Stress analysis of horizontal mid-root fracture managed with different intraradicular fixation protocols: A 3D-finite element study.

The current study evaluated the stress distribution in a maxillary central incisor with mid-root fracture after splinting with different intra-radicular posts using 3D-finite element analysis (FEA). Five 3D-FEA models were constructed. Model 1 was an intact tooth with no fracture, Model 2: A tooth with a horizontal mid-root fracture, with no treatment. Model 3: Same as model 2, and intraradicular splinting using fiber post. Model 4: Same as model 2 and intra-radicular splinting using Protaper Gold file F3. Model 5: Same as model 2, and with intraradicular splinting with Ribbond. The FEA of all models was done to obtain the maximum Von-Mises stress in the root canal space, the dentin, the periodontal ligament, and the bone. The highest Von Mises stresses for the root canal space and the dentin were found in Model 3, followed by models 4, 5, and 2, and least in Model 1. The Von Mises stress of the periodontal ligament was the least in model 1. The Von Mises stress of bone was higher in all experimental models than in the baseline model. The results suggest that in cases where intra-radicular splinting is indicated, fiber posts and Ribbond are better alternatives to endodontic files due to the lower stresses exerted.

Isolated Fracture of Lateral Pterygoid Plate by Penetrating Foreign Body - A Rarity Indeed.

BACKGROUND: Fractures of mid-face were first described by Le Fort and are classified into three categories - Le Fort I, Le Fort II and Le Fort III. The pterygoid processes of the sphenoid bone are fractured in all the three categories of Le Fort fractures as the sphenoid bone connects the cranium vault to the facial bones. Fractures of the pterygoid processes without associated Le Fort fractures are rare and are usually associated with fractures of the mandible, temporal bone or other facial bones. An isolated fracture of pterygoid plates without associated Le Fort fractures or fractures of other mid-face bones are exceedingly rare. CASE REPORT: We present a case of an isolated fracture of the right lateral pterygoid plate by a penetrating foreign body (wooden twig) in an adult male who presented with discharging sinus in the oropharynx. The presence of the foreign body was confirmed on computed tomography and was removed under general anesthesia via submandibular incision. The patient had an uneventful postoperative hospital stay and was asymptomatic on a follow-up five months later. CONCLUSIONS: This article emphasizes the fact that pterygoid plates may be fractured without an associated Le Fort fracture or a fracture of the mandible. This is the first case of an isolated pterygoid plate fracture in the literature.

Pediatric Clear Cell Renal Cell Carcinoma with Pelvicalyceal System Invasion and Contiguous Extension Upto Bladder: Novel and Bizarre Tumor Behaviour.

BACKGROUND: Paediatric renal cell carcinoma (RCC) is a rare neoplasm which differs significantly in its clinico-pathological behaviour from the adult variant. The clear cell variant constitutes a relatively small histological subset of this neoplasm. CASE REPORT: We present a very unusual, pathologically proven case of clear cell variety of pediatric RCC which showed invasion into the pelvicalyceal system with contiguous extension up to the urinary bladder. Such a novel manifestation of paediatric RCC has not been described previously in literature. A relevant review of literature is included. CONCLUSIONS: The aggressive biological behaviour of the paediatric RCC in our case and the consequent atypical imaging findings are distinctly unusual. These findings may represent a new aggressive variant of this rare neoplasm. The radiologist and clinician should be aware of these novel manifestations of paediatric clear cell RCC.

Oral care needs, barriers and challenges among elderly in India.

OBJECTIVE: This paper presents an approach to the assessment of oral health needs of elderly and barriers to receive oral care in the life course. BACKGROUND: The dental needs of the elderly are changing and growing day by day. The management of older patients requires not only an understanding of the medical and dental aspects of ageing but also provide them good oral health service. In the life course of elderly there are many hurdles to receive proper oral care. The use of an assessment of oral health need will be essential in the development of care pathways to the elderly. METHODS: The proportion of older people is growing faster than that of any other age group. There is no sound database regarding the oral disease burden and treatment needs of the elderly in India. Physical and biological barriers with age can also affect oral health care either directly or indirectly. CONCLUSION: Oral care guidelines designed to assist elderly should consider not only prevention and treatment modalities but also the means of implementing such therapies in varying settings and utilizing the whole dental team.

Glutaraldehyde-Induced Allergic Contact Dermatitis: A Case Report and Safety Standards.

Glutaraldehyde (GA), a potent disinfectant and sterilizing agent extensively used in healthcare settings, has garnered attention for its association with contact dermatitis. This occupational skin condition, often induced by repeated exposure to GA, poses significant challenges to the well-being of healthcare professionals and patients alike. Understanding the causes, symptoms, and preventive measures against GA-induced contact dermatitis is essential for promoting a safe and healthy working environment in healthcare facilities. A 28-year-old female presented with a severe burning sensation and dark brown patches in the lower chin region, one day following root canal treatment. Based on the characteristic appearance of patches and the typical burning sensation associated with an allergic reaction, a diagnosis of acute contact dermatitis was made. Patch testing by an expert dermatologist confirmed that the patient was allergic to GA. GA, a popular commercial germicidal product, is widely used as a cold sterilizing agent for operative dental instruments. The patient developed a reaction as the endodontic files used during the root canal procedure were cold sterilized with 2% GA. The lesion experienced significant improvement and ultimately healed following the administration of corticosteroids and antihistamines. This report concerns a case of GA-induced contact dermatitis. As GA is being used more widely, particularly in dental clinics, this case was of interest and is reported in the safety interest of patients and clinicians.

Effect of platelet-rich fibrin and concentrated growth factor on the regenerative potential of human-induced pluripotent stem cells: A comparative analysis.

Background: Platelet-rich fibrin (PRF) has been used, while concentrated growth factor (CGF) has recently evolved as a bioscaffold in regenerative endodontics. Aims: This study aimed to evaluate the effect of PRF and CGF on the proliferation, migration, and differentiation of human-induced pluripotent stem cells (hiPSCs). Materials and Methods: CGF and PRF were fabricated from voluntarily donated human blood, and a conditioned medium was prepared. HiPSCs were isolated and cultivated on a conditioned medium for 12 days. The proliferation rate was analyzed using a trypan blue assay on days 9, 10, and 11. The migratory rate was evaluated using a wound healing assay after 24, 48, and 72 h. For assessing the differentiation of hiPSCs, various markers with quantitative real-time polymerase chain reactions on day 12 were used. Results: Mesenchymal phenotypic transition was seen with an increase in proliferation rate in the PRF group more than in the CGF group on day 9, along with the differentiation of cells with an increase in osteoblastic markers on day 12 in both groups. The migratory capacity of cells was significantly increased in the CGF and PRF groups, with a greater increase in the CGF group. Conclusions: CGF and PRF extend the duration of growth factor activity and enhance cell proliferation and osteogenic differentiation, with hiPSCs serving as a bioscaffold with high regenerative potential.

Analysis of porosity, sealer dissolution and apical extrusion of endodontic sealers: A micro computed tomography study.

Aim: The aim of the study was to determine the porosity, dissolution and apical extrusion of AH Plus, MTA Fillapex and EndoSequence BC sealer after immersion in phosphate buffered saline (PBS) using microcomputed tomography (micro-CT). Methodology: Forty-eight single-rooted teeth were selected. Gutta percha and one of the aforementioned root canal sealers was used for obturation using continuous wave technique. The specimens were scanned after obturation and after seven days of immersion in PBS, by using micro-computed tomography. Porosity, sealer dissolution and apical extrusion were calculated. Statistical analysis was done by using paired t-test, post hoc tukey test and Fischer exact test. Results: Significantly higher percentage of porosity and dissolution of sealer in the apical 4 mm was found for MTA Fillapex and EndoSequence BC sealer than for AH Plus. The incidence of apical extrusion was significantly more in MTA Fillapex (56.25%), followed by EndoSequence BC (31.25%) and AH Plus (0%). Conclusions: None of the three root canal sealers exhibited perfect three-dimensional obturation. The sealers manifested porosity, dissolution and apical extrusion to varying degrees both after obturation and after storage in PBS for 7 days.

A randomized controlled trial of endodontic treatment using ultrasonic irrigation and laser activated irrigation to evaluate healing in chronic apical periodontitis.

BACKGROUND: Aim of this trial was to evaluate the combined clinical and radiographic success rate of endodontic treatment using passive ultrasonic irrigation (PUI) and laser activated irrigation (LAI) as compared to conventional syringe irrigation. MATERIAL AND METHODS: Permanent incisors and single rooted premolars were assessed for eligibility and 69 patients were randomly divided into three treatment groups (n=23) by allocation concealment method and irrigation was performed in accordance with the allocated group. Teeth were evaluated clinically and radiographically with CBCT after 6 months and 12 months of the treatment. RESULTS: A significant difference was observed in the radiographic healing rates among three groups (χ2=12.29, p=0.05). On comparing the final outcome among the three groups (n=19), it was found that 2 (10.5%) cases of group I(Conventional Syringe irrigation), 7 (36.8%) cases of group II (Passive ultrasonic irrigation) and 8 (42.1%) cases of group III(Laser activated irrigation) were healed while under healing category 13 (68.4%) cases of group I, 12 (63.2%) cases of group II and 11 (57.9%) of group III were observed whereas 4 (21.1%) cases were categorised as diseased in group I only. CONCLUSIONS: LAI and PUI can increase the predictability of the endodontic treatment success in cases of chronic apical periodontitis. Key words:Cone-beam computed tomography, CBCT-PAI, Irrigation, LASER, Radiographic healing, Root canal treatment, Ultrasonic.

"Effect of local application of simvastatin in bone regeneration of peri-apical defects-a clinico-radiographic study.

OBJECTIVE: The present study evaluates and compares the effectiveness of Simvastatin (SIM), Hydroxyapatite (HA), and platelet-rich fibrin (PRF) in bone regeneration of periapical defects. MATERIAL& METHOD: Thirty-nine patients were selected and randomized into three groups, Group 1: HA (n = 13), Group 2: PRF (n = 13), Group 3: SIM (n = 13). After completion of RCT and apicoectomy, the grafts were placed locally in the defect and sutured. RESULTS: At the end of twelve months, postoperative symptoms and radiographic analysis assessed the outcome of the treatment. CONCLUSION: Intragroup analysis of CBCT- Periapical Index (PAI) scores at 6th and 12th month revealed a significant change in the SIM group (p = 0.018 and 0.001 respectively), compared to PRF (p = 0.026 and 0.001 respectively) and HA (p = 0.053 and 0.039 respectively). Intergroup analysis of change in the level of CBCT-PAI score was highly significant (p = 0.003).SIM caused a more considerable change in the level of CBCT-PAI score compared to other groups, thereby indicating a faster rate of bone regeneration.

Depth and percentage of resin-based sealer penetration inside the dentinal tubules using EndoVac, EndoActivator, Navi tip FX irrigation system: A confocal laser scanning microscope study.

AIM: This in vitro study was conducted to evaluate the effect of EndoVac, EndoActivator, and Navy Tip FX irrigation system on lateral depth and percentage of sealer penetration into the dentinal tubules using confocal laser scanning microscope. MATERIALS AND METHODS: Forty recently extracted single-rooted mandibular premolars were taken and root canal treatment was performed using three different irrigation system, that is, EndoVac, EndoActivator, and Navi tip FX. The samples were divided into 4 groups according to the irrigation system used: Control or conventional needle (Group I), Navi Tip FX (Group II), EndoActivator (Group III), and EndoVac (Group IV). All teeth were obturated using AH Plus sealer labeled with fluorescent rhodamine B dye. The teeth were sectioned at coronal (5 mm), middle (3 mm), and apical 3rd (1 mm) from the apex. Total percentage and maximum depth of sealer penetration were measured using confocal laser scanning microscopy. The data were evaluated statistically using Kruskal-Wallis test with a 95% confidence level (P = 0.01). RESULTS: EndoVac resulted in more sealer penetration then EndoActivator and Navi Tip FX irrigation system. Endoactivator resulted in more sealer penetration in comparison to Navi Tip FX. CONCLUSION: Percentage and depth of sealer penetration were more at apical and middle 3rd with Endovac system followed by Endoactivator and Navi tip FX system.

An ex vivo evaluation of effect of dentin pretreatment with various agents for varying time intervals on the shear bond strength of resin.

BACKGROUND: This article highlights the contribution of collagen structure/stability to the bond strength. We hypothesize that induction of cross-linking in dentin collagen fibrils improves dentin collagen stability and thus bond strength with composite also improves. AIMS: The aim of the study was to evaluate the effect of collagen cross-linking agents on the shear bond strength of composite resins. SUBJECTS AND METHODS: One hundred human permanent teeth were randomly divided into three groups: Group I (n = 20) - no dentin pretreatment done, Group II - dentin pretreatment with 10% sodium ascorbate for 5 min (IIa) and 10 min (IIb), and Group III - dentin pretreatment with 6.5% proanthocyanidin (PA) for 5 min (IIIa) and 10 min (IIIb). A composite resin was bonded on prepared surfaces and cured. Thermocycling was done, and shear bond strength of the prepared samples was tested using a universal testing machine. RESULTS: Values of Group I (control) were lowest whereas that of Group II (sodium ascorbate) were highest. The following order of shear bond strength was observed: IIb > IIa > IIIb ~ IIIa > I. Results for sodium ascorbate were found to be time dependent, whereas for PA, differences were nonsignificant. CONCLUSIONS: Treatment of dentinal surfaces with collagen cross-linking agent increases the shear bond strengths.

Role of ultrasound and color doppler in diagnosis of periapical lesions of endodontic origin at varying bone thickness.

AIMS: To access the role of ultrasound and color doppler in diagnosing periapical lesions of maxilla and mandible. SETTINGS AND DESIGN: This study was conducted in the Department of Conservative Dentistry and Endodontics (Faculty of Dental Sciences), Department of Radiotherapy, and Department of Pathology. MATERIALS AND METHODS: The study group comprised 30 patients with periapical lesions of endodontic origin in maxilla and mandible requiring endodontic surgery. After thorough clinical and radiographic examination patients were subjected to ultrasound and color doppler examination, where the lesions were assessed for their contents as to cystic or solid. Following which periapical surgery was done and the pathological tissue obtained was subjected to histopathological examination. The results of the ultrasound examination were correlated with histopathological features. The diagnostic validity of ultrasound was assessed by calculating the sensitivity, specificity, positive predictive value, and negative predictive value. STATISTICAL ANALYSIS USED: The statistical analysis was done using statistical package for social sciences (SPSS) version 15.0 statistical analysis software. The values were represented in number (%). RESULTS: Within the limitations of the current study it can be stated that although ultrasound may not establish the definitive diagnosis, it can facilitate the differential diagnosis between cystic and solid granulomatous lesions. However, this technique may have a limited role in detecting periapical lesions present in the region with thick overlying cortical bone. CONCLUSION: Ultrasound can routinely be recommended as a complimentary method for the diagnosis of periapical lesions of endodontic origin. However, this technique may have a limited role in detecting periapical lesions present in the region with thick overlying cortical bone.

An Invitro Evaluation of Antimicrobial Efficacy and Flow Characteristics for AH Plus, MTA Fillapex, CRCS and Gutta Flow 2 Root Canal Sealer.

INTRODUCTION: Cleaning and shaping of root canal does not guarantee complete disinfection of the canal, regardless of the systems and techniques used for this purpose. Therefore, it becomes mandatory for the endodontic filling materials to have a good antimicrobial potential especially against E. faecalis. This research was aimed therefore to evaluate the antibacterial efficacy and flow properties of different root canal sealers. AIM: To study invitro antimicrobial activity and flow characteristics for Resin based (AH Plus), Mineral Trioxide Aggregate based (MTA Fillapex), Calcium hydroxide based (CRCS) and Flowable Gutta-Percha (Gutta Flow 2) endodontic sealers on Enterococcus faecalis. MATERIALS AND METHODS: Enterococcus faecalis ATCC 29212 was used to test antibacterial potential of sealers by Agar diffusion test (ADT) and Direct Contact Test (DCT). ADT was performed by punching the sealers on a well of 4×6mm diameter on Muller Hinton agar plates. These plates were inoculated with standard suspension of E. faecalis and the zone of inhibition was measured at 24 hours and after 7 days. All the sealers were prepared in accordance with the manufacturer's recommendations. Flow of sealers was measured according to ADA specification no. 57. RESULTS: All sealers showed antibacterial activity against E. faecalis except Gutta Flow 2. At 24 hours, zone of inhibition was highest in Calcibiotic Root Canal Sealer (CRCS) and lowest in AH Plus. After 7 days the zone of inhibition decreased in AH plus, CRCS and MTA Fillapex. DCT showed a significant lower number of organisms in AH Plus, CRCS and MTA than controls at both the time intervals. Gutta Flow 2 did not show any significant antimicrobial action. Maximum and minimum flow was shown by AH Plus and CRCS respectively. CONCLUSION: Highest microbial inhibition was shown by (CRCS), followed by MTA Fillapex and AH Plus. Gutta Flow 2 did not show any inhibition of E. faecalis by ADT. Maximum reduction in antibacterial property with time against E. faecalis was seen with AH Plus. Maximum flow was shown by AH Plus and minimum by CRCS.

Mucinous tubular and spindle cell carcinoma of kidney: A case report of an unusual tumor.

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare and unusual variant of renal cell carcinoma (RCC). It is important to differentiate this from the other variants particularly papillary RCC since MTSCC is generally low-grade, has low malignant potential and favorable prognosis. We are reporting a 40-year-old female presenting with right flank pain and well-circumscribed renal mass confined to the lower pole. Tumor consisted of tubules and cords separated by pale mucinous material in some areas, whereas other areas showed dense cellularity without significant mucin. The tumor cells were cuboidal or spindle and did not show significant atypical features. The patient underwent nephrectomy and is asymptomatic clinically and radiologically after 2 years.

Renal cell carcinoma, unclassified with unique features.

Renal cell carcinoma, unclassified constitute about 3-4% of all renal carcinomas. It essentially is a tumor where more than morphological variants or subtypes are seen in a single tumor. Usually there is a mixture of 2-3 different types. However, in this particular case there were at least 5 different types of morphological patterns in a single tumor including areas of so-called rhabdoid differentiation. The patient underwent nephrectomy and has been asymptomatic for the last 3.5. years. To the best of our knowledge, this is the first case of its own kind in the published literature.

Prevalence of Taurodont molars in a North Indian population.

BACKGROUND: It is very important for dentists to be familiar with anomalies of teeth not only for the clinical complications but also their management. Taurodontism also provides a valuable clue in detecting its association with various syndromes and other systemic conditions. The purpose of this study was to assess the prevalence of Taurodont molars among a North Indian population. MATERIALS AND METHODS: A total of 1000 patients' full-mouth periapical radiographs were screened. The radiographs were evaluated under optimal conditions using double magnifying glasses. A total of 7615 molars (including third molars) were evaluated. The relative incidence and the correlations regarding the location of Taurodont teeth (right versus left side and maxillary versus mandibular) were analyzed using the Chi-square test. RESULTS: Twenty-eight patients were found to have a Taurodont molar (11 women and 17 men [P = 0.250]). The prevalence of Taurodont molar was 2.8%. Males had a higher prevalence rate than females (3.4% vs. 2.2%, respectively). A cluster analysis of total Taurodonts in the mandible (45%) versus maxilla (55%) of both males and females combined showed a statistically significant difference (P < 0.05). CONCLUSION: The occurrence of Taurodontism is basically based on racial expression in different populations. These variations in prevalence between different populations may be due to ethnic variations. The occurrence of Taurodont molars among this Indian population was rare.

Analysis of micro-shear bond strength of self-etch adhesive systems with dentine: An in vitro study.

BACKGROUND: Success or failure of a composite restoration largely depends on its bonding to enamel/dentine. Several better adhesive systems have been developed during the last few years due to rapid advancement in the technology. Recent self-etched adhesives have fewer clinical steps and are less technique sensitive. METHODS: Ninety extracted human permanent molars were collected, grounded and finished to prepare flat dentine-bonding surfaces on their occlusal surface. All specimens were divided into three groups (n = 30) on the basis of three adhesive systems Adper Easy Bond (AE), Beautibond (BB) and Xeno IV (XE). These adhesive systems were applied on prepared mid-dentine-bonding surface. A restorative resin was added with the help of a transparent tube of 2 mm height and 1.7 mm internal diameter and cured. Fifteen specimens in each group were loaded to failure in an Instron Universal Testing Machine after storage for 24 h at 37 °C to check micro-shear bond strength. Another fifteen specimens from each group were thermocycled 500 times at 5 °C and 55 °C with dwell time of 1 min in each bath followed by loading to failure. The data obtained was analyzed with SPSS version 21 at significance level of <05. RESULTS: After 24 h, micro-shear bond strength of BB was higher (26.04 MPa) than XE (23.69 MPa) and AE (21.50 MPa). After thermocycling, micro-shear bond strength decreased significantly in BB (P = .001) and XE (P = .03). CONCLUSION: The micro-shear bond strength of BB was highest among three groups, which decreased after thermocycling.

Management of mucosal fenestration with external root resorption by multidisciplinary approach.

Mucosal fenestration is a clinical condition in which the overlying gingiva is denuded and the root is exposed to the oral cavity. Invasive cervical resorption is an entirely uncommon entity and its aetiology is poorly understood. This case presents an invasive cervical resorption of maxillary right central incisor with fenestration at the cervical third of the tooth. The resorption area was chemomechanically debrided. It was then restored with Mineral Trioxide Aggregate over which pink glass ionomer cement (GC Fuji VII) was placed. Lateral pedicle flap was used to cover the fenestration. The resorptive defect was restored using tooth coloured restorative resin after removal of the pink glass ionomer cement. Orthodontic treatment was continued for correction of malocclusion.

Spectrophotometric evaluation of peroxide penetration into the pulp chamber from whitening strips and gel: An in vitro study.

AIM: To investigate pulp chamber penetration of different concentration of hydrogen peroxide. MATERIALS AND METHODS: Fifty extracted human maxillary central incisor teeth were taken and grouped into five (n = 10). All teeth were cut approximately 3 mm apical to the cemento-enamel junction. Pulp was removed and the pulp chamber filled with acetate buffer. Buccal crown surfaces of teeth in the experimental groups were subjected to whitening strip and paint on whitener gel. Control group teeth were exposed to distilled water. The acetate buffer solution in each tooth was then transferred to a glass test tube after 30 min. Leuco-crystal violet dye and enzyme horse radish peroxidase were added. The optical density of resultant blue color in the tubes was measured by UV-visible spectrophotometer. The values were converted into microgram equivalents of hydrogen peroxide. RESULTS: The results were evaluated statistically using nonparametric Mann-Whitney U test. Whitening strip showed the lowest pulpal peroxide penetration whereas paint on whitener gel showed highest pulpal peroxide penetration. CONCLUSION: This study demonstrate that peroxide is readily penetrate into the pulp chamber of teeth.

Are full cast crowns mandatory after endodontic treatment in posterior teeth?

The success of endodontic treatment is not only measured by the alleviation of pain and formation of healthy bone, replacing the diseased periapical tissue. Concepts for restoring pulpless teeth have been formed more from clinical observation than valid scientific investigation. Endodontically treated posterior teeth present numerous problems because of coronal destruction from dental caries, fractures, and previous restorations or endodontic techniques. The result is loss of tooth structure and a reduction in the capacity of the tooth to resist a myriad of intraoral forces. A summary of this review article suggests that coronal coverage significantly improves the clinical success rate of endodontically treated posterior teeth.