Despite enjoying high favourable outcome rates, root canal treatment is not always successful. Ro... more Despite enjoying high favourable outcome rates, root canal treatment is not always successful. Root canal retreatment is a widely practised option for managing a non-healing root treated tooth. A basic distinction between retreatment and initial treatment is the requirement to remove the existing root filling material occupying the root canal space. Only then, can the technical deficiencies and possible causes of failure be addressed. Hence, the successful removal of the root filling material is critical to achieving the objectives of retreatment. Many different materials and techniques have been used for root canal filling, which have been documented in a plethora of studies; these are mainly laboratory studies investigating the removal of root filling materials. To help guide future research, which may then better inform clinical practice in relation to retreatment procedures, the focus of this narrative review is on the research methods and experimental models employed to study the removal of root filling materials. The current available literature demonstrates great variation in the research methodologies used to study the removal of root filling material, including direct visualisation by splitting tooth samples or clearing, three-dimensional radiographic imaging including using micro-computed tomography or cone beam computed tomography, and a combination of these techniques. Depending on the research method employed, variation also exists in quantification of root filling material removal; these include measurements of surface area, volume, or weight, and criteria-based (semi-quantitative) assessment. Experimental models, using human teeth or resin models, differ with respect to standardisation techniques and replication of the clinical scenario including initial sample preparation, canal filling, allocation, and technical aspects of retreatment procedures. Future models should replicate, as closely as possible, the clinical scenario. Currently, micro-computed tomography provides a highly detailed, non-invasive, and non-destructive method of objectively assessing and quantifying root filling removal.
Coronal preflaring NiTi files should possess proper hardness, resistance to fracture and flexibil... more Coronal preflaring NiTi files should possess proper hardness, resistance to fracture and flexibility. This study compared the bending resistance and cyclic fatigue resistance of three orifice preflaring NiTi files. HyFlex EDM Orifice opener (#25/12), HyFlex CM (#25/08) and One Flare (#25/09) were tested (n = 46/instrument). Bending resistance was assessed with the stress when perpendicular displacement was applied to a 3 mm point from the file tip, and was performed at either room temperature (RT, n = 10) or body temperature (BT, n = 10). Cyclic fatigue resistance was tested with an artificial ceramic root canal at RT (n = 10) and BT (n = 10), and the number of cycles to failure (NCF) was obtained. The bending resistance and the NCF results were analyzed by two-way ANOVA and Tukey’s test. Differential scanning calorimetry (DSC) and X-ray diffraction (XRD) analyses were performed (n = 3, respectively). HyFlex EDM exhibited the highest bending resistance, followed by One Flare and HyF...
Inflammation is a crucial step prior to healing, and the regulatory effects of endodontic materia... more Inflammation is a crucial step prior to healing, and the regulatory effects of endodontic materials on the immune response can influence tissue repair. This review aimed to answer whether endodontic sealers can modulate the immune cells and inflammation. An electronic search in Scopus, Web of Science, PubMed, and Google Scholar databases were performed. This systematic review was mainly based on PRISMA guidelines, and the risk of bias was evaluated by SYRCLEs and the Modified CONSORT checklist for in vivo and in vitro studies, respectively. In total, 28 articles: 22 in vitro studies, and six in vivo studies were included in this systematic review. AH Plus and AH 26 can down-regulate iNOS mRNA, while S-PRG sealers can down-regulate p65 of NF-κB pathways to inhibit the production of TNF-α, IL-1, and IL-6. In vitro and in vivo studies suggested that various endodontic sealers exhibited immunomodulatory impact in macrophages polarization and inflammatory cytokine production, which could...
AimTo report the most common terminology used in titles of scientific papers published in the Int... more AimTo report the most common terminology used in titles of scientific papers published in the International Endodontic Journal (IEJ) and Journal of Endodontics (JOE) between 1980 and 2019 and to identify the most‐cited papers in these journals.MethodologyThe Web of Science database was searched to retrieve all the manuscripts published in the IEJ and JOE between 1980 and 2019. The articles were analysed using the VOS viewer software and the terms within the titles extracted. The top‐10 terms were categorized according to the number of occurrences and the decade of publication. Maps were created using the text data for each decade of publication. Classic papers were identified when the number of citations was >400. During the same period of time, highly cited studies were identified including the authors, institutions and countries associated with these papers.ResultsTerms such as canal, molar and periapical lesion were the most commonly used in titles between 1980 and 1999. The t...
Journal of the American Dental Association, Aug 1, 2014
In 2010, one of the authors proposed that lasers could be used to enhance the decontaminating act... more In 2010, one of the authors proposed that lasers could be used to enhance the decontaminating action of sodium hypochlorite (NaOCl). The authors conducted a study to compare the disinfection efficacy of laser-activated irrigation (LAI) by using a photon-induced photoacoustic streaming (PIPS) tip with conventional irrigation and specifically LAI's ability to remove bacterial film formed on root canal walls. The authors shaped 26 human anterior teeth to a master apical file size of International Organization for Standardization 25/06 (size 25 tip and size .06 taper) and then sterilized the teeth, infected them with Enterococcus faecalis and incubated them for four weeks. The authors used two irrigation protocols. Group A received two cycles of 30 seconds each of 5 percent NaOCl laser activation and one cycle of 30 seconds with laser activation involving the use of 17 percent ethylenediaminetetraacetic acid (EDTA). The erbium:yttrium-aluminum-garnet (Er:YAG) laser's settings were 20 millijoules, 15 hertz, 50-microsecond pulse duration, and it had a 600-micrometer PIPS tip. Group B received two cycles of 30 seconds each of 5 percent NaOCl and 17 percent EDTA irrigation alone, delivered via a syringe with a 25-gauge needle. The authors found that group A had significantly better disinfection compared with group B (P < .05). The results of cultures obtained after 48 hours showed that disinfection was maintained better in group A compared with group B (P < .0001). Scanning electron microscopic images showed absence of bacterial biofilm remaining after LAI using PIPS. Er:YAG laser activation of 5 percent NaOCl and 17 percent EDTA was more effective than conventional irrigation for eradicating E. faecalis and preventing new bacterial growth ex vivo. Additional clinical studies are needed to clarify the effect on endodontic treatment outcomes. PIPS appears to be effective in enhancing the effect of the irrigants commonly used in endodontics.
Periapical inflammation is often responsible for distinct maxillary sinus (MS) changes. This retr... more Periapical inflammation is often responsible for distinct maxillary sinus (MS) changes. This retrospective, cross-sectional study evaluated the association between the clinical characteristics of periapical lesions (presence, size, and distance) in maxillary posterior teeth and the presence of sinus abnormalities by evaluating cone-beam computed tomographic (CBCT) images obtained from an archived collection. Apart from sex, no other patient information was available. The study sample was composed of CBCT images of 143 MSs of patients with at least 1 maxillary posterior tooth with a periapical lesion and 178 MSs of patients without periapical radiolucent lesions. Sinus abnormalities were classified as mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, and antral calcification; periapical radiolucent areas were classified using the CBCT periapical index, and the distance between the periapical lesion edge and the MS floor was measured. Data were analyzed using chi-square tests at a level of significance set at α = 0.05. Most sinus abnormalities were associated with at least 1 maxillary posterior tooth with a periapical lesion (P > .05). The most frequent sinus abnormality in the presence of a periapical lesion was mucosal thickening. All teeth with a CBCT periapical index score of 5 were associated with sinus abnormalities. The highest frequency of abnormalities was found when the radiolucent area was subjacent to the sinus floor. Maxillary posterior teeth with periapical radiolucent lesions had the highest frequency of sinus abnormalities. The size of a periapical lesion was not associated with the frequency of sinus abnormalities. A close spatial relationship between periapical lesions and sinuses resulted most frequently in sinus abnormalities.
INTRODUCTION This study aimed to investigate whether the direction of force applied to the occlus... more INTRODUCTION This study aimed to investigate whether the direction of force applied to the occlusal surface influenced the pattern of tensile stresses in roots of sound and root canal-prepared mandibular molar teeth. The effect of obturation forces on the development of apical stress was also investigated. To this end models were constructed using micro computed-tomography (MCT) and investigated using finite element analysis (FEA). METHODS MCT data established boundaries of internal and external model surfaces to allow FEA analysis. Individually segmented components were modelled based on mechanical properties in precedent literature. The following conditions were considered: axial force directed over the mesial marginal ridge, a mesial or a distal tipping force, a combination of both a torquing force and axial loading, as well as hydrostatic pressure. Maximum principal stresses (MPS) were determined. RESULTS Highest root stress occurred in the cervical third of root surfaces (i.e., not apically) under all loading conditions. Importantly, mesial tipping forces resulted in tension on distal roots, whereas distal tipping resulted in tension in the mesial roots. Intra-canal pressures produced tensile stress on the internal root canal walls in the cervical third of the root. Stresses were calculated to be less than the fatigue tensile strength of dentin. CONCLUSIONS Static loading, under the conditions modelled, does not result in stress concentration at the root apices that would cause root fracture under normal masticatory loads. Stress patterns developing from mesial and distal tipping forces help to explain the appearance of vertical root fractures reported in sound non-restored molar teeth.
The aim of the study was to compare cyclic fatigue (CF) resistance of reciprocating and rotary gl... more The aim of the study was to compare cyclic fatigue (CF) resistance of reciprocating and rotary glide path instruments in the presence of irrigation solutions at body temperature. CF resistance of 100 instruments (50 ProGlider and 50 WaveOne Gold Glider) was tested in sodium hypochlorite solutions alone (NaOCl) or in combination with etidronate (NaOCl/HEBP). The CF platform with a simulated canal (curvature = 60°/radius = 3 mm) was submerged in a temperature‐controlled bath with the solutions kept at 37 ± 1°C controlled by a precision mercury glass thermometer. Instruments were actioned following manufacturer guidelines, and time to failure was recorded and compared among groups with Weibull analysis. Reciprocating glide path preparation instruments were more resistant to CF than rotary instruments in both irrigation solutions. The irrigation solution did not affect the mean life of ProGlider, but reciprocating instruments lasted significantly longer used in presence of NaOCl compared to NaOCl/HEBP.
INTRODUCTION The aim of this study was to describe the mechanical properties both in stationary a... more INTRODUCTION The aim of this study was to describe the mechanical properties both in stationary and dynamic conditions in vitro of the novel TruNatomy (TN; (Dentsply Sirona, Ballaigues, Switzerland) shaping files and compare them with a conventional rotary system, ProTaper Next (PTN, Dentsply Sirona). METHODS Different sizes of 2 types of rotary files, TN and PTN, were compared for their fatigue limit (n = 20 each size) and torsional resistance (n = 6 each size) and subjected to simulated shaping (n = 6 each size). Fatigue limits were determined in a novel fixture including a tapered simulated curved canal (angle = 75°, radius = 5 mm) with a thermal probe and a cooling airstream (minimum of 2 bars) attached to keep the temperature rise below 2°C. Torsional resistance was tested according to ISO 3630-1. Shaping was simulated in plastic blocks with standardized J-shaped curved root canals in a computer-controlled device to register real-time torque and force. Fracture patterns were assessed using scanning electron microscopy. Parametric statistics and Weibull analysis were used to compare groups. RESULTS The tested sizes for TN were significantly more fatigue resistant and reliable compared with PTN; torsional limits were similar, but twist angles at failure were larger for TN. No instruments fractured during simulated shaping, and the working torque and the threading-in force were significantly lower for TN. CONCLUSIONS This study showed the mechanical properties of both TN and PTN in terms of fatigue limit and torsional resistance and compared them with simulated canal shaping. TN was found to be more fatigue resistant and showed significantly more predicable torque and threading-in force compared with PTN.
Historically, obtaining several periapical radiographs has been recommended to diagnose horizonta... more Historically, obtaining several periapical radiographs has been recommended to diagnose horizontal root fractures. Assessing the 3-dimensional orientation of a fracture is correlated to treatment and outcome. However, conventional radiography yields only limited information for accurate diagnosis. Cone-beam computed tomography (CBCT) is a relatively new and useful technology, which provides an auxiliary imaging modality to supplement conventional radiography for evaluating horizontal root fractures. Despite the increasing application of this technology as well as a growing body of evidence supporting its value in diagnosing horizontal root fractures, there are no specific guidelines for its use. This article aimed to provide such preliminary guidelines for cases of suspected horizontal root fracture as a result of trauma. From a database search it was concluded that CBCT is most useful in cases in which conventional radiography yields inconclusive results or shows a fracture in the middle third of a root. In such cases CBCT may rule out false negatives, ie, a suspected root fracture not visualized with conventional radiography. For a root fracture in the middle third, CBCT may rule out or confirm an oblique course of fracture involving the cervical third in the labiolingual dimension. Although there are considerable advantages when CBCT is included in the assessment of horizontal root fracture and its possible sequelae, more experimental and clinical studies are warranted to determine the exact impact on outcomes.
Despite enjoying high favourable outcome rates, root canal treatment is not always successful. Ro... more Despite enjoying high favourable outcome rates, root canal treatment is not always successful. Root canal retreatment is a widely practised option for managing a non-healing root treated tooth. A basic distinction between retreatment and initial treatment is the requirement to remove the existing root filling material occupying the root canal space. Only then, can the technical deficiencies and possible causes of failure be addressed. Hence, the successful removal of the root filling material is critical to achieving the objectives of retreatment. Many different materials and techniques have been used for root canal filling, which have been documented in a plethora of studies; these are mainly laboratory studies investigating the removal of root filling materials. To help guide future research, which may then better inform clinical practice in relation to retreatment procedures, the focus of this narrative review is on the research methods and experimental models employed to study the removal of root filling materials. The current available literature demonstrates great variation in the research methodologies used to study the removal of root filling material, including direct visualisation by splitting tooth samples or clearing, three-dimensional radiographic imaging including using micro-computed tomography or cone beam computed tomography, and a combination of these techniques. Depending on the research method employed, variation also exists in quantification of root filling material removal; these include measurements of surface area, volume, or weight, and criteria-based (semi-quantitative) assessment. Experimental models, using human teeth or resin models, differ with respect to standardisation techniques and replication of the clinical scenario including initial sample preparation, canal filling, allocation, and technical aspects of retreatment procedures. Future models should replicate, as closely as possible, the clinical scenario. Currently, micro-computed tomography provides a highly detailed, non-invasive, and non-destructive method of objectively assessing and quantifying root filling removal.
Coronal preflaring NiTi files should possess proper hardness, resistance to fracture and flexibil... more Coronal preflaring NiTi files should possess proper hardness, resistance to fracture and flexibility. This study compared the bending resistance and cyclic fatigue resistance of three orifice preflaring NiTi files. HyFlex EDM Orifice opener (#25/12), HyFlex CM (#25/08) and One Flare (#25/09) were tested (n = 46/instrument). Bending resistance was assessed with the stress when perpendicular displacement was applied to a 3 mm point from the file tip, and was performed at either room temperature (RT, n = 10) or body temperature (BT, n = 10). Cyclic fatigue resistance was tested with an artificial ceramic root canal at RT (n = 10) and BT (n = 10), and the number of cycles to failure (NCF) was obtained. The bending resistance and the NCF results were analyzed by two-way ANOVA and Tukey’s test. Differential scanning calorimetry (DSC) and X-ray diffraction (XRD) analyses were performed (n = 3, respectively). HyFlex EDM exhibited the highest bending resistance, followed by One Flare and HyF...
Inflammation is a crucial step prior to healing, and the regulatory effects of endodontic materia... more Inflammation is a crucial step prior to healing, and the regulatory effects of endodontic materials on the immune response can influence tissue repair. This review aimed to answer whether endodontic sealers can modulate the immune cells and inflammation. An electronic search in Scopus, Web of Science, PubMed, and Google Scholar databases were performed. This systematic review was mainly based on PRISMA guidelines, and the risk of bias was evaluated by SYRCLEs and the Modified CONSORT checklist for in vivo and in vitro studies, respectively. In total, 28 articles: 22 in vitro studies, and six in vivo studies were included in this systematic review. AH Plus and AH 26 can down-regulate iNOS mRNA, while S-PRG sealers can down-regulate p65 of NF-κB pathways to inhibit the production of TNF-α, IL-1, and IL-6. In vitro and in vivo studies suggested that various endodontic sealers exhibited immunomodulatory impact in macrophages polarization and inflammatory cytokine production, which could...
AimTo report the most common terminology used in titles of scientific papers published in the Int... more AimTo report the most common terminology used in titles of scientific papers published in the International Endodontic Journal (IEJ) and Journal of Endodontics (JOE) between 1980 and 2019 and to identify the most‐cited papers in these journals.MethodologyThe Web of Science database was searched to retrieve all the manuscripts published in the IEJ and JOE between 1980 and 2019. The articles were analysed using the VOS viewer software and the terms within the titles extracted. The top‐10 terms were categorized according to the number of occurrences and the decade of publication. Maps were created using the text data for each decade of publication. Classic papers were identified when the number of citations was >400. During the same period of time, highly cited studies were identified including the authors, institutions and countries associated with these papers.ResultsTerms such as canal, molar and periapical lesion were the most commonly used in titles between 1980 and 1999. The t...
Journal of the American Dental Association, Aug 1, 2014
In 2010, one of the authors proposed that lasers could be used to enhance the decontaminating act... more In 2010, one of the authors proposed that lasers could be used to enhance the decontaminating action of sodium hypochlorite (NaOCl). The authors conducted a study to compare the disinfection efficacy of laser-activated irrigation (LAI) by using a photon-induced photoacoustic streaming (PIPS) tip with conventional irrigation and specifically LAI's ability to remove bacterial film formed on root canal walls. The authors shaped 26 human anterior teeth to a master apical file size of International Organization for Standardization 25/06 (size 25 tip and size .06 taper) and then sterilized the teeth, infected them with Enterococcus faecalis and incubated them for four weeks. The authors used two irrigation protocols. Group A received two cycles of 30 seconds each of 5 percent NaOCl laser activation and one cycle of 30 seconds with laser activation involving the use of 17 percent ethylenediaminetetraacetic acid (EDTA). The erbium:yttrium-aluminum-garnet (Er:YAG) laser's settings were 20 millijoules, 15 hertz, 50-microsecond pulse duration, and it had a 600-micrometer PIPS tip. Group B received two cycles of 30 seconds each of 5 percent NaOCl and 17 percent EDTA irrigation alone, delivered via a syringe with a 25-gauge needle. The authors found that group A had significantly better disinfection compared with group B (P < .05). The results of cultures obtained after 48 hours showed that disinfection was maintained better in group A compared with group B (P < .0001). Scanning electron microscopic images showed absence of bacterial biofilm remaining after LAI using PIPS. Er:YAG laser activation of 5 percent NaOCl and 17 percent EDTA was more effective than conventional irrigation for eradicating E. faecalis and preventing new bacterial growth ex vivo. Additional clinical studies are needed to clarify the effect on endodontic treatment outcomes. PIPS appears to be effective in enhancing the effect of the irrigants commonly used in endodontics.
Periapical inflammation is often responsible for distinct maxillary sinus (MS) changes. This retr... more Periapical inflammation is often responsible for distinct maxillary sinus (MS) changes. This retrospective, cross-sectional study evaluated the association between the clinical characteristics of periapical lesions (presence, size, and distance) in maxillary posterior teeth and the presence of sinus abnormalities by evaluating cone-beam computed tomographic (CBCT) images obtained from an archived collection. Apart from sex, no other patient information was available. The study sample was composed of CBCT images of 143 MSs of patients with at least 1 maxillary posterior tooth with a periapical lesion and 178 MSs of patients without periapical radiolucent lesions. Sinus abnormalities were classified as mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, and antral calcification; periapical radiolucent areas were classified using the CBCT periapical index, and the distance between the periapical lesion edge and the MS floor was measured. Data were analyzed using chi-square tests at a level of significance set at α = 0.05. Most sinus abnormalities were associated with at least 1 maxillary posterior tooth with a periapical lesion (P > .05). The most frequent sinus abnormality in the presence of a periapical lesion was mucosal thickening. All teeth with a CBCT periapical index score of 5 were associated with sinus abnormalities. The highest frequency of abnormalities was found when the radiolucent area was subjacent to the sinus floor. Maxillary posterior teeth with periapical radiolucent lesions had the highest frequency of sinus abnormalities. The size of a periapical lesion was not associated with the frequency of sinus abnormalities. A close spatial relationship between periapical lesions and sinuses resulted most frequently in sinus abnormalities.
INTRODUCTION This study aimed to investigate whether the direction of force applied to the occlus... more INTRODUCTION This study aimed to investigate whether the direction of force applied to the occlusal surface influenced the pattern of tensile stresses in roots of sound and root canal-prepared mandibular molar teeth. The effect of obturation forces on the development of apical stress was also investigated. To this end models were constructed using micro computed-tomography (MCT) and investigated using finite element analysis (FEA). METHODS MCT data established boundaries of internal and external model surfaces to allow FEA analysis. Individually segmented components were modelled based on mechanical properties in precedent literature. The following conditions were considered: axial force directed over the mesial marginal ridge, a mesial or a distal tipping force, a combination of both a torquing force and axial loading, as well as hydrostatic pressure. Maximum principal stresses (MPS) were determined. RESULTS Highest root stress occurred in the cervical third of root surfaces (i.e., not apically) under all loading conditions. Importantly, mesial tipping forces resulted in tension on distal roots, whereas distal tipping resulted in tension in the mesial roots. Intra-canal pressures produced tensile stress on the internal root canal walls in the cervical third of the root. Stresses were calculated to be less than the fatigue tensile strength of dentin. CONCLUSIONS Static loading, under the conditions modelled, does not result in stress concentration at the root apices that would cause root fracture under normal masticatory loads. Stress patterns developing from mesial and distal tipping forces help to explain the appearance of vertical root fractures reported in sound non-restored molar teeth.
The aim of the study was to compare cyclic fatigue (CF) resistance of reciprocating and rotary gl... more The aim of the study was to compare cyclic fatigue (CF) resistance of reciprocating and rotary glide path instruments in the presence of irrigation solutions at body temperature. CF resistance of 100 instruments (50 ProGlider and 50 WaveOne Gold Glider) was tested in sodium hypochlorite solutions alone (NaOCl) or in combination with etidronate (NaOCl/HEBP). The CF platform with a simulated canal (curvature = 60°/radius = 3 mm) was submerged in a temperature‐controlled bath with the solutions kept at 37 ± 1°C controlled by a precision mercury glass thermometer. Instruments were actioned following manufacturer guidelines, and time to failure was recorded and compared among groups with Weibull analysis. Reciprocating glide path preparation instruments were more resistant to CF than rotary instruments in both irrigation solutions. The irrigation solution did not affect the mean life of ProGlider, but reciprocating instruments lasted significantly longer used in presence of NaOCl compared to NaOCl/HEBP.
INTRODUCTION The aim of this study was to describe the mechanical properties both in stationary a... more INTRODUCTION The aim of this study was to describe the mechanical properties both in stationary and dynamic conditions in vitro of the novel TruNatomy (TN; (Dentsply Sirona, Ballaigues, Switzerland) shaping files and compare them with a conventional rotary system, ProTaper Next (PTN, Dentsply Sirona). METHODS Different sizes of 2 types of rotary files, TN and PTN, were compared for their fatigue limit (n = 20 each size) and torsional resistance (n = 6 each size) and subjected to simulated shaping (n = 6 each size). Fatigue limits were determined in a novel fixture including a tapered simulated curved canal (angle = 75°, radius = 5 mm) with a thermal probe and a cooling airstream (minimum of 2 bars) attached to keep the temperature rise below 2°C. Torsional resistance was tested according to ISO 3630-1. Shaping was simulated in plastic blocks with standardized J-shaped curved root canals in a computer-controlled device to register real-time torque and force. Fracture patterns were assessed using scanning electron microscopy. Parametric statistics and Weibull analysis were used to compare groups. RESULTS The tested sizes for TN were significantly more fatigue resistant and reliable compared with PTN; torsional limits were similar, but twist angles at failure were larger for TN. No instruments fractured during simulated shaping, and the working torque and the threading-in force were significantly lower for TN. CONCLUSIONS This study showed the mechanical properties of both TN and PTN in terms of fatigue limit and torsional resistance and compared them with simulated canal shaping. TN was found to be more fatigue resistant and showed significantly more predicable torque and threading-in force compared with PTN.
Historically, obtaining several periapical radiographs has been recommended to diagnose horizonta... more Historically, obtaining several periapical radiographs has been recommended to diagnose horizontal root fractures. Assessing the 3-dimensional orientation of a fracture is correlated to treatment and outcome. However, conventional radiography yields only limited information for accurate diagnosis. Cone-beam computed tomography (CBCT) is a relatively new and useful technology, which provides an auxiliary imaging modality to supplement conventional radiography for evaluating horizontal root fractures. Despite the increasing application of this technology as well as a growing body of evidence supporting its value in diagnosing horizontal root fractures, there are no specific guidelines for its use. This article aimed to provide such preliminary guidelines for cases of suspected horizontal root fracture as a result of trauma. From a database search it was concluded that CBCT is most useful in cases in which conventional radiography yields inconclusive results or shows a fracture in the middle third of a root. In such cases CBCT may rule out false negatives, ie, a suspected root fracture not visualized with conventional radiography. For a root fracture in the middle third, CBCT may rule out or confirm an oblique course of fracture involving the cervical third in the labiolingual dimension. Although there are considerable advantages when CBCT is included in the assessment of horizontal root fracture and its possible sequelae, more experimental and clinical studies are warranted to determine the exact impact on outcomes.
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