Lower Molar Teeth Research Articles

The effect of pre-emptive ibuprofen on post-operative pain after removal of lower third molar teeth: a systematic review.

Objective To investigate the effect of pre-emptive ibuprofen on post-operative pain after lower third molar surgery.Methods A search for randomised controlled trials was undertaken across the databases Medline, Embase, Cochrane Central and Dentistry and Oral Sciences Source. Citation searching was used to supplement the database search. Inclusion and exclusion criteria were used for independent double screening by two assessors.Results A total of five randomised controlled trials were included in the review. A risk of bias assessment identified some concerns in four of the included studies. One study was assessed as having low risk of bias. The important outcomes measured were post-operative pain intensity, total pain relief, use of rescue analgesia, time to rescue analgesia and total consumption of rescue analgesia. In two trials, pre-emptive ibuprofen was shown to significantly reduce pain intensity after lower third molar surgery compared with placebo. Two trials showed no significant difference between ibuprofen and placebo groups. Pre-emptive ibuprofen was shown to provide superior pain relief compared with placebo in the one trial measuring this outcome. Where the use of rescue medication was measured as an outcome, two trials showed that pre-emptive ibuprofen was superior to placebo, one trial showed that placebo was superior to ibuprofen and two trials found no significant difference between ibuprofen and placebo groups.Conclusion Due to the inconsistency of the results, there is insufficient evidence to support the use of pre-emptive ibuprofen for management of post-operative pain after lower third molar surgery. Further research into the effects of pre-emptive analgesia on the surgical pain pathway is required.

Comparison between Modified Triangular Flap and Envelop Flap Techniques for Surgical Removal of Impacted Mandibular Third Molar

Objective: To compare postoperative outcomes in surgical extraction of mandibular third molar with envelop flap versus modified triangular flap.
 Setting & Duration: Oral & Maxillofacial Surgery Unit at Faculty of Dentistry, Liaquat University of Medical and Health Sciences Jamshoro. Study period was from January 2021 to December 2021.
 Subject and Methods: A set of 60 individuals were sequentially assigned 30 to the Group A envelop flap and 30 to the Group B modified triangular flap for surgical removal of the mandibular third molar tooth. The demographic and clinical parameters was identified and recorded in proforma. The discomfort, swelling, and restricted mouth opening linked with an impacted mandibular third tooth are all assessed prior to surgery. The flap pattern employed for the extraction of the impacted lower third molar tooth, pain, and mouth opening was all reported on the proforma at the end of the procedure. On the seventh postoperative day, each patient was evaluated again.
 Results: - The average age of patients in group A was 29.77±7.17 years and 28.20±6.28 years in group B. Mean pain score was significantly low in group A as compare to group B [0.87±0.86 vs. 2.93±0.87 p=0.0005]. Mean mouth opening was significantly high in group A than group B [12.86±3.59 vs. 6.12±1.67; p=0.0005].
 Conclusion: In comparison to the envelope flap, the modified triangular flap was more effective when considering the postoperative periodontal state of the surrounding third molar and the dehiscence after wound recovery.

Morphological evolution of the cave bear (Ursus spelaeus) mandibular molars: coordinated size and shape changes through the Scladina Cave chronostratigraphy

Out of all extinct megafaunal mammals of the Quaternary, the cave bear Ursus spelaeus is one of the best represented in the fossil record. This species has been found to exhibit skeletal morphological adaptations when exploiting varied environmental niches, be that spatially or temporally. Here, we employ geometric morphometrics and phenotypic trajectory analysis to explore temporal morphological changes across the entire lower molar tooth row from the infilling of Scladina Cave, Belgium. We show that molar tooth size increases from Marine Isotope Stage (MIS) 5 – MIS 3, with cusp position varying temporally in relation to a larger talonid grinding platform in later time periods. Phenotypic trajectory analyses further show similar evolutionary shape trajectories in the first and second molars, but not in the third molar. Morphological changes related to a larger grinding platform are found in the second and third molars, with the divergent morphological change of M 3 suggesting that this tooth is less constrained and appears much more responsive to environmental changes. The need to cope with harder fibrous plant material present in the palaeoenvironment potentially constrained morphological evolution of the cave bear until its disappearance throughout Europe. • Lower molar tooth size increases from Marine Isotope Stage 5 – MIS 3. • M 3 appears less constrained and much more responsive to environmental changes. • Cave bear lower molar shape changed to process more fibrous plant material. • Tooth shape is a powerful ecological tool to understand adaptation of cave bears.

Comparative Analysis of Ease of Removal of Fractured NiTi Endodontic Rotary Files from the Root Canal System-An In Vitro Study.

This study aimed at analyzing and comparing the ease of removal of fractured nickel–titanium (NiTi) endodontic rotary files from the root canal system between the ultrasonic tips and the Endo Rescue appliance removal systems, as well as comparing the volume of dentin removed between ultrasonic tips and the Endo Rescue appliance using a micro-computed tomography (micro-CT) scan. Material and Methods: Forty NiTi endodontic rotary files were intentionally fractured in 40 root canal systems of 20 lower first molar teeth and distributed into the following study groups: A: Ultrasonic tips (n = 20) (US) and B: Endo Rescue device (n = 20) (ER). Preoperative and postoperative micro-CT scans were uploaded into image processing software to analyze the volumetric variations of dentin using an algorithm that enables progressive differentiation between neighboring pixels after defining and segmenting the fractured NiTi endodontic rotary files and the root canal systems in both micro-CT scans. A non-parametric Mann–Whitney–Wilcoxon test or t-test for independent samples was used to analyze the results. Results: The US and ES study groups saw 8 (1 mesiobuccal and 7 distal root canal system) and 3 (distal root canal system) fractured NiTi endodontic rotary files removed, respectively. No statistically significant differences were found in the amount of dentin removed between the US and ER study groups at the mesiobuccal (p = 0.9109) and distal root canal system (p = 0.8669). Conclusions: Ultrasonic tips enable greater ease of removal of NiTi endodontic rotary files from the root canal system, with similar amounts of dentin removal between the two methods.

The effect of different positions of unerupted lower third molar teeth on the fragility of mandibular angle: Finite element analysis.

The mandibular bone is the largest and strongest bone in comparison to the other bones in the face skeleton. However, it is the most commonly fractured in facial injuries. The location of the fracture in mandible depends on various factors. The relationship of the impacted lower third molar teeth to mandibular angle fracture has been the subject of many epidemiological studies. It is argued that the risk of fracture in mandibular angle is two to four times more when there are particularly an impacted or partially impacted third molar teeth. However, the effect of the position of the impacted tooth on mandibular angle fracture is not clear yet. This study seeks to reveal the effect of third molar teeth that are impacted in various positions on the angle fragility. This study was performed using three-dimensional finite element stress analysis and static linear analysis methodology. Computed tomography (CT) images obtained previously from a patient were used to construct models of the bone tissue. An ILUMA CBCT device (3M Imtec, OK, USA) was used for tomographic scans. Impacted teeth in various positions were digitally modeled separately. Different direction forces were applied to the mandible, the stress values on the bone surrounding the third molar teeth impacted in different positions were determined. Third molar teeth are impacted in mandibular bone in the following positions: mesioangular, vertical, horizontal, and distoangular positions. The study showed that the force that created the highest stress in the Mandibular angle among the modelled groups is the force by ipsilateral angle. For all kinds of impacted teeth, there was more stress accumulation in the buccal area than in the lingual area when the force is from the symphisis.

Evaluation of the clinical effects of impacted lower third molar tooth on adjacent oral tissues

Objective: Impacted tooth develops when the tooth fails to erupt into its anatomical functional position. Theaim of this prospective study was to find out common clinical effects of impacted lower molar on adjacent tissuesand to evaluate the relationship between signs and symptoms of impacted tooth as regards gender and agerespectively. Material and Methods: Data for this study were obtained using a well-structured questionnaireat the Teem Dental Hospital Warri, Nigeria. The data included age, sex, and clinical features of patients withconfirmed diagnosis of impacted lower third molar following clinical examination and radiographic investigation.Data were analysed and chi-square was employed. Results: A total of 131 patients were examined, 57 (44.5%)were males and 74 (56.5%) were females within the ages of 10-40 years. Patients within the ages of 21-25 yearshad the highest frequency (32.1%) of impacted lower third molar. It was observed that impacted tooth had agender predilection towards females than males. Inflamed gingivae around lower 3rd molar 60(45.8%) and painon the lower third molar 72(55.0%) were most predominantly associated with impacted third molar teeth. Nosignificant association was observed between age (0.909) and gender (0.461) against symptoms of impactedtooth but significant association (0.001) between age and sign was observed. Conclusion: The most commonlyassociated effect of impacted third molar is inflammation of the adjacent gingivae alongside pain around thelower third molar. Prevalence of impacted molar tooth was gender based with age being a predilection factorin its signs of presentation.KEYWORDSClinical effects; Impacted tooth; Third molar; Teem Dental Hospital.

МОРФОЛОГИЯ ПЕРВОГО НИЖНЕКОРЕННОГО ЗУБА MICROTUS GREGALIS (RODENTIA, ARVICOLINAE) ИЗ СРЕДНЕГО НЕОПЛЕЙСТОЦЕНА ПРЕДАЛТАЙСКОЙ РАВНИНЫ

In this paper morphological structure of the first lower molar m1 tooth of the narrow-skulled vole from alluvial deposits of the Pre-Altai Plain Middle Neo-Pleistocene is described. Morphological study of the vole remains showed that they belong to the modern species Microtus gregalis. At the same time, the study sample showed significant differences, both in morphological structure and in the size of the first lower molar, in comparison with the recent representatives of the same territory. The set of morphological and morphometric data shows that the studied voles occupy an intermediate position between M. gregaloides of the Early and M. gregalis of the Late Neo-Pleistocene. The ratio of m1 morphotypes also showed the relative primitiveness of the M. gregalis sampling. Morphological study of remains of the narrow-skulled vole from the Solonovka, Petropavlovskoe and Malinovka-4 locations confirmed the previously determined age for sediments containing the remains of microtheriofauna.

Causes of subcutaneous emphysema following dental procedures: a systematic review of cases 1993-2020.

Objectives Causes of subcutaneous emphysema (SE) following dental treatment have changed with new operative techniques and equipment. This review demonstrates the frequency and aetiology of SE to inform prevention strategies for reducing SE occurrences.Methods A systematic search of Medline, Embase and PubMed databases identified 135 cases of SE which met inclusion criteria after independent review by two authors. Trends in frequency and causes of SE were displayed graphically and significant differences in frequency of SE by time period, site and hospital stay were analysed using t-tests.Results Dental extractions often preceded development of SE (54% of cases), commonly surgical extractions. Treatment of posterior mandibular teeth most often resulted in development of SE. Most cases were iatrogenic, with 51% resulting from an air-driven handpiece and 9% from air syringes. Factors such as nose blowing accounted for 10%. There was a significant (p <0.05) increase in cases over time. Mandibular teeth had increased hospital stay time compared to maxillary teeth (p <0.01).Conclusion Increased risks of SE were identified following use of air-driven handpieces during dental extractions and when treating lower molar teeth. Use of air-driven handpieces should be avoided during dental extractions to reduce risks and subsequent morbidity that results from SE.

Endometriosis de región mandibular: reporte de caso

Introduction: Endometriosis is a chronic gynecological disease, which refers to the presence of endometrial glands and stroma outside the uterine endometrium. This entity has a frequency of 10 to 15% in women of reproductive age, and its most common site of presentation is the ovary. At the extrapelvic level, the most common location is the gastrointestinal and genitourinary location. However, it can occur in any location. Presentation: The case of a 40-year-old female patient with a face tumor in the mandibular region is described, presenting with a disease time of 2 years. Among the important antecedents, two months before the appearance of the tumor region, the patient underwent endodontic surgery of a lower molar tooth, contiguous to the mandibular. Likewise, one month before the appearance of the tumor, the patient underwent an exploratory laparoscopy for electrofulguration of endometriotic foci in the uterine myometrium. The patient underwent a surgical resection of the tumor in the mandibular region described; and after reviewing the histological and immunohistochemical slides at the institution, the diagnosis of endometriosis was established. Conclusion: Extrapelvic endometriosis is rare in our country, and its diagnosis requires experience and visual training in the recognition of normal endometrial tissue. The presentation of this case was considered important because it would be the first case reported in Peru and in the world, of an endometriosis located in the mandibular region.

Effect of Aging on Mineral Content of Resin-Dentin Interface Treated with Total Etch Adhesives

Background/Aim: Slow release of fluoride from adhesives might increase the concentration of fluorapatite in the hybrid layer and the underlying dentin and subsequently could stabilize the adhesive interface. The present study aimed to evaluate the effect of aging on the mineral content of the bonded resin/dentin interface and to compare between two similar commercial adhesive systems. Materials and Methods: This in vitro study was carried out on 20 caries-free upper and lower human molar teeth. All the procedures of acid etching, application of adhesives and resin composite buildup were only restricted to dentin. Each tooth was prepared to receive Adper Single Bond 2 on one half (Group I) and Prime & Bond NT on the other half (Group II). Sticks from the same tooth half were randomly divided into 3 subgroups according to storage time regimen: immediate, 3 months and 9 months in deionized water. The mineral content at resin-dentin interfaces were analyzed using an environmental scanning electron microscope and expressed as a atom percentage of the total area evaluated. One-way ANOVA test was used to determine the significant effect of aging on the mineral content of resin-dentin interface. Comparison between the two adhesives at different time intervals was done using independent student t test. Results: There was significant difference among different follow up intervals regarding the mineral content of Group I (p=0.040), while Group II showed non-significant difference (p=0.093). There was non-significant difference between the two adhesives in all storage periods, except at 9 months (p=0.050).

Retention Strength of Polyetheretherketone Crowns Vs. Zirconia Crowns Restoring Molar Teeth: An in Vitro Study

Aim: This study was designed to compare the retention strength of monolithic CAD/CAM PEEK crowns to that of CAD/CAM monolithic YTZP-zirconia crowns, both resin-cemented to epoxy resin dies resembling lower molar teeth; after thermomechanical aging simulating 3 months of in-vivo service. Materials and methods: 22 identical epoxy dies, resembling the preparation of a lower second molar (4mm height, 6° axial convergence and 1 mm-thick deep chamfer finish line), were produced by replicating one master stainless steel die via 22 polyvinyl siloxane impressions. The epoxy dies were randomly equally distributed into 2 groups (Zr and P groups); 11 dies each. The first (control) group (Zr) received CAD/CAM milled monolithic Y-TZP zirconia crowns (Katana™ ML), while the other group (intervention) received CAD/CAM milled monolithic PEEK crowns (breCAM.BioHPP™). Two opposing, laterally projecting (mesial and distal) arms were included in the design of all crowns for the retention test. The fitting surfaces of crowns of both groups were sandblasted with 110-µm alumina particles. All crowns were cemented over their corresponding epoxy dies using the (hand-mixed) dual-cured, self-adhesive resin cement (RelyX™ U200) (3-kg seating force). Samples were stored in water incubator for 24 hours (37 °C); then, subjected to mechanical aging (37,500 cycles, 49 N load) with simultaneous thermocycling (300 cycles, 5-55 °C, 12 s dwell time). Retention strength was evaluated by vertically pulling-up the crowns from their corresponding dies, through the pull-out test performed via a universal testing machine (UTM). Failure modes were then observed under digital microscope. The mean dislodgment force (retention strength) for each group was calculated, and statistically compared using Student t-test. Statistical analysis was performed with three-way ANOVA. Pair-wise comparison of groups was made with the Tukey test. Pearson’s Chi-Square test was used to analyze the failure modes. Results: PEEK crowns group (P) demonstrated statistically insignificant higher retention strength (171.28 N ± 26.30) than zirconia (Zr) crowns group (150.40 N ± 24.40). “Mixed” failure mode was predominant in both groups, followed by the adhesive “cement on crown” failure-mode.

Atypical presentation of lateral periodontal cyst associated with impacted teeth: two case reports

BackgroundLateral periodontal cyst (LPC) is an uncommon form of developmental odontogenic cyst. LPC can be suspected when there is a round, well-circumscribed radiolucency, usually of small diameter, along the lateral surface of vital erupted teeth, predominantly in the mandibular premolar region. Histopathological analysis allows LPC to be diagnosed based on its characteristic features such as a thin cuboidal to stratified squamous non-keratinizing epithelium containing epithelial plaques and glycogen-rich clear cells.The aim of this article was to report two cases of atypical LPC associated either with an impacted lower left canine (tooth #33) or with a lower right third molar (tooth #48).Case presentationCase 1: A 56-year-old man was referred to us for an oro-dental assessment. Panoramic radiography revealed an impacted lower left permanent canine (tooth #33) with well-defined radiolucency on its upper cervical margin. A CT scan revealed a pericoronal radiolucency of 5 mm at its widest diameter around the impacted tooth #33. The pericoronal tissue was removed and sent for histopathological examination. The results revealed a lateral periodontal cyst. Satisfactory postoperative healing was achieved at the site. Follow-up at 12 months indicated no recurrence of the lesion.Case 2: A 54-year-old woman consulted with the main issue being pain on the lower right side of the face. Intra-oral examination revealed a vestibular swelling involving the region of the second molar (tooth #47), with obliteration of buccal sulcus. Pocket depth was determined to be 9 mm at the distal of #47. A diagnosis of gingival abscess resulting from chronic periodontitis was made. Panoramic radiography revealed a radiolucent cystic lesion associated with an impacted horizontal lower right third molar (tooth #48), suggestive of a dentigerous cyst. X-rays also revealed alveolar bone resorption on the molar (tooth #47). The cyst was removed along with the third molar and submitted for histopathological diagnosis. The diagnosis was LPC. Follow-up at 18 months indicated no recurrence of the lesion.ConclusionThese cases represent atypical presentations of LPC. They provide examples of the differential diagnosis of pericoronal radiolucencies involving an impacted tooth and our observations provide insights regarding the pathogenesis of LPC.

EFFECT OF CO-ADMINISTERED PREDNISOLONE AND DICLOFENAC POTASSIUM IN REDUCING POSTOPERATIVE TRISMUS AFTER IMPACTED LOWER THIRD MOLAR SURGERY.

Objective:&#x0D; To determine the effect of adding a combination of oral Diclofenac Potassium with an intramuscular dose of Prednisolone preoperatively to minimize postoperative trismus after the surgical removal of the lower third molar tooth. &#x0D; Materials and Methods:&#x0D; A total of 160 patients undergoing surgical removal of their impacted lower third molar tooth were randomized into 2experimental groups; Group A (50mg Diclofenac Potassium oral and 40mg Prednisolone administered intramuscularly one hour before surgery) and Group B (40mg of intramuscular Prednisolone administered one hour before surgery). In this randomized control trial,both groups were prescribed the combination of Paracetamol and codeine as analgesics postoperatively for 48 hours. The maximum inter incisal distance was measured immediately before and 48 hours after surgery.&#x0D; Results:&#x0D; Mean preoperative maximum inter incisial opening in Group A and Group B were 48.28±5.12 and 47.51±5.18 respectively. On postoperative second day the Mean maximum inter incisial opening in Group A was 34.49±3.73mm when compared to 27.71±5.48 in Group B. The mean postoperative trismus in Group A and Group B were 13.79±6.39mm and 19.95±7.07mm respectively. The mean difference in post operative trismus was 6.160mm which was statistically significant at a 99% confidence interval (p&lt;0.01). &#x0D; Conclusion:&#x0D; Preemptive medication with a combination of Prednisolone-Diclofenac Potassium was more effective in reducing postoperative trismus compared to Prednisolone alone.

Pathological Abnormalities Due to Impaction of Third Molar Mandibular Horizontal and Mesioangular Angulation with Observation of Panoramic Radiography

Background: The lower third molar teeth are the most commonly impacted teeth due to a lack of place for an eruption. Impacted teeth affect the surrounding tissue and can lead to pathological abnormalities. The effect of impacted teeth results in various complaints such as pain, caries, pericoronitis, adjacent tooth root resorption, dentigerous cysts, and odontogenic tumors. The impacted mandibular third molars and associated pathological abnormalities were observed with panoramic radiography. Purpose: To determine the pathological abnormalities that accompany the molar impaction of horizontal and mesioangular angular mandibula with panoramic radiographic observation. Material&Methods: In this study, using the panoramic radiograph, consisting of 53 samples of radiographs were evaluated based on the mesioangular and horizontal angulation of mandibular impacted third molars and pathology abnormalities caused. The data were processed and analyzed by using the Friedman test and Chi-square test. Result: In impaction with mesioangular angulation, bone loss at the interalveolar between third molar and mandibular second molars by 33.3%, caries on the mandibular second molars and mandibular second molar’s root resorption had a similar percentage by 26.7% and caries in mandibular third molar impaction amounted to 13.3%. In impaction with horizontal angulation bone loss at interalveolar third molar and mandibular second molar by 59.1%, mandibular second molars of caries were 22.7%, caries in mandibular third molar impaction and mandibular second molar root resorption by 9.1%. Conclusions: The most common pathological abnormalities in mandibular third molar impaction of mesioangular and horizontal angulation are bone loss in the interalveolar third molar and the mandibular second molar.

Correlation between preoperative pressure pain assessments and anxiety and postoperative pain in impacted lower third molar surgery.

ObjectivesThe aim of this study was to evaluate correlations between anxiety and preoperative pressure pain assessments and postoperative pain and analgesic requirements in impacted lower third molar tooth surgery.Materials and MethodsThis prospective study enrolled 60 patients who underwent impacted lower third molar surgery. The preoperative State-Trait Anxiety Inventory-I (STAI-I), pressure pain threshold, and pressure pain tolerance scores were measured. At 2, 4, 6, 12, and 24 hours, and at 6 days following surgery, the patients scored their pain on the visual analogue scale and recorded their analgesic drug usage. The data were evaluated, and the results were statistically analyzed.ResultsOf the 60 patients, 38 were female. Mean age was 24.62±7.42 years. The study found no relationship between preoperative pressure pain assessments and postoperative pain (P>0.05). There was also no relationship observed between preoperative STAI-I scores and postoperative pain (P>0.05). However, there was a positive correlation between operation time and total medication taken (P<0.05).ConclusionPreoperative pressure pain threshold, pressure pain tolerance, and anxiety level had no significant effects on postoperative pain and analgesic requirements in impacted lower third molar surgery.

Can polylactic acid be a CAD/CAM material for provisional crown restorations in terms of fit and fracture strength?

This study aimed to evaluate polylactic acid (PLA) as a provisional crown material. Lower right first molar phantom tooth was used for the fabrication of 60 crowns. Samples were divided into three groups (n=20) according to the material: Group PL (PLA), Group PM (polymethyl methacrylate), and Group PE (polyetheretherketone). Each group was investigated for internal and marginal fit, fracture strength, and fracture mode. Data were analyzed using ANOVA, chi-squared test, and Tukey's tests (p≤0.05). The average marginal gap value of each group was: PE 56.00±4.67 µm, PM 61.15±4.44 µm, and PL 60.40±2.85 µm (p<0.001). The average internal gap value for each group was: PE 128.90±8.39 µm, PM 132.40±7.51 µm, and PL 130.75±9.76 µm (p=0.442). The average fracture strength of each group was: PE 840.90±13.23 N, PM 733.30±9.00 N, and PL 664.50±10.79 N (p<0.001). Results demonstrated that PLA may be a good option as a provisional crown material.

Comparative evaluation of ropivacaine and lidocaine as dental pulp anaesthesia.

Root canal therapy linked to pulpal diseases or trauma is common in modern dental care. The 2% Lidocaine which is considered as the gold standard has some drawbacks in pulpal anaesthesia. Ropivacaine has beneficial anaesthetic effects on pulpal anaesthesia. Therefore, it is of interest to compare and evaluate the pulpal aesthetic effect using 0.5% Ropivacaine and 2% Lidocaine in symptomatic irreversible pulpitis. A double blinded randomized controlled clinical trial consisting of 110 lower molar and premolar tooth with irreversible pulpitis cases for root canal therapy were selected and randomly divided into 2 groups. Group A: 2% lidocaine with epinephrine and Group B: 0.5% ropivacaine. The pulp sensibility tests with heat test, cold test and electric pulp test were completed. The preoperative pain score was measured with Visual Analogue Scale (VAS) pain scale. The classical inferior alveolar nerve block (IANB) technique was administered to all patients by a single operator. Subjects were asked for lip numbness and presence or absence of lip numbness. Postoperative pain scores were recorded during access opening and on placing files in the canal. There is no statistical difference between the groups during pre operative conditions. The mean pain scores within group A and group B is recorded. The difference was found to be statistically significant with p value ≤ 0.05. Significant difference between the mean values after and before the treatment is observed. However, there is no statistical significance between the mean pain scores between the access and pulp. The 0.5% Ropivacaine and 2% Lidocaine with epinephrine does not have any significant difference during access opening. However, 0.5% Ropivacaine groups were effective while placing the file in the canal. Thus, 0.5% Ropivacaine showed better results even though it was not statistically significant for further consideration in this context.

Management of furcal involvement with Portland cement: A new approach to save a hopeless tooth

Be it a root canal perforation or a furcal involvement, MTA has proven itself to be the material of choice for repair of the same. But it may not be the easiest available material for treatment every time. In this era of conservative treatment that too in a minimally invasive manner extraction of tooth due to non-availability of material is not acceptable. There are a huge list of materials available which has been a full-proof material for the furcation repair. But Portland cement is one such material which is easily available and can be treated to make it usable in the oral cavity.This paper aims to present a case where chronic pulpal inflammation had led to furcal involvement of the lower first molar tooth which has been treated with Portland cement.

Micro-cleanliness of Hard Tissue Debris After Advanced Irrigation and Comparison Between EndoVac and XP-endo Finisher: A Microcomputed Tomographic Study.

ABSTRACTIntroduction:Conventional irrigation techniques do not remove debris adequately. The remaining tissue debris cause infection inside the root canal and may also affect the seal of the root canal. The study aimed to compare the ability of EndoVac (EV) with XP-endo finisher (XPF) in debris removal using micro-CT analysis.Materials and Methods:We used 12 lower first permanent molar human teeth for this study. The root canals were instrumented using a small TF adaptive system. Then, the volume of debris was calculated. Teeth were divided into two groups, according to advanced irrigation methods, with six teeth per group: EV group and XPF group. The volume of debris was calculated again. The paired-sample t-test was used to compare the volume of the debris before and after the use of advanced irrigation methods with the statistical significance of P < 0.05. The percentage of debris reduction was also calculated.Results:Both EV and XPF showed a significant decrease of debris in the mesial canals (P < 0.05), whereas EV only showed a significant reduction of debris in the distal canals.Conclusion:Both EV and XPF were able to significantly reduce debris after instrumentation in the mesial canals of lower first mandibular molars.Clinical Significance:The study provides insight into the recent advanced methods used in debris removal and canal disinfection.

Efficiency of Laser versus Bur in Impacted Mandibular Third Molar Surgery: An Original Research.

Introduction:In oral and maxillofacial surgery, their clinical application has largely been restricted to soft tissue. Hence, the aim of this study was to assess the feasibility of erbium-yttrium aluminum garnet (Er: YAG) laser in bone cutting for removal of impacted lower third molar teeth and to compare its outcomes with that of surgical bur.Materials and Methods:The study comprised forty subjects requiring removal of impacted mandibular third molar, randomly categorized into two equal groups of 20 each, who had their impacted third molar removed either using Er: YAG laser or surgical bur as per their group, using standard methodology of extraction of impacted teeth. Clinical parameters such as pain, bleeding, time taken for bone cutting, postoperative swelling, trismus, wound healing, and complications were compared for both groups.Results:Clinical parameters such as pain, bleeding, and swelling were lower in laser group than bur group, although the difference was statistically not significant. However, postoperative swelling showed a significant difference in the two groups. Laser group required almost double the time taken for bone cutting with bur. Trismus persisted for a longer period in laser group. Wound healing and complications were assessed clinically and there was no significant difference in both the groups.Conclusion:Based on the results of our study, the possibility of bone cutting using lasers is pursued, the osteotomy is easily performed, and the technique is better suited to minimally invasive surgical procedures. The use of Er: YAG laser may be considered an alternative tool to surgical bur, especially in anxious patients.