Effect of Heated Sodium Hypochlorite Irrigant on Structural Changes and Microhardness of Radicular Dentin: An In Vitro Study.

AIM: This study is aimed to evaluate the combined effect of sodium hypochlorite at varied concentrations and temperatures on radicular dentin microhardness along with its surface structural changes using an FTIR spectrometer. MATERIALS AND METHODS: Mandibular premolars were cleaned and shaped up to F3 Protaper gold rotary files, after which they were subjected to five experimental conditions - group I - neutral saline as negative control, group II - 3% NaOCl solution, group III - 5% NaOCl solution, group IV - 3% intracanal-heated NaOCl solution, and group V - 5% intracanal-heated NaOCl solution. Following this, the microhardness of radicular dentin at 100 µm and 300 µm from the canal lumen and Fourier-transform infrared (FTIR) spectroscopic analysis were performed. RESULTS: The results showed that intracanal-heated sodium hypochlorite group reduced root dentin microhardness at 300 µm than its nonheated counterpart. No difference in microhardness values was observed between 3% intracanal-heated and room-temperature sodium hypochlorite groups at 100 µm. Reduction in amide/phosphate ratio was noted in all the groups treated with sodium hypochlorite irrespective of temperature and concentration. CONCLUSION: Thus, considering that the level of alteration in physical and structural changes of root dentin with or without heating is insignificant, intracanal-heated low-concentration sodium hypochlorite solutions could be used as an alternative to high-concentration sodium hypochlorite. CLINICAL SIGNIFICANCE: Intracanal-heated low-concentration sodium hypochlorite enables the clinicians to achieve maximum disinfection while keeping the structural and physical properties of the dentin similar to room-temperature sodium hypochlorite.

External Root Surface Temperature Control with 1,1,1,2-Tetrafluoroethane Intracanal Cryotherapy during Thermoplastic Obturation: An In Vitro Study.

AIM: The aim of this in vitro study was to determine the effectiveness of 1,1,1,2-tetrafluoroethane (TFE) intracanal cryotherapy for external root surface temperature control during thermoplastic obturation. MATERIALS AND METHODS: Thirty extracted adult single-rooted mandibular incisors were selected for this study. Endodontic shaping was performed until size X3 Protaper Next Rotary endodontic file. The teeth were divided into three groups: Group I-Control group wherein conventional irrigation was done using physiologic saline stored at room temperature, Group II-Irrigational Cryotherapy group using physiologic saline at 2.5°C, and Group III-Intracanal TFE cryotherapy group with intracanal refrigerant TFE application. Temperatures were recorded in the apical 3 mm before and after completion of each intervention and post thermoplastic obturation using a noncontact digital laser infrared thermometer. RESULTS: Intracanal cryotherapy with TFE resulted in a mean decrease of 9.27°C compared with conventional irrigation that exhibited in a mean decrease of 2.13°C. Also, in intracanal cryotherapy group with TFE application, compared with the baseline (24.50°C), no significant differences were observed post obturation (24.61°C) with high-temperature-injectable gutta percha technique indicating good control of temperature rise on the external root surface. CONCLUSION: Intracanal cryotherapy with refrigerant TFE was highly effective in controlling temperature rise on the external root surface during injectable thermoplastic obturation technique. CLINICAL SIGNIFICANCE: Minimizing deleterious effects due to high temperatures generated during the thermoplastic obturation is critical. Clinically feasible measures to reduce the transmission of heat generated during thermoplastic obturation have been searched since long. In this regard, intracanal cryotherapy with TFE can be effectively used to control the rise of temperature on the external root surface when employing thermoplastic obturation technique.

Evaluation of Nanomagnesium Oxide in Combination with Garlic Extract as an Endodontic Irrigant: An In Vitro Study.

AIM: The aim of this in vitro study was to evaluate the effectiveness of the combination of garlic extract in combination with magnesium oxide (MgO) for use as an endodontic irrigant at various contact times. MATERIALS AND METHODS: All 48 teeth were divided into 6 groups according to irrigation used after inoculation with Enterococcus faecalis and incubation. The control groups consisted of saline and sodium hypochlorite (NaOCl) used as irrigants and the test groups employed garlic extract combined with nano-magnesium oxide (nano-MgO) used as irrigant with two contact times, namely, 2 and 5 minutes, and garlic extract and nano-MgO used solely for 5 minutes each. Colony-forming units (CFUs) were counted after plating and incubation. RESULTS: In NaOCl, and in both combination groups, there was a significant reduction in CFU counts. The saline group showed no decrease. Statistical analysis showed no difference in efficacy between NaOCl and the two combination groups. There was a statistical difference between the combination group and garlic/nano-MgO alone at both 2 and 5 minutes. CONCLUSIONS: Under the conditions of this study, a novel irrigant, a combination of nanoparticles of MgO and garlic extract was as effective as NaOCl against E. faecalis in an in vitro model at two tested contact times. CLINICAL SIGNIFICANCE: Combination of MgO nanoparticles and garlic extract achieves disinfection comparable to gold standard NaOCl without harmful caustic effects of hypochlorite.

Cyclic Fatigue Resistance of Different Glide Path Files in Simulated Double Curved Canal in Continuous Rotary Motion: An In Vitro Study.

AIM: This in vitro study aimed to compare and evaluate the resistance to cyclic fatigue of a newly developed glide path file in a simulated double curvature canal in a cyclic fatigue-testing machine. METHODS: In this in vitro study, a static cyclic fatigue-testing machine with a simulated double curve was created and the samples were divided into the following three groups: Group I-HyFlex EDM; group II-TruNatomy file; and group III-Aurum G files and each instrument is continued to rotate in the canal and a number of cycles to failure (NCF) was calculated and Fractographic analysis was done using scanning electron microscope (SEM), and the results were statistically analyzed. RESULTS: Statistical analysis was done using parametric methods one-way analysis of variance (ANOVA) shows statistical significance between groups and then Tukey's HSD post hoc tests were used for multiple pairwise comparisons. TruNatomy glide path files had the highest cyclic fatigue resistance when compared to HyFlex EDM and Aurum G files. CONCLUSION: The selection of file systems in cleaning and shaping protocols is an enigma to endodontics. From the results of this study, it can be concluded that TruNatomy files had higher cyclic fatigue resistance than other glide path files are canals with double curvature, hence it is suitable for usage in root canals with extreme curvature. CLINICAL SIGNIFICANCE: The selection of file systems in cleaning and shaping protocols is an enigma to endodontics. This in vitro study explored the selection protocols for the execution of root canal preparation. Heat treatment of nickel-titanium (NiTi) endodontic files had improved the cyclic fatigue resistance significantly enhancing the clinical life of file systems.

Antibacterial Efficacy of Irrigants with Varying Osmolarity on E. faecalis Biofilm: An In Vitro Study.

AIM: To evaluate the role of the addition of different concentrations of sodium chloride salt to conventional intracanal irrigants to vary their osmotic values and thereby compare their antibacterial efficacy. MATERIALS AND METHODS: In an active attachment biofilm model, Enterococcus faecalis (ATCC 29212) biofilms were grown. Sodium chloride salts were added to 100 mL of distilled water to make 6M (hyperosmotic), 0.5M, and 0.25M (hypoosmotic) sodium chloride solutions, respectively. The experimental groups were divided into three groups: Group I: 5.25% sodium hypochlorite, group II: 2% chlorhexidine, and group III: 2% povidone iodine, and four subgroups within these three groups, such as subgroup A (without salt solution), subgroup B (with 6M of hyperosmotic salt solution), subgroup C (with 0.5M of hypoosmotic salt solution), and subgroup D (with 0.25M of hypoosmotic salt solution), respectively. Biofilms were treated with all the subgroups for a contact time of 15 min. A crystal violet assay was done to estimate the bacterial cell biomass. RESULTS: The results revealed that subgroups IIIB, IB, and IID, ID had a statistical reduction in bacterial biomass at p < 0.05. There were no significant differences between subgroups IC, IIC, and IIIC and subgroups IA, IIA, and IIIA. CONCLUSION: The antibacterial efficacy of all three irrigants was significantly affected by varying the osmolarities. CLINICAL SIGNIFICANCE: The results prove that the hyperosmotic and hypoosmotic salt solutions, along with irrigants, have enhanced antibacterial efficacy on E. faecalis biofilm due to its ability to vary the turgor pressure of cell wall, as well as the inherent properties of the irrigants such as hypochlorous acid formation, ionic interaction, and free radical interactions.

Influence of occlusal surface reduction on post endodontic pain following instrumentation and obturation: A randomized double blinded clinical study.

Objective: The purpose of this randomized clinical study was to investigate the influence of occlusal surface reduction on postendodontic pain. Methodology: Sixty patients were included with a diagnosis of acute irreversible pulpitis and acute apical periodontitis and divided randomly into two groups. In the intervention group, occlusal surfaces were reduced and left intact in the control group. Postoperative pain was evaluated at the 6th, 12th, 24th, and 48th h after the root canal instrumentation and 6th and 12th h following obturation using visual analog scale. Data were evaluated using the Chi-square test, t-test, Friedman test, Mann-Whitney U-test, and Wilcoxon rank test. Results: Postoperative pain levels in both groups were reduced significantly over the time period evaluated, however, between the two groups, there was no difference evident. Conclusion: Occlusal surface reduction did not influence the pain following root canal instrumentation and obturation.

Fracture resistance of resin based and lithium disilicate endocrowns. Which is better? - A systematic review of in-vitro studies.

Objectives: The primary objective of this systematic review is to compare the fracture resistance of lithium disilicate (LDS)-based endocrowns and resin-based (RB) endocrowns of in-vitro studies, and the secondary objective is to compare their catastrophic failures. Materials and Methods: The review protocol was registered in the P ROSP ERO database (CRD42020166201). A comprehensive literature search was done in PubMed, Cochrane, EBSCOhost and Google Scholar using key terms. Only in-vitro studies that compared fracture resistance of LDS-based endocrowns and indirect RB endocrowns in molars were included. Data extraction, risk of bias assessment and qualitative analysis of the included studies were performed. Results: Five studies were included in this systematic review. The overall risk of bias for the included studies was moderate. Under axial loading, RB endocrowns showed similar fracture resistance when compared with LDS endocrowns. However, they showed better fracture resistance when compared with zirconia reinforced lithium silicate (ZLS) endocrowns. Furthermore, RB endocrowns showed fewer catastrophic failures than LDS-based endocrowns. Conclusions: RB endocrowns have similar or better fracture resistance and fewer catastrophic failures when compared to LDS-based endocrowns.

Evaluation of Root Dentin Thickness and Smear Layer Removal Efficacy of Two Novel Nickel Titanium Rotary Instruments - An In Vitro Cone-Beam Computed Tomography and Scanning Electron Microscopy Study.

OBJECTIVE: This study aimed to compare the two nickel-titanium (NiTi) instruments on root dentin thickness using cone-beam computed tomography (CBCT) and ability to remove the smear layer using scanning electron microscope (SEM). MATERIALS AND METHODS: The effect of two NiTi rotary instruments such as XP Endo shaper and ProTaper Gold (PTG) in retaining adequate dentin thickness and debridement (i.e., removal of smear layer) was evaluated in vitro using CBCT and SEM. After cleaning and shaping of the root canal with adequate irrigation, the effect of two NiTi instrument systems at 3 mm (apical), 6 mm (middle), and 9 mm (coronal) levels on buccal, lingual, mesial, and distal aspects in terms of amount of dentin removal and smear layer removal was evaluated. The data were analyzed using student's unpaired t-test with a significance of P ≤ 0.05. RESULTS: Both NiTi instrument systems had no statistically significant difference in amount of dentin removal at all three levels and on all four aspects. In smear layer removal, PTG had significantly better efficacy compared to XP Endo shaper at the coronal third of root canal. CONCLUSION: Instrumentation with XP Endo Shaper and PTG showed a similar amount of dentin removal. PTG has a significant effect on smear layer removal compared to XP Endo Shaper only at the coronal third of root canal.

Evaluation of debris and smear layer removal with XP-endo finisher: A scanning electron microscopic study.

CONTEXT: The presence of smear layer and debris can prevent the irrigant and sealer from penetrating the dentinal tubules thereby compromising the seal of the root canal filling. AIM: This study aims to evaluate the efficacy of XP-endo Finisher with ProTaper Next and HyFlex in smear layer and debris removal. MATERIALS AND METHODS: : Thirty-two extracted mandibular premolar teeth were selected and sectioned at the cementoenamel junction. The roots were then randomly divided into 4 groups. In group 1 and 2, canals were instrumented with X2 ProTaper Next (25 0.06 taper). In group 3 and 4, canals were instrumented with HyFlex system (25 0.06 taper). The canals in group 2 and 4 were further finished with XP-endo Finisher. Irrigation was carried out using 3% sodium hypochlorite during instrumentation, and 17% ethylenediaminetetraacetic acid was used as the final rinse. The roots were then split longitudinally. The canal wall was observed under the scanning electron microscope in coronal, middle, and apical thirds at a magnification of ×400 and ×1000 for evaluation of debris and smear layer, respectively. Photomicrographs were taken, and qualitative assessment for debris and smear layer removal was done. STATISTICAL ANALYSIS USED: The results were analyzed using Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: Lower debris and smear layer scores were seen in canal thirds instrumented with ProTaper Next and XP-endo Finisher (P < 0.01). CONCLUSION: The use of XP-endo Finisher as an adjuvant during shaping and cleaning produced cleaner root canal walls.

Comparative Evaluation of the Anti-bacterial Efficacy of Herbal Medicaments and Synthetic Medicaments Against Enterococcus faecalis using Real-time Polymerase Chain Reaction.

Periradicular bacterial infections are the proven cause of the failure of endodontic treatment. When the pulp canal gets infected or becomes necrotic, bacterial growth takes place in the form of biofilms and aggregates. During the endodontic procedure, bacterial colonies are disrupted, and the microbial load is reduced by biomechanical preparation, cleaning with anti-microbial solutions, and placing anti-bacterial medicaments in the root canal. These anti-microbial substances are synthetic, having a cytotoxicity effect. In recent times, herbal medicines are an alternative medicine being used increasingly as an intra-canal medicament to fight or prevent common endodontic infections. Aim The objective of this study is to compare the anti-bacterial efficacy of herbal medicaments and synthetic medicaments against Enterococcus faecalis (E. faecalis). Materials and methods This was an in-vitro study in which a total of 60 teeth specimens (n=60) were inoculated with E. faecalis for 21 days. Specimens were divided into six groups (Group 1: Piper nigrum (Piperaceae); Group 2: Piper longum (Piperaceae); Group 3: Zingiber officinale Roscoe (Zingiberaceae); Group 4: Calcium hydroxide; Group 5: 2% chlorhexidine gel (CHX); and Group 6: saline (negative control). The intra-canal medicaments were packed inside the tooth. After five days, the remaining microbial load was determined by using real-time PCR. Results The threshold cycle (Ct) values of Piper nigrum, Piper longum, dried ginger extract, 2% CHX, calcium hydroxide, and saline were found to be 21.36, 20.55, 22.14, 22.51, 23.62, and 17.81, respectively. The obtained mean bacterial load of these products was 8.64, 12.52, 7.23, 0.82, 0.14, and 149.49, respectively. Conclusion Two percent CHX showed high antibacterial activity against E. faecalis followed by calcium hydroxide, Zingiber officinale Roscoe, Piper nigrum, Piper longum, and saline.

Evaluation of bioflavonoids on the immediate and delayed microtensile bond strength of self-etch and total-etch adhesive systems to sound dentin.

AIM: This study aims to evaluate the effect of two bioflavonoids (epigallocatechin-3-gallate [EGCG] and catechin) and a protein inhibitor (chlorhexidine [CHX]) on the immediate and delayed microtensile bond strength of self-etch and total-etch adhesive systems to sound dentin. MATERIALS AND METHODS: The occlusal surfaces of 96 mandibular human third molar teeth specimens were ground after removal of the excess tissues, to expose the middle dentin. The dentin specimens were randomly allocated into four groups, each consisting of 24 teeth (n = 24) according to the application of the enzyme inhibitor. The adhesive system used in this study was Adper easy bond, a self-etch adhesive system, and Adper Single Bond 2, a total-etch adhesive system. Microtensile bond strength testing was conducted using thermocycler 2000, Heto-Holten A/S. RESULTS: All the three enzyme inhibitors increase the bond strength values of the resin-dentin interphase when used during dentin bonding. The EGCG enzyme inhibitor has shown the highest immediate bond strength to dentin when used with both the adhesive systems.