Syed Mukhtar-Un-Nisar Andrabi

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.

Necrotizing periodontitis in a heavy smoker and tobacco chewer – A case report

Necrotizing periodontitis is a distinct and specific disease characterized by rapidly progressing ulceration of the interdental gingiva and then spreading along the gingival margins and leading to acute destruction of periodontal tissues. Necrotizing ulcerative gingival lesions are common in developing countries because of poor nutritional status, poor oral hygiene and debilitating conditions. In the developed world it is mostly seen in patients with the HIV infections and other immune system dysfunctions. The exact etiology of the necrotizing lesions is still unknown; however a fuso-spirochaetal infection along with weakened host immune system seems to play a major role in the pathogenesis of these diseases. Presented is the case of acute necrotizing periodontitis in a 21 year old male patient with no systemic disease but a history of tobacco use (chewing and smoking) since 7 years. The patient was managed by conservative treatment followed by surgery for the correction of gingival defects.

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.

Endodontic irrigant as a root conditioning agent: An in vitro scanning electron microscopic study evaluating the ability of MTAD to remove smear layer from periodontally affected root surfaces.

BACKGROUND Instrumentation of the root surface, results in formation of a smear layer of organic and mineralized debris which serves as a physical barrier, inhibiting new connective tissue attachment to the root surface. The present study advocates the use of an endodontic irrigant MTAD (mixture of tetracycline, citric acid and detergent) as a root conditioning agent. The main aim of the study was to compare the root conditioning ability of an endodontic irrigant MTAD (mixture of tetracycline, acid and detergent) with 17% EDTA (ethylenediaminetetraacetic acid). MATERIALS AND METHODS Sixty freshly extracted human single rooted teeth with confirmed periodontal involvement were selected for this study and decoronated. The apical third of each root was removed and the remaining root was sectioned longitudinally to produce a 6mm to 8mm long tooth section. The root surface was then instrumented by hand using a sharp Gracey 1-2 periodontal curette with 6-8 strokes per area to achieve a smooth glass-like surface. A total of 60 specimens were prepared which were randomly divided into three groups (n=20). Each group received the root conditioning treatments as follows: All specimens were prepared for SEM and scored according to the presence of smear layer. RESULTS AND CONCLUSIONS MTAD removed the smear layer successfully from the root surfaces. The mean smear score for samples treated with Biopure MTAD was lower than those treated with EDTA, (p=0.04). MTAD can be used as a root conditioning agent with efficient smear layer removal ability and known antimicrobial and anticollagenase activity.

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.