Objective: Laser therapy has been used in various fields of endodontics like cleaning and shaping of root canals, sterilization and apical sealing after apicoectomy. The purpose of this study was to evaluate the antibacterial efficacy of CO₂ and Nd:YAG lasers against E. Faecalis. Method and materials: Thirty human mandibular premolars were sectioned and inoculated with a pure bacterial culture of E. Faecalis (ATCC10541). The samples were then divided into two experimental groups and treated with Nd:YAG and CO₂ lasers respectively. The third group was used as control, which was only treated with saline. The microbiological assay was carried out both before and after radiation therapy by counting the Colony Forming Unit (CFU)/ml. Results: There was a significant reduction in the bacterial load after laser therapy. CO₂ laser showed complete sterilization of the samples showing a 100% reduction as compared to Nd:YAG laser which showed a 84% reduction. Conclusion: CO₂ laser (1.064nm, 1.5W, 100mJ, 15Hz, 10sec) showed a higher antibacterial efficacy against E. Faecalis as compared to Nd:YAG laser.

Aim: Aim of this study was to compare the difference between the in vivo working length established by viewing a periapical radiograph and the in vitro measurement from the file tip to the apical foramen of the extracted tooth. Materials and methods: Working length was determined, in vivo by using an electronic apex locator (Root ZX) in twenty canals of incisors, premolars and molars. Size 10 and 15 K-type files were fixed in the teeth to the length determined by EAL. Periapical radiographs were exposed with files fixed in teeth which were extracted afterwards. Three examiners viewed each radiograph and assessed the working length of each canal. Extracted teeth were examined under stereomicroscope and distance between file tip and most coronal part of apical foramen was measured. Results: The examiners overestimated the distance between the file tip and the apical foramen of the tooth when the file was placed short, and underestimated the distance when the file was placed long. Conclusion: When the file is short it is actually closer to the apical foramen than it appears radiographically; when it is long it is actually longer than it appears radiographically.

Aim: To determine the effect of carbamide peroxide gel combined with or without 2% chlorhexidine gel and the effect of sodium perborate in combination with three different vehicles on dentin microhardness following walking bleach technique. Method: 30 extracted maxillary anteriors were collected and sectioned at 2mm below Cemento-Enamel Junction. Endodontic access cavities were prepared and pulp was completly extirpated. The crowns were randomly divided into six groups. A fresh portion of bleaching agent was appropriately combined with the designated vehicle and placed in the pulp chamber. After 7 days, bleaching agent was changed. The procedure was repeated for 3 weeks. Dentin microhardness was tested. Result: The results were statistically analysed and Sodium perborate when combined with hydrogen peroxide showed the lowest microhardness. Conclusion: Chlorhexidine can be considered during intra coronal bleaching as an antimicrobial vehicle without adversely affecting dentin microhardness.

Objective: The objective of this in vitro study was to compare the accuracy of the Root -ZX apex locator and Propex II apex locator and to locate the major diameter (apical foramen). Methods and Material: Forty single rooted extracted teeth were used. The teeth were decoronated and the coronal section of each canal was flared using Gates- Glidden drills. Canals were irrigated with 2.5 % sodium hypochloride solution. Actual root canal length were determined by inserting a # 15K- file until the tip was visualized (5x magnification) just within the apical foramen .The results obtained with each electronic apex locator (EAL) were compared with the actual canal length. Differences between the electronic and actual length were calculated . Results: The statistical analysis of the results showed EAL reliability in detecting the apical foramen to 89.7% for Root-ZX and 82.1% for the Propex II , taking the tolerance of ± 0.5 into consideration. A paired sample t- test showed that there was no statistically significant difference between the accuracy of the two devices (p= 0.4305 ). Conclusion: The results of this study indicate that the Root- ZX and Propex II are useful devices for apical foramen location.

The present in vitro study was undertaken to evaluate the antimicrobial efficacy of 5% doxycycline, 0.2% chlorhexidine gluconate and 2.5% sodium hypochlorite when used alone or in combinations against Enterococcus faecalis. Agar diffusion test was done to evaluate the antimicrobial efficacy of the various intracanal irrigants. Enterococcus faecalis (ATCC 29212) was used as a test organism. The inoculum of E. faecalis was streaked on the agar plates. Using a punch, wells each measuring 6mm in diameter and 4mm depth were made and 50 μl of the experimental irrigant was pipetted into each well. A total of 200 wells were made, 40 for each group and the plates were placed in a carbon dioxide incubator at 37° C for 48 hours. The zones of inhibition were measured using a mm scale and the results statistically analyzed using ANOVA test and Tukeys HSD. The zones of inhibition recorded were 19.90, 14.60, 24.75, 25.58, 26.86 mm for Group A (chlorhexidine gluconate), Group B (sodium hypochlorite), Group C (doxycycline), Group D (combination of doxycycline and sodium hypochlorite) and Group E (combination of doxycycline and chlorhexidine gluconate) respectively. Within the limitations of this experiment, the results of the present study concluded that a combination of 5% doxycycline and 0.2% chlorhexidine is the choice of irrigant against E.faecalis.

Forty one maxillary anterior teeth indicated for post and core and patients of either sex between the age group of 18-25 years who fulfilled the selected criteria were involved in this study. All the selected teeth were endodontically treated and the post space preparations were performed by rotary instruments. Patients were randomly divided into two groups: Cast Metal Posts [MP] group which served as control and Quartz Fibre Post [FP] the test group. After cementation of the posts in both groups as per standard procedure, ceramic restorations were placed. Periodic evaluation was carried out at 3, 6 and 9 months. The clinical parameters assessed were debonding at post-core and tooth interfaces, core fracture, crown fracture, periodontal status and aesthetics. The radiological parameters assessed were root fracture, post fracture, periapical status and post adaptation in the root canal. The data was tabulated and statistically analyzed. Survival analysis by Kaplan Meier and median survival time methods were compared using Wilcoxon Test. Results suggest Fibre post and core group showed only one failure whereas cast metal group exhibited three failures. However, there was no statistical significant difference between the groups.

Aim: To evaluate the effectiveness of routine sterilization procedure for both rotary and hand endodontic files. Materials and Methods: The sterility of new (unused) and used endodontic files before and after routine cleaning and processing were autoclaved and were then microbiologically analyzed. The new set of unused files from sealed packet were tested immediately. The used files were evaluated both without sterilization and with cleaning and processing along with autoclaving for the presence of micro-organisms. Each file was inoculated in Nutrient Broth (liquid media) and incubated at 37°C for 24-48 hours. First sub-culture was done on blood agar after 24 hours and then second sub-culture after 48 hours. The files were then observed for micro-organisms. Results: All endodontic files both rotary and hand which were new and un-used and the ones which were used, cleaned and sterilized showed no growth whereas the files both rotary and hand which were used and unsterilized showed the presence of growth. Conclusion: Endodontic files, as supplied by the manufacturers to the endodontists are not pre-sterile routinely. The routine sterilization procedure followed in clinical and academic practice is autoclaving for both new and used instruments, rotary as well as hands. Even though the packaged instruments used in this study were sterile with no growth one should not draw a conclusion that all of the packaged instruments are sterile. Clinical Significance: The goal of instrument sterilization in dentistry is to protect patients from cross contamination via instruments. Thus, utmost care should be taken to clean and sterilize each and every instrument before it is used in patients. If the re-sterilization procedures are not adequate then the instruments should perhaps be considered as single-use devices as this would reduce the risk of transmission of infectious agents.

Objective - To study, measure and compare the apical sealing ability of laterally compacted gutta percha using 2% gutta percha with 2% accessory cones , 6% gutta percha with 2% accessory cones with single cone compacted ProTaper gutta percha point corresponding to ProTaper preparation, using fluorescent dye penetration technique. Study Design: 79 extracted human mandibular premolars were collected and disinfected. They were divided into 25 teeth each in 3 experimental groups and 2 teeth each in positive and negative control group. Biomechanical preparation was done using ProTaper rotary system. Group I and II were obturated with 2% and 6% gutta percha cones along with 2% accessory cones using lateral compaction technique. In group III single cone compaction with ProTaper gutta percha cone was done. 2 teeth instrumented but not obturated were used as positive control whereas 2 teeth obturated and sealed completely with nail varnish served as negative control. All the specimens were immersed in Rhodomine 6G fluorescent dye for 48 hours, and then teeth were sectioned longitudinally. Apical leakage was measured under a fluorescent microscope. Results - Data obtained was subjected to statistical analysis using Anova Test and Tukey's HSD test, it showed statistically significant difference in apical leakage among the single cone obturated ProTaper gutta percha points and the laterally compacted 2% and 6% gutta percha points, with no statistically significant difference seen between laterally compacted 2% and 6% gutta percha. Conclusion - Under the limitations of the present study single cone compaction using ProTaper gutta percha points corresponding to its respective preparation provided a better apical seal than the laterally compacted 2% and 6% gutta percha.

Intentional reimplantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth into its own alveolus. In this article, intentional reimplantation is described and discussed as a treatment approach for failed root canal treatment with broken instrument periapically in mandibular second molar and in a case of perforating internal resorption in maxillary central incisor. A 2 year follow up and 6 month follow up respectively revealed the patient to be asymptomatic, the tooth to be functional and a recall film showed no evidence of root resorption. The indications for and limitations of intentional replantation as well as recommended literature on the subject are discussed.

This article presents the procedures that must be considered for periapical cyst repair by nonsurgical endodontic treatment. The case of a periapical cyst associated with 21 and 22 is reported. Nonsurgical root canal therapy was performed and lesion healing was observed radiographically after 14 months. Diagnosis, endodontic infection control, apical foramen enlargement, irrigation of the cystic cavity with iodine saline solution and a calcium hydroxide paste intracanal dressing were important procedures for case resolution.

Perforations are undesirable complications and unfortunate incidents that can occur during pulp space therapy. Materials used for perforation repair before were inadequate because of their bacterial leakage and lack of biocompatibility to the underlying tissues. Studies have shown that the material used recently have been showing the promising results to correct these iatrogenic mishaps. In the recent literatures MTA has been regarded as an ideal material for perforation repairs and a barrier for these kind of communications. This article describes a couple of case reports where an iatrogenic supracrestal and furcation perforation were repaired successfully with Mineral Trioxide Aggregate.

As with all surgical procedures, there is a risk of operative and post-operative complications associated with endodontics, but these should be unusual provided appropriate precautions are taken.This article reviews the evidence on complications alongwith a case report of occurence of air emphysema during endodontic treatment.

Traumatic fracture of anterior teeth is one of the common dilemmas faced by the dentist during daily practice. Maxillary incisor are the most common teeth involved in facial trauma and most of the time, dental anterior crowns are damaged. An unrestorable tooth should be extracted and this may lead to more complex treatments such as implant or conventional prosthetic rehabilitation, which will restore function but impair esthetics. This case report present a clinical technique for the restoration of a fractured maxillary central incisor, by reattaching the fracture coronal tooth fragment using a Para post and resin composite restoration. A challenging, conservative and economically viable procedure with in the compass of a single visit.

External apical root resorption in permanent dentition is usually pathological. Local factors are the most frequent causes of resorption, especially excessive pressure and inflammation. Depending upon the type of resorption and etiology, different treatment regimens have been proposed. This case demonstrates external root resorption arrest and formation of an apical barrier by conventional endodontic therapy combined with calcium hydroxide dressing and a mineral trioxide aggregate (MTA) apical plug. The upper left central incisor exhibited severe external root resorption along with open apex in both right and left central incisors which received pulp space therapy combined with calcium hydroxide dressing. MTA apical plug backfilled with gutta-percha was performed and the access cavity was restored with composite resin. The patient has been regularly recalled every 6 months, and no symptoms or signs have been noted. Radiography the apical lesion healed and the external root resorption has been arrested after 1 year.

Sodium hypochlorite (NaOCI) is an effective intra canal irrigant and used in concentrations ranging from 0.5 to 5.25%. At these concentrations, it is highly hypertonic and strongly alkaline with pH 11 to 13. Sodium hypochlorite accident is a rare complication seen in endodontic therapy. It was first reported by Becker et al in 1974. Since then it has been infrequently reported in literature including cases of accidental misuse as a local anesthetic agent and accidental extrusion into maxillary sinus. Majority of NaOCl accidents has pulp necrosis, periradicular radiolucency as preoperative status. No specific treatment can reverse the damage due to NaOCl. Mainstay of treatment is supportive including airway protection, control of swelling, pain relief and prevention of secondary infection. Present article highlights a case of sodium hypochlorite accident and its successful management.

Before endondontic therapy is performed the clinician should know the number of roots and canals of the tooth that is to be treated. False assumptions about root canal morphology may lead to incomplete debridement and obturation of the root canal space eventually leading to endondontic failures. Access cavity modification may be required for stress free anatomic manipulations. Coupled with the sound knowledge of root canal anatomy is the use of higher magnification that can bridge the gap between oneself and higher percentage of successful endondontic treatment. This rare case report discusses the diagnosis and treatment of a three rooted maxillary first premolar.

Avulsion is the total displacement of tooth from its socket. It usually occurs after severe traumatic injury. Management of tooth avulsion in the permanent dentition often presents a challenge. Definite treatment planning and consultationwith specialists is seldom possible at the time of emergency treatment. Reimplantation of the avulsed tooth can restore esthetic appearance and occlusal function shortly after the injury. But post traumatic root resorption canprogressively occur, resulting in permanent loss of the traumatized tooth. This article presents the same type of post operative complication because of delayed reimplantation. The reimplanted central incisor retained its esthetic appearance and function for 6 years. The long-term prognosis was not good because of progressive replacement root resorption.

Tissue engineering is a novel and highly exciting field of research that aims to repair damaged tissue as well as their replacement. Research in this field continues to advance knowledge about how an organism develops from a single cell and how healthy cells replace damaged cells in adult organisms. Stem cells are undifferentiated cells capable of self-renewal and differentiation into multifunctional cell types. Tissue engineering in Endodontics is both exciting and promising and the future would only see an increase in this interdisciplinary field. However, regenerative endodontics is an emerging field of modern tissue engineering that has demonstrated promising results using stem cells associated with scaffolds and responsive molecules. Thereby, this article reviews the most recent endeavors to regenerate pulp tissue based on tissue engineering principles and provides insightful information to readers about the different aspects involved in tissue engineering.

Proper handling, treatment and disposal of biomedical wastes are important elements of health care office infection control programme. Properly designed and applied, waste management can be a relatively effective and an efficient compliance-related practice. Some waste from healthcare facilities, however, is contaminated. If not disposed of properly, contaminated wastes may carry microorganisms that can infect the people who come in contact with the waste as well as the community at large.

The availability of datasets comprising of digitized images of human body cross sections as well as images acquired with other modalities such as CT and MRI, along with the recent advances in fields like graphics, 3D visualization, virtual reality, 2D and 3D image processing and analysis (segmentation, registration, filtering, etc.) have given rise to a broad range of educational, diagnostic and treatment planning applications, such as virtual anatomy and digital atlases, virtual endoscopy, intervention planning etc. This article presents the insight into the present state of virtual reality technology in dental training and treatment.