Management of a bulbous blunderbuss maxillary central incisor with one root and three canals in a patient with cleft lip and palate.

Unique anatomical deviations in canal structure are rare in anterior teeth, especially central incisors, and thus risk being overlooked. For successful intervention, a meticulous diagnostic procedure and treatment plan, significantly aided by cone-beam computed tomography (CBCT), are crucial. The case at hand explores the management of a maxillary left central incisor in a cleft palate patient, characterized by multiple developmental lobes, a bulbous crown, and an atypical root anatomy. The primary symptom was pain, accompanied by a history of trauma at age 8 years and ensuing tooth discoloration. Initial evaluations, augmented by CBCT, revealed pulpal necrosis in a single-rooted tooth with three distinct canals. Initial clinical examination was supplemented by electrical pulp testing, RadioVisioGraphy (RVG), and CBCT, after which the root canal therapy was initiated. Informed consent was obtained from the patient. The access cavity preparation resulted in a three-orifice cavity. Subsequently, the canals were enlarged and sufficiently debrided. Calcium-hydroxide was applied for 2 weeks before the commencement of apexification and obturation, followed by esthetic rehabilitation. This case highlights the importance of recognizing rare anatomical variations in anterior teeth and demonstrates the invaluable role of CBCT in both diagnosing and managing such complexities.

Deep margin elevation in class II cavities: A comparative evaluation of microleakage and interface integrity using confocal laser microscopy and scanning electron microscopy.

Aim: This study aims to evaluate the microleakage between the gingival seat and base material and to assess the interface integrity between the base material and overlying composite in class II cavities restored using deep margin elevation. Materials and Methods: Thirty maxillary molars (n = 30) were taken, and class II cavities were prepared with a gingival seat extending below the cementoenamel junction. These teeth were divided into three groups for subgingival margin elevation using different materials: Group A (n = 10) - flowable composite, Group B (n = 10) - glass ionomer cement (GIC), and Group C (n = 10) - GIC with nanohydroxyapatite (GIC n-HAp). The remaining cavities were restored with bulk-fill composite. After undergoing 1000 thermocycling cycles, half of the samples were examined for microleakage using confocal laser microscopy, and the other half were assessed for interface integrity using scanning electron microscopy. Microleakage was statistically analyzed by one-way ANOVA, and interface integrity was analyzed by Kruskal-Wallis tests. Results: The study found that GIC n-HAp exhibited significantly lower microleakage between the base material and gingival seat than flowable composite and GIC. However, regarding interface integrity between the base material and bulk-fill composite, flowable composite, and GIC outperformed GIC n-HAp. Conclusions: Incorporating n-HAp into GIC effectively reduced microleakage at the dentin-base material interface. However, the interface integrity between GIC n-HAp and the composite poses a challenge.

Evaluation of rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials: An in vitro study.

Context: External inflammatory root resorption has rapid onset and progresses aggressively. It leads to cementum loss, which allows communication between the infected pulp and the periodontium through the denuded dentinal tubules. Primary management strategy includes adequate chemomechanical debridement and lesion arrest for which maintaining alkaline pH and aerobic conditions is essential for healing and repair of the resorption defect. Aims: The aim of this study is to evaluate rise in pH and oxygen release at the site of simulated external root resorption cavities using different oxygen-releasing biomaterials. Materials and Methods: In 40 extracted single-rooted teeth access opening and chemomechanical debridement were done. Cavities simulating resorption defect are prepared on the roots. The samples are divided into four groups (n = 10) based on the biomaterial used. After placing the biomaterial, the root apices were sealed. Half of the samples from each group were tested for oxygen release using dissolved oxygen meter and the other half for rise in pH using pH meter at 7, 14, 21, and 28 days. Statistical Analysis: The pH values were analyzed using Friedman 2-way analysis of variance (ANOVA) and Kruskal-Wallis test. Oxygen release was measured using the two-way and repeated-measures ANOVA. Results: Calcium peroxide group showed the highest mean pH and oxygen release than other groups at any given point of time. Conclusions: Incorporating oxygen-releasing biomaterials such as calcium peroxide and perfluorodecalin into intracanal medicaments, such as calcium hydroxide, creates an alkaline and oxygen-enriched milieu in the periapical tissues.

Effect of collagen cross-linking agents on the depth of penetration of bioceramic sealer and release of hydroxyproline: An in vitro study.

Context: During endodontic treatment, sealers seal off dentinal tubules and prevent microbial attack. Bioceramic sealers have excellent bioactivity, but its high alkalinity is found to have detrimental effects on radicular collagen. Collagen cross linkers have the ability to chemically modify collagen and can prevent the detrimental effects of the sealer. Aim: This research was aimed to assess the effect of collagen cross-linking agents on the integrity of radicular collagen matrix and depth of penetration of sealer. Materials and Methods: Mandibular premolars (n = 48) were taken. Teeth were decoronated; canals were prepared till ProTaper size F2 and were irrigated with 5 mL of 2.5% NaOCl, followed by 3 mL of 17% ethylenediaminetetraacetic acid between instrumentation and finally rinsed with saline following which teeth were divided into three groups based on the surface treatments: Group 1: 6.5% proanthocyanin (PA), Group 2: chlorhexidine (CHX), and Group 3: saline. Teeth were obturated using gutta-percha and bioceramic sealer and stored in artificial saliva. Hydroxyproline (HYP) release was assessed after 14 and 21 days using spectrophotometer. Sealer penetration was assessed using the scanning electron microscope. Statistical Analysis: Wilcoxon signed-rank test and Kruskal-Wallis test for release of HYP and paired t-test and ANOVA for sealer penetration were performed. Results: Significantly lower release of HYP was seen in proanthocyanin-treated group. Sealer penetration was better for both the proanthocyanin- and CHX-treated groups when compared to saline. Conclusion: Surface treatment with collagen cross-linkers caused a decrease in the amount of HYP released, indicating lesser degradation of collagen. Sealer penetration was better due to the removal of smear layer following the surface treatments.

Evaluation of the efficacy of a novel disinfecting material on the surface topography of gutta-percha: An in vitro study.

Context: The effect of chemical disinfection on gutta-percha (GP) has to be closely studied whether it affects surface topography and thereby causes leakage and reinfection of canals. Aims: The purpose of the study is to assess the surface topography of GP cones after disinfecting with a novel disinfecting material, graphene oxide (GO), and compare the same with other disinfecting materials, including sodium hypochlorite (NaOCl) and silver nanoparticles (AgNps). Settings and Design: After determining the power (0.84) of the study, 48 GP cones were taken and categorized into four different groups based on disinfecting agents. Materials and Methods: Forty-eight GP cones (ISO size 30 6% taper, DIADENT) were taken and are randomly selected and grouped as follows according to the disinfecting agents: Group 1 - control (untreated GP points, n = 12), Group 2 - NaOCl (n = 12), Group 3 - AgNPs (n = 12), and Group 4 - GO (n = 12), respectively. After treating with the above disinfecting materials, the surface topography of samples was evaluated using atomic force microscopy. The data were analyzed statistically using one-way ANOVA and post hoc (Tukey's honestly significant difference) tests. Statistical Analysis Used: IBM SPSS (version 21.0) software was used. The tests performed were one-way ANOVA and post hoc. Statistically, significance was set at a P ≤ 0.05. Results: The root means square values and surface roughness values were lesser for the GO group and AgNPs when compared with the NaOCl group, which were statistically significant. Conclusions: Within the limitations of the study, this study had shown lesser surface topography deterioration of GP cones when treated with GO and AgNPs, whereas more deterioration was observed with NaOCl.