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Traumatic injuries of anterior teeth can seriously affect a person's smile, which contributes significantly to an individual's overall personality and sense of self. Hence, various efforts have been made over the years to develop techniques that enable clinicians to replicate the natural tooth anatomy while being practical enough to allow its use in clinical practice. The putty index technique helps to make significant progress in achieving such goals by forming a template against which composite material can be placed for restoration of various modalities - in this case, Ellis class I and II. The prepared index replicates the palatal anatomy of the wax build-up done on the patient's cast. This reduces the chair time while improving the predictability of the final restoration.
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The maxillary second premolar has long been regarded as a tooth with a straight root canal anatomy, typically featuring a single root with two canals. However, emerging evidence suggests this tooth may harbor a more intricate internal morphology, challenging conventional perceptions, and treatment approaches. One such variation is three root canals within the upper second premolar, which has been gaining increasing attention in endodontic literature. Root canal treatment of maxillary second premolars with three canals demands meticulous debridement, shaping, and disinfection. A combination of magnification, illumination, and appropriate instrumentation aids in locating, negotiating, and cleaning the accessory canals effectively. Thorough cleaning of accessory canals can be achieved through effective irrigation solutions such as sodium hypochlorite, ethylenediaminetetraacetic (EDTA), and chlorhexidine, which help dissolve organic tissues and remove debris. Techniques like ultrasonic and sonic activation, as well as negative pressure irrigation systems, enhance the penetration and effectiveness of these irrigants. Additionally, the use of modern nickel-titanium rotary files, ultrasonic irrigation, and supplementary chelating agents enhances the management of complex canal configurations.
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Dentistry is currently undergoing a phase where the pursuit of excellence has become continuous, and there is a rising demand for aesthetic standards, especially in the posterior region of the oral cavity. The "stamp technique" introduces a novel, straightforward method to restore carious teeth with unaltered occlusal structures using composite restoration. It effectively replicates the natural occlusal anatomy with remarkable precision. This method applies to preoperative carious teeth with preserved anatomy, minimally affected by carious lesions. Essentially, it involves creating an occlusal matrix from an undamaged occlusal surface of the tooth, aiming to achieve an accurate restoration resembling the natural tooth. This facilitates the restoration of the tooth's natural contour and contact, ensuring precise functional occlusion. This procedure offers increased efficiency, requires less time while maintaining high accuracy, and reduces the time needed for finishing and polishing.
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A C-shaped canal describes an anatomical configuration of a tooth's root canal that resembles the alphabet C when viewed occlusally in a prepared access cavity. In the second molar of the maxillary arch, the root canals unite into a single, continuous, extensive root canal morphology to form a C-shaped canal. The natural crevices found in tooth roots where blood vessels and nerves are housed are called root canals. The frequently referred etiology resulting in the development of the C-shaped canal arrangement is the inability of Hertwig's epithelial root sheath to undergo fusion. The occurrence of the C-shaped canal anatomic variation varies among populations, with the majority of cases occurring in mandibular second molars. C-shaped canals pose several challenges in endodontic treatment such as in their diagnosis, biomechanical preparation, debridement, and obturation. Nevertheless, the desired result can be achieved with relative ease if one has a solid grasp of the different root canal configurations and uses the relevant clinical expertise. Therefore, three-dimensional radiography is utilized to help identify and negotiate C-shaped canals by enabling three-dimensional reconstruction of the root canal system. Efficient C-shaped canal configuration treatment may be attained using hand-driven and rotary instruments assisted by sonic or ultrasonic hand-pieces. Four alternative gutta-percha filling methods are used in C-shaped canals: core-carrier, ultrasonic compaction, cold lateral compaction, and single cone with injectable gutta-percha. The core-carrier technique is the most efficient obturation technique in the C-shaped canal. Calcium silicate materials (CSMs) are also used for the obturation of C-shaped canals. The most frequently used CSMs are mineral trioxide aggregate and biodentine.
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Infection of the dental pulp involves mainly Gram-negative, anaerobic bacterial flora and due to this infection, the periapical area experiences an immunological response, which is termed a periapical lesion. This lesion may appear as a radiolucent (dark) area on X-rays, which indicates periapical inflammation and infection. Its prevalence depends on factors such as age, oral health maintenance, and dental care. Men are more likely to be affected by this infection than women. There are two modalities for the treatment of periapical lesions: surgical or non-surgical endodontic therapy. The modified triple antibiotic paste (TAP) comprising ciprofloxacin, metronidazole, and clindamycin in the ratio of 1:1:1 was first prepared expressly to treat the teeth with necrotic pulp and to support the protocol for revitalization and regrowth. The treatment was very successful in eliminating germs from the root canal system. It provides broad-spectrum antimicrobial activity against a wide range of bacteria commonly associated with endodontic infections. The modified TAP is usually inserted into the canal for a predetermined amount of time and then removed followed by the irrigation of root canal, which helps to eliminate the microorganisms from the root canal. The non-surgical treatment should always be the first choice over the surgical approach so as to avoid a more invasive procedure.
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The stamping technique, a pivotal process, has undergone significant advancements with the integration of composites. Traditionally, direct or indirect restorative cements, e.g., amalgam or composite resin, have been used to restore teeth, often presenting challenges in achieving optimal fit, esthetics, and durability. This process begins with creating an accurate impression of the prepared tooth, which serves as a blueprint for crafting the restoration. In contrast, the stamp technique, also known as the indirect restoration technique, offers several distinct advantages. The stamping technique enables the use of advanced materials that offer superior esthetics and durability. Composite resins used in stamp restorations can be shade-matched to the patient's natural teeth, resulting in seamless integration with the smile. These materials also exhibit excellent strength and wear resistance, ensuring restorations that last longer and are capable of withstanding stresses without fracture.
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Separating an endodontic instrument is one of the most frequent errors during a root canal treatment. If endodontic instruments get separated, it could hinder disinfection and prevent access to the apical portion of the root. It compromises the success of the treatment by impeding the proper debris removal from the canal. But now that techniques and tools have advanced, it is feasible to remove a separated instrument from the root canal successfully. This case report presents the management of a separated instrument, demonstrating the successful removal of the separated instrument.
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In addition to helping with wound healing, periapical surgery is performed to remove periapical disease. Concentrates of platelets have been applied extensively in endodontics and other fields of regenerative medicine. A periapical inflammatory lesion was found in a 35-year-old male patient who complained of pain in the maxillary anterior region and displayed slight edema in the same area. The lesion was treated with periapical surgery utilizing advanced platelet-rich fibrin (A-PRF). Mesenchymal stem cell processes of proliferation and differentiation can be induced by several types of platelet concentrates. Growth factors are released at the application site by platelet-rich fibrin (PRF) for a minimum of seven days. The activity of osteoblasts is stimulated by growth factors and secreted cytokines. Furthermore, the release of growth factors promotes fibroblast migration, which quickens tissue regeneration. In addition to helping with wound healing, periapical surgery is performed to remove periapical disease. The synthesis of fibrin networks laden with platelets and growth factors is made possible by PRF, which is subsequently used to accelerate bone regeneration and, consequently, to improve bone formation. In this instance, the best possible bone regeneration and repair were accomplished. After 12 weeks, 24 weeks, and 36 weeks, the patient was brought back for follow-ups. He was found to be asymptomatic, and the radiograph showed considerable periapical healing with nearly enough bone production.
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The outcome of an endodontic procedure determines the clinical success of the treated tooth. A post-endodontic restoration will restore the tooth's form, function, and aesthetics while preserving and safeguarding its existing tooth structure. To restore endodontically treated teeth with the best possible tissue preservation, the least invasive preparation is the aim. Full-coverage crowns are still more popular than partial-coverage crowns. Conservative dental procedures such as inlays, overlays, and endocrowns maximize the amount of tooth structure that is intact while minimizing the amount of tooth structure that is removed. Compared to posts, cores, and crowns, endocrowns offer several advantages in terms of ease of preparation, application, and reduced clinical visits and time. Endocrown is a simple, minimally invasive preparation usually given when margins are supragingival, which makes it self-cleansable and maintains natural tooth contact, preventing interference with periodontal tissue. This case report focuses on managing endodontically treated teeth with the fabrication of endocrown using computer-aided design (CAD) and computer-assisted manufacturing (CAM) techniques.
RESUMEN
If left untreated, an inflammatory periodontal disease eventually leads to attachment loss. This may have an impact on a multi-rooted tooth's bifurcation or trifurcation. The division of a tooth with two roots into two distinct parts is known as hemisection. Hemisection is the term used to describe the removal or separation of a two-rooted tooth's root and crown, most likely a mandibular molar. Compared to other treatment options, hemi-sectioning the affected tooth can help preserve the tooth's structure and alveolar bone. Careful selection of cases is essential for the long-term success of the procedure. In this case report, in contrast to the more common option of extracting the natural tooth, a treatment option is discussed for molars with extensive decay that threatens tooth loss. Therefore, this option should be discussed with patients when deciding on a course of treatment, and it may be a good substitute for extraction and implant therapy, particularly in cases of advanced endo-perio lesions.
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Background The aim was to evaluate and compare the efficacy of TheraCal LC, mineral trioxide aggregate (MTA), and Biodentine as direct pulp capping (DPC) materials in patients with pulpal exposure in the posterior teeth. Methodology A total of 54 samples were assessed for eligibility. Out of this, 12 teeth samples failed to meet the inclusion criteria. Finally, 42 teeth samples were selected which were randomly distributed into three groups (n = 14). Groups A, B, and C received the intervention of MTA, Biodentine, and TheraCal LC, respectively. The assessment was performed clinically to check for postoperative pain, tenderness, and neural sensibility, and the radiographs were used to check the presence of periodontal ligament (PDL) space widening, calcified barrier, and periapical radiolucency at the follow-up of 21 days, three months, and 12 months. The outcomes depended on the clinical and radiographic success rates recorded at 12 months of recall. Results Overall successful outcome of DPC clinically at different periods was 97.61% at three months and 88.09% at 12 months. A Chi-square test was used which showed that the difference was statistically nonsignificant. For groups A, B, and C, the success rate at follow-up came out to be 85.71%, 100%, and 78.57% at 12 months, respectively. The overall radiographic success rate of DPC at different time periods was 83.33% at three months and 88.09% at 12 months. A Chi-square test was used which showed that the difference was statistically nonsignificant. For groups A, B, and C, the success rate at follow-up came out to be 85.71%, 100%, and 78.57% at 12 months, respectively. Conclusion Resin-based calcium-silicate agent (TheraCal LC) showed good efficacy and can be used in practice with the predictability of a good success rate both clinically and radiographically. Thus, TheraCal LC can be utilized as an alternative to MTA or Biodentine in clinical practice, with the predictability of similar successful outcomes in patients with pulpal exposure in the posterior teeth.
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Traumatic oral ulcers are one of the most commonly encountered oral ulcers. Their healing may be delayed due to factors like the presence of opportunistic infectious microbes in the oral cavity, secondary trauma from sharp edges of teeth, and the systemic condition of the patient. AIM: To compare the efficacy of a newly developed neem extract containing herbal ointments (propolis and Hemidesmus indicus) in enhancing the wound contraction of traumatic oral ulcers and to determine the relationship between oxidative stress and oral ulcers. METHOD: Ulcers were inflicted by trauma in the mouths of experimental rabbits using a 5 mm punch biopsy device. Forty-eight animals were randomly put into six groups (n = 12). Group 1 was the control group that did not receive any intervention; Group 2 had a systemic treatment of Hemidesmus indicus extract; Group 3 received a topical application of propolis; Group 4 had a topical application of a neem extract-based herbal ointment; Group 5 was administered a combination of Hemidesmus indicus and propolis; and Group 6 had a combination of a neem-based herbal ointment and Hemidesmus indicus. Oxidative stress levels were calculated by measuring superoxide dismutases and malondialdehyde levels in the blood on days 0, one, seven, and 14. Wound contraction scores of ulcers were also assessed on days seven and 14. RESULTS: Significantly higher wound contraction scores were seen in groups treated with herbal ointment in comparison to groups treated without herbal ointment. Oxidative stress levels increased in all groups after the infliction of ulcers (day one) and then declined as the ulcers healed, reaching near-normal levels on day 14. Groups containing Hemidesmus indicus showed a significant reduction in oxidative stress in comparison to groups without Hemidesmus indicus. A p-value of <0.05 was considered significant. CONCLUSION: A combined formulation of herbal ointment and Hemidesmus indicus proved to be the most efficacious in enhancing wound contraction of oral ulcers along with significantly reducing oxidative stress in experimental rabbits.
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Introduction Microorganisms are pivotal contributors to pulp and periapical pathology, often culminating in endodontic treatment failures. The successful outcome of such treatment hinges on the effective eradication of microbial flora through various interventions, including intracanal medicaments (ICMs). However, Enterococcus faecalis (E. faecalis), a highly adaptive Gram-positive bacterium, exhibits remarkable resilience and can persist even after rigorous disinfection efforts. This study explores the efficacy of two ICMs, calcium hydroxide-based triple antibiotic paste (TAP) and a novel alternative containing bromelain, derived from pineapples, in combating E. faecalis infections in vivo. Methodology This in-vivo study was conducted at Sharad Pawar Dental College and Hospital, Wardha, India, and ethical approval was obtained from the institutional ethical committee. The sample size was calculated using the OpenEpi program (version 3.04.04, Open Source Epidemiologic Statistics for Public Health, www.OpenEpi.com), resulting in 15 participants per group. Inclusion criteria encompassed mandibular premolars with carious involvement but no prior restorations, diagnosed with necrotic or infected pulp, and no significant medical history. Exclusion criteria included systemic conditions, pregnancy, retreatment cases, recent antibiotic therapy, calcified canals, and other contraindications. After proper patient consent, access opening and chemomechanical preparation were performed, and root canals (RCs) were randomly divided into two groups: TAP and bromelain paste (BP). TAP was prepared using ciprofloxacin, metronidazole, and minocycline, while BP comprised bromelain powder mixed with saline. Both groups received intracanal medicaments, followed by temporary sealing. Microbiological samples were collected before and after treatment for analysis. Results E. faecalis count (CFU/mL) before instrumentation for the TAP group was (1.94 x 105 [Formula: see text] 7.45 x 103) and for BP group was (1.97 x 105 [Formula: see text] 7.70 x 103) with p-value 0.26 [Formula: see text] p=0.05, so no significant difference was found between them. E. faecalis count (CFU/mL) after instrumentation for the TAP group was (7.70 x 103 [Formula: see text] 9.11 x 102) and for the BP group was (7.26 x 103 [Formula: see text] 8.43 x 102) with p-value 0.18 [Formula: see text] p=0.05, so no significant difference was found between them. However, the E. faecalis count obtained after seven days of intracanal medicament for the TAP group was (3.63 x 101 [Formula: see text] 5.60) and for the BP group was (3.13 x 101 [Formula: see text] 4.55) with p-value 0.012 < p=0.05, so a significant difference was found between them. This means that when compared with the TAP group, there was a greater amount of reduction in E. faecalis count (CFU/mL) for the BP group seven days after the placement of intracanal medicament, and this reduction was statistically significant. Conclusion This in-vivo study highlights the potential of BP as a more effective intracanal medicament against E. faecalis when compared to the conventional TAP. Bromelain's selectivity for Gram-positive bacteria and its diverse therapeutic properties make it a promising natural alternative for endodontic treatment. Further research is warranted to optimize bromelain's clinical application and assess its potential to enhance endodontic outcomes, potentially revolutionizing the field of endodontics.
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Fluoride has performed a central role in the growth over the last fifty years. This report examines the present state of knowledge about fluoride's involvement in preventing dental caries. In recent years, our knowledge of the development of dental caries and the manner of operation of fluoride has been shifted. Dental caries is a constant procedure for enamel demineralization and remineralization, and fluoride plays an important part in this action by acting at the plaque-enamel contact. Fluoride's major method of action is now recognized as posteruptive. Fluoride's post-eruptive activity has led to the development of novel fluoride delivery systems. The importance of various fluoride delivery techniques on a population and societal level is discussed, along with suggestions.
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Aim To evaluate and compare the microleakage In class II restorations using open- and closed-sandwich techniques with zirconomer as an intermediate material. Material and method Twenty-six non-carious mandibular first molars were selected and randomly divided into two groups (groups 1 and 2 where n=13). A standardized Class II preparation was made with the cervical margin 1 mm below the cementum-enamel junction. Samples of group 1 were restored using the open-sandwich technique and samples of group 2 with the close-sandwich technique, and zirconomer was used as an intermediate restorative material. Following that, the restorations underwent 200 heat cycles with dwell times of 20 seconds at 5°C and 55°C. Dye penetration and scanning electron microscope (SEM) analysis using the replica approach were used to assess adaptation at the cervical margin. The data were statistically analyzed using the Paired T-test (p<0.05). Results Lower dye penetration was seen in the open-sandwich technique compared to the closed-sandwich technique (p<0.001). Conclusion When comparing the open-sandwich technique with the closed one, it was observed that less microleakage was seen in the open-sandwich technique as it has better marginal adaptation and fewer voids.
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Aim The current study aims to evaluate and compare the efficacy of light-cured calcium hydroxide and a fourth-generation calcium silicate cement (TheraCal LC®) as indirect pulp capping (IPC) materials in patients with deep carious lesions. Materials and methods A total of 28 patients were randomly divided into two groups (n=14). Group A was managed by light-cured calcium hydroxide, while group B was treated with TheraCal LC (a fourth-generation calcium silicate cement). Clinical examination was conducted to check for postoperative pain, tenderness, and neural sensibility, and radiographical examination was conducted to check for periodontal ligament space widening, presence of calcific barrier, and periapical radiolucency at patient recall of 21 days, three months, and six months. Primary and secondary outcome variables were based on clinical and radiographical success rates noted at six months' follow-up. Results Success rate for light-cured calcium hydroxide group at follow-up came out to be 0% at 21 days, 85.71% at three months, and 92.85% at six months. The success rate for TheraCal LC group came out to be 0% at 21 days, 92.85% at three months, and 100% at six months. The overall success rate for IPC procedure was 89.28% at three months' follow-up and 96.42% at six months' follow-up for both groups. The difference was statistically non-significant at the end of three and six months' follow-up. Conclusion Within the limitations of our study, it was concluded that TheraCal LC can be used alternatively with light-cured calcium hydroxide in IPC, with a predictability of similar success outcome in patients with deep carious lesions.
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Hemisection is the sectioning of teeth with multiple roots, the removal of the damaged root and its associated crown piece, and the preservation of the healthy root (with crown). When periodontal, resorption, perforation, or caries damage is limited to one root and the other root is still largely healthy, this treatment option may be taken into account. The right case selection is the most important component in determining the long-term success in such cases. This case report details the hemisection of a mandibular molar with root caries, followed by appropriate restoration.
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Traumatic dental injuries often occur to the teeth and their supporting tissues and they are the main reasons for an emergency visit to a dental clinic. Horizontal root fractures usually are characterized by a fracture line that is perpendicular to the long axis of the root. Root fractures are diagnosed through clinical and radiographic examination. Treatment depends on the position of the fracture, the extent of root involvement, correct diagnosis, clinical management, and radiographic follow-up. This article presents endodontic management of horizontal root fracture using a fibre post. A 28-year-old male patient presented with a horizontal fracture of the maxillary left central incisor at the junction of the apical and middle third of the root. Root canal treatment followed by MTA apexification of the coronal fragment and fibre post gave satisfactory results.