Context:Anxiety and fear of pain are the two major deterrents for which patients avoid dental treatment. Local anesthetic, which forms the foundation for the delivery of pain-free endodontic treatment, does not serve the purpose in anxious patients and requires augmentation with other pharmacological agents.Aims:The aim of this study is to observe the effectiveness of nitrous oxide in alleviating patient anxiety and pain during endodontic treatment of a vital tooth.Settings and Design:The present in vivo study was conducted on sixty healthy patients from the Outpatient Department of Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India.Subjects and Methods:Sixty anxious patients having irreversible pulpitis in their lower molar were selected and divided into two groups, namely control group and intervention group, with thirty patients placed in each group. In control group, access opening and pulp extirpation was done under local anesthesia only, whereas in intervention group, access opening and pulp extirpation was done under local anesthesia and nitrous oxide sedation. The anxiety levels of patients, before and after the treatment, were measured using the Modified Dental Anxiety Scale. Pain felt by the patients during administration of local anesthesia and during access opening was measured using the Visual Analog Scale.Statistical Analysis Used:The data were analyzed using ANOVA and paired t-test, and graphical analysis of the data was done.Results:Significant reduction in anxiety and pain levels of patients during endodontic access opening including significant reduction in pain during administration of local anesthesia was observed under nitrous oxide sedation.Conclusions:Conscious sedation with nitrous oxide is a useful technique to add to the armamentarium used in the treatment of teeth with symptomatic irreversible pulpitis.

Aim:To compare dentinal damage caused by hand and rotary nickel-titanium instruments using ProTaper, K3 Endo, and Easy RaCe systems after root canal preparation.Materials and Methods:One hundred and fifty freshly extracted mandibular premolars were randomly divided into five experimental groups of 30 teeth each and biomechanical preparation was done: Group 1 with unprepared teeth; Group 2 were prepared with hand files; Group 3 with ProTaper rotary instruments; Group 4 with K3 rotary; Group 5 with Easy RaCe rotary instruments. Then, roots were cut horizontally at 3, 6, and 9 mm from apex and were viewed under stereomicroscope. The presence of dentinal defects was noted.Statistical analysis:Groups were analyzed with the Chi-square test.Results:Significant difference was seen between groups. No defects were found in unprepared roots and those prepared with hand files. ProTaper, K3 rotary, and Easy RaCe preparations resulted in dentinal defects in 23.3%, 10%, and 16.7% of teeth, respectively. More defects were shown in coronal and middle sections, and no defect was seen in apical third.Conclusion:The present study revealed that use of rotary instruments could result in an increased chance for dentinal defects as compared to hand instrumentation.

Success of endodontic therapy depends on the proper identification of all the canals, thorough chemo-mechanical preparation followed by three dimensional obturation with fluid tight seal. Failure of any of these steps may occur due to unusual tooth morphology. Proper knowledge of root canal anatomy is a basic prerequisite for the endodontic treatment successful. Mandibular molars may have an additional root located lingually (radix entomolaris) or buccally (radix paramolaris). Awareness and understanding of the presence of unusual external and internal root canal morphology contributes to the successful outcome of the root canal treatment.Bangladesh Journal of Dental Research and Education Vol.5(2) 2015: 66-69