Beyond the simple perception is often the intricate internal tooth anatomy and a complex root canal system. Root canal treatment has transformed remarkably since the hollow tube theory was postulated in 1930. Research into the morphology of the pulp has revealed that the dental pulp takes many intricate shapes and configurations before reaching the tooth apex. The prospect of the treatment depends on accurate diagnosis followed by location, cleaning and shaping and finally obturation of the root canal system. As a professional, one should be aware of all the probable nooks and crannies of the complex root canal, its protean permutations and combinations, to render the finest possible treatment. As is the case with any other treatment, endodontic therapy; if performed in the properly delineated and precise manner spells more than 99% success rate. This review article attempts to bring out the possible nuances of the complex root canal system and various methods of reckoning with these significantly essential details.

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This invitro study evaluated the fracture resistance of endodontically treated teeth restored with resin composite using different corono- radicular retentive techniques and also to check for the type of fracture seen. 50 extracted maxillary premolars from young adults were used and divided them into 5 groups. Group 1 to 3 standard MOD cavity preparation were prepared with endodontic treatment, and restored with dual cure composite. Group 1- Nayyar's core, Group 2- Glass fibre post and core, Group 3- Composite core only, Group 4- Standard MOD cavity without endodontic treatment restored with light cured composite, Group 5- Intact teeth used as control group. All samples were restored in incremental technique. Fracture resistance of the entire specimen group was measured using Lloyd testing machine and the data obtained was statistically analyzed.

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The aim of this study was to comparatively evaluate stereomicroscopically the microleakage of three root end filling materials Mineral Trioxide Aggregate (MTA), Glass Inomer Cement (GIC) & Biodentine using dye penetration. Thirty extracted human maxillary central incisors were instrumented and obturated with gutta percha using lateral compaction technique. Following this, the teeth were stored in saline. After one week the teeth were apically resected & standardized root end cavities were prepared. The teeth were then randomly divided into 3 groups of 10 specimens each & were filled with Group – I: MTA, Group – II: GIC & Group – III: Biodentine. The samples were coated with varnish & after drying, they were immersed in 1% methylene blue dye for 72hrs. The teeth were then sectioned longitudinally & examined under stereomicroscope. The depth of dye penetration was measured in millimeters. Results: Microleakage was found to be significantly less in Biodentine.

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Aims and Objectives: To compare the quality of root canal obturation using ultrasonic or cold lateral condensation of gutta percha and to determine the effect of power setting and activation time on the quality of obturation, using the former technique. Materials and Methods: The study consisted of 10 groups of 15 teeth in each group. 9 groups served as experimental groups (ultrasonic condensation) and 10^th group served as control group (cold lateral condensation). An extracted human maxillary canine was used as an in vitro split tooth model to allow repeated obturations of the same root canal system using an ultrasonic device to thermo compact gutta-percha without sealer. After each obturation the root filling was removed from the tooth to allow evaluation of its quality and for the tooth to be reobturated. Voids within the body of the root filling as well as the surface were measured. Image analysis was used to quantify the voids within the body of the root filling. Cold lateral condensation served as the control. Conclusion: Ultrasonic condensation of gutta percha was found to be more effective in obturation of the root canal space as compared to cold lateral condensation.

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The prime objective in pediatric dentistry is to maintain primary teeth in the oral cavity till exfoliation. Endodontic treatment, being less invasive is a viable choice in children. Various obturating materials are used in the primary teeth like, zinc oxide eugenol, calcium hydroxide, KRI, iodoform, metapex, vitapex, endoflas etc. However, none of the material has all the qualities of an ideal obturating material. Zinc oxide eugenol is the most widely used in the primary teeth, however it resorbs at a slower rate than that of the root and is known to cause irritation to the periapical tissue. Calcium hydroxide and iodoform resorbs faster than that of the root hence it gives a hollow like effect. Whereas Endoflas which is a combination of calcium hydroxide, zinc oxide eugenol and iodoform, resorbs periapically at a similar rate as that of root. Our case report shows that Endoflas when overextruded resorbs periapically and intraradicularly without causing any irritation to the periapical area. The intraradicular resorption of Endoflas is a novel finding.

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Effective management and appropriate treatment of external root resorption can only be carried out if the true nature and exact location of the lesion are known. This case report presents a nonsurgical endodontic management of trauma induced external root resorptions at two different sites (cervical and apical) in a maxillary lateral incisor using a bioactive dental material (Biodentine). On completion of root canal cleaning and shaping, cervical resorption defect was treated with trichloroacetic acid and granulation tissue was removed through the access cavity. Calcium hydroxide was placed as an intracanal dressing for ten days. After this period orthograde filling of the root canal space along with the resorption defects was performed with Biodentine. Fifteen months follow up review with Cone Beam Computed Tomography showed arrest of root resorption and progressive healing of the defect.

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Diabetes mellitus is a chronic disease with serious health consequences. Diabetics are associated with depression of natural defence against infection, increases the risk of periodontal and periradicular diseases. However the effect of diabetes on periradicular tissues which differs structurally than periodontal tissuees are not discussed much. In this review, diabetes mellitus and its effect on pulp and periradicular tissues and its effect on treatment outcome are discussed. Some other studies suggests that some bacterial species are more prevalent in diabetics than non diabetics patients .Here diabetics is considered as a potential modulating factor for endodontic pathosis and alterations in the treatment pattern needed for the same are discussed.

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Aim : Endodontic management of maxillary right first molar with ‘five roots and six canals’ of which ‘three separate palatal roots’ were mesiopalatal, middle palatal and distopalatal roots were evaluated using spiral computed tomography (SCT) which has not been still upgraded in the literature. Summary : Endodontic treatment was carried out and with recent advanced techniques like dental operating microscope (DOM), intraoral camera with radio-visuo graphy (RVG) and Spiral computed tomography (SCT) the canals were identified and the number of roots were confirmed. Spiral CT scan slices revealed five roots of which, ‘three roots were palatal roots’, one mesiobuccal root and one distobuccal root in maxillary right first molar. This case report describes and discusses variation in morphology of maxillary first molar and use of advanced techniques in successfully diagnosing and negotiating the canals and number of roots.

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A mandibular first molar tooth requiring root canal treatment was found to have one mesial and one distal root and a total of five canals. The mesial root had two separate canals; the distal root had three canals. This case demonstrates a rare anatomical configuration and supplements previous reports of the existence of such configurations in mandibular first molars.

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Aim: To report the diagnosis and management of a case series of C shaped canals in mandibular second molars. Summary: A thorough knowledge of the root canal morphology is required for successful endodontic therapy. Coupled with information gleaned from preoperative dental radiography, the clinician can assess to a great extent the anatomic challenges in each tooth. Although not all-encompassing, preoperative radiographs might aid in visualizing and observing the main anatomy of various root canal systems. One of the most important anatomic variations is the “C” shape configuration of the canal system. C shape canal presents an extensive complex system and is mostly seen in mandibular second molars. Careful assessment of preoperative radiograph is a key step for its subsequent management, and this assessment might impact greatly on the treatment outcomes. The main anatomic feature of this is the presence of fins or webs connecting individual mesial and distal canals. The C-shape configuration presents a challenge to debridement and obturation. This paper reports four cases of ‘C’ shaped canal in the mandibular second molar which were diagnosed and managed successfully. Key Learning Points :

• ‘C’ shape canals in mandibular second molars are found more in Asians than in cancasuions.
• They can be successfully diagnosed and treated by careful endodontic instrumentation.

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This case report describes an endodontic retreatment of a maxillary central incisor with two roots. A 13 year old female patient reported with labial swelling and pain associated with upper left maxillary central incisor. Radiographs showed an under filled primary canal and a supernumerary root with periapical changes. Access was gained into the additional root after removal of gutta-percha. Conventional cleaning and shaping of both the roots were performed and obturation done with gutta-percha. This case emphasizes the need for complete knowledge of the internal and external dental anatomy and the variations presented. Radiographs are vital in diagnosing such variations.

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Aim: To evaluate cytotoxicity of endodontic irrigants at various concentrations. Objective : Analysis of cytotoxicity on exposure of various dilutions of Sodium hypochlorite , Chlorhexidine and Betadine scrub by checking for hemolysis of human RBCs. Materials and methods : RBCs was obtained from fresh blood. 100 μl of diluted RBCs was added to 3 groups (Group I : 3% Sodium hypochlorite, Group II : 0.2% Chlorhexidine , Group III : 7.5% Betadine scrub ) of 6 test tube each. Individual irrigants per group were added in increasing volume starting from the second test tube. The first one was the control. For each volume added the experiment was repeated 5 times. After incubation for 3 minutes hemoglobin content was measured . Data was analyzed using one sample t test . Results : Cytotoxicity was directly proportional to concentration and exposure time. Betadine scrub was most cytotoxic and Chlorhexidine the least. 0.023% Sodium hypochlorite caused complete hemolysis. Conclusion : Sodium hypochlorite though an irrigant of choice should be used cautiously. Chlorhexedine should be used when excessive extrusion is expected. Betadine scrub should be used in special retreatment cases with precautions.

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Aim: The aim of this study was to assess and compare the apical seal obtained with Calcium hydroxide, glass ionomer cement, polycarboxylate cement, gutta-percha, composite resin, silver amalgam, mineral trioxide aggregate (MTA) and new endodontic cement (NEC) by an electrochemical method. Materials and Method: Apical cavities were prepared in maxillary & mandibular anterior teeth which were then divided equally into six groups. The restorative materials namely, calcium hydroxide, glass ionomer cement, polycarboxylate cement, gutta percha, composite resin, silver amalgam, mineral trioxide aggregate and new endodontic cement, were manipulated according to the manufacturers' instructions and filled in the respective groups of ten samples each. An electrochemical method was used to evaluate the apical seal. The observations were recorded at 24 hour intervals for 7 days. Results: The data obtained was recorded and subjected to statistical analysis. Student‘t’ test was used to derive‘t’ values of comparisons of all the test materials with Glass ionomer cement (which came out to be the best material in the present study). Conclusions: Glass ionomer cement provided the best apical seal of all the materials tested whereas Polycarboxylate cement produced the worst apical seal of all the materials tested. MTA & NEC which are more biocompatible, have better sealability when used as a retrograde filling material because of their good handling characteristics and regenerative properties.

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The aim of this case report is to describe the diagnosis and treatment of a rare case of mandibular second premolar with two roots and four separate root canals. The pre-operative radiograph showed two separate roots one mesially and other distally. During access cavity preparation four canal orifices were located using operating microscope and pre-operative Denta-scan readings. A proper cleaning and shaping was done immediately. After 3 weeks all the four canals were obturated with gutta percha and AH plus sealer using lateral condensation technique.The anatomic make-up of the root canal system with aberrant morphologies like these can only become clear from reports like these on endodontic treatment.

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Dental caries is an infectious microbiological disease that results in localized dissolution and destruction of the calcified tissues of the teeth. Streptococcus mutans is the single most important organism in the initiation of dental caries. However there is other microorganisms also associated with the oral microbiota and have been isolated from the different sites of oral cavity. In general, dental cements have a strong proclivity for the dissolution in the oral fluids resulting in marginal leakage and a roughened surface that accumulates food debris and bacteria. Due to this potentiality for leakage, any restorative/base/liner material used in the mouth should have anti-bacterial properties in defense against bacterial migration. Hence a study was conducted to evaluate the antimicrobial efficacy of various Restorative, Base and Liner Materials

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Aims: This in- vitro study aimed to compare the microleakage in three different core materials (Para core, Multicore and Fluorocore). Materials and Method: 30 samples of first mandibular premolar were selected and divided into three groups, each group consisting of 10 samples. Standardized class V cavities were prepared on buccal surface and were restored with assigned core materials. After thermocycling for 500 cycles (5°-55° c), the specimen were then coated with two layer of nail varnish leaving an area of 1mm around the filling material uncovered .The samples were then immersed in 0.5% in methyl blue dye for 24 hours. The teeth were sectioned longitudinally and greatest depth of dye penetration was recorded in coronal and cervical surface under stereomicroscope (15X). Results: The result revealed that at Occlusal and gingival surface Paracore showed less microleakage as compared to other materials in the study. Conclusion: Paracore (at occlusal & gingival) core build up material showed significantly more effective seal than the Multi core and Fluorocore.

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The present in vitro study was conducted with the aim of evaluating and comparing the contact angles of calcium hydroxide to the radicular dentine using different aqueous and non-aqueous vehicles. Sixty dentine disks of 2mm thickness were divided into two groups and three sub-groups of ten specimens each. In group 1 aqueous vehicles and group 2 non-aqueous vehicles were used. The calcium hydroxide powder was mixed with various vehicles in the ratio 2:1 by weight. Controlled volume (0.1ml) droplets of intracanal medicaments were placed on to dentine disks and contact angle was measured by Dynamic contact angle analyzer. One-way ANOVA and Post hoc test were used to analyze the result statistically. Present study concluded that aqueous vehicles produced lower contact angles (distilled water < chlorhexidine < anesthetic solution) with no statistical significance among the experimental groups, compared to non-aqueous vehicles (glycerin < propylene glycol < iodoform) with iodoform showing statistical significance with other non-aqueous experimental vehicles.

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Perforations have been found to be one of the most eminent cause of endodontic failures. Perforations of the root walls may be induced by iatrogenic causes, resorptive processes, or caries. The prognosis of endodontically treated teeth with perforations depends on factors such as the time lapsed before obturating the defect,the location of the perforation, adequacy of the perforation seal, size of the perforation and the material used to seal the perforation. Numerous materials have been recommended for the repair of perforations including gutta-percha, amalgam, indium foil, calcium hydroxide, tricalcium phosphate, cavit, zinc oxide eugenol, hydroxyapatite and plaster of paris. The objective of the present study is to evaluate the sealing ability of MTA when used as a furcation repair material and to compare its sealing ability with Light cured GIC and Cavit

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Objectives: To evaluate the efficiency of Doxycycline Hydrochloride on the apical seal of retrograde filling materials. Materials and methods: Sixty freshly extracted human maxillary central incisors were selected. Endodontic access cavity preparation was done and the canals were located. Cleaning and shaping of root canals was done using k-files upto size 45. The root canals were obturated with gutta percha in lateral condensation technique. The apical 2 mm were resected, and a retrograde preparation was made to a depth of 3mm with a no:331 bur. The teeth were divided into 6 groups of 10 teeth each. The apical cavities in Group A, B and C were irrigated with saline as control groups. The cavities in Group D, E and F were irrigated with doxycycline HCl, 100 mg/ml as experimental group. The apical cavities in Group A and D were filled with IRM, Group B and E were filled Type-II GIC, Group C and F were filled with MTA. The surfaces of all the teeth except the apical 3mm were sealed using two coats of nail polish and one coat of sticky wax. All the teeth were then immersed in India ink dye and were subjected to thermocycling for 7 days. The teeth were then longitudinally sectioned and the degree of linear dye penetration was measured using stereomicroscope The mean results were statistically evaluated by Student-Newman-Keuls test and ANOVA. Results : MTA and GIC retrograde filling materials allowed significantly less dye leakage than IRM in both experimental and control groups, especially when preceded with doxycycline irrigation of the apical cavities. Conclusion: Irrigation of the apical cavities with Doxycycline Hydrochloride significantly improved the apical seal of retrograde filling materials. Abbreviations: MTA-Mineral Trioxide Aggregate. GIC-Glass ionomer cement. IRM-Intermediate restorative material.

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Maxillary premolars have a highly variable root canal morphology. Anatomical variations must be considered in clinical and radiographical evaluations during endodontic treatment. Access cavity modifications may be required for stress free entry to complex anatomy. Higher magnification and illumination can be useful for access cavity preparation and to recognize and locate additional canals. This article describes the clinical management of three rooted maxillary premolars in two case reports.

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The main aim this in vitro study was to compare three techniques and establish the clinically best technique in terms of sealing capabilities, lateral adaptation and microleakage at the root dentine–material interface with dye penetration using ”macro-lens photography”. This method has been used for the first time and was found effective, reliable as well as less time consuming for the measurement of dye leakage. Methodology: Mesiobuccal roots of ninety-three mandibular molars were instrumented (Profile.04) using crowndown technique and divided into three groups. Group 1: obturated with lateral condensation, group 2: obturated with Thermafil plus and Group 3: obturated with Obtura II. AH plus sealer was used in all the three groups. All specimens were stored in 100% humidity for 1 week, coated with nail polish, except apical 2mm, and were suspended in blank India ink. Molars were decalcified, rendered transparent and linear dye penetration was measured, initially, using StereoZoom Microscope and macro-lens photography. Results: Macro-lens photography proved better as compared to StereoZoom microscope. No statistical difference was found between Lateral Condensation and Obtura II (P>0.05). However, significant statistical difference was found between lateral condensation and Thermafil (P<0.05) (post hoc test). Conclusion: Using Macro-lens photography, thermafil system proved to be the material of choice when compared with lateral condensation and Obtura II for filling of the root canal system.

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Aim and objective: To compare the quality of superficial debris, nature of smear layer, characteristics of various surfaces of cervical, middle and apical one thirds of each root canal when sodium hypochlorite is used for irrigation at room temperature(37°C) and at 50°C. Materials and method: Twenty two single rooted maxillary anterior teeth were instrumented using step back technique. Sample was randomly divided into two groups of ten teeth. Group A and B was irrigated with sodium hypochlorite at room temperature and at 500C respectively. Two teeth were irrigated with saline used as control. Result: Cervical and middle thirds of teeth in group B appeared much cleaner than that of in group A, It seemed to be formed of finer particles and the structure was more delicate and powdery. However in apical third of both experimental group presented similar picture with the smear layer was well organized, apparently formed of coarse particles well compacted to form a fairly thick layer. Conclusion: Increasing the temperature of sodium hypochlorite, does increase the debridement efficacy. the cervical and middle thirds of the root canal in both the experimental groups, showed a remarkable difference in appearance than the apical third, this could be due to intimate contact of sodium hypochlorite at elevated temperature with walls of root canal in these regions.

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Aim and Objectives : The purpose of this study is to evaluate and compare the depth of penetration of Tubli- Seal[EWT], AH Plus, EndoREZ and GuttaFlow sealers into the root canal dentinal tubules using a scanning electron microscope. Materials and methods : Hundred extracted permanent human mandibular premolars with a single root canal were used for the purpose of this study. All teeth were prepared using ProTaper Nickel Titanium Rotary System to apical size #30. After removal of smear layer, teeth were randomly divided into five groups of 20 teeth each. Tubli-Seal [EWT], AH Plus, EndoREZ and GuttaFlow were used as sealers in Group I, Group II, Group III and Group IV respectively. In the control i.e. Group V, no sealer was used. All the teeth were obturated with the thermoplasticized gutta-percha technique using the E&Q Plus System. After storage at 370 C and 100% humidity for 14 days, the teeth were sectioned at 3, 5 and 7 mm from the root apex to obtain 2 mm thick specimens. The surfaces of the specimen representing the 3 and 5 mm level were observed using a scanning electron microscope (SEM). The maximum depth of sealer penetration into the dentinal tubules was measured for each section in microns. Statistical analysis was performed by using the Mann–Whitney test to compare the penetration of each sealer. Results and Conclusion : Within the parameters of the present study it was concluded that the dentinal tubule penetration of sealers is affected by their physical and chemical properties. While resin-based sealers (AH Plus and EndoREZ) showed a greater depth of penetration, zinc oxide eugenol-based sealer (Tubli-Seal [EWT]) showed the least penetration. The penetration of the polydimethylsiloxane-based sealer (GuttaFlow) was intermediate.

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Objectives – This study was undertaken to compare the fracture resistance of root filled teeth with four different obturating materials. Study design : Fifty freshly extracted human maxillary central incisor teeth with similar dimension were selected . Crowns were sectioned at the cementoenamel junction, and the length of the roots were adjusted to 13 mm. Following the preparation of the root canals and final irrigation with EDTA and saline, 15 root canals in group I were filled with Resilon cones and Epiphany sealer, 15 root canals in group II were filled with Gutta-percha and AH Plus, 15 root canals in group III were filled with Gutta-percha and Tubliseal Sealer and 15 root canals were filled with Gutta-percha and Sealapex Sealer. All materials were used with a cold lateral condensation technique. Tests for fracture strength were performed using a universal testing machine and a round tip that had a diameter of 4 mm. The force was applied vertically with a constant speed of 1 mm/min. For each root, the force at the time of fracture was recorded in Newtons. Results were evaluated statistically with ANOVA and Tukey Honestly Significant Difference (HSD) tests. Results : The mean force of fracture values was 738.15N,650.82N,575.39N and 551.41N for groups I,II,III and IV respectively. There was a significant difference (p<0.01) between the groups. Group I showed the highest fracture resistance as compared to group II and group III and group IV showed similar result. Conclusions: It was concluded that Resilon and Epiphany combination showed the highest fracture resistance followed by Gutta percha and AH Plus . Gutta percha and Tubliseal & Gutta percha and Sealapex showed the similar strength.

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Perforation is a procedural accident that occurs during root canal treatment, creating an artificial communication between the root canal and the supporting periodontal apparatus. Root perforation results in the loss of integrity of the root and further destruction of the adjacent periodontal tissues. This case report is the management of a large perforation at the junction of the coronal and middle third of the root on the palatal surface of the root that was using composite resin. Successful treatment depends on immediate sealing of the perforation and prevention of infection.

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