Fracture Incidence of Kedo-S Square Pediatric Rotary Files: A Prospective Clinical Study

Objective The primary focus of this clinical study was to analyze the probability of occurrence of instrument fracture after root canal preparation of primary molars with the help of Kedo-S Square pediatric rotary file. Materials and Methods Three experienced specialists treated 100 primary maxillary and mandibular molars (335 root canals) using a standardized protocol over 2 months. Biomechanical preparations were carried out using Kedo-S Square file, as per the suggestions given by the manufacturer. Every instrument in Group A helped handle three clinical cases, while for groups B, C and D, they helped in handling 5, 9, and 12 cases, respectively. Making use of an operational microscope, the rotary files, after being pulled out from the canal, were observed. The values were tabulated, and descriptive statistics were performed. Results There were two fractures (2%), of which 1 occurred in group C in the apical 1/3rd of distobuccal canal of maxillary molar, and the other occurred in group D in the apical 1/3rd of mesiobuccal canal of maxillary molar. Conclusions The fracture rate of Kedo-S Square rotary file is quite low. It is primarily in the buccal canals of the maxillary molars and the apical third of the root canal that the instrument has a greater probability of separation.

Optimal sites for orthodontic anchor screw placement using panoramic images: risk of maxillary sinus perforation and contact with adjacent tooth roots during screw placement

Objectives This study investigated the safety of orthodontic anchor screw (OAS) placement by examining the morphology and degree of depression of the maxillary sinus adjacent to the alveolar bone between the maxillary molars. Methods We reviewed panoramic and CT imaging data of 25 patients. First, the morphology of the maxillary sinus adjacent to the alveolar bone between the maxillary molars on panoramic images was classified into three types: non-depressed sinus, funnel-like sinus depression, and sawtooth-like sinus depression. Then, the distance from the maxillary buccal bone to the maxillary sinus or to the maxillary lingual bone and the distance between the roots of the maxillary second premolar and first molar at heights of 5, 6.5, and 8 mm from the alveolar crest were measured on CT images and compared between the three sinus morphology groups. Results The sawtooth-like depression group had significantly smaller bone thickness than the other two groups, with mean thickness of < 4 mm at any height from the alveolar crest. The funnel-like depression and non-depression groups had mean bone thickness of > 8 mm at any height from the alveolar crest. Conclusions Sawtooth-like sinus depression had increased risk of maxillary sinus perforation, suggesting that OAS placement in this region should be avoided. In contrast, OAS placement between 6.5 and 8 mm from the alveolar crest is advisable in patients with funnel-like sinus depression and at a site > 8 mm from the alveolar crest in those with a non-depressed sinus.

Occurrence and Morphology of MB2 Canals in Maxillary First Molars in an Indian Subpopulation: A Cone Beam Computed Tomography Study

Introduction Molars have been known to display varied morphologies. Maxillary first molar is the tooth with the largest volume and most complex root and root canal anatomy; also, possibly the most treated and least understood posterior tooth. The present study aimed to investigate the occurrence and morphology of MB2 canals in maxillary first molars in an Indian subpopulation (Dakshina kannada) using cone beam CT (CBCT) imaging. Materials and Methods A total of 330 maxillary molars were placed on “U-” shaped modelling wax template, mimicking the natural arch and digitally scanned, of which 196 scans met the inclusion criteria and were analyzed for unusual root canal anatomy by CBCT. To analyze the occurrence and morphology of the canals, the acquired data was examined by two endodontists and discussed till an agreement was reached. Results The results were subjected to descriptive analysis. The majority of patients 103 (52.6%) teeth showed the presence of MB2 canals. As much as 83.5% of teeth depicted Vertucci's type II morphology, and 16.5% teeth presented with Vertucci's type IV morphology. Conclusion CBCT overcomes the limitations of conventional radiography. However, the decision to use CBCT in the management of endodontic problems must be based on a case-by-case basis and only when sufficient diagnostic information is not obtained from diagnostic tests.

The Examination of Root Morphology of the Maxillary First and Second Molars Using Cone Beam Computed Tomography

Introduction: Maxillary molars usually have three roots, four canals and the extra canal often exists in the mesiobuccal root. This study aimed to investigate the root morphology of maxillary first and second molars using CBCT. Materials & Methods: In this descriptive-analytical study, CBCT samples of 200 patients referred to maxillofacial radiology centers were selected and evaluated. Two-dimensional images in panoramic, cross-sectional, and transverse axial planes and three-dimensional images of the maxilla building that were reconstructed by a computer were examined. Analyzed data using one-way ANOVA and t-test (p value < 0.05) Results: The highest number of roots in the first molar was 3 (89.5%) and, the highest number of the second molar was 3 (90%). The maximum number of root canals in the first molar was 4 (65%) and, the highest number of root canals in the second molar was 3 (68%). The MB2 canal of maxillary first molars was 67.5% and the MB2 canal of maxillary second molars was absent at 71.5%. The presence of MB2 canal of maxillary first and second molars had no significant difference (p value > 0.05), but the presence of MB2 canal of maxillary first and second molars was significant (p value < 0.001). Conclusion: There is a significant relationship between being unilateral and bilateral with the presence of the mesiobuccal canal. Most of the first maxillary molars and, maxillary second molars had three separate roots. Also, there was no significant relationship between gender and side of study with the presence of mesiobuccal canal.

Stress Distribution in Modified Veneer Crowns: 3D Finite Element Analysis

(1) Background: to propose a new approach for crown veneers, with the use of an aesthetic porcelain coating, only in part of the zirconia infrastructure, and to analyze its biomechanical behavior to minimize chipping failures. (2) Methods: a maxillary molar was modeled using CAD software, preparing for traditional crowns and veneer crowns with various lengths. Five groups were formed: M—control group (monolithic crown of ultra-translucent zirconia); B—conventional (bilayer crown of ultra-translucent zirconia and ceramic covering); V—veneer (ultra-translucent zirconia crown with reduction only in the buccal and application of covering ceramics); V1—ultra-translucent zirconia crown with buccal reduction and 1 mm occlusal extension for covering ceramic application); V1.5—ultra-translucent zirconia crown with buccal reduction and 1.5 mm occlusal extension for application of covering ceramics. A load of 600 N was performed axially to a fossa bottom to simulate parafunction, and 300 N to the cusp tip to obtain the maximum principal stress results. (3) Results: group B showed a higher stress concentration in the occlusal region of the restorations, while the other groups absorbed the stress and dissipated it throughout the crown, presenting a higher stress concentration in the interface region with the tooth. (4) Conclusion: the highly translucent zirconia ceramic only associated with buccal covering ceramic could add aesthetic gain and rigidity to the system and could be a good option to restore maxillary molars in patients who do not have parafunction.

Retrograde Spread of Buccal Space Infection into Temporal Space with Temporal Muscle Necrosis in a Medically Compromised Patient - A Case Report

Superficial temporal space lies between the temporal fasciae. Abscess in the temporal and infratemporal space is very rare. They develop as a result of the extraction of infected maxillary molars. Temporal space infections or abscesses can be seen in the superficial or deep temporal regions. A 65 - year - old male patient reported with a complaint of painful swelling over the right cheek and restricted mouth opening with a history of extraction of second mandibular molar before four weeks. On examination, an ill-defined diffuse swelling was seen. Treatment was started with IV empirical antibiotics and planned for surgical drainage. Surgical drainage of the abscess in the temporal space was done along with debridement of the necrosed temporalis muscle. Infections of the maxillofacial region are of great significance to general dentists and maxillofacial surgeons. They are of clinical importance as they are commonly encountered, and are also challenging as timely intervention is needed to prevent fatal complications. The infections arising from the tooth are initially confined to the alveolar bone and surrounding periosteum. They spread along the path of the least resistance to the cortical plates. Once the infection penetrates the cortical plates, they reach the muscle plane.1 If the infection perforated is above the muscle attachments, it’s confined to an intraoral abscess. If the cortical plates are perforated below the muscular attachments, extraoral swelling develops. The next barrier is the periosteum which is strong and elastic in nature. Once the periosteum is breached, infections reach the soft tissue planes, the fascia. Most of the infections are confined to a particular space and the surrounding fascia. Based on the toxins produced by the microorganisms, the infection can spread to adjacent spaces and even retrograde. Common deep space infections are Ludwig's angina followed by peritonsillar, submandibular, and parotid abscesses. 2 Infratemporal and temporal space infections are rarely compared to other deep space infections. Many etiological factors form the base for the infections of deep spaces, dental caries, extraction of infected, non-infected tooth maxillary sinusitis, tonsillitis, maxillary sinus fracture, temporomandibular arthroscopy, drug-induced infections. Infections of odontogenic origin, spreading along infratemporal and temporal space are most common with maxillary molars followed by mandibular molars. We report a case of retrograde spread of buccal space infection into temporal space secondary to mandibular tooth extraction.

Retrograde Spread of Buccal Space Infection into Temporal Space with Temporal Muscle Necrosis in a Medically Compromised Patient - A Case Report

Superficial temporal space lies between the temporal fasciae. Abscess in the temporal and infratemporal space is very rare. They develop as a result of the extraction of infected maxillary molars. Temporal space infections or abscesses can be seen in the superficial or deep temporal regions. A 65 - year - old male patient reported with a complaint of painful swelling over the right cheek and restricted mouth opening with a history of extraction of second mandibular molar before four weeks. On examination, an ill-defined diffuse swelling was seen. Treatment was started with IV empirical antibiotics and planned for surgical drainage. Surgical drainage of the abscess in the temporal space was done along with debridement of the necrosed temporalis muscle. Infections of the maxillofacial region are of great significance to general dentists and maxillofacial surgeons. They are of clinical importance as they are commonly encountered, and are also challenging as timely intervention is needed to prevent fatal complications. The infections arising from the tooth are initially confined to the alveolar bone and surrounding periosteum. They spread along the path of the least resistance to the cortical plates. Once the infection penetrates the cortical plates, they reach the muscle plane.1 If the infection perforated is above the muscle attachments, it’s confined to an intraoral abscess. If the cortical plates are perforated below the muscular attachments, extraoral swelling develops. The next barrier is the periosteum which is strong and elastic in nature. Once the periosteum is breached, infections reach the soft tissue planes, the fascia. Most of the infections are confined to a particular space and the surrounding fascia. Based on the toxins produced by the microorganisms, the infection can spread to adjacent spaces and even retrograde. Common deep space infections are Ludwig's angina followed by peritonsillar, submandibular, and parotid abscesses. 2 Infratemporal and temporal space infections are rarely compared to other deep space infections. Many etiological factors form the base for the infections of deep spaces, dental caries, extraction of infected, non-infected tooth maxillary sinusitis, tonsillitis, maxillary sinus fracture, temporomandibular arthroscopy, drug-induced infections. Infections of odontogenic origin, spreading along infratemporal and temporal space are most common with maxillary molars followed by mandibular molars. We report a case of retrograde spread of buccal space infection into temporal space secondary to mandibular tooth extraction.