Effect of Various Acid Solutions as an Aid in Removing the OrthoMTA-Based Root Canal Filling.

The objectives of this study were to compare the effects of various acid solutions combined with ultrasonics as an aid to remove mineral trioxide aggregate (MTA)-based root canal filling and to assess their effect on the surface topography and microhardness of root canal dentin. MATERIALS AND METHOD: Fifty human permanent single rooted and single canaled freshly extracted teeth were decoronated and sectioned apically to prepare the middle third of root sections of 5 mm length. The canals were prepared in a step-back manner. OrthoMTA was packed throughout the prepared canals. These root sections were incubated for one week and subsequently randomly allocated to five groups (n = 10) according to the OrthoMTA removal method: No treatment (NT); 5% glycolic acid + ultrasonics (5% GA+U); 10% glycolic acid + ultrasonics (10% GA+U); 10% citric acid + ultrasonics (10% CA+U); Distilled water + ultrasonics (DW+U). A 1 mm deep well was created within the coronal end of the set OrthoMTA. Wells were filled with each respective test solution and left for 5 min. Thereafter, further removal of OrthoMTA used a specific ultrasonic tip. Finally, the canals were flushed using 1 mL of the respective test solutions and activated with a Controlled Memory ultrasonic tip for two cycles of 20 s each followed by flushing with 1 mL of distilled water and paper point drying of the canals. Then, specimens were longitudinally split into two halves and examined under a scanning electron microscope (1000×) to assess the residual OrthoMTA and surface topography of root canal dentin. The Vickers surface microhardness of treated radicular dentin was measured using the HMV-2 microhardness tester. RESULT: Data were analysed using one-way ANOVA followed by Tukey's post hoc test. Significant differences for residual OrthoMTA were observed between (10% GA+U) with (5% GA+U), (10% CA+U), (DW+U) and (NT) (p value < 0.01). In the context of microhardness, (5% GA+U) and (10% GA+U) showed statistically significant difference compared to (NT), (10% CA+U) and (DW+U) (p value < 0.01). CONCLUSION: 10% GA+U was superior to other tested groups in removing OrthoMTA, but it substantially reduced dentin microhardness.

Comparative evaluation of fracture resistance of endodontically treated maxillary premolars reinforced by customized glass fiber post in two different ways: An in vitro study.

Context: Endodontically treated premolars are currently restored with direct bonded techniques in conservative manner enabling them to bear functional stresses homogeneously. Aim: The study aimed to evaluate the effect of placement of compactable glass fibers in reinforcing the endodontically treated teeth in a novel conservative manner. Settings and Design: Research laboratory, in vitro study. Materials and Methods: Seventy-five extracted maxillary premolars were procured. Fifteen teeth were left untreated (Group A) and the remaining teeth were endodontically treated followed by standardized mesio-occluso-distal preparation and randomly assigned to experimental groups (n = 15) as follows: (B) no restoration, (C) restoration with composite, (D) EverStick® POST followed by composite, and (E) vertical glass fibers within 3 mm of the coronal root canal space and buccopalatal flaring of the coronal fibers followed by composite. After conditioning and thermocycling, specimens were loaded under a universal testing machine to evaluate fracture resistance and fracture pattern of specimens. Statistical Analysis Used: Obtained scores were statistically analyzed using one-way analysis of variance test for stress analysis, post hoc Tukey's test for intergroup comparison, and Chi-square test for analysis of favorable and unfavorable fracture. Results: The fracture resistance was highest to lowest as follows: Group A > E > C > D > B (P < 0.001). Conclusion: EverStick®POST used in conservative manner improved fracture strength of teeth significantly.

Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study.

Aim: The Purpose of This In-Vitro Study Was to Comparatively Evaluate the Aesthetic Outcome Of Direct Polychromatic Layering Of Anterior Composites Restoration With The "Index Cut-Back" Technique While Restoring Class IV Defects of Teeth. Methodology: An extracted tooth specimen of maxillary central incisor crown was 3-D scanned for obtaining its dimensions, these dimensions were transferred to AUTOCAD™ software and a customised 3-D Printed mould was fabricated (Temporary Patent no. 336763-001 ). 50 specimens of Maxillary Central Incisor Crowns were then constructed with the help of Composite restorative material (Palfique Estelite LX5, Tokuyama Dental Corporation, Japan) in this mould. Afterwards with the help of a Straight fissure diamond bur a standardized size (4 cm length x 4 cm width) class IV defect was created on all 50 specimens and then they were allocated to 2 groups, Group A & B. 25 specimens for each Group (N = 25). Group A was restored using conventional Direct Polychromatic Layering technique and Group B was restored using the "Index cut-back" Technique. Shade Outcome and Translucency were evaluated using Spectrophotometer and Time taken was evaluated using a stop-watch chair side. Results: There was a significant difference in the values (P < .05) between Group A (Polychromatic) & Group B (Index cut-back) in terms of both Shade Outcome & Translucency; Group B showed better aesthetic values (closer to baseline) than Group A. In contrast, Time required for restoring the Class IV defects was significantly lower in Group A compared to Group B (P < .05). Conclusion: The Index Cut-Back Technique showed superior aesthetic outcome restoring Class IV defects, however it requires a planned pre-operative course of action before executing the clinical procedure.

Stationary Fatigue Resistance of Various Rotary Instruments with Different Alloys after Preparing Three Root Canals.

OBJECTIVE: This study aimed to evaluate the stationary fatigue resistance of three endodontic instrument systems after preparing three root canals with different curvatures and comparing them with unused instruments. METHODS: A total of 60 endodontic files from 3 instrument systems, TruNatomy (TRN), HyFlex CM (HFC) and Revo-S (RS), were selected for this study. These systems were divided into 2 groups: Group I (Used files) and Group II (Unused files). Each group was further divided into 3 subgroups, each containing 10 TRN (#26/v.04), 10 HFC (#25.04) and 10 RS (#25/.04) rotary files. The group I instruments were used for shaping the root canals of extracted third molars, while the group II instruments were not used for canal shaping procedures. Both Group I and Group II instruments were subjected to stationary cyclic fatigue testing at simulated body temperature (37±0.5°C) using a stainless-steel block with an artificial canal. The number of cycles to failure (NCF), the length of fractured instruments and the preparation time were recorded. The statistical analysis was performed using two-way ANOVA and Tukey post-hoc tests with a 95% confidence interval (P=0.05). RESULTS: NCF was significantly affected by the instrument type and whether the instrument was unused or used (P<0.001). The Group II instruments were more resistant to stationary cyclic fatigue than Group I (P<0.05). HFC instruments were most resistant to stationary fatigue among all tested conditions, followed by TRN and RS instruments. Canal preparation with TRN was significantly faster than with HFC and RS. During preparation, no file was fractured. A statistically significant difference (P<0.05) was observed in the mean length of the fractured instruments among used instrument groups. CONCLUSION: The stationary cyclic fatigue resistance of HFC instruments were significantly greater than that of the TRN and RS instruments (P<0.05). TRN was faster in shaping the root canals than other instruments tested in the study.

Platelet-Rich Fibrin as an Aid to Soft- and Hard-Tissue Healing.

INTRODUCTION: Contemporary published data present confounding results on use of PRF in soft- and hard-tissue healing in the oral cavity, and many authors have suggested for further studies to reach the definitive conclusion. AIM: Our main objective therefore was to evaluate soft-tissue healing and osseous regeneration (by using VIXWIN PRO software) in extraction sites of mandibular third molars with substantial sample size to understand the effect of PRF in bony defects. METHODOLOGY: Sixty patients had their bilaterally impacted third molars (120 sites) extracted in the split mouth study, following which platelet-rich fibrin was placed in one of the sockets. Patients were followed up clinically and radiographically, and pain score, presence of infection, exudation of graft and VIXWIN PRO software were used to evaluate healing of soft tissue and bone. RESULT AND CONCLUSION: Our study advocates the use of PRF for enhanced soft- and hard-tissue healing. Though the osseous regeneration could be differentiated in both the groups at second month interval only, pain scores were better with PRF at most instances. Subsequent phase to the research should include histopathological investigations for ancillary support.

Cyst Enucleation Revisited: A New Technical Modification to Ensure Complete Removal of Cystic Lining.

BACKGROUND: Treatment modalities for cysts have evoked the greatest debates and controversies because of the size, localization, pathological formation and recurrence potential of cysts. Enucleation has been most effective and reliable method to treat cysts. It completely removes the cystic capsule, thus reducing the possibility of recurrence. Certain modifications to the method of enucleation have been proposed for ease of removal and to assure complete enucleation. AIM AND OBJECTIVE: A new modification aimed at increasing the probability of a good and complete enucleation has been proposed at the Department of Oral and Maxillofacial surgery in DAV Dental College, Yamunanagar. METHOD: A window is created in the cystic roof with complete aspiration and evacuation of cystic contents following which the complete cystic lumen is packed with a ribbon gauze. The ribbon gauze is then wetted with normal saline or povidone iodine. Once enucleation is started at the correct plane, it gives a stable base from inside the cystic lumen due to which perforation of cyst is reduced markedly. CONCLUSION: The newly proposed technique reduced the chances of cystic lining perforation and ensures the in toto enucleation of cysts in majority of the operated cases.

Management of maxillary first molar with six canals using operating microscope.

The purpose of this article was to highlight the importance of having a thorough knowledge about the root canal morphology. This case report highlights the unusual anatomy of a maxillary first molar with three mesiobuccal (MB) canals, two palatal canals, and one distobuccal canal which is extremely rare. The use of operating microscope was crucial, both for the detection and for the management of the additional canals. The use of surgical operating microscope and digital radiograph showed that MB root had Type 3-1 of Gulabivala classification and palatal canal showed Vertucci's Type II canal morphology This report describes and discusses the identification of variation in canal morphology of maxillary first molar and the use of latest adjuncts in successfully diagnosing and negotiating them.

Efficacy of various solutions in preventing orange-brown precipitate formed during alternate use of sodium hypochlorite and chlorhexidine: An in vitro study.

AIM: The study evaluated the effectiveness of three intermediate endodontic irrigating solutions in eliminating the residual sodium hypochlorite (NaOCl), thus preventing the formation of the orange-brown precipitate when 2% chlorhexidine (CHX) is used as the final irrigant. MATERIALS AND METHODS: A total of 40 extracted human maxillary anterior teeth were selected, disinfected, and decoronated to obtain a standardized length of 10 mm. The teeth were prepared with Protaper universal rotary files until size F4 using 2.5% NaOCl as an irrigant during instrumentation. The teeth were then randomly divided into four groups of 10 samples each based on the irrigating solutions used during final wash sequence as follows: Group A - (2.5% NaOCl and 2% CHX), Group B - (2.5% NaOCl followed by 70% Isopropyl Alcohol and 2% CHX), Group C - (2.5% NaOCl followed by 6.25% sodium metabisulfite and 2% CHX), and Group D - (2.5% NaOCl followed by 3.86% sodium Thiosulfate and 2% CHX). The roots were sectioned longitudinally and the canal surface was evaluated under dental operating microscope (×16) for the presence of orange-brown precipitate. The results were tabulated as per scoring criteria and statistically analyzed. STATISTICAL ANALYSIS USED: One-way ANOVA test and post hoc Tukey's test. RESULTS: The lowest mean score was observed in Group C, followed by Group D and Group B, respectively. In comparison, there was a statistically significant (P < 0.001) difference in results between Group C and the other experimental groups. However, there was no statistically significant difference between Group B and Group D. CONCLUSION: Sodium metabisulfite was found to be very effective in preventing the formation of orange-brown precipitate.

Wound Healing Concepts in Clinical Practice of OMFS.

BACKGROUND: Wound healing is a complex and dynamic process and a thorough knowledge of the basics of physiology of wound healing is a must to implement principles of chronic wound care. Understanding wound healing at multiple levels-biochemical, physiologic, cellular and molecular provides the surgeon with a framework for basing clinical decisions aimed at optimizing the healing response. OBJECTIVE: This review article describes the classification of wounds and aims to highlight the fundamentals of wound repair, enumerating the dressings used commonly and also, the newer concepts of wound healing. MATERIALS AND METHODS: Search engines and medical databases were tapped to gather information on the subject. Search words employed were "Wounds", "wounds in OSMF", "Wound healing", "Repair", "Dressings in OMFS". RESULTS: The search resulted in total of 153 articles which we reviewed to add to the literature the concepts of wound healing and to throw some light on recent advances in wound care. CONCLUSIONS: Wound healing remains a challenging clinical problem and correct, efficient wound management is essential to positively influence the wound healing course and reduce potential complications.

Comparative assessment of efficacy of two different pretreatment single oral doses of betamethasone on inter-appointment and postoperative discomfort: An in vivo clinical evaluation.

AIM: Study aimed to evaluate the efficacy of two different pretreatment single oral doses of betamethasone on the incidence of inter-appointment flare up and postoperative discomfort. MATERIALS AND METHODS: Fifty-four patients aged 18-59 years requiring endodontic treatment were selected and randomly assigned to three groups; single pretreatment oral dose of placebo or betamethasone in two different oral doses of 0.5 mg and 1 mg, respectively. Endodontic therapy was completed in two visits using triple antibiotic paste as intracanal medicament. Patients were given a questionnaire to record their pain at 1, 2, 3, and 7 days after treatment. In the second visit, obturation was done, and the patients were again instructed to record their pain scores after treatment and discharged. The verbal rating scale was used for recording the pain scores. Statistical analysis was done using ANOVA and the Friedman test. RESULTS: 0.5 mg betamethasone group showed least mean pain scores among all experimental groups; however, there was no statistically significant difference between any of the groups (P > 0.05). CONCLUSION: Pretreatment single oral dose of betamethasone is an effective in managing endodontic flare-ups; however, the results were statistically insignificant.

Microleakage in Sub-Gingival Class II Preparations Restored Using Two Different Liners for Open Sandwich Technique Supplemented With or Without Ultrasonic Agitation: An In Vitro Study.

INTRODUCTION: Probability of bond failure at sub-gingival cavosurface margin is high in class II cavity designs especially when margins are located in cementum or dentin. Previous researches have proved ultrasonics to be a beneficial tool in improving the marginal adaptation of the restorative material. Therefore, the effect of ultrasonic activation of the lining material at the gingival cavosurface margin was tested in the present research. AIM: The study aimed to evaluate the cervical micro-leakage in class II preparations with gingival margin located below cemento enamel junction and restored using open sandwich technique using two different liners and supplemented with or without ultrasonic agitation. MATERIALS AND METHODS: Forty recently extracted human molars were collected, disinfected and stored in 0.9% saline solution. Standar dized class II cavities were prepared with gingival margin located 1mm below the cemento-enamel junction. Teeth were randomly divided into four groups (n=10) and restored using open sandwich technique as follows - Group A: Resin Modified Glass Ionomer Cement as liner and Beautifil II as coronal restoration; Group B: Same as group A supplemented with ultrasonic agitation; Group C: Beautifil Flow Plus as liner and Beautifil II as coronal restoration; Group D: Same as Group C supplemented with ultrasonic agitation. Prepared samples were subjected to thermo cycling, followed by immersing in 0.5% methylene blue dye solution. After 24 hours they were cleaned and sectioned in mesio-distal direction using diamond disc and evaluated for microleakage. Obtained scores were statistically analysed using one way ANOVA test and Post Hoc test. RESULTS: Group B showed least microleakage amongst all groups but the results were statistically insignificant (p value > 0.05). CONCLUSION: Marginal adaptation of liner with ultrasonic activation was somewhat better however, the results were statistically insignificant.

Effect of different polishing systems on the surface roughness of nano-hybrid composites.

OBJECTIVE: The study aimed to investigate the influence of different polishing systems on the surface roughness of nano-hybrid composite resins. BACKGROUND: Different shapes of polishing systems are available according to the site of work. To minimize variability, a new system with single shape is developed that can be utilized in both anterior as well as posterior teeth. MATERIALS AND METHODS: Seventy composite discs were fabricated using Teflon well (10 mm × 3 mm). Two main group of nano-hybrid composite Group I - Filtek Z350 and Group II - Tetric N-Ceram were used (n = 35 for each group). Both groups were further divided into four subgroups. Subgroup a - OneGloss (n = 10), Subgroup b - PoGo (n = 10), Subgroup c - Sof-Lex spiral (n = 10), Subgroup d - Mylar strip (control, n = 5). Samples were polished according to the manufacturer's recommendations. Surface roughness test was performed using contact profilometer. The obtained data were analyzed using the one-way analysis of variance test. RESULT: Tetric N-Ceram produced smoother surfaces than Filtek Z350 (P < 0.05). Mylar strip and "PoGo" created equally smooth surfaces, while significantly rougher surfaces were obtained after applications of "Sof-Lex spiral" and "OneGloss" (P < 0.05). CONCLUSION: Polishing ability of Tetric N-Ceram is better than Filtek Z350 XT. "PoGo" seems to be a better polishing system than "OneGloss" and "Sof-Lex Spiral."

Twist to matricing: Restoration of adjacent proximal defects in a novel manner.

The quality treatment in an efficient way is the road map to successful clinical practice. Various methods are employed to achieve goals. Refurbishment of the adequate marginal ridge, proximal contact, and contour are the prime challenges in restoring two adjacent proximal defects. This paper presents an overview of achieving satisfactory proximal restorations in a time saving innovative manner.

Smear layer removal efficacy of combination of herbal extracts in two different ratios either alone or supplemented with sonic agitation: An in vitro scanning electron microscope study.

OBJECTIVES: The study aimed to evaluate the effectiveness of the combination of two natural extracts in varying ratios for removal of smear layer either alone or supplemented with sonic agitation. MATERIALS AND METHODS: Fifty extracted single-rooted teeth were collected, disinfected and decoronated below the cementoenamel junction to obtain standardized root length of 10 mm. Root canals were instrumented using rotary files at working length 1 mm short of the apex. Specimens were divided into six groups according to the irrigation protocol as follows: Group A - Distilled water, Group B - 17% ethylenediaminetetraacetic acid, Group C - Herbal extracts in 1:1 ratio, Group D - Herbal extracts in 1:1 ratio supplemented with sonic agitation, Group E - Herbal extracts in 2:1 ratio, Group F - Herbal extracts in 2:1 ratio supplemented with sonic agitation. Specimens were longitudinally sectioned and evaluated under scanning electron microscope for smear layer removal efficacy. Obtained scores were statistically analyzed using one-way analysis of variance and post-hoc test. RESULTS: Among all, Group B showed the best results followed by Group F. Remaining other groups showed inferior outcome (P < 0.05). CONCLUSION: The combination of two extracts in 2:1 ratio was slightly better than 1:1 ratio and the smear layer removal efficacy was further improved when accompanied with sonic agitation.

Maxillofacial injuries due to animal bites.

INTRODUCTION: Animal bites are a significant public health problem, with the majority of bites coming from dogs, cats and humans. These may present as punctures, abrasions, tears, or avulsions. The force and relative bluntness of the teeth also increases the possibility of a crush injury with devitalized tissue .The clinical presentation and appropriate treatment of infected bite wounds vary according to the animal and causative organisms. These wounds have always been considered complex injuries contaminated with a unique polymicrobial inoculum. MATERIALS: This article reviews animal bite wound incidence, bacteriology, risk factors for complications, evaluation components, recommended treatment and prevention based on advanced PUBMED search of the English language literature from the years 1970 to present. CONCLUSION: As the bite wounds are frequently located on the face, an oral and maxillofacial surgeon needs to be familiar with the treatment of animal bites, pitfalls in management and to educate patients on ways to avoid future bite injuries. The management of animal bites is an evidence poor area and most recommendations are based on small case series, microbiological data and expert opinion. The main controversies include whether wounds should or should not undergo primary closure and the use of prophylactic antimicrobials.

Diagnostic modalities for squamous cell carcinoma: an extensive review of literature-considering toluidine blue as a useful adjunct.

INTRODUCTION: Oral Squamous Cell Carcinomas have been considered as the most prevalent malignancies in the head and neck region and are frequently undiagnosed until symptomatic with an advanced stage of disease. So there is an urgent need to device methods for the detection of oral premalignant lesions and oral cancer at an early stage in order to improve the survival rate for patients. A number of tests have been done for the detection of oral cancer which include oral brush biopsy, the Vizilite, oral autofluorescence including chemiluscence, photodynamic detection, toluidine blue staining, methylene blue staining, incisional biopsy and many more. MATERIAL: The article reviews various diagnostic modalities available at present for detection of squamous cell carcinomas and oral epithelial dysplasias based on advanced PUBMED search of the English language literature from the year 1972 to present in order to help us select the most suitable among them fulfilling the desired criteria of being non-invasive, highly specific and sensitive, economically viable, having a scope to be used for mass screening, easy to process, having low inter examiner variability and possibly not requiring high expertise to conduct and interpret the results. CONCLUSION: After reviewing various diagnostic modalities, we conclude that toluidine blue staining emerges as a clear winner among all these and it can act as a valuable adjunct to incisional biopsy in detection of oral cancer and may not substitute it except in certain circumstances when its results are carefully correlated with the patient history and clinical characteristics of the mucosal disorder, considering the fact that incisional biopsy has been reported to cause dissemination of cancer cells in the circulation there by increasing the possibility of metastasis. We must emphasize that toludine blue is a screening modality and not a diagnostic procedure like biopsy and hence cannot replace a confirmatory biopsy as a whole.

Evaluation of intra ocular pressure in zygomatico maxillary complex fractures.

PURPOSE: To study effects of zygomatico maxillary fractures and fracture reduction on intra ocular pressure (IOP). MATERIALS AND METHODS: IOPs of 20 patients with unilateral zygomatico-maxillary complex (ZMC) fractures (divided into 2 groups of 10 undisplaced, 10 displaced) were measured at various time intervals. The relationship between IOPs between the two groups at various time intervals was recorded and evaluated using independent T-tests. RESULTS: 20 subjects were divided into two equal groups (10 each of displaced and undisplaced fractures). Mean age of patients was 33.8 years with 90 % males and 10 % females. The change in IOP at the time of reporting, after 24 h and 7 days for patients with undisplaced ZMC fractures (Group I) was recorded and was found to be significant. The change in IOP at the time of reporting, before and after surgery, after 24 h and 7 days for patients with displaced ZMC fractures (Group II) was recorded and was also found to be significant. The IOPs of the two groups was compared at various time intervals and was found to be significant. Also, a significant increase in IOP was noted just after fracture reduction, which could be attributed to oculocardiac reflex, which has been proven to cause bradycardia, and in some cases, even death. CONCLUSION: A cautious eye needs to be kept over IOP while reducing ZMC fractures at regular intervals and the anaesthetist has to be informed to look for any bradycardia that can occur. Tonometers should be a part of standard armamentarium while reducing and fixing ZMC fractures.

Evaluation of two different methods of arch bar application: a comparative prospective study.

PURPOSE: To comparatively evaluate the efficacy of a pencil type wire twister and the normal wire twister in terms of various parameters during arch bars application. METHOD: The study involved residents of the department enrolled in MDS course. Two study groups of 60 patients each were made by randomly selecting the patients from the outpatient department of Oral and Maxillofacial surgery who required arch bar application. Group A included the patients who underwent upper and lower arch bar application with the use of a pencil type twister and group B included patients who underwent arch bar application with a normal wire twister. All respondents were given a questionnaire after the completion of procedure involving the use of medical sharps. The paired samples t test was used for statistical analysis. RESULT: Among group A, mean glove perforations, actual wire stick injuries, mean time taken to complete the procedure, mean wire breakage during the procedure was less than in group B. Comfort level of patients and Ease of operator while performing the procedure was more in group A than in group B. Frictional abrasion of the finger was not associated with the use of pencil type twister. Overall rating of the procedure was more in group A than group B. CONCLUSION: The use of pencil type wire twister outweighs normal wire twister in various ways. It increases the overall efficacy of the operator during the procedure.

Recurrent Mandibular Dislocation in Geriatric Patients: Treatment and Prevention by a Simple and Non-invasive Technique.

Dislocation is defined as the complete loss of articular relationship between the articular fossa of the temporal bone and the condyle-disk complex. Most common aetiology of dislocation is wide mouth opening, trauma and use of certain drugs. It is classified as acute, chronic and recurrent. Chronic recurrent dislocation of mandible is a distressing condition especially for geriatric patients. Various non-surgical methods of reduction include Hippocratic method, Awang's gag reflex method, wrist-pivot technique, combined ipsilateral staggering technique, recumbent approach, intermaxillary fixation, injection of a sclerosing solution, autologus blood transfusion and botulinum toxin. In geriatric population, the ridges become atrophic with time and use of any method of reduction which exerts force on mandible increases chances of fracture of mandible. Awang's gag reflex method is a non invasive technique which helps in treatment of chronic recurrent dislocation in geriatric patients. Along with this technique the use of a cervical collar has been reported in this article, which not only acts as a restrainer but also is helpful for cervical spondylosis, a common condition encountered in geriatric population.

Endodontic management of a four rooted retained primary maxillary second molar.

The presence of accessory roots is rare in the primary dentition. Complete knowledge and understanding of tooth anatomy is essential to carry out high quality dental treatment with excellent outcome. In addition, the persistent primary tooth and its missing permanent successor in the dental arch pose several hurdles in front of the clinician due to doubtful survival of primary tooth. In this paper, highlights the root canal treatment of a rarest four rooted retained primary maxillary second molar.