Micro-computed Tomography-aided Evaluation for Root Dentin Micro-cracks after Root Canal Instrumentation in Diabetic
Vimala Ranjhani1, Hrudi Sundar Sahoo1
1Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College and Hospital, Dr. M. G. R. Educational and Research Institute, Chennai, Tamil Nadu, India.
Context:
Dentinal microcracks during root canal preparation with endomotor-driven files suggest adverse consequences, while research results remain inconsistent. Diabetic individuals have modified dentin properties due to advanced glycation end-products (AGEs), altering collagen-rich tissue mechanics. Age-related changes and diabetes reduce mechanical strength and cause progressive dentinal tubule occlusion.
Aims:
This pilot in vivo study assessed microcrack formation following rotational and reciprocating instrumentation in diabetic versus nondiabetic elderly adults using micro-computed tomography (CT).
Settings And Design:
Pilot in vivo comparative study design.
Subjects And Methods:
Twenty-two vital mandibular anterior teeth from patients aged 50-70 years requiring extraction were included. Teeth were categorized into diabetic (n = 9) and nondiabetic (n = 8) groups, instrumented with ProTaper Gold or Reciproc Blue systems. An over-instrumented control group (n = 5) was prepared 3 mm beyond the apex. Following atraumatic extraction, specimens were scanned using micro-CT (7.9 μm resolution) and analyzed for microcracks in coronal, middle, and apical thirds using ImageJ software.
Statistical Analysis Used:
Frequency and percentages were calculated for microcrack occurrence.
Results:
Irrespective of the type of instrumentation, no microcracks were observed in diabetic or nondiabetic groups. In the over-instrumented group, 60% of samples (3/5) developed incomplete apical microcracks extending from the canal into root dentin.
Conclusions:
Root canal instrumentation to apical constriction did not produce microcracks in diabetic or nondiabetic older patients. However, over-instrumentation significantly increased microcrack formation, suggesting adherence to root canal anatomy improves endodontic treatment efficacy.
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