Padmanabh Jha

Corelation between Machines Assisted Endodontic Irrigant Agitation and Apical Extrusion of Debris and Irrigant: A Laboratory Study

Aims. To compare amount of root canal debris and irrigant extruded apically after irrigants agitation using closed and open chambers. Methods and Material. Sixty maxillary central incisors were selected, decoronated, and mounted in preweighed glass vials filled with distilled water. Biomechanical preparation was completed using ProTaper rotary files until number F4 and 1 mL of 3% NaOCl solution after each file use. Samples were randomly divided into closed or open chamber sets which were further subdivided into 6 groups, based on the agitation techniques: no agitation (control), canalBrush, lentulospiral, passive ultrasonic agitation (PUA), EndoActivator, and EndoVac. Canals were irrigated with 1 mL of 17% EDTA and agitated for 30 s and then flushed with 2 mL of distilled water. Apically extruded irrigant was measured and vials were kept in incubator for 5 days at 68°C for drying for weight calculation. Statistical Analysis. Analysis was done using Students t-test, one-way ANOVA, and post-hoc. Results. All agitation techniques showed apical extrusion of the debris and irrigant. The closed chamber apparatus showed significantly less extrusion of debris and irrigant than open chamber (P < 0.05). Conclusions. EndoVac was found to be the safest agitation system among all test groups with regard to apical extrusion of debris and irrigant.

Comparative Evaluation of Fracture Resistance of Simulated Immature Teeth Restored with Glass Fiber Posts, Intracanal Composite Resin, and Experimental Dentine Posts

Aim. The aim of this study was to compare the fracture resistance of simulated immature teeth restored with gutta-percha, glass fiber posts (GFP), experimental dentine posts (DP) or Intracanal composite Resin (ICR). Materials and Methods. Fifty maxillary canines were decoronated, standardized and enlarged until, number 5 Peeso reamers were allowed to simulate immature teeth. After placement of 5 mm of MTA, the canals were divided into 5 groups and filled as follows: Group 1: AH Plus + gutta-percha, lateral compaction; Group 2: GFP luted with PARACORE dual cure resin; Group 3: DP luted with PARACORE dual cure resin; Group 4: PARACORE dual cure resin. A standardized core was built in all groups except in Group 5. Each of the specimens was tested for fracture resistance by universal testing machine. Results. The mean fracture resistance were 817 ± 27.753, 1164.6 ± 21.624, 994.4 ± 96.8747, 873.8 ± 105.446 and 493.7 ± 6.945 newtons for Groups 1, 2, 3, 4, and 5 respectively. Independent “t” test revealed statistically significant discrepancies, in the fracture resistance among the 4 groups except Group 1 and Group 4 (P < 0.05). Conclusions. This study suggests that GFP and DP may be preferred for additional reinforcement of immature teeth.

The root and root canal morphology of the human mandibular premolars: A literature review

The objective was to review thoroughly the literature of the root and root canal morphology of the human mandibular premolars. Published studies were divided into anatomic studies reporting the number of roots, number of canals, and apical anatomy. Differences caused by gender and ethnicity have also been reported. Individual case reports of anomalies were included to demonstrate the extreme range of variation. Almost all of the teeth in the anatomic studies were single rooted (99.6%). The incidence of two roots (0.3%) and three roots (0.1%) was extremely rare. Anatomic studies of the internal canal morphology found that a single canal was present in 91.0% of the teeth. A single apical foramen was found in 91.8% of the teeth. However, the root and root canal morphology of the mandibular premolars can be extremely complex and requires careful assessment.

Evaluation of marginal sealing ability of self-adhesive flowable composite resin in Class II composite restoration: An in vitro study

Aim: The aim of this study is to evaluate the marginal sealing ability of self-adhesive flowable composite resin when used as a liner in Class II composite restoration with and without aging. Materials and Methods: A total of 120 standardized Class II tooth preparations with gingival margins 1 mm coronal and apical to cementenamel junction (CEJ) were prepared on 60 extracted permanent mandibular molars and were randomly divided into eight equal Groups: Group 1: cavities coronal to CEJ and restored with Dyad flow liner + Herculite ultra, Group 2: same as Group 1 but cavities margins apical to CEJ, Group 5: cavities coronal to CEJ and restored with only Herculite ultra, and Group 6: same as Group 5 but cavities apical to CEJ. Groups 3,4,7,8 were similar to Groups 1,2,5,6, respectively, but were aged for 6 months. After thermocycling, microleakage testing was done using 0.5% basic fuchsin dye. Result: At cervical level, Group 5 exhibited statistically lower (P = 0.006) microleakage than Group 6, and Group 1 showed lesser microleakage than Group 5 (P = 0.162). Group 2 exhibited significantly less microleakage than Group 6 (P = 0.002). Increased microleakage was observed in aging Groups; however, the difference with nonaging Groups was not statistically significant (P > 0.005). Conclusion: Margins of the cavity in cementum can be better sealed by placing self-adhesive liner and is not affected by aging.

An in vitro comparative evaluation of different intraorifice barriers on the fracture resistance of endodontically treated roots obturated with gutta-percha

Aim: To compare and evaluate the root reinforcement potential of four different intraorifice barriers: Mineral trioxide aggregate (MTA), resin-modified glass ionomer cement (RMGIC), fiber-reinforced composite (FRC), and nanohybrid composite (NC). Materials and Methods: Seventy-five mandibular premolars were decoronated to a standardized length, and prepared and obturated with gutta-percha and AH Plus sealer. Except for control specimens, the coronal 3-mm gutta-percha was removed and filled with different materials. The specimens (75) were divided into five groups (n = 15) on the basis of the intraorifice barrier material used. Group 1: MTA, Group 2: RMGIC, Group 3: FRC, Group 4: NC, Group 5: no barrier (control). Fracture resistance of the specimens was tested. Results: Fracture resistance of roots was significantly affected by the type of intraorifice barrier used and the following pattern was observed: RMGIC > FRC > NC > MTA. Conclusion: Intraorifice barriers can be regarded as a viable choice to reduce the occurrence of postendodontic root fractures. Among the four tested materials, RMGIC showed the maximum reinforcement.

Effect of methods of evaluation on sealing ability of mineral trioxide aggregate apical plug

Aim: The purpose of the study was to evaluate and compare the sealing ability of mineral trioxide aggregate (MTA) with three different methods. Materials and Methods: Forty single canal teeth were decoronated, and root canals were enlarged to simulate immature apex. The samples were randomly divided into Group M D = MTA-angelus mixed with distilled water and Group M C = MTA-angelus mixed with 2% chlorhexidine, and apical seal was recorded with glucose penetration method, fluid filtration method, and dye penetration methods and compared. Results: The three methods of evaluation resulted differently. The glucose penetration method showed that M D sealed better than M C , but difference was statistically insignificant (P > 0.05). The fluid filtration method resulted that Group M C was statistically insignificant superior to Group M D (P > 0.05). The dye penetration method showed that Group M C sealed statistically better than Group M D . Conclusion: No correlation was found among the results obtained with the three methods of evaluation. Addition of chlorhexidine enhanced the sealing ability of MTA according to the fluid filtration test and dye leakage while according to the glucose penetration test, chlorhexidine did not enhance the sealing ability of MTA. This study showed that relying on the results of apical sealing by only method can be misleading.

Absorbable Suture as an Apical Matrix in Single Visit Apexification with Mineral Trioxide Aggregate

Several procedures have been recommended to induce the root end barrier formation in teeth with open apices. Conventional treatment for such cases will require many appointments with an average duration of 12.9 months. During this period, the root canal is susceptible to reinfection from around the provisional restoration, which may promote apical periodontitis and arrest of apical repair. Mineral trioxide aggregate (MTA) has been successfully used for one visit apexification wherein the root canal can be obturated within 24 hours after placement of MTA. Using a matrix prior to the placement of MTA avoids its extrusion, reduces leakage in the sealing material, and allows favorable response of the periapical tissues. This report presents a case of apexification where an absorbable suture was used as an apical matrix. Use of an absorbable suture circumvents all the problems associated with other conventional materials. Conclusion. Placement of the matrix made from the suture material is predictable and is easily positioned at the apex and the length can be adjusted as required. 10-month follow-up of the case shows resorbed matrix and bone healing in the periapical region. The patient was asymptomatic during the whole follow-up period and tooth exhibited mobility within physiologic limits and was functioning normally.

Evaluation of effect of addition of 2% chlorhexidine on the sealing ability of Biodentine: An in vitro study.

Aim: To evaluate the effect of the addition of 2% chlorhexidine on the sealing ability of Biodentine. Materials and Methods: Forty-six extracted human premolar teeth with single canal and apical foramen were selected, cleaned, and decoronated to standardize the length of 17 mm. Canals were prepared using ProTaper rotary files till size F4. The samples were divided into 2 experimental groups of 20 samples each on the basis of absence/presence of 2% chlorhexidine in liquid: Group BM = Biodentine mixed with the provided liquid, Group BC = Biodentine mixed with 2% chlorhexidine in provided liquid. Three samples, each were assigned to control groups: Group BP (positive control) = No root end filling was placed, Group BN (negative control) = Root ends were filled as in Group BM, and entire external surface was coated with sticky wax. The samples were then evaluated for the apical sealing using fluid filtration method. Results: Results were analyzed using Students t-test (P ≤ 0.05). Group BC showed the better sealing ability (3.06) as compared to Group BM (3.85). However, the difference was statistically insignificant (P > 0.05). Conclusion: Addition of 2% chlorhexidine to the liquid enhanced the sealing ability of Biodentine.

Endodontic management of maxillary second molar with 2 palatal roots and root canals: A rare case report

This case report presents the endodontic management of a maxillary second molar with 2 palatal roots, which have canals with separate orifices and apical foramen. The diagnosis was confirmed by the clinical and radiographic examination of the tooth. Root-canal treatment was performed using rotary instrumentation with Protaper files and obturated with corresponding protaper gutta percha cones and AH Plus sealer.