Dentinal Crack Formation Induced by Ultrasonic Tips and Laser as Compared to Conventional Burs During Root-end Preparation: A Systematic Review and Meta-analysis

Abstract

Aim:

The objective was to evaluate and compare the crack formation induced by ultrasonic tips and lasers with conventional burs during root-end preparation.

Materials and Methods:

The PROSPERO registration code for this study is CRD42023470898. Both manual and electronic database searches were performed up to 2023, August in three databases, namely, the Cochrane Library, PubMed and Google Scholar. In vitro or laboratory studies that employed the use of ultrasonic tips, LASER and conventional burs for root-end preparation on extracted teeth were collected. The data were extracted by two independent reviewers using a predesigned template. Information about the study design, year, full-text publications, inclusion and exclusion criteria were gathered. The PRISMA guidelines 2020 were followed in the reporting and execution of the systematic review and meta-analysis. To evaluate statistical heterogeneity, χ² values and I² values were employed in conjunction with a random-effects model for the meta-analysis.

Results:

A total of 689 articles were identified. After removing the duplicates in total 567 articles were screened. Finally, six articles were included in the meta-analysis. QUIN Risk of Bias tool showed an overall moderate risk of bias in the included studies. The pooled odds ratio for crack formation was 1.77 (0.82, 3.82) for ultrasonic tips and conventional burs suggesting higher odds of crack formation for ultrasonic tips.

Conclusion:

None of the included studies provided information on sample size calculation, sampling technique, randomization or blinding. The meta-analysis suggests higher chances of crack formation from ultrasonic followed by laser and conventional burs preparation. Therefore, efforts to standardize an acceptable procedure for root-end cavity preparation should be made in future study, along with encouragement of the clinical application of the same, taking into account issues like economic feasibility and convenience of usage.

Keywords

Apicoectomy Crack Lasers SEM Ultrasonic

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References

Kim

and Kratchman

Modern endodontic surgery concepts and practice: A review. J Endod, 2006; 32: 601–623.

von Arx

and Walker

3rd . Microsurgical instruments for root-end cavity preparation following apicoectomy: A literature review. Endod Dent Traumatol, 2000; 16: 47–62.

Palma

, Marques

, Casau

, . Evaluation of root-end preparation with two different endodontic microsurgery ultrasonic tips. Biomedicines, 2020; 8(10): 383. doi: 10.3390/biomedicines8100383 PMID: 32998221; PMCID: PMC7601836.

Chaudhry

, Yadav

, Oberoi

, . Evaluation of root‑end cavity preparation using erbium, chromium:yttrium, scandium, gallium, and garnet laser, ultrasonic retro tips, and conventional burs. J Dent Lasers, 2016; 10: 43.

Peters

, Peters

and Barbakow

An in vitro study comparing root-end cavities prepared by diamond-coated and stainless steel ultrasonic retro tips. Int Endod J, 2001; 34: 142–148.

Plotino

, Pameijer

, Grande

, . Ultrasonics in endodontics: A review of the literature. J. Endod, 2007; 33: 81–95.

von Arx

and Kurt

. Root-end cavity preparation after apicoectomy using a new type of sonic and diamond-surfaced retro tip: A 1-year follow-up study. J Oral Maxillofac Surg, 1999; 57: 656–661.

Khabbaz

, Kerezoudis

, Aroni

, . Evaluation of different methods for the root-end cavity preparation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2004; 98: 237–242.

Beling

, Marshall

, Morgan

, . Evaluation for cracks associated with ultrasonic root-end preparation of gutta-percha filled canals. J Endod, 1997; 23: 323–326.

10.

Bernardes

, Moraes

, Garcia

, . Evaluation of apical cavity preparation with a new type of ultrasonic diamond tip. J Endod, 2007; 33: 484–487.

11.

Lin

, Chou

, Kuo

, . The quality of ultrasonic root-end preparation: A quantitative study. J Endod, 1998; 24: 666–670.

12.

Bertrand

, Festal

, Barailly

. Use of ultrasound in apicoectomy. Quintessence Int, 1976; 7: 9–12.

13.

De Bruyne

and De Moor

. SEM analysis of the integrity of resected root apices of cadaver and extracted teeth after ultrasonic root-end preparation at different intensities. Int Endod J, 2005; 38: 310–319.

14.

Abedi

, Van Mierlo

, Wilder-Smith

, . Effects of ultrasonic root-end cavity preparation on the root apex. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995; 80: 207–213.

15.

Layton

, Marshall

, Morgan

, . Evaluation of cracks associated with ultrasonic root-end preparation. J Endod, 1996; 22: 157–160.

16.

von Arx

and Walker

3rd . Microsurgical instruments for root-end cavity preparation following apicoectomy: A literature review. Endod Dent Traumatol, 2000; 16(2): 47–62.

17.

Gilheany

, Figdor

, Tyas

. Apical dentin permeability and microleakage associated with root end resection and retrograde filling. J Endod, 1994; 20: 22–26.

18.

Karlovic

, Pezelj-Ribaric

, Miletic

, . Erbium:YAG laser versus ultrasonic in preparation of root-end cavities. J Endod, 2005; 31: 821–823.

19.

Lee

, Lin

, Chen

, . Tensile bond strength of Er,Cr:YSGG laser-irradiated human dentin and analysis of dentin–resin interface. Dent Mater, 2007; 23: 570–578.

20.

Secilmis

, Altintas

, Usumez

, . Evaluation of mineral content of dentin prepared by erbium, chromium:yttrium scandium gallium garnet laser. Lasers Med Sci, 2008; 23: 421–425.

21.

Arslan

, Bala

, Berk

, . Comparison of crack formation in retrograde cavities prepared with ultrasound Er,Cr:YSGG laser or bur: An ex vivo study. J Contem Dent, 2013; 3(1), 1–6.

22.

Aydemir

, Cimilli

, Yoruç

, . Evaluation of two different root-end cavity preparation techniques: A scanning electron microscope study. Eur J Dent, 2013; 7(02): 186–190.

23.

Page

, McKenzie

, Bossuyt

, . The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg, 2021; 88: 105906.

24.

Sheth

, Shah

, Jain

, . Development and validation of risk of bias tool for assessing in vitro studies conducted in dentistry: The QUIN. J Prosthet Dent, 2022; 131(6): 1038–1042. doi: 10.1016/j.prosdent.2022.05.019.

25.

Rainwater

, Jeansonne

, Sarkar

. Effects of ultrasonic root-end preparation on microcrack formation and leakage. J Endod, 2000; 26(2): 72–75.

26.

Aydemir

, Cimilli

, Mumcu

, . Crack formation on resected root surfaces subjected to conventional, ultrasonic, and laser root-end cavity preparation. Photomed Laser Surg, 2014; 32(6): 351–355.

27.

Mandviwala

, Agrawal

and Kapoor

. Evaluation of microcrack formation after root-end preparation with two different types of ultrasonic retro tips and conventional bur: A stereomicroscopic study. Endodontology, 2021; 33(2): 69–74.

28.

Braun

, Hagelauer

, Wenzler

, . Microcrack analysis of dental hard tissue after root canal irradiation with a 970-nm diode laser. Photomed Laser Surg, 2018; 36(11): 621–628.

29.

Alghamdi

and Shakir

The influence of Enterococcus faecalis as a dental root canal pathogen on endodontic treatment: A systematic review. Cureus, 2020; 12(3): e7257.

30.

Sohrabi

, Sooratgar

, Zolfagharnasab

, . Antibacterial activity of diode laser and sodium hypochlorite in Enterococcus faecalis-contaminated root canals. Iran Endod J, 2016; 11(1): 8–12.

31.

Samiei

, Shahi

, Abdollahi

, . The antibacterial efficacy of photo-activated disinfection, chlorhexidine and sodium hypochlorite in infected root canals: An in vitro study. Iran Endod J, 2016; 11(3): 179–183.

32.

Neves

GdV

, Santos

KSAd

, Rocha

EALdSS

, . Antibacterial effect of photodynamic therapy on root canal disinfection combined with different irrigation protocols. Iran Endod J, 2020; 15(2): 90–95.

33.

Hasna

, Khoury

, Toia

, . In vitro evaluation of the antimicrobial effect of N-acetylcysteine and photodynamic therapy on root canals infected with Enterococcus faecalis. Iran Endod J, 2020; 15(4): 236–245.

34.

Abdo

, Alkaisi

, Saleem

, . Clinical applications of lasers in endodontic. J Dent Res, 2018; 1(1): 7–15.

35.

Yoldas

, Yilmaz

, Atakan

, . Dentinal microcrack formation during root canal preparations by different NiTi rotary instruments and the self- adjusting file. J Endod, 2012; 38(2): 232–235.

36.

Kang

, Kim

. Cracked teeth: distribution, characteristics, and survival after root canal treatment. J Endod, 2016; 42(4): 557–562.

37.

Barone

, Covani

, Crespi

, . Root surface morphological changes after focused versus defocused CO₂ laser irradiation: A scanning electron microscopy analysis. J Periodontol, 2002; 73(4): 370–373.

38.

Komori

, Yokoyama

, Takato

, Matsumoto

. Clinical application of the erbium:YAG laser for apicoectomy. J Endod, 1997; 23(12): 748–750.

39.

Arashiro

, De Deus

, Belladonna

, . Dentinal microcracks on freshly extracted teeth: The impact of the extraction technique. Int Endod J, 2020; 53: 440–446.

40.

Gondim

Jr , Gomes

, Ferraz

, . Effect of sonic and ultrasonic retrograde cavity preparation on the integrity of root apices of freshly extracted human teeth: Scanning electron microscopy analysis. J Endod, 2002; 28: 646–650.