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Context: The use of mineral trioxide aggregate (MTA) and Biodentine as a root-end filling materials used in the root-end cavities prepared by laser or ultrasonic technique is a current topic in the branch of dentistry and push-out bond strength is used to measure the adhesiveness provided by the root-end filling materials. Aim: The aim of this study is to evaluate the push-out bond strength of MTA and Biodentine in root-end cavities prepared by erbium:yttrium-aluminium-garne (Er:YAG) laser and ultrasonic retrotip. Materials and Methods: A total of 40 extracted maxillary central incisors and canines were selected. Chemomechanical preparation and obturation were done. Root-end resections were performed followed by the root-end cavity preparation and root-end filling. Specimens were divided into four groups. Root-end cavities prepared by Er:YAG laser and filled with MTA, root-end cavities prepared by Er:YAG laser and filled with Biodentine, root-end cavities prepared by ultrasonic retrotip and filled with MTA and root-end cavities prepared by ultrasonic retrotip and filled with Biodentine, respectively. The apical end was again sectioned perpendicular to the long axis. The push-out bond strength was evaluated using a universal testing machine. Statistical Analysis Used: The data were analyzed using the analysis of variance and post hoc Tukey test. Results: Difference between push-out bond strength of root-end filling materials to root-end cavity walls prepared by laser and ultrasonic retrotips was statistically nonsignificant. Push-out bond strength of MTA and Biodentine did not differ significantly. Conclusion: Difference between push-out bond strength of MTA and Biodentine to root-end cavity walls prepared by Er:YAG Laser or ultrasonic retrotip were statistically nonsignificant.

Introduction: Aim of this study was to evaluate the effective of premedication and to determine the difference between non steroidal anti- inflammatory drugs and centrally acting opioids like tramadol on success rate of inferior alveolar nerve block in patients with asymptomatic irreversible pulpitis.Methods: This double blind clinical study was conducted on 60 patients with asymptomatic irreversible pulpitis in first or second mandibular molar with normal periapical radiographic findings. Three medications i.e., ibuprofen (600mg), tramadol (50 mg) and combination of ibuprofen (400 mg) + acetaminophen (325) were compared and lactose powder capsules were taken as placebo. All patients received IANB and teeth were examined with a cold pulp test using endofrost. Then, endodontic access cavity preparation was initiated. In case of pain during treatment, patients were asked to rate their pain on the visual analog scale.Results: The tramadol group showed significantly higher success rates but ibuprofen and combination of ibuprofen and acetaminophen groups were not significant with placebo (p>05). No Significant differences were there regarding sex of the patients.Conclusion: Premedication with tramadol increased the success rate of IANB.Bangladesh Journal of Medical Science Vol.16(3) 2017 p.370-374

Objectives: To compare the dimensions of gutta-percha (GP) cones of ProTaper Next (25/0.06) and WaveOne (25/0.08) in relation to their corresponding instruments of the same dimension, respectively. Materials and Methods: Two groups of GP cones were made with 25 cones in each group. Group 1 consisted of 25 GP cones # 25/0.06 (ProTaper Next). Group 2 consisted of 25 GP cones # 25/0.08 (WaveOne). Measurements were done at D1 (1 mm short of the tip), D3 (3 mm short of the tip), and D11 (11 mm short of the tip) for GP cones of both groups and were compared with their corresponding instruments. Results: Group 1 (ProTaper) 25/.06 GP points showed greater diameters than those of the corresponding instrument, which was statistically significant. Group 2 (WaveOne) 25/0.08 GP points showed greater diameters than those of the corresponding instrument which was statistically significant whereas it was nonsignificant at level D1. Conclusion: Diameters of both ProTaper Next and WaveOne GP cones were greater than their corresponding instruments. Hence, there are chances of under obturation with both systems.

Biomechanical preparation is one of the most important steps in endodontic therapy. Rotary instrumentation has facilitated this step. Nowadays the market is flooded with different types of rotary instruments. The present study compared the root dentinal crack formation with continuous rotating versus reciprocating root canal preparation methods. One hundred and fifty freshly extracted teeth were used for the study. They were divided into 5 groups with 30 teeth in each group. Thirty teeth were kept under control group A and no root canal preparation was done for this group. Another 30 teeth were prepared with hand files which were kept under control group B. In the experimental groups (sample size, n=30 each) root canals were prepared with ProTaper, K3XF rotary system and WaveOne. Sectioning of these teeth was done at 3, 6 and 9mm from the apex and were evaluated for the presence of any defects. Root dentinal cracks were produced with each type of rotary instruments. Statistical analysis showed no significant difference in root dentinal crack formation between control groups and WaveOne system. There was statistically significant difference in root dentinal crack formation when the canals were prepared with ProTaper and K3XF rotary system. So it was concluded, that continuous rotating instruments could produce dentinal crack formation. Root canal instruments with reciprocating movement appear to be a better option than continuous rotation movement.

Success of endodontic therapy depends on the proper identification of all the canals, thorough chemo-mechanical preparation followed by three dimensional obturation with fluid tight seal. Failure of any of these steps may occur due to unusual tooth morphology. Proper knowledge of root canal anatomy is a basic prerequisite for the endodontic treatment successful. Mandibular molars may have an additional root located lingually (radix entomolaris) or buccally (radix paramolaris). Awareness and understanding of the presence of unusual external and internal root canal morphology contributes to the successful outcome of the root canal treatment.Bangladesh Journal of Dental Research and Education Vol.5(2) 2015: 66-69

Context: Anxiety and fear of pain are the two major deterrents for which patients avoid dental treatment. Local anesthetic, which forms the foundation for the delivery of pain-free endodontic treatment, does not serve the purpose in anxious patients and requires augmentation with other pharmacological agents. Aims: The aim of this study is to observe the effectiveness of nitrous oxide in alleviating patient anxiety and pain during endodontic treatment of a vital tooth. Settings and Design: The present in vivo study was conducted on sixty healthy patients from the Outpatient Department of Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India. Subjects and Methods: Sixty anxious patients having irreversible pulpitis in their lower molar were selected and divided into two groups, namely control group and intervention group, with thirty patients placed in each group. In control group, access opening and pulp extirpation was done under local anesthesia only, whereas in intervention group, access opening and pulp extirpation was done under local anesthesia and nitrous oxide sedation. The anxiety levels of patients, before and after the treatment, were measured using the Modified Dental Anxiety Scale. Pain felt by the patients during administration of local anesthesia and during access opening was measured using the Visual Analog Scale. Statistical Analysis Used: The data were analyzed using ANOVA and paired t-test, and graphical analysis of the data was done. Results: Significant reduction in anxiety and pain levels of patients during endodontic access opening including significant reduction in pain during administration of local anesthesia was observed under nitrous oxide sedation. Conclusions: Conscious sedation with nitrous oxide is a useful technique to add to the armamentarium used in the treatment of teeth with symptomatic irreversible pulpitis.

Aim: The aim of this in vitro study was to evaluate and compare the push-out bond strength of Adseal and mineral trioxide aggregate (MTA) Fillapex sealer after using various irrigants and Erbium-Yttrium-Aluminum-Garnet (Er:YAG) laser irradiation on radicular dentin surface. Materials and Methods: A total of 80 freshly extracted human permanent maxillary anterior teeth were sectioned transversally below the cemento-enamel junction. The remaining root portion was sectioned to get 4-mm thick dentin disc from coronal end of the root, with straight handpiece, and diamond disc. Root canal of specimens was prepared with bur to create space for sealer placement. Specimens were divided into eight groups of 10 samples each, as per irrigants and sealer used. In Group 1, 3, 5, and 7 specimens irrigated with distilled water, NaOCl, Ethylenediaminetetraacetic acid (EDTA), and Er:YAG laser, respectively, and obturated with Adseal sealer. In Group 2, 4, 6, and 8 irrigated with distilled water, NaOCl, EDTA, and Er:YAG laser, respectively, and obturated with MTA Fillapex sealer. After sealer setting, the force used to remove the sealer was evaluated using universal testing machine. Recorded force used to calculate the push-out bond strength in Megapascals and scanning electron microscopy examination was done for specimens. Results: Adseal sealer had significantly higher bond strength than MTA Fillapex sealer, irrespective of irrigant used. The highest bond strength was seen in specimens irrigated with EDTA and obturated with Adseal sealer and least in specimens irrigated with distilled water and obturated with MTA Fillapex sealer. Conclusion: Adseal sealer had significantly higher bond strength than the MTA Fillapex sealer. EDTA irrigation showed better smear layer removal, followed by Er:YAG laser irradiation, then NaOCl, least by distilled water.

Many people would prefer to keep their natural teeth and advances in dentistry have lead to treatment of teeth that once would have been removed. In order to carry out this present day mandate, hemisection is the procedure of cutting a tooth that has two roots in half. This will create a front half and a back half. This procedure can be done by a periodontist, an experienced dentist, an endodontist, or an oral surgeon. This article describes a simple procedure for hemisection in mandibular molar and its subsequent restoration.

Successful outcome of endodontic treatment depends on the identification of all root canals which in turn guarantee complete extirpation of pulp tissue, proper chemo-mechanical cleaning and shaping and three dimensional obturation of the root canal system with an inert filling material. However endodontic treatment can fail for many reasons, such as diagnostic errors, persistence of the infection in the root canal system, errors in debridement and shaping of the root canal systems, instrument fractures, poor restorations and extra roots or canals if not detected are the reasons for failure. Undetected extra roots or root canals have been considered as a major reason for failure of root canal treatment. Many of the challenges faced during root canal treatment may be directly attributed to an inadequate understanding of the canal morphology of teeth. A broad knowledge of both the external and internal anatomy of teeth is of great importance for adequate endodontic treatment. We present a case report of 2 roots in mandibular lateral incisor.

Introduction: Determination of the canal wall cleanliness and to detect the residual filling material after removal of old obturating material. Materials and Methods: Thirty single-rooted premolar teeth were instrumented with rotary universal Protaper to size F2 and filled with resilon. The removal of root canal fillings was done with manual Hedstrom files and rotary Protaper retreatment files (RPRs) with orange oil as a solvent. Two-dimensional images of the obturated and retreated roots were evaluated with AutoCAD for percentage of remaining filling material. This area was confirmed under the scanning electron microscope. The data were statistically analyzed by t-test to identify differences. Results: Statistically significant differences were obtained for remaining filling material between hand and rotary both the groups. It was found that the canals instrumented with RPRs had lesser percentage of remaining filling material as compared to the hand files. Residual filling material and debris was found mostly in the apical portion of the root canal, however middle and cervical portions were relatively clean. Conclusion: RPRs were efficient in removing resilon from root canals as compared to the hand files.

Aims: To evaluate and compare the effectiveness of periapical surgery using mineral trioxide aggregate (MTA) as a retrograde filling material with/without using hydroxyapatite or platelet-rich fibrin (PRF) in curetted periapical defect and to evaluate the patients clinically and radiographically at each recall visit. Subjects and Methods: The study was conducted on thirty patients having periapical radiolucency in maxillary anterior teeth. The selected teeth were divided into three groups: Group A, Group B, and Group C having 10 teeth each. All the teeth were treated with single visit root canal treatment. The periapical curettage along with apicoectomy was followed thereafter. In all the groups, root end cavity was prepared. In Group A, root end cavity was filled with MTA. In Group B, root end cavity was filled with MTA followed by placement of hydroxyapatite in the curetted periapical defect. In Group C, root end cavity was filled with MTA followed by placement of PRF in the curetted periapical defect. In all the three groups, patient recall visits were scheduled after 1, 3, 6, and 9 months time interval for clinical and radiological examination. Results: A significantly higher rate of healing was observed after 9 months in Group C (82.36%) followed by Group B (65.16%) and Group A (60.12%). Conclusions: Placement of root end filling material contributes greatly to the success of surgical treatment. To enhance the healing of periapical defect, use of host modulating agents such as PRF is preferred over grafts as these are autologous and contain growth factors that promote faster healing of periapical defects.

Aim: To compare dentinal damage caused by hand and rotary nickel-titanium instruments using ProTaper, K3 Endo, and Easy RaCe systems after root canal preparation. Materials and Methods: One hundred and fifty freshly extracted mandibular premolars were randomly divided into five experimental groups of 30 teeth each and biomechanical preparation was done: Group 1 with unprepared teeth; Group 2 were prepared with hand files; Group 3 with ProTaper rotary instruments; Group 4 with K3 rotary; Group 5 with Easy RaCe rotary instruments. Then, roots were cut horizontally at 3, 6, and 9 mm from apex and were viewed under stereomicroscope. The presence of dentinal defects was noted. Statistical analysis: Groups were analyzed with the Chi-square test. Results: Significant difference was seen between groups. No defects were found in unprepared roots and those prepared with hand files. ProTaper, K3 rotary, and Easy RaCe preparations resulted in dentinal defects in 23.3%, 10%, and 16.7% of teeth, respectively. More defects were shown in coronal and middle sections, and no defect was seen in apical third. Conclusion: The present study revealed that use of rotary instruments could result in an increased chance for dentinal defects as compared to hand instrumentation.

Aim/Objective: To evaluate the in vitro effect of bonded restorations on the fracture resistance of root canal-treated teeth. Materials and Methods: One hundred twenty extracted, maxillary, permanent premolars were collected. After preparing the access cavity, the teeth were biomechanically prepared and obturated. Samples were divided into six groups based on the type of restorative material used to restore them. Teeth were embedded in acrylic resin and their fracture strength was measured using a Universal Testing Machine. Data were evaluated statistically using one-way ANOVA-F and unpaired t-test. Results: Teeth restored with bonded amalgam and composite resin showed higher fracture resistance than those restored with conventional amalgam. Fracture strengths of bonded restorations and intact teeth were not statistically different. The results suggested that the group restored with conventional amalgam had the lowest fracture resistance. No statistically significant differences were found between the bonded amalgam and composite resin groups. Conclusion: Conventional amalgam core showed the least fracture resistance whereas; composite resin and bonded amalgam core showed fracture resistance was similar to that of natural tooth.