Effect of dentin roughening and type of composite material on the restoration of non-carious cervical lesions: an in vivo study with 18 months of follow-up.

Objectives: The purpose of this study was to evaluate the impact of dentin roughening and the type of composite resin used (either bulk-fill flowable or nanohybrid) on the restoration of non-carious cervical lesions (NCCLs) with an 18-month follow-up period. Materials and Methods: This prospective split-mouth study included 36 patients, each with a minimum of 4 NCCLs. For each patient, 4 types of restorations were performed: unroughened dentin with nanohybrid composite, unroughened dentin with bulk-fill flowable composite, roughened dentin with nanohybrid composite, and roughened dentin with bulk-fill flowable composite. A universal bonding agent (Tetric N Bond Universal) was applied in self-etch mode for all groups. The restorations were subsequently evaluated at 6, 12, and 18 months in accordance with the criteria set by the FDI World Dental Federation. Inferential statistics were computed using the Friedman test, with the level of statistical significance established at 0.05. Results: The 4 groups exhibited no significant differences in relation to fracture and retention, marginal staining, marginal adaptation, postoperative hypersensitivity, or the recurrence of caries at any follow-up point. Conclusions: Within the limitations of the present study, over an 18-month follow-up period, no significant difference was present in the clinical performance of bulk-fill flowable and nanohybrid composite restorations of non-carious cervical lesions. This held true regardless of whether dentin roughening was performed.

Comparative assessment of the outcome of complete pulpotomy using mineral trioxide aggregate and Biodentine in mature permanent mandibular molars with symptomatic irreversible pulpitis: A randomized clinical trial with 18 months of follow-up.

Background: Mature permanent teeth with irreversible pulpitis have traditionally been managed with pulpectomy. With advancements in pulp biology and dental materials, many clinicians are using vital pulp therapies like pulpotomy to manage such teeth. The current study was conducted to help clinicians in making decisions about case selection and choice of material for such cases. Aim: This randomized clinical trial evaluated the outcome of complete pulpotomy, using mineral trioxide aggregate (MTA) and Biodentine, in permanent mandibular molars with symptomatic irreversible pulpitis (SIP). Materials and Methods: Fifty patients with moderate-to-severe pain in mandibular molars with SIP were included in this prospective, parallel, single-blind clinical trial. Coronal pulp was completely removed and hemostasis was achieved with a cotton pellet moistened with 2.5% sodium hypochlorite. Subsequently, the radicular orifices were randomly covered with MTA or Biodentine. All teeth were permanently restored with composite restoration at the same appointment. Clinical evaluation was performed at 1 week, 3 months, 6 months, 12 months, and 18 months and radiographic evaluation was done after 6 months, 12 months, and 18 months. Mann-Whitney U and Chi-square tests were utilized for statistical analysis. Results: Success rates of MTA and Biodentine pulpotomy were 63.6% and 69.6%, respectively, with no significant difference between the two groups at any follow-up period (P > 0.05). Conclusion: There were no significant differences in complete pulpotomy success rates between MTA and Biodentine over 18 months in mandibular molars with SIP.

Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up: A case report and review of literature.

BACKGROUND: The presence of dens invaginatus (DI) complicates treatment of any tooth, from diagnosis to access cavity and biomechanical preparation and obturation. Reports of successful non-surgical management of DI type IIIB in maxillary lateral incisor are rare. Here, we report such a case, with three root canals and a long follow-up. CASE SUMMARY: A 13-year-old female patient presented with mild pain in the maxillary right lateral incisor (#7) for 10-15 d. On examination, the tooth was slightly rotated, with slight tenderness on percussion and grade I mobility but with no caries, pockets or restorations and non-vital pulp (via vitality tests). Radiographic examination revealed unusual configuration of the tooth's root canals, with an enamel-lined invagination extending to the apex, suggesting the possibility of DI Oehler's type IIIB and a periapical radiolucency. Widening the access cavity lingually revealed one distinct buccal orifice and two distinct palatal orifices; under higher magnification of a dental operating microscope (DOM), the mesio-palatal and disto-palatal orifices were observed as connected by a C-shaped groove. The root canals were prepared with hand K-files following a step-back technique, and obturated using a combination technique of lateral condensation and vertical compaction. At the 6-year follow-up, the patient was asymptomatic, and the periapical radiography displayed significant healing around the apical end of the root. CONCLUSION: Proper knowledge of unusual root canal anatomy is required in treating DI. Conventional methods of root canal treatment can successfully resolve such complex cases, facilitated by DOM and cone-beam computed tomography.

Evaluating Combined Effect of Oral Premedication with Ibuprofen and Dexamethasone on Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial.

INTRODUCTION: The success rate of inferior alveolar nerve block decreases exorbitantly in teeth with symptomatic irreversible pulpitis. The purpose of this prospective, double-blind, randomized clinical trial was to evaluate the combined effect of oral premedication with ibuprofen and dexamethasone on the success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis. METHODS: Ninety-four adult patients actively experiencing pain and diagnosed with symptomatic irreversible pulpitis willingly participated in this study. Preoperative pain was recorded on the Heft-Parker visual analog scale. Patients were randomly allocated to 4 different groups and received placebo, 0.5 mg dexamethasone, 800 mg ibuprofen, or a combination of 0.5 mg dexamethasone and 800 mg ibuprofen. One hour after oral premedication, all patients received standard inferior alveolar nerve block containing 2% lignocaine with 1:200,000 adrenaline. Access cavity preparation was initiated 15 minutes after the administration of anesthesia. Pain scores were recorded on VAS after anesthesia, at dentin penetration to pulp chamber opening, and on file placement. Success was defined as no or mild pain (0-54 mm) throughout the procedure. RESULTS: The chi-square test was used for qualitative data comparison. The 1-way analysis of variance test and post hoc Bonferroni test showed a statistically significant difference between the combination of 0.5 mg dexamethasone and 800 mg ibuprofen group and the other 3 groups (P < .001). CONCLUSIONS: Preoperative administration of a combination of dexamethasone and ibuprofen improved the success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis.

Multidisciplinary Approach for the Management of Mandibular Canines with Rare Configuration.

It is very rare (2%-6% cases) for a mandibular canine to have two root canals and the incidence of finding two roots with two root canals in a mandibular canine that too bilaterally is almost negligible. This case report discusses the presence and multidisciplinary management of such rarest configuration in both mandibular canines of a female patient. This case shows the importance of recognition of anatomical variations in successful accomplishment of root canal treatment.

Endodontic Management of a Severely Dilacerated Mandibular Third Molar: Case Report and Clinical Considerations.

This article aims at providing an insight to the clinical modifications required for the endodontic management of severely dilacerated mandibular third molar. A 35-year-old patient was referred for the root canal treatment of the mandibular left third molar. An intraoral periapical radiograph revealed a severe curvature in both the canals. A wide trapezoidal access was prepared following the use of intermediate-sized files for apical preparation. Owing to increased flexibility, Hero Shaper NITI files were used for the biomechanical preparation and single cone obturation was carried out. Third molars owing to their most posterior location-limited access coupled with a severe curvature pose utmost clinical challenges require meticulous skill, advanced technology, and patience to achieve success.

An in vitro comparison of the antimicrobial efficacy of positive pressure and negative pressure irrigation techniques in root canals infected with Enterococcus faecalis.

AIM: The aim of this in vitro study was to compare the efficacy of irrigation with the negative pressure and the traditional positive pressure in eradicating Enterococcus faecalis from the root canal. MATERIALS AND METHODS: A total of 40 extracted mandibular premolars were sterilized and divided into four groups with 10 samples each. Then, they were prepared to apical size #35 (Group 1, 3) and 45 (Group 2, 4) and inoculated with E. faecalis for 7 days and then irrigated with 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. The positive pressure irrigation was performed in Group 1 and Group 2 while the negative pressure irrigation (NPI) using the Endovac in Group 3 and Group 4. Samples taken after the root canal irrigation procedures were cultured and the colony-forming units were counted. Data were statistically analyzed using the Fisher's exact test. RESULTS: Results were statistically significant when comparing apical negative-pressure irrigation size 45 (Group 4) to positive-pressure irrigation size 35 (Group 1). CONCLUSION: The results of this in vitro study showed that the apical NPI method (Endovac) was more effective in removing E. faecalis from the root canal at the larger apical preparation size.

Effect of local anesthesia containing vasoconstrictor on sealing ability of dentin with two adhesive systems: Dye leakage and scanning electron microscopy study.

OBJECTIVES: To evaluate the effect of 2% lignocaine containing 1:80,000 adrenaline on the microleakage and ultrastructure of resin tooth interface using an acetone based total etch adhesive (Prime and Bond NT) and an ethanol water based self etch adhesive system (Xeno III). MATERIALS AND METHOD: Class V cavities were prepared on buccal surfaces of 72 maxillary first premolars scheduled for orthodontic extraction. In 36 premolars procedure was performed under local anaesthesia (LA) and in other 36 teeth without LA. Restorations were done with hybrid composite Spectrum TPH using either Prime and Bond NT or Xeno III bonding agents. RESULTS: Administration of 2% lignocaine with 1:80,000 adrenaline significantly reduced microleakage and improved quality of hybrid layer and tubular penetration in Prime and Bond NT specimens; but no significant effect was observed in Xeno III specimens. CONCLUSION: Under clinical conditions, administration of LA reduced microleakage and improved quality of hybrid layer and tubular penetration in total etch adhesive systems.

Management of A Rare Case of Communicating Internal-External Inflammatory Resorption.

The present case describes the successful management of a rare case of communicating internal-external resorption in which both internal and external resorption seem to develop independent of each other. The case report highlights the importance of correct diagnosis and need of revision of classification system of resorptive defects.

The prevalence and pattern of cavitated carious lesions in primary dentition among children under 5 years age in Sirsa, Haryana (India).

BACKGROUND: To determine the prevalence and pattern of cavitated carious lesions in primary dentition in children below 5 years of age in Sirsa, Haryana. AIMS: The aim of this study was to evaluate the status of dental caries in primary dentition and compute data for planning anticipatory programs in children aged less than 5 years. SETTINGS AND DESIGN: The study was conducted among children attending the outpatient department of pedodontics, JCD Dental College, Sirsa, Haryana (India) from April to December 2014. MATERIALS AND METHODS: This study consisted of 576 children of both sexes (311 males and 265 females) up to 5 years of age. Dentition status and treatment proforma (WHO, 1997) was used to assess the prevalence of cavitated carious lesions. Selection of children for the study was done by simple random sampling method. STATISTICAL ANALYSIS: Chi-square test and t-test were used to compute data for statistical analysis. RESULTS: 33.85% of children in the study population showed presence of cavitated carious lesions. Males showed slightly higher prevalence of cavitated carious lesions than females (P = 0.35). Incidence of caries was higher in mandibular arch in both the sexes (males P = 0.9, females P = 0.7) and in posterior teeth (both sex wise and arch wise). Higher caries prevalence was noticed in maxillary anterior teeth (P = 0.04) and mandibular posterior teeth (P = 0.7). Primary second molars showed highest caries prevalence (P = 0.39) in both the arches and sexes. CONCLUSION: The mean prevalence of cavitated carious lesions in primary dentition was found to be 33.85%. Males were more affected than females. Mandibular molars and maxillary anterior teeth were the predominantly affected teeth. Mandibular anterior teeth were least affected. The increase in incidence of cavitated carious lesions shows that there is necessity of implementing dental health awareness programs and modifications in types of food consumed are needed to eliminate the cause of decay.

Management of a large internal resorption lesion with metal reinforced glass ionomer cement.

Mineral trioxide aggregate is the mainstay of treatment of large internal resorption defects. But its cost may be a deterrent to its use in some patients. The present case report describes the successful endodontic management of an extensive internal resorptive lesion in a mandibular molar with metal reinforced glass ionomer cement.

Root canal configuration of permanent maxillary first molar in Khasi population of Meghalaya: An in vitro study.

AIMS AND OBJECTIVE: To investigate the root canal configuration of permanent maxillary first molar in Khasi population of Meghalaya. MATERIAL AND METHODS: Sixty (60) permanent maxillary first molars collected from patients of Khasi population of Meghalaya were studied using canal staining and clearing technique. Observations of the number of roots, root canal configuration, lateral canal, apical delta, and presence of the additional type of canals were made. RESULTS: Based on Vertucci's classification the different types of canal identified are: Mesiobuccal root, Type I (28.3%), Type II (28.3%), Type IV (30.0%), Type V (5.0%), Type VI (6.7%), and an additional type of canal (2-1-2-1-2; 1.7%) were observed. The distobuccal root displayed Type I (95%), Type II (1.7%), Type V (3.3%). The most prevalent canal configuration in the palatal roots is Type I (98.3%), Type II (1.7%). CONCLUSION: In Khasi population of Meghalaya, the most prevalent root canal configuration in the mesiobuccal root is Type IV followed by Type I and Type II. MB2 canals are present in more than 65% cases. In palatal and distobuccal roots, Type I configuration is present in most cases. Racial divergence may be responsible for such variations.