Clinical utility index for root canal sealers.

BACKGROUND: Effective endodontic treatment requires the use of a root canal sealer with optimal properties to ensure a hermetic seal, prevent reinfection, and promote healing. Despite the availability of various sealers, a standardized evaluation system still needs to be improved. OBJECTIVES: To develop a Clinical Utility Index (CUI) that systematically evaluates and ranks root canal sealers based on their sealing ability, antimicrobial efficacy, flow rate, and solubility. METHODS: The CUI was developed through a structured process involving expert identification, panel discussions, and the establishment of scoring criteria. Five sealers were evaluated (Sealers A, B, C, D, and E). Mean values for the core properties were calculated, and sealers were ranked accordingly. The total CUI for each sealer was computed based on the assigned scores for each property. RESULTS: Sealer B achieved the highest CUI at 95%, demonstrating superior performance across all core properties. Sealer C followed with a CUI of 80%, while Sealer A ranked third with 60%. Sealers D and E showed the lowest performance, with CUIs of 30% and 35%, respectively, highlighting deficiencies in multiple properties. DISCUSSION: The CUI provides a comprehensive evaluation framework for root canal sealers, facilitating informed decision-making by practitioners. Sealer B's high CUI underscores the importance of balancing sealing ability, antimicrobial effect, flow rate, and solubility. The results align with existing literature emphasizing the critical role of these properties in endodontic success. CONCLUSION: The CUI offers a robust and balanced method for evaluating root canal sealers, aiding in selecting the most suitable sealer based on empirical data. Future research should refine the index and validate its applicability in diverse clinical scenarios to enhance endodontic treatment outcomes.

Breakthrough in the Development of Endodontic Irrigants.

The three main components of endodontic success are three-dimensional obturation, pulp space sterilization, and biomechanical preparation. Instrumentation techniques are insufficient to accomplish complete disinfection of the pulp space. It is essential to use additional tools, such as endodontic irrigants. This review article aims to provide a general overview of the different root canal irrigants and their clinical uses. Endodontic treatment focuses more on removing infectious material from the root canal system to facilitate the healing of an existing periapical lesion or to prevent the periradicular tissues from being infected. It is important to note that instrumentation alone can reach every part of the root canal wall. Therefore, the irrigation procedure is a crucial aspect of endodontic therapy. Irrigation requires the application of various irrigants, like sodium and chlorhexidine, to get rid of debris, bacteria, and tissue leftovers. The accomplishment of root canal treatments counts heavily on the thoroughness of irrigation, contributing to optimal canal shaping and disinfection. Modern root canal irrigation systems incorporate syringes, needles, and advanced delivery mechanisms, including sonic and ultrasonic devices. These inventions aim to enhance the mechanical action of irrigants, reaching intricate canal anatomy more efficiently. Understanding the dynamics of root canal irrigation and staying abreast of technological advancements are essential for clinicians to achieve improved treatment outcomes in endodontic procedures.

Evaluation of the physical properties of bromelain-modified biodentine for direct pulp capping.

BACKGROUND: This study aims to evaluate the compressive strength, solubility, radiopacity, and flow of Bromelain (BR)-modified Biodentine (BD) for direct pulp capping (DPC). This is suggested to determine the impact of BR on the physical properties of BD. METHODS: Eighty samples were prepared according to the ISO and ADA specifications and evaluated for compressive strength, solubility, radiopacity, and flow. The compressive strength was evaluated at 24 h and 21 days via a universal testing machine. The solubility was determined by weight loss after 24-hours immersion in deionized water. Radiopacity was assessed via X-ray with aluminum step-wedges, and flow was measured by the diameter of the discs under a standard weight. Independent sample t-tests were used to statistically assess the data. A significance level of 5% was considered. RESULTS: The compressive strength was 41.08 ± 1.84 MPa for BD and 40.92 ± 1.80 MPa for BR + BD after 24 h, and 88.93 ± 3.39 MPa for BD and 87.92 ± 3.76 MPa for BR + BD after 21 days, with no significant differences. Solubility was slightly greater in the BR + BD (2.75 ± 0.10%) compared to BD (2.62 ± 0.25%), but not significantly different. The radiopacity was similar between BD (2.82 ± 0.11 mm) and BR + BD (2.73 ± 0.10 mm). BR + BD resulted in significantly greater flow (9.99 ± 0.18 mm) than did BD (9.65 ± 0.27 mm) (p ≤ 0.05). CONCLUSION: BR-modified BD maintains BD's physical properties, with improved flow, making it a promising DPC agent that warrants further study.

The Management of a C1-Shaped Canal Configuration in a Mandibular Second Molar.

The mandibular second molar has one unique feature regarding internal anatomy: it tends to have a C-shaped configuration in many cases. In mandibular second molar teeth, it is a variance of racial predilection that is frequently observed. During negotiation, debridement, and obturation, the physician is frequently faced with difficulties due to the complexity inherent in this diversity of canal morphology. This case report describes the management of such canal variation, which requires a thorough knowledge of internal anatomy combined with detailed investigations and the operator's skill in cleaning and shaping the canal for better prognostic outcomes.

Management of a Case of a Large Perforation Repair With Biodentine.

Perforations, which are artificial contact connections among teeth and supporting tissues, have a substantial impact on the success of root canal therapy, whether caused by iatrogenic or pathological causes. This case report describes a 51-year-old female who had intermittent jaw pain that was diagnosed as perforation and was successfully controlled with endodontic intervention following a referral due to procedural problems. The perforation in the furcation zone of a molar was treated with biodentine, demonstrating its sealing, biocompatibility, and tissue restoration properties. The discussion emphasizes the necessity of choosing the right repair materials and techniques based on perforation size and location. Biodentine emerges as a viable option due to its capacity to form a dependable seal in demanding settings.  The study concluded by emphasizing the need for physician competence, tooth morphology understanding, and operative proficiency in preventing and properly treating perforations for the best treatment outcomes.

Repair of Iatrogenic Furcal Perforation With Mineral Trioxide Aggregate: A Case Report.

In endodontic and restorative procedures, an accidental perforation of the pulp chamber floor or roots presents a considerable risk, potentially leading to persistent inflammatory responses and ultimately tooth loss. Accidental root canal perforations are primary complications encountered by clinicians, requiring either surgical or non-surgical intervention, depending on the severity of the perforation. Over the years, various materials have been utilized for the treatment of such complications, but mineral trioxide aggregate (MTA) stands out prominently due to its exceptional biocompatibility, remarkable sealing capacity, and potent antibacterial properties. The unique ability of MTA to set in the presence of moisture facilitates the formation of a robust seal, thereby making it highly effective in managing root perforations and fostering tissue regeneration within the affected area. Its versatility and effectiveness have made MTA a cornerstone material in modern endodontic therapy, offering clinicians a reliable solution for enhancing the long-term prognosis of teeth affected by perforations.

Reviving the Art of Onlay Cast Metal Restoration.

Cast metal restorations have been a cornerstone in restorative dentistry for decades, providing durable and reliable solutions for restoring damaged teeth. This case report explores the evolution of cast metal restoration techniques, highlighting recent advancements and their implications in modern dental practice involving indirect cast metal onlay restoration as a successful treatment option that involves the replacement of the tooth cusp and reinforcement of the tooth through indirect restoration. Historically, cast metal restorations, commonly fabricated from alloys such as gold, have offered superior mechanical properties, biocompatibility, and longevity compared to other materials. However, concerns regarding esthetics and cost have prompted the development of alternative materials such as ceramics and composite resins. Nonetheless, cast metal restorations remain indispensable for certain clinical scenarios, particularly in cases of extensive damage or high occlusal forces.

Platelet Power: Revitalizing Endodontics With Scaffolds.

This article provides an overview of a biologically based method for restoring damaged tooth structures and pulp tissues known as regenerative endodontics. It explores the concept of regenerative endodontics, its tissue engineering approach, and its application in maintaining vitality. The article discusses the significance of the factors affecting growth, scaffolds, and stem cells being the three tissue engineering components involved in the regeneration of pulp tissues. It also delves into the classification of scaffolds and the role of platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) as biological scaffolds. The methodology section details the search process for relevant studies, and the review section presents research findings associated with PRF and its application in regeneration and repair of tissue. The article concludes by highlighting the potential of advanced PRF and injectable PRF in regenerative endodontics, with a focus on their impact on tissue regeneration and healing.

In-Office Power Bleaching for the Aesthetic Management of Dental Fluorosis.

Fluorosis is a widespread condition that is endemic and found in approximately 25 nations worldwide. It manifests as dental fluorosis, an inherited enamel imperfection resulting from excessive fluoride exposure during tooth development. This condition can lead to varying degrees of tooth discoloration, often requiring aesthetic correction. Bleaching represents one of the treatment approaches for such instances, with in-office power bleaching being a technique that comprises the clinical implementation and triggering of bleaching agents using light to expedite the procedure. This case report outlines the successful aesthetic revision of moderate dental fluorosis through power bleaching, obviating the demand for intrusive procedures. It underscores the efficacy and conservative nature of in-office power bleaching to address tooth discoloration associated with extensive fluorosis.

From Crisis to Victory: Rescuing Root Canal Treatment With Bioactive Material in a Nail-Biting Case of Furcal Perforation.

This case report illustrates the successful treatment of an iatrogenic furcal perforation using mineral trioxide aggregate (MTA) and its reinforcement with fiber-reinforced composites (FRCs). Endodontic perforations, particularly in the furcal area, present unique challenges that demand effective management strategies. MTA, known for its multifaceted properties including osteoinductive activity and sealing capabilities, has emerged as the gold standard material for perforation repair. This case report demonstrates the application of MTA in repairing the perforation site following thorough cleaning and shaping of the root canals. Furthermore, the use of FRCs, specifically glass fiber-reinforced composite (GFRC), is introduced to reinforce the repaired site, enhancing its mechanical properties and long-term stability. The discussion emphasizes the importance of selecting appropriate materials for endodontic perforation repair and highlights the advantages of FRCs in preventing structural failures. Future directions suggest further research to refine FRC formulations and standardize clinical protocols to maximize treatment outcomes. This case report contributes valuable insights to the advancement of endodontic therapy, showcasing the combined benefits of MTA and FRCs in achieving favorable treatment outcomes for iatrogenic furcal perforations.

Metal Marvels: Revolutionizing Endodontic Restoration With a Novel Endocrown Approach.

This case report explores the innovative application of the endocrown technique for restoring a severely damaged mandibular molar (tooth #46) in a 28-year-old male patient. With a recent root canal treatment history, the patient presented with a dislodged prosthesis. Due to financial constraints, a base metal alloy was chosen for the endocrown restoration. The unique preparation process involved reducing the occlusal surface by 2 mm, creating a shoulder cervical margin, and preserving enamel walls. The endocrown, crafted from a base metal alloy, demonstrated a semi-conservative approach, providing cost-effectiveness and minimal tooth preparation. The case adheres to the 2013 CAse REport (CARE) guidelines. The discussion highlights the biomechanical benefits of the endocrown, emphasizing stress resistance, stability, and superior performance compared to traditional treatments. Materials like ceramic, resin nanoceramic, and polyetheretherketone are briefly discussed, focusing on the promising success rates of endocrowns, mainly through computer-aided designing/computer-aided manufacturing systems. The report provides valuable insights for clinicians considering this endocrown technique in reconstructing severely damaged molars and premolars.

Revolutionizing endodontics: Advancements in nickel-titanium instrument surfaces.

Nickel-titanium (NiTi) instruments have become the backbone of endodontics due to their exceptional properties, superelasticity, and shape memory. However, challenges such as unexpected breakage, poor cutting efficiency, and corrosion have prompted researchers to explore innovative surface modifications to enhance their performance. This comprehensive review discusses the latest advancements in NiTi metallurgy and their impact on rotary NiTi file systems. Various surface treatment techniques, including ion implantation, cryogenic treatment (CT), thermal nitridation, electropolishing, and physical or chemical vapor deposition, have been investigated to minimize defects, boost surface hardness, and improve cyclic fatigue resistance. Ion implantation has shown promise by increasing wear resistance and cutting efficiency through nitrogen ion incorporation. Thermal nitridation has successfully formed titanium nitride (TiN) coatings, resulting in improved corrosion resistance and cutting efficiency. CT has demonstrated increased cutting efficiency and overall strength by creating a martensite transformation and finer carbide particles. Electropolishing has yielded mixed results, providing smoother surfaces but varying impacts on fatigue resistance. Physical or chemical vapor deposition has proven effective in forming TiN coatings, enhancing hardness and wear resistance. Furthermore, the concept of surface functionalization with silver ions for antibacterial properties has been explored. These advancements present an exciting future for endodontic procedures, offering the potential for enhanced NiTi instruments with improved performance, durability, and patient outcomes.

Unveiling the Enigma: A Confluence of Two Case Reports for the Negotiation of Mid-Mesial Canals.

Mandibular molars display a wide spectrum of intricate anatomical variations among the Indian population. This case report details the diagnosis and successful endodontic management of a mid-mesial canal in the mandibular first molar tooth, emphasizing the importance of radiographic imaging and meticulous instrumentation. The patient presented with symptoms of irreversible pulpitis that led to accurate relief of symptoms after shaping and cleaning protocols were followed. This case series discusses the challenges encountered during canal negotiation, cleaning, shaping, and obturation, providing insights into the complexities associated with mid-mesial canals.

Application of Low-Level Laser Therapy in Endodontics: A Narrative Review.

Low-level laser therapy (LLLT) stands out in the realm of dentistry for its unique attributes that set it apart from traditional therapeutic approaches. This non-invasive and painless modality harnesses the power of low-intensity lasers, offering a distinct advantage in terms of safety and patient comfort. Unlike many conventional methods, LLLT does not rely on pharmaceutical interventions or invasive procedures, making it a gentle yet effective option for various dental applications. Its non-thermal, photobiomodulatory effects on cellular and tissue functions mark a notable departure from the more aggressive treatment modalities commonly associated with dentistry. This article provides an extensive exploration of LLLT's applications in dentistry, focusing on its mechanisms of action and biological effects, and emphasizes the uniqueness of LLLT as a transformative tool in modern dental care.

Efficacy of Triple Antibiotic Paste and Bromelain Paste As Intracanal Medicament Against Enterococcus faecalis: An In-Vivo Study.

Introduction Microorganisms are pivotal contributors to pulp and periapical pathology, often culminating in endodontic treatment failures. The successful outcome of such treatment hinges on the effective eradication of microbial flora through various interventions, including intracanal medicaments (ICMs). However, Enterococcus faecalis (E. faecalis), a highly adaptive Gram-positive bacterium, exhibits remarkable resilience and can persist even after rigorous disinfection efforts. This study explores the efficacy of two ICMs, calcium hydroxide-based triple antibiotic paste (TAP) and a novel alternative containing bromelain, derived from pineapples, in combating E. faecalis infections in vivo. Methodology This in-vivo study was conducted at Sharad Pawar Dental College and Hospital, Wardha, India, and ethical approval was obtained from the institutional ethical committee. The sample size was calculated using the OpenEpi program (version 3.04.04, Open Source Epidemiologic Statistics for Public Health, www.OpenEpi.com), resulting in 15 participants per group. Inclusion criteria encompassed mandibular premolars with carious involvement but no prior restorations, diagnosed with necrotic or infected pulp, and no significant medical history. Exclusion criteria included systemic conditions, pregnancy, retreatment cases, recent antibiotic therapy, calcified canals, and other contraindications. After proper patient consent, access opening and chemomechanical preparation were performed, and root canals (RCs) were randomly divided into two groups: TAP and bromelain paste (BP). TAP was prepared using ciprofloxacin, metronidazole, and minocycline, while BP comprised bromelain powder mixed with saline. Both groups received intracanal medicaments, followed by temporary sealing. Microbiological samples were collected before and after treatment for analysis. Results E. faecalis count (CFU/mL) before instrumentation for the TAP group was (1.94 x 105 [Formula: see text] 7.45 x 103) and for BP group was (1.97 x 105 [Formula: see text] 7.70 x 103) with p-value 0.26 [Formula: see text] p=0.05, so no significant difference was found between them. E. faecalis count (CFU/mL) after instrumentation for the TAP group was (7.70 x 103 [Formula: see text] 9.11 x 102) and for the BP group was (7.26 x 103 [Formula: see text] 8.43 x 102) with p-value 0.18 [Formula: see text] p=0.05, so no significant difference was found between them. However, the E. faecalis count obtained after seven days of intracanal medicament for the TAP group was (3.63 x 101 [Formula: see text] 5.60) and for the BP group was (3.13 x 101 [Formula: see text] 4.55) with p-value 0.012 < p=0.05, so a significant difference was found between them. This means that when compared with the TAP group, there was a greater amount of reduction in E. faecalis count (CFU/mL) for the BP group seven days after the placement of intracanal medicament, and this reduction was statistically significant. Conclusion This in-vivo study highlights the potential of BP as a more effective intracanal medicament against E. faecalis when compared to the conventional TAP. Bromelain's selectivity for Gram-positive bacteria and its diverse therapeutic properties make it a promising natural alternative for endodontic treatment. Further research is warranted to optimize bromelain's clinical application and assess its potential to enhance endodontic outcomes, potentially revolutionizing the field of endodontics.

Examining the Impact of Preheating on the Fracture Toughness and Microhardness of Composite Resin: A Systematic Review.

The objective of this comprehensive study was to systematically evaluate the effects of preheating on two critical mechanical properties, microhardness and fracture toughness, in resin composite materials. The overarching goal was to provide valuable insights into the potential benefits and limitations of this technique for enhancing the overall mechanical performance of such materials. To achieve this, an extensive and systematic electronic search was conducted across multiple reputable databases, including MEDLINE/PubMed, SCOPUS, ProQuest, SpringerLink, Web of Science, ScienceDirect, and Google Scholar, with data collection extending until June 2023. This rigorous search process resulted in the identification of 29 pertinent articles, which were subjected to a thorough risk of bias assessment employing the Quality Assessment Tool For In Vitro Studies (QUIN). The findings of this comprehensive investigation revealed several noteworthy trends. First, concerning microhardness, all the studies consistently demonstrated a positive effect of preheating on this mechanical property. This uniformity in results corroborates the initial hypothesis that preheating indeed enhances microhardness in resin composite materials. Second, with respect to fracture toughness, a majority of the studies provided evidence supporting the notion that preheating has a favorable influence on this particular mechanical property. This alignment of outcomes suggests that preheating can be a beneficial technique for improving fracture toughness in resin composites. However, it is essential to note that there were a few exceptions within the collected data, where preheating appeared to lead to a decrease in fracture toughness. Additionally, one study reported no statistically significant effect on fracture toughness. These deviations from the general trend highlight the complexity of the relationship between preheating and fracture toughness, indicating that other factors or material-specific nuances may come into play. In conclusion, the results of this study indicate that preheating resin composites can improve microhardness and fracture toughness, offering potential benefits for dental restorations. Yet, conflicting data warrants further research to uncover the reasons behind these discrepancies. Future studies should also investigate preheating's broader impact on composite resin materials to gain a comprehensive understanding of its applications and limitations in the field.

Pioneering Periapical Healing: The Novel Synergy of Mineral Trioxide Aggregate and Injectable Platelet-Rich Fibrin.

This case report presents a novel non-surgical approach for managing a substantial periapical lesion associated with tooth 12 using a combination of injectable platelet-rich fibrin (i-PRF) and mineral trioxide aggregate (MTA). A 28-year-old male patient presented with pus discharge and intermittent swelling following a history of dental trauma. Clinical and radiographic assessments confirmed a large periapical cyst associated with tooth 12. The treatment involved root canal therapy with calcium hydroxide medication, leading to symptom relief. Subsequently, i-PRF combined with MTA was used as a regenerative material for periapical healing. Follow-up examinations at three, six, and nine months showed complete resolution of symptoms and radiographic evidence of lesion healing. This innovative technique demonstrates the potential of i-PRF and MTA synergy in the non-surgical management of periapical lesions, avoiding the risks associated with surgical interventions and promoting effective tissue healing.

Navigating Challenges in the Management of Mandibular Third Molars With Radix Paramolaris: A Case Report.

This study aims to shed light on a contemporary approach to preserving third molars instead of opting for immediate extraction. Third molars are known for their diverse shapes and unique anatomy, making root canal treatment a complex task due to limited access. However, there are situations where it is crucial to retain these molars, such as when they provide support or for self-transplantation purposes. The case report focuses on a 33-year-old female patient who presented with pulp necrosis and acute apical periodontitis in the lower right third molar. Instead of extraction, a two-visit conventional root canal treatment was planned. During the initial diagnostic radiographs, only two visible roots were observed, illustrating the typical anatomy of the third molar. However, an unforeseen additional root, referred to as radix paramolaris, was encountered in the mesiobuccal region during the access opening, presenting numerous challenges in the treatment process. Thankfully, advancements in dental technology, such as magnification aids, ultrasonic tips and flexible nickel-titanium (NiTi) rotary files, have rendered the management of such intricate cases more attainable. In conclusion, dealing with intricately curved canals in difficult-to-reach teeth like third molars has become more achievable with technological progress, although the operator's skill and experience remain crucial for effective management.

Management of Discoloured Anterior Teeth With Radicular Cyst: A Case Report.

Dental trauma often has tooth discoloration and periapical lesion as its sequelae. Intracoronal bleaching restores the aesthetics, while a retrograde approach is required for non-healing lesions. A patient with discolored teeth, draining sinus, tenderness and a periapical lesion on the radiograph was treated initially with conventional root canal therapy and walking bleach technique. After four months, the sinus tract reappeared and on cone-beam computed tomography (CBCT) examination, a large periapical lesion with loss of buccal cortical plate was seen. A minimally invasive retrograde cystic enucleation, apicectomy, and filling with biodentine were then performed. The defect area was filled with synthetic nanocrystalline hydroxyapatite granules combined with platelet-rich-fibrin. Follow-ups after one, three, and six months were taken. The six-month CBCT revealed complete bone healing. Non-vital bleaching yields acceptable cosmetic results. Additionally, if the conventional procedures are not successful in treating radicular cyst, apical surgery must be the ultimate choice.

Emerging Paradigms in Internal Root Resorption Management: Harnessing the Power of Bioceramics.

Internal root resorption is a pathological activity involving dentin deterioration within the root canal walls. Numerous variables, including traumatic injury, infection, and orthodontic therapy, can trigger this process. Traditional materials such as mineral trioxide aggregate (MTA) have been utilized to treat internal root resorption but have limitations such as tooth discoloration and handling challenges. Bioceramic materials, such as Bio-C Repair, have emerged as possible MTA substitutes. This case study outlines the effective management of idiopathic extensive perforating internal root resorption using a non-surgical laser-assisted approach and the application of Bio-C Repair as an obturation material. The treatment resulted in the resolution of symptoms and the restoration of periapical tissues. Bioceramics, with their unique composition and favorable biological properties, offer the potential for effective tissue repair and provide alternatives to traditional materials in the treatment of internal resorption. The utilization of bioceramics, including Bio-C Repair, holds promise for achieving successful outcomes and preserving natural dentition.