Niosomal Doxycycline and Triamcinolone: A Novel Approach to Minimize Cytotoxicity in Endodontic Medicaments.

Introduction: Mechanical root canal preparations and irrigation solutions are essential for reducing microbial counts in the root canal system. However, these methods do not completely eliminate microorganisms. Intracanal medicaments are used to further decrease microbial counts. This study aims to assess the cytotoxicity of various intracanal medicaments. Materials and methods: In this in vitro study, murine fibroblast cell lines (L929) were cultured in a controlled environment. The MTT assay was employed to evaluate the cytotoxicity of different medicament combinations, including calcium hydroxide and triamcinolone (D1), niosomal doxycycline and triamcinolone (D2), calcium hydroxide (D3), and a combination of doxycycline and triamcinolone (D4). Statistical analysis was performed using ANOVA and Dunnett's test. Results: The results indicated that D1 and D2 had lower cytotoxicity, while D4 exhibited the highest cytotoxicity. D1 was found to be non-cytotoxic up to a concentration of 500 µg/mL over a period of 72 hours. D2 and D3 showed similar effects up to concentrations of 250 µg/mL and 100 µg/mL, respectively, for 72 hours. In contrast, D4 exhibited cytotoxicity at concentrations above 75 µg/mL at 72 hours. Conclusion: This study suggests that encapsulating doxycycline in niosomal structures (D2) reduces cytotoxicity in murine fibroblast cell lines (L929) for at least 24 and 48 hours. These findings offer promising implications for the development of endodontic medicaments with improved biocompatibility.

Comparative Efficacy of Analgesics for Pain Relief in Patients with Symptomatic Irreversible Pulpitis Prior to Emergency Endodontic Treatment: A Randomized Controlled Trial.

Introduction: This study aimed to compare the efficacy of ibuprofen, Novafen, mefenamic acid (MA), and celecoxib for pain relief in patients with symptomatic irreversible pulpitis prior to emergency endodontic treatment. Materials and Methods: This clinical trial was conducted on 120 patients with moderate to severe pain due to symptomatic irreversible pulpitis seeking emergency endodontic treatment. The patients were randomly divided into 4 groups to receive Novafen, MA, Celecoxib, and ibuprofen. The pain score of patients was measured before and 1 hour after analgesic intake using a visual analog scale (VAS). The success of analgesic treatment was analyzed by the binary logistic regression model. Results: A total of 117 patients including 76 females and 41 males with a mean age of 30.29 years completed the study and were statistically analyzed. Ibuprofen had the highest analgesic efficacy followed by Novafen, and caused a significantly greater reduction in pain score compared with MA and celecoxib [OR (Ibuprofen vs MA)=1.28, OR (Ibuprofen vs Celecoxib)=3.74, OR (Novafen vs MA)=2.94, OR (Novafen vs Celecoxib)=2.94, P<0.05]. Ibuprofen and Novafen had no significant difference in analgesic efficacy (P>0.05). Baseline pain score was a predictive factor for the success of analgesics (P<0.05). The success of analgesic treatment decreased by 0.68 times with each unit increase in pain score (P<0.05). Gender and age of patients had no significant effect on success of analgesics (P>0.05). Conclusion: Both ibuprofen and Novafen can serve as the analgesics of choice for pain relief in patients with symptomatic irreversible pulpitis with moderate to severe pain when emergency endodontic treatment cannot be immediately performed.

Antimicrobial efficacy of different herbal extracts against root canal pathogens - An in vitro study.

Background: The antimicrobial activity exhibited by the plant extracts against various pathogens has previously been demonstrated to a limited extent. However, the antibacterial effects of most of them have not yet been clarified in endodontics. Aim: This study aimed to determine the antimicrobial activity of some medicinal plants' methanolic extracts against some root canal microorganisms. Methods and Materials: In this in vitro study, after gathering the five plants (pomegranate peel, clove, Zhumeria majdae, Eucalyptus galbie and green tea), their methanolic extracts were obtained by the maceration method, and the antimicrobial activity was determined using micro- and macro-dilution methods. The microorganisms tested in this study were Enterococcus (E.) faecalis, Porphyromonas (P.) gingivalis and Fusobacterium (F.) nucleatum. Non-ready-to-use calcium hydroxide (CH), ready-to-use Calcipex II CH and methanol were used as control materials. Statistical Analysis: The nonparametric Kruskal-Wallis and Friedman tests were used to analyse and evaluate the data and variables. Results: In all concentrations and time intervals studied, eucalyptus extract showed the highest antimicrobial activity against E. faecalis. All the extracts showed growth-inhibitory effects against P. gingivalis and F. nucleatum. There were no significant differences between the anti-enterococcus effects of eucalyptus extracts and non-ready-to-use CH (P > 0.05). Conclusion: There was a greater efficacy of Eucalyptus galbie extract than other extracts.

Oral Health-Related Quality of Life among Children Aged 11-14 Years Old with and without Parental Care in South-East of Iran

ABSTRACT Objective: To measure the Oral Health-Related Quality of Life (OHRQoL) and compare children with and without parental care. Material and Methods: This cross-sectional study was conducted on 160 schoolchildren with parental care and 100 orphans in Kerman, Iran. After fulfilling the questionnaire voluntarily, a clinical examination was performed, and indices such as decayed, missing, and filled teeth (DMFT), molar-incisor hypoplasia (MIH), modified gingival index (MGI), traumatic dental injury (TDI), and malocclusion were recorded. Data were statistically analyzed using SPSS version 25 via the ANOVA, Pearson's correlation coefficient test, Chi-Square test, and descriptive statistics. Results: Children without parents scored poorly for OHQRoL items compared to those with parents (p<0.001). DMFT was not significantly related to OHRQoL; however, missing teeth were correlated with the CPQ11-14 overall. Also, the TDI index had a significant relationship with CPQ mean score (p=0.02). Moreover, the difference in the mean CPQ11-14 score in children with TDI in the two groups was significant regarding the quality of life (0.031). Conclusion: OHRQoL differed significantly between children in the two groups, which can be influenced by gender and habits. Due to the vulnerability of welfare-supported children without parental care, these findings emphasize the value of preventive and health-promoting measures for this group of children.

Possibility of Bypassing Three Fractured Rotary NiTi Files and Its Correlation with the Degree of Root Canal Curvature and Location of the Fractured File: An In Vitro Study.

Introduction: This study aimed to evaluate the success rate of bypassing three NiTi rotary files (RaCe®, Hero 642®, and K3®), fractured in various root canal locations of extracted mandibular molars with two different canal curvatures. Materials and Methods: Ninety freshly extracted human first or second mandibular molars were selected. Three millimeters of the file tip (RaCe®, Hero 642®, and K3®), was fractured intentionally in the mesiobuccal root canal of each tooth by weakening the file in the last 3 mm of files #30 with 4% taper and preparing the root canals with two different degrees of curvature (n=30). Then, bypass possibility of the fractured files was evaluated using #8, #10, and #15 K-files and compared in different groups. In addition, the rate of accidental procedural errors was compared between these groups. Data were analyzed with univariate analysis and logistic regression models at a significance level of 0.05. Results: The overall success rate of bypassing was 61.1%. RaCe® files had the highest and the K3® files had the lowest bypass possibility rates (P=0.01); the greater the degree of canal curvature, the less successful the bypass procedure (P=0.01). The fracture of the files used to bypass was the most prevalent error. Conclusion: Based on this in vitro study the type of fractured file and the amount of canal curvature affected the success rate of the bypassing technique. In RaCe® files and the mild curvature group, the success rate was the highest.

Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial.

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative "Pain Intensity" (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients' demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P < 0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.

Resolved Tooth Discolouration Following Root Fracture Employing a Conservative Approach: A Case Report.

Dental trauma is one of the most common childhood incidents that leads to the damage or loss of deciduous and permanent teeth. One of the most challenging types of dental trauma is horizontal root fracture (HRF). In this case report, a central maxillary incisor with horizontal root fracture had been treated by the conservative approach of splinting the tooth and follow-up. In the initial evaluation, the tooth had a normal appearance and did not respond to either the cold test or electric pulp tester. After 4 weeks, the tooth was sensitive to the cold test; however, showed discolouration. After 4 months, discolouration disappeared and the tooth had a positive response to pulp sensibility tests. The tooth remained asymptomatic with a positive response to pulp sensitivity tests up to 15 months following the treatment.