Manish Agarwal

Effect of single dose pretreatment analgesia with three different analgesics on postoperative endodontic pain: A randomized clinical trial

Introduction: One of the aims of root canal treatment is to prevent or eliminate pain. Postoperative endodontic pain control continues to be a significant challenge. Aim: To compare and evaluate the effect of single oral dose of 100 mg of tapentadol, 400 mg of etodolac, or 10 mg of ketorolac as a pretreatment analgesic for the prevention and control of postoperative endodontic pain in patients with symptomatic irreversible pulpitis. The incidence of side effects was recorded as secondary outcome. Materials and Methods: Sixty emergency patients with moderate to severe pain, diagnosed with symptomatic irreversible pulpitis were randomly allocated (1:1:1) to any of the three groups; tapentadol, etodolac, or ketorolac. Medications were administered 30 min before beginning of the endodontic treatment. Patients recorded pain intensity on 10 cm visual analog scale (VAS) after treatment, for upto 24 h. Results: At 24 h, mean ±standard deviation (SD) of VAS scores (in cm) for tapentadol, etodolac, and ketorolac were 0.89 ± 0.83, 2.68 ± 2.29, and 0.42 ± 0.69, respectively. Kruskal-Wallis (K-W) test showed significant difference among the three groups (P = 0.001). Mann-Whitney test showed significantly lower VAS scores in tapentadol and ketorolac than etodolac group (P = 0.013 and 0.001, respectively). Conclusions: Single oral dose of 10 mg of ketorolac and 100mg of tapentadol as a pretreatment analgesic significantly reduced postoperative endodontic pain in patients with symptomatic irreversible pulpitis when compared to 400 mg of etodolac.

Retrospective study of root canal configurations of maxillary third molars in Central India population using cone beam computed tomography Part- I

Objective: The aim of this study was to investigate the root and canal morphology of maxillary third molars in Central India population using cone-beam computed tomography (CBCT) analysis. Materials and Methods: CBCT images of 116 maxillary third molars were observed, and data regarding the number of roots, the number of canals, and Vertuccis Classification in each root was statistically evaluated. Results: Majority of Maxillary third molars had three roots (55.2%) and three canals (37.9%). Most MB root (43.8%), DB root (87.5%), and palatal root (100%) of maxillary third molars had Vertucci Type I. Mesiobuccal root of three-rooted maxillary third molars had Vertucci Type I (43.8%) and Type IV (40.6%) configuration. Overall prevalence of C-shaped canals in maxillary third molars was 3.4%. Conclusion: There was a high prevalence of three-rooted maxillary molars with three canals.

Quantitative evaluation of apical extrusion of intracanal bacteria using rotary ProTaper, K3XF, twisted and hand K-file system: An ex vivo study

AIMS The aim of this study was to evaluate the number of intracanal bacteria extruded apically during root canal preparation using rotary ProTaper, K3XF, twisted, and hand K-file system. SUBJECTS AND METHODS Seventy extracted single-rooted human mandibular premolar teeth were used. Access cavities were prepared and the teeth were mounted in glass vials. Root canals were then contaminated with a pure culture of Enterococcus faecalis (ATCC 29212) and incubated at 37°C for 24 h. The contaminated roots were divided into four experimental groups of 15 teeth each and one control group of 10 teeth. Group 1: ProTaper; Group 2: K3XF; Group 3: Twisted file; Group 4: Hand K-file; Group 5: Control group. Bacteria extruded from the apical foramen during instrumentation were collected into vials. The microbiological samples were incubated in culture media for 24 h. Colonies of bacteria were counted and the results were given as number of colony-forming units (CFU)/ml. STATISTICAL ANALYSIS USED The obtained data were analyzed using the Kruskal-Wallis one-way analysis of variance and Mann-Whitney U-tests. RESULTS There was a significant difference between the rotary and hand instrumentation system related to the apically extruded intracanal bacteria. CONCLUSIONS Both the rotary and hand instrumentation systems extruded intracanal bacteria through the apical foramen. K3XF file system showed least bacterial extrusion amongst all instrumentation groups.

Endodontic practice management with cone-beam computed tomography

Traditionally, conventional periapical radiology formed the backbone of endodontics for diagnosis, treatment planning, and management. One of the major associated gripes being the technique created two-dimensional images of three-dimensional (3D) structures, suffered magnification, superimposition, and distortion, leading to compromised diagnostic information. The need to analyze the area of interest in all the possible planes led to the introduction of cone-beam computed tomography (CBCT), a novel modality specifically designed to produce precise, undistorted 3D reconstructed images of the maxillofacial skeleton. CBCT is increasingly being embraced by various fields in dentistry, remarkably in endodontic practice. A systematic literature-based and book-based review was conducted using the keywords “CBCT in endodontics” and “endodontic applications of CBCT.” This article hereby discusses the prospects of CBCT in endodontics with an emphasis on its application in diagnosis and management along with treatment outcome assessment.

Prevalence of C-shaped canals in mandibular second and third molars in a central India population: A cone beam computed tomography analysis

Introduction: To evaluate the prevalence of C-shaped root canals in mandibular molars using cone beam computed tomography (CBCT) in a subpopulation of Central India. Materials and Methods: CBCT scans of patients from diagnostic imaging center were selected in accordance with the criteria given by Fan et al. (2004) for C-shaped canals. A total of 238 CBCT scans fulfilled the inclusion criteria and thereby divided into two groups: Group 1: Images showing C-shaped canal configuration in mandibular second molars. Group 2: Images showing C-shaped canal configuration in mandibular third molars. The frequency and distribution of canals and their configuration along with the position of lingual/buccal grooves in the images were evaluated, and the data was analyzed. Results: CBCT evaluation showed that 9.7% of second molars and 8% of third molars had C-shaped canals. A prominent buccal groove was seen in these teeth. The data showed a significant difference (P = 0.038) for the presence of such anatomy on the right side for mandibular third molars. Conclusion: The study showed a significant prevalence of C-shaped canal configuration in the subpopulation studied.

Endodontic Management of a Rare Anatomic Variation of Radix Entomolaris in Mandibular First and Second Molar using Cone-beam Computed Tomography as a Diagnostic Aid

Radix entomolaris (RE) is the presence of an extra root in the lingual aspect of the mandibular molars. This is a rare anatomic variant, prevalence of which ranges between 5.96 and 6.67% in the Indian population. For a successful endodontic management, detection of these extra roots is important. In conventional radiography, these extra roots tend to be overlapped; thus, conebeam computed tomography (CBCT) provides a noninvasive technique to study the internal and external anatomy and aids in proper detection. The endodontic treatment of RE requires some modifications in the endodontic treatment as compared with the common two-rooted anatomic variant. This article presents a clinical case report of successful detection and endodontic management of mandibular first and second molar with extralingual root using CBCT as a diagnostic tool. This case report involves the endodontic treatment and presence of extra roots in both the mandibular first molar and second molar simultaneously in a single patient of Indian origin, which is a rare finding and has not been reported in endodontic literature till date.

Endodontic Management of Pathologic Root Resorption using EndoSeal Mineral Trioxide Aggregate

Mineral trioxide aggregate (MTA) has emerged as a reliable bioactive material with extended applications in endodontics that includes the obturation of the root canal space. Recently, introduced sealers based on MTA have been reported to be biocompatible, also to stimulate mineralization and encourage apatite-like crystalline deposits along the apical and middle third of the canal walls. This article examines the literature supporting EndoSeal MTA (MARUCHI, Wonju, Korea) as a root canal sealer, suggests method for its delivery and placement, and presents a case report that demonstrates its effectiveness in resolving a chronic periapical lesion.

Effect of QMix 2 in 1, BioPure MTAD and 17% Ethylenediaminetetraacetic Acid on Microhardness of Root Canal Dentin: An in vitro Study

Aim: To compare the effect of QMix, a mixture of tetracycline, citric acid, and detergent (MTAD), and ethylenediaminetetracetic acid (EDTA) on the microhardness of the root canal dentin. Materials and methods: A total of 30 single-rooted teeth were decoronated at 15 mm from the root apex. Root canal instrumentation using step back technique was done and the specimens were split into two halves using diamond disc. These were embedded in acrylic blocks and sent for testing by Vickers hardness test. The other half of the specimens was divided into four groups. Control group: In this, normal saline was used. Group I: MTAD was used. Group II: 17% EDTA was used. Group IV: QMix 2 in 1 (DENTSPLY) was used. The specimens were immersed in test irrigant for 5 minutes in closed glass plates. The tested specimens were sent for Vickers hardness test under 100 gm load for 15 seconds. The post Vickers hardness number readings were recorded and sent for statistical analysis. Results: Data were analyzed using one-way analysis of variance and least significant difference post hoc test was applied for pairwise comparison. QMix showed significantly less reduction in microhardness than EDTA and QMix: Normal saline > QMix>EDTA>MTAD. Conclusion: QMix as a root canal irrigant is efficient as it caused least reduction of microhardness of dentin. It has antibacterial properties and is also efficient for smear layer removal.