RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE.

ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

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Dr. VENKATA SU ES! V Name of the candidate and address (In block N" #$ %nd & "SS$ 'th (AIN$ letters) SA)TA*I I +A,"UT$ T!IND+U (AIN "AD$ VID,A AN,A)U A )"ST $ -AN*A+" E ./00#1. N" #$ %nd & "SS$ 'th (AIN$ SA)TA*I I +A,"UT$ T!IND+U (AIN "AD$ VID,A AN,A)U A )"ST $ -AN*A+" E ./00#1. V"KKA+I*A A SAN*!A DENTA+ &"++E*E AND !"S)ITA+ (aster of Dental S5r8er3 ((.D.S.) De2artment of &onser9ati9e dentistr3 and Endodontics %':0.:%011

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Tem2orar3 address

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Name of the instit5tion

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&o5rse of the st5d3 and s5b7ect

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Date of admission to co5rse Title o t!e to"i#

THE EFFECT OF INSTRUMENT TYPE AND PREFLARING ON APICAL FILE SI$E DETERMINATION % AN IN VITRO STUDY

&. BRIEF RESUME OF THE INTENDED 'ORK

&.( NEED FOR THE STUDY

Effecti9e canal debridement relies on the acc5rate determination of the ;orkin8 len8th and ade<5ate a2ical canal enlar8ement. The e=tent of a2ical enlar8ement is based on estimation of the initial canal si>e as determined b3 the si>e of hand file that binds at the ;orkin8 len8th (*rossman et al 1#'' )?(). Since the diameter of the a2ical canals 9ar3 8reatl3 in all tooth 8ro52s$ no standard si>e is ad9isable for the a2ical enlar8ement. "ne recommended a22roach is to enlar8e the a2ical root canal to three si>es lar8er than the first file to bind?%@. If the *rossman criteria of enlar8in8 a root canal to atleast three si>es be3ond the first file that binds at ;orkin8 len8th is 9alid then one sho5ld <5estion ;hether a standard master a2ical file si>e of %. or 40 ;o5ld be s5fficient for a2ical 2re2aration of narro; canals$ as ro5tinel3 recommended b3 most a5thors?1@. It ma3 be more acc5rate to si>e each canal indi9id5all3 and s5bse<5entl3 determine the master a2ical file si>e to ens5re that the a2ical third re8ion is ade<5atel3 enlar8ed and debrided 2rior to obt5ration ?1@. !ence the 25r2ose of this st5d3 is to determine ;hether the first file that binds at ;orkin8 len8th reflects the diameter of the canal.

&.*REVIE' OF LITERATURE+ 1) In this st5d3 one h5ndred and t;ent3 one canals from /0 e=tracted intact h5man ma=illar3 and mandib5lar 2remolars ;ere 5tili>ed to determine the effect of instr5ment t32e ( k files and li8ht s2eed instr5ment ) and the im2act of 2reflarin8 on the first file si>e that binds at ;orkin8 len8th. It ;as concl5ded that 2re flarin8 and hand held li8ht s2eed instr5ments res5lted in an increase in the instr5ment si>e that bo5nd at ;orkin8 len8th. To determine an acc5rate master a2ical file si>e$ canal orifice enlar8ement sho5ld be 2erformed first before the 2lacement of the assessment file?1@. %. In this st5d3 t;o similar 8ro52s (nA10) of mandib5lar 2remolars ;ith c5r9ed canals ;ere selected to determine$ ;hether the first file to bind corres2onds to the diameter of the canal in the a2ical re8ion. It ;as concl5ded that$ neither the first K file nor the first li8ht s2eed instr5ment that bo5nd at ;orkin8 len8th acc5ratel3 reflected the diameter of the a2ical canal in c5r9ed mandib5lar 2remolars ?%@. 4. In this st5d3 %1% root canals ;ere 2reflared from '0 e=tracted molars to establish a ne; a22roach for determination of the o2timal a2ical 2re2aration si>e. Borkin8 len8th ;as determined 5sin8 electronic a2e= locator and s2ecial instr5ments s2ecificall3 desi8ned to meas5re the a2ical canal diameter ;ere 5sed. The s2ecial instr5ments had nonta2ered $ nonc5ttin8 shafts that allo;ed for better access in the a2ical re8ion ;itho5t bindin8 in remote areas of the root canal. This st5d3 concl5ded that the o2timal a2ical

si>e 2re2aration of the root canals sho5ld be sha2ed to lar8er si>es than normall3 recommended?4@ . 6. In this st5d3 fort3 h5man lateral incisors ;ith com2lete root formation ;ere 5sed to in9esti8ate the infl5ence of cer9ical 2reflarin8 on determination of the initial a2ical file in ma=illar3 lateral incisors. This st5d3 concl5ded that instr5ment bindin8 techni<5e for determinin8 anatomical diameter at ;orkin8 len8th ;as not acc5rate. )reflarin8 of cer9ical and middle thirds of the root canal im2ro9ed anatomical diameter determination$ the instr5ment 5sed for 2reflarin8 2la3ed a ma7or role on determination of the anatomical diameter at the ;orkin8 len8th?6@ . .. In this st5d3 a total of 410 canals ;ere e9al5ated in 2atients 2resentin8 for root canal thera23 to com2are si>es of the first instr5ment ;ith or ;itho5t a ta2er that binds at the a2ical constriction of a root canal after coronal flarin8. This st5d3 concl5ded that the a9era8e si>e of first li8ht s2eed to bind a8ainst the canal ;alls at the ;orkin8 len8th ;as a22ro=imatel3 t;o IS" si>es lar8er than the first k file to bind (2C0.00.). So one sho5ld consider introd5cin8 a nonta2ered instr5ment to ;orkin8 len8th after coronal flarin8 beca5se determination of the initial a2ical canal diameter 2la3s a ma7or role in identif3in8 the e=tent of final a2ical sha2in8 ?.@.

&., OBJECTIVES OF THE STUDYD 1.To determine ;hether the first file that binds reflects the diameter of a2ical canal at the ;orkin8 len8th. %. To determine the infl5ence of cer9ical 2reEflarin8 on the initial a2ical file si>e.

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MATERIALS AND METHODSD

-.( SOURCE OF DATA '0 freshl3 e=tracted mandib5lar 2remolars from the de2artment of "ral s5r8er3$ V. S Dental &olle8e and !os2ital ;ill be selected for this st5d3.
INCLUSION CRITERIA

Teeth dis2la3in8 normal 25l2 chambers$ sin8le root canal and f5ll3 formed a2ices.
EXCLUSION CRITERIA

Teeth ;ith com2licated anatom3$ e=treme root c5r9at5res and root resor2tions.

METHOD
Standard access to the 25l2 chambers ;ill be 2erformed and 25l2 tiss5e e=tri2ated ;ith fine barbed broach$ a9oidin8 contact ;ith root canal ;alls. A si>e 10 file ;ill be inserted in to the canal 5ntil the ti2 of the

file is 9isible at the a2ical foramen and the ;orkin8 len8th established b3 red5cin8 1 mm. Thereafter$ the teeth are randoml3 di9ided into % main 8ro52s ;ith 60 sam2les in each 8ro52. The 8ro52s ;ill be identified b3 labelin8 them as 8ro52 A (sam2les ;ith cer9ical 2reflarin8 ) and 8ro52 - (sam2les ;itho5t cer9ical 2reflarin8). The sam2les in 8ro52 A (sam2les ;ith cer9ical 2reflain8) ;ill be s5bdi9ided into 6 s5b8ro52s$ ;ith each 8ro52 containin8 10 sam2les. Initial a2ical file si>e is determined in each 8ro52 ;ith the follo;in8 files$ * "U) 1E K file * "U) % F (odified K file (1mm ti2 of the K file is remo9ed ) * "U) 4 F +i8ht s2eed * "U) 6E (odified li8ht s2eed (a2ical half of c5ttin8 head is remo9ed) The sam2les in 8ro52 - (sam2les ;itho5t cer9ical 2reflarin8) ;ill be s5bdi9ided into 6 s5b 8ro52s$ ;ith each 8ro52 containin8 10 sam2les. Initial a2ical file si>e is determined the same ;a3 as 8ro52 A. The coronal as2ect of each canal in 8ro52 A ;ill be flared 5sin8 8ates 8lidden drill si>e .0 (no 1) 52to a de2th ;here resistance is met$ then si>es 10E110 ( nos %E6) res2ecti9el3 to 1$ %$ and 4mm shorter. The canals ;ill be irri8ated ;ith %ml of ..%.G sodi5m h32ochlorite after each 8ates 8lidden drill. Initial a2ical file si>e for both 8ro52 A and 8ro52 - ;ill be determined ;ith man5al k file and modified k file startin8 ;ith 1. si>e $ ;here as initial a2ical file si>e of li8ht s2eed and modified li8ht s2eed ;ill be determined startin8 ;ith smallest si>e (no %0). Hile si>es ;ill be increased 5ntil a bindin8 sensation is felt at the ;orkin8 len8th and the instr5ment si>e ;ill be recorded for each tooth.
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After a2ical file si>e determination for each tooth$ the bindin8 instr5ment ;ill be fi=ed in the canal at ;orkin8 len8th ;ith acr3lic resin. The teeth ;ill then be sectioned hori>ontall3 1mm from the a2e=$ ;ith the bindin8 file in fi=ed 2osition. The root s5rfaces ;ill then be stained ;ith %G meth3lene bl5e and obser9ed 5nder stereo microsco2e. Ima8es obtained of the c5t root s5rface ;ill be ca2t5red. The anal3sis of the ima8es ;ill be carried o5t 5sin8 Ima8e )roe=2ress soft;are. Diameters of root canal and file ;ill be recorded for each sam2le. The discre2anc3 bet;een these diameters ;ill be calc5lated (in mm) . -., FOLLO' UP

Not rele9ant
-.. STATISTICAL TESTS The data collected ;ill be s5b7ected to statistical anal3sis. T;o ;a3 AN"VA ;ill be 5sed to determine ;hether the first file that binds at ;orkin8 len8th reflects the diameter of the canal in the a2ical re8ion and the infl5ence of 2reflarin8 on the initial a2ical file si>e. -./ Doe0 t!e 0t123 4e51i4e 673 i78e0ti96tio7 o4 i7te48e7tio7 to :e #o721#te2 o7 "6tie7t0 o4 ot!e4 !1;67 o4 67i;6l<
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-.. ETHICAL CLEARENCE+

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>. LIST OF REFERENCES+ 1. -. T. Tan and !. ! (esser. The effect of instr5ment t32e and 2reflarin8 on a2ical file si>e determination. International 7o5rnal of endodontics (%00%) $ 4.$ 1.%E1.' %. (.EK$ B5$ D. -akris $ A. oris $ and ). Besselink. Does the first file to bind corres2ond to the diameter of the canal in the a2ical re8ion. International 7o5rnal of endodontics (%00%) $ 4.$ %/6E%/1. 4. oland Bei8er$ D(D$ Tabor -artha$ D(D$ (atthias Kal;it>ki$ D(D et

al .A clinical method to determine the o2timal a2ical 2re2aration. "ral s5r8 oral med oral 2ath oral radiol endo (%00/)$ 10%$ /'/E/#1. 6) *5ilherme Si<5eira I-E++I$ J5liana (achado -A "SS"$ Ale=ander

&A)E++I et al. Infl5ence of cer9ical 2reflarin8 on a2ical file si>e determination in ma=illar3 lateral incisors. -ra>illian dental 7o5rnal (%001)$ 9ol 1' (% )$ 640E64.. .) S5meet Darda$ Narendra (an;ar$ (ano7 &handak et al. An in 9i9o e9al5ation of t;o t32es of files 5sed to acc5ratel3 determine the diameter of the a2ical constriction of a root canalD An in 9i9o st5d3. Jo5rnal of contem2orar3 dental 2ractice(%00#)$ 9ol 10$ no 6.
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SIGNATURE

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THE

CANDIDATE T!i0 0t123 !60 i;"o4t67t #li7i#6l 4ele867#e (@. REMARKS OF THE GUIDE 60 it Aill 2ete4;i7e A!et!e4 #e48i#6l "4e l64i79 672 t3"e o i70t41;e7t Aill !el" 600e00 t!e i7iti6l 6"i#6l ile 0iBe.

((.NAME AND DESIGNATION OF DR. USHA H.L GUIDE CIN BLOCK LETTERSD PROFESSOR E HEAD DEPARTMENT CONSERVATIVE DENTISTRY E ENDODONTICS V.S DENTAL COLLEGE E HOSPITAL K.R ROAD, V.V PURAM, BANGALORE=/&@ @@.

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((.* CO=GUIDE IF ANY

((., SIGNATURE

((.. HEAD OF THE DEPARTMENT

DR. USHA H.L V.S DENTAL COLLEGE E HOSPITAL K.R ROAD, V.V PURAM, BANGALORE=/&@ @@.

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(*.( REMARKS OF THE CHAIRMAN AND PRINCIPAL

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