Root Canal Procedures Research Articles

Evaluation and Comparison of Manual and Mechanical Endodontic Instrumentation Completed by Undergraduate Dental Students on Endodontic Blocks.

Background: The shaping of root canal space was completed using manual stainless steel files in earlier decades and with the advent of mechanical nickel-titanium (NiTi) instruments, there is potential for more efficient root canal preparation. Despite the advantages of NiTi instruments, their adoption in undergraduate dental education remains limited. The aim of this study was to evaluate three root canal instrumentation techniques, manual instrumentation using stainless steel hand files, continuous rotation employing ProTaper Gold (PTG) files, and reciprocation with WaveOne Gold (WOG) files, on endodontic resin blocks to assess the quality of preparation and the time required for instrumentation. Methods: A total of 36 third-year dental students, all lacking prior experience in root canal procedures, were divided into six groups to prepare 108 resin endodontic blocks with each student preparing 3 blocks. Images were captured at the preoperative, intraoperative, and postoperative stages to facilitate comparisons and measurements of the prepared blocks to assess the degree of resin removal, apical deviation, and mid-cervical wear. Furthermore, questionnaires were distributed to assess the students' experiences and satisfaction with the techniques. The Friedman test, Wilcoxon test with Bonferroni correction, and Kruskal-Wallis test with Mann-Whitney U test were used to analyse and compare techniques, with the level of significance set at p < 0.05. Results: Instrumentation with PTG exhibited significantly reduced apical deviation (0.073 ± 0.003) compared to both the WOG and manual instrumentations (p < 0.001). Significant differences in mid-cervical wear were observed only between PTG and the manual instrumentation. In terms of resin removal, the manual instrumentation displayed greater variability and was five times slower to complete the instrumentation. In total, 90% of students favoured mechanical instrumentation, with substantial preferences for them over manual techniques. Conclusions: Mechanical instrumentation techniques, notably with the PTG system, were significantly faster and more effective in preparation quality. This highlights the potential for the inclusion of mechanical instrumentation in undergraduate dental curricula.

Effect of Cross-sectional Designs on Torsional Resistance of Endodontic Nickel-Titanium Files: A Finite Element Study.

This study aimed to assess the influence of two key design parameters on the torsional resistance of endodontic rotary files: the ratio of the equivalent radius (re ) to the polar moment of inertia (J), or re /J ratio, and the percentage of the inner core area. Understanding these factors can guide the development of files with improved performance during root canal procedures. Finite element analysis was employed to simulate the behavior of rotary files under torsional loading conditions. This method allowed for the investigation of maximum shear stress across various cross-sections (D4-D16) of the files. The relationship between the re /J ratio and the maximum shear stress was also evaluated. To assess the impact of cross-sectional design modifications on stress distribution, the study analyzed files with progressively changing configurations. Regions situated outside the inner core circle experienced lower shear stress compared with a circular shaft. Furthermore, a strong linear correlation was observed between the maximum shear stress experienced by the file, the applied torque during operation, and the re /J ratio. Significantly, the study established a connection between the percentage of the inner core area and the torsional resistance of the file. Files with a larger inner core area exhibited a lower coefficient (C) within a newly derived torsional formula. This lower C value directly translated to a reduction in the maximum shear stress experienced by the file. In essence, files with a higher percentage of inner core area demonstrated enhanced torsional resistance, allowing them to withstand higher torsional loads encountered during root canal procedures. This study identified the re /J ratio and the percentage of inner core area as the most critical design factors influencing the torsional resistance of rotary files. Files with a lower re /J ratio and a larger inner core area experienced lower shear stress, resulting in enhanced torsional resistance and potentially reducing the risk of torsional fracture during use. These findings offer valuable insights for both clinicians selecting rotary files and manufacturers designing future iterations, ultimately contributing to improved safety and efficacy during root canal treatments.

Reasons for Patients Preferring Extraction over Root Canal Treatment in a Tertiary Care Hospital

Introduction: Dental caries is a major global oral health issue, potentially progressing to irreversible pulpitis and causing substantial discomfort. Although advancements in materials, instruments and knowledge have improved the success rates of root canal procedures, some patients opt for tooth extraction instead of root canal treatment. This choice can result in tooth loss, necessitating costly prosthetic replacements. Objective: The objective of this study was to determine the reasons for patients choosing extraction over root canal treatment. Methods: A descriptive cross-sectional study was conducted among 205 patients visiting the Department of Conservative Dentistry and Endodontics at Kathmandu Medical College for the treatment of irreversible pulpitis, who ultimately opted for extraction. A structured questionnaire was utilized, and responses were recorded and analyzed using the Statistical Package for the Social Sciences. Mean, standard deviation, frequency and percentage were calculated depending upon the nature of data. Results: The study found that the primary reason for patients not undergoing root canal treatment (RCT) was the high cost of RCT and crown, accounting for 42.9% (88 patients), followed by the need for more appointments with pain, at 31.2% (64 patients). Conclusions: This study revealed the cost of RCT and crown to be the major factor for patients opting out from RCT. The study provides valuable insights into the psychology of patients regarding RCT, highlighting reasons for its rejection. Such understanding assists dentists and specialists in tailoring treatment plans that align with patient preferences and needs.

Mustard Gel versus Chlorhexidine Gel as Root-Canal Medicament Against Enterococcus Faecalis: An in vitro Study.

To evaluate the efficacy of mustard gel versus chlorhexidine (CHX) gel in treating the most resistant Enterococcus faecalis (E. faecalis) bacteria as intra-canal medications. Randomised controlled trial (in vitro study). Place and Duration of the Study: Department of Operative Dentistry, de'Montmorency College of Dentistry, in collaboration with Lahore General Hospital, between March and October 2021. Forty single-rooted teeth, extracted and randomly allocated, were divided into two groups. Group 1 underwent treatment with CHX gel, while Group 2 was treated with Mustard gel. Subsequently, after disinfection, each tooth was horizontally divided into three equal parts. The middle section was standardised and inoculated with a controlled strain of E. faecalis. Intra-canal medicaments were administered for seven days. Bacterial colonies were quantified as colony forming units (CFU/mL) and subjected to analysis using Statistical Package for Social Sciences (SPSS) version 25. The median bacterial count observed was 1,550 (range 775 - 2,500) for Group 1, contrasting with 400 (range 200 - 775) for Group 2, indicating a significant difference in bacterial count between the groups (p <0.001). Mustard gel demonstrated significantly superior efficacy compared to chlorhexidine gel against E. faecalis in root canal procedures. Chlorhexidine, Enterococcus faecalis, Mustard, Root canal medicament, Antimicrobial drug-resistance, Root canal irrigants.

Comprehensive Survey on the Performance of Lignocaine in Root Canal Treatment

Objective: The study aimed to evaluate the efficacy of lignocaine as a local anesthetic in root canal treatment, particularly focusing on its use in lower teeth, different administration techniques, and its performance in patients with specific challenges such as inflammation or allergy. Methods: A survey-based approach was utilized to gather data from clinicians on their experiences with lignocaine in endodontic procedures. The study assessed the success rates of various techniques, including the inferior alveolar nerve block (IANB), intraligamentary, and intraosseous injections. The impact of different adrenaline ratios (1:100,000, 1:80,000, and 1:200,000) on anesthesia duration and effectiveness was also analyzed. Results: Lignocaine with 1:100,000 adrenaline was effective in the majority of cases, with IANB being the primary technique used for lower Lignocaine was identified as the anesthetic of choice by the majority of participants, preferred for its rapid onset and adequate duration of action. Most clinicians reported that lignocaine provided effective anesthesia for routine root canal procedures when inflammation was present or additional duration was required, clinicians recommended using supplemental techniques such as intraligamentary and intraosseous. Alternative anesthetics like articaine and bupivacaine were used successfully in patients with lignocaine allergies. Conclusion: Lignocaine remains a reliable anesthetic for root canal treatments, particularly in the lower jaw, when used with appropriate techniques and adrenaline ratios. However, challenges such as inflamed tissues and patient allergies require alternative strategies, including supplemental injection techniques and the use of different anesthetic agents. Clinicians should be adaptable in their approach to ensure effective anesthesia and patient safety. The study aimed to evaluate the efficacy of lignocaine as a local anesthetic in root canal treatment, particularly focusing on its use in lower teeth, different administration techniques, and its performance in patients with specific challenges such as inflammation or allergy.

Evaluating the Depth of Penetration of Calcium Hydroxide Mixed With Three Different Herbal Essential Oils Using a Confocal Laser Scanning Microscope.

Introduction The goal of endodontic therapy is to completely eliminate the infection and stop microbesfrom infecting or reinfecting the root canal and the periradicular tissues. Amongst the primary microorganisms,Enterococcus faecalis (E. faecalis), a Gram-positive anaerobe, is the main cause of pulpal and periapical inflammation causing root canal failure. Literature evidenceshows that the gold-standard calcium hydroxide is ineffective against E. faecalisdue to its resistance to the alkaline pH and proton pump mechanism. Herbal essential oils such as oregano, basil, and thyme are known to possess antimicrobial properties against E. faecalis. However, their combination with calcium hydroxide as an intracanal medicament and thedepth of penetration is still unknown. Aim To evaluate the depth of penetration of calcium hydroxide mixed with three different herbal essential oils using a confocal laser scanning microscope. Material and methods Fifty single-rooted premolars were decoronated and randomly divided into five groups. Group 1 - Oregano oil with calcium hydroxide, Group 2 - Basil oil with Calcium hydroxide, Group 3 - Thyme oil with calcium hydroxide, Group 4 - Calcium hydroxide with saline, Group 5 - Negative control. The teeth were instrumented and inoculated with E. faecalis and incubated for 21 days. Calcium hydroxide mixed with respective oils or saline and 0.1% rhodamine B dye was placed in the canals and again incubated for 7 days. Two sections each of 1 mm were horizontally cut at 3 mm and 5 mm from the apex and later subjected to a confocal laser scanning microscope to evaluate the depth of penetration. One-way ANOVA, post-hoc Tukey test, and student t-test were performed. Results At the middle third, basil oil had the maximum depth of penetration (1377.47±14.1 µm) followed by oregano oil (1345.4±26.5 µm) and thyme oil (1160.4±24.6 µm). At apical third, basil oil (1152.4±31.6 µm) showed maximum depth of penetration, followed by thyme (988.3±26.2 µm) andoregano oils (419.5±19.8 µm). The depth of penetration of these oils was greater at the middle third than at the apical third. Conclusion Basil, oregano, and thyme oilhave good penetration depth into the dentinal tubules and can be successfully used in root canal procedures as intracanal medicaments.

Root canal transportation with ProTaper Next and WaveOne Gold: A systematic review

Root canal transportation is a significant concern in endodontic therapy, impacting treatment outcomes. ProTaper Next (PTN) and WaveOne Gold (WOG) are popular endodontic instrumentation systems used to shape root canals. This systematic review aimed to evaluate the literature on root canal transport with PTN and WOG. Fourteen studies were analyzed, highlighting the overall effectiveness of both systems. The PTN showed potential advantages in minimizing canal transport, while the WOG preserved the original canal shape. Operator experience and canal curvature influence performance. This review provides evidence-based insights to aid endodontic practitioners in making informed decisions for successful root canal treatments. The aim of this systematic review was to evaluate and synthesize the literature on root canal transportation with ProTaper Next (PTN) and WaveOne Gold (WOG) instrumentation systems in endodontic therapy. A comprehensive literature search was conducted using the PubMed Central, Scopus, EBSCO, Embase and Web of Science databases from 2000 to 2022. Studies that met the predefined inclusion and exclusion criteria were selected for analysis. Data on study design, participant characteristics, intervention details, comparison groups, outcomes, and results were extracted from the included studies. The methodological quality of the studies was assessed using appropriate tools, and the findings were synthesized qualitatively. A total of 14 studies were included in the systematic review. The analysis revealed that both the PTN and WOG systems demonstrated overall effectiveness in root canal preparation. PTN rotary files performed adequately with inexperienced operators and showed potential advantages in minimizing canal transportation. On the other hand, WOG files exhibited a conservative approach, preserving the original canal shape. However, variations in performance were observed depending on the instrumentation method, operator experience, and canal curvature. This systematic review provides valuable insights into the ability of the PTN and WOG to manage root canal transport. Both systems demonstrated satisfactory outcomes, with WOG often preserving the natural canal anatomy. The findings suggest that proper operator training and technique play vital roles in achieving optimal results. Clinicians should consider the unique characteristics of each system when selecting instrumentation for root canal treatments. Nonetheless, it is crucial to acknowledge the limitations of the included studies, such as variations in sample sizes and operator experience, which may impact the interpretability of the findings. Future research should address these limitations and further explore the efficacy of these instrumentation systems in various clinical settings. The evidence derived from this systematic review can aid endodontic practitioners in making evidence-based decisions for successful root canal procedures.

Knowledge, awareness, and approaches of dentistry students about separated instruments in root canals: A cross-sectional study.

This survey aims to assess the understanding, viewpoints, and methods employed by undergraduate dental students in the fourth and fifth grades regarding broken endodontic instruments in root canal procedures. A survey comprising 27 questions across three sections-demographic information, practical application, and knowledge-approach-awareness inquiries-was developed. It was distributed to 282 students either in person or via a link shared through WhatsApp groups using Google Forms. Out of the total 219 respondents (77.6%), 10.6% experienced instrument breakage once during their clinical internship, while 2.8% encountered it more than once. The majority (86.7%) did not face instrument fracture incidents. Among these occurrences, it was observed that endodontic instruments were most commonly separated in molars, accounting for 51.9%. Nearly half (48.1%) of the students noted instrument breakage during the initial attempt to reach the apical part of the canal, while 55.6% reported breakage during root canal cleaning and shaping. Most dental students opted to leave the separated instrument in the root canal and proceed with filling it. Enhancing students' understanding and awareness of this matter will help prevent potential complications and enable them to handle such situations appropriately when they arise.

Management of additional roots in mandibular molars: report of radix entomolaris and radix paramolaris cases

Achieving a favorable outcome after endodontic treatment depends on a clear understanding of tooth anatomy, identification of variations, and precise root canal location. Multi-rooted mandibular molars often deviate from the expected configuration, sometimes featuring additional roots, such as radix entomolaris (RE) and radix paramolaris (RP), posing challenges during treatment. Detecting these variations is challenging due to their proximity to the distal root, and overlooking them can lead to complications. This study presents three cases involving RE and RP and offers insights into their clinical management, encompassing thorough clinical assessment, diagnosis, and root canal treatment. At follow-up examinations, patients were asymptomatic with no radiographic evidence of persistent infection. Therefore, clinicians must be aware and informed about the potential presence of additional roots in mandibular molars during root canal procedures, as understanding and addressing anatomical variations like RE and RP is crucial for achieving favorable outcomes in root canal treatments.

Comparative evaluation of intraligamentary injection and traditional inferior alveolar nerve block in endodontic management of mandibular molar with symptomatic irreversible pulpitis: A randomized double-blinded clinical trial

Background: Intraligamentary anesthesia (ILA) injection using a single-tooth anesthesia (STA) system has been used as a supplementary technique for pulpal anesthesia in cases of irreversible pulpitis. Aims and Objective: The current clinical trial was undertaken to assess and compare the effectiveness of the conventional inferior alveolar nerve block (IANB) and the ILA technique utilizing the STA system for endodontic management of mandibular molars presenting symptomatic irreversible pulpitis. Materials and Methods: Patients diagnosed with symptomatic irreversible pulpitis inmandibular molar were allocated into two groups: Group I IANB (n=30) and Group II- STA system (n=30). The onset of anesthesia was evaluated using the electric pulp test, whereas for pain perception the Heft-Parker Visual Analog Scale score was recorded before, during, and after anesthesia. Post-anesthetic pain was recorded at 3 h, 24 h, and 1 week. The collected data was evaluated for effectiveness pain perception, and acceptability of the anesthetic technique, using appropriate statistical tests. Results: The mean time of onset for the Group II STA system (2.93±1.80) was significantly higher (P=0.0001) than Group I IANB (1.40±0.86). Pain at the site of injection was insignificant (P&gt;0.05) between both groups. The severity of pain during the root canal procedure was significantly different (P&lt;0.0001) in both cohorts. For both groups, the patient’s acceptance of the anesthetic procedure was statistically insignificant (P=0.21). Conclusions: The STA system reported similar effectiveness in terms of effectiveness, pain perception, and acceptability of anesthetic technique when compared to IANB. Hence, the primary anesthetic treatment for conducting endodontic procedures on molars with symptomatic irreversible pulpitis appears to be the utilization of the ILA-employing STA system.

Mixed reality guided root canal therapy.

Root canal therapy (RCT) is a widely performed procedure in dentistry, with over 25 million individuals undergoing it annually. This procedure is carried out to address inflammation or infection within the root canal system of affected teeth. However, accurately aligning CT scan information with the patient's tooth has posed challenges, leading to errors in tool positioning and potential negative outcomes. To overcome these challenges, a mixed reality application is developed using an optical see-through head-mounted display (OST-HMD). The application incorporates visual cues, an augmented mirror, and dynamically updated multi-view CT slices to address depth perception issues and achieve accurate tooth localization, comprehensive canal exploration, and prevention of perforation during RCT. Through the preliminary experimental assessment, significant improvements in the accuracy of the procedure are observed. Specifically, with the system the accuracy in position was improved from 1.4 to 0.4 mm (more than a 70% gain) using an Optical Tracker (NDI) and from 2.8 to 2.4 mm using an HMD, thereby achieving submillimeter accuracy with NDI. 6 participants were enrolled in the user study. The result of the study suggests that the average displacement on the crown plane of 1.27 ± 0.83 cm, an average depth error of 0.90 ± 0.72 cm and an average angular deviation of 1.83 ± 0.83°. Our error analysis further highlights the impact of HMD spatial localization and head motion on the registration and calibration process. Through seamless integration of CT image information with the patient's tooth, our mixed reality application assists dentists in achieving precise tool placement. This advancement in technology has the potential to elevate the quality of root canal procedures, ensuring better accuracy and enhancing overall treatmentoutcomes.

Opinions and Attitudes of Dental Practitioners towards Intracanal Separation of Endodontic Instruments

Objective: To investigate the opinions and attitudes of dental practitioners towards intracanal separation of endodontic instruments and to create awareness regarding the management of separated instruments Study Design: Cross-sectional survey Place and Duration of Study: Department of Operative Dentistry Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Mar to Apr 2021. Methodology: An online questionnaire was circulated among 374 dentists of private and public hospitals in Rawalpindi and Islamabad. The questionnaire consisted of close-ended questions related to demographic details, dentists' awareness of instrument separation, the frequency of separated instruments, the causes of separation, the management of separated instruments, and the retrieval strategies if used. Results: Out of 374 study participants, 307(82.1%) of the participants thought that operator-related factors such as improper or overuse of the instrument were considered the most common factors for instrument separation during root canal procedures. 205(54.8%) thought unwinding, defective flutes and shiny areas were the most common factors affecting instrument separation. 241(64.4%) of the instruments are separated during cleaning and shaping. 135(36.1%) K files and 119(31.8%) H files were separated in this survey. Conclusion: Most dentists of Rawalpindi and Islamabad face the problem of endodontic instrument separation during rootcanal preparation.

Management of Intracanal Separated Instrument Using Bypassing and Braiding Techniques: Case Reports

The separation of an endodontic instrument during a root canal procedure is a complication that can significantly hinder successful treatment. Separated instruments blocked access to the apical portion of the root, impeding adequate apical canal debridement and potentially compromising disinfection efficacy, thereby jeopardizing the long-term success of the endodontic therapy. Recent advancements in endodontic technology and methodology have facilitated the management of separated instruments (SIs), potentially enhancing treatment prognosis This article presents a case series of the management of SI using bypassing and braiding techniques. Separated instruments were lodged at various levels in the middle and apical third of the maxillary and mandibular incisor and canine teeth. Today, the majority of broken instruments can potentially be removed safely and effectively. However, instrument removal techniques lead to significant loss of tooth substances, which increases the risk of tooth fracture. The choice of the most appropriate technique for removing the fractured fragment depends on several parameters. The two techniques used in these clinical cases are conservative, simple and less invasive for instrument removal.

Biocompatibility of mineral trioxide aggregate and biodentine as root-end filling materials: an in vivo study

This study evaluated the biocompatibility of mineral trioxide aggregate (MTA) and Biodentine (BD) as root-end filling materials. Six mongrel dogs were divided into two equal groups according to the evaluation period; group A: one month and group B: three months. Three premolars of the same quadrant in each arch were used, summing up 36 teeth (6 teeth/dog). These teeth were randomly subdivided into three subgroups according to the root-end filling material used: MTA, BD and no root-end filling material (control). Endodontic access cavities were performed for induction of periapical pathosis. After the infection period, root canal instrumentation and obturation were accomplished. One day after root canal procedures, root-end surgery was performed. Surgical access was achieved and the root-end was resected approximately 3 mm above the apex. Root-end cavity was prepared ultrasonically and filled with the tested materials. All samples were evaluated by radiography and histopathology (Inflammation and new hard tissue formation). Data were collected and subjected to statistical analysis. In group A, MTA subgroup exhibited significant higher mean inflammatory score than BD subgroup (P < 0.05) while no significant difference was recorded between MTA and BD subgroups in group B (P > 0.05). Regarding mean mineralization score, there was no significant difference between all subgroups in both groups A and B (P > 0.05). Biodentine exhibited favorable biocompatibility in the initial stage of healing than MTA and comparable biomineralization. Clinical relevance: Biodentine could be considered as an acceptable alternative to MTA in peri-radicular surgeries.

Analysis of Post-Operative Pain Following Single Sitting Root Canal Treatment

ABSTRACT Background: The objective of root canal therapy is the complete cleansing and sealing of the entire root canal system, encompassing all of its elements. This current study was undertaken to evaluate the occurrence of postoperative pain in the patients during single-session RCT. Materials and Methods: A total of 70 maxillary central incisor teeth from 55 patients, representing both genders, were chosen for a one-session root canal procedure. Postoperative discomfort was measured using the Visual Analog Scale (VAS) at the following time intervals: 6 hours, 12 hours, 24 hours, and 48 hours following the treatment. Results: Among the 55 patients, there were 35 males and 20 females. The average VAS scores at various time points were as follows: 6 hours (7.4), 12 hours (5.2), 24 hours (3.4), and 48 hours (2.5). These differences were found to be statistically significant (P &lt; 0.05). Conclusion: The authors observed a significant reduction in postoperative pain following a one-session RCT.

Bioceramic Materials: A Boon in Pediatric Dentistry: A Literature Review

Abstract Over the past few decades, bioceramic materials have developed from extremely biocompatible, but low-strength dental materials to novel product compositions for broader clinical uses in pediatric dentistry. The most crucial thing is to better understand the elements that encourage remineralization and how they operate dynamically. Some of the major drawbacks of prior generations of endodontic materials have been effectively solved by new bioceramic materials. In particular, these materials have been used for vital pulp therapy treatment, restorative, and root canal procedures in a variety of dental applications. They may be used in clinical pediatric dentistry since they have been demonstrated to be more biocompatible, induce tissue regeneration, have low cytotoxicity, excel at sealing, cause little to no postoperative pain, and have improved physiochemical properties. When employing bioceramic materials, it is crucial to adhere to suitable clinical standards and techniques to guarantee positive results in pediatric dentistry. Therefore, the focus of this review is on the properties and advantages of using bioceramic materials in pediatric dentistry.

A Rare Case Of Mandibular Second Molar Characterized By A Single Canal - A Case Report

Mandibular second molars with a single root canal present a distinctive anatomical variation. This case report aims to present a rare morphological variation of mandibular second molar characterized by a single canal diagnosed with a peri-apical radiograph and orthopantomogram. A 43-year-old Saudi Arabian woman was referred to the dental clinic complaining of discomfort and pain while chewing on the right back region of her mouth. A fixed partial denture was noted on clinical examination that spanned from the right mandibular second premolar (tooth #45) to the right mandibular second molar (tooth #47). The right mandibular second molar (tooth #47) had no mobility but was sensitive to percussion. The periapical radiograph revealed the existence of one root canal with apical radiolucency associated with this tooth. The final diagnosis of the tooth under consideration was pulpal necrosis with symptomatic apical periodontitis. This case confirms the presence of a single root and root canal in a second mandibular molar. Root canal treatment was done for the symptomatic tooth. Furthermore, longitudinal follow-up of the treated tooth for four years after the root canal procedure, both clinically and radiographically, demonstrated complete resolution of the peri-apical lesion. This case report unveils a unique and infrequent variation in the root canal system of a mandibular second molar: a single root associated with a single root canal. For optimal dental care management, clinicians must vigilantly acknowledge the potential for variations in the root canal systems of mandibular molars.

Efficacy of Two Paediatric Rotary Systems: Kedo-SG Blue™ and Prime Pedo™ Files in Primary Mandibular Molars: A Randomised Clinical Trial

Introduction: The success of root canal procedures depends on cleaning and shaping of canals. There are several instrumentation techniques available for root canal preparation. Recently, exclusive rotary file systems called Kedo-SG Blue and Prime-Pedo have been introduced for root canal preparation in primary teeth. The inherent flexibility of these files allows them to preserve the anatomy of curved canals in primary molars. Aim: To compare the instrumentation time, obturation time, and quality of obturation using two paediatric rotary file systems, KedoSG BlueTM and Prime-PedoTM, in mandibular primary molars. Materials and Methods: A randomised clinical trial was conducted in the outpatient Department of Paediatric and Preventive Dentistry, Narayana Dental College and Hospital, Nellore Andhra Pradesh, India, from February 1, 2019 to January 20, 2020. Fifty primary molars with necrotic pulp were included and randomly divided into two groups, with 25 teeth in each group. Group 1 and Group 2 were instrumented with Kedo-SG BlueTM and Prime-PedoTM, respectively. The time taken for instrumentation and obturation was noted in minutes, and the quality of root canal filling was recorded as optimal, underfilled, or overfilled. The data were statistically analysed using an independent Student’s t-test for time measurements and a Chi-square test for the quality of obturation. Results: There was a statistically significant difference in instrumentation time and obturation time between the two groups (p-value=0.009; 0.011). The Kedo-SG BlueTM rotary system showed a better quality of obturation compared to the Prime-PedoTM rotary system, although the difference was not statistically significant (p-value=0.22). Conclusion: The Kedo-SG BlueTM rotary system demonstrated shorter instrumentation and obturation times, as well as a higher number of optimally filled canals compared to the Prime-PedoTM rotary system. Therefore, the Kedo-SG BlueTM rotary system exhibited better clinical performance in primary molars than the Prime-PedoTM rotary system.

Transitioning from the dental chair to the bronchoscopy table: a rare complication of a root canal procedure

Background: Dental needle aspiration is a rare complication of oral procedures given the advances in medical technology. Aspirations in general may also be asymptomatic, apart from the possible remote history of upper airway irritation at the time of induction. Clinicians should take a detailed history and examination, along with appropriate diagnostic imaging before discharging these patients from the emergency department. Case presentation: A young patient presented with an acute complaint of pain and coughing post-dental procedure. On arrival at the emergency department, she was vitally and clinically stable, without signs of respiratory distress. There were no complaints reported apart from minor throat pain. Imaging done in the emergency department revealed the presence of a 32 mm needle in the distal airway. She underwent emergency flexible bronchoscopy, and the foreign body was removed under direct visualization. The patient remained stable throughout the procedure and had an uneventful stay until discharge. Conclusion: While needle aspiration is a relatively uncommon occurrence, its early detection is always critical before further damage to local structures can occur. Regardless of presentation and symptoms, basic imaging is mandatory before the disposition is decided.

Synthesis, characterization of Ca (OH)2: TiO2 nanocomposite and evaluation of its antimicrobial efficacy

Introduction and Aim: Root canal treatment is a dental operation that entails the extraction of the compromised tooth pulp tissue, sterilization of the root canal system, and subsequent filling with an inert substance. To mitigate the potential for bacterial infections and subsequent difficulties, it is customary for patients to receive a prescription for antibiotics prior to undergoing a root canal procedure. The objective of this study was to assess the effectiveness of Ca(OH)2: TiO2 nanoparticles as a potential substitute for antibiotics in root canal therapies, while also investigating their antibacterial properties against specific infections. Materials and Methods: Ca (OH)2: TiO2 nanoparticles were synthesized chemically using calcium hydroxide and varying concentrations of titanium oxide powder by a sol-gel process. The Ca (OH)2: TiO2 nanoparticles synthesized was characterized using Field Emission Scanning Electron Microscope (FE-SEM), energy dispersive X-ray (EDX), Fourier Transform Infrared Spectrometer (FT-IR), and UV-Vis spectrophotometry. The antibacterial activity of the synthesized nanoparticles was evaluated against pathogens Escherichia coli, Staphylococcus aureus, and Candida albicans spp.) by gel diffusion method. Results: FE-SEM analysis indicated that the Ca (OH)2: TiO2 composite material exhibited an amorphous structure, characterized by a particle size measuring 25.88 nm. But FTIR was focused on the spectral region between 4000 and 450 cm-1. The absorption spectra of nanoparticles composed of titanium dioxide consistently displayed a prominent peak at a wavelength of 300 nm. The results of the experiment pertaining to the biological effects of composites suggest that the inclusion of TiO2 nanoparticles at concentrations of 25%, 50%, and 75% in the composite material led to a notably wider inhibitory zone in comparison to the use of Ca(OH)2 alone, with a statistically significant p-value of 0.05. Conclusion: The use of varying concentrations of Ca (OH)2TiO2 improves microbial activity against Escherichia coli, Staphylococcus, and Candida.