Coronal rehabilitation of severely damaged endodontically treated teeth (ETT) is the most challenging task as there is high risk of failure than vital teeth. Advances in adhesive dentistry have made great contributions to cosmetic & restorative dentistry over the past few decades. The endocrown is indicated for the restoration of severely damaged molars, which requires specific restoration techniques to satisfy criteria that are primarily biomechanical in nature. In this paper, restorations of severely damage molar teeth were done by endocrown which represent a conservative and esthetic restorative alternative to full coverage crown. Endocrown type restoration fabricated from injected lithium disilicate ceramic in molars with extensive coronal destruction. This endocrowns can be acid etched, that have aggregate strength and esthetics, that bond to remaining tooth structure. New generation of ceramics & adhesives may lead to view of this endocrown as an alternative to conventional crownroot anchored restoration.

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Aim: To compare and evaluate the effect of commercially available products containing CPP-ACP^® (GC Tooth mousse, Recaldent; GC corp, Japan), CPP-ACP+ fluoride (GC Tooth Mousse Plus, Recaldent; GC corp, Japan), Novamin (Vantej, Reddy laboratories, India), and NovaMin +fluoride (Sensodyne Repair and Protect, Glaxo Smith Kline, Ontario, USA) on remineralization of enamel as assessed by Enamel micro hardness recovery. Materials and methods: Enamel slabs obtained from 30 extracted maxillary central incisors were evaluated for baseline micro hardness and then subjected to demineralization. After remineralization cycle using different products, mean and surface changes in micro hardness were measured and compared for different groups. Results: A statistically significant difference was found between mean values of % micro hardness when compared as Group I v/s II, III, IV and Group II v/s III, IV, and Group III v/s IV (i.e. p<0.01). Novamin+Fluoride performed the best followed by Novamin, CPP-ACP+Fluoride & CPP-ACP. Conclusion: Novamin based products show superior performance over CPP-ACP based products and that addition of Fluoride to either of these has a synergistic effect on remineralizing potential of these materials.

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Background/Aim: Effective management of endodontic pain presents a continuing challenge. This study evaluated the use of a preoperative, single dose of steroidal anti-inflammatory (SAID) drug given through various routes for the prevention and control of post-endodontic pain. Materials and Methods: In this randomized placebo controlled clinical trial 100 patients were randomly assigned to 5 groups and subgroups, Placebo and Dexamethasone given through oral, intramuscular, supraperiosteal and intraligamentary routes. The medications were administered 1 h before the start of standard endodontic treatment. Postoperative pain was assessed after 6, 12, and 24 h by using a visual analogue scale (VAS). Results: Based on student t-test analysis, the outcome showed that post operatively, percentage reduction of preoperative pain was significantly more with preoperative administration of steroids than placebo irrespective of the route of administration (P<0.05). Also, oral administration of dexamethasone resulted in significantly more percentage of reduction in preoperative pain as compared to other routes after 24 h (P<0.05). Conclusions: This study suggested that a preoperative administration of SAID resulted in significant less post-operative endodontic pain at all time-intervals. Preoperative oral administration of Dexamethasone performed best in reducing pain post operatively. Further studies are needed to evaluate the applicability of these finding in other clinical conditions, single versus multiple visit endodontic treatment models or utilizing other drug regimens.

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Objectives: One of the important objectives of root canal instrumentation is the removal of vital and/or necrotic pulp tissue, as well as dentin debris ensuring a completely clean canal environment. During the past few decades, various nickel titanium rotary endodontic file systems have been developed with high efficiency and sound safety to ensure completely clean canals. The purpose of the present study was to compare the cleaning efficacy of two different rotary file systems- ProTaper NEXT and WaveOne, using a Scanning Electron Microscope. Study Design: 60 extracted single rooted teeth with single root canals were selected for the study and access cavities were prepared. The working lengths were determined using #10/15 K files and the samples were divided into two experimental groups. Group-1: Cleaning and Shaping was performed using ProTaper NEXT rotary files following manufacturer's instructions up to size X4 (apical diameter of 0.40 mm). Group-2: Cleaning and Shaping was performed using WaveOne rotary files of size 40 (apical diameter of 0.40 mm) following manufacturer's instructions. 6 samples from each group were left uninstrumented which served as control. The radicular portion of all the samples were split buccolingually following decoronation at the cementoenamel junction. The samples were examined in the coronal, middle and apical third of the root canal under the scanning electron microscope. Results: The analysis of the results demonstrated that WaveOne (Mean debris score= 1.22) presented higher cleaning capacity of root canals when compared to ProTaper NEXT (Mean debris score= 1.58) (p value <0.05) Conclusion: Both the rotary systems WaveOne and ProTaper NEXT resulted in cleaner canals after instrumentation. However, the apical thirds of the root canals demonstrated more residual debris scores when compared to the middle and coronal thirds. Also, the WaveOne files resulted in cleaner canals than ProTaper NEXT file system.

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Successful root canal treatment relies on addressing to the root canal anatomy and possible variation with its thorough management. C-shaped root canal is an anatomic variation that presents an endodontist with diagnostic, operational, debridement and obturation challenges. A mandibular second molar frequently exhibits this root canal configuration with some cases reported in mandibular premolars and maxillary molars also. The Self-Adjusting File (SAF) (Re-Dent-Nova, Ra'anana, Israel) has introduced a new era of three-dimensional adaptive endodontics for treating irregularly shaped canals, including flat-oval canals like those in C-shaped. This file is advantageous as it is associated with continuous irrigation during shaping, effectively debriding and disinfecting the root canals. This paper presents a case series of C-shaped canals seen in mandibular second molar, diagnosed and endodontically managed using the novel three-dimensional concept of the Self-Adjusting File system.

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Introduction: Chemomechanical preparation reduces the bacterial load but does not result in complete disinfection of the root canal system. Irrigation is a critical compliment to instrumentation and 2% Chlorhexidine has shown a great promise in recent times as an endodontic irrigant. Penetration of root canal sealer into the dentinal tubules is considered a desirable feature beneficial for entombing residual bacteria. Making smear-free dentin more wettable with the help of tensioactive agents may further increase sealer penetration. Studies have shown that smear layer removal and final rinse with 2% chlorhexidine favoured the wettability of sealers. So, this study is done to determine the effect of 2% chlorhexidine as final rinse on dentinal tubule penetration of two different endodontic sealers: TubliSeal™ (zinc oxide eugenol- based) and AH Plus^® (epoxy resin- based) with the aid of Confocal laser scanning microscope. Materials and Method: 80 extracted, human, single- rooted mandibular premolars were decoronated at the level of CEJ. Working length was determined and instrumentation done to apical #30 (0.06 taper). Irrigation was done with 5 mL of 3% NaOCl solution between instruments. 2% chlorhexidine was used as the final irrigant in half of the samples. Teeth were obturated using sealers labelled with 0.1% Rhodamine B dye, sectioned into coronal, middle and apical sections and examined under confocal laser scanning microscope. Results and Conclusion: AH Plus^® showed more penetration depths than TubliSeal™. Maximum mean sealer penetration depth was seen in middle sections, followed by coronal root sections and least in apical sections.

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Aim: The purpose of current survey is to investigate the opinions and attitudes of endodontists towards the intracanal separation of endodontic instruments, attending a national conference in India. Materials and Methods: 1000 copies of the questionnaire were circulated at the 28^th IACDE and 21^st IES National Conference, held at Hyderabad, amongst the Endodontists and students pursuing post- graduation in conservative dentistry and endodontics at various colleges across the country, on the issue of instrument separation. The survey participants were asked about experience of instrument separation, management of fractured instruments, techniques used for removal of fractured instruments. Results: This survey elicited a response rate of 68.5%. The respondents of our survey comprised of 73.4% being post graduate students and 26.6% being staff delegates. Of the respondents, 51.4% would use an endodontic file for 2-5 times before discarding. Files manufactured by Nickel-Titanium alloy were most commonly separated in root canal (64.4%). Step back technique is more prone for separation of instrument (60.4%). The majority of respondents reported that they would try to retrieve fractured instruments located in the coronal one-third (71.7%), bypass when located in middle third (69.1%), leave and review when located in apical third (76.8%) of root canal. The most frequently used technique for the retrieval of fractured instrument was ultrasonic (39.7%). Overall, 35.2% of the respondents reported experience of root perforation as a complication during retrieval of fractured instruments. Most respondents have reported a poor success rate in retrieving the fractured instrument when in apical third (91.2%). A total of 66.7% of respondents noticed highest incidence of fracture in mesial root of mandibular molar. 45% preferred using microscope for removal of separated instrument. Conclusion: General awareness, knowledge and understanding of most aspects related to fracture of endodontic instruments was apparent among majority of the participants.

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Many of the difficulties found in endodontic therapy are caused by variations in root canal anatomy. Any pre-assumptions regarding the root canal morphology will eventually lead to endodontic failure. Maxillary first premolars show a considerable variation in root canal morphology but the presence of three roots is rare. The incidence shown in the literature for three rooted maxillary first premolar is 0.5 to 6%. Endodontic–periodontal lesions offer a constant challenge to the clinician for diagnosis, treatment and prognosis. Treatment and prognosis of endodontic–periodontal diseases vary depending on the cause and the correct diagnosis of each specific condition. Management of such lesions needs a multidisciplinary approach. Use of three dimensional imaging technology like Cone Beam Computed Tomography (CBCT) has proven to be an essential tool for successful diagnosis of such lesion and higher magnification using the Dental Operating Microscope (DOM) should always be given preference during the clinical procedure. This case report describes the treatment performed on a maxillary first premolar having three independent roots and threedistinct root canals with furcation involvement. Special care needs to be taken during clinical examination, refining the access cavity, locating the orifices of the root canals on the pulpal floor and cleaning, shaping and obturating all identified root canals. The tooth was successfully managed by conventional endodontic treatment and regenerative periodontal surgical intervention.

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Aim: The aim of this in vitro study is to evaluate the change in color and shear bond strength of enamel bleached with different concentrations of carbamide peroxide and green tea extract solution. Materials and Methods: The specimens are grouped as follows:Group –A: 16 % carbamide peroxide,Group –B: 16% carbamide peroxide & green tea extract, Group –C: 21% carbamide peroxide, Group -D: 21% carbamide peroxide & green tea extract Specimens are tagged and colors are recorded using Vita classic shade guide. Two concentrations of carbamide peroxide gels are applied onto the enamel fragments of extracted human teeth of respective groups. Green tea extract, an antioxidant is later applied on bleached specimens of group B and group D. These specimens are then stored in artificial saliva for 24 hrs. Surfaces of all the specimens are examined for color using shade guide followed by shear bond strength test. Results: At the end of the whitening process, no change was seen in the value of the shade before and after treatment with cabamide peroxide gel and green tea extract, but a significant difference in the shade was seen in group D after the application of carbamide peroxide gel and green tea extract. The ANOVA did not show differences in shear bond strengths with the various treatment agents. No statistically significant difference was seen between all the four treatment groups, but the groups B and D in which antioxidant was used, showed slightly higher bond strength when compared to groups A and group C. Conclusion: Within the limitations of this study, though increase in the concentration of carbamide peroxide improves the lightening of enamel surface, it affecs the bond strength of the specimens bonded immediately with the adhesive resin.

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Aim: To report a case of middle third root fracture in right maxillary central incisor with compromised root-crown ratio which was successfully managed by a single unit endodontic stabilizer core and crown. Summary: Conservation is fast becoming the basis of human activity in many fields. Restoration of fractured anterior teeth has long been a test of a clinician's skill due to the inherent demand for excellent aesthetics. The tooth with fractured root impairing crown-root ratio can be saved by use of endodontic stabilizers. This case report describes an innovative treatment strategy for the management of right maxillary central incisor with middle third fracture of the root with compromised root-crown ratio which was successfully managed by a single unit endodontic stabilizer core and crown. Key learning points:

• Management of mid-root fractures presents a formidable challenge for clinicians because of the difficulty of achieving a stable reunion of fracture fragments.
• The use of endodontic stabilizers for improving crown root ratio of the tooth is recommended

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Objectives: The aim of this in vitro study was to evaluate the shear bond strength of composite resin to deep dentin after pretreatment with different collagen cross linking agents i.e proanthocyanidin and glutaraldehyde. Study design: 30 freshly extracted molars were collected. The occlusal surfaces of the teeth were ground flat to expose the deep dentin. After acid etching of the dentin surface with 37% phosphoric acid, all the specimens were randomly divided into three groups based on the pretreatment to be done. Group I (control, n=10, no surface pretreatment), Group II (n=10, pretreatment with 6.5% proanthocyanidin), Group III (n=10, pretreatment with 30% glutaraldehyde). Following bonding agent application and light curing, a 4 mm composite build up was done using a tube with an internal diameter of 3 mm. All the specimens were tested for shear bond strength using universal testing machine. Results and conclusion: Both the collagen cross linking agents significantly increased the shear bond strength of composite to dentin when compared to the control group (p value = 0.002). There was no statistically significant difference between the two experimental groups (p value = 0.007).

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Objective: The purpose of this study was to evaluate the efficacy of three different newer irrigation delivery techniques; namely endovac system, stropko irrigator and lasers with 2% chlorhexidine. Methods: Forty teeth after disinfection by OSHA regulations were instrumented and inoculated with bacterial strains of E.faecalis. The teeth were divided into four groups and the irrigants were delivered with the Endovac, stropko irrigator and laser irradiation. One group served as the control and received no irrigation. The samples were incubated in Muller Hilton media plates and incubated for 24 hours. The colony forming units were determined and statistically analysed using the chi square test. Results & Conclusion: According to the results obtained, laser group resulted in significantly higher antimicrobial effects compared with the endovac and stropko irrigation groups when in conjunction with chlorhexidine.

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Understanding the morphological and structural variations of the tooth is a primary determining factor in predicting the success of endodontic treatment. The complexity of the root canal system of ‘seemingly simple’ premolar teeth has been underestimated. Two rare cases of aberrant root canal anatomy of maxillary and mandibular premolars are presented and appropriate diagnostic and treatment modifications necessary to achieve success in these complex cases are discussed.

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The accomplishment of a successful treatment outcome following endodontic therapy depends on a thorough chemomechanical preparation of the root canals followed by 3- dimensional obturation with a dense root canal inert filling material. An understanding of the presence of complex and unpredictable root canal morphology can positively affect the outcome of the therapy. Thus it is imperative that any aberrant root-canal configuration to be identified and treated accordingly. Therefore mandibular first molar with an intricate root canal anatomy can be clinically very challenging. This case report discusses endodontic treatment of mandibular first molar with seven root canals. This finding was confirmed using radiographs at different angulations and Dental CT scan during and after completion of the treatment.

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Aim: The current study aimed to compare, bond strength exhibited by root fillings made with gutta-percha/AH Plus after instrumenting oval root canals with different file systems. Material and Methods: 60 recently extracted mandibular premolars exhibiting oval canals were selected for the study. These samples were randomly divided into 3 groups (n=20) for instrumentation: Group 1: Self-Adjusting File, Group 2: WaveOne and Group 3: Protaper NEXT. Post instrumentation, the samples were obturated with gutta-percha and AH Plus, and the sealer was allowed to set for 7 days. The teeth were then prepared for micro push-out assessment using 1.0 mm-thick root slices. Loading was performed with a universal testing machine at a speed of 0.5 mm/min. The load at which push-out occurred was registered and statistical analysis was done using one-way analysis of variance and Tukey's post hoc test. Results: Bond strength of root fillings in specimens instrumented with SAF were significantly higher (p<0.01) compared to WO and PTN instrumentation at coronal, middle and apical thirds. The bond strength of SAF instrumented samples was higher in coronal by 40% and 35% and the apical thirds by 30% and 25% compared to those instrumented by WO and PTN, respectively. No difference was found between the other two groups. Conclusion: Gutta-percha/AH Plus root fillings exhibited higher bond strength in oval canals instrumented by the SAF System, as compared to WaveOne or Protaper NEXT.

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The goal of endodontic treatment is to provide a hermetic seal, which aids in the elimination of disease causing microorganisms. However, a procedural error during treatment may jeopardize the outcome. The case report presented here is on the management of the ‘Spaghetti phenomenon’ which is the result of gross overfilling of the root canal. Retrieval of the material which had extruded beyond the apex in this case was impossible in the orthograde manner, which is why surgical intervention had to be undertaken. Visualization of the extent of the lesion was greatly enhanced by the use of advanced diagnostic techniques such as Cone Beam Computed Tomography.

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Aim: The aim of this study was to evaluate the clinical efficacy of two apex locators i.e. Propex pixi and Root ZX in comparison with standard radiographic technique in cases with and without lesions. Methodology: A total of 40 patients scheduled for pulp space therapy with carious intact maxillary molars were taken into the study of which 20 cases with periapical lesions and 20 without periapical lesions were selected and the working length of palatal canal was determined using standard radiographic technique and two apex locators Propex pixi and Root ZX mini. Results: All the analysis was done using SPSS version 14. A p-value of <0.05 was considered statistically significant. Intragroup comparison was done using repeated measures ANOVA with post-hoc Bonferroni test and inter-group comparison was done using Independent sample t test. Conclusion: The results of the study concluded that in cases with lesions there was no much significance between the radiographic method and the apex locators whereas in cases without lesions radiographic method consistently showed a higher value when compared to the apex locators.

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Aim & Objective: This study aimed to compare the efficacy of two instrumentation techniques: Anatomic Endodontic Technology (AET) & Anthogyr with K3 NiTi instruments in oval shaped root canals. Materials and methods: Two groups each of 15 extracted human mandibular premolars with oval-shaped root canals were used. In group 1, canal preparation was carried out using Anatomic Endodontic Technology and in group 2, Anthogyr system both using K3 Nickel Titanium (NiTi) instruments. Irrigation was done using 3% sodium hypochlorite. Pre and post instrumentation images obtained from cone beam computed tomography were compared using Kodak dental software to assess cross sectional canal shape. Results: No significant difference was found between the two techniques with regard to preparation of oval shaped root canals. Conclusion: Anatomic Endodontic Technology (AET) did not perform better than rotary Anthogyr in oval-shaped root canals.

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Fracture of anterior teeth after trauma adversely affects the emotional well-being of a person in addition to the discomfort and pain. Complexity and extension of fracture along with the associated injury to the tooth influence the restorative design. Crown-root fracture of anterior teeth cause concomitant periodontal injury and there will be concern about appearance, and aesthetics. Clinical considerations for the management of crown-root fractures include extent and pattern of fracture, restorability of remaining tooth, availability of fractured fragment, and damage to the attachment apparatus. Sub-gingival extension of fracture raises concern about biological width violation. This report of two cases described the clinical procedures involved in the treatment of a complicated crown-root fracture in the maxillary anterior teeth.

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Objective: To evaluate and compare the effect of accelerators on the pH and antimicrobial activity of white Portland cement and white mineral trioxide aggregate. Study Design: Fifty Plastic tubes were filled with the test material and immersed in deionized water. The pH of the water was measured at 0, 10, 30, 60 minutes and 24 hours using pH meter. The antimicrobial activity of the cement was evaluated using agar-diffusion test. The plates containing BHI agar were inoculated with microorganisms Pseudomonas aeruginosa (ATCC 27853), Streptococcus sanguis (ATCC 10556), Enterococcus faecalis (ATCC 29212) and Candida albicans (ATCC 5314) (HiMedia). Subsequently, wells were prepared and immediately filled with test materials and incubated at 37°C for 24 hours and 48 hours. The diameters of the zone of inhibition were measured at 24 hours and 48 hours and data analysed using Anova, Posthoc Bonferroni and paired - t test. Results: The results showed that the maximum pH values were obtained when 15% calcium chloride was used as an accelerator with both WMTA and WPC. The antimicrobial activity of WPC and WMTA mixed with 10% and 15% calcium chloride was superior to the control group for all the tested microorganisms. Conclusion: The use of 15% calcium chloride revealed enhanced antimicrobial activity of WPC and WMTA due to its high pH values.

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Immature teeth predisposed with necrotic pulp and large periapical lesions are a challenge to treat using conventional endodontic therapy, therefore application of materials like calcium hydroxide and mineral trioxide aggregate is indispensable in achieving apexification, in such cases. In the recent years there has been advancement in management of open apex cases by use of an apical plug. On the horizon a new calcium silicate based material, biodentine has been introduced for substitution ofnatural dentin wherever there is damage to natural dentin. .Its properties have been reported to be very similar to portland cement and MTA. The positive outcome, clinically, in such cases encourages the use of biodentine as an apical barrier in single visit apexification procedures, as demonstrated by the following case report.

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