Effect of three different rotary instrumentation systems on postinstrumentation pain: A randomized clinical trial.

BACKGROUND: Endodontic instrumentation is liable to cause some postinstrumentation pain (PIP). Rotary endodontic instruments differ in their design, metallurgy, surface treatment, etc. AIM: This randomized clinical trial aimed to assess the incidence of PIP after root canal instrumentation with three different rotary endodontic systems which differ in their design, namely, ProTaper, Mtwo, and K3. MATERIALS AND METHODS: A total of 150 patients between the ages of 25 and 50 were chosen for the study. Teeth with asymptomatic irreversible pulpitis due to carious exposure were selected. The patients received local anesthesia by inferior alveolar nerve block. After preparing the access cavity, root canal instrumentation was done with one of the three instruments (n = 50) and closed dressing was given. PIP was assessed every 12 h for 5 days, and tenderness to percussion was analyzed at the end of 1, 3, and 7 days. STATISTICAL ANALYSIS: Mann-Whitney U-test to determine significant differences at P < 0.01. RESULTS: The PIP and tenderness were less in Mtwo group when compared to ProTaper and K3 groups up to 84 h and 72 h respectively and statistically significant (P < 0.05). There was no statistically significant difference between ProTaper and K3 both in PIP and tenderness. CONCLUSION: Rotary endodontic instrumentation causes some degree of PIP and tenderness to percussion. Among the instruments used, Mtwo causes less PIP and tenderness when compared to ProTaper and K3, and there was no difference between ProTaper and K3. CLINICAL RELEVANCE: PIP is highly subjective and may vary among different subjects. The apical (3 mm) taper of ProTaper was 0.08 followed by a smaller taper, whereas, the other two files were of a constant 0.06 taper, which means there could have been a greater apical extrusion and therefore more PIP. Despite, the mean of the age was similar, there could have been a difference in the size of the canal and therefore a difference in apical extrusion and PIP.

Comparison of apical debris extrusion of two rotary systems and one reciprocating system.

BACKGROUND: Postoperative inflammation and endodontic failure occur due to apical extrusion of debris. AIM: To evaluate the amount of apically extruded debris after preparation of straight root canals in extracted human teeth using three rotary systems. MATERIALS AND METHODS: Sixty single-rooted human teeth with single root canal and apical foramen were selected and randomly divided into three experimental groups (n = 20) according to the rotary system used: Group 1 - ProTaper, Group 2 - Revo-S, Group 3 - WaveOne. Apical enlargement was done up to size 40/0.06 for Groups 1 and 2 and 40/0.08 for Group 3. For debris collection, each tooth was held in a preweighed Eppendorf tube fixed inside a glass vial through rubber plug. After instrumentation, each tooth was separated from the Eppendorf tube and the debris adhering to the root surface was collected by washing the root with 1 mL of bi-distilled water and incubated at 70°C for 5 days. The dry weight of extruded debris was weighed in an electronic balance. STATISTICAL ANALYSIS: The mean weights of extruded debris were statistically analyzed using GraphPad prism version 6 and the intergroup comparison was done using unpaired t-test. RESULTS: There was a statistically significant difference in the mean debris score among all the three groups - ProTaper (0.00065 g), Revo-S (0.00045 g) and WaveOne (0.00089 g). CONCLUSION: Revo-S system was associated with significantly less debris extrusion compared with ProTaper or WaveOne.

Evaluation of surface roughness of three different composite resins with three different polishing systems.

AIM: The aim of this study was to evaluate the surface roughness of three composites with three different polishing systems. MATERIALS AND METHODS: Composite specimens were made from the Teflon mold with a standardized cavity size (6 mm diameter and 3 mm height). Group I - Filtek Z350XT (Nano clusters), group II - T-Econom plus (Microhybrid), group III - G-aenial Flo (True Nano). The samples were cured for 30 s from both sides with the matrices in place. The 60 samples were divided into 3 groups (N = 20), which accounted for 40 surfaces, (n = 20 × 2 = 40) in each groups. Each group were subdivided into four subgroups based on the type polishing material, subgroup A - Control, subgroup B - Astrobrush, subgroup C - Astropol, and subgroup D - Soflex spiral wheel. The samples of all groups except group A (control) were finished and polished according to the manufacture's instruction. RESULTS: After polishing, the roughness (Ra) of the resin composite of all the specimens were measured using a profilometer. Soflex spiral wheel (group D) significantly had the least roughness (Ra) value as compared to the other groups. CONCLUSION: Among the three resin composites tested, G-aenial Flo exhibited least Ra value due to its reduced filler size and its uniform distribution.

Effect of Preoperative Pain on Inferior Alveolar Nerve Block.

The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.

Comparison of variation in the light curing cycle with a time gap and its effect on polymerization shrinkage, degree of conversion and microhardness of a nanohybrid composite.

BACKGROUND: Giving a time gap and distance during curing can decrease the polymerization shrinkage. AIM: To evaluate the effect of time gap and distance between the curing tip and restoration on the polymerization shrinkage, degree of monomer conversion (DOC), and microhardness of a nanohybrid composite. MATERIALS AND METHODS: A total of 50 standardized cylindrical specimens (Z350, 3M ESPE) were fabricated using a brass mould. The curing was done in contact with the sample surface for 20 seconds in the control group. In the four experimental groups, curing was initiated at 1-cm distance, followed by variation in the time gap and the curing cycle. The polymerization shrinkage, DOC, microhardness was calculated. STATISTICAL ANALYSIS: One-way analysis of variance (ANOVA) and post hoc-Dunnett test were used to analyze the data. RESULTS: Curing at 1-cm distance for 10 seconds with a gap of 10 seconds and finishing the curing cycle with 20 seconds at 0 cm proved to be an appropriate technique to reduce the polymerization shrinkage without significantly affecting the DOC and microhardness. CONCLUSION: A simple innovative modification of varying the distance of curing and a time gap in the curing cycle can decrease the polymerization shrinkage without affecting the DOC and microhardness.

An Unusual Type II Dens Invaginatus with Calcified Canals in a Maxillary Lateral Incisor - A Case Report.

Dens invaginatus is a developmental malformation resulting from the invagination of enamel organ into the dental papilla. Management of dens invaginatus is an endodontic challenge. Presence of calcified canals in dens invaginatus makes it even more complicated. Modification of the treatment plan is required to treat such cases. This case report deals with the management of a Type II Dens Invaginatus in a lateral incisor with calcified canals.

Management of mandibular first molar with four canals in mesial root.

Successful root canal treatment depends on adequate cleaning, shaping, and filling of the root canal system. The presence of middle mesial (MM) root canal of mandibular molars has been reported by various authors. But incidence of four canals in mesial root of mandibular molar is very rare. The aim of this case report is to present and describe the identification and management of a mandibular first molar with four canals in the mesial root and single canal in the distal root.

Management of an endodontic infection with an extra oral sinus tract in a single visit: a case report.

Chronic apical periodontitis can drain through a sinus tract, which may be intra-oral or extra-oral, though an intra-oral drainage is more common. Though such cases can be treated in a single visit, there is no report on a single visit endodontic treatment for a chronic apical periodontitis with a draining sinus. This case report demonstrates that the apical periodontitis with a cutaneous sinus tract can be successfully treated endodontically as a single visit procedure, if the patient is in good systemic health.