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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 32 | Issue 1
Page Nos. 1-53

Online since Friday, March 20, 2020

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EDITORIAL  

Welcome to the International Federation of Endodontic Association 12th world Endodontic Congress to be held at Chennai, India: September 23–26, 2020 p. 1
Gopikrishna Velayutham
DOI:10.4103/endo.endo_32_20  
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ORIGINAL ARTICLES Top

Root and canal anatomy of mandibular first molar teeth of an Indian population p. 3
Jatin Atram, Kulvinder Singh Banga, Pankaj Gupta, Ajinkya M Pawar
DOI:10.4103/endo.endo_71_19  
Aim: The current study evaluated the root and root canal anatomy of permanent mandibular first molar teeth of an Indian population. Materials and Methods: A total of 486 freshly extracted human permanent noncarious mandibular first molar teeth were acquired from a pool of extracted teeth of patients of indigenous Indian population. The root canal morphology (including the root numbers) and the anatomy of the root canal system (including the number and type of canals based on Vertucci's classification) were evaluated using cone-beam computed tomography. Results: Predominantly, the studied specimens exhibited two roots with a prevalence of 86.84%, followed by three roots with a prevalence of 13.16%. The third root was exclusively found on the lingual aspect of distal roots. The two- and three-rooted permanent mandibular first molars exhibited two, three, and four in 1.64%, 55.34%, and 43.02% of teeth, respectively. In the mesial roots, the most common pattern was Type IV (54.94%), followed by Type II (42.38%) and Type I (2.68%). In the distal roots, the most common pattern was Type I (53.29%), followed by Type II (31.06%), Type IV (9.47%), Type III (4.74%), and Type V (1.44%). The three-rooted permanent mandibular first molars exhibited Type I canal configuration in 100% of the specimens in the extra root. Conclusion: The most common morphology of permanent mandibular first molars of an Indian population was the two-rooted teeth with three canals (two mesial and one distal). The root canal configurations most commonly seen were Type IV in mesial roots and Type I in the distal roots. In teeth with three roots, the extra root it was located lingually and exhibited Type I root canal configuration.
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Posttreatment endodontic disease among patients seeking treatment at a referral dental hospital in Kenya p. 8
Benjamin Simiyu Nyongesa, Kaaria Mwirigi, Laura Gwahalla Edalia, Bernina Kisumbi, Tom Dienya
DOI:10.4103/endo.endo_68_19  
Background: The incidence of postendodontic treatment disease has equally increased in prevalence among patients with previous root-treated teeth. Objective: This study aimed at determining the characteristics of post-treatment disease following endodontic treatment. Materials and Methods: This was a descriptive cross-sectional study. Convenience sampling was used to select periapical radiographs of patients who needed treatment of teeth with previous root canal treatment. Data were analysed using SPSS. Study Benefits: This research will aid in the development of realistic, evidence-based oral health care policies that could be integrated into general health care within the region. Results: A total of 42 patients participated in the study with 54 teeth presenting with posttreatment endodontic disease (PTEDx). The ages of most patients were distributed in the range of 31–40 years with maxillary molars (25.9%) being the most commonly affected teeth. Thirty-nine (72.2%) teeth were asymptomatic, whereas 15 (27.8%) were associated with pain of varying severity. Well-defined radiolucent lesions were present in 59.3% of the cases, whereas 74.1% of the teeth presented with voids. Inadequate root-filling length (79.6%) appeared to be the most common characteristic of PTEDx. Conclusion: Posttreatment disease in this sample presented with the comparatively high substandard technical quality of root fillings and restorations. Recommendations: Academic institutions teaching dentistry and related authorities should collaborate managing this problem of posttreatment disease judiciously. Technical skills, technology, and performance of root canal filling procedures should be emphasized, and suitable methods should be developed in order to achieve better treatment outcomes. Further studies should be done to establish the challenges that lead to substandard root canal treatment.
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Comparative evaluation of shear bond strength of Biodentine, Endocem mineral trioxide aggregate, and TheraCal LC to resin composite using a universal adhesive: An in vitro study p. 14
Meenu Garg Singla, Palak Wahi
DOI:10.4103/endo.endo_7_19  
Introduction: The efficacy of the bond between the restorative materials and the pulp capping materials has an important role in the success of vital pulp therapy. Aims and Objective: This study was conducted to investigate and compare the shear bond strength (SBS) of Biodentine, Endocem mineral trioxide aggregate (MTA), and TheraCal LC to resin composite using a universal adhesive at their respective initial setting time and to identify the specific modes of failure using a stereomicroscope at × 25 magnification. Materials and Methods: A total of 60 acrylic blocks were prepared. Each of the blocks were prepared 20 mm high and 12 mm diameter and had a central hole of 2 mm depth and 5 mm diameter. These acrylic blocks were divided into three groups of 20 samples each based on the liner that is condensed into prepared central hole as Group A – Biodentine, Group B – Endocem MTA, and Group C – TheraCal LC. Composite was then bonded to each sample using universal adhesive. SBS analysis was performed at a cross-head speed of 1 mm/min. Observation and Results: Mean SBS of Group B (Endocem MTA) with composite was found to be significantly lower than that of Group A (Biodentine) with composite which was further significantly lower than that of Group C (TheraCal LC) with composite. Conclusion: This present study concludes that the bond strength of resin-based light-curable TheraCal LC showed clinically acceptable and highest SBS values when used with a universal silane containing adhesive.
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Comparative evaluation of apical debris extrusion during root canal preparation using three different file systems: An in vitro study p. 20
Ami R Patel, Urvashi M Ujariya, Anjali K Kothari, Rajendra P Bharatiya
DOI:10.4103/endo.endo_42_19  
Introduction: One of the most important factors which form the foundation of successful root canal treatment is cleaning and shaping without extruding significant amount of debris in periradicular tissues. Aims: The objective of this study is to evaluate and compare the amount of apically extruded debris during root canal preparation with three different instrumentation systems. Materials and Methods: The mesiobuccal canals of ninety mature, human mandibular molars were randomly divided into three groups (n = 30 teeth/group). Each group was instrumented using one of the three different instrumentation systems: WaveOne Gold (WOG), self-adjusting files (SAFs), and Hyflex EDM (HEDM). The canals were irrigated using bidistilled water. Debris extruded was collected in preweighed Eppendorf tubes, and the extruded irrigant was evaporated. The weight of the dry extruded debris was established by comparing the pre- and post-instrumentation weight of Eppendorf tubes for each group. Statistical Analysis: The debris extrusion was compared and statistically analyzed using the analysis of variance and the post hoc Tukey test. Results: The WOG and HEDM file systems produced significantly more debris compared with SAF system (P < 0.05). Conclusions: All instrumentation systems tested produced apical extrusion of debris. SAFs extruded significantly lesser amount of debris than WOG and HEDM.
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A comparative evaluation of the efficacy of activated irrigation protocol on root canal debridement – A scanning electron microscopic study p. 26
Renuka Singh, Vineeta Nikhil, Shikha Jaiswal, Sachin Gupta, Shalya Raj, Rohit Arora
DOI:10.4103/endo.endo_79_18  
Introduction: The aim of this study was to evaluate and compare root canal debridement with three different irrigation systems, i.e., syringe, sonic, and ultrasonic. Materials and Methods: Forty-five maxillary anterior teeth were decoronated and prepared biomechanically using Protaper rotary files till size F4. Irrigation was done with 1 ml of 4% sodium hypochlorite solution after each file use. The samples were divided into three groups on the basis of final irrigation protocol - Group 1 = Syringe irrigation, Group 2 = Passive sonic irrigation, and Group 3 = Passive ultrasonic irrigation. The samples were then sectioned and observed under the scanning electron microscope (SEM) at coronal, middle and apical thirds of root canal. The SEM was evaluated and scored for residual debris and smear layer. Results: Intragroup comparison showed that smear layer and debris removal at coronal third was significantly better when compared to apical third. Intergroup comparison showed that all the systems performed equally well in the coronal third. At apical one-third, passive ultrasonic performed significantly better than both sonic and syringe irrigation. Conclusion: Root canal cleanliness achieved by ultrasonic, especially in the apical third is significantly better than sonic and syringe irrigation.
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Effect of intracanal calcium hydroxide dressing on the push out bond strength of AH Plus, MTA Fillapex®, and endosequence BC sealer p. 33
Ayushi Gupta, Mohit Kumar, Sonali Taneja
DOI:10.4103/endo.endo_58_19  
Aim: This study aimed to compare the effect of intracanal calcium hydroxide dressing on the push-out bond strength of AH Plus, mineral trioxide aggregate (MTA) Fillapex®, and endosequence BC sealer. Methodology: Sixty single-rooted human mandibular premolars were decoronated and subjected to biomechanical preparation with the help of a ProTaper rotary file up to size F2. Half of the samples worked as control and the other half that worked as experimental group was treated with calcium hydroxide intracanal medicament. All the samples were divided into three groups (n = 20), according to the sealer used. The samples were obturated using endosequence BC sealer, AH Plus, and MTA Fillapex. Each sample was sectioned horizontally into three parts: cervical, middle, and apical. The sample so prepared was subjected to universal testing machine for the evaluation of the push-out bond strength of the sealers. Results: Endosequence BC sealer showed the best results, followed by AH Plus sealer and MTA Fillapex sealer. In addition, the push-out bond strength decreased significantly after the use of intracanal calcium hydroxide medicament (ApexCal). Push-out bond strength also decreased from cervical to middle followed by apical third. Conclusion: Calcium hydroxide intracanal medicament dressing reduced the push out bond strength of all the three sealers used in the study.
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CASE REPORTS Top

Management options for dens invaginatus: Case series report p. 38
J Joyson Joe Asir, V Subashri, T Ramyadharshini, S Pavula, I Anand Sherwood, James L Gutmann
DOI:10.4103/endo.endo_5_20  
Dens invaginatus (DI) is a developmental defect with invagination of enamel organ into the dental papilla before calcification of dental tissues. This report intends to emphasize the significance of early detection and management options when DI is evident, and will explore the extensive pulpal and periapical pathosis that is often accompany a nontreated DI.
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Mineral trioxide aggregate apical plug and biodynamic intraradicular restoration for rehabilitation of fractured anterior central incisor with open apex: A case report with 1-year follow-up p. 45
Rishu Gautam, Ritesh Sood, Bharti Goyal, Divya Batra
DOI:10.4103/endo.endo_73_19  
Restoration of teeth with the extensive loss of coronal structure requires post and core for its rehabilitation. In this context, Biological post prepared from natural tooth offers a feasible and promising treatment option to restore the tooth with a “biologic restoration”. Properties of biologic post similar to dentin make it a good alternative in comparison to conventional post systems. Along with post and core if teeth have open apices, it needs a more rationalized approach. It becomes necessary to create an apical barrier for root canal filling. For this purpose, MTA has gained enough popularity thanks to its biomimetic properties and good sealing ability. This case report discusses the successful management of fractured anterior teeth having an open apex. Treatment was done under three phases- Formation of apical barrier with MTA apical plug causing root formation, followed by thermoplasticised obturation and final rehabilitation with the placement of biological dentin post. Freshly extracted maxillary canine was trimmed and shaped to form biological post. This customized biological post was sterilized and cemented. One year of follow up showed successful structural functioning, performance and esthetics of the tooth along with apical root formation.
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An unusual case of periapical actinomycosis p. 50
Shishir Singh, Rajesh Podar, SM Meghana, Snehal Vivrekar
DOI:10.4103/endo.endo_117_18  
Actinomycosis is a granulomatous infection of the cervicofacial, thoracic, abdominal and cerebral regions. Periapical actinomycosis is a rare form of cervicofacial actinomycosis, which is a persistent lesion that usually does not respond to routine endodontic treatment. The prevalence of this infection is indeed low and therefore is not a common cause of endodontic failure. We report a case of periapical actinomycosis in a 24 yr old patient who presented with a complaint of swelling and pain in the maxillary incisors. The accidental finding of sulphur granules during the endodontic surgery led to the provisional diagnosis of periapical actinomycosis. Upon biopsy, actinomycosis was diagnosed where classic colonies were demonstrated. Apicoectomy was performed and the patient was maintained on follow up. Satisfactory healing was achieved after 10 months. Early diagnosis of such lesions with actinomyces is important since it directly impacts the treatment plan.
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