Pradeep Jain

Maxillary right second molar with two palatal root canals

We report a clinical case of maxillary right second molar with two palatal root canals. The morphology is atypical because it is characterized by two palatal roots with two canals with widely separated orifices and canals. Modifications to the normal access opening and examination of the pulpal floor for additional canals are stressed.

Successful removal of a 16 mm long pulp stone using ultrasonic tips from maxillary left first molar and its endodontic management

To present a case report describing successful removal of a 16 mm long pulp stone in a single mass from a maxillary left first molar and its endodontic management. In the presented case, the conventional approach of dissecting the pulp stone was not considered, as radiographically the calcification was extending up to the apex of the palatal root canal and the separation of the coronal and radicular pulp stone would have risked the obliteration of its orifice. A new set of ultrasonic endodontic tips were used for the removal of significantly large pulp stone in single mass.

Internal tunneling resorption associated with invasive cervical resorption

Treating pathological defects that are caused by resorption in teeth can be challenging. The task is complicated further if the resorption extends beyond the restrains of the root. The aim of this report is to describe a case of extensive internal tunneling resorption (ITR) associated with invasive cervical resorption (ICR) in a maxillary right lateral incisor and its nonsurgical treatment. A 22-year-old male was referred to the department of endodontics with a chief complaint of discolored maxillary right lateral incisor or tooth 12 and a history of trauma. An extensive ITR associated with ICR accompanied by apical periodontitis was detected on a preoperative radiograph which was confirmed on a cone-beam computed tomography (CBCT) scan in a maxillary lateral incisor. After chemomechanical debridement and withdrawal of a separated file in the canal, calcium hydroxide was placed as an intracanal medicament for 2 weeks. Biodentine (BD) was used to obturate the defect as well as entire root canal system and to restore ICR. On a 5-year follow-up, the tooth was functional, and periapical healing was evident. Based on results of this case, successful repair of ITR associated with ICR with BD may lead to resolution of apical periodontitis. Trauma to teeth may lead to resorption which may be internal, external, and or a combination of both which may be asymptomatic in some patients. Preoperative assessment using CBCT imaging achieves visualization of location and extents of resorptive defects. Bioactive materials like BD may lead to favorable results in treating such extensive defects.

Management of intrinsic discoloration using walking bleach technique in maxillary central incisors

Introduction Non-vital bleaching is a non-invasive technique to treat the intrinsic discoloration of teeth of several etiologies. Hydrogen peroxide and sodium perborate are commonly used bleaching agents. Aim The aim of this case report is to demonstrate the non-vital bleaching technique in maxillary anterior teeth. Method Maxillary central incisors were isolated with rubber dam and root canal treatment was performed. Barrier space preparation was done using a heated instrument. Glass ionomer cement was used a barrier material. Mixture of hydrogen peroxide and sodium perborate was placed in the canal and sealed with intermediate restorative material. After 1 week, the procedure was repeated to achieve the desired results. Conclusion Non-vital bleaching is a minimally invasive procedure to restore the esthetics of a discolored non-vital tooth. However, care should be taken to prevent any post-operative complications.

CYSTEAMINE IMPROVES THE BACTERICIDAL EFFICACY OF INTRA-CANAL MEDICAMENTS AGAINST ENTEROCOCCUS FAECALIS

Aim The aim of this study was to compare the antimicrobial efficacy of cysteamine, calcium hydroxide[Ca(OH)2], triple antibiotic paste (TAP), chlorhexidine (CHX) and their combinations against Enterococcus faecalis (E. Faecalis). Methods The E. Faecalis eradication capacity of cysteamine, Calcium hydroxide (Ca[OH]2), TAP, CHX, and their combinations was tested on E. Faecalis by Kirby Brauer disc diffusion method. Results Cysteamine in combination with TAP was able to completely eradicate E. Faecalis within 24 hours. Ca(OH)2 was unable to show its effect on E. Faecalis in the given time. Conclusion Cysteamine increased the E. Faecalis eradicating capacity of TAP and also showed positive results when used in combination with Ca(OH)2, which if used alone was unable to show any action in 24 hours.

Endodontic management of maxillary third molar with MB2 (Vertucci type IV) canal configuration diagnosed with Cone Beam Computed Tomography – a case report

The endodontic treatment of maxillary third molar often poses a challenge even to an experienced endodontist because of their most posterior location in the dental arch, aberrant occlusal anatomy, abnormal root canal configuration and eruption patterns. Owing to these anatomical limitations, their extraction remains the treatment of choice for many clinicians. As we know, retaining every functional component of the dental arch is of prime importance in contemporary dental practice. This clinical case report aims to discuss the endodontic treatment of maxillary third molar with MB2 root canal separated throughout the length and exit at two separate apical foramina (Vertucci type IV) diagnosed with Cone Beam Computed Tomography (CBCT)..

Comparison of different irrigation and agitation methods for the removal of two types of calcium hydroxide medicaments from the root canal wall: An in-vitro study

Background and aim Comparison of different irrigation and agitation methods for the removal of two types of calcium hydroxide medicaments from the root canal walls. Methods Fifty extracted single rooted teeth were selected for this study. After decoronation, the root canals of these teeth were prepared to the size F3 (30 no.) using rotary ProTaper file system. These samples were randomly divided into four groups. Group 1 (n=20) were filled completely with water based calcium hydroxide (CH), Group 2 (n=20) were filled with oil based CH using lentulo spiral, Group 3 (n=5) - the positive control group received the CH as intracanal medication, but no subsequent removal, Group 4 (n=5) - the negative control did not receive CH placement. Further on, Group 1 and Group 2 were divided into four sub-groups (n=5). In sub-group A we performed conventional syringe irrigation with side-vented needle sub-group B) manual dynamic agitation, sub-group C sonic agitation using endoactivator, sub-group D passive ultrasonic irrigation (PUI). Roots were split longitudinally into mesial and distal halves. Digital images of the root canal walls were acquired by a Dental Operating Microscope (DOM) and assessed by using a scoring criteria at different thirds (coronal, middle and apical) of the root canal as follows: score 1, score 2, score 3, and score 4. Data were analyzed applying one-way analysis of variance (ANOVA) and Tukey’s multiple comparison tests at a 95% confidence interval (P < 0.05). Results Statistically significant differences were not found between the experimental groups and the negative group in any one third of the root canal (P>0.05). However, a difference did exist between the experimental groups and the positive control group (P<0.05). None of the experimental groups totally removed CH substances from root canal walls. Conclusion Among all experimental groups, removal of CH was best achieved by sonic agitation using endoactivator followed by passive ultrasonic irrigation (PUI), manual dynamic agitation and conventional syringe irrigation with side-vented needle.

Cutaneous dental sinus of submental region: An eight years follow-up

A 22-year-old female patient had a history of a 7-month recurrent pus discharge from her chin. She had been previously treated by physicians, dermatologist, and surgeons. The sinus kept re-occurring and she was referred to dental hospital for opinion. The patient had cutaneous opening of size 5 mm × 6 mm with purulent discharge in submental region. Patient had undergone three surgical excisions and multiple antibiotic regimens. Patient had a history of trauma due to fall six years back. A 30 number standard gutta-percha was used to trace the sinus tract and dental origin was confirmed radiographically. The tract led to in-between the root canal apices of both mandibular incisors. Treatment included non-surgical endodontic treatment with both mandibular central incisors and antibiotic coverage following bacterial culture of discharge. The pus culture showed Streptococcus anginosus which was found to be sensitive to penicillin. Patient was kept on 1-week course of oral amoxicillin-clavulanate along with root canal therapy. The cutaneous sinus healed following root canal treatment and antibiotic coverage. On an 8-year follow-up skin of sub-mental region appeared normal and peri-apical healing with both mandibular central incisors was evident radiographically. Cutaneous lesions on face may be of dental origin. A cross referral between dentists, physicians, surgeons, and dermatologists should be considered in such cases.

Cutaneous sinus tract of dental origin

A 22-year-old male patient was referred to the department of endodontics from the department of general surgery for a dental opinion. His chief complaint was intermittent pus discharge from an opening located on the right upper cheek area of size 11×13 mm since the past 1 month (figure 1). The patient had undergone multiple excisional surgeries for the same reason. Hence, cone beam CT (CBCT) with contrast was …

Stereomicroscopic Evaluation of Sealing Ability of Four Different Root Canal Sealers- An invitro Study.

INTRODUCTION The most commonly used core material for root canal filling is gutta-percha and as the gutta-percha by itself cannot obturate the complete root canal system, owing to its poor sealing properties hence, a sealer is used in combination with root filling material. Sealer is more important than the core obturating material. Sealer plays a secondary role by merely reinforcing (binding or luting) the gutta-percha to the canal walls, however, it is now confirmed that the sealer has a prime role in sealing the canal by blocking the irregularities between the canal space and the core filling material. AIM To investigate the effectiveness of the apical seal obtained by different sealers used in conjugation with cold lateral condensation technique of obturation using gutta-percha under stereomicroscope. MATERIALS AND METHODS One hundred single-rooted extracted human permanent teeth with a single root canal were used in this in-vitro study. The sealers tested were conventional Zinc oxide eugenol sealer, Apexit, AH-Plus and Roekoseal Automix (RSA). The specimens were examined under a stereomicroscope. For the analysis of data Snedocors F test for the quality of variances among the experimental group and control group (One-Way ANOVA) were employed. RESULTS The polydimethylsiloxane endodontic root canal sealer RSA provided a significantly better apical seal followed by AH plus and Apexit whereas conventional zinc oxide eugenol showed the lowest sealing ability. CONCLUSION It was concluded that there were statistically significant differences amongst the experimental groups. The shrinkage related to setting and potential dissolution might risk the proper seal of the root canal leading to treatment failure.