Single Versus Multiple Visits for Endodontic Treatment of Permanent Teeth: A Cochrane Systematic Review
Lara Figini, DDS, Giovanni Lodi, DDS, PhD, Fabio Gorni, MD, Massimo Gagliani, MD
The Cochrane Collaboration promotes evidence-based healthcare decision making globally through systematic reviews of the effects of healthcare intervention. The purpose of this systematic review was to investigate whether the effectiveness and frequency of short-term and long-term complications are different when endodontic procedure is completed in one or multiple visits. Randomized and quasi-randomized controlled trials enrolling patients undergoing endodontic treatment were identified by searching biomedical databases and hand-searching relevant journals. The following outcomes were considered: tooth extraction as a result of endodontic problems and radiologic failure after 1 year, postoperative discomfort, swelling, analgesic use, or sinus track. Twelve studies were included in the review. No detectable difference was found in the effectiveness of root canal treatment in terms of radiologic success between single and multiple visits. Neither single-visit root canal treatment nor multiple-visit root canal treatment can prevent 100% of short-term and long-term complications. Patients undergoing a single visit might experience a slightly higher frequency of swelling and refer significantly more analgesic use.
Terminal Restriction Fragment Length Polymorphism Analysis of the Microflora in Necrotic Teeth of Patients Irradiated in the Head and Neck Region
Geert M.G. Hommez, DDS, PhD, Rita Verhelst, PhD, Mario Vaneechoutte, PhD, Geert Claeys, PhD, Roeland J.G. De Moor, PhD
This study evaluated the microflora in root canals of necrotic teeth after radiotherapy of the head and neck region. The microbial composition of samples taken from necrotic root canals in patients treated with irradiation of the head and neck (group A, n = 13) and in healthy controls (group B, n = 11) was analyzed by terminal restriction fragment-length polymorphism (T-RFLP) analysis. A total of 50 different terminal restriction fragment lengths (T-RFs) (each representing one or more bacterial species) were detected in the T-RFLP profiles, 44 in group A and 28 in group B. A mean of 13.2 T-RFs per sample were detected in group A and 6.6 T-RFs were present per sample for group B (p < 0.05). Twenty-two different T-RFs (mainly subspecies of Lactobacillus spp., Capnocytophaga spp., and Actinomyces spp.) found in group A were not found in group B. In conclusion, the diversity of root canal microflora increases significantly after head-neck radiotherapy.
Radiographic Investigation of Location and Angulation of Curvatures in Human Maxillary Incisors
Brita Willershausen, DDS, PhD, Adrian Kasaj, DDS, Haki Tekyatan, DDS, Bernd Roehrig, DDS, Benjamin Briseno, DDS, PhD
The aim of this radiographic study was to evaluate the degree and location of root canal curvatures of human maxillary incisors. A total of 286 extracted human maxillary incisors (145 central and 141 lateral incisors) were included in this investigation. Exclusion criteria were teeth with extensive carious lesions, restorations, and root canal treatment. For this in vitro study, the teeth were fixed in a special device and digitally x-rayed with the parallel technique. The distances from the cementoenamel junction (CEJ) to the first curvature and the according angle were recorded. The results were analyzed descriptively, and p values were calculated with the Wilcoxon Mann-Whitney test. The mean distance between the CEJ and the first curvature of the central maxillary incisors was 10.4 mm (standard deviation [SD] ± 2.8) and that of the lateral incisors was 11.1 mm (SD ± 3.0). Most of the central incisors (right: 94.2%, left: 98.7%) and all of the lateral incisors exhibited curvatures. Statistically significant differences between central and lateral maxillary incisors could be observed regarding the canal curvature locations (p = 0.016) and the angle values (p < 0.001), but there was no statistical difference between the right and the left side. The results showed the high percentage of root canal curvatures in maxillary incisors with a mean curvature located 10.7 mm apical from the CEJ. These findings are important to minimize failures during post insertion.
The Effect of Mineral Trioxide Aggregate on the Mineralization Ability of Rat Dental Pulp Cells: An In Vitro Study
Yoshiyuki Yasuda, DDS, PhD, Masafumi Ogawa, DDS, PhD, Toshiya Arakawa, PhD, Tomoko Kadowaki, DDS, PhD, Takashi Saito, DDS, PhD
The aim of this study was to investigate the effect of mineral trioxide aggregate (MTA) on cell viability and mineralization ability of rat dental pulp cells. The pulp capping materials, such as MTA, Dycal (Dentsply Caulk, Milford, DE), and Superbond C&B (SB; Sun Medical, Shiga, Japan) were placed on transwell inserts and cultured with rat dental pulp cells. MTA and SB exhibited no cytotoxicity, whereas almost all cells had died after 72 hours of culture with Dycal. MTA significantly stimulated mineralization by 60% compared with the control. MTA and Dycal significantly upregulated by two-fold the level of bone morphogenetic protein (BMP)-2 messenger RNA expression compared with the control. Furthermore, MTA increased BMP-2 protein production by about 40%, whereas Dycal significantly reduced it. Although MTA and Dycal increased the concentration of extracellular calcium by about 0.4 mmol/L, SB had no effect. These results suggest that BMP-2 may play an important role in mineralization stimulated by MTA.
Nicotine Inhibits Mineralization of Human Dental Pulp Cells
Manabu Yanagita, DDS, PhD, Yoichiro Kashiwagi, DDS, Ryohei Kobayashi, DDS, PhD, Miki Tomoeda, DDS, PhD, Yoshio Shimabukuro, DDS, PhD, Shinya Murakami, DDS, PhD
Nicotine is a major component of tobacco smoke, and signals via nicotinic acetylcholine receptors (nAChR). However, little is known about the effects of nicotine on human dental pulp cells (HDPCs). In this study, we assessed the effects of nicotine on mineralization in HDPCs. We confirmed messenger RNA expression of nAChR subunits and examined the effects of nicotine on expression of extracellular matrices (ECMs), alkaline phosphatase (ALP) activity, and mineralized nodule formation by HDPCs. Gene expression of nAChR subunits α1, α2, α4, α5, α6, α7, β1, β2, and β4 was detected in HDPCs. Interestingly, the messenger RNA expression of dentin matrix acidic phosphoprotein-1, bone sialoprotein, and ALP activity were significantly reduced in nicotine-treated HDPC. In addition, mineralized nodule formation, which was examined by alizarin red staining, was also inhibited in HDPCs by the same treatment. These results indicate that nicotine suppresses the cytodifferentiation and mineralization of HDPCs, possibly via nAChR.
The Influence of Mineral Trioxide Aggregate on Adaptive Immune Responses to Endodontic Pathogens in Mice
Taia Maria Berto Rezende, DDS, PhD, Leda Quercia Vieira, PhD, Antônio Paulino Ribeiro Sobrinho, DDS, PhD, Ricardo Reis Oliveira, DDS, Martin A. Taubman, DDS, PhD, Toshihisa Kawai, DDS, PhD
This study assessed the influence of mineral trioxide aggregate (MTA) on adaptive immune responses. BALB/c mice were immunized with heat-killed Fusobacterium nucleatum (Fn) in MTA or other control adjuvants, and serum IgG responses to Fn were measured. Either Fn- or Peptostreptococcus anaerobius (Pa)–reactive memory T cells (Tm) were preincubated in vitro with/without MTA and restimulated with Fn or Pa. Tm proliferation and cytokine production were assessed. Compared with control groups, immunoglobulin G–antibody responses were upregulated in mice immunized with Fn in MTA in a similar manner to animals immunized with Fn in Freund's adjuvant or aluminum hydroxide adjuvant. Although MTA did not affect the upregulated expression of interleukin 10, tumor necrosis factor α, or RANKL by Tm, it suppressed the proliferation of Pa- or Fn-Tm and inhibited their production of Th1- or Th2-signature cytokines. MTA upregulated the adaptive humoral immune responses but had little or no effect on pro- or anti-inflammatory cytokine production by Tm.
The Expression of Macrophage and Neutrophil Elastases in Rat Periradicular Lesions
Taisuke Morimoto, DDS, PhD, Masahiro Yamasaki, DDS, PhD, Kazuhiko Nakata, DDS, PhD, Masahito Tsuji, DDS, PhD, Hiroshi Nakamura, DDS, PhD
Macrophage elastase and neutrophil elastase are involved in tissue destruction in periradicular lesions. The purpose of this study was to examine these elastases immunohistochemically during development of periradicular lesions induced in rat mandibular first molar by pulpal exposure for 7, 14, 21, 28, and 42 days. Histologically, periapical inflammation developed from 7 to 21 days and then subsided after 28 days. The area of these lesions gradually increased from 7 to 28 days and subsequently decreased at 42 days. Macrophage elastase was first detected at 7 days and predominantly shown from 14 to 28 days, whereas neutrophil elastase gradually increased from 14 to 28 days. Macrophage elastase was significantly greater than neutrophil elastase from 7 to 21 days. These results suggest that macrophage elastase was enhanced from an early stage during the development of these lesions and that neutrophil elastase was related to the expansion of periapical tissue destruction including bone resorption.
Differentially Expressed Protein Profile of Human Dental Pulp Cells in the Early Process of Odontoblast-like Differentiation In Vitro
Xi Wei, MDS, PhD, Liping Wu, MS, Junqi Ling, PhD, Lu Liu, MS, Shaojun Liu, MS, Wei Liu, PhD, Mingtao Li, PhD, Yin Xiao, PhD
Dental pulp cells (DPCs) are capable of differentiating into odontoblasts that secrete reparative dentin after pulp injury. The molecular mechanisms governing reparative dentinogenesis are yet to be fully understood. Here we investigated the differential protein profile of human DPCs undergoing odontogenic induction for 7 days. Using two-dimensional differential gel electrophoresis coupled with matrix-assisted laser adsorption ionization time of flight mass spectrometry, 23 protein spots related to the early odontogenic differentiation were identified. These proteins included cytoskeleton proteins, nuclear proteins, cell membrane-bound molecules, proteins involved in matrix synthesis, and metabolic enzymes. The expression of four identified proteins, which were heteronuclear ribonuclear proteins C, annexin VI, collagen type VI, and matrilin-2, was confirmed by Western blot and real-time real-time polymerase chain reaction analyses. This study generated a proteome reference map during odontoblast-like differentiation of human DPCs, which will be valuable to better understand the underlying molecular mechanisms in odontoblast-like differentiation.
In Vitro Cytotoxicity Evaluation of a Self-adhesive, Methacrylate Resin–based Root Canal Sealer
Luigi Pinna, DDS, Martha G. Brackett, DDS, MSD, Petra E. Lockwood, Bradford P. Huffman, Sui Mai, DDS, Elisabetta Cotti, DDS, MS, Claudia Dettori, DDS, David H. Pashley, DMD, PhD, Franklin R. Tay, BDSc (Hons), PhD
This study compared the cytotoxicity of MetaSEAL (Parkell Inc, Farmington, NY), a methacrylate resin-based sealer with an epoxy resin-based (AH Plus Jet; Dentsply Caulk, Milford, DE) and a zinc oxide–eugenol-based sealer (Pulp Canal Sealer; SybronEndo, Orange, CA). Five-millimeter diameter disks prepared from the respective sealer and disks prepared from Teflon (negative control) and polymethyl methacrylate (positive control) were placed in direct contact with a rat osteosarcoma (ROS) 17/2.8 rat osteoblast-like cell line at six intervals after setting completely at 72 hours and for 5 succeeding weeks after the disks were immersed in simulated body fluid. Succinate dehydrogenase activity was evaluated by using 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyl tetrazolium bromide assay. All sealers exhibited severe toxicity at 72 hours, after which toxicity decreased gradually over the experimental period except for Pulp Canal Sealer, which remained severely toxic. MetaSEAL was more toxic than AH Plus Jet during the first week. Both were similar to the toxicity profile of the positive control after the first week, which was probably diffusion controlled.
In Vitro Cytotoxicity Evaluation of a Self-adhesive, Methacrylate Resin–based Root Canal Sealer
Luigi Pinna, DDS, Martha G. Brackett, DDS, MSD, Petra E. Lockwood, Bradford P. Huffman, Sui Mai, DDS, Elisabetta Cotti, DDS, MS, Claudia Dettori, DDS, David H. Pashley, DMD, PhD, Franklin R. Tay, BDSc (Hons), PhD
This study compared the cytotoxicity of MetaSEAL (Parkell Inc, Farmington, NY), a methacrylate resin-based sealer with an epoxy resin-based (AH Plus Jet; Dentsply Caulk, Milford, DE) and a zinc oxide–eugenol-based sealer (Pulp Canal Sealer; SybronEndo, Orange, CA). Five-millimeter diameter disks prepared from the respective sealer and disks prepared from Teflon (negative control) and polymethyl methacrylate (positive control) were placed in direct contact with a rat osteosarcoma (ROS) 17/2.8 rat osteoblast-like cell line at six intervals after setting completely at 72 hours and for 5 succeeding weeks after the disks were immersed in simulated body fluid. Succinate dehydrogenase activity was evaluated by using 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyl tetrazolium bromide assay. All sealers exhibited severe toxicity at 72 hours, after which toxicity decreased gradually over the experimental period except for Pulp Canal Sealer, which remained severely toxic. MetaSEAL was more toxic than AH Plus Jet during the first week. Both were similar to the toxicity profile of the positive control after the first week, which was probably diffusion controlled.
Dye Extraction Results on Bacterial Leakproof Root Fillings
Gustavo De-Deus, DDS, MS, Fernanda Leal, DDS, Juliana Soares, DDS, Aderval S. Luna, PhD, Criatiana Murad, DDS, MS, Sandra Fidel, DDS, MS, PhD, Rivail Antonio Sergio Fidel, DDS, MS, PhD
This study was designed to assess and compare the sensitivity and sealability results between bacterial leakage and dye extraction. Eighty mandibular incisors were prepared, and their roots were filled as follows (n = 20): G1, lateral condensation; G2, System B; and G3, Thermafil system. All teeth were mounted in a 2-chamber apparatus, and the coronal access was exposed to human saliva for 100 days. The remaining bacterial leakproof specimens were randomly assigned to create 3 new and equal groups (n = 10). These bacterial leakproof specimens were submitted to a dye extraction setup. Each specimen was placed into a plastic vial with 5 mL of 2% methylene blue for 48 hours. After storage, the specimens were rinsed with tap water and dissolved in nitric acid. A sample of 100 μL of the supernatant from each specimen was analyzed in a UV-Visible spectrophotometer to determine the amount of methylene blue leakage. The log-rank test showed no significant difference in the bacterial leakage pattern among the groups (P > .05). In the dye extraction analysis, Kruskal-Wallis H test was unable to detect significant differences among all experimental groups (P > .05). The 3 filling techniques displayed similar leakage for both leakage models. Moreover, the present study demonstrated that all bacterial leakproof specimens leaked when submitted to the blue methylene extraction model.
The Development of Carbonate-containing Apatite/Collagen Composite for Osteoconductive Apical Barrier Material
Yoshihiro Takenaka, PhD, Mayumi Iijima, PhD, Satoshi Kawano, PhD, Yasumitsu Akita, PhD, Takakazu Yoshida, PhD, Yutaka Doi, PhD, Ichiro Sekine, PhD
The current report describes the properties of a new apical barrier material formulated from carbonate-containing apatite (CAp) and collagen. CAp particles of around 50 nm were deposited on reconstituted collagen fibers. CAp/col with about 60 wt % CAp (corresponding to apatite content of bone) was obtained after 1 day of calcification. CAp content increased up to about 80 wt % in a 15-day calcification reaction. CAp/col was composed of fine calcified collagen fibers. The crystallinity and Ca/PO4 ratio of CAp were comparable to those of bone apatite. The mixture of CAp/col and saline reached a pH of about 9. The optimum powder-to-liquid ratio (P/L) to set into a root canal was determined to be 1.2. Furthermore, the mixture (P/L = 1.2) condensed in a root canal was liquid permeable. Thus, the CAp/col was expected as an apical barrier material with osteoconductivity.
Differences in Aluminum Equivalent Values of Endodontic Sealers: Conventional Versus Digital Radiography
B. Guniz Baksi, DDS, PhD, B. Hakan Sen, DDS, PhD, Tan Firat Eyuboglu, DDS
The aims of this study were to compare film and digital radiography in assessing the radiopacities of root canal sealers and to establish the relation in aluminum equivalent values of different methods. Standard disks of 5 different sealers were exposed together with an aluminum step wedge by using occlusal films and storage phosphor plates. Optical density of the sealers was evaluated by transmission densitometry, and mean gray values were determined by digital analysis. The data were analyzed by using two-way analysis of variance (P = .05). Pairwise comparisons were made by using Tukey post hoc and paired t tests (P = .05). The order from the most radiopaque to the most radiolucent sealer was the same for both methods; however, aluminum equivalent values determined by transmission densitometry were significantly higher (P < .01). Aluminum equivalent values of the 2 radiographic methods were 7%–20% different. The International Standards Organization standard for the radiopacity of dental root canal sealing materials needs modifications for digital systems.
An Ex Vivo Evaluation of a Gutta-Percha Filling Technique When Used with Two Endodontic Sealers: Analysis of the Filling of Main and Lateral Canals
Mauro Venturi, MD, DDS
The aim of this study was to evaluate both the precision of filling and the extension of voids in main root canals as well as filling of lateral canals after using a two-phase filling technique with two sealers. Twenty-four maxillary and 26 mandibular molars were selected and randomly assigned to two groups. Root canals were instrumented and then filled using the vertical compaction with the apical backfilling technique, with Pulp Canal Sealer (EWT) in group “A” and AH Plus in group “B.” After clearing, voids within the filled main canals were measured by using a stereomicroscope. In addition, visible lateral canals were counted, each unfilled space was measured, and five ratings (0–4) were fixed. In both groups, in the most apical 4 mm of main canals, where gutta-percha was cold compacted, lesser voids (p ≤ 0.05) were found than in the middle-coronal thirds backfilled with thermomechanical compaction. In group “B,” more precision (p ≤ 0.05) and lesser voids (p ≤ 0.05) were found than in group “A.” Regarding lateral canals, better filling scores (p ≤ 0.05) were found in group “B” than in group “A.” In both groups, better filling scores (p ≤ 0.05) were found at the coronal levels than at the middle ones and at the middle levels than at the apical ones.
A Comparison of Five Radiographic Systems to D-Speed Film in the Detection of Artificial Bone Lesions
David L. Hadley, DDS, Karan J. Replogle, DDS, MS, John C. Kirkam, MD, Al M. Best, PhD
The purpose of this study was to compare three direct digital sensors (Kodak 6100 [Rochester, NY], Schick CDR [Long Island City, NY], and Dexis PerfectSize [Alpharetta, GA]), a phosphor plate system (OpTime; Milwaukee, WI), and F-speed film to standard D-speed film in the detection of artificial bone lesions prepared in mandible bone sections. Artificial bone lesions were prepared at varying depths in the cortical bone. Radiographs were randomly presented to nine different observers. Logistic regression analysis indicated significant differences in lesion detection among the radiographic systems at the mean percentage of cortical bone remaining. The Kodak filtered, Schick filtered, OpTime unfiltered, Schick unfiltered, and Dexis filtered images were significantly better at lesion detection compared with D-speed film.
Kinetics of Conversion of Two Dual-cured Adhesive Systems
André Luis Faria-e-Silva, DDS, MS, PhD, Denise Sá Maia Casselli, DDS, MS, PhD, Giana Silveira Lima, DDS, MS, PhD, Fabrício Aulo Ogliari, DDS, MS, PhD†, Evandro Piva, DDS, MS, PhD, Luis Roberto Marcondes Martins, DDS, MS, PhD
The aim of this study was to evaluate the kinetics of conversion of Scotchbond Multi-purpose Plus (3M ESPE, St Paul, MN) and Prime&Bond NT (Dentsply De Trey, Konstanz, Germany) used in light-cured, self-cured, or dual-cured versions. The adhesive systems were used in the light-cured version (without the use of chemical initiator) or mixed with its respective chemical initiator either with light activation (dual-cured) or not (self-cured). The degree of conversion (DC) was monitored as a function of time during 5 minutes with a Fourier transform infrared spectrometer equipped with an attenuated total reflectance device. Light-cured and dual-cured modes of Scotchbond Multi-purpose Plus presented the highest DC at 5 minutes. The addition of the self-cure activator (dual-cured mode) to Prime&Bond NT reduced the DC. For the self-cured versions, only the Scotchbond Multi-purpose Plus presented any polymerization reaction at 5 minutes. For the two bonding systems tested, it appears that light curing of the adhesive is important in order to reach a high DC in the first moments after the bonding procedure.
Augmenting the Antibiofilm Efficacy of Advanced Noninvasive Light Activated Disinfection with Emulsified Oxidizer and Oxygen Carrier
Saji George, PhD, Anil Kishen, MDS, PhD
In this study, we tested the hypothesis that the inclusion of an oxidizer and oxygen carrier in the photosensitization formulation would facilitate comprehensive disinfection of matured endodontic biofilm by light-activated disinfection (LAD). Photosensitizing formulations containing methylene blue (MB) and an oxygen carrier alone (perfluorodecahydronaphthalene) (PF1) or in combination with oxidizer (H2O2) (PF2) or their emulsions formed with triton-X100 (Bio-Rad Laboratories, Hercules, CA) in different proportions (PF3 and PF4) were tested for photochemical properties and damage to the biofilm structure using confocal laser scanning microscopy. Conventional chemomechanical preparation, LAD using MB in water, and LAD using MB in emulsion (PF4) were also conducted on 10-week-old Enterococcus faecalis biofilm within root canals. MB in emulsion (PF4) was overall the most effective photosensitizer formulation for photooxidation, generation of singlet oxygen (p = 0.001), and in disinfecting biofilm bacteria. Advanced noninvasive LAD using a photosensitizer formulation containing oxidizer and oxygen carrier disrupted the biofilm matrix and facilitated comprehensive inactivation of biofilm bacteria. This modified photosensitizer formulation will have potential advantages in endodontic disinfection.
Apical Actinomycosis as a Continuum of Intraradicular and Extraradicular Infection: Case Report and Critical Review on Its Involvement with Treatment Failure
Domenico Ricucci, MD, DDS, José F. Siqueira Jr, DDS, MSc, PhD
This article reports a case of extraradicular actinomycosis that clearly formed a continuum with the intraradicular infection. Histobacteriologic and histopathologic analyses of the root tip and attached apical periodontitis lesion obtained by surgery from a tooth with persistent disease were performed to look for the possible reasons for persistent disease. Although no stainable bacteria were observed in the apparently well-treated main canal, apical ramifications were clogged with dense bacterial biofilms that were contiguous to extraradicular actinomycotic aggregates. A critical review of the literature revealed that there is no clear evidence that apical actinomycosis is indeed an independent entity leading to persistent apical periodontitis lesions.
Mineral Trioxide Aggregate as Repair Material for Furcal Perforation: Case Series
Riccardo Pace, MD, DMD, Valentina Giuliani, DMD, Gabriella Pagavino, MD, DMD
The purpose of treating furcal perforation is to seal the artificial communication between the endodontic space and the periradicular tissue to prevent alveolar bone resorption and damage to the periodontal ligament. These complications are not infrequent in cases of furcal and/or old perforations, which show a worse prognosis than fresh, small, coronal, and apical perforations. Mineral trioxide aggregate (MTA) is widely used to seal perforations because of its biocompatibility and sealability. Ten cases of furcal perforation were selected at the department of Endodontics, University of Florence. All the perforations were cleaned with NaOCl, EDTA, and ultrasonic tips and sealed with MTA without internal matrix. Finally, the teeth were endodontically treated and coronally restored. Clinical and radiographic follow-ups were done at 6 months, 1 year, 2 years, and 5 years. After 5 years, the absence of periradicular radiolucent lesions, pain. and swelling along with functional tooth stability indicated a successful outcome of sealing perforations in 9 out of 10 teeth. One patient dropped out of the study after the 1-year follow-up and could not be contacted for further recalls. The results confirm that MTA without matrix provides an effective seal of root perforations and clinical healing of the surrounding periodontal tissue.
Comprehensive Treatment of the Infected Maxillary Lateral Incisor with an Accessory Root
Muhammed Selim Yavuz, PhD, DDS, Ali Keleş, DDS, Mehmet Özgöz, PhD, DDS, Fuat Ahmetoğlu, DDS
Rare anatomic anomalies may occur in the dentition and can affect treatment decisions and prognosis. Accurate diagnosis and therapy performed at the highest level can result in predictable success in these cases. This case report shows the clinical and radiographic findings and successful treatment (nonsurgical and surgical) of a combined apical and marginal periodontal inflammatory lesion of a maxillary lateral incisor with an accessory root.
Management of Dens Invaginatus Diagnosed by Spiral Computed Tomography: A Case Report
Y. Pallavi Reddy, BDS, Kumaraguru Karpagavinayagam, MDS, C.V. Subbarao, MDS
A thorough knowledge of the normal anatomy of the root canal system as well as the possible aberrancies is imperative for success of endodontic therapy. The challenge lies in diagnosing these conditions properly, complete debridement of the root canal system, and 3-dimensional sealing of the same. Conventional diagnostic aids like radiographs play an important role in assessment of complex root canal morphologies. These modalities, however, do not provide detailed information of the complexity as a result of their inherent limitations. This calls for use of more advanced imaging modalities such as spiral computed tomography, which can help the clinician in making a more accurate diagnosis. This report discusses the usefulness of spiral computed tomography in accurate diagnosis of a case of dens invaginatus and its successful management.