The treatment of choice for necrotic teeth with immature root is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide although recently considerable interest has been expressed in the use of mineral trioxide aggregate (MTA). MTA offers the option of a two-visit apexification procedure so that the fragile tooth can be restored immediately. However, difficulty in placing the material in the wide apical area requires the use of an apical matrix. Materials such as collagen, calcium sulfate, and hydroxyapatite have been used for this purpose. This article describes the use of resorbable suture material to form the apical matrix which offers many advantages over the contemporary materials.
Background: The root canal sealers form an important component of the three dimensional obturation of the root canals. Moreover, the penetration of the sealers into the dentinal tubules is a desirable phenomenon for their adequate sealing and antibacterial action. The aim of this study was to evaluate the effects of ultrasonic activation on the intratubular penetration of bioceramic root canal sealer. Methods: Eighty extracted human mandibular premolars were divided into 2 groups (n =40) according to the sealer activation method used to obturate the root canals instrumented with F3 Pro-Taper instruments .The canals were obturated using Protaper F3 guttapercha cones. Previously, the bio ceramic sealer was labeled with rhodamine B dye to allow analysis under a confocal microscope. The two groups were: UA (ultrasonically activated) and NA (no activation; control). All samples were sectioned at 3 and 8 mm from the apex. The percentages of dentinal sealer penetration segments of canal were analyzed. Results: Students T test was performed for the statistical analysis and we found that there was a significant increase in tubular penetration for the ultrasonic activation group.Conclusion: Use of ultrasonic activation of a bioceramic sealer promoted greater dentinal sealer penetration.
BACKGROUNDSmear layer formed by mechanical action of endodontic instruments is the potential source of microbial infection. Various chelating actions have been used for managing the smear layer but none of them showed promising results at the apical third of root canal. The purpose of this study was to evaluate the intracanal smear layer removal efficacy of 10% citric acid, 7% maleic acid and 17% EDTA at the apical third area of single rooted teeth when irrigated with apical negative pressure system. METHODSEighty single-rooted human premolars with straight canals and fully formed apex were selected. Samples were randomly divided into two groups-groups I and II of 40 patients each, depending on the method of irrigation. Root canals were then prepared with Pro Taper rotary files up to size F4. The samples were irrigated with 5% NaOCl solution during the preparation of root canals with a 30-gauge side vented, closed end needle and EndoVac in group I and II respectively. The samples were again divided into four different subgroups (n=10 each) in each group depending upon the chelating agent (distilled water, 17% EDTA, 10% critic acid, 7% maleic acid) used for smear layer removal in the final irrigation procedure. The apical third of the root canal was examined using scanning electron microscope at 1000X magnification as it was the area of concern in the present study. Analysis of variance (ANOVA) and Least Significant Difference (LSD) tests were employed for intra-group analysis of data. For inter group analysis, Student's independent t-test was used. A p-value of less than 0.05 was considered statistically significant. RESULTS10% citric acid and 7% maleic acid were able to remove the smear layer at the apical third, when irrigated with EndoVac, significantly better than all the groups tested. EndoVac did remove the smear layer significantly better than traditional needle irrigation but was not able to remove it completely at the apical third. CONCLUSIONSUse of EndoVac along with chelating agents, benefits smear layer removal from root canals.
ARTICLE INFO ABSTRACTEndo-perio lesions are common but difficult to diagnose problems. Although most cases resolve following endodontic management, extensive tissue loss calls for the surgical intervention. Currently more and more research is focused on regeneration of dental tissues. Recent advances in regenerative procedures like platelet rich fibrin have made the results of the procedure more predictable. In our case, a 45 year old male patient with endo-perio lesion in right maxillary first molar was treated with platelet rich fibrin and demineralized freeze dried bone graft after conventional endodontic therapy. At the end of 6 months, there was significant radiographic and clinical healing. The novel technique described in the case report will help the clinicians in managing an endo-perio case through regenerative procedures in an efficient way.
Background: A sealer is required during obturation to fill space between gutta-percha and canal walls. It provides an impervious seal, fills the irregularities and minor discrepancies between the root canal wall and core filling material, and assists in microbial control. Aim: To evaluate the penetration depth and percentage area of a root canal sealer placed by five different techniques using confocal laser scanning microscope (CLSM). In our study we compared ultrasonic, endoactivator (sonic device), lentulospiral (rotary) and master gutta-percha with NiTi spreader in reciprocating hand piece for sealer placement using AH Plus sealer. Methods: Thirty extracted then decoronated and standardised mandibular premolars were prepared by Protaper rotary files up to master apical file F3. Samples were randomly divided into five groups for sealer placement; Group 1, Ultrasonic file; Group 2, Endoactivator; Group 3, Reciprocating hand piece with NiTi spreader; Group 4, Rotary Lentulospiral; Group 5, Master apical gutta-percha .Two root sections from apical and coronal third were analysed for sealer distribution and depth of sealer penetration by confocal microscope, using the ruler tool of the IOB software (Olympus). Results: Results showed that maximum depth and percentage of sealer penetration is shown by Group 1; ultrasonic file and least by Group 5; master apical gutta-percha both at apical as well as coronal levels. Conclusion: Sealer penetration is influenced by placement method and new method of using reciprocating NiTi spreader was comparable to ultrasonic method which showed best sealer penetration and distribution.
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