, pitch length, depth of flutes, ratio between the external and internal diameters, angles of cutting blades. All measurement values then were processed with the mathematics program Mathcad 14.0 (PTC, Needham, Massachusetts, USA). Results Technical analysis based on the measured parameters enabled to calculate the important instrument properties which influence its behaviour inside the root canal: distribution of torsion rigidity along the axis of the instrument, torsion angle per unit length along the axis, self-feeding force component, volume of fluting along the axis, safe depth of cutting per unit step of treatment. Conclusions Physics-mathematical analysis is accurate and objective method for the assessment of the principal design parameters of rotary endodontic instruments. It enables evaluating of outstanding characteristics of each instrument and carrying out comprehensive comparative analysis of the instruments of different types. F6 - 6 Endodontic treatment of a maxillary second molar with four roots Chairpersons: Paul McCabe, Maria Teresa Sberna Enver Ozturk, Vildan Mert Gunduz, Kemal R. Subay Department of Endodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey Session F7 – 13.30 Abstract Aim: Variations in the root numbers of maxillary second molar teeth are occasionaly seen during root canal treatments. Clinical and radiographical diagnosis of extra roots of maxillary second molars by clinicians is important for successful root canal treatment. Presence of four-rooted maxillary second molars was known as very rare (0.4%). In this report, we present a case of four-rooted maxillary second molar that has three separated buccal roots (2 distobuccal,one mesiobuccal), each containing single root canal. Case Report: The tooth responded positively to vitaliy tests and was showing symptoms of irreversible pulpitis. Control radiography revealed a four-rooted appareance with presence of an extra distobuccal root. The radiographic control of symmetric tooth showed a three-rooted appareance. After local anesthesia and isolation, an endodontic access was prepared. There was four root canal orifices on pulp chamber floor. The locations of canals were mesiobuccal, palatal, distobuccal-one and distobuccal-two. Distobuccal-two canal orifice was between distobuccal-one and mesiobuccal and located buccally and near distobuccal-one orifice. The working lengths were determined with an electronic apex locator and controlled with a periapical radiograph. All four root canals were biomechanically prepared using step-back technique. Canals were irrigated with 2.5% sodium hypochloride between each file during instrumentation. Root canals were obturated by lateral condensation with gutta-percha and AH-plus! sealer. The tooth was restored with an amalgam filling. Conclusion: This case demonstrates the presence of a rarely seen four-rooted maxillary second molar tooth in order to avoid possible failure of endodontic treatment in such teeth. F6 - 7 Design features of rotary endodontic instruments and its physico-mathematical analysis Tatiana Belyaeva, E.A. Rzhanov Moscow State University of Medicine and Dentistry Department of Operative Dentistry and Endodontics, Moscow, Russia Abstract Aim:To develop a new procedure for the analysis of the basic design parameters of rotary endodontic instruments, which allows carrying out comprehensive comparative evaluation of its properties. Methodology: Four systems of nickel-titanium rotary instruments with different geometries were selected: ProFile (Tulsa Dental, Tulsa, Oklahoma), ProTaper (Dentsply Maillefer, Ballaigues, Switzerland), FlexMaster (VDW, Munich, Germany) and Mtwo (VDW, Munich, Germany). A scanning electron photomicrographs were taken of each instrument from each system at the magnification ×25, ×100 and ×120. Then three instruments 36 F7 - 1 Effects of fiber-reinforced composite post systems on fracture resistance of non-circular root canal teeth Thong-ngarm Weeranuch, Issarawan Boonsiri Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Thailand. Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Thailand Abstract Purpose: To compare the fracture resistance and fracture mode of non-circular premolar root canals restored with different fiberreinforced composite post systems. Materials and methods: Forty non-circular single premolar root canals were randomly assigned to four groups (n=10). Coronal portions of the teeth were removed at a level 2 mm incisal to the cemento-enamel junction (CEJ). In Group 1 (Var), FibreKleer® posts were cemented with Variolink® II; in Group 2 (Ref), FibreKleer® posts and REFORPIN were cemented with Variolink® II; in Group 3 (Mul), FibreKleer® posts were cemented with Multicore® flow; in Group 4 (Evo), Variolink® II was used for cementation of Evolution posts and cores. Metallic crowns were cemented with Variolink® II in all teeth. The samples were loaded in an Instron® universal testing machine with a crosshead speed of 0.5 mm/ min at a 45° angle to the long axis of the tooth. The mean fracture load of each group was analyzed using the one-way ANOVA, Tukey multiple comparison test (p<0.05). The fracture modes of all experimental groups were analyzed. Results: The mean fracture resistance of the Var group was statistically significantly lower than that of the others (p<0.05). No statistically significant difference was found between the Ref, Mul and Evo groups. Restorable failures were most frequently found in the Ref group (70%). Conclusions: The use of Multicore® flow instead of the high thickness of resin cement layer can increase fracture resistance of theeth with non-circular root canals. Fiber-reinforced composite posts and REFORPIN accessory posts or Evolution posts and cores with Variolink® II can be used as an alternative treatment in teeth with non-circular root canals. F7 - 2 Fiber posts bonding to root canal dentin after ethanol drying Alberto Dagna, M. Lombardini, M. Colombo, M. Chiesa, C. Poggio, S. Bianchi Department of Endodontics, School of Dentistry, University of Pavia, Italy Abstract Aim. To verify by SEM the influence of root canal walls ethanol drying ESE ROME 2011 NOT ONLY ROOTS in promoting the adhesion of fiber posts. Methodology. Thirty extracted human maxillary incisors with an average length of 22±1 mm were prepared with Revo-S Ni-Ti instruments (MicroMega, France) and shaped to ISO size 25 and .06 taper. All root canals were irrigated with 5% NaOCl and 17% EDTA solutions. The samples were obturated with gutta-percha and AH Plus sealer (Dentsply DeTrey, Germany) using the continuous wave warm vertical compaction technique. After a week the post space were prepared. All the specimens were randomly divided into two groups: in group 1 post space was etched and bonded with All Bond 3 (Bisco Inc. USA), in group 2 it was etched, dried with ethanol and bonded with the same adhesive system. Then a D.T. Light Post (Bisco Inc., USA) was placed using the same dual-cured resin cement (Duo Link, Bisco Inc. USA) and the same restorative protocol. Restored samples were longitudinally sectioned and prepared for SEM observation in order to evaluate the characteristics of the interfaces between root dentin, resin cement and fiber posts at coronal, middle and apical third. Each section was observed separately by two investigators and the incidence of gaps was recorded and scored (0: no gaps; 1: gap no longer than 200 μm; 2: gap between 200 and 500 μm; 3: gap longer than 500 μm) in order to perform statistical analysis. Results. All the interfaces between resin cement and fiber post were free of gaps. The interfaces between resin cement and root dentin showed significant differences (P<0.05): 58% of samples dried with ethanol showed presence of voids/bubbles and gaps at cement-dentin interface. Conclusions. Ethanol drying seems to be not effective in improving the adhesion of fiber posts into root canal. F7 - 3 Experimental evaluation of two new restoring techniques of endodontically treated tooth Nicola Maria Grande, Carla Cumbo, Rocco Zaccone, Daniele Angerame, Francesco Somma Università Cattolica del Sacro Cuore, Rome, Italy Sapienza Università di Roma, Rome, Italy Università di Trieste, Trieste, Italy Abstract Background: the aim of this study was to evaluate the differences in maximum static load to fracture and the type of failure of single roothed teeth restored with traditional preformed fiber posts, with anatomical fiber posts and with Ellipson system (Satelec Acteon, Bordeaux, France) through the application of a static load. Methods and Materials: 20 extracted seconds premolars and 10 extracted canines were divided into 3 groups of 10 teeth each in order to obtain a uniform distribution of the oval canals. All canals were prepared with NiTi rotary instruments M-two (Sweden & Martina, Due Carrare, Italy) and obturated with guttapercha and TopSeal cement (Maillefer - Dentsply, Ballaigues, Switzerland). The groups have been restored in different ways: group A with preformed fiber posts, group B with adapted fiber posts and group C with Ellipson posts. A core of light-curing composite was created above the fiber post and standardized silicon layers was created to simulate the periodontal ligament. Samples were tested in a universal load testing machine. The fracture loads were measured in N and the kinds of fracture were recorded and defined favorable or not favorable. ANOVA and Tukey test were used to determine the differences in fracture loads between the groups. A nonparametric test (chisquare) was conducted for the statistical evaluation of the fracture model. Results: The highest fracture resistance was detected for the modified fiber posts followed by the oval Ellipson posts and finally by the traditional fiber posts (B: 83 ± 6, C: 79 ± 2; A: 73 ± 6). In group B 90% of fractures was favorable, in group C 80% of fractures was favorable and in group A 70% of fractures was favorable. Conclusions: maximum load results were favorable to the elements restored with adapted fiber post and with Ellipson oval fiber post. The adapted fiber posts showed a higher percentage of favorable fractures. www.eserome2011.com F7 - 4 Bacterial leakage of temporary filling materials used in endodontic treatment Igor Kriznar, K. Seme, A. Fidler Department of Dental Diseases and Endodontology, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloska 4, 1000 Ljubljana, Slovenia Abstract The aim of our study was to assess the bacterial leakage of materials used for short and long term temporization in endodontics. A standardized access cavity was prepared in 124 upper third molars and irrigated with 2 ml of 2.5 % NaOCl followed by 4 ml of saline. The teeth were divided into six groups of 20 teeth each and two teeth as negative and two as positive controls. The access cavities were filled with 1) Cavit, 2) Fuji II LC, 3) Fuji IX, 4) Voco Clip, 5) Tetric EvoCeram with a self-etch adhesive AdheSE and 6) Tetric EvoCeram with an etch and rinse adhesive Excite according to the manufacturer’s instructions. After storage in saline for 24 hours the crown of each tooth was sectioned to obtain 5.5 mm high disks. Each disk was assembled in a standard setup for bacterial leakage studies with Streptococcus mutants and monitored for 90 days. Kaplan-Meier survival analysis was performed. The lowest amount of leaking samples was found in Tetric - AdheSE (31.3%), Cavit (33.3%) and Tetric - Excite groups (35.3%), followed by Fuji II LC (66.7%), Voco Clip (83.3%) and Fuji IX (88.2%) groups. Materials could be classified in three groups with statistically significant differences (p<0.5). In the first group were Cavit (70 days), followed by Tetric - AdheSE (68 days) and Tetric - Excite (65 days), in the second group were Voco Clip (44 days) and Fuji II LC (43 days), and in the third group was Fuji IX (21 days). In conclusion, none of the tested materials was able to completely prevent bacterial leakage during the time of the study. Adhesively bonded composites and Cavit offer better sealing of the access cavity compared to GIC, RMGIC and composites without the use of an adhesive system. F7 - 5 Evaluation of fracture strength and mode of molars restored using polyethylene fiber and different posts Kara Tuncer Aysun, F. Haznedaroglu, S. Tuncer Faculty of Dentistry, Istanbul University,Istanbul, Turkey Abstract Objectives: To compare the resistance of teeth restored with fiber/ titanium post, polyethylene fiber and adhesive composite. Study design: The mesial, distal and palatal walls of the human maxillary molar teeth were removed so only buccal wall was remained. Group I with caries free maxillary molars were used as a positive control group and the remaining groups were restored as follows: group II with only adhesive composite, group III with polyethylene fiber and adhesive composite, group IV with fiber post and adhesive composite, group V with fiber post, polyethylene fiber and adhesive composite, group VI with titanium post and adhesive composite, group VII with titanium post, polyethylene fiber and adhesive composite. Universal testing machine was used for fracture tests. Compressive loads were applied at an angle of 90 degrees on the occlusal surface of the specimens at crosshead speed of 1mm/min until fracture was occurred. Kruskal Wallis and Mann Whithney U tests were adopted for statistical analysis. Results: The study shows that based on the fracture strength, the teeth group: restored with glass fiber post, polyethylene fiber and adhesive composite has the most significant improvement over all the other teeth groups. The mean force of fracture values were 2667.07, 1665.20, 1735.21, 1731.05, 2184.87, 1749.27 and 1640.25 N for groups I,II,III,IV,V,VI and VII respectively. Based on the fracture mode, the teeth groups; restored with only glass fiber post, adhesive composite and polyethylene fiber, adhesive composite have relatively more restorable cohesive fractures observed. 37 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY Conclusions: The combined use of glass fiber dowel, polyethylene fiber and composite resin was improved the mechanical properties of restored teeth and ultimately fracture resistance of teeth. F7 - 6 Root canal pretreatment increased push-out bond strength of self-adhesive resin cement with FRC posts Duronwong Supaporn, Issarawan Boonsiri, Siriporn Arunpraditkul Postgraduate student of Prosthetics department, Chulalongkorn University, Bangkok, Thailand Prosthetics department, Chulalongkorn university. Bangkok, Thailand Prosthetics department, Chulalongkorn university. Bangkok, Thailand Abstract Our study objectives were to evaluate push out bond strength (PBS) of fiber-reinforced-composite (FRC) posts luted with three resin cement systems and to investigate the effect of root canal surface treatments before FRC posts luting on PBS. Sixty single-rooted mandibular premolars were divided into six groups (n=10), endodontically treated and post-space was prepared for Fibrekleer® posts. Root canal surfaces were treated as follows, group 1-total etch resin cement, applied Excite® DSC and Variolink®II. Group 2-self etch resin cement, applied ED primer II and PanaviaTF 2.0. Group 3-self adhesive resin cement, RelyXTUnicem. In groups 4-6; root canal surfaces were treated with 37% H3PO4 for 5 s, 17% EDTA for 60 s, and 17% EDTA for 60 s/2.5% NaOCl for 15 s, respectively before posts were luted with RelyXTUnicem. Six slices of 1±0.05 mm were prepared from each root. Push out tests were performed by an Instron® machine at a crosshead speed of 0.5 mm/min. Data were analyzed by twoway ANOVA and Tukey test at P<0.05. PBS was significantly affected by root regions only in group 1 which that of the coronal region was higher than middle and apical regions (P<0.05). PBS of group 1 in the coronal region was higher than group 2 and 3 for all regions (P<0.05). The bond strength of group 1 in the middle region was higher than group 2 but not different from group 3 for all regions (P<0.05). PBS of group 1-3 in the apical region were not different (P<0.05). Moreover, PBS of group 4 was significantly higher than group 3, 5, and 6. However, there was no significant difference between group 3 and 6. Thus, we did not observe meaningful differences in PBS between groups 1-3 while canal pretreatment resulted in increased PBS for group 4 and 5. F7 - 7 Evaluation of the root canal seal with a secondary monoblock as root canal filling Cos Tine, Filip Calberson, Mieke De Bruyne, Roeland De Moor Dept. Restorative, Dentistry & Endodontology, Dental School, Ghent University, Ghent, Belgium Abstract Aims: (I) To evaluate microleakage of three different set-ups for creating a monoblock in a root canal. (II) To visualize the integrity of the interface of the created monoblocks. Methodology: One hundred and twenty extracted teeth were endodontically treated and obturated. They were randomly divided into 3 groups according to the tips/bur used for post-space preparation and the type of post: (1) oval shaped canal + oval ultrasonic tip + oval post, (2) round canal + round ultrasonic tip + round post, (3) round canal + round calibration bur + round post. Each group was divided into 2 groups: (A) EDTA 17% conditioning before acid-etch procedure, (B) only acid-etch procedure. Groups 4 and 5 were control groups. A section of root and post was made resulting in an 8 mm sample. Results of capillary flow porometry (CFP) performed on the samples were analysed statistically using nonparametric Kruskal-Wallis and Mann-Whitney tests with Bonferroni correction (p < 0.05). Samples were each cut into 4 slices of 2 mm thickness. Digital images of the slices were examined for post fit, voids and cracks in the root dentin. 38 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L Results: Through and through leakage was observed in all samples. Group 1A showed significantly more leakage than groups 2A, 3A and 5. Group 1B showed significantly more leakage than group 5. Digital images displayed good cone fit in root canals with a circular diameter and a less consistent cone fit in the ovoid canals. Voids could be categorized as air bubbles or as interfacial gaps and were seen in several samples. Conclusion: It can be concluded that monoblocks created with glass fibre posts and resin cement do not provide a hermetic seal of the root canal. Voids may negatively influence microleakage. The additional use of EDTA resulted in no significant reduction of the microleakage. Chairpersons: Andrea Gesi, Linda Peters Session F8 – 13.30 F8 - 1 In vivo evaluation of the effectiveness of electronic locator foraminal low cost ROOT-PI ® Carvalhal Julio Cesar, Ricardo Augusto Aguiar De Lira Santos, Walter Cavalcante De Sa Neto, Liliane Pereira Do Nascimento, Frederico Antonio Genezini Departament of Endodontics Faculty of Catholic Queen of the Wild, Quixadá, Brazil Clinical Private,Quixadá, Brazil Departament of division of environmental analysis IPEM/CNEM, São Paulo, Brazil Abstract The aim of this study was to evaluate the in vivo efficiency of a low cost electronic apex locator ROOT-PI ® compared to other electronic apex locators. A total of 19 adult patients that were undergoing endodontic treatment, 9 patients with vital teeth and 10 patients with non-vital teeth were followed for this study. The subjects were divided in three groups (GI, GII and GIII) according to each electronic device: Group I(ENDEX®), Group II(Novapex®) and Group III(ROOT-PI ®). For GroupI were obtained 30 measurements, for GroupII 30 measures and and for GroupIII 23 measures. 7 measures was discarded for technical limitations of the devices. A total of 83 measurements, 43 measurements were analyzed relating to vital teeth and 40 teeth not vital related to measurements obtained by the same operator and at the same clinic session. The resulting values were statistically analyzed using student’s t-test. Results showed significant differences (p <0.05) for tooth length values in Groups I, III and II, and III in vital teeth with no statistically significant differences between Groups I, II, III (p> 0.05) in non-vital teeth. The efficiency of the apical locator ROOT-PI® low cost resulted in inaccurate readings in teeth with vital pulp and in accurate readings for non-vital teeth when compared with electronic tracking devices ENDEX® and Novapex®. F8 - 2 Comparison of Apex locators integrated into rotary endodontic motors and conventionally electronical length determination Holly Matthias, J. Klimscha, M. Erdem, M. Sabo Bernhard Gottlieb University Clinic of Dentistry Division for Dental Education Vienna Austria Abstract Aim: To compare the accuracy of two rotary endodontic motors with integrated apex locators, the Dentaport Root ZX (Morita, USA) and the VDW Gold Raypex 5 (VDW, Germany) with the conventional method of electronically root canal length determination and preparation. Methodology: A number of 160 root canals of recently extracted teeth ESE ROME 2011 NOT ONLY ROOTS were were divided into two groups of 80 root canals (device A and B) and mounted in a special apparatus to establish standardised measurements and X-rays. In each group the accuracies of the devices were compared to standard electronic root canal measurements of the canals with stainless steel files iso 10 and the preparation of canals to the determined working length with (40 canals) and without (40 canals) simultaneously measuring the root canal length by the integrated apex locators. Data was acquired by measuring the distances of file tips to radiological apex in X-rays taken after each step of the procedure and then statistically evaluated. Furthermore the correlation of root canal curvature and accuracy was evaluated. Results: No statistically correlation was found between the degree root canal curvature and the accuracy of the devices and the methods of use. Significant statistically difference (p<0,001) was found for the device A (Dentaport Root ZX) and the methods of use. No statistically difference was found for the device B (VDW Gold Raypex 5) and the methods of use, although in the measurement five big outliners occurred. Conclusions: The rotary preparation of root canals with simultaneously measuring the root canal length by the integrated apex locators is comparable to the standard procedure of electronically length determination and root canal preparation, but it occurred a sign of technique sensibility in the combined method for one of the devices. F8 - 3 Diagnosis vertical root fracture using MSCT Maria K. Makeeva, Svetlana F. Byakova, Nina V. Novozhilova First Moscow State Medical University Operative Dentistry, Moscow, Russia Abstract Aim: To optimise the diagnostic of vertical tooth fracture using MSKT. Methodology: Twenty-five patients with 26 teeth in which vertical root fracture was clinically suspected underwent dental radiography and MSCT. Two clinicians estimated the results. The results were compared with intraoperative findings. Five cracked extracted teeth were investigated using MSKT with and without metal post in the root canal. Results: 25 of the 26 teeth were proved intraoperatively to be fractured. The sensitivity and specificity averaged for the two reviewers in the assessment of vertical fractures were 20 and 75%, respectively, with dental radiography and 100% and 100%, respectively, with MSCT. One case was false positive – extracted tooth had no crack. Conclusions: MSCT is superior to dental radiography in the detection of dental vertical root fractures, but it show false positive result if there is metal post in the root canal. F8 - 4 Accuracy of the apex locating function of different endodontic motors Gurel Melek, Ondokuz May Turkey Abstract Aim: To compare ex vivo the accuracy of the apex locating function of different endodontic motors;VDW.Gold,X-SmartT Dual and SIROEndo Pocket during root canal treatment. Methodology: Sixty freshly extracted human anterior teeth were selected. following access cavity preparation the length of root canals measured visually with a K-file 1mm short of apical foramen (true working length- TWL) .All samples were mounted in an alginate and randomly divided to three groups. Group A: before root canal preparation only apex locator function of VDW Gold was used according to the manufacturer’s recommendations and working lengths measured (WL1-A). During root canal preparation constant length monitoring was performed with VDW Gold.(WL2-A). Group B: before root canal preparation only apex locator function of X-SmartT Dual was used according to the manufacturer’s recommendations and working lengths measured (WL1-B). During root canal preparation constant length monitoring was performed with X-SmartT Dual (WL2-B). Group C: before root canal preparation only apex locator function of www.eserome2011.com SIROEndo Pocket was used according to the manufacturer’s recommendations and working lengths measured (WL1-C). During root canal preparation constant length monitoring was performed with SIROEndo Pocket(WL2-C). Differences between working lengths were calculated. Results: There were no statistically significant differences between both working lengths and endodontic motors. Conclusion: With the limitation of this ex vivo study the combination of electronic apex locators with endontic motor was accurate in terms of length control during root canal treatment. F8 - 5 Synchrotron light based μCT imaging of the shaping of root canals and presence of dentinal micro-crack post rotary and reciprocating NiTi instrumentation Ioana Pop, F. Zanini, G. Tromba, S. Patel, F. Mannocci, F. Foschi Department of Conservative Dentistry, Dental Institute, King’s College London, London, UK Sincrotrone Trieste S.C.p.A. in Area Science Park I, Basovizza, TS 34012, Italy Abstract Background: Despite benefits introduced by NiTi instrumentation, recent investigations reported that mechanized preparation may damage dentin and create microcracks. To date destructive investigation methods, that may introduce preparatory artifacts, have been used. Non-destructive imaging technique (e.g. μCT, CBCT) would be more appropriate to investigate these alterations; nevertheless their resolution is technically limited by power fluency and beam coherence. Synchrotron Radiation as a source for μCT overcomes these limitations. Synchrotron provides a monochromatic laminar-section X-ray operating at 2.0 GeV. Materials and Methods: Twelve mandibular and maxillary roots of extracted molars (South East London ethical approval 10/H0804/056), randomly distributed, have been scanned pre and post instrumentation. Half of the roots were prepared with rotary ProTaper (Dentsply Maillefer, Baillagues, Switzerland) size F2 and half with reciprocating Wave One (Dentsply Maillefer, Baillagues) size 25, according to manufacturer’s instruction. Specimens were analysed with the SRμCT at SYRMEP Beamline (Elettra, Trieste, Italy). The samples were re-positioned on the rotational stage with an impression silicon putty matrix. The tomographies were performed at 0 to 180°, in steps of 0.2°, resulting in 900 projections. The tomographic reconstructions were completed with “Tomo Project” program. Results: The synchrotron light based μCT could detect microcracks present in the thickness of dentine to a resolution of up to 10 μm. Microcracks developed and propagated post instrumentation in dentine. These microcracks often developed firstly on the outer surface of dentin. Conclusions: Conventional rotary and rotary “reciprocating” instrumentation within the limitation of this in vitro study may result in the formation of microcracks in root dentine. SR-μCT is a suitable mean for the detection of these cracks. F8 - 6 In vitro endodontic imaging: 3-D high resolution microcomputed tomographic study Arbab Chirani Reza, G. Bourbouze, J. D’Arboneau, V. Chevalier, C. Roux Bretagne Occidentale University, School of Dentistry and Laboratory of Medical Information Processing (LATIM) – INSERM U650 Endodontics and Conservative Dentistry Brest, France CRT (Technical Resource Centre) / Morlaix, France University Hospital Odontology Brest, France School of Dentistry Endodontics and Conservative Dentistry Brest, France LATIM – INSERM U650 / Brest, France Abstract Aim: The aim of this study was to evaluate a 3-D reconstruction methodology applicable to endodontic images. This paper provides in vitro study to illustrate the usefulness of 3-D reconstruction for 39 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY evaluation of complex endodontic anatomy and to assess root canal geometry and changes after endodontic preparation (apical transportation, surface changes,…). Methodology: Two steps have been used to obtain root canal images: image acquisition by high resolution micro-computed tomography and three-dimensional (3-D) reconstruction. Acquisition: The specimens (freshly extracted human maxillary and mandibular molars and kept in 10% buffered formalin) have been scanned, before and after root canal shaping with different rotary NiTi systems. Acquisitions have been realized using a very high resolution micro-computed tomographic scanner, v|tome|x 240D® (General Electric, MA, USA) with an isotropic resolution of 5/20 μm. 3-D Reconstruction: Three major steps have been involved by this generic task: 1) data filtering; 2) delineation and registration of the 3-D shape of the ROI; and 3) mapping measurements over these shapes. The second step, i.e., 3-D image segmentation and registration, has been performed using Amira® (Visage Imaging Inc, CA, USA). Results: Three-dimensional images of the root canal have been obtained, and the assessment of the anatomical changes done. Volumes and surfaces area and canal axis for each canal before and after preparation have been also calculated. Changes after endodontic preparation were calculated for each canal before and after canal shaping. Conclusions: This methodology seems to be a very adequate in vitro endodontic methodology to explore root canal geometry and to assess anatomical changes. F8 - 7 Clinical evaluation of the accuracy of two electronic apex locators Tsaltas Konstantinos Department of Endodontics, University of Athens, Athens, Greece Abstract AIM. To examine the clinical reliability of two last generation electronic apex locating devices, Propex and Apex Finder 7005. METHODOLOGY. A total of 180 root canals from 100 teeth of 81 patients, who were informed and consented, were used for the study. All measurements were made after instrumentation of the coronal and middle thirds of the root canal (with Profile) and irrigation with NaOCl 5%. Thereafter, a file was introduced into the canal and forwarded until the apex locator showed that it reached the apex. A radiograph was then taken and the distance of the end of the file from the radiographic root apex was measured. As accurate were designated all measurements in which the distance of the file to the root apex ranged from 0-2mm. RESULTS. The electronic device Propex was accurate in all of 86 root canals (success rate: 100%). Apex Finder had an overall success rate of 80%. The success rate was 87% in teeth with vital pulp, 81% in teeth with non vital pulp and 65% in retreatment cases. CONCLUSIONS. The results of the present investigation showed that the clinical accuracy of both electronic devices was high. However, it is still necessary to verify their measurements with the radiographic method. F8 - 8 Reliability of an endodontic motor integrated with an apex locator Umberto Baracchi, Paolo Ambrogio, Livio Mollo, Damiano Pasqualini, Elio Berutti Department of Endodontics – Prof. E. Berutti, University of Turin Dental School, Turin, Italy Abstract Aim: This in-vivo study assessed the reliability of an endodontic motor integrated with an apex locator, compared with a convential apex locator . Materials and methods: The study was performed on cooperating patients of Turin University Dental School with irreversible pulpitis or pulp necrosis. After access cavity preparation, the root canal was scouted with a #10 k-file (Dentsply Maillefer, Baillague, Switzerland) and the first working length (WL1) was recorded with Root ZX 40 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L (J.Morita MFG. Corp, Kyoto, Japan). The glide path was created with NiTi rotary instruments PathFile (Dentsply Maillefer, Baillague, Switzerland) using X-Smart Dual (Dentsply Maillefer, Baillague, Switzerland). WL2 was determined using X-Smart Dual, with PathFile 3. WL3 was determined with a #20 k-file (Dentsply Maillefer, Baillague, Switzerland) with Root ZX, and the radiographic WL was checked with an intraoral x-ray. 5% sodium hypochlorite (Ogna Niclor 5, Muggiò, Italy) was used as irrigant during the procedure. Results: Within a 9-month period, 40 teeth were analyzed, for a total of 80 root canals. An exact match was found between X-Smart Dual WL2and Root ZX WL3 in 38 root canals. However, in 42 root canals there was no correspondence between WL2 and WL3. In most cases, WL2 was significantly shorter than WL3. Conclusions: X-Smart Dual proved to be reliable only in 47.5% of cases. However, the endodontic motor with electronic apex locator function can be very useful clinically, since rotary instruments can be very efficient in cutting and particular attention must be paid to avoiding excessively widening and/or altering the apical foramen Keywords: Working length, apex locator, pre-flaring, endodontic motor. F8 - 9 Effect of ultrasonic activation on the efficacy of MTA filling in simulated root canals Park JC, Ha JH, Jin MU, Kim YK, Kim Sung Kyo Department of Conservative Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea Abstract Aim: The aim was to investigate the effect of ultrasonic activation on the filling efficacy of MTA in accessory canals. Methodology: Twenty simulated root canals with 3 accessory canals (Obtura Spartan, Fenton, USA) was used. The first accessory canal was located in apical third of the main canal with 45 degree, the second one was located more apically with 45 degree in an opposite side to the first one, and the third one was at the apical end of the main canal with the same direction of main canal. A special hinge arm was designed with aluminum on which an endodontic plugger (Obtura S-Kondenser 40-80, Obtura Spartan) was mounted and ultrasonic unit (Suprasson Pimax, Satelec, Merignac, France) was connected. White MTA (ProRoot, MTA, Tulsa, USA) was mixed with sterile water and placed into the coronal third of the simulated root canals with an amalgam carrier. In control group, ten root canals were filled with MTA using 200 g of apparatus weight only. In ultrasonic group, ten root canals were filled with MTA using ultrasonic activation in addition to 200 g of apparatus weight. Digital photo images of the MTA obturation in each canal were taken and MTA obturated areas of each canal were analyzed using an image software (Image J, National Institutes of Health, Bethesda, USA). Mann-Whitney U test was used for statistical analysis. Results: Ultrasonic group showed significantly higher filled area ratio than control group in all the three accessory canals (p<0.001). Filled area ratios of two lateral accessory canals were significantly higher than that of apical accessory canal in the control group (p<0.001), while there were no difference in the ultrasonic group(p<0.05) Conclusion: Ultrasonic activation might improve the filling efficacy of MTA in accessory canals. F8 - 10 Single-matched, taper-sized cone technique: introduction of a novel obturation method Mohammed Abdullah Alshehri, BDS, AEGD, SSC-ARD Riyadh Military Hospital, Departments of Restorative Dentistry, Saudi Arabia Abstract Aim: To describe a novel canal obturation method using the singlematched, taper-sized cone technique. Summary of the technique: A root canal system prepared using specific rotary nickel-titanium files. Obturation is performed with filling cones that match the taper and size of the rotary instruments in order to provide three-dimensional obturation of the root canal over its entire length. This can be performed without the need for accessory ESE ROME 2011 NOT ONLY ROOTS cones or spending time on lateral condensation. Conclusion: The advantages of employing this technique include safe coronal extrusion of excess cement, the ability to create a uniform mass of gutta-percha with less sealer at the canal wall interface and within the filling mass, a higher percentage of sealer-coated canals and a better sealer distribution and elimination of the use of lateral stresses (which may result in overfills and root fractures) during obturation. In addition, higher quality obturation is obtained compared to other methods, and the potential to cause tissue damage due to an increase in the root surface temperature and obturation material shrinkage is minimised. Finally, the technique takes significantly less time comparing with other obturation techniques, is easy to learn and incurs less cost to implement. Chairpersons: Bettina Basrani, Charlotte Ulin Session F9 – 13.30 F9 - 1 Calcium hydroxide induced apexification with partial apical root development: a case report Selcuk Gokyay, I. Karagöz-Küçükay Istanbul University, Faculty of Dentistry, Istanbul, Turkey Abstract Aim: To present a case of a traumatized immature incisor where apexification was induced with apical root development partially by long-term calcium hydroxide (CaOH2) treatment. Methodology: A 14-year-old boy was referred to our endodontic clinic with a history of trauma three-years previously. He informed that endodontic treatment was initiated a-year ago, but he gave up since extraction or apical surgery were advised. Intraoral examination showed that the left maxillary incisor had discoloration and crownfracture with a large endodontic cavity which had been exposed to oral contamination. Oral mucosa had a swelling and was sensitive to palpation. The tooth had tenderness to percussion and slight mobility. Radiological examination revealed a wide radioluscent lesion surrounding the mesial side and whole apex of the root with a wide apical opening located on the mesial side of root apex. The root canal was extremely wide as well. An apexification tretment was initiated on this tooth. The root canal was biomechanically prepared under copious irrigation of %5 sodium hypochlorite and filled with CaOH2 powder mixed with physiologic saline to a dense consistency. Access cavity was then sealed with glass-ionomer cement. CaOH2 was changed in intervals of one or three months upon the radiographic examination. The apical barrier was detected after 6 months, and the root canal was permanently obturated and the tooth was restored. At recall visits, the tooth was evaluated clinically and radiographically. Results: In this clinical case, long-term CaOH2 treatment was found to induce periapical repair through the closure of apical foramen. Over a period of 24-months follow-up, partial root growth and healing of bone were assessed radiographically. The tooth was clinically asymptomatic. Conclusions: This case report confirms the efficacy of CaOH2 as an aid in inducing apexification. The use of long-term CaOH2 is a valid treatment in immature teeth with periapical lesions. F9 - 2 Treatment of traumatised anterior teeth: an interdisciplinary approach Ilgin Akcay, B. Yasa, G. Oncag School of Dentistry, Ege University, Izmir, Turkey Abstract Treatment of crown-root fractures often requires an interdisciplinary approach. It is important for the patient to reestablish a proper esthetic and function. Tooth fracture at or below the gingival attachment or alveolar bone crest presents restorative complexities. A 35-year-old female patient with epilepsy presented with horizontal crown-root fracture of the maxillary right and an oblique crown-root fracture of the left central incisor under the cervical region, as a re- www.eserome2011.com sult of fall from the stairs. Radiographic and intraoral examinations of the teeth revealed crown-root fractures with pulpal exposures of the central teeth. Treatment planning was as follows: endodontic therapy for both incisors and to extrude the remaining tooth segment with orthodontic forces to provide sufficient tooth structure with proper dento-gingival relationships and reestablish proper esthetics and function for the patient. The patient received local anaesthesia. The mobile coronal portion of the left central incisor was extracted. The teeth were subjected to endodontic treatment in a single appointment. The canals were obturated with lateral condensation technique with gutta percha and AH Plus sealer (Dentsply DeTrey GmbH, Konstanz, Germany). A hook was luted with resin-based luting agent into the root canal of left central incisor. As a result of this procedure, use of the adjacent teeth as an anchorage for the extrusion was avoided. The upper traumatised teeth were bonded, and the root was extruded via light orthodontic forces. All extrusion was completed in 14 weeks. After healing of the gingiva, maxillary right canine, lateral and left lateral were restored with porcelain laminate veneers, right central was restored with full ceramic crown and left cental was restored with zirconium crown. The patient is on a recall schedule for 1 year and has reported asymptomatically. The subsequent monitoring of the radiographs did not demonstrate any signs of pathology. F9 - 3 Modern management of crown fractures of permanent incisors- a case series R.S. Austin, S. Djemal King’s College London Dental Institute, London, UK Abstract Crown fractures are unfortunate, painful and distressing events which, if managed inappropriately, may have life-long oral health, psychosocial and economic consequences. Vital pulp therapy using modern techniques and materials for teeth with enamel-dentinepulp fractures can maintain 95 % vitality after five years. High quality treatment can therefore reduce costs to individuals and society at large. This clinical poster shows how modern management of crown fractures of permanent incisors can result in optimal outcomes using the 2007 IADT evidence-based guidelines. Special features of clinical cases: Case 1: diagnosis: enamel-dentine crown fractures of 11 and 22 presented 7 hours after fall; procedure: bonding of tooth fragment using composite resin with fragment handling and isolation using OptraStick and OptraGate (Ivoclar Vivadent AG, Schaan, Liechtenstein), outcome: excellent aesthetics and pulp vital at follow-up. Case 2: diagnosis, enamel-dentine-pulp fractures of 11 and 21 presented less than 12 hours after assault; procedure, partial pulpotomy with white mineral trioxide aggregate (ProRoot®, Tulsa Dental, USA) and immediate restoration with Enamel plus HFO® composite (Enamel Plus HFO; Micerium Spa, Italy); outcome, excellent aesthetics and pulp vital at follow-up. Case 3: diagnosis, enamel-dentine fracture 11 and enamel-dentine-pulp fracture 21 and enamel-dentine-pulp crown-root fracture 22 presented less than 12 hours after road traffic accident; procedure, fragment removal, gingivectomy and partial pulpectomy with white mineral trioxide aggregate (ProRoot®, Tulsa Dental, USA) and restoration with composite resin; outcome: excellent aesthetics and pulp vital at follow-up. Conclusion: This poster has shown how evidence-based management of crown fractured permanent incisors, using modern techniques and materials, ensures optimal treatment outcomes, as well as potentially reducing negative impacts on patients oral health and psychosocial wellbeing. F9 - 4 Intraalveolar root fracture: a case report García Briones Julio Cesar, JF Raygoza, A Percevault, A Guizar, ME Hofmann, MA Cadena Universidad Autonoma de Baja California, Campus Tijuana, USA Abstract A sequelae to a traumatic injury of a tooth is a root fracture. When a 41 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY root fracture is horizontal and the fragment is completely encased by the bone, it has a favorable prognosis. An 18 year old female patient sufferd 10 years ago a traumatic injury in tooth # 9 (ULI) . This tooth presented a horizontal root fracture, the radiographic visualization showed a displaced apical fragment and a wide diastasis with a radiolucency present between the fragments. The coronal segment was treated endodontically. The coronal fragment was cleaned and shaped. NaOCl 5.25% was used to irrigate, later the coronal fragment was dried with paper points and Ca(OH)2 was placed as intracanal medication. In the second appointment a surgical intervention was required to seal the apical area of the coronal fragment and the removal of the apical fragment. The surgical intervention started with a flat and an osteotomy of the site. The granulation tissue was curetted and the area rinsed witn saline solution. The apical fragment wasn’t removed because it showed ankylosis and also to prevent damage to adjacent tissues. The coronal fragment was sealed using thermo plasticized technique (obtura II) and the guttapercha was adapted in the apical area in the surgical act. The surgical flat was closed. Post-op radiographic controls showed a healed bone and the patient didn’t mention any signs or symptoms after 4 years of the surgery. Conclusion: Endodontic treatment and surgical intervention is an excellent treatment plan for intraalveolar root fractures, and has a good prognosis. F9 - 5 Treatment of horizontal root fracture: case report Acar Gozde, T.Yagmur Yalcin Istanbul University Faculty of Dentitry, Department of Endodontics, Turkey Abstract Root fractures of permanent tooth are the most frequent type of dental injury. Restoration of teeth becomes more complex when the involved teeth exhibits a cervical root fracture. The development and use of fiber- root canal posts make possible the stabilized of the fragments of fractured root. The present paper reports a case in which the treatment of a cervical root fracture was accomplished by stabilized the tooth fragment with a fiber post. The author will also discuss the concept of adhesive restorations and clinicall show how to utilize the best materials and techniques for this specific use. F9 - 6 Endodontic treatment of root fractures using mineral trioxide aggregate: case reports Jung Kyoung hwa, Jiwan Yum, Hyeon-Cheol Kim , Bock Hur, Jeongkill Park South Korea Abstract Introduction: Dental traumas, which can lead to a wide range of injuries, are the most common damages among all facial injuries. Complicated crown fractures and root fractures of fully developed teeth are examples of these injuries. Root fractures commonly occur at the anterior maxilla, and generally teeth with complete root formation are affected. Root fractures may be located at the coronal, middle, or apical thirds. Although the coronal fragment is commonly indicated to be treated endodonitcally, it is not easy to get an adequate sealing of the apical end of the coronal fragment. Mineral trioxide aggregate (MTA) has been shown to be very effective in sealing the pathways of communication between the root canal system and periodontal 42 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L tissue. The root canal could be filled in orthograde way using MTA. These case reports describe the treatment and follow-up of teeth with root fratures treated with MTA as apical plug. Case Presentation <Case 1> 1. Sex/age: F/56 2. Chief Complaint (C.C): Fractured tooth after accident. 3. Past Dental History (PDH): Apical fragment of #43 was removed on open reduction 4. Present Illness (P.I): Extraoral multiple laceration and #43 root tip fx. 5. Impression: Horizontal foot fx. in the apical third of #43 6. Tx. plan: #43 root canal treatment and MTA filling <Case 2> 1. Sex/age: M/15 2. Chief complaint (C.C): Fractured tooth after slip-down accident. 3. Past Dental History (PDH): N/S 4. Present Illness (P.I): #11 horizontal foot fx., temporary filling state 5. Impression: Horizontal fx. in the middle third of #11 6. Tx. plan: #11 root canal treatment of coronal fragment and MTA filling Conclusion In all traumatic injuries, early diagnosis and appropriate intervention dramatically enhance the outcome. The use of MTA as an apical plug seems to be an appropriate application in the treatment of root fractures and may secure favorable prognosis. F9 - 7 Rehydration of the reattached fractured tooth fragment after prolonged dehydration Ungor Mete, Neslihan Arhun, Emel O. Onay Turkey Abstract The reattachment of dental fragments is a conservative treatment and should be considered as a first treatment choice in the restoration of anterior tooth fractures. This article presents a clinical technique for the restoration of a fractured maxillary lateral incisor by reattaching the tooth fragment which was kept in dry conditions for 5 days with the aid of adhesive dentistry. The fractured tooth fragment was recovered by a witness at the site of outdoor accident injury, handed to the patient and maintained in a paper tissue for 5 days. After disinfection of the fragment, the fracture site and the fragment were treated acid etched with 37% phosphoric acid for 30 seconds and rinsed thoroughly with water for 10 seconds but not dried. A single step adhesive (Single Bond, 3M, St. Paul, MN, USA) was applied, gently dried for 5 seconds. The fragment was carefully repositioned to the fractured tooth with firm finger pressure and light cured for 20 s from each direction. After reattaching the fragment, a circumferential groove in the fracture site was prepared with a round diamond bur and etched with 37% phosphoric acid. The same adhesive system was applied and light cured for 20 seconds, and the groove was restored with a hybrid resin composite (Z250, 3M) and finishedpolished with finishing disks (Sof-Lex, 3M). However, the crown fragment was much whiter than the fractured tooth because of excessive dehydration as it was kept in dry conditions for 5 days. The esthetic compromise in white color was compensated after 1 month service in the mouth by gaining the natural color by rehydration. One year clinical evaluation revealed successful results for this technique and the patient was with the esthetic outcome of the conservative treatment modality. ESE ROME 2011 NOT ONLY ROOTS NOTES www.eserome2011.com 43 1 5 TH B I E N N I A L C O N G R E S S OF THE EUROPEAN SOCIETY OF ENDODONTOLOGY NOTES 44 R O M E - 2 0 1 1 , S E P T E M B E R 1 4 TH - 1 7 TH R O M E CAVA L I E R I H OT E L