Papers by Raghavendra Penukonda
Endodontology
The separation of the nickel-titanium (NiTi) rotary files is seen occasionally due to improper us... more The separation of the nickel-titanium (NiTi) rotary files is seen occasionally due to improper use and lack of technique, which results in improper cleaning and shaping of the root canals, compromising the treatment outcome. Various techniques have been introduced to either bypass or retrieve the separated instrument. The present case series highlighted a low-cost and straightforward alternative to retrieve the separated NiTi rotary instruments using a customized syringe and loop technique with the assistance of a dental operating microscope. Three cases of fractured instruments in different root canals were addressed, with the customized syringe and loop technique being used to retrieve the instruments successfully. This supports the use of a convenient, reliable, and cost-effective approach to managing fractured endodontic instruments without costly equipment or specific retrieval kits.
Journal of Conservative Dentistry, 2021
Successful root canal treatment requires a thorough understanding of the normal root canal anatom... more Successful root canal treatment requires a thorough understanding of the normal root canal anatomy and possible variations for each tooth. Variations in the root canal anatomy are frequently associated with complex orientations of pulp tissues and complicating mechanical and chemical debridement. Inability to manage such complications may result in endodontic failure. Mandibular first premolars often exhibit a wide range of anatomic variations, complicating clinicians' treatment. This clinical case report discusses the cone-beam computed tomography (CBCT) diagnosis and nonsurgical management of a taurodontic mandibular first premolar with two roots and four canals under a dental operating microscope (DOM). In endodontically challenging cases, using a DOM and CBCT imaging can help the clinician gain a better understanding of the complex root canal anatomy, allowing the clinician to more efficiently explore, clean, shape, and obturate the root canal system.
Odontology, 2021
To compare the vertical root fracture (VRF) resistance of root canal-treated teeth instrumented w... more 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.
Journal of Dental Research and Review, 2020
Removal of the different materials from the root canal in a failed endodontic treatment is a prim... more Removal of the different materials from the root canal in a failed endodontic treatment is a prime requisite for endodontic retreatment. Complete removal of the materials such as gutta percha, broken instruments, or post is of particular importance for accessing endodontic space, cleaning, shaping, and disinfection of the root canal. Intraradicular post removal poses a challenge to the clinician with associated risks. This case report focuses on removal of the metal post and endodontic retreatment of the maxillary canine with minimum armamentarium to enhance the longevity of the tooth.
Biomedical and Pharmacology Journal, 2020
Journal of Conservative Dentistry, 2017
Aim: The purpose of this clinical study was to compare and clinically, to evaluate the accuracy o... more Aim: The purpose of this clinical study was to compare and clinically, to evaluate the accuracy of six apex locators with intra oral periapical (IOPA) radiograph in multirooted teeth. Materials and Methods: A total of 90 multirooted teeth (maxillary and mandibular molars) with irreversible, infected or necrotic pulp tissue and completely formed roots were included in this study and were divided randomly into six groups (Root ZX II, Raypex 6, I-Root, Romiapex A-15, Sybron Endo Mini and Root ZX mini). The working length was determined using six different apex locators, and the accuracy of the apex locators was compared with IOPA radiographs, to be categorized as accurate, short, and long or beyond. Results: A total of 270 canals were evaluated, of which 233 (86.3%) canals exhibited acceptable working length, 28 (10.4%) canals exhibited short working length, and only 9 (3.3%) canals exhibited working length beyond the apex. There were a statistically significant results in all the groups (P < 0.05) and the comparison between the groups was statistically insignificant. Conclusion: The repeatability with that of apex locators is of great advantage, but the information gained from the radiographs cannot be obtained by any other means. Therefore, it is recommended that radiograph and apex locators are the best combinations in accurately determining the working length and the successful endodontics.
Saudi Endodontic Journal, 2018
The possible variations of anatomical and morphological characteristics of the teeth are very imp... more The possible variations of anatomical and morphological characteristics of the teeth are very important especially for the endodontic practitioners for successful treatment. Mandibular molars are most commonly affected by dental caries and require endodontic treatment. Mandibular molars exhibit variations in its internal anatomy; one among those is the presence of an extra canal in the mesial root called as middle mesial (MM) canal. Detection of these minute canals requires a proper clinical knowledge and radiographic examination. This article presents the treatment of three cases of mandibular first molars with MM canals without the aid of any magnification devices.
International Journal of Recent Scientific Research, 2017
Introduction: Removal of infected pulp tissue from the coronal portion leads to preservation of a... more Introduction: Removal of infected pulp tissue from the coronal portion leads to preservation of a remaining vital and functioning pulp. Preservation of pulp vitality by pulpotomy is one of the universally accepted treatment procedure with the aid of latest bioactive materials leading to a more conservative approach in the management of teeth involving the pulp based on clinical conditions. Aim: To comparatively evaluate the clinical and radiological outcome of single visit pulpotomy procedure using Biodentine and the combination of Plasma Rich Fibrin (PRF) and Biodentine Materials and Methods: Twenty permanent molars were selected and randomly assigned to two groups that included pulpotomy with only Biodentine and the other group with the PRF-Biodentine combination. Single visit pulpotomy procedure was completed with the restoration. Later the patients were recalled after one day, three months and six months for clinical and radiographical evaluation. Results: Chi-square test was used to compare the responses for various study variables between Biodentine and PRF-Biodentine combination. The comparison between the two groups was statistically not significant. Conclusion: Single visit pulpotomy procedure performed with either Biodentine or Combined PRF and Biodentine was equally efficient at 6 months follow-up. But with PRF-Biodentine combination, PRF an ideal biomaterial which is autologous can help better than Biodentine alone in the success of vital pulp therapy
Journal of clinical and diagnostic research : JCDR, 2017
The preference and usage of nickel titanium rotary instruments varies from individual to individu... more The preference and usage of nickel titanium rotary instruments varies from individual to individual based on their technique, experience with the rotary systems and the clinical situation. Very limited information is available to explain the adoption of changing concepts with respect to nickel titanium rotary instruments pertaining to the endodontists in India. The aim of this study was to conduct a questionnaire survey to acquire the knowledge concerning different NiTi rotary instruments and their usage techniques by endodontists in India. A Survey questionnaire was designed which consisted of 32 questions regarding designation, demographics, experience with rotary instruments, usage of different file systems, usage techniques, frequency of reuse, occurrence of file fracture, reasons and their management was distributed by hand in the national postgraduate convention and also disseminated via electronic medium to 400 and 600 endodontists respectively. Information was collected from...
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Papers by Raghavendra Penukonda