Root Canal Configuration of Human Permanent Mandibular First Molars of an Indo-Dravidian Population Based in Southern India: An In vitro Study.

AIM: This study aims to analyze root canal configuration of human permanent mandibular first molars of an indo-Dravidian population based in southern India. MATERIALS AND METHODS: A total of 1147 mandibular first permanent molars were collected, cleansed, and stored. The number of roots was recorded, access preparations made, pattern of orifices recorded after pulpal floor debridement, dye injected into the canals using apical negative pressure and subjected to a clearing technique. They were then analyzed using a stereo microscope and the canal configurations recorded (Vertucci). The number of roots, the pattern of orifices and canal configuration were recorded. RESULTS: The pattern of orifices was triangular (87.9%), rectangular (8.5%), C-shaped (3.0%), and two orifice pattern (0.6%). About 95.6% of teeth had two roots, and 4.4% had three roots. The most common canal system configuration in mesial root was Vertucci type IV (52.3%), followed by type II (35%). Root canal configuration of the distal root revealed type I configuration in 62.7%, followed by types II (14.5%) and IV (12.4%). The distolingual root had a type I configuration. CONCLUSION: Awareness of canal configuration, adequate clinical skills, use of specialized techniques of diagnosis, debridement and obturation will pave the way for successful treatment outcomes.

A Comparative Evaluation of Intraradicular Smear Removal Efficacy of 2% Chitosan (Low Molecular Weight), 4% Chitosan Citrate, and 10% Citric Acid when Used as Final Rinse in Irrigation Protocols: A Field Emission Scanning Electron Microscopic Study.

AIM: This study aims to compare the smear layer removal efficacy of 2% chitosan (low molecular weight) (C-LMV), 4% chitosan citrate (CC), and 10% citric acid (CA) when used in specific irrigant protocols. MATERIALS AND METHODS: A total of 60 single-rooted maxillary incisors and canines were decoronated, standardized to a root length of 15 mm, and prepared with rotary files up to protaper F3 size. Sodium hypochlorite was used as initial rinse [8 ml]. The samples were divided into experimental (Group III, IV, V, and VI) (n = 10) and control groups (I - 17% EDTA, II - normal saline) (n = 5) based on the type of final rinse solution (5 ml) used, that is, 2% C-LMV, 4% C-citrate, 10% CA, and 1% acetic acid. Samples were dehydrated, split buccolingually, gold sputter coated, and examined in field emission scanning electron microscope. RESULTS: Overall, the Group IV, V, and III presented the least amounts of smear, debris, and erosion among the experimental groups at the apical, middle, and coronal one-thirds of the root canal with a mean value of 1.53 ± 0.42, 1.33 ± 0.42, and 1.60 ± 0.46, respectively, and there was no statistically significant difference (P > 0.05). CONCLUSION: The use of CC as final rinse solution during biomechanical preparation seems promising.

Successful Nonsurgical Management of Periapical Lesions of Endodontic Origin: A Conservative Orthograde Approach.

Periapical lesions of endodontic origin are common pathological conditions affecting periradicular tissues. Microbial infection of pulpal tissues is primarily responsible for initiation and progression of apical periodontitis. The primary objective of endodontic therapy should be to restore involved teeth to a state of normalcy nonsurgically. Different nonsurgical management techniques, namely, conservative root canal therapy, decompression technique, method using calcium hydroxide, aspiration-irrigation technique, lesion sterilization and tissue repair therapy, active nonsurgical decompression technique, and the apexum procedure have been advocated. New techniques which use drug-loaded injectable scaffolds, simvastatin, and epigallocatechin-3-gallate have been tried. Surgical option should be considered when intra- or extra-radicular infections are persistent. Incidence of nonendodontic periapical lesions has also been reported. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Surgical methods have many disadvantages, and hence should be considered as an option only in the case of failure of nonsurgical techniques. Assessment of healing of periapical lesions has to be done periodically which necessitates a long-term follow-up. Even large periapical lesions and retreatment cases where the lesion is of endodontic origin have been successfully managed nonsurgically with orthograde endodontic therapy.

Successful Surgical Management of Palatogingival Groove Using Platelet-rich Fibrin and Guided Tissue Regeneration: A Novel Approach.

Palatogingival groove also known as radicularlingual groove is a developmental anomaly involving the lingual surface of the maxillary incisors. They are inconspicuous, funnel-shaped, extend for varying distances on root surface and occur due to infolding of the hertwigs epithelial root sheath. This encourages adherence of microorganisms and plaque to levels significant for pathological changes resulting in endodontic and periodontal lesions. The variations in anatomy of the tooth as a cause of pulp necrosis in teeth of anterior maxillary segment should be considered by the clinician when other etiological factors are ruled out. Recognition of palatogingival groove is critical, especially because of its diagnostic complexity and the problems that may arise if it is not properly interpreted and treated. Regeneration is a new emerging approach in endodontics. Choukroun et al. were among the pioneers for using platelet-rich fibrin (PRF) to improve bone healing. PRF is rich in platelet cytokines and growth factors. Numerous techniques have been used to eliminate or seal the groove and regenerate endodontic and periodontal tissues. In this case report of two cases, a novel combination therapy involving ultrasonics, blend of PRF with bone graft, guided tissue regeneration membrane was used in the treatment of a palatogingival groove with an endoperio lesion to ensure arrest of disease progression and promote regeneration. The groove was cleaned and prepared ultrasonically and sealed with a bioactive dentin substitute.

Management of invasive cervical resorption in a maxillary central incisor.

Invasive cervical resorption is often not diagnosed properly, leading to improper treatment or unnecessary loss of the tooth structure. Early diagnosis and appropriate treatment are the keys to a successful outcome of therapy. Invasive cervical resorption is often seen in the cervical area of the tooth, but because it is initiated apical to the epithelial attachment, it can present anywhere in the root. In the early stages, it may be symmetrical, but larger lesions have the tendency to be asymmetrical. It can expand apically or coronally.

Biological post.

Anterior tooth fracture as a result of traumatic injuries, is frequently encountered in endodontic practice. Proper reconstruction of extensively damaged teeth can be achieved through the fragment reattachment procedure known as "biological restoration." This case report refers to the esthetics and functional recovery of extensively damaged maxillary central incisor through the preparation and adhesive cementation of "biological post" in a young patient. Biological post obtained through extracted teeth from another individual-represent a low-cost option and alternative technique for the morphofunctional recovery of extensively damaged anterior teeth.

The effects of various irrigating solutions on intra-radicular dentinal surface: An SEM analysis.

AIM: The action of irrigant solutions on intra- radicular dentinal surface were evaluated in an in vitro setting using a scanning electron microscope (SEM) and it was observed that sodium hypochlorite and MTAD produced the cleanest surface and that none of the irrigants were able to produce an ideal preparation of the dentinal surface when used individually. The primary objective of endodontic therapy is to achieve a clean, optimal environment in root canals to avoid unsuccessful treatment outcomes. The complexities of the root canal system necessitate the use of irrigating solutions which act on radicular dentin surface, modifying it. The action of irrigants can be beneficial, and yet at the same time, as they modify the surface structure of dentin, they can have an adverse impact on the properties of dentin. The present study was undertaken to assess the effect of various irrigants on the dentinal surface using an SEM. MATERIALS AND METHODS: Forty-five roots were randomly divided into nine groups (n=5) and prepared by sectioning at the level of cemento-enamel junction (CEJ) and 10 mm from the CEJ and split longitudinally. The dentin surface was prepared and the cemental surfaces were coated with double layer of varnish. The irrigants tested were normal saline, de-ionized water, 17% ethylenediaminetetraacetic acid (EDTA), 5% sodium hypochlorite (NaOCl), 5% NaOCl with ultrasonic agitation, 3% hydrogen peroxide, 2% chlorhexidine (CHX), MTAD, and MTAD with ultrasonic agitation. The prepared samples were placed in the irrigant solution for 3 min, subsequently dehydrated, sputter coated, and observed under SEM. The images were subsequently analyzed for dentinal surface changes. RESULTS: 17% EDTA and MTAD produced the cleanest dentinal surface. Ultrasonic agitation enhanced the effect of irrigants. 5% NaOCl and 3% hydrogen peroxide were efficient at removal of organic debris, but were unable to remove the smear layer. De-ionized water, normal saline, and 2% chlorhexidine were not effective at removing the debris or the smear layer. CONCLUSION: None of the irrigants individually were able to achieve conditions of an ideal dentinal surface preparation.

Management of middle mesial canal in mandibular second molar.

The primary objective of endodontic therapy is to achieve a three-dimensional obturation of the root canal space after adequate preparation of the canal space to remove the tissue debris, microorganisms, and their byproducts. Anatomical variations have frequently been encountered in endodontic practice and have to be adequately managed by the clinician. Missed roots and canals are a major reason for failure of therapy. Technological advances have given the clinician ample opportunity to identify and treat these aberrations successfully. The present report describes a left mandibular second permanent molar requiring root canal treatment, found to have three separate canals in the mesial root. This case demonstrates a rare anatomical configuration and emphasizes the need for the clinician to be aware of and look out for such variations and use adequate diagnostic methodologies prior to and during therapy to detect such variations. The possibility of additional canals, whenever in doubt, should be explored with the assistance of technologies such as those of magnification and illumination and various diagnostic aids. Operator experience has also shown to be a key factor in negotiation and management of these aberrant canal configurations.

Fracture resistance of teeth restored with cast post and core: An in vitro study.

CONTEXT: Influence of luting agent, design of tooth preparation for cast posts on tooth resistance to fracture. AIM: To evaluate fracture resistance of teeth restored with cast posts and cores with or without cervical ferrule and cemented with zinc phosphate, glass ionomer, or resin cement. MATERIALS AND METHODS: Sixty single-rooted maxillary first premolars of similar sizes were selected. Biomechanical preparation and post space preparation for cast post was done for all samples and then they were divided into two groups (n=30). Cervical ferrule preparation was done for Group A, and Group B was prepared without any cervical ferrule. Both groups were further divided into three subgroups (1, 2, and 3; n=10) Cast posts for subgroups 1, 2, and 3 were cemented with zinc phosphate, glass ionomer, and resin cement, respectively. A shearing load was applied to indented buccal cusp of specimens at an angle of 45° in universal testing machine at a cross-head speed of 1 mm/min until fracture. RESULTS: Specimens with ferrule (Group A) had significantly higher shear bond strength values (mean 1503.37 N) than specimens without ferrule (Group B) (mean 1052.09 N). CONCLUSION: Inclusion of ferrule in tooth preparations for posts increased the fracture resistance regardless of the luting agent.