BRIEF RESUME OF THE INTENDED RESEARCH WORK

Need for the study

Maintaining the integrity of primary dentition until normal exfoliation is a major goal of modern dentistry.1Various procedures must be utilized to preserve primary teeth in healthy state so as to enable them to function as designated because it is presumed that there can be no better space maintainer than patient’s own primary tooth.2

Dental caries is the most prolific disease of the primary dentition.Morphologic variations and improper oral hygiene practices make deciduous dentition more prone to vagaries of dental caries leading to early involvement of pulp.3

Based on the extent of pathologic involvement of primary tooth pulp tissue,various therapeutic procedures are outlined eg-Indirect pulp capping, Direct pulp capping, Pulpotomy,and Pulpectomy.2

Pulpectomy is an option for treating severely infected primary teeth involving radicularpulp.The success of pulpectomy not only depends on proper case selection and materials used but also proper technique of obturating the root canals.3However the complex morphology of the root canal system in deciduous teeth make the proper obturation of root canalsdifficult.The ultimate goal of obturation is to create fluid-tight seal along the length of the root canal system from coronal opening to apical termination.4

Many studies have been done to determine ideal root canal obturation material for primary teeth but not too many techniques of obturation of primary tooth root canal have been described in literature.

This study is taken up to comparatively evaluate in vitro the effectiveness of four different techniques of obturation in primary teeth using endodontic pressure syringe, insulin syringe, jiffy tube and local anaesthetic syringe.

Review of literature

An in vitro study was undertaken to compare five techniques of delivering zinc oxide eugenol into straight and curved simulated root canals for their depth of fill capabilities.The techniques tested were those using the endodontic pressure syringe,the mechanical syringe,thelentulospiral,the jiffy tube and the tuberculin syringe.The study showed that endodontic pressure syringe and lentulospiral were

superior for filling straight canals.Thelentulospiral filling method was superior for filling curved canals.Overalllentulospiral performed best.5

An in vitro study was conducted on ten extracted human maxillary first molars with a variety of root curvatures.Three techniques were used to introduce calcium hydroxide paste into the instrumented canal.These were, a lentulospiral in a slow speed hand piece,a syringe and a cartridge identical to the Calasept paste system and a K-file.The study showed that lentulospiral performed best for placing calcium hydroxide paste to working length producing best quality fill,theCalasept injection system was the second mosteffective technique,where as K-file was least effective.6

An in vitro study was conducted on fifty four extracted primary maxillary central incisors,which had no more than twenty five percent root resorption,or any root anomalies.Authors compared the effectiveness of three obturation techniques, using pressure syringe,lentulospiral and endodontic plugger.They found the obturating technique using endodontic plugger yielded best apical seal,while pressure syringe resulted in fewer voids.The technique using lentulospiral yielded the least extrusion.They concluded that there was no statistically significant differences among the three techniques.1

A study was conducted to evaluate,invivo,two different obturation techniques using a lentulo spiral mounted in a slow-speed hand-piece and hand-held lentulospiral.The study showed 96% clinical success rate in the group obturated by lentulo spiral mounted in a slow-speed hand-piece compared to hand-held,which showed 92% clinical success rate.The study concluded that there was no statisticallysignificant difference between the two techniques of obturation,according to the quality of the root canal filling or success rate.7

An in vivo study was done to evaluate two obturation techniques in deciduous teeth:traditional reamer technique compared to a new technique using Insulin syringe as a paste delivery system.Filling techniques were assessed for radiopacity,presence of voids and canal obturation quality using radiographs.The results showed that the obturation quality of both the techniques was found to be very closely related and Insulin syringe can be used as an effective and economical delivery system for obturating deciduous teeth.3

Research question

Which is the best and effective way of obturating root canals of primary teeth?

Objectives of the study

To compare and evaluate the effectiveness of endodontic pressure syringe, insulin syringe, jiffy tube and local anaesthetic syringe for obturation of root canals of primary teeth.

Materials and Methods

Source of data

Maxillary and mandibular primary molars will be collected from the department of Pedodontics and Preventive Dentistry, Government Dental College and Research Institute, Bangalore.

MATERIALS USED IN THE STUDY:

  • Formalin
  • Normal Saline
  • Modelling wax
  • Plaster of paris
  • Zinc oxide eugenol

ARMAMENTARIUM:

  • Round Bur
  • Airotor hand-piece
  • K-files
  • Absorbent paper points
  • Endodontic Pressure Syringe
  • Insulin Syringe
  • Jiffy tube
  • Local Anaesthetic Syringe

Methods of collection of data

SAMPLE SIZE:

Ninety six extracted human primary maxillary and mandibular molarroot canals will be used.

INCLUSION CRITERIA:

  1. Teeth having at least two-third root remaining.

EXCLUSION CRITERIA:

  1. Teeth having root caries.
  1. Teeth which are grossly decayed.
  1. Teeth with signs of canal obstruction.

Method of allocation of data

Ninety six extractedhuman primary maxillary andmandibular molar root canals will be selected for thestudy.Immediately following extraction each tooth will be placed in 10% formalin.Teeth will be prepared by removing all soft tissue remnants and then placed in normal salineuntilluse.Root canals will be equally and randomly divided into four groups with twenty four teeth per group-

Group I. Endodontic Pressure Syringe

Group II. Insulin Syringe

Group III. Jiffy Tube

Group IV. Local Anaesthetic Syringe

Method of study.

For all teeth standard endodontic access to the pulp chamber will be prepared using diamond round burs.A size 10 K-file will be used to locate the canal and its patency.The canal length will be established with size 10 K-file just visible through the apex.The working length will be determined by substracting 1mm from the total canal length.

Modelling wax and plaster of paris will be used for specimen preparation. Specimens will be placed on a flat table and pre-operative radiographs will be taken.

Biomechanical preparation of the root canals will be initiated with size 15 K-file and canals will be enlarged sequentially to size 40 K-file.Normal saline will be used to irrigate the canals.The canals will be dried with paper points and obturation will be performed with standard mix of zinc oxide eugenol in four test groups using endodontic pressure syringe, insulin syringe, jiffy tube and local anaestheticsyringe.The pulp chamber will be covered with temporary restoration.

Effectiveness of the four obturation techniques will be assessed using post-

obturation radiographs for depth of fill in the canals.

Two evaluators,blindedto the filling techniques,will assess the radiographs.

The quality of the root canal filling will be defined as-3

1.UNDERFILLING-All canals filled more than 2mm short of the apex.

2.OPTIMAL FILLING-Canals having zinc oxide eugenol ending at the radiographic apex or upto 2mm short of apex.

3.OVERFILLING-Any canal showing zinc oxide eugenol outside the root.

When disagreement occurs,the radiograph will be reevaluated and diagnostic consensus will be reached.

Does the study require any investigations or interventions to be conducted on

patients or humans or animals? If so, please describe briefly.

No.

Has the Ethical clearance been obtained from your institution?

Notapplicable.

Statistical analysis

Stastistical analysis of the data will be carried out using Chi-square test.

Duration of the study

The duration of the study is for a period of six months(approximately)

LIST OF REFERENCES:

  1. Dandashi MB, Nazif MM, Zullo T, Elliott MA, Schneider LG, Czonstkowsky M. An in vitro comparison of three endodontic techniques for primary incisors.Pediatr Dent1993 July;15(4):254-256.
  2. Bhandari SK, Prajapati U. Root canal obturation of primary teeth:Disposable injection technique. J Indian Soc PedoPrev Dent2012 Jan;30(1):13-18.
  3. Nagar P, Araali V, Ninawe N. An alternative obturating technique using insulin syringe delivery system to traditional reamer-an in-vivo study. Journal of Dentistry and Oral Biosciences2011;2(2):7-9.
  4. Jha M, Patil SD, Sevekar S, Jagani V, Shingare P. Pediatric Obturating Materials And Techniques. Journal of Contemporary Dentistry 2011 Oct-Dec;1(12):27-32.
  5. Aylard SR, Johnson R. Assessment of filling techniques for primary teeth. Pediatr Dent 1987 Sept;9(3):195-198.
  6. Sigurdsson A, Stancill R, Madison S. Intracanal Placement of Ca(OH)2:A Comparison of Techniques. J of Endod1992 Aug;18(8):367-370.
  7. Bawazir OA, Salama FS. Clinical Evaluation of Root Canal Obturation Methods in Primary Teeth. Pediatr Dent2006 Jan;28(1):39-47.