Mandibular Teeth Research Articles

Accuracy evaluation of dental CBCT and scanned model registration method based on pulp horn mapping surface: an in vitro proof-of-concept

Background and aim3D fusion model of cone-beam computed tomography (CBCT) and oral scanned data can be used for the accurate design of root canal access and guide plates in root canal therapy (RCT). However, the pose accuracy of the dental pulp and crown in data registration has not been investigated, which affects the precise implementation of clinical planning goals. We aimed to establish a novel registration method based on pulp horn mapping surface (PHMSR), to evaluate the accuracy of PHMSR versus traditional methods for crown-pulp registration of CBCT and oral scan data.Materials and methodsThis vitro study collected 8 groups of oral scanned and CBCT data in which the left mandibular teeth were not missing, No. 35 and No. 36 teeth were selected as the target teeth. The CBCT and scanned model were processed to generate equivalent point clouds. For the PHMSR method, the similarity between the feature directions of the pulp horn and the surface normal vectors of the crown were used to determine the mapping points in the CBCT point cloud that have a great influence on the pulp pose. The small surface with adjustable parameters is reconstructed near the mapping point of the crown, and the new matching point pairs between the point and the mapping surface are searched. The sparse iterative closest point (ICP) algorithm is used to solve the new matching point pairs. Then, in the C + + programming environment with a point cloud library (PCL), the PHMSR, the traditional sparse ICP, ICP, and coherent point drift (CPD) algorithms are used to register the point clouds under two different initial deviations. The root square mean error (RSME) of the crown, crown-pulp orientation deviation (CPOD), and position deviation (CPPD) were calculated to evaluate the registration accuracy. The significance between the groups was tested by a two-tailed paired t-test (p < 0.05).ResultsThe crown RSME values of the sparse ICP method (0.257), the ICP method (0.217), and the CPD method (0.209) were not significantly different from the PHMSR method (0.250). The CPOD and CPPD values of the sparse ICP method (4.089 and 0.133), the ICP method (1.787 and 0.700), and the CPD method (1.665 and 0.718) than for the PHMSR method, which suggests that the accuracy of crown-pulp registration is higher with the PHMSR method.ConclusionCompared with the traditional method, the PHMSR method has a smaller crown-pulp registration accuracy and a clinically acceptable deviation range, these results support the use of PHMSR method instead of the traditional method for clinical planning of root canal therapy.

Influence of endodontic access cavity design on mechanical properties of a first mandibular premolar tooth: a finite element analysis study

ObjectivesThis study aimed to investigate the influence of access cavity designs on the mechanical properties of a single-rooted mandibular first premolar tooth under various static loads using a finite element analysis.Materials and methods3-dimensional FEA designs were modeled according to the access cavity designs: an intact tooth (control), traditional access cavity (TEC-I), traditional access cavity with Class-II mesio-occlusal cavity design (TEC-II), conservative access cavity (CEC), ninja access cavity (NEC), caries-driven access cavity (Cd-EC), buccal access cavity (BEC) and bucco-occlusal access cavity (BOEC). After the simulated access cavity preparations, root canal treatment was simulated and three different static loads which mimicked oblique and vertical mastication forces were applied to the models. The stress distribution and maximum Von Misses stress values were recorded. The maximum stress values were obtained on both enamel and dentin under multi-point vertical loads.ResultsThe maximum stress values were obtained on both enamel and dentin under multi-point vertical loads. Under all load types, the minimum stress distribution was observed in the control group, followed by CEC, NEC and BEC designs. The highest stress concentration was detected in Cd-EC and TEC-II designs. Under single-point vertical loading, the stress was mostly concentrated in the lingual PCD area, while under multi-point vertical loading, the entire root surface was stress-loaded except for the lingual apical third of the root.ConclusionPreserving tooth tissue by simulating CEC, NEC and BEC access cavities increased the load capacity of a single-rooted mandibular first premolar following simulated endodontic treatment.

EVALUATION OF THE RELATIVE POSITION OF THE MANDIBULAR FORAMEN IN YEMENI CHILDREN AS A REFERENCE FOR INFERIOR ALVEOLAR NERVE BLOCK USING AN ORTHOPANTAMOGRAPH

Aim and objectives: A crucial component of managing a kid dentistry patient's behavior is pain control. For mandibular teeth, the most used local anesthetic method is inferior alveolar nerve block (IANB). So, an effective IANB anesthetic requires knowledge of the mandibular foramen's location. Using digital panoramic radiography pictures, the mandibular foramen's position in relation to the occlusal plane and the deepest point of the anterior border of the ramus was assessed in a sample of Yemeni children aged 4 to 12. Materials and Methods: This retrospective study consisted of 501 orthodontic charts that were analyzed and divided into three groups: Group 1: 4-6 years, Group 2: 7-9 years and Group 3: 10-12 years. The OPGS were traced directly on radiographic films and measurements were taken from the mandibular foramen to the occlusal level and to the deepest point of the anterior border of the ramus, respectively, on the right and left sides of the mandible. Data were analyzed and the mean and SD were determined and compared for different gender, age groups and side (right/left). Results: Male participants showed slightly higher mean distance values for MF-AB-Right compared to females (16.276±2.03 mm VS 15.952±1.82), but the contrast was not statistically significant. The study found significant differences in the mean MF distances of ABR between the 10-12 year age group and the 4-6 year age group (16.518±1.86 mm VS 15.487±1.95 mm), (p=0.0001). The mean OP-MF distances for the 10-12 year age group were also significant, with significant differences observed in the right side and left side. Conclusion: The results were similar for the total children, regardless of gender. The study suggests that the mandibular foramina position may vary among different age groups. For inferior alveolar nerve block, the needle should be inserted slightly below the OP in 4-6 years old girls and at the same level of OP in 7-9 years old girls, and 4-6 years old boys. Peer Review History: Received 23 March 2024; Revised 6 May 2024; Accepted 29 June; Available online 15 July 2024 Academic Editor: Dr. Asia Selman Abdullah, Pharmacy institute, University of Basrah, Iraq, asia_abdullah65@yahoo.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. Masoumeh Divar, Shiraz University, Shiraz, Iran, zhaledivar@gmail.com

Enhanced pendulum appliance utilizing temporary anchorage device-based Nance arch and modified springs for optimized molar distalization control: a case report.

A 20-year-old female patient with severe maxillary crowding and skeletal Class III malocclusion was successfully treated using an enhanced pendulum appliance. Camouflage treatment was chosen because the patient refused surgical intervention. Detailed examination and analysis revealed that labial inclination of the maxillary anterior teeth could provide the alignment space necessary after tooth extraction in the maxillary arch but it would not be beneficial esthetically and would increase the moment perpendicular to the tooth long axis as well as increase the risk of bone dehiscence. Therefore, lingual inclination of the mandibular anterior teeth was performed. To create space for aligning the maxillary arch, an enhanced pendulum appliance was utilized, in addition to premolar extraction. The enhanced pendulum appliance had one mesial and one distal helix on each spring, exerting opposing forces in the buccolingual direction and reducing the buccolingual inclination of the molars. In addition, miniscrews were integrated into the Nance arch of the enhanced pendulum appliance to provide skeletal anchorage, minimizing the reciprocal movement of anchorage teeth. This modification not only enhanced control over tooth movement but also improved treatment efficiency. During the entire treatment duration of 17 months, substantial improvement in facial and occlusal aspects were noted. Additionally, the patient retained these positive changes until the subsequent 2-year follow-up period.

Antibacterial Efficacy of Graphene Nanoparticles against Enterococcus faecalis: In Vitro Study.

This study compared the antimicrobial efficacy of nanographene (NG) particles with chlorhexidine (CHX) and calcium hydroxide (Ca(OH)2) against Enterococcus faecalis. Forty extracted human mandibular premolar teeth were cleaned using a scaler, and the middle-third of the root (6 mm) was decoronated using a rotary diamond disk. The inner diameter of the teeth was made consistent using Gates Glidden Drills #3, treated with ethylene diamine tetra-acetic acid and sodium hypochlorite before sterilization. The samples were then contaminated with E. faecalis grown in Tryptic soy broth for 21 days. Tooth samples were then randomly divided into four groups: Group I (Control), untreated saline; Group II, Ca(OH)2; Group III, CHX; and Group IV, NG. The assessment of bacterial growth was carried out by harvesting dentin chips at the end of 1, 3, and 7 days. The colonies were physically counted and tabulated after 24 hours from seeding. Statistical analysis of the collected data was performed with analysis of variance and Tukey's post hoc test using SPSS Version 20.0. The contaminated dentine blocks irrigated with NG (0.5 µg) and CHX (0 ± 0; p < 0.001) had no growth of E. faecalis colonies compared to blocks of Ca(OH)2 (10 ± 21) and saline (927 ± 455). All concentrations of NG (0.5 and 1.0 µg) showed effectiveness higher (p < 0.001) than 2% CHX when measured by the zone of inhibition against E. faecalis. CONCLUSION: It may be concluded that NG is effective against growth of E. faecalis and may be used as a promising antimicrobial agent during root canal treatment. However, further studies should be done to investigate the effect of NG against other dental pathogens.

Evaluation of the accuracy of conventional and digital implant impression techniques in bilateral distal extension cases: a randomized clinical trial

BackgroundThis clinical study aims to evaluate the accuracy of the conventional implant impression techniques compared to the digital impression ones in bilateral distal extension cases.MethodsA total of 32 implants were placed in eight patients missing all mandibular posterior teeth except the first premolars. Each patient received a total of four implants, with two implants placed on each side, in order to provide support for three units of screw-retained zirconia restorations. Following osteointegration, the same patient underwent two implant-level impression techniques: Conventional open-tray impressions CII (splinted pick-up) and digital implant impressions DII with TRIOS 3 Shape intraoral scanner. The accuracy of impressions was evaluated utilizing a three-dimensional superimposition analysis of standard tessellation language (STL) files. Subsequently, the scan bodies were segmented using Gom inspect software to measure three-dimensional deviations in a color-coding map. Data were statistically analyzed using the Kruskal Wallis test and then a post-hoc test to determine the significance level (P < 0.05).ResultsThe study revealed that higher angular and positional deviations were shown toward distal scan bodies compared to mesial ones for both impression techniques. However, this difference was not statistically significant (P > 0.05).ConclusionSplinted open-tray conventional impression and intraoral scanning implant impression techniques have demonstrated comparable accuracy.Trial registrationClinical Trials.gov Registration ID NCT05912725. Registered 22/06/ 2023- Retrospectively registered, https://register.clinicaltrials.gov.

Postoperative Pain Following Single Visit Root Canal Treatment With Reciproc Blue And Hyflex EDM Instrumentation; A Prospective Randomized Clinical Trial

Objective: Single file systems with continuous rotation or reciprocation produced with many new technologies promising in terms of postoperative pain. The aim of this study was to investigate the efficacy of using novel Reciproc Blue (RBlue) and HyFlex EDM (HEDM) files on postoperative pain after single visit root canal treatment. Materials and Methods: 72 patients with asymptomatic pulp necrosis in mandibular molar and premolar teeth were included. The root canals were prepared using HEDM (n=29) or RBlue (n=28) and hand-instruments (n=15) in single visit. Pain presence using verbal rating scale (VRS) and analgesic intake were recorded after 24h, 48h, 72h and 7 days. Results: Postoperative pain at 24h and 48h was statistically higher at RBlue group than HEDM and control groups (p0.05).There was no difference between groups in terms of analgesic intake (p&gt;0.05). RBlue files were associated with higher incidence of postoperative pain and higher VRS scores than HEDM and hand-instruments. Conclusion: RBlue files working with reciprocating motion caused much more postoperative pain than HEDM files and manual files.

Effect of two esthetic digitally produced materials used in fabrication of extracoronal attachments on the stresses Induced in removable partial dentures

BackgroundPreservation of the remaining structures while maintaining an esthetic appearance is a major objective in removable partial prosthodontics. So, the aim of the current study was to compare the stresses induced on the supporting structures by two digitally produced esthetic core materials; Zirconia and Polyetheretherketone when used as an extracoronal attachment in distal extension removable partial dentures using strain gauge analysis.MethodsA mandibular Kennedy class II stone cast with the necessary abutments’ preparations was scanned. The mandibular left canine and first premolar teeth were virtually removed. An acrylic mandibular left canine and first premolar teeth were prepared with heavy chamfer finish line and scanned. Virtual superimposition of the acrylic teeth in their corresponding positions was done. Two strain gauge slots were designed: distal to the terminal abutment and in the residual ridge. Two models and two sets of scanned teeth were digitally printed. The printed teeth were then placed in their corresponding sockets in each model and scanned. The attachment design was selected from the software library and milled out of Zirconia in the model ZR and Polyetheretherketone in the model PE. Five removable partial dentures were constructed for each model. The strain gauges were installed in their grooves. A Universal testing machine was used for unilateral load application of 100 N (N). For each removable partial denture, five measurements were made. The data followed normal distribution and were statistically analyzed by using unpaired t test. P value < 0.05 was considered to be statistically significant.ResultsDuring unilateral loading unpaired t test showed statistically significant difference (p = 0.0001) in the microstrain values recorded distal to the abutment between the models ZR (-1001.6 µε ± 24.56) and PE (-682.6 µε ± 22.18). However, non statistically significant difference (p = 0.3122) was observed in the residual ridge between them; ZR (16.2 µε ± 4.53) and PE (15 µε ± 3.74).ConclusionsIn removable partial dentures, Polyetheretherketone extracoronal attachment induces less stress on the supporting abutments compared to the zirconia one with no difference in the stresses induced by them on the residual ridge.

Cardiac transplantation and dentistry

The number of cardiac transplants carried out each year within the UK is increasing. With this rise in numbers, it is important that dental professionals are aware of both pre- and post-operative considerations for these patients. This paper considers the practical elements of managing these patients, outlining important aspects of history taking, treatment planning, and safe pain and anxiety management options. CPD/Clinical Relevance: The unilateral sagittal split osteotomy may present an alternative method for removing impacted mandibular third molar teeth in certain situations.

The unilateral sagittal split osteotomy: A useful tool in the armamentarium for deeply impacted mandibular third molars

The unilateral sagittal split osteotomy may not be a particularly popularized method to access and remove impacted mandibular third molars (M3Ms). However, in unusual cases of deep impaction, it can provide a surgical option that minimizes bone removal and may reduce the risk of iatrogenic mandibular fracture and inferior alveolar nerve (IAN) injury, depending on the position of the third molar relative to the neurovascular bundle. CPD/Clinical Relevance: The unilateral sagittal split osteotomy may present an alternative method for removing impacted mandibular third molar teeth in certain situations.

Marginal Adaptation of BioRoot RCS, MTA-Fillapex, EpoxySeal, and Sealapex to Radicular Dentin: An In Vitro Study.

Introduction The primary goal of endodontic therapy is to achieve a three-dimensional filling of the root canal. The sealer plays a crucial role in filling the residual gaps between the gutta-percha and the canal wall, which prevents fluids and bacteria from entering the canal and causing complications. This study evaluates and compares the sealing ability of four root canal sealers to the root dentin. Methods and materials In this study, forty single-rooted mandibular premolar teeth with fully-formed apices were collected. The teeth were decoronated and instrumented. Later, the teeth were randomly divided into four groups, each comprising ten specimens, based on the sealer used for obturation. The first group was obturated with BioRoot RCS (Septodont, Septodont Holding, Paris, France), the second group with MTA-Fillapex (Angelus, Angelus Indústria de Produtos Odontológicos S/A, Brazil), the third group with EpoxySeal (Safe Endo, SafeEndo Dental India Pvt. Ltd., Gujarat, India), and the fourth group with Sealapex (Kerr, Kerr Corporation, Brea, CA). Following obturation, the teeth were sectioned vertically using a diamond disc, and the marginal adaptation of these sealers to the root dentin was assessed using scanning electron microscopy (SEM). The values were then statistically analyzed. Results EpoxySeal showed the maximum amount of marginal adaptation (5.22±0.47), followed by BioRoot RCS (5.48±0.58) and MTA-Fillapex (8.24±0.74), and the least amount of marginal adaptation was shown by Sealapex (11.64±1.35). Based on the analysis of variance (ANOVA), a statistically significant difference (p≤0.001) was observed. According to Tukey's post hoc test, the mean difference between all groups showed statistical significance (p≤0.05) except between BioRoot RCS and EpoxySeal. Conclusion Within the limitations of this in vitro study, it is concluded that EpoxySeal and BioRoot RCS exhibited superior marginal adaptation to the root dentin. BioRoot RCS can be recommended as a sealer of choice owing to its additional properties, such as antimicrobial and hydrophilic affinity during setting.

An In Vitro Study of Retention and Marginal Adaptation of Endocrowns With Different Intracoronal Depths.

Marginal adaptation and retention of endocrowns are crucial for the success and survival of endocrowns. This study aimed to investigate the effect of different materials and intracoronal depth on the retention and marginal adaptation of CAD/CAM fabricated all-ceramic endocrowns. Thirty-six mandibular premolar teeth with an average surface area of 64.49 mm2 were prepared to receive CAM/CAM fabricated endocrowns. Samples were divided randomly and equally into groups of lithium disilicate with 2 mm intracoronal depth (LD2), lithium disilicate with 4 mm intracoronal depth (LD4), polymer infiltrated ceramic network with 2 mm intracoronal depth (PICN2) and polymer infiltrated ceramic network with 4 mm intracoronal depth (PICN4). All endocrowns were cemented using ParaCore resin cement with 14N pressure and cured for 20 seconds. Fifty measurements of absolute marginal discrepancy (AMD) were done using a stereomicroscope after cementation. After 24 hours, all samples were subjected to thermocycling before the retention test. This involved using a universal testing machine with a crosshead speed of 0.5 mm/min and applying a load of 500N. The maximum force to detach the crown was recorded in newtons and the mode of failure was identified. Two-way ANOVA revealed that the AMD for PICN was statistically significantly better than lithium disilicate (p=0.01). No statistically significant difference was detected in the AMD between the two intracoronal depths (p=0.72). PICN and endocrowns with 4 mm intracoronal depth had statistically significant better retention (p<0.05). 72.22% of the sample suffered from cohesive failures and 10 LD endocrowns suffered adhesive failures. Within the limitations of this study, we found that different materials and intracoronal depths can indeed influence the retention of CAD/CAM fabricated endocrowns. Based on the controlled setting findings, PICN was found to have better retention and better marginal adaptation than similar lithium disilicate premolar endocrowns.

Correlation between root canal anatomy of mandibular incisors and premolars in Western Uttar Pradesh population of India - A cross sectional study

ABSTRACT Aim: This study aimed to evaluate the correlation between the presence of two canals in mandibular incisors and multiple canals in mandibular premolars in the Western Uttar Pradesh population of India using cone-beam computed tomography (CBCT). Methods: CBCT scans with 0.125-mm voxel size and 50 mm × 50 mm field of view of 800 patients were evaluated for the parameters; a number of canals, root canal configurations (according to Vertucci’s classification), unilateral/bilateral occurrences, and correlation between presence of two canal configuration in mandibular incisors and multiple canals (&gt;1 canal) in mandibular premolars. The data obtained were subjected to statistical analysis using the SPSS statistical program version 22.0 using the Chi-square test. The significance level was set as 5%. Results: According to the current analysis, the prevalence of mandibular incisors with one canal was 68.1% and two canals were 31.9% whereas in mandibular premolars prevalence of one canal was 71.5%, two canals were 27.2%, and three canals were 1.3%. The incidence of Vertucci type I canal configuration (68.1% mandibular incisors and 71.5% mandibular premolars) was more prevalent than the other types. The incidence of C-shaped canals was 2.6%. The prevalence of bilateral occurrence of the same canal configuration was 16.6%. A positive correlation was found between the presence of two canals in mandibular incisors with multiple canals in mandibular premolars (20.4%). Conclusion: The root canal morphology of mandibular premolar teeth of the Western Uttar Pradesh Indian population is complex. Two canals in mandibular incisors are frequently associated with multiple canals in mandibular premolars.

Comparative evaluation of remaining dentin thickness using single file, two file, and multiple rotary file system - An in vitro CBCT study.

Endodontic success hinges on a multifactorial interplay, with meticulous canal shaping, proper disinfection, and three-dimensional obturation being paramount. Among these factors, the amount of dentin remaining after instrumentation directly influences the biomechanical resilience and longevity of the tooth. This study aims to evaluate the impact of various rotary instrumentation systems, including single-file, two-file, and multiple-file configurations, on the remaining dentin thickness (RDT) following canal preparation. This was an in vitro study, original research article. Sixty mandibular premolar human extracted teeth were decoronated at the cementoenamel junction with a diamond disc. Samples were randomly assigned to three groups using a simple random sampling technique (n = 60). Group I - Single-file system (One Curve, MicroMega) (n = 20), Group II - Two-file systems (2Shape, MicroMega) (n = 20), and Group III - Multiple-file system (Hero Gold, MicroMega) (n = 20). Preoperative cone-beam computed tomography (CBCT) scans were obtained after the sample was mounted on a modeling wax sheet. The biomechanical preparation of canals followed the manufacturer's protocols for every system. Postoperative CBCT scans were obtained. Pre- and postoperative scans were compared at standardized depths (4 mm, 7 mm, and 11 mm) within the canals (coronal, middle, and apical thirds), allowing for a comprehensive assessment of RDT throughout the canal. According to one-way ANOVA, the highest mean was seen in Group I, followed by Group II and Group III. Hence, a statistically significant difference was found between all the groups. Post hoc Tukey's test was done for intergroup comparison. A single-file system preserved more dentin with less aggressive cutting compared to two-file and multiple-file systems.

The Effect of a Horizontal Apical Mattress Suturing Technique on the Width and Thickness of the Keratinized Mucosa After Dental Implant Surgery: A Cohort Study.

Introduction There is general agreement that a thick zone of the keratinized tissues around implants promotes accurate prosthetic procedures, permits oral hygiene maintenance, resists recession, and enables esthetic blending with surrounding tissues. A new procedure called Choukroun's technique has been suggested, and it consists of a combination of horizontal apical mattress suture with regular suture to increase the keratinized tissue in the mandibular arch during the first stage after implantation. The proposed procedure has not been evaluated yet in a cohort of patients. Therefore, this prospective study aimed to evaluate the impact of Choukroun's technique on the width and thickness of the keratinized gingiva after oral surgery. Materials and methods A one-group prospective cohort study was conducted on patients referred to the Department of Oral and Maxillofacial Surgery at the Dental College of Al-Wataniya Private University who had been referred to undergo dental implant surgery.The inclusion criteria for the study group were as follows: patients with mandibular missing teeth, good oral health, good general health, 18-70 years old, at least 1 mm thickness of keratinized gingiva, and at least 1 mm width of the attached gingiva. A total of 14 patients aged 27-67 years were included in the study. After inserting the dental implants, the suturing was accomplished according to Choukroun's method. The width and thickness of the keratinized gingiva were assessed before surgery and at one and two months post-surgery. Repeated measures analysis of variance (ANOVA) was applied to detect significant differences between assessment times. Results The study sample comprised 14 patients, of which four were females (28.6%) and 10 were males (71.4%). Patients' ages ranged from 27 to 67 years, with a mean age of 54.86 ± 11.73 years. The surgical procedure was performed in three different regions: the upper posterior teeth with four patients (28.6%), the upper anterior teeth with three patients (21.4%), and the lower posterior teeth with seven patients (50%). The mean gingival width before surgery was 5.78 mm, whereas the mean gingival thickness was 2.82 mm. There was no significant difference between the three evaluation times in the mean gingival width (P=0.222), and there was a significant difference between the three evaluation times in the mean gingival thickness (P<0.001). The mean mean gingival thickness one month after surgery was significantly greater than its mean value before surgery (mean difference: 0.749 mm). Additionally, the mean gingival thickness two months after surgery was significantly greater than its mean value before(mean differences: 0.636 mm). Conclusions Using horizontal apical mattress sutures (Choukroun's technique) does not provide any advantage in increasing the width of the keratinized gingiva. However, it does lead to an increase in the thickness of keratinized gingiva in the surgical area. Therefore, the use of horizontal apical mattress sutures is recommended.

A quantitative comparison of apically extruded debris during root canal preparation using NiTi full-sequence rotary and single-file rotary systems: An in vitro study

ABSTRACT Aim: The purpose of this study was to compare quantitatively the apically extruded debris during root canal preparation using NiTi full-sequence rotary and single-file rotary systems. Methods: Sixty extracted mandibular premolar teeth with single canals and similar lengths were used and divided into four groups. Groups A and B are NiTi full-sequence rotary systems and Groups C and D are single-file rotary systems. In Group A, the canals were prepared using V-Taper 2H file (up to 25/0.06), Group B: TruNatomy file (up to 26/0.04), Group C: OneShape file (25/0.06), and Group D: OneCurve file (25/0.04). The initial weight of each Eppendorf tube to be used was calculated using an analytical balance before instrumentation. After instrumentation, the tubes were then stored for 15 days in an incubator at 37°C. The Eppendorf tubes were weighed again to determine their final weight which contained the extruded debris. The data were statistically analyzed using a one-way ANOVA test and Tukey’s post hoc test. Results: The OneCurve single-file system resulted in statistically significant less debris extrusion than the OneShape single-file system, TruNatomy multifile system, and V-Taper 2H multifile system (P &lt; 0.001). Among the full-sequence rotary file systems, the TruNatomy rotary file system produced statistically significantly less debris extrusion than the V-Taper 2H rotary file system (P = 0.01). Conclusion: All the instrumentation systems caused apical extrusion of debris. OneCurve system showed least debris extrusion, followed by OneShape, TruNatomy, and V-Taper 2H systems. Thus, single-file rotary instruments performed better with the less extrusion of debris when compared to multifile rotary systems.

Comparison of Cardiovascular Changes Seen in Patients When Using Local Anesthesia with Adrenalin 1:80,000 vs Local Anesthesia with Adrenalin 1:2,00,000

ABSTRACT Aim: The aim of this study is to compare the efficacy with the use of 2% lignocaine with adrenalin with two different concentrations and also its effect on the cardiovascular system. Materials and Methods: 100 patients were taken for this study. 68 were Male &amp; 32 females. Extractions of mandibular bilateral teeth (Molars and Pre Molars).2% lignocaine with two different concentrations - one with 1:80000 and the other with 1:200000. Irrespective of the number of teeth extracted, inferior alveolar and lingual nerve blocks were administered (long buccal whenever necessary). Unilateral extractions were carried out in a single sitting and the other side was done on next visit. A single operator carried out all the cases. All the patients were given the same pre-operative and post-operative instructions. A total of 4ml solution was injected on each side. Results: Systolic blood pressure, pulse rate, onset of anesthesia, durationnof anesthesia and blood loss all the parameter were significant woth p value less tan 0.05. Conclusion: In accordance to our study, 2% lignocaine in 1:2,00,000 dilution of adrenaline can safely be used in minor oral surgical procedures, and is safe in hypertensive and cardiac patients as this dilution does not alter any haemodynamic parameters to a great extent.

Variations in Root Canal Morphology of Mandibular Incisors in a North Indian SubPopulation: A Retrospective Cone-Beam Computed Tomography Analysis

Abstract Background: There is a high failure rate of endodontic treatment in the mandibular incisors due to insufficient knowledge of the morphology. Aim: The aim of this study was to analyze the root canal morphology in mandibular incisor teeth in the North Indian subpopulation to improve the outcome of endodontic treatment. Setting and Design: A cross-sectional study was conducted at the OPD of a tertiary care institute. Materials and Methods: A total of 200 mandibular central incisors and 200 mandibular lateral incisors were selected from available cone-beam computed tomography examinations of 100 patients aged 18–79 years. They were evaluated for root canal system configuration and symmetry between right and left elements in the same individual. Statistical Analysis: Chi-square/Fisher’s exact test was used to find the association between different study variables. Results: For mandibular central incisors, type I Vertucci classification was present in 69% of cases, type II in 3.5%, type III in 18.5%, type IV in 2%, and type V in 7% of cases. For mandibular lateral incisors, type I was present in 70.5% of cases, type II in 4% of cases, type III in 19.5%, type IV in 2%, and type V in 4% of cases. There was no evidence of types VI, VII, and VIII. Symmetry of root canal morphology between left and right teeth was observed in 90% of central incisors and 93% of lateral incisors. Conclusion: Type I Vertucci configuration was the most prevalent; however, the prevalence of other configurations is also evident. Therefore, endodontists should explore the morphology of these teeth carefully while performing root canal treatments.

Potential Crown Discoloration Induced by the Combination of Various Intracanal Medicaments and Scaffolds Applied in Regenerative Endodontic Therapy.

Regenerative endodontics involves the use of various root canal medicaments and scaffolds, which may cause crown discoloration. This study aimed to investigate the combined crown discoloration of scaffolds [platelet-rich fibrin (PRF) and blood clot] applied after administration of different medicaments [modified triple antibiotic paste including doxycycline (mTAPd), modified double antibiotic paste (mDAP), calcium hydroxide (CH), and propolis]. In total, 100 human mandibular premolar teeth were selected and prepared. The teeth were apically resected to simulate immature teeth. The positive and negative control groups (n = 10) consisted solely of blood-only and serum-only samples. The remaining 80 teeth were used for the experimental groups with four different medicaments. Three weeks later, either blood or PRF was applied as a scaffold after removing the medicaments (n = 10). Color changes were assessed before medication placement and at the end of the first, second, and third weeks, as well as on days 0, 1, 30, 60, and 90 after scaffold application. Analysis was carried out using repeated measures of variance, Friedman, one-way ANOVA, Kruskal-Wallis, the dependent paired t-test, and Wilcoxon test. Statistical significance was determined at P = 0.05. All groups including blood and the group including propolis and PRF combination, resulted in a significant increase in discoloration (P < 0.05) and discoloration exceeding clinically acceptable thresholds. CH and the modified versions of TAP (mTAPd) and DAP (mDAP) demonstrated an acceptable level of discoloration when used with a combination of PRF at day 90.

Determining the Effect of Different Ferrule Designs on Fracture Resistance of Endodontically Treated Mandibular Premolars Restored with Fiber Posts: An In Vitro Study

Abstract Aim: This study aims to evaluate the effect of different crown ferrule designs on fracture resistance of endodontically treated mandibular premolars restored with glass fiber post, composite core, and metal crown. Materials and Methods: A total of 150 mandibular premolar teeth underwent endodontic treatment, and based on ferrule design, the teeth were divided into five groups (n = 30 each). Group 1—2 mm circumferential ferrule; group 2—2 mm buccal + lingual ferrule; Group 3—2 mm buccal ferrule; group 4—2 mm lingual ferrule; and group 5—no ferrule. Each tooth was restored using a glass fiber post, composite core, and metal crown, and then loaded at 160° on the lingual slope of the buccal cusp in a universal testing machine until fracture. Fracture values were recorded in Newtons. Data were analyzed using the Kruskal–Wallis test, and post hoc analysis was conducted with the Mann–Whitney U test (P = 0.05). Results: The highest load to fracture was seen in group 1 (1027.35 ± 164.68 N), followed by group 2 (922.42 ± 49.14 N), group 3 (916.06 ± 64.79 N), group 4 (888.91 ± 47.36 N), and group 5 (801.55 ± 52.45 N), respectively. There was a statistically significant difference in fracture resistance among different groups. Conclusions: While a tooth with an incomplete ferrule was less resistant to fracture than one with a complete ferrule, it was still more resistant to fracture than one with no ferrule. Thus, increasing the number of ferrule walls improves the fracture resistance of endodontically treated teeth.