Nonsurgical Endodontic Management Case Study

Nonsurgical Endodontic Management Case Study Introduction The main aim of any endodontic treatment is to thoroughly debride and disinfect the root canal system followed by the contouring of root canal walls and apical tip, for the purpose of sealing the root canal completely with a condensed, inert filling material. Failure to acknowledge the presence of an additional root canal during an endodontic treatment is amongst the major causes of an endodontic treatment failure. Other causes include inappropriate canal instrumentation, incomplete obturation and untreated major canals. An important key to success of any root canal treatment is proper understanding of the anatomy of root canal system this can be achieved by knowledge of the morphology of the root and root canal systems of teeth and diagnostic imaging techniques are required for successful root canal treatment, especially in mandibular premolar teeth (England et al. 1991). In-depth knowledge about the occurrence of atypical external and internal root canal morphologies contributes to the success of root canal treatment. It has been indicated by slowey that due to the variations in the root canal anatomy of mandibular premolars, they have a high flare up and failure rate and are hence the most difficult teeth to treat. Both the mandibular first and second premolars most often have a single root and a single canal, however, anomalies of the root and root canal systems as well as multiple canals have been reported in the literature (Baisden et al. 1992, Robinson et al. 2002).4 Zillich and Dowson have, in a definitive anatomical study, unveiled the occurrence of three canals in mandibular second premolars to be 0.4%.5 The mandibular first premolars show a large variation in the occurrence of number of root canals and apical foramina. Data from anatomical studies report that three rooted mandibular first premolars are rare, about 0.2%.6 This case report presents a case of a successful nonsurgical endodontic management of a mandibular first premolar with three separate roots using Cone Beam Computed Tomography (CBCT). Case Report A twenty four year old female patient of Indian origin, with the chief complaint of intermittent pain along with food lodgement in the lower left back region of jaw since 3 months, was referred to the Post Graduate Department of Conservative Dentistry and Endodontics. Patient also complained of bleeding from gums while brushing since eight months. Medical and dental history was non-contributory. On clinical examination, patients oral hygiene was found to be moderate. Deep occlusal carious lesion was seen with respect to tooth # 34 and 35 and both the teeth were found to be tender on percussion, with no associated periodontal pockets. Neither the affected nor the contralateral side of the crown of the mandibular first premolar showed any unusual anatomy in terms of number of cusps and dimensions. A lingering response was seen on heat testing and electric pulp testing. No evidence of swelling or sinus tract was seen. Intra oral periapical radiographic evaluation of the involved tooth revealed normal mandibular first premolar root anatomy. There was widening of the periodontal ligament space with periapical radiolucency around the root of tooth #34. A diagnosis of irreversible pulpitis was made based on clinical and radiographic evidences. After the administration of local anesthesia (2% Lidocaine with1:80,000 adrenaline), access was gained to the pulp chamber under isolation and conventional access opening was done to locate the canal. Tactile examination of the walls of the major canals was done with a small precurved pathfinder file, while locating the canal, which was proceeded slowly down each wall of the major canal, probing for a catch. A slight catch may indicate the orifice of an additional canal, especially in case of the buccal and lingual walls, because these are not generally visible on the radiograph. . On thorough inspection of the pulp chamber floor, three separate root canal orifices were detected (one mesiobuccal, one mesiolingual, and one distal). With the help of a pathfinder file, access cavity was temporarily sealed with Cavit, and to confirm the root morphology, the patient was referred to an oral and maxillofacial radiologist for a cone-beam computed tomography. CBCT of the mandible was performe d using the CS 3D imaging, after obtaining an informed consent of the patient. A three-dimensional image of the mandible was obtained. The involved tooth was focused, and the morphology was obtained in transverse, axial, and sagittal sections with a thickness of 0.48 mm, along with three-dimensional reconstructed images. The axial image obtained from CBCT confirmed the presence of three roots in mandibular first pre molar # 34. The roots were found to be mesiobuccal, mesiolingual and distal . After re-isolating the tooth, coronal flaring of all the three canals was carried out using Gates Glidden drills and working length was determined using an apex locator, which was later confirmed by a radiograph. The canals were cleaned and shaped up to ISO #35 masterapical file under copious irrigation with 2.5% sodium hypochlorite and 17% EDTA. The root canals were dried with sterile paper points, followed by temporary sealing of the access cavity with Cavit (3M ESPE AG, Seefeld, Germany). The patient was re-scheduled a week after for follow up. The tooth was found to be completely asymptomatic after a week, and the roots canals were obturated by cold lateral compaction of gutta-percha using AH26 sealer (Kemdent; Associated Dental Products Ltd, Wiltshire, UK). A postoperative radiograph was taken (Figure 3B), and the access cavity was permanently restored using universal amalgam restorative material. Discussion Diagnosis and management of extra roots and root canals in mandibular premolars is one of the major challenges in endodontics. 8-18 Therefore, the clinician must have an appropriate knowledge about the normal root canal anatomy and the most common variations associated. Inability to find, debride and obturate a root canal has been reported to be a major reason for failures in endodontic treatment. 19Based on race, only one study by Trope et al. has showed an increased prevalence of two or more canals in mandibular first premolar in African American patients as compared to Caucasian American patients .20 The failure rate in mandibular first premolar was shown to be 11.45% according to the Washington study. 21This might be due to the extreme variations in the root canal morphology of the mandibular premolar teeth and therefore poses an endodontic challenge to the clinician. Considering the high prevalence of aberrations in these teeth, an endodontist must suspect the presence of one or more missed canals, when a patient returns with persistent post-operative pain or sensitivity to hot and cold. Judicious use of high-end diagnostic aids should also be considered in such cases. Radiographs obtain two-dimensional images of three dimensional objects, resulting in superimposition of the images. Therefore, they are of limited use in complex root canal anatomy cases. Interpretation based on a two-dimensional radiograph may circumspect the clinician of the presence of aberrant root canal anatomy but cannot completely show the morphological structure of the root canals and their interrelations .22 Based on the results of previous studies carried out by Kottoor et al., and La et al. wherein spiral CT was used for the confirmatory diagnosis of morphological aberrations in the root canal anatomy, CBCT of the involved tooth was planned in the present case .23-25 The 3D CBCT images in this study revealed three roots (mesiobuccal, mesiolingual and distal ), with three distinct canals, each canal having a separate apical orifice as compared to the two dimensional radiograph which showed only one root, just like the anatomy of a typical single-rooted mandibular first premolar, that led to a false diagnosis and treatment plan. This is probably why the mandibular first premolar is known as an enigma to the endodontist. However, the high cost and inaccessibility to the patient as well as the extra radiations as compared to the standard radiographic methods makes its routine use limited.We can therefore conclude that a thorough knowledge of the root canal anatomy and its variations, careful interpretation of the radiographs, close clinical examination of the floor of the chamber and proper techniques of access opening along with adequate magnification are essential for successful treatment outcome. Conclusion The mandibular premolar teeth can present with extremely complex root and root canal system morphology, and if not considered during treatment can lead to difficulties when performing root canal treatment. The use of 3D CBCT is a valuable tool in studying the variations that may occur in root canal anatomy.

Eureka! :: Australian History Essays

Eureka! Nearly four decades after the events at Eureka Stockade, Henry Lawson marked the death of the battle's leader, Peter Lalor, with an anti-establishment piece of verse, 'Eureka!'. In this and other poems such as his first, 'The Republic', 'The Fight of Eureka Stockade' and 'Freedom of the Wallaby', Lawson may well have been trying to light the fire of Australian nationalism and a move to independence with our own flag, The Southern Cross. To many, the Eureka rebellion of the 3rd of December 1854 is a defining moment in Australian history. It is not surprising that the legendary Australian poet, Henry Lawson (1867-1922), wrote about an event of such national trauma - as many others have in the years since - more than 100 works according to one source (Austlit website). He wrote 'Eureka!' (Lee 25) in 1889, to mark Eureka hero Peter Lalor's death, and also penned 'The Fight of Eureka Stockade' (Cronin 115) the following year. Both could be described as anti-establishment, as were many others of his poems such as the first published verse, 'The Republican' (Cronin 39), and 'Freedom on the Wallaby' (Cronin 146) about the Barcaldine (Qld) shearers' strike. As we shall see below, Lawson was trying to light the fire of Australian nationalism and a move to independence with our own flag, The Southern Cross. At the Victorian mining site of Eureka, Lalor led miners in battle against government troops over the cost of licences and other issues. Thirty-four miners and six troops died at Eureka Stockade, in what is seen by some as a battle for the 'concept of fair play and equal opportunity' (Heritage website). Some get more passionate: the National republicans describe it as a 'patriotic struggle bathed in Australian blood' (alphalink website). The miners also carried a blue and white Southern Cross flag which has become an important anti-establishment symbol. Lalor, who lost an arm, and the other survivors were acquitted. He went on to become a Member of the Legislative Council and was its Speaker when he died in 1889. Henry Lawson was born 13 years after Eureka in 1867 in a tent on the Grenfell (NSW) goldfields, his father a former Norse sailor and his mother from a Kentish gypsy family, according to Wright (viii) in a foreword to a Lawson anthology. He goes on to say that 'at 21, Lawson was probably the most remarkable writer of verse in Australia' (ix).

The aim of this paper is to discuss achievement in South Africa

The aim of this paper is to discuss achievement in South Africa since 1976 in terms of youth and revolutionary morality as well as youth and class. During the Soweto Uprising, the youth of South Africa has firmly established itself on the national political scene:‘[I]n 1976, South Africa’s youth took center stage and remained there throughout the unrest and strife of the 1980s and the political transformation of the 1990s. In fact, many observers see 1976 as the political watershed that culminated in the country’s first democratic elections in 1994. A direct line can be drawn between the Soweto uprising of 1976 and these elections’ (Slabbert et. al., 1994, p.9).  Ever since, the youth has played a major role in the public life of the country (Worden, 2000). By being preoccupied with burning political and social problems, the youth in South Africa takes control over their own future.Revolutionary identity, which was developed in 1976 and subsequent decades of struggle against apartheid, is still present in the young generation (Dlamini, 2005). However, youth in South Africa gradually accepts models of behavior typical for other developed nations. The development of youth subcultures is associated with the influence of new technologies and mass media as well as with increasing level of well-being of certain strata of the society (Dolby, 2001).Another reason for this development is that the decades of universal political activism are gone. As politics became routine matter and major social change was brought about by the deeds of young revolutionaries, the attention to politics has been gradually decreasing. At the moment, young people are more interested in solving problems of economic and social nature (Saul, 2005).Thus, other factors prove to be more important in the process of youth identity formation. Speaking about the process of youth identity formation in more detail, it is necessary to note another change that occurred in the recent period. For a long time, identity formation happened across racial lines, since blacks and whites developed subcultures of their own. Yet as the society becomes more just and integrated, there is a need to take into account all other factors influencing identity formation, such as class, gender, and ethnicity:‘The mutual political accommodation of the essentially human characteristics (identities) of the various categories of black South Africans may accordingly prove to be one of the crucial aspects determining the future of the country’ (Zegeye, 2002, ‘The end of black politics?’, para.5).   Proceeding with the discussion of challenges young people encounter, one of the major problems the youth faces nowadays is associated with lack of social power and deep class segmentation of the society:‘South African society is, even after the change brought about by the demise of apartheid in the 1990s, characterized by deep segmentation not only on t he basis of culture, race, historical background, language and religion, but also on the basis of economic and/or class status’ (Zegeye, 2002, para.7).  Many young people with string revolutionary identity and desire to contribute to social good are trapped in the vicious circle of poverty, isolation, and deprivation. It is of paramount importance for the government to unleash the creative potential of these young South Africans.On the practical level, this can be done by offering universal access to different types of education and crating more employment opportunities for the young. With unemployment on the rise, many young people cannot reap the benefits of vertical mobility and stay in the lower class for the rest of their life, despite their ability and willingness to work hard.Another major preoccupation for young people in South Africa is the HIV/AIDS. The spread of this disease produces a powerful impact on the patters of sexual conduct as well as sexual identity of young people (Peltzer, Pengpid & Mashego, 2006). HIV prevalence rate is especially high is young female citizens (Pettifor et. al., 2004). Apart from youth NGOs, church and religious organizations are believed to play a major role in addressing the issue of HIV/AIDS through encouraging healthy sexual behavior patterns in the representatives of 15 to 24 age group which are at the highest risk (Ruden, 2000).Numerous youth organizations address the issue. In fact, it is necessary to mention that during the 1990s youth is South Africa manifested astonishing skills in advocacy and self-organization. As early as in 1992, the National Youth Development Forum as the united platform and the voice for the youth was founded (SAYC, n/d., ‘Historical Background’).Summing up, it is possible to observe that revolutionary identity is still present in the youth, yet activism is directed as solving problems related to social justice, economic empowerment, and public health.ReferencesDla mini, S.N. (2005). Youth and Identity Politics in South Africa, 1990-94. Toronto: University of Toronto Press.Dolby, N.E. (2001). Constructing Race: Youth, Identity, and Popular Culture in South Africa. Albany, NY: State University of New York Press.Peltzer, K., Pengpid, S., & T.B.Mashego. (2006). Youth Sexuality in the Context of HIV/Aids in South Africa. New York: Nova Science Publishers.Saul, J.S. (2005). The Next Liberation Struggle: Capitalism, Socialism, and Democracy in South Africa. New York: Monthly Review Press.Slabbert, van Zyl F., Malan, C., Olivers, K., & R. Riordan. (1994). Youth in the new South Africa: Towards policy formation. Pretoria: HSRC Publishers.Worden, N. (2000). The Making of Modern South Africa: Conquest, Segregation and Apartheid, 3rd ed. Oxford: Blackwell Publishing.Pettifor, A.E., Measham , D.M., Rees, H.V., & N.S. Padian. (November 2004). ‘Sexual Power and HIV Risk: South Africa.’ Emerging Infectious Diseases, 10(11), 1996-2004.Ruden, S. ( May 17, 2000). ‘AIDS in South Africa: Why the churches matter.’ Christian Century, 117(16), 566S.

terracotta warriors essays

terracotta warriors essays Since the unearthing of the 8th world wonder, many new worth while discoveries have been made about Chinas first emperor and the Chinese civilization. The 7,000(and rising) life size terracotta warriors were discovered by a local farmer digging a well. The Terracotta Warriors were made during the rule of Emperor Qin Shi Huang- the first emperor to rule the whole of China in its known history. The terracotta warriors were crafted and then fired in a kiln 100s at a time by the citizens and craftsmen inside of the Qin Empire. Terra Cotta warriors were both beneficial and detrimental to Chinese culture. Even now, archeologists are excavating the site of the life like warriors. The 2000 year old Terracotta Warriors are one of Chinas largest attractions. With out its tourism, China would not be as famous as it is today. So the terracotta warriors in all are very helpful to China. They give people jobs on the excavation sites. They give a large amount of tourism, and are a national symbol of China. The uncovering of Chinas terracotta warriors has helped Chinas tourism very much. There are over 7000 terracotta statues, each one different from the last. All of them are helping China with its economy. The figurines consist of horses, archers, foot soldiers, and mounted soldiers (on horses). The details go into a great deal of unnecessary extent, even though it helps the economy with tourists now. All of the soldiers are life size, made completely out of terracotta mud. They all face east (the direction of the entrance) in battle positions. There were also auto firing crossbows placed i n the tunnels of both the terracotta warriors and Emperor Qin Shi Huangs Mausoleum that would fire when triggered by intruders.(2.) Emperor Qin Shi Huang was the first emperor of unified China. Qin was a great leader from the start, and without him China would not be what it i ...

Get the Definition of Schwa With Examples in English

Get the Definition of 'Schwa' With Examples in English The term  schwa  (from the Hebrew; pronounced SHWA with alternate spelling shwa) was first used in  linguistics  by the 19th-century German  philologist  Jacob Grimm. The  schwa is the most common vowel sound in English, represented as É™ in the International Phonetic Alphabet. Any vowel letter can stand for the schwa sound. Only words with two or more syllables may have a schwa, which is also called the  mid-central vowel. The schwa represents a mid-central vowel in an unstressed syllable, such as the second syllable in the word woman and the second syllable in the word buses.   Examples and Observations It is extremely important. ... to recognize that pronouncing unstressed vowels as schwa is not lazy or sloppy. All native speakers of Standard English, including the Queen of England, the Prime Minister of Canada, and the President of the United States, use schwa.(Avery, Peter and Susan Ehrlich. Teaching American English Pronunciation, Oxford University Press, 1992.) Reduced Vowels Vowels change in quality when they are reduced. The reduced vowel tends to be not only very short but also very unclear, producing an obscure sound that is hard to identify. Consider, as an example, the name of the California town Orinda, pronounced /É™rin-dÉ™/, with the first vowel and the last vowel reduced to schwa. Only the second vowel in the word, the stressed vowel, maintains its clarity. The other two vowels are very unclear.(Gilbert, Judy B. Clear Speech: Pronunciation and Listening Comprehension in North American English, 3rd ed., Cambridge University Press, 2005.) Dialectal Variations in Schwa Usage If you listen for it, you can hear schwa in all sorts of places where syllables arent stressed- for example, at the beginnings of words like official, occasion, event, and fatigue. Many people... feel that schwa-ful pronunciations are lazy, but really you would sound pretty odd if you did pronounce the full vowel in place of schwa in these words. Pronunciations like ohfficial and ohccasion sound unnatural and rather theatrical. Schwa also occurs in the middle of words like coronation and afterwards. Again, it would be peculiar not to sound schwa in this position- for instance, corohnation for coronation. ... Schwa usage varies greatly between dialects. Australian English speakers often put schwas in places where British and American speakers wont. Striking differences are also now appearing as a consequence of the worldwide spread of English.(Burridge, Kate. Blooming English: Observations on the Roots, Cultivation and Hybrids of the English Language, Cambridge University Press, 2004.) Schwa and Zero Schwa In terms of duration- a phonetic property that the IPA vowel chart does not indicate- schwa is typically quite short, and this short duration may covary with its tendency to be coarticulated. ... [G]iven its short duration and its consequent tendency to camouflage itself to its context through coarticulation, schwa may be confused with its absence, setting up a situation in which schwa-zero alternations may take hold in a system...(Silverman, Daniel. Schwa The Blackwell Companion to Phonology, edited by Marc van Oostendorp et al., Wiley-Blackwell, 2011.) Schwa and English Spelling For the most part, the schwa vowel sound in a two-syllable word is identified by the uh pronunciation and sound. Oftentimes, children spell chocolate as choclat, separate as seprate, or memory as memry. The schwa vowel is thus omitted. The vowel sound schwa is also found in two-syllable words such as alone, pencil, syringe, and taken. Children commonly misrepresent the schwa vowel and spell these words: ulone for alone, pencol for pencil, suringe for syringe, and takin for taken. It is still the vowel in the unstressed syllable that is featured in this case. ... This time, it is substituted with another incorrect vowel. These aforementioned misunderstandings generally disappear as the child advances in his reasoning and knowledge of the English language, learns conventional alternatives for representing sounds, and begins to apply patterning including syllables and a visual sense to his spelling.(Heembrock, Roberta. Why Kids Cant Spell: A Practical Guide to the Missing Component in Language Proficiency, Rowman Littlefield, 2008.) Schwa and the Evolution of Language [T]here is one vowel, now quite common in the languages of the world, that is ... unlikely to have been in the inventories of earliest languages. This is the schwa vowel, [É™], as in the second syllable of English sofa. ... In English, schwa is the classic weak vowel, not used in any crucial contrasting function, but as a variant of (almost) any vowel in unstressed position. ... Not all languages have a schwa vowel, weakening an unstressed vowel as English does. But many languages with similar rhythmic properties to English have an equivalent to the English schwa vowel. It seems likely that the earliest languages, before they had had time to evolve such weakening rules, would not have had a schwa vowel.(Hurford, James R. The Origins of Language, Oxford University Press, 2014.)

Comcast voip telecommunications Research Paper Example | Topics and Well Written Essays - 1500 words

Comcast voip telecommunications - Research Paper Example This age is known as the age of information technology and we see information technology everywhere. In this scenario, Comcast based VoIP is completely an innovative and high-tech technology for the superior management of business and corporate issues. Additionally, Comcast Digital Voice presents a completely new set of alternatives for our home telephone service with the Comcast superior broadband network. For example, Comcast Digital communication and phone service allows us to choose unlimited local as well as long distance communication plans through which we can keep our present telephone number as well as touch-tone telephone. Moreover, we can enjoy all of our preferred options similar to call waiting, voice mail, caller ID and a lot more (OnlineComcast, 2011). This paper outlines strategic Implications of information technology on COMCAST with a focus on VoIP Telecommunications over the next three years. This paper will also present a recommendation on what Strategic Action sh ould be taken. Technology Overview Comcast VoIP has emerged as a modern and high-tech technology service that offers a lot of facilities for the business management. Presently Comcast VoIP service is attracting a large number of VoIP clients every quarter and has extremely quickly turned out to be the nation's (US) 4th major phone carrier. However, they are not only one of the major VoIP communication service providers, but they also present the maximum quality local and international calls. Additionally, the Comcast VoIP Digital phone service offers a range of improved telephone characteristics with cost savings that exceed a lot of customary telephone services. In addition, the modern services of Comcast VoIP technology based service allows its users to keep their present telephone number as well as touch-tone telephone thus offering advantages of countless characteristics similar to improved Voice Mail that allows the users to get and send their messages through online or phone s ystems. Moreover, digital phone service as well allows the users to take pleasure of unlimited local as well as nationwide long distance calls, such as calls to Puerto Rico and Canada at least monthly price. Thus, people are able to save money. It also allows its users to connect TV and Internet service with Comcast phone service and take pleasure pay less for the entire Comcast communication services (Bode, 2008) and (OnlineComcast, 2011). Company  Background For this report I have selected Animusoft Company that is making use of VoIP services offered by ActivePBX. While using traditional VoIP services, Animusoft Corporation faced a lot of problems regarding internal communication of business and departmental interaction. The business is aimed at improving its overall services and potential working capability with new VoIP services. In this way the company will be able to achieve high level performance (Animusoft Corporation, 2011). Current Business Issues of VoIP   VoIP is a c omparatively modern technology. In this scenario, the research work shows that a lot of corporations are now making use of VoIP technology to reduce costs, tonnage efficiency and maintaining strategic position.

Use of Music in Marketing Essay Example | Topics and Well Written Essays - 2500 words

Use of Music in Marketing - Essay Example This essay "Use of music in marketing" outlines the role of music in the advertising. The music creates the association between sound and product's image in the consumers' minds. People buying certain brand in the XXI century do not need just a brand, they also want emotional connection with it and they want to make sure that this brand will speak of them to other people. And emotional feedback from the act of purchase is possible only when the advertisement has created buzz and excitement in advance. So commercials with the right music can guarantee three important things to consumers: identity with the product, engagement, and currency of the marketing situation. Music can be that last step helping the brand to draw attention of the customers and stick in their memory. Moreover, with the help of music it is possible to provide consumers with the content to examine and share (Olenski, 2014). Whenever there are emotions involved people start speaking about artistic approach. That is how choosing the right music has become a special kind of art in marketing. Music as a universal language can speak to all layers of the audience and be understood without words. Music instantly gives a full of scope of information about the main characteristics of the product: for example, if a company is launching a completely new product they may introduce a fresh band in their commercial to be associated with coolness and innovations. Music appeals to a more profound level of information processing-emotions.