Permanent Mandibular Molar Teeth Research Articles

Novel cryotherapy technique for pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis- a randomized controlled trial.

To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis. The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups (n = 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.50C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer's exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test. The cryotherapy group achieved haemostasis in less time (p < 0.05). There was a significant pain reduction at 24 and 48h in the cryotherapy group when compared with the conventional pulpotomy group (P < 0.005). The overall success rate of pulpotomy after 12 months was 88% (n = 22) in both study groups(p < 0.05). Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis. The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.

Selective Removal to Soft Dentine versus Full Pulpotomy for Management of Proximal Deep Carious Lesions: A Randomized Controlled Non-Inferiority Trial

The management of the deep carious lesion with reversible pulpitis is a dilemma for the dentist. The current study compared selective removal to soft dentine (SRSD) and full pulpotomy (FP) for treating proximal deep carious lesions in teeth with reversible pulpitis. Visual-tactile examination and bitewing radiographs were used to determine the depth of carious lesion, and American Association of Endodontists recommendations were used to formulate pulp diagnosis. Sixty mandibular molar teeth from healthy patients between the ages of 16–35 years and a diagnosis of proximal deep carious lesion with reversible pulpitis were included. Teeth were randomly allocated to two study groups. SRSD group (n = 30): soft dentine was preserved over the pulpal aspect. A hard-setting calcium hydroxide cement liner and resin-modified glass ionomer cement base were applied over the remaining soft carious dentine. FP group (n = 30): complete caries removal followed by mineral trioxide aggregate FP was performed. The teeth in both groups were restored with composite resin restoration. The established criteria for outcome assessment of SRSD and pulpotomy were used. Accordingly, only asymptomatic teeth with no radiological evidence of periapical rarefaction were considered successful at the 12-month follow-up. Two-sample t test, Pearson χ² test/Fisher’s exact test, and percentage agreement were used for statistical evaluation. According to the per-protocol analysis, the success rate of both SRSD and FP treatment was 95.45% and 95.65%, respectively, and the actual difference between the two treatments was 1% (95% CI: [−10, 9]). The data suggests that both treatments (SRSD and FP) appear to have a good success rate (>95%) when used to manage permanent mandibular molar teeth with proximal deep carious lesion and reversible pulpitis. As SRSD is a noninvasive procedure, it should be favored over FP in these instances.

Prevalence and morphological analysis of isthmuses in mandibular molars of the Indian population: A micro-computed tomographic study.

This study evaluated the prevalence, configurations, and correlation of isthmuses at coronal, middle, and apical root 3rd in mandibular molars of the Indian population using micro-computed tomography μCT). One hundred and five permanent mandibular molar teeth were scanned under μCT. The axial sections were analyzed at the coronal, middle, and apical thirds of the root for isthmus types and classified according to Hsu and Kim's classification. Descriptive statistics for each isthmus type were calculated. The correlations between the apical, middle, and coronal thirds of the root were determined using Pearson's correlation coefficient. Type IV isthmus was the most common in the coronal third of the mesial root of mandibular 1st molar (42.9%), while Type V was prevalent in the coronal third of the mesial root of 2nd molar (42.9%). Type I isthmus was found to be highly prevalent in the middle 3rd (71.4%) and apical 3rd (61.9%) of mesial roots of 1st molars, and in the middle 3rd (71.4%) and apical 3rd (42.9%) of mesial roots of 2nd molars. Type V isthmus was the most prevalent in all the thirds of the distal roots of both 1st and 2nd molars, ranging from 40% to 50%. Furthermore, a strong correlation of 0.965 (P < 0.01) was found between the isthmuses in the apical and middle thirds of roots. There are variations in the prevalence and type of isthmuses across different sections of the root, including the presence of atypical isthmuses. Micro-CT with high-resolution imaging and three-dimensional reconstruction is crucial for investigating root canal morphology. Clinicians could benefit from considering demographic characteristics to better predict the presence of isthmus variations. The isthmus configurations and frequency differ at each section of mandibular teeth.

Evaluation of postoperative pain and healing following regenerative endodontics using platelet-rich plasma versus conventional endodontic treatment in necrotic mature mandibular molars with chronic periapical periodontitis. A randomized clinical trial.

To evaluate the post-operative pain and the healing of necrotic mature permanent mandibular molar teeth with peri-apical periodontitis after conventional endodontic treatment versus after platelet-rich plasma (PRP) revascularization. The protocol of this randomized clinical trial was registered at www. gov with identification number NCT03350841. Twenty-eight patients were included in the study after confirming the diagnosis clinically and radiographically. In the first visit, mandibular molar teeth of both groups were mechanically prepared. Double antibiotic paste was prepared and injected then the cavity that was sealed with glass ionomer. At the second visit, the patients were randomized either to control group where standard endodontic treatment was completed by lateral condensation technique or assigned to intervention group where PRP revascularization technique. The degree of spontaneous pain was assessed using numerical rating scale (NRS) pre-operatively, then post-operatively after 6, 12 h and daily for 5 days. Patients were given a placebo to be administrated in case of pain. An analgesic (ibuprofen 400mg) was prescribed in case of persistent pain. Clinical and radiographic healing was assessed after 6 and 12 months. All demographic, baseline and outcome data were collected and statistically analysed. Regarding the post revascularization/obturation pain, there was no statistically significant difference between severity of pain in the two groups at all time intervals except after 12 h, revascularization group showed statistically significantly higher prevalence of no pain than endodontic treatment group. Regarding the healing; the periapical lesions decrease in size significantly from the pre-operative lesion size in both groups without significant difference between the both groups. Within the limitation of this study, PRP revascularization could be an alternative treatment to root canal treatment but further randomized clinical trials with standardized techniques and long follow up periods are recommended for more reliable results.

Shear bond strength analysis and marginal gap evaluation of restoration–tooth interface of aesthetic restorations after simulated Co-60 gamma irradiation

Abstract Background: Radiotherapy to the head and neck region may cause considerable radiotherapy-induced changes in the surrounding tissues. These changes are oral mucositis, hyposalivation, dental caries, osteoradionecrosis, trismus and overall impact on patients’ quality of life. Tooth-coloured synthetic materials, unlike metallic restoration, did not influence radiation dose distribution. However, their exposure to a gamma radiation therapeutic dose during treatment might cause structural and compositional changes that alter their mechanical and physical properties. Aim: This study intends to evaluate the effect of Co 60 gamma rays on shear bond strength and marginal adaptation of already restored tooth surfaces, to help in material selection before the onset of radiotherapy. Materials and methods: Hundred freshly extracted human permanent mandibular molar teeth collected and stored in a 0·2% thymol solution for disinfection and were randomly divided into two groups of 50 each, to be tested for the shear bond strength of restoration to dentin and the marginal gap at tooth–restoration interface, respectively. Results: ANOVA showed a significant effect of both radiotherapy (F = 40·33, p &lt; 0·001) and restorations (134·00, p &lt; 0·001) on the marginal gap at the interface. In the without radiotherapy group, the mean marginal gap was least in Group Z250, and in with radiation, Bulk Fill has the least mean marginal gap. The mean shear bond strength was comparatively higher for all restorations without radiation than with radiation (p &lt; 0·001). Findings: Gamma radiation affects the physical or mechanical properties of tooth structure and the tooth restorative interface. Composites seem to be good restorative material when placed before the onset of radiotherapy in head and neck cancer patients.

Influence of occlusal and proximal caries on the outcome of full pulpotomy in permanent mandibular molar teeth with partial irreversible pulpitis: A prospective study.

To assess the influence of occlusal and proximal deep carious lesions on the outcome of full pulpotomy performed in mandibular teeth with pulpal diagnosis of symptomatic partial irreversible pulpitis. Eighty deep carious mandibular molar teeth with clinical and radiographic diagnosis of symptomatic partial irreversible pulpitis without periapical rarefaction from patients of either gender between the age of 16-35years were included. Depending upon the location of deep carious lesion, the teeth were distributed equally into occlusal (n=40) and proximal caries groups (n=40). Full pulpotomy was performed under local anaesthesia and aseptic conditions. The pulp tissue was removed until the root canal orifices, and 2.5% sodium hypochlorite (NaOCl) was applied to arrest pulpal bleeding. Mineral trioxide aggregate (MTA) was compacted over the radicular pulp. Teeth were restored with resin-modified glass ionomer cement (RMGIC) and bulk-fill composite resin. Pre- and post-operative pain was assessed at 24, 48 and 72h using a 11-point Numerical Rating Scale (NRS). Patients were followed at 6 and 12months for clinical and radiographic evaluation. Asymptomatic teeth without any radiographic evidence of periapical rarefaction were considered successful. The data were analysed using the Shapiro-Wilk W test, two-sample Wilcoxon rank-sum test, Pearson chi-square test, Fisher's exact test and Kappa coefficient. The significance level was predetermined at p<.05. An intergroup comparison revealed that the pre- and post-operative pain scores at 24, 48 and 72h were not significantly different (p>.05). At the end of follow-up period (12months), success of full pulpotomy in occlusal and proximal caries group was 95% and 92.5%, respectively (p=.644). For both groups, the combined success rate of full pulpotomy was 93.75%. The site of carious lesions (i.e., occlusal or proximal) did not affect the clinical and radiographic outcome of full pulpotomy performed in mature permanent mandibular teeth with symptomatic partial irreversible pulpitis.

Effect of different clinical practices on postoperative pain in permanent mandibular molar teeth with symptomatic apical periodontitis: A randomized controlled clinical trial.

This clinical study aimed to evaluate the effect of different clinical practices with endodontic emergency treatment on postoperative pain in mandibular permanent molar teeth with symptomatic apical periodontitis. In the present study, root canal treatment was applied to 100 patients who met the inclusion criteria. Patients were randomly assigned to 5 groups (control, nonsteroidal anti-inflammatory drug [NSAID], NSAID and antihistaminic drug combination, placebo drug, and intracanal cryotherapy) using a web program. In the first visit, after preparation with the WaveOne Gold file system, calcium hydroxide (Ca(OH)2) medicament was placed on the root canals. However, after the treatment of the patients was completed, six patients patients were excluded from the study because they did not come to the control appointment 7 days later. After the removal of Ca(OH)2 medicament in the second session, the root canals were obturated according to cold lateral condensation technique and final restorations of the teeth were performed. Patients' preoperative and postoperative pain values (4-8-12-24-48 and 72 hours) determined by visual analog scale (VAS) were recorded. The data were analyzed statistically using analysis of variance, Kruskal-Wallis test, Friedman test, Wilcoxon test, and Chi-square test. According to the results of our study; there was no significant difference between the groups in terms of age, gender, preoperative pain, and postoperative analgesic requirement (P > 0.05). In all groups, there were significant differences between the values of different times (P < 0.05). While initial pain values were higher than the hours after treatment (P < 0.05), there was no significant difference between postoperative pain values (P > 0.05). When the groups in terms of pain scales measured at different times compared with each other; in all times there was no significant difference between the groups (P > 0.05). It was observed that all clinical practices significantly reduced preoperative pain.

Combination of Nonsurgical Endodontic and Vital Pulp Therapy for Management of Mature Permanent Mandibular Molar Teeth with Symptomatic Irreversible Pulpitis and Apical Periodontitis

IntroductionThis prospective study evaluated the outcome of a combination of nonsurgical endodontic (NSET) and vital pulp therapy (VPT) for the management of mature permanent mandibular molar teeth with symptomatic irreversible pulpitis (SIP) and apical periodontitis (AP). MethodsInstitutional ethical clearance was obtained. Mandibular molar teeth (N = 60) with a definitive diagnosis of SIP and AP with a radiographic periapical index score (PAI) of ≥3 in either 1 of the roots (mesial or distal) were included. Block randomization was used for allocation. In the NSET group (n = 30), single-visit NSET was performed using a standardized operating protocol. In the NSET-VPT group (n = 30), subsequent to full pulpotomy, at the root orifice where a vital pulp was observed (as determined by the arrest of pulpal bleed upon application of a 2.5% sodium hypochlorite pressure pack), a mineral trioxide aggregate radicular barrier was placed, and it was covered with light-cured resin-modified glass ionomer cement. NSET was performed in the root exhibiting a PAI score ≥3. The tooth was permanently restored. Postoperative pain was assessed at 24, 48, and 72 hours. Teeth were followed up clinically and radiographically at 12 months. The presence/absence of symptoms and the change in PAI scores were noted. The data were statistically analyzed. ResultsThe success rate was 90% in the NSET group and 93.3% in the NSET-VPT group. According to an intergroup comparison between the proportion of teeth healed and nonhealed (radiographic), there was no significant difference (P > .05). ConclusionsThe combination of NSET and VPT is a viable biologically based minimally invasive treatment option for multirooted mandibular teeth with SIP and AP.

A comparative evaluation of sealing ability of three perforation repair materials using a field emission gun-scanning electron microscope

Introduction: The study aimed to assess the sealing ability of Biodentine™, ProRoot mineral trioxide aggregate (MTA), and Super-EBA as furcation perforation repair materials using field emission gun-scanning electron microscope (FEG-SEM). Materials and Methods: Thirty-six extracted human permanent mandibular molar teeth were collected and cleaned. Standard access cavity preparation was made, and intentional perforation was created in each of the access cavity-prepared teeth using #12 round bur. The teeth were randomly divided into three groups each containing 12 teeth. The perforations were sealed as follows: Group A with Biodentine™, Group B with ProRoot MTA, and Group C with Super-EBA. The repair materials for all the three groups were evaluated for marginal adaptation using FEG-SEM. Data were statistically analyzed using one-way ANOVA and Tukey's honest significance test. Results: Quantitative FEG-SEM observations illustrated that the mean gap at the dentin–furcation repair material interface was as follows: Biodentine (3.01 ± 0.37 μm), ProRoot MTA (4.98 ± 0.68 μm), and Super-EBA (8.03 ± 0.68 μm). The difference between Biodentine™ and ProRoot MTA was not statistically significant (P > 0.05). Individually, Biodentine and ProRoot MTA showed statistically significant differences when compared to Super-EBA (P Conclusion: The sealing ability of ProRoot MTA and Biodentine™ as a repair material of furcation perforation was better than Super-EBA.

Radix Entomolaris in the Mandibular Molar Teeth of an Iranian Population.

Purpose. Supernumerary roots in permanent mandibular molar teeth make endodontic treatment more complicated. The aim of this study was to determine the prevalence of Radix Entomolaris (RE) in permanent mandibular first and second molars in the population of Kerman, in the southeast of Iran. Materials and Methods. From a collection of 500 mandibular first and second molar teeth extracted over 2015-2016 at dental clinics in Kerman, teeth were scored for an additional distolingual root, and the average root length and root morphology of this extra root were determined using the De Moor classification scheme. Results. In this population, RE occurred in 6% of mandibular first molars (4% with a straight apex (Type I) and 2% with buccal apical curvature (Type III)). In all cases, RE was the shortest root, with an average root length of 18.37 mm. RE occurred in only 0.8% of mandibular second molars, with an average root length of 18.0 mm. All mandibular second molars with RE were of Type III. Fisher's exact test showed that the difference in frequency between first and second molars was statistically significant (two-sided P = 0.002). Conclusion. Radix Entomolaris occurs more frequently in mandibular first molars than in mandibular second molars in this sample of 500 mandibular molars. The reported rate of 6% in first molars is expected to be higher than reported rates in European or Caucasian populations where the prevalence is typically less than 2%.

Relationship between nutritional status and eruption of first permanent mandibular molar teeth among the school children in Indonesia

Abstract not available DOI: http://dx.doi.org/10.3329/seajph.v2i2.15962 South East Asia J Public Health | Jul-Dec 2012 | Vol 2 Issue 2 | 85-86

Analisi della morfologia radicolare e canalare di molari superiori ed inferiori in una popolazione Caucasica: studio in vivo alla CBCT

AimTo investigate the root and canal morphology of maxillary and mandibular permanent molar teeth in a Caucasian population by using Cone Beam Computed Tomography (CBCT). MethodsA total of 596 permanent molars were included. The number of roots, the number of canals per root and the root canal configurations according to the method of Vertucci were recorded. ResultsAlmost all of maxillary first molars (95.7%) had three separate roots; however, 40.3% of mesiobuccal roots had two canals (MB2). Of 157 maxillary second molars, 88.5% had three roots. Among the mesiobuccal roots, 15.1% had two canals. The majority of mandibular molars (100% of first molars, 89.4% of second molars) had two separate roots. Most distal roots had a simple type I configuration, whereas mesial roots had more complex canal systems, with more than one canal. ConclusionsCBCT is an efficient method of studying root canal systems.

NUTRITION STATUS CORRELATED TO THE FIRST PERMANENT MANDIBULAR MOLAR TEETH OF ELEMENTARY SCHOOL CHILDREN IN LINTAU BUO, TANAH DATAR REGENCY, WEST-SUMATRA

The first permanent mandibular molar teeth is the most important for child, especially to stimulate growth of jaw. The teeth has normally erupted at children age of 6-7 years old. However, it is frequently not happened at this stage. This study aims to determine the nutritional status relate to the first permanent mandibular molars teeth eruption in the elementary school children age of 6-7 years old at Lintau Buo, Tanah Datar Regency, West-Sumatra Indonesia.This is an analytical cross-sectional study, with anthropometric measurements of body mass index/BMI of elementary school children related to eruption of the first permanent mandibular teeth.The results showed that nutritional status of elementary school children age of  6-7 years old for the most were within normal category (51.2%). Grade-I (6-7 years old) suffered from emaciation is still quite high (45.4%), 20.3% of 187 students who suffer from emaciation first permanent mandibular molars have erupted, the first permanent mandibular molars in first grade children (6-7 years old) with normal nutritional status, risk of overweight and obese have erupted.Nutritional status affects children’s first permanent mandibular molar erupted lower jow. The better the nutritional status of a child then the erupstion of the  first mandibular molars  will get better and grow in time.

Endodontic Treatment of Primary and Permanent Mandibular Molar Teeth with Radix Entomolaris: A Case Report

Endodontic Treatment of Primary and Permanent Mandibular Molar Teeth with Radix Entomolaris: A Case Report

Effectiveness of Ozone with or without the Additional Use of Remineralizing Solution on Non-Cavitated Fissure Carious Lesions in Permanent Molars

The aim of this study was to evaluate the efficiency of ozone alone and with a re-mineralizing solution following application on initial pit and fissure caries lesions in permanent molars. Forty children (9-12 years) having non-cavitated fissure caries lesions on bilateral 40 first permanent mandibular molar teeth were participated in the study. Patients were randomly allocated to 2 experimental groups consisting of 20 subjects. In the first group, ozone was applied once for 40 seconds to the assigned test teeth of each pair. In the second group, ozone was applied once for 40 seconds to the assigned test teeth of each pair with the use of re-mineralizing solution. Progression or improvement of the caries was assessed at baseline, immediately after treatment and at 1-,2-,3-, and 6 month follow-up by comparing the DIAGNOdent values, Clinical Severity Indexes, Oral Hygiene Scores. The results were analyzed statistically by using the Wilcoxon-Test for dependent samples in each group. When comparing different test groups (control and experimental groups) the Friedman S test followed by the Mann-Whitney U test was used. A statistically significant difference was found between all of the control and experimental test lesions in each group (P<.001). However, there was no statistically significant difference between the ozone treated groups and those using the additional re-mineralizing solution (P>.001). Ozone treatment either alone or combined with a re-mineralizing solution was found to be effective for remineralization of initial fissure caries lesions.

Root and canal morphology of mandibular first and second permanent molar teeth in a Ugandan population

We investigated root and canal morphology of permanent mandibular molar teeth in a Ugandan population. Mandibular first (n = 224) and second (n = 223) molars were collected from patients visiting dental clinics in Kampala and prepared by a clearing technique. An endodontic access cavity was prepared in each tooth. The teeth were consecutively immersed in 5% sodium hypochlorite, 10% nitric acid, and 99% methyl salicylate. India ink was coronally injected into the pulp chamber and withdrawn apically by suction. The teeth were viewed under a magnifying lens and the numbers of root canals and their configurations, lateral canals, intercanal communications, and multiple apical foramina were recorded, along with the number of roots and their morphology. Student's t test for independent samples was used to assess significant differences in the root canal system. All specimens were two-rooted with one mesial and one distal root. Root fusion was more frequent in the second than in the first molar: 3.2% versus 0.4%. Vertucci type IV canal configuration was most frequently recorded in the mesial root of the first (44.6%) and second (49.8%) molars. Type 1 canal configuration was predominant in the distal root in first (84.8%) and second (94.2%) molars. Multiple apical foramina were more frequent in the first than in the second molar, as were intercanal communications and lateral canals. Type I and IV canal configurations were predominant in the distal and mesial roots, respectively, of both the first and second molars.

Root canal morphology of mandibular permanent molars at different ages

To investigate differences in the root canal morphology of permanent mandibular molar teeth at various ages. Four hundred and eighty permanent mandibular first and second molars were examined. First and second molars were divided into six and five groups, respectively, according to the age of the patient at the time of extraction. Root canal morphology was studied using a clearing technique. The canal morphology of the mesial root was classified into three stages depending on its developmental pattern. When the root canal system was completely differentiated, the canal classification and the number of lateral canals and inter-canal communications were recorded. Vertucci's classification was taken as the main reference. Canal morphology was compared amongst age groups. In both first and second molars, developmental stages of canal morphology amongst age groups were significantly different (P < 0.0001). The prevalence of inter-canal communications was highly significantly different in the first (P < 0.0001) and less significant in the second molar (P < 0.05). After completion of the canal differentiation, the mesial roots of first molars had type IV and II canal forms. The majority of the mesial roots of second molars had type I and III canals. C-shaped canals were found in 3% of second molars. Mesial roots of first and second molars mostly had one large canal until 11 and 15 years of age, respectively. In both molars, the canal system was completely defined at 30-40 years. The prevalence of inter-canal communications was low at young and old ages but high at intermediate ages.

Root and canal morphology of permanent mandibular molars in a Sudanese population

To investigate variations in the root canal systems of first and second permanent mandibular molar teeth in a Sudanese population using a clearing technique. Two hundred extracted first and second permanent mandibular molars from three cities in the state of Khartoum were studied. Access cavities were prepared and pulp tissue was removed by immersion in 5% sodium hypochlorite under ultrasonication; Indian ink was then injected into the root canal systems assisted by a vacuum applied apically. The teeth were rendered clear by demineralization and immersion in methyl salicylate before evaluation. The following observations were made (i) number of roots and their morphology; (ii) number of root canals per tooth; (iii) number of root canals per root and (iv) root canal configuration. Overall 59% of mandibular first molars had four canals with 3% having a third distolingual root. Seventy-eight per cent of second mandibular molars had two separate flat roots, whilst 10% were C-shaped. The most common canal system configurations were type IV (73%) and type II (14%). Inter-canal communications were more common in the mesial roots. The prevalence of inter-canal communications was 65% in first molars and 49% in second molars. In this sample of Sudanese teeth, 59% of the mandibular first permanent molars had four root canals whilst 10% of the mandibular second molars had C-shaped roots/canals.

The use of a radiopaque contrast medium in endodontic radiography.

A series of in vitro studies were carried out to investigate the use and application of a radiopaque contrast medium in conventional periapical dental radiography for the diagnosis and evaluation of root canal systems. The water-soluble radiopaque contrast medium was introduced into the root canals of 30 first permanent maxillary and 30 first permanent mandibular molar teeth. The radiographic images of these teeth with and without radiopaque contrast medium in the root canal systems were compared and contrasted. Further comparisons were made with the same teeth rendered transparent. The results indicate that by standardizing the diagnostic criteria the inter-examiner reliability was in good agreement; it was independent of the radiographic technique used. The validity of the radiographs was enhanced by the use of the radiopaque contrast medium. The results confirm that, with the use of a radiopaque contrast medium, images of root canal systems are easier to read and interpret than plain radiographic images of root canal systems. The use of radiopaque contrast medium in endodontic radiography may be a valuable aid in the diagnosis and evaluation of root canal systems. This system would complement rather than replace plain radiography.