Agrawal and Shah Modified Cast Index - A Novel Index Assessing Prevalence of Dental Caries and Treatment Needs of the Adult Indian Population.

Background: Agrawal and Shah modified CAST (Caries Assessment Spectrum and Treatment) is the novel index prepared specifically for the Indian population for the complete evaluation of the spectrum/range of dental caries described hierarchically. Objective: To assess the prevalence of dental caries and treatment needs in an adult Indian population using Agrawal and Shah modified CAST index. Materials and Methods: A cross-sectional transverse study was performed on 2000 adult patients in the age range of 19-70 years. All the adult patients were scored for caries presence by Agrawal and Shah modified CAST codes on a structured proforma. SPSS version 20 was used to analyze the data. Results: The prevalence of dental caries calculated using Agrawal and Shah modified CAST index was 85.6%. 5.2% (104) adults had sound dentition, 4.1% (82) adults had restorations, 2.1% (42) adults had non-cavitated lesions, 13.7% (274) adults had the presence of caries in the enamel, 19% (380) adults had the presence of caries in dentine, and pulpal involvement was observed in 27.7% (554) adults. 10.3% (206) adults had presented with a root surface and cervical caries. 13.6% (272) adults had lost at least one tooth due to caries, and 3% (60) adults had lost teeth due to any other reason except dental caries. 1.3% (26) adult patients do not show any caries-related diagnosis but were having predisposing conditions. Conclusion: Agrawal and Shah modified CAST index proved to be simple, useful, and appropriate in assessing dental caries prevalence in the Indian population along with the treatment needs of the Indian population.

Stress distribution pattern in two different no-post systems in endodontically treated maxillary central incisors: A three-dimensional finite element analysis.

Aim: This study aimed to evaluate the stress distribution in an endodontically treated tooth restored with two different reinforcing fibers followed by direct composite restoration using a finite element analysis (FEA). Settings and Design: FEA. Subjects and Methods: Two three-dimensional models of endodontically treated maxillary central incisors were restored with two reinforcing fibers: the polyethylene fibers (PFs) and the short fiber-reinforced composite (SFRC), respectively. The restoration was carried out without any intraradicular preparation using direct composite restoration. The models were generated using SolidWorks. The elastic modulus and Poisson's ratio for various structures and materials were installed into the simulation software, Abaqus. A FEA was then conducted. Each model received a mixed-mode loading of 150 N as distributed pressure to the specified region, and stress distribution was evaluated using the von Mises criteria. Results: Both the reinforcing materials, PF and SRFC, showed maximum concentration of stresses in the cervical third of the tooth. The calculated values of the von Mises stresses for the PF and the SFRC models were 1.7 Mpa and 1.9 Mpa, respectively. Moreover, the stresses generated were of low intensity and were uniformly distributed, suggesting that by using this technique, stresses may be very well tolerated by the remaining tooth structure without any fracture. Conclusion: This no-posttechnique, using the two reinforcing fibers, showed minimal stress concentration in the cervical region of the tooth. Thus, using this ultraconservative approach that aims to preserve and reinforce the pericervical dentin and restore the remaining tooth structure with direct composite restoration could be a promising treatment option for the rehabilitation of badly mutilated teeth.

Evaluation of pre-heated composite resins with soft-start polymerization and conventional composite restorations in class-I carious lesions - A randomized clinical trial.

Background: By increasing fluidity and conversion, pre-heated composites enhance adaptability and strength, while soft-start polymerization decreases internal stresses. Aim: Over a period of a year, this split-mouth design, randomized controlled clinical trial (RCT) compared pre-heated composites with soft-start polymerization to conventional composites in class-I lesions, with the goal of improving restoration outcomes. Methods: and Findings: Immediately following ethical approval and registration with CTRI, 37 patients with in-formed permission who met specified inclusion and exclusion criteria for class-I lesions were chosen for enrollment. Using a 1:1 ratio, teeth were randomly assigned to Group-A (pre-heated composite with soft-start polymerization) or Group-B (traditional composite restoration). At three-time intervals, the evaluation was blinded and calibrated using Modified United States Public Health Service (USPHS) criteria: baseline, six-month, and one-year marks. Statistical analysis was performed using SPSS 21.0 and the Mann-Whitney U test for inter-group comparisons and the Friedman test for intra-group comparisons. Interpretation: Pre-heated composites with soft-start polymerization performed better in terms of marginal adaptation with a statistically significant difference (p = 0.019) and in terms of color match they performed better clinically (p = 0.062) at 12 months. Other variables like marginal discolouration, sec-ondary caries, anatomic form, post-operative sensitivity, surface texture and retention showed no statistically significant difference (p < 0.05). Pre-heated composites with soft-start mode performed marginally better than nanofilled composites. However, both techniques can be used to successfully restore simple class-I carious lesions.

To assess the prevalence of impaired glucose tolerance and impaired fasting glucose in Western Indian population.

OBJECTIVES: The objective of the study to determine the prevalence of Impaired Glucose Tolerance and Impaired Fasting Glucose (both combined termed as Pre Diabetes) in the population of Gujarat. METHODS: In year 2007 and 2008, a cross sectional survey was conducted via mode of camps at various urban and rural part of Gujarat. After obtaining an informed consent, comprehensive questionnaire was used to collect the various anthropological details, physical examination and blood collection was performed from around 1700 subjects > or = 20 years of age from the different areas of Gujarat. Chi square test was used for all categorical comparisons. Also multiple logistic regression was used for detailed exploratory analysis. RESULTS: The crude prevalence of IFG in Gujarati population is around 2.76% and IGT is around 6.12%. But the age adjusted prevalence of IFG is around 2.72% and IGT is around 4.67%. If we extrapolate these to population of Gujarat, it indicates that around 1.3 million people are having impaired fasting glucose and around 2.3 million people have impaired glucose tolerance. The prevalence of IGT found more after age of 40 years. For IFG, there is increase after age of 40 years, but not significant statistically. CONCLUSIONS: High prevalence of IGT validates that there are chances of the pandemic trend in Gujarat, as eventually IGT may get converted into Diabetes in near future. These results need urgent attention to develop a public awareness programme.

Impact of contracted endodontic cavities on instrumentation efficacy-A systematic review.

The aim of the present systematic review was to summarise and evaluate the studies comparing the role of contracted endodontic cavities (CECs) and traditional endodontic cavities (TECs) in terms of instrumentation efficacy. The present systematic review comprised of a search of the online databases of Cochrane, PubMed, Google Scholar and grey literature. The articles which were pertaining to instrumentation efficacy in contracted and traditional endodontic cavities were selected based on the PRISMA checklist. Out of the 660 articles which were obtained, irrelevant articles were excluded and a total of 17 articles were selected for this systematic review which assessed the instrumentation efficacy. Eleven studies compared the volume of dentin removed and canal transportation ability. Four studies compared the pulp debridement, and two studies compared the anti-bacterial efficacy between the two groups. The extrusion of debris between the groups was compared by one study. Out of the 17 studies included, 11 studies proved that contracted endodontic cavities negatively impacted the instrumentation efficacy. Hence, the data suggest that the traditional endodontic access cavities have better results when comparing the instrumentation efficacy.

Clinical evaluation of winged versus wingless rubber dam clamps in single tooth isolation - A randomized clinical study.

Context: Retention of the rubber dam is done with metallic or nonmetallic clamps for isolation. The two types of metallic clamps most frequently used are winged and wingless. The clinical efficacy of both clamps is needed to be compared. Aim: The aim of the study was to evaluate and compare the postoperative pain and clinical efficacy of winged clamps and wingless metallic clamps in rubber dam isolation of permanent molars in class I restoration. Materials and Methods: After obtaining ethical approval and CTRI registration, a total of 60 patients with mild-to-moderate deep class I caries were included after obtaining informed consent and randomly allocated into two assigned groups: Group A - winged clamp and Group B - wingless clamp, with n = 30 per group. Local anesthesia was administered and the tooth was isolated using a rubber dam as per the standardized protocol. The postoperative evaluation was done for pain using the Verbal Rating Scale (VRS) at 6 and 12 h; trauma to the gingival tissues, sealing ability of the clamp, and slippage of the clamp were evaluated using criteria for clinical evaluation of rubber dam isolation. Statistical Analysis Used: Independent t-test and Chi-square test were used to compare VRS and clinical parameters, respectively, with P < 0.05. Results: Gingival trauma (P = 0.006) and postoperative pain were statistically significantly more in the wingless group at 6 h (P = 0.016) and 12 h (0.01). Statistically significant lower seepage of fluid (P = 0.017) was observed in the wingless group. Slippage was observed more with the winged group but was statistically insignificant. Conclusion: Both clamps showed acceptable clinical performance. Their use should be planned as per the requisite of the case and the position of the tooth.

Comparative evaluation of the effect of calcium silicate and epoxy resinbased root canal sealers on postoperative pain in patients with primary endodontic lesion: A randomized clinical study.

Introduction: This study's objective was to assess and compare postoperative pain response between bioceramic sealer (Nishika BG) and epoxy resin based (AH Plus) in patients with primary endodontic lesion at time interval of 24 h, 48 h, and 7 days using the Visual Analog Scale (VAS). Materials and Methods: The study included 40 individuals with necrotic pulp and apical periodontitis. Calcium hydroxide was administered as the intracanal medication during the two-visit endodontic therapy. They were subsequently allocated randomly to either the AH Plus root canal sealer or the Nishika Canal Sealer BG, with a total of 20 participants in each group. Patients were told to use a VAS to rate their postoperative pain severity as none, minimal, moderate, or severe after 24 h, 48 h, and 7 days following obturation using the appropriate sealers. Results: Nishika Canal Sealer BG (CS-BG) has a lower pain score as compared to the AH Plus group at 24-h time point. VAS ratings for both the groups decreased over time. According to the intergroup analysis, there was a significant difference in postoperative pain at the 24 h (P = 0.022), but not at the 48 h or 7 days (P > 0.05). Conclusion: Although bioceramic sealer (Nishika Canal Sealer BG) resulted in significantly lower levels of pain as compared to epoxy resin-based sealer (AH Plus) at 24-h interval, there was no significant difference of postoperative pain at 48-h interval and 7-day period.

Microbiological Effectiveness of Sodium Hypochlorite Gel and Aqueous Solution When Implemented for Root Canal Disinfection in Multirooted Teeth: A Randomized Clinical Study.

The aim of endodontic therapy is to use various antimicrobial medications for proper cleaning and shaping to create an environment free of microorganisms by eradicating as many as possible from the root canal space. Even although it is a gold standard irrigant, sodium hypochlorite (NaOCl) is known for its cytotoxic effects on vital periapical tissues, making its higher concentrations inappropriate for use in conditions such as wide, underdeveloped, or damaged apices and in cases of perforations. Consequently, if it is ascertained that a gel form of sodium hypochlorite has equivalent antibacterial activity to the aqueous solution form, it could be employed in such situations. The aim of this study was the microbiologic evaluation of 5.25% sodium hypochlorite gel and aqueous solution as root canal disinfectants in multirooted teeth with primary endodontic lesions. Following ethical approval and CTRI registration, 42 patients who gave their consent and had multirooted teeth with pulpal necrosis and asymptomatic apical periodontitis were considered for the study. Following the opening of the access, pre-endodontic build up in case of class-II cavities and working length determination, a pre-operative sample (S1), which was regarded as the pre-operative microbial load of that canal, was acquired from the largest canal using a sterile paper point while maintaining strict isolation and disinfection. The computer randomization approach was used to divide the teeth into two groups at random just before beginning of chemo-mechanical preparation: Group A (n = 21)-canal disinfection with 5.25% sodium hypochlorite gel; Group B (n = 21)-canal disinfection with 5.25% sodium hypochlorite aqueous solution. Following the canal disinfection, a post-operative (S2) sample which was regarded as the postoperative microbial load of that canal was collected from the same canal using a sterile paper point. The Colony-Forming Units (CFUs) for the S1 and S2 samples were determined after 48 h aerobic incubation on Brain Heart Infusion (BHI) agar plates. The patients and the microbiologist were blinded throughout the procedure. Using SPSS 20.0 software (USA), the Shapiro-Wilk test and the Lilliefors Significance Correction were used for normality, followed by the Mann-Whitney U test which was used to compare the CFU difference (×105) between the two groups. A p value of <0.05 was perceived as statistically significant. The mean colony-forming units count difference between the 5.25% sodium hypochlorite gel and aqueous solution groups did not differ in a manner that was statistically significant (p = 0.744). In multirooted teeth with primary endodontic lesions, the 5.25% sodium hypochlorite gel and the aqueous solution demonstrated comparable antimicrobial effectiveness when implemented as root canal disinfectants.

Comparative Evaluation of Efficacy of Ketoprofen and Diclofenac Transdermal Patches with Oral Diclofenac Tablet on Postoperative Endodontic Pain- A Randomized Clinical Trial.

Purpose: Evaluate the efficacy of transdermal patches containing ketoprofen and diclofenac sodium compared to oral diclofenac tablets in reducing post-endodontic pain after single-visit root canal therapy for teeth with symptomatic irreversible pulpitis. Methods: A total of 78 eligible participants with symptomatic irreversible pulpitis and preoperative VAS scores of 4 or above were enrolled after obtaining ethical approval (SVIEC/ON/DENT/SRP/22064) and CTRI registration (CTRI/2022/07/044231). Exclusion criteria included pregnancy, lactation, fractured/cracked teeth, developmental anomalies, tooth pathology, or ongoing analgesic/NSAID use. After root canal treatment, participants were randomized into three groups using computer randomization. Groups A and B received transdermal patches with Ketoprofen and diclofenac sodium, respectively, applied to the right forearm for 24 hours, with an additional patch on the left forearm for the next day. Group C received four diclofenac sodium oral tablets, twice daily for two days. VAS scales were used to assess pain at 4, 8, 24, and 48 hours post-treatment. The VAS scores collected were tabulated and statistically analyzed using SPSS version 21 with (P < 0.05). Shapiro Wilk test and the Related Samples Friedman's Two-Way Analysis of Variance by Ranks were used for statistical evaluation. Results: Statistically significant reductions in mean postoperative pain scores were observed across all groups at all time points compared to preoperative scores. Notably, the Ketoprofen patch group exhibited superior performance compared to the diclofenac transdermal patch and oral diclofenac tablet groups at 48 hours, with statistical significance (p=0.047). Conclusion: The present evidence substantiates the efficacy of transdermal patches containing diclofenac and ketoprofen in managing postoperative pain arising from symptomatic irreversible pulpitis in single-rooted teeth. By avoiding the use of oral NSAIDs, these patches provide effective pain relief while minimizing the risk of adverse effects, presenting a favorable option for patients.

Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study.

Aim: The Purpose of This In-Vitro Study Was to Comparatively Evaluate the Aesthetic Outcome Of Direct Polychromatic Layering Of Anterior Composites Restoration With The "Index Cut-Back" Technique While Restoring Class IV Defects of Teeth. Methodology: An extracted tooth specimen of maxillary central incisor crown was 3-D scanned for obtaining its dimensions, these dimensions were transferred to AUTOCAD™ software and a customised 3-D Printed mould was fabricated (Temporary Patent no. 336763-001 ). 50 specimens of Maxillary Central Incisor Crowns were then constructed with the help of Composite restorative material (Palfique Estelite LX5, Tokuyama Dental Corporation, Japan) in this mould. Afterwards with the help of a Straight fissure diamond bur a standardized size (4 cm length x 4 cm width) class IV defect was created on all 50 specimens and then they were allocated to 2 groups, Group A & B. 25 specimens for each Group (N = 25). Group A was restored using conventional Direct Polychromatic Layering technique and Group B was restored using the "Index cut-back" Technique. Shade Outcome and Translucency were evaluated using Spectrophotometer and Time taken was evaluated using a stop-watch chair side. Results: There was a significant difference in the values (P < .05) between Group A (Polychromatic) & Group B (Index cut-back) in terms of both Shade Outcome & Translucency; Group B showed better aesthetic values (closer to baseline) than Group A. In contrast, Time required for restoring the Class IV defects was significantly lower in Group A compared to Group B (P < .05). Conclusion: The Index Cut-Back Technique showed superior aesthetic outcome restoring Class IV defects, however it requires a planned pre-operative course of action before executing the clinical procedure.

Evaluation of pulpal anesthesia and injection pain using IANB with pre-heated, buffered and conventional 2% lignocaine in teeth with symptomatic irreversible pulpitis-a randomized clinical study.

Background: The efficacy of 2% lignocaine is reduced in a hot tooth. Local aesthetic agents can be preheated and buffered to increase their effectiveness. The present investigation was carried out due to limited information concerning adult patients with symptomatic irreversible pulpitis in mandibular teeth. Methods: A total of 252 individuals were included in the clinical trial in accordance with the selection criteria only after clinical study was registered with the Clinical Trial Registry of India (CTRI/2020/09/027796). Scores on the visual analog scale (VAS) and electric pulp test (EPT) on a 1-10 scale were recorded prior to the commencement of therapy. In this double-blinded study, patients were randomly divided by a co-investigator using computer randomisation (www.randomizer.org) into three groups, group A: inferior alveolar nerve blocks (IANB) with 2% lignocaine preheated at 42 °C (injected at 37 °C) (N = 84), group B: IANB of 2% lignocaine buffered with 0.18 ml of 8.4% sodium bicarbonate (N = 80) and group C: 2% lignocaine (N = 88). Excluding the dropouts of individuals (n = 11), wherein the anaesthesia failed, a total of 241 people were finally assessed 15 minutes after profound anaesthesia, endodontic access, and intraoperative pain were quantified using VAS. Pain on injection for all three groups was recorded immediately after IANB with VAS. The analysis was performed using one way ANOVA with Tukey's post hoc test and Paired T-Test using SPSS version 21. Results: Preheated, Buffered, and conventional 2% lignocaine showed statistically significant reduction in intraoperative pain (P < 0.001) compared to pre-operative but on inter-group comparison preheated and buffered showed highly significant pain reduction compared with conventional 2% lignocaine (P < 0.001). Conclusions: Warm and buffered local anaesthetic (LA) were effective in reducing intraoperative discomfort than conventional LA. Preheated local anesthetics caused the least pain, followed by buffered local anesthetics, while conventional local anesthetics caused the most pain.

A 1-year comparative evaluation of clinical performance of conventional direct composite restoration technique with a novel "custom shield" technique in class I compound lesions - A randomized clinical study.

Aim: The aim of the study is to evaluate and compare the 1-year clinical performance of conventional direct composite restoration technique with a novel "custom shield" technique in class I compound lesions. Subjects and Methods: After ethical approval, 72 patients who signed the informed consent form participated in the study. They were divided into two groups - Group A: Conventional direct composite restoration (n = 36) and Group B: Composite restoration using custom shield technique (n = 36) by computer randomization. In Group A, composite restoration was performed by the incremental layering technique. In Group B, restoration was performed using a novel custom shield and occlusal stamp along with the incremental layering technique. Patients were evaluated using the modified USPHS criteria by blinded evaluators for 1 year. Statistical Analysis: Chi-square test and Friedman test using SPSS version 21.0. Results: A statistically significant difference was obtained for marginal adaptation (P = 0.024), retention (P = 0.23), surface texture, and anatomic form (P < 0.001), and time taken to perform the procedure for Group B was higher than Group A. Conclusion: Conventional composite restoration and custom shield technique can be successfully used in class I compound lesions with custom shield technique having a higher edge over the conventional technique.

Root canal morphology and variations of mandibular premolars by clearing technique: an in vitro study.

BACKGROUND AND OBJECTIVES: The aim of this study was to compare internal anatomy between first and second mandibular premolars and to study different percentage variations of root canal morphology of mandibular premolars in Gujarat population based on Vertucci's classification by clearing technique. METHODOLOGY: A total of 80 extracted intact permanent mandibular premolars (40 each mandibular first premolar and mandibular second premolar) with fully formed apices were collected. Access cavity was prepared with endo access kit, all samples were placed in 2.5% sodium hypochlorite for 48 hours, after that all samples were washed in running water for 2 hours. After washing, all samples were transferred to 5% nitric acid, for decalcification, for 72 hours, with the acid being changed every 24 hours and stirred once every 8 hours. All samples were washed in running water and dehydrated using ascending grades (70%, 80%, 90% and 100%) of isopropyl alcohol for 2 days. Finally, they were rendered transparent by immersion in methyl salicylate for 15 minutes and then India ink dye was injected into the access cavity. The anatomy of the root canal was observed and classified based on the Vertucci's classification. STATISTICAL ANALYSIS: Parametric Z-test was used to compare the variation between mandibular first and second premolars. RESULTS: In mandibular first premolar, type 1 was found in 20%, type 2 was 5%, type 3 was 5%, type 4 was 25%, type 5 was 12.5% and type 6 was 2.5% of total samples. Whereas, in mandibular second premolar, type 1 was found in 80% out of all samples, type 4 was 2.5%, type 5 was 17.5%. Type 2, type 3, type 6, type 7 and type 8 were not found in this study. CONCLUSION: Mandibular first premolar showed higher variation (75%) compared to mandibular second premolar (37.5%). CLINICAL SIGNIFICANCE: The knowledge of variations in the root canal morphology of the mandibular premolars can enhance the level of endodontic treatment of mandibular premolars. KEYWORDS: Root canal morphology, Vertucci's classification, Clearing technique. How to cite this article: Parekh V, Shah N, Joshi H. Root Canal Morphology and Variations of Mandibular Premolars by Clearing Technique: An in vitro Study. J Contemp Dent Pract 2011;12(4):318-321. Source of support: Nil Conflict of interest: None declared.

Comparative evaluation of biodentine and endosequence root repair material as direct pulp capping material: A clinical study.

Aim: The study was designed to clinically evaluate biodentine and endosequence root repair material (ERRM) as direct pulp capping agent at 3 months, 6 months, and 12 months intervals. Materials and Methods: Sixty permanent posterior teeth with deep caries, without any signs of irreversible pulpitis were allotted into two experimental groups: Group I -Biodentine, Group II-ERRM. Follow-up evaluations were done. Every 24 h for 7 days, the pain was assessed using visual analog scale. Statistical Analysis: Paired t-test along with Pearson's Chi-square test was performed. Results: The success rate of clinical assessment at 12 months for biodentine group is 78.60% and ERRM Group is 64.70%. Conclusion: Biodentine group performed superior than ERRM group clinically at all-time interval and hence it can be successfully used to restore exposed vital tooth.

Comparative evaluation of novel customized cushees during rubber dam isolation using self-designed evaluation criteria: A randomized clinical study.

BACKGROUND: Rubber dam plays essential role in dentistry and various modifications have been done to improve patients acceptance and to eliminate the discomfort caused due to clamps. AIM: Clinical evaluation of efficacy and postoperative outcome of metal clamps with customized cushions and standard metal clamps during rubber dam isolation procedures. MATERIALS AND METHODS: After institutional ethical approval and informed consent total 64 patients were randomly assigned in two groups. Group A - rubber dam metal clamp with customized cushees (n = 32), Group B - rubber dam with standard metal clamp (n = 32). After selection of appropriate clamp for Group A, Customized cushions were prepared and restoration was performed. The evaluation was done using self-designed assessment criteria which included postoperative pain, rubber dam slippage, trauma to gingival and adjacent tissues and sealing ability of both the groups. STATISTICAL ANALYSIS USED: Chi-square value was calculated with SPSS software version 18.0. RESULTS: There was statistically significant difference between postoperative pain, rubber dam slippage, trauma to gingival tissues (P < 0.001) with reduced postoperative pain. CONCLUSION: Cushions have played significant role in reducing postoperative pain, trauma to the gingival tissue and slippage of rubber dam clamp compared to standard metal clamps.

Three-dimensional printing: A revealing pathway to an unpredictable maze.

Three-dimensional (3D) technology has gained wide acceptance in dentistry. It has been used for treatment planning and surgical guidance. This case report presented a novel treatment approach to remove and preserve the cortical bone and root-end resection during periapical surgery with the help of cone-beam computed tomography (CBCT), computer-aided design, and 3D printing technology. A 22-year-old male patient presented with a large periapical lesion in the right maxillary central and lateral incisors was referred for endodontic surgery. The data acquired from a preoperative diagnostic CBCT scan and an intraoral scan were uploaded into surgical planning software and matched. A template that could be used to locate root ends and lesion areas was virtually designed based on the data and was fabricated using a 3D printer. With the guidance of the template, the overlying cortical bone was precisely removed and preserved, and apicectomy was performed. The patient was clinically asymptomatic at a 6-month follow-up review. Six months after the surgery, the lesion was healing well, and no periapical radiolucency was observed on radiographic examination. The digitally designed directional template worked in all aspects to facilitate the periapical surgery as anticipated. The root ends were accurately located and resected. The surgical procedure was simplified, and the treatment efficiency was improved. This technique minimized the damage and reduced iatrogenic injury.

Evaluation of Extrusion and Apical Seal of Thermafil™ Obturation with and without MTA as an Apical Barrier in Comparison with Lateral Condensation Technique: An In Vitro Study.

AIM AND OBJECTIVE: This study aimed to compare the apical sealing ability and periapical extrusion in the Thermafil™ obturation technique, with and without an apical barrier of MTA, with lateral condensation technique. MATERIALS AND METHODS: Sixty freshly extracted human central incisors were instrumented with the crown down technique and divided into three experimental groups. Group I: lateral condensation technique obturation, group II: Thermafil obturation (DENTSPLY Tulsa), and group III: this group was obturated into two parts; first MTA (ProRoot) was placed in apical 3 mm and later the remaining canal was obturated with Thermafil™ obturation technique (DENTSPLY Tulsa). AH Plus sealer was used in all the groups. Specimens of all the groups were layered with nail paint excluding the apical 3 mm. Twenty-four hours later, all the teeth were suspended in Black India ink for 48 hours. Finally, all the teeth were decalcified, rendered transparent and linear dye leakage and periapical extrusion was measured using ×60 magnification of stereomicroscope with an in-built ruler. RESULTS: A Chi-square test done to evaluate periapical extrusion showed there was a significant difference found among all the groups (p < 0.05), whereas in case of linear apical dye leakage using a Student's "t" test showed there was no significant difference among all the groups (p > 0.05). CONCLUSION: Despite showing apical leakage, the thermo-plasticized gutta-percha obturation technique can be advantageous when used with MTA as an apical barrier since there is no scope for apical extrusion along with the benefit of three-dimensional obturation of the root canal system when compared with the lateral condensation technique. HOW TO CITE THIS ARTICLE: Rao AS, Mathur R, Shah NC, et al. Evaluation of Extrusion and Apical Seal of Thermafil™ Obturation with and without MTA as an Apical Barrier in Comparison with Lateral Condensation Technique: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(S-1):S40-S44.

Comparative evaluation of sealing ability of calcium sulfate with self-etch adhesive, mineral trioxide aggregate plus, and bone cement as furcal perforation repair materials: An In vitro dye extraction study.

AIM: The aim of this study was to determine the sealing ability of three different materials mineral trioxide aggregate (MTA) Plus, bone cement, and calcium sulfate with self-etch adhesive (SEA) for the repair of furcal perforation, using dye extraction method. MATERIALS AND METHODS: Forty-eight extracted human permanent first and second molars were included and randomly divided into four groups: Group 1, n = 12, negative control, perforation not repaired with any material, Group 2, n = 12, perforation repair material used, MTA Plus, Group 3, n = 12, perforation repair material used, calcium sulfate with SEA, Group 4, n = 12, perforation repair material used, bone cement. The teeth were then coated with two coats of clear nail varnish immersed in methylene blue dye for 24 h, kept in 65% concentrated nitric acid for 3 days. Dye leakage was measured with the dye extraction method using a spectrophotometer at 550 nm. RESULTS: The negative control showed the highest mean values of dye absorbance (1.45). Bone cement (0.94) came second. Calcium sulfate with SEA (0.58) and MTA Plus (0.32) had no significant difference in their dye absorbance values. CONCLUSION: Within the limitations of the study, MTA Plus showed the least microleakage followed by calcium sulfate with SEA which has shown promising results and can be used as an alternative followed by bone cement which showed the highest microleakage.

Herbal medicaments in endodontics - Current guidelines for in vivo studies in India.

Elimination of bacteria from infected root canal systems is a challenging task. Various techniques have been described to reduce the number of bacteria within the root canal system, which include chemomechanical instrumentation, use of various irrigants to remove or dissolve organic and inorganic debris, and to destroy bacteria. The intracanal medicament plays a key role in the success of root canal treatment. With the rise in bacterial resistance to antibiotics, there is considerable interest in the development of other classes of antimicrobials for the control of infection. Natural products are known to play an important role in human life. The use of herbal products as mouthwash has been tried and tested in the literature. However, the use of herbal intracanal medicament has been shown promising results when used under in vitro conditions, but in vivo studies are very scarce. This may be due to the limited supporting literature available to use it as intracanal medicament in patients due to the ethical concern. Hence, the purpose of this review is to highlight the current guidelines (laid by the drugs and cosmetics act as per the Gazette of India) regarding the use of herbal medicaments for the clinical trials in endodontics.

An in vitro comparative evaluation of commonly consumed catechu and catechu with lime on surface roughness and color stability of the conventional nano-hybrid composite.

AIM: Comparative evaluation of commonly consumed catechu and catechu with lime on surface roughness and color stability of the conventional nano-hybrid composite. METHODOLOGY: A total of 50 uniform cylindrical disks of 10-mm diameter and 2-mm thickness prepared from the nano-hybrid composite were used in the study. Each sample was randomly divided into three subgroups of 20 samples each in two experimental groups (catechu, catechu, and lime) and 10 samples in the control group (artificial saliva). The samples were immersed in each agent for 15 days. Surface roughness and color changes measurements were noted at the baseline and 15th day by two-dimensional profilometer and spectrophotometer, respectively. RESULTS: It was found that nano-hybrid composite resin showed more surface roughness and color change when immersed in catechu and catechu with lime as compared to the control group. Intergroup comparison showed statistical significant increase in surface roughness and color change in the catechu group followed by the catechu with the lime group and artificial saliva. CONCLUSION: Within the limits of the present study, it can be concluded that all experimental specimens showed discoloration. At the end of 15th day, among the groups, catechu showed more surface roughness and color change followed by the catechu and lime and the control group.