Conventional Endodontic Therapy Research Articles

Negotiation of Calcified Canals.

The gradual formation of hard tissue along the root canal walls is a natural process associated with aging, typically progressing slowly over time. In reaction to tooth wear, operative procedures, vital pulp treatments, or regenerative endodontic procedures, hard tissue may also accumulate within the pulp canal space at a slow rate. In certain cases, such as dental trauma, autotransplantation, or orthodontic treatment, this deposition of hard tissue can accelerate unexpectedly, resulting in rapid narrowing or complete closure of the root canal space. This situation is called calcific metamorphosis (CM), root canal calcification, or pulp canal obliteration (PCO). Performing conventional endodontic therapy on severely calcified canals presents significant challenges and increases the risk of procedural accidents. Calcified canals introduce such complexity that dedicated negotiation concepts and specially designed instruments have been developed to deal with the challenge. This article seeks to review the existing methods for effectively navigating calcified canals and to introduce the buckling resistance activation test (BRAT) technique.

Effective Treatment of Recurrent Periapical Lesion Involving Multiple Teeth in a Pediatric Patient: A Rare Case Report with Review of Literature

Nonsurgical endodontic therapy is usually advised as primary approach to treat the nonvital teeth with pulpal or periapical infection. However, in certain clinical scenarios and also owing to various factors, surgical modality of endodontics is eventually adopted to manage the recurrent or persistent pulpal or periapical infection and also to treat the failed cases of previously endodontically-treated teeth with conventional approach. In existing literature, there is deficiency of published case report articles regarding successful surgical endodontic management of recurrent pulpal/priapical signs and symptoms and also of failed cases of nonsurgical modality of endodontic therapy in growing pediatric patients. Hence, the present article describes the case report of the effective and successful clinical management of recurrent and failed case of conventional nonsurgical orthograde endodontic therapy by employing the surgical endodontic modality in an adolescent pediatric patient aged 13 years. The whole clinical procedure in step-wise manner has been described, and furthermore, the relevant contemporary endodontic techniques have been elucidated in context of the present case.

Endodontic tooth treatment with internal root resorption: case report

INTRODUCTION: Internal tooth resorption is characterized by the destruction of dentin in the root canal wall due to an imbalance of clastic cell activity resulting mainly from trauma. Thus, endodontic treatment is indicated with the aim of removing the etiology of resorption by using intracanal medication to combat possible infection and thus provide tissue repair. OBJECTIVE: The aim of this study is to investigate the treatment of root resorption by conventional endodontic therapy by identifying internal resorption and highlighting the steps of endodontic treatment. CASE REPORT: The methodology adopted was a clinical study in which we selected a female patient who required endodontic treatment of tooth 12 with pulp necrosis and resorption in the middle third of the root. Thus, the endodontic treatment was performed according to the technique, through instrumentation of the root canal followed by irrigation with sodium hypochlorite 6%. After instrumentation, the PUI (Ultrasonic Passive Irrigation) was performed followed by irrigation with 6% sodium hypochlorite and EDTA solution. The root canal was also dried and filled, allowing the respective tooth to be provisionally restored with glass ionomer so that it could later be permanently restored according to the indication of the material. Therefore, internal tooth resorption causes irreversible damage to the individual, such as tooth loss, thus altering the functioning of the stomatognathic system. Thus, endodontic treatment has great advantages in the treatment of teeth with internal tooth resorption since it promotes stagnation of the resorption process and tissue repair. CONCLUSIONS: Therefore, the treatment of internal tooth resorption requires close attention by the dental surgeon due to careful evaluation throughout the entire clinical case.

Comparative evaluation between conventional endodontic therapy and a non-instrumental technique

Aim: Dental pulp necrosis is a complication caused mainly by dental caries and lesions. No consensus has been reached on the best technique and materials for endodontic treatment in the primary dentition. The objective was to present a clinical case report in which different endodontic approaches were performed in traumatized and necrotic homologous teeth. Methods: A one-year-and-eight-month-old boy suffered dentoalveolar trauma after a fall and sought out the Deciduous Trauma Dental Center of the Federal University of Minas Gerais in October 2018 for clinical and radiographic evaluation. The left maxillary central incisor presented enamel and dentin fracture without pulp exposure, while the right maxillary central incisor presented a small intrusive dislocation. Both presented the development of periapical lesions. Results: The teeth were treated respectively, using the non-instrumental technique with CTZ paste and the conventional endodontic therapy with Guedes-Pinto paste. Clinical and radiographic follow-ups after treatments revealed asymptomatic teeth and evidence of periapical healing. Conclusion: The use of CTZ paste in this case report presented satisfactory and similar results to traditional therapy in the short term.

Poly(caprolactone)-aligned nanofibers associated with fibronectin-loaded collagen hydrogel as a potent bioactive scaffold for cell-free regenerative endodontics.

Guided tissue regeneration has been considered a promising strategy to replace conventional endodontic therapy of teeth with incomplete root formation. Therefore, the objective of this study was to develop a tubular scaffold (TB-SC) with poly (caprolactone)-aligned nanofibres associated with a fibronectin (FN)-loaded collagen hydrogel and assess the pulp regeneration potential mediated by human apical papilla cells (hAPCs) using an in vitro model of teeth with incomplete root formation. Aligned nanofibre strips based on 10% poly(caprolactone) (PCL) were synthesized with the electrospinning technique to produce the TB-SCs. These were submitted to different treatments, according to the following groups: TB-SC (negative control): TB-SC without treatment; TB-SC + FN (positive control): TB-SC coated with 10μg/ml of FN; TB-SC + H: TB-SC associated with collagen hydrogel; TB-SC + HFN: TB-SC associated with FN-loaded collagen hydrogel. Then, the biomaterials were inserted into cylindrical devices to mimic the regenerative therapy of teeth with incomplete root formation. The hAPCs were seeded on the upper surface of the TB-SCs associated or not with any treatment, and cell migration/proliferation and the gene expression of markers related to pulp regeneration (ITGA5, ITGAV, COL1A1 and COL1A3) were evaluated. The data were submitted to anova/Tukey's tests (α=5%). Higher values of cell migration/proliferation and gene expression of all markers tested were observed in groups TB-SC + FN, TB-SC + H, and TB-SC + HFN compared with the TB-SC group (p < .05). The hAPCs in the TB-SC + HFN group showed the highest values of cell proliferation and gene expression of COL1A1 and COL3A1 (p < .05), as well as superior cell migration results to groups TB-SC and TB-SC + H (p < .05). Aligned nanofibre scaffolds associated with the FN-loaded collagen hydrogel enhanced the migration and proliferation of hAPCs and gene expression of pulp regeneration markers. Therefore, the use of these biomaterials may be considered an interesting strategy for regenerative pulp therapy of teeth with incomplete root formation.

Is apicectomy with retrograde filling still relevant in contemporary dental practice? A 25‐year retrospective review

AbstractBackgroundApicectomy with retrograde filling has always been a viable treatment option for a tooth when conventional endodontic therapy is not indicated, impossible or unsuccessful.ObjectiveTo determine reasons for apicectomy with retrograde filling, dentitions affected, age and gender of the patients, including complication(s) 4 years after the procedures.Materials and MethodsThis is a 25‐year retrospective cohort study of consecutive patients treated in the study centre. Clinical symptoms and signs of morbidity and mortality of tooth‐like pain, tenderness to percussion and evidence of discharging sinus or fistula formation, swelling, tooth mobility and loss were recorded 4 weeks after the procedures. Descriptive and bivariate statistics were computed.ResultsA total of 567 procedures were done in 567 patients, 34 (6.0%) failed to meet the inclusion criteria. Consequently, of the 533 patients used for analysis, 58.4% were males whilst 41.6% are females with a male to female ratio of 1.4:1 (p = 0.04). A majority (94.2%) of the patients are in the age group of 17–46 years (p = 0.000). The indications for the procedures showed that failed root canal therapy (78.2%) was significant (p = 0.001). More cases were done in the maxillary anterior dentition (82.7%, p = 0.001), and 97.8% (p = 0.000) was treated successfully.ConclusionThis study shows that a significant majority of the patients were successfully managed, which suggests that the procedure is still an indication for the management of the conditions diagnosed.

Modern versus Traditional Endodontic Access Cavity Designs.

By creating a precise access cavity (AC) and finishing the pulp chamber, less invasive endodontic therapy attempts to improve conventional endodontic therapy. The cingulum, oblique ridge, and roof of the pulp chamber, which all play a vital role in functional activity, might be preserved to increase fracture resistance. To reduce tooth structure loss, endodontic new ACs have recently been created. The preparation of the conservative access opening had advanced to a new level with the advent of microscopes and improved root canal equipment. The conservation of the cervical dentin is the most essential factor in preserving the restored tooth's normal function and lifespan. In recent years, minimally invasive endodontics has posed a challenge to the traditional method.

Postoperative Pain after Use of the WaveOne Gold and XP-endo Shaper Systems: A Randomized Clinical Trial

IntroductionThe present study aimed to clinically compare the incidence of postoperative pain after endodontic treatment of posterior teeth using the WaveOne Gold (WOG; Dentsply Sirona, Ballaigues, Switzerland) and XP-endo Shaper (XPES; FKG Dentaire, La Chaux-de-Fonds, Switzerland) systems. MethodsIn a single-blind randomized clinical trial, 148 vital teeth with an indication for conventional endodontic therapy for prosthetic purposes were treated by 5 specialists following a preestablished protocol. All participants were unaware of the treatment they received. The teeth were randomly divided into 2 groups (n = 74) according to the instrumentation system used (the WOG group and XPES group). The treatments were performed in a single session. The participants were asked to rate the intensity of postoperative pain on a visual analog scale (no pain, mild pain, moderate pain, and severe pain) after 24, 48, and 72 hours and 7 days. ResultsThe incidence of postoperative pain was higher in the XPES group after 24, 48, and 72 hours compared with those in the WOG group (P < .05). Two participants in the WOG group experienced severe postoperative pain after 24 hours. None of the participants in either group reported pain after 7 days (P > .05, Mann-Whitney test). ConclusionsPostoperative pain is expected after preparation of the root canal system with the WOG and XPES systems tested, but it only persists for a short period. Although more common after the use of the XPES system, the pain was classified as mild at all time points.

INVESTIGATION OF ANTIBACTERIAL ACTIVITY OF ND: YAG - LASER AND STANDARD ENDODONTIC TREATMENT

Introduction: The microbial infection is one of the main causes of the dental pulp and periodontal diseases. Previously used methods for its elimination are not fully effective, and often some microorganisms in root canals (RC) remain unaffected after treatment. Another modern method for disinfection of root canal system is laser disinfection. Different types of lasers are used - Nd: YAG, Er: YAG, Diode laser. Purpose: The purpose of our study is to compare the antibacterial activity of ND: YAG laser and conventional endodontic therapy in the treatment of infected root canals. Materials and methods The study involved 36 teeth of patients diagnosed with pulp gangrene or chronic periapical periodontitis, requiring endodontic treatment. They were divided into two groups of 18 teeth each one. The teeth in both groups are prepared by Protaper Universal rotary instruments (Maillefer Instruments SA, Ballaigues, Switzerland). In group 1the root canals disinfection is performed with a Nd: YAG laser (source of Nd: YAG laser (1064 nm) is the AT Fidelis - Fotona d.d., Ljubljana laser system). In group 2 was used the following protocol of root canal disinfection: 2.5% sodium hypochlorite solution and 17% EDTA divided by irrigation with distilled water. Then a sterile paper point is placed in the root canals, and a microbiological sample is taken again. Results: In all compared pairs, there was no significantly different effect regarding the number of microorganisms. Conclusions: The disinfection rinsing method with NaOCl has the strongest antimicrobial effect in clinical studies (90% against all microbial isolates). The use of Nd: YAG laser independently is not always sufficient for root canal disinfection - the effect is about 66%.

English

BACKGROUND The vitality of dental pulp is essential for long-term survival of the tooth. Vital pulp therapy (VPT) intends to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. There are many treatment options for vital pulp therapy in extensively decayed teeth. Pulp capping or pulpotomy procedures rely upon an accurate assessment of the pulp status, and careful management of the remaining pulp tissue. We wanted to evaluate as to whether biodentine total pulpotomy is an effective alternative to conventional endodontic therapy for young permanent teeth. METHODS Full coronal pulpotomy was performed in young permanent molars diagnosed with acute irreversible pulpitis with Biodentine as the pulpotomy medicament. Follow up evaluation was done clinically and radiographically at 3, 6 and 12 months. RESULTS During follow-up periods clinical signs/symptoms were absent including pulpal pain, swelling or presence of sinus and percussion pain. Continuous root development and healing of periapical radiolucency were noticed in the study which were indicative of maintenance of vitality of the pulp. CONCLUSIONS Within the limitations of this clinical study, it is concluded that total pulpotomy with Biodentine has a promising scope in regenerative approaches in the treatment of carious young permanent teeth. KEY WORDS Biodentine, Coronal Pulpotomy, Permanent Teeth, Total Pulpotomy

COMPARATIVE STUDY OF ANTIBACTERIAL ACTIVITY OF PHOTOACTIVATED DISINFECTION WITH FOTOSAN AND STANDARD ENDODONTIC TREATMENT

Introduction: The purpose of endodontic treatment is to eliminate the bacterial infection in the root canal system and allow healing of apical periodontitis. Sometimes the anatomical complexity of the root canal system makes complete removal of bacteria almost impossible even if the conventional methods of chemo-mechanical debridement are performed strictly according to the protocol. So additional methods of root canal disinfection can be applied such as photoactivated disinfection (PAD). Purpose: The aim of our study was to compare the antibacterial activity of PAD with FotoSan, and conventional endodontic therapy in the treatment of infected root canals. Materials and methods: The study involved 36 teeth of patients who are diagnosed with pulp necrosis or with the periapical chronic periodontitis and require endodontic treatment and divided into two groups of 18 teeth each. The first microbiological sample was taken by placing a sterile paper point in the root canal, after endodontic access cavity preparation. All root canals are prepared by Protaper Universal rotary instruments (Maillefer Instruments SA, Ballaigues, Switzerland). In the first group, the disinfection of the root canals was made with photoactivated disinfection with FotoSan. In the second group was performed the endodontic treatment with the standard protocol of irrigation - 2.5% sodium hypochlorite solution and 17% EDTA. After that, the root canals are dried with sterile points, and a second microbiological sample is taken. Results: In all compared pairs, there was no significantly different effect regarding the number of microorganisms. Conclusions; The disinfection with NaOCl has the strongest antimicrobial effect in this study. Second place is occupied by PAD with FotoSan. We believe that the established antimicrobial effect of PAD make the method appropriate as complementary to routine endodontic treatment.

Cytotoxicity evaluation of calcium hypochlorite and other commonly used root canal irrigants against human gingival fibroblast cells: An in vitro evaluation.

The conventional endodontic therapy primarily focuses on biomechanical preparation, which is achieved by the application of various intracanal irrigants and intracanal medicaments. One of the most commonly used intracanal irrigants - sodium hypochlorite (NaOCl) - has already been proven to have an antimicrobial effect as well as the ability to dissolve tissues in the areas where files cannot reach. One of the recently used irrigants having a promising effect is calcium hypochlorite (Ca(OCl)2), which has been shown to be relatively more stable than NaOCl and has much more chlorine ions. The aim of this study was to assess the individual cytotoxicity of various root canal irrigants and the combined cytotoxicity of NaOCl and Ca(OCl)2 with ethylenediaminetetraacetic acid (EDTA) against human gingival fibroblast (hGF) cells. The evaluation of the individual cytotoxicity was carried out with regard to the following root canal irrigants: NaOCl; Ca(OCl)2; and chlorhexidine (CHX). The evaluation of the combined cytotoxicity regarded NaOCl/EDTA and Ca(OCl)2/EDTA. The concentrations used were 0.025%, 0.050%, 0.10%, and 0.20%. The cytotoxicity against hGF cells was examined within a timeframe of 6 h and 24 h with the use of the sulforhodamine B (SRB) assay. It was observed that Ca(OCl)2 had a mean absorbance rate of 0.315 ±0.02, 0.294 ±0.03, 0.265 ±0.03, and 0.240 ±0.02 at 0.025%, 0.050%, 0.10%, and 0.20%, respectively. In combination with EDTA, the mean absorbance rate was 70.12 ±2.9, 67.42 ±4.3, 64.35 ±3.6, and 61.58 ±4.1 at 0.025%, 0.050%, 0.10%, and 0.20%, respectively. The cytotoxic effect of the root canal irrigants on hGF cells was observed to be statistically significant (p < 0.05). Calcium hypochlorite is less cytotoxic than NaOCl, and when used in combination with EDTA, it was shown to have its cytotoxic effect on hGF cells reduced to a great extent.

Intentional replantation: A measure to save the natural tooth

Context: Intentional replantation (IR): is an accepted procedure in which a tooth is extracted and treated outside the oral cavity, then reinserted into its original socket, this technique can be useful for teeth that cannot be treated with conventional endodontic therapy (or) surgery. Aim: Preservation of natural dentitions is the primary (aim) of any conservative treatment modality, so IR is one of the techniques used to save the natural tooth. I treated thirty infected hopeless teeth for thirty patients. These cases cannot be treated with conventional endodontic therapy (or) surgery and the results were satisfactory. In these papers I reported four cases had been done according to the same principle (IR) but differ in simple things such as: (the patient complaint, type of crown filling, type of fixation of the tooth, and time of follow up). First case: A 23-years old male was referred to with a complaint of recurrent pain and discomfort in the mandibular right area. Clinically there was a sinus tract present, associated with the 1st right molar, the crown repair with a large amalgam filling, radiology showed there was per apical radiolucency and root canal filling with unsatisfactory obturation. When the patient selects IR and refused other options, so IR was planned. Clinical and radiograph follow-up 6 months postoperatively revealed no sign or symptoms of infection or inflammation and the tooth retain natural function. Second case: A 25-years old male, with a complaint of severe pain following the 2nd visit of retreated Root Canal Therapy to the right upper second premolar. The patient refused to continue endodontic treatment and wanted a solution to keep his tooth the other way, after a discussion about the options that help him to keep his tooth, he selects the I R option. So, IR was done followed by clinical examination 7 months postoperatively revealed no signs or symptoms of infection or inflammation. Third case: A 39-years old female, referred with a persistent dull pain at right upper teeth, clinical and radiological exam shown that there was apical lesion. I R planned after agreement of patient, post-operative follow up revealed no sign or symptom of infection or inflammation. Fourth case: A 20-years old female, referred a complaint of severe pain in the right mandibular molar, clinically there was a large carious lesion, the gum swollen, radiograph showed that there was an apical lesion around the apical root of 3rd molar. IR was done, after follow up the tooth was healthy and functions.

Bilateral Nasopalatine Duct Cyst: A Diagnostic Quandary Solved

The Nasopalatine Duct Cyst (NPDC) also commonly referred to as the anterior midline palatine cyst is a developmental cyst derived from the proliferation of embryonic epithelial remnants of nasopalatine duct. It is unique for the reason that it develops in only one location, which is the midline of anterior maxilla in close relationship to the nasopalatine canal. Radiographically, it presents as a well-demarcated ovoid or heart shaped cystic structure which is seen in close proximity to the apex of maxillary central incisors. Due to its anatomical location, it can be sometimes misdiagnosed as central giant cell granuloma, periapical cyst or follicular cyst. Chronic, large periapical lesions following traumatic injuries are challenging to diagnose and treat. The present case report described the successful management of a rare case of bilateral NPDC in a 30-year-old male patient, who gave a presentation closely mimicking that of an infected periapical cyst. The case was treated by both conventional endodontic therapy and surgical intervention. The NPDC tends to show a predilection in giving rise to squamous cell carcinomas which commonly occur in the anterior part of the maxilla. Therefore, cystic lesions seen in the premaxillary region require a thorough analysis so as to successfully treat the lesion and to avoid further complications that may arise due to a missed diagnosis.

Guided endodontic treatment of multiple teeth with dentin dysplasia: a case report

BackgroundTo report the outcome of guided endodontic treatment (GET) of a case of dentin dysplasia with pulp canal calcification (PCC) and apical periodontitis based on the use of a 3D-printed template designed by merging cone-beam computed tomography (CBCT) and surface scan data.Case presentationA 12-year old female with radicular dentin dysplasia type I (DD-1) presented for endodontic treatment. Radiography revealed PCC in all teeth and apical radiolucency in seven teeth (12, 15, 26, 31, 32, 36 and 46). Tooth 36 had the most acute symptoms and was thus treated first by conventional access cavity preparation and root canal detection. Despite meticulous technique, the distal and mesiolingual canals were perforated. The perforations were immediately repaired with mineral trioxide aggregate, and the decision was made to switch to guided endodontic treatment for the remaining 6 teeth. CBCT and intraoral surface scans were acquired and matched using coDiagnostix planning software (Dental Wings Inc.), the respective drill positions for root canal location were determined, and templates were virtually designed and 3D-printed. The template was positioned on the respective tooth, and a customized drill was used to penetrate the calcified part of the root canal and perform minimally invasive access cavity preparation up to the apical region. All root canals were rapidly and successfully located with the templates. At 1-year follow-up, clear signs of apical healing were present in all treated teeth.ConclusionsIn patients with dentin dysplasia, conventional endodontic therapy is challenging. GET considerably facilitates the root canal treatment of teeth affected by dentin dysplasia.

Assessment of Postoperative Obturation Quality of Retreatment Cases - A Retrospective Study

Conventional endodontic therapy emphasizes many factors which mainly emphasize root canal disinfection.However there is a probability of endodontic therapy to give an unfavourable outcome such as persistentclinical symptoms and unfavourable periapical healing. The frequency of failure is reported to be around 20%and various factors contribute to it which mostly relies on the treatment procedure followed by the previousoperator. It is of paramount importance that postgraduate doctors should learn to treat these case scenarioswith high effectiveness. This study aims to assess the postoperative obturation quality of retreatment casesdone by graduate doctors. The study was done by using data collected from electronic medical records ofSaveetha Dental College, Chennai, India. The time frame of data collection was seen from June 2019 toMarch 2020. A total sample size of 230 was assessed radiographically and the quality of obturation wasanalyzed using 2 grading criteria in compliance with 2 operators. From the cases assessed, about 80% hadachieved correct radiographic length of obturation and about 70% of obturation was not of optimal quality.Quality of obturation was not adequate. The length of root canal filling was desirable whereas the quality ofcondensation was not adequate about 60% of the assessed cases

Evaluation of effectiveness of photosensitizers used in laser endodontics disinfection: A systematic review

AbstractPhoto‐activated disinfection using photosensitizers has been proposed as an adjunct to conventional endodontic therapy for additional disinfection and improved treatment outcomes. This systematic review aims to investigate the effectiveness of photosensitizers used in laser endodontics disinfection. A comprehensive literature search is conducted to identify in vitro and in vivo studies involving photo‐activated disinfection in endodontic treatment. Publications are selected based on predetermined eligibility criteria. From 121 articles, 34 met the inclusion criteria, comprising eight polymicrobial and 26 bacteria‐specific studies. A total of 10 photosensitizers were investigated, including methylene blue, tolonium chloride, polyethylenimine and chlorin (e6), phenothia zinium, chitosan, rose bengal, malachite green, indocyanine green, chlorine p6 and curcumin. Photo‐activated disinfection using tolonium chloride or methylene blue can be an effective adjunct to conventional root canal therapy. More studies are needed to assess the performance of newer photosensitizers to optimize photo‐activated disinfection of the complex root canal space.

In Vivo Evaluation of Effect of Preoperative Ibuprofen on Proinflammatory Mediators in Irreversible Pulpitis Cases

IntroductionPreoperative administration of nonsteroidal anti-inflammatory drugs has been suggested as a method for increasing the efficacy of local anesthetics and decreasing postoperative pain in symptomatic irreversible pulpitis cases. However, the effects of ibuprofen at the molecular level are still unknown. Hence, the purpose of this study was to compare the levels of proinflammatory mediators in the dental pulp of teeth with irreversible pulpitis in patients who medicated with preoperative ibuprofen versus those who did not. MethodsThirty-four patients undergoing conventional endodontic therapy for teeth with irreversible pulpitis were selected and randomly assigned into either the ibuprofen or nonibuprofen group. Four patients undergoing endodontic therapy for prosthodontic reasons served as controls. Patients in the ibuprofen group were instructed to take 600 mg ibuprofen 1 hour before treatment, whereas patients in the nonibuprofen and control groups were asked to avoid analgesics before treatment. Blood samples obtained from the pulp upon access were tested for levels of prostaglandin E2, tumor necrosis efactor alpha, interleukin (IL)-6, IL-1β, and interferon gamma using high-sensitivity enzyme-linked immunosorbent assay. Postoperative pain levels were recorded for the groups. Data for the cytokine levels and postoperative pain were analyzed using statistical analysis. ResultsThere was a significant decrease in the levels of prostaglandin E2, tumor necrosis factor alpha, IL-6, and interferon gamma in the ibuprofen group compared with the nonibuprofen group. No significant differences were noted in the postoperative pain levels between these groups. ConclusionsThe data showed that preoperative ibuprofen significantly decreased the levels of most proinflammatory cytokines in the dental pulp, which could possibly help with anesthesia in irreversible cases.

Inter disciplinary approach of chronic periapical lesion with extraoral sinus tract opening on to the nasal floor: A case report

Dental pulp and periodontium are closely related and the pathway of communication between these structures helps in determining the progress and prognosis of the disease. Though periapical lesions can be managed non-surgically, surgical intervention is needed in cases of recalcitrant chronic periapical lesions that do not respond to conventional endodontic therapy. This case report highlights the surgical management of chronic periapical lesion of endodontic origin with an unusual location of the extra-oral sinus on the nasal floor. Keywords: Chronic periapical lesion, Nasal floor, Extra-oral sinus tract, Deformed nose, Surgical endodontics.

Magnification aids in endodontics: A review

Objective: The purpose of this review for the magnification aids in endodontics was to describe in detail various magnifying devices, their use and the advantages and disadvantages in clinical surgical and conventional endodontic therapy with recent innovation and technological advancement in magnifying Methodology: The author searched Qassim university library relevant journal articles manually and the website MEDLINE, Clinical key, EBSCO, google Scholar, Cochrane. The keywords for the search articles were dental operating microscope, dental magnifying loupes, dental endoscopes, dental orascope, root canal treatment, endodontic micro-surgeries magnification devices. The relevant articles describing the magnification devices were considered for the review.Conclusion: The literature on the magnification devices is very limited for the most recent magnifying devices and their use is also very limited to the elite and developed countries in endodontic practice. However, dental operating microscope, being considered as standard of care, is commonly available but are less frequently used routinely. Dental magnifying loupes are with low magnification. However, its use is common due to low price and easy to use. Randomized clinical trials, comparing between these magnifying devices for precision and root canal treatment outcome is the need of the hour. Conventional Endodontic therapy and surgical endodontics should apply magnification devices to be used in clinical practice routinely.