Introduction: The purpose of this in vitro study was to assess the influence of AH Plus, EndoREZ and MetaSEAL, on the resistance to vertical root fracture of endodontically treated teeth when either the matched taper single cone or lateral condensation technique was used. Methods: Eighty extracted single-canal mandibular teeth were sectioned, leaving a standard root length of 13 mm. The buccolingual and mesiodistal diameters were measured, and the teeth were randomly divided into 8 groups (n = 10). There were no statistically significant differences between the groups in terms of the diameters. In group 1, no instrumentation or obturation was performed. The rest of the roots were chemo mechanically prepared with nickel-titanium ProTaper rotary instruments up to size F3 at the working length. Group 2 was left unobstructed. Groups 3 and 4 were obturated with AH Plus used with the matched-taper single-cone and lateral condensation techniques, respectively. In groups 5 and 6 Endorez was used with the matched-taper single-cone and lateral condensation techniques, respectively whereas in groups 7 and 8, MetaSEAL root canal sealer was used with the matched-taper single-cone and lateral condensation techniques, respectively. All of the roots were mounted vertically in self-curing acrylic resin blocks that exposed 8 mm of the coronal part. Then the roots were subjected to a vertical loading force (1 mm/min). The force required to produce a fracture was recorded in newtons. The data were analyzed by using Kruskal–Wallis one way analysis of variance and mann whitney u &wilcoxon w tests. (P < .05). Results: The fracture resistance values of intact and instrumented but not obturated roots was significantly lower than the remaining groups in study. When roots were obturated with matched taper single cone technique, MetaSEAL and AH Plus exhibited statistically significant higher values of fracture resistance than EndoREZ. There was no statistically significant difference in the values of fracture resisitance of AH Plus & MetaSEAL. When lateral condensation technique was used, there was statistically significant difference in the values of AH Plus, EndoREZ & MetaSEAL with AH Plus exhibiting higher values than the latter two. The fracture resistance values of MetaSEAL and EndoREZ were not statistically significant with each other. The values of fracture resistance of MetaSEAL were significantly higher when used with matched taper single cone technique as compared to lateral condensation. Conclusion: When used with the matched-taper single-cone technique, MetaSEAL and AH Plus have the potential to reinforce endodontically treated teeth.

Aim: To compare the initial penetration depth of Stainless Steel and Nickel Titanium spreaders during lateral condensation of 0.02 tapered gutta-percha master cones. Materials and Methods: 30 human extracted single-rooted and single canal teeth were selected. The crowns were removed and the canals were prepared using the hybrid step-back technique. Patency of the apical foramen as were maintained. The teeth were divided into 2 experimental groups of 15 teeth each. 0.02 tapered gutta-percha were inserted in the root canals of the first and second groups, respectively. A Stainless steel and Nickel Titanium spreader was then placed next to the master cone into two different groups and a digital scale was used to measure the force that was applied during spreader placement. An apical force of 1.5kg was employed to place the spreaders. The penetration depth was measured, subtracted from the working length, and recorded. Statistical analysis was then performed using t-test. Results: The mean spreader penetration depth, recorded as distance from working length, was 0.93 mm when using stainless steel spreader and 1.87 mm following insertion of nickel-titanium spreader. The difference between the two penetration depths was statistically significant (P<0.05). Conclusion: The results of this study showed that the spreader penetration using stainless steel spreader was significantly larger than the nickel-titanium spreader.

Background: Cleaning the root canal system of organic remnants and removing debris and microorganisms from the apical portion of the root canal are important steps in successful endodontic treatment. The potential for endodontically treated teeth to fracture increases proportionally to the amount of dentin removed. This risk is even higher in oval roots in which their M-D diameter is much narrower than the B-L, such as the maxillary and mandibular premolars and mesial roots of mandibular molars. The purpose of this paper is to evaluate importance of the centric ability in endodontics. Methods: 90 Mandibular teeth were taken and three groups of 30 each were made. Teeth with previous endodontic treatments, metal restorations, resorptions, incomplete apex formations and multiple visible foramina were excluded. Biomechanical Preparation was with Protaper Next and Protaper Rotary File system and Centric ability was compared. Results: There was a significant statistically difference between Protaper Next Group & Protaper Group and Wave One and Protaper Group. Conclusion: Under experimental conditions, Protaper Next has better centric ability than Wave One and Protaper.

Aim: The purpose of the study was to compare the apical seal produced by Zinc oxide eugenol sealer, calcium hydroxide based sealer (Metapex), Glass ionomer root canal sealer (Ketac Endo) and epoxy resin root canal sealer (AH Plus). Materials and methods: Biomechanical preparation using step back technique and irrigation with 5.25% sodium hypochlorite was done on 120 extracted, single rooted, non carious anterior teeth. The teeth were divided into four groups of 30 teeth each and roots filled with Zinc oxide eugenol, Metapex, Ketac Endo or AH Plus sealer. After decalcification and clearing process, level of dye leakage was measured using stereomicroscope and statistically analysed. Results: The results of the study revealed that all the specimens showed some leakage. The mean dye penetration values of Group I (Zinc oxide eu2enol), Group II (Metapex), Group III (Ketac Endo) and Group IV (AR Plus) were 1.39 mm, I.15 mm, 0.422 mm and 0.60 mm respectively. Conclusion: The present study concluded that Ketac Endo provides the best seal when compared with Zinc oxide eugenol, Metapex and AH Plus root canal sealers. Clinical Significance: The primary goal of successful endodontic therapy is complete obliteration of the root canal space which can be achieved by three dimensional obturation of the canal space. Previous studies have shown that lateral condensation of gutta percha and sealer can provide an adequate apical seal. The study enabled us to know the comparative sealing efficacy of different sealing materials employed and hence guide us towards better treatment results.

Aim: This study compared the efficacy of gutta percha removal by conventional and three different rotary retreatment systems during retreatment procedures. Methodology: Forty extracted single rooted maxillary central incisors were collected and obturated after cleaning and shaping. Samples were divided into four groups depending upon retreatment method. Group I: H-FILES Group II: PROTAPER RETREATMENT Group III: R ENDO SYSTEM Group IV: GPX SYSTEM After retreatment, samples were split longitudinally and observed by scanning electron microscopy. Amount of remaining filling material, smear layer and surface profile within each third of the canal was assessed. Results were subjected to statistical analysis using Mann-Whitney and Wilcoxon test. Results: In coronal and middle third, the remaining debris and smear layer were effectively removed by Protaper retreatment files and R Endo followed by GPX and Hand files. All techniques left filling debris especially in apical third. All groups showed similar effect in surface profile after retreatment.

Aims and objectives: The purpose of this study was to describe and evaluate a novel marginal incision technique –the papilla base incision, which preserves the integrity of the interdental papilla during and after endodontic surgery in cases where there is no evidence of marginal periodontitis. Methodology: Fifteen patients in general good health referred to the department of endodontics with periradicular pathology where endodontic surgery was indicated were selected for the study irrespective of age, sex and socioeconomic status. Results: The visual observation of the incisions at one month recall demonstrated one site with visible defects (grade 1), five sites with partially detectable incision defect (grade 2) and nine sites with perfect healing (grade 3). Conclusion: Papilla based incision is an excellent method of elevating the mucoperiosteal flap with excellent esthetics and without any postoperative loss of papilla height or gingival recession.

Background and Objectives: To compare the apical sealing ability of AH Plus and GuttaFlow sealer at three different lengths of remaining gutta-percha after post space preparation. Method: 100 freshly extracted human maxillary anterior teeth were decoronated, biomechanically prepared and were randomly divided into six experimental groups and two control groups. The root canals were obturated using AH Plus sealer in first three groups and GuttaFlow sealer in other three groups. The positive control group was filled with lateral compaction of gutta-percha without sealer. In the negative control group, Canals were left unfilled. After one week, the post spaces were prepared to a depth that left 3, 4 and 5 mm of gutta-percha apically in groups 1, 2, 3 respectively and 4, 5, 6 respectively and the coronal parts of the canals were sealed with Glass Ionomer Cement. The apical leakage was assessed through dye penetration observed under a stereomicroscope and the obtained data was statistically analyzed. Results: AH Plus recorded a slightly higher mean microleakage compared to GuttaFlow, but the difference was not statistically significant. The interaction of the sealer and the length of remaining apical Gutta-percha on microleakage was not statistically significant. Conclusion: Irrespective of the type of sealer used, a 5 mm length of remaining apical gutta-percha filling provides a better seal than 3 mm and 4 mm.

Background: Successful endodontic treatment involves accurate diagnosis, good understanding of the biological principles and excellent execution of the treatment. To execute an excellent treatment, it’s imperative that the clinician has comprehensive knowledge of the root canal anatomy and then know-how to locate and treat this anatomy. Objective: To analyze the internal anatomy of the maxillary first molar, to report the incidence of fourth root canals by comparing the efficacy of three diagnostic methods, Operating microscope, Cone beam computerized tomography and clearing technique. Material methods: A sample size of 126 sound non carious, intact human maxillary 1st molar were taken for the study and were divided into three groups according of method of analysis of root canal system-(Group 1: operating microscope, Group 2: Cone beam computerized tomography, Group 3:clearing technique). Anatomical variation in form of additional canal in mesiobuccal root was analyzed for total incidence. Results: For statistical analysis, Mean and Standard deviation were calculated for each group by using chi square test which revealed statistically significant difference between group 2 and 3 and non-significant difference between group 1 and group 2.

Background: Forty, human, maxillary single-rooted teeth with mature apices were selected. The access cavities were prepared and the working length was determined by placing a 15 K file 1mm short of the apex. All teeth were instrumented at the working length to a 50K file and were irrigated with 2mL of 2.5 % sodium hypochlorite solution. Following instrumentation, the experimental IRC were created. The mounted specimens were randomly separated according to the obturation technique into two groups, Group I-lateral condensation, group II- thermoplasticized obturation. Teeth were sectioned at 7 mm from the apex. Then sectioned root were examined under a dissecting stereomicroscope.(10X magnification) and evaluated by Wardhan India Make with image analysis system MVIG 2005. Results: It is seen that teeth obturated with Hot-Shot obturating technique Shows show better results then lateral condensation technique. Conclusion: Within the limitations of my study I like to conclude that to obturate internal resorption cavities thermoplasticized obturartion technique are superior then that of traditional lateral condensation technique.

Aim: The purpose of this study was to compare the biodegradability of Resilon and Gutta percha root canal filling materials, when subjected to a mixed microbial flora of Enterococcus faecalis, Streptococcus mutans and Staphylococcus epidermidis, which are organisms commonly found in failed root canal treatment cases. Materials and Method: 20 Gutta percha and 20 Resilon pellets were taken, examined under Scanning Electron Microscope and then divided into 4 groups of 10 samples each, Group I and Group II being Gutta percha and Resilon pellets respectively in TSB (Trypticase soy broth) medium without the addition of any microorganisms and Group III and Group IV being Gutta percha and Resilon pellets in TSB medium along with mixed bacterial flora. The pellets in each group were then incubated under aerobic, mesophilic conditions (37°c) and retrieved at the end of 4 months. The Resilon and Gutta percha pellets from the four groups were then examined for topographical changes using field emission scanning electron microscope (1500x). Results: The results indicated that the Gutta percha pellets showed significant biodegradation in the form of well-defined surface pitting and erosions while the Resilon pellets showed only minimal surface degradation. Conclusion: Within the limitations of this in-vitro observational simulated field study, it can be concluded that gutta percha undergoes significant biodegradation in the presence of mixed microbial flora while resilon samples showed very minimal degradation. The tested microorganisms, may have enzyme systems capable of degrading Gutta percha, which requires further investigation.

Aim: This study was aimed to evaluate the viability of current obturating systems as replacememt endodontic monoblocks by three dimensional finite element analysis (FEA). The mechanical performance of central incisors obturated by different types of obturating materials was evaluated under three different loading conditions. Materials and Method: The model of the tooth and supporting structures was designed, based on material properties and features obtained from previous studies and review of literature. The tooth was obturated by three different obturating systems and three different loading conditions were separately considered i.e inclined load - 70 N at 45 degree to simulate masticatory forces, vertical load of 100 N applied on the incisal edge of crown to simulate bruxism and horizontal load of 100 N to simulate external traumatic forces. The FE stress analysis was performed with the ANSYS, a commercial FEM package. Results: The results of finite element analysis are expressed as stresses, i.e tensile compressive, shear or a combination known as Von Mises stresses. These stresses became increasingly more complex as additional interfaces with varying modulus of elasticity were incorporated from the primary to the tertiary monoblocks. Conclusion And Clinical Relevance: Replacement endodontic monoblocks created in the root canal spaces may be classified as primary, secondary, or tertiary depending on the number of interfaces present between the bonding substrate and the bulk material core. Within the limitations of the study it can be inferred that the closer the elasticity of modulus of the replacement monoblock to dentin, the lower the stresses generated. The viability of integrating this emerging concept in clinical situations is highlighted and the search for ideal obturating materials for reinforcing the root canal may be viewed as an ideal goal.

To analyze and compare stress distribution in class V restoration with different restorative materials using finite element analysis. 3D model of upper first premolar was created, which was then altered to accommodate Class V cavity of fixed dimension. The restoration was done with four different materials i.e microfilled composite, flowable composite, glass ionomer cement and resin modified glass ionomer cement. The restored model was subjected to a force of 100N, 150N, 200N, and 250N at right angles to the buccal cusp. Stresses were analyzed and compared in different materials and tooth tissues both. From the biomechanical point of view, the restorations of class V defects are important and the best clinical approach would be to apply restorative materials, which have large Young’s moduli.

Objectives: To evaluate in-vitro, the pH and calcium ion diffusion from MTA Fillapex and Sealapex through simulated external root resorption. Materials and Method: Thirty single rooted mandibular premolars were divided into three groups of ten teeth each. Access openings were done and canals were instrumented by crown down technique. To simulate external root resorption, standardized defects were created. RDT was evaluated using Digital Radiovisiography. The root canal and external defects were irrigated followed by thorough drying with paper points. In group I, MTA Fillapex (Angelus) and in group II, Sealapex (Sybron Endo) was used as root canal sealer. In group III, pulp space was not filled with any material. All root canals were obturated with F2 cones (Dentsply). The teeth were sealed with three coats of nail varnish except at the defect. Each tooth was immersed in a vial containing 10 ml of HPLC water and stored in incubator at 37°C. The Ca²+ concentrations and pH values of the immersion media were measured at 1, 3, 7, 14, and 28 days using atomic absorption spectrophotometer and by pH meter respectively. The results were submitted to ANOVA and Tukey’s test. Results: The mean pH and Calcium values of Sealapex (group II) exhibited very high significant values (p < 0.001) at all evaluation periods. Conclusion: Sealapex provided highest pH and calcium release as compared to other groups (p < 0.001).

The purpose of this study was to evaluate the effectiveness of various intermediate irrigants for the prevention of precipitate formed by the interaction of sodium hypochlorite and chlorhexidine. Sixty extracted single-rooted human teeth were decoronated, and the canals were instrumented. In the Group 1, canals were irrigated with 17% EDTA and 2.5% NaOCl followed by 2% CHX. In Group 2, 3 and 4, saline, 10% citric acid and 70% isopropyl alcohol were used as intermediate flushes between the last two irrigants. Teeth were sectioned longitudinally and subjected to stereomicroscopic examination. The samples in Group 1 and 2 showed orange-brown precipitate, concentrated more in the coronal and middle thirds, whereas Group 3 and 4 showed no evidence of precipitate. The thickness of the precipitate was measured using the Image Analysis System (Chroma System Pvt. Ltd, India). The interaction between NaOCl and CHX resulted in an insoluble neutral salt as a precipitate that can be prevented using citric acid and isopropyl as intermediate flushes.

The aim of this case report is to add to literature the occurrence of the ‘radiculous’ or three- rooted maxillary upper premolar and the guidelines to manage such a case. Recognition of unusual canal configurations and variations are paramount because it has been established that the root with a single tapering canal and the apical foramen is the exception rather than rule. A female patient presented with symptoms of pain in the left upper quadrant. A diagnosis of irreversible pulpitis was arrived at. Magnification and illumination aided in the visualization of a premolar with three roots. Root canal treatment was then successfully completed.

Histological studies of regenerated tissue in the pulp canal space following successful revascularisation procedure in human teeth without extracting them are very rare. This case report describes the histological findings of tissue formed within the canal space of tooth on which revascularisation procedure was attempted. An 11 year old girl, reported 3 years ago with an injury in her upper front region with immature, non vital maxillary central incisors. Revascularization was attempted. Patient reported at the age of 14 years with pain and sensation of hot and cold in one of the treated teeth. On examination secondary caries were present and signs of maturogenesis were observed radiographically. On re-entering the canal the regenerated tissue was obtained and analysed histologically. H/E staining revealed dominantly fibrous connective tissue with spindle shaped fibroblasts in the apical region and numerous RBC’s and inflammatory cells in the coronal region. The connective tissue was not well organized.

The goal of endodontics and restorative dentistry is to retain the natural teeth with maximal function and pleasing aesthetics. Endodontically treated tooth with little or no clinical crown can be restored with different post and core materials for additional retention and support but appropriated material and method depend on type, function and remaining tooth structure as well as tooth prognosis and economic status of patient. Three case reports are discussed here where structurally compromised, endodontically treated anterior & posterior teeth were restored with fibre post and core, cast post and core and biological/dentin post.

The presence of unusual canal anatomy can be a hurdle to successful Endodontic treatment. Diagnosing the abnormal canal morphology is difficult with conventional aids and newer imaging systems are now being increasingly used. Self implanted foreign objects in the root canal are now being increasingly reported in the Endodontic literature and this can further complicate conventional endodontic treatment. This case report describes a Maxillary Central Incisor with an unusual anatomy and self implanted foreign object, diagnosed with the help of Spiral CT

Introduction: Though dentin is flexible still at times the teeth undergoes fractures. Coronal fractures are easy to manage and repair but when it comes to root fractures, treating them has always been a tough job. Though different types of healing patterns have been mentioned in the text, still most of these teeth suffer from either continuous pain or they get extracted. To conserve and salvage such fractured teeth different techniques have been explored and many a times surgical approach has also been used but the results have often not been that promising. This paper describes a case with apical third fracture managed non-surgically with application of MTA. Case discussion: A female patient reported with severally retroclined central incisors with apical third fracture in 11 with history of trauma and complaint of dull continuous pain. Multiple appointment endodontic therapy also couldn’t not subside the pain. The canal was obturated by MTA and fiber post was placed to change the angulation of tooth. At same time 21 was intentionally RC treated and obturated by gutta percha followed by post placement for straightening the crown. Both the teeth were given full ceramic crowns. Post operatively the pain reduced within days and there was remarkable stability of root fragment Conclusion: It was concluded that apical third fractures can be splinted successfully by intra-radicular approach using MTA and thus enhance their healing.

Mineral Trioxide Aggregate (MTA) was introduced as an alternative to traditional materials for the repair of root perforations, pulp-capping and as a retrograde root filling due to its superior biocompatibilty and ability to seal the root canal system. Traditionally, calcium hydroxide Ca(OH)2 has been the material of choice for the apexification of immature permanent teeth but MTA holds significant promise as an alternative to multiple treatments with calcium hydroxide. The paper discusses the use of MTA in apexification of immature permanent teeth and as a root canal obturating material.

Considering the primary goal of endodontic treatment, Cleaning and shaping appears to be one of the most crucial step in endodontic therapy. It is only via adequate shaping and cleaning of root canal system, predictable root canal disinfection can be achieved. In view of complexity of root canal system, it is beyond doubt that instruments only cannot clean canals effectively. Hence, an irrigant is must to achieve a clean bacteria free root canal system. A plethora of chemical/ herbal products have been introduced in the dental market in the last two decades but none of the agents developed till date can completely eliminate bacteria and its by-products from the root canal system without any cytotoxicity concerns. This paper compares some of the important properties of the contemporary endodontic irrigants and their current status in the field of endodontic irrigation.