Evaluation of Apical Vapor Lock Formation and comparative Evaluation of its Elimination using Three different Techniques: An in vitro Study.

AIM: The aim of this study was (i) to evaluate the formation of air bubbles in the apical region of root canal (apical vapor lock) during syringe irrigation, using cone beam computed tomography (CBCT) and (ii) comparative evaluation of the elimination of an established vapor lock by EndoActivator, ultrasonics, and manual dynamic agitation (MDA), using CBCT. MATERIALS AND METHODS: A total of 60 extracted human single-rooted teeth were equally divided into three groups of 20 teeth each. The samples were decoronated 17 mm from the apex, cleaned, and shaped to size F4 Protaper using 3% sodium hypochlorite. Samples were irrigated with 3% sodium hypochlorite + cesium chloride radiopaque dye, and preoperative CBCT images were obtained. After formation of apical vapor lock in the scanned teeth, EndoActivator (group I), passive ultrasonic irrigation (group II), and MDA with K-file (group III) were performed and the teeth were again placed in CBCT scanner and results analyzed using the chi-square test. RESULTS: The apical vapor lock was formed in all the samples. Out of the 20 teeth in each group, the apical vapor lock was eliminated in 18 samples of EndoActivator group (90%), 16 samples of ultrasonic group (80%), while it was eliminated in 10 samples by MDA (50%). CONCLUSION: It is concluded that (1) apical vapor lock is consistently formed during endodontic irrigation in closed canal systems and (2) sonic activation performs better than the ultrasonics and MDA in eliminating the apical vapor lock, with statistically significant difference between all the three groups (p < 0.05). CLINICAL SIGNIFICANCE: The results suggest that the apical vapor lock (dead water zone) is consistently formed during routine endodontic irrigation which impedes irrigant penetration till the working length, thereby leading to inefficient debridement. Hence, to eliminate this vapor lock, techniques, such as sonics or ultrasonics should be used along with the irrigant after shaping and cleaning of the root canal.

A comparative evaluation of the healing ability of bilateral periapical lesions treated with and without the use of platelet-rich fibrin.

Periradicular surgery aims to achieve complete wound healing and regeneration of the periodontal unit. Platelet-rich fibrin (PRF) is a platelet concentrate that is widely used to promote tissue healing and bone induction through its various growth factors and has been used in this study. This case report describes the use of PRF unilaterally in a bilateral periapical lesion in the same patient. The site treated with PRF showed better healing than the other site. This was confirmed with a 3-D X-ray.

A comparative evaluation of the effect of different access cavity designs on root canal instrumentation efficacy and resistance to fracture assessed on maxillary central incisors: An in vitro study.

AIM: The purpose of this study is to evaluate and compare the effect of different access cavity designs on root canal instrumentation efficacy using micro-computed tomography (CT) scan and resistance to fracture evaluated using the universal testing machine on maxillary central incisor. MATERIALS AND METHODOLOGY: Forty extracted human permanent maxillary central incisors were divided into four groups for each access cavity. The access cavities were prepared according to predefined criteria and were further assessed under Micro-CT to evaluate pre and postoperative instrumentation efficacy. After biomechanical preparation and obturation, the teeth were wrapped with tin foil to maintain a thickness of 0.2-0.3 mm as periodontal ligament. Then, the silicon impression material was applied in the acrylic alveolus, to maintain and simulate the thickness of periodontal ligament and fracture resistance was checked using the universal testing machine. STATISTICAL ANALYSIS: Data were analyzed using one-way analysis of variance test. Pair-wise comparison was made using post hoc multiple comparison (Tukey) test. RESULTS: Fracture resistance was highest (1272 N) for the control group followed by the Lingual Conventional Access Group (1153.90 N). Fracture resistance for Lingual Cingulum Access Group was 1130.70 N and least for the Lingual Incisal Straight-Line Access Group (1022.80 N). This difference in fracture resistance among all the groups was significant (P = 0.001). Overall comparison showed that dentin volume reduction (DVR) for Group II was 22.45 mm3, for Group III was 17.37 mm3 and for Group IV was 28. 41 mm3. This difference in DVR among the three groups was significant (P = 0.001). CONCLUSION: The most effective instrumentation efficacy was obtained in lingual incisal straight-line access group, followed by lingual cingulum access group, followed by lingual conventional access group. The most effective fracture resistance was obtained in the lingual conventional access group, followed by the lingual cingulum access group, followed by the lingual incisal straight-line access group.

Multidisciplinary approach to the management of complicated crown-root fracture: a case report.

Oblique crown-root fracture in the cervical third of the root is a common event following trauma to the anterior region of the mouth. As a result, sound tooth structure coronal to the attachment apparatus may not be available for restorative needs. Invasion of biological width by fracture line presents a clinical challenge in restorative planning. Placing a restoration margin on sound tooth structure within the dentogingival biological width might result in violation of biological width and should be considered a restorative failure. Maintaining a healthy periodontal attachment apparatus is crucial for long term prognosis and esthetics of the restored tooth. Surgical crown lengthening, surgical extrusion or orthodontic extrusions are the few alternative modalities to expose the fracture line. This case presentation demonstrates a predictable solution in overcoming an oblique crown-root fracture caused by trauma during a road accident. Orthodontic extrusion was used to elevate the fractured tooth from within the alveolar socket to allow the placement of crown margins on sound tooth structure without harming the biologic width. Combining fiberotomy with the extrusion procedure in this case eliminated the need for the surgical procedure. This allowed proper fabrication of post and core and the placement of the crown on sound tooth structure, fulfilling the biological and mechanical principles including obligatory ferrule effect.

One-step apexification in immature tooth using grey mineral trioxide aggregate as an apical barrier and autologus platelet rich fibrin membrane as an internal matrix.

Immature teeth with necrotic pulp and periapical lesion are difficult to treat via conventional endodontic therapy. Numerous procedures and materials have been utilized to induce root-end barrier formation. Traditionally, calcium hydroxide has been the material of choice for the apexification of immature permanent teeth; however, Mineral Trioxide Aggregate holds significant promise as an alternative to multiple treatments with calcium hydroxide. One of the technical problems associated with the placement of the restorative materials used as artificial barrier is to prevent overfill and underfill. Using a matrix avoids the extrusion of the material into the periodontal tissues. This case report presents the successful healing and apexification with combined use of Mineral Trioxide Aggregate as an apical barrier, and autologus platelet rich fibrin membrane as an internal matrix.

Endodontic management of mandibular second molar fused to a supernumerary tooth, using spiral computed tomography as a diagnostic aid: a case report.

Fusion is a developmental anomaly characterized by the union of two adjacent teeth. In this paper we report a rare case of fusion involving permanent mandibular second molar with supernumerary tooth. The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to treat. The use of high-end diagnostic imaging modalities such as spiral computed tomography can help the clinician in making a confirmatory diagnosis and determining the treatment plan before undertaking the actual treatment. In the present case, we have used spiral computed tomography (SCT) for better understanding the complicated root canal morphology of the fused tooth and successful management of this rare case.