ENDO, 01/2014

Effective and efficient local anaesthesia is the cornerstone of pain-free dentistry. Dental, but especially endodontic, procedures are often perceived by patients to inevitably inflict pain. Patients must not be discouraged from seeking dental or endodontic treatment for fear of pain. Local anaesthesia for dental or endodontic procedures is usually achieved by using an anaesthetic drug, in solutionform, which is injected using a needle and syringe. Although this method of delivery is effective, the local anaesthetic injection itself is not completely pain-free. As a result, there are patients who fear the injection or the needle itself, as it is associated with pain. The aim of this article is to review alternative local anaesthetic delivery systems and devices, including supplementary aids, to the conventional needle and syringe, which are designed to minimise painful injections. Keywords: dental anxiety, injection, local anaesthetic, needle, pain

Introduction: Trauma to anterior teeth is a significant clinical problem among all age groups, especially in children and adolescents. The purpose of this study was to report on the prevalence and severity of anterior tooth trauma in a large population-based sample of residents from Greater Noida, India. Method: Clinical data from 9074 patients was collected at the Dept. of Conservative Dentistry and Endodontics, School of Dental Sciences, Sharda University, Greater Noida, India between January 2010 and December 2011. The type of injury, age, aetiology, risk factors, gender predilection, overjet and lip incompetency were determined and statistically analysed. Results: Some 9.26% of the patients examined had experienced a traumatic injury to permanent anterior teeth. A total of 1359 traumatised teeth were identified with the male-to-female ratio of 2.7:1. The most injuries were reported between the ages of 16 to 24 years. The most frequent risk factor was ascertained to be road traffic accidents (35%), followed by falls and collisions (23%). The commonest type of injury was uncomplicated crown fractures (37.4%), followed by complicated fractures (25.6%). The maxillary central incisor was the most commonly affected tooth. Only 8.6% of the patients presented for dental treatment within 24 h of the injury, while the remainder delayed seeking treatment for varying times of up to 1 year or more. Conclusion: It was concluded that road traffic accidents are the most common cause of dental trauma among the young adults in Greater Noida. Patients and parents should be informed about the prevention and necessity of the early treatment of dental trauma and the possible consequences of delayed treatment. Keywords: India, prevalence, trauma

Introduction: This study compared the angular deflection at failure, maximum torque, and toughness of two nickel-titanium (NiTi) instruments under torsional stress: Reciproc (VDW, Munich, Germany) and WaveOne (Dentsply Maillefer, Ballaigues, Switzerland). Two NiTi instruments: Mtwo (VDW) and ProTaper (Dentsply Maillefer) served as controls. Methods: The instruments were subjected to torsional assays to evaluate the maximum torque and angular deflection at failure. A stress-strain (N × mm) curve was plotted using specific software and toughness was calculated as the integral of the area under the curve. Data obtained were statistically evaluated by ANOVA and Student-Newman-Keuls (SNK) test for multiple comparisons, with the significance level set at 5%. Results: Significant difference was observed in the angular deflection at failure for pairwise comparisons between ProTaper and the other instruments (P 0.05). No significant differences were observed in the comparisons between the other instruments (P > 0.05). The maximum torque was ranked as follows: ProTaper > Reciproc > WaveOne > Mtwo; significant differences were observed between all instruments (P 0.05). Differences in toughness were also detected between all instruments tested (P 0.05), except for Reciproc versus WaveOne. Conclusion: The findings from this study revealed that Reciproc and WaveOne displayed similar mechanical behaviour in terms of angular deflection and toughness, typical of ductile metallic materials under torsion. This suggests that both instruments absorb comparable amounts of energy until fracture. Regarding torque, Reciproc exhibited the best results in comparison with WaveOne. Keywords: angular deflection, endodontic instruments, maximum torque, torsional fracture, toughness

The clinician's difficulty in performing the correct diagnosis for some endodontic situations sometimes leads to a compromised treatment of some teeth. Considering this, a consistent knowledge of the root canal morphology and its variations is very important to the success of root canal treatment. This case report presents the retreatment of a mandibular first molar with four root canals, of which three were located in the mesial root. A middle mesial root canal was found between the mesiobuccal and mesiolingual root canals with the use of magnification and ultrasonic tips. The morphological pattern of separate apical terminations of the three mesial root canals, as manifested in this case, is a very rare condition. After 1 year, the tooth revealed adequate clinical function, and radiographic findings showed adequate healing. It can be concluded that the knowledge of the root canal anatomy is important to prevent endodontic failures. Keywords: endodontic retreatment, middle mesial canal, root canal anatomy

The aim of this case report is to present the root canal treatment of a maxillary left lateral incisor fused to a supernumerary tooth associated with incomplete root development. After thorough chemomechanical debridement of the root canal using 3% sodium hypochlorite and 2% chlorhexidine, aqueous-based calcium hydroxide was used as an intracanal dressing. The apical 3-4 mm of the canal were sealed with mineral trioxide aggregate. The 1-year follow-up radiograph revealed successful apical closure and periapical healing. This case report points out that: (i) A careful clinical and radiographic examination is necessary to establish the diagnosis of fusion with a supernumerary tooth or with a normal tooth. (ii) Even in a fused tooth with an open apex and associated with large periapical radiolucency, careful nonsurgical root canal treatment might result in satisfactory periradicular healing. (iii) The single-visit MTA plug method is an alternative to multi-visit apexification in the treatment of immature teeth with open apex. Keywords: developmental anomalies, fusion, gemination, MTA, open apex

A C-shaped root canal configuration is the most common anatomical variation of the root canal system and exists mostly in mandibular second molars, but may be found also in other teeth. The management of C-shaped canals is challenging for clinicians in diagnosis, shaping, cleaning and obturation because of the broad spectrum of canal configurations. This case report presents the diagnosis and treatment of a C-shaped canal in a mandibular first molar and discusses the use of CBCT in cases of unusual root canal anatomy. Keywords: calcium hydroxide, C-shaped canal, mandibular first molar

Introduction: The aim of the study was to evaluate the cytotoxicity, radiopacity, pH, flow and solubility of a silicone-based and an epoxy resin-based endodontic sealer: GuttaFlow 2 and AH Plus, respectively. Methods: Cytotoxicity, radiopacity and flow evaluation were performed following ISO requirements. pH was measured at periods of 3, 24, 72, 168 h. Cytotoxicity was evaluated by MTT assay to check the Balb/c 3T3 cells viability at 1 to 3 week periods. Data were statistically analysed by ANOVA and Tukey test with a significance level of 5%. Results: GuttaFlow 2 was non-cytotoxic in all tested periods. AH Plus was more cytotoxic than GuttaFlow 2 when freshly mixed and after 1 week (P 0.05). After 2 weeks, AH Plus becomes noncytotoxic. Although AH Plus presented higher radiopacity than GuttaFlow 2 (P 0.05), both sealers showed minimum required values. GuttaFlow 2 and AH Plus presented a pH level close to neutral in all tested times. AH Plus also showed significantly lower flow than that of GuttaFlow 2 (P 0.05). Both sealers showed values complying with the solubility minimum requirements. Conclusion: GuttaFlow 2 demonstrated suitable biological and physicochemical properties for an endodontic sealer. Keywords: AH Plus, cytotoxicity, GuttaFlow 2, physicochemical properties, root canal sealer

Introduction: Sensory disturbances of the inferior alveolar and mental nerves are often associated to endodontic-related causes. For their diagnosis and management, a precise history and imaging of the area are required. The aim of this article is to present two cases of successfully treated endodonticrelated mental nerve paraesthesia, in which cone beam computed tomography (CBCT) images aided the precise diagnosis and decision-making for the treatment plan. Case report: In this report, two cases of endodontic-related mental nerve paraesthesia are described. Cone beam computed tomography (CBCT) images supplemented the information obtained from the conventional radiographs and offered superior diagnostic accuracy. In both cases, a non-surgical management of the neurosensory disturbances was decided, including the non-surgical retreatment of a failed root canal treatment and monitoring of the patient in the first case and pharmaceutical coverage and monitoring in the second one. Conclusion: The use of CBCT in cases of endodontic-related neurosensory disturbances is a proven adjunct to the two-dimensional imaging, enabling a more predictable management. Keywords: cone beam CT, mental nerve, paraesthesia, second mandibular premolar