A permanent mandibular second molar with seven root canal systems

This case report illustrates the nonsurgical endodontic management of a seven-canaled mandibular second molar. The root canal configuration presented as four mesial and three distal canals. Identification of the canal system was made with the aid of magnification, ultrasonics, and multiple angulated radiographs. Postoperative examination at 18 months showed a clinically asymptomatic tooth with resolution of the periapical pathology.

Evaluation and endodontic management of a patient with 6 single-rooted molars: a case report

This case report describes a patient with unusual tooth morphology involving the bilateral presence of 6 maxillary and mandibular first and second molars with a single root and a single canal. The article also discusses the endodontic management of a single-rooted maxillary molar and the use of cone beam computed tomography for evaluation and diagnosis of these anatomical variations.

Evaluation of an Indigenously Prepared Herbal Extract (EndoPam) as an Antimicrobial Endodontic Irrigant: An Ex Vivo Study

BACKGROUNDG

Root canal irrigation plays a pivotal role in endodontics. Constant increase in antibiotic resistance and side effects caused by synthetic irrigants has shifted the research toward developing herbal alternatives. The current study aims to assess the ex vivo effectiveness of an indigenously prepared herbal extract "EndoPam" and compare it with the conventional endodontic irrigants for disinfection of root canals infected with Enterococcus faecalis.

MATERIALS AND METHODS

As a preliminary study of the antimicrobial efficacy of the test irrigants, an Agar diffusion study was conducted, and zone of inhibition measured. Forty extracted mandibular premolars with straight root canals were selected and standardized to 12 ± 1 mm in length. Root canals were prepared using rotary ProTaper system until F3 instrument and were infected with the culture of E. faecalis for three weeks. Specimens were divided into four groups (n = 10). Group 1: EndoPam (.

INGREDIENTS

Syzigium aromaticum, Eucalyptus globulus, Cinnamomum zeylanicum and Mentha piperita), Group 2: 2% chlorhexidine, Group 3: 5.25% Sodium hypochlorite, Group 4: Normal Saline. Irrigation was performed for each group. Samples were inoculated and incubated for 24 h at 37°C for qualitative analysis qualitative analysis.

RESULTS

In the preliminary Agar diffusion study, EndoPam exhibited a zone of inhibition comparable to that of sodium hypochrorite. The diameter of the inhibition zone was in the following order: 2% chlorhexidine gluconate > EndoPam > 5.25% NaOCl > Normal Saline. The qualitative assay done by culturing the bacteria after a period of 3 weeks showed no bacterial growth in any of the tested irrigants, except in normal saline.

CONCLUSION

It was found that the experimental product was as effective as conventional irrigants in reducing the microbial count.

Dentine microhardness changes following conventional and alternate irrigation regimens: An in vitro study

AIM

To compare the changes in microhardness of root dentin caused by two novel irrigation regimens with conventional irrigation.

MATERIALS AND METHODS

Forty extracted human permanent incisor teeth were selected. Decoronated roots were separated longitudinally to get 80 specimens that were embedded in autopolymerizing acrylic resin and grounded flat with silicon carbide abrasive papers. Of these, 60 root segments without any cracks or defects were selected and divided into four groups according to the irrigation regimen used (n = 15). Group I: 5% sodium hypochlorite (NaOCl) + 17% ethylenediaminetetraacetic acid (EDTA) + 0.2% chlorhexidine digluconate (CHX) (conventional). Group II: 6% Morinda Citrifolia Juice + 17% EDTA (MCJ). Group III: 5% NaOCl + Q Mix 2 in 1 (QMix). Group IV: Distilled water (control). Irrigation regimens were performed for 5 minutes. Dentin microhardness was measured with a Vickers indenter under a 200-g load and a 20-s dwell time at the midroot level of root dentin. The data were analyzed using Kruskal Wallis test and Dunn's multiple comparison tests.

RESULTS

A significant difference was seen in the median values of the four groups. The control group showed the least reduction in microhardness when comparison with the other groups. Except for Group III (Q Mix), the other groups that were tested (MCJ and conventional regimens) showed statistically significant difference from the control group.

CONCLUSION

Within the limitation of this study, it was concluded that NaOCl + Q Mix were least detrimental to root dentin microhardness when compared with MCJ and conventional irrigation regimens.

Morphologic variations in mandibular premolars: a report of three cases

AIM

To report cases with morphologic variations in mandibular premolars.

BACKGROUND

Mandibular premolars have earned the reputation for having aberrant anatomy. The occurrence of three canals with three separate (type V, Vertucci) foramina in mandibular premolars is very rare. In this report, three cases are presented involving the root canal treatment of mandibular premolars with three different root and canal configurations. The present report also emphasizes the use of the dental operating microscope to enhance visualization.

CASE DESCRIPTION

Correlation between radiographic findings, use of dental operating microscope and knowledge of aberrant anatomy helps to identify, locate and treat the aberrant anatomy of the tooth.

CLINICAL SIGNIFICANCE

The treatment was successful as all canals were identified and filled and also as evidenced by relief of symptoms.

CONCLUSION

Success is largely dependent on the use of magnification, which aided in identifying the location of the three individual root canal orifices; thus emphasizing the need to familiarize ourselves with dental microscopy, to obtain maximal anatomic information in endodontic practice.

Palatogingival groove mimicking as a mutilated root fracture in a maxillary lateral incisor: a case report

This article presents a case of a palatogingival groove (PPG) in tooth No. 12 that was misdiagnosed as a mutilated root fracture. A PPG is a developmental anomaly that predisposes a tooth to a severe periodontal defect. The initial diagnosis of mutilated root fracture on tooth No. 12 was made solely from radiographs that showed a vertical and horizontal radiolucent line with a radiolucent halo-shaped bone resorption in relation to the root apex. Transillumination, bite test, surgical visualization of the site, and the use of high-end diagnostic modalitieswere not considered prior to the final diagnosis. PPG was confirmed only after the tooth was extracted and observed under a dental operating microscope.

Revascularization for a necrotic immature permanent lateral incisor: a case report and literature review

BACKGROUND

Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development.

CASE REPORT

This article describes the successful revascularization treatment of an immature maxillary lateral incisor that was initially diagnosed with apical periodontitis. The tooth was asymptomatic and functional clinically and radiographically during the follow-up period of 5 years.

CONCLUSION

The follow-up showed evidence of progressive thickening of the dentinal walls, development of root length and apical closure. The article also discusses the currently available literature regarding revascularization of immature permanent teeth.

Maxillary first molar with three buccal roots evaluated with cone-beam computed tomography: a rare case report

This case report describes the nonsurgical endodontic management of a maxillary first molar with the unusual morphology of three separate buccal roots. An accurate assessment of this morphology was made with the help of cone-beam computed tomography (CBCT). This report also describes the varied root morphology associated with maxillary first molars and the role of CBCT as a diagnostic tool for managing these complex cases successfully.

A maxillary lateral incisor with four root canals

AIM

To describe the successful non-surgical endodontic management of a permanent maxillary lateral incisor tooth with four root canals.

SUMMARY

Aberrant morphology of root canals can occur in any tooth, including maxillary lateral incisors. In the presented case, clinical examination and radiographs clearly depicted the presence of four root canals in a right maxillary lateral incisor. The differential diagnosis included fusion, gemination, dens invaginatus or a combination of these. The report emphasises the need for attention during root canal treatment of maxillary lateral incisors.

KEY LEARNING POINTS

• Clinicians should be aware of the variable root canal anatomy in maxillary lateral incisor teeth. • Careful examination of radiographs and the internal anatomy of teeth are essential prerequisites for successful root canal treatment. • Four root canals in maxillary lateral incisors is a possibility.

Endodontic management of a maxillary first molar with eight root canal systems evaluated using cone-beam computed tomography scanning: a case report

INTRODUCTION

Root canal treatment of maxillary molars presenting with complex root canal configurations can be diagnostically and technically challenging.

METHODS

Nonsurgical endodontic therapy of a left maxillary first molar with three roots and eight root canals was successfully performed. This unusual morphology was diagnosed using a dental operating microscope (DOM) and confirmed with the help of cone-beam computed tomography (CBCT) images.

RESULTS

CBCT axial images showed that both the mesiobuccal and distobuccal root contained a Sert and Bayirli type XV canal, whereas the palatal root showed a Vertucci type II canal configuration.

CONCLUSIONS

The use of a DOM and CBCT imaging in endodontically challenging cases can facilitate a better understanding of the complex root canal anatomy, which ultimately enables the clinician to explore the root canal system and clean, shape, and obturate it more efficiently.

Mandibular first molar having an unusual mesial root canal morphology with contradictory cone-beam computed tomography findings: a case report

INTRODUCTION

The objective of this article is to highlight the importance of having a thorough knowledge about the root canal anatomy and the possibility of misleading findings in the cone-beam computed tomography (CBCT) images.

METHODS

This case report presents the endodontic management of a right mandibular first molar with 2 roots and 2 canals. A CBCT imaging was performed to ascertain this rare root canal anatomy.

RESULTS

The clinical and radiographic diagnosis of the existence of a single root canal within the mesial root of mandibular first molar did not correlate with the CBCT findings.

CONCLUSIONS

The confirmative diagnosis should be based on cognitive deduction of the clinical picture and intelligent interpretation of radiologic information.

Endodontic management of maxillary permanent first molar with 6 root canals: 3 case reports

This article discusses the successful endodontic management of 3 permanent maxillary first molars presenting with the anatomical variation of 3 roots and 6 root canals. A literature review pertaining to the variable root canal morphology of the permanent maxillary first molar is also presented. Modifications in the root canal access preparation and methods for examination of the pulpal floor with the aid of magnification for identification of additional canals are emphasized.

Middle distal canal of the mandibular first molar: a case report and literature review

AIM

To present a clinical case report in a mandibular first molar with a middle distal canal, along with a review of the literature.

SUMMARY

With the use of magnification, either by microscopes or by loupes, there is an increasing possibility of detecting additional canals. The present case describes root canal treatment in a mandibular first molar with two roots and a Sert and Bayirli Type XVIII canal configuration in the distal root. The presence of a three canals in the distal root of mandibular first molars has been reported to have an incidence of 0.2-3%.

KEY LEARNING POINTS

* Clinicians should be aware of the variable root canal anatomy in the distal root of mandibular first molars. * Use of magnification helps to identify and locate additional root canals. * Three root canals in the distal root of mandibular first molar teeth might occur.

Maxillary second molar with 5 roots and 5 canals evaluated using cone beam computerized tomography: a case report

This case report presents the endodontic management of maxillary right second molar exhibiting 5 roots and 5 root canals. The diagnosis was confirmed with the help of cone beam computerized tomography (CBCT). The article also describes the varied morphology associated with maxillary second molar and the use of a high-end diagnostic imaging modality like CBCT in diagnosing and negotiating these anatomic variations.