Root canal therapy used in conjunction with follow-ups for the nonsurgical handling of an enormous periapical lesion of endodontic origin: Clinical case record.

Key Clinical Message: The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. Abstract: The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery.

A clinical case concerning an extraordinary maxillary second molar having two separate palatal roots.

Key Clinical Message: Main objective of root canal therapy is to locate all the canals, cleaning and shaping, and obturation to obtain fluid tight seal. Failure to locate all canals can lead to the failure of root canal therapy. Abstract: Variation of pulp aperture, among teeth with multiple roots, constitutes recurring issue during diagnosing and completing efficient endodontic procedures. Understanding normal anatomy features and associated likely modifications is critical in the effective execution of the dental procedure, since the inability to effectively treat simply one canal may end up into endodontic unsuccessful therapy. The paper covers a procedure whereby the root pattern and canals of the maxillary second molar were modified employing an operative microscope and verified with cone-beam computed tomography (CBCT). Cone-beam computed tomography revealed that the maxillary second molar containing two different palatal roots and canals and two distinct buccal roots and canals. This Research paper presents and investigates the morphological difference observed on the maxillary second molar in order to guarantee the effectiveness of root canal treatment examined utilizing imaging techniques like CBCT.

Synthesis, Physicochemical and Third Order Nonlinear Optical Properties of Bis-Chalcone (BBDP) as Donor-pi Acceptor Chromophore in Organize Medium.

Bis-Chalcone (BBDP) has been prepared by condensation of N, N-dimethyl benzaldehyde and 1,1'-([1,1'-biphenyl]-4,4'-diyl) di (ethan-1-one), and structure of BBDP was characterized by Mass Spectra, 13C-NMR, 1H-NMR, and IR. Physicochemical properties including Dipole-moments, Stoke-Shifts, Oscillator-strength, dielectric constant and quantum-yields of fluorescence of BBDP were investigated by the emission and absorbances in different solvents. Compound (BBDP) displayed bathochromic shift upon increasing the solvent polarity (from n-Hexane to DMSO). Furthermore, we have exploited third-order nonlinear optical characteristics of the bisChalone were invigilated by the Z-scan techniques in Chloroform. The measurements were taken with a continuous-wave (CW) diode laser having a wavelength of 520 nm in CHCl3 solvent. The third-order nonlinear optical properties, such as the nonlinear refractive index (NLRI) n2, nonlinear absorption coefficient (NLAC) ß, and nonlinear susceptibility χ(3), were measured at various solution concentrations and laser powers. The obtained values of n2, ß, and χ(3) were estimated to be high, of the order of 10-7(cm2/W), 10-3 (cm/W), and 10-6 (esu), respectively. As a result, bis-chalcone (BBDP) is considered as a promising candidate for applications in nonlinear optical (NLO) devices and optical limiting (OL).

Respiratory Epithelial Adenomatoid Hamartoma in a Young Female: A Diagnostic Dilemma.

Hamartomas are non-neoplastic tissue abnormalities commonly found in various organs but rarely in the upper aerodigestive tract. Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign proliferation affecting the nasal cavity and sinonasal tract. It often mimics other nasal masses, leading to diagnostic challenges. We present the case of a 25-year-old female with recurrent epistaxis and chronic bilateral nasal obstruction. Diagnostic endoscopy revealed a polypoidal mass, later confirmed as REAH through histopathological examination. CT scans demonstrated soft tissue opacity but no erosion of surrounding bony structures. The patient underwent endoscopic excision, and the excised mass exhibited characteristic histological features of REAH. Endoscopic excision with careful postoperative follow-up can lead to successful outcomes in REAH cases. A year of follow-up revealed no recurrence.

Evaluation of Effects of Various Irrigating Solutions on Chemical Structure of Root Canal Dentin Using FTIR, SEM, and EDS: An In Vitro Study.

Background: Sequential chemical application for irrigating a root canal during chemomechanical debridement can affect the dentin microstructure. Understanding the effects of various irrigants on chemical properties of dentin can elucidate their effects on physical properties and thereby explain the higher incidence of structural failure in endodontically treated teeth. This in vitro research aimed to compare and evaluate the effects of three different irrigating solutions on the chemical structure of root canal dentin in extracted human teeth. Methods: Forty-eight extracted single-rooted mandibular premolar teeth were sectioned at the cemento−enamel junction by a diamond disc and were then randomly assigned to four groups of twelve samples each. The groups were irrigated using 5.25% NaOCl, ozonated olive oil, silver citrate, or distilled water. Dentin sections measuring 1.5 mm were obtained from the root portion and each section and were analyzed using Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and electron-dispersive spectroscopy (EDS). FTIR and EDS values are reported as means ± standard deviations. Data were analyzed using an ANOVA and a post hoc Bonferroni test (p < 0.05). Results: A comparison of the FTIR and EDS values among the groups using ANOVA revealed statistically significant differences in the organic and inorganic peak values among the groups. An intergroup comparison between NaOCl with silver citrate and ozonated olive oil revealed significant reductions in the carbonate and phosphate peak values in the NaOCl group (p < 0.05). The EDS values tabulated for the carbon, oxygen, phosphorous, and calcium peak levels showed significant differences between the groups using an ANOVA. An SEM analysis was conducted under 1500× magnification, which revealed smear layer removal in the silver citrate group. Conclusions: The silver citrate solution and the ozonated olive oil caused less changes in the organic and mineral contents of dentin than sodium hypochlorite.

Asymptomatic HyperCKemia: A Diagnostic Trap.

Elevated creatine kinase (CK) levels are the most sensitive indicator of muscle injury. Levels >5000 U/L warns physicians to initiate aggressive hydration and prevent renal failure. We present a rare case of asymptomatic hyperCkemia with levels >80 times the upper limit of normal (ULN), refractory to fluid resuscitation. Our patient was found to have elevated macroenzymes- macroCkemia, causing decreased clearance of CK. The objective of this case report is to bring to attention a rare and benign cause of CK elevation which can lead to diagnostic and therapeutic errors.

Euglycemic Diabetic Ketoacidosis Precipitated by a Keto Diet: Importance of Dietary History in Diagnosis.

Diabetic ketoacidosis (DKA) is one of the serious complications of diabetes, especially type 1. It is defined by the triad of hyperglycemia (>250 mg/dL [>13.9 mmol/L]), high anion-gap metabolic acidosis, and increased plasma ketones. Euglycemic ketoacidosis is characterized by DKA without hyperglycemia. We present a rare case of a 28-year-old type 1 diabetic male, presenting with abdominal pain, fatigue, and dizziness after one week of starting a keto diet. He was diagnosed with euglycemic DKA, managed with DKA protocol and given detailed dietary counselling to avoid the keto diet in future.

Curcumin Preparations Can Improve Flow-Mediated Dilation and Endothelial Function: A Meta-Analysis.

INTRODUCTION: Endothelial dysfunction is an early marker of atherosclerosis. Flow-mediated dilation (FMD), measured by ultrasonography, is used to noninvasively assess endothelial dysfunction. Preparations of curcumin, a naturally occurring pigment found in turmeric, may improve FMD and thus endothelial dysfunction. We did a systematic review and meta-analysis to analyze the effect of curcumin preparations on endothelial dysfunction. METHODS: Five randomized clinical trials met the inclusion criteria for meta-analysis. The primary outcome was an improvement in FMD, as measured at brachial artery, after supplementations with curcumin preparations compared to the control group. Standardized mean difference and Hedges' g were used for effect size (ES) measurement. An ES of 0.2-0.5 is considered small, 0.5-0.8 is medium, and more than 0.8 is large. Publication bias was studied too. RESULTS: We found supplementation with curcumin preparations had an overall ES (standard difference in means) of 1.379 (95% CI 0.485-2.274, p = 0.003) on FMD. The overall Hedges' g was 1.353 (95% CI 0.47-2.235, p = 0.03). This analysis suggests a positive and large ES of curcumin preparations on FMD using a random effect model. Smokers had a smaller increase in FMD compared to nonsmokers (ES 0.379 vs. 1.639, p = 0.034). CONCLUSION: This meta-analysis of 5 randomized clinical trials indicates a significant effect of curcumin preparations to increase the FMD compared to placebo and thus endothelial function. This effect is not strongly noticed in smokers.

Systematic Review and Proportional Meta-Analysis of Endarterectomy and Endovascular Therapy with Routine or Selective Stenting for Common Femoral Artery Atherosclerotic Disease.

INTRODUCTION: Common femoral endarterectomy (CFE) has been the therapy of choice for common femoral artery atherosclerotic disease (CFA-ASD). In the past, there was inhibition to treat CFA-ASD endovascularly with stents due to fear of stent fracture and compromise of future vascular access site. However, recent advances and new evidence suggest that CFA may no longer be a 'stent-forbidden zone'. In the light of new evidence, we conducted a meta-analysis to determine the use of endovascular treatment for CFA-ASD and compare it with common femoral endarterectomy in the present era. METHODS: Using certain MeSH terms we searched multiple databases for studies done on endovascular and surgical treatment of CFA-ASD in the last two decades. Inclusion criteria were randomized control trials, observational, prospective, or retrospective studies evaluating an endovascular treatment or CFE for CFA-ASD. For comparison, studies were grouped based on the treatment strategy used for CFA-ASD: endovascular treatment with selective stenting (EVT-SS), endovascular treatment with routine stenting (EVT-RS), or common femoral endarterectomy (CFE). Primary patency (PP), target lesion revascularization (TLR), and complications were the outcomes studied. We did proportional meta-analysis using a random-effect model due to heterogeneity among the included studies. If confidence intervals of two results do not overlap, then statistical significance is determined. RESULTS: Twenty-eight studies met inclusion criteria (7 for EVT-RS, 8 for EVT-SS, and 13 for CFE). Total limbs involved were 2914 (306 in EVT-RS, 678 in EVT-SS, and 1930 in CFE). The pooled PP at 1 year was 84% (95% CI 75-92%) for EVT-RS, 78% (95% CI 69-85%) for EVT-SS, and 93% (95% CI 90-96%) for CFE. PP at maximum follow-up in EVT-RS was 83.7% (95% CI 74-91%) and in CFE group was 88.3% (95% CI 81-94%). The pooled target lesion revascularization (TLR) rate at one year was 8% (95% CI 4-13%) for EVT-RS, 19% (95% CI 14-23%) for EVT-SS, and 4.5% (95% CI 1-9%) for CFE. The pooled rate of local complications for EVT-RS was 5% (95% CI 2-10%), for EVT-SS was 7% (95% CI 3 to 12%), and CFE was 22% (95% CI 14-32%). Mortality at maximum follow-up in CFE group was 23.1% (95% CI 14-33%) and EVT-RS was 5.3% (95% CI 1-11%). CONCLUSION: EVT-RS has comparable one-year PP and TLR as CFE. CFE showed an advantage over EVT-SS for one-year PP. The complication rate is lower in EVT RS and EVT SS compared to CFE. At maximum follow-up, CFE and EVT-RS have similar PP but CFE has a higher mortality. These findings support EVT-RS as a management alternative for CFA-ASD.

Coronary bypass graft perforation during percutaneous intervention.

INTRODUCTION: Coronary artery bypass grafts are prone to accelerated atherosclerosis and as such graft stenosis is frequently encountered in clinical practice. Complications specific to graft- PCI include no-reflow, distal embolization, stent restenosis and thrombosis. Graft perforation during PCI is a rare coomplication of the procedure. Published literature on the predictors of perforation and management strategy remains limited to anecdotal cases. METHOD: In this review we collected data on all cases of graft perforations reported in PubMed/Medline from 1987 to 2015. RESULT: 37 cases of graft perforation were reported. High risk grafts for perforations included, old grafts (14±7.8years) with more than 80% luminal stenosis. Perforations were noted after use of different cardiac devices and included stent placement (30%, N=11), balloon angioplasty (36%, N=14), post-dilation with non complaint balloon (16%, N=6), guide wire perforation (1 case), post IVUS imaging (1 case) and one case after use of thrombus extraction device. Average stent diameter of 3.7±0.7 mm, average balloon pressure of 15.5±5 atm and 3 or more balloon inflations commonly resulted in graft perforation. 78% of cases reported class III perforation. Covered stent implantation was strongly associated with controlling acute bleed after graft perforation than prolonged balloon inflation (p=0.0001). Majority of cases reported using covered stents (81%). Average stent diameter of 3.9±0.7mm, average stent length of 18.5±6mm and the average deployment pressure of 14±2atm were reported to be effective in controlling the bleed. 95% of the patients did well post procedure and with prolonged hospitalization (8±4days). 24% of cases reported cardiac tamponade causing hemodynamic compromise including 2 peri-procedural deaths. CONCLUSION: Graft perforation can be effectively treated with covered stent grafts with good immediate results, short term outcome and acceptable peri-procedural risks.

Cuspal movement and microleakage in premolar teeth restored with posterior restorative materials.

BACKGROUND: With the increase in various resin-based composites with varying monomeric formulations and fi llers had led to a significant number of problems, and one of such is postoperative pain. Clinician is in a dilemma what to select and what not to. The latest nanocomposite is there for a short while that no individual research is available currently, hence, this study was undertaken. The aim of this present study was to assess the cuspal deflection at each stage of polymerization for the incremental restoration of standardized large (mesio occlusal distal [MOD]) cavities with three posterior restorative resins. And also to assess the cervical microleakage. MATERIALS AND METHODS: 18 extracted upper premolar teeth were selected. Teeth were divided into three groups (A, B, and C), each group consisting six teeth, large (MOD) cavity preparation was done. Groups A, B, and C were restored with P60, Filtek supreme (3M, ESPE), and ormocer material (Admira:Voco). The lingual cusps of the extracted teeth were approximated to the receptor of a compactor - deflection measuring gauge, following each stage of polymerization using light emitting diode curing light a measurement of the cuspal deflection was recorded. The restored teeth were prepared for microleakage testing and were examined under stereomicroscope at ×25 for the extent of the cervical gingival microleakage. RESULTS: The cuspal deflection was the greatest for Filtek P60 and least for filtek supreme - nanocomposite with ormocer ranked between the two. For the microleakage, none of the materials were identified as producing less gingival microleakage. CONCLUSION: The lesser cuspal deflection values with filtek supreme nanocomposite could be due to resin chemistry and also filler particle size. Hence, this nanocomposite could be the first choice of material for use in large esthetic restorations.

In vitro evaluation of topical fluoride pH and their effect on surface hardness of composite resin-based restorative materials.

AIM: The aim of the study was to correlate the pH and fluoride ion uptake with surface hardness of composite resin based restorative materials after topical fluoride application. METHODOLOGY: Forty disks of each of test materials Composite (Filtek Z350XT, 3M ESPE, St Paul, MN, USA), Resin modified glass ionomer (Vitremer) and Compomer (Dyract AP) were made and ten disks of each material were placed in different test solutions - 1.23% APF gel, Sodium fluoride mouth rinse, 0.9% neutral fluoride and distilled water (Control group). After 36 hours of immersion, specimens were subjected to microhardness testing machine for evaluation of surface hardness. RESULTS: The greater hardness deterioration for all materials resulted with 1.23% APF gel when compared to the control group. Composite (Filtek Z350XT, 3M ESPE, St Paul, MN, USA) showed 17.13 VHN (control group 59.11 VHN). Vitremer showed 9.71 VHN (control group 37.71 VHN). Compomer showed 19.22 VHN (control group 36.78 VHN). CONCLUSION: 1.23% ApF gel significantly decreased hardness of composite, Vitremer and Compomer. Hardness deterioration associated with sodium fluoride mouth rinse and 0.9% neutral fluoride was less compared to 1.23% ApF gel.

In vitro evaluation of antibacterial efficacy of calcium hydroxide in different vehicles.

AIM: This study was aimed to evaluate the antibacterial effect of calcium hydroxide (CH) in different vehicles in an in vitro model. MATERIALS AND METHODS: Calcium hydroxide paste prepared with two conventionally used vehicles namely, camphorated monochlophenol, distilled water and propylene glycol. The antibacterial activity of these paste were tested against five micro-organisms that can commonly occur in the infected root canals. RESULTS: The results of this study indicate that a paste of CH made with propylene glycol exerts significant antibacterial action. Hence, it can be recommended for use as an intracanal medicament in preference to a paste prepared with a tissue toxic phenolic compound like camphorated monochlorophenol.

Mandibular third molar impactions in male adults: Relationship of Operative time and Types of impaction on inflammatory complications.

BACKGROUND: This paper investigates the relationship betweendifferent types of impactions with postoperativeinflammatory tissue reaction. MATERIALS & METHODS: Consecutive patients with only mandibular third molar impactions were included in our study. They were classified by winter's classification. The disimpactions were performed under local anaesthesia. Time for surgery was noted for each surgical procedure. Postoperative inflammatory complication in terms of pain, swelling and trismus were noted. RESULTS: 150 male patients in the age groupof 18-40 years were studied. Inflammatory tissue reactions were increasing with more operative time. Distoangular and Horizontal impactions were associated with more pain on first 3 days of surgery along with more swelling and trismus. Vertically impacted teeth were associated with least complications. CONCLUSION: Post operative morbidity was increasing along with moreoperating time and increase in the depth of mandibular third molar impaction. How to cite the article: Mansuri S, Mujeeb A, Hussain SA, Hussain MA. Mandibular third molar impactions in male adults: Relationship of Operative time and Types of impaction on inflammatory complications. J Int Oral Health 2014;6(2):9-15.

Advancing mandibular swelling: a diagnostic dilemma.

Asymmetrical swelling of the mandible in adolescence may pose a significant diagnostic dilemma. The differential diagnosis ranges from traumatic, infectious, and metabolic processes to benign and malignant tumors. Also may present with similar clinical and radiological features, making an accurate diagnosis quite difficult. This is an illustrative case involving a 30-year-old female who initially presented with complaint of pain and swelling in the lower left side of the face for 2 months. Multiple investigations and several biopsies were required to arrive at a diagnosis. This paper deals with a case report of a fibrosarcoma involving the mandible highlighting the importance of early diagnosis and treatment planning.

An evaluation of shear bond strength of self-etch adhesive on pre-etched enamel: an in vitro study.

AIM: To determine the shear bond strength of self-etch adhesive G-bond on pre-etched enamel. MATERIALS AND METHODS: Thirty caries free human mandibular premolars extracted for orthodontic purpose were used for the study. Occlusal surfaces of all the teeth were flattened with diamond bur and a silicon carbide paper was used for surface smoothening. The thirty samples were randomly grouped into three groups. Three different etch systems were used for the composite build up: group 1 (G-bond self-etch adhesive system), group 2 (G-bond) and group 3 (Adper single bond). Light cured was applied for 10 seconds with a LED unit for composite buildup on the occlusal surface of each tooth with 8 millimeters (mm) in diameter and 3 mm in thickness. The specimens in each group were tested in shear mode using a knife-edge testing apparatus in a universal testing machine across head speed of 1 mm/ minute. Shear bond strength values in Mpa were calculated from the peak load at failure divided by the specimen surface area. The mean shear bond strength of all the groups were calculated and statistical analysis was carried out using one-way Analysis of Variance (ANOVA). RESULTS: The mean bond strength of group 1 is 15.5 Mpa, group 2 is 19.5 Mpa and group 3 is 20.1 Mpa. Statistical analysis was carried out between the groups using one-way ANOVA. Group 1 showed statistically significant lower bond strength when compared to groups 2 and 3. No statistical significant difference between groups 2 and 3 (p < 0.05). CONCLUSION: Self-etch adhesive G-bond showed increase in shear bond strength on pre-etched enamel.