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Avulsion and root fractures are complications may be seen after a traumatic accident. These should be diagnosed and treated as soon as possible because the time elapsed between the trauma and start of the treatment is considered as the most important factor in the prognosis. All treatment protocols should be directed toward the management of the pulp and periodontal ligament. The present case report reviews a 22-year-old male patient which was visited with 5 hours delay after accident and avulsion of right central incisor. The avulsed tooth soaked in 2.4% fluoride solution for 20 minutes. Extra-oral root canal treatment was performed and it was immediately replanted. Anterior maxillary teeth were splinted by a semi-rigid splint. After 10 days, an intra-oral sinus tract was observed on the oral mucosa of the left central incisor, its tracing revealed a root fracture on this tooth. The coronal section of this tooth was endodontically treated. Four years follow-up revealed no radiographic or clinical signs and symptoms.

Background: Although the crazy-paving pattern on computed tomography is characteristic for pulmonary alveolar proteinosis (PAP), it is not specific and has not been compared between idiopathic and secondary PAPs in the large studies. The aim of this study was to determine the high resolution computed tomography (HRCT) features of idiopathic PAP., Material/methods: HRCT images of 35 patients (mean age: 38±14years; 54.3% male) with idiopathic PAP (proved by bronchoalveolar lavage or biopsy) were reviewed by two experienced pulmonary radiologist and detailed findings were reported., Results: The predominant HRCT presentation of PAP was interlobular septal thickening (ILST;100%) and ground glass opacities (GGOs; 91.7%), resulting in crazy-paving pattern (83%). All patients had diffuse bilateral lung involvement that was symmetric in 97%. ILST and GGO without crazy-paving were seen in 17% and 14.7%, respectively. The overall extent of parenchymal involvement was 50 to 75% in 80% of patients. Thirty three cases (94%) had areas of geographic sparing within the affected lung. Peripheral sparing was seen in 85.7% of patients, including three patterns with some overlap: costophrenic angle (80%), apices (60%), and subpleural (57%) sparing. Other HRCT findings were: consolidation (63%), pulmonary nodules (31.4%), mediastinal and/or hilar lymphadenopathy (23%), mass-like consolidation (17%), pleural effusion (8.6%), and honey combing (5.7%). All female patients (n=16) had crazy-paving, while 13 out of 19 (68%) male patients had crazy-paving on their lung HRCT (p=0.02)., Conclusions: This study demonstrated that the predominant HRCT presentation of idiopathic PAP was interlobular septal thickening and ground glass opacities, resulting in crazy-paving pattern.

The main goal of endodontic treatment is healing of the periapical tissues which are gained by elimination of bacteria and their byproducts from the canal and prevention from reinfection. Understanding of root canal anatomy is an essential part in endodontic treatment. Anatomic forms and variations in special teeth should be well known, one of them is extra roots/ canals. Although possible aberrations of canal anatomy should be considered for all teeth, some teeth should be highlighted. This review addresses the prevalence, diagnosis (clinical and radiographic), and endodontic management of teeth with extra roots/canals.

Aim: This clinical report presents a rare case of maxillary central incisor with two separate roots., Background: Unusual morphology of the roots and root canals may exist in any tooth. Recognition of the dental anatomy and its variations is necessary for successful endodontic therapy. It is well known that maxillary incisors are usually single-rooted teeth., Case Report: The root canals were instrumented with conventional hand files and Gates Glidden and obturated by using the lateral technique. Recall radiograph after 1 year shows the healing process of the preoperative apical periodontitis., Conclusion and Clinical Significance: Clinicians should be aware of unexpected root canal morphology when performing root canal therapy. The present case demonstrated the importance of accurate preoperative radiograph and adequate access preparation.

Aim: To investigate the pattern of routine endodontic practices among Nigerian dentists., Materials and Methods: This study was a questionnaire-based survey of samples of dentists in the Nigerian cities of Enugu and Benin. The self-administered questionnaire contained 25 close-ended questions with multiple choice options. The data collected included demographic details of respondents, root canal preparation techniques, irrigants and intracanal medicaments used, the number of appointments, method of working length determination, root filling techniques, cements used, and the scope of treatment performed., Results: Most respondents used sodium hypochlorite as the irrigant, the step back technique for canal preparation, and lateral condensation with a zinc oxide-eugenol-based sealer for obturation. Most respondents did root canal treatment on all types of teeth and used radiographs to determine the working length 70% of the time. Most respondents followed up their patients for less than 12 months and most treated teeth with periapical areas larger than 10 mm by root canal therapy combined with apical surgery., Conclusion: Most Nigerian dentists use step back technique for canal preparation and lateral condensation for obturation., Clinical Significance: Endodontic practice by Nigerian dentists differs from some established practice quality guidelines in many other countries, particularly in nonperfusion of modern techniques into practice, popularity of antibiotic use for endodontic emergencies and a high rate of perforations.

Aim: To evaluate the ability of dental students to match shades under three various light conditions., Materials and Methods: Sixty senior dental students participated in this study. All students were tested for color deficiency using Ishahara's tests. Nine classical vita shade tabs were randomly selected and their identification codes were concealed. The students were asked to match these 9 selected items by using a complete vita shade guide under three various light conditions (natural light, clinical light, and correcting light source). The chosen shade tabs were recorded and the correct matches were counted. Scores were calculated by adding the number of correct matches., Results: The mean values of correct match scores with natural light, clinical light and correcting light source were 4.82, 4.75 and 6.82, respectively. There was no significant difference in correct matches scores between men and women, nor among various vita A, B, C and D shades., Conclusion: The students showed a better performance in shade matching under the correcting light source than natural light and clinical light. Gender had no effect on shade matching selection and there was no difference in shade matching ability among vita A, B, C, D shades., Clinical Significance: Shade matching performance is significantly improved with correcting light source.

Aim: To compare the antimicrobial effect of 2% chlorhexidine, 2.5% sodium hypochlorite and MUMS containing 2% chlorhexidine., Materials and Methods: All of the above irrigants were examined on Enterococcus faecalis, Streptococcus mutans, Candida albicans, Lactobacillus casei and E. coli. A total of 0.5 CC of each solution and 0.5 CC of McFarland solution bacterium were added to each examination tube. After 15, 30 and 45 minutes, colony count was performed for each tube. The difference in the number of bacteria indicated the effect taken by disinfectant material., Results: MUMS containing chlorhexidine showed the antimicrobial properties just like chlorhexidine's effect against E. coli, Streptococcus mutans, Candida albicans, Enterococcus faecalis and Lactobacillus casei in preventing these entire microorganisms to incubate. Sodium hypochlorite was not effective against Enterococcus faecalis and Candida albicans incubated in 15, 30 and 45 minutes and Enterococcus faecalis in 15 minutes., Conclusion: MUMS has antimicrobial properties similar to chlorhexidine., Clinical Significance: As MUMS containing chlorhexidine can transfer chlorhexidine through its own surfactant around apical area and it can open the dentinal tubules by its own chelator for more penetration of chlorhexidine, it may be a choice for canal irrigation.

Aim: To compare the apical seal of lateral condensation technique, thermafil and one-step by using this model., Materials and Methods: A two-chamber bacterial microleakage model using E. faecalis as microbial marker was used for evaluation of the leakage. Bacterial penetration was monitored over a 60-day period. Leakage was recorded when turbidity was observed in the lower chamber., Results: After comparing the bacterial penetration values, total penetration was observed 45% in lateral condensation technique, 80% in thermafil and 75% in one-step. There was no significant difference between groups after 60 days; however, the microleakage in lateral condensation group was seen later than one-step and thermafil., Conclusion: Thermafil and one-step obturator can be advocated as effective obturation techniques for achieving predictable success in endodontic therapy., Clinical Significance: Thermafil and one-step obturator are suitable devices for obturation.

Aim: To address the indications, contraindications, surgical procedure, complications following treatment, factors influencing the results and success rate of intentional replantation procedure., Background: Intentional replantation is extraction of a tooth to do extraoral root canal therapy, curettage of apical lesion when present, and its replacement in its socket. It has been proposed as an alternative to routine extraction; however, it should be considered a last resort because the root may be fractured during extraction., Results: The success rate of intentional replantation is far below than routine endodontic treatment or apical surgery. Difficultness of tooth extraction, the possibility of fracture during extraction and the risk of external resorption are some limitations of this treatment. The most common causes of failure in intentionally replanted teeth are external inflammatory resorption or replacement resorption and ankylosis caused by periodontal ligament damage., Conclusion: The success rate up to 95% with an average retention of 3 to 5 years, has been reported., Clinical Significance: In some cases, endodontic retreatment or apical surgery is impossible or impractical. In these situations, intentional replantation may be considered as a last resort for preserving the tooth, so all clinicians should know about its indications/contraindications, surgical procedure and complications following treatment.

Aim: The study highlighted the effect of patient-related factors on levels of pain felt by subjects during root canal treatment, as well as the association between treatment duration and pain severity., Materials and Methods: Maxillary central incisors with either necrotic pulp or irreversibly inflamed pulp, with or without preoperative pain were studied in 160 subjects aged 18 years and above. Subject's age and gender as well as pulp status and preoperative pain status were recorded. The procedure was done using a standard protocol. Visual analog scale was used to record the level of pain felt., Results: Those cases with irreversible pulpitis felt higher pain. None with necrotic pulp experienced intense pain, while those in the 51 to 60 year age bands had severe, unbearable or intense pain. Mild pain was a common denominator in all age bands. Pain level increased with treatment duration., Conclusion: Except for age, the level of pain felt by subjects during RCT is significantly correlated with gender and pulp status. Furthermore, the experienced pain levels increased with treatment duration., Clinical Significance: Clinicians should be prepared to make use of supplemental local anesthesia in women and in teeth with IP.

Aim: To reevaluate all cases previously diagnosed as calcifying odontogenic cyst (COC) from the archives of the Department of Oral Pathology at Mashhad Faculty of Dentistry from 1978 to 2008., Materials and Methods: Clinical histories and microscopic slides of all cases diagnosed as COC were reviewed and analyzed statistically. The information about patients such as age, sex, clinical features, radiographic view and other necessary data was gathered from biopsy files., Results: The majority of cases occurred in mandible and four cases were peripherally. Thirteen cases were associated with other odontogenic tumors and 11 cases were odontoma type. In two cases, recurrence was reported after surgical treatment which underwent malignant transformation., Conclusion: Calcifying cystic odontogenic tumor (CCOT) in Iranian population occurs in younger age group with slightly male predilection and more mandibular, unicystic and simple type., Clinical Significance: It is better to address the noncystic CCOT lesions with their specific terms in order to make histopathological characteristics clear.

Aim: To determine the incidence of flare-up and the effect of age, gender, visit type, treatment duration, preoperative pain and intraoperative pain on flare-up in Nigerian adults., Materials and Methods: A total of 175 participants, aged 18 to 60 years with a necrotic central incisor, with or without preoperative pain, participated. They received postoperative paracetamol tablets and were asked to report back if unbearable pain/swelling developed., Results: A 10% flare-up rate was recorded, while none of the studied factors had a significant relationship with flare-up., Conclusion: The relationships between flare-up and studied related factors were not proven., Clinical Significance: Age, gender, visit type, treatment duration, preoperative pain and intraoperative pain have no effect on flare-up incidence.

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 ofa taurodont tooth may be very difficult because it requires special care in identifying and treatment of the complex root canal system. The endodontic treatment ofa taurodont maxillary first molar is presented.

Dilaceration is the result of a developmental anomaly in which an abrupt change in the axial inclination between crown and root is observed. Its prevalence in various races is different and its association with history of trauma is controversial. This study assessed the prevalence and distribution of dilacerated teeth among Nigerians and also investigated whether there was a relation between a history of trauma and teeth that had dilaceration. A total of 465 records of adult attendees (involving 706 teeth and 256 films) were retrospectively studied. Dilacerated teeth were scored using Hamasha et al.'s criteria. Dilaceration occurred more often in the maxilla, posterior teeth and in women, though no association between a history of trauma and occurrence of dilaceration was found. Prevalence of dilaceration in the population and in all teeth was 4.5% and 2.97%, respectively. Dentists should pay detailed attention to baseline radiographs, especially in maxilla and posterior teeth.

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.

This study highlighted the characteristics and distribution of cracked tooth syndrome (CTS) and the associated factors in adult attendees in the University of Nigeria Teaching Hospital. Three hundred seventy patients aged 18 years to 77 years with CTS-like conditions were included and studied over 12 months. The following information was recorded: suspected tooth and the dental arch, restorative status of the tooth, age and sex of the patient, results of bite test and transillumination, and the pulpal and periapical status of the tooth. CTS was seen most often in the 41 to 50 years age band (36.4%), in molars (63.6%), and in the maxillary arch (51.5%). Also, it was more frequent in men (55.8%). About 82% of CTS occurred in amalgam-restored teeth. All cases had a positive response to the bite test and a normal response to the electric pulp test. Only 10% gave a positive history of masticatory accident as against none with history of bruxism habits. It was concluded that patients with unexplained pain in a vital, amalgam-restored tooth (especially in maxillary molars), with or without a history of a masticatory accident, may have a cracked or fractured tooth.

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.

The calcifying epithelial odontogenic tumor is a benign epithelial odontogenic lesion that accounts for less than 1% of all odontogenic tumors. It is most frequently seen in the posterior areas of the mandible. Extension of this lesion to the maxillary sinus is extremely rare. In this paper, we report the fourth of such cases which has been reported, up to now. This tumor was encased between the right maxillary lateral and canine roots with extension to the maxillary sinus. Histologically, the tumor is composed of sheets of epithelial cells with eosinophilic or clear cytoplasm, intercellular bridges, nuclear pleomorphism, but no mitotic figures, amorphous eosinophilic and calcified materials were seen within the sheets of epithelial cells.

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.

Dilaceration is the result of a developmental anomaly in which there has been an abrupt change in the axial inclination between the crown and the root of a tooth, but the criteria in the literature for recognizing root dilaceration vary. Two possible causes of dilaceration are trauma and developmental disturbances, and it has also been proposed that it might be associated with some developmental syndromes. Dilaceration can be seen in both the permanent and deciduous dentitions, and it is more commonly found in posterior teeth and in the maxilla. Periapical radiographs are the most appropriate way to diagnose the presence of root dilacerations. Diagnosis, endodontic access cavity preparation, root canal preparation and filling, and other related treatments might be complicated by the presence of a dilaceration. A review of the literature and a discussion of the options for managing this condition are presented.

The possibility of bilateral maxillary first premolars having three separate roots is quite low; however, it must be taken into account in clinical and radiographic evaluations during endodontic treatment. This case report describes the presence of three roots occurring bilaterally in maxillary first premolars in one patient, drawing particular attention to radiographic interpretation and access refinements. The case report underlines the importance of complete knowledge about root canal morphology and possible variations, coupled with clinical and radiographic examination in order to increase the ability of clinicians to treat difficult cases.

Recognition of unusual variations in the canal configuration is critical because it has been established that the root with a single tapering canal and apical foramen is the exception rather than the rule. The early recognition of these configurations facilitates cleaning, shaping, and obturation of the root canal system. "C" configuration, which is an important anatomic variation, presents a thin fin connecting the root canals. Because of the importance of its true diagnosis and treatment, a comprehensive review of published information and investigations about it in addition to approaches for its treatment is necessary.