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The present case report highlights the need to identify variations in root canal anatomy as a prerequisite for effective nonsurgical root canal therapy planning. As clinicians, we need to develop our observational and clinical abilities as well as amend our understanding of the complexities of the canal anatomy. Reports describing the structure of teeth and pulp canals rarely report the presence of two pulp canals in two permanent upper 1st molars. In this case, it describes the nonsurgical root canal therapy of the upper right 1st permanent molar with two pulp canals, which was confirmed by a cone beam.

The primary objective of root canal treatment is complete cleaning and shaping of all root canals so that microorganism and debris are removed from the root canal that result in hermetic seal of root canal space. The endodontic treatment of every tooth poses some endodontic challenges which have to be carefully managed by proper clinical and radiographic evaluation before treatment. The teeth with partial or complete obliteration of pulp canal results in endodontic challenge due to difficulty in negotiation of canal orifice. It is always important to take necessary precautions while locating canal orifice to apex, otherwise it will result in iatrogenic errors including perforation and separation of instrument. This present case describes the successful location and management of calcified canal in maxillary central incisor with proper knowledge of internal anatomy, thorough radiographic assessment and canal orifice locating instrument such as c+ files under microscope. Keywords: Calcified tooth, Dental Operating Microscope, Maxillary central incisor

Objectives This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. Materials and methods Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan–Meier statistics. The level of significance was set at α = 0.05. Results Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18–85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. Conclusions Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. Clinical relevance Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients’ age.

AIM To evaluate the correlation between the volume of dental hard tissues removed and the fracture resistance of mandibular molar teeth with ultraconservative (UltraAC) or traditional (TradAC) access cavity preparations. METHODOLOGY Sixty recently extracted and intact mandibular first molars were scanned in a microcomputed tomographic (micro-CT) device, anatomically matched and assigned at random to 2 groups (n = 30), according to the access cavity type: UltraAC or TradAC. After access preparation, mesial and distal canals were prepared using Reciproc instruments and a new scan was taken. The volumes of pulp chamber and dental hard tissues in each specimen were measured before and after the experimental procedures, and the percentage volume reduction of hard tissues calculated for the entire tooth and for the crown separately. Teeth were then root filled, restored and subjected to fracture resistance tests in an universal testing machine. The force required to fracture was recorded in Newtons (N). The adherence of the variables to a Gaussian curve was verified using a Shapiro-Wilk test. Skewed data were analysed with nonparametric Wilcoxon signed rank or Spearman correlation tests, whilst the normally distributed data were analysed with a dependent samples Student t-test. Level of significance was set at 5%. RESULTS Pre-operatively, no difference was observed between groups regarding the volume of pulp canal space or dental hard tissues (P > 0.05). After access preparation, volumes of the removed hard tissues from the entire tooth and from the crown were significantly greater in teeth prepared with TradAC than with UltraAC (P

Background: A desirable property of an obturation material in primary teeth is its antibacterial effect, this property promotes the disinfection of the pulp canals and improve the prognosis of pulpectomy and treatment outcomes. Aim of the study: evaluation the antibacterial potential of various obturation materials for primary teeth; Zinc oxide eugenol (ZOE) only, calcium hydroxide with iodoform (Metapex) and a mixture of zinc oxide eugenol, calcium hydroxide and iodoform (Endoflas) against selected strains of bacteria; Enterococcus faecalis and Bacteroid fragilis. Materials and Methods: Agar diffusion method was used in which the antibacterial potential was tested by measuring the inhibition zone around each tested obturating material. Results: (Endoflas) showed the highest mean value of inhibition zone, in both types of bacteria, over the (Zinc-oxide and Eugenol) and (Metapex). The difference between the three obturating materials was statistically significant. Conclusion: The three obturating materials reported different antibacterial effect however, Endoflas was superior to Metapex and ZOE.

A detailed knowledge of the pulp canal anatomy and variations in individual tooth is important to effectively clean and shape the root canal system. Identification of such variations and their instrumentation together with adequate disinfection can avoid need for future retreatment and surgical intervention. Several case reports reported variations in tooth morphology and root canal systems related to the mandibular first premolars. The occurrence of three roots in the mandibular first premolar is unusual. This article reports the identification and management of mandibular first premolar with aberrant root and root canal system. Keywords: Anatomical variations, Mandibular first premolar, Three root canals.

Background: Root canal Therapy is one of the procedures for the management of nonvital tooth with periapical lesion. The principle of this therapy is the complete sterilization of the total pulp canal space thereby healing of the periradicular lesion. Objectives: This experimental study assessed the clinical and radiological outcome of root canal treatment for nonsurgical management of nonvital teeth with periapical lesion. Materials and Methods: A total number of 40 infected teeth with periapical lesion were treated by conventional root canal treatment. Irritants from the root canal system was removed by mechanical instrumentation( Crown down Technique), chemical irrigation with NaOCL and by using Calcium Hydroxide as intracanal medicaments and fluid tight obturation both apically and coronally resulting repairs of inflamed periradicular tissues. The protocol for follow up examination will be 3, 6 and 12 months post operatively. At the time of follow up examination a standard follow up chart will be maintained. Results: Among 40 cases 32 cases could be treated as acceptable as their responses were good both clinically and radiologically and 5 patients came back with some complications among them 3 cases were uncertain and 2 cases were unacceptable. Conclusion: It was concluded that conventional root canal treatment reduced clinical signs and symptoms successfully in teeth with periapical lesion and radiologically. TAJ 2020; 33(1): 25-30

Fracture of an endodontic file inside a primary root canal is a rare but critical complication during the pulpectomy treatment, because the mechanical obstruction impedes the optimal cleaning and obturation of the pulp canal, compromising seriously the clinical outcome. This accidental event is mainly associated with over-use and excessive torque of intracanal files. Most clinicians opt to proceed with the extraction of the affected tooth followed by a space maintainer placement. Other practitioners attempt the non-surgical retrieval of the separated fragment through available proven techniques in permanent teeth; however, these methods may involve significant damage to the tooth and surround tissues. On the other hand, preservation of the metallic fragment might affect the treatment prognosis and interfere with the physiological root resorption. La fractura de una lima endodóntica dentro de un conducto radicular primario es una complicación rara aunque critica durante el tratamiento de pulpectomía, debido a que la obstrucción mecánica impide la limpieza y obturación óptimas del conducto pulpar, comprometiendo seriamente el resultado clínico. Este evento accidental está principalmente asociado con el sobreuso y torque excesivo de las limas dentro del conducto. La mayoría de los clínicos optan por realizar la extracción del diente afectado, seguido por la colocación de un mantenedor de espacio. Otros practicantes intentan la remoción no quirúrgica del fragmento separado a través de técnicas disponibles probadas en dientes permanentes; sin embargo, estos métodos pueden causar daños significativos al diente y tejidos circundantes. Por otra parte, la preservación del fragmento metálico puede afectar el pronóstico del tratamiento e interferir con el proceso de reabsorción radicular fisiológico.

The purpose of this study was to compare the speed of removal of root canal filling material and re-establishment of apical patency in root canals filled with a tricalcium silicate-based sealer (BioRoot RCS [BRCS]; Septodont, Saint-Maur-des-Fossés, France) versus a zinc oxide-eugenol sealer (Pulp Canal Sealer [PCS]; Sybron Endo Kerr, Orange, CA) and to analyze the effect of the operator's experience.One hundred twenty root canals of 40 Dentalike dental simulators (Dentsply Sirona, York, PA) were shaped with a WaveOne (Dentsply Sirona) reciprocating file using short 3-mm strokes. Root canals were obturated using a single gutta-percha cone and either BRCS or PCS. Samples treated either with BRCS or PCS were equally dispatched between experienced practitioners and junior practitioners. The time required to remove root filling material and establish apical patency was recorded for each root canal. Samples were compared according to the sealer used and the practitioner's experience (Mann-Whitney test).One hundred fifteen root canals were successfully retreated. No differences in the time required to remove the filling material were observed between the 2 materials for mesiobuccal or distobuccal canals (P.05). In contrast, the procedure was longer for palatal canals filled with BRCS compared with PCS (79.10 vs 182.45 seconds, P.01). Experienced practitioners took significantly less time than junior practitioners (P.05).BRCS can be successfully removed from root canals as quickly as a zinc oxide-eugenol sealer in both mesiobuccal and distobuccal canals but not in palatal ones. The duration of the procedure was affected by the operator's experience independent of the filling material used or the canal type.

Equine dentistry is a rapidly developing clinical specialty. It has benefitted from key advances in anatomical and physiological research, development of equipment and instrumentation, utilisation of standing sedation and anaesthesia protocols, a change towards minimally invasive surgical techniques, and the introduction of restorative and endodontic techniques translated from techniques used in human and canine dentistry. Anatomical research has provided further insight into the endodontic system of incisors and cheek teeth and how it changes throughout development with age. Studies of the periodontium have demonstrated a rich vascular supply and repair capacity. Routine dental visits are increasingly being performed utilising sedation and clinical instruments for routine examinations. Equipment has become more efficient, battery-operated and miniaturised giving benefits to both equine dental maintenance work and advanced techniques, assisting the transition to minimally invasive techniques, and the development of endodontic and restorative dentistry. Diagnosis has also benefitted from advances in equipment such as patient-side digital radiography systems, high definition oroscopy, and small diameter flexible fibrescopes that are capable of visualising inside a pulp canal. Dental units combining endodontic high- and low-speed drills, suction and air or water flush are becoming increasingly used and adapted for equine use. Sedative combinations and standing anaesthesia protocols have meant that revisions of traditional techniques, as well as novel techniques, can be performed with almost no requirement for general anaesthesia. Equine dentistry can only continue to advance in this way if there is early identification of dental disease through clinical oral examinations, leading to a system based on prophylaxis, as in human dentistry. This necessitates a change in attitude of the public and industry in general to a proactive approach, with early intervention based on examination and diagnostic findings of practitioners and not necessarily based on the clinical signs displayed by the patient.

Aim This 3-year retrospective case series evaluated the clinical and radiographic outcome of ferric sulfate and formocresol pulpotomy in primary molar teeth in a dental teaching hospital in Malaysia. Materials and methods Clinical and radiographic records of all pediatric patients who had pulpotomy of primary molar teeth between July 2005 and October 2008 were evaluated. A total of 55 pulpotomized primary molars were observed. Clinical assessments were carried out during the second visit to assess the presence of sinus tract, gingival swelling, excessive tooth mobility, tenderness to percussion, and abnormal exfoliation of the treated teeth. Periapical radiographs were reviewed for evidence of pathologic root resorption, radicular and/or periapical radiolucency, and abnormal pulp canal calcification. Treatments were regarded as failure in the presence of one or more of the above clinical and/or radiographic signs and symptoms. Results Of 55 pulpotomized teeth, 26 (47.3%) remained free from any clinical signs and symptoms and 48 (87.3%) showed no pathological radiographic findings. The clinical success rates of ferric sulfate and formocresol pulpotomy were 44.4% and 60.0%, respectively, whereas the radiographic success rates of ferric sulfate and formocresol pulpotomy were 86.7% and 90.0%, respectively. Although teeth treated with formocresol had higher both clinical and radiographic success rates compared with those treated with ferric sulfate, it was not statistically significant. Conclusion The clinical success rates of pulpotomy were lower compared with radiographic success rates. Ferric sulfate is an alternative to formocresol; however, the use of both agents in the dental undergraduate teaching at Universiti Sains Malaysia can still be recommended. Clinical significance Formocresol and ferric sulfate are advocated as pulpotomy agents in primary molar teeth since both agents showed comparable clinical and radiographic success rates. How to cite this article Sanusi SY, Jamaludin SA, Al-Batayneh OB, et al. Fate of Pulpotomized Teeth in Pediatric Patients: A 3-year Case Series in a Malaysian Dental Teaching Hospital. Int J Clin Pediatr Dent 2020;13(1):79–84.

Loeys-Dietz syndrome type 1 (LDS1) is caused by a mutation in the transforming growth factor-beta receptor 1 (TGFBR1) gene. We previously characterized the oral and dental anomalies in a cohort of individuals diagnosed with LDS and showed that LDS1 had a high frequency of oral manifestations, and most affected individuals had enamel defects. However, dentin anomalies were not apparent in most patients in the cohort. In this cohort, we had identified dentin anomalies in a patient with LDS1, harboring mutationTGFBR1c.1459C>T (p.Arg487Trp), and in this report, we present clinical and radiographic findings to confirm the dentin anomaly. The proband had gray-brown discoloration of most teeth typical for dentinogenesis imperfecta (DI). A radiographic exam revealed obliterated or very narrow pulp canals, with maxillary anterior teeth being affected more than the posterior teeth. The son of the proband, who also has the same mutation variant, had a history of DI affecting the primary teeth; however, his permanent teeth were normal in appearance at the time of exam.TGFBR1is expressed by odontoblasts throughout tooth development and deletion ofTGFBR1in mouse models is known to affect dentin development. In this report, we present a rare case of abnormal dentin in two individuals with LDS1. These dental anomalies may be the first obvious manifestation of a life-threatening systemic disease and demonstrate the variable and multi-organ phenotypic effects in rare diseases.

Purpose: To evaluate clinically, radiographically and histologically the postoperative success of Ankaferd Blood Stopper (ABS) and formocreosl (FC) in pulpotomy procedures for primary teeth. Materials and Method: 70 Primary molars found in 27 patients were selected according to inclusion criteria. In the first part of the study pulpotomy was accomplished in 22 patients having 60 teeth (30 each group) and depending on the type of radicular pulp medicament, the teeth were divided randomly and equally into 2 groups: Group I(FC) and Group II (ABS). Clinical follow up was done after 1,3,6 and 9 months.Periapical radiographs were taken at 3 ,6 and 9 months follow up visits . In the second part of the study 10 primary molars were found in 5 patients planned for extraction due to orthodontic purpose were treated by pulpotomy procedure. Teeth were divided into2 groups(5 each group) and the teeth were extracted after 2 months for observation under light microscope. Results: No statistically significant difference between groups in the overall cumulative clinical or radiographic success at follow up periods. Histopathological examination revealed dentin bridge formation and continuous regular arrangement of odontoblastic layer at the pulp dentin junction along the root length in primary molars treated with ABS while FC specimens revealed Severe pulp hyperemia with thrombus formation at the entrance of pulp canal. Conclusion: ABS can be considered as good natural alternative to FC in primary molars pulpotomy.

This paper describes a case with a 5- year follow-up of Antimicrobial Photodynamic Therapy (aPDT) associated with long-term success in endodontic treatment in a tooth with separated instruments. The patient presented with a tooth exhibiting a periapical lesion, slight swelling, and severe pain. A radiograph revealed the presence of two separated files in the middle and apical thirds of the mesial root on a lower first molar. Attempts at bypassing were not successful. In the mesial root, instrumentation was limited to the coronal ends of the separated instruments. The apical patency could not be achieved due to the blockage of the separated files. aPDT was performed in two visits, at a 660-nm wavelength and 100 mW of power, for 90 s to a total energy of 9.0 Joules. Methylene blue solution was used as photosensitizer at concentration of 0005%. A 300-μm light diffusor was coupled to the diode laser and was inserted into the root canal 2 mm short of WL, where it was set to allow better diffusion of light. Each root canal was sealed with gutta-percha by warm vertical compaction and Pulp Canal Sealer™. After 5 years of follow-up, clear evidence of remineralization of the radiolucency and bone healing was observed. This case report suggests that the addition of aPDT to conventional endodontic treatment improved microbial disinfection leading to a successful long-term outcome.

The objective of this report is to describe a surgical treatment in a traumatized tooth presenting pulp canal calcification (PCC) and periapical pathology. Three months after a patient had suffered injuries by luxation in the right central mandibular incisor, complete calcification of root canals was radiographically observed in addition to a radiographic image compatible with apical periodontitis. The chosen treatment was endodontic surgery and apical root sealing with mineral trioxide aggregate endodontic cement. After 4 months, the tooth showed complete apical repair. We concluded that the endodontic surgery is a procedure specifically indicated for cases of impossibility of conventional endodontic treatment, as in teeth with PCC.

Dentoalveolar ankylosis in growing patients is associated with continuing replacement root resorption, tooth infrapositioning, and the local arrest of alveolar bone growth. While extraction of ankylosed teeth might be associated with bone loss, decoronation of the offending tooth (removal of crown portion and instrumentation of pulp canal to stimulate bleeding) has been suggested as a more conservative approach of bone preservation until definitive implant placement is planned. This is a case presentation of a 14-year-old patient who presented with root resorption in relation to the left maxillary central incisor such that decoronation with a prosthetic tooth replacement was decided as the treatment option.

These case reports aimed to describe the management of lateral perforation in the middle cervical third of the root in two maxillary incisors with pulp canal calcification using Bio-C Repair, with safe and viable clinical treatment strategies. Digital radiographic exams were obtained with different angles and analyzed using different filters. Cone-beam computed tomography (CBCT) images were requested to show the actual position of the canal, location of the perforation, and guide the strategic planning of the case. Subsequently, cavity access was prepared with the aid of dental operating microscopy. After perforation was identified, granulation tissue was removed and the original canal was identified and then dressed with calcium hydroxide. In the second visit, the perforation was filled with Bio-C Repair and the canal system filled with gutta-percha points and a root canal sealer (Bio-C Sealer). The teeth were restored with glass fiber post, 4 mm beyond the perforation level, and provisory crowns. Both teeth treated as described above were functional and asymptomatic with a 1-year clinical and radiographic assessment. The Bio-C Repair is suggested as a new cement option for the management of lateral canal perforations, with effective results as observed after a one-year follow-up. Resumo O presente relato de caso teve como objetivo descrever o manejo da perfuração lateral no terço médio cervical da raiz em dois incisivos superiores com calcificação pulpar utilizando o Bio-C Repair, com estratégias de tratamento clínico seguras e viáveis. Radiografias digitais foram obtidas em diferentes ângulos e analisadas com diferentes filtros. Imagens de tomografia computadorizada de feixe cônico (TCFC) foram solicitadas para mostrar a real posição do canal e a localização da perfuração, e orientar o planejamento estratégico do caso. Posteriormente, o acesso à cavidade foi preparado com auxílio de microscopia cirúrgica. Após a identificação da perfuração, o tecido de granulação foi removido, o canal original foi identificado e, em seguida, recebeu medicação intracanal à base de hidróxido de cálcio. Na segunda visita, a perfuração foi selada com Bio-C Repair e o sistema de canais obturado com cones de guta-percha e cimento endodôntico (Bio-C Sealer). Os dentes foram restaurados com pino de fibra de vidro, 4 mm além do nível da perfuração, e coroas provisórias. Ambos os dentes tratados conforme descrito acima se mostraram funcionais e assintomáticos na avaliação clínica e radiográfica de 1 ano. O Bio-C Repair é sugerido como uma nova opção de cimento endodôntico para o manejo de perfurações laterais, com resultados efetivos observados após um ano de acompanhamento.

Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomography, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster, and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. | Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice where guided endodontics cannot be employed safely or when it fails.

The aim of this review was to evaluate the effects of different access cavity designs on endodontic treatment and tooth prognosis. Two independent reviewers conducted an unrestricted search of the relevant literature contained in the following electronic databases: PubMed, Science Direct, Scopus, Web of Science, and OpenGrey. The electronic search was supplemented by a manual search during the same time period. The reference lists of the articles that advanced to second-round screening were hand-searched to identify additional potential articles. Experts were also contacted in an effort to learn about possible unpublished or ongoing studies. The benefits of minimally invasive access (MIA) cavities are not yet fully supported by research data. There is no evidence that this approach can replace the traditional approach of straight-line access cavities. Guided endodontics is a new method for teeth with pulp canal calcification and apical infection, but there have been no cost-benefit investigations or time studies to verify these personal opinions. Although the purpose of MIA cavities is to reflect clinicians' interest in retaining a greater amount of the dental substance, traditional cavities are the safer method for effective instrument operation and the prevention of iatrogenic complications.

BACKGROUND/AIM Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. METHODS Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. RESULTS Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods

Pulp canal calcification is 1 of the possible outcomes after certain types of dental trauma. This can make endodontic treatment more challenging should it become necessary. Because of the increased degree of difficulty, sometimes procedural incidents do occur during root canal treatment. This case report demonstrates an unusual clinical presentation of a root perforation and missed canal, which had undergone calcification as a result of trauma some years earlier. A contemporary approach to treatment involved a combination of treating the biological complication of the calcified canal combined with surgical repair of the iatrogenic complication of a perforation using modern imaging techniques and materials.

Objective The rehabilitation of extensively damaged teeth with great structural loss and calcified root canals represents a challenge for dentistry. Classically, this restorative procedure of endodontically treated teeth involves intraradicular post placement. Retentive function post that can closely adapt to the root canal without the excessive wear of intraradicular dentin has a fundamental importance to ensure the longevity of the restoration. Clinical considerations This report presents a clinical case of 3D guided access to a severely calcified pulp canal followed by the cementation of a fiberglass post that is adaptable to the root canal and prosthetic rehabilitation with full ceramic crown. Conclusions 3D guided access allowed conservative and safe root canal treatment. The adaptable fiberglass post meets the specific needs of the described case and has a simple technique and low cost. Clinical significance Guided endodontics is a minimally invasive approach for teeth with calcified root canals. The post used in this study meets the demands of teeth endodontically treated with conservative techniques. The professional should not need to adapt the anatomy of the root canal to the anatomical reality of the post. This one adapts itself to the shape of the canal.

Pulp canal calcification is characterized by the deposition of calcified tissue along the canal walls. As a result, the root canal space can become partially or completely obliterated. Recently, "guided endodontics" has been reported as an alternative solution in cases of partial or completed canal obliteration. Although this technique can enhance minimally invasive access to the calcified canal, it has been shown that the incisal surfaces are often removed during the access of anterior teeth. This report describes 2 cases of guided endodontics using conventional palatal access in calcified anterior teeth and discusses the applicability of this approach in cases of pulp canal calcification with apical periodontitis and acute symptoms. The method demonstrated high reliability and permitted proper root canal disinfection expeditiously, without the unnecessary removal of enamel and dentin in the incisal surface.

Optical coherence tomography (OCT) is a noninvasive diagnostic technique providing cross-sectional images of biologic structures based on the differences in tissue optical properties. OCT has been widely used in numerous clinical applications and is becoming popular as a promising technology in dentistry. Today, dental hard (tooth) and soft (hard palate mucosa and gingiva mucosa) tissues are visualized with OCT. With new developments in technology, the applications of OCT are being investigated in various fields in dentistry, such as to detect microleakage around restoration, tooth cracks/fractures, examination of periodontal tissues/pockets, early detection of oral cancerous tissues, and in endodontics for location of pulp canal.

The mucosa exogenous pigmentation may occur in consequence of dental materials contact, such as amalgam pigmentation. Aim: This paper reports a rare case of oral pigmentation due to extrusion of N-Rickert root canal sealer from a pre-existing fistula associated with a lateral canal in a 47-year-old female patient. Subjects and Methods: The clinical presentation was a well-defined grayish macule of about 3 mm located in the attached gingiva close to the maxillary left central incisor. Analysis Used and Results: Upon identification of endodontic treatment and a mesial lateral canal, a CT scan was requested. According to the endodontist that performed the prior treatment the tooth was filled with Rickert Pulp Canal SealerTM (Sybron Endo) and there was a material extrusion through a fistula associated with the infected lateral canal at the time. Conclusion: The knowledge of exogenous pigmentations caused by dental materials is necessary to proper diagnosis.

Aim: To evaluate tissue engineering technology to regenerate pulp-dentin like tissues in pulp canals of immature necrotic permanent teeth with apical periodontitis in dogs. Study design: The study was performed on 36 teeth in 12 dogs. The experiment was carried out using split mouth design. In each dog 3 teeth were selected for implementing the study procedure. Apical periodontitis was induced in Group A and B teeth. Group (A): immature upper left 2nd permanent incisors that were transplanted with a construct of autologous dental pulp stem cells with growth factors seeded in a chitosn hydrogel scaffold. Group (B): immature upper right 2nd permanent incisor that received only growth factors with scaffold. A third tooth in each dog was selected randomly for isolation of dental pulp stem cells (DPSCs). Both groups were closed with a double coronal seal of white MTA (Mineral trioxide aggregate) and glass ionomer cement. Both groups were monitored radiographically for 4 months and histologically after sacrificing the animals. Results: There was no statistically significant difference in radiographic findings between group (A) and group (B) for healing of radiolucencies, while there was statistically significant difference between group (A) and group (B) regarding radicular thickening, root lengthening and apical closure. Histologically, group (A) teeth showed regeneration of pulp- dentin like tissue while group (B) teeth did not show any tissue regeneration. Conclusion: Dental pulp stem cells and growth factors incorporated in chitosan hydrogel are able to regenerate pulp- dentine like tissue and help in complete root maturation of non-vital immature permanent teeth with apical periodontitis in dogs.

Aim To study the prevalence of additional root canal orifices of upper first permanent molars in Saudi subpopulation in Jeddah, Kingdom of Saudi Arabia, utilizing micro-computed tomography X-ray (micro-CT). Materials and methods One hundred extracted upper first permanent molars of Saudi patients were included in the study. Micro-CT was used to detect the prevalence of extra root canal orifices of the permanent upper first molars. Results The evaluation of three-dimensional (3D) images of this study showed that of 100 upper permanent first molars scanned and analyzed, 10.53% had 6 pulp canal orifices, 35.09% had 5 pulp canal orifices, 47.37% had 4 pulp canal orifices and 7.01% had 3 pulp canal orifices. Conclusion The current data showed the highest prevalence of 4 and 5 root canal orifices compared to 3 and 6 root canal orifices. Clinical significance The knowledge of anatomic variations of teeth before starting root canal treatment can help dentists to detect and manage all root canals successfully.

Triplication is a rare dental anomaly and defined as the fusion of three teeth. In the present case report, a five-year-old healthy girl with the triplication of the two mandibular primary right incisors along with a supernumerary tooth was presented. A periapical radiograph, panoramic radiograph and cone-beam tomography of the triple tooth revealed separate pulp chambers combining in the cervical area and forming one pulp canal along the root. In the treatment planning, pit and fissure sealant was applied for prevention and the patient was recalled for regular follow-up appointments. After 24 months, the triple tooth had been replaced by the permanent successor without any dental abnormality.

Aim To present a novel miniaturized and minimally invasive treatment approach for root canal localization in mandibular incisors with pulp canal calcification and apical periodontitis. Summary A 51-year-old male patient presented with pain from his mandibular incisors. The patient had a history of severe dental trauma over 30 years ago. Both mandibular central incisors (teeth 31, 41) were tender to percussion and had a yellowish discoloration. They did not respond to thermal and electrical sensitivity tests. Two periapical radiographs from different projections revealed severe pulp canal calcifications and signs of periapical periodontitis. To facilitate the ‘Microguided Endodontics’ technique, a CBCT and an intra-oral surface scan were aligned using special software. This allowed the virtual planning of optimal access cavities up to the apical third of the root. In this technique, a 3D-printed template guides a customized drill to the orifice of the root canal. After negotiation of the root canals, conventional root canal treatment was performed. This case report demonstrates that minimally invasive and apically extended access cavities are feasible in mandibular incisors with this technique. Key learning points The ‘Microguided Endodontics’ technique is a safe and minimally invasive method for root canal location and prevention of technical failures in anterior teeth with pulp canal calcification.

Apical periodontitis, the inflammation of periapical tissue, commonly requires root canal treatment to achieve apical healing. However, if it is accompanied by pulp canal calcification, the treatment becomes complicated, and locating the root canal can be challenging. This case report describes a novel approach for treating a molar with pulp canal calcification and apical pathology. Due to the risk of perforation during treatment, a digitally printed template was used to assist in accurately locating the root canal. After six months, the patient was asymptomatic and the periradicular radiolucency was gradually reducing in size.

Pulpal necrosis and infection in an immature anterior tooth subsequent to traumatic injury is a challenging situation. Regenerative endodontics, resulting in continued development of the tooth, provides a biological response to this clinical challenge. Regenerative endodontic procedures require disinfection of the infected root canal and sealing of the pulp canal space. Mineral trioxide aggregate (MTA) provides a good seal, is biocompatible and allows the formation of a hard tissue to occur within the root canal. MTA, however, can lead to significant staining of the crown of the tooth that is difficult to mask. This case report describes the management of discolouration in an 11 year old girl subsequent to a regenerative endodontic procedure in an immature traumatized maxillary central incisor.

Background This study compared the solubility and the pH of different root canal sealers in vitro. Material and Methods BioRoot™RCS, TotalFill BC Sealer, MTA Fillapex, SealapexTM, AH Plus, EasySeal, Pulp Canal Sealer™ and N2 were tested. Similar specimens were prepared using ring molds with an internal diameter of 20 ± 0,1 mm and a height of 1,5 ± 0,1 mm and digitally weighted to register the mass of each specimen before and after immersion in distilled water. Solubility was determined after 24 hours and statistically analysed using a one-way ANOVA test and post-hoc Tukey test. The pH value was measured by a digital pH meter after 3 and 24 hours from manipulation. Results BioRoot™RCS and TotalFill BC Sealer showed significantly higher solubility (P

Objective: Sodium hypochlorite has been routinely delivered into the pulp canal via irrigation needle. The study aimed at to determine the advantage and disadvantage of apical extrusion of sodium hypochloride using monoject or hypodermic irrigation needle in root canal treatment.Materials and Methods: Eighty single rooted teeth with closed apices were used in this in vitro study to determine apical extrusion of sodium hypochlorite using the gel diffusion technique. Extracted human anterior teeth were used as study samples. Monoject (size 27G) and hypodermic (27G× ½, 0.40×13mm, Terumo Needle) irrigation needle were used. The highest concentration of 5.25% hypochlorite solution was used for irrigation. To standardize the time diffusion of the dye, the gel was photographed at exactly 20 minutes after the initial irrigation with sodium hypochlorite.Results: A total of 36 out of 40 (90%) teeth in the hypodermic needle group showed positive apical extrusion compared to 14 of 40 teeth (35%) in the monoject group regardless of apical size. The discoloration of agar was clearly obtained after the sample tooth had been irrigated with sodium hypochlorite indicating the sign of apical extrusion. It is therefore; recommend that monoject irrigation needle should be used by students regardless of costs during root canal treatment in the polyclinic or dental clinic due to its safety in order to prevent sodium hypochlorite accident.Conclusion: Monoject needle showed significantly less sodium hypochlorite extrusion compared to hypodermic needleBangladesh Journal of Medical Science Vol.15(4) 2016 p.575-578

The aim of the present study was to evaluate the cytotoxic effects of five endodontic sealers (AH Plus, Endomethasone N, EndoSequence BC, MTA Fillapex and Pulp Canal Sealer EWT) using a three-dimensional (3D) cell culture model. A conventional bi-dimensional (2D) cell culture model was used as reference technique for comparison. Balb/c 3T3 fibroblasts were cultured in conventional bi-dimensional cell culture and in rat-tail collagen type I three-dimensional cell culture models. Then, both cell cultures were incubated with elutes of freshly mixed endodontic sealers for 24 h. Cell viability was measured by the methyl-thiazol-diphenyltetrazolium assay (MTT). Data were statistically analyzed using ANOVA and the Tukey test at a significance level of p0.05). Endomethasone N and Pulp Canal Sealer EWT showed lower cytotoxic effects than AH Plus in 2D cell culture model (p0,05). Endomethasone N e EWT mostraram efeitos citotóxicos mais baixos do que AH Plus no modelo de cultura de células 2D (p

Background This study evaluated the antibacterial efficiency and ability of propolis to promote regeneration of immature permanent non-vital dogs’ teeth. Methods Ninety six immature permanent premolars teeth in 6 mongrel dogs were divided randomly into: experimental teeth (N = 72) and control teeth (N = 24). Periapical pathosis was induced in all experimental and positive control teeth. Experimental teeth were classified according to the used intra-canal medication into: group I (N = 36), propolis paste was used and group II (N = 36), triple antibiotic paste (TAP) was used. Bacteriologic samplings were collected before and after exposure to intra-canal medicaments. After the disinfection period (3 weeks), revascularization was induced in all experimental teeth. Each group was subdivided according to the root canal orifice plug into: subgroup A (N = 18), propolis paste was used and subgroup B (N = 18), mineral trioxide aggregates (MTA) was used. Each subgroup was further subdivided according to the evaluation period into 3 subdivisions (6 teeth each): subdivision 1; after 2 weeks, subdivision 2; after one month and subdivision 3; after 2 months. Positive control group had 12 teeth with induced untreated periapical pathosis. Negative control group had 12 untouched sound teeth. All teeth were evaluated with radiography and histology. The bacteriologic and radiographic data were analyzed using repeated measures ANOVA and post-hoc Tukey tests. The histologic data were analyzed using Kruskal-Wallis test, Mann-Whitney U test with Bonferroni’s adjustment and Chi-square test. The significance level was set at P ≤ .05. Results There was no significant difference in the antibacterial effectiveness between TAP and propolis groups (P > .05). In all subdivisions, there was no significant difference between the experimental groups in terms of increase in root length and dentin thickness, decrease in apical closure, new hard tissue formation, vital tissue formation inside the pulp canal and apical closure scores (P > .05). Conclusion Propolis can be comparable with TAP as a disinfection treatment option in regenerative endodontic. As a root canal orifice plug after revascularization of necrotic immature permanent teeth in dogs, propolis induces a progressive increase in root length and dentin thickness and a decrease in apical diameter similar to those of MTA.

Periradicular bacterial infections are the proven cause of the failure of endodontic treatment. When the pulp canal gets infected or becomes necrotic, bacterial growth takes place in the form of biofilms and aggregates. During the endodontic procedure, bacterial colonies are disrupted, and the microbial load is reduced by biomechanical preparation, cleaning with anti-microbial solutions, and placing anti-bacterial medicaments in the root canal. These anti-microbial substances are synthetic, having a cytotoxicity effect. In recent times, herbal medicines are an alternative medicine being used increasingly as an intra-canal medicament to fight or prevent common endodontic infections. Aim The objective of this study is to compare the anti-bacterial efficacy of herbal medicaments and synthetic medicaments against Enterococcus faecalis (E. faecalis). Materials and methods This was an in-vitro study in which a total of 60 teeth specimens (n=60) were inoculated with E. faecalis for 21 days. Specimens were divided into six groups (Group 1: Piper nigrum (Piperaceae); Group 2: Piper longum (Piperaceae); Group 3: Zingiber officinale Roscoe (Zingiberaceae); Group 4: Calcium hydroxide; Group 5: 2% chlorhexidine gel (CHX); and Group 6: saline (negative control). The intra-canal medicaments were packed inside the tooth. After five days, the remaining microbial load was determined by using real-time PCR. Results The threshold cycle (Ct) values of Piper nigrum, Piper longum, dried ginger extract, 2% CHX, calcium hydroxide, and saline were found to be 21.36, 20.55, 22.14, 22.51, 23.62, and 17.81, respectively. The obtained mean bacterial load of these products was 8.64, 12.52, 7.23, 0.82, 0.14, and 149.49, respectively. Conclusion Two percent CHX showed high antibacterial activity against E. faecalis followed by calcium hydroxide, Zingiber officinale Roscoe, Piper nigrum, Piper longum, and saline.

Background/purpose: In order to prevent reinfection of the pulp canal space and dressing for regenerative purpose, the coronal seal should have a perfect marginal adaptation. Mineral trioxide aggregate (MTA) and Biodentine are among the most popular sealing materials. These are commonly used in combination with antibiotic medicaments, to ensure disinfection. Aim of the present study was to evaluate the effect of 3 different medicaments on the marginal adaptation of MTA and Biodentine to the dentin. Materials and methods: Teeth were divided into 4 groups (n = 20) that were treated with the following medicaments; triple antibiotic paste (TAP), double antibiotic paste (DAP), a calcium hydroxide (CH) and a control group. The specimens were then assigned into two subgroups (n = 10), which received a coronal barrier of MTA or Biodentine. The specimens were scanned using an ex vivo micro-CT scanner. The data were statistically analysed using one-way ANOVA and the unpaired Student's t-test (P TAP > Control > CH. In the Biodentine group, the percentage of voids was determined in the following order: TAP ≥ DAP > CH > Control. Significantly lower percentage of voids was observed in the CH-medicated specimens in the MTA group when compared to all test groups (P = 0.04). Conclusion: The application of CH as an intracanal medicament reduced the void occurrence between the ProRoot MTA and root dentin. However, TAP and or DAP decreased the marginal adaptation in both ProRoot MTA and Biodentine. Keywords: MTA, Biodentine, TAP, Regenerative endodontics, Micro-computed tomography

We present a 16-year-old boy with a history of ankylosis of the temporomandibular joint (TMJ) who had been treated with a costochondral graft and mandibular distraction. The distraction seems to have caused pulp canal obliteration of the lower right second premolar and lower right first molar on radiographic examination. To our knowledge this is the only reported instance of such damage related to mandibular distraction. We aim to highlight the risks of this complication and the importance of discussing it with patients as part of the process of informed consent.

In the case of calcified pulp canal, a customized guide is used for the formation of access cavity to remove the infected pulp from pulp chamber; this guided approach of treatment is known as guided endodontic. The accuracy of guided endodontic treatment depends on design and fabrication of the guide. Guide path and support structure are the two essential part of the endodontic guide. The guide path is a hole of specific orientation and diameter, responsible for the orientation of file to follow the pre-decided drilling path during treatment while the support structure of guide will provide grip and placement on the teeth. If there is some deviation between the reference point of guide and teeth, then it will be the cause of the surgical error. So the intent is to fabricate optimally oriented guide path with the detailed negative impression of the tooth crown on the guide, which will be able to perfectly grip and place on the teeth. Cone beam computed tomography (CBCT) of the patient face is used to get anatomical details of the tooth to decide the orientation of guide path. Similarly, the architectural details of teeth captured by intraoral surface scan (SS) data are used to design support structure of guide. CBCT and intraoral SS data are merged to get the combined detail of teeth anatomy and architecture. This combined dataset exported from computational software (CAD software package) to design the endodontic guide. After that the STL model of the designed guide will send for fabrication on additive manufacturing (AM) machine. The endodontic guide comprises of freeform surfaces, negative impression of teeth, and guide path, so it is utterly essential to retain these features after fabrication. However, AM is the prevalent technology for fabrication of customized parts, but due to induced volumetric error, feature loss will occur which may lead drill path deviation and treatment failure. If guide designs for additive manufacturing by keeping some factors (triangulation, slicing, build orientation, nozzle/laser velocity) in mind, then feature loss can easily be controlled. The design and fabrication issues for additive manufacturing of endodontic guide along with the recent developments in guided endodontic discussed in this article.

Purpose: The aim of this study was to develop an automated software to extract tooth and pulpal area from sectional cone-beam computed tomography (CBCT) images, which can guarantee more reproducible, objective and time-saving way to measure pulp/tooth volume ratio. Methods: The software program was developed using MATLAB (MathWorks). To determine the optimal threshold for the region of interest (ROI) extraction, user interface to adjust the threshold for extraction algorithm was added. Default threshold was determined after several trials to make the outline of extracted ROI fitting to the tooth and pulpal outlines. To test the effect of starting point location selected initially in the pulpal area on the final result, pulp/tooth volume ratio was calculated 5 times with different 5 starting points. Results: Navigation interface is composed of image loading, zoom-in, zoom-out, and move tool. ROI extraction process can be shown by check in the option box. Default threshold is adjusted for the extracted tooth area to cover whole tooth including dentin, cementum, and enamel. Of course, the result can be corrected, if necessary, by the examiner as well as by changing the threshold of density of hard tissue. Extracted tooth and pulp area are reconstructed three-dimensional (3D) and pulp/tooth volume ratio is calculated by voxel counting on reconstructed model. The difference between the pulp/tooth volume ratio results from the 5 different extraction starting points was not significant. Conclusions: In further studies based on a large-scale sample, the most proper threshold to present the most significant relationship between age and pulp/tooth volume ratio and the tooth correlated with age the most will be explored. If the software can be improved to use whole CBCT data set rather than just sectional images and to detect pulp canal in the original 3D images generated by CBCT software itself, it will be more promising in practical uses.

Introduction: The present study compared the ability of the endodontic sealers AH Plus, Pulp Canal Sealer and EndoREZ to fill the root canal system in association with gutta-percha. Methods: Ninety mandibular premolars were accessed, prepared and divided into three groups of 30 teeth each, according to the sealer used to fill the canals: AH Plus, Pulp Canal Sealer and EndoREZ. All the teeth were filled using the continuous wave of condensation technique. The specimens were then decalcified, dehydrated, rendered transparent, and analyzed by three independent evaluators with 8x magnification. Chi-squared test (χ2, p < 0.05) was used to compare the groups in relation to the totally filled, the partially filled and the non filled ramifications. The same test was used to compare the directions of filled ramifications and the number of ramifications among the three thirds of the roots. Results: EndoREZ filled a significantly higher number of ramifications than AH Plus and Pulp Canal Sealer (χ2, p < 0.05). All the groups showed higher number of totally filled ramifications than partially filled and unfilled ramifications. The ramifications were more frequently detected in the apical third, followed by medium and coronal thirds, respectively (χ2, p < 0.05). The ramifications were more frequently detected towards lingual direction (χ2, p < 0.05). Conclusion: EndoREZ presented higher ability to fill the root canal system in association with gutta-percha when compared to AH Plus and Pulp Canal Sealer. The ramifications were more frequently detected in the apical third, running in a lingual direction.

Life cycles of dental trauma victims can provide important clinical information, especially when viewed over many years. In this first series of life cycles, the pulp and periodontal responses to traumatic injuries of four patients are documented over periods varying from 26 to 51 years. The dynamics of pulp survival following an intrusive luxation and two avulsions are followed, with particular reference to pulp canal calcification to which a new term, root canal stenosis, has been proposed. The life cycles include the successful management of inflammatory root resorption in a replanted tooth with an open apex contrasting with the early prophylactic endodontic treatment of two replanted teeth in a patient with mature apices. The long-term development of invasive cervical resorption in one of the patient's life cycle highlights the importance of ongoing follow-up examinations for dental trauma victims.

The purpose of this study was to evaluate the efficacy of TRUShape (Dentsply Tulsa Dental Specialties, Tulsa, OK) compared with the Reciproc file (VDW, Munich, Germany) in the removal of filling material from oval canals filled with 2 different sealers and differences in the working time.Sixty-four mandibular canines with oval canals were prepared and divided into 4 groups (n = 16). Half of the specimens were filled with gutta-percha and pulp canal sealer (PCS), and the remainders were filled with gutta-percha and bioceramic sealer (BCS). The specimens were retreated using either the Reciproc or TRUShape files. A micro-computed tomographic scanner was used to assess filling material removal, and the time taken for removal was also recorded. Data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests.The mean volume of the remaining filling material was similar when comparing both files (P ≥ .05). However, in the groups filled with BCS, the percentage of remaining filling material was higher than in the groups filled with PCS (P.05). The reciprocating file allowed for faster filling removal than the TRUShape files (P.05). Retreatment was faster in the groups that were filled with PCS compared with those filled with BCS (P.05).There was no difference regarding the percentage of remaining filling material when comparing both files system; however, Reciproc was faster than TRUShape. BCS groups exhibited significantly more remaining filling material in the canals and required more time for retreatment. Remaining filling material was observed in all samples regardless of the technique or sealer used.

Introduction Success and failure of root canal therapy is largely dependent on the clinician and the patient. Once the tooth is restored into its functional and esthetic place, the root canal therapy is considered to be complete. It is a well-known fact that root canal space acts as a rich reservoir for microorganisms. Past studies show that root canal harbors an array of different microorganisms. Streptococcus mitis and Enterococcus faecalis have been found to be the most prevalent microorganisms isolated from the infected pulp canal space. Hence, we evaluated the association of endodontic signs and symptoms with root canal pathogens. Materials and methods A total of 120 patients were selected for the study and divided broadly into two groups: Group I containing patients with primary infection and group II containing patients in which retreatment was required. Both groups contained 60 patients each. Clinical parameters recorded for the study are pain, tenderness on percussion, swelling, periapical radiolucency on radiographic analysis, caries, sinus formation, and tooth mobility. After assessment, opening, and initial filing, sterile paper points were inserted into the root canal space for collection of microbiological sample, which was further send to laboratory for cultural analysis. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Student's t-test and Fisher's exact test were used to evaluate the level of significance. Results While comparing the mean age of the patients in the two groups, no significant association was seen. Statistically significant results were obtained while comparing the association between pain and S. mitis. Positive correlation was seen on comparing the association between tenderness on percussion and E. faecalis. Also, a positive association was seen between periapical radiolucency and S. mitis. Conclusion Strong positive correlation exists between S. mitis and E. faecalis and endodontic signs and symptoms. Clinical significance Sound knowledge regarding the association of microbes of root canal and specific endodontic signs and symptoms could help therapeutic management of root canal infections effectively. How to cite this article Pandey V, Choudhary I, Kumar V, Tripathi P, Misra A, Bagde H. Assessment of Correlation between Clinical Parameters and Pulp Canal Pathogens in Endodontic Pathologies: A Microbiological Study. J Contemp Dent Pract 2016;17(8):654-658.

Background: Root canal irrigants are considered momentous in their tissue dissolving property, eliminating microorganisms, and removing smear layer. The present study was aimed to compare the removal of endodontic smear layer using ethylene glycol bis (beta-amino ethyl ether)-N, N, N', N'-tetraacetic acid (EGTA) and citric acid solutions with saline as a control in primary anterior teeth. Materials and Methods: Thirty primary anterior teeth were chosen for the study. The teeth were distributed into three groups having ten teeth each. Following instrumentation, root canals of the first group were treated with 17% EGTA and the second group with 6% citric acid. Only saline was used as an irrigant for the control group. Then, the teeth were subjected to scanning electron microscopy (SEM) study. The scale given by Rome et al . for the smear layer removal was used in the present study. Results: The pictures from the SEM showed that among the tested irrigants, 17% EGTA + 5% sodium hypochlorite (NaOCl) group showed the best results when compared to other groups. Conclusion: The results advocate that the sequential irrigation of the pulp canal walls with 17% EGTA followed by 5% NaOCl produced efficacious and smear-free root canal walls.

Aim: The aim of this in vivo study is to evaluate the antimicrobial efficacy of calcium hydroxide (Ca(OH)2), chlorhexidine (CHX), and metronidazole gel as intracanal medicaments against aerobic and facultative anaerobic microorganisms found in root canals of human primary teeth with necrotic pulp. Setting and Design: It is a double-blinded randomized clinical trial. Materials and Methods: Pulp canals of 45 single-rooted primary maxillary anterior teeth with pulp necrosis in 34 children were included in the study. They were divided into three groups of 15 samples each: Group I: Ca(OH)2; Group II: 1% CHX gel; and Group III: 1% metronidazole gel. Microbial count was obtained from each tooth at two different stages – (1) after instrumentation and (2) after placement of the medication. Statistical analysis using the SPSS 10.0 software program (SPSS Inc., Chicago, IL, USA) with Wilcoxon signed-rank test after grouping the samples was performed. Results: Ca(OH)2, 1% CHX gel, and 1% metronidazole gel were ineffective in completely eliminating aerobic and facultative anaerobic microorganism from root canal of human primary teeth with necrotic pulp. Conclusion: None of the commonly used intracanal medicaments, that is Ca(OH)2, 1% CHX gel, and 1% metronidazole gel, was effective in completely eliminating aerobic and facultative anaerobic microorganism from root canal of human primary teeth with necrotic pulp. Ineffectiveness of these medicaments against aerobic and facultative anaerobic microorganism has opened new door of research regarding the manner of bacterial growth in unfavorable environmental and nutritional conditions, the way root canal environment favors biofilm formation and the use of suitable intracanal medicaments against single and multispecies biofilms.

Formocresol is used in endodontic therapy for pulp canal sterilization. Formocresol contains 10% formaldehyde, 35% cresol, and 15% glycerol. Various researchers have said that formocresol is effective in fixing the pulpal tissue, and it also has an impact on the enzymes and connective tissue surrounding the apices of the treated teeth. Hence, this paper reviews the history, sources, pharmacokinetics of formaldehyde and cresol, carcinogenicity, mutagenicity, clinical success and controversies regarding the safety of formocresol as medicament.

Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.

Aim To present a new treatment approach for teeth with pulp canal calcification (PCC) which require root canal treatment. Case A 15-year-old male patient presented with pain of his upper right central incisor. The tooth showed signs of apical periodontitis. Due to PCC, location of the root canal was judged to be difficult and associated with a high risk of perforation. A cone beam computed tomography (CBCT) and an intra-oral surface scan were performed and matched using software for virtual implant planning. After planning the position of the drill for root canal location, a virtual template was designed, and the data were exported as an STL file and sent to a 3D printer for template fabrication. The template was positioned on the anterior maxillary teeth. A specific drill was used to penetrate through the obliterated part of the root canal and obtain minimally invasive access to the apical part. The root canal was accessible at 9 mm distance from the apex. Further root canal preparation was carried out using an endodontic rotary instrumentation system. After an interappointment dressing for 4 weeks, the root canal was filled with vertically condensed gutta-percha using an epoxy sealer. The access cavity was restored with a composite material. After 15 months, the patient was clinically asymptomatic with no pain on percussion. The radiograph showed no apical pathology. Conclusions The presented guided endodontic approach seems to be a safe, clinically feasible method to locate root canals and prevent root perforation in teeth with PCC.