Both activation techniques are important adjuncts in removing the smear layer, with manual dynamic activation being a simpler, safer, and more cost-effective technique.

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During root canal preparation procedures, the potential for instrument breakage is always present. When instrument breakage occurs, it leads to anxiety of the clinician and as well as a metallic obstruction of the canal which hinders further cleaning and shaping. Separated instruments must always be attempted for retrieval and if retrieval is not possible bypass should be tried. With the increased use of nickel-titanium (NiTi) instruments the incidence of separated instruments has increased. A considerable amount of research has been done to understand the various factors related to the fracture of NiTi instruments to minimize its occurrence. This paper presents a review of the literature regarding the fracture of NiTi instruments and also describes a case report showing the use of a modified 18-guage needle and cyanoacrylate glue to retrieve a separated NiTi instrument from the mesiolingual canal of a mandibular first molar. (Restor Dent Endod 2013;38(2):93-97)

A 22-year-old male patient reported to the Department of Conservative Dentistry and Endodontics with a chief complaint of pain in the upper left front teeth region associated with swelling for one month. He gave history of trauma around 10 y back and noticed discoloration of teeth with time but no history of treatment. Intraoral examination revealed there were no carious teeth. Intraoral periapical radiograph (IOPA) revealed large periapical radiolucency in relation to upper left central and lateral incisor. Root apex of tooth 21 revealed blunderbuss type apex. Electric pulp testing (EPT) was done to check the vitality of the tooth which confirmed that the teeth 21 and 22 were non vital and tender on percussion. Endodontic treatment was taken up first and then periapical surgery was planned for treatment of defect. Access opening done in teeth 21 and 22, root canals were prepared using step back technique till an apical size of # 70 and #60 in relation to teeth 21 and 22 respectively. 5.25% sodium hypochlorite solution (Novo Dental Product Pvt Ltd, Mumbai, India) was used as irrigation agent during biomechanical preparation. Calcium hydroxide was given as intracanal medicament and recalled after a month. PRF PREPARAtionBefore proceeding the cases ethical clearance was obtained from the university ethical committee for all the cases. Choukroun's protocol had been followed for the preparation of PRF. Just prior to surgery, 8 ml intravenous blood was drawn from the antecubital vein and was collected in a 10-ml sterile tube without anticoagulant. The tube was centrifuged immediately at 3,000 rotations per minute for 10 min. This allows the structured fibrin clot in the middle of the tube between the red blood cells at the down most and acellular plasma layer which lacks platelets at the top. A natural and progressive polymerization which occurs during centrifugation results the formation of PRF. PRF can be separated easily from red blood cells ABStRACtThe pulp tissue necrosis and extensive periodontal diseases leads to the development of the inflammatory periapical lesion which causes a local response of bone around the apex of the tooth. Depends upon the nature of wound and available biological growth factors the outcome will be either regeneration or repair. Being a rich source of growth factors, platelet rich fibrin (PRF) posses many advantages in bone regeneration. The purpose of this case report is to present an attempt to evaluate the healing potential of the combination of PRF and Hydroxyapatite bone graft as opposed to using these materials alone. A periapical endodontic surgery was performed on three patients with a large periapical inflammatory lesion and a large bony defect. The defect was then filled with a combination of PRF and Hydroxyapatite bone graft crystals. Clinical examination exhibited uneventful wound healing. The HA crystals have been replaced by new bone radiographically at the end of two years in Case 1 and Case 2, Case 3 were followed upto one year. On the basis of our cases outcome, we co...