Mature permanent teeth with irreversible pulpitis have traditionally been managed with pulpectomy. With advancements in pulp biology and dental materials, many clinicians are using vital pulp therapies like pulpotomy to manage such teeth. The current study was conducted to help clinicians in making decisions about case selection and choice of material for such cases. This randomized clinical trial evaluated the outcome of complete pulpotomy, using mineral trioxide aggregate (MTA) and Biodentine, in permanent mandibular molars with symptomatic irreversible pulpitis (SIP). Fifty patients with moderate-to-severe pain in mandibular molars with SIP were included in this prospective, parallel, single-blind clinical trial. Coronal pulp was completely removed and hemostasis was achieved with a cotton pellet moistened with 2.5% sodium hypochlorite. Subsequently, the radicular orifices were randomly covered with MTA or Biodentine. All teeth were permanently restored with composite restoration at the same appointment. Clinical evaluation was performed at 1 week, 3 months, 6 months, 12 months, and 18 months and radiographic evaluation was done after 6 months, 12 months, and 18 months. Mann–Whitney U and Chi-square tests were utilized for statistical analysis. Success rates of MTA and Biodentine pulpotomy were 63.6% and 69.6%, respectively, with no significant difference between the two groups at any follow-up period (P > 0.05). There were no significant differences in complete pulpotomy success rates between MTA and Biodentine over 18 months in mandibular molars with SIP.

Verma S, et al. Restor Dent Endod. 2023 Oct;48:e35. https://doi.org/10.5395/rde.2023.48.e35

Inter-appointment pain (IAP) is a subtype of postoperative pain which occurs between endodontic appointments. It may begin within a few hours after the first appointment and may continue for several days. Apart from mechanical instrumentation and thorough irrigation, intracanal medicaments play a central role in the disinfection of root canals and thus decreasing IAP. The aim of this study was to evaluate the effect of Curcuma Longa as an intracanal medicament on IAP in patients with symptomatic irreversible pulpitis (SIP). One hundred healthy adult patients having SIP in one of their single-rooted maxillary or mandibular teeth participated in this randomized, parallel, single-blinded clinical trial. After thorough biomechanical preparation, the root canals were randomly medicated with one of the following medicaments, Control (no medicament), Calcium Hydroxide, triple antibiotic paste (TAP), and Curcuma Longa. The pain was recorded using Visual analog scale at 4 h, 24 h, and every day until the seventh day. Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-rank tests. No statistical difference in pain scores was observed between Calcium Hydroxide, TAP or Curcuma Longa groups. It can be concluded that Curcuma Longa, Calcium hydroxide, and TAP are equally effective in controlling IAP.

This article aims at providing an insight to the clinical modifications required for the endodontic management of severely dilacerated mandibular third molar. A 35-year-old patient was referred for the root canal treatment of the mandibular left third molar. An intraoral periapical radiograph revealed a severe curvature in both the canals. A wide trapezoidal access was prepared following the use of intermediate-sized files for apical preparation. Owing to increased flexibility, Hero Shaper NITI files were used for the biomechanical preparation and single cone obturation was carried out. Third molars owing to their most posterior location-limited access coupled with a severe curvature pose utmost clinical challenges require meticulous skill, advanced technology, and patience to achieve success.

Rationale: Dens invaginatus (DI) is a rare condition with a prevalence of only 0.3% to 10% mainly affecting the maxillary lateral incisors. In the present case, we describe management of the rarest variant of DI, that is, Oehler type III DI. Patient concerns: Patient complained of severe pain in upper left front teeth since 1 month which aggravated on taking hot liquids. Patient had visited a general dentist who did emergency access opening on #9 and #10 and referred the patient. Diagnoses: Oehler type III DI with apical periodontitis w.r.t.#10 (maxillary left lateral incisor). Interventions: Nonsurgical root canal treatment of the main canal and apexification of pseudo canal with mineral trioxide aggregate. Outcomes: At 6 months follow-up, the patient was asymptomatic, and the clinical evaluation revealed no sensitivity to percussion or palpation on tooth #10 and mobility within normal limits. The radiograph examination displayed significant periapical healing. Lessons: The unusual morphological appearance of the crown in the maxillary lateral incisor or the radiographic appearance should alert the dentist to the possibility of DI. Knowledge of tooth anatomy and its variations, correct diagnosis, and use of magnification and advanced materials like mineral trioxide aggregate can help in managing rare variations.

Aim: This study was conducted to evaluate the effect of intracanal heating (IH) of sodium hypochlorite (NaOCl), alone, and in combination with passive ultrasonic irrigation (PUI), on postoperative pain (PP) in teeth with symptomatic irreversible pulpitis (SIP). Materials and Methods: Ninety-two patients diagnosed with SIP were randomly divided into 4 groups on the basis of the method of activation, i.e., syringe irrigation, PUI, IH, and heating and PUI (HPUI) (combination of IH and PUI). Pain was assessed up to 1 week. Friedman and Wilcoxon tests (intragroup), Kruskal–Wallis and Mann–Whitney test (intergroup), and Chi-square test (categorical variables) were used for statistical analysis. Results: The pain was significantly higher in the syringe irrigation group up to the 3 ^rd day compared to other groups. At 6 h, pain in the PUI group was significantly higher than HPUI group. No significant difference was found between the groups at all other postoperative time points. Conclusion: Activation of NaOCl by IH, PUI, and combination of both (HPUI) results in lesser PP compared to conventional irrigation alone. However, no additional benefit in terms of pain was obtained when the two activation techniques were combined.