Adhesive Dentistry and Endodontics. Part 2: Bonding in the Root Canal System—The Promise and the Problems: A Review
Richard S. Schwartz, DDS
One of the recent trends in endodontics has been the development of bonded obturating materials, in an effort to provide a more effective seal coronally and apically. Materials utilizing dentin adhesive technology have been borrowed from restorative dentistry and adapted to obturating materials. This review discusses the obstacles to effective bonding in the root canal system, the progress that has been made, and possible strategies for improved materials in the future. Much of the literature reviewed and many of the principles discussed are taken from the restorative dentistry literature and applied to the unique environment of the root canal system.
Prevalence of Selected Bacterial Named Species and Uncultivated Phylotypes in Endodontic Abscesses From Two Geographic Locations
Isabela N. Rôças, DDS, PhD, J. Craig Baumgartner, DDS, PhD, Tian Xia, DDS, José F. Siqueira Jr, DDS, PhD
Evidence is mounting that the prevalence of some putative endodontic pathogens can significantly vary according to the geographic location in which samples were taken. This study aimed to provide additional knowledge on this subject by comparing the frequencies of 10 selected candidate endodontic pathogens in samples of acute apical abscesses obtained from two distinct geographic locations; Portland, OR, and Rio de Janeiro, Brazil. DNA was extracted from aspirates and used as template in nested PCR assays using 16S rRNA gene taxon-specific oligonucleotide primers. Of the target species/phylotypes, Treponema denticola (73% of the cases), Porphyromonas endodontalis (70%), and Tannerella forsythia (57%) were the most prevalent taxa found in Brazilian samples. Dialister invisus (70% of the cases), P. endodontalis (63%) and Dialister pneumosintes (55%) were the most frequent taxa in the Portland, OR samples. Data analysis revealed that T. denticola and T. forsythia were significantly more detected in Brazilian samples than in the Portland, OR samples. Although D. invisus, Filifactor alocis, and Synergistes oral clone W090 were detected in many more samples from the Portland, OR patients, differences were not found to be statistically significant. These findings confirmed that some bacterial taxa can markedly differ in the frequencies they occur in samples from different locations. It remains to be clarified whether this observation translates into relevant therapeutic implications.
Separation Incidence of Protaper Rotary Instruments: A Large Cohort Clinical Evaluation
Susan Wolcott, DDS, James Wolcott, DDS, David Ishley, DDS, MS, Wade Kennedy, DMD, Scott Johnson, DMD, MS, Scott Minnich, DDS, John Meyers, DDS
Separation is a potential risk when using any instrument in the root canal system. Presently, there are no large clinical studies investigating the separation incidence of the ProTaper rotary file system or the number of times a ProTaper rotary file can be safely used. The purpose of this study was to determine if the number of uses affects the separation incidence of ProTaper rotary instruments. 4652 consecutively treated root canals were performed in an endodontic group practice over a 17-month period. Both the separation incidence and the number of uses were tracked for each file. The overall rate of instrument fracture in this study was 2.4% with no significant differences over the first four uses. The results of this study indicate that ProTaper rotary files may be safely reused at least four times. The size of the rotary file, among other factors, will determine how many times a particular file should be used.
Effect of Calcium Hydroxide-Treated Prevotella nigrescens on the Gene Expression of Matrix Metalloproteinase and Its Inhibitor in MG63 Cells
Won-Kyung Yang, DDS, MSD, Mi-Ri Kim, DDS, PhD, YoungKyoo Lee, DDs, PhD, Ho-Hyun Son, DDS, PhD, WooCheol Lee, DDS, PhD
The purpose of this study was to monitor the expression of matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) produced by an osteoblastic cell line MG63 stimulated with Prevotella nigrescens lipopolysaccharides (LPS), and to compare the level of secretion before and after the P. nigrescens LPS was treated with calcium hydroxide [Ca(OH)2]. The underlying hypothesis is that the balance between MMP and TIMP secretion is the key to an understanding of the host degradative pathways involved in the pathogenesis of bacterial derived pulpal and periapical diseases. Confluent monolayers of MG63 human osteosarcoma cells were exposed to varying concentrations of P. nigrescens or Escherichia coli LPS. Alternately, confluent cultures were exposed to 10 μg/ml of bacterial LPS pretreated with Ca(OH)2 (12.5 mg/ml) for 72 hours. At the end of the experimental period, total RNA was extracted and real-time quantitative polymerase chain reaction (PCR) was performed for MMP-1, TIMP-1, and glyceraldehyde-3-phosphate dehydrogenase (GAPDH). The results showed that the expression of MMP-1 mRNA was low and invariant for the experimental period in the negative controls. However, exposure to P. nigrescens LPS increased expression after 48 hours. Expression of TIMP-1 mRNA was highly increased at 24 and 48 hours with lower concentrations of LPS in contrast to a suppression with a concentration of 10 μg/ml. Treatment of P. nigrescens LPS with Ca(OH)2 resulted in a down-regulation of MMP-1, whereas pretreated E. coli LPS demonstrated no stimulatory activity for MMP-1 gene expression. Both types of LPS when pretreated with Ca(OH)2 induced slightly up-regulated expression of TIMP-1.
An Analysis of Current Analgesic Preferences for Endodontic Pain Management
André K. Mickel, DDS, MSD, Andrew P. Wright, DDS, Sami Chogle, BDS, DDS, MSD, Jefferson J. Jones, DDS, Igor Kantorovich, DDS, MSD, Francis Curd, DDS
A descriptive, cross sectional survey was developed to determine the preferences of endodontists when prescribing analgesics. Eleven clinical scenarios describing common endodontic diagnoses or procedures with specified severity of pain were provided. A survey was sent to 310 AAE members and 63 responded, providing a 20% response rate. Respondents were given various choices for analgesic prescription including various dosages of ibuprofen or acetaminophen (APAP), or combination narcotic medications. Data were analyzed by χ2 tests. Non-narcotics were preferred over narcotics for all clinical situations. Significantly more respondents selected ibuprofen 600 mg (4× a day) regardless of the severity of preoperative or postoperative pain (p < 0.001). Educators and board-certified AAE members were less likely than nonboard certified AAE members to manage their patient’s perceived severe pain with narcotic analgesics.
C-shaped Canal System in Mandibular Second Molars Part III: The Morphology of the Pulp Chamber Floor
Yi Min, DDS, MS, PhD, Bing Fan, DDS, MS, PhD, Gary S.P. Cheung, DDS, MDS, James L. Gutmann, DDS, FACD, FICD, Mingwen Fan, DDS
The purpose of this study was to investigate the morphology of pulp chamber floors in mandibular second molars with a C-shaped canal system. Forty-four extracted mandibular second molars with C-shaped roots were collected from a native Chinese population. After the teeth were scanned by the micro-computed tomography (μCT), the pulp chamber floors were reconstructed three-dimensionally using three-dimensional software. The reconstructed images were classified into four types based on the shape of the pulp chamber floor and the location of the dentin fusion between the peninsular-like floor and the pulp chamber wall. Of the 44 reconstructed pulpal floors, 38 (86.37%) were C-shaped (peninsula-like floor) in which 8 (18.18%) had a continuous C-shaped orifice (type I); 16 (36.37%) had a dentin fusion between the peninsula-like floor and buccal pulp chamber wall, forming one or two mesial orifice(s) and a distal orifice (type II); and 14 (31.82%) had a dentin fusion between the peninsula-like floor and the mesial pulp chamber wall, forming a large mesiobuccal-distal (MB-D) orifice and a small mesiolingual orifice (type III). Six (13.63%) teeth did not have a C-shaped floor configuration (type IV). The number and configuration of the canals at different levels below the orifices were analyzed. The results suggested that most teeth in this study with C-shaped roots also have a C-shaped pulpal floor and that a new classification of pulpal floor anatomy would be helpful in locating the C-shaped canals.
A Demographic Analysis of Vertical Root Fractures
Stephen Cohen, MA, DDS, Louis H. Berman, DDS, Lucia Blanco, DDS, Leif Bakland, DDS, Jay S. Kim, PhD
Teeth with vertical root fractures (VRFs) have complete or incomplete fractures that extends through the enamel, dentin and pulp, down the long axis of the tooth. Several different variables were investigated and statistically evaluated as to their correlation with the presence of VRFs. Specifically analyzed were gender, tooth location, age, radiographic and clinical findings, bruxism, and pulpal status. The data were collected from three different endodontists, from three different geographic locations, comprising a total of 227 teeth. Although VRFs may occur in conjunction with any of the parameters investigated, only certain factors were found to occur in a significant number of cases. The results indicate that VRFs are statistically more prevalent in mandibular molars and maxillary premolars. They are associated with periradicular bone loss, pain to percussion, extensive restorations, and seem to occur more often in females and older patients. However, VRFs are not necessarily related to periapical bone loss, a widening of the periodontal ligament space, associated periodontal pockets, a sinus tract, particular pulpal status, or bruxism.
Immunoelectron Microscopic Analysis of CD11c-Positive Dendritic Cells in the Periapical Region of the Periodontal Ligament of Rat Molars
Liying Zhao, DDS, MS, Tomoatsu Kaneko, DDS, PhD, Takashi Okiji, DDS, PhD, Minoru Takagi, DDS, PhD†, Hideaki Suda, DDS, PhD
To increase understanding of structural and phenotypic characteristics of dendritic cells (DCs) in the periapical region of the periodontal ligament (PDL) of rat molars, we performed immunoelectron microscopy for CD11c, a previously untested DC marker. Results demonstrated that CD11c clearly recognized DCs, although it also labeled certain macrophage subpopulation(s). In the normal PDL, resident DCs that extended several long cytoplasmic processes from their oval to slender cell body were identified. When the PDL was bacterially challenged by three days of unsealed pulp exposure, relatively small, irregularly shaped DCs with many thin and short cytoplasmic processes, most likely representing newly recruited DCs, were detected. The ratio of DCs in CD11c+ cells was significantly higher than that in ED1 (anti-macrophages and DCs)-positive and OX6 (anti-major histocompatibility complex class II molecules)-positive cells in normal and challenged PDL.
Evaluation of Microleakage of Roots Filled With Different Techniques With a Computerized Fluid Filtration Technique
Burak Sagsen, DDS, PhD, Ozgür Er, DDS, PhD, Yasemin Kahraman, Hasan Orucoglu, DDS, PhD
The aim of this study was to compare the apical leakage of roots filled with different materials using a computerized fluid filtration technique. There were 36 freshly extracted human maxillary central incisors selected. After preparation and irrigation, 3 experimental groups of 10 roots were constituted. Ten roots were filled with AH Plus and gutta-percha, 10 roots were filled with Sealapex and gutta-percha, and 10 roots were filled with Epiphany sealer and Resilon cone using a single cone technique. Three roots were used as a positive control and three roots were used as a negative control group. Evaluation of the apical leakages was performed with a computerized fluid filtration technique. According to the results, the difference between group 3 and 1 and group 3 and 2 was statistically significant (p < 0.05). Although group 2 leaked the most, there was no significant difference between group 1 and 2.
Variability of the Diameter and Taper of Size #30, 0.04 Nickel-Titanium Rotary Files
John T. Lask, DDS, Mary P. Walker, DDS, PhD, James C. Kulild, DDS, MS, Kevin P. Cunningham, DDS, Peter A. Shull, PhD
This investigation examined the variability of tip diameter (D0) and taper measurements among four different brands of #30, 0.04 nickel-titanium (NiTi) rotary files (n = 15/brand). With all brands, the mean percent D0 difference from the manufacturer’s reported (nominal) diameter (Profile GT, 1.73 ± 2.03%; Endo Sequence, 3.38 ± 3.91%; K3, 4.56 ± 2.36%; Profile, 6.13 ± 4.07%) indicated that files tended to be larger than the nominal diameter. A 1-factor ANOVA and Tukey’s post hoc test revealed a statistically significant difference (p ≤ 0.05) between Profile GT (smallest difference from nominal) and Profile (largest difference). The ANOVA also indicated no significant effect (p > 0.05) of brand on the mean percent difference of the measured taper compared to the nominal taper with the majority of measurements at either 0.039 or 0.040 taper.
Immediate and 24-Hour Evaluation of the Interfacial Strengths of Fiber Posts
Fernanda Tranchesi Sadek, PhD, Cecilia Goracci, PhD, Francesca Monticelli, PhD, Simone Grandini, PhD, Álvaro Hafiz Cury, DDS, Franklin Tay, BDSc (Hons), PhD, Marco Ferrari, PhD
This study examined the contribution of testing time on the interfacial strengths of fiber posts to radicular dentin. Twenty-five fiber posts were luted to root segments with resin cements and a zinc phosphate cement. Immediately upon setting of the materials, the roots were sectioned into slices and randomly divided into two subgroups, depending on testing time (immediate vs. 24-hours), for push-out test. The results showed an improvement on the interfacial strength after 24 hours of storage. When data were pooled for each cement, the interfacial strengths (MPa) were: Optibond Solo Plus/Nexus: 10.3 ± 3.8a; zinc phosphate cement: 10.1 ± 2.7a; Multilink: 9.6 ± 3.8ab; RelyX Unicem: 7.1 ± 4.9bc; AllBond 2/Duolink: 6.7 ± 3.5c (groups with same superscript letter were not statistically significant). It is concluded that bond strength can increase during the first 24 hours and that the interfacial strength is predominantly contributed by frictional retention.
Electric Pulp Tester Conductance Through Various Interface Media
André K. Mickel, DDS, MSD, Kimberly A.D. Lindquist, DDS, MSD, Sami Chogle, BDS, DDS, MSD, Jefferson J. Jones, DMD, Francis Curd, DDS
A conducting media is necessary when using an electric pulp tester (EPT). The objective of this study was to observe differences in conductance through various media. We hypothesized that variations in current conductance through different media exist. The pulp chamber of a freshly extracted premolar was exposed, and the cathode of a voltmeter was inserted into the pulpal tissue. The anode was coupled to the EPT handpiece. The measurement taken during dry (no interface media) EPT tip-to-tooth contact was 0 V, which served as negative control. EPT tip directly touching the cathode measured 3.9V and served as positive control. A number of media readily available in the dental office were tested. Data was analyzed using single factor ANOVA. Listerine (3.3) conducted the most voltage (p < 0.5). Of nonliquids, K-Y Brand UltraGel and Crest Baking Soda & Peroxide Whitening Tartar Control toothpaste recorded significantly (p < 0.05) higher voltage readings (1.4 V).
Efficacy of a New Brush-Covered Irrigation Needle in Removing Root Canal Debris: A Scanning Electron Microscopic Study
Solaiman M. Al-Hadlaq, BDS, MS, PhD, Sami A. Al-Turaiki, BDS, Uthman Al-Sulami, BDS, Abdulhamied Y. Saad, BDS, HDD, PhD
The usefulness of NaviTip FX, a brush-covered irrigation needle, in endodontic therapy has never been reported. Therefore, the purpose of this investigation was to evaluate the cleaning efficacy of this new brush-covered irrigation needle, the NaviTip FX. Thirty single-rooted teeth were randomly divided into two equal groups and instrumented using the crown-down technique with 0.04 taper ProFile. Following each file use, the canals were irrigated with 1 ml of 5.25% NaOCl using the NaviTip FX needle for group 1 or using the same needle without the brush for group 2. At the end of instrumentation, the roots were cut longitudinally and each half was divided into three equal parts. The specimens were then routinely prepared for scanning electron microscopic evaluation. The results showed that using the NaviTip FX produced cleaner coronal thirds of instrumented root canals compared to the control group. On the other hand, the middle and apical thirds were not statistically significantly different between the two groups. Further development of this irrigation technique to improve cleanliness of the apical and middle thirds is required before the NaviTip FX can be recommended for routine use during root canal therapy.
The Antimicrobial Effect of Chloroform on Enterococcus faecalis After Gutta-Percha Removal
Scott W. Edgar, DMD, J. Gordon Marshall, DMD, J. Craig Baumgartner, DDS, PhD
The purpose of this in vitro study was to evaluate the antimicrobial effectiveness of chloroform on Enterococcus faecalis when used as a gutta-percha solvent during endodontic retreatment. Bilaterally matched human teeth were instrumented, infected with E. faecalis, and obturated. The gutta-percha was then removed using either chloroform or saline. Bacterial samples were collected after gutta-percha removal and following additional apical enlargement. A significant difference was seen (p < 0.05) between the number of colony forming units (CFU) of E. faecalis for teeth retreated using chloroform (mean 21 + 56 CFU/ml) versus saline (mean 280 + 480 CFU/ml). Negative cultures were obtained in 11 of 17 chloroform samples and none of the saline samples. Samples taken after apical enlargement two sizes larger than the original master apical file showed a significant difference (p < 0.05) between teeth retreated using chloroform versus saline. Negative cultures were seen in 9 of 17 chloroform samples and 1 of 17 saline samples. This study demonstrated that the use of chloroform during endodontic retreatment significantly reduced intracanal levels of cultivatable E. faecalis.
Comparison of Seal After Obturation Techniques Using a Polydimethylsiloxane-Based Root Canal Sealer
Martha G. Brackett, DDS, Rebecca Martin, BS, Jeremy Sword, BS, Cindy Oxford, BS, Frederick A. Rueggeberg, DDS, MS, Franklin R. Tay, BDSc (Hons), PhD, David H. Pashley, DMD, PhD
A polydimethylsiloxane-based sealer (GuttaFlow) was used for filling single-rooted teeth with four obturation techniques. Prefitted gutta-percha master-cones were employed in groups 1 to 3 with backfilling of the sealer. Apical third of the roots were first filled with GuttaFlow, and sealer-coated master cones were seated with up-and-down motion (group 1) or rotated to place (group 2). Master-cones were used as carriers for introducing GuttaFlow into the canals (group 3). Canals were filled with GuttaFlow without master-cones (group 4). Canals were filled with AH Plus/gutta-percha using warm vertical compaction (control group 5). All obturated canals were tested for leakage after 1, 6, and 12 weeks using the fluid filtration technique. All groups exhibited equivalent seal regardless of time except for more extensive leakage in group 3. The use of GuttaFlow with a single gutta-percha master cone creates an apical seal that is equivalent to that produced with gutta-percha/AH Plus sealer using warm vertical compaction.
Vickers Hardness Investigation of Work-Hardening in Used NiTi Rotary Instruments
Satish B. Alapati, BDS, MS, William A. Brantley, PhD, John M. Nusstein, DDS, MS, Glenn S. Daehn, PhD, Timothy A. Svec, DDS, MS, MS, John M. Powers, PhD, William M. Johnston, PhD, Wenhua Guo, PhD
A contributing mechanism for clinical failure of NiTi rotary instruments might be excessive work hardening. Vickers hardness was measured with 300 gm load near the flutes in three regions (D2–D4, D6–D10, and D14 towards the shank) for nine representative clinically used ProFile GT instruments that had been axially sectioned (10 measurements in each region). Consistent values could not be obtained at D1. Minimum hardness occurred at D2 to D4, with means from 313 to 324 (SD from 7 to 16). Maximum hardness with means ranging widely from 330 to 481 was found beyond D14. Mean hardness at D2 to D4 was 320 for an as-received ProFile instrument. Because a mean Vickers hardness of 326 has been reported for a shape-memory NiTi orthodontic wire product, it can be concluded that the NiTi instruments did not experience substantial work hardening at D2 to D4 during clinical use, in agreement with previous differential scanning calorimetric analyses.
The Use of a Setting Accelerator and Its Effect on pH and Calcium Ion Release of Mineral Trioxide Aggregate and White Portland Cement
Eduardo Antunes Bortoluzzi, DDS, MS, Norberto Juárez Broon, DDS, MS, Marco Antonio Hungaro Duarte, DDS, MS, PhD, Ana Claudia Cardoso de Oliveira Demarchi, MS, Clovis Monteiro Bramante, DDS, MS, PhD
The aim of this study was to evaluate the influence of adding 10% calcium chloride (CaCl2) indicated as setting accelerator on pH and release of calcium ions of commercially available materials: ProRoot MTA (tooth-colored formula), MTA Branco, and White Portland cement. The products were mixed for 30 seconds in previously established ratios. To estimate the values of pH and release of calcium ion, polyethylene tubes were filled with the materials and immersed in containers with 10 ml of deionized water. The analyses were performed baseline, 30 minutes, 60 minutes, and 24hours after the mixing process. A pHmeter (MicroNal B 371, Sao Paulo, SP, Brazil) and an atomic absorption spectrophotometer (Model GBC 904; CG Corp, Melbourne, Australia) equipped with a hollow cathode lamp were used to determine the data. According to the Student’s t-test, the comparison between the pure and the CaCl2 -added products indicated that the presence of this substance increased immediately the pH, although the results were very similar when they were analyzed in the other intervals. In addition, products with CaCl2 released more calcium ions than pure materials in the 24-hour period (p < 0.05). The results revealed that the addition of CaCl2 to MTA enhanced the physicochemical properties of this product. Thus, materials mixed with CaCl2 became easier to handle and needed lower amounts of water in the mixing process.
A Comparison of the Canal Centering Ability of ProFile, K3, and RaCe Nickel Titanium Rotary Systems
Dina Al-Sudani, DDS, MsEdu, Saad Al-Shahrani, DDS
The purpose of this investigation was to compare the ability of three Nickel Titanium (NiTi) rotary systems (ProFile, K3, and RaCe) to centralize instrumentation relative to the original canal location and to determine the distance of transportation of these canals. Sixty mesial root canals mandibular molars with curvature ranging from 15 to 40 degrees were selected. The canals were divided randomly into three groups of 20 canals each. The roots were sectioned horizontally at 3 mm, 5 mm, and 8 mm from the root apex. Teeth were reassembled and instrumented according to the manufacturer’s guidelines, with all groups being prepared to size 30 (0.06) taper master apical file. The cross-sections were digitally scanned before and after preparation, and image analysis software was used to assess the centering ability and the extent and direction of transportation. The three groups were statistically compared with analysis of variance and Tukey’s HSD test. The results indicated that all three rotary NiTi systems used in this study were able to preserve dentin structure. The RaCe system significantly showed most transportation (p < 0.05). The ProFile system was found to be the best for all variables measured in this study.
The Rapid Sterilization of Gutta-Percha Cones with Sodium Hypochlorite and Glutaraldehyde
Nurhan Özalp, DDS, PhD, Zeynep Ökte, DDS, PhD⁎, Berrin Özcelik, DDS, PhD†
The purpose of this in vitro study was to evaluate the effectiveness of sodium hypochlorite and glutaraldehyde for rapid sterilization of gutta-percha cones contaminated with Bacillus subtilis ATCC 6633. Cones were treated with either 2% glutaraldehyde or 2.5% sodium hypochlorite. The gutta-percha cones were sterilized with a 2.5% sodium hypochlorite solution throughout the test. Glutaraldehyde did not decontaminate the gutta-percha cones even after 15 minutes of contact. All positive controls showed positive results during the first 24 hours. Negative controls were followed up for 24 and 48 hours and demonstrated the efficiency of previous sterilization. No microbial growth was observed in the groups tested. Even though gutta-percha cones are usually sterile during storage, they can be easily contaminated if incorrectly manipulated. NaOCl at 2.5% concentration is an effective agent for decontamination of gutta-percha cones at no additional cost.
Immature Teeth With Periradicular Periodontitis or Abscess Undergoing Apexogenesis: A Paradigm Shift
Ling-Huey Chueh, DDS, MS, George T.-J. Huang, DDS, MSD, DSc
Four clinical cases of immature teeth that developed periradicular periodontitis or abscess underwent a conservative treatment approach, i.e. without canal instrumentation. Instead, only copious 2.5% NaOCl irrigation was performed. All cases presented herein developed mature apices after 7 months to 5 years after the initial treatment without complications, although narrowing canal space was observed. Our clinical observations support a shifting paradigm toward a conservative approach by providing a favorable environment for tissue regeneration. The mechanism of this continued development and formation of the root end is discussed.
Nonsurgical Endodontic Retreatment of Geminated Teeth: A Case Report
AliÇağın Yücel, DDS, PhD, Eda Güler, DDS
The purpose of this case presentation is to describe nonsurgical retreatment of anterior teeth with gemination. A 21-year-old male patient was referred for endodontic treatment of his maxillary left lateral incisor. In the clinical examination, a large crown was observed in the left maxillary incisor region when compared with the right maxillary lateral incisor. In the present case, a tooth gemination of a maxillary lateral incisor has been described. A periapical radiograph showed that the tooth had partially separated two crowns having a single root and one root canal, but the access cavity of the distal crown had not been opened, and the root canal had been obturated with single cone technique. Nonsurgical endodontic retreatment was decided for geminated lateral incisor. At the 6-month follow-up, the tooth was asymptomatic and there was no radiolucency around the apical region.
Endodontic Management of a Fused Maxillary Lateral Incisor With a Supernumerary Tooth: A Case Report
R. Indra, MDS, M.R. Srinivasan, MDS, H. Farzana, MDS, K. Karthikeyan, BDS
Fusion is a rare occurrence and its definitive diagnosis is of prime importance for successful root canal treatment. This case report discusses the endodontic and esthetic management of fused maxillary lateral incisor with a supernumerary tooth that presented with spacing between the fused tooth and the adjacent central incisor. Nonsurgical endodontic treatment was performed on the fused teeth followed by postendodontic esthetic restoration. The patient remained symptom-free and there was a reduction in the size of periapical radiolucency after 1 year.