Comparative Evaluation of Different Endodontic Access Cavity Designs with Different Burs-An in vitro Experimental Insight into the Aspect of Fracture Resistance.

Introduction: In vitro fracture resistance of extracted mandibular molars treated with various access cavity designs, including traditional endodontic cavity (TradAC), conservative/contracted endodontic cavity (ConsAC), ninja endodontic cavity (UltraAC), truss endodontic cavity (TrussAC), caries-driven access cavity (CariesAC), and intact teeth, is the focus of this study. Materials and Methods: Six groups of 20 mandibular molars, totaling 120, were used in the investigation. While the other five groups underwent various access cavity preparations, chemomechanical preparation, and obturation procedures before being repaired with composite resin, Group 1 was left unaltered (the control). A 6 mm round head tip was used to apply the fracture force, which was measured in newtons, at a crosshead speed of 1 mm/min until fracture developed. Results: According to the current study, the intact control group had the maximum fracture resistance. The access cavity groups' mean values were maximum in CariesAC followed by ConsAC, TrussAC, UltraAC, and TraditonalAC respectively. Conclusion: While among the four minimally invasive designs, CariesAC showed a higher fracture resistance despite the results being statistically insignificant, TradAC had a significantly lower resistance than other conservative access cavity designs.

Analysis of cyclic fatigue resistance of different endodontic nickel-titanium rotary instruments: An in vitro study.

Aims: The aim of this in vitro study was to compare the cyclic fatigue resistance of three different endodontic nickel-titanium rotary instruments using a dynamic testing device. Materials and Methods: Ten files each of ProTaper Gold (PG), Hyflex Electro-discharge Machining (HEDM), and TruNatomy (TN) were tested in a custom-fabricated dynamic cyclic fatigue testing device at 60° curvature having a radius of curvature of 5 mm. The number of cycles to the fracture (NCF) of each instrument was calculated and three continuous groups were compared by the Kruskal-Wallis test and Dunn post hoc test was used for pairwise comparison. Results: Cyclic fatigue resistance of HEDM was the highest, followed by TN. PG had the lowest among the three. Conclusion: Within the limitations of the present in vitro results, it can be concluded that HEDM files appeared to be suitable for shaping complex canals with the greater number of cycles before it fractures.

Comparative clinical evaluation of a self-adhering flowable composite with conventional flowable composite in Class I cavity: An in vivo study.

Context: The purpose of this study was to evaluate the efficiency of self-adhering flowable composite with that of a time-tested conventional flowable composite. Since the self-adhering composite reduces chair time and is convenient to use, its clinical behavior was monitored for a year. Aim: This study aimed to evaluate the clinical behavior of self-adhering flowable composite - Fusio Liquid Dentin - in small-sized Class I cavities and also to compare it with conventional flowable composite - Tetric N-Flow - bonded to the tooth structure with fifth-generation two-step-etch-and-rinse adhesive. Subjects and Methods: A total of 60 cavities were restored using flowable composite materials (30 cavities in each group) and evaluated at baseline, 1 month, 3 months, 6 months, and 1 year with modified United States Public Health Service criteria. The statistical analysis for the study was done using Fisher's exact test for intergroup comparison and Chi-square test for intragroup comparison. P < 0.05 was considered statistically significant. Results: Statistically no significant differences were observed in Fusio Liquid Dentin restorations during the recall visits. Statistically significant differences were found in color match evaluated for Tetric restorations during the recall visits. Conclusion: Based on the data acquired, the novel self-adhering composite material demonstrated good clinical behavior. As a result, at this point in the prospective clinical study, the use of Fusio Liquid Dentin to repair Class I cavities is acceptable.

Evaluation of Ozone Therapy in Endodontic Treatment of Teeth with Necrotic Pulp and Apical Periodontitis: A Randomized Clinical Trial.

INTRODUCTION: The aim of this study was to compare the effect of different application techniques of ozone on the prevalence of postendodontic pain in patients undergoing single-visit root canal treatment. METHODS: hundred eight patients with necrotic pulp in single-rooted teeth and apical periodontitis participated in the trial. A standard single-visit endodontics protocol was followed with 5.25% sodium hypochlorite and rotary nickel-titanium files. After shaping and cleaning, patients were randomly allocated into the following groups: group 1 (n = 21), ozone treatment with no activation (NA); group 2 (n = 22), ozone treatment with manual dynamic activation (MDA); group 3, (n = 21), ozone treatment with passive ultrasonic activation (PUA); group 4 (n = 23), ozone treatment with sonic activation (SA); and group 5 (n = 21), no ozone treatment (the control group). Patient levels of discomfort were recorded at 6 different time intervals using the visual analog scale (VAS). Comparison of the mean difference between the groups and time intervals was performed using 2-way analysis of variance followed by a post hoc Bonferroni test. The level of significance was set at 5%. RESULTS: VAS scores were highest for the control > NA > MDA > SA > PUA groups. A statistically significant reduction in VAS scores was observed in the PUA and SA groups in comparison with the NA, control, and MDA groups. Timewise comparison showed a highly significant decline in VAS scores at all time intervals (P < .001). CONCLUSIONS: Ultrasonic and sonic activation of ozone resulted in less pain in patients undergoing single-visit endodontics compared with no ozone treatment.

Dental practice management during COVID-19 times-Now and beyond.

AIM: Coronavirus disease 2019 (COVID-19) being declared a global public health emergency has become a significant challenge for all healthcare workers, including dentistry, recognised as a high-risk profession during these times. This consensus statement aims to highlight and provide guidelines necessary to be implemented for a clinical dental practice. MATERIALS AND METHODS: A total of nine conservative Dentists and Endodontists and one Oral and Maxillofacial Surgeon; with four panelists from government dental colleges, one each from the North, South, East and West India and six resource persons from private colleges in South India, all of them being clinicians and administrators practicing dentistry since the inception of the pandemic, collaborated in this consensus statement. The consensus statement was developed through a symposium conducted on the topics; general dental practice during COVID-19 times, the importance of aerosols in clinical dental practice in the spread of COVID-19, effective standard operating protocols for clinical dental practice and Institutional settings with scientific evidence-based justifications, followed by a panel discussion with to devise mandatory protocols to be followed in clinical and institutional settings. The symposium was attended by 46 practitioners who participated in the deliberation. RESULTS: This consensus statement provides clinicians and researchers with protocols for the dental practice, agreed upon by experts in the field. The Consensus Statement has been formulated according to the AGREE Reporting checklist for the formulation of guidelines. CONCLUSION: The experts and panelists reached a Consensus on the protocols and guidelines for the safe clinical and institutional dental practice.

Comparative evaluation of different direct pulp capping agents in carious tooth: An in vivo study.

BACKGROUND: The success of direct pulp capping (DPC) depends on the preoperative assessment of pulpal status, intraoperative judgment after pulp exposure, and the biomaterials used to cap the pulp. AIM: The study aims to compare the clinical and radiographic responses of the pulp-dentin complex after DPC with TheraCal LC, Biodentine, and current gold standard mineral trioxide aggregate (MTA) Plus. MATERIALS AND METHODS: Ninety vital permanent teeth with Class I deep carious lesions were randomly divided into three different groups. After the caries excavation, hemostasis was established using sodium hypochlorite at the site of pulp exposure on which the material was placed. Clinical and radiographic follow-ups were performed at 1-, 3-, and 6-month intervals. RESULTS: Overall success rates of MTA Plus, Biodentine, and TheraCal LC were statistically insignificant. CONCLUSIONS: TheraCal LC and Biodentine showed similar success rates when compared to MTA Plus and can be used as an agent in DPC.

Analysis of association between various fertility indicators and production traits in Mehsana buffaloes.

Female fertility in domestic animals in India has exhaustively suffered owing to indiscriminate breeding with single objective of increasing milk production. First lactation data on 7782 Mehsana buffaloes sired by 184 bulls maintained under field progeny testing programme at Dudhsagar Research and Development Association, Dudhsagar Dairy, Mehsana, over a period of 24 years were used for study of fertility traits viz. days open, first to successful service period (FTSS) and daughter pregnancy rate (DPR) and production traits viz. first lactation milk yield (FLMY), first lactation fat yield (FLFY) and average fat percentage (AFP). The voluntary waiting period (VWP) was standardised based on the higher estimates for FLMY and FLMY per unit first calving interval. VWP for Mehsana buffaloes was standardised as 63 days after first calving and consequently DPR of Mehsana buffalo was also estimated as 31%. Fertility traits were further evaluated in terms of production traits. Regression analysis revealed that the increase in 1 kg FLFY and 100 kg FLMY led to the increase of First Service Period by 0.013 days and decrease in the DPR by 1.89%, respectively. Increase in milk yield led to increase in FTSS. However, for each 100 kg increase in fat yield and 1% increase in AFP, there is increase in DPR by 0.08% and 0.051%, respectively. Based on the present findings, it may be recommended to have a breeding programme which give due weightage to both production and fertility traits.

Evaluation of cell viability of Human Dental Pulp Stem Cells in Two dimensional and Three dimensional Fibrin Glue Scaffold.

CONTEXT: Regenerative endodontics uses the concept of tissue engineering to restore the diseased immature tooth, allowing for continued development of the root to a healthy state. For regenerative endodontics, the use of human dental pulp stem cells (HDPSCs) with appropriate scaffolds and growth factors is imperative. AIMS: The aim of the study was to evaluate the human dental pulp cell viability in two-dimensional (2D) and 3D fibrin glue scaffold to be used in regenerative endodontics. SUBJECTS AND METHODS: Regenerative potential of HDPSCs was comparatively assessed usings 2D and 3D fibrin glue scaffold. 3D scaffold was made with different concentrations of fibrinogen. Cell morphology was studied under inverted phase-contrast microscopy, and cell proliferation was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay at various time intervals. STATISTICAL ANALYSIS USED: Collected data underwent a two-way ANOVA test. The P value of the study was kept 0.05 according to the sample size. RESULTS: Study revealed a significant increase in the proliferation of HDPSCs in fibrin glue precoated wells of 2D fibrin glue compared to preseeded cells on day 1 and day 3. The concentration of fibrinogen has a major role in cell viability in 3D fibrin glue scaffold. Homing of HDPSCs in the 3D scaffold improves with time. CONCLUSIONS: This study concludes that the concentration of fibrin glue has a significant role in HDPSC Viability in 3D scaffold.

Launching a new fellowship in microrestorative and endodontics for postgraduates in conservative dentistry and endodontics.

Expanding and refining the skill sets of postgraduates specialists is required by the many current and changing demands of dental science education and research. To meet this challenge, the Indian Board of Micro Restorative and Endodontics under the aegis of the Indian Association of Conservative Dentistry and Endodontics has begun a fellowship program in Micro Restorative and Endodontics; the main aim being to improve the knowledge and skills of these specialists empowering them to go a step higher and beyond their areas of specialization. The objectives of the fellowship course are as follows: (1) Achieving necessary skills in managing routine and advanced restorative and endodontic scenarios using modern magnification technology. (2) Constantly enhancing the existing knowledge by pursuing new arenas in magnification technology. (3) Complete understanding and application of cutting edge research in the practice of microrestorative and endodontics. (4) Ensuring the highest possible patient-centric quality of care. Learning experiences shall be provided under the guidance and supervision of competent mentors at predesignated centers all over India. The learning strategies will be through workshops, contact sessions, and learning assignments. The carefully designed curriculum shall prepare the restorative dentists and endodontists, to be an autonomous, effective, safe, and a compassionate professional, who practices collaboratively in a variety of clinical and academic setups, responsive to the current and future needs of the restorative and endodontic health-care system. A passion for microdentistry would be a great way to make a positive difference to your patient care and creative work.

The DA Vinci Diet.

Ample evidence implicating diet as the root cause of diseases exists in the scientific arena. It is always intruiging to know the diet pattern of our ancestors. Leonardo da Vinci was a 'universal genius' with universal appeal. This article describes the basic principles of the diet that he followed. "Dining discipline" and moderation in eating should be coupled with the aim of savouring smell, taste, and texture of food. Fresh, fibre rich, vegetarian food forms the bulk of the da Vinci diet. Saturated fat, salt and sugar use is minimal, but water and water-rich food intake is encouraged.

Glycemic management during Jain fasts.

This review describes the various fasts observed by adherents of the Jain religion. It attempts to classify them according to their suitability for people with diabetes and suggests appropriate regime and dose modification for those observing these fasts. The review is an endeavor to encourage rational and evidence-based management in this field of diabetology.

Teneligliptin in management of type 2 diabetes mellitus.

Teneligliptin is a recently developed oral dipeptidyl peptidase 4 inhibitor indicated for the management of type 2 diabetes mellitus (T2DM) in adults along with diet and exercise. Teneligliptin has been recently available in Japan (Teneria(®)), Argentina (Teneglucon(®)), and India (Tenepure; Teneza) at relatively affordable price. This is a positive step toward the management of T2DM in developing countries, where the cost of medicine is out-of-pocket expenditure and is a limiting factor for health care. This review evaluates the efficacy and safety of teneligliptin in the management of T2DM. Teneligliptin has been systematically evaluated in T2DM as monotherapy with diet and exercise and in combination with metformin, glimepiride, pioglitazone, and insulin in short-term (12 weeks) and long-term (52 weeks) studies. These studies have reported a reduction in HbA1c of 0.8%-0.9% within 12 weeks of therapy. Two 52-week studies reported sustained improvement in glycemic control with teneligliptin. Teneligliptin has been found to be well tolerated, and the safety profile is similar to other dipeptidyl peptidase 4 inhibitors. Hypoglycemia and constipation are the main adverse events. Teneligliptin can be administered safely to patients with mild, moderate, or severe renal impairment or end-stage renal disease without dose adjustment. Similarly, it can be used in patients with mild-to-moderate hepatic impairment. Teneligliptin is effective and well tolerated and may have an important role in the management of T2DM.

Stereomicroscopic evaluation of defects caused by torsional fatigue in used hand and rotary nickel-titanium instruments.

OBJECTIVE: The aim of this study was to evaluate defects caused by torsional fatigue in used hand and rotary nickel-titanium (Ni-Ti) instruments by stereomicroscopic examination. MATERIALS AND METHODS: One hundred five greater taper Ni-Ti instruments were used including Protaper universal hand (Dentsply Maillefer, Ballaigues, Switzerland), Protaper universal rotary (Dentsply Maillefer, Ballaigues, Switzerland), and Revo-S rotary (MicroMega, Besançon, France) files. Files were used on lower anterior teeth. After every use, the files were observed with both naked eyes and stereomicroscope at 20× magnification (Olympus, Shinjuku, Tokyo, Japan) to evaluate defects caused by torsional fatigue. Scoring was assigned to each file according to the degree of damage. STATISTICS: The results were statistically analyzed using the Mann-Whitney U test and the Kruskal-Wallis test. RESULTS: A greater number of defects were seen under the stereomicroscope than on examining with naked eyes. However, the difference in methods of evaluation was not statistically significant. Revo-S files showed minimum defects, while Protaper universal hand showed maximum defects. The intergroup comparison of defects showed that the bend in Protaper universal hand instruments was statistically significant. CONCLUSION: Visible defects in Ni-Ti files due to torsional fatigue were seen by naked eyes as well as by stereomicroscope. This study emphasizes that all the files should be observed before and after every instrument cycle to minimize the risk of separation.

Fasts, feasts, and festivals in diabetes: Glycemic management during Parsi rituals.

The article is one in the series of articles related to glycaemic management in festivals across all religions in India. The article discusses issues in glycaemic management among Parsi culture, which represent a small but ever important group of Indian population.

Antibacterial efficacy of Azadirachta indica, Mimusops elengi and 2% CHX on multispecies dentinal biofilm.

AIMS: To check the antimicrobial activity of Azadirachta indica (Neem), Mimusops elengi (Bakul), and Chlorhexidine gluconate (CHX) on multispecies biofilm of common endodontic pathogens such as Streptococcus mutans, Enterococcus faecalis, Staphylococcus aureus and Candida albicans. SETTINGS AND DESIGN: In vitro dentin disinfection model used to check the antimicrobial efficacy of herbal extracts. MATERIALS AND METHODS: The in vitro dentin disinfection model was used to check the antimicrobial activity of the methanolic extracts of the medicinal plants along with Chlorhexidine gluconate. The polymicrobial biofilm was allowed to grow on extracted teeth sections for a period of 21 days. Remaining microbial load in the form of CFU/ml after the antimicrobial treatment was tabulated, and data were statistically analyzed using ANOVA and Bonferroni post-hoc tests. STATISTICAL ANALYSIS USED: SPSS version 17, one-way ANOVA, Bonferroni post-hoc test. RESULTS: Both the plant extracts showed considerable antimicrobial efficacy as compared to negative control. 2% CHX was the most effective antimicrobial agent having statistically significant difference against plant extracts and negative control (saline). CONCLUSION: The methanolic extract of A. Indica, M. elengi, and Chlorhexidine Gluconate has considerable antimicrobial activity against polymicrobial dentinal biofilm of S. mutans, E. faecalis, S. aureus and C. albicans.

In-silico analysis of heat shock protein 47 for identifying the novel therapeutic agents in the management of oral submucous fibrosis.

BACKGROUND: Heat shock proteins-47 (HSP47) is a collagen specific molecular chaperone, involved in the processing and/or secretion of procollagen. It seems to be regularly upregulated in various fibrotic or collagen disorders. Hence, this protein can be a potential target for the treatment of various fibrotic diseases including oral submucous fibrosis (OSF), which is a collagen metabolic disorder of oral cavity and whose etiopathogeneic mechanism and therapeutic protocols are still not well documented. AIM: The aim of this study is to identify the novel therapeutic agents using in-silico methods for the management of OSF. OBJECTIVES: The objectives of this study are to identify the binding sites of HSP47 on the collagen molecule and to identify the lead compound with anti-HSP47 activity from the library of natural compounds, using in-silico methodology. MATERIALS AND METHODS: The web-based and tool based in-silico analysis of the HSP47 and collagen molecules are used in this study. The crystal structure of collagen and HSP47 were retrieved from Protein Data Bank website. The binding site identification and the docking studies are done using Molegro Virtual Docker offline tool. RESULTS: Out of the 104 Natural compounds, six ligands are found to possess best binding affinity to the binding amino acid residues. Silymarin binds with the 4AU2A receptor and the energy value are found to be -178.193 with four Hbonds. The other best five natural compounds are hesperidin, ginkgolides, withanolides, resveratrol, and gingerol. Our findings provide the basis for the in-vitro validation of the above specified compounds, which can possibly act as "lead" molecules in designing the drugs for OSF. CONCLUSION: HSP47 can be a potential candidate to target, in order to control the production of abundance collagen in OSF. Hence, the binding sites of HSP47 with collagen are identified and some natural compounds with a potential to bind with these binding receptors are also recognized. These natural compounds might act as anti-HSP47 lead molecules in designing novel therapeutic agents for OSF, which are so far unavailable.

Insulin therapy: going the "smarter" way.

Insulin pharmacology has evolved from nonhuman source based extraction of insulin, to use of recombinant technologies for human insulin production, to tailor made synthetic insulin analogues. The delivery techniques of insulin have also improved, from injections to pumps, and to pumps with sensors. However, to achieve the final goal of a closed loop insulin delivery is far from achieved. One of the researches in this direction includes synthetic smart insulins. These are systems with chemical sensors for glucose, linked to reactions that trigger glucose mediated insulin delivery. Interest in this field is high and recent publications and patents show promise. The current review tries to summarize the basic concept of smart insulin as well as cater the recent developments and patents in this direction.

The antimicrobial activity of Azadirachta indica, Mimusops elengi, Tinospora cardifolia, Ocimum sanctum and 2% chlorhexidine gluconate on common endodontic pathogens: An in vitro study.

OBJECTIVE: To check the antimicrobial activity of Azadirachta indica (Neem), Ocimum sanctum (Tulsi), Mimusops elelngi (Bakul), Tinospora cardifolia (Giloy) and Chlorhexidine Gluconate (CHX) on common endodontic pathogens like Streptococcus mutans, Enterococcus faecalis and staphylococcus aureus. MATERIALS AND METHODS: The agar diffusion test was used to check the antimicrobial activity of the Methanolic extracts of the medicinal plants along with CHX. Six different concentrations of the tested agents were used for the study. The values of Zone of Inhibition were tabulated according to the concentration of the tested agent and data was statistically analyzed using ANOVA and Bonferroni post- hoc tests. The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentrations (MBC) values were also recorded. RESULTS: All the plants extracts showed considerable antimicrobial activity against selected endodontic pathogens. At 3mg. concentration, O.sanctum was the most effective against S. mutans, M. elengi showed highest zone of inhibition against E.faecalis, whereas CHX was the most effective agent against S.aureus. CHX was also the most consistent of all the medicaments testes, showing inhibitory effect against all the tree pathogens at all the selected concentrations. CONCLUSIONS: The Methanolic extract of A.Indica, O.sanctum, M. Elengi, T.cardifolia and Chlorhexidine Gluconate has considerable antimicrobial activity against S. mutans, E. faecalis and S. aureus.

Polycystic ovarian syndrome.

Polycystic ovarian syndrome (PCOS) is a "multispeciality" disorder suspected in patients with irregular menses and clinical signs of hyperandrogenism such as acne, seborrhoea, hirsutism, irregular menses, infertility, and alopecia. Recently, PCOS has been associated with the metabolic syndrome. Patients may develop obesity, insulin resistance, acanthosis nigricans, Type 2 diabetes, dyslipidemias, hypertension, non-alcoholic liver disease, and obstructive sleep apnoea. Good clinical examination with hematological and radiological investigations is required for clinical evaluation. Management is a combined effort involving a dermatologist, endocrinologist, gynecologist, and nutritionist. Morbidity in addition includes a low "self image" and poor quality of life. Long term medications and lifestyle changes are essential for a successful outcome. This article focuses on understanding the normal and abnormal endocrine functions involved in the pathogenesis of PCOS. Proper diagnosis and management of the patient is discussed.