Pulp Chamber Floor Research Articles

Sealing ability of three different materials to repair furcation perforations using computerized fluid filtration method.

Background. The present study aimed to evaluate the sealing ability of three different calcium silicate-based materials in furcation perforations. Methods. Seventy-six human mandibular molar teeth were selected. Perforations were created in the center of the pulp chamber floor. The experimental teeth were randomly divided into three groups (n=22). Perforations were repaired with MTA Angelus, Endocem MTA, or EndoSequence BioCeramic Root Repair Material Fast Set Putty (BC-RRM Putty). Microleakage of the different repair materials to be tested was measured by computerized fluid filtration method at 24- and 72-hour intervals. Results. For each time interval, no statistically significant difference was observed between the groups. For Endocem MTA and BC-RRM Putty groups, the difference between the leakage values measured at both periods was not statistically significant (P > 0.05). However, there was a significant difference for the MTA Angelus group (P < 0.05). Conclusion. All the calcium silicate-based materials used in the present study showed similar performance in repairing furcation perforations at 24- and 72-hour intervals.

Non-surgical management of maxillary first molars with five root canals

Aim: This case series reports the non-surgical management of five maxillary first molars with five root canals in different ethnic groups and geographic locations. Summary: Diagnosis and management of complex root canal anatomy, especially of the maxillary first molar, can be frustrating and challenging and also may increase the risk of failure if not managed with appropriate tools. In this case series the primary endodontic treatment of four, and a non-surgical retreatment of one maxillary first molar with five root canals treated by three different endodontists from India, Spain and Portugal has been described. None of the cases presented in the paper were performed without magnification and troughing of the pulp chamber floor using ultrasonic tips. Although, CBCT wasn’t used in all cases although it’s prudent use respecting the ALARA principle is highlighted in the paper. This paper also highlights the importance of anatomical variations in different ethnic groups with the maxillary first molar. Key learning points Operator should consider the ethnicity of the patient and thoroughly study pre-operative radiograph to carry out successful endodontic treatment. Use of magnification and ultrasonic tips is fundamental especially in treating unusual canal anatomies. The prudent use of CBCT should be performed respecting the ALARA principle in all given situations.

Prevalence of Second Mesio-Buccal (Mb2) Canal in Permanent Maxillary First Molar

Objective: The aim of this study is to determine the prevalence of second mesio-buccal canal in permanent maxillary first molars. Study Design: Cross sectional study. Place and Duration: Dr Ishrat ul Ebad Khan Institute of Oral Health Sciences, Karachi during the period from February 2020 to January 2021 Patients and Methods: Three hundred and fifty cases of both genders were presented in this study. Patients were aged between 18-60years. Patients’ detailed demographics including age, sex and body mass index were recorded after taking written consent. Local anesthesia was given for isolation of rubber dam. The pulp chamber floor was clearly visualized and the access cavity was ready. The location of the MB2 channel in three phases was done. Complete data was analyzed by SPSS 22.0 version. Results: Mean age of the patients were 30.14±17.47 years with mean BMI 25.61±8.25 kg/m2. Among 350 cases, Majority of the patients 225 (64.3%) were male while the rest 125 (35.7%) were females. Majority of the patients were from age group 20-30 years and less patients were between 51-60 years old. Frequency of second mesiobuccal canal was found in 280 (80%) patients. Conclusion: We concluded in this study that prevalence of MB2 channel was reported in 80% in the initially permanent maxillary molars. Most MB2 canal apertures are distal from the main MB channel and most MB2 apertures are palatal. Key words: Permanent maxillary first molar, MB2 canals, Frequency

Effect of horizontal position of fiber post placement on fracture resistance and location in endodontically treated premolars with a MOD preparation

Aim: To evaluate the effect of the position of fiber post placement on fracture resistance and location in endodontically treated teeth. Methodology: Forty healthy double-rooted human first premolars were divided into five groups. S: healthy teeth without intervention; C: endodontic treatment with MOD cavity preparation; CR: restoration with composite resin; CMP: fiber post placed horizontally in the center of the middle third of the crown; CAP: fiber post placed horizontally 2 mm below the center of the middle third of the crown. After thermocycling and fracture strength tests using a universal test machine, pulp floor involvement was evaluated. The Tukey test was used for statistical analysis. Results: Means and standard deviations of fracture strength (N) were as follow. S: 2451A±552.9; C: 32.63B±4.89; CR: 398.7C73.8; CRMFP: 1253D ±82.15; and CRAFP: 1156D±88.23 (different letters indicate statistical differences, P> 0.05). Posts placed 2 mm below the center of the middle third of the crown were associated with catastrophic fractures of the pulp chamber floor. Conclusions: The position of a fiber post seems to affect fracture location. The use of fiber posts, regardless of position, increases fracture resistance of endodontically treated teeth.

Management of Intracanal Separated File Fragment in a Four-Rooted Mandibular Third Molar

The success of endodontic therapy is attributed to complete arbitration of the bound entities concealed within the complexity and absolute disinfection of the root canal system, thus, deeming it mandatory to effectively negotiate and overcome the challenges posed by obstruction, either iatrogenic or anatomic. To achieve this, considerable depth of knowledge and expertise with reference to variations in root canal morphology and clinical mishap management is substantially as important as developing fine observation skills in conjunction with an appropriate armamentarium and a keen sense of determination, thereby enhancing one's clinical acumen by several folds. In the present case, following rubber dam isolation, the temporary restoration was removed, and the remaining carious dentin was excavated. Endodontic access cavity was refined and explored with a DG-16 probe, following which three separate canal orifices were identified in the pulp chamber floor (mesiobuccal, mesiolingual, and distal). On further observation under a surgical operating microscope and continuous exploration with the DG-16 probe, a fourth canal was found in the mesial aspect of the tooth (middle mesial). With instrumentation, it was confirmed that a fractured object was indeed present at the apical third of the mesiolingual root of tooth 38. Bypassing of the fractured fragment was initiated with a size 10 SS K-file coupled with copious irrigation with 3% sodium hypochlorite. In the present case report, four distinct canals comprising 3 mesial and 1 distal canal were recognized, and the fractured instrument in one of the canals was bypassed successfully.

Effect of glass fiber on the restorative procedure in relation to fracture strength of endodontically treated molars

Aim: To evaluate whether the restorative procedure using glass fibers influence the fracture strength of endodontically treated molars with class II mesio-occlusal (MO) preparation. Methodology: Fifty human maxillary third molars were selected and randomly assigned to five groups (n=10). MO cavity preparation and endodontic treatment were standardized, except for the positive control group (S, sound teeth). The other groups were classified as: ET, no restoration (negative control); SF, restoration with SonicFill 2® system; SFB, restoration with braided glass fiber and SonicFill 2® system; and SFP, restoration with transfixed glass fiber post and SonicFill 2® system. The specimens were subjected to fracture strength testing on a universal testing machine. Fracture site – either pulp chamber floor or cusp – was inspected. Statistical analysis was performed using ANOVA, followed by Tukey’s multiple comparison test (α=5%). Results: Means followed by the same letter did not show statistical difference in Tukey’s test (P>0.05). S: 3563A ± 780.7; ET: 1001D ± 237.6; SF: 1689C ± 280.7; SFB: 2256B ± 289.2; and SFP: 2493B ± 364. Conclusions: The glass fiber, regardless of composition, increases the fracture strength of endodontically treated teeth. The use of a glass fiber post attached to the dental crown seems to provide more favorable rehabilitation when the fracture position is determined.

Microtensile Bond Strength of Fiber-Reinforced and Particulate Filler Composite to Coronal and Pulp Chamber Floor Dentin

This ex vivo study aimed to compare the microtensile bond strength of fiber-reinforced and particulate filler composite to coronal and pulp chamber floor dentin using a self-etching adhesive system. Coronal dentin of 40 human molar teeth was exposed by cutting occlusal enamel with a low-speed saw. Teeth were then randomly divided into two groups (n = 20). The first group was left as is, while in the second group, pulp chamber floor dentin was exposed by trepanation. After placement of a self-etching adhesive system (G-aenial Bond, GC, Tokyo, Japan), groups were further divided into two sub-groups (n = 10) according to the type of composite: fiber-reinforced composite (EP, everX Posterior, GC, Tokyo, Japan) and particulate filler composite (GP, G-aenial Posterior, GC, Tokyo, Japan). Then, composite blocks were built up. Sticks (1.0 × 1.0 mm2) were obtained from each specimen by sectioning, then microtensile bond strength (μTBS) test was performed. Statistical analysis included one-way ANOVA test and Student’s t-test (p < 0.05). μTBS values were 22.91 ± 14.66 and 24.44 ± 13.72 MPa on coronal dentin, 14.00 ± 5.83 and 12.10 ± 8.89 MPa on pulp chamber floor dentin for EP and GP, respectively. Coronal dentin yielded significantly higher μTBS than pulp chamber floor dentin (p < 0.05), independently from the tested composites.

Morphometric Analysis Comparing Human Mandibular Deciduous Molars using Cone Beam Computed Tomography.

Background:The presence of variations in crown and root measurements in deciduous teeth usually leads to complications during and after treatment. Hence, in order to improve the success rate in pediatric treatment, there must be proper knowledge of dental morphological and morphometric characteristics of deciduous teeth among different populations.Objective:The aim of the present study was to assess length of the crowns, length of the roots, roots to crown (R/C) ratio, and distance between the floor of pulp chamber to furcation using cone beam computed tomography (CBCT).Materials and Methods:Extracted deciduous molar teeth were collected and divided into: group I: Deciduous mandibular first molars (lower D) (n = 16) and Group II: Deciduous mandibular second molars (lower E) (n = 21). The length of the crowns, length of the roots, R/C ratio and distance between the floor of pulp chamber and furcation were measured using CBCT. Data were statistically analyzed.Results:Lower D showed smaller crown length with a mean of 4.87 mm, longer mesial root length with a mean of 9.68 mm and greater R/C ratio with a mean of 2 mm when compared to lower E. As for the distal root length and the distance between the floor of the pulp chamber and the furcation area, both molars closely resembled each other. There was a statistical significant difference between both molars regarding mesial root length, crown length, and R/C ratio.Conclusion:The current study concluded that dental morphological characteristics are important in research as they provide valuable information about diversities within a population.

Endodontic Management of Mandibular First Premolar with Type IV Root Canal: A Case Report

ABSTRACT Thorough knowledge of the root canal morphology, appropriate assessment of the pulp chamber floor, and critical interpretation of radiographs are foundation for successful root canal therapy. Mandibular premolars have earned the reputation for having an aberrant anatomy, making them one of the most difficult teeth to manage endodontically. Therefore, clinician should be aware of the configuration of the pulp system as the incidence of having two roots in these teeth is quite rare. These two case reports present the clinical management of mandibular first premolar having two roots bifurcated at the mid-root level. How to cite this article: Jharwal A, Raisingani D, Prasad AB, et al. Endodontic Management of Mandibular First Premolar with Type IV Root Canal: A Case Report. J Mahatma Gandhi Univ Med Sci Tech 2020;5(1):26–30.

Histomorphometric and immunohistochemical study shows that tricalcium silicate cement associated with zirconium oxide or niobium oxide is a promising material in the periodontal tissue repair of rat molars with perforated pulp chamber floors.

To evaluate the periodontium response to tricalcium silicate (TCS) with zirconium oxide (ZrO2 ) or niobium oxide (Nb2 O5 ) used in the sealing of perforated pulp chamber floors in rat maxillary molars. In eighty rats, the perforations in right maxillary molars were filled with either TCS+ZrO2 , TCS+Nb2 O5 , White MTA (used as a gold standard material) or no repair material was placed (Sham Group, SG); the left molars of SG, were used as controls (CG). Sections of maxillary fragments following 7, 15, 30 and 60days were used to evaluate the volume densities of inflammatory cells (VvIC) and fibroblasts (VvFb), width of the periodontal space, amount of collagen, number of osteoclasts and number of IL-6-immunostained cells. The data were subjected to two-way ANOVA followed by Tukey's test (P≤0.05). At all periods, significant differences in VvIC were not detected among TCS+ZrO2, TCS+Nb2 O5 and MTA groups, which had values significantly lower (P<0.05) than the SG. Significant differences in the number of IL-6-immunolabelled cells were not observed among TCS+ZrO2 , TCS+Nb2 O5 and MTA groups (P>0.05) at 15, 30 and 60days. At 7, 15 and 30days, the number of osteoclast was significantly greater in TCS+ZrO2, TCS+Nb2 O5 and MTA (P<0.05) than in the CG; no significant difference was detected after 60days (P>0.05). The width of the periodontal space and amount of collagen in TCS+ZrO2 and TCS+Nb2 O5 groups were similar to the CG at 30 and 60days while SG specimens had a significant reduction (P<0.05) in the amount of collagen and significant increase (P<0.05) in the width of the periodontal space. TCS+ZrO2 and TCS+Nb2 O5 were associated with periodontium repair since these materials allowed the reestablishment of periodontal space width and collagen formation when used in the filling of uninfected perforations in the pulp chamber floor of maxillary rat molars. Furthermore, the significant reduction in the periodontal space of TCS+ZrO2 and TCS+Nb2 O5 specimens after 60days confirmed that the experimental materials were associated with a more rapid recovery of the injured tissues than MTA.

Significance of the Coronal Pulp Chamber Floor Anatomy in the Human Dentition: A Narrative Review

In root canal treatment, the foundation on which all surgical procedures are performed is a thorough knowledge of the anatomy of the pulp chamber and the root canal system. The endodontic triad comprises biomechanical preparation, microbial control and complete obturation of the root canal space. Knowledge of the pulp chamber floor anatomy is important in locating the numbers and orifices of root canals present within the tooth being root canal treated. This is particularly important while treating teeth that are heavily restored, mal-positioned, or calcified. The current review attempts to explain the complex anatomy of the pulp chamber floor and its significance in root canal treatment.CPD/Clinical Relevance: To allow the location of all root canal orifices in the pulp chamber and to perform successful root canal treatment, knowledge of pulp chamber floor anatomy is essential. The clinician should consider that, as the external morphology of the tooth varies in individuals, so does the internal morphology.

Dentin Thickness of Pulp Chamber Floor in Primary Molars: Evaluation by Cone-Beam Computed Tomography

Objective: Use cone-beam computed tomography (CBCT) images to evaluate the dentin thickness of the pulp chamber floor in primary molars . Material and Methods: Cross-sectional study, conducted with CBCT images of teeth of children. Primary molars with preserved pulp chamber floor were included. The dentin thickness of the pulp chamber floor in the primary molars was measured linearly in CBCT cross-sections. Data were descriptively analyzed and the Mann-Whitney test was applied (p<0.05). Results: 27 CBCT exams and 123 primary molars of children aged 4 to 13 years were analyzed; the majority was female (52.0%). In maxillary molars, the median dentin thickness was 1.50 (0.6–2.2) mm in the first and 1.65 (0.6–2.3) mm in the second (p=0.049) molars. In mandibular molars, the median was 1.20 (0.3–1.7) mm in the first and 1.60 (1.0–2.2) mm in the second (p<0.001) molars. Children aged 4 to 8 years showed less dentin thickness (p<0.001) . Conclusion: The median dentin thickness of the pulp chamber floor in primary molars was 1.50 mm, ranging from 0.3 to 2.3 mm. Less dentin thickness was associated with younger children, teeth in the mandibular arch, and first molars.

Management of Bilateral Maxillary Second Molars with Extra Palatal Root: A Case Report

A crucial understanding of teeth’ internal and external anatomy is critical for the successful outcome of endodontic therapy. The presence of two palatal roots in maxillary molars, particularly in the second molar is rare. The present case report addresses this anatomical variation in an 18-year-old female patient with a chief complaint of severe pain in the upper left back teeth region since one week. Preoperative radiographic evaluation of maxillary second molar did not reveal the aberrant anatomy due to its location and impaction of maxillary third molar onto the roots of the second molar. After access opening, inspection of the pulp chamber floor revealed a slightly deviated location of the palatal canal and a bleeding point mesial to the palatal canal. Intensive exploration for determining any additional canals was done using David Green (DG) 16 endodontic explorer under 3X magnification using dental loupes. A narrow field of view Cone Beam Computed Tomography (CBCT) was obtained to evaluate the unusual root canal morphology. Following a thorough analysis of CBCT, root canal treatment was performed employing a standard protocol. This case report highlights the successful diagnosis and management of the bilateral maxillary second molar with two separate palatal roots. With CBCT and magnification, determining the root morphology and canal configuration will be more accurate, further improving the quality of root canal treatment.

A population-based observational morphologic measurements of anatomic landmarks in maxillary and mandibular molar

Aim: The aim of this study is to study the morphological measurements of external and internal anatomic landmarks in human maxillary and mandibular molars and their correlation with critical pulp chamber morphology.Materials and Methods: A total of 200 mandibular and maxillary molar teeth of patients were evaluated. Teeth whose pulp chamber were not violated by caries, restoration, fracture crown, and those having closed apex were included in the study. Teeth were subjected to radiovisiography of bitewing projection and imaging tool was utilized for measuring-A: Distance from the pulp chamber floor to the furcation, B: Distance from the pulp chamber ceiling to the furcation, C: Distance from the buccal cusp tip to the furcation, D: Distance from the buccal cusp to the floor of the pulp chamber, E: Distance from the buccal cusp to the ceiling of pulp chamber, and F: Pulp chamber height. Differences in the measurements were examined using the Student's t-test and Pearson correlations. All results were considered statistically significant if P < 0.05.Results: There were significant differences found among the various measurements between young and old population groups (P < 0.05). The highest percentage variance was found for the height of the pulp chamber (P < 0.001).Conclusions: The knowledge of pulp chamber morphology should be integrated with preoperative radiograph and intraoperative tactile perception during endodontic access preparation.

Topography of Primary Molar Pulp Chamber Floor: A Scanning Electron Microscopy and Micro-Computed Tomography Analysis

Objective: To determine in vitro the frequency, shape, type, diameter, and patency of accessory canals in the primary molars pulp chamber floor . Material and Methods: Sixteen healthy primary molars were evaluated by micro-computed tomography and scanning electron microscopy. Descriptive analyses of the frequency, shape (round, oval, or irregular), type (blind, true, or hidden), patency and diameter of the accessory canals were performed. Results: Half of the teeth presented accessory canals, 62.5% of which were located in the upper molars and 37.5% in the lower molars. The most frequent shape was irregular. In three-dimensional analysis, blind accessory canals (12.5%) and with patency (18.7%) of the teeth were observed. The average accessory canal diameter was 51.97 µm (± 26.03 µm) . Conclusion: Upper molars showed a higher frequency of accessory canals with larger diameters. The irregular shape was the most frequent. 18.7% of accessory channels showed patency.

Maxillary lateral incisor with four root canals: A rare case report

The objective of the present study is to present a case report of endodontic treatment of a maxillary lateral incisor with 1 root and 4 root canals. The success of endodontic treatment requires knowledge of dental anatomy and its variations. The maxillary lateral incisor usually presents with one root canal system within one root. The incidence of 4 root canals in this tooth is rare. However, it must be taken into consideration, the clinical and radiographic evaluations during the endodontic treatment in order to enhance the diagnostic. The detection of all canals was achieved by examination of the pulp chamber floor with the help of the dental loupes as well as careful examination of intraoral radiographs.

Influence of access cavity design on fracture strength of endodontically treated lower molars.

To assess whether access cavity design influences the fracture strength of endodontically treated and restored molars. Fifty human lower molars with standard crown dimensions were selected and assigned to the following groups: S - positive control (healthy tooth), ET - negative control (conventional endodontic access (CEA) and no restoration), NI - negative control (minimally invasive endodontic access (MEA) and no restoration), ETR (CEA+restoration with Bulkfill flow) and NIR (MEA+restoration with Bulkfill flow). The specimens were subjected to a compression test. The teeth were inspected for the site of fracture: either pulp floor or cusp. ANOVA, followed by Tukey's multiple comparison test (α=5%), was used for statistical analysis. The type of access cavity preparation did not increase the fracture strength of endodontically treated teeth. Even with the restoration, all teeth with endodontic access performed had a higher incidence of fractures at the pulp chamber floor level.

Endodontic Management of Permanent Mandibular First Premolar with Type V Canal Configuration: Case Report

Effective endodontic treatment relies on a strong understanding of root canal anatomy, specific evaluation of the pulp chamber floor, critical interpretation of radiograph, and chemo-mechanical planning accompanied by three-dimensional obturation of root canal system. The risk of extra root /canal should be considered even in teeth with a small incidence of irregular root canal morphology. Mandibular premolars have acquired the distinction for having aberrant anatomy. This article reports and discusses the successful endodontic management of mandibular first premolar with one canal bifurcating into two canals.

The MB3 canal in maxillary molars: a micro-CT study.

To assess the internal and external morphologies of the mesiobuccal (MB) root of maxillary molars presenting a third root canal (MB3), using micro-computed tomography (micro-CT). Two-hundred and sixty-five extracted maxillary first and second molars with different root configurations were imaged in a micro-CT scanner at 19.6-μm pixel size. Sixteen teeth presenting MB3 canal were selected and evaluated regarding root configuration, minimal dentine thickness 2mm under the furcation area, canal configuration of the MB root, MB3 canal morphology (location, independent or confluent orifice, and anatomy types), and the apical anatomy (aspect ratio, number of accessory canals and foramina, presence of isthmus, and independent MB3 foramen). Overall, a high variability in canal configuration was detected in the MB root. MB3 canal was observed in 10 maxillary first molars and 6 maxillary second molars (n = 16). Minimal dentine thickness related to the MB3 canal at the coronal third was smaller than that of the MB1 canal. A complex internal anatomy comprising 13 different root canal configurations was observed. A high number of independent MB3 orifices at the pulp chamber floor was observed in the first molars (7 out of 10 teeth), while most of the specimens (n = 14) showed a confluent anatomy of the MB3 canal. A varied number of accessory canals and foramina were observed. At the apical third, isthmus could be observed in 6 specimens, while an independent MB3 foramen was present in 37.5% of the MB roots. MB3 canal is a rare anatomical variation present in maxillary first and second molars. Its presence can be associated to a complex internal anatomy of the MB root which includes the presence of isthmuses and multiple accessory canals and foramina at the apical third, but also a thin dentine thickness at the coronal third and a confluent anatomy of the MB3 with the other main canals.

Observation of the Pulp Chamber of Maxillary First Premolars: A Micro-computed Tomographic Study.

There are a few studies about the evaluation of maxillary first premolars internal structure with micro-computed tomography (micro-CT). The aim of this study was to assess morphological features of the pulp chamber in maxillary first premolar teeth using micro- CT. Extracted 15 maxillary first premolar teeth were selected from the patients who were in different age groups. The distance between the pulp orifices, the diameter of the pulp and the width of the pulp chamber floor were measured on the micro-CT images with the slice thickness of 13.6 µm. The number of root canal orifices and the presence of isthmus were evaluated. The mean diameter of orifices was 0.73 mm on the buccal side while it was 0.61 mm on palatinal side. The mean distance between pulp orifices was 2.84 mm. The mean angle between pulp orifices was -21.53°. The mean height of pulp orifices on the buccal side was 4.32 mm while the mean height of pulp orifices on the palatinal side was 3.56 mm. The most observed shape of root canal orifices was flattened ribbon. No isthmus was found in specimens. Minor anatomical structures can be evaluated in more detail with micro-CT. The observation of the pulp cavity was analyzed using micro-CT.