Endodontic management of single rooted immature mandibular second molar with single canal using MTA and platelet-rich fibrin membrane barrier: A case report

An immature tooth with pulpal necrosis and periapical pathology imposes a great difficulty to the endodontists. Endodontic treatment options for such teeth consist of conventional apexification procedure with and without apical barriers. Various materials have been tried as apical matrix in the past. This article demonstrates the newer concept of using platelet rich fibrin membrane as an apical matrix barrier for stabilization of MTA in root end apexification procedure. Platelet Rich Fibrin is an autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines, which enhance healing by release of growth factors. This case report represents successful management of a case of an immature mandibular second molar with single root and single c-shaped canal. The unusual canal morphology was diagnosed with the help of a CBCT scan. Faster periradicular healing and complete resolution of symptoms occurred with combined use of MTA and PRF membrane as an apical barrie

Endodontic management of open apex using MTA and platelet-rich fibrin membrane barrier: A newer matrix concept

Objectives: Endodontic management of open apex using MTA and platelet-rich fibrin membrane as an apical matrix barrier. Study design: An immature tooth with pulpal necrosis and periapical pathology imposes a great difficulty to the endodontist. Endodontic treatment options for such teeth consist of conventional apexification procedure with and without apical barriers. This article demonstrates the use of an apical matrix barrier in form of a platelet rich fibrin membrane for stabilization of MTA in root end apexification procedure. PRF is an autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines, which enhance healing by release of growth factors. These case reports present apexification and successful healing with combined use of MTA and PRF membrane as an apical barrier Results: PRF membrane can serve as an efficient apical matrix for condensation of MTA. Combination of PRF membrane and MTA is an effective method for management of difficult cases of open apex. PRF is a strong fibrin membrane enriched with platelet and growth factors that accelerate periapical healing

Effect of EndoActivator and Er,Cr:YSGG laser activation of Qmix, as final endodontic irrigant, on sealer penetration: a confocal microscopic study

Through chemomechanical debridement of the root canal is a primary requisite for successful endodontic therapy. Thus the aim of this study was to evaluate the effects of using QmiX alone, QmiX with EndoActivator and QmiX with Er,Cr:YSGG laser for final irrigation on sealer penetration into the dentinal tubules. 75 extracted human mandibular premolar teeth were treated with sodium hypochlorite (NaOCl) irrigation. The samples were divided into 5 groups according to the final irrigation solution used: (1) 17% EDTA and 2.5% NaOCl, (2) QmiX (3) QmiX with Er,Cr:YSGG laser and (4) QmiX with EndoActivator (5) 2.5%NaOCl. All teeth were obturated using cold lateral condensation technique with gutta percha and AH 26 sealer (Dentsply; DeTrey,Konstanz, Germany) labeled with Rhodamine B dye. The teeth were sectioned at distances of 2 and 5 from root apex. Total percentage and maximum depth of sealer penetration were measured using confocal laser scanning microscopy. Results of one way Anova analysis showed that there was a significant difference in the percentage and depth of sealer penetration among all groups at 3 and 5 mm level sections (P < .05). Within the groups maximum sealer penetration was recorded for Er,Cr:YSGG laser activated group. Greater depth of sealer penetration was recorded at 5mm as compared to 3mm in all the groups. Activation of QMix using EndoActivator and Er,Cr:YSGG laser enhanced the sealer penetration at apical and middle third. Thus Er,Cr:YSGG laser and EndoActivator may act as an appropriate adjunct during chemomechanical preparation of the root canal

Magnetic Resonance (MR) Patterns of Brain Metastasis in Lung Cancer Patients: Correlation of Imaging Findings with Symptom

IntroductionAsymptomatic brain metastasis in lung cancer patients, if detected early have been reported to show survival benefit with treatment. These asymptomatic metastasis have been found to be smaller and less in number than those with symptoms. We however observed that many lung cancer patients bear a significant metastatic load in the brain irrespective of the stage or neurologic symptoms at the time of initial presentation.Material and MethodsA retrospective study was conducted on 175 patients of proven non-small cell lung cancer to assess the patterns of brain metastasis in the two groups of patients, with and without neurologic symptoms. All patients had undergone screening magnetic resonance imaging for brain metastasis as an initial staging protocol. The patients with brain metastasis were divided into two groups: asymptomatic (group I) and symptomatic (group II). The lesions were studied with regards to the number, size, site, nature (solid with and without necrosis), and presence of perilesional edema and intralesional hemorrhage in both the groups in various stages of disease.ResultsBrain metastasis was seen in 62 (31.3%) patients of whom 46.7% were neurologically asymptomatic. Patients (90.3%) with brain metastasis were in stage IV at the time of presentation. No statistically significant correlation was found between the two groups regarding the number of lesions (p = 0.554), size of lesion (p = 0.282), site of lesion (p = 0.344), nature of lesion (p = 0.280), presence of perilesional edema (p = 0.404), and presence or absence of intralesional hemorrhage (p = 0.09). In our study, brain metastases were present only in stages III and IV disease with no statistically significant difference in the lesion patterns.ConclusionThe study reveals almost equal number of patients with brain metastasis in the symptomatic and asymptomatic groups with no significant difference in lesion patterns. We therefore conclude that although imaging surveillance of the brain for metastasis will detect asymptomatic metastasis early for early institution of appropriate therapy the prognosis in these patients would not solely depend on the presence or absence of symptoms and the pattern of lesion may have an influence on the patients’ response to therapy and survival benefit specially for those asymptomatic patients with equally large metastatic load

Complicated Crown-Root Fracture Treated Using Reattachment Procedure: A Single Visit Technique

Complicated crown-root fracture of maxillary central and lateral incisors is common in case of severe trauma or sports-related injury. It happens because of their anterior positioning in oral cavity and protrusive eruptive pattern. On their first dental visit, these patients are in pain and need emergency care. Because of impaired function, esthetics, and phonetics, such patients are quite apprehensive during their emergency visit. Successful pain management with immediate restoration of function, esthetics and phonetics should be the prime objective while handling such cases. This paper describes immediate treatment of oblique crown root fracture of maxillary right lateral incisor with reattachment procedure using light transmitting fiber post. After two and half years, the reattached fragment still has satisfying esthetics and excellent function

Evaluation of Antimicrobial and Antifungal efficacy of Chitosan as endodontic irrigant against Enterococcus Faecalis and Candida Albicans Biofilm formed on tooth substrate

Bacterial biofilms formed on the root canal wall are often difficult to remove. This study aimed to evaluate the cytotoxic effect and antibacterial efficacy of chitosan when used as root canal irrigant against E. Faecalis and Candida albicans biofilm formed on tooth substrate. The present study evaluated antibacterial effect of 0.25% Chitosan, 0.5% Chitosan, 2% chlorhexidine and 3% sodium hypochlorite against Enterococcus faecalis and Candida Albicans. Agar-well diffusion methods, minimal inhibitory concentration tests and biofilm susceptibility assays were used to determine antibacterial activity. Teeth specimens were sectioned to obtain a standardized tooth length of 12mm. Specimens were inoculated with 10 mL of the freshly prepared E. Faecalis suspension and Candida albicans for 4 weeks. The specimens were then instrumented with ProTaper rotary files F3 size. After irrigation with test solution, three sterile paper points were placed into one canal, left for 60 s and transferred to a test tube containing 1 mL of reduced transport fluid. The number of CFU in 1 mL was determined. 3-week biofilm qualitative assay showed complete inhibition of bacterial growth with 3% Sodium hypochlorite, 2% Chlorhexidine and Chitosan except saline, which showed presence of bacterial growth. Significant reduction of colony forming units (CFU)/mL was observed for the chitosan groups and the antibacterial activity of the chitosan groups was at par with 3% NaOCl and 2% Chlorhexidine. It was observed that the chitosan showed no cytotoxicity at 3mg/ml and 10% cytotoxicity at 6mg/ml. The use of chitosan as a root canal irrigant might be an alternative considering the various undesirable properties of NaOCl and chlorhexidine

In vitro evaluation of efficacy of different rotary instrument systems for gutta percha removal during root canal retreatment

Background: Complete removal of old filling material during root canal retreatment is fundamental for predictable cleaning and shaping of canal anatomy. Most of the retreatment methods tested in earlier studies have shown inability to achieve complete removal of root canal filling. Therefore the aim of this investigation was to assess the efficacy of three different rotary nickel titanium retreatment systems and Hedstrom files in removing filling material from root canals. Material and Methods: Sixty extracted mandibular premolars were decoronated to leave 15 mm root. Specimen were hand instrumented and obturated using gutta percha and AH plus root canal sealer. After storage period of two weeks, roots were retreated with three (Protaper retreatment files, Mtwo retreatment files, NRT GPR) rotary retreatment instrument systems and Hedstroem files. Subsequently, samples were sectioned longitudinally and examined under stereomicroscope. Digital images were recorded and evaluated using Digital Image Analysing Software. The retreatment time was recorded for each tooth using a stopwatch. The area of canal and the residual filling material was recorded in mm 2 and the percentage of remaining filling material on canal walls was calculated. Data was analysed using ANOVA test. Results: Significantly less amount of residual filling material was present in protaper and Mtwo instrumented teeth ( p < 0.05) compared to NRT GPR and Hedstrom files group. Protaper instruments also required lesser time during removal of filling material followed by Mtwo instruments, NRT GPR files and Hedstrom files. Conclusions: None of the instruments were able to remove the filling material completely from root canal. Protaper universal retreatment system and Mtwo retreatment files were more efficient and faster compared to NRT GPR fles and Hedstrom files

Endodontic management of open apex using Biodentine as a novel apical matrix

Aim: Endodontic management of open apex using Biodentine as an apical matrix. Summary : An immature tooth with pulpal necrosis and periapical pathology imposes a great difficulty to the endodontist. Endodontic treatment options for such teeth consist of conventional apexification procedure with and without apical barriers. Biodentine™ is new calcium silicate based cement that exhibits physical and chemical properties similar to those described for certain Portland cement derivatives. This article demonstrates the use of the newer material, Biodentine as an apical matrix barrier in root end apexification procedure. This case reports present apexification and successful healing with the use of Biodentine as an apical barrier matrix. Conclusion : Apexification in one step using an apical plug of Biodentine can be considered a predictable treatment and may be an alternative to mineral trioxide aggregate apexification

Successful management of pulpo-periodontal lesion in maxillary lateral incisor with palatogingival groove using CBCT scan

Palatogingival groove is a rare developmental anomaly involving the lingual surface of the maxillary incisor and resulting in severe endodontic and periodontal lesions. This case report describes a multidisciplinary approach for the combined management of the endodontic and periodontal problems for successful rehabilitation of the involved tooth. Cone-beam computed tomography (CBCT) helped in correct diagnosis of the lesion and hence enabled effective treatment