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Vertical root fracture resistance and dentinal crack formation of root canal-treated teeth instrumented with different nickel-titanium rotary systems: an in-vitro study

Lin GSS, Singbal KP, Noorani TY, Penukonda R

Odontology, 2022 Jan;110(1):106-112.
PMID: 34269933 DOI: 10.1007/s10266-021-00643-y

To compare the vertical root fracture (VRF) resistance of root canal-treated teeth instrumented with four different nickel-titanium (NiTi) rotary file systems and examine the dentinal crack pattern and direction using a new classification. Eighty mature mandibular premolars were selected and decoronated, leaving 13 mm of the root. The root samples were mounted in acrylic resin and divided randomly into five groups of different NiTi file systems: Group 1-control, Group 2-T-Pro, Group 3-HyFlex CM, Group 4-TG6 and lastly Group 5-ZenFlex. Samples in Group 2 and Group 3 were instrumented up to size 25/0.04, whereas Group 4 and Group 5 were instrumented up to size 25/0.06. Obturation was performed with AH Plus sealer and gutta-percha using single cone technique. Subsequently, all samples were subjected to occlusal compressive force until they were fractured. The force (N) needed to cause root fracture was recorded. The crack patterns and directions were also inspected under magnification and classified using a new and simple classification. The highest (VRF) resistance was noted in the control group (453.15 ± 92.23 N), followed by T-Pro (387.43 ± 76.81 N), HyFlex CM (381.88 ± 52.73 N), ZenFlex (369.15 ± 89.41 N) and finally TG6 (346.05 ± 72.08 N), but there was no significant difference between T-Pro and HyFlex (P = 0.438). A significantly higher prevalence (P = 0.001) of Type 1 crack pattern was observed, especially in samples instrumented with TG6. Majority of the cracks ran buccolingually except in some samples instrumented with ZenFlex (P = 0.898). Smaller file taper increased the VRF resistance of root canal-treated teeth. Majority of the dentinal crack exhibited Type 1 pattern and ran buccolingually.
Middle mesial canal in mandibular first molar: A narrative review

Penukonda R, Pattar H, Nambiar P, Al-Haddad A

Saudi Dent J, 2023 Jul;35(5):468-475.
PMID: 37520597 DOI: 10.1016/j.sdentj.2023.05.008

PURPOSE: This review aimed to assess the incidence, anatomical characteristics, identification, and clinical management using conventional techniques and advanced tools to manage MMCs successfully.
METHODS: Medline/PubMed and Scopus databases were searched using "Middle mesial canal," "Middle mesial root canal," OR "Accessory mesial canal" keywords from 1 January 1970 and 1 February 2023. The most pertinent articles were chosen for the review from the retrieved articles. In addition, relevant articles were added by manually searching the list of references.
RESULTS: The incidence of MMC is noticeable in younger people, and the confluent canal is the most common type. The majority of MMCs merged with mesiobuccal (MB) canals rather than mesiolingual (ML) canals. Clinical management could be employed using the standard endodontics protocol, and recent radiography technologies, magnification, rotary, and obturation materials can facilitate the procedures.
CONCLUSION: The possibility of the incidence of MMC is not unusual. Detection and thorough debridement followed by obturation of the canal could increase the success rate of clinical outcomes.
Impact of calcium hydroxide and 2-hydroxyisocaproic acid on the microhardness of root dentine: an in vitro study

Niranjan NT, Dastidar PG, Penukonda R, Lin GSS, Babannavar R, Jaysheel A, et al.

Odontology, 2024 Jul;112(3):711-717.
PMID: 38087010 DOI: 10.1007/s10266-023-00874-1

To evaluate and compare the effect of calcium hydroxide [Ca(OH)2] and 2-hydroxyisocaproic acid (HICA) on the microhardness of root dentine. Fifty-one matured maxillary central incisors with straight root and type I canal configuration were decoronated to a standardized length of 16 mm. The root canals were cleaned and shaped using rotary instruments up to size F5. The tooth samples were then randomly assigned into three groups (n = 17) based on the intracanal medicament placed. Group A: control group with no intracanal medicament, Group B: root canals placed with Ca(OH)2, and Group C: root canals placed with HICA. After 1 week, the intracanal medicaments placed within the root canals were removed and the canals were dried. Subsequently, the specimens were split longitudinally into two halves and subjected to the Vickers microhardness test with indentations made at the coronal, middle, and apical-third root regions. The data were analyzed using one-way ANOVA and Tukey's post hoc tests. The control group showed significantly highest microhardness value (P
The pattern of antibiotics prescription for endodontic infections in Malaysia: Cross sectional survey study

Al-Haddad A, Azmi NN, Penukonda R, Chia MA, Lee XW, K Anuar AF

Aust Endod J, 2024 Nov 07.
PMID: 39508744 DOI: 10.1111/aej.12900

This study aimed to assess the antibiotic prescribing pattern for endodontic infections among general dental practitioners (GDPs) and endodontic specialists in Malaysia. A 22-questions survey on demographic and general information on antibiotic prescribing patterns for endodontic infection was delivered to the email addresses of general dentists and specialists via the Dental Practitifoner Information Management System database. Collected data were analysed using multivariate logistic regression tests at the significance level of 0.05. A total of 372 responses were collected. 94% of respondents were GDPs, and 6% endodontists. Clinical experience and frequency of endodontic treatment performance were the significant factors in prescribing antibiotics (p