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Teeth with vital pulp are those with an adequate vascular supply, so the circulatory status, and not sensitivity response of the pulp tissue, has been proposed to assess pulp vitality. Some experimental methods have been used to assess this; one of them is the measurement of tooth temperature, which may indicate the pulp vasculature. Some authors have found no differences between the temperatures of teeth with vital and nonvital pulp; however, others found that teeth with nonvital pulp have lower temperatures than teeth with vital pulp. Temperature measurement as a diagnostic procedure has been described with the use of thermocouple, thermistors, infrared thermography, and cholesteric liquid crystals. Many factors may influence the results of the temperature measurement procedure. For creating controlled conditions, each patient should be examined in a thermologic environment. Patients should be asked to refrain from smoking and eating/drinking for 60 minutes before the procedure. The room should be insulated and draft free, and the temperature should be maintained at 20 degrees C. It is desirable to have them lie down or sit with adequate support for the head. The use of a rubber dam is also advocated. Tooth temperature measurement as a diagnostic procedure is reviewed to include description of devices for the test, associated factors, and value of the test.

Missed canals pose a potential risk in the treatment of teeth with anatomical variations, even when multi-angled radiographs have been used. Incomplete mechanical and chemical debridement of the root canal system can lead to treatment failure. Therefore, clinicians must have adequate knowledge of normal root canal systems as well as any possible variations in order to prevent any failure during or after the treatment of teeth with anatomical variations. Any case report of such rare variations would add to this critically required body of knowledge. The current case report presents the diagnosis and endodontic treatment of a maxillary first premolar with one root and three canals (one palatal and two buccal canals, all buccolingually positioned, bifurcating in the apical region), which was different from premolars with 3 canals reported up to now. This configuration describes an unusual root canal system for the maxillary first premolar and does not fit into any of the well-known root canal classification systems. [ABSTRACT FROM AUTHOR]

Electric pulp testing is one of the pulp vitality tests which aid dentists in diagnosis of the pulp status. This test is technique sensitive and hence may elicit false responses. There are some concerns regarding the optimal placement of the probe tip. The threshold value (the lowest electric current at which sensation is perceived) is reached when an adequate number of nerve fibers are stimulated, so the sensation would be greatest where the density of neural distribution is the highest. The purpose of this study was to identify the optimum site for electrode placement in anterior teeth of adults, the threshold values of these teeth using an electric pulp test, and to determine the influence of sex, age, and arch on the outcome. The optimum electrode placement sites and threshold values varied with type of tooth and arch. The maxillary teeth, canines, male gender and increasing age required higher electric current to evoke a sensation, while incisal edges required lower current to evoke a sensation. [ABSTRACT FROM AUTHOR]

Abstract: Tests relying on the passage of light through a tooth have been considered to be a suitable means of assessing vascularity and pulp vitality. Pulse oximetry is an effective, objective oxygen saturation monitoring technique broadly used in medicine for recording blood oxygen saturation levels. It can also be used in endodontic diagnosis for differential diagnosis of vital pulps and necrotic ones. In pulse oximetry, light is passed from a photoelectric diode across the tooth structure into a receptor. The instrument detects changes in absorption in both red and infrared light caused by alteration in tissue volume (tissue perfusion) during the cardiac cycle. However, there are some limitations inherent in the technology of pulse oximetry, such as the effect of increased acidity and metabolic rate, which cause deoxygenating of hemoglobin and changes in the blood oxygen saturation. Also, movements of the body or probe can complicate readings. Because this test produces no noxious stimuli, apprehensive or distressed patients may accept it more readily than routine methods. A review of the literature and a discussion of the potential application of this system in endodontics are presented. [Copyright &y& Elsevier]

Abstract: Failure to grasp the rationale behind cleaning and shaping concepts can increase the occurrence of needless complications, such as ledges. A ledge is created when the working length can no longer be negotiated and the original pathway of the canal has been lost. Extension of the access cavity to provide unobstructed access to the root canals, precurving and not forcing instruments, using NiTi files, using passive step-back and balanced force techniques, and instrumenting the canal to its full length will all help to prevent ledge formation. Initial negotiation and bypassing the ledge can be achieved using a small file with a distinct curve at the tip, whereas a slight rotation motion of the file combined with a ″picking″ motion can often help advance the instrument. A review of the literature and a discussion of the options for prevention, recognition and managing the ledge are presented. [Copyright &y& Elsevier]

Taurodontism is an abnormal morphological trait of tooth shape, which usually occurs in multi-rooted teeth. An enlarged pulp chamber and apical displacement of the pulpal floor are characteristics. Endodontic treatment of a taurodont tooth may be very difficult because it requires special care in identifying and treatment of the complex root canal system. The endodontic treatment of a taurodont maxillary first molar is presented. [ABSTRACT FROM AUTHOR]