Post-instrumentation pain after the use of either Mtwo or the SAF system: a randomized controlled clinical trial.

AIM: This randomized controlled trial compared the incidence of post-instrumentation pain associated with Mtwo rotary NiTi files and the self-adjusting file system following canal shaping and cleaning. METHODOLOGY: Following sample size estimation, a total of 130 patients were randomized into two groups based on selection criteria [group Mtwo and group SAF (self-adjusting file)]. Root canal treatment was carried out in two appointments. The teeth were endodontically treated with the appropriate allotted systems following the similar clinical parameters. Patients were asked to rate the intensity of pre-instrumentation and post-instrumentation pain (at 2, 4, 6, 8, 24, 48 h) using the VAS score. The Kruskal-Wallis test was carried out for the overall comparisons of the two systems. The Friedman test was used to compare between time-points with each system. Subgroup analyses for independent variables (gender, pulp status and diagnosis) used the Mann-Whitney test and Wilcoxon signed ranks test (P < 0.05). RESULTS: No significant difference was found between the two groups with respect to post-instrumentation pain. Teeth with pulpal necrosis had significant pain at 8 h compared with teeth with vital pulps (P = 0.04). Teeth with vital pulps in the SAF group had significantly less post-instrumentation pain compared with those in the Mtwo group at 6 h (P = 0.042). Patients who had teeth with nonvital pulps in the SAF group experienced more post-instrumentation pain at 8 h (P = 0.017) and 24 h (P = 0.005). CONCLUSION: The incidence of post-instrumentation pain at different time intervals in patients undergoing root canal treatment was similar for both the self-adjusting file and Mtwo file systems.

Radix entomolaris: 2 case reports and clinical guidelines for endodontic management.

Variations in dental anatomy and root canal systems are often reported in the dental literature. Among them, Radix entomolaris (RE) is the presence of an additional lingual root in mandibular molars. Though RE appears relatively infrequently, knowledge of the condition will aid in its management. This article presents 2 case reports of RE and clinical guidelines for endodontic management.

Effect of reciprocating file motion on microcrack formation in root canals: an SEM study.

AIM: To compare dentinal microcrack formation whilst using Ni-Ti hand K-files, ProTaper hand and rotary files and the WaveOne reciprocating file. METHODOLOGY: One hundred and fifty mandibular first molars were selected. Thirty teeth were left unprepared and served as controls, and the remaining 120 teeth were divided into four groups. Ni-Ti hand K-files, ProTaper hand files, ProTaper rotary files and WaveOne Primary reciprocating files were used to prepare the mesial canals. Roots were then sectioned 3, 6 and 9 mm from the apex, and the cut surface was observed under scanning electron microscope (SEM) and checked for the presence of dentinal microcracks. RESULTS: The control and Ni-Ti hand K-files groups were not associated with microcracks. In roots prepared with ProTaper hand files, ProTaper rotary files and WaveOne Primary reciprocating files, dentinal microcracks were present. There was a significant difference between control/Ni-Ti hand K-files group and ProTaper hand files/ProTaper rotary files/WaveOne Primary reciprocating file group (P < 0.001) with ProTaper rotary files producing the most microcracks. No significant difference was observed between teeth prepared with ProTaper hand files and WaveOne Primary reciprocating files. CONCLUSION: ProTaper rotary files were associated with significantly more microcracks than ProTaper hand files and WaveOne Primary reciprocating files. Ni-Ti hand K-files did not produce microcracks at any levels inside the root canals.

Apical Extrusion of Irrigants in Immature Permanent Teeth by Using EndoVac and Needle Irrigation: An In Vitro Study.

OBJECTIVE: Immature teeth have a large apical opening and thin divergent or parallel dentinal walls; hence, with conventional needle irrigation there is a very high possibility of extrusion. This study was done to compare the apical extrusion of NaOCl in an immature root delivered using EndoVac and needle irrigation. MATERIALS AND METHODS: Eighty freshly extracted maxillary central incisors were decoronated followed by access cavity preparation. Modified organotypic protocol was performed to create an open apex; then, the samples were divided into four groups (n=20): EndoVac Microcannula (group I), EndoVac Macrocannula (group II), NaviTip irrigation needle (group III) and Max-i-Probe Irrigating needle (group IV); 9.0 ml of 3% sodium hypochlorite was delivered slowly over a period of 60 seconds. Extruded irrigants were collected in a vial and analysed statistically. RESULTS: Group I, group III and group IV showed 100% extrusion (20/20) but group II showed only 40% extrusion (8/20). The difference in this respect between group II and other groups was statistically significant (P<0.001). With regards to the volume of extrusion, group II had only 0.23 ml of extruded irrigant. Group I extruded 7.53ml of the irrigant. Group III and group IV extruded the entire volume of irrigant delivered. CONCLUSION: EndoVac Macrocannula resulted in the least extrusion of irrigant in immature teeth when compared to EndoVac Microcannula and conventional needle irrigation.

Comparison of irrigant penetration up to working length and into simulated lateral canals using various irrigating techniques.

AIM: To evaluate the effect of an apical negative pressure system, a passive ultrasonic irrigation system and a combination of both apical negative pressure and passive ultrasonic irrigation on the penetration of the irrigating contrast solution (ICS) up to working length and into simulated lateral canals. METHODOLOGY: The root canals of 64 single-rooted teeth were instrumented using the ProTaper rotary system. In each sample, three simulated lateral canals were created at 2, 4 and 6 mm levels from the root apex using a 06-size C+ file (Dentsply Maillefer, Ballaigues, Switzerland). Samples were randomly assigned into 4 experimental groups (n = 16): group I - conventional needle irrigation, group II - passive ultrasonic irrigation, group III - apical negative irrigation system and group IV - combination of passive ultrasonic irrigation and apical negative pressure irrigation system. To examine irrigating solution penetration, Indian ink was mixed with 5.25% NaOCl and delivered into the root canals. Samples were then assessed by direct observation of the images taken using Canon EOS rebel T3. The depth of penetration of ICS up to the working length and into the simulated lateral canals was analysed using chi-squared tests. RESULTS: The combination (ANP and PUI) and ANP group had significantly deeper ICS penetration up to the working length (P < 0.001). The combination (ANP and PUI) and the PUI group exhibited significantly greater ICS penetration into lateral canals at the 6 mm level (P < 0.001). At the 4 and 2 mm levels, the combination of ANP and PUI had significantly greater ICS penetration into the lateral canals than the other groups (P < 0.001). CONCLUSIONS: The combination of ANP and PUI was the only group able to achieve irrigating contrast solution penetration both up to the working length and into lateral canals.

Comparative evaluation of the regional micro-push-out bond strength of custom-made resin post system with a prefabricated resin post: an in vitro study.

AIM: The purpose of the study is to compare the regional micro-push-out bond strength of custom-made resin post and a prefabricated resin post luted using self-etch adhesive and/or etch and rinse adhesive system at various regions. MATERIALS AND METHODS: Forty freshly extracted human maxillary central incisors were selected for this study; 1.5-2-mm coronal to the cemento-enamel junction was removed with a diamond disk using a slow speed handpiece under cooling water. Working lengths were established, root canals were sequentially enlarged upto the apex until ISO size 50-K-file and obturated using gutta-percha and AH plus sealer by cold lateral compaction. Post spaces were prepared to a depth of 10 mm using paeso-reamer upto size #3. After preparation, each specimen was embedded in chemically cured acrylic resin. The roots were randomly assigned to four groups: Group I: Custom-made resin post+Self-etch adhesive, Group II: Glass FRC post+Self-etch adhesive, Group III: Custom-made resin post+Etch and Rinse adhesive, Group IV: Glass FRC post+Etch and Rinse adhesive. Fabrication of custom-made resin post was done. All the posts were cemented using a dual cure resin luting cement. Each root was sectioned perpendicular to the long axis using a microtome and subjected to micro-push-out bond strength. RESULTS: The micro-push-out bond strength in the coronal region, in Group I 13.5 ± 1.66 MPa, Group II 12.08 ± 0.8 MPa, Group III 11.15 ± 1.06 MPa, Group IV 11.81 ± 1.11 MPa. In the middle third region: Group I 11.43 ± 0.740 MPa, Group II 10.584 ± 0.504 MPa, Group III 10.0582 ± 0.830 MPa, Group IV 10.35 ± 0772 MPa. In the apical third: Group I 10.38 ± 0.878 MPa, Group II 9.59 ± 1.06 MPa, Group III 9.34 ± 0.73o MPa, Group IV 8.77 ± 1.02 MPa. CONCLUSION: Within the limitations of the study, amongst all the four groups tested, custom-made resin post luted with self-etch system (CMPR-SE) showed higher micro-push-out bond strength values in all regions when compared to the other groups.

Management of recently traumatized maxillary central incisors by partial pulpotomy using MTA: Case reports with two-year follow-up.

In traumatized, young, permanent teeth, pulpotomy is classically undertaken to promote apexogenesis. The objective is to promote root development and apical closure. Once root end development and apical closure is achieved, the root canal treatment is completed. However, it has been suggested that mere pulp exposure does not cause pulpitis in the absence of bacteria. Recent studies have proposed that as long as a good seal is ensured, root canal treatment may not be necessary following pulpotomy. In this article we report two cases of traumatized, fully matured, maxillary permanent central incisors, which have been treated with mineral trioxide aggregate following partial pulpotomy, with a two-year follow-up.

Middle distal canal of the mandibular first molar: a case report and literature review.

AIM: To present a clinical case report in a mandibular first molar with a middle distal canal, along with a review of the literature. SUMMARY: With the use of magnification, either by microscopes or by loupes, there is an increasing possibility of detecting additional canals. The present case describes root canal treatment in a mandibular first molar with two roots and a Sert and Bayirli Type XVIII canal configuration in the distal root. The presence of a three canals in the distal root of mandibular first molars has been reported to have an incidence of 0.2-3%. KEY LEARNING POINTS: * Clinicians should be aware of the variable root canal anatomy in the distal root of mandibular first molars. * Use of magnification helps to identify and locate additional root canals. * Three root canals in the distal root of mandibular first molar teeth might occur.

Volumetric analysis of root fillings using spiral computed tomography: an in vitro study.

AIM: To analyse volumetrically using spiral computed tomography (SCT) the efficacy of various techniques to fill root canals. METHODOLOGY: Root canals in 40 maxillary central incisors were instrumented with K-files to size 60 and the volume of the canal measured using SCT. The teeth were divided into four groups of 10 each and root filled by lateral compaction, Thermafil, Obtura II and System B techniques, respectively. AH plus was used as sealer with all techniques. The filled volume in each canal was measured using SCT and the percentage of obturated volume (POV) was calculated. The data were statistically analysed using Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: The four groups were comparable in canal volume. The overall POV was 80.4%, 93.3%, 84.8% and 93.7% for lateral compaction, Thermafil, Obtura II and System B, respectively (P < 0.05). CONCLUSION: The greatest POV was obtained with System B and Thermafil. Voids were seen in all root fillings.

Root canal morphology of mandibular first premolars in an Indian population: a laboratory study.

AIM: To determine the root canal morphology of mandibular first premolar teeth in an Indian population using a decalcification and clearing technique. METHODOLOGY: One hundred extracted adult mandibular first premolar teeth were studied following decalcification and clearing. The shape of the canal orifice, root canal pattern and length of the teeth were determined. RESULTS: The mandibular first premolars were identified to have a round orifice (38%), oval orifice (44%), flattened orifice (17%) and C-shaped orifice (1%). The canal patterns were classified as Type I (72%), Type II (6%), Type III (3%), Type IV (10%) and Type V (8%) according to Vertucci's classification. C-shaped canals were identified in one tooth (1%). The average length of the teeth was 21.6 mm. Fourteen per cent of the teeth had mesial invaginations of the root. CONCLUSIONS: Type I canal patterns were the most frequently occurring in mandibular first premolars amongst the Indian population. 85.7% of the teeth with mesial invagination of the root had either two canals or division of canals.

Restoration of a vertical tooth fracture and a badly mutilated tooth using canal projection.

Management of vertically fractured tooth or a perforation frequently poses problem during endodontic management. Such teeth often need a pre-endodontic restoration prior to initiation of root canal therapy to aid in the placement of rubber dam clamp. This paper describes a simple method of placement of a pre-endodontic restoration using the canal projection technique using hollow metallic needles as sleeves.

MB2 in maxillary second molar.

Occurrence of the second mesiobuccal canal (MB2) is a frequent finding. Literary reports have shown it to be found more in the cases of the maxillary first molar. However the maxillary second molars have also been found with this variation in a number of canals. This paper presents a case report on the occurrence of a second mesiobuccal canal or the MB2 in the maxillary second molar.

Bilateral mandibular canines with type two canals.

Presence of two canals with type II pattern in mandibular canine is around 15%. Even though the incidence rate is high, multiple angled diagnostic radiographs are not regularly taken. This article highlights the importance of multiple angled radiographs and indicates that the dentist should have a mind set to look out for extra canals in all root canal cases.

Maxillary second premolar with three roots and three separate root canals--case reports.

Aberrations in root canal systems are a commonly occurring phenomenon. Knowledge of the basic root canal anatomy and its variation is necessary for successful completion of endodontics. Maxillary second premolars usually have one root and one canal. The occurrence of these teeth having three roots and three canals is very rare. Three such cases of maxillary second premolar with three roots and three canals are presented here.

Endodontic management of taurodontic teeth.

Taurodontism is a morpho-anatomical change in the shape of the tooth in which the body of the tooth is enlarged and the roots are reduced in size. Although taurodontism is a dental rarity, this unusual radicular form should merit circumspect considerations in planning and treatment. Endodontic management in taurodont teeth has been described as complex and difficult. The present paper describes the successful completion of endodontic treatment in three taurodontic teeth with appropriate use of instruments and techniques and also emphasizes the need for post endodontic rehabilitation.

Custom-made resin post and core.

Resin posts are used more often than metal posts, as they are esthetically compatible and less damaging to remaining tooth structure. Many resin post systems are available, where a light transmitting post is used to build up the composite in layers. An easier and economical alternative method, a custom-made resin post, is described.