Browsing by Author "Acharya, N"
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Publication A Comparative Evaluation of Removal of Intracanal Calcium Hydroxide with Endoactivator System and Mechanical Instrumentation with K File, Using Two Irrigating Solutions: an in Vitro Study(Kathmandu University, 2018) Acharya, N; Poudel, D; Chakradhar, AABSTRACT Background Calcium Hydroxide [Ca(OH)2] is widely used intracanal medicament in endodontics due to its antimicrobial activity against persistent microorganisms. Although routine use of calcium hydroxide is highly recommended, its removal at the time of canal obturation is equally important and challenging because its remnant might prevent the sealer penetration into dentinal tubules, potentially interact with zinc oxide eugenol sealers making them brittle and granular, and adversely affect the bonding of resin sealer adhesion thus significantly increasing the apical leakage of root canal treated teeth. Removal of intracanal calcium hydroxide is performed usually with different irrigants in combinations with ultrasonic, sonic, hand or rotary instruments. Objective The objective of this study is to evaluate the efficacy of Endoactivator system and mechanical instrumentation with K files using two irrigants for removal of intracanal Ca(OH)2. Method Forty extracted single rooted human mandibular premolars were collected and divided into two groups of 20 samples each (N=40; Group A: 1-20; Group B: 21-40). All samples were decoronated, instrumented, irrigated, dried and filled with Ca(OH)2 paste. Samples were stored in a humidor for a week and were instrumented with conventional k-file (Group A) and Endoactivator system (Group B). A radiograph was taken to evaluate the remnants of intracanal medicament. Result Overall there is not any statistically significant difference on any method of intracanal calcium hydroxide removal (p=0.45). However, on section wise comparison of efficacy of Ca(OH)2 removal, Endoactivator seems to be more effective than hand files on apical section (p=0.047). There is no statistically significant difference on coronal and middle segments between two methods (p=0.99). Conclusion The efficacy of removal of calcium hydroxide medicament from overall canal by conventional method and endoactivator system is similar though endoactivator system seems to be relatively more efficient on apical portion of root. KEY WORDS Calcium hydroxide, Endoactivator, Intracanal, SonicPublication Endodontic Management of Radix Paramolaris with Six Canals: A Clinical Case Report(Kathmandu University, 2013) Acharya, N; Singh, A; Samant, PS; Gautam, VABSTRACT Endodontic therapy of mandibular molars is a challenging task due to its varied root canal morphology. A mandibular first molar with additional buccal root (Radix paramolaris) and additional distolingual root (Radix Entomolaris) is an example of its varied anatomy. A successful management of atypical root canal configurations is an important aspect in determining the success rate of root canal therapy. The detail knowledge of the root morphology and canal anatomy allows the clinician for accurate location of the extra roots and canals and accordingly the refinement of the access cavity for the stress free entry of complex anatomy. Hence, for a successful root canal therapy, clinician must be aware of the external and internal anatomic variations .The aim of this clinical case report is to present and describe the unusual presence of two separate mesial roots and six root canals in mandibular first molar, detected during routine endodontic therapy. KEY WORDS Atypical configurations, extra root, mandibular first molar, radix paramolaris, radix entomolarisPublication Radiographic Assessment of Occurrence of Pulp Stones in Molars of Selected Adult Nepalese Populations at Tertiary Care Center(Kathmandu University, 2021) Acharya, N; Chakradhar, A; Kafle, DABSTRACT Background Pulp stones or “denticles” are a frequent finding in coronal and radicular pulp of primary and permanent dentition. These discrete calcified bodies can be seen in a healthy, diseased and sometimes even in an unerupted tooth. These calcifications are mostly present in molars as free, attached or embedded to dentine of pulp chamber or root canals. Objective To determine the occurrence of pulp stones in molars of selected adult Nepalese population using radiographs and assess the association of its occurrence gender and arch wise. Method A descriptive cross-sectional study was performed using orthopantomogram of total 380 patients (190 male and 190 females) of age group ranging from 16-30 years by convenience sampling. Data were collected through the examination of both hard and soft copies of radiographs under magnification. Pulp stones were scored as present or absent and their association with gender and dental arch were recorded. Descriptive statistics and chi square test was performed to see the prevalence and to compare the occurrence of pulp stone respectively. Result Out of 380 radiographic samples, pulp stones were present in 41.05% of the samples. The occurrence of pulp stones were found to be higher in females than in males, although the difference was not statistically significant (p=0.060).The total number of teeth with pulp stones was 238 and 61 in maxillary and mandibular arches respectively, with statistically significant difference (p<0.001). Conclusion The overall occurrence of pulp stone was found to be 41.05%. It was observed more in females (45.78%) than in males (37%) and more frequently located in maxillary molars (29.2%) than in mandibular molars (8.2%). KEY WORDS Denticles, Molars, Nepalese population, Prevalence, Pulp stonesPublication Self-confidence Level among Intern Dentists in Performing Endodontic Treatment Procedures in Nepal(Kathmandu University, 2021) Chakradhar, A; Humagain, M; Acharya, N; Pradhan, S; Poudel, PABSTRACT Background Endodontics is considered as one of the most difficult and stressful disciplines in dentistry. This might be due to the complex anatomical variations, recent advances in equipment, technology, materials and lack of self-confidence. Objective To determine the self-confidence level among the intern dentists in performing endodontic procedures from six different colleges of Kathmandu University, Nepal. Method A descriptive cross-sectional study was conducted among 145 intern dentists. The online questionnaire regarding confidence level (5 point Likert scale) in different endodontic procedures and difficulty level (easy, ok and difficult) with respect to teeth was distributed. For descriptive purpose, frequency and percentage for each response were calculated. Result Dental interns were confident in performing majority of the normal endodontic procedures, however, they showed less confidence in performing difficult steps like rubber dam application for anterior (74, 51%) and posterior tooth (91, 62.7%), use of electronic apex locator (89, 61.4%), using rotary files (114, 78.6%), management of flare-ups (86, 59.4%), assessment of quality of post-endodontic treatment (85, 58.5%), recall periods (75, 51.6%) and performing post and core (82, 56.6%). Likewise, upper first molars (84, 57.9%) and second molars (104, 71.7%) were found to be the most difficult teeth to treat. Conclusion It can be concluded that majority of the dental interns were confident in performing basic endodontic procedures, however, they were found to have low confidence in performing difficult steps. Further training and exposure should be incorporated to increase their confidence level. KEY WORDS Confidence level, Endodontic procedures, Intern dentists, Kathmandu UniversityPublication The Need of Endodontic Therapy among Patients Attending Tertiary Care Center in Central Nepal(Kathmandu University, 2022) Acharya, N; Humagain, R; Dahal, S; Kafle, DABSTRACT Background Dental caries is considered as the most prevalent oral disease in Nepalese population that frequently needs endodontic therapy or root canal treatment (RCT). Pulp infection is one of the most common sequels of dental caries which when left untreated leads to pulpal necrosis and peri-radicular diseases. Patients usually reports to the dental hospital after there is pain, sensitivity, swelling or fracture of the tooth structure which usually impedes their normal routine of daily life. RCT is one of the efficacious therapeutic procedures that can save the teeth retaining its aesthetics and function. Objective To determine the need of RCT among patients attending Tertiary Care Hospital. Method A cross-sectional epidemiological study was conducted in the Department of Conservative Dentistry and Endodontics over the period of one year from April 2019 to April 2020. Ethical approval was taken from the Institutional Review Committee Kathmandu University School of Medical Sciences. In total, 7566 records of the patients that needed endodontic therapy and other treatments were collected and the need of endodontic therapy versus other treatments were assessed. The data obtained were analyzed using the SPSS version 20. The association between various patient-related variables were calculated by chi square test and mean, standard deviation, frequency and percentage were calculated using descriptive statistics. P value was set at < 0.05 for statistical significance. Result Among the total study population, (n=7566), the mean age was 34.97±14.34 years among which 4387 (58%) were females and 3179 (42%) were males. The type of treatment required by the study participants were significantly associated with age and sex (p < 0.001) and p < 0.001, respectively). Conclusion The findings of this study concluded that there was an increased need for endodontic therapy among patients visiting the department compared to other treatments. There was a significant association between gender and age showing females and elderly patients in greater need for endodontic therapy. KEY WORDS Endodontic therapy, Epidemiology, Periapical periodontitis, Pulpal pain, Treatment needPublication The Occurrence of an Optical Phenomenon: “The Butterfly Effect” in Cross Section of Extracted Mandibular First Premolars(Kathmandu University, 2025) Acharya, N; Srii, R; Hasan, R; Kafle, D; Dahal, S; Saito, TABSTRACT Background The butterfly effect is an optical phenomenon with endodontic and a restorative significance that can be seen in cross-sections of some of the tooth roots. Objective To investigate occurrence of butterfly effect in roots of extracted human mandibular first premolars and to determine differences in tubule density in mesio-distal and bucco-lingual direction of sections of root having buttery effect. Method It was an prospective experimental study comprised of twenty single rooted extracted mandibular first premolars. Each tooth was divided into three sections: coronal, middle and apical third. Then, nine sections of each sample were taken, three from each section i.e., coronal, middle and apical third, hence making sample size of total 180. All the selected samples were ground into 1 mm thickness and examined under 20X magnification microscope. Five samples presenting with the butterfly effect were selected and prepared for Scanning Electron Microscope to evaluate the difference in density of dentinal tubules among mesio-distal and bucco- lingual direction. Mann Whitney U test was applied to find out the significance of butterfly effect among different sections. The data was entered in Microsoft excel sheet and transferred to Statistical Package for Social Sciences (SPSS) version 20 for statistical analysis. Ethical approval was obtained from Kathmandu University School of Medical Sciences institutional review committee (IRC No.:127/16). Result Butterfly effect was seen in 19.4% of sample. Apical sections had more occurrence rate (30%) followed by middle (23.3%), and coronal sections (5%). Female predilection (30%) for occurrence was seen. Under SEM, the samples with butterfly effect presented with higher median density (2349.32 number/mm2) of dentinal tubules in bucco-lingual section as compared to mesio-distal section (1208.23 number/mm2). Conclusion Butterfly effect was present in 19% of the samples. Butterfly effect is more seen on aplical section of tooth. Female have more chance of having butterfly effect than male. KEY WORDS Butterfly effect, Dentinal tubules, Optical phenomenon, Tubular sclerosis, Vertical root fracture