Rajendra Kumar Tewari

Prevalence of Three-rooted Mandibular Permanent First Molars among the Indian Population

INTRODUCTION The aim of this retrospective study was to determine the prevalence of three-rooted mandibular permanent first molars among the Indian population by using periapical radiographs. METHODS Five hundred eighty-six patients (320 females and 266 males) were selected, with at least 1 mandibular first molar. A total of 1054 periapical radiographs of mandibular first molars, comprising 526 right side and 528 left side, were included. The radiographs were taken at 30-degree mesial angulation and were evaluated by using the magnifying lens. The incidence, gender, and symmetry of three-rooted mandibular first molars were recorded and analyzed by using the chi(2) test. RESULTS The prevalence of three-rooted mandibular first molars was 5.97% for all patients and 4.55% for all teeth, respectively. The incidence of bilateral symmetrical distribution was 37.14%. The incidence was 6.88% for female patients and 4.89% for male patients (chi(2) = 1.02, P > .05) and 4.94% for the right side and 4.17% for the left side, respectively (chi(2) = 0.36, P > .05). No statistically significant differences were found between female and male patients and between the right-side and left-side occurrences. CONCLUSIONS Clinicians should be aware of the high racial prevalence of this unusual root morphology in mandibular first molars among the Indian population before and during the root canal treatment of three-rooted mandibular first molars.

Antibiotic prescription pattern among Indian oral healthcare providers: a cross-sectional survey

OBJECTIVES Inappropriate prescribing of antibiotics by healthcare professionals is a worldwide concern. The purpose of this study was to determine the pattern of antibiotic prescription among oral healthcare providers in India. METHODS A one-page questionnaire was sent to 1600 oral healthcare practitioners registered under the Indian Dental Association by using multistage sampling; 552 (34.5%) responded to the survey. The data were analysed using the χ(2) test and multiple logistic regression analysis. RESULTS Of 552 questionnaire respondents, 405 (73.4%) chose amoxicillin in non-allergic patients, alone [279 (50.5%)] or associated with clavulanic acid [126 (22.8%)]. The average duration of antibiotic therapy was 4.26 ± 1.26 days. The drug of first choice for patients with an allergy to penicillin was erythromycin [242 (43.8%) of respondents]. A majority prescribed antibiotics for irreversible pulpitis and acute apical periodontitis [395 (71.6%)] and necrotic pulp, acute apical periodontitis and no swelling [326 (59.1%)]. Five hundred and ten (92.4%) of the oral healthcare providers overprescribed antibiotics. CONCLUSIONS Oral healthcare providers in India are overprescribing, which could be a major contributor to the world problem of antimicrobial resistance. As there is overprescription of antibiotics by Indian oral healthcare providers, there is an urgent need to raise public and professional awareness regarding the risks of antibiotic use.

Prevalence of Three-Rooted Mandibular First Molars among Indians Using SCT

Undetected extra roots or root canals are a major reason for failure of endodontic treatment. Failure to recognize an extra distolingual (DL) root in mandibular first molar may lead to incomplete debridement of the root canal system and eventually treatment failure. Therefore, it is crucial that atypical anatomy is identified before and during dental treatment. Spiral computed tomography (SCT) images can show 3D images, and therefore much detail can be used when traditional methods prevent adequate endodontic treatment. The overall incidence of DL roots on the mandibular first molars was 6.40% for all patients and 5.00% for all teeth, respectively. The occurrence of DL roots on the right side and on the left side showed a statistically significant difference. The bilateral incidence of symmetrical distribution of DL roots was 56.25%. The DL root canal orifice was separated from DB canal orifice by 2.79 ± 0.34 mm, from the MB canal orifice by 4.23 ± 0.81 mm, and from the ML canal orifice by 3.29 ± 0.52 mm. The high prevalence of the DL root in permanent mandibular first molars among the Indian population by using SCT and estimations of the interorifice distance of such teeth might be useful for successful endodontic treatments.

Effect of manual dynamic activation on smear layer removal efficacy of ethylenediaminetetraacetic acid and SmearClear: An in vitro scanning electron microscopic study

The purpose of the present study was to evaluate the effect of manual dynamic activation (MDA) with a master gutta-percha point on the smear layer removal efficacy of 17% ethylenediaminetetraacetic acid (EDTA) and SmearClear. Fifty freshly extracted human single-rooted teeth were prepared using ProTaper rotary system up to F3 size. The prepared teeth were divided into five groups on the basis of final irrigation received. Group A: 3% NaOCl solution (negative control group). Group B: 5 mL of 17% EDTA. Group C: 1 mL of 17% EDTA + MDA for 2 min + 4 mL of 17% EDTA rinse. Group D: 5 mL of SmearClear. Group E: 1 mL of SmearClear + MDA for 2 min + 4 mL of SmearClear rinse. Prepared samples were decoronated and then longitudinally split into two halves and evaluated under scanning electron microscope. Representative images at coronal, middle and apical third level were taken and scored for the amount of smear layer present, using a three-score system. The data were analysed through Kruskal-Wallis and Mann-Whitney U-test. The root canal surfaces of samples of group C and group E (where MDA was done) were significantly cleaner in apical third regions than those of group B and group D (P < 0.05).

Double Dens Invaginatus with Multiple Canals in a Maxillary Central Incisor: Retreatment and Managing Complications

Dens invaginatus is a developmental anomaly that often presents a perplexing challenge to the endodontist. It involves the maxillary central incisor less commonly than the maxillary lateral incisor. Double dens invaginatus is even rarer. Herein a unique case of dens invaginatus in a maxillary central incisor is presented. The tooth had an inadequate previous root canal treatment. On retreatment, multiple canals and double dens invaginatus were found. The invaginations were Oehlers type 3b and type 2. The complex morphology was diagnosed and confirmed with cone-beam computed tomography imaging and managed with a combined surgical and orthograde approach. Four canals and a blind sac along with an open apex were found. There were many intercommunications between the canals. During the treatment, a complication of a separated instrument occurred, which was managed successfully. The 1-year follow-up shows successful outcome of the treatment. Dens invaginatus may be more complicated than it seems. It needs meticulous treatment by a specialist. Failure or a delay in referring the case to a specialty setting may further increase the complications. With the advancements in equipment and materials, it is possible to save even severe cases of dens invaginatus.

Newer Endodontic irrigation devices: An update

The ultimate aim of endodontic therapy is thorough debridement of root canal system. The aim of this review is to give a brief description of endodontic irrigation devices and their efficacy in root canal therapy. Recently developed irrigation devices and their application mode also discussed. Mechanism of these devices and the phenomenon that governs the irrigation efficacy discussed briefly. 5 Irrigation allows for cleaning beyond what might be achieved by root canal instrumentation alone so it is an essential part of root canal debridement. Till date none of the irrigant posses ideal quality that is why in contemporary endodontic practice, dual irrigants such as sodium hypochlorite (NaOCl) with ethylenediaminetetraacetic acid (EDTA) or chlorhexidine (CHX) are often used as initial and final rinses to complement the shortcomings that are associated with the use of a single irrigant. Irrigants must be brought into direct contact with the entire canal wall surfaces for effective action particularly for the apical portions of small root canals. Various methods have been developed in order to provide effective delivery. These systems might be divided into 2 broad categories, manual agitation techniques and machine-assisted agitation devices. The objective of this review was to present an overview of contemporary irrigation methods available in endodontics. II. Manual irrigation techniques Manual irrigation system using needles is still widely accepted by both general practitioners and endodontists. In this technique the dispensing of an irrigant into a canal through needles/cannulas of variable gauges, either passively or with agitation. The agitation might be achieved by moving the needle up and down the canal space. The design of these needles can be closed-ended, side-vented channels. III. Max-i-probe

Management of C-shaped root canal configuration with three different obturation systems

Unusual root canal anatomy always poses a diagnostic and treatment challenge. Identification of such variation is important for the success of the root canal treatment outcome. The C-shaped root canal configuration is one of the aberrant morphology of molar teeth, commonly the mandibular second molar. In this configuration, the canals are connected by slit or web. The presence of fin, slit and web makes through debridement obstacle for the clinician. This case reports present successful management of C-shaped mandibular molars with three different obturation systems.

Radix Entomolaris: A Clinical Challenge

ABSTRACT A major anatomical variant of the two-rooted mandibular first molar is a tooth with an additional distolingual third root: The radix entomolaris (RE). It is essential to anticipate and find all roots and canals during root canal treatment. Proper angulations and interpretation of radiographs help to identify pulp chamber and root anatomy. If present, an awareness and understanding of this unusual root and its root canal morphology can contribute to the successful outcome of root canal treatment.

Root canal morphology of mandibular first molars in a North Indian subpopulation: An in vitro clearing study

Introduction: Limited information is available about the canal morphology of mandibular first molars in North Indian population. The purpose of this study was to evaluate the root canal morphology of North Indian mandibular first molars by clearing and staining technique. Materials and Methods: A total of 863 mandibular first molars collected from various places in North India were subjected to canal staining and decalcification procedures. Access cavities were prepared, and pulp tissue dissolved with sodium hypochlorite. Indian ink was injected into the root canals aided by negative pressure applied at the root tips. The stained teeth were decalcified with 7% hydrochloric acid. Instead of ascending concentrations of alcohol, a nonalcohol-based drying agent (anhydrous calcium chloride) was used to remove traces of acid and water from the specimens. The dried specimens were immersed in methyl salicylate to render them transparent. The following features were observed under operating microscope at ×6 magnification: (i) Number of root canals per tooth, (ii) number of root canals per root, (iii) root canal configuration in each root (Vertuccis classification), and (iv) lateral canals, intercanal communications, and their location. Results: Majority had two roots (85%) with three (61%) and four (30%) canals. Three roots were present in 15% of the specimens. Type IV (49%) and type I (48%) were the most common configurations in mesial and distal roots, respectively. Conclusion: First molars with two roots and three canals are a common feature in North Indian patients. Both roots showed wide variations in canal anatomy with type IV and type I configurations predominating in mesial and distal roots, respectively.

Esthetic recovery of permanent Mandibular Lateral Incisor using biological post after non-surgical healing of Periradicular Lesion: A Case Report

Statement of the problem: Anterior tooth fracture, as a result of traumatic injuries, frequently occurs in dentistry. This leads to necrosis of pulp and periapical pathology. The goal of endodontic and restorative dentistry is to retain natural teeth with maximum function and pleasing esthetics. Purpose of the study: This study aimed at proper reconstruction of extensively damaged teeth through the procedure known as “Biological Restoration.” Materials and methods: Biological post obtained through natural, extracted teeth from another individual represents a low-cost option and alternative technique for the morphofunctional recovery of damaged anterior teeth that provides highly functional and esthetic outcomes. Conclusions: This case report refers to the esthetics and functional recovery of mandibular left lateral incisor after non-surgical healing of periradicular lesion. Case Report Esthetic recovery of permanent Mandibular Lateral Incisor using biological post after non-surgical healing of Periradicular Lesion: A Case Report Amit Kumar Garg1, Neha Agrawal2*, Rajendra Kumar Tewari3 and Surendra Kumar Mishra4 1Associate Professor, Dept. of Conservative Dentistry and Endodontics, K.D. Dental College and Hospital, Mathura, India 2Associate Professor, Dept. of Periodontics and Community Dentistry, Dr. Z. A. Dental College, A.M.U., Aligarh, UP, India 3Professor and Principal, Dept. of Conservative Dentistry and Endodontics, Dr Z. A. Dental College, AMU., Aligarh,, UP, Indore, India 4Professor and Chairman, Dept. of Conservative Dentistry and Endodontics, Dr. Z. A. Dental College, A.M.U., Aligarh, UP, India *Address for Correspondence: Dr. Neha Agrawal, MDS, Associate Professor, Dept of Periodontics and Community Dentistry, Dr. Z. A. Dental College, A.M.U., Aligarh, UP, India, Tel: 917895335770; Email: dr.n_agrawal@yahoo.co.in Submitted: 25 May 2017 Approved: 20 June 2017 Published: 22 June 2017 Copyright: 2017 Garg AK, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.