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-treatment of gutta-percha filled root canals. Int Endod J, 2002; 35:651-654. 5. Brown DC, Moore BK, Brown CE Jr, Newton CW. An in vitro study of apical extrusion of sodium hypochlorite during endodontic canal preparation. J Endod, 1995; 21:587-591. 6. Burklein S, Schafer E. Apically extruded debris with reciprocating single-file and full-sequence rotary instrumentation systems. J Endod, 2012; 38:850-852. 7. Caliscan M. Nonsurgical retreatment of teeth with periapical lesions previously managed by either endodontic or surgical intervention. Oral Surg Oral Med Oral Pathol Oral

importance of material preparation for the expression of cytotoxicity during in vitro evaluation of biomaterials. J Endod , 1988; 14:247-250. 5. Delany GM, Patterson SS, Miller CH, Newton CW . The effect of chlorhexidine gluconate irrigation on the canal flora of freshly extracted necrotic teeth. Oral Surg , 1982; 53:518-522. 6. Vivacqua-Gomes N, Ferraz CC, Gomes BP, Zaia AA, Teixeira FB, Souza-Filho FJ . Influence of irrigants on the coronal microleakage of laterally condensed gutta-percha root fillings. Int Endod J , 2002; 35:791-795. 7. Basrani BR, Manek S, Sodhi


Root fractures are relatively uncommon among other dental traumas and mostly affect the anterior dentition. This case report presents the endodontic and prosthodontic management of a maxillary central incisor with a combined fracture in the middle third of the root and the crown, as well as the 7-year follow up of the case. The healing potential of a horizontal root fracture in the middle third of the root is highlighted when appropriate treatment is applied. MTA used for obturation of the coronal fragment, induced hard tissue formation apically and promoted healing in the area, while the 2mm MTA left as apical barrier at the second stage of re-treatment and obturation with gutta-percha prevented its extrusion. The multidisciplinary approach in the management of such cases ensures a long term survival.


Background/Aim: The aim of root canal treatment is the thorough cleaning, shaping and obturation of the root canals. Variations in root canal anatomy increase the difficulty of the root canal treatment and therefore the possibility of failure. The mandibular premolars often present complex anatomy and the existence of mandibular second premolars with three root canals is very scarce. This report presents the successful endodontic management of four mandibular second premolars with three root canals.

Cases Report: In all cases working length was estimated using the working length radiograph and an apex locator. Canal orifices were enlarged with Gates-Glidden drills and manual instrumentation performed with Stainless Steel reamers and Hedstroem files, using either step-back or crown-down technique. Sodium hypochlorite (NaOCl) 2.5% was used as an irrigant. Root canal obturation were then performed using the cold lateral condensation technique with gutta-percha points and Roth’s 801 canal sealer. The cases were scheduled for clinical and radiographic follow-up examination. Clinically in all follow-up examinations the teeth were asymptomatic. For the three cases with periapical lesions, post treatment radiographs, demonstrated periapical healing. Additionally, in the case without periapical lesion, the 9 months recall radiograph revealed healthy periapical conditions.

Conclusions: Mandibular premolars should never be underestimated and the clinician should always be alerted for anatomic variations.


Objective: The aim of our study is to compare the ability of two nickel-titanium systems that use different rotation motions to create preparations that could promote a complete filling of the apical third of root canals.

Methods: We used 36 freshly extracted teeth, randomly divided in two groups, as follows: in Group A we used ProTaper Next, a system characterized by a continuous rotary motion and in Group B the teeth were instrumented with Wave-One, in which the files have a reciprocating motion. All teeth were root filled based on the same protocol, using gutta-percha and AH Plus. The teeth were further prepared for microleakage evaluation based on dye penetration technique, as follows: immersion in 2% methylene blue, longitudinally sectioned and examination of the apical thirds with an operating microscope. The distance of dye penetration along dentin walls was measured using the ImageJ program.

Results: The comparison between rotational and reciprocating systems showed that reciprocating files significantly promoted a reduced apical microleakage, as demonstrated by unpaired t test, Welch corrected (p=0.0346).

Conclusion: The use of Wave-One Reciprocating system was considered more effective in the shaping of root canals, as they demonstrating better conditions for the hermetic, tridimensional sealing of apical third of the roots canals.

RL, Schuster GS, Weller RN, Ferrari M, Pashley DH, Tay FR. Sealing properties of two contemporary single-cone obturation systems. Int Endod J 2007; 40:374-385. 10. Somma F, Cretella G, Carotenuto M, Pecci R, Bedini R, De Biasi M, Angerame D. Quality of thermoplasticized and single point root fillings assessed by micro-computed tomography. Int Endod J 2011;44:362-369. 11. Scărlătescu SA, Iliescu A, Didilescu AC, Ştefan DS, Iliescu AlA. A comparative study of the root canal fillings based on warm gutta-percha condensation techniques. Int J of Romanian Dent 2012a;2

for retreatment. J Endod, 1988;14:607-614. 5. Mandel E, Friedman S. Endodontic retreatment: a rational approach to root canal reinstrumentation. J Endod, 1992;18:565-569. 6. Friedman S, Stabholz A, Tamse A. Endodontic retreatment: case selection and technique - part 3: Retreatment techniques. J Endod, 1990;16:543-549. 7. Hülsmann M, Stotz S. Efficacy, cleaning ability and safety of different devices for gutta-percha removal in root canal retreatment. Int Endod J, 1997;30:227-233. 8. Pitt Ford TR, Rhodes JS. Root canal retreatment: 2 practical solutions. Dent Update

controlled trial. F1000Res, 2018;7:1768. 9. Wong AW, Tsang CS, Zhang S, Li KY, Zhang C, Chu CH. Treatment outcomes of single-visit versus multiple-visit non-surgical endodontic therapy: a randomised clinical trial. BMC Oral Health, 2015;15:162 10. Kandemir Demirci G, Çalışkan MK. A prospective randomized comparative study of cold lateral condensation versus core/gutta-percha in teeth with periapical lesions. J Endod, 2016;42:206-210. 11. U.S. National Library of Medicine. National Institutes of Health. HTA 101: Glossary. Systematic review. Available from: https

reaction. Anesth Analg , 1993; 76:650-652. 72. Birmingham PK, Dsisa RM, Grayhack JJ, Han J, Wheeler M, Pongracic JA, et al . Do latex precautions in children with myelodysplasia reduce intra-operative allergic reactions? J Pediatr Orthop , 1996; 16:799-802. 73. Pumphrey RS, Duddridge M, Norton J . Fatal latex allergy. J Allergy Clin Immunol , 2001; 107:558. 74. Costa GE, Johnson JD, Hamilton RG . Cross-Reactivity studies of gutta-percha, gutta-balata, and natural rubber latex (Hevea brasiliensis). J Endod , 2001; 27:584-587. 75. Hamann C, Rodgers PA, Alenius H

Ch, Jungback LI, Wrbas KT. Comparison between two thermoplastic root canal obturation techniques regarding extrusion of root canal filling- a retrospective in vivo study. Clin Oral Invest, 2013; 17:449-454. 8. Khabbaz MG, Papadopoulos PD. Depositiion of calcified tissue around an overextended gutta-percha cone: case report. Int Endod J, 1999; 32:232-235. 9. El Ayouti A, Weiger R, Lost C. Frequency of overintrumentation with an acceptable radiographic working length. J Endod, 2001; 27:49-52. 10. Vier FV, Figueiredo JAP. Prevalence of different periapical lesions