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BACKGROUND Sodium hypochlorite & chlorhexidine are usually employed as endodontic irrigants due to their antimicrobial properties, however, their cytotoxicity & allergenicity issues demand an equally effective but safer irrigant. The purpose of the study was to compare the antimicrobial efficacy of octenidine hydrochloride (OCT), green tea, sodium hypochlorite and chlorhexidine (CHX) at various concentrations against E. faecalis, C. albicans and its mixture. METHODS The study was conducted in Hitkarini Dental College, Jabalpur. Various concentrations of irrigants were prepared. Muller Hinton agar media plates were swabbed with the culture broth of E faecalis ATCC 29212, Candida albicans ATCC 10231 or a mixture of these. Five Whatman paper disks (6 mm), each loaded with experimental concentration of the irrigant, were placed at equal distance on to the plate. The plates were incubated at 370 C for 48 hours. This was done in 6 replicates. The plates were evaluated for clear zone of inhibition measured in mm. RESULTS The diameter readings were analysed using Kruskal Wallis and Mann Whitney U tests. There was a significant difference between the groups against Enterococcus faecalis; candida, & mixed culture (P < 0.01). CONCLUSIONS 5 % Sodium hypochlorite is better than all others whereas 2 % CHX is better than OCT & Green tea. 0.1 % OCT is better than 3 % Green tea. OCT can be used as a contributory irrigant along with NaOCl to achieve antimicrobial advantage. KEY WORDS Antimicrobial Efficacy, Candida Albicans, Chlorhexidine Gluconate, E Faecalis, Green Tea, Octenidine Hydrochloride, Sodium Hypochlorite

Introduction: Periapical lesions generally develop as a sequel to pulpal infection. When there is a large periapical tendency visible on the radiograph, clinicians tend to have a surgical approach towards treatment. Most periapical lesions can be classified as abscess, granuloma or cysts. However a non- surgical approach with appropriate use of intracanal medicaments should be attempted to salvage teeth. This paper demonstrates healing of large periapical lesions in two cases by non – surgical Endodontic treatment. Case Presentation: This report describes Endodontic treatment of a mandibular first molar and maxillary incisors. Calcium hydroxide in an aqueous vehicle was placed as intracanal medicament, the dressing changed every fifteen days for a period of three months. Continued follow ups demonstrated radiographic healing and the patients were asymptomatic. Conclusion: The case reports presented in this article showed healing of large periapical lesions following endodontic treatment. Isolation with rubber dam, thorough chemo mechanical debridement of the root canal space with use of calcium hydroxide as intracanal medicament is emphasized. It is recommended to monitor radiographically the prognosis of a large periapical lesion following an orthograde endodontic therapy before the decision of performing a periapical surgery is contemplated.

Objectives. The aim of this study is to evaluate electrolyzed saline, produced from a custom-made chair side apparatus for its cleaning effect on root canal walls.Methods. A chair side apparatus has been designed to produce and dispense electrolytically activated solutions (Electrolyzed saline) for the purpose of root canal irrigation. Two different solutions, one, which is oxidizing in nature, consisting primarily of Chlorine derivatives and another, reducing in nature, consisting primarily of sodium hydroxide, are obtained. A combination of these two solutions was used for root canal irrigation in extracted teeth. Root canals were split and the samples were subjected to Scanning electron microscopic evaluation.Results. Under the conditions of this study, electrolyzed saline significantly cleaned the root canal surfaces well, opening the dentinal tubules and removing the smear layer.Significance. There has been a constant search for the ideal root canal irrigant. Sodium hypochlorite has been vastly used but its toxicity and storage risks are of concern. Electrolyzed saline has been produced from saline and the apparatus prepares and dispenses the solution chair side, obviating storage needs.

Mandibular premolar can present a complex pulp anatomy. Apart from the usual single root and single canal a many other variations may be seen. Hence not only a thorough knowledge of the root canal anatomy but also it’s variations are indispensable pre requisites for the success of any endodontic treatment. Good magnification and CBCT scans will definitely be beneficial for successful endodontic treatment. The present case provides evidence that mandibular premolars may have more than one canal.

Introduction: This study aims to compare the efficacy of a combination of an inferior alveolar nerve block (IANB) plus buccal infiltration using 4% articaine versus 2% lignocaine in achieving anesthesia of lower first molar teeth with irreversible pulpitis. Materials and Methods: Seventy adult patients were selected. A random sequence list was employed to administer IANB plus buccal infiltration. After the onset of lip numbness, cold test and electric pulp testing were performed. Five patients, four missed blocks and one no bleeding, were excluded. Heft Parker Visual Analog Scale scores during pulp extirpation were recorded. The data of sixty-five patients were statistically analyzed using Chi-square and Mann–Whitney U-test. Results: The success rate after lip-numbness for articaine is 91.42% and for lignocaine is 94.28%. The difference is statistically, not significant (P = 0.6425). During access, the success rate for lignocaine is 96.87%, whereas 96.96% for articaine. This difference is also not significant (P = 0.982366). Conclusion: IANB plus buccal infiltration using articaine or lignocaine is equally effective in anesthetizing mandibular first molar with irreversible pulpitis.

Aim: This study aims to estimate and compare the fracture resistance of endodontically treated mandibular first molar restored with reinforced composite resin or cusp capping. Materials and Methods: Seventy-five freshly extracted intact mandibular molars were randomly divided into five groups. The teeth were embedded vertically into the self-cure acrylic lined with elastomeric impression material to a level 1 mm apical to the cement-enamel junction. Group 1 included intact teeth. After access preparation in Groups 2–5, canals were negotiated with 10 K file, cleaned shaped using K3XF NiTi rotary files, 17% Ethylenediaminetetraacetic acid, and 3% sodium hypochlorite. After drying, the canals were obturated with gutta-percha and Sealapex sealer. Group 2 teeth were restored using Cavit. In Groups 3–5, the access cavity floor was lined by resin-modified glass-ionomer cement. After etching, rinsing, and bonding, teeth were restored. Group 3 teeth with everX posterior as a base and 1.5 mm of occlusal nanohybrid composite. Group 4 teeth were restored with nanohybrid composite after bonding Interlig fiber circumferentially in the access cavity. In Group 5, after 2 mm cusp reduction, etching, and bonding, teeth were restored by cusp capping using nanohybrid composite. All specimens were subjected to a fracture test. The peak-load fracture value in Newton was recorded. Results: One-way analysis of variance test for intergroup comparison revealed a statistically significant difference between the groups (P = 0.011). Post hoc Tukey's test showed a significant difference (P = 0.005) between everX posterior and Cavit specimens. The Chi-square test results revealed that there is a significant difference (P = 0.0276) in the fracture pattern between the groups. Conclusion: It is concluded that restoration using short fiber-reinforced composite improved the fracture resistance of endodontically treated mandibular molars. Cusp-capped teeth exhibited more favorable fractures. The combined use of fiber-reinforced composite and capping the cusps using nanohybrid composite could be a viable option to restore molar favorably.

Introduction: Periapical lesions generally develop as a sequel to pulpal infection. When there is a large periapical tendency visible on the radiograph, clinicians tend to have a surgical approach towards treatment. However a nonsurgical approach with appropriate use of intracanal medicaments should be attempted to salvage teeth. This paper demonstrates healing of large periapical lesions in two cases by non – surgical Endodontic treatment Case Presentation: This report describes Endodontic treatment of a mandibular first molar and maxillary incisors. Calcium hydroxide in an aqueous vehicle was placed as intracanal medicament, the dressing changed every fifteen days for a period of three months. Continued follow ups demonstrated radiographic healing and the patients were asymptomatic. Conclusion: The case reports presented in this article showed healing of large periapical lesions following endodontic treatment. Isolation with rubber dam, thorough chemo mechanical debridement of the root canal space with use of calcium hydroxide as intracanal medicament is emphasized. Case Study Paul and Dube; BJMMR, 10(5): 1-6, 2015; Article no.BJMMR.18978 2

Aim: To evaluate the scouting ability of three pathfinding nickel-titanium rotary instruments in moderately curved molar canals. Materials and Methods: Ninety maxillary and mandibular molars were collected and were divided randomly into three groups each having 15 maxillary and 15 mandibular molars. The teeth were mounted on a specific apparatus for simulation of dento-alveolar socket. After access cavity preparation, the canals were negotiated with 08 K-file. Glide path preparation was performed using Mtwo or ProGlider or OneG instruments. The number of teeth in which the file reached the full working length (RFWL), number of passes required, and number of fractured instruments were recorded and subjected to statistical analysis using Chi-square, Kruskal–Wallis, and Mann–Whitney tests. Results: There was a significant difference between the groups (P < 0.05). The RFWL of ProGlider was significantly higher than that of Mtwo (P = 0.005) and OneG (P = 0.037). The percentage of fracture with ProGlider was 6.67% and both Mtwo and OneG had 26.67% frequency. The difference was not statistically significant (P > 0.05). There was significant difference in the number of insertion passes in maxillary distobuccal (P < 0.05), mandibular mesiobuccal (P < 0.01), and distal (P < 0.01) canals. ProGlider was the most effective pathfinding instrument due to its file's design and a progressive taper of 2%–8%. This achieves a greater preflaring of the coronal and middle portions of the root canal, rendering the advance of the instrument toward the apex easier. Conclusion: ProGlider performed more efficiently and with less instrument breakage in scouting moderately curved canals of molar teeth.

This case report describes the autotransplantation of a third molar with developing roots in a young female patient. Following transplantation into the socket of mandibular first molar, the tooth was stabilized with sutures and a custom made semi rigid splint. On recall examination one year after completion of the surgical technique, the transplant responded positively to electric pulp testing and showed absence of infection, ankylosis or progressive resorption. The transplantation of a third molar can be seen as a promising method to replace a lost permanent tooth. Clinical relevance :The permanent first molar is the most caries prone permanent tooth, probably because of its early exposure to the oral environment. Unrestorable teeth need to be extracted. Its extraction leads to unfavorable occlusal changes . Fixed prosthesis and implants are not feasible in growing patients because they may impede the normal growth of facial bones, in particular, of the alveolar process. This case report describes autotransplantation of third molar with incompletely formed roots as a viable treatment option when permanent first molar needs to be extracted. The use of semirigid splint has been demonstrated and follow up showed good prognosis.

Introduction: Treatment of mechanical exposure of the pulp during caries excavation presents a clinical challenge. In this case series of 15 patients, with a follow-up period of over a year, the outcome of direct pulp capping with Biodentine (septodont) after mechanical pulp exposure was assessed. Aim of Study: The aim of this study is to evaluate the outcome of direct pulp capping with Biodentine in deeply carious teeth when pulp was mechanically exposed during caries excavation and cavity preparation. Vital pulps exposed during caries excavation in molar teeth were treated with 3% sodium hypochlorite for 2 min. If adequate hemostasis was achieved, the pulp tissue was capped with Biodentine, which covered the entire pulpal floor. This was followed by the placement of a layer of resin-modified glass ionomer cement and a final layer of composite resin (Filtek Z350-3M) to complete the restoration. The patients were recalled periodically and evaluated for any evidence of pulpal/periapical pathology. Results: In the follow-up period that ranged from 12 to 24 months, all teeth were asymptomatic. Conclusion: Biodentine appears to be a suitable material for direct pulp capping under clinical conditions. However, long-term follow-up studies and controlled trials involving a large sample size are warranted.

Endodontic treatments are routinely done with the help of radiographs. However, radiographs represent only a two-dimensional image of an object. Failure to identify aberrant anatomy can lead to endodontic failure. This case report presents the use of three-dimensional imaging with cone beam computed tomography (CBCT) as an adjunct to digital radiography in identification and management of mandibular second molar with three mesial canals.

Root resorption is a dental complication caused by dental trauma, surgical procedures, excessive pressure or irritation from bleaching agents that can lead to loss of tooth. This paper presents a case of internal resorption in maxillary central incisor and demonstrates the use of MTA as filling material

The incidence of a two palatal rooted maxillary second molar has rarely been seen in literature [1]. Libfeld and Rotstein, in a radiographic survey done on 1200 teeth, reported a 0.4% incidence of four rooted maxillary second molars. Christie reported 14 cases of maxillary second molars with two palatal roots in a period of 40 years. Slowey reported a maxillary molar with two palatal roots [2]. A precise radiographic examination alerts the clinician to the presence of a varied root canal anatomy. A surgical operating microscope has been found to be particularly useful, as it gives the clinician the opportunity to distinguish microstructures that are not distinctly seen with the naked eye [3]. A 32-year-old, female with a non contributory medical history was referred to the Department of Endodontics, Hitkarini Dental College, Jabalpur, with spontaneous pain in maxillary right posterior teeth, which aggravated on chewing and thermal stimuli since the past 3 days. Clinical examination revealed a fixed partial denture (FDP) involving second premolar and second molar as abutments [Table/Fig-1]. Cold vitality testing done on maxillary second molar caused severe lingering pain. The FPD was removed under local anaesthesia and the teeth were temporized. Second molar still revealed severe tenderness to percussion and a premature response to electric stimulation on the next day. A diagnosis of symptomatic irreversible pulpitis with apical periodontitis was made. An access cavity was prepared under local anaesthesia after rubber dam isolation. A clinical examination done with a DG 16 explorer revealed four orifices (mesoibuccal, distobuccal, mesiopalatal and distopalatal).The access cavity was modified to a square shape, to clearly expose the distopalatal orifice. The working length was determined using an apex locator (Root ZX; Morita). Multiple radiographs taken [Table/Fig-2 and ​and3],3], confirmed the presence of four separate roots. The case was classified under Type 3 Christie et al’s. classification. A biomechanical preparation was made by using crown down technique. The middle and apical third of the teeth were instrumented using flexofiles (Dentsply Maillefer) while irrigating with normal saline and 3% NaOCl. The canals were dried and obturated using lateral condensation technique with guttapercha and AHplus (Dentsply) sealer [Table/Fig-4]. A recall after one week showed that the patient was asymptomatic. [Table/Fig-1]: Pre Operative Radiograph [Table/Fig-2]: Diagnostic radiograph 1 [Table/Fig-3]: Diagnostic Radiograph 2 [Table/Fig-4]: Post obturation radiograph The prevalence of maxillary second molar with two palatal roots is very rare. However, clinicians ought to be aware of the possibilities, as nontreatment of one canal could lead to endodontic failure.