Tooth autotransplantation (TA) is indicated in cases of structurally compromised teeth with poor prognosis when a donor tooth is available. This case report describes the TA of a mandibular right third molar (48) into the position of the mandibular right second molar (47) in a 32-year-old male patient. Clinically, extensive coronal destruction and a sinus tract were observed in tooth 47, rendering retreatment unfavorable. The tooth was diagnosed as previously treated, with a chronic apical abscess. Therefore, tooth 48 was autotransplanted into the 47 position. Four months later, apical external inflammatory root resorption was observed. However, root canal treatment was performed one year after TA because the patient did not adhere to follow-up recommendations. After two years, the tooth remained asymptomatic, with no signs of periapical lesions or periodontal changes. In conclusion, TA may serve as a viable strategy for replacing structurally compromised permanent molars, thereby preserving the function of the natural dentition.
Introduction:The close relationship between pulp stones in the pulp chamber and pulp neurovascular tissues suggests that the presence of pulp stones may compromise successful anesthesia. The present study assessed the effect of pulp stone presence on the failure of anesthesia in mandibular and maxillary molars. Materials & Methods:In this retrospective cohort study, 126 patients were studied. Pulp stones were diagnosed by periapical radiography. After the anesthetic agent injection, failure was defined as patients raising their hand upon experiencing pain during any procedural step of endodontic treatment. Furthermore, sound, eye, and motor (SEM) measures were used to assess the pain experience. In the case of either pain felt or the patients' demand, supplementary injections were made using the intraligamental technique. Multivariate logistic regression analysis was used to assess the effects of different variables on the success of anesthesia. Results:The overall prevalence of pulp stones in the patients was 59.5%, with 42.9% and 57.1% for males and females, respectively. The incidence of pulp stones in patients under the age of 40 was 54.7%, whereas in the ≥40 age group, it was 64.5%. The highest incidences of pulp stones were reported for maxillary second (42.9%) and first (21.4%) molars, followed by mandibular second (18.6%) and first molars (17.1%). Overall, the success rate of anesthesia was 55.6% for treated teeth. However, no significant differences were observed in the success rate of anesthesia regarding gender, tooth type, and pulp stone presence. Only the age group of patients significantly predicted the success of anesthesia (Odds ratio: 1.135; CI 95%: 1.43-6.76; P=0.004). Conclusion:Pulp stones had no significant effect on the success of anesthesia in mandibular and maxillary molars.
This case report presents the endodontic management of a hypertaurodontic mandibular second premolar with five root canals, a rare and complex anatomical variation. A 12-year-old male patient presented with a previously treated tooth (history of pulpotomy) with symptomatic apical periodontitis and necrotic pulp. Initial periapical radiographs suggested taurodontism, but conebeam computed tomography (CBCT) revealed the presence of five canals merging into four distinct apices. Under CBCT guidance, all canals were negotiated, cleaned, and shaped. An apical barrier was created with bioceramic material, followed by obturation using warm vertical condensation with resinbased sealer. At the sixmonth followup, the tooth was asymptomatic and radiographically satisfactory. This case highlights the diagnostic indispensability of CBCT in detecting intricate root canal configurations in taurodontic teeth and outlines a structured clinical protocol for managing such challenging anatomies.
Maxillary central incisors typically exhibit a single root and canal. The presence of two roots with separate canals, as defined by Vertucci's type V morphology, is extremely rare and presents diagnostic and technical challenges for nonsurgical endodontic treatment. This report describes the endodontic management of a maxillary right central incisor (tooth #11) exhibiting a sinus tract, negative responses to pulp sensibility tests, and radiographic evidence of apical periodontitis in a 24-year-old female patient. Cone-beam computed tomography (CBCT) revealed a two-rooted anatomy with independent canals splitting at the middle third. Under magnification, access was refined using ultrasonic tips. The palatal root canal was prepared with NiTi CM rotary files, while the wider buccal canal was instrumented with stainless steel K-files. Both canals were disinfected using passive ultrasonic irrigation with 2.5% sodium hypochlorite and 17% EDTA, followed by intracanal calcium hydroxide medication. Obturation was completed using the single-cone technique with a bioceramic sealer. Radiographic follow-up at 14 and 57 months confirmed complete periapical healing and absence of symptoms, demonstrating long-term clinical success. Atypical root canal anatomy in maxillary incisors necessitates advanced imaging/magnification. The use of CBCT, NiTi CM files, and bioceramic sealers enabled accurate diagnosis, conservative canal shaping, and a successful long-term outcome in this rare morphology case.
Introduction:This study aimed to evaluate the bond strength of a bioceramic endodontic sealer and AH-Plus sealer irrigated with 2% chlorhexidine (CHX), compared to irrigation with 2.5% sodium hypochlorite (NaOCl) as a control group. Materials and Methods:Thirty freshly extracted single-rooted human teeth were prepared using reciprocating R25 and R40 files. Irrigation consisted of 2.5% NaOCl in the control group and 2% CHX gel in the experimental group, with additional irrigation using saline solution after each instrument change. Samples were divided into four groups: two with CHX, one with bioceramic sealer, and the other with AH-Plus sealer, and two with hypochlorite, one with bioceramic sealer and the other with AH-Plus sealer. The teeth were sectioned, and the resulting slices were subjected to the push-out test using a mechanical testing machine for measuring the microtensile force. After testing, samples were examined to determine the failure pattern. Data normality was assessed (Shapiro-Wilk, P<0.05), and non-parametric analyses (Kruskal-Wallis with Dunn's post hoc, Wilcoxon rank-sum with Benjamini-Hochberg correction) were applied. Effect sizes (Cohen's d, Cliff's Delta), bootstrap 95% confidence intervals (CIs) (2000 replicates), and the post hoc power were calculated. Significance was set at P<0.05. Results:AH-Plus exhibited higher bond strength than Sealer Plus BC across all root thirds, independent of irrigant. For Sealer Plus BC, bond strength was influenced by irrigant, with NaOCl producing higher values than CHX (P<0.05). Conclusion:AH-Plus exhibited superior bond strength irrespective of the irrigant used. In contrast, the bond strength of the Sealer Plus bioceramic sealer was influenced by the irrigant, with NaOCl yielding higher values than CHX.
