Morphometric analysis of the relationship between maxillary posterior teeth and maxillary sinus floor in central Indian population: A cone-beam computed tomography study.

Background: The relationship between the maxillary sinus (MS) and the root apices of posterior teeth is of significant clinical relevance as it influences the diagnosis and treatment planning when operating in the posterior areas of the maxilla. The aim of this study, therefore, is to assess this anatomic relationship and evaluate the propensity of roots of posterior maxillary teeth to be intruded into the MS space using cone-beam computed tomography (CBCT) scanning. Materials and Methods: One thousand CBCT scans of patients, aged 20 years or above, were analyzed in the study. The distance from the MS floor to the root apices of the posterior teeth was measured and the relationship between the MS and the posterior teeth roots were recorded, based on Kwak's and Didilescu's classification. Results: Based on Kwak's classification, type I configuration was frequently observed in the maxillary posterior teeth, followed by type II. Based on Didilescu's classification, the longest distance, among premolars, was observed between the palatal root of the left 1st premolar and MS, i.e., 8.2467 mm. Among molars, the longest distance was observed between mesiobuccal root of the right first molar and MS, i.e., 5.8966 mm. The shortest distance, among premolars, was observed between the buccal root of the left second premolar and MS, i.e., 3.5500 mm, and among molars, the shortest distance was between the mesiobuccal root of the left second molar and MS, i.e., 1.3556 mm. Conclusion: From the present study, it may be concluded that, among the central Indian population, mesiobuccal root of the second molars and buccal root of the second premolars show the closest proximity to the MS floor. Therefore, any surgical or endodontic intervention in the vicinity of these roots must be performed with utmost care.

Comparative evaluation of canal transportation and canal centering ability in oval canals with newer nickel-titanium rotary single file systems - A cone-beam computed tomography study.

Context: The purpose of this study was to evaluate and compare the centering ability and canal transportation of TruNatomy, OneCurve, and Jizai file systems to assess their performance in oval-shaped canals using cone-beam computed tomography imaging. Materials and Methods: Forty-two fully formed single-rooted mandibular premolars were selected with a buccolingual canal size 2-2.5 times the mesiodistal size at 5 mm from the apex, with 0°-10° canal curvature with a 5-6 mm radius, at 5 mm from the apex. The teeth were divided into three groups (n = 14) and prepared with TruNatomy, OneCurve, and Jizai files based on the manufacturer's instructions. Cone-beam computed tomographic images were taken before and after instrumentation. The canal transportation and centering ability was calculated at 3, 6, and 9 mm from the apex in both mesiodistal and buccolingual directions. Statistical Analysis: Intergroup comparison was done using Kolmogorov-Smirnov test. Intragroup comparison was done using Freidman test. A comparison of categorical variables was done using the Chi-square test. Results: The results obtained did not present any statistically significant difference between the three groups, with TruNatomy and OneCurve showing relatively lesser canal transportation and better centering ratio when compared to the Jizai file system. Conclusions: It can, therefore, be concluded that all three systems used in the study are capable of safely preparing root canals with minimal errors.

Internal tunneling resorption associated with invasive cervical resorption.

Treating pathological defects that are caused by resorption in teeth can be challenging. The task is complicated further if the resorption extends beyond the restrains of the root. The aim of this report is to describe a case of extensive internal tunneling resorption (ITR) associated with invasive cervical resorption (ICR) in a maxillary right lateral incisor and its nonsurgical treatment. A 22-year-old male was referred to the department of endodontics with a chief complaint of discolored maxillary right lateral incisor or tooth 12 and a history of trauma. An extensive ITR associated with ICR accompanied by apical periodontitis was detected on a preoperative radiograph which was confirmed on a cone-beam computed tomography (CBCT) scan in a maxillary lateral incisor. After chemomechanical debridement and withdrawal of a separated file in the canal, calcium hydroxide was placed as an intracanal medicament for 2 weeks. Biodentine (BD) was used to obturate the defect as well as entire root canal system and to restore ICR. On a 5-year follow-up, the tooth was functional, and periapical healing was evident. Based on results of this case, successful repair of ITR associated with ICR with BD may lead to resolution of apical periodontitis. Trauma to teeth may lead to resorption which may be internal, external, and or a combination of both which may be asymptomatic in some patients. Preoperative assessment using CBCT imaging achieves visualization of location and extents of resorptive defects. Bioactive materials like BD may lead to favorable results in treating such extensive defects.

Evaluation of proximity of mandibular molars and second premolar to inferior alveolar nerve canal among central Indians: A cone-beam computed tomographic retrospective study.

CONTEXT: A study was done to assess the average distances of root apices of mandibular first molar, second molar, and second premolar to inferior alveolar nerve canal (IANC), among males and females in central India. MATERIALS AND METHODS: High-resolution full-volume cone-beam computed tomography (CBCT) scans were obtained from the radiology database at the Sri Aurobindo College of Dentistry, Indore. After scrutinizing the database, CBCT of 40 males and 40 females that conformed to the inclusion and exclusion criteria were selected for the study. RESULTS: All the data were analyzed using SPSS, Version 16. Descriptive statistics of the variables and measurements are presented using Students t-test (paired and unpaired), and correlation between age was tabled by Karl Pearson's correlation coefficient method. CONCLUSION: For the second premolar, the average distance to the IANC was 0.88-13.03 mm for males and 0.00-5.49 mm for females. The average distance of IANC to the mesial root apex of first molar was 1.46-13.23 mm for males and 0.93-8.03 mm for females. For the second molar, the average distance was 1.31-14.71 mm for males and 0.00-6.91 mm for females (values on left side were shorter as compared to right side). In the overall population, only second molar exhibited significant difference in the distance from root apex to IANC when compared bilaterally. In addition to gender differences, age-related differences were found to be significant for the first molar on left side and second molar on the right side of the population (P< 0.05).

Accidental injection of 2% chlorhexidine gluconate instead of an anesthetic agent: A case report.

We report a case where 2% chlorhexidine (CHX) gluconate was mistaken for an anesthetic solution and infiltrated into the buccal vestibule during routine root canal treatment. Accidentally, 2% CHX gluconate solution was injected in the right upper buccal vestibule (16) of a 23-year-old male during routine root canal treatment. The patient experienced pain and a burning sensation over the injected area shortly after injection. Swelling with mild extraoral redness over the right cheek area was observed clinically. The patient was immediately administered dexamethasone intramuscularly, and was prescribed antibiotics, analgesics, and antihistamines. The patient complained of a loss of sensation over the right cheek by the 15(th) day. The swelling reduced gradually over a period of 15 days. Reversal of sensation was attained after 35 days.

Analysis of Information, Impact and Control of HIV amongst Dental Professionals of Central India.

BACKGROUND: Dental health care providers may be exposed to a variety of microorganisms via blood, oral or respiratory secretions. Though the risk of transmission of Human Immunodeficiency Virus (HIV) in dental settings is low, the consequences of being infected are life threatening. Therefore, high standards in infection control and waste management are required in controlling occupational contagion and cross infection. AIM: To obtain comprehensive information about the HIV related information, its impact on the health care provider's attitude towards treating patients living with HIV/AIDS (PLWHA), infection control & waste disposal practices among dental professionals of Malwa region of Madhya Pradesh; situated in Central India. MATERIALS AND METHODS: A cross-sectional survey was conducted among 320 private dental practitioners. Data was collected using a pretested, self administered 40 item questionnaire and statistically analysed. RESULTS: The response rate was 81.25%. Over all 50.76% dentists were graded as having good knowledge of HIV. Unfortunately, their willingness to treat these patients remained low. In all 39.23% dentist were willing to render care to PLWHA. Junior dentists expressed less hesitation with regard to acceptance of risk patients than other dentists. Over 65% of the respondents reported adherence to universal precautions. The most alarming observation was that dentists were not following safe waste management practices. CONCLUSION: Dental professionals continue to indicate a reluctance to treat patients with HIV/AIDS or those in high- risk groups. The results suggest need to have a comprehensive motivational program and implementing ways to ensure access and availability of safe dental care for PLWHA. The desire to get training on how to handle PLWHA illustrates that receptiveness to change exists.

Comparative Analysis of Canal Centering Ability of Different Single File Systems Using Cone Beam Computed Tomography- An In-Vitro Study.

BACKGROUND: The ability of an endodontic instrument to remain centered in the root canal system is one of the most important characteristic influencing the clinical performance of a particular file system. Thus, it is important to assess the canal centering ability of newly introduced single file systems before they can be considered a viable replacement of full-sequence rotary file systems. AIM: The aim of the study was to compare the canal transportation, centering ability, and time taken for preparation of curved root canals after instrumentation with single file systems One Shape and Wave One, using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Sixty mesiobuccal canals of mandibular molars with an angle of curvature ranging from 20(o) to 35(o) were divided into three groups of 20 samples each: ProTaper PT (group I) - full-sequence rotary control group, OneShape OS (group II)- single file continuous rotation, WaveOne WO - single file reciprocal motion (group III). Pre instrumentation and post instrumentation three-dimensional CBCT images were obtained from root cross-sections at 3mm, 6mm and 9mm from the apex. Scanned images were then accessed to determine canal transportation and centering ability. The data collected were evaluated using one-way analysis of variance (ANOVA) with Tukey's honestly significant difference test. RESULTS: It was observed that there were no differences in the magnitude of transportation between the rotary instruments (p >0.05) at both 3mm as well as 6mm from the apex. At 9 mm from the apex, Group I PT showed significantly higher mean canal transportation and lower centering ability (0.19±0.08 and 0.39±0.16), as compared to Group II OS (0.12±0.07 and 0.54±0.24) and Group III WO (0.13±0.06 and 0.55±0.18) while the differences between OS and WO were not statistically significant. CONCLUSION: It was concluded that there was minor difference between the tested groups. Single file systems demonstrated average canal transportation and centering ability comparable to full sequence Protaper system in curved root canals.

Evaluation of cervical marginal and internal adaptation using newer bulk fill composites: An in vitro study.

OBJECTIVE: To evaluate the cervical marginal and internal adaptation of posterior bulk fill resin composites of different viscosities, before and after thermo-cycling (TMC). MATERIALS AND METHODS: Eighty box-only class II cavities were prepared in 40 extracted human premolars with the distal proximal box beneath the enamel-cementum junction (CEJ). The teeth in the experimental groups were restored with bulk fill resin composite restorations (Gr. I- Sonic Fill, Gr. II- SDR, Gr. III- Tetric N Ceram Bulk Fill or a conventional composite designed for 2-mm increments (Gr. IV- Tetric N Flow along with Tetric N Ceram). Before and after thermal cycling, the gap-free marginal length was analyzed using SEM of epoxy resin replicas. After thermal cycling, specimens were cut longitudinally in order to investigate internal dentine adaptation by epoxy replicas under SEM (500 × magnification). RESULTS: Statistical analysis was performed using the ANOVA and Tukey Post Hoc tests (P < 0.05). In enamel, high percentages of gap-free margins were initially identified for all the groups, which declined after thermal cycling. However, no significant differences were identified among any of the groups (P > 0.05). In dentine, bulk fill groups performed at par with the incremental placement; for both marginal and internal adaptation (P < 0.05), for all materials except Tetric N Ceram Bulk Fill. CONCLUSIONS: Viscosity of the bulk fill restorative material influenced the proportion of gap-free marginal interface and the internal adaptation in dentin.

Influence of Implant Surface Topography and Loading Condition on Stress Distribution in Bone Around Implants: A Comparative 3D FEA.

A three-dimensional Finite Element Method was used to study the influence of porous coated surface topography of an implant on stress and strain distribution pattern in the cortical and cancellous bone during axial and non-axial loading. Two implants, one with porous surface topography and one with smooth surface were embedded in separate geometric models of posterior mandibular region which was generated using a CT scan data. Material properties and boundary conditions were applied. Load of 100 and 50 N were applied on to the abutment from axial and non-axial directions respectively. Porous surface topography appeared to distribute stress in a more uniform pattern around the implant with near absence of stress in the apical region of implant. Smooth surfaced implant showed high punching stress at the apex of the implant. The porous coated interface was considered to simulate the shock absorbing behavior of periodontal ligament of natural dentition. Maximum amount of stress concentration was observed in the cortical bone which plays a major role in the dissipation of the stress.