Comparative evaluation of working length determined using integrated apex locator and root ZX mini under various irrigating solutions: An in vivo study.

Background: Electronic apex locators (EALs) are frequently used as adjuvant to radiographs in working length (WL) determination. The introduction of integrated apex locators (IALs) further simplified the root canal treatment by continuous monitoring of the apex while root canal shaping. Aim: The aim of this study was to evaluate the efficacy of radiographs, EAL, and IAL in determining the WL in the presence of various irrigants. Materials and Methods: The present in vivo study was carried out on 30 patients who were divided into 10 in each group, based on the type of irrigant used; 0.9% saline (Group 1), 0.2% chlorhexidine (Group 2), and 2.5% of sodium hypochlorite (NaOCL) (Group 3). In each group, WL is determined using conventional radiographs, Root ZX Mini (EAL), and CanalPro CL2i (IAL). Statistical Analysis: Kruskal-Wallis test and Friedman's two-way ANOVA test were used for statistical analysis. Results: Mean WL was comparably lower with Root ZX Mini, while the WL by CanalPro CL2i and the radiographic method were comparable. In all methods, the type of solutions used did not influence the WL, with a higher mean WL when NaOCL is used as an irrigant. Nevertheless, the above comparisons were not statistically significant. Conclusion: the irrigation solutions employed in this study had no impact on the performance of apex locators and radiographs.

Evaluation of surface analysis of gutta-percha after disinfecting with sodium hypochlorite, silver nanoparticles, and chitosan nanoparticles by atomic force microscopy: An in vitro study.

AIMS AND OBJECTIVES: The purpose of this study is to evaluate the surface topography of gutta-percha (GP) after disinfecting with sodium hypochlorite (NaOCl) (5.25%), silver nanoparticles (AgNPs) (70 µg/ml), and chitosan nanoparticles (ChNPs) (1.5 mg/ml) by atomic force microscopy (AFM). MATERIALS AND METHODS: Forty GP cones were taken in this in vitro study. These samples were divided into four different groups such as Group I - control group (untreated GP Points) and Group II, III, and IV were treated with 5.25% NaOCl, 70 µg/ml AgNPs, and 1.5 mg/ml ChNPs, respectively. The surface topography analysis of the samples was performed using AFM. STATISTICAL ANALYSIS: Root mean square (RMS) and surface roughness parameters were used to compare the structure of GP points with contact mode imaging. These values were tested by IBM SPSS-20.0 version statistical software using one-way ANOVA and post hoc (Tukey's honestly significant difference) tests. They were considered statistically significant when P < 0.05. RESULTS: The RMS and surface roughness values are significantly higher for NaOCl group (5.25% NaOCl) when compared with AgNPs group (70 µg/ml AgNPs) and ChNPs group (1.5 mg/ml ChNPs). CONCLUSION: This study has shown more surface topography deterioration of GP treated with NaOCl and lesser deterioration with AgNPs and ChNPs which affects postoperative prognosis.

Endodontic Management of Radix Entomolaris in Second Molar.

The presence of radix entomolaris (RE) in a mandibular first molar is a common occurrence, which accounts for 0.2%-32% of the population, but the presence of RE in a mandibular second molar is a rare occurrence in our ethnic group. This presence of additional root can lead to difficulties during endodontic treatment. A thorough knowledge of anatomy is necessary for the success of endodontic treatment. This article presents a review on clinical approach and a case series on the detection and management of RE on mandibular second molar. RE was identified using Same lingual opposite buccal (SLOB) technique with preoperative radiograph, modifying the access cavity preparation, locating the canals followed by cleaning, and shaping of canals with nickel-titanium instruments. Obturation was done with respective master cones and AH + resin sealer.

Evaluating the effectiveness of clarithromycin as an adjunct to scaling and root planing: A randomized clinical trial.

BACKGROUND: Administration of systemic antibiotics may implement persuasive treatment effect for chronic periodontitis by intending tissue-invasive bacteria in addition to accustomed nonsurgical periodontal therapy (NSPT). AIMS: The aim of this study was to assess the ancillary effects of oral clarithromycin (CLM) along with NSPT for chronic periodontitis. MATERIALS AND METHODS: Thirty periodontitis patients were randomly divided into two equal groups in this double-blind, randomized, parallel group, and active-controlled trial: test group - scaling and root planning (SRP) plus CLM (500 mg thrice daily for 7 days, orally) was given, and control group - only SRP was done. Clinical analysis, such as gingival index (GI), probing depth (PD), and clinical attachment loss (CAL), were taken at baseline, 3 months, and 6-month intervals for both groups. Subgingival plaque samples were cultured for periodontopathic organisms. Immunological parameter C-reactive protein (CRP) levels were estimated. RESULTS: SPSS version 14 was used for statistical analysis. The intragroup comparison showed a significant reduction in the mean scores of all the parameters from baseline to 6 months. The intergroup comparison showed a statistically significant reduction of PD from baseline to 3 months (P < 0.001). GI, CAL, and CRP levels were also reduced but not statistically significant. The mean colony-forming units (CFU) of Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) showed a statistically significant reduction from baseline to 3 months only in the test group (P = 0.042) and (P = 0.046), respectively. There was no statistically significant reduction of Aa and Pg at 6 months. CONCLUSIONS: CLM conceivably accepted as an addendum to NSPT for a shorter period.

Revitalization of traumatized immature tooth with platelet-rich fibrin.

Endodontic treatment options for immature, nonvital teeth conventionally include surgical endodontics, apexification with calcium hydroxide, or single visit mineral trioxide aggregate plug. Regeneration is a new concept which is been introduced in the treatment of traumatized open apex tooth. Regeneration of pulp-dentin complex in an infected necrotic tooth with an open apex is possible if the canal is effectively disinfected. The purpose of this case report is to add a new vista in regenerative, endodontic therapy by using platelet-rich fibrin for revitalization of immature nonvital tooth.

Coronal Pulpotomy Technique Analysis as an Alternative to Pulpectomy for Preserving the Tooth Vitality, in the Context of Tissue Regeneration: A Correlated Clinical Study across 4 Adult Permanent Molars.

Aim. (1) The aim of the clinical study revolves around the accurate diagnosis, proper case selection, and the management of acute irreversible pulpitis in permanent molars with closed apices using conservative and economical treatment modalities like vital pulpotomies with regenerative approaches over conventional root canal procedures. (2) To evaluate the use of autologous substances such as platelet concentrates and calcium silicate based materials in promoting the healing and regeneration of the inflamed pulp. Summary. Vital pulpotomy was performed on 5 carious involved, permanent molars diagnosed with acute irreversible pulpitis in 17- to 22-year-old patients. Taking into consideration the patient's age and the condition of the underlying pulp tissue, PRF pulpotomy was planned in view of preserving the vitality of the intact radicular pulps. Regenerative procedures with second generation blood matrices were chosen to encourage the recovery of the inflamed pulps. The systematic follow-up examinations performed at 3, 6, 9, 12, 18, 22, and 24 months revealed a successful clinical and radiological outcome. Within the limits of the present clinical study and correlating the success across the treated clinical cases, we safely conclude the potential scope of regenerative pulpotomy approaches in acute irreversible pulpitis in adult permanent teeth.

Analysis of the rate of maturogenesis of a traumatized Cvek's stage 3 anterior tooth treated with platelet-rich fibrin as a regenerative tool using three-dimensional cone-beam computed tomography: an original case report.

Regenerative endodontic procedures are biologically based procedures which deal with the regeneration of pulp-like tissue, more idealistically the pulp-dentin complex. The regeneration of this pulp-dentin complex in an infected necrotic tooth with an open apex is possible only when the canal is effectively disinfected. Though there are various procedures for treating open apex ranging from Ca(OH) 2 apexification, mineral trioxide aggregate apexification and surgical approach, regeneration of tissues has always taken superior hand over the repair of tissues. The mechanics behind the regenerative endodontic procedures is that despite the tooth being necrotic, some pulp tissue can survive apically which under favorable conditions proliferate to aid in the process of regeneration. In the past 2 decades, an increased understanding of the physiological roles of platelets in wound healing and after tissue injury has led to the idea of using platelets as therapeutic tools in the field regenerative endodontics. In the present case report with an open apex, high sterilization protocol is followed using triple antibiotic paste as intra-canal medicament, followed which platelet rich fibrin is used as the regenerative material of choice. Over an 18-month follow-up period, clinically patient is asymptomatic and radiographically there is complete regression of the periapical lesion and initiation of the root end closure.