Endodontically Treated Maxillary Premolars Restored with Glass Fiber Post under All Ceramic Crown

Glass fiber posts and core are increasingly used in order to restore severely damaged endodontically treated teeth and particularly maxillary premolars that are prone to fracture. Their low modulus of elasticity which is similar to that of dentin allows the post to absorb stress and prevent root fracture. In addition, the glass fiber posts provide a natural hue by integrally bonding to the composite, thereby improving the aesthetics without compromising much on the strength. Various factors are involved in the longevity of such treatment option, remaining tooth structure seems to be the most important. Key words: glass fiber posts, premolars, endodontically treated teeth, composite resin, fracture resistance, crown, ferrule, failure .

Retrospective Evaluation of Variations in Root Canal Morphology of Permanent Maxillary Premolars Among the Emirate Population

Background: This research aims to identify the most common morphology of the upper premolars in a group of local and nonlocal people in the UAE using cone-beam computed tomography (CBCT).Methods: CBCT images of a total of 214 intact maxillary premolars were analysed with 3D reconstruction GALAXIS viewer software. The Pearson Chi squared test and the two samples t test were applied.Results: In all, 90% of the maxillary first premolars had two roots (92% females, 88% males, 83% locals, 96% nonlocals). A total of 52% of maxillary second premolars had two roots (47% females, 56% males, 38% locals, 67% nonlocals). Two cases had three roots among local males. A significant difference of one root in the maxillary second premolar was observed between locals (63%) and nonlocals (33%), while two roots were higher among nonlocals (67%) than locals (37%, p = 0.002). Three roots were discovered in two teeth of the local UAE first premolar. The most common canal morphology in the maxillary first premolar group among local UAE subjects was type V (52%), and among nonlocal UAE subjects was type V (59%). Additional types included 7 (13.2%) identified and unrelated to the Vertucci classification. The dominant canal morphology in the maxillary second premolar among local UAE subjects was type II (32%), and among nonlocal UAE subjects was type V (25%); among the additional types, 12 (23.1%) were identified and not related to the Vertucci classification. There was a significant difference in the distance from the pulp chamber roof to the cementoenamel junction (CEJ) and the measurement between the single-rooted maxillary premolar CBCT for local UAE subjects was 1.36 mm (SD ±0.75) and for nonlocal subjects was 1 mm (SD ±0.27, p = 0.049). There were statistically significant differences in all measurements between multiple rooted maxillary premolar CBCTs for local UAE and South Asian subjects (p < 0.05)Conclusions: The results suggest a more quantitative approach to maxillary first and second premolar access cavity preparation in the UAE population to prevent errors and iatrogenic damage when identifying the canals; using CBCT measurements for more precise access preparations may be advantageous.

A Cephalometric Evaluation of Soft Tissue Following Maxillary Incisors Retraction

Background: Class 2 Division 1 is the most prevalent type of malocclusion affecting about 32% of Pakistani population. With upper maxillary premolar extraction is one of most frequent treatment choice. Aim: To evaluate the effects of these extractions on soft tissue show variable results depending upon the sex, ethnicity, maxillary arch crowding and pretreatment structure of lips. Methods: In this study pretreatment cephalograms of 106 Class 2 div 1 patients were taken whose treatment plan include extraction of maxillary 1st premolar. Then the second and final cephalograms were taken when retraction of incisors was completed. Mean changes in the position of upper and lower lip were measured with respect to Ricketts E-line before and after completion of retraction of maxillary incisors. Results: After the extraction of premolars there is a significant (P value=0.000) reduction in the lip protrusion of -2.033mm±1.148mm and -1.695mm±1.628mm in both upper and lower lip respectively. Conclusion: Extraction of maxillary premolars cause significant reduction of lip prominence and achieve facial esthetic balance. Keywords: Class 2 div 1, lip position, Premolar Extraction

Canal Configuration of Maxillary Premolars in Cukurova Population: A CBCT Analysis

Summary Background/Aim: Aim of this study was to evaluate the anatomy of root-canal systems and numbers of permanent maxillary premolars’ roots and canals, using cone beam computed tomography scans. Material and Methods: In this retrospective and observational study, maxillary right/left and first/second premolars of patients who were screened with cone beam computed tomography for various reasons in a Turkish dental school, were examined. Evaluated parameters were age, gender, canal configuration (Vertucci classification) and numbers of roots and canals. Chi-square test was used for statistical analysis. The level of significance was set at p<0.05. Results: A total of 1086 maxillary premolars including 555 first premolars and 531 second premolars were examined in 331 patients (186 female, 145 male). Presence of two roots was shown in 75% of first premolars. 76.3% of second premolars were found to have a single root. Most common canal configuration was type IV (73.2%) for first premolars and type II (32.4%) for second premolars. There was a significant relationship between gender and numbers of first and second premolars’ roots and canals. Conclusions: High heterogeneity of maxillary premolar root-canal system anatomy should be considered during endodontic treatment.

Impact of Contracted Endodontic Access Cavity on Shaping Ability of Hyflex Electrical Discharge Machining Single File Using Cone Beam Computed Tomography: An Ex Vivo Study

AIM: The aim of the study was to evaluate and compare the effect of different access cavity designs, using cone-beam computed tomography (CBCT), on root canal transportation, and centralization performed on two rooted maxillary premolars. METHODS: Twenty maxillary premolars were randomly divided into two groups. In Group 1, traditional endodontic cavities (TECs) were prepared. In Group 2, contracted endodontic cavities (CECs) were prepared. Mechanical preparation was done by HyFlex electrical discharge machining (EDM) single file in both groups. CBCT imaging was performed pre- and post-root canal preparation for calculations of root canal transportation and centering ability. RESULTS: Data were analyzed using Mann–Whitney U test and Kruskal–Wallis test. For transportation, teeth with CECs showed the statistically significantly highest median amount of transportation, while as for centering ability, results showed no significant difference between both groups. CONCLUSION: Under the conditions of this study, HyFlex EDM prepared canals with different access cavity designs without significant shaping errors. TEC showed less transportation than CEC, while both TEC and CEC had no effect on the file centering ability.

Residual Dentin Thickness in Bifurcated Maxillary Premolars after Cervical Preflaring Preparation: A CBCT Analysis

Objective: This study evaluated the residual dentin thickness (RDT) of maxillary premolars after the use of different cervical preflaring (PF) drills by using cone-beam computed tomography (CBCT). Methods: Eighty bifurcated maxillary premolars were accessed and randomly divided into 5 groups (n=16). PF was performed with Gates-Glidden #1, #2, and #3 (group 1), Largo #1 and #2 (group 2), and LA Axxess #20/.06 (group 3), #35/.06 (group 4), and #45/.06 (group 5). CBCT images were acquired before (preoperative) and after (postoperative) PF. Initial and final cervical dentin thickness was measured at the buccal, palatal, mesial, and distal aspects, 0.5 mm coronally to the furcation, on both buccal and palatal roots, using CBCT’s image analysis software. The percentage of removed dentin after PF preparation was also calculated. Data were analyzed using ANOVA followed by Tukey’s test at a significance level of P < 0.05. Results: No statistically significant differences were found among the groups for preoperative or postoperative RDT (P > 0.05). LA Axxess #20/.06 (group 3) removed significantly less cervical dentin at all root canal aspects on both buccal and palatal roots. The mesial aspect of the buccal root and distal aspect of the palatal root were significantly reduced after the use of LA Axxess #45/.06 (group 5) and Largo #1 and #2 drills (group 2), respectively (P < 0.05). Conclusion: PF in bifurcated maxillary premolars should be performed with LA Axxess instrument #20/.06. The use of Gates-Glidden #1, #2, and #3, Largo #1 and #2, and LA Axxess #45/.06 drills should be done with caution.

Articaine VS Lignocaine in Orthodontic Extraction of Maxillary Premolars - A Randomized, Double-Blinded Study

BACKGROUND Local anaesthetics helps in preventing pain during surgical and dental procedures by blocking the peripheral nerves. The primary objective of this investigation was to compare and evaluate 4 % articaine hydrochloride (with 1 : 100000 adrenaline) and 2 % lignocaine hydrochloride (with 1 : 80000 adrenaline) in terms of pulpal anaesthesia, volume of anaesthetic solution administered, need of re-anaesthesia and difficulty of extraction during orthodontic extraction of maxillary first premolars. METHODS This prospective randomized, double-blinded study was conducted on 43 patients of less than 40 years of age requiring bilateral maxillary first premolar extractions for orthodontic purposes. Each patient was randomly assigned to receive either 2 % lignocaine hydrochloride or 4 % articaine hydrochloride for premolar extraction of one side and other solution was administered for premolar extraction of contralateral side spaced 1 to 3 weeks apart. In each patient, the difference in pulpal anaesthesia, volume of anaesthetic solution administered, need of re-anaesthesia, difficulty of extraction and duration of anaesthesia was assessed on administration of lignocaine hydrochloride and articaine hydrochloride. RESULTS Statistically significant difference in pulpal anaesthesia levels was found when the articaine and lignocaine groups (P > 0.05) were compared, with a higher mean pulpal anaesthesia among the articaine group. There was no difference in volume of anaesthetic solution administered on buccal and palatal side among the articaine and lignocaine groups. Only 2.3 % of patients in both the groups required re-anaesthesia on the buccal side. There was no significant difference in difficulty of extraction in both the groups. The articaine group had a longer mean duration of anaesthesia as compared to the lignocaine group which was highly significant. CONCLUSIONS Articaine may be used to replace lignocaine in orthodontic extraction of maxillary premolars with clinical advantages like higher pulpal anaesthesia and longer duration of anaesthesia. KEY WORDS Local Anaesthetic, Lignocaine Hydrochloride, Articaine Hydrochloride, Orthodontic Extraction, Prospective Study, Double-Blinded Study.

Comparison of Efficacy of 4% Articaine and 0.5% Bupivacaine and 2% Lignocaine Anaesthetic agents in Orthodontic Extractions-A Prospective Randomised Controlled Study

Aim: Articaine, bupivacaine, lignocaine are amide type of local anesthetic agents, which are of almost equal potency. However, lidocaine is considered the gold standard and is the most widely used anesthetic agent because of its potency, safety, and efficiency. Articaine is fast acting and bupivacaine is long lasting local anaesthesia. The aim of this clinical study was to evaluate and compare the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine and 2% lignocaine in therapeutic orthodontic extractions. Materials and Methods: A 150 healthy patients, requiring Maxillary premolars extraction for orthodontic reasons were included. Patients were categorized into three groups (4% articaine and 0.5% bupivacaine, 2% lignocaine) in a crossover manner. Subjective and objective observations recorded that include age, gender, and pain score using visual analog scale. At the first appointment, both upper premolars were extracted on one or two sides of the jaws. Each patient was evaluated using a visual analogue scale. Results: The results showed that 0.5% Bupivacaine had significantly faster onset of action and lower visual analogue scores when compared with articaine and lignocaine. However, the duration of analgesia and need of first rescue analgesic medication was longer in the bupivacaine group. Conclusion: Within the limitations of study we found that Bupivacaine has the best anaesthetic effect with low pain scores followed by Articaine and followed by Lignocaine. Bupivacaine is an alternative local anaesthetic drug for performing therapeutic orthodontic extractions.

Assessment of root morphology and canal configuration of maxillary premolars in a Saudi subpopulation: a cone-beam computed tomographic study

Background The objective of this study was to use CBCT to look into the root canal morphology of maxillary premolars in a Saudi Arabian subpopulation and associate the results to existing canal morphology classifications. Methods The sample size for this analysis was 500 right and left untreated maxillary first and second premolars with fully formed roots from 250 Saudi residents (125 male and 125 female). The following observations were made using CBCT on the teeth related: (1) The number and morphology of roots; (2) The canal morphology for each root according to Vertucci's classification. The frequency and similarities between the right and left sides, as well as between females and males, were studied. The Chi-square test was used to assess the results. Results Of the 500 maxillary first premolars studied, 199 teeth had one root (39.8%), whilst 293 (58.6%) were two-rooted. Three-rooted maxillary first premolars were found in 8 (1.6%). For maxillary second premolars, 416 premolars had one root (83.2%), whilst 79 (15.8%) had two roots and the rest 5 (1.0%) were three roots. There were significant differences of number of root were found between groups (p > 0.05). For maxillary first premolar, Type IV was the most frequent, accounting for 57.8% of the sample (n = 289), followed by type II (32.8%, n = 164). For maxillary second premolar, Type I was mainly occurrence 302 (60.4%), followed by Type II (16.4%, n = 82). Conclusions The majority of maxillary first premolars had two roots and two root canals, while one root and one root canal was the most common anatomical configuration for maxillary second premolars. Additional canal forms do occur on occasion, and clinicians should pay close attention to them.