Comparative evaluation of pH and Ca + ion release from MTA on interaction with platelet-rich fibrin and blood clot: an in vitro study.

Background: 'Regenerative endodontics' using host-derived scaffolds and biomaterials (MTA) is popular in the management of teeth with open apex. Alkaline pH and bioactivity contribute to tissue healing and remineralization. We assessed the influence of PRF and Blood Clot on the pH and Ca + ion release from MTA. Methods: A total of 15 single-rooted human extracted teeth were sectioned at the level of the cementoenamel junction. Based on the type of scaffolds used, samples were divided into three groups. Group 1 (MTA+ PRF), Group 2 (MTA + Blood Clot), Group 3 (control MTA). The prepared specimens were transferred to a fresh falcon tube containing 10mL of distilled water and the collected solutions were analysed for pH and Ca + ion release at 3h, seventh day and 14 th day. Results: It was observed that the mean pH and Ca + ion release were significantly lower in the experimental groups as compared to the control group. Though there was an increase in the pH recorded in Group 1 and 2 at all time periods, the difference was not significant. Ca + ion release peaked at Day 7 (Group3 > Group2 > Group1) and reduced significantly on the 14 th day for all groups. Conclusions: Within the limitations of the study, it can be concluded that PRF and blood clot influence the pH and Ca + ion release from MTA.

Effect of nano-hydroxyapatite with biomimetic analogues on the characteristics of partially demineralised dentin: An in-vitro study.

BACKGROUND: Research on dentin remineralisation protocols in particular 'biomimetic remineralisation' has gained huge momentum. Aim of this study was to evaluate if biomimetic analogs, incorporated in n-HAp, as an experimental formulation could aid in remineralization of artificial caries-like dentin and have anti-microbial effect on cariogenic bacteria, S mutans. MATERIALS AND METHODOLOGY: An experimental paste was formulated using nano-hydroxyapatite (nHAp) with Non-Collagenous Protein analogs- polyacrylic acid (PAA), sodium tri-poly phosphate (STPP) with Simulated Body Fluid. Partially demineralised dentin specimens were divided into three groups (n=10) based on the remineralisation treatment as, Group A- n-HAp paste, Group B- n-HAp and NCP analogues and Group C (Control) - no treatment. At the end of the experimental period, the specimens were assessed using SEM-EDS analysis and Vickers microhardness testing. Further, the antimicrobial efficacy of the paste was assessed. STATISTICAL ANALYSIS: The results were statistically analyzed using ANOVA with post-hoc Bonferroni test. RESULTS: Dentin specimens treated with the experimental paste revealed greater tubular occlusion, with intra tubular deposits and increased mineral content. Specimens treated with n-HAp alone had higher microhardness values and inhibitory effect on the cariogenic bacteria. CONCLUSION: Non-Collagenous Protein analogs incorporated in n-HAp could remineralize the demineralised dentin and had antibacterial efficacy against S mutans.

The efficacy of transdermal and oral diclofenac for post-endodontic pain control: A randomised controlled trial.

OBJECTIVE: The aim of the present study was to compare the effect of transdermal diclofenac patch against oral diclofenac for post-endodontic pain control. MATERIALS AND METHODS: Thirty-two patients with symptomatic irreversible pulpitis in single-rooted premolar teeth of either arch were treated endodontically in a single visit by a single endodontist. Oral diclofenac (50 mg twice daily) for group I and transdermal diclofenac patch (100 mg once daily) for group II were administered as post-endodontic analgesics for two days. Visual analogue scale (VAS) chart was used to record pain intensity scores preoperatively and at intervals of 4, 8, 12 and 24 h postoperatively for 2 days. Paracetamol 650 mg tablets were provided as rescue medication. RESULTS: There was a significant decrease in the postoperative pain intensity scores for both groups. The postoperative scores gradually decreased from day 1 to day 2 in both groups. Twelve out of sixteen patients who had received diclofenac tablets complained of gastric discomfort. CONCLUSION: Transdermal diclofenac patch was as effective as an oral diclofenac tablet and can be used as an alternative and effective analgesic for post-endodontic pain management, especially in patients with gastric discomfort.

Clinical evaluation of mineral trioxide aggregate and biodentine as direct pulp capping agents in carious teeth.

BACKGROUND: Root canal treatment has been a routine treatment option for carious exposure of the dental pulp. In the context of minimally invasive dentistry, direct pulp capping (DPC) procedure with a reliable biomaterial may be considered as an alternative provided the pulp status is favorable. Mineral trioxide aggregate (MTA), a bioactive cement with excellent sealing ability and biocompatibility is capable of regenerating relatively damaged pulp and formation of dentin bridge when used as DPC agent. Biodentine is comparatively a new biomaterial claimed to possess properties similar to MTA and is currently explored for vital pulp therapy procedures. AIM: The aim of the present study was to evaluate the clinical response of pulp-dentin complex after DPC with MTA and biodentine in carious teeth. SUBJECTS AND METHODS: Twenty-four permanent molars with carious exposure having no signs and symptoms of irreversible pulpitis were selected and assigned to one of the two groups, Group I - MTA and Group II - biodentine. Patients were recalled at 3 weeks, 3 months, and 6 months for clinical and radiographic evaluation. Fisher's exact test was used along with Chi-square test for statistical analysis. RESULTS: Over a period of 6 months, MTA and biodentine showed 91.7% and 83.3% success rate, respectively, based on the subjective symptoms, pulp sensibility tests, and radiographic appearance. CONCLUSION: MTA and biodentine may be used as DPC agents when the pulpal diagnosis is not more than reversible pulpitis.

Comparative evaluation of the efficacy of two modes of delivery of Piroxicam (Dolonex(®)) for the management of postendodontic pain: A randomized control trial.

BACKGROUND: Alleviating pain is of utmost importance when treating patients with endodontic pain. AIM: To compare and evaluate the efficacy of two modes of delivery of pretreatment Piroxicam (Dolonex(®), Pfizer) for the management of postendodontic pain. MATERIALS AND METHODS: Sixty-six patients with symptomatic irreversible pulpitis were randomly divided into three groups of 22 subjects Group I - control group, no pharmacological intervention, Group II - patients received pretreatment oral Piroxicam (40 mg), Group III - patients received pretreatment intraligamentary injections totaling 0.4 mL of Piroxicam. Single visit endodontic therapy was performed by a single endodontist. Visual analogue scale was used to record pain before treatment and 4, 8, 12, 24, and 48 h postoperatively. Mann-Whitney U-test and Kruskal-Wallis tests were used to analyze the data. RESULTS: The patients in Groups II and III perceived less postendodontic pain as compared to Group I (P < 0.05), at all the time intervals. At 12, 24, and 48 h, pain experience in patients of Group III was significantly less. CONCLUSIONS: Intraligamentary mode of delivery of Piroxicam was more efficacious.

Effect of pretreatment diclofenac sodium on postendodontic pain: A randomised controlled trial.

INTRODUCTION: Effective management of endodontic pain represents a continuing challenge. Many of the dental professionals are facing significant problems associated with postendodontic pain. Hence, the postendodontic pain has to be prevented at its primary stage without waiting for its occurrence. This trial was carried out to evaluate the use of a preoperative, single oral dose of diclofenac sodium for the prevention and control of postendodontic pain. MATERIALS AND METHODS: Fifty patients were randomly assigned to two groups, placebo and diclofenac sodium (100 mg). The medications were administered 30 min before the start of standard endodontic treatment. Postoperative pain was assessed after 6, 12, and 24 h by using a visual analog scale. RESULTS: Postendodontic pain showed a statistically significant difference between both groups at 6 and 12 h (P < 0.05) and there was no significant difference at 24 h. CONCLUSION: Postendodontic pain was substantially reduced by preoperative administration of single oral dose of diclofenac sodium. It is thus possible to conclude that these favorable results might help to prevent postendodontic pain, especially in patients with a low pain threshold.

Efficacy of Ribbond and a fibre post on the fracture resistance of reattached maxillary central incisors with two fracture patterns: a comparative in vitro study.

AIM: To compare the fracture resistance of maxillary central incisor fragments having two different fracture patterns and re-attached using two different posts - fibre post and Ribbond. MATERIALS AND METHODS: Sixty extracted human maxillary central incisors were randomly divided into two groups of thirty samples each. Group A consisted of samples with 'labio-palatal' fracture pattern and Group B with a 'palato-labial' fracture pattern. The crowns of all the samples were sectioned using safe-sided diamond discs. Following cleaning and shaping and sectional obturation, the samples were randomly subdivided into two subgroups of 15 samples each. Prefabricated fibre post (Reforpost, Angelus, Londrina, PR, Brazil) was placed in all samples of Subgroup I, and Ribbond (Ribbond Inc., Seattle, WA, USA) was placed in all samples of Subgroup II. The fragments were re-attached, fracture resistance was tested using Instron Universal Testing Machine, and the failure modes were assessed using a stereomicroscope. RESULTS: Group A with a labio-palatal fracture pattern exhibited higher fracture resistance as compared to Group B (palato-labial) in both subgroups. The fibre post (Subgroup I) exhibited higher fracture resistance as compared to Ribbond (Subgroup II). The Ribbond group exhibited significantly more number of repairable failures as compared to fibre post group. CONCLUSION: The labio-palatal pattern of fracture is a favourable type of fracture on palatal load application. The fragments re-attached using the fibre post (Reforpost) had a higher resistance to fracture. However, teeth restored with Ribbond posts exhibited 100% repairable failures upon load application. The fracture pattern had no influence on the failure modes.

Comparative Evaluation of Two Final Irrigation Techniques for the Removal of Precipitate Formed by the Interaction between Sodium Hypochlorite and Chlorhexidine.

AIM: To evaluate the effectiveness of two final irrigation techniques for the removal of precipitate formed by the interaction between sodium hypochlorite (NaOCl) and chlorhexidine (CHX). MATERIALS AND METHODS: Sixty freshly extracted human maxillary incisor teeth were taken and randomly divided into three groups, containing 20 teeth each. Group 1 (control group), were irrigated with 5 ml of 2.5% NaOCl and a final flush with 5 ml of 2% chlorhexidine. Group 2 were irrigated with 5 ml of 2.5% NaOCl and 5 ml of 2% chlorhexidine followed by 5 ml of saline and agitated with F-files. Group 3 were irrigated with 5 ml of 2.5% NaOCl and 5 ml of 2% chlorhexidine followed by 5 ml of 15% citric acid and passively agitated with ultrasonics. A thin longitudinal groove was made along the buccal and lingual aspect of the root using diamond disks and split with chisel and mallet. Both halves of the split tooth will be examined under stereomicroscope. Results were tabulated and analyzed statistically using analysis of variance (ANOVA) and Mann-Whitney U test. RESULT: There was a significant difference between the mean values (p < 0.05) in groups 2 and 3 compared to group 1 at each level. CONCLUSION: Passive ultrasonic irrigation is more effective than the F-file agitation technique to remove the precipitate at all three levels measured. CLINICAL SIGNIFICANCE: Combination of sodium hypochlorite and chlorhexidine irrigation protocol has been practiced since from many years to achieve good results. However, it has adverse effect in the form of precipitate and which is considered to be a carcinogenic in nature, hence this precipitate should be removed.

Evaluation of Gingival Microleakage in Class II Composite Restorations with Different Lining Techniques: An In Vitro Study.

Aim. To compare the microleakage in class II composite restorations without a liner/with resin modified glass ionomer and flowable composite liner. Method. Forty standardized MO cavities were prepared on human permanent mandibular molars extracted for periodontal reasons and then divided into 4 groups of ten specimens. The cavity preparations were etched, rinsed, blot dried, and light cured and Adper Single Bond 2 is applied. Group 1 is restored with Filtek P60 packable composite in 2 mm oblique increments. Group 2 is precure group where 1 mm Filtek Z350 flowable liner is applied and light cured for 20 sec. Group 3 is the same as Group 2, but the liner was cocured with packable composite. In Group 4, 1 mm RMGIC, Fuji Lining LC is applied and cured for 20 sec. All the teeth were restored as in Group 1. The specimens were coated with nail varnish leaving 1 mm around the restoration, subjected to thermocycling, basic fuchsin dye penetration, sectioned mesiodistally, and observed under a stereomicroscope. Results. The mean leakage scores of the individual study groups were Group 1 (33.40), Group 2 (7.85), Group 3 (16.40), and Group 4 (24.35). Group 1 without a liner showed maximum leakage. Flowable composite liner precured was the best.

The effect of 2% chlorhexidine on the bond strength of two different obturating materials.

The bond strength of ActiV GP and gutta-percha/AH Plus after using 2% CHX as final rinse was evaluated in this study. According to the final irrigation regimen forty roots were divided into two groups (n = 20) randomly: Group 1-5 ml of 17% EDTA; Group 2-5 ml of 17% EDTA followed by 5 ml of 2% chlorhexidine gluconate (CHX). Based on the obturation system the two groups were further subdivided into two subgroups (n = 10). The roots were horizontally sectioned from the coronal and midthird sections for measuring the push-out bond strength. CHX/AH Plus (2.795 ± 0.42 MPa) and EDTA/ActiV GP (1.489 ± 0.117 MPa) recorded the highest and lowest mean bond strength values respectively. It was concluded that when 2% CHX was used as a final irrigation rinse the bond strength of both gutta-percha/AH Plus and ActiV GP obturation system improved significantly.

Comparison of Radicular Peroxide Leakage from four Commonly used Bleaching agents following Intracoronal Bleaching in Endodontically treated teeth - An In Vitro Study.

BACKGROUND: Non vital bleaching is simple, conservative procedure for esthetic correction of discolored endodontically treated teeth. The aim of this study was to determine and compare the amount of peroxide leakage from four different bleaching agents i.e superoxol, sodium perborate, combination of superoxol & sodium perborate and carbamide peroxide during intracoronal bleaching, as the safe and effective bleaching is the need of the hour. MATERIALS & METHODS: 50 extracted maxillary centrals were selected for the study. Following standardized protocol access, cleaning and shaping by step back technique and obturation was done using guttapercha and AH plus sealer. Access was sealed with Cavit G and outer root surface was coated with wax and nail varnish. The teeth were separated into crown and root and the root portion was placed in plastic tube containing distilled water for 7days.After incubation, 3mm of gutta-percha was removed below CEJ and 2mm glass ionomer cement base was placed. Grouped into five categories based on the bleaching agent placed in pulp chamber as -group1 (control)-distilled water, group 2-sodium perborate with distilled water , group 3- 30% hydrogen peroxide ,group 4-mixture of sodium perborate and 30% hydrogen peroxide and group 5-10% carbamide peroxide gel. Peroxide leakage was measured after 24hrs using ferrothiocyanate method and optical density using spectrophotometer. Statistical analysis of the data was conducted using ANOVA and multiple comparisons within the groups was done using BONFERRONI method (Post-Hoc tests). RESULTS: The results showed highest peroxide penetration from 30% hydrogen peroxide followed by mixture of sodium perborate with 30% hydrogen peroxide, mixture of sodium perborate with distilled water and least penetration from 10% carbamide peroxide gel. The results were statistically significant. CONCLUSION: Radicular peroxide leakage in 10% carbamide peroxide was significantly lower than the other tested bleaching agents making it a very safe alternative for intracoronal bleaching. How to cite this article: Madhu KS, Hegde S, Mathew S, Lata DA, Bhandi SH, Shruthi N. Comparison of Radicular Peroxide Leakage from four Commonly used Bleaching agents following Intracoronal Bleaching in Endodontically treated teeth - An In Vitro Study. J Int Oral Health 2013; 5(4):49-55.