Prevalence of middle mesial canals and Isthmi in mandibular molars in a subpopulation of Andhra Pradesh: An in vivo investigation using CBCT.

Background: Pulp and root canal space is enigmatic and highly complex. Encountering rare has become a norm with the advancements in the technology of materials and types of equipment. The success of the root canal treatment depends on the effective removal of bacteria from the whole pulp space. A high percentage of the missed canal is reported for the failure of Endodontic therapy. Mandibular molars have complex root canal anatomy. Two roots with two canals in mesial root and one to two canals in distal root is a common occurrence.    Nevertheless, the incidence of variation is relatively high, including separate distolingual, mesiobuccal, C-Shaped canals, isthmus, and additional canal in the mesial root. A wide range of the middle mesial canal occurrence, i.e., 3.1 to 46.1%, is reported in the world and 28.3% in North India. Aim: To identify the prevalence of the true middle mesial canal (MM) and configuration of Isthmi in the mesial root of the mandibular molar in the AP   subpopulation of South India.   Materials and methods: CBCT of 89 patients were randomly selected from the institutional database. Data entry was performed in Excel, and data analysis was done with the Statistical Package for Social Sciences (SPSS). Results: Four images (4.5%) revealed Middle Mesial canals with no statically significant occurrence. The frequency of isthmi in the mesial roots was 52.7%.  This showed a considerable presence. Conclusion: MM canals are 4.5% in a subpopulation of Andhra Pradesh. Isthmuses are very common in the mesial roots of permanent mandibular molars. Isthmus about 58% was seen with Type II configuration that is the presence of two canals without a definite communication

Evaluation of the accuracy of working length determination and automatic apical reverse function accuracy of endodontic rotary motor integrated apex locator: an in-vitro study

Background: The outcome of a Root canal therapy depends upon complete cleaning of the root canal system without damaging periapical integrity. Accurate determination of working length determination is essential. The development of Endodontic motor integrated apex locators (EALs) for locating canal terminus has been significant innovation in the field of Endodontics. Aim: To evaluate the accuracy of Endomotor integrated electronic apex locator in determining the working length before and after cleaning and shaping with Automatic Apical Reverse action set at the "0.5mm" mark. Methodology: Forty extracted premolars were decoronated, patency was verified. The actual length of tooth measured and teeth were embedded in alginate and file was advanced. Readings at the apex and 0.5mm short of the apex was recorded using Dentaport ZX (DZ group) and EConnect S (ES group) apex locator. Cleaning and shaping were done with rotary files with Automatic Apical Reverse action set at 0.5mm short of apex and reading recorded as Automatic Apical Reverse Length (AARL), and actual tooth length is measured. The data obtained were statistically analyzed. Results: Within the limitations of the study, the EALs readings of the DZ group & ES group provided an acceptable determination of working length within range ± 0.5mm, and AAR function set at 0.5mm mark of Endomotor integrated apex locator (E Connect S) provided an adequate apical limit. Conclusion: Under the invitro conditions of this study, both Electronic Apex Locators showed an acceptable determination of working length within range ± 0.5mm from the actual length. The AAR function set at the 0.5mm mark of Econnect S provided an adequate apical limit

Comparison of push-out bond strength of bioceramic sealer with bioceramic coated and non-bioceramic coated Guttapercha: an in vitro study

Background: The goal of the endodontic treatment is to achieve a fluid-tight impervious seal to prevent the ingress of bacteria and the occurrence of any pathology in future. The endodontic sealer plays a crucial role in obtaining the hermetic seal by filling all the spaces and by binding to the root dentin and to the core obturating material, which is usually gutta-percha. Aim: This study aimed to compare the push-out bond strength of Endosequence BC sealer with bioceramic coated gutta-percha and non-bioceramic coated gutta-percha. Materials and methods: A total of 36 extracted human maxillary central incisors were decoronated to standardize the root length of 15mm. Working length was determined and Biomechanical preparation for all the samples was done with a Mtwo (VDW Company) rotary file till 40/.06. Samples were randomly divided into three groups containing 12 teeth in each group based on the obturation procedure, namely Group 1: Endosequence BC sealer along with Endosequence bioceramic coated gutta-percha (n=12), Group 2: Endosequence BC sealer along with normal gutta-percha (n=12), Group 3: AH Plus sealer along with normal gutta-percha. All the samples were obturated using single cone technique. The specimens were sectioned orthogonally at middle third to obtain three sections of 1mm thick. All the samples were subjected to the push-out bond strength test with the universal testing machine. The data were subjected to one-way Analysis of Variance (ANOVA) followed by post hoc analysis. Results: Samples obturated with Endosequence BC sealer with Endosequence bioceramic coated gutta-percha showed the maximum push-out bond strength followed by Group 3 and Group 2.  One-way Anova showed significant differences (p=0.021) among the groups. In posthoc analysis, the specimens from group 1 exhibited significant differences (p=0.016) with the group 2 specimens. Conclusion: The push-out bond strength of Endosequence Bioceramic sealer with Endosequence Bioceramic coated gutta-percha was significantly higher than that of Endosequence Bioceramic sealer with normal gutta-percha and AH Plus sealer with normal gutta-percha

Advances in the management of post-endodontic pain: a review

This review describes the management of post-endodontic pain pharmacologically and non-pharmacologically. Acute periapical inflammation brought on by endodontic treatment-related chemical, mechanical, and/or microbiological damage to the periapical region causes postoperative pain, which is multifactorial in nature. A wide range of technical and pharmacological techniques are taken into consideration and proposed to control post-operative endodontic pain, the present study primarily comprised an overview of systematic reviews, randomized clinical trials, and in vitro studies summarizing advancement in the management of post-operative endodontic pain

Apical microleakage assessment of teeth obturated with single-cone gutta-percha using two calcium silicate sealers and a resin sealer: an in vitro study.

Background: Achieving a fluid-tight seal of the root canal space is the most desirable outcome for the success of endodontic treatment. Root canal sealers are used in combination with core filling materials to fill the irregularities in the root canal, thereby obtaining a three-dimensional seal, which results in the inhibition of bacterial regrowth. Aim: This study was aimed to compare the apical sealing ability of three root canal sealers AH Plus, Endosequence BC, and Endoseal MTA, using a single cone gutta-percha obturation technique. Methodology: Forty extracted human single-rooted mandibular premolar teeth were decoronated to a standardized length of 15 mm and instrumented using crown down technique with the ProTaper gold rotary file system to apical file size F3. The roots were randomly allocated into three experimental groups (n=10) and two control groups (n=5). All the samples in experimental groups were obturated with a matched taper single cone: Group 1, Group 2 and Group 3 were obturated using AH Plus, Endosequence BC and Endoseal MTA sealers respectively. Samples were immersed in 1% Methylene blue dye solution for 72 hours, and then the roots were split longitudinally and observed under a stereomicroscope. Apical microleakage was measured from the apex to the most coronal level of dye penetration. The data obtained were subjected to statistical analysis. Results: Samples in all the groups showed evidence of leakage, except in the negative control group. Group I did not show significant differences with  Group 2 and Group 3 (p = 0.446 and p= 0.147, respectively). Whereas, statistically significant differences were observed between Group 2 and Group 3. Conclusion:  Endosequence BC showed a superior seal and less microleakage compared to the two other sealers used in this study using a single cone gutta-percha obturation technique

Comparative evaluation of sealer penetration depth into radicular dentinal tubules using confocal scanning microscope: an in vitro study

Background: Endodontic treatment involves the removal of the vital and necrotic contents of the root canal through chemo-mechanical means followed by obturation of the prepared root canal to prevent the ingress of fluids and avoid bacterial infection or regrowth. Root canal sealers and core filling materials are used together to fill the irregularities in the root. Penetration into the dentinal tubules also results in the inhibition of bacterial regrowth and increases the success of root canal therapy. Aim: This study aimed to evaluate the penetration depth of various sealers into the dentinal tubules using a confocal microscope. Materials and methods: A total of 65 specimens were decoronated to standardize the root length of 13mm. Working length was determined, and Biomechanical preparation for all the samples was done with a rotary ProTaper file till F4. Samples were randomly divided into five groups containing 13 teeth in each group based on the sealer used, namely Group 1: Endomethasone (n=13), Group 2: AH-Plus (n=13), Group 3: Roekoseal (n=13), Group 4: MTA Fillapex (n=13), Group 5: Endosequence BC (n=13). All the sealers were labelled with Rhodamine-B dye, and samples were obturated using cold lateral compaction technique. The specimens were sectioned orthogonally at coronal, middle, and apical thirds. All the samples were examined with a Zeiss Pascal Laser Scanning Microscope to examine the sealer penetration depth into the dentinal tubules. The data were subjected to statistical analysis using one- way Analysis of Variance (ANOVA) and Tukey\u27s Honest Significant Difference (HSD) tests. Results: Endosequence BC showed the highest penetration into dentinal tubules, followed by MTA Fillapex and Roekoseal, AH-Plus, and Endomethasone exhibited the least penetration. Conclusion: Endosequence BC sealer exhibited maximum penetration. All the groups showed maximum penetration at coronal third, followed by the middle and apical third

Evaluation of different custom angulated elastic glass fibre post on fracture resistance of maxillary central incisor: an in vitro study.

Background: Restoring Endodontically treated teeth (ETT) can be challenging for most dentists, particularly when a significant tooth structure is lost. Depending on the coronal tooth structure remaining and the technique used (direct or indirect), endodontic anchorage can involve either a cast post and core or a prefabricated post. Aim: This study aimed to investigate the effect of different custom angulated, i.e.,0°,5°,10°,15° elastic glass fibre post (Everstick post) on fracture resistance of maxillary central incisors. Materials and methods:  A total of forty-eight single-rooted maxillary central incisors were selected. All the samples were decoronated 2mm above the CEJ and endodontically treated. Post-space preparation was done for all the samples using peesoreamers ranging in size from 1-3.  The samples were then randomly divided into four groups (n=12) based on the different angulations, i.e., the angle between the core and the long axis of the root, with 0°, 5°, 10°, and 15° angulations, respectively. The fit of each post in the root canal was verified. Before cementation, the coronal part of each post was bent according to their respective groups. Dual-cure resin cement was used for luting the posts and cured subsequently. The fracture resistance of all the samples was evaluated using the universal testing machine after they were mounted in self-cure acrylic resin blocks. The data were analysed using One- way ANOVA and Tukey’s post-hoc test. Results: Group I exhibited the highest mean fracture resistance compared to other groups. However, One-way ANOVA showed no significant differences (p=0.161) between the four groups. Conclusion: Everstick fibre posts are a preferable alternative for maxillary central incisors with core angulations up to 15° between coronal and radicular segments as they provide better fracture resistance with a more favourable stress distribution

A comprehensive review on electrospinning design, parameters and potential use of electrospun nanofibers in regenerative endodontics

Electrospinning is a versatile technique that has gathered interest due to its ability to fabricate nano and microscale fibres with unique properties of high surface area and fibrous porosity. This technique has been widely used in the late 20th (1990) and early 21st (2000) centuries. Since the beginning of its use, significant improvements have been made in the design, materials used, and fibres produced. The electrospinning technique is used to fabricate a material with therapeutic properties as it allows the researchers to incorporate various anti-microbial agents to different polymers without altering the chemical characteristicsof polymers.The production of nanofibres through electrospinning is affected by many operating parameters. It is, therefore, essential to know various parameters and processes that aid in fabricating the desired fibre assemblies. The nanofibres remain an essential division of biomaterials due to a wide range of biomedicalapplications. Nanofibres have unique properties such as protein absorption, binding sites to cell receptors, can provide maximum volume fraction by controlling fibres\u27 alignment and orientation hence improving the material properties like surface morphology, porosity, and geometry.Recent trends in endodontics, encourage regenerative therapy for the treatment of necrotic immature permanent teeth for root development and maturation. In this context, efficient disinfection of the root canal system is a crucial step. Existing chemical irrigating solutions (for eg., NaOCl) and antibiotic pastes (for eg., Triple antibiotic paste) usage at higher doses showed toxic results on the pulpal stem cells. Therefore, it was found to be beneficial to use a nanofibre-based intracanal drug delivery construct to release antibiotics at lower, yet anti-microbially effective concentrations.This review aims to discuss the basic concepts of electrospinning and its potential application in regenerative endodontics along with various parameters, which affect the fibre morphology and properties of produced nanofibres

Biomaterials in Endodontics: a review

Biomaterials have evolved over the past three decades and are relatively specialized, highly biocompatible, but low-strength dental materials. Bioactive materials can interact with living tissues or systems. The newly emerging bioactive category of dental materials has expanded clinical uses in restorative dentistry and endodontics. Examples of bioactive materials are  Calcium Silicate containing Mineral Trioxide Aggregate (Portland cement); Calcium Silicate cements lacking aluminium and containing phosphate: Bioagrregate,  iRoot SP and iRoot BP (Endosequence), Calcium Silicate cements containing predominantly Tricalcium Silicate: Bio-active Glass, Calcium Phosphate based materials: Tricalcium Phosphate, Hydroxyapatite, Calcium Phosphate cements and Calcium Aluminate based materials: GIC based luting cements; Bioactive Glass. Other biomimetic materials include Emdogain, Platelet Rich Plasma, Platelet Rich Fibrin, Bone grafts and barrier membranes. Thus, the objective of this review was to compare and review the composition, and properties of these bioactive materials in endodontics

Comparative evaluation of remaining dentin thickness with three different rotary Ni-Ti File systems: an in vitro CBCT study

Background: Endodontic therapy and its success depend on effective cleaning and shaping the root canal without deviating from the original anatomy. Ideally, during root canal preparation, the instruments should always confine to and retain the original shape of the canal to maximize the cleaning effectiveness and minimize unnecessary weakening of tooth structure to achieve the optimal result. The remaining dentin thickness in endodontically treated teeth is a significant factor, which is responsible for its longevity. Aim: This study aimed to evaluate the remaining dentin thickness after instrumentation with ProTaper Next (PTN), TruNatomy (TN), and Neohybrid (NH) file systems using cone-beam computed tomography. Materials and methods: Thirty extracted single-rooted mandibular premolars were decoronated and divided into three experimental groups with ten in each. Groups I, II, and III were assigned to the file systems ProTaper Next (PTN), TruNatomy (TN), and Neohybrid (NH), respectively. Cone-beam computed tomographic pre-scans were taken, followed by the biomechanical preparation with the respective file systems. Post CBCT scans were taken and compared with pre-scans for remaining dentin thickness. The data obtained were statistically analyzed. Results: Among the three file systems, TruNatomy rotary files resulted in significantly less dentin removal (p<0.05). The majority of the intergroup comparisons showed significant differences in remaining dentin thickness after biomechanical preparation at 3, 6, and 9mm. Conclusion: TruNatomy (TN) exhibited the maximum remaining dentin thickness followed by Neohybrid (NH) and comparatively minimum with ProTaper Next (PTN) file systems