Jojo Kottoor

Royal Dental college · Conservative Dentsistry & Endodontics

Introduction. Mandibular premolars have been reported with complex anatomical aberrations, making them one of the most difficult teeth to manage endodontically. Methodology. An exhaustive search was undertaken to identify associated anatomic studies of mandibular premolars through MEDLINE/PubMed database using keywords, and a systematic review of t...

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 m...

Root canal treatment of maxillary molars presenting with complex root canal configurations can be diagnostically and technically challenging. Nonsurgical endodontic therapy of a left maxillary first molar with three roots and eight root canals was successfully performed. This unusual morphology was diagnosed using a dental operating microscope (DOM...

Clinical steps in biomimetic dentistry.

Introduction: This cross-sectional study assessed the influence of patient demographics on the worldwide prevalence of a lingual canal in mandibular incisors. Methods: 26,400 mandibular incisors were evaluated using cone-beam computed tomography imaging by pre-calibrated observers from 44 countries. A standardized screening method was employed t...

A clinical endodontic case report of non surgical and surgical management of complexities involving multiple instrument fractures and concomitant external cervical root resorption.

Practice of Endodontics majorly revolves around prevention and treatment of pulpal infection Although the strategies followed for treatments are usually evidence based, but, due to development of technology and advancements in material science newer concepts are being floated and practiced for the management of diseases. This section highlights the...

Dr Denzil Albuquerque and Dr Jojo Kottoor discuss the management and prevention of endodontic perforations to increase the success rate and predictability of treatment.

Purpose: Mineral trioxide aggregate (MTA) has been shown a potential endodontic material in several clinical applications. Certain inherent disadvantages of MTA led to the introduction of Biodentine (BD). The retrieval of MTA and BD has been challenging for most clinicians. This study aimed to compare and evaluate the effect of carbonic acid (CA) o...

Endodontic success depends on multiple factors. The tooth position, morphology, anatomic variations, clinical skills, and expertise along with equipment and materials used, all contribute to clinical success. This article describes in detail non-surgical retreatment of two anatomic variations in mandibular molars that were failing because of persis...

Introduction This study assessed the prevalence of radix entomolaris and two canals at the distal aspect of mandibular first molars amongst different geographic regions by means of cone-beam computed tomography (CBCT). Methods Pre-calibrated observers from 23 worldwide geographic locations followed a standardized screening protocol to assess 5,750...

Advancement in restorative material science and better understanding of bonding have influenced the treatment approach for restoring dentition. Thus evolved the concept of biomimetics in the field of restorative dentistry. Biomimetic dentistry helps to recreate the form, function and aesthetics of the dentition in a natural way. This narrative revi...

This chapter presents a case of separated instrument retrieval from the apical third of a mandibular premolar and management of complex apical third trifurcation. When an instrument fractures in the root canal system, a decision has to be made to leave, bypass or remove the fragment, the choice being based on an assessment of the potential benefit...

Abstract Introduction The presence of multiple root canals is an important morphological aspect of mandibular premolars. This study aimed to perform a worldwide analysis on the prevalence of a lingual canal in mandibular premolars and evaluate its influence on patients’ demographics of 23 countries using CBCT images. Methods Observers from 23 co...

Introduction: 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) assessmen...

The goal of endodontic therapy is the removal of all vital or necrotic tissues, microorganisms, and microbial by-products from the root canal space. Amongst the treatment steps, chemomechanical procedures play a pivotal role in eliminating or reducing bacterial populations from the main root canal, but the disinfecting effects of instruments and ir...

1. What should be the ideal gauge or size of the needle selected for thermoplastic GP obturation? 2. What is the length of time required to introduce thermoplasticized gutta percha in prepared root canals? 3. Till what apical extent of the root canal should the needle be introduced during obturation? Is it different for different teeth and differen...

Cone beam computed tomography (CBCT) has enhanced three-dimensional visualization, allowing for greater knowledge acquisition and diagnostic insights. However, this could be a double edged sword with the potential radiation risk associated with its widespread use. The lack of any coherent adoption of guidelines and widespread arbitrary usage of adv...

Supernumerary teeth are developmental anomalies that might require endodontic treatment for functional and/or aesthetic reasons. A review of the literature was conducted using appropriate key words (Supernumerary’ OR ‘Supplemental’ OR “Rudimentary” AND ‘Tooth’. ‘Mesiodens’ OR ‘Paramolar’ OR ‘Distomolar’).in major endodontic journals (Australian End...

Introduction 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. Methods Nine field observers from 9 different geographic regions were calibrated. A total of 400 samples were collected in each region. The pr...

Understanding the complexity of the root canal system and the aim to provide successful endodontic treatment has led to the development of newer techniques, instruments, and materials. These recent developments have greatly enhanced the clinician’s ability to achieve biologically-based objectives of root canal treatment. In order to achieve these o...

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 diagn...

The aim of this study was to compare the effectiveness of 30% propolis extract, 3% Sodium hypochlorite (NaOCl), 2% chlorhexidine gluconate (CHX), 10% povidone iodine and 0.9% saline solution to disinfect Guttapercha (GP) cones contaminated by Enterococcus faecalis (E. faecalis). Fifty four size 80 GP cones were used. The cones were contaminated by...

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 c...

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...

Aim: To compare the changes in microhardness of root dentin caused by two novel irrigation regimens with conventional irrigation. Materials and Methods: Forty extracted human permanent incisor teeth were selected. Decoronated roots were separated longitudinally to get 80 specimens that were embedded in autopolymerizing acrylic resin and grounded f...

Aim: To report cases with morphologic variations in mandibular premolars. Background: 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 tre...

The purpose of this article is to describe a clinical case of a maxillary fi rst molar with three roots and six root canals.The clinical detection of the six canals was made using a dental operating microscope and confirmed using multiple angled radiographs.This report serves to remind clinicians that such anatomical variations should be taken into...

Mandibular premolars are known to have numerous anatomic variations of their roots and root canals, which are a challenge to treat endodontically. The paper reviews literature to detail the various clinically relevant anatomic considerations with detailed techniques and methods to successfully manage these anomalies. An emphasis and detailed descri...

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 horiz...

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 mont...

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 th...

Aim: The purpose of this study was to evaluate the effect of multiple root canal usage on the surface topography and fracture of Twisted File (TF) and ProTaper (PT) rotary Ni-Ti file systems, using scanning electron microscope (SEM). Materials and methods: Ten sets of PT and TF instruments were used to prepare the mesial canals of mandibular fir...

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...

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 radiographi...

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 l...

Several terminologies have been employed in the dental literature to describe the roots and root canal systems of mandibular molars with no consensus being arrived at, thus far. The anatomical relation of roots and their root canals were identified and a naming system was formulated. The proposed nomenclature attempts to make certain essential modi...

To describe the successful non-surgical endodontic management of a permanent maxillary lateral incisor tooth with four root canals. Aberrant morphology of root canals can occur in any tooth, including maxillary lateral incisors. In the presented case, clinical examination and radiographs clearly depicted the presence of four root canals in a right...

The aim of this article was to present an endodontically managed maxillary first molar with unusual C-shaped palatal root morphology confirmed by cone-beam computerized tomography (CBCT) images. CBCT axial images showed the presence of C-shaped palatal root canal anatomy with a palatal root bifurcation at the apical third. The evaluation of CBCT im...

This article discusses the successful endodontic management of 3 permanent maxillary first molars presenting with the anatomical variation of 3 roots and 6 root canals. A literature review pertaining to the variable root canal morphology of the permanent maxillary first molar is also presented. Modifications in the root canal access preparation and...

The objective of this article is to highlight the importance of having a thorough knowledge about the root canal anatomy and the possibility of misleading findings in the cone-beam computed tomography (CBCT) images. This case report presents the endodontic management of a right mandibular first molar with 2 roots and 2 canals. A CBCT imaging was pe...

To present a clinical case report in a mandibular first molar with a middle distal canal, along with a review of the literature. With the use of magnification, either by microscopes or by loupes, there is an increasing possibility of detecting additional canals. The present case describes root canal treatment in a mandibular first molar with two ro...

The purpose of this article was to emphasize the importance of having a thorough knowledge about the root canal anatomy. 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-...

This case report presents the endodontic management of maxillary right second molar exhibiting 5 roots and 5 root canals. The diagnosis was confirmed with the help of cone beam computerized tomography (CBCT). The article also describes the varied morphology associated with maxillary second molar and the use of a high-end diagnostic imaging modality...