The unique morphology of dilacerated and S-shaped root canals often pose utmost challenges in their endodontic management. Common causes of failures in such cases are primarily related to procedural errors such as ledges, fractured instruments, canal blockages, zip and elbow creations. Knowledge of dental anatomy and its variations is essential for the success of endodontic treatment. A clinician is required to have an insight of the morphology of tooth related to its shape, form and structure before commencing treatment. Routine periapical radiographs aids in assessing these morphological variations in the root canal system. This article gives a review of the literature and reports an interesting case of dilacerated and S-shaped root canals of adjacent teeth in the same patient.

Background:The achievement of successful local anesthesia is a continual challenge in dentistry. Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection (the Stabident system and the X-tip system) have been proposed to be advantageous in cases where the conventional local anesthetic techniques have failed.Aim:A clinical study was undertaken using intraosseous injection system by name X-tip to evaluate its effectiveness in cases where inferior alveolar nerve block has failed to provide pulpal anesthesia.Materials and Methods:Sixty adult patients selected were to undergo endodontic treatment for a mandibular molar tooth. Inferior alveolar nerve block was given using 4% articaine with 1:100,000 epinephrine. Twenty-four patients (40%) had pain even after administration of IAN block; intraosseous injection was administered using 4% articaine containing 1:100,000 epinephrine, using the X-tip system. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analog scale ratings ≤ 54 mm) on endodontic access or initial instrumentation.Results:Intraosseous injection technique was successful in 21 out of 24 patients (87.5%), except three patients who had pain even after supplemental X-tip injection.Conclusion:Within the limits of this study, we can conclude that supplemental intraosseous injection using 4% articaine with 1:100,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.

Context: Mineral trioxide aggregate (MTA) is widely advocated as perforation repair material even though it has limited handling properties and prolonged setting time. Biodentine is an advanced calcium silicate material, which can overcome various disadvantages of MTA. Aim: To evaluate and compare the sealing ability of MTA and Biodentine as furcation perforation repair materials. Statistical analysis used: One-way analysis of variance (ANOVA) and Scheffe multiple comparison test. Results: Statistically significant difference (p-value < 0.001) in the mean dye leakage values was obtained on comparing Biodentine with MTA, where Biodentine exhibited less leakage. Conclusion: Biodentine exhibited significantly less microleakage compared with white MTA-Angelus when used as a furcation perforation repair material and may be considered over MTA for the purpose.

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