L’irrigazione nei canali radicolari: revisione della letteratura
Irrigation in the root canals: a literature review
Franco V., Fabiani C.
G It Endo - vol. 19 - n. 4, pp. 262-272 October-Dicember 2005
Aim: to describe currently available materials and techniques for efficient endodontic irrigation.
Cleaning and shaping is one of the main phases of the endodontic procedure. While shaping is achieved only with the mechanical action of the endodontic instruments, cleaning is obtained with both the combined mechanical action of the instruments and the chemical action of the irrigating solutions. Thus, the irrigating solutions must have different actions: they should remove the organic substrate, have a bactericidal effect, and remove the inorganic layer produced by the filing action of the instruments (smear layer). Currently, there is no irrigating solution achieving all of these three objectives. This literature review is focused mainly on showing the different properties, and there- fore different indications of use, of the most widely used irrigating solutions, namely NaOCl and EDTA. NaOCl is more effective in removing the organic necrotic sub- strate, while its action on vital tissues seems to be weaker. Two methods (discussed here) to strengthen the action of NaOCl are increase in temperature and increase in concentra- tion. EDTA and organic acids are pro- posed for the removal of the smear layer: be- cause of the unpredictability in thickness and areas of deposition of the smear layer, a unique clinical protocol for their use is not well established. Further research, as well as testing of multi-component irrigants of new generation, can lead to a better clinical as- sessment of this fundamental procedure in endodontic treatment.
The Operative Microscope in the Location of Canal Orifices : a guideline
Italian Academy of Microscopic Dentistry (AIOM)
Inter-Society Co-ordination Committee of the Italian Dental Associations CIC, College of Dentistry Teachers
Commission for the drawing up of the guidelines
Cristiano FABIANI, Vittorio FRANCO, Damiano PASQUALINI, Annalisa CASTELLA, Giuseppe MIGLIARETTI, Riccardo PRETI, Mauro RIGOLONE
SUMMARY OF RECOMMENDATIONS
The use of an operative microscope would enable to locate a higher number of canals, thus allowing to increase the chances of success in the treatment (recommendation grade C)
Terapia canalare in seduta unica o in più sedute
Root canal therapy in one or multiple visits: a guideline
Inter-Society Coordination Committee of the Italian Dental Associations College of Dentistry Teachers (C.I.C.)
College of Dentistry Teachers
Commission for the drawing up of the guidelines
FRANCO Vittorio, FABIANI Cristiano, FIGINI Lara, GAGLIANI Massimo, LODI Giovanni, PASQUALINI Damiano, ARCURI Claudio,
Fabiani C., Franco V.
Chaper of a Textbook: cap 1, pag 7-20
Le basi razionali del trattamento endodontico ortogrado
The rationale of the orthograde endodontic treatment.
in “Endodonzia del terzo millennio, sicura, affidabile, predicibile. ("Endodontics of the third millennium, safe, reliable, predict- able)
Aries2 editore, Carimate (Co). 2007
L’azione di dissoluzione di quattro differenti protocolli di irrigazione: studio in- vivo
Debridement action of four different irrigation protocols in vital teeth. An in-vivo study
Cristiano Fabiani, Vittorio Franco, Massimo Gagliani G It Endo - vol. 22 - n. 2, pp. 67-72 April-June 2008 Abstract
The action of sodium hypochlorite has been showed to be very effective to- wards necrotic tissues. Few studies have been conducted to ascertain its real action towards vital pulp tissue. This in-vivo investigation compared the debridement action of different NaOCl ir- rigation regimens in vital teeth during cleaning and shaping using Ni-Ti in- struments.
22 vital teeth were cleaned and shaped following the standard ProTaper proto- col and di- vided into four groups. Group A was irrigated with 5.25% NaOCl at room temperature. Group B was irrigat- ed with 5.25% NaOCl at room tempera- ture and received 3 extra irri- gations every 5 minutes at the end of the instru- mentation. Group C was irrigated with NaOCl warmed at 50°C. Group D was ir- rigated with the alternate use of 5.25% NaOCl at room temperature and 17% EDTA. All teeth were then immediately extracted and fixed for evaluation.
When the results were compared, the warm NaOCl group ranked best even if the statisti- cal analysis showed a weak significance (p=0.058). The only group that did not produce sections scored D (debris present in more than 60% of the section) was the warm NaOCl group. No specimen showed completely clean surfaces in all observed portions.It was concluded that the irrigation protocols used in this in-vivo study were not effective in totally debriding the root canal.
Effect of sodium hypochlorite with the addition of a proteolytic enzyme on postoperative discomfort: a multicenter randomized clinical trial.
S Taschieri, C Fabiani, V Franco, T Weinstein, M Del Fabbro Minerva stomatologica 09/2009; 58(9):415-23.
ABSTRACT: The purpose of this study was to compare the patient's postoperative discom- fort when root canal irrigation was performed either with standard sodium hypochlorite or with sodium hypochlorite with the adjunct of a proteolytic enzyme. Two hundred patients were endodontically treated in two clinics. The type of irrigant to be used during root canal instrumentation was randomly assigned. Final irrigation was done using EDTA 17%. The canals were filled by warm vertical condensation with guttha- percha and the coronal seal was made using IRM. Patients were given a questionnaire to assess pain and swelling and the number of analgesics and other drugs taken during the first week after treatment. A total of 166 questionnaires could have been evaluated. No significant difference was found between groups for pain, swelling and analgesics taken. Moderate pain and swelling was reported only in the first two days after treatment. No antibiotics use was reported. No guttha-percha excess beyond root apex was found by radiographic assessment. The irri- gating solution containing a proteolytic enzyme does not produce greater postoperative discomfort as compared to the conventional sodium hypochlorite in patients undergoing endodontic therapy.
PREVALENCE OF APICAL PERIODONTITIS AND QUALITY OF ENDODONTIC TREATMENT IN AN ITALIAN ADULT POPULATION
F. COVELLO*, V. FRANCO**, R. SCHIAVETTI*, M. CLEMENTINI* A. MANNOCCI***, L. OTTRIA*, M. COSTACURTA*
ORAL & Implantology - Anno III - N. 4/2010
Objective. The aim of this study was to analyze the preva- lence of AP in relation to the quality of endodontic treat- ment in an Italian adult population. Methods. We examined panoramic radiographs (OPG) of 384 patients aged between 18 and 60 years who came un- der observation for a first dental examination. Two expe- ri- enced examiners assessed the radiographs according to standardized criteria by examin- ing the following parame- ters: periapical status, quality of endodontic treatment, qual- ity of root canal filling and quality of coronal restoration. Results. 9423 teeth were analyzed. By examining the ra- diographs 1076 teeth had undergone previous endodon- tic treat- ment, of these 448 (41.6%) had AP. Statistical analy- sis shows a significant association between periapical sta- tus and quality of endodontic treatment (p <0.001), between peria- pical status and quality of root canal filling (p <0.001) and between periapical status and quality of coronal restora- tion (p <0.001).
Conclusions. The prevalence of AP was found to be close- ly related to the quality of en- dodontic treatment, quality of root canal filling and coronal restoration.
Final rinse optimization: influence of different agitation protocols.
Raffaele Paragliola, Vittorio Franco, Cristiano Fabiani, Annalisa Mazzoni, Fernando Nato, Franklin R Tay, Lorenzo Breschi, Simone Grandini Journal of endodontics 02/2010; 36(2):282-5.
ABSTRACT: This study examined the effect of different root canal irrigant agitation proto- cols in the penetration of an endodontic irrigant into dentinal tubules. Fifty-six human single-rooted teeth were shaped with nickel-titanium instruments, and a final rinse of 5% sodium hypochlorite labeled with 0.2% alizarin red was performed. Specimens were as- signed to 7 groups (N = 8) and submitted to the following rinse activation protocols: no agi- tation (control group), K-File or gutta-percha agitation, or different sonic (EndoActivator [Advanced Endodontics, Santa Barbara, CA] and Plastic Endo, Lincolnshire, IL) and ultra- sonic (Satelec [Acteongroup, Merignac, France] and EMS, Nyon, Switzerland) agitations. Specimens were sectioned at 1, 3, and 5 mm from the apex in 1-mm-thick slabs, ground, and prepared for fluorescence microscopy at 100x with a wavelength of 450 milliseconds. Irrigant penetration into dentinal tubules was analyzed by using Kruskal- Wallis analysis of variance followed by post-hoc comparisons. Groups were ranked in the following order: control = K-file = gutta-percha < EndoActivator = Plastic Endo < Satelec = EMS. At 1 mm from the apex, the highest score was found for the EMS group compared with the control, K-file, gutta-percha, EndoActivator, and Plastic Endo groups, whereas no difference was found with the Satelec group. The results support the use of an ultrasonic agitation to in- crease the effectiveness of the final rinse procedure in the apical third of the canal walls.
Removal of Surgical Smear Layer
Cristiano Fabiani, Vittorio Franco, Francesco Covello, Eugenio Brambilla, Massimo M Gagliani
Journal of endodontics 06/2011; 37(6):836-8.
ABSTRACT: During apicoectomy and retrograde cavity preparation, a smear layer, which contains microorganisms and necrotic pulpal tissues, is formed on the dentinal surfaces cut by the instruments. Bacteria can survive and proliferate inside or below the smear layer. The purpose of this study was to evaluate in-vitro two different procedures for the removal of the smear layer in retrocavities prepared with ultrasonic retrotips. Twenty-eight single-rooted teeth were cleaned, shaped, and obturated with gutta-percha and sealer. The apical 3 mm of each root were cut with a carbide bur, and retrograde cavities were prepared with ProUltra ultrasonic retrotips (Maillefer Dentsply, Baillagues, Switzerland) at a depth of 3 mm. Teeth in group A were treated with a gel of 35% orthophosphoric acid for 15 seconds, and teeth in group B were treated with a gel of 24% EDTA at a neutral pH for 2 minutes. The samples were prepared for scanning electron microscopic observation and scored for the presence of the smear layer on the retrocavity walls. Eighty percent of the teeth in group A showed an optimal degree of cleanliness of the walls, with dentinal tu- bules completely open. The majority of analyzed samples coming from group B showed dentinal tubules covered with the smear layer. The analysis of the samples showed that orthophosphoric acid is more effective than EDTA in removing surgical smear layer even with less time of action.
Investigation on the Shaping Ability of Nickel-Titanium Files When Used with a Reciprocating Motion
Vittorio Franco, Cristiano Fabiani, Silvio Taschieri, Augusto Malentacca, Monica Bortolin, Massimo Del Fabbro
Journal of endodontics 10/2011; 37(10):1398-401.
ABSTRACT: The introduction of nickel-titanium (NiTi) files into clinical practice has im- proved the quality of canal shaping, but increasing the curvature of the root canal (or the diameter of the master instrument that prepares the full working length) could result in more transportation, straightening, and aberration of the canal. Nickel-titanium instruments are significantly safer and have an extended cyclic fatigue life when used with a reciprocat- ing movement. The purpose of this study was to compare the shaping ability of FlexMaster NiTi instruments when used in either continuous or reciprocating movements. Thirty-two Endo Training Blocks ISO 15, 2% taper, 10-mm radius of curvature, and 70° angle of cur- vature were prepared, according to the group, with FlexMaster NiTi instruments either in continuous rotation or in reciprocating (60° clockwise, 40° counterclockwise) movement. Preoperative and postoperative images of the simulated canals were taken under stan- dardized conditions. The preoperative and postoperative images were combined exactly. The amount of resin removed was determined both for the inner (convex) and the outer (concave) sides of the curvature at 10 produced the largest enlargement of the canal as compared with the Reciprocating group (P < .05). In the apical third, the Continuous group displayed signifi- cantly greater enlargement of the canal at the external side. The shaping of simulated ca- nals is more centered by using a reciprocating motion when compared with continuous ro- tation, but the reciprocating motion could be more time-consuming.
Resistenza alla fatica ciclica di strumenti in lega Nichel-Titanio
Cyclic fatigue resistance of Nickel-Titanium instruments
Giovanni Franciosi, Linda Fulceri, Gerardo Cafaro, Raffaele Paragliola, Vittorio Franco, Cristiano Fabiani, Simone Grandini *
Giornale Italiano di Endodonzia (2012) 26, 52—56
Objectives: The aim of the present study was to evaluate the fatigue resistance of Flex- Master and MTwo used in continuous rotation and in alternate movement, and the influ- ence of various parameters on this.Materialsandmethods:Forty FlexMaster and 20 MTwo were used,and subjected to fatigue test. Results: Statistically significant differences were found among all groups.
Conclusions: Lower taper leads to increased resistance to cyclic fatigue of the instrument. Alternate rotation increases the average life of the instrument, and gives greater resistance to cyclic fatigue to those with similar taper.
The endodontic line: A clinical approach
Vittorio Franco, Eugenio Tosco
Giornale italiano di endodonzia 06/2013; 27(1):2–12.
The shaping using instruments in nickel titanium and the obturation made with thermoplas- tic materials represent the current trends for what concerns shaping and canal filling. To this protocol is added the use of high title NaOCl and EDTA solution. Endodontic treat- ments are currently based on changes in the shape and contents of what is known as the endodontic space: it is ‘‘in’’ and ‘‘out’’. This article is focused on the management of the endodontic line. Endodontic anatomy is complex and only rarely formed by one canal with a unique foramen. However, our current treatments are based on techniques in which the shaping is focused on a single port of exit. With these recent methods it is better to bring the wound at the end of the endodontic space by identifying this space using electronic apex locators. The authors believe that it is not convenient to let the repairing mechanisms occur inside the endodontic space.
Strumenti in lega Nichel-Titanio azionati con movimento reciprocante: una nuova prospet- tiva nella sagomatura canalare
Ni-Ti engine driven instruments used by reciprocating motion motors: a new perspective in root canal shaping
Vittorio Franco, Roberto Fornara, Gianluca Plotino, Gianluca Gambarini ildentistamoderno, October 2013
The evolution of Nickel-Titanium (Ni-Ti) instruments has been, since a couple of decades, continuous: new alloys technology, new shapes of the blades and, at last, the reciprocating motions of the instruments. Using in a reciprocating motion, clockwise and counterclockwise at different amplitude, has recently proposed, even though it had utilized long time ago, with the main purpose to lower the ciclic fatigue on the Ni-Ti instrument in order to obtain, as consequence, a higher resistance during root canal instrumentation. Several manifacturers put in the market such a kind of systems: Reciproc, Wave-One and TF. In all these systems the instruments are dedicated to the specific technique, but, it’s well known that a great part of the previous literature reported favourable results using recipro- cating motion of Ni-Ti instruments utilizing regular Ni-Ti instruments available on the market. The aim of this paper is to examine and review the advantages of the recip- rocating motion, the opportuNi-Ties to have a better root canal shaping and to give a rough perspective to the possible evolution of these type of systems.
Chapter 5: Techniques for root canal disinfection
Tecniche di disinfezione endocanalare
Franco V., Fabiani C.
in Manuale di Endodonzia; Scientific coordinators: Berutti E., Gagliani M. Edra editor, Milan, May 2013
Resistance of endodontically treated roots restored with different fibre post systems with or without post space preparation:
in vitro analysis and SEM investigation
Daniele Angerame, Matteo De Biasi, Mauro Cattaruzza , Vittorio Franco , Gianluca Turco , Julia Filingeri , Fernando Zarone , Roberto Sorrentino
Giornale Italiano di Endodonzia (2016) 30, 111—119
Aim: To compare the mechanical resistance to fracture of two conical post systems placed with no preparation of the root canal with that of double taper fibre posts seated in endodontically treated single roots after standard post space preparation using dedicated drills.
Methodology: Thirty fibre posts with double (G1, n = 10, DT Light Post) and single taper (G2, n = 10, SurgiPost Multiconical; G3, n = 10, Tech ES Endoshape) were luted with self-adhesive cement in endodontically treated single roots using different post space preparation techniques. The bonded posts were experimentally loaded until failure and the maximum load to fracture was registered. Fracture patterns were qualitatively evaluated and SEM analysis was performed to assess the quality of endodontic treatments and cementation. Data were statistically analysed by means of one-way ANOVA.
Results: The mean maximum load to fracture was 165.05 23.46 N in G1, 151.52 16.23 N in G2 and 129.09 15.25 N in G3. Statistically significant differences were pointed out between G1 and G3 (p < 0.01) and G2 and G3 (p < 0.05). No root fractures were evidenced. SEM analyses showed slightly thicker cement layers at the apical and middle thirds of single taper posts (G2 and G3).
Conclusions: DT Light Post and SurgiPost Multiconical fibre posts showed similar properties in terms of mechanical resistance to fracture and higher than those of Tech ES Endoshape. Unrestorable root fractures did not occur with any of the tested posts.
Upper central incisors with periapical lesions treated with two integrated endodontic systems: A six-month randomized controlled trial
Daniele Angerame, Matteo De Biasi, Vittorio Franco, Lorenzo Bevilacqua, Attilio Castaldo
Giornale Italiano di Endodonzia (2016) 30, 33–40
To assess preliminarily the success rate of the root canal treatment with two integrated shaping and filling systems of upper central incisors with chronic periapical pathosis.
Methodology: Sixty adult subjects with an untreated maxillary central incisor presenting a chronic periapical lesion smaller than 5 mm in diameter were recruited for the present study. The patients were randomly divided into two treatment groups: G1 (n = 30), Revo-S/One Step Obturator; G2 (n = 30) GTX/GTX Obturator. All root canal treatments were performed in a single session by the same operator. Sensitivity to palpation and percussion was registered at baseline and at the six-month recall. Radiographic healing was scored by two blind examiners according to a previously described scale. The absence of statistically significant differences in terms of baseline clinical parameters between the two groups was assessed by means of a Mann–Whitney test (age, apical gauging) and χ2 test (sensitivity to percussion and palpation). The radiographic scores attributed to the two groups were compared with a Mann–Whitney test, while a χ2 test served to compare the clinical data gathered after six months (p < 0.05).
Results: Baseline clinical parameters registered in the two groups were found to be comparable. All patients attended the six-month recall and all the teeth were referred to be negative to sensitivity, with the exemption of two subjects per group. The periapical lesions were scored as totally healed, partially healed and not healed in 43.4%, 53.3% and 3.3% of cases in G1 and in 43.3%, 50.0% and 6.7% of cases in G2. The differences between the groups were not significant.
Conclusions: Tough cases scored as incomplete healing should be further followed up, the present study attests that the two tested integrated shaping and filling systems are capable of high and comparable six-month success rate in upper central incisors with periapical pathosis.
Application of platelet-rich fibrin in endodontic surgery: a pilot study
Daniele Angerame, Matteo De Biasi, Iva Kastrioti, Vittorio Franco, Attilio Castaldo, Michele Maglione
Giornale Italiano di Endodonzia (2015) 29, 51—57
Aim: To assess preliminarily the potential benefits of the use of the platelet-rich fibrin (PRF) in modern endodontic surgical procedures in terms of radiographic healing acceleration and postoperative discomfort reduction.
Methodology: Elevenpatientswithchronicapicalperiodontitiswererandomlyassignedtoeither the PRF (n = 7) or the control group (n = 4). Postoperative swelling and pain were assessed with a questionnaire. Radiographic healing was scored according to Molven’s scale up to a period of one year. Data were statistically analyzed with non-parametric tests.
Results: InthePRFgroupthepatientsexperiencedlesspaininthe2—6hpostoperativelyaswellas oedema, which never exceeded the moderate intraoral swelling. Radiographic healing was detecta- ble earlier in the PRF group, with the majority of cases scored as complete healing after 2—3 months. Conclusions: TheadjunctiveuseofPRFmightpromotetheaccelerationoftheradiographichealing and reduce the postoperative discomfort.
other papers should be added soon.......