Reattachment of Fractured Tooth: A Comprehensive Review.

Dental trauma is one of the most prevalent problems encountered in clinical practice. Traumatic injuries involving fractures of the anterior tooth are one of the most common problems among children and adolescents. There is a physical and social impact on patients' quality of life due to traumatic dental injuries (TDIs). Children and adolescents frequently present with a crown fracture that necessitates immediate intervention. Clinicians need to be aware of various treatment modalities for TDIs and have to address these injuries immediately. Due to advances in adhesive technologies, fragment reattachment is the treatment of choice when the fragment is available and well stored. The purpose of this article is to cover various techniques for reattaching fractured fragments and the most current developments in adhesive systems for this purpose.

Unraveling the Enigma of Managing a Large Periapical Lesion: A Case Report.

This case report documents the diagnosis and successful management of a substantial periapical lesion located in the lower left region of the jaw. The patient presented with clinical symptoms indicative of periapical pathology, and radiographic examination revealed an extensive radiolucent lesion. The chosen treatment approach involved endodontic intervention coupled with surgical decompression, leading to the resolution of the lesion and restoration of oral health. This case underscores the significance of an accurate diagnosis and a multidisciplinary treatment approach in addressing large periapical lesions.

Application of Low-Level Laser Therapy in Endodontics: A Narrative Review.

Low-level laser therapy (LLLT) stands out in the realm of dentistry for its unique attributes that set it apart from traditional therapeutic approaches. This non-invasive and painless modality harnesses the power of low-intensity lasers, offering a distinct advantage in terms of safety and patient comfort. Unlike many conventional methods, LLLT does not rely on pharmaceutical interventions or invasive procedures, making it a gentle yet effective option for various dental applications. Its non-thermal, photobiomodulatory effects on cellular and tissue functions mark a notable departure from the more aggressive treatment modalities commonly associated with dentistry. This article provides an extensive exploration of LLLT's applications in dentistry, focusing on its mechanisms of action and biological effects, and emphasizes the uniqueness of LLLT as a transformative tool in modern dental care.

Examining the Impact of Preheating on the Fracture Toughness and Microhardness of Composite Resin: A Systematic Review.

The objective of this comprehensive study was to systematically evaluate the effects of preheating on two critical mechanical properties, microhardness and fracture toughness, in resin composite materials. The overarching goal was to provide valuable insights into the potential benefits and limitations of this technique for enhancing the overall mechanical performance of such materials. To achieve this, an extensive and systematic electronic search was conducted across multiple reputable databases, including MEDLINE/PubMed, SCOPUS, ProQuest, SpringerLink, Web of Science, ScienceDirect, and Google Scholar, with data collection extending until June 2023. This rigorous search process resulted in the identification of 29 pertinent articles, which were subjected to a thorough risk of bias assessment employing the Quality Assessment Tool For In Vitro Studies (QUIN). The findings of this comprehensive investigation revealed several noteworthy trends. First, concerning microhardness, all the studies consistently demonstrated a positive effect of preheating on this mechanical property. This uniformity in results corroborates the initial hypothesis that preheating indeed enhances microhardness in resin composite materials. Second, with respect to fracture toughness, a majority of the studies provided evidence supporting the notion that preheating has a favorable influence on this particular mechanical property. This alignment of outcomes suggests that preheating can be a beneficial technique for improving fracture toughness in resin composites. However, it is essential to note that there were a few exceptions within the collected data, where preheating appeared to lead to a decrease in fracture toughness. Additionally, one study reported no statistically significant effect on fracture toughness. These deviations from the general trend highlight the complexity of the relationship between preheating and fracture toughness, indicating that other factors or material-specific nuances may come into play. In conclusion, the results of this study indicate that preheating resin composites can improve microhardness and fracture toughness, offering potential benefits for dental restorations. Yet, conflicting data warrants further research to uncover the reasons behind these discrepancies. Future studies should also investigate preheating's broader impact on composite resin materials to gain a comprehensive understanding of its applications and limitations in the field.

Unveiling Hidden Canals: Middle Mesial Canal Prevalence in Mandibular First Molars Using Cone-Beam Computed Tomography Analysis in Central India.

Background The most frequent reason involving failure of root canal treatment in molar teeth is the inability to locate additional canals. While much research has been conducted on the morphology of mandibular molars, little is known about isthmuses and middle mesial (MM) canals in the Indian population. The primary aim of the present research was to determine the prevalence of MM canals and isthmuses of mandibular first molars in the Central India population using cone-beam computed tomography (CBCT) images. Methodology CBCT of 140 mandibular first molar teeth was analyzed from the institutional database images in the coronal, sagittal, and axial planes. Data concerning the number of root canals, the presence of middle mesial canals, and the presence of isthmus were noted. Information collected was transferred into an Excel sheet and analyzed using the Statistical Package for Social Sciences (IBM Corp., Armonk, NY, USA). Results Eight images (5.71%) revealed the presence of middle mesial canals with no statistically significant occurrence. The incidence of isthmi in the mandibular first molar was 84.3%, and the presence of isthmi in the coronal third was about 38.6%. This showed a considerable presence. Conclusion There is incidence of the middle mesial canal, which emphasizes the need to locate extra canals in patients undergoing root canal endodontic treatment. The implementation of CBCT will help identify the extra canal before the treatment. This will help ultimately in providing better patient care.

Emerging Paradigms in Internal Root Resorption Management: Harnessing the Power of Bioceramics.

Internal root resorption is a pathological activity involving dentin deterioration within the root canal walls. Numerous variables, including traumatic injury, infection, and orthodontic therapy, can trigger this process. Traditional materials such as mineral trioxide aggregate (MTA) have been utilized to treat internal root resorption but have limitations such as tooth discoloration and handling challenges. Bioceramic materials, such as Bio-C Repair, have emerged as possible MTA substitutes. This case study outlines the effective management of idiopathic extensive perforating internal root resorption using a non-surgical laser-assisted approach and the application of Bio-C Repair as an obturation material. The treatment resulted in the resolution of symptoms and the restoration of periapical tissues. Bioceramics, with their unique composition and favorable biological properties, offer the potential for effective tissue repair and provide alternatives to traditional materials in the treatment of internal resorption. The utilization of bioceramics, including Bio-C Repair, holds promise for achieving successful outcomes and preserving natural dentition.

Navigating Challenges in the Management of Mandibular Third Molars With Radix Paramolaris: A Case Report.

This study aims to shed light on a contemporary approach to preserving third molars instead of opting for immediate extraction. Third molars are known for their diverse shapes and unique anatomy, making root canal treatment a complex task due to limited access. However, there are situations where it is crucial to retain these molars, such as when they provide support or for self-transplantation purposes. The case report focuses on a 33-year-old female patient who presented with pulp necrosis and acute apical periodontitis in the lower right third molar. Instead of extraction, a two-visit conventional root canal treatment was planned. During the initial diagnostic radiographs, only two visible roots were observed, illustrating the typical anatomy of the third molar. However, an unforeseen additional root, referred to as radix paramolaris, was encountered in the mesiobuccal region during the access opening, presenting numerous challenges in the treatment process. Thankfully, advancements in dental technology, such as magnification aids, ultrasonic tips and flexible nickel-titanium (NiTi) rotary files, have rendered the management of such intricate cases more attainable. In conclusion, dealing with intricately curved canals in difficult-to-reach teeth like third molars has become more achievable with technological progress, although the operator's skill and experience remain crucial for effective management.

Anterior Matrix Systems for Composite Restorations: A Review.

In the field of restorative dentistry, composite resins have emerged as the most utilized materials. They revolutionized the cosmetic approach to anterior tooth treatment since their introduction to dental practice. In cases where one or more of the tooth's walls are absent, matrices are employed to assist in the creation of the proper anatomic contour and proximal contacts without the occurrence of gingival overhangs. Matrices come in a variety of designs suitable for various therapeutic conditions. Depending on the level of tooth destruction, they might range from a simple metal or plastic strip to a circumferential ring of metal surrounding the entire crown. Although the handling characteristics of modern composites have significantly improved, dentists still encounter challenges with the development of good interproximal contact and proper anatomical contour. The utilization of an anterior matrix system can be paramount in achieving these objectives.

Evolution of Biomimetic Approaches for Regenerative and Restorative Dentistry.

Biomimetics refers to human-made processes, substances, systems, or devices that imitate nature. The art and science of designing and building biomimetic apparatus are called biomimetics. This method can be widely used in dentistry to restore the structure and function of normal tooth structure. Traditional approaches to treating damaged and decayed teeth require more aggressive preparation to place a "strong," stiff restoration. The emphasis was made on the strength of the restoration as well as its function and mechanical properties, despite several disadvantages like tooth fracture, making future treatment more difficult and invasive. This review paper will seek to provide a clear explanation of its scope, different fields of biomimetic dentistry, and materials used in biomimetics that improve the strength of the tooth.

Management of Ellis Class-IV Fractured Tooth With an Open Apex: A Case Report.

Dental professionals face difficulty in managing "immature non-vital teeth with an open apex." It is considered to be challenging because, in this situation, root canal filling material should be confined within the boundaries of the root canal without extruding peri-apically. Apexification tries to create a hard tissue barrier that will cause the open apex to close, allowing root filling to be compacted. The current case report describes the application of mineral trioxide aggregate (MTA) to create an apical plug in an open apex, as MTA is considered a versatile material for apexification, which was followed by the reinforcing of the weekend root using glass fiber post and core build-up to manage the Ellis class IV fracture.

Comparative Evaluation of Shear Bond Strength of Nanohybrid Composite Restoration After the Placement of Flowable Compomer and Composite Using the Snowplow Technique.

AIM: Based on the importance of bonding during restoration, this in vitro study aimed to evaluate the difference in shear bond strength of nanohybrid composite restoration in molars after the placement of flowable compomer and composite using the snowplow technique. MATERIALS AND METHODS: Twenty-four freshly extracted molars were taken and sectioned at the level of 2.5 mm from the coronal cusp and root tip. These sections were embedded in methacrylate and, after etching and bonding, were randomly divided into two groups (n=12) for placement of restorative materials. In group A, the plastic tube was filled with uncured flowable composite resin followed by the placement of packable nanohybrid composite in oblique increments. In group B, the plastic tube was filled with uncured flowable compomer followed by the placement of packable nanohybrid composite in oblique increments. Each specimen was then tested under a universal testing machine to determine the shear bond strength. RESULTS: Independent sample 't' test revealed a statistically significant difference between the mean shear bond strength of compomer and composite (P value<0.001), where flowable composite showed higher values compared to compomer.  Conclusion: It was seen that the use of composite showed a significantly better bond strength of the restoration when compared to compomer using the snowplow technique. Both materials and application techniques can influence the bond strength of a material as determined in this study.

The Hidden Anatomy of a Lower Premolar With Two Canals.

Variations in the root canal configuration are a great challenge for the endodontist during endodontic procedures. This necessitates the understanding of canal morphology before initiating the treatment. Mandibular second premolars have been always studied to have only a single canal in their root. The present case reported shows an unusual, rare occurrence of an extra canal in the single-rooted second premolar. The patient reported pain associated with #35 which was due to deep distant proximal caries. The second canal was revealed during the intraoperative phase and was successfully treated. The current case adds an important insight to the existing literature related to diverse canal configurations in lower premolars.

Esthetic Reconstruction of Badly Mutilated Endodontically Treated Teeth Using Glass Fiber Reinforced Post: A Case Report.

Cast-metal posts have historically been used to repair teeth that have undergone endodontic treatment before receiving aesthetic rehabilitation. Resources have been used to create biocompatible dental posts that can meet functional and cosmetic standards since early posts were difficult to use. These activities led to the development of glass-fiber and carbon-based posts for use in adhesive dental procedures that have translucencies and flexibility close to that of dentin. The use of translucent glass-fiber posts for the repair of pulpless teeth is demonstrated in this case study.

Management of Untreated Horizontal Root Fracture: A Case Report.

Traumatic dental injuries often occur to the teeth and their supporting tissues and they are the main reasons for an emergency visit to a dental clinic. Horizontal root fractures usually are characterized by a fracture line that is perpendicular to the long axis of the root. Root fractures are diagnosed through clinical and radiographic examination. Treatment depends on the position of the fracture, the extent of root involvement, correct diagnosis, clinical management, and radiographic follow-up. This article presents endodontic management of horizontal root fracture using a fibre post. A 28-year-old male patient presented with a horizontal fracture of the maxillary left central incisor at the junction of the apical and middle third of the root. Root canal treatment followed by MTA apexification of the coronal fragment and fibre post gave satisfactory results.

Dentin Matrix Metalloproteinases: A Futuristic Approach Toward Dentin Repair and Regeneration.

Matrix metalloproteinases (MMPs) have been linked to modulating healing during the production of tertiary dentin, as well as the liberation of physiologically active molecules and the control of developmental processes. Although efforts to protect dentin have mostly centered on preventing these proteases from doing their jobs, their role is actually much more intricate and crucial for dentin healing than anticipated. The role of MMPs as bioactive dentin matrix components involved in dentin production, repair, and regeneration is examined in the current review. The mechanical characteristics of dentin, especially those of reparative and reactionary dentin, and the established functions of MMPs in dentin production are given particular attention. Because they are essential parts of the dentin matrix, MMPs should be regarded as leading applicants for dentin regeneration.

Utility of Dental Operating Microscopes in Assessing Microleakage of Nanohybrid Resin Restorations Using Different Placement Techniques.

Background Composite resin has become a material of choice due to its aesthetic potential and durability. It is at a lower cost compared to ceramic restorations. But it has a tendency to shrink during polymerization, leading to the formation of gaps at the margins. Placement techniques of restoration can be modified to reduce stress shrinkage. A dental operating microscope will help in the precise and thin layering of composite against the cavity wall and the matrix band. Methodology Class I cavities were prepared in 30 human permanent premolars. All cavity surfaces were dried and acid-etched. A bonding agent was applied and they were light-cured. Specimens were divided into three groups: I, II, and III, where restorations were performed using horizontal layering, oblique layering, and split-increment horizontal layering techniques respectively. Samples were then submerged in silver nitrate solution and were examined under a stereomicroscope after a longitudinal section and graded for dye penetration. Results The dye penetration scores were subjected to a statistical analysis using Analysis of variance (ANOVA) with post hoc Tukey's test with the statistical software Statistical Package for Social Sciences (SPSS version 12). The level of significance was set at 0.05 for all statistical inferences. Conclusion The split-increment horizontal layering technique under the dental operating microscope showed less microleakage when compared to other methods and is the preferred method for composite restorations.

Ultraconservative and Aesthetic Approach for Rehabilitation of Complicated Crown Fracture of Tooth.

Dental trauma is well considered to be a general health issue. The prevalence of tooth fracture in the anterior region looks for a conservative approach to treatment. Currently, a novel and ultraconservative approach is the most popular treatment option for the rehabilitation of the fractured tooth. Fragment removal and proper repositioning followed by retention of the tooth's fragments using adhesive techniques provides added benefits such as aesthetics, restoration of surface gloss, function, shape, and texture, as well as maintaining the tooth's position and original morphology. Satisfactory results with less tooth destruction and utmost original anatomy preservation were seen during follow-ups. This approach is seen to be ultraconservative, safe, and pleasing aesthetically. However, careful planning, preoperative assessment, and case selection are the prerequisites in order to attain a favourable prognosis for the long term.

Composite Pre-heating: A Novel Approach in Restorative Dentistry.

Resin composite pre-heating is a novel approach that might improve handling and marginal adaptation of the unset material paste in clinical application. The goal of this review article is to compile all laboratory experiments on resin composite preheating and see how it impacts the mechanical properties of the material. Results have shown that preheating composite resins improves the degree of conversion, stiffness, marginal adaptability, and microhardness. While flexural strength is unbothered, polymerization shrinkage is hindered, and the microleakage results are unknown.

Clinical Efficacy of Two Different Desensitizers in Reducing Postoperative Sensitivity Following Composite Restorations.

OBJECTIVE: The objective is to evaluate the efficacy of different desensitizing agents in the reduction of postoperative sensitivity after composite restoration. MATERIALS AND METHODS: Class I cavities were prepared in 39 patients by the same operator. The patients included in the study were between 20 and 45 years with vital pulp and a remaining dentin thickness of 1mm. Previously restored, nonvital and tooth with periodical changes were excluded. Patients were randomly assigned into three groups of 13 each - Group I (Control); Group II (Gluma desensitizer) and Group III (shield active desensitizer [SAD]). After the surface treatment, the teeth were restored with composite. The patients were assessed for postoperative sensitivity at 24 hours and one week with a visual analog scale (VAS). STATISTICAL ANALYSIS: Data were analyzed using SPSS v23 software. Data were analyzed using one-way ANOVA and post-hoc Tukey test. RESULTS:  Gluma and SAD on comparison with control group i.e. composite group showed statistical significance difference at day 1 (P-value 0.003), but on comparing the sensitivity after one week, there is no significant difference in sensitivity score between all three groups (P-value 0.073). There was no statistically significant difference between day 1 and one week when comparing Gluma desensitizer and SAD. CONCLUSION: The application of the desensitizer led to a statistically significant reduction in postoperative sensitivity on day 1 and a clinically significant reduction was observed at one week.

Comparative evaluation of push-out bond strength of three retrograde filling materials in teeth with root apices resected at 90°: Mineral trioxide aggregate Angelus, Zirconomer, and Bioactive bone cement.

Background: Surgical endodontic dissatisfaction is frequently caused by an inadequate seal at the apex. The retrograde filling material utilized should prevent any contaminants from seeping into the periradicular tissue. Aim: (1) To evaluate push-out bond strength of mineral trioxide aggregate (MTA) Angelus, Zirconomer, and Bioactive bone cement as root-end filling material, (2) To compare push-out bond strength of three different retrograde filling materials with a universal testing machine. Materials and Methods: At the cementoenamel junction, 36 removed upper anterior teeth were sliced horizontally. The samples were resected 3 mm at the apical end at a 90° angle along the long axis of the tooth, following the standard protocols. With an ultrasonic tip S12 90ND, a 3 mm root-end cavity was made. The teeth were then divided into three groups at random: Group 1: MTA Angelus, Group 2: Zirconomer, and Group 3: Bioactive bone cement. With the help of small pluggers, each material was compacted in the root-end cavity. Acrylic resin was used to embed the specimens. Each specimen's apical section was sliced into 2-mm thick slices perpendicular to the long axis. A universal testing equipment was used to apply a compressive push-out load, and the push-out bond strength was determined in megapascals. Results: Zirconomer showed higher push-out bond strength when placed in the retrograde cavity preparation, followed by MTA Angelus and then Bioactive bone cement. Conclusion: Zirconomer showed superior resistance to dislodgment when compared to MTA Angelus, followed by Bioactive bone cement.