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Teeth with calcification provide an endodontic treatment challenge; traumatized teeth usually develop partial or total pulpal obliteration which is characterized by apparent loss of the pulp space radiographically and a yellow discoloration of the clinical crown. Since only 7-27% of such teeth develop pulp necrosis with radiographic signs of apical periodontitis, it is difficult to decide whether to treat these teeth immediately upon detection of the pulpal obliteration or to wait until signs and symptoms of pulp and/or apical periodontitis occur. This article reviews the etiology, prevalence, classification, mechanism, diagnosis as well as treatment options for teeth with pulp obliteration and the various management approaches and treatment strategies for overcoming potential complications. A search of articles from "PubMed" and "Medline" from 1965 to present was done with the keywords dental trauma, discoloration, pathfinding instruments, pulp canal obliteration, and root canal treatment was conducted. A total of 94 abstracts were collected, of which 70 relevant articles were read and 31 most relevant articles were included in this article.

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With the increasing number of reports of aberrant root canal morphology, the clinician needs to be aware of the variable anatomy. Various case reports have been published with the finding of middle mesial canal in mandibular first molar, however finding of three distal canals in distal roots of mandibular first molar is rare. This article reports endodontic management of two mandibular first molars presented with three distal canals present in a single distal root (Sert and Bayirli type XVIII) and distal and distolingual root.

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Aim: To evaluate the effect of duration of application of 17% ethylene diamine tetraacetic acid (EDTA) and SmearClear on the removal of intracanal smear layer by SEM. Materials and Methods: Seventy-two extracted maxillary incisors were root canal instrumented and randomly distributed into three groups of 24 teeth each according to different final irrigation regimens, Group A-17% EDTA + 1% sodium hypochlorite (NaOCl), Group B-SmearClear + 1% NaOCl, Group C (Control group)-Distilled water + 1% NaOCl. Further each group was subdivided into 3 subgroups according to the duration of application of the irrigating solutions for 1, 3 and 5 minutes. Following de-coronation and splitting of roots, one-half of each root was examined under scanning electron microscope (SEM) at 1000Χ magnification for smear layer at 6 mm and 2 mm levels. Data were subjected to statistical analysis using Kruskal-Wallis and Mann-Whitney U test (P < 0.05) Results: At 6 mm level, the mean smear scores were similar with both 17% EDTA solution and Smear Clear, however, at 2 mm level, they were significantly lower with Smear Clear (P < 0.05). The smear scores decreased as the duration of application of either 17% EDTA or Smear Clear increased from 1 to 5 minutes. Conclusion: Final irrigation with either 17% EDTA solution or Smear Clear followed by 1% NaOCl was effective in removing the smear layer for all three durations of applications. But, in the apical third, Smear Clear was more effective when compared with 17% EDTA solution.

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Aim : The aim of the study was to evaluate and compare the efficacy of commercially available three bleaching agents when used internally or by internal-external method in non-vital teeth. Materials and Methods: Seventy extracted single-rooted premolars were artificially stained with whole blood in centrifugal machine. Teeth were divided into six experimental groups (Group I-VI) and one control group (Group VII). Bleaching was carried out in all the experimental groups using either of three commercially available bleaching agents: In Group I and group IV, 35% carbamide peroxide was used. In group II and V, 21% carbamide peroxide was used. Teeth in Group III and VI were bleached using 35% hydrogen peroxide (H ₂ O ₂ ). In the first three experimental groups (Group I, II, III), internal bleaching was done and in other three groups (Group IV, V, VI), both internal and external application was done. The evaluation was done at 0, 7, and 14 days using VITA shade guide. Statistical Analysis: The results obtained were statistically analyzed using ANOVA, Paired t-test, and ANOVA with post hoc Tukey's modification to evaluate the significant change and efficacy of the groups tested. Results: All bleaching agents showed effective shade reduction. The effects of 35% H ₂ O ₂ and 35% carbamide peroxide were statistically similar. The least reduction was seen with 21% carbamide peroxide groups. There was no difference between internal bleaching and internal-external methods. Conclusions: Within the limitation of the study, it could be concluded that 35% carbamide peroxide is an effective intracoronal bleaching agent similar to that of 35% H ₂ O ₂ .

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The purpose of this ex vivo study was to evaluate the efficacy of three different irrigation techniques, ProRinse® syringe needle, ProUltra^® PiezoFlow ^TM , and EndoActivator®, in cleaning the canals and isthmuses of human mandibular molars using a software program ImageJ. Materials and Methods : A custom-made metal cube was used to create a sealed canal system. Eighty extracted mandibular molars were randomly divided into four equal groups. Teeth were mounted; sectioned at 2, 4, and 6 mm; and reassembled into the metal cube. Chemo-mechanical preparation was done for all teeth. The teeth were divided into four groups for final debridement: Group 1 (control group) received only needle irrigation, group 2 used the ProRinse® syringe needle with 5% NaOCl irrigation within a 1-mm working length, group 3 used ProUltra^® PiezoFlow ^TM ultrasonic agitation for 30 seconds, and group 4 used the EndoActivator® system to agitate for 30 seconds. All groups received a final irrigation with 5% NaOCl in each canal. Specimens were evaluated by digital image capture with a stereomicroscope. Statistical analysis was completed using an ANOVA test and Tukey's test. Results: The results showed no statistically significant difference in canal or isthmus cleanliness between the four groups. However, there was a statistically significant difference (P < 0.05) in isthmus cleanliness in group 4 at the 4-mm level. Conclusions: EndoActivator® produced a good result in isthmus cleaning at the 4-mm level.

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A thorough understanding of internal and external anatomy of various teeth is critical for a successful outcome of endodontic therapy. The aims of this paper were (1) to describe the clinical retreatment of a maxillary second molar with two palatal roots and (2) to review the available literature regarding this anatomical variation. A 45-year-old Saudi female presented for non-surgical retreatment of maxillary left second molar. Careful radiographic and clinical examinations revealed the presence of two buccal and two palatal roots each with a single root canal. Anatomical variations can occur in any tooth; therefore, the clinicians should always anticipate the occurrence of these variations and utilize all the available tools to diagnose and manage them

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Aim: To evaluate the microleakage of a simplified etch-and-rinse adhesive bonded to pulp chamber dentin with water-wet bonding (WWB) or ethanol-wet bonding (EWB) with and without proanthocyanidins (PA) application. Materials and Methods: Total 88 non-carious extracted human molar teeth were sectioned horizontally to expose the pulp chambers 1.5 mm coronal to the cemento-enamel junction. After the pulp tissue extirpation, canal orifices were enlarged and the root ends were sealed. The samples were randomly divided equally into following four groups according to the four bonding techniques performed using Adper Single Bond 2 [SB] adhesive (1) WWB; (2) EWB; (3) WWB and PA application [WWB + PA]; (4) EWB and PA application [EWB + PA]. Composite resin restorations were performed in all the pulp chambers. Total 20 samples from each group were subjected to microleakage evaluation, and two samples per group were assessed under scanning electron microscope for interfacial micromorphology. Results: The least microleakage score was observed in group 2 (EWB) with similar results seen in group 4 (EWB + PA) (P = 0.918). Group 2 (EWB) showed significantly less microleakage than group 1 (WWB; P = 0.002) and group 3 (WWB + PA; P = 0.009). Group 4 (EWB + PA) also depicted significantly reduced microleakage as compared with group 1 (WWB; P = 0.001) and group 3 (WWB + PA; P = 0.003). Conclusion: The use of EWB technique in a clinically relevant simplified dehydration protocol significantly reduced microleakage in simplified etch-and-rinse adhesive, Adper Single Bond 2, bonded to pulp chamber dentin. Application of PA had no significant effect on the microleakage of the adhesive bonded with either WWB or EWB.

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Dens evaginatus is the developmental anomaly of tooth that exhibits protrusion of a tubercle from occlusal surfaces of premolar, and lingual surfaces of maxillary central incisor and lateral incisors. Dens evaginatus is common in Caucasian population. Saudi Arabia is also well evidenced of such cases. These tubercles have an enamel layer covering dentin core containing a thin extension of pulp. These cusp-like protrusions are susceptible to pulp exposure from wear or fracture because of malocclusion. Type II dens evaginatus involves normal pulp with immature root apex. Materials to enhance the pulpal recession or pulpotomy procedures indicated in such cases require long time and efforts to ensure pulpal recession or root maturity, respectively. Also prolonged treatment has risk of fracture of the cusp and reinfection and requires patient commitment for the follow-up procedures. Present case describes the use of mineral trioxide aggregate (MTA) in type II dens evaginatus of maxillary central incisor.

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This case report describes the endodontic management of bilateral mandibular canines with unusual root canal anatomy in a patient. The right mandibular canine had two separate roots (buccal and lingual), each root having a single canal. The left mandibular molar had two separate canals coronally joining into a single canal in the apical 3 ^rd (Vertucci Type II). While the presence of two roots and two canals in one root is not uncommon, finding a combination of these morphological variations in the same patient has not been reported previously. This emphasizes the perception of the clinician that a given tooth will contain a specific number of roots and/or root canals canal should be changed, and such variations should be kept in mind during the endodontic treatment of permanent mandibular canines.

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