The aim of this work was to present a case report describing lower lip paresthesia following failed endodontic treatment and development of periapical lesion. A 42-year-old female presented difficulty in swallowing with pain in right mandibular second premolar and numbness in the right side of her lower lip. Radiographic examination revealed inadequate root canal and a large periapical lesion in the mental nerve area. The lesion appeared extending into the inferior alveolar canal causing irritation of inferior alveolar nerve and its mental branch. Following root canal retreatment, there was improvement of the clinical symptoms and gradual reduction in size of the lesion. A full resolution of symptoms was demonstrated 4 months after successful endodontic therapy. It was concluded that careful clinical and radiographic diagnosis followed by proper endodontic treatment proved to be successful in treating lower lip paresthesia occurred following failed root canal therapy.

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Studies on the anatomy of the root apex are an area of interest to the endodontist; they have reported that the position of the apical constriction, apical foramen and the cemento-dentinal junction varies across the tooth types. These anatomical apical landmarks are considered extension limits for root canal instrumentation and filling. Achieving an optimum working length is thought essential for successful root canal treatment, so adopting any of these landmarks is associated with certain risks and benefits. The variability in the position of the apical constriction and apical foramen, for example, complicates their clinical detection, while the cemento-dentinal junction is a histological landmark that cannot be detected clinically. The radiographic apex does not always coincide with the anatomic apex of the tooth. The pre-operative status of the pulp must be considered while obtaining the working length. Most prognostic studies agree that extending the root filling to within 2-3 mm of the radiographic apex is associated with favorable treatment outcomes.

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Mental nerve paraesthesia can occur as a result of a variety of reasons. Paraesthesia following endodontic treatment is an uncommon treatment complication. Causes of paraesthesia in the mental nerve region are reviewed and two cases involving endodontic treatment are discussed. In the first instance, a patient presented with difficulty in swallowing and severe pain localized to her right mandible, with numbness of her lower lip. Paraesthesia resolved quickly with endodontic treatment. In the second instance, a patient referred for treatment a mandibular second premolar developed profound paraesthesia in the distribution of the mental nerve after treatment. The local anesthetic used was 4% articaine by infiltration. CBCT imaging revealed two accessory mental foramen and slight extrusion of sealant into one of the neurovascular exits. Possible causes of paraesthesia are discussed in the light of the literature review. CBCT imaging may be useful in the diagnosis and management of these conditions.

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A radicular cyst arises from epithelial remnants stimulated to proliferate by an inflammatory process originating from pulpal necrosis of a non-vital tooth. Radiographically, the classical description of the lesion is a round or oval, well-circumscribed radiolucent image involving the apex of the tooth. A radicular cyst is usually sterile unless it is secondarily infected. This paper presents a case report of conservative non-surgical management of a radicular cyst associated with permanent maxillary right central incisor, right lateral incisor and right canine in a 24-year-old female patient. Root canal treatment was done together with cystic aspiration of the lesion. The lesion was periodically followed up and significant bone formation was seen at the periapical region of affected teeth and at the palate at about 9 months. Thus, nonsurgical healing of a large radicular cyst with palatal swelling provided favorable clinical and radiographic response.

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Iatrogenic root perforations, which may have serious implications, occur in approximately 2-12% of endodontically treated teeth. Successful management of root perforations is dependent on early diagnosis of the defect, location of the perforation, choice of treatment, materials used, host response, and the experience of the practitioner. This report presents the successful management of an iatrogenic perforation in a tooth with radiographic evidence of pulp canal obliteration.

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Root amputation is an option available to extend the function of a molar tooth when there is a persistent endodontic failure. This case report of a 52-year-old male provides an overview of the feasibility of mesiobuccal root amputation and bone grafting with calcium sulfate of maxillary right first molar after failed non-surgical and surgical endodontics due to root fracture. A 2 year follow-up showed successful clinical and radiographic results. In specific situations, root amputation is a viable treatment to retain a functional portion of the tooth.

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The main objective of performing root canal therapy is to eliminate bacteria from the infected root canal system or remove inflamed pulp tissue and close it with a biologically acceptable filling material. If this treatment managed well, regardless of the number of visits, it will create a favorable environment for healing. The recent advances in Endodontic technology, attracts the dental practitioners as well as the Endodontist to perform the root canal treatment in one visit. The question that we consider in this review article focuses on the long term prognosis of one-and multiple appointment endodontic therapy for teeth with vital pulp, necrotic pulp, and apical periodontitis .

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Objectives: The aim of the present research was to identify pulpitis through periapical radiography by applying edges as basis image features, the texture description and the artificial neural networks (ANNs). Materials and Methods: Input image data records of 10 molar and 10 canine teeth were used. The clinical diagnosis of interest cases were represented as normal pulp, reversible and irreversible pulpitis, and necrotic pulp. The following image processing steps were done. First, the data records were converted digitally and preprocessed as its original image using the Gaussian Filter to obtain the best smoothed intensity distribution. Second, the local image differentiation was used to produce edge detector operators, e(x,y) as the image gradient; ∇f(x,y) providing useful information about the local intensity variations. Third, these results were analyzed by using the texture descriptors to obtain digitally the image entropy, H. The fourth step, all were characterized by the ANNs. Results: The edge detection carried important information about the object boundaries of pulpal health and pain conditions in the dental pulp significantly. The image entropy which was identified, the diagnostic term, was obtained from texture descriptors in the segmentation regions where the curves of pulp states tent convergence with the normal pulp line from 4.9014 to 4.6843 decreasing to the reversible and the irreversible pulpitis line include the nectrotic pulp line from 4.6812 to 4.5926 and then inputting to the ANNs analysis at the same of mean square error around 0.0003. Conclusions: Referred to these results, the correlation of the image entropy and the ANNs analysis could be linearly classified with the critical point of 4.6827. Finally, it could be concluded that the direct reading radiography is better to be digitized in order to provide us the best choice for diagnosis validation.

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Radix entomolaris (RE) is considered to be an Asiatic trait. However, its prevalence in Indian population is found to be lower than in other Asian races. Nevertheless, its awareness and identification is vital to achieve endodontic success. This article presents a review on clinical approach and a case series on the detection and endodontic management of RE in mandibular first molars. Radix entomolaris was detected by identifying the presence of a double or extra root outline in the preoperative radiograph, modifying the access opening and closely inspecting the pulp chamber and was endodontically treated following cleaning, shaping, and obturation of the canals. Achieving the endodontic success in the presence of an RE requires knowledge about its prevalence, diagnosis, morphology, canal configuration, and clinical approach.

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During mechanical preparation, the use of hand or rotary instruments results in the production of considerable amount of smear layer. The smear layer consists of two parts: a superficial layer that covers the dentinal wall and a smear plug which occludes that dentinal tubules. Researchers had reached to different conclusions on the importance of removing or maintaining this layer. Removing the smear layer allows for more cleaning and disinfecting root canal walls and better adaptation of root canal filling materials. However, the presence of smear layer can act as a seal to the dentinal tubules and minimize the ability of bacteria and its toxins from penetrating the dentinal tubules. The ability to remove smear layer depends primarily on chemomechanical preparation. There are three main methods to remove smear layer: chemically, mechanically (ultrasonically), laser, or combinations. No one single irrigant has the ability to kill microorganisms, dissolve organic tissues, and demineralize smear layer. Thus, alternating between organic and inorganic solvents and the use of different methods and techniques have been recommended. Indeed, there is little relevance attributed to the influence of smear layer on the clinical treatment outcomes. Moreover, there is critical lack of clinical studies to determine the role of smear layer since all previous studies were carried out on laboratory based. Further experimental model with a longitudinal observational characteristic should be applied.

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Avulsion of tooth is complete displacement of tooth out of its socket that results in mutilation of periodontal ligaments. The desirable treatment option is replantation of the tooth. However, unsuccessful replantation is a matter of great discontentment. Unsuccessful replantation is due to inappropriate management of the avulsed tooth. Protection of teeth from desiccation due to drying of the periodontal ligament tissue, by keeping it in storage media can improve the outcome of the treatment. This review paper focuses on the use of natural products as storage media for avulsed teeth. In vitro and in vivo research published during 1995-2014, allowing open access on National Center for Biotechnology Information (NCBI) database and articles on EBSCO host (EBSCO-Elton B. Stephens Company) were included. It was found that natural products such as milk, coconut water, propolis, green tea, red mulberry, Aloe vera, egg-white and pomegranate have shown ability to maintain viability of periodontal ligament cells of avulsed teeth. Few natural products such as coconut water and milk can be used in raw form, while other products such as green tea and red mulberry need processing. Ability to maintain periodontal cell viability for a longer time is warranted in cases of major accidents, where teeth can be replanted only after other major surgeries. Natural products have easy availability, greater efficacy and longer storage time as compared to Hank's balanced salt solution which has been recommended by the International Association of Dental Traumatology as standard solution for storage of avulsed teeth. Natural products have shown good qualities in in vitro experiments; further in vivo studies are needed to evaluate their efficacy as storage media.

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The use of radiographs for working length determination is usual practice in endodontics. Exposing radiographs following the principles of the paralleling technique allows more accurate length determination compared to the bisecting-angle method. However, it has been reported that up to 28.5% of cases can have the file tip extending beyond the confines of the root canals despite an acceptable radiographic appearance. The accuracy of radiographic working length determination could be affected by the location of the apical foramen, tooth type, canal curvature and superimposition of surrounding structures. Variations among observers by virtue of training and experience may also influence the accuracy of the procedure. The interpretation of radiographs could be affected by film speed and viewing conditions, with the superiority of digital imaging over conventional radiography for working length determination remaining debatable. The combination of several methods is recommended for acquiring the most accurate working length.

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Aims: The aim of this study was to investigate the degree of tug-back after canal preparation with respect to the Gutta-percha-occupied area (GPOA). Materials and Methods: Roots of twenty premolar teeth were prepared till size 35/0.04, then GP cones of same size and taper were adapted to root canals and the degree of tug-back sensation was scored as loose, slight, adequate, and strong. Root canals were filled with GP and AH26 sealer, and then sectioned horizontally 1 mm from the apical end at three levels. GPOA and its sum from the three levels sum of GPOA (sGPOA%) were calculated using digital stereomicroscope. Statistical Analysis: At each sectioned level, GPOA% was compared with the score of tug-back sensation using one-way ANOVA at a 5% significance level. Multiple pairwise comparisons were performed using Tukey test. Results: Tug-back sensation was present in all canals, described as slight, adequate, and strong in 4, 8, and 8 canals, respectively. Among the tug-back scores, quantitative analyses of GPOA% showed significant differences at 2- and 3-mm levels. The strong tug-back with sGPOA of 76.5 ± 11.1% was significantly higher than that of slight tug-back. Conclusions: Under the conditions of this study, the tug-back scoring system can be applied to determine the amount of GP adaptation inside the root canal. Strong tug-back sensation showed the highest GP adaptation although at least one-fifth of the apical canal region was left unfilled.

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Introduction: The aims of this study were to (1) investigate the root and root canal morphology of human third molars in a Jordanian subpopulation and (2) determine the effect of age, gender, and tooth location on the morphology of these teeth. Materials and Methods: A total of 159 maxillary and mandibular third molars were used in this study. After canal staining and tooth clearing, the specimens were examined, and the following morphological features were recorded: Number of roots and presence of roots fusion, number of canals and their configurations in each root, total number of canals per tooth, and incidence of lateral canals and intercanal communications. Results: The majority (74.2%) of maxillary molars had 3 roots and 3 (55.1%) or 4 (27%) canals while the majority (74.3%) of mandibular molars had 2 roots and 2 (38.6%) or 3 (45.7%) canals. Roots fusion was found in 70.1% of maxillary molars and 40.7% of mandibular molars. Type I canal configuration was the predominant type in distal roots of mandibular molars and distobuccal and palatal roots of maxillary molars. Multiple canals were evident in 36% of the maxillary mesiobuccal roots and 56% of mandibular mesial roots. Single/fused roots showed a wide range of canals number and configurations. The number of roots and canals in both molars did not differ with gender, age, and tooth location. Females had a higher incidence of roots fusion than males and this difference was significant in mandibular molars (P = 0.034). Conclusions: Third molars showed a range of root and canal morphologies. Careful preoperative assessment is essential before commencing root canal treatment on these teeth.

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The use of triple antibiotic paste (TAP) (mixture of ciprofloxacin, metronidazole and minocycline) as an intra-canal medicament have shown very encouraging results particularly in non-vital immature teeth associated with periradicular lesions. Hence, before opting for a surgical approach, a non-surgical approach can be thought of with extended use of TAP as intra-canal medicament, especially in patients who are phobic to invasive procedures. On the flip side, the use of TAP has few side-effects, of which one is the discoloration it can cause due to the presence of minocycline in the mix. The purpose of this article is to presents a case of coronal discoloration due to the use of TAP as an endodontic intra-canal medicament.

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Aspirin is one of the most effective oral analgesic agents available worldwide without prescription. Aspirin tablets can be directly placed on the painful tooth and adjunct mucosa to relieve pain and avoid dental visits. However, aspirin is acidic in nature and its protein coagulation effects can cause severe chemical burns to the surrounding mucosa when placed directly. Here, we describe a rare case of chemical burn caused by the direct placement of an aspirin tablet on a painful tooth. A 55-year-old healthy African female presented to the clinic with a history of pain in the right maxillary region. The patient stated that she had placed aspirin locally to relieve her toothache for a few days. On intraoral examination, a grayish-white fibrin-coated ulcer was observed on the buccal mucosa near the painful tooth, extending to the upper and lower buccal vestibules, up to the premolar area. The source of pain was resolved by root canal treatment of #17, and the patient was advised to discontinue the direct application of aspirin to oral tissues. Two weeks later, the lesion had healed entirely without scarring. This case highlights the differences in the degree of clinical presentation of the lesion and the importance of considering the injudicious use of aspirin as a potential cause of white lesions in the oral cavity.

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Traumatized anterior teeth with sub-gingival crown fractures are a challenge to treat. The management of sub-gingival fractures includes exposing the cervical margin followed by appropriate coronal restoration. The treatment modalities, which involve exposing the cervical margin, are surgical crown lengthening and orthodontic extrusion. This paper reports a case of fractured maxillary anterior tooth at the sub-gingival level that was managed by forced orthodontic extrusion after endodontic treatment followed by esthetic rehabilitation, a much forgotten technique not utilized routinely yet conservative and cost-effective.

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Biomechanical preparation of the entire root canal system is one of the most important procedures in endodontic treatment. Separation of instruments while preparing root canals presents a compromised situation in which a biologically inert segment is left behind with potential contamination that has the ability to affect the healing process. Management of this procedural error is tedious and requires creativity as well as clinical knowledge and skills. In this report, we demonstrated two cases with separated instrument in which a combined technique of ultrasonic method with microtube tube method was used to retrieve the separated tips using a modified Vista dental tip.

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The aim of this review was to evaluate studies assessing the accuracy of Root ZX when used for working length determination in permanent teeth and to identify factors affecting the device's precision. An electronic search for articles published in English language since 1994 was conducted on the Medline via Ovid interface. All issues of the International Endodontic Journal, Journal of Endodontics and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology since 1994 were manually searched. The reference lists of review articles were cross-referenced to identify any potential publications. A total of 76 publications fulfilled the inclusion criteria. The studies varied in their methodologies, and most of them did not adhere to the manufacturer's recommendations while operating the device. The Root ZX failed to consistently detect the apical constriction or the apical foramen. Nonetheless, it mostly allowed file tip placement in the area bounded by these two landmarks, especially when the 0.5 mark of its digital meter was adopted. Tooth-related factors potentially influencing the precision of Root ZX included pre-operative pulp status, tooth type, position of the apical foramen, canal obliteration, and the size of apical diameter. Operative factors including coronal pre-flaring, presence or absence of irrigants, file size, file alloy, and mode of file operation could also influence the performance of Root ZX. In conclusion, adopting the 0.5 mark of the digital meter of the Root ZX reduces chances of violating the apical foramen. Further, factors influencing the precision of Root ZX must be considered while operating it.

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This investigation presents a chart that can assist clinicians, in general and endodontists, in particular, in making the right decision when they are deciding, which rout to take; endodontic treatment to save the natural tooth or extraction and osseointegrated implant. Systematic review of the literature was used to investigate success rates of both endodontic therapy and extraction of the tooth and placement of an implant, with the intent of determining the superior treatment modality. The results demonstrated that both treatment modalities produced nearly similar success rates, with implants generally showing slightly higher success rates. It was concluded that endodontic treatment should first be given to save compromised natural tooth before pursuing extraction and implant. A protocol to assist clinicians in making the right decision to endodontically save or extract the offending tooth and replacement of implant is presented.

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Introduction: Endodontic infections are polymicrobial in nature. Enterococcus fecalis is the most common micro-organism isolated from failed endodontic cases. The constant increase in antibiotic resistant strains and side effects caused by synthetic drugs has prompted researchers to look for herbal alternatives since the gold standard for irrigation i.e., sodium hypochlorite (NaOCl) has many disadvantages. Objective: The present study was aimed to explore newer irrigation solutions, which would probably be as effective as NaOCl. Materials and Methods: Extracted human single rooted premolar teeth were biomechanically prepared, vertically sectioned, placed in tissue culture wells exposing the root canal surface to E. fecalis is grown on Mueller Hinton agar plates to form a biofilm for 6 weeks. At the end of 6 ^th week, all seven groups were treated with 3 ml of test solutions and control for 10 minutes and evaluated for E. fecalis growth and number of colony forming units. Results: Propolis, NaOCl and triphala showed no statistically significant difference, whereas all the other inter-group differences were statistically significant (Tukey's honest significant difference (HSD)) (P < 0.001). Conclusion: Propolis and triphala were found to be as efficacious as NaOCl. The use of herbal alternatives as root canal irrigation solutions might prove to be advantageous considering several unfavorable properties of NaOCl.

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Chronic kidney disease is associated with progressive deterioration of renal function resulting in reduced glomerular filtration rate. Multiple drugs used for its management invariably alter the common oral manifestations associated with the disease. The patients require special considerations for endodontic management because of increased tendency towards bleeding episodes, odontogenic infections and drug interactions. The present case report describes the comprehensive endodontic management in a patient of chronic renal disease taking plethora of medications.

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Aim: The purpose of this in vitro study is to provide clinical data on the presence of the second canal in mandibular incisor teeth of Saudi Arabian Samples. Materials and Methods: Eighty extracted human mandibular incisors were collected from Saudi patients. The teeth were accessed by small round bur then placed in 5.25% sodium hypochlorite for 24 hours to dissolve the organic debris. Indian ink was injected inside the root canal systems under negative pressure. The teeth were decalcified in 5% nitric acid for three days then dehydrated in different concentrations of ethyl alcohol. Following the decalcification process, the teeth were cleared in methyl salicylate and evaluated according to Vertucci's classification. Result: Fifty six of both mandibular central and lateral incisor teeth (70%) had type I canal configuration (one main canal and one main apical foramen), while the remaining 30% of the sample (24 teeth) had a type III canal configuration (two separate canals and merged into one canal before exiting the tooth through single apical foramen). Conclusion : The incidence of two canals in mandibular incisor teeth is about one third of the examined Saudi Arabian samples with no difference between the centrals and laterals. The clinician should deal with these teeth as if they have two canals unless it is proved otherwise.

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Objectives: This study was done to evaluate the flexural strength of carbon, quartz, and glass fiber posts by means of three-point bending test. Materials and Methods: Thirty pre-fabricated fiber posts were used and divided into three groups. Group I carbon fiber posts (C-Post), group II quartz fiber post (Aestheti Plus), group III glass fiber post (Para Post White) Ten posts (N = 10) were used for each experimental group and were measured with digital caliper before test accomplishment. The fracture load of post specimens was measured, and flexural strength was obtained by the formula using S = 8FL/pd ³ . The values in Kgf/mm ² were obtained and calculated to Mpa and submitted to ANOVA (a = 0.01) and to the Tukey's test. Results: The mean values of flexural strength show that group II quartz fiber posts (666 MPa) are significantly higher than group I carbon fiber (614 MPa) and group III glass fiber (575 MPa). C onclusion: Hence, this study concluded that quartz fiber post showed significantly higher flexural strength values. Further scope of this study lies in the evaluation and evolution of a restorative materials used for post and core preparation, which have modulus of elasticity in harmony with that of dentin and near-natural esthetic appearance.

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