Investigation using cone beam computed tomography analysis, of radicular grooves and canal configurations of mandibular premolars in a Turkish subpopulation.

OBJECTIVE: To conduct an in vivo evaluation of prevalence of root canal configurations, lengths of C-shaped canals, prevalence and depths of radicular grooves (RGs), in mandibular first and second premolars in a Turkish subpopulation using cone beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT images of 327 first and 264 second premolars were included. Canal configurations, locations, lengths, and types of C-shaped canals, and RGs were evaluated on CBCT images. Data were statistically analyzed (P < 0.05). RESULTS: First and second premolars were classified as follows: type I, (83.8%, 97.72%); type V, (12.22%, 0.76%); type III, (3.06%, 0.76%); and other types. RGs were exhibited by 14.68% of first and 2.27% of second premolars (P < 0.05). Incidence of complex canals (types III, V and other types, 89.8%) in first premolars with RGs was significantly higher versuswithout RGs (P < 0.05). C-shaped configuration was exhibited by 4.58% of first (80% semilunar-type), and 1.13% of second premolars (P < 0.05). All first premolars with C-shaped canals showed RGs and complex canals. CONCLUSIONS: Complex canals and RGs frequently co-exist in mandibular premolars. C-shaped canals are not common in mandibular premolars, and mostly located in middle thirds. Type V is the most prevalent complex canal configuration in first premolars, and frequently associated with a C-shaped semilunar-type anatomy.

Endodontic management of root perforating internal replacement resorption.

This case report presents the management of a case of rarely seen perforating internal replacement resorption using calcium hydroxide (CH) medication and mineral trioxide aggregate (MTA) root canal obturation. A maxillary central incisor of a 20-year-old female was showing a sinus track on the mucosa. Radiographically, an irregularly shaped and perforating internal resorption area was seen at the middle third of the root canal. Appearances of the bone-like fuzzy material were observed inside the resorption site. The apical part of the canal was obliterated. Following 3 months of CH medication, the canal and the perforation were obturated with MTA filling. At 6-year follow-up, the tooth was clinically asymptomatic and showing radiographical appearances of the hard tissue repair, resembling a barrier and periodontal membrane healing around MTA at the perforation site.

Comparison of four electronic root canal length measurement devices.

OBJECTIVE: The objective of this study is to evaluate the performance of four electronic root canal length measurement devices (ERCLMDs) [Root ZX, Raypex 6, ProPex II, and VDW Gold with ERCLMD] in wet and dry root canals with different major foramen diameters, in association with three file positions within the final 1 mm of canals. MATERIALS AND METHODS: Fifty roots were divided into five groups that were instrumented apically to the terminus diameter using K-files 15, 20, 30, 40, and 60. ERCLMD measurements were made when the file tip was at major foramen, 0.5 mm and 1.0 mm short of the foramen, when the apex touched to the surface of saline or was immersed 3 mm into saline, and when the canal was dry or was irrigated with saline. The differences between the electronic lengths and the actual lengths were calculated. The data were analyzed using the three-, two-, and one-way ANOVA and the LSD test (p < .05). RESULTS: Overall, the four ERCLMDs demonstrated 12.8% unstable and beyond the foramen measurements (11.3%). About 85% of the beyond the foramen measurements had foramen diameters 0.40 and 0.60. ERCLMD comparisons related to the file positions in the foramen diameters showed significant differences between ERCLMDs in each foramen diameter (p < .05). CONCLUSIONS: All ERCLMDs provided highly accurate measurements within the final 1 mm of the foramen. Wet or dry canals and apex conditions did not adversely affect the accuracy of the ERCLMDs' readings. ProPex II located the file positions in the teeth with different foramen diameters more accurately than the other ERCLMDs.

Mineral trioxide aggregate as a pulpotomy agent in immature teeth: Long-term case report.

This case report aimed to present the long-term clinical performance of mineral trioxide aggregate (MTA) pulpotomies in immature permanent teeth. Four patients with complicated crown fractures of five maxillary immature central incisor teeth were treated with pulpotomy using gray MTA. An immature mandibular first molar showing signs of reversible pulpitis that was exposed mechanically during cavity preparation was also treated with MTA pulpotomy. Four of the 6 immature teeth were diagnosed vitally with complete root maturation and with the presence of dentin bridges after 55 months (mean time of follow-ups). MTA pulpotomy was assessed unsuccessfully in two fractured central incisors. Severe discoloration in the crowns was present in all 6 cases. MTA may induce pulp healing with dentin bridge formation and prevent necrosis at long-term periods in most of the pulpotomy cases. However, discoloration following MTA pulpotomy is a significant clinical complication.

Surgical retreatment of an invaginated maxillary central incisor following overfilled endodontic treatment: a case report.

This case report presents the periapical surgical retreatment of an Oehlers Class III invaginated maxillary central incisor with extruded root canal filling into the periapical lesion. After local anesthesia, a full-thickness mucoperiosteal flap was reflected, and the granulomatous tissue and extruded gutta-percha points were curetted carefully. A deep and wide root-end cavity was prepared and filled with mineral trioxide aggregate (MTA). At 6 months and 2 years after the treatment, the tooth exhibited no clinical symptoms, and the radiograph performed during the 2-year follow-up showed a complete periapical healing around the root end. The present report indicates that MTA retrofilling can be used successfully in the surgical retreatment of dens invaginatus type III cases in which the invagination exits apically.

Intraradicular splinting of a horizontally fractured central incisor: a case report.

This case report presents the endodontic management of a horizontally fractured right incisor involving healing with granulation tissue using an intraradicular splinting technique. We also discuss the spontaneous healing of the fractured left central incisor with calcified tissue. A composite resin splint was made for all of the upper anterior teeth. The root canal of the right incisor was temporarily filled with calcium hydroxide slurry. The intraradicular splinting involved placing a file in the canal. Sealer was introduced into the canal and then a no. 110 K file was fixed in the canal with polycarboxylate cement. The tooth was asymptomatic and the composite splint was removed after 1 month. The right incisor appeared normal clinically and radiographically at the 30-month recall. This case demonstrates that intraradicular splinting can be used to manage horizontally fractured teeth with necrotic and mobile coronal segment.

Delayed multidisciplinary management of an extrusively luxated maxillary central incisor.

This paper reports a case of delayed (1 month after the injury) multidisciplinary management of an extrusively luxated permanent central incisor. The extruded tooth was diagnosed as necrotic without coronal discoloration. Upon completion of root canal treatment, the tooth was repositioned orthodontically and finally restored for esthetic purposes with a composite resin. The tooth was diagnosed as normal in the 1 year check-up.

Dens invaginatus in an immature maxillary lateral incisor: a case report of complex endodontic treatment.

This case report presents the surgical endodontic treatment of an Oehlers Class II invaginated immature tooth. In this case, communication between the invagination and the pulp caused pulp necrosis, periapical inflammation, and cessation of root formation. The initial treatment goal was to achieve apexification and then fill both the root canal and the canal of the invagination. After a 6-month treatment with calcium hydroxide dressings, there was no healing radiographically and no sign of a hard tissue barrier in the apex. Periapical surgery with the placement of mineral trioxide aggregate (MTA) root-end filling was deemed successful at the 1-year recall. To treat dens invaginatus, both conventional and surgical endodontic treatment techniques should be considered. In dens invaginatus, conventional endodontic treatment modalities may be unsuccessful because of inadequate debridement and disinfection; however, subsequent periapical surgery and retrofilling with MTA may promote healing.

Anesthesia following overfilling of a root canal sealer into the mandibular canal: a case report.

The surgical treatment of a case of anesthesia that occurred with the extrusion of Endomethasone root canal sealer into the mandibular canal is presented. Endomethasone is a neurotoxic root canal sealer containing paraformaldehyde and eugenol. The literature indicates immediate surgical decompression on the extrusion of Endomethasone into the mandibular canal. In our case, the decompression surgery was done 3 weeks after the endodontic mishap. The nearly complete resolution of anesthesia 4 months following the decompression surgery suggests that the neurotoxic effects of Endomethasone are still reversible after 3 weeks.

Pulp tissue reactions to a dentin bonding agent as a direct capping agent.

The aim of this study was to investigate the response of human pulp tissue to a dentin bonding agent, Scotchbond Multi-Purpose Plus (SMPP), in exposed class V cavities. Sixteen human premolar teeth were mechanically exposed. Ten pulps were capped with SMPP and six teeth were capped with Dycal. The cavities were filled with a composite. After 40 days, the teeth were extracted and processed for histologic evaluation. Of the 10 teeth capped with SMPP, eight showed moderate chronic inflammation, one was severely inflamed, and one pulp had no to slight inflammation. None of the teeth capped with SMPP showed dentin bridge formation. Of the six teeth capped with Dycal, three exhibited incomplete dentin bridges associated with no to slight inflammation, and three showed no to slight inflammation, without formation of dentin bridges. Direct capping with Dycal with subsequent sealing with SMPP may show favorable results in pulp tissue. SMPP may cause inflammatory changes when applied directly to exposed pulp tissue.