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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. /
NAME OF THE CANDIDATE AND ADDRESS (IN BLOCK LETTERS) /
DR.CHINMAYA KUMAR SAMANTAROY
BANGALORE INSTITUE OF DENTAL
SCIENCES AND HOSPITAL AND
POST GRADUATE RESEARCH CENTER,
5/3, HOSUR ROAD,
BANGALORE -560029
2. /
NAME NAME OF THE INSTITUTION /
BANGALORE INSTITUTE OF DENTAL SCIENCES AND HOSPITAL AND
POST GRADUATE RESEARCH CENTRE,
5/3, HOSUR ROAD,
BANGALORE-560029
3. /
COURSE OF STUDY AND SUBJECT /
MASTER OF DENTAL SURGERY IN
CONSERVATIVE DENTISTRY AND
ENDODONTICS.
4. /
DATE OF ADMISSION: /
18/04/2011
5. / TITLE OF THE TOPIC: / An in-vitro comparative evaluation of 3-dimensional volumetric analysis of fourobturation techniques in curved canals using spiral CT
6. / BRIEF RESUME OF THE WORK:
6.1 NEED FOR STUDY:
Success of endodontic therapy hinges on effective cleaning and shaping followed by a three dimensional obturation of the entire root canal system. The primary objective of endodontic obturation is to completely seal the pulp space both apically and laterally in order to ensure the healing and sustained health of the peri-radicular tissues1.
An ideal obturating material should provide a complete fluid-tight seal of the entire root canal space to prevent ingress of bacteria and their toxins into the peri-radicular tissues2.
Gutta-percha, in conjunction with a sealer is presently the most widely accepted obturating material. Over the years many techniques have been introduced to effectively and efficiently fill the root canal space with gutta-percha. Lateral compaction is one of the most common techniques in clinical practice5. However its ability to replicate the internal surface of the root canal has been questioned1. This technique relies on sealer to fill accessory anatomy because the core filling material will not move out of the main canal6.
In recent years, with Ni-Ti rotary instruments gaining widespread acceptances, obturation using matched greater taper gutta-percha cone without the requirement for accessory cones has also emerged as a well-accepted technique.
Thermoplasticized injectable obturation techniques and coated carrier systems are available in recent times to improve the seal and quality of root canal obturation. EQ obturating system is a thermoplasticized injectable technique that was introduced to improve the homogeneity and surface adaptation of gutta-percha1. It utilizes the regular mode of vertical condensation for the apical-third3. Thermafil system (Dentsply) consists of a flexible central coated with a layer of alpha-phase gutta-percha. The device is heated to soften the gutta-percha before insertion into the canal6.
Numerous methods have been employed over the years to assess the quality of obturation. These include leakage studies, microscopic analysis and clearing techniques. These methods are invasive, labour intensive and also result in loss of material upon sectioning.
High-resolution computed tomography is an emerging technology with several promising applications in many fields of dentistry. Spiral (helical) CT scan is a rapid, non-invasive tool that supports effective differential diagnosis of hard and soft tissues structures. Spiral CT offers the advantage of accurately measuring the volume occupied by gutta-percha and the 3-D adequacy of various obturating techniques. This is therefore a superior means of assessing the quality of root canal obturation.
Therefore, the aim of present study is to evaluate the 3-dimensional volumetric analysis of four obturation techniques, – 1)Lateral compaction, 2)Single- Cone technique, 3)Thermafil system and 4) EQ obturating system in curved canals of mandibular premolars using spiral CT.
6.2 REVIEW OF LITERATURE:
  1. A study1 was done to volumetrically analyse and compare laterally condensed, vertically compacted thermo-plasticized, and cold free flow gutta percha obturation using spiral CT. It was found that cold free flow obturation showed the highest volume of obturation followed by vertically compaction thermo-plasticized technique. While the least volume of obturation was observed in cold lateral compaction.
  2. A study2 was done to measure the percentage of volume of voids and gaps in root canals obturated with different obturation materials by using micro-computed tomography. It was found that gutta-percha showed less voids and gaps than roots filled with remaining filling materials.
  3. A study3 was done to evaluate the adequacy of three obturation techniques namely lateral condensation, EQ fil and Thermafil techniques using three dimensional helical computed tomography by volume rendering method. It was found that lateral condensation technique showed maximal inadequacy of obturation and thermafil showed the least inadequacy of obturation.
  1. A study4 was done to evaluate the ability of three obturation methods to seal root canals prepared using 0.06 taper rotary instruments using dye penetration. 3 obturation methods used were System B technique with 0.06 taper standardized gutta-percha, System B technique with non-standardized MF gutta-percha points and the third was cold lateral condensation using standardized 0.02 taper master gutta-percha points. It was found that the group obturated with system B and 0.06 taper gutta percha points showed least dye penetration.
  1. A study5 was done to evaluate and compare the sealability and radiographic quality of root fillings in extracted teeth by using lateral condensation of gutta-percha or alpha phase gutta-percha in conjunction with single gutta-percha cone. It was concluded that thermo-mechanically condensed alpha phase gutta-percha used in conjunction with single gutta-percha cone had poorer radiographic quality than laterally condensed gutta-percha.
  1. A study6 was done to determine the percentage of gutta-percha filled area in the apical-third of root-canal when filled with either Thermafill, System B or lateral condensation. It was found that Thermafil produced significantly higher percentage of gutta-percha filled area than lateral condensation and System-B techniques.

6.3 OBJECTIVES OF THE STUDY:
The aimof the study is to comparatively evaluate 3-dimensional volumetric analysis of four obturation techniques namely Single cone, Thermafil, Lateral compaction and EQ system in curved canals using spiral CT.
7. / MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
60 freshly extracted, human mandibular premolars teeth will be collected from the Department of Oral Surgery, Bangalore Institute of Dental Science and Government Dental College.
Inclusion criteria:
  • 60 mandibular premolars with mature root apex and curved root canals with 20 to 40 degrees curvature will be included for this study.
Exclusion criteria:
  • Teeth with incompletely formed apices
  • Fractured teeth
  • Resorption
  • Endodontically treated teeth
7.2 METHODS OF COLLECTING THE DATA:
60human mandibular premolars will be used in this study. The teeth collected will be cleansed of visible blood and debris and maintained in a hydrated state. Sodium hypochlorite diluted with tap water in the ratio 1: 10 will be employed to reduce bacterial accumulation during storage of teeth. Teeth will be stored in an economical storage solution like saline or water. Teeth will be placed in well-constructed container with a secure lid.
Canal access angle technique will be used for determining the canal curvature and tooth with root curvature of 20 to 40 degrees were selected for the study.
Access cavity preparation will be done for the 60 sample using a No.2 endodontic access bur. Working length determination will be done using a size 10 k-file. Canal preparation will be done using M-two upto size 30, 6% taper. Sodium hypochlorite and saline will be used as irrigant between each instrumentation. EDTA was used as a lubricant. After canal preparation the root canals will be dried using absorbent points.
Then the teeth will be numbered from 1 to 60. First spiral CT scan will be done under high resolution, both cross-sectionally and longitudinally with a constant thickness. Area of the prepared root canal in each slice will be measured from cement-enamel junction to apex of the root. Finally volume(V) of each slice will be calculated by:-
V = calculated area x thickness of each slice selected
Volume of each slice will be calculated using this formula and finally added together to find the total root canal volume(X).
60 teeth will be randomly divided into 4 groups of 15 each. In all the teeth AH plus sealer will be placed along the prepared canal walls using Lentulo-spirals and finally obturated using one of the following obturating techniques.
  • Group-I : ISO 0.06 taper size 30 standardized M-two gutta-percha cones will be selected to match the master apical file and will be coated with AH plus sealer and obturated.
  • Group-II : Canal will be obturated by using 30 size Thermafil obturation.
  • Group-III : ISO size (.02 taper) gutta-percha will be coated with AH-plus sealer and placed in the canal and laterally compared using a spreader 1mm short of the working length making space for the next gutta-percha point process. This will be repeated until the entire canal was filled with gutta-percha.
  • Group-IV: canal will be obturated by using EQ obturating system.
A second spiral CT will be performed to determine the volume of the gutta-percha and sealer filled by various obturating technique. The area occupied by gutta-percha and sealer will be measured for each tooth(Y).
The, percentage of obturated volume(POV) in each tooth will be calculated using the formula:
POV = (Y/X) X 100
Finally statistical analysis will be performed with non – parametric tests. Intra – group comparison will be done with Kruskal – Wallis test and inter – group comparison will be done with Mann-Whitney U test.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
Not applicable.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Not applicable.
8. / LIST OF REFERENCES:
1. Deivanayagam kandaswamy, Nagendrababu Venketeshbabu,
Reddy Gopi Krishna, Rosaline Hannah, Ganesh Araathi, Riaz Roohi.
Comparision of laterally condensed, vertically compacted thermoplasticized, cold free-
flow GP obturations – A volumetric analysis using spiral CT
Journal of Conservative Dentistry, 2009; 12(4): 145-149.
2. Mohammad Hammad, Alison Qualtrough and Nick Silikas.
Evaluation of root canal obturation: A three- dimensional in-vitro study.
Journal of Endodontics, 2009; 35(4): 541- 544.
3. M Chokkalingam, Ramprabha, D Kandaswamy.
Three-dimensional helical computed tomographic evaluation of three
obturation techniques: In-vitro study.
Journal of Conservative Dentistry, 2011; 14(3): 273- 276.
4. Solaiman M.Al- Hadlaq and Abdulmohsen A. Al-Rabiah.
In vitro evaluation of three techniques to obturate 0.06 taper canal preparations.
Australian Endodontic Journal, 2005; 31(2): 63- 65.
5. Ralph M.P.Gilhooly, Simon J. Hayes, Susan T. Bryant and Paul M.H.Dummer
Comparision of lateral condensation and thermomechanically compacted warm
alpha- phase gutta-percha with a single cone for obturating curved root canals.
Oral Surg., Oral Med., Oral Path. & Endodontics, 2001; 91(1): 89-94.
  1. G.De-Deus, E.D.Gurgel-Filho, K.M. Magalhaes and T. Coutinho-Filho A laboratory analysis of gutta-percha-filled area obtained using Thermafil, System B and lateral condensation.
International Endodontic Journal, 2006; 39: 378- 383.
9. /
SIGNATURE OF THE CANDIDATE / (Dr. CHINMAYA KUMAR SAMANTAROY)
10. /
REMARKS OF THE GUIDE
11. / NAME AND DESIGNATION OF
(IN BLOCK LETTERS)
11.1 GUIDE / Dr. RAMYA RAGHU, MDS
PROFESSOR AND H.O.D,
DEPARTMENT OF CONSERVATIVE
DENTISTRY AND ENDODONTICS,
BANGALORE INSTIUTE OF DENTAL
SCIENCES & HOSPITAL,
BANGALORE-560029
11.2 SIGNATURE OF GUIDE
11.3 HEAD OF THE
DEPARTMENT
11.4 SIGNATURE / Dr. RAMYA RAGHU, MDS
PROFESSOR AND H.O.D
DEPARTMENT OF CONSERVATIVE
DENTISTRY AND ENDODONTICS,
BANGALORE INSTIUTE OF DENTAL
SCIENCES & HOSPITAL,
BANGALORE-560029
12. / 12.1REMARKS OFCHAIRMAN
ANDPRINCIPAL
12.2 SIGNATURE