Advancements in bio-ceramic technology has revolutionised endodontic material science by enhancing the treatment outcome for patients. This class of dental materials conciliates excellent biocompatibility with high osseoconductivity that render them ideal for endodontic care. Few recently introduced bio-ceramic materials have shown considerable clinical success over their early generations in terms of good handling characteristics. Calcium enriched mixture (CEM) cement, Endosequence sealer, and root repair materials, Biodentine and BioAggregate are the new classes of bio-ceramic materials. The aim of this literature review is to present investigations regarding properties and applications of CEM cement in endodontics. A review of the existing literature was performed by using electronic and hand searching methods for CEM cement from January 2006 to December 2013. CEM cement has a different chemical composition from that of mineral trioxide aggregate (MTA) but has similar clinical applications. It combines the biocompatibility of MTA with more efficient characteristics, such as significantly shorter setting time, good handling characteristics, no staining of tooth and effective seal against bacterial leakage.

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Objectives:The aim of this study was: (i) to formulate pit and fissure sealants (PFS) containing nano-hydroxyapatite (nHAP) filler; nHAP filler and silica co-filler; nHAP and nano-Amorphous Calcium Phosphate (nACP) co-filler, (ii) to evaluate physical properties; degree of conversion (DOC), curing depth (CD) and mechanical properties; microshear bond strength (MBS) of fortified PFS, and (iii) to assess remineralization potential and release of Ca2= and PO4 ions from newly synthesized sealants.Materials and Methods:Four PFS were prepared using monomers with mixture of 35.5 wt % BisGMA, 35.5 wt % triethylene glycol dimethacrylate and 28 wt % hydroxyethyl methacrylate. Bioactive nanofillers (nHAP and n-ACP) were added in various concentrations (0%–30%). Three commercial sealants were used as follows: unfilled (Clinpro; 3M ESPE), Fluoride releasing (Delton FS plus, Dentsply), ACP filled (Aegis, Bosworth). The samples (n = 35.5/gp) were tested for MBS, DOC, and CD. Remineralization potential was assessed by scanning electron microscopy (SEM). The concentrations of Ca2= and PO4 released from the sealant specimens were analyzed with Ultraviolet-visible Spectrophotometer. Data obtained was statistically analyzed (one-way analysis of variance, Tukey's test, P < 0.05).Results:10% hydroxyapatite (HAP) =20% ACP sealant showed significantly higher DOC. A remineralized region on the surface between fissure sealant and tooth enamel was observed by SEM in all three HAP filled bioactive sealants. Decreasing the solution pH significantly increased ion release from sealant filled with 10% nHAP = 20% nACP (P ≤ 0.001).Conclusion:Results suggested that admixture of nHAP and nACP to PFS showed remineralizing capability, without declining their mechanical and physical properties.

Purpose. The aim of this paper is to present cases of mandibular first molars with an additional distolingual root and their management using appropriate instruments and techniques. Basic Procedures and Main Findings. Mandibular molars can sometimes present a variation called radix entomolaris, wherein the tooth has an extra root attached to its lingual aspect. This additional root may complicate the endodontic management of the tooth if it is misdiagnosed or maltreated. This paper reviews the prevalence of such cases in Indian population and reports the management of 6 such teeth. Principal Conclusions. (1) It is crucial to be familiar with variations in tooth/canal anatomy and characteristic features since such knowledge can aid location and negotiation of canals, as well as their subsequent management. (2) Accurate diagnosis and careful application of clinical endodontic skill can favorably alter the prognosis of mandibular molars with this root morphology.

Aim:The objective of this survey was to study the level of awareness, current state of knowledge and opinions towards regenerative endodontic treatments amongst the endodontic residents of India.Settings and Design:Questionnaire based survey was designed.Materials and Methods:After approval from the organizing committee of 26th Federation of Operative Dentistry of India and 19th Indian Endodontic Society National conference 2011, 200 copies of the questionnaire were circulated amongst the endodontic residents in conservative dentistry and endodontics at various colleges across the country about regenerative endodontic procedures. The survey included profile of the respondents and consisted of 23 questions about their knowledge, attitude and opinions regarding use of these procedures as part of future dental treatment.Results:The survey showed that half the participants (50.6%) had received continued education in stem cells and/or regenerative dental treatments. The majority of participants were of the opinion (86.6%) that regenerative therapy should be incorporated into dentistry, and most of them (88%) were willing to acquire training in learning this new treatment strategy. The results indicated that half of the participants (52.6%) were already using some type of regenerative therapy in their clinical practice; however, with a majority of these limited to use of membranes, scaffolds or bioactive materials.Conclusions:These results reflect that endodontic residents are optimistic about the use of regenerative endodontic procedures; however, a need for more research and training was felt.

Inflammatory external root resorption is one of the major complications after traumatic dental injury. In this case report, we describe treatment of a maxillary central incisor affected by severe, perforating external root resorption. An 18-year-old patient presented with a previously traumatized, root-filled maxillary central incisor associated with pain and sinus tract. Radiographic examination revealed periradicular lesion involving pathologic resorption of the apical region of the root and lateral root surface both mesially and distally. After removal of the root canal filling, the tooth was disinfected with intracanal triple antibiotic paste for 2 weeks. The antibiotic dressing was then removed, and the entire root canal was filled with mineral trioxide aggregate. The endodontic access cavity was restored with composite resin. After 18 months, significant osseous healing of the periradicular region and lateral periodontium had occurred with arrest of external root resorption, and no clinical symptoms were apparent.

The purpose of this prospective case series was to report the long-term clinical and radiographic outcomes of regenerative endodontic procedures (REP) using platelet-rich fibrin (PRF), in traumatized immature permanent teeth with necrotic pulps. Six immature necrotic permanent maxillary central incisors from six patients were treated with REP supplemented with PRF. Patients were recalled at 6, 12, 18, 24, 36, 48, and 60 months. Radiographic changes in the radiographic root area (RRA), apical diameter, root thickness, and root length were quantified. Clinically, tooth survival in terms of tooth retention in the arch and absence of any sign and symptoms of endodontic pathology were noted. All the teeth survived and met the clinical criteria for success throughout the follow-up period. Follow-up radiographs at 5 years revealed complete resolution of the periapical lesions in all patients and the average apical diameter decrease was 30.96%. An average increase of 13.18% for root length, 40.20% for root thickness, and 26.35% for RRA were noted.