Giornale Italiano di Endodonzia (2018) 32, 47—50

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Removal of fiber posts during endodontic

retreatments using ultrasonic tips: A comparison
between two different endodontic fiber posts
Ritrattamento di denti trattati endodonticamente e ricostruiti con perni in
fibra: Tecniche di rimozione, vantaggi e limiti

Lorenza Capriotti *, Katia Greco, Gaetano Paolone, Maria Teresa

Sberna, Giuseppe Cantatore

Università degli Studi Vita-Salute San Raffaele, Milano, Italy

Received 27 February 2018; accepted 17 April 2018

KEYWORDS Abstract
Fiber post; Aim: The purpose of this study was to evaluate temperature changes generated on radicular
Retreatment; surface of extracted monoradicular teeth during ultrasonic removal of fiber posts.
Ultrasonic tips; Methodology: Forty intact monoradicular teeth, with not less than 15 mm root canal length,
Temperature increase; with mature apex and without root fractures, were selected. After root canal instrumentation
Thermographic and obturation of teeth, dowel space preparation was obtained at 9 mm length. Samples were
measurements. randomly divided into two groups according to the type of fiber post used: the first group received
quartz fiber posts D.T. Light Post n. 0.5; the second group cemented silica fiber post TECHOLE S
with central hole. Removal technique was performed with microblades ultrasonic tips, in
particular Start-X #3. Operative protocol provided succession of dry use of ultrasonic inserts
for a period of 25 s, air cooling for 25 s and water cooling for 25 s, until posts entire removal.
Thermographic measurements were recorded taking photography and videos using Thermal
Imaging Camera FLIR-One.
Results: Results show that dry use leads to rapid increase in root surface temperature beyond
critical limit, while both air cooling and water one decreases it to lower value for both of groups.
The best results were obtained by water cooling.

* Corresponding author at: Via Antonio Orsini 1, Ascoli Piceno 63100 (AP), Italy.
E-mail: lorenzacapriotti@gmail.com (L. Capriotti).
Peer review under responsibility of Società Italiana di Endodonzia.

https://doi.org/10.1016/j.gien.2018.04.002
1121-4171/ß 2018 Società Italiana di Endodonzia. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
48 L. Capriotti et al.

Conclusions: Air or water cooling seems to be essential during the use of ultrasonic tips to reduce
the risk of periodontal tissue and bone damage due to an excessive temperature raise. It’s
necessary to increase the samples number to conduct statistical analyses.
ß 2018 Società Italiana di Endodonzia. Production and hosting by Elsevier B.V. This is an open
access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/
4.0/).

PAROLE CHIAVE Riassunto

Perni in fibra; Obiettivi: Lo scopo di questo lavoro è quello di valutare su denti estratti le variazioni di
Ritrattamento; temperatura che si sviluppano lungo la superficie radicolare durante la rimozione ultrasonica
Punte ultrasoniche; di due tipologie di perni endocanalari in fibra.
Aumento temperatura; Materiali e metodi: Sono stati selezionati 40 denti integri monoradicolari, con lunghezza
Misurazioni canalare minima di 15 mm, apice maturo e assenza di fratture radicolari. Dopo preparazione
termografiche. ed otturazione canalare, è stato preparato un ‘‘dowel space’’ della profondità costante di 9 mm. I
campioni sono stati divisi in due gruppi: nel gruppo A sono stati cementati perni in fibra di quarzo
D.T. Light Post n. 0.5; nel gruppo B perni cavi in fibra di silice TECHOLE S. La procedura abrasiva
dei perni è stata effettuata con punte ultrasoniche multilama StartX #3, alternando 25 secondi di
lavoro a secco, con raffreddamento ad aria e con raffreddamento ad acqua fino alla completa
rimozione del perno ed effettuando le misurazioni termografiche tramite Termocamera ad
infrarossi Flir-One.
Risultati: Il lavoro a secco ha mostrato un brusco innalzamento della temperatura sulla
superficie radicolare in entrambi i gruppi, mentre entrambe le tipologie di raffreddamento
sono state efficaci nel mantenere bassi valori di temperatura. Il raffreddamento ad acqua ha
ottenuto i risultati migliori.
Conclusioni: Risulta di primaria importanza la fase di raffreddamento durante l’uso degli inserti
ultrasonici per evitare un eccessivo aumento della temperatura con la possibilità di indurre danni al
tessuto parodontale circostante e all’osso alveolare. È necessario aumentare il numero dei campioni
per ottenere risultati con possibili differenze statisticamente significative tra i due gruppi.
ß 2018 Società Italiana di Endodonzia. Production and hosting by Elsevier B.V. Cet article est publié en
Open Access sous licence CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Introduction
When an endodontic retreatment of an element restored
with fiber post is needed, it will be necessary to remove the
post to complete ‘‘disassembling phases’’; during this phase,
however, an increase in the temperature of the root surface
can occur, that could be a detrimental effect on the cells of
the periodontal ligament and the alveolar bone.
The purpose of the study is to evaluate, through a ther-
mographic analysis, if the temperature variations, that occur
on the root surface of extracted teeth during the removal of
two types of fiber posts with dedicated ultrasonic tips, go
beyond physiologically values consented from the hard tis-
sues surrounding the dental element.
Materials and methods
Forty single-rooted teeth (27 premolars, 8 incisors, 5 canines)
with a root canal length greater than 15 mm, mature root
apex and no signs of infractions or fractures on the root
surface, were selected. Pulp chambers were opened and
probing, pre-flaring and shaping of all the samples were
performed with Protaper Universal from S1 to F2; later,
the obturation of the canals was carried out with System B
technique and Top Seal endodontic cement.
All clinical crowns were transversely sectioned at 1 mm
from the cemento-enamel junction; then, a constant depth
of 9 mm Post Space was performed with calibrated drill D.T.
Light Universal #0.5. The samples were divided into two
groups of 20 elements each:
 Group A: quartz fiber post (D.T. LIGHT-POST #0.5) cemen-
tation with dual Core-X Flow cement (Fig. 1A—H).
 Group B: silica fiber posts with central hole (TECHOLE S)
cementation with NEW TECHCEM dual self-adhesive
cement (Fig. 2A—H).
The removal due to wear of fiber post was performed with
ultrasonic tips Start-X # 3, until their total removal, alter-
nating:
 25 s of dry work;
 25 s of work with air cooling of Stropko syringe;
 25 s of work with water cooling by waterport of ultrasonic
tip.
During the procedure, the thermographic measurements
were performed by means of Flir-One Infrared Thermal
Imaging Camera, recording the highest and lowest values
of the temperature reached on the root surface for all the
phases of the working protocol and taking thermographic
images after each phase.
Results
Dry use of ultrasonic inserts led to a more abrupt tempera-
ture raising on the root surface up to a maximum value of
46.6 8C (Fig. 3). Higher values of temperature were recorded
during dry use in group A, with a difference of 4.1 8C com-
pared to Group B. Air cooling using Stropko syringe, although
Cementation of fiber posts before endodontic retreatment
Figure 1 Cementation phases of quartz D.T. Light Post (Group A).
Figure 2 Cementation phases of silica TECHOLE Post (Group B).
effective in both groups, was most significant in Group B,
while water cooling appeared to be equivalent in both
groups. However, the best results were obtained with the
use of water cooling in both group: the water, that come from
the tip itself, thanks to the presence of waterport in the
ultrasonic Start-X tips, is able to effectively cool the insert
during the phases of work.
49
Discussion
During the retreatment of teeth reconstructed with fiber
posts, the removal by wear of the post with dedicated
ultrasound tips can cause an increase in the external tem-
perature of the root surface with more or less severe com-
50
Figure 3 Termographic image of the value of the maximum
temperature reached.
plications for the periodontal ligament. In particular, it would
seem to play a decisive role the dry or under-cooling use of
dedicated ultrasonic tips. Dry use of ultrasonic tips would
seem to cause an increase in the values of the external root
temperature beyond the allowed physiological limits and
would seem to be more relevant in the case of removal of
high density fiber posts (DT LIGHT-POST), compared to the
removal of hollow posts (TECHOLE). Although the air-cooled
procedure was effective, the most suitable procedure would
seem to be water-based to maintain the ‘‘working’’ tem-
perature within the physiological body temperature range.
This procedure, in fact, would record temperatures closer to
those of body temperature regardless of the type of post
used.
L. Capriotti et al.
Conclusions
In a case of endodontic retreatment it would be preferable to
use ultrasonic inserts with ‘‘waterport’’ because, among the
many advantages, it would effectively lower the tempera-
ture on the tip and on the work area, safeguarding the health
of the tooth-ligament-alveolar bone complex.
Clinical relevance
The cooling of the ultrasonic tips would be fundamental for
the protection of the tooth support tissues during the fiber
posts removal.
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgement
The authors thank Prof. Enrico Gherlone for his assistance in
this study.
Further reading
1. Basrani B, Haapasalo M. Update on endodontic
irrigating solutions. Endod Top 2012;27:74—102.2.
Dineshkumar MK, Vinothkumar TS, Arathi G, Shanthis-
ree P, Kandaswamy D. Effect of ethylene diamine tetra-
acetic acid, MTADTM, and HEBP as a final rinse on the
microhardness of root dentin. J Conserv Dent
2012;15(2):170—173.3. Cantatore G, Malagnino VA,
Passariello P. Indagine al SEM di 2 differenti metodiche
di detersione canalare. G It Endo 1994;4(8):151—
156.4. Meredith N, Sherriff M, Setchell DJ, Swanson
SA. Measurement of the microhardness and Young’s
modulus of human enamel and dentine using an inden-
tation technique. Arch Oral Biol 1996;41:539—45.5.
Libman WJ, Nicholls JI. Load fatigue of teeth restored
with cast posts and cores and complete crowns. Int J
Prosthodont 1995;8:155—61.