Endodontic management of maxillary supplementary premolar using cone-beam computed tomography.

UNLABELLED: Extra teeth in dentition is termed as 'supernumerary teeth' and is a very well-known dental developmental anomaly. Supernumerary premolars are a rare anomaly in the maxillofacial complex. Its rarity and complex characteristics often makes it difficult to treat. Radiographs play an important role in assessment of both the location and the typing of supernumerary teeth. This article reports the rare case of 'nonsyndromic bilateral maxillary supernumerary premolars' in which the endodontic management of supernumerary premolar tooth is described. In this case the value of cone-beam computerized tomography is also emphasized. CLINICAL SIGNIFICANCE: Developmental anomalies can occur in any tooth and supplementary premolars are no exception. The complexity of such teeth has to be considered for planning endodontic treatment to increase the chances of success.

Effect of final irrigating solutions on penetration depth of resin-based sealers into dentinal tubules.

Background: The goal of root canal therapy depends on chemomechanical debridement and three-dimensional filling of the root canal system.[1]. Aim: The aim of this study is to assess the effect of NaOCl + Ethylenediaminetetraacetic acid (EDTA) and Twin Kleen as a final irrigating solution on the depth of penetration of AH Plus and Perma Evolution sealers into the dentinal tubules. Materials and Methods: Forty mandibular premolars were decoronated and instrumented up to size 30. Moreover, randomly assigned into two groups based on final rinse Group A (n = 20): 5.25% NaOCl + 17% EDTA. Group B (n = 20): Twin Kleen solution. Resin sealers were labeled with few grains of fluorescent rhodamine B dye and subdivided into two subgroups, Subgroup A1and B1 (n 1= 10): AH Plus; Subgroup A2 and B2 (n 2= 10): Perma Evolution and obturated. Confocal laser scanning microscopy was used to examine the sections taken 2, 5, and 8 mm from the apex. Images were exported to Image J software to determine the sealer penetration depth. Statistical Analysis: Independent t-test and one-way analysis of variance followed by Tukey's HSD post hoc test. Results: Maximum depth of sealer penetration was seen in Twin Kleen in all sections. Perma Evolution showed highest sealer penetration at the middle and apical third region of root canal for both groups. Conclusions: Final irrigation with Twin Kleen produced highest sealer penetration than with EDTA.

Biological posts and crown: An esthetic recovery of smile.

Anterior teeth fracture is a common form of dental trauma that mainly affects children and adolescents. Maxillary incisors are the most commonly affected teeth. Loss of coronal tooth structure might affect esthetics and function. In recent decades, dentistry has shown many scientific and technological advances in restorative materials. However, no synthetic restorative material can replicate the natural tooth structure. Hence, the use of natural tooth as a restorative material has been suggested in literature and is termed as a biological restoration. The present case report represents the successful use of biological post and crown and was adequate with respect to adhesion, function, and esthetics with the follow-up period of 1 year. Hence, it may be concluded that the biological restoration, if feasible, is a cost-effective way to restore a damaged tooth with acceptable esthetics and tooth functions in the stomatognathic system.

Clinical efficacy of universal adhesives for the restoration of noncarious cervical lesions: A randomized clinical trial.

INTRODUCTION: The efficacy of an adhesive agent is an important aspect in restoring noncarious cervical lesion (NCCL) as studies have proved that compromise in adhesive agent results in reduced bond strength. The purpose of this prospective randomized double-blind clinical trial was to evaluate the efficacy of the newly formulated "universal" dental adhesive in the restoration of NCCLs in permanent dentition using either a self-etch or a selective-etch approach. MATERIALS AND METHODS: The study was done following the consolidated standards of reporting trials. 100 NCCLs randomly divided into 2 groups were restored using G-Premio Bond adhesive and Genial flowable composite in selective etch mode and self-etch mode. Restorations were evaluated at 1 week, 6 months, and 12 months using modified US Public Health Service criteria for marginal staining, fracture, and postoperative sensitivity. Statistical analysis was performed using appropriate tests. RESULTS: Recall rates were 100%, 98%, and 78% at the evaluation time. The result showed that neither the self-etch nor the selective etch mode had significant difference in ALPHA/BRAVO/CHARLIE scores (P > 0.05). Percentage-wise comparison showed less changes reported in the selective etch group compared to self-etch group. CONCLUSION: It was concluded that there was no statistical significance between the groups for the parameters evaluated, but selective etch performed better than self-etch group.

Extracellular matrix degradation by host matrix metalloproteinases in restorative dentistry and endodontics: An overview.

Matrix metalloproteinases (MMPs) are a group of over 25 secreted and membrane-bound enzymes responsible for pericellular substrate degeneration. In response to injury, they play key roles in morphogenesis, wound healing, tissue repair and remodeling. They have been isolated from dentin, odontoblasts, pulp and periapical tissue. They play a major role in the formation of dentin matrix and secondary and tertiary dentin. These are also responsible for releasing dentinal growth factors. MMP family proteins elicit a dual role in the pathogenesis of inflammation, stimulating protective innate and/or adaptive immune functions, as well as tissue destruction. The main organic component of tooth structure is collagen, and MMPs that degrade collagen and the extracellular matrix have been implicated in the progression of dental caries, dental erosion as well as degradation of the hybrid layer. MMPs have also been shown to be active in pulpitis, and studies have shown that they can be used as diagnostic markers of pulpal and periapical inflammation. This review describes the role of MMPs in dental caries, dental erosion, bond stability as well as in pulpal and periapical inflammation.

The second mesiobuccal canal in three-rooted maxillary first molar of Karnataka Indian sub-populations: A cone-beam computed tomography study.

INTRODUCTION: Elusive second mesiobuccal canal (MB2) in maxillary first molar are often missed during endodontic therapy and are a major cause of treatment failures. Its prevalence is known to vary among different populations and there is limited information on its prevalence in Indian population. AIM: This study investigated the prevalence and location of second mesiobuccal (MB2) canal in mesiobuccal root of maxillary first molar using cone beam computed tomography (CBCT) images in an Indian population. MATERIALS AND METHODS: CBCT images of 598 three rooted maxillary first molars were studied. In each CBCT image, the floor of pulp chamber was located and advanced by 2 mm to standardize the observation for MB2 canal. Its location was determined in relation to mesiobuccal (MB1) and palatal (P) canal. STATISTICAL ANALYSIS: The data was analysed using descriptive statistics. The presence of MB2 canal was correlated with age, gender and tooth position using Chi square test. RESULTS: The prevalence of MB2 canal in three rooted maxillary first molar was 61.9%. It was seen that the prevalence of MB2 was highest in 20-40years age group (67.4%) followed by > 40 years (57.5%) and lowest in <20 years (50.6%) and the difference was statistically significant (p = 0.005). It is located mesiopalatally; 2.5 mm ±â€¯0.6 mm palatally and 1.0 ±â€¯0.4mmmesially to the MB1 canal or present directly on the line joining the MB1 and palatal canal. CONCLUSION: There is a high probability of finding MB2 canal in Indian patients. The access cavity must be modified from a triangular shape to rhomboid shape. Troughingmesiopaltally (about 2.5 mm palatally and 1 mm mesially) from MB1 to a depth of about 2 mm from the floor of pulp chamber may be necessary for locating MB2 canal.

A comparative evaluation of antimicrobial efficacy and flow characteristics of two epoxy resin-based sealers-AH plus and Perma Evolution: An in vitro study.

AIM OF THE STUDY: Bacteria that persist at the time of obturation increase the possibility of persistent apical periodontitis. An ideal sealer should be able to kill these remaining bacteria that are present on the dentinal walls as well as inside the dentinal tubules. This could be possible if a sealer has antimicrobial properties with optimum flow characteristics. Hence, the aim of this in vitro study was to assess the antimicrobial efficacy of epoxy resin-based sealer: AH Plus and Perma Evolution against Enterococcus faecalis on the 1st, 3rd, 5th, and 7th day and also to compare the flow characteristics of both epoxy resin-based sealers. MATERIALS AND METHODS: E. faecalis ATCC 35550 strain was used to assess the antibacterial efficacy of sealers by agar-diffusion test (ADT) and direct-contact test (DCT). Flow characteristics of sealers were measured according to the ADA specification no. 57. RESULTS: In ADT, Perma Evolution sealer showed larger zone of inhibition than AH plus on the 1st, 3rd, 5th, and 7th day, and in DCT, both sealers were equally effective in inhibiting E. faecalis growth on the 1st, 3rd, 5th, and 7th day. Flow test showed no significant difference between Perma Evolution and AH Plus sealer. CONCLUSION: Both the tested sealers were equally effective against E. faecalis up to 7 days of incubation period. Considering flow properties, both the tested sealers showed optimum flow as per the ADA specification no. 57.

The efficiency of root canal disinfection using a diode laser: in vitro study.

AIMS: The aim of this study is to verify the disinfection of diode laser, following chemo-mechanical procedures against Enterococcus fecalis. MATERIALS AND METHODS: Crowns of 30 extracted premolar teeth were sectioned at the cemento- enamel junction. The canals were shaped using step-back technique to K-file #40. The teeth were randomly assigned to three groups and placed into nutrient broth containing bacterial suspension of Enterococcus fecalis. Group A received no laser radiation. Specimens of group B and C were treated with diode laser (Sirona) with energy set at 1.5 and 3 W, respectively. After laser irradiation, the teeth were placed in vials, which contained 2 mL of the nutrient broth. The vials were incubated at 37°C for 24 h. Grown colonies were identified by standard methods. STATISTICAL ANALYSIS USED: Statistical analysis used was the nonparametric Kruskal-Wallis test, with comparison using the Bonferroni methods of means. RESULTS: Higher mean CFU/mL is recorded in Group A (without laser disinfection) followed by Group B (with 1.5 W laser disinfection) and Group C (with 3 W laser disinfection), respectively. The difference in CFU/mL between the three groups is found to be statistically significant ( P < 0.001). CONCLUSIONS: The results of this research show that the 980 nm diode laser can eliminate bacteria that has immigrated into dentin, thus being able to increase the success rate in endodontic therapy.