Two Palatal Roots in Maxillary First Molar, a Rare Entity: Report of Two Cases.

An in-depth understanding of the anatomical variations of maxillary molars is essential for endodontic success. Unlike the maxillary second molars, the presence of a second palatal root is uncommon in the first maxillary molar. This case report describes two cases of non-surgical management of maxillary molars with extra palatal roots. Careful clinical examination, knowledge of the internal anatomy, and the use of advanced radiographic modalities like cone beam computed tomography (CBCT) can reveal the presence of variations in the internal and external anatomy of any tooth. Therefore, for nonsurgical as well as surgical management clinicians should always watch out for any deviations in a tooth and utilize all the available tools to diagnose and manage them successfully.

Effect of monowave and polywave light curing on the degree of conversion and microhardness of composites with different photoinitiators: An in vitro study.

Aim: The purpose of this study was to evaluate the effect of light-curing units (LCUs) on the degree of conversion (DC) and microhardness of composites with varying photoinitiator systems. Materials and Methodology: Two groups were formed based on LCU - monowave (Group M) and polywave (Group P). Each group was further divided into two subgroups based on photoinitiator systems - combination of camphorquinone (CQ), Ivocerin, and 2,4,6-trimethylbenzoyl diphenylphosphine oxide (Subgroup CIT) and only CQ (Subgroup C) in the composite. Samples prepared were 4 mm thick. Microhardness was measured at bottom surface by Vickers hardness tester, and DC was evaluated by Fourier transformation infrared spectroscopy. Statistical Analysis: Kolmogorov-Smirnov test was used. Results: Both the mean microhardness and DC of composite in subgroup C were similar (P > 0.05) in Group M (52.42 ± 2.67 and 48.30 ± 5.81) and Group P (51.77 ± 1.96 and 48.50 ± 4.87). The mean microhardness of composite containing a combination of photoinitiators was more in Group P (57.09 ± 2.61) as compared to Group M (47.37 ± 3.51). The mean DC was higher in Group P (59.75 ± 5.30) as compared to Group M (39.70 ± 3.57), and these differences were statistically significant (P < 0.05). Conclusion: The type of LCU affects DC and microhardness only in the case of composites containing a combination of photoinitiators.

To compare the continuous and intermittent irrigation method on the removal of dentin debris from root canals and to evaluate the dynamics of irrigant flow using computational fluid dynamics.

AIM: This study aimed to compare the efficiency of continuous and intermittent irrigating methods on the removal of dentin debris from the simulated grooves and to evaluate the dynamics of irrigant using computational fluid dynamics (CFD). METHODOLOGY: Seventy-five extracted human permanent maxillary canines were selected. Access cavities were made, working length was determined, and canals were prepared by crown down technique. The teeth were split longitudinally and standard groove 2.0 mm in length was made in split halves and each groove was filled with dentin debris and the images were taken under a microscope (E200). The halves were re-assembled and divided into five groups based on different irrigation methods. Group 1: ultrasonic Irrigation with continuous flow for 3.0 min; Group 2: ultrasonic irrigation with continuous flow for 1.5 min; Group 3: ultrasonic irrigation with intermittent flow for 3.0 min; Group 4: ultrasonic irrigation with the intermittent flow for 1.5 min; and Group 5: syringe irrigation for 1 min. The root halves were again separated and re-evaluated for debris elimination after the irrigation protocol for all the groups separately. The effect of time and method of passive ultrasonic irrigation were compared. For the computational fluid analysis, a GAMBIT 2.2 (Ansys) software was used for mesh construction. FLUENT 6.2 (Ansys) software was used to set the boundary conditions and reconstruction of the canal; flow patterns and turbulence were graphically constructed. RESULTS: The continuous irrigation methods were better at debris removal than intermittent irrigation flow methods. The CFD showed that the turbulence of flow of irrigant was dependent on the inlet velocity and pressure of the irrigant. CONCLUSION: Debris removal from the simulated grooves was better with continuous irrigation compared with intermittent irrigation. CFD study revealed that the turbulence that was affected by the velocity and pressure of the irrigant introduced and is a variable entity.

Does eugenol affect the microtensile bond strength of self-adhering composite? - An in vitro study.

Objectives: The objective of the study is to evaluate the effect of eugenol-based temporary on microtensile bond strength of self-adhering composite at 1 day and 7-day time intervals. Materials and Methods: Occlusal enamel of 24 human molars was removed. Zinc oxide eugenol (ZnOE) and noneugenol temporary cement (ZnONE) were placed on the dentin surfaces and left for different times (1 day, 7 days). After removal of temporary cement, teeth were randomly divided into eight subgroups: subgroup GE1S (n = 3): ZnOE cement + Self-adhering composite (SAC), subgroup GE1N (n = 3): ZnOE cement + adhesive system (one coat 7 universal) + nanohybrid composite, subgroup GE7S (n = 3): ZnOE cement + SAC, subgroup GE7N (n = 3): ZnOE cement + adhesive system + nanohybrid composite, subgroup GNE1S (n = 3): ZnONE cement + SAC, subgroup GNE1N (n = 3): ZnONE cement + adhesive system + nanohybrid composite, subgroup GNE7S (n = 3): ZnONE cement + SAC, subgroup GNE7N (n = 3): ZnONE cement + adhesive system + nanohybrid composite. Four sticks per tooth were obtained, resulting in 12 sticks per group with a cross-sectional area of 0.5 mm 2. The µTBS test was performed with a crosshead speed of 0.5 mm/min. Statistical Analysis: Kruskal-Wallis and Mann-Whitney U-test were used for analysis. Results: Highest and lowest mean value of microtensile bond strength was observed in GNE7N (12.75MPa) and GE1S (1.42MPa), respectively. Conclusion: The presence of eugenol at early stage, i.e. 1 day, has a negative influence on microtensile bond strength of SAC. At 7 days, the negative effect of eugenol on microtensile bond strength gets nullified. Thus, a waiting period of 1 week is sufficient to overcome negative influence of eugenol-based temporaries on polymerization of SAC.

Effect of ultrasonic root-end cavity preparation on dentinal microcrack formation: A micro-computed tomography study.

BACKGROUND: Root-end preparation during surgical endodontics may produce dentinal microcrack formation and/or propagation, leading to vertical root fractures. AIM: This study aimed to evaluate and compare the microcrack formation and propagation during ultrasonic root-end cavity preparation, with diamond- and zirconium nitride-coated tips using micro-computed tomography (CT). METHODOLOGY: Twenty-eight extracted, mature, free-of-defect, mandibular premolars were decoronated and micro-CT scanned for the presence of preexisting microcracks. Samples were prepared till F4, were obturated, and were re-scanned to determine an increase in the number of microcracks. After 3 mm of root-end resection, the samples were randomly divided for ultrasonic root-end preparation into Group 1 (n = 12): preparation was done with ProUltra Surg tip, Group 2 (n = 12): preparation was done with KiS tip, and Group 3 (n = 4): no preparation was done. The samples were rescanned, and data collected were analyzed using ANOVA and Student's t-test. The level of significance was set at 5%. RESULTS: Preexisting microcracks were observed in few samples. The mean percentage number increase of microcracks after root-end preparation in ProUltra Surg group was 1.25 and in KiS group, it was 0.5. The difference in mean percentage increase for the number of microcracks after root-end cavity preparation using ProUltra Surg tip and KiS tip was 0.75. However, this difference was not statistically significant (P = 0.34). CONCLUSION: Both diamond- and zirconium nitride-coated ultrasonic tips resulted in more number of dentinal crack formation and propagation when preexisting cracks were present.

Comparison of fluoride ion release and alkalizing potential of a new bulk-fill alkasite.

AIM: This study was conducted to evaluate and compare fluoride ion release by Cention-N (self-cure and light-cure) and conventional glass-ionomer cement (GIC) at different pH and time intervals. METHODOLOGY: Cavities of similar dimensions were prepared in mandibular molars and restored with Cention-N (by self-cure and light-cure techniques) and GIC. Samples were stored in deionized water, and the cumulative fluoride ion release and change in pH were assessed utilizing spectrophotometer and pH meter, respectively, at the end of 7 days, 14 days, and 21 days. The data thus obtained were statistically analyzed. RESULTS: All the tested materials released fluoride ions in both acidic and neutral pH at all time intervals, and the fluoride ion release was significantly higher (<0.05) in acidic pH as compared to neutral pH except in GIC. All the groups showed a statistically significant increase in pH in acidic medium, whereas no significant increase was observed in neutral medium. CONCLUSIONS: Cention-N (self-cure) has the highest fluoride ion release and alkalizing potential in acidic pH as compared to Cention-N (light-cure) and GIC.

Evaluation of marginal sealing ability of self-adhesive flowable composite resin in Class II composite restoration: An in vitro study.

AIM: The aim of this study is to evaluate the marginal sealing ability of self-adhesive flowable composite resin when used as a liner in Class II composite restoration with and without aging. MATERIALS AND METHODS: A total of 120 standardized Class II tooth preparations with gingival margins 1 mm coronal and apical to cementenamel junction (CEJ) were prepared on 60 extracted permanent mandibular molars and were randomly divided into eight equal Groups: Group 1: cavities coronal to CEJ and restored with Dyad flow liner + Herculite ultra, Group 2: same as Group 1 but cavities margins apical to CEJ, Group 5: cavities coronal to CEJ and restored with only Herculite ultra, and Group 6: same as Group 5 but cavities apical to CEJ. Groups 3,4,7,8 were similar to Groups 1,2,5,6, respectively, but were aged for 6 months. After thermocycling, microleakage testing was done using 0.5% basic fuchsin dye. RESULT: At cervical level, Group 5 exhibited statistically lower (P = 0.006) microleakage than Group 6, and Group 1 showed lesser microleakage than Group 5 (P = 0.162). Group 2 exhibited significantly less microleakage than Group 6 (P = 0.002). Increased microleakage was observed in aging Groups; however, the difference with nonaging Groups was not statistically significant (P > 0.005). CONCLUSION: Margins of the cavity in cementum can be better sealed by placing self-adhesive liner and is not affected by aging.

Esthetic Management of a Patient with Severely Fluorosed Enamel and Pigmented Gingiva: A Conservative Approach.

Isolated brown or white defects of less than few tenths of millimeter depth can be successfully treated with microabrasion. However, for deeper enamel defects, a combination of various techniques such as microabrasion/macroabrasion along with bleaching or full or partial veneering are available. Template-assisted direct veneering technique helps for better separation and contouring of individual tooth through which composite resin can be applied directly to tooth structure and artistically sculpted. Frequently, the gingival hyperpigmentation is caused by excessive melanin deposits mainly located in the basal and suprabasal cell layers of the epithelium. Recently, laser ablation has been recognized as one of the most effective, pleasant, and reliable techniques. This article describes a conservative approach for a complete smile makeover of a patient with severe fluorosis and pigmented gingiva with the help of enamel microabrasion and template-assisted direct composite veneering followed by laser depigmentation of gingiva.

Effect of methods of evaluation on sealing ability of mineral trioxide aggregate apical plug.

AIM: The purpose of the study was to evaluate and compare the sealing ability of mineral trioxide aggregate (MTA) with three different methods. MATERIALS AND METHODS: Forty single canal teeth were decoronated, and root canals were enlarged to simulate immature apex. The samples were randomly divided into Group MD = MTA-angelus mixed with distilled water and Group MC = MTA-angelus mixed with 2% chlorhexidine, and apical seal was recorded with glucose penetration method, fluid filtration method, and dye penetration methods and compared. RESULTS: The three methods of evaluation resulted differently. The glucose penetration method showed that MD sealed better than MC, but difference was statistically insignificant (P > 0.05). The fluid filtration method resulted that Group MC was statistically insignificant superior to Group MD (P > 0.05). The dye penetration method showed that Group MC sealed statistically better than Group MD. CONCLUSION: No correlation was found among the results obtained with the three methods of evaluation. Addition of chlorhexidine enhanced the sealing ability of MTA according to the fluid filtration test and dye leakage while according to the glucose penetration test, chlorhexidine did not enhance the sealing ability of MTA. This study showed that relying on the results of apical sealing by only method can be misleading.

An in vitro comparative evaluation of different intraorifice barriers on the fracture resistance of endodontically treated roots obturated with gutta-percha.

AIM: To compare and evaluate the root reinforcement potential of four different intraorifice barriers: Mineral trioxide aggregate (MTA), resin-modified glass ionomer cement (RMGIC), fiber-reinforced composite (FRC), and nanohybrid composite (NC). MATERIALS AND METHODS: Seventy-five mandibular premolars were decoronated to a standardized length, and prepared and obturated with gutta-percha and AH Plus sealer. Except for control specimens, the coronal 3-mm gutta-percha was removed and filled with different materials. The specimens (75) were divided into five groups (n = 15) on the basis of the intraorifice barrier material used. Group 1: MTA, Group 2: RMGIC, Group 3: FRC, Group 4: NC, Group 5: no barrier (control). Fracture resistance of the specimens was tested. RESULTS: Fracture resistance of roots was significantly affected by the type of intraorifice barrier used and the following pattern was observed: RMGIC > FRC > NC > MTA. CONCLUSION: Intraorifice barriers can be regarded as a viable choice to reduce the occurrence of postendodontic root fractures. Among the four tested materials, RMGIC showed the maximum reinforcement.

Absorbable Suture as an Apical Matrix in Single Visit Apexification with Mineral Trioxide Aggregate.

Several procedures have been recommended to induce the root end barrier formation in teeth with open apices. Conventional treatment for such cases will require many appointments with an average duration of 12.9 months. During this period, the root canal is susceptible to reinfection from around the provisional restoration, which may promote apical periodontitis and arrest of apical repair. Mineral trioxide aggregate (MTA) has been successfully used for one visit apexification wherein the root canal can be obturated within 24 hours after placement of MTA. Using a matrix prior to the placement of MTA avoids its extrusion, reduces leakage in the sealing material, and allows favorable response of the periapical tissues. This report presents a case of apexification where an absorbable suture was used as an apical matrix. Use of an absorbable suture circumvents all the problems associated with other conventional materials. Conclusion. Placement of the matrix made from the suture material is predictable and is easily positioned at the apex and the length can be adjusted as required. 10-month follow-up of the case shows resorbed matrix and bone healing in the periapical region. The patient was asymptomatic during the whole follow-up period and tooth exhibited mobility within physiologic limits and was functioning normally.

Comparative evaluation of fracture resistance of simulated immature teeth restored with glass fiber posts, intracanal composite resin, and experimental dentine posts.

AIM: The aim of this study was to compare the fracture resistance of simulated immature teeth restored with gutta-percha, glass fiber posts (GFP), experimental dentine posts (DP) or Intracanal composite Resin (ICR). MATERIALS AND METHODS: Fifty maxillary canines were decoronated, standardized and enlarged until, number 5 Peeso reamers were allowed to simulate immature teeth. After placement of 5 mm of MTA, the canals were divided into 5 groups and filled as follows: Group 1: AH Plus + gutta-percha, lateral compaction; Group 2: GFP luted with PARACORE dual cure resin; Group 3: DP luted with PARACORE dual cure resin; Group 4: PARACORE dual cure resin. A standardized core was built in all groups except in Group 5. Each of the specimens was tested for fracture resistance by universal testing machine. RESULTS: The mean fracture resistance were 817 ± 27.753, 1164.6 ± 21.624, 994.4 ± 96.8747, 873.8 ± 105.446 and 493.7 ± 6.945 newtons for Groups 1, 2, 3, 4, and 5 respectively. Independent "t" test revealed statistically significant discrepancies, in the fracture resistance among the 4 groups except Group 1 and Group 4 (P < 0.05). CONCLUSIONS: This study suggests that GFP and DP may be preferred for additional reinforcement of immature teeth.

Evaluation of effect of addition of 2% chlorhexidine on the sealing ability of Biodentine: An in vitro study.

AIM: To evaluate the effect of the addition of 2% chlorhexidine on the sealing ability of Biodentine. MATERIALS AND METHODS: Forty-six extracted human premolar teeth with single canal and apical foramen were selected, cleaned, and decoronated to standardize the length of 17 mm. Canals were prepared using ProTaper rotary files till size F4. The samples were divided into 2 experimental groups of 20 samples each on the basis of absence/presence of 2% chlorhexidine in liquid: Group BM = Biodentine mixed with the provided liquid, Group BC = Biodentine mixed with 2% chlorhexidine in provided liquid. Three samples, each were assigned to control groups: Group BP (positive control) = No root end filling was placed, Group BN (negative control) = Root ends were filled as in Group BM, and entire external surface was coated with sticky wax. The samples were then evaluated for the apical sealing using fluid filtration method. RESULTS: Results were analyzed using Student's t-test (P ≤ 0.05). Group BC showed the better sealing ability (3.06) as compared to Group BM (3.85). However, the difference was statistically insignificant (P > 0.05). CONCLUSION: Addition of 2% chlorhexidine to the liquid enhanced the sealing ability of Biodentine.

Corelation between machines assisted endodontic irrigant agitation and apical extrusion of debris and irrigant: a laboratory study.

AIMS: To compare amount of root canal debris and irrigant extruded apically after irrigants agitation using closed and open chambers. METHODS AND MATERIAL: Sixty maxillary central incisors were selected, decoronated, and mounted in preweighed glass vials filled with distilled water. Biomechanical preparation was completed using ProTaper rotary files until number F4 and 1 mL of 3% NaOCl solution after each file use. Samples were randomly divided into closed or open chamber sets which were further subdivided into 6 groups, based on the agitation techniques: no agitation (control), canalBrush, lentulospiral, passive ultrasonic agitation (PUA), EndoActivator, and EndoVac. Canals were irrigated with 1 mL of 17% EDTA and agitated for 30 s and then flushed with 2 mL of distilled water. Apically extruded irrigant was measured and vials were kept in incubator for 5 days at 68 °C for drying for weight calculation. Statistical Analysis. Analysis was done using Student's t-test, one-way ANOVA, and post-hoc. RESULTS: All agitation techniques showed apical extrusion of the debris and irrigant. The closed chamber apparatus showed significantly less extrusion of debris and irrigant than open chamber (P < 0.05). CONCLUSIONS: EndoVac was found to be the safest agitation system among all test groups with regard to apical extrusion of debris and irrigant.

Retention of fiber posts in different dentin regions: an in vitro study.

AIM: The aim of this study was to evaluate the influence of different regions of dentin within the post space on the retention of fiber posts. MATERIALS AND METHODS: Ten human incisors with straight roots were selected for this study. Endodontic treatment of the specimens was done. The post spaces were created immediately after obturation and the posts were luted with dual-cure resin cement. Approximately 2.5-mm-thick sections were made from the coronal, middle, and apical thirds of the post space and thus we had three groups: Group I: Cervical, Group II: Middle, Group III: Apical. The specimens were tested on a universal testing machine. Statistical analysis was done using the unpaired Student's t-test and one-way ANOVA test. RESULT: The best push-out strength was obtained with the apical sections (14.69 ± 0.298 MPa), followed by the middle (10.66 ± 0.34 MPa) and cervical sections (9.73 ± 0.42 MPa). CONCLUSION: highest pust out strengths were obtained in apical sections followed by middle and coronal.

Management of congenitally missing second premolars in a growing child.

The second premolars have the highest incidence of congenital absence, after the third molars. The problem resides not in the prevalence of congenitally missing premolars but in the selection of a treatment plan that will yield the best results over the long term. The present study reports a case of a 14 year old female patient with bilaterally congenitally missing second mandibular premolars with associated crowding of teeth. The case has been managed using a multi-speciality approach, in which both deciduous mandibular second molars were sectioned and the distal half retained. The retained half was prepared to receive a full coverage restoration which was contoured as a premolar. The space created was then utilized to correct the crowding by fixed orthodontics. A two year follow up shows retained distal half of the deciduous mandibular second molar with correction of crowding and space closure.