Effect of apical foraminal enlargement on postoperative pain and inflammatory markers in asymtomatic single-rooted mandibular teeth with apical periodontitis - An in vivo randomized controlled trial.

Aim of the Study: This study aims to assess the effect of apical foraminal enlargement on inflammatory markers and pain in patients with asymptomatic single-rooted mandibular teeth with apical periodontitis. Materials and Methods: The study included 60 patients based on inclusion and exclusion criteria. Before beginning root canal treatment (RCT), a blood sample was obtained from the antecubital fossa to evaluate the inflammatory markers, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Access opening was done and initial irrigation was done. Working length (WL) was determined with an electronic apex locator and verified with a radiograph. In the control group, the determined WL was maintained, while in the experimental group, the WL was set till the apical foramen. Biomechanical preparation was done in both groups till F2 or F3 based on the initial apical file, followed by final irrigation and obturation based on the master apical file size. Patients were given a Visual Analog Scale to record pain sensations at 24, 48, and 72 h postoperative. After 72 h, patients were recalled for follow-up appointments, and blood was taken from the antecubital fossa again to evaluate inflammatory markers. Statistical Analysis: The resultant findings for the reduction in inflammatory markers before and after RCT with or without foraminal enlargement were statistically analyzed using the Student's t-test. The pain was statistically examined with one-way "analysis of variance" and Tukey's post hoc test for inter-group comparison of pain. The level of significance was set at P < 0.05. The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 23 for Windows (SPSS Inc., Chicago, IL, USA). As pain in the control groups is zero before and after RCT, statistical analysis is not required as the overall pain score is zero. Results: The P values of the CRP and ESR of the control group were 0.02 and 0.03, respectively, which indicates it is significant whereas the P values of the ESR and CRP of the experimental group were 0.0002 and 0.0008 which indicates it is highly significant. Results indicate that the experimental group is more effective compared to the control group in reducing inflammatory markers. Pain in the control group after RCT was zero at the end of 24, 48, and 72 h. In the experimental group, where RCT was done with apical foraminal enlargement, mild pain was present at the end of 24 h which gradually decreased at the end of 48 h and no pain was reported at the end of 72 h. Conclusion: Reduction in inflammatory markers was more effective in RCT with apical enlargement than without apical enlargement. RCT with apical enlargement caused mild pain in the patients immediately after treatment which gradually decreased over time.

Influence of Access Cavity Design on the Fracture Strength of Endodontically Treated Teeth Restored Using Short Fiber-Reinforced Composite and High Strength Posterior Glass Ionomer Cement.

AIM: This in vitro study aimed to determine the influence of access cavity design and residual tooth structure and to compare the fracture resistance of the teeth post endodontically restored with short fiber-reinforced composite (GC everX Posterior; GC, India) and conventional posterior high-strength GIC (Glass Ionomer Cement) (GC Gold Label IX; GC, India). METHODS: Ninety extracted human mandibular molars were classified into five groups, i.e., one control group (n = 10) and four test groups based on the access cavity design (n = 20): Traditional access cavity (TAC), Conservative access cavity (CAC), Ninja access cavity (NAC), and Truss access cavity (TRAC). Then 80 teeth in test groups were endodontically treated and further subdivided (n = 10) based on post-endodontic restorative materials, i.e., short fiber-reinforced composite (SFC) and Type 9 GIC. Samples were then subjected to fracture resistance under a universal testing machine and fracture loads were compared statistically. RESULTS: The fracture resistance of various access cavity designs (TAC, CAC, NAC, and TRAC) varied significantly (P < .05). Regardless of access cavity design, teeth restored with SFC had higher fracture resistance than teeth restored with high strength posterior GIC (P = .001). CONCLUSION: Using newer access cavity designs like (CAC, NAC, and TRAC) and reinforcing the teeth with a post-endodontic restoration such as SFC, fracture resistance of endodontically treated teeth can be improved notably.

Comparative evaluation of push-out bond strength of bioceramic and epoxy sealers after using various final irrigants: An in vitro study.

Aim: The aim of the study is to compare the push-out bond strength of bioceramic and epoxy sealers after using various final irrigants. Materials and Methods: Hundred single-rooted teeth were divided into two groups (n = 50) according to the sealer used: Group A: Bio C (bioceramic sealer), Group B: Dia-Proseal (epoxy sealer). Each group was subdivided into five subgroups (n = 10) according to the final irrigation protocol: Group A1 and B1 - 5% glycolic acid (GA), Group A2 and B2 - 17% GA, Group A3 and B3 - 0.2% chitosan, Group A4 and B4 - 17% ethylenediaminetetraacetic acid, and Group A5 and B5 - 0.9% saline. Samples were obturated in combination with one of the mentioned sealers and were allowed to set for 1 week. Two horizontal slices were obtained from each sample and subjected to push-out test. Statistical Analysis: The data were statistically analyzed using two-way ANOVA and independent Student's t-test. Results: Both the sealers exhibited higher push-out bond strength after treatment with GA with no significant difference between 5% and 17% GA. Bio C sealer with GA as final irrigant showed higher bond strength than Dia-Proseal (P < 0.05). Conclusion: The push-out bond strength of the sealer was significantly affected by the final irrigation solution used. The highest push-out bond strength was seen with Bio C sealer after treatment with GA with no significant difference between 5% and 17% GA.

Retrievability of Odontopaste and Metapex With 17% Ethylenediaminetetraacetic Acid and 10% Maleic Acid From Root Canals: An Invitro Study.

Aim To evaluate the efficacy of 10% maleic acid in comparison with 17% ethylenediaminetetraacetic acid (EDTA) in the removal of intracanal medicaments from the root canal system. Materials and methods Forty-eight extracted single-rooted mandibular premolars were decoronated to standardize the length of 14 mm. Chemomechanical preparation was done using the crown-down technique with Protaper files (Dentsply­Maillefer, Ballaigues, Switzerland) till F4, followed by irrigation with 2 ml of 5.25% sodium hypochlorite (NaOCl) after each instrument, and 5 ml of 17% EDTA was used as the final irrigating agent. Metapex (Meta Dental Corp. Ltd., Elmhurst, NY, USA) and Odontopaste (Australian Dental Manufacturing, Kenmore Hills, Qld, Australia) were the two intracanal medicaments that were used in this study. Total samples were divided into two groups based on the intracanal medicament that was placed in the canal. In group 1, Metapex was injected into the root canal until the material extruded through the apex. In group 2, Odontopaste was placed into the canal until the material extruded through the root apex. Cleaning off the excess medicament was done with a moist cotton pellet. After temporary sealing with a cotton pellet and Cavit, all the samples were stored at 37 ºC and 100% relative humidity for a period of seven days. The teeth in each group were further randomly divided into three subgroups on the basis of the irrigant used for retrieval of medicament. In groups 1A and 2A, 1ml of 17% EDTA was used; in groups 1B and 2B, 1ml of 10% maleic acid was used; in groups 1C and 2C, 1ml of 0.9% saline was used. Sonic agitation for 1 minute, followed by a final rinse of 1 ml distilled water, was used in all the groups. After the intracanal medicament was removed from the canal, the roots were longitudinally sectioned using a diamond disk (Bego, Berman, Germany). The residual medicament on each section was evaluated under a stereomicroscope (×30; Medilux, MDL-DS4-BI, Biosystems, Curitiba, PR, Brazil). The data were analyzed using SPSS version 23.0 software (IBM Corp., Armonk, NY). Kruskal-Wallis ANOVA and Mann-Whitney U test (post hoc) were applied for intergroup comparisons. A Wilcoxon signed-rank test was applied for intragroup comparisons. Results Both the chelators, 17% EDTA and 10% maleic acid, removed the Odontopaste significantly better than Metapex. However, 17% EDTA was more effective in the removal of Odontopaste. 10% Maleic acid showed better results in the removal of Metapex than 17% EDTA. Conclusion None of the chelating agents was able to totally retrieve the intracanal medicaments. When compared to Metapex, Odontopaste showed significantly better retrievability from the root canal with both 17% EDTA and 10% Maleic acid, whereas the retrievability of Metapex was significantly better with 10% Maleic acid in comparison to 17% EDTA.

Amelogenesis Imperfecta with Nephrocalcinosis: A Rare Association in Siblings.

Enamel hypoplasia secondary to amelogenesis imperfect (AI) is one of the common developmental disturbances associated with the oral cavity. AI in association with multiple unerupted teeth is a rare entity, and in adolescence it not only has an affect on esthetics but also has an impact on the psychological status of the person. AI has been reported with other systemic anomalies previously. We report a case of AI in association with multiple unerupted teeth and nephrocalcinosis in siblings. The present case also highlights the importance of systemic examination and investigations in planning the treatment of a patient with AI.

Extensive external localized idiopathic root resorption - An unusual case report.

External root resorption of permanent teeth is a multifactorial process. This article presents an unusual case of localized idiopathic extensive external root resorption involving the whole mesial root of the right mandibular first molar in a 42-year-old female patient. No significant systemic, dental, or familial findings could be identified as a possible cause. The cause of the resorption remained unclear. The tooth was managed by nonsurgical endodontic treatment using mineral trioxide aggregate to seal resorbed canals. A 5-year follow-up revealed satisfactory results clinically and radiographically with mobility within physiological limits.

Comparative Evaluation of the Antibacterial Efficacy of Aloe Vera, 3% Sodium Hypochlorite, and 2% Chlorhexidine Gluconate Against Enterococcus faecalis: An In Vitro Study.

Aim To compare the antibacterial efficacy of irrigants (aloe vera, 3% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and saline) against Enterococcus faecalis using the turbidometric analysis and colony count method. Materials and methods Eighty freshly extracted, single-rooted, human mandibular premolar teeth were taken. Access opening was done, instrumented, and autoclaved. Samples were inoculated with 10 µL of an Enterococcus faecalis (E. faecalis) bacterial suspension and incubated at 37◦C for three days. Samples were divided into four groups of 20 teeth each based on the type of irrigating solution used. Group 1 was irrigated with 3% sodium hypochlorite; Group 2 with 2% chlorhexidine; group 3 with aloe vera; and Group 4 with 0.9% saline (the control group). Ten teeth from each group were subjected to a turbidity analysis by spectrophotometer and the remaining 10 teeth from each group were tested for colony-forming units (CFU)/mL. The plates were incubated at 37◦C for 24 hours and CFU that were grown were counted using a bacterial colony counter. Results were subjected to an analysis of variance (ANOVA) followed by a post hoc Games-Howell test. Results All the tested irrigating solutions demonstrated an antibacterial effect against E. faecalis. The greatest antimicrobial effects were observed in samples treated with 2% CHX (p<0.001). No statistically significant difference was found between 3% NaOCl and aloe vera (p > 0.001) against E. faecalis. Conclusion Two percent chlorhexidine exhibited good antimicrobial efficacy against E. faecalis. Three percent NaOCl and aloe vera showed a similar antimicrobial efficacy against E. faecalis. Aloe vera can be used as an antibacterial agent in novel drugs for the treatment of bacterial diseases.

Effectiveness of N-acetyl cysteine, 2% chlorhexidine, and their combination as intracanal medicaments on Enterococcus faecalis biofilm.

AIM: The purpose of this study was to evaluate the antibacterial efficacies of 2% chlorhexidine (CHX), N-acetyl cysteine (NAC) and assess their synergistic or antagonist action as intracanal medicament. MATERIALS AND METHODS: Agar diffusion test was performed with 2% CHX, NAC, and their combination against E. faecalis planktonic cells. The diameters of the zones of bacterial inhibition were measured and recorded for each solution. The assay was further extended to 2 weeks old E. faecalis dentinal biofilm. Sixteen freshly extracted teeth were vertically sectioned into two halves resulting in a total of 32 samples. The samples were inoculated with bacterial suspension and incubated at 37°C for 2 weeks for biofilm formation. The samples were then divided into four experimental groups with 8 samples in each group. The samples were gently washed in saline and placed in culture wells containing the test solutions, i.e., 2% CHX, NAC, a combination of 2% CHX and NAC in 1:1 ratio, and a control group containing saline. The biofilm formed on the root canal surface were removed with a sterile scalpel and inoculated on blood agar plates to check for the formation of E. faecalis colonies. STATISTICAL ANALYSIS: For agar diffusion test, data were analyzed statistically using one-way analysis of variance and then by post-hoc Scheffe's test to compare the antimicrobial efficacy between the groups. Statistical analysis was not done for the cultures obtained from the biofilm as there was no growth in all the three test groups except the control group, i.e., saline. RESULTS: In agar diffusion test, among the three groups tested, 2% CHX and NAC showed almost equal zones of inhibition whereas maximum inhibition was shown by a combination of NAC and 2% CHX suggesting a synergistic action. The results obtained were highly significant (P < 0.001) for the combination of medicament when compared to individual test group. In culture analysis, which was done for the biofilm, no growth was observed in all the three test groups. The results obtained were biologically significant but statistically insignificant. CONCLUSION: NAC has almost equal antimicrobial property as 2% CHX whereas their combination showed a synergistic action.

Minimal Apical Enlargement for Penetration of Irrigants to the Apical Third of Root Canal System: A Scanning Electron Microscope Study.

BACKGROUND: The aim of this study was to determine minimal apical enlargement for irrigant penetration into apical third of root canal system using scanning electron microscope (SEM). MATERIALS AND METHODS: Distobuccal canals of 40 freshly extracted human maxillary first molar teeth were instrumented using crown-down technique. The teeth were divided into four test groups according to size of their master apical file (MAF) (#20, #25, #30, #35 0.06% taper), and two control groups. After final irrigation, removal of debris and smear layer from the apical third of root canals was determined under a SEM. Data was analyzed using Kruskal-Wallis and Mann-Whitney tests. RESULTS: Smear layer removal in apical third for MAF size #30 was comparable with that of the control group (size #40). CONCLUSION: Minimal apical enlargement for penetration of irrigants to the apical third of root canal system is #30 size.

A rare presentation of bilateral maxillary dens invaginatus diagnosed using cone beam computed tomography.

Dens invaginatus is a developmental variation in the formation of a tooth that causes changes in the internal anatomy of the tooth. The presence of double dens invaginatus is extremely rare. Understanding the type, extension, and complex morphology of dens invaginatus is essential. Diagnosis of this condition using conventional radiographic techniques is not easy. Advanced imaging techniques, such as cone beam computed tomography (CBCT) are very helpful in diagnosis of these complex anatomic variations. In the present case report, we demonstrate the use of CBCT in the evaluation and treatment planning of bilateral maxillary dens invaginatus, of which one presented as a case of double dens.