Mahesh Verma

Assessment of dentinal damage during canal preparation using reciprocating and rotary files.

INTRODUCTION The role of motion kinematics in creating dentinal damage during instrumentation is not very clear. The purpose of this study was to compare the formation of dentinal cracks with instruments working in continuous rotation and reciprocating motion. METHODS One hundred twenty extracted human mandibular premolars were selected for the study. Thirty teeth served as controls, and the remaining 90 teeth were divided into 3 groups depending on the root canal preparation technique. Group 1 samples were treated with WaveOne primary files (Dentsply Maillefer, Ballaigues, Switzerland), group 2 samples with single F2 ProTaper (Dentsply Maillefer) working in reciprocating motion, and group 3 samples were prepared with sequential ProTaper (Dentsply Maillefer) until F2 working in continuous rotation motion. Roots were then sectioned at 3, 6, and 9 mm from the apex, and the cut surface was observed under a stereomicroscope for the presence of dentinal microcracks. RESULTS The control group and WaveOne, single F2 ProTaper in reciprocating motion, and continuous ProTaper groups caused cracks in 0%, 15%, 26%, and 53% of samples, respectively. A statistically significant difference was found between 2 reciprocating file groups (WaveOne and single F2 ProTaper in reciprocating motion) and the continuous rotation group (ProTaper) (P < .05). However, no significant difference was found among the 2 reciprocating file groups (P > .05). CONCLUSIONS Dentinal cracks are produced irrespective of motion kinematics. Within the limits of this study and the current literature, such incidence is less with instruments working in reciprocating motion compared with those working in continuous rotation.

Endodontic management of open apex using MTA and platelet - rich fibrin membrane barrier: A newer matrix concept.

Objectives: Endodontic management of open apex using MTA and platelet – rich fibrin membrane as an apical matrix barrier. Study design: An immature tooth with pulpal necrosis and periapical pathology imposes a great difficulty to the endodontist. Endodontic treatment options for such teeth consist of conventional apexification procedure with and without apical barriers. This article demonstrates the use of an apical matrix barrier in form of a platelet rich fibrin membrane for stabilization of MTA in root end apexification procedure. PRF is an autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines, which enhance healing by release of growth factors. These case reports present apexification and successful healing with combined use of MTA and PRF membrane as an apical barrier Results: PRF membrane can serve as an efficient apical matrix for condensation of MTA. Combination of PRF membrane and MTA is an effective method for management of difficult cases of open apex. PRF is a strong fibrin membrane enriched with platelet and growth factors that accelerate periapical healing. Key words:Apexification, apical barrier, platelet rich fibrin (PRF), mineral trioxide (MTA).

A survey of attitude and opinions of endodontic residents towards regenerative endodontics.

Aim: The objective of this survey was to study the level of awareness, current state of knowledge and opinions towards regenerative endodontic treatments amongst the endodontic residents of India. Settings and Design: Questionnaire based survey was designed. Materials and Methods: After approval from the organizing committee of 26th Federation of Operative Dentistry of India and 19th Indian Endodontic Society National conference 2011, 200 copies of the questionnaire were circulated amongst the endodontic residents in conservative dentistry and endodontics at various colleges across the country about regenerative endodontic procedures. The survey included profile of the respondents and consisted of 23 questions about their knowledge, attitude and opinions regarding use of these procedures as part of future dental treatment. Results: The survey showed that half the participants (50.6%) had received continued education in stem cells and/or regenerative dental treatments. The majority of participants were of the opinion (86.6%) that regenerative therapy should be incorporated into dentistry, and most of them (88%) were willing to acquire training in learning this new treatment strategy. The results indicated that half of the participants (52.6%) were already using some type of regenerative therapy in their clinical practice; however, with a majority of these limited to use of membranes, scaffolds or bioactive materials. Conclusions: These results reflect that endodontic residents are optimistic about the use of regenerative endodontic procedures; however, a need for more research and training was felt.

Creating a Single-Visit, Fibre-Reinforced, Composite Resin Bridge by Using a Natural Tooth Pontic: A Viable Alternative to a PFM Bridge

BACKGROUND The rehabilitation of an anterior tooth space presents a confronting situation. Several modalities are presently available to address the challenge of an immediate replacement of a missing anterior tooth. These include a removable temporary acrylic prosthesis or resin-bonded bridges. Fibre-Reinforced Composite (FRC) bridges are preferable if they are fixed and if a cost-effective tooth replacement is desired. Also, they provide an aesthetic and a conservative treatment choice as the abutment teeth require a minimal or no preparation. METHODS This article is describing two cases with an immediate replacement of the maxillary incisor teeth by a single visit technique, with the use of FRC Resin (Ribbond) bridges and natural tooth crowns as pontics. RESULTS AND CONCLUSIONS The procedure was completed at the chair side, thereby avoiding the laboratory costs. A two year follow up of the cases has shown a successful outcome. Creating an adhesive FRC bridge by using a natural tooth pontic is a successful treatment option for the direct aesthetic replacement of missing anterior teeth.

Restorative management of grossly mutilated molar teeth using endocrown: A novel concept

The endocrown is a restorative option for endodontically treated teeth. It consists of a circular butt-joint margin and a central retention cavity inside the pulp chamber and lacks intraradicular anchorage. Endocrowns are formed from a monoblock containing the coronal portion integrated into the apical projection that fills the pulp chamber space and possibly the root canal ingresses. This article describes the rationale and clinical guidelines for the placement of endocrowns. In the cases presented, extensively damaged teeth were superseded with endocrowns composed of pressed ceramics (Empress 2, Ivoclar), following endodontic and periodontal therapy. The substructure of this technique is to utilize the surface available in the pulpal chamber to assume the stability and retention of the restoration through adhesive procedures. By eliminating the utilization of a post and filling core, the number of adhesive bond interfaces is reduced, thus making the restoration less susceptible to the adverse effects of degradation of the hybrid layer. In these clinical cases, the 24 months survival of the endocrown restoration may be considered prosperous.

CBCT Imaging Modality Used to Diagnose Dental Anomalies: Case Reports

The advent of CBCT has made it possible to visualize the dentition, the maxillofacial skeleton, and the relationship of anatomic structures in three-dimensions. adiographic imaging is essential in diagnosis, treatment planning and follow-up in endodontics. The interpretation of an image can be confounded by a number of factors including the regional anatomy as well as superimposition of both the teeth and surrounding dentoalveolar structures. As a result of superimposition, periapical radiographs reveal only limited aspects, a two-dimensional view, of the true three-dimensional anatomy. Additionally, there is often geometric distortion of the anatomical structures being imaged with conventional radiographic methods. These problems can be overcome by utilizing smallor limited-volume cone beam-computed tomography imaging techniques, which produce accurate 3-D images of the teeth and surrounding dentoalveolar structures. CBCT Imaging Modality Used to Diagnose Dental Anomalies: Case Reports

Complicated crown-root fracture treated using reattachment procedure: a single visit technique.

Complicated crown-root fracture of maxillary central and lateral incisors is common in case of severe trauma or sports-related injury. It happens because of their anterior positioning in oral cavity and protrusive eruptive pattern. On their first dental visit, these patients are in pain and need emergency care. Because of impaired function, esthetics, and phonetics, such patients are quite apprehensive during their emergency visit. Successful pain management with immediate restoration of function, esthetics and phonetics should be the prime objective while handling such cases. This paper describes immediate treatment of oblique crown root fracture of maxillary right lateral incisor with reattachment procedure using light transmitting fiber post. After two and half years, the reattached fragment still has satisfying esthetics and excellent function.

Endodontic management of horizontally placed molars after gunshot injury to mandible: a case report.

A 37-year-old man reported to our department with the history of gunshot injury to the mandible 15 years before. His anterior mandible had been resected earlier and bone graft was seen. Intraoral examination of lower jaw revealed 4 remaining mandibular molars. These teeth were severely rotated such that they lay horizontal with respect to the mandibular base. Preoperative Dentascan spiral computerized tomography (CT) of the patient revealed obliteration of the mesial canals of the mandibular right first molar and pear-shaped internal resorption defect in the distal canal of the same tooth. This paper reports the challenging endodontic management of a rare case of severely angulated teeth also exhibiting traumatic sequelae in both roots of the impact tooth. It also highlights the usefulness of spiral CT scan in diagnosis of traumatic sequelae such as pulp canal obliteration and internal resorption.