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Arnold M, Ahmed HMA. Detection, characterisation and management of complex root canal configurations in the mesiobuccal roots of maxillary first molars: A case series. AUST ENDOD J 2024. [PMID: 38509790 DOI: 10.1111/aej.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/12/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
This report presents the detection, characterisation, instrumentation and filling of complex canal configurations in the mesiobuccal (MB) root of maxillary first molars. Three patients were referred for root canal treatment in first maxillary molars. Medical history, age, sex and clinical findings were recorded. Intraoral periapical radiographs and cone beam computed tomography (CBCT) were used for diagnosis and pre-operative assessment. Using Ahmed et al. (2017) classification system, codes 3MaxM MB3-5-4-2 DB1-2-1 P1 (case 1), 3MaxM MB2-5-3-2 DB1 P1 (case 2) and 3MaxM MB1-4-2-1-2 DB1 P1 (case 3) were identified. Using the dental operating microscope, CBCT (if indicated) and troughing up to 3 mm allowed identification of more than three canals in the MB root of maxillary first molars. The coding system proposed by Ahmed et al. (2017) allows the classification of MB roots with highly complex canal configurations.
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Affiliation(s)
- Michael Arnold
- Praxis für Endodontie Und Zahnerhaltung, Dresden, Germany
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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2
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Liu H, Shen Y. Endodontic Treatment of a Maxillary First Molar With Two Separate Palatal Roots: A Case Report. Cureus 2024; 16:e51907. [PMID: 38333498 PMCID: PMC10850443 DOI: 10.7759/cureus.51907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Maxillary first molars exhibit considerable anatomical variation, with a single palatal root being the most common occurrence, while two palatal roots are notably less frequent. This case report details the endodontic treatment of a maxillary first molar with two separate palatal roots. It highlights the critical importance of recognizing these anatomical variations and their unique challenges during endodontic procedures. This report emphasizes the essential role of advanced diagnostic methods, such as cone-beam computed tomography, and the use of microscopic techniques in identifying and treating such cases.
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Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, CAN
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vacnouver, CAN
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Liu H, Hieawy A, Shen Y. Endodontic Treatment of Two Calcified Mandibular Central Incisors: A Case Report. Cureus 2024; 16:e53066. [PMID: 38410353 PMCID: PMC10896276 DOI: 10.7759/cureus.53066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Treating calcified root canals presents significant challenges, as incorrect approaches can result in treatment failure or lead to complications. The necessity for advanced diagnostic and therapeutic tools is often paramount in these situations. This case report demonstrates the successful treatment of two calcified mandibular central incisors, followed up for a period of up to six years. It emphasizes the effectiveness of integrating cone-beam computed tomography, dental operating microscopes, and ultrasonic instruments in the treatment of such challenging cases.
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Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological & Medical Sciences, University of British Columbia, Vancouver, CAN
| | - Ahmed Hieawy
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, CAN
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, CAN
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Ghabraei S, Bolhari B, Hashemi N, Gharehchahi H. Conservative management of an advanced external cervical resorption with internal approach using bio-ceramic materials: A case report. Clin Case Rep 2024; 12:e8378. [PMID: 38161643 PMCID: PMC10753636 DOI: 10.1002/ccr3.8378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Key clinical message A successful management of an advanced external cervical resorption using a conservative approach with CBCT, dental operating microscope, and a new bio-ceramic material. Abstract External cervical resorption (ECR) is a pathologic condition that is initiated on the external aspect of the root, below the epithelial attachment in the cervical position. This article will report a case of external cervical resorption (ESR) in an advanced stage, which was asymptomatic and was incidentally detected in a follow-up radiograph after the end of orthodontic treatment. Cone-beam computed tomography (CBCT) was prescribed to accurately diagnose the resorptive lesion and differentiate it from internal root resorption (IRR), and the final diagnosis was Heithersay's class IV ECR. Considering the health of the periodontium and the absence of attachment loss, it was decided to use a conservative internal approach to the management of this case. After the treatment, the patient was asymptomatic and the radiographic examinations showed no signs of peri-radicular pathology during the follow-up period. With the correct case selection and the availability of the appropriate materials and equipment such as a dental operating microscope (DOM) and bio-ceramic materials, the internal approach can be a successful and minimally invasive treatment, even for the management of advanced ECR cases.
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Affiliation(s)
- Sholeh Ghabraei
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
| | - Behnam Bolhari
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
| | - Nasim Hashemi
- Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
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Liu H, Shen Y. Endodontic Retreatment of a Mandibular Second Molar With a C-shaped Root Canal Configuration: A Case Report. Cureus 2024; 16:e52812. [PMID: 38389597 PMCID: PMC10883750 DOI: 10.7759/cureus.52812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Root canal retreatment in mandibular second molars with C-shaped root canal configurations presents notable challenges. This article presents a case of successful root canal retreatment in a mandibular second molar exhibiting this complex configuration. Achieving a successful endodontic outcome in such cases necessitates a comprehensive understanding of the unique root canal anatomy. Moreover, the employment of advanced instruments and techniques is crucial to effectively address the intricacies of the C-shaped root canal system.
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Affiliation(s)
- He Liu
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, CAN
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, CAN
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Biswas M, Mazumder D, Saha KK, Murmu LB, Das S, Banerjee S. See-through "C": Case series. J Conserv Dent Endod 2023; 26:478-483. [PMID: 37705560 PMCID: PMC10497081 DOI: 10.4103/jcd.jcd_322_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 09/15/2023]
Abstract
Successful endodontic treatment relies upon a thorough knowledge of root canal anatomical variations along with proper diagnosis, treatment planning, and clinical expertise. One of the difficult root canal configurations that are frequently encountered commonly in mandibular second molars is C-shaped root canal. Due to the intricate root canal configuration, it is often difficult to negotiate, debride, and obturate such canals leading to failure of root canal treatment. Understanding the anatomical variation and adequate visualization will enable the clinician to manage these cases effectively. Advanced irrigation and obturation techniques help in managing such anomalous canal configurations. This article presents the management of two different C-shaped root canal configurations under dental operating microscope using thermoplasticized obturation techniques.
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Affiliation(s)
- Mousumi Biswas
- Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, India
| | - Dibyendu Mazumder
- Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, India
| | - Kallol Kumar Saha
- Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, India
| | - Lugu Buru Murmu
- Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, India
| | - Siddhartha Das
- Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, India
| | - Srimanta Banerjee
- Department of Conservative Dentistry and Endodontics, Burdwan Dental College and Hospital, Bardhaman, West Bengal, India
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Hausdörfer T, Harms L, Kanzow P, Hülsmann M. Three Visual-Diagnostic Methods for the Detection of Enamel Cracks: An In Vitro Study. J Clin Med 2023; 12. [PMID: 36769621 DOI: 10.3390/jcm12030973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023] Open
Abstract
Tooth fractures are a common cause of tooth loss, frequently starting as enamel cracks. However, methods for the detection of enamel cracks are poorly investigated. The aim of the study was the validation of three clinical methods for the detection of enamel cracks: dental operating microscope (DOM), near-infrared transillumination (NIR), and fiber-optic transillumination (FOTI), with hard-tissue slices serving as controls. A total of 89 extracted teeth, set up as diagnostic models, were investigated, and the maximum crack depth was scored by two examiners. The actual crack depth was determined microscopically (25×) using horizontal sections. The accuracy of each method was analyzed using receiver operating characteristic (ROC) curves. Across all tooth surfaces, the area under the curve (AUC) amounted to 0.57 (DOM), 0.70 (FOTI), and 0.67 (NIR). For crack detection on vestibular/oral surfaces, the AUC was 0.61 (DOM), 0.78 (FOTI), and 0.74 (NIR); for proximal surfaces, it was 0.59 (DOM), 0.65 (FOTI), and 0.67 (NIR). However, the actual crack depth was underestimated with each method (p < 0.001). Under in vitro conditions, FOTI and NIR are suitable for detection of enamel cracks, especially on vestibular and oral tooth surfaces. However, an exact estimation of crack depth is not possible. Therefore, FOTI and NIR seem to be helpful for the clinical detection of enamel cracks.
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Liu M, Zhang Y, Sun P, Qiao Y, Pan K. Endodontic treatment of the mandibular first molar with six root canals: A case report and literature review. Exp Ther Med 2022; 24:760. [PMID: 36561975 PMCID: PMC9748712 DOI: 10.3892/etm.2022.11696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/16/2022] [Indexed: 11/11/2022] Open
Abstract
The mandibular first molars normally have three or four root canals and rarely have five or more root canals. The present study reported a rare anatomical configuration with six root canals in the mandibular right first molar diagnosed during endodontic treatment using a dental operating microscope and confirmed with the help of cone-beam computed tomography (CBCT) images. The present case report revealed that there is an increasing possibility of detecting additional canals through the magnification of the microscope and the improvement of CBCT diagnostic technology. As more abnormal morphologies in root canals are reported, dentists need to understand this diversity in anatomical structure and improve treatment techniques.
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Affiliation(s)
- Meiwei Liu
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China,School of Stomatology, Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Yan Zhang
- School of Stomatology, Qingdao University, Qingdao, Shandong 266003, P.R. China,Department of Stomatology, Linyi People's Hospital, Linyi, Shandong 276002, P.R. China
| | - Pei Sun
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China,School of Stomatology, Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Yanya Qiao
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China,School of Stomatology, Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Keqing Pan
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China,School of Stomatology, Qingdao University, Qingdao, Shandong 266003, P.R. China,Correspondence to: Dr Keqing Pan, Department of Stomatology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Shinan, Qingdao, Shandong 266000, P.R. China
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Battula MS, Kaushik M, Mehra N, Singh A. Endodontic management of maxillary first molar with unusual anatomy. J Conserv Dent 2022; 25:569-572. [PMID: 36506634 PMCID: PMC9733555 DOI: 10.4103/jcd.jcd_266_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/15/2022] Open
Abstract
This article reports nonsurgical endodontic management of bilateral maxillary first molars with an unusual morphology of a single root and a Sert and Bayirli type-IX canal configuration. A 41-year-old female reported with dull continuous pain in the maxillary left and right quadrants. On clinical examination, the maxillary first molars on both sides were carious with pulpal exposure and radiographic evaluation revealed an unusual anatomy of single root and single canal for both of them. Based on clinical and radiographic examination, tooth numbers 16 and 26 were diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. Root canal treatment was initiated and cone-beam computed tomography (CBCT) imaging was advised on encountering unusual internal anatomy. The CBCT images revealed the presence single root and a Sert and Bayirli type-IX canal configuration bilaterally. Root canal treatment was performed under magnification using the dental operating microscope.
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Affiliation(s)
- Madhuri Sai Battula
- Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Hyderabad, Telangana, India,Address for correspondence: Dr. Madhuri Sai Battula, Army College of Dental Sciences, CRPF Road, Jai Jawahar Nagar Post, Hyderabad - 500 087, Telangana, India. E-mail:
| | - Mamta Kaushik
- Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Hyderabad, Telangana, India
| | - Neha Mehra
- Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Hyderabad, Telangana, India
| | - Ankeeta Singh
- Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Hyderabad, Telangana, India
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Adnan S, Tabassum S. Perception and practices of Operative and Endodontic specialists in Pakistan towards the use of dental magnification. Work 2021; 70:1279-1287. [PMID: 34842213 DOI: 10.3233/wor-210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The perceptions and trends of magnification use in dentistry need to be determined since magnification significantly enhances clinical practice. OBJECTIVE To assess perception and practices of Operative and Endodontic specialists currently working in Pakistan, regarding use of magnification. METHODS A structured questionnaire administered for this analytical cross-sectional study recorded demographics, trends of magnification devices used in practice and their perceived advantages and disadvantages by the specialists with close-ended questions and three-point Likert scale. RESULTS Out of 91 forms, 77 responses were received (response rate of 84%). Most participants had 1-4 years of practical experience, were employed at both faculty and clinical positions, were more interested in operative/restorative procedures and used TLL (through the lens loupes) at low magnification. Use of magnification devices was learnt mostly during post-graduate training and was used daily or weekly for complicated cases. Noteworthy perceptions included improved treatment quality and standard of care. However, they were also perceived as irritating, increasing treatment time, with adverse effect on eyesight with prolonged use. No statistically significant correlation was found between the variables recorded (p > 0.05). CONCLUSIONS Most specialists used magnification devices in some form and were abreast with their advantages. Proper training and continued dental education courses can help dispel any observed misapprehensions.
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Affiliation(s)
- Samira Adnan
- Department of Operative Dentistry, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Sadia Tabassum
- Department of Operative Dentistry, Jinnah Medical and Dental College, Karachi, Pakistan
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Arias Martinez Z, Lopez Videla J, Yamashiro K, Shinoda-Ito Y, Yamamoto T, Takashiba S. Use of Highly Accurate Devices for a First Lower Premolar Endodontic Treatment with Multiple Root Canals. Acta Med Okayama 2021; 75:641-645. [PMID: 34703048 DOI: 10.18926/amo/62778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This case report highlights the importance of using a dental operating microscope (DOM) and ultrasonic endodontic tips (UETs) to locate all root canals in the lower first premolar. A 53-year-old woman presented to our clinic with pain in the lower right first premolar. After a detailed search using a DOM and UETs, three root canals were found, prepared with rotary HyFlex endodontic files, and obturated using the lateral condensation technique. At the five-year follow-up after treatment, the tooth was completely restored and fulfilling its function, with no signs or symptoms of any post-treatment flare-up.
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Affiliation(s)
- Zulema Arias Martinez
- Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.,Former Address: Emer-Dent (Private Dental Clinic)
| | | | - Keisuke Yamashiro
- Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.,Current Address: Department of Oral Health, Kobe Tokiwa Junior College
| | - Yuki Shinoda-Ito
- Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tadashi Yamamoto
- Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Shogo Takashiba
- Department of Pathophysiology - Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Rashkova M, Bogovska-Gigova R, Tankova H, Gateva N, Mitova N, Hristov K. Application of Contemporary Magnifying Methods in the Diagnostics of Occlusal Carious Lesions on First Permanent Molars in Children. Folia Med (Plovdiv) 2021; 62:585-591. [PMID: 33009759 DOI: 10.3897/folmed.62.e47751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/20/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Dental operating microscopes (DOM) enable dentists to examine, with the aid of magnification and photodocumentation in clinical conditions, the occlusal anatomy of newly erupted permanent molars and to detect any early carious lesions more precisely. AIM To determine the advantages of magnifying technology in detecting early occlusal carious lesions in newly erupted permanent first molars. MATERIALS AND METHODS We examined 176 first molars of 44 children divided into two age groups: 7-8 and 9-10 years. The surfaces of each of the teeth were examined after they were cleaned with a brush without paste. The diagnoses were first made using only illumination and a clinical examination. These were followed by a visual examination of the occlusal surface using a DOM at ×8 magnification. A photo of the occlusal surface was then taken with a camera at the respective magnification for the purposes of photodocumentation. RESULTS This study demonstrated that dental operating microscopes increased by 7% the rate of successful detection of early caries lesions on the occlusal surfaces. There was also a significant increase of the number of diagnosed cavitated caries in the dentine in comparison with those detected with naked eye. Using DOMs in pediatric dentistry facilitates the more detailed and precise diagnosing of early stage carious lesions and/or cavitations in the fissures. CONCLUSION The use of a DOM facilitates differential diagnosing between deep fissures and early carious lesions, which is a key point in the assessment of occlusal surfaces of newly erupted permanent molars, necessary for their preventative sealing and micro-invasive treatment.
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Bud M, Jitaru S, Lucaciu O, Korkut B, Dumitrascu-Timis L, Ionescu C, Cimpean S, Delean A. The advantages of the dental operative microscope in restorative dentistry. Med Pharm Rep 2021; 94:22-27. [PMID: 33629044 PMCID: PMC7880065 DOI: 10.15386/mpr-1662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/10/2020] [Accepted: 09/28/2020] [Indexed: 12/05/2022] Open
Abstract
Magnification devices improve direct and indirect vision and precision being significantly higher in microscope use compared to the loupes. Dental loupes are the most commonly used devices for magnification, due to the more affordable prices and the ease of use without major changes in the working protocol and ergonomics. Loupes primary benefits reported refers to ergonomics and posture, restoration evaluation/detection and overall treatment quality. There are some disadvantages that limit the use of loupes among dentists: lack of fixed position (fine movements of the dentist’s head disturb the image of the magnified operating field); the need to change the loupes to achieve different magnification. On the contrary, the use of a dental microscope require minimum adjustment and effort so as to reduce postural deviation while working. It has been more than 30 years since dental practitioners raised the issue of using dental operating microscopes (DOM) in restorative dentistry, identifying the benefits of magnification in diagnosis and treatment steps. The growth is evident in recent years, maybe because of the familiarity of dentists with dental microscopes which have already become implicit endowment for endodontic specialists. Fiber optic lighting is the key factor that complements the magnification offered by the microscope so that treatments can now be performed under increased safety conditions and in conditions of significantly higher quality than in the past. Since the beginning of the 2000s the principles of minimally invasive dentistry have been widely promoted in dentistry. These principles are major impetus for the use of microscope by dentists. Working with magnification leads dentists to be more conservative with dental tissues.
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Affiliation(s)
- Marius Bud
- Department of Conservative Dentistry, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stefan Jitaru
- Department of Conservative Dentistry, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ondine Lucaciu
- Department of Oral Rehabilitation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bora Korkut
- Department of Restorative Dentistry, Marmara University, Istanbul, Turkey
| | - Lucia Dumitrascu-Timis
- Department of Conservative Dentistry, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Corina Ionescu
- Department of Conservative Dentistry, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sanda Cimpean
- Department of Conservative Dentistry, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ada Delean
- Department of Conservative Dentistry, University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Abstract
Pulp stones (PSs) are calcified masses that can be found in the pulp cavity of any deciduous or permanent tooth. They can be observed in healthy, diseased, and even unerupted or impacted teeth. Calcifications within the pulp may lead to a poorer outcome of a root canal procedure, as they can block access to the root canals, and hinder their subsequent cleaning and shaping. The paper describes 4 clinical cases of denticles located in the coronal and radicular pulp. Therapeutic methods of PS removal with different techniques and instruments are discussed. Specialist root canal treatment (RCT) was performed in aseptic conditions with the use of long-shank rose-head burs and an endodontic ultrasonic device under the magnification of a dental operative microscope (OM). During endodontic treatment, all PSs were totally removed, which allowed the further preparation, and finally obturation of the canal system. The use of modern diagnostic and therapeutic methods - three-dimensional (3D) diagnostic radiology, endodontic techniques, such as ultrasounds used during the removal of PSs and the irrigation of the canals, and the thermoplastic methods of canal obturation - can provide good results of treatment of this pathology. The removal of PSs from the pulp cavity is a complex and difficult procedure, requiring skill, dexterity, and appropriate equipment and facilities. The clinical approach introduced in this paper allows endodontists to avoid potential complications like perforation, the unnecessary removal of hard tissues or the weakening of the tooth structure.
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Affiliation(s)
| | - Halina Pawlicka
- Department of Endodontics, Medical University of Lodz, Poland
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15
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Manigandan K, Ravishankar P, Sridevi K, Keerthi V, Prashanth P, Pradeep Kumar AR. Impact of dental operating microscope, selective dentin removal and cone beam computed tomography on detection of second mesiobuccal canal in maxillary molars: A clinical study. Indian J Dent Res 2020; 31:526-530. [PMID: 33107451 DOI: 10.4103/ijdr.ijdr_353_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Maxillary molars may frequently require root canal therapy and can have complex anatomy. It is important to locate and treat the second mesiobuccal canal to significantly improve prognosis. Aim of the Study The purpose of this study was to evaluate direct vision, dental operating microscope (DOM), selective dentin removal under DOM, and cone beam computed tomography (CBCT) in clinical detection of second mesiobuccal root canal (MB2) in maxillary molars. Materials and Methods A total of 122 maxillary first and second molars indicated for root canal treatment were included in our study. Following access cavity preparation, the presence of MB2 canal orifice was assessed in four stages. Stage I: with direct vision. Stage II: under DOM, Stage III: after selective dentin removal under DOM and Stage IV: teeth in which MB2 canal was not identified by Stage III were further investigated with CBCT. The number of canals identified during each stage was analyzed statistically. Results Clinical detection of MB2 canal in our study was 90%, with 93% in maxillary first molar and 86% in maxillary second molar. 64% MB2 canals were located at Stage I (direct vision) which improved to 84% at Stage II (under DOM) and 90% at Stage III (selective dentin removal under DOM). CBCT investigation (Stage IV) further improved the identification of MB2 canal leading to overall prevalence of 93%. Conclusion The results of our study demonstrated that MB2 canal can be clinically detected in up to 90% of maxillary molars by the use of DOM and selective dentin removal. CBCT investigation is indicated when MB2 canals are not clinically detected.
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Affiliation(s)
- Kuzhanchinathan Manigandan
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Periasamy Ravishankar
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Research Institute (Deemed to be University), Chennai, Tamil Nadu, India
| | - Krishnamoorthy Sridevi
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Research Institute (Deemed to be University), Chennai, Tamil Nadu, India
| | - Venkatesan Keerthi
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Research Institute (Deemed to be University), Chennai, Tamil Nadu, India
| | - Prakash Prashanth
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Research Institute (Deemed to be University), Chennai, Tamil Nadu, India
| | - Angambakkam Rajasekaran Pradeep Kumar
- Department of Conservative Dentistry and Endodontics, Thai Moogambigai Dental College and Hospital, Dr. MGR Educational and Research Institute (Deemed to be University), Chennai, Tamil Nadu, India
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16
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Terauchi Y, Bakland LK, Bogen G. Combined Root Canal Therapies in Multirooted Teeth with Pulpal Disease. J Endod 2020; 47:44-51. [PMID: 33045261 DOI: 10.1016/j.joen.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/12/2020] [Accepted: 09/05/2020] [Indexed: 12/12/2022]
Abstract
The types of pulpal disease found in multirooted teeth may vary from one root canal to the next. Current endodontic treatment strategies allow for options such as regenerative endodontics, vital pulp therapy, or conventional root canal treatment depending on the disease status of the pulp in a specific root canal. A combination of procedures was used in the 3 teeth in this case series based on the assumed pulpal status in each canal. The follow-up ranged from 24-27 months, and in each case the healing response was satisfactory. This report illustrates the use of a combination of treatment procedures that can provide specific treatment benefits in various clinical situations.
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Affiliation(s)
| | - Leif K Bakland
- Loma Linda University, School of Dentistry, Loma Linda, California
| | - George Bogen
- Department of Endodontics, School of Dentistry, University of Queensland, Brisbane, Queensland, Australia.
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17
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Abstract
The worldwide coronavirus disease 2019 pandemic has greatly impacted dental practice. Issues confronting practicing dentists include possible transmission of disease by droplets/aerosol or contact with contaminated surfaces. Dentists are at increased risk because of their proximity to the oropharynx. In an effort to reduce potential exposure to aerosols generated during treatment, a device has been developed in which a polycarbonate shield is mounted to the dental operating microscope with an attached high-velocity vacuum hose. Anemometer measurements show an exhaust outflow of 3.9 ft/min at a position approximating the patient’s oropharynx. More research may be warranted using this or similar approaches to mitigate aerosol transmission.
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18
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Brown MG, Qualtrough AJE, McLean W. Magnification in undergraduate endodontic teaching in the UK and Ireland: a survey of teaching leads in Endodontology. Int Endod J 2019; 53:553-561. [PMID: 31644836 DOI: 10.1111/iej.13240] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022]
Abstract
AIM To investigate the use of magnification in undergraduate endodontic teaching in dental schools within the UK and Ireland and identify factors that may impact on levels of adoption. METHODOLOGY An electronic questionnaire was distributed to teaching leads in undergraduate endodontics in all UK and Ireland dental schools. RESULTS Completed questionnaires were received from 15 of 18 course leads. The study revealed magnification is not universally embedded within the undergraduate curricula, and the majority of schools had no expectation for students to use magnification, although it was encouraged. The study provided insight into teaching staff factors, student factors and institutional factors that impact upon the adoption of magnification in undergraduate endodontic teaching. Although course leads utilized magnification in their own practice, this did not translate into institutional expectation for students to use magnification. Barriers to adoption of such an institutional expectation included cost and lack of staff training. CONCLUSIONS Magnification has become viewed as an essential part of endodontic practice. The dental operating microscope has the most significant impact on endodontic visualization; however, the use of dental loupes in nonsurgical endodontics could be considered the minimum standard. The pedagogical dilemma faced by dental educators training undergraduates to behave in a manner that they themselves would not, cannot be rationalized on the basis of cost and lack of staff training. It is proposed that although significant, these barriers are not insurmountable and the use of dental loupe should become an expectation in undergraduate training in the UK and Ireland.
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Affiliation(s)
- M G Brown
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - A J E Qualtrough
- School of Dentistry, The University of Manchester, Manchester, UK
| | - W McLean
- Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
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19
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Abstract
This case report deals with the successful endodontic treatment of double dens invaginatus in maxillary left central incisor. Dens invaginatus is a rare developmental anomaly that is challenging to diagnose and treat. A patient reported with unesthetic appearance and previously attempted endodontic treatment of tooth #21. Cone beam computed tomography revealed the presence of a complex invagination communicating with the periodontium. A combination of techniques enhanced the debridement of the complex invagination. Obturation was performed using warm vertical compaction. The patient was asymptomatic during the follow-up period of 12 months.
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Affiliation(s)
- Vishnupriya Koteeswaran
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
| | - Sooriaprakas Chandrasekaran
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
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20
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Fatima K, Nair R, Khasnis S, Vallabhaneni S, Patil JD. Efficacy of rotary and reciprocating single-file systems on different access outlines for gutta-percha removal in retreatment: An in vitro study. J Conserv Dent 2018; 21:354-358. [PMID: 30122812 PMCID: PMC6080186 DOI: 10.4103/jcd.jcd_339_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: The aim of this study is to compare the effectiveness of reciprocating and continuous rotary nickel-titanium instruments during retreatment performed through two different access outlines. Methodology: A total of 48 freshly extracted mandibular first and second premolars with single root and canal were selected. Initial root canal treatment was completed through a contracted endodontic cavity (CEC) design. Canals were instrumented with F2 ProTaper instrument, obturated with warm lateral condensation of gutta-percha with AH Plus sealer, and allowed to set for 30 days at 37°C and 100% humidity. For retreatment, specimens were divided into two groups (n = 24) on the basis of access outline, CEC or traditional endodontic cavity. Retreatment was initiated using ProTaper Retreatment instruments (D1–D3). Specimens were further divided (n = 12) and reinstrumented up to Neoniti 25/0.08 or WaveOne 25/0.08. Irrigation was performed using 3% sodium hypochlorite and 17% ethylene diamine tetraacetic acid. Retreatment time was recorded. Teeth were sectioned and photographed, and the percentage of remaining obturation material was measured. Results: Data were collected, and statistical analysis was performed using one-way analysis of variance and Tukey honestly significant difference multiple post hoc procedures (P < 0.05). Conclusion: None of the systems completely removed the root filling material from root canals. However, ProTaper/Neoniti instruments removed more GP when compared to Protaper/WaveOne instruments with both the access outlines. Both the instruments with traditional access outline required less time for removal of obturating material when compared to CEC.
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Affiliation(s)
- Kainath Fatima
- Department of Conservative Dentistry and Endodontics, P.M.N.M Dental College, Bagalkot, Karnataka, India
| | - Rohit Nair
- Department of Conservative Dentistry and Endodontics, P.M.N.M Dental College, Bagalkot, Karnataka, India
| | - Sandhya Khasnis
- Department of Conservative Dentistry and Endodontics, P.M.N.M Dental College, Bagalkot, Karnataka, India
| | - Saritha Vallabhaneni
- Department of Conservative Dentistry and Endodontics, P.M.N.M Dental College, Bagalkot, Karnataka, India
| | - Jayaprakash D Patil
- Department of Conservative Dentistry and Endodontics, P.M.N.M Dental College, Bagalkot, Karnataka, India
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21
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Praveen R, Thakur S, Kirthiga M, Shankar S, Nair VS, Manghani P. The radiculous' premolars: Case reports of a maxillary and mandibular premolar with three canals. J Nat Sci Biol Med 2015; 6:442-5. [PMID: 26283848 PMCID: PMC4518428 DOI: 10.4103/0976-9668.160032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Successful root canal therapy requires an accurate diagnosis and management of complex root canal morphology. Although the occurrence of three root canals in maxillary and mandibular premolars is very rare, the clinician must be able to identify it clinically and radiographically to make the necessary changes in his shaping and obturation techniques. We present the endodontic management of a maxillary first premolar with three separate roots and canals, which was diagnosed with the aberrant anatomy only after the access preparation. Then, a mandibular premolar with three root canals and fused roots, which were diagnosed radiographically, is presented. The necessary modifications of the routine clinical steps and the application of dental operating microscope for successful management of the complex anatomy, with emphasis on access modifications and radiographic interpretations are also explained. Teeth with extra roots and/or canals pose a challenge in clinical management. Identifying them early is necessary to facilitate appropriate modifications in treatment protocol, armamentarium to be used and plan optimal number of treatment sittings.
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Affiliation(s)
- R Praveen
- Department of Conservative Dentistry and Endodontics, M.R. Ambedkar Dental College and Hospital, Karnataka, India
| | - Sophia Thakur
- Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
| | - M Kirthiga
- Department of Pedodontic and Preventive Dentistry, Dr. Shamala Reddy Dental College Hospital and Research Centre, Bengaluru, Karnataka, India
| | - S Shankar
- Department of Conservative Dentistry and Endodontics, M.R. Ambedkar Dental College and Hospital, Karnataka, India
| | - Veena S Nair
- Department of Conservative Dentistry and Endodontics, M.R. Ambedkar Dental College and Hospital, Karnataka, India
| | - Priya Manghani
- Department of Conservative Dentistry and Endodontics, M.R. Ambedkar Dental College and Hospital, Karnataka, India
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22
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Raghavendra SS, Hindlekar AN, Desai NN, Vyavahare NK, Napte BD. Endodontic management of maxillary first molar with seven root canals diagnosed using Cone Beam Computed Tomography scanning. Indian J Dent 2015; 5:152-6. [PMID: 25565745 PMCID: PMC4213875 DOI: 10.4103/0975-962x.140837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The main objective of root canal treatment is thorough cleaning and shaping of the entire pulp space and its complete filling with an inert filling material. A major cause of post-treatment disease is the inability to locate, debride or adequately fill all canals of the root canal system. The form, configuration, and number of root canals in the maxillary first molars have been discussed for more than half a century. Maxillary first molars commonly present with three roots and three canals, with a second mesiobuccal canal (MB2) also present. With the advent of improved magnification there are reports of multiple root canals in the maxillary first molars. Nonsurgical endodontic therapy of a left maxillary first molar with three roots and seven root canals was successfully performed under a dental operating microscope. The diagnosis of multiple root canals was confirmed with the help of Cone Beam Computed Tomography (CBCT) images.
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Affiliation(s)
- Srinidhi Surya Raghavendra
- Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
| | - Ajit Narayan Hindlekar
- Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
| | - Niranjan Nanasaheb Desai
- Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
| | - Nishant Kishor Vyavahare
- Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
| | - Bandu Devrao Napte
- Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
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23
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Ahmad IA, Al-Jadaa A. Three root canals in the mesiobuccal root of maxillary molars: case reports and literature review. J Endod 2014; 40:2087-94. [PMID: 25443283 DOI: 10.1016/j.joen.2014.07.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The knowledge of root canal anatomy is essential to ensure a successful outcome of surgical and nonsurgical root canal treatment. The aims of this article were to present 2 cases of maxillary molars with 3 mesiobuccal root canals and to review the available literature on this anatomic variation. METHODS The first case described a nonsurgical root canal treatment of tooth #16 in a 29-year-old man with the aid of a dental operating microscope. In the second case, an extracted maxillary right first molar was scanned by a micro-computed tomographic system and reconstructed 3-dimensionally using modeling software. RESULTS In both cases, the mesiobuccal root had 3 canals (type 3-2 in case I and type 3-3 in case II), whereas the distobuccal and palatal roots had a single canal. The literature review showed that the overall incidence of 3-canaled mesiobuccal roots in maxillary molars ranged from 1.3%-2.4% and that the most common root canal configuration was type 3-2. CONCLUSIONS Clinicians should always anticipate the presence of extra canals in maxillary molars and use all the available tools to locate and treat these.
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Affiliation(s)
- Ibrahim Ali Ahmad
- Restorative Dentistry Department, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia.
| | - Anas Al-Jadaa
- Clinic for Preventive Dentistry, Periodontology and Cariology, University Dental Center, University of Zurich, Zurich, Switzerland
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24
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Mohan R, Agrawal S, Gundappa M. Atomic force microscopy and scanning electron microscopy evaluation of efficacy of scaling and root planing using magnification: A randomized controlled clinical study. Contemp Clin Dent 2013; 4:286-94. [PMID: 24124292 PMCID: PMC3793547 DOI: 10.4103/0976-237x.118347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim: A randomized controlled clinical study was undertaken to evaluate the effectiveness of scaling and root planing (SRP) by using Magnifying Loupes (ML) and dental operating microscope (DOM). Materials and Methods: A total of 90 human teeth scheduled for extraction from 18 patients aged between 25 and 65 years suffering from generalized chronic severe periodontitis were randomly assigned to three treatment groups. Group 1 consisted SRP performed without using magnification (unaided), Group 2-SRP with ML and Group 3-SRP with DOM. Following extractions, samples were prepared for (i) evaluation of surface topography by atomic force microscopy, (ii) presence of smear layer, debris by scanning electron microscopy (iii) elemental analysis by energy dispersive X-ray analysis. Data was subjected to statistical analysis using analysis of variance, post-hoc (Tukey-HSD) and Chi-square test. Results: Statistically significant (P < 0.001) difference was found among the different treatment groups. Group 3 was the best while Group 1 was the least effective technique for SRP. Order of efficacy in terms of the surface was found to be - Palatal < Lingual < Distal ≃ Mesial < Buccal. Efficiency in mandibular to maxillary teeth was found to be significant (P < 0.05), also anterior to posterior teeth (P < 0.05). Conclusion: Magnification tools significantly enhance the efficacy of supragingival and subgingival SRP.
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Affiliation(s)
- Ranjana Mohan
- Department of Periodontics, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, India
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25
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Chauhan R, Tikku A, Chandra A. Detection of residual obturation material after root canal retreatment with three different techniques using a dental operating microscope and a stereomicroscope: An in vitro comparative evaluation. J Conserv Dent 2012; 15:218-22. [PMID: 22876005 PMCID: PMC3410328 DOI: 10.4103/0972-0707.97940] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 12/06/2011] [Accepted: 12/29/2011] [Indexed: 11/23/2022] Open
Abstract
Aim: The study was designed to compare the efficiency of three different methods used for retreatment using a dental operating microscope (DOM) and a stereomicroscope and to evaluate and compare the two methods for detection of residual obturation material after retreatment. Background: The DOM can play an important role in the successful retreatment by detecting the remaining obturation material. Materials and Methods: Thirty extracted maxillary central incisors were collected and obturated after biomechanical preparation. The samples were divided into three groups depending on the method of retreatment: Group I, H-files; Group II, ProTaper Universal retreatment files; and Group III: H-files + Gates-Glidden drills, with 10 samples in each group. After retreatment, the samples were observed under a DOM for detection of residual obturation material. Later, the teeth were cleared and observed under a stereomicroscope for detecting the remaining filling material. The results were subjected to the Spearman's rank order test and other statistical analysis. Results: The maximum cleanliness of the root canal walls was seen in Group I while Group II showed the least. The difference between the mean scores obtained with a DOM and a stereomicroscope was statistically significant (P = 0.05). Conclusion: None of the techniques could completely remove the obturation material. The root canal cleanliness is best achieved when retreatment is performed under a DOM.
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Affiliation(s)
- Raju Chauhan
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Pilibhit Bypass Road, Bareilly, India
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