A case report of multiple bilateral dens invaginatus in maxillary anteriors

The present report presents a case of dens invaginatus (DI) in a patient with 4 maxillary incisors. A 24-year-old female complained of swelling of the maxillary left anterior region and discoloration of the maxillary left anterior tooth. The maxillary left lateral incisor (tooth #22) showed pulp necrosis and a chronic apical abscess, and a periapical X-ray demonstrated DI on bilateral maxillary central and lateral incisors. All teeth responded to a vitality test, except tooth #22. The anatomic form of tooth #22 was similar to that of tooth #12, and both teeth had lingual pits. In addition, panoramic and periapical X-rays demonstrated root canal calcification, such as pulp stones, in the maxillary canines, first and second premolars, and the mandibular incisors, canines, and first premolars bilaterally. The patient underwent root canal treatment of tooth #22 and non-vital tooth bleaching. After a temporary filling material was removed, the invaginated mass was removed using ultrasonic tips under an operating microscope. The working length was established, and the root canal was enlarged up to #50 apical size and obturated with gutta-percha and AH 26 sealer using the continuous wave of condensation technique. Finally, non-vital bleaching was performed, and the access cavity was filled with composite resin.

Cutting efficiency of apical preparation using ultrasonic tips with microprojections: confocal laser scanning microscopy study

OBJECTIVES: The purpose of this study was to compare the cutting efficiency of a newly developed microprojection tip and a diamond-coated tip under two different engine powers. MATERIALS AND METHODS: The apical 3-mm of each root was resected, and root-end preparation was performed with upward and downward pressure using one of the ultrasonic tips, KIS-1D (Obtura Spartan) or JT-5B (B&L Biotech Ltd.). The ultrasonic engine was set to power-1 or -4. Forty teeth were randomly divided into four groups: K1 (KIS-1D / Power-1), J1 (JT-5B / Power-1), K4 (KIS-1D / Power-4), and J4 (JT-5B / Power-4). The total time required for root-end preparation was recorded. All teeth were resected and the apical parts were evaluated for the number and length of cracks using a confocal scanning micrscope. The size of the root-end cavity and the width of the remaining dentin were recorded. The data were statistically analyzed using two-way analysis of variance and a Mann-Whitney test. RESULTS: There was no significant difference in the time required between the instrument groups, but the power-4 groups showed reduced preparation time for both instrument groups (p < 0.05). The K4 and J4 groups with a power-4 showed a significantly higher crack formation and a longer crack irrespective of the instruments. There was no significant difference in the remaining dentin thickness or any of the parameters after preparation. CONCLUSIONS: Ultrasonic tips with microprojections would be an option to substitute for the conventional ultrasonic tips with a diamond coating with the same clinical efficiency.

MB2 canal detection using dental loupe and ultrasonic tip

Background: In Vietnam, using dental loupe and ultrasonic tip to detect MB2 canal in mesiobuccal roots of maxillary molars is appropriate and necessary. Objective: The purpose of this study is to assess the effectiveness of magnification and dentine removal when locating the second mesiobuccal canal (MB2) in mesiobuccal roots of maxillary molars. Subject and methods: 49 mesiobuccal roots of maxillary molars were collected and studied. Conventional access of the cavity was prepared. After that, the MB1 and 2 canals in mesiobuccal roots were located in three stages. Stage 1: canals were located with no magnification. Stage 2: additional canals in the same teeth were located under magnification with a dental loupe. Stage 3: additional canals in the same teeth were located by removing dentine from the pulp chamber floor within 3mm from the MB1 canal towards the palatal canal in a groove 2 mm deep using ultrasonic tip (P5, Salatec). Result: The frequency of MB2 canal detection for an ultrasonic tip, dental loupes, and no magnification groups was 77.6%, 59.2% and 24.5%, respectively. Conclusion: Based on these results, more emphasis should be placed on the importance of using magnification dental ultrasonic tip to locate the MB2 canal.