Papers by Dr. Jojo Kottoor
Journal of endodontics, Jan 19, 2018
Maxillary first molar second mesiobuccal (MB2) root canal prevalence may change among different p... more Maxillary first molar second mesiobuccal (MB2) root canal prevalence may change among different populations. The aim of this study was to analyze the worldwide prevalence of the MB2 root canal and understand its possible relation with sex, age, side, and root configuration using in vivo cone-beam computed tomographic (CBCT) assessment. Observers from 21 regions were calibrated to achieve a similar CBCT assessment methodology and instructed to collect data from 250 maxillary first molars in previously existing examinations. Intra- and interrater reliability tests were performed. The sample size included 5250 molars and was defined by way of a preliminary trial. Data collected included MB2 presence, sex, age, side, number of roots per tooth, and mesiobuccal root configuration. The z test for proportions in independent groups was used to analyze the differences among subgroups. P < .05 was considered significant. The worldwide CBCT-assessed MB2 prevalence was 73.8%, ranging from 48....
Journal of endodontics, Jan 19, 2017
The aim of this study was to evaluate and compare the C-shaped mandibular second molar prevalence... more The aim of this study was to evaluate and compare the C-shaped mandibular second molar prevalence in different regions around the world with the aid of cone-beam computed tomography technology. Nine field observers from 9 different geographic regions were calibrated. A total of 400 samples were collected in each region. The prevalence of C-shaped anatomy was calculated. The number of roots and the configuration of the C-shaped canals at 3 different axial levels were also evaluated. The z-test was used to analyze the difference between the means of each independent group. Intrarater reliability was also tested. A total of 3600 teeth from 2735 patients were included in this research; 499 teeth presented C-shaped root canal configuration, representing a global prevalence of 13.9%. China had a prevalence of 44.0%, which was significantly higher than any other region. The C-shape prevalence in women was 16.5%, which was significantly higher than the 10.4% prevalence found in men. No diff...
Journal of Endodontics, 2011
... Jojo Kottoor MDS Corresponding Author Contact Information , a , E-mail The Corresponding Auth... more ... Jojo Kottoor MDS Corresponding Author Contact Information , a , E-mail The Corresponding Author , Natanasabapathy Velmurugan MDS a and Smitha ... the floor of the pulp chamber under a dental operating microscope (DOM) (Seiler Revelation, St Louis, MO), two additional ...
Restorative Dentistry & Endodontics, 2016
Questioning the spot light on Hi-tech endodontics Endodontics as a field of dentistry has made gi... more Questioning the spot light on Hi-tech endodontics Endodontics as a field of dentistry has made giant leaps in the past two to three decades. Pioneering technological advancements include magnification, innovative material science, designs and techniques for instrumentation and obturation of the root canal systems. Contrary to this ascent in endodontic material, technique, and equipment innovations, a number of treatment outcome data reveal no statistically significant improvement in overall endodontic success in the corresponding period. 1-6 The answers to this debate could be fairly uncomplicated but have been widely overlooked in the race for sophisticated technology and innovation in endodontics. The foremost factors that have repeatedly been documented to significantly impact the outcome of primary root canal treatment are pre-operative pulpal and periapical status, root anatomy with complex canal systems, achievement of patency to the canal terminus, mid-treatment complications including perforation and instrument separation, root filling with no voids that extends upto 2 mm of the radiographic apex and a leakage free coronal restoration. 4-11 Other than the first two aspects, which are beyond the direct control of the treating clinician, all other factors are directly dependant on the operator's performance. 12 Objective analysis and diagnosis of pulpal and periapical preoperative status is critical for long term success of adequately treated teeth. 5 The ability of routinely used diagnostic tools to accurately determine the health or disease status of the pulp or periapical tissues is at best questionable. 13 Traditional techniques for pulpal diagnosis primarily assess neural response (electric and thermal pulp tests), instead of the true vitality of the tooth like the pulse oximeter or Laser Doppler Flowmetry, which have been shown to be more objective and accurate in making a clinical diagnosis. 14 Unfortunately, the latter are inaccessible to a large number of dentists, and are neither cost effective nor simplified enough for widespread clinical use. An accurate clinical diagnosis of the pulpal condition could possibly enable managing initial irreversible pulpitis with vital pulp therapy instead of the radical devitalization approach of root canal treatment. 15 The clinical inefficiencies of traditional pulpal diagnostic methods hinder accurate, scientific decision making ability regarding noninvasive, preservative, preventive, therapeutic or biologic endodontic procedures like pulp capping or pulpotomies with mineral trioxide aggregate (MTA) versus invasive, synthetic, non-biologic based orthograde root canal procedures. 15 As for intra-treatment factors affecting endodontic outcome, it has been frequently reported that the material of the instrument 16 and their design and taper or motion of instrumentation have had no significant impact. 17,18 Neither has the type of sealer, 19 material, 20 method or equipment 21 used for obturation been of consequence to overall
General Dentistry, Nov 1, 2012
This case report describes the nonsurgical endodontic management of a maxillary first molar with ... more This case report describes the nonsurgical endodontic management of a maxillary first molar with the unusual morphology of three separate buccal roots. An accurate assessment of this morphology was made with the help of cone-beam computed tomography (CBCT). This report also describes the varied root morphology associated with maxillary first molars and the role of CBCT as a diagnostic tool for managing these complex cases successfully.
Journal of international oral health : JIOH, 2015
Root canal irrigation plays a pivotal role in endodontics. Constant increase in antibiotic resist... more Root canal irrigation plays a pivotal role in endodontics. Constant increase in antibiotic resistance and side effects caused by synthetic irrigants has shifted the research toward developing herbal alternatives. The current study aims to assess the ex vivo effectiveness of an indigenously prepared herbal extract "EndoPam" and compare it with the conventional endodontic irrigants for disinfection of root canals infected with Enterococcus faecalis. As a preliminary study of the antimicrobial efficacy of the test irrigants, an Agar diffusion study was conducted, and zone of inhibition measured. Forty extracted mandibular premolars with straight root canals were selected and standardized to 12 ± 1 mm in length. Root canals were prepared using rotary ProTaper system until F3 instrument and were infected with the culture of E. faecalis for three weeks. Specimens were divided into four groups (n = 10). Group 1: EndoPam (. Syzigium aromaticum, Eucalyptus globulus, Cinnamomum zeyl...
Restorative Dentistry & Endodontics, 2015
General dentistry
This case report describes a patient with unusual tooth morphology involving the bilateral presen... more This case report describes a patient with unusual tooth morphology involving the bilateral presence of 6 maxillary and mandibular first and second molars with a single root and a single canal. The article also discusses the endodontic management of a single-rooted maxillary molar and the use of cone beam computed tomography for evaluation and diagnosis of these anatomical variations.
DESCRIPTION Accurate determination of the endodontic working length and working width is a crucia... more DESCRIPTION Accurate determination of the endodontic working length and working width is a crucial part of successful root canal treatment. The horizontal dimension (working width) of the root canal system is not only more complicated than the vertical dimension (working length), but also more difficult to investigate because it varies greatly at each vertical level of canal. Haga found mechanical enlargement of the root canal to a size two sizes larger than the original canal size was still inadequate. In histological sections, bacteria were found in the dentinal tubules. As a result, enlarging the apical portion of the root canal to three sizes larger than the first file to bind has been recommended. However, there is no evidence that the instrument that binds first actually reflects the diameter of the canal in the apical region. Thus, the concept of widening the apical canal to three sizes larger than the first file to bind is not based on evidence. This finding suggests that ea...
Stainless Steel files are widely used in field of Dentistry for root canal treatment. During exce... more Stainless Steel files are widely used in field of Dentistry for root canal treatment. During excessive usage of the Stainless Steel tool in dentistry the tool breaks inside the root canal. This makes it hard for the dentist to remove the stainless steel tool out of the root canal [1]. So if the rupture can be avoided from occurring, it will help the dentist from the tedious job of tool removal from the root canal. This experiment is done to compare the performance of the stainless steel file with NiTi coated stainless steel file using Electron Beam Physical Vapour Deposition process. The coated material with different coating thickness is tested using an ABB robot and the result shows that the stainless steel file coated with NiTi demonstrates less deformation than the stainless steel file.
The journal of contemporary dental practice, 2014
To report cases with morphologic variations in mandibular premolars. Mandibular premolars have ea... more To report cases with morphologic variations in mandibular premolars. Mandibular premolars have earned the reputation for having aberrant anatomy. The occurrence of three canals with three separate (type V, Vertucci) foramina in mandibular premolars is very rare. In this report, three cases are presented involving the root canal treatment of mandibular premolars with three different root and canal configurations. The present report also emphasizes the use of the dental operating microscope to enhance visualization. Correlation between radiographic findings, use of dental operating microscope and knowledge of aberrant anatomy helps to identify, locate and treat the aberrant anatomy of the tooth. The treatment was successful as all canals were identified and flled and also as evidenced by relief of symptoms. Success is largely dependent on the use of magnification, which aided in identifying the location of the three individual root canal orifices; thus emphasizing the need to familiar...
General dentistry
This case report describes the nonsurgical endodontic management of a maxillary first molar with ... more This case report describes the nonsurgical endodontic management of a maxillary first molar with the unusual morphology of three separate buccal roots. An accurate assessment of this morphology was made with the help of cone-beam computed tomography (CBCT). This report also describes the varied root morphology associated with maxillary first molars and the role of CBCT as a diagnostic tool for managing these complex cases successfully.
Quintessence international (Berlin, Germany : 1985), 2014
This case report illustrates the nonsurgical endodontic management of a seven-canaled mandibular ... more This case report illustrates the nonsurgical endodontic management of a seven-canaled mandibular second molar. The root canal configuration presented as four mesial and three distal canals. Identification of the canal system was made with the aid of magnification, ultrasonics, and multiple angulated radiographs. Postoperative examination at 18 months showed a clinically asymptomatic tooth with resolution of the periapical pathology.
General dentistry
This article presents a case of a palatogingival groove (PPG) in tooth No. 12 that was misdiagnos... more This article presents a case of a palatogingival groove (PPG) in tooth No. 12 that was misdiagnosed as a mutilated root fracture. A PPG is a developmental anomaly that predisposes a tooth to a severe periodontal defect. The initial diagnosis of mutilated root fracture on tooth No. 12 was made solely from radiographs that showed a vertical and horizontal radiolucent line with a radiolucent halo-shaped bone resorption in relation to the root apex. Transillumination, bite test, surgical visualization of the site, and the use of high-end diagnostic modalitieswere not considered prior to the final diagnosis. PPG was confirmed only after the tooth was extracted and observed under a dental operating microscope.
Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation... more Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. This article describes the successful revascularization treatment of an immature maxillary lateral incisor that was initially diagnosed with apical periodontitis. The tooth was asymptomatic and functional clinically and radiographically during the follow-up period of 5 years. The follow-up showed evidence of progressive thickening of the dentinal walls, development of root length and apical closure. The article also discusses the currently available literature regarding revascularization of immature permanent teeth.
Numerous terminologies have been employed in the dental literature to describe the roots and root... more Numerous terminologies have been employed in the dental literature to describe the roots and root canal systems of maxillary molars. This multiplicity in naming of roots and canals makes the reader susceptible to misinterpretation and confusion. No consensus thus far has been arrived at for defining the names of roots and root canals in maxillary molars, including their various morphological aberrations. The anatomical relation of roots and their root canals were identified and were subsequently named based on definite sets of criteria. A new method for identification and naming of roots and root canal anatomy in maxillary molars, based on their root and canal relationship, was formulated and is presented in this paper. The nomenclature makes certain essential modifications to the traditional approach to accommodate naming of the various aberrations presented in the maxillary molars. A simple, yet extensive, nomenclature system has been proposed that appropriately names the internal and external morphology of maxillary molars.
Case Reports in Dentistry, 2012
The paper describes the anatomical variation of four roots in a mandibular permanent first molar ... more The paper describes the anatomical variation of four roots in a mandibular permanent first molar diagnosed using multiple angulated preoperative radiographs and its successful nonsurgical endodontic management. Careful observation and exploration of the pulpal floor using a dental operating microscope revealed a peculiar developmental root fusion line on the pulp chamber floor. Based on the above observation, a correlation between this unusual line and the existence of additional roots has been proposed and discussed.
Journal of Endodontics, 2010
Introduction: The purpose of this article was to emphasize the importance of having a thorough kn... more Introduction: The purpose of this article was to emphasize the importance of having a thorough knowledge about the root canal anatomy. Methods: This case report presents the endodontic management of a maxillary first molar with three roots and seven canals. The clinical detection of the seven canals was made using a surgical operating microscope and confirmed using cone-beam computed tomography (CBCT) scanning. Results: CBCT axial images showed that both the palatal and distobuccal root have a Vertucci type II canal pattern, whereas the mesiobuccal root showed a Sert and Bayirli type XV canal configuration. Conclusion: This report describes and discusses the variation in canal morphology of maxillary first molar and the use of latest adjuncts in successfully diagnosing and negotiating them.
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Papers by Dr. Jojo Kottoor