ENDO, 03/2014

Introduction: To assess the incidence and configuration of the second mesiobuccal (MB2) canal in maxillary first and second molars in an adult sub-population in London from cone beam computed tomography (CBCT) scans. Materials and methods: CBCT scans from the adult patient record database at a dental teaching hospital were selected and viewed using 3D viewing software. Each tooth was assessed, in 1 mm axial and 0.5 mm sagittal sections, to determine the presence of a MB2 canal and then categorised according to Weine's classification. Results: A total of 110 CBCT scans of 323 teeth (172 maxillary first molars and 151 maxillary second molars) from 57 male and 53 female patients were assessed. A MB2 canal was found in 60.5% of maxillary first molars but only 41.7% of maxillary second molars; when present, the most common configuration was two separate and distinct canals (Weine Type III) at 46.2% for maxillary first molars and 43.8% for maxillary second molars. Two separate canals merging to form one canal at the apex (Weine Type II) were found in 39.4% of maxillary first molars and 28.1% of maxillary second molars; whilst 14.4% of maxillary first molars and 26.6% of maxillary second molars had two or more canals at the apex (Weine Type IV). Conclusions: The high incidence of a MB2 canal in maxillary first and second molars was re-confirmed in this study and clinical strategies are needed to manage, especially, the most challenging Weine Type IV variety. CBCT has again proven to be an excellent imaging tool and useful for assessing complex root canal morphology. Keywords: cone beam computed tomography, maxillary first molar, maxillary second molar, root canal morphology, second mesiobuccal canal

Numerous case reports emphasise the importance of thorough knowledge of the anatomic morphology in the maxillary molars for the success of root canal treatment. The aim of this paper was to present a case of a maxillary second molar with four roots (two palatal roots) and four distinct canals requiring root canal therapy. Root canal treatment was performed using nickel-titanium rotary files. In addition, the role of cone beam computed tomography as an objective tool for confirmatory diagnosis and successful treatment is demonstrated. Properly prepared access cavity and cone beam computed tomography (CBCT) scanning revealed unusual root morphology and led to a favourable outcome for root canal treatment. A thorough knowledge of possible variations in internal anatomy of human teeth is important for successful root canal treatment. Keywords: anatomical variations, cone beam computed tomography, maxillary molars, root anatomy

The aim of this study was to ascertain whether applying a 1% sodium fluorescein (SF) solution to the pulp chamber floor of human molars, together with a cobalt blue filter coupled to a dental operating microscope (DOM), could improve the location of root canals, compared to detection with the naked eye or with the DOM alone. Methods: Forty maxillary first molars were studied. The pulp chambers of the teeth were sequentially inspected by three endodontists in three different ways: (i) without use of a DOM and with only standard dental light for illumination; (ii) with use of a DOM (12.5×); and (iii) by application of 1% SF and canal location using a cobalt blue filter coupled to a DOM. The interclass correlation coefficient was used to assess interexaminer agreement. Kendall's W test, complemented by Wilcoxon's signed rank test, (P 0.05) was used to conduct the statistical analysis. Results: A good level of agreement among examiners was found (interclass correlation coefficient ICC: 0.87 to 0.89). The mean number of canals located in the third inspection was 3.93, a significantly greater number than that observed in the first and second inspections, i.e. 3.68 and 3.70, respectively. Conclusions: A 1% SF solution used in conjunction with a cobalt blue filter coupled to an operating microscope enabled the location of a greater number of canals in maxillary first molars. Keywords: dental pulp cavity, fluorescein, fluorescence, microscopy, molar

Aim: The aim of this study was to evaluate the efficacy of crude propolis as a direct pulp-capping agent in both primary and immature permanent teeth. Materials and methods: Eighty-nine asymptomatic molars with pulp exposure were treated by direct pulp capping using Syrian crude propolis. Forty-seven of them were primary molars and forty-two were immature permanent molars. The children were between 5 and 8 years old. The teeth were controlled clinically and radiographically after three observation intervals (1, 6 and 12 months). Coronal restoration has been done with posterior resin composite using light cured glass ionomer cement as a liner. All cases were randomised according to the Consolidated Standards of Reporting Trails (CONSORT). Teeth were evaluated clinically and radiographically, and statistical analyses were performed using the Friedman test. Results: After 12 months, the success rate was 87.23% in primary teeth and 100% in permanent teeth. Conclusion: The Syrian crude propolis seems to be an effective direct pulp-capping agent in immature permanent teeth. Keywords: direct pulp capping, immature permanent teeth, primary teeth, propolis

There is a paucity of experimental information and clinical data that address the nature of the periapical tissue response following root-end surgery and subsequent orthodontic tooth movement. This case report will address the tissue responses seen in a case with long-term follow-up, and highlight the potential factors that may influence a variable healing response when these procedures are performed sequentially. Keywords: orthodontic tooth movement, periapical healing, root-end surgery

From a technical point of view, root canal treatment of invaginated teeth is not an easy task due to the complexity of their canal morphology. In this article, three cases are reported, for which two different treatment approaches were applied. One case was treated following the conventional approach, whereas the other two were treated applying the conventional approach together with endodontic surgery. Follow-up examinations showed successful clinical and radiographic results in the three cases mentioned in this article. Keywords: cone beam computed tomography, dens invaginatus, endodontic surgery, maxillary lateral incisor, non-surgical root canal treatment, operative microscope

This article deals with a root canal treatment of a case of fusion between a third molar and a distomolar. Furthermore, since there was also communication between the two parts of the pulp chambers and the root canal systems, such a treatment had to be performed on both parts of the involved teeth. Keywords: CBCT, distomolar, fusion, nonsurgical root canal treatment, operative microscope