Root Canal Treatment Of Teeth Research Articles

COMBINED EFFECT OF GENTAMYCIN, AMPICILLIN WITH N – ACETYLCYSTEINE AGAINST ENTEROCOCCUS FAECALIS BIOFILM : AN IN VITRO STUDY

Biolm-related infections pose a major problem in the society from both an economical and health perspective. Persisting biolms inside the root canal system after root canal therapy may result in re-infections and persistent apical periodontitis. Enterococcus Faecalis (E.Faecalis) has been found in 38% of the failed root canal-treated teeth. Aim: Evaluation of in vitro antibacterial efcacy of Gentamycin (GMC), Ampicillin (AMP) and their combination with N-acetylcysteine (NAC) in root canals infected with E.Faecalis. Methods And Materials: 60 extracted single rooted human teeth were prepared and randomly divided into six groups: Calcium hydroxide (CH), Gentamycin (GMC), Ampicillin (AMP), Gentamycin and N-acetylcysteine (GMC+NAC), Ampicillin and N-acetylcysteine (AMP+NAC) and Normal Saline as a positive control. According to the name of the groups, intracanal medicaments were placed into the canals and the teeth were restored with a temporary lling. After one week, intracanal medicament was removed and the nal count of bacteria was measured. Antibacterial effect of medicament was assessed by measuring the percentage reduction in the colony counts and Scanning Electron Microscopy (SEM). The Mann-Whitney U test and the Kruskal-Wallis test were used to compare the overall antibacterial efcacy of the intracanal medicaments at signicance level of 0.05. Result & Conclusion: Comparatively the combination of Ampicillin and NAC has a higher disruptive effect on biolms when compared to calcium hydroxide.

Guided Endodontics: Three-dimensional Planning and Template-aided Preparation of Endodontic Access Cavities.

Pulp canal obliterations (PCO) are often a consequence of dental trauma, such as luxation injuries. Even though dentin apposition is a sign of vital pulp, pulpitis or apical periodontitis may develop in the long term. Root canal treatment of teeth with severe PCO and pulpal or periapical pathosis is challenging for general practitioners and even for well-equipped endodontic specialists. To ensure detection of the calcified root canal and avoid excessive loss of tooth structure or root perforation, static navigation using templates ("Guided Endodontics") was introduced a few years ago. The general workflow includes three-dimensional imaging using cone-beam computed tomography (CBCT), a digital surface scan, and superimposition of both in a planning software. This is followed by virtual planning of the access cavity and the design of a template that will guide the drill to the desired target point. To do this, a true-to-scale virtual image of the drill must be placed in a way that the tip of the drill reaches the orifice of the calcified root canal. Once the template has been fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM) or a 3D printer, guided preparation of the access cavity can be performed clinically. For research purposes, a postoperative CBCT image can be used to quantify the accuracy of the access cavity performed. This work aims to present the technique of static guided endodontics from imaging to clinical implementation.

Vertical root fracture resistance and crack formation of root canal-treated teeth restored with different post-luting systems

The aim was to investigate the vertical root fracture (VRF) resistance and crack formation of root canal-treated teeth restored with different post-luting systems. Human maxillary lateral incisors of similar size were decoronated, assigned to five groups (n = 18, power = 0.9) and embedded in acrylic blocks with artificial periodontal ligament. After root canal filling, post spaces were prepared to place coated fiber-reinforced composite (FRC) or sandblasted titanium (Ti) posts of the same shape and size. Half of the posts were zinc phosphate cemented (C), while the other half was adhesively luted (A). Untreated teeth served as control. After thermal cycling and staircase loading in a chewing simulator, the crack formation on the root dentin surface was microscopically examined and classified as no defect, craze line, vertical crack, and horizontal crack. Subsequently, the samples were loaded until root fracture. Data were analyzed by one-way ANOVA, Tukey’s test, and Fisher’s exact test. All samples survived the chewing simulation without VRF, but crack formation was significantly different between the groups (P = 0.009). The control showed significantly fewer defects than FRC/C, Ti/C, and Ti/A (P = 0.001, P = 0.008, P = 0.008, respectively). FRC/C showed the highest incidence of vertical cracks. FRC/A had the lowest incidence of defects. There was no significant difference in VRF resistance between the groups (P = 0.265). Adhesively luted FRC posts did not increase VRF resistance but reduced the risk of defects. Most defects were craze lines and vertical root cracks.

Management of External Cervical Resorption in Mandibular Molar Furcation Area - A Case Series

<p>External cervical resorption (ECR) is an aggressive form of root resorption causing loss of tooth structure and sometimes leading to destruction of adjacent alveolar bone. In the advanced extent of ECR lesion, surgical intervention is inevitable. Several studies presented favorable treatment outcomes on advanced ECR lesions at single teeth. In the light of these studies, this article reports on surgical management of two ECR cases. Materials and Methods: Two cases had ECR combined with bony defect in left mandibular first molar. Case 1 had ECR lesion over buccal furcation area combined with buccal bone plate loss. Following root canal treatment, the resorptive defect was restored by mineral trioxide aggregate and the bony defect was treated with guided tissue regeneration (GTR). Case 2 had class II furcation defect with ECR over furcal surfaces of mesial and distal roots. The resorptive defect was restored with bioceramic putty and class II furcation bony defect was treated by GTR. Root canal treatment of tooth 36 was done later after case 2 suffered from symptomatic irreversible pulpitis of tooth 36. Result: At one-year follow-up of case 1, no inflammatory signs with probing pocket depth (PPD) less than 3mm clinically and regeneration of buccal bone plate radiographically were found of tooth 36. At half year follow-up of case 2, there was a healthy gingiva with PPD less than 3mm clinically and the furcation area has been partially filled with regenerated bone radiographically of tooth 36. Conclusion: These case series presented an interdisciplinary surgical management of two cases with external cervical resorption combined with bony defect over lower molar furcation area which were successfully treated with biocompatible restorative material in combination with GTR technique in short-term follow-up.</p> <p> </p>

Microbial analysis of endodontic infections in teeth with post-treatment apical periodontitis before and after medication.

This study aimed to determine the intraradicular microbiota of previously root canal-treated teeth with apical periodontitis and to investigate the antibacterial effectiveness of different intracanal medicaments. Sixteen patients with post-treatment apical periodontitis were allocated into two groups according to the intracanal medicament used: calcium hydroxide (CH) and 2% chlorhexidine gluconate gel (CHX) group. Total bacterial loads, as well as the amount of Enterococcus faecalis (E. faecalis) were determined before (S1) and after (S2) chemomechanical preparation and finally, after intracanal medication (S3) by means of ddPCR. The unpaired t test was used to compare parametric. S3-total bacteria copy number of the CH group was lower than the CHX group (p<0.05). There was no statistical difference between the CHX- and the CH groups in terms of E.faecalis copy number (p>0.05). But in terms of total bacteria, CH is better than CHX. Consequently, CH can be used to optimise the antibacterial efficiency of chemomechanical preparation in previously root canal-treated teeth with apical periodontitis.

Improving the microbial sampling and analysis of secondary infected root canals by passive ultrasonic irrigation

ObjectiveThe persistence of pathogenic microorganisms in root canals is the most common reason for the failure of root canal treatment and the necessity of a root filling treatment, which results in an uncertain prognosis due to technical complexity and the variety of highly adaptable microorganisms.This study evaluated the effect of passive ultrasonic irrigation (PUI) on the outcome of the microbial analysis of root canal-treated teeth with persistent or recurrent apical inflammation in vivo.Materials and methodsSample collection was performed after root filling removal (sample S1, control group) and after PUI with NaCl (sample S2) using sterile paper points. In total, 19 samples were obtained. Quantification was performed by means of serial dilution of the samples. Subcultivated pure cultures were identified using MALDI-TOF MS complemented by the Vitek-2-System or PCR, followed by sequencing of the 16S rRNA gene. The results of the samples (S1 and S2) were evaluated regarding their bacterial count and composition.ResultsThe total count of bacteria and the number of aerobic/facultative anaerobic microorganisms significantly increased in the S2-samples after application of PUI. The number of obligate anaerobic microorganisms showed an increase after PUI, although it was not significant. We detected 12 different aerobic/facultative anaerobic microorganisms before PUI, and in 21 cases after PUI. Two different obligate anaerobic microorganisms were found in S1 samples compared to nine different species in S2 samples.ConclusionsPUI is a powerful method for detaching bacteria in infected root canals and enables a more precise analysis of the etiology of persistent endodontic infections.Clinical relevanceThis study indicates that PUI exerts a positive cleansing effect and adds to the accessibility of microorganisms during the application of bactericidal rinsing solution in root canal treatments.

Effectiveness of Intracanal Cryotherapy using Different Irrigants on Reduction of Post Endodontic Pain – A Systematic Review and Meta-analysis

Introduction: Recently the non-pharmacological management of post endodontic pain has been extensively studied. The aim of this systematic review was to evaluate the effectiveness of intracanal cryotherapy in reducing postoperative endodontic pain. A comprehensive search was conducted by accessing electronic databases like PubMed, Google Scholar, Google and EBSCO. Articles evaluating the effect of intracanal cryotherapy in reducing postoperative pain using different irrigating agents which were published till November 2020 were included in the study. Risk of bias was assessed using the Cochrane risk of bias criteria. Meta-analysis was performed for ten studies and tested the heterogeneity using I2 index. Qualitative and quantitative analysis was done for thirteen and ten studies respectively. Intracanal cryotherapy was found to be effective in reducing post-operative pain at 6 hours and 24 hours. Within the limitations of the study, it can be concluded that intracanal cryotherapy using cold saline or 17% EDTA at a temperature range of 2.5°C to 6°C as final irrigating agent helps in reducing postoperative pain at 6 hrs and 24 hrs following single-visit or multi visit root canal treatment in teeth diagnosed with irreversible pulpitis with apical periodontitis.

Evaluation of microleakage of three different endodontic sealers in the presence and absence of moisture

Background and aims: AH26, Master-Dent, and Endoseal mineral trioxide aggregate (MTA) are three different types of sealers. The purpose of this study was to assess and compare THE apical seal of the root canal-treated teeth with the above-mentioned sealers in the presence and absence of moisture using the fluid filtration method. Methods: To this end, 54 freshly extracted single root canal human canines were selected for this study. The canals were prepared using rotary instruments, and then sodium hypochlorite was applied as an irrigation solution in this protocol. The specimens were randomly divided into three groups of 18. One group was obturated with the gutta-percha by the cold lateral compaction technique. Half of one of the aforementioned sealers belonged to the group of moistened teeth and the other half to the group of the dried teeth. Microleakage in all groups was assessed 3 months after the obturation of canals by the fluid filtration method. The data were analyzed using ANOVA and Tukey’s post hoc tests, and the level of significance was set at P&lt;0.05. Results: The results showed that the minimum and maximum micro-leakage belonged to Masterdent dry (mean leakage = 1.7778 μL/ min/CmH20) and Endoseal-MTA dry (mean leakage = 3.5000 μL/min/CmH20), respectively. All three groups of sealers exhibited a significant difference in apical micro-leakage between dry and moist conditions (PMasterdent &lt;0.001, PAH26=0.002, and PEndoseaL-MTA =0.007). Conclusion: The findings of this experimental study demonstrated that Masterdent provided the least apical micro-leakage under dry conditions while Endoseal-MTA had the highest micro-leakage under these conditions. There was a significant difference between dry and moist conditions in all groups.

Management of C-shaped canals using “Membrane-Barrier Technique”: A Case report

A 61-year old Chinese female was referred from a general private practitioner for persistent buccal abscess after completion of root canal treatment of tooth 37. On clinical examination, tooth 37 presented with a metal-ceramic crown (CMC) with 2mm of gingival recession noted at the buccal region. The overlying amalgam core was overhanging on distal and grade 2 mobility. The 37 CMC have no contact point at the distal. Tooth 37 was not tender to palpation but tender to percussion. No periodontal pocketing was detected. The periapical radiograph revealed a periapical radiolucent area associated end of its root. These 37 apices were resorbed, probably a result of the apical periodontitis there. Widening of periodontal space was noted with this 37. A diagnosis of chronic apical periodontitis with external resorption of root apices with a C-shaped canal was made for the tooth 37.Membrane barrier technique with MTA was used for obturation. A bonded amalgam core was placed in this tooth.

Apical Periodontitis Healing Following Treatment is Impacted by Root Canal Sealer Composition: An in Vivo and in Vitro Investigation

Objective: To evaluate the periapical healing following root canal treatment in teeth with apical periodontitis (in vivo) and the cytotoxic potential of root canal sealers in vitro. Material and Methods: Apical periodontitis was induced in 60 dogs' teeth and root canals were filled with Sealapex (40 roots), EndoREZ (40 roots), intracanal dressing (20 roots), or left untreated (20 roots). After 30 and 90 days, histopathological analyses were made. In vitro, J774.1 macrophages were stimulated with root canal sealers extracts, cytotoxicity was assessed using lactate dehydrogenase assay, and qRT-PCR was used to analyze TNF-α gene expression. Results: In vivo, smaller apical periodontitis and lower inflammatory cell infiltrate were found in teeth treated with Sealapex compared to EndoREZ. In vitro, EndoREZ was cytotoxic and induced TNF-α gene expression by macrophages differently from Sealapex. Conclusion: Sealapex allowed improved tissue repair following root canal treatment in teeth with apical periodontitis compared to EndoREZ. Synthesis of TNF-α induced by LPS was enhanced by EndoREZ, whereas Sealapex prevented pro-inflammatory gene expression.

Quality of Root Canal Fillings and Prevalence of Apical Radiolucencies; A Retrospective Study

The criteria typically used include the incidence of procedural mistakes and obturation characteristics, such as length and density. Apical periodontitis in root canal treated teeth (RCTT) is a significant public health problem. Apical periodontitis in root canal treated teeth (RCTT) is a significant public health problem. Epidemiological studies&nbsp;are conducted to explore the frequency of the Periapical status of RCTT in several populations. Many authors&nbsp;have examined the effect of RCT

Prevalence of periapical lesions in non-endodontically and endodontically treated teeth in an urban Iraqi adult subpopulation: A retrospective CBCT analysis

This study aimed to assess the prevalence of apical periodontitis (AP) and its association with the presence/quality of root canal filling (RCF) and coronal restoration (CR) in Iraqi population. A total of 385 CBCT scans of patients (18-45) yrs. old with 9250 teeth were examined. The teeth were grouped according to the presence/absence of apical radiolucency, presence/radiographic quality of RCF, and CR. Chi-square and Kappa were used to assess associations and intra-consensus reliability. Logistic regression was used to predict risk factors associated with AP. The significant level was set at p<0.05. AP was prevalent in 17.7 and 80.2% of teeth without RCT and with RCT (p<0.05), respectively. AP in root canal-treated teeth with missed canals (93.2%) was higher than that in root canal-treated teeth with no missing canal (78.3%) (p<0.05). AP in teeth with inadequate RCF (87%) was higher than that in teeth with adequate RCF (63%) (P<0.05). No difference in the prevalence of AP in teeth with adequate vs inadequate CR ((79.7%) vs (81%), respectively) (p>0.05). The presence of AP was significantly associated with inadequate RCF (vs adequate RCF) (OR=4.16, CI 95% 2.29-7.56, P<0.05), and was not associated with inadequate CR (vs adequate CR) (OR=-0.71, CI 95% 0.35-1.42, P>0.05). Intra-consensus reliability was (0.9) for AP and (0.82) for RCF and CR quality. AP was highly prevalent in teeth with previous root canal filling compared to non-treated teeth. AP was significantly associated with inadequacy of root canal filling but not with the inadequacy of coronal restoration. Key words:Apical periodontitis, cone beam computed tomography, root canal treatment, endodontics.

Diabetes Mellitus Affects the Microhardness of Root Dentine: An in-vitro Study.

ObjectiveThis study was undertaken to compare microhardness and erosion susceptibility of root dentine in teeth extracted from diabetic and non-diabetic donors after the application of different root canal irrigants.MethodsForty-eight single-rooted premolars with single canals (24 each from diabetic and non-diabetic) were selected, and root canals were shaped by using rotary ProTaper files. Dentine slices of 4 mm were transversely sectioned from the middle root third. Specimens were assigned to four subgroups (n=6) and irrigated for 5 minutes: 1) 2.6% sodium hypochlorite (NaOCl); 2) 17% ethylenediaminetetraacetic acid (EDTA); 3) 2% chlorhexidine (CHX); and 4) normal saline. Surface microhardness was determined at 100- and 500-µm depths from the pulp–dentine interface. Scanning electron microscope (SEM) was used to determine the severity of dentine erosion. Data were analyzed by using two-way ANOVA, Post-hoc Tukey’s, and Chi-square tests (P<0.05).ResultsDiabetes as well as NaOCl and EDTA decreased surface microhardness of dentine significantly (P<0.05). Diabetes had little effect on the erosion susceptibility of dentine (P>0.05).ConclusionRoot canal irrigants can significantly lower the microhardness; specifically, in diabetic patients, and may be a factor affecting the longevity of root canal-treated teeth.

Comparative evaluation of the effect of adhesive restorative composite resins on the reinforcement of peri-cervical dentin: An in vitro study.

Background:Peri-cervical dentin (PCD) and its reinforcement play a crucial role in the fracture resistance of root canal-treated teeth.Aims:The aim of this study was to compare the fracture resistance of dual-cure, nano-hybrid, and short-fiber reinforced composite resins restored PCD with conventional hybrid composite (CHC) resin restored endodontically treated mandibular premolars.Settings and Design:Academic, in vitro study.Materials and Methods:The prepared mandibular premolar samples were randomly divided into five groups of 10 each. In Group 1, teeth were left intact. The remaining 40 teeth were endodontically treated and obturated as follows: In Group 2, teeth were obturated with gutta-percha till cementoenamel junction and restored with CHC. Teeth in Groups 3, 4, and 5 were obturated to a depth of 5 mm from the cervical line and restored with dual-cure, nano-hybrid, and short-fiber reinforced composite resins, respectively. Fracture resistance was tested using a universal testing machine.Statistical Analysis Used:One-way analysis of variance and post hoc Tukey's test.Results:Short-fiber reinforced composite resin showed a significantly higher mean fracture resistance value compared with other experimental groups. The mean fracture resistance values were obtained as Group 1 > Group 5 > Group 4 > Group 3 > Group 2.Conclusions:Reinforcement with short-fiber reinforced composite showed significantly higher fracture resistance compared with nano-hybrid and dual-cure composite resins.

Penatalaksanaan Perawatan Saluran Akar pada Gigi dengan Lesi Abfraksi : Laporan Kasus

Background: Pulp and periapical disease may also result from the presence of a cervical cavity reaching the pulp chamber as an abfraction lesion. Abfraction causes the dentinal tubules to be exposed so that it becomes a pathway for microorganisms to enter the pulp. Root canal treatment in cases with abfraction lesions requires special management, so that contamination does not occur during treatment due to the exposed cervical part. Objective: Discusses the management of root canal treatment in teeth with abfractional lesions that penetrate the pulp chamber. Case Management: A 53-year-old male patient came RSGM Unand because he wanted to be treated for a cavity in his right lower posterior tooth and had a sudden throbbing pain. Based on the results of subjective, objective and preoperative radiographs, tooth 45 was diagnosed with pulp necrosis with chronic apical abscess. Pulp and periapical disease of tooth 45 was probably caused by the entry of microorganisms through the abfraction lesion that reached the pulp chamber. Temporary coronal seal of the abfraction cavity and access occlusal cavity is necessary to prevent the entry of microorganisms during root canal treatment procedures. The final restoration is a direct composite resin using a fiber-reinforced composite (FRC). Conclusion: The management of root canal treatment in this case of abfraction lesion showed success as indicated by the absence of subjective complaints, objective examination showed negative results, and periapical lesions showed healing seen on periapical radiographs.&#x0D;

Endodontic mishaps during root canal treatment performed by undergraduate dental students: An observational study.

Endodontic mishaps during root canal treatment (RCT) are considered to be one of the most commonly encountered errors, which affect the quality of treatment and may have dangerous health implications for patients.The present study was conducted to assess the frequency and types of endodontic mishaps in root canal-treated teeth performed by undergraduate dental students.A total 404 endodontically treated teeth were performed by undergraduate dental students of King Khalid University College of Dentistry, Abha, Kingdom of Saudi Arabia. The radiographs of the endodontically treated teeth were studied for a period of 6 months, and the related demographic data were collected from patient files.The most commonly identified mishaps were related to obturation, where the maximum number of cases (68.1%) had under-obturated root canals. More endodontic mishaps were performed by students in level 9 education. The upper left 2nd molar teeth had a higher frequency of mishaps, and molars were found to have more access-related mishaps. Lastly, access-related and instrument-related mishaps had a low frequency of occurrence.The majority of endodontic mishaps found in the study sample were related to root canal obturation. The undergraduate students at level 9 were less proficient in conducting RCTs with many endodontic mishaps when compared to the cases performed by students at higher levels. The study suggests relevant guidance for dental students while performing RCTs, especially during obturation of the root canals.

Aesthetic dental challenges for the paediatric patient

Advancements in material science have contributed greatly towards aesthetic dentistry. However, achieving satisfactory aesthetics for children in the developing dentition poses unique challenges. Challenges include, but are not limited to: (1) patient co-operation; (2) optimum moisture control; (3) continuing gingival maturation and bone growth; and (4) the increased need for minimally invasive and non-irreversible techniques to maintain future treatment options. This article addresses the common paediatric dental aesthetic challenges of uncomplicated crown fractures (ie those confined to enamel and dentine), localized, discrete enamel opacities and intrinsic discolouration of anterior, root canal-treated teeth. Treatment techniques and helpful tips for the general dental practitioner are presented. CPD/Clinical Relevance: This article focuses on common dental aesthetic challenges that present in the paediatric dental population and suggests methods to manage this effectively in primary and secondary care.

Prevalence of apical periodontitis between root canal-treated and non-treated teeth and between genders: A cross-sectional CBCT study.

Apical periodontitis (AP) is one of the most important prognostic factors in almost all endodontic outcome studies. The high prevalence of AP has been reported in different populations. The aim of the present study was to investigate (a) the overall prevalence of AP among all permanent teeth, (b) the differences between root canal-treated (RCT) and non-treated teeth in association with AP, and (c) the influence of gender on AP in a Saudi Arabian population using cone-beam computed tomography (CBCT). A total of 208 CBCT radiographs (including 5,504 permanent teeth) were investigated. The CBCT machine used in this study was a 3D Accuitomo 170 (Morita, Japan) with the following features: 90 kV, 5-8 mA, 17.5 s exposure time, and 0.25 mm voxel size. The radiographs of the axial, coronal, and sagittal segments of each tooth were acquired to evaluate the presence or absence of RCT teeth and AP. The data were presented as frequencies and percentages. Z test was used to analyze the differences in proportions at the significance level of P < 0.05. The overall prevalence of AP was 4.5% (264 out of 5,504 permanent teeth). AP had the highest frequencies in the mandibular and maxillary first molars (18.4 and 9.3%, respectively) with a higher prevalence in the maxillary teeth. AP was associated with endodontically treated teeth more than the untreated ones (66.3% compared with 33.7%) with a highly significant difference (P < 0.001). AP was more prevalent in females than in males but with no statistically significant difference (P > 0.05). AP had a low prevalence (4.5%) in all permanent teeth and was highly associated with RCT teeth (66.3%). First molars had the highest prevalence of AP. Care must be taken when examining patient radiographs to avoid missing AP, particularly in RCT teeth.

A novel insertion design of fiber materials for the adhesive reattachment in vertically fractured teeth.

ObjectiveThis ex vivo study aimed to evaluate the strengthening effect of different ferrule and reattachment designs with fiber and adhesive materials on vertically fractured teeth.MethodsNinety extracted single-root premolars were instrumented and divided into nine groups (two control groups and seven experimental groups; n = 10). The negative control (NC) group comprised of intact teeth, while the positive control (PC) group comprised of root canal-treated teeth. The roots of the teeth in the experimental groups were vertically fractured into two equal fragments. The fragments were reattached with one of the followings: 4-methacryloxyethyl trimellitate anhydride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin, 4-META/MMA-TBB + quartz fiber post, 4-META/MMA-TBB + glass fiber bundles, 4-META/MMA-TBB + quartz fiber post + 1 mm ferrule, 4-META/MMA-TBB + glass fiber bundles + 1 mm ferrule, 4-META/MMA-TBB + quartz fiber post + 2 mm ferrule, and 4-META/MMA-TBB + glass fiber bundles + 2 mm ferrule. The core build-ups were made with composite resin. The specimens were subjected to compressive loading until failure occurred. Mean load necessary to fracture each sample and the fracture types of these samples were recorded.ResultsThe highest mean fracture load was recorded in the NC group (1,036.7 N), which was not significantly higher than the PC group (989.66 N) (p > 0.05). The roots reattached with quartz fiber post demonstrated significantly less fracture strength (871.9 N) as compared to the other test and control groups (p < 0.05). There was no significant difference between the PC group and reattached fragments with different ferrule designs in terms of fracture resistance (p > 0.05).ConclusionsThe customized fiber bundles may be more suitable for reattachment of vertically fractured teeth than the rigid fiber posts. For reattachment procedures, the ferrule design may be preferred to increase the fracture strength of vertically fractured teeth.

Resistance against Fracture in Teeth Managed by Root Canal Treatment on Restoring with Onlays, Inlays, and Endocrowns: A Comparative Analysis

To compare the fracture resistance in teeth managed by root canal treatment after restoring with different types of onlays, inlays, and endocrowns prepared with hybrid ceramics and pulp chambers restored with fiber-reinforced composite and resin composite that were radiopaque, light-cured, and flowable. The present study was carried out on 252 extracted mandibular molars. All the specimens were divided into six groups randomly. Each group consisted of 42 specimens. Group 1 consisted of intact teeth without any access cavity. It was the control group. Group 2 consisted of teeth with endocrown and empty pulp chamber. Group 3 consisted of teeth with mesio-occlusal-distal (MOD) onlay prepared with hybrid ceramics and pulp chamber filled with flowable, light-cured, radiopaque resin composite. Group 4 consisted of teeth with MOD onlay and pulp chamber filled with fiber-reinforced composite. Group 5 consisted of teeth with MOD inlay and pulp chamber filled with flowable, light-cured, radiopaque resin composite. Group 6 consisted of teeth with MOD inlay and pulp chamber filled with fiber-reinforced composite. Inlay, onlay, and endocrowns were prepared with computer-aided design (CAD) and computer-aided machine (CAM) using hybrid ceramics. Universal testing machine was used for the measurement of the fracture resistance of each specimen. Inferential statistics were performed by applying Fisher's exact test and chi-square test. Fracture strength was found to be maximum in the intact teeth group followed by the endocrown. The fracture strength was minimum in the inlay group. The fracture strength was intermediate in the onlay groups. Endocrown showed maximum fracture resistance as compared to the inlay and onlay restorations. Proper management of root canal-treated teeth is one of the greatest challenges for endodontists. It has been observed that tooth preparation design and the material used for the restoration of root canal-treated teeth play a vital role in the resistance against fracture in the teeth.