Comparison of Dentin Microstructure and Its Correlation to the Direction of Fracture Line in Mandibular Molars of Young and Older Individuals: In Vitro Study.

INTRODUCTION: The aim of the study was to assess the presence and extent of sclerotic dentin and to study its impact on the direction of fracture lines in extracted mandibular first molars of young (20-44 years) and older age groups (45 and older). METHODS: Extracted permanent mandibular first molars were collected along with the related demographic details. A total of 40 teeth were included in this study, 20 each from young age group (YA group) (20-44 years) and older age group (OA group) (45-70 years). All molars were decoronated, and the sectioned mesial roots were embedded in acrylic blocks. They were subjected to vertical force in a universal testing machine. Fractured roots were then examined under the stereomicroscope at ×8 magnification to determine the direction and pattern of the fracture line. The roots were then sectioned and evaluated at ×10 and ×20 magnification to assess the dentin microstructure and its correlation with the direction of the fracture line. Statistical analysis was done by using χ2 test (P < .05). RESULTS: A greater incidence and degree of sclerotic dentin were found in the OA group as compared with the YA group, which was statistically significant. The sclerotic dentin was distributed predominantly mesiodistally and the fracture line propagated buccolingually in both young and older groups, which was statistically significant (P < .05). CONCLUSIONS: The presence of sclerotic dentin mesiodistally may impede crack propagation in this direction for both young and older age groups, causing the fracture line to extend buccolingually in coronal third of the root.

Three-dimensional Assessment of Two-rooted Maxillary Central Incisor with Labiogingival Groove: Endodontic and Periodontal Surgical Management.

Understanding the diversity of root canal systems and their anatomical/morphological variations helps in achieving improved outcomes of root canal treatment. The outcome of endodontic treatment depends on a thorough knowledge of dental anatomy and its variations. Maxillary central incisor with two roots is a rare entity, so a complete clinical and radiological examination is important before initiating the treatment. Recently, three-dimensional (3D) radiography has improved the diagnosis and treatment planning in endodontics. So, the current report describes the endodontic and periodontal surgical management of traumatized discolored maxillary central incisors with two separated roots and root canals identified by two-dimensional (2D) and 3D radiographic examination. How to cite this article: Prasad P, Galani M, Nawal RR, et al. Three-dimensional Assessment of Two-rooted Maxillary Central Incisor with Labiogingival Groove: Endodontic and Periodontal Surgical Management. Int J Clin Pediatr Dent 2023;16(3):528-533.

Nonsurgical Management of a Large Periapical Lesion Following Instrument Retrieval From the Apical Third: A Case Report With a Three-Year Follow-Up.

Instrument separation in the apical third of the tooth, which is associated with a large periapical lesion, presents an arduous task for the clinician. This case report presents nonsurgical endodontic management of a maxillary central incisor associated with a large periapical lesion and a separated instrument in the apical third of the root canal. A 28-year-old male patient presented with pain and labial swelling in the left maxillary central incisor region. Pulp sensibility testing showed no response. The radiograph revealed the presence of a separated instrument in the apical third of the root canal and periapical radiolucency. A diagnosis of previously initiated therapy with acute apical abscess was made. In the first visit, instrument retrieval was done using ProUltra Endo tips (Dentsply Sirona, York, Pennsylvania) under a dental operating microscope. In the subsequent visit, obturation was done as the patient was asymptomatic. The patient was recalled for follow-up at six, 12, 18, 24, and 36 months. Complete healing of the periapical tissues was evident on the radiograph, and the tooth remained functional for the entire follow-up period of three years. The successful outcome seen in this case shows that even large periapical lesions can be managed conservatively by nonsurgical endodontic treatment.

Endodontic Management of Maxillary Central Incisor with Rare Root Canal Anatomy.

A maxillary central incisor presenting with more than one root or root canal is an exceptionally rare scenario considering the fact that most of the anatomic studies describe maxillary central incisor as a single rooted tooth with single canal. However, several case reports have shown the presence of up to four canals in maxillary central incisors. The aim of this article is to present a case report of maxillary central incisor with a rare anatomic variation, i.e. Vertucci's type V root canal anatomy. Failure to locate and clean additional root canal system may lead to post treatment disease. Hence, an astute clinician should be aware of possible anatomic variations this tooth might present with.

Low-level laser therapy for management of large periapical lesions associated with open apex cases.

CONTEXT: Low-level laser therapy (LLLT) is an established method to accelerate wound healing through the phenomenon of biostimulation. AIMS: This case study presents a novel approach for management of open apex cases associated with large peripapical lesions using 980-nm diode laser for biostimulation. SETTINGS AND DESIGN: Case report. MATERIALS AND METHODS: Two patients presenting with open apex associated with periapical lesion were selected. After access opening, canal disinfection was carried out with sodium hypochlorite and 980-nm diode laser. Calcium hydroxide was given as intracanal medicament for 1 week. When patient was asymptomatic, apical plug of 4-5 mm MTA was placed. In addition, seven sessions of LLLT were administered transcutaneously around the apices of involved teeth every alternate day for 15 days. RESULTS: One year follow-up radiograph revealed remarkable healing of the lesion. CONCLUSION: The combination of increased cellular proliferation with laser biostimulation and meticulous canal disinfection with lasers has the potential of accelerating healing of the periapical lesions.

Demystifying the Complexity: A Case Report on the Management of Mandibular Canine with Two Roots.

Mandibular canine often presents with only one root and one root canal in most of the cases. However, approximately 15% of the mandibular canines have two root canals and even less frequently two distinct roots. This article presents a case of root canal treatment in mandibular canine with two roots and two root canals. Meticulous cleaning and shaping followed by three-dimensional filling help in the successful treatment of such anatomical aberrations. Failure to do so may lead to post-treatment disease and further complications.