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To assess the effect of additional apical enlargement using nickel titanium (NiTi) instruments on the incidence of microcracks using micro-computed tomographic analysis. Fifty-one premolars with single canals were enlarged to ProTaper Gold (PTG) F2 (25/08) (Dentsply Sirona), ProFile Vortex Blue (VB) 25/06 (Dentsply Tulsa), or WaveOne Gold (WOG) primary (25/07) (Dentsply Sirona) NiTi rotary instruments (n = 17 each). Afterward, additional apical enlargement was performed in each group with its corresponding larger instrument (F3 (30/09), VB 30/06, or WOG Medium (35/06) instruments, respectively). All teeth were imaged with micro-computed tomography before canal enlargement and after initial and additional apical enlargements to detect new microcracks at the apical 5 mm. An Aligned Rank Transform ANOVA was conducted to examine the effects of file type and canal enlargement on the number of new microcracks resulting from enlargement. A Kruskal-Wallis test was run to compare the file types at each canal enlargement stage. A significant main effect (P = 0.026) of canal enlargement on the number of new microcracks was found; the number of apical microcracks found after additional enlargement was significantly greater than baseline (P = 0.021); no significant difference was found between baseline and initial enlargement (P = 0.506) and between initial enlargement and additional enlargement (P = 0.252). The Kruskal-Wallis tests found no difference between file types at baseline (P = 0.348), after initial enlargement (P = 0.369) or additional enlargement (P = 0.133). Regardless of the instrumentation system used, additional apical enlargement led to the formation of high number of new microcracks. The results indicated that additional enlargement induced significant number of apical microcracks.

Purpose: To determine the Maximum voluntary bite force among patients having different personality traits. Methods: In total, 323 patients were given the big-five inventory (BFI) questionnaire to fill and allotted to the various personality traits. The patients in the Agreeableness (n = 62) and Neuroticism traits (n = 62) were included in the study. They were categorized into groups as Group 1a – Neuroticism male (41 patients) and Group 1b – Neuroticism Female (21 patients) and Group 2a – Agreeableness male (26 patients) and Group 2b – Agreeableness female (36 patients). Highest value of the maximal voluntary bite force (MVBF) was recorded using FlexiForce sensor (B 201) (Tekscan, USA). The statistical data were analyzed by independent t-test (P < 0.05). Results: The mean bite force values for Neuroticism male was 778.66 N, Agreeableness male was 699 N, Neuroticism female was 686.24 N, and for Agreeableness female was 565.47 N. Statistically significant differences in the bite forces between the male and female groups of both the groups with the males showing significantly higher bite force values in both groups was seen. Also, the bite force in Neuroticism male was significantly higher than Agreeableness male and bite force in Neuroticism female was higher than Agreeableness female. Conclusion: In this study, the highest bite force was seen in Neuroticism males. Additionally, this study infers that personality has significant influence on the quantum of bite force. Thus, personality assessment of the patient can assist the clinician in planning the appropriate treatment.

Anupama Ramachandran,1 Sulthan Ibrahim Raja Khan,2 Manal Al-maslamani,3 Jagan Kumar Baskaradoss4 1Department of Conservative Dentistry & Endodontics, Chettinad Dental College & Research Institute, Tamil Nadu, India; 2Restorative & Endodontics, Department of Restorative & Prosthetic Dental Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 3Department of Restorative Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait; 4Department of Developmental and Preventive Sciences, Faculty of Dentistry, Kuwait University, Safat, KuwaitCorrespondence: Jagan Kumar BaskaradossDepartment of Developmental and Preventive Sciences, Faculty of Dentistry, Kuwait University, P.O. Box: 24923, Safat, 13110, KuwaitTel +965 2463-6807Fax +965 25326049Email drjaganb@gmail.comBackground: The etiology, presentation and management of traumatic dental injuries (TDIs) vary significantly between the adult and the younger population. Most epidemiological studies on TDIs have focused on the pediatric age group. This study aims to report and compare the distributions of TDIs among adults in a sub-population in India.Methods: This prospective observational study was performed on 1562 consecutively selected patients (1218 males and 344 females) from a university dental hospital in India, between July 2014 and June 2018. The clinical examinations were performed by a single trained and calibrated endodontist. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the World Health Organization’s (WHO’s) classification. Periapical and panoramic radiographs were taken for all the subjects.Results: A total of 1562 patients aged between 20 and 73 years, with a mean age of 36 years, were examined during the study period. The total number of teeth with TDIs was 3044. Males (78%) clearly outnumbered the females (22%) in all the age groups. The most common type of injury occurring in both the genders is uncomplicated crown fractures (male=31.0% and female=36.6%). Avulsion injuries are more likely to be seen by a dentist within 1 hour post-trauma. About two-third of the TDIs were caused by road traffic accidents (RTAs) followed by falls in about 20% of the patients.Conclusion: Uncomplicated crown fracture was the most commonly observed type of TDI, and RTAs were the primary cause of TDI.Keywords: adults, dental injuries, trauma

Occlusion and chewing-side preference (CSP) are complex aspects of the stomatognathic system. The present study aimed to record the difference in bite force between the dominant and nondominant chewing sides of patients with a CSP. A sample of 95 subjects (aged 20-35 years) with established CSPs was selected. Measurements of bite force on both sides of the jaw were recorded while the subjects were seated in an upright, forward-looking, unsupported natural position. The recordings of each subject were accomplished in a single session with a portable customized bite recording sensor, and the maximal voluntary bite force (MVBF) value was recorded in newtons. The MVBF data were compared in pairs (dominant vs nondominant side; men vs women; and age30 vs ≥ 30 years) with independent-samples t tests. The combined mean (SD) MVBF for men and women was 694.73 (110.47) N on the dominant chewing side and 507.20 (86.76) N on the nondominant chewing side. In the male group, the mean MVBF was significantly greater (P0.0001) on the dominant chewing side (755.73 N) than on the nondominant chewing side (548.10 N). Similarly, in the female group, the mean MVBF was significantly greater (P0.0001) on the dominant chewing side (620.95 N) than on the nondominant chewing side (457.74 N). Furthermore, the differences between the male and female dominant sides and between the male and female nondominant sides were statistically significant (P0.0001). However, there was no statistically significant difference in bite force between the age groups (P0.05).

The regenerative endodontic procedure (REP) is considered a viable treatment option for immature teeth with necrotic pulp and periapical radiolucency which can facilitate continued root formation. In this report, an immature necrotic mandibular molar received REP in three appointments wherein chemomechanical debridement was performed with a sequential application of nonsetting calcium hydroxide (in the whole canal) and triple antibiotics paste (in the root’s middle third) dressings in the first and second appointments, respectively. In the third appointment, blood clots were created in the root canals. MTA was placed over the blood clots and the tooth was restored with a composite filling and stainless-steel crown. Recall appointments were performed for two years where the tooth was deemed asymptomatic clinically and a complete root formation with significant periapical healing was evident radiographically. More cases are required to warrant the feasibility of this disinfection protocol.

Aim: Gastroesophageal reflux disease (GERD) is a very common condition whose consequences of are localized not only in the esophagus; extra-esophageal involvement has frequently been reported. The aim of the study is to examine the incidence and pattern of dental erosion in GERD patients. Methodology: A total of 50 patients were recruited in this study (control -25 and GERD -25). All participants diagnosed having GERD by the endoscopic examination by their gastroenterologist are included. The patients were examined for dental erosion and will be quantified using Basic erosive wear examination index. Results: The results showed that the incidence of dental erosion was 88% as compared to 32% in the control group which was found to be statistically significant.

Background The etiology, presentation and management of traumatic dental injuries (TDI’s) varies significantly between the adult and the younger population. Most epidemiological studies on TDI’s have focused on the pediatric age group. This study aims to report and compare the distributions of TDI’s among adults in a sub-population in India. Methods This prospective observational study was performed on 1562 consecutively selected patients (1218 Males and 344 females) from a University dental hospital in India, between July 2014 to June 2018. The clinical examinations were performed by a single trained and calibrated Endodontist. Only TDI’s to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the WHO’s classification. Intraoral periapical and panoramic radiographs were also taken for all the subjects. Result A total of 1562 patients aged between 20 and 73 years, with a mean age of 36 years were examined during the study period. The total number of teeth with TDI’s were 3044. Males (78%) clearly outnumbered the females (22%) in all the age groups. The most common type of injury occurring in both the genders is uncomplicated crown fracture. Avulsion injuries are more likely to be seen by a dentist within 1hour post-trauma. About two third of the TDI’s were caused by road traffic accidents (RTA) followed by falls in about 20% of the patients. Conclusion Uncomplicated crown fracture was the most commonly observed type of TDI and RTA’s were the primary cause of TDI.

Aim: This study aimed to compare the clinical performance of nanoceramic and microhybrid-based composite restorations in adult patients with different personality traits. Materials and Methods: Patients in accordance with the inclusion and exclusion criteria were asked to complete the BFI (Big Five Inventory) questionnaire. Of a total of 323 patients, 124 (67 males and 57 females) patients were categorized into agreeableness and neuroticism traits and were included in the study. The patients were randomly divided into two subgroups: SG I A (n = 31) and II A (n = 31) for microhybrid composite (Spectrum TPH 3, Dentsply/DeTrey, Konstanz, Germany), SG I B (n = 31) and II B (n = 32) for nanoceramic composite restorations (Ceram X mono, Dentsply/DeTrey, Germany). At baseline, 6 and 12 months, the restorations were evaluated using the Modified USPHS (United States Public Health Service) evaluation criteria. The Pearson chi-square and the Fisher’s exact test were used to assess the difference between the personality traits and restorative material groups where a probability value of P < 0.05 was considered to be statistically significant. Result: Most of the restorations scored alfa (A), whereas very few scored bravo (B) in all the subgroups. However, there were no charlie (C) or delta (D) scores. Overall, Spectrum TPH and Ceram x mono displayed superior performances in retention and postoperative sensitivity than all the other clinical parameters. Furthermore, Ceram x mono restorations showed more surface roughness than Spectrum TPH. No statistical differences in the restoration performance were found between both personalities and restorative material types. Conclusion: Although neuroticism has an effect on various health outcomes, its impact on the clinical performance of composite restorations during the follow-up period was not observed. In addition, there was no difference between the performance of nanohybrid and microhybrid composite.

This study aims to compare the ex vivo fracture resistance of root canal treated (RCT) teeth restored with four different types of fibers under composite resin.One hundred and forty extracted mandibular first molar teeth were assigned to seven groups (n = 20/group). Group 1 was the control group. In groups 2-7, endodontic access and standard Mesio-occluso-distal (MOD) cavities were prepared. Following RCT, group 2 was left unrestored. In group 3, flowable composite resin (FCR) was used to line the cavities and restored with composite resin. In groups 4,5,6 and 7, Ribbond, Everstick, Dentapreg and Bioctris fibers were inserted in flowable resin and restored respectively.All the groups restored with fiber reinforced composite displayed higher fracture resistance than the group restored with only composite resin (p 0.001). In addition, Groups restored with Everstick and Bioctris (Groups 5 and 7) showed higher fracture resistance when compared to Ribbond and Dentapreg (Groups 4 and 6).E glass fibers demonstrated highest fracture resistance and hence can be preferred over other fiber types to reinforce RCT teeth with weakened crown structures.

Medical imaging technologies involve from X-rays to more advanced imaging modalities like computerized tomography (CT) and magnetic resonance imaging (MRI). These new technologies are able to provide detailed three-dimensional (3D) pictures of areas of interest and therefore valuable data for diagnosis and therapeutic management. The construction of a physical model using this data provides numerous advantages like better visualization of complex anatomic areas, pretreatment surgical practice and enhanced communication and patient education. The following paper describes a case report of a large periapical lesion involving upper anterior teeth requiring periapical surgery. The use of rapid prototyping technology aided in the accurate diagnosis and the precise measurements of the size and location of the lesion and its subsequent management.How to cite this articleRamachandran A, Khan SIR. Diagnosis and Treatment Planning using Rapid Prototyping Technology in Surgical Endodontics. J Contemp Dent 2013;3(3):147-150.

The dynamic concept of the root canal system, which describes a variable morphology of the multiple root canals which are inter-connected by anastomoses, has been established as the prevailing state in the mandibular molars. The aim of this case report was to describe the unusual root canal anatomy that was detected in the mandibular first molar during the routine endodontic treatment. The clinical and the radiographic examinations allowed the detection of the middle mesial root canal between the mesiobuccal and the mesiolingual root canals. This report highlights the importance of such examinations and the need to find and treat the additional canals, to achieve a successful endodontic treatment.

Aim: To determine the effect of preoperative administration of paracetamol (PARA), ibuprofen (IBUP), or aceclofenac (ACEC) on the success of maxillary infiltration anesthesia in patients with irreversible pulpitis in a double-blinded randomized controlled trial. Materials and Methods: One hundred and twenty patients with irreversible pulpitis of a maxillary first molar participated. Patients indicated their pain scores on a Heft Parker visual analog scale, after which they were randomly divided into four groups (n = 30). The subjects received identical capsules containing 1000 mg PARA, 800 mg IBUP, 100 mg ACEC or cellulose powder (placebo, PLAC), 1 h before administration of maxillary infiltration anesthesia with 2% lidocaine containing 1:200,000 epinephrine. Access cavities were then prepared and success of anesthesia was defined as the absence of pain during access preparation and root canal instrumentation. The data were analyzed using chi-squared tests. Results: The success rates in descending order were 93.3% (IBUP), 90% (ACEC), 73.3% (PARA), and 26.5 % (PLAC). A significant (P < 0.001) difference was found between the drug groups and the PLAC group. Conclusions: Pre-operative administration of PARA, IBUP, and ACEC significantly improved the efficacy of maxillary infiltration anesthesia in patients with irreversible pulpitis.