Candida albicans and Enterococcus faecalis are the most resistant and predominant microorganisms recovered from root canals of teeth where, previous treatment has failed. Thorough debridement of an infected root canal and complete elimination of microorganisms are objectives of an effective endodontic therapy. Over the past decade, interest in drugs derived from medicinal plants has markedly increased. In dentistry,phytomedicines has been used as an anti-inflammatory, antibiotic, analgesic, sedative and also as endodontic irrigant. Many plants with biological and antimicrobiological properties have been studied since there has been a relevant increase in the incidence of antibiotic overuse and misuse. In endodontics, because of the cytotoxic reactions of most of the commercial intracanal medicaments used and their inability to eliminate bacteria completely from dentinal tubules, trend of recent medicine use intends to use biologic medication extracted from natural plants. The aim of the study was to explore the antimicrobial efficacy of newer irriganting agents which would probably be as effective or more and at the same time less irritating to the tissues than sodium hypochlorite. The objective of this ex-vivo study was to compare the antimicrobial activity of 2% sodium hypochlorite, propolis, neem leaf extract, turmeric and liquorice against E. Faecalis and C. Albicans, using the agar diffusion method. Results: Neem leaf extract showed the highest zone of inhibition against E.faecalis and C.Albicans.

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This article describes the nonsurgical management of traumatized teeth that had undergone apisectomy and associated with a large periapical lesion. A combination of antibacterial drugs consisting of metronidazole, ciprofloxacin and minocycline was used for root canal disinfection. The common problem encountered with this drug combination is tooth discoloration due to minocycline. Adhesive restoration was used to address this problem. Mineral trioxide aggregate apical plug was placed in the lateral incisor that had undergone unsuccessful root resection. On two year follow up the patient was asymptomatic and intraoral periapical radiograph showed successful healing with complete resolution of the periradicular lesion.

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Success of endodontic treatment depends on biomechanical preparation followed by three dimensional obturation. Major reason for failure of root canal treatment is miss canals. Mandibular premolars have earned the reputation for having aberrant anatomy. Vertucci in his series of studies conducted on extracted teeth, reported 2.5% incidence of a second canal¹. Zilich and Dawson reported 11.7% occurrence of two canals and 0.4% of three canals^2,3. This article reports and discusses the successful treatment of mandibular second premolar with Two canals.

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Familiarity with the normal and abnormal anatomy of the root canal system is essential for successful root canal treatment. The possibility of concomitant two-rooted mandibular premolars is extremely rare. The objective of this case report is to familiarize clinicians with unusual tooth morphology of first mandibular premolar.

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One of the most common mishaps that occur during routine endodontic treatment is the fracture of instrument inside the root canal. The separated instrument, particularly a broken file leads to metallic obstruction in the root canal and prevents thorough cleaning and shaping procedures. Continuous pain or discomfort occurs in the involved tooth if the broken instrument is not removed or bypassed. There are several methods and techniques available to retrieve the separated instruments from the root canal. This article describes the successful removal of a broken instrument from the root canal of a maxillary central incisor using Instrument Removal System (iRS) followed by healing of a large radiolucency applying non surgical approach in relation to maxillary central and lateral incisors.

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Background And Objectives : To compare in-vitro, the cleaning effectiveness of pulp space preparation under Scanning electron microscope (SEM) using four different NiTi rotary instrumentation systems – Quantec SC, K3 Endo, RaCe and HERO 642. Materials and Method : Forty-eight freshly extracted palatal roots of human maxillary first molar teeth were procured, stored and surfaced adhering to infection control protocols in the laboratory as prescribed by Centre for Disease Control Global. Random sampling of specimens into four groups of ten teeth each and one group of eight teeth was done. Groups I, II, III & IV served as experimental with Group V as control. Access cavities were prepared in all groups and working length was determined only in experimental groups. Control group remained non-instrumented. Cleaning and shaping was done for experimental groups only. Teeth were prepared to # 40 master apical file using crown down technique. The experimental groups: I. Teeth with Pulp space instrumented with Quantec SC. II. Teeth with Pulp space instrumented with K3 Endo. III. Teeth with Pulp space instrumented with RaCe. IV. Teeth with Pulp space instrumented with HERO 642. V. Control group: Teeth with pulp space not instrumented. Thereafter all teeth were longitudinally sectioned buccolingually and examined under SEM at 20.0 kV and 500 X magnifications in the middle third of the canal. Debris was defined as dentin chips, pulp remnants, and particles loosely attached to the root canal wall. Analysis of SEM images was performed using following five score index:-Numerical Evaluation (Scoring System): Score 1 – Clean root canal walls, only few small debris particles. Score 2 - Few small agglomeration of debris. Score 3- Many agglomerations of debris covering less than 50% of the root canal wall. Score 4- More than 50% of the root canal wall covered with debris. Score 5- Complete or nearly complete root canal walls covered with debris. Statistical Analysis : Kruskal Wallis test was used to determine whether a statistical difference existed amongst the four group of instruments, with P < 0.001, considered to be statistically very highly significant. Whitney Mann -U test for individual intergroup comparison and “CHI-square” test was used to detect frequency of individual debris score in each tested groups followed by Kendell’s tau-b test to measure observer agreement. Results : Teeth with pulp space instrumented with RaCe system exhibited maximum canal cleanliness compared to the other experimental groups. The differences observed within the groups were statistically very highly significant (p<0.001). Conclusion : Post pulp space preparation with four different NiTi rotary systems, statistically very highly significant differences in canal wall cleanliness at the midroot level was achieved. Under the conditions of this study, best canal cleaning efficacy was achieved by RaCe, followed by HERO 642, K3 Endo and Quantec SC.

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Advances in dentistry, as well as the increased desire of patients to maintain their dentition, have led to treatment of teeth that once would have been removed. Furcally-involved teeth present unique challenges to the success of periodontal therapy. Anatomic and morphological complicating factors dictate modifications in treatment approaches used for managing these areas. This article describes a simple procedure of hemisection and bicuspidization in mandibular molars and its subsequent restoration. Key learning points:

• The prognosis for the endodontic element of treatment is excellent.
• Local pathological processes may affect a patient’s general health.
• To achieve good results in periodontally diseased molars, more than 5o% bone support of the remaining roots is an important factor.

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Aim - The present study was conducted in vitro to evaluate the relationship of composite resin core thickness to the apical strain produced in the root surface of the teeth. Methodology - A parametric evaluation method using strain gauges was applied to study the effect of composite resin thickness overlying the head of a prefabricated post on apical root strain produced in an endodontically treated tooth. 20 extracted premolars were selected. A common clinical occurrence was simulated by performing endodontic treatment on each tooth and then restoring the teeth with prefabricated posts and composite resin cores over which Ni- Cr alloy crowns were cemented. Each tooth was tested at three separate stages. Stage I – After endodontic treatment but before post insertion. Stage II – The teeth were randomly divided into 2 groups of 10 teeth each after baseline testing. Group I – Post buried within the cores. Group II – The head of the post was exposed on the occlusal surface of the core. Stage III – After a cast crown was cemented. Results - of the study indicated a significant reduction in apical strain produced with 1mm of composite resin overlying the head of post at post and core stage whereas complete coronal coverage with 2mm on healthy tooth structure. Conclusion - Within the limitation of the experimental design the present study reported a significant reduction in the apical strain produced when the post head is covered with composite resin.

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The purpose of this study was to compare the flare up rates in nonvital molars in Single –visit versus multi-visit endodontic treatment. In this retrospective study only. First and second molars without detectable sinus tracts were considered.400 patients were divide in to two groups of 200 patients each. Group 1 patients had undergone single visit endodontic treatment, while group 2 patients were treated by multi visit endodontic treatment. Flare up was described as post operative pain not controlled with over the counter medication or as worsening swelling as reported by the patient. Results were subjected to chi square test for statistical significance. No significant statistical differences between the above groups were observed in the study.

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Knowledge of the morphology and an awareness of unusual anatomy are essential for the successful endodontic treatment. Undetected anatomical variations of roots or root canals which remain untreated are the main reasons for endodontic failure. Clinical and radiographic evaluations should be done thoroughly before initiating endodontic treatment so that the clinician can modify the access cavity for stress free entry to the complex root canal anatomy. The present article describes a case in which anatomical variation existed in the form of additional palatal root in maxillary second molar. The literature review, clinical implication, need to recognize and methods to identify these variations are described in this article.

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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 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 calcium hydroxide as a traditional apexification material and provides an overview of the composition, properties and applications of Mineral Trioxide Aggregate with emphasis on its use in apexification of immature permanent teeth. A case report is presented to highlight its use.

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The study is aimed to evaluate in-vitro the quality of root fillings completed by two gutta percha techniques – lateral condensation and single cone technique. Two sets of maxillary and mandibular teeth were selected (upto second molar). Root canals were prepared with Protaper instruments and then randomly divided into two groups. In group 1 canals were filled with lateral condensation technique and in group 2, canals were filled with single cone technique. AH-Plus sealer was used in all groups. After obturation the quality was assessed by subjecting the samples through spiral CT using an innovative technique having pixel frames. Percentage of root canal filled and unfilled space was calculated and compared using obturation index. Both techniques produced comparable results in terms of percentage of root canal filling. Void distribution was found to be different in both groups. External voids were found to be more common in single cone technique and internal voids were found mostly with lateral condensation technique. The Obturation Index (as proposed by the authors) may find its applications in daily clinical practise for judging the efficacy of obturation techniques, so that a technique with an aim to create voidless obturation space may be devised.

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Objectives: To evaluate change in morphology, texture and thickness of the smear layer of root canal walls after 4% titanium tetrafluoride (TiF₄) irrigation and to verify stability of this altered smear layer to EDTA and NaOCl wash. Study design: 40 prepared root canal specimens were randomly divided into control group (Group I) receiving normal saline irrigation and three experimental subgroups receiving-TiF₄ (Group IIA), EDTA + NaOCl (Group IIB) and TiF₄ followed by EDTA+ NaOCl (Group IIC) irrigation. The root canal surfaces were observed under SEM and the mean thickness of the smear layer were recorded. The data was statistically analyzed using anova and t test. Result: TiF₄ irrigated samples showed an extensive granular coating with increased thickness (5.10μm + 0.16) and higher stability when compared to the controls. Statistically insignificant difference in the mean thickness was observed between subgroups IIA & IIC. Conclusion: The study extrapolated use of TiF₄ to modify the smeared root canal dentine into a more stable state before root canal obturation.

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Tooth-bleaching techniques today mostly employ hydrogen peroxide as the active agent. It is applied directly, or produced in a chemical reaction from sodium perborate or carbamide peroxide. More than 90% of success rate has been reported for intracoronal bleaching of non-vital teeth. Intracoronal bleaching is a conservative alternative to the more invasive esthetic treatment of non-vital discolored teeth. Careful examination is necessary, since the method requires healthy periodontal tissues and a root canal that is properly obturated to prevent the bleaching agent from reaching the peiapical tissues, and an effective gingival barrier which prevents the bleaching agents from leaching into the periodontium. Cervical root resorption is a possible sequel of internal bleaching and is more frequently observed in teeth treated with the thermo-catalytic bleaching method. A high concentration of hydrogen peroxide in combination with heat or etching also seems to promote cervical root resorption. Cervical root resorption is an inflammatory-mediated external resorption of the root, which can be seen after trauma and following intracoronal bleaching.

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Objectives: To examine the presence of biological debris and the level of contamination on reusable endodontic instruments subjected to different cleaning methods prior to sterilization. Methodology: Sixty used and fifteen unused hand instruments were analysed. These instruments were subjected to different decontamination protocols using mechanical, chemical or a combination. The presence of organic debris was detected by the use of Van Gieson’s stain using a stereomicroscope. Results: The highest mean value of maximum biological contamination(MBC) was found in instruments immersed in 2% glutaraldehyde and lowest in instruments that were cleaned manually with brush, immersed in sodium hypochlorite and ultrasonically cleaned with an enzymatic solution. This difference was found to be statistically significant. (P < 0.001). Conclusion: The most efficient cleaning protocol was found in instruments that were cleaned by a combination of mechanical, chemical and ultrasonic cleaning.

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Objective : The aim of the study was to evaluate the antimicrobial activity of Calcium hydroxide and Chlorhexidine (Activ points) releasing gutta-percha points to Enterococcus faecalis and Candida albicans in simulated root canals using microbiological method. Methadology : Sixteen sterile capillary tubes acted as simulated root canals. Eight sterile simulated root canals were filled with 20μl of E. faecalis suspension and divided into 4 groups with 2 samples each and were filled with Chlorhexidine points (Activ points), Calcium Hydroxide points, Conventional gutta-percha points, without gutta-percha points (Control). The procedure was repeated with pure culture of Candida albicans (MTCC 3017). The samples were incubated for 37° and colony count was calculated with samples recovered after 10 mins and 5 hours after incubation. Results : Statistically significant difference in the antimicrobial efficacy of CHX gutta percha, Ca(OH)₂ gutta percha, normal gutta percha and no gutta percha against E. faecalis and candida albicans both at 10 minutes and 5 hours since the p value was <0.05. Conclusion: Within the limitation of this invitro study it can be concluded that there is significant difference in the antimicrobial activity of Calcium hydroxide points and Chlorhexidine impregnated gutta percha points (Activ points) against Enterococcus faecalis and Candida albicans

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