Aim: To present a case in which clinical and radiographic signs of healing were obtained after apical plugging of an immature open apex with MTA. Summary: A discolored tooth (9) was subjected to radiographic examination revealing an open apex and a periapical radioluscency. The canal was cleaned using intracanal instruments and 5.25% of NaOCl irrigation. To obtain canal disinfection, a slurry of calcium hydroxide mixed with sterile saline was temporized in the canal. The patient was asked to return after two weeks for the MTA apical plug placement. The patient returned after three months, during which interval she had got the calcium hydroxide dressing repeated four times from a local dentist. The tooth was opened, instrumented and irrigated. At this time, a definite apical stop was felt by an endodontic instrument. Around 3mm of MTA plug was compacted apically and allowed to set. Thereafter, the remainder of canal system was filled with thermoplasticised gutta- percha. A corono-radicular composite restoration sealed the access after non vital bleaching. A six-month follow up demonstrated clinically asymptomatic and adequately functional tooth, with radiographic signs of healing. Key Learning point: The positive clinical resolution of this case is encouraging for the use of white MTA as an apical plug, in immature teeth with open apex.

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Amalgam Tattoo is an iatrogenic entity defined as a bluish black or grey lesion of the oral mucous membrane caused by accidental implantation of silver amalgam into the tissue during tooth restoration or extraction. According to Stedman’s medical dictionary 2nd edition Amalgam Tattoo is defined as “A bluish black or grey lesion of the oral mucous membrane caused by accidental implantation of silver amalgam into the tissue during tooth restoration or extraction.” A 35 year old male patient reported to the Department of Conservative Dentistry & Endodontics with the complaint of discoloration of upper front tooth since 5-6 years. On examination tooth was found non vital and there was blackish discoloration of attached gingiva in relation to the same tooth, measuring around 0.5 x 0.5 cm in diameter with pus discharge in relation to the same. A periodontal pocket measuring 7 mm was present in relation to mesial surface of 11. Radiographically a radiopacity was observed in relation to apex of 11 suggestive of retrograde filling. Radiolucency was also seen around this suggestive of periapical abscess. Empty pulp canal space and an intact palatal surface was seen in relation to 11 indicating that no root canal treatment was done. Regenerative procedures were carried out along with Periapical Curettage and Root end resection. This is an iatrogenic case which is being handled by interdisciplinary approach. The case was diagnosed as chronic periapical abscess with amalgam tattoo.

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Aim: The purpose of this in vivo study was to compare the accuracy of a third generation electronic apex locator (Root ZX) and conventional radiography in determining the working length. Method: Twenty adult human teeth indicated for extraction were taken for the study. Endodontic access was prepared, pulp extirpated, canals irrigated and the pulp space dried. Occlusal reference point was established. A third generation electronic apex locator, Root ZX was used according to the manufacture’s instructions to measure the working length. The working length was also measured by conventional radiography using Ingles method. After extraction, No. 15 K file with rubber stop was introduced into the canal and advanced until the file tip was visualized at the foramen using 3X magnification. The true canal length was measured for each tooth and the measurements were read to the nearest 0.5 mm. The actual working length was then established by subtracting 0.5 mm from the true canal length. Result: The mean of the working length determined was calculated. Mean of the working length obtained by Root ZX (G1) and that obtained by conventional radiographic method (G2) was compared with the mean of the actual working length (G3) by One sample T test. The results revealed no statistically significant difference between the actual working length and the working length obtained by Root ZX and conventional radiography. Even though Root ZX showed less deviation from the actual working length than the conventional radiographic method, there was no significant difference between the actual working length, the working length obtained by Root ZX and conventional radiography. Conclusion: Working length determined using Root ZX showed lesser deviation from actual working length compared to conventional radiographic method, even though there was no statistically significant difference between the experimental groups. Clinical significance: The third generation apex locators are reliable tool for the determination of the working length, even though the use of intra oral radiography cannot be ignored. A technique that combines the use of electronic devices and radiograph will certainly reduce the radiation exposure, since the adjustment of the lengths of the file would be minimal.

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The purpose of this study was to compare the first file that fits to the apex (FFFA) in each canal before and after early flaring to analyze if the size of file to fit to the apex would increase after flaring. Eighty mesial canals of lower first and second molars with complete apical formation and patent foramen were selected. The samples were randomly divided into two groups of 40 canals each. A file was fit to the apex in each canal and that size recorded. Coronal flaring was completed using Gates Glidden in group 1 and Pro Taper in group 2. After flaring a file was again fit to the apex in the same manner as before it is recorded. The mean diameter of first file fitting at apex before flaring (FFFAb) and first file fitting at apex after flaring (FFFAa) flaring was 12.30 (+ 4.31)×10^-2 mm and 18.83 (+ 5.91)×10^-2 mm respectively for group 1 and was 10.58 (+ 2.56)×10^-2 mm and 18.25 (+ 5.94)×10^-2 mm respectively for group 2. A paired t test of intragroup values indicated a significance difference (p<0.001) of file size before and after flaring. The increase in diameter was approximately two file sizes for both groups. From this observation it can be concluded that early coronal flaring increases the file size that snug at the apex and awareness of that difference gives the clinician a better sense of canal size. Early flaring of the canal provides better apical size information and with this awareness, a better decision can be made concerning the appropriate final diameter needed for complete apical shaping.

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Fiber reinforced posts have been used with the aim of improving the retention of core build up material in endodontically treated teeth when remaining crown dentin is scarce. Post fabrication and placement are part of endodontic treatment not only in the retentive contribution to the core, but also to the filling and sealing of the root canal space. As there is a direct relationship between the polymerization shrinkage and degree of conversion, this study evaluates the degree of conversion of various luting resin cements with fiber post at different levels of post space. Thirty freshly extracted, non carious, human single rooted mandibular premolars with patent canals were stored in saline until use. Following cleaning, shaping and sectional obturation, post space preparation was done. Samples were divided into three groups of ten each. Group I : Panavia F, Group II : Variolink, Group III : Rely X ARC. After the posts were luted with resin cements, roots were sectioned at three different levels of post space. Degree of conversion was evaluated using Fourier-Transformed Infrared Spectroscopy (FTIR). Variolink II and Panavia F showed the highest degree of conversion.

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The purpose of this study was to evaluate the antifungal efficacy of 5% doxycycline hydrochloride (Doxy-HCl) and its comparison with the antifungal efficacy of 2.5% sodium hypochlorite, 17% EDTA and 0.2% chlorhexidine gluconate against Candida albicans in vitro. Twenty-five, single rooted extracted human teeth were randomly divided into five groups with saline as negative control. After root canal preparation, experimental teeth were inoculated with the standard strain (ATCC 24433) of Candida albicans and incubated for 24 and 72 hours. The specimens were irrigated as follows: 2 ml of 2.5% NaOCl, 2 ml of 17% EDTA, 2 ml of 0.2% CHX and 2 ml of 5% Doxy-HCl for 1 minute. Aliquots from the experimental teeth were transferred on Sabouraud’s dextrose agar (SDA) plates with paper points and colony-forming units were counted as a measure of antifungal activity. The results showed that 5% Doxy-HCl had an antifungal efficacy and was statistically significant (p<0.002) to 17% EDTA and 2.5% NaOCl.

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Objectives: The present in-vitro study was undertaken to evaluate and compare fracture strength of tooth roots following canal preparation by hand and rotary instrumentation and, further, to determine the effect of these different canal preparation techniques on the direction and pattern of fracture lines. Study design: 60 freshly extracted human mandibular premolars were randomly divided into four groups of 15 teeth each. In Group I, canals were prepared with step-back technique using standardized nickel-titanium K-files. In Groups II, III and IV canals were prepared with crown-down technique using Quantec LX, ProTaper and V-Taper rotary files respectively. After obturation, a vertical load was applied by means of a spreader inserted into the canal until fracture occurred. The roots were subsequently examined under a dissecting microscope with 20X magnification to determine the direction and pattern of fracture lines. The results were statistically analyzed using Kruskal-Wallis and Mann-Whitney U-test. Results: The Mean fracture load was 10.1 ± 3.9 kg for K-files, 12.9 ± 5.2 kg for Quantec LX files, 13.6 ± 5.1 for ProTaper files and 14.3 ± 6.1 kg for V-Taper files, but the differences between four groups were not statistically significant (p>0.05). Most of the fracture lines observed were in bucco-lingual direction, followed by proximal and compound fractures. Conclusion: Increased canal taper as advocated by Quantec LX, ProTaper and V-Taper files did not increase the fracture susceptibility of mandibular premolars any more than conventional step-back K-file preparations and may even increase the fracture resistance.

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