Sharique Alam

Retrieval of a separated nickel-titanium instrument using a modified 18-guage needle and cyanoacrylate glue: a case report

During root canal preparation procedures, the potential for instrument breakage is always present. When instrument breakage occurs, it leads to anxiety of the clinician and as well as a metallic obstruction of the canal which hinders further cleaning and shaping. Separated instruments must always be attempted for retrieval and if retrieval is not possible bypass should be tried. With the increased use of nickel-titanium (NiTi) instruments the incidence of separated instruments has increased. A considerable amount of research has been done to understand the various factors related to the fracture of NiTi instruments to minimize its occurrence. This paper presents a review of the literature regarding the fracture of NiTi instruments and also describes a case report showing the use of a modified 18-guage needle and cyanoacrylate glue to retrieve a separated NiTi instrument from the mesiolingual canal of a mandibular first molar.

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.

Mental nerve paresthesia secondary to initiation of endodontic therapy: a case report

Whenever endodontic therapy is performed on mandibular posterior teeth, damage to the inferior alveolar nerve or any of its branches is possible. Acute periapical infection in mandibular posterior teeth may also sometimes disturb the normal functioning of the inferior alveolar nerve. The most common clinical manifestation of these insults is the paresthesia of the inferior alveolar nerve or mental nerve paresthesia. Paresthesia usually manifests as burning, prickling, tingling, numbness, itching or any deviation from normal sensation. Altered sensation and pain in the involved areas may interfere with speaking, eating, drinking, shaving, tooth brushing and other events of social interaction which will have a disturbing impact on the patient. Paresthesia can be short term, long term or even permanent. The duration of the paresthesia depends upon the extent of the nerve damage or persistence of the etiology. Permanent paresthesia is the result of nerve trunk laceration or actual total nerve damage. Paresthesia must be treated as soon as diagnosed to have better treatment outcomes. The present paper describes a case of mental nerve paresthesia arising after the start of the endodontic therapy in left mandibular first molar which was managed successfully by conservative treatment.

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.

Frequency of middle mesial canals in mandibular first molars in North Indian population - An in vivo study

Objectives: The primary aim of the study was to determine the frequency of middle mesial (MM) canals in mandibular first molars in North Indian population. The secondary aim was to analyze whether an association exists between the detection rate of MM canals and age, gender, and number of distal canals. Materials and Methods: All mature mandibular first molars endodontically treated between March 2013 and March 2015 were included in the study. After instrumenting the main canals, the clinician inspected the mesial developmental groove under dental operating microscope (DOM) using ultrasonic tips and endodontic explorer to detect accessory mesial canals. The canal, if found, was negotiated, cleaned, shaped, and recorded. Results were analyzed using Chi-square test. Results: A total of 258 first molars from 243 patients were treated during the specified period, of which 28.3% had negotiable MM canals. The frequency of MM canals was 36.6% in patients 11-30 years old, 22.6% in patients 31-50 years old, and 18.4% in patients >50 years. Statistical analysis revealed a significant relationship of different age groups with the incidence of MM canals (P < 0.05). A significant relationship was also found between the detection rate of two canals in distal root and the presence of MM canals (P < 0.05) with gender having no influence. Conclusion: The presence of MM canals is quite high in North Indian population. Younger patients had a higher incidence of MM canals. Mandibular first molars with two separate distal canals showed a tendency to have MM canals.

Management of grossly destroyed endodontically treated teeth with lock and key custom modified cast post and core design: A case series

The purpose of this paper is to demonstrate a more retentive custom modified lock and key design of metal cast post and core for the restoration of grossly destroyed endodontically treated molar tooth. The lock and key metal cast post consists of two parts, one in the distal canal (primary post) and the other one in mesio-lingual canal (secondary post). The primary post has a lock design, while the secondary post contains the key design, both of which interlock together. Lock and key cast post, mentioned in this report can be an effective design for the management of grossly destroyed molar teeth.