Evaluation of the Effect of Long-term Use of Three Intracanal Medicaments on the Radicular Dentin Microhardness and Fracture Resistance: An in vitro study.

OBJECTIVES: The aim of this research was to evaluate the effect of long-term use of three intracanal medicaments on the radicular dentin microhardness and fracture resistance. MATERIAL AND METHODS: A chemomechanical preparation was done using the Protaper rotary instruments up to F3. The teeth were stored in an incubator at 37°C at 100% humidity and were categorized in three groups by random allocation, namely: Triple Antibiotic Paste (TAP), Calcium hydroxide paste (Apexcal) and Ledermix. Following medicament application, the access openings of all teeth were sealed with 4 mm thickness of cavit. The samples were stored for periods of 1 week, 1 month and 3months. Two dentin cylinders measuring 5mm and 3mm were obtained from each sample. The cervical third was used for fracture resistance and the middle third was used for micro hardness evaluation. The microhardness testing was done using a Knoop microhardness tester, and the fracture resistance testing was done using the universal testing machine. RESULTS: Calcium hydroxide showed maximally negative effect on the physical properties of radicular dentin compared to TAP (p= 0.0100 at one month and Ledermix (p=0.0001 at one month). With an increase in the application time, there was an increased deterioration in the physical properties of radicular dentin. CONCLUSION: Long-term placement of calcium hydroxide, Triple Antibiotic Paste, and Ledermix (p= 0.0001at 3 months) significantly affects the microhardness and fracture resistance of radicular dentin.

Comparative Evaluation of Efficacy of Calcium Hydroxide, Propolis, and Glycyrrhiza glabra as Intracanal Medicaments in Root Canal Treatment.

AIM: To evaluate and compare the antimicrobial efficacy of Ca(OH)2, 25% propolis, and 25% Glycyrrhiza glabra as intracanal medicaments in root canal treatment. MATERIALS AND METHODS: Total 60 freshly extracted permanent incisors were decoronated and chemomechanical preparation of root canal was performed. Samples were inoculated with a pure culture of Enterococcus faecalis and incubated for 21 days. Colony-forming units (CFUs) were recorded before medication. Incubated samples were randomly categorized into three groups, namely, Ca(OH)2, propolis, and G. glabra, with 20 samples in each group. Antibacterial activity was assessed by evaluating the variance in the CFUs on Day 7. Paired "t" test and Post-hoc Tukey's test were applied to analyze the data. RESULTS: Reduction of CFUs was noticed in all the groups (p <0.001), however the reduction was more predominant in the propolis group. CONCLUSION: Propolis is more effective against E. faecalis, when compared to G. glabra and Ca(OH)2. CLINICAL SIGNIFICANCE: Propolis could be used as an effective medicament in root canal treatment.

Comparative Evaluation of Cytotoxic and Genotoxic Effects of Three Resin-Based Sealers by 3,(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide Assay and Comet Assay - An In Vitro Study.

BACKGROUND AND AIM: The complete sealing of the pulpal space contributes to the better healing potential after an root canal treatment, and root canal sealers are an integral part of this treatment which comes in contact with the periodontal tissue. Biocompatibility of an endodontic sealer plays an important role in the root canal treatment procedure. Hence, the aim of the study was to compare and evaluate the cytotoxicity and genotoxicity effect of three resin-based sealers on human periodontal fibroblast cells. SETTINGS AND DESIGN: This in vitro study was conducted in Dr. Prabhakar Kore's Basic Science and Research Center and K. L. E V. K. Institute of Dental Sciences, Belagavi. MATERIALS AND METHODS: Human periodontal fibroblasts were incubated with 15 specimens of Group 1 - AH Plus Group 2 - MTA Fillapex, and Group 3 - GuttaFlow 2, respectively. Cytotoxicity was assessed by 3,(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and genotoxicity was assessed by Comet assay at time intervals at 24 h and 48 h. STATISTICAL ANALYSIS: Data were analyzed by the Kruskal-Wallis and Mann-Whitney U-test. RESULTS: AH Plus and GuttaFlow 2 did not show any cytotoxicity or genotoxicity. MTA Fillapex was slightly cytotoxic throughout the time interval, and it also showed low genotoxicity throughout the time periods for which it was tested. CONCLUSION: AH Plus and GuttaFlow 2 did not show any cytotoxic and genotoxic effect; however, MTA Fillapex showed cytotoxic and genotoxic effect throughout the time interval.

Comparison of cleaning effectiveness of single rotary file OneShape and reciprocating F2 Protaper with Protaper Universal sequence: A SEM analysis.

AIM: This in vitro study intend to compare the cleaning effectiveness of Protaper universal sequence with reciprocating F2 Protaper and single rotary file One shape. MATERIALS AND METHOD: 30 extracted human 1st mandibular molars were chosen for the analysis. Three NiTi file systems were used for mechanical preparation, ProTaper full sequence in rotary motion, single F2 Protaper file used in reciprocating motion, and One shape single file used in a circular motion. Irrigation was carried out after each instrument use using 5 ml of 5% NaOCl followed by normal saline. The root canal surface was evaluated at three different areas (coronal, middle and apical thirds) using Scanning Electron Microscopy. Debris and the Smear layer were evaluated. Data were analyzed statistically using the Friedman test and Kruskal-Wallis test (p ≤ 0.05). RESULTS: A statistically significant difference (p ≤ 0.05) was observed in the debris score of the Protaper universal group when the 3 thirds of the root were compared. Intergroup comparisons confirmed a statistically significant difference at the coronal and apical third of the roots when debris scores were evaluated. Intragroup comparison for the smear layer demonstrated a statistically significant difference (p ≤ 0.05) at all the 3 levels of the radicular canal for the 3 groups studied. Intergroup comparisons revealed a statistically significant difference (p ≤ 0.05) in the middle and apical 1/3rd when the smear layer was evaluated. CONCLUSION: The Protaper full sequence group provided better results than Single F2 ProTaper and One shape groups when debris and smear layer removal was investigated.

Evaluation of Push-out Bond Strength of a Resin Sealer to Dentin after a Final Flush of Three Irrigants.

AIM: To evaluate the push-out bond strength of resin-based sealer to root dentin after a final flush of three different irrigants. MATERIALS AND METHODS: Thirty extracted human mandibular premolars were sectioned 4 mm below the cement-enamel junction and 60 horizontal disks of 2 mm from middle one-third of the root were prepared. The disks were immersed in 3% sodium hypochlorite for 1 minute, and after drying the disks, they were finally flushed with the following irrigants: group I-Chitosan solution, group II-Morinda citrifolia juice (MCJ), and group III-ethylenediaminetetraacetic acid (EDTA). The disks were filled with AH Plus sealer, and after 7 days, the disks were subjected to push-out bond strength using a universal testing machine. RESULTS: EDTA had the highest push-out bond strength followed by MCJ and then chitosan. CONCLUSION: Chitosan and MCJ can be used as alternative irrigants as a final flush during the cleaning and shaping of the root canals. CLINICAL SIGNIFICANCE: EDTA, chitosan solution, and MCJ are efficient in smear layer removal which thereby increases better sealer penetration and prevents the dislocation of obturating materials.

Anesthetic efficacy of anterior middle superior alveolar injection in single-visit endodontic therapy: an in vivo study.

OBJECTIVES: To evaluate and compare the anesthetic efficacy of anterior middle superior alveolar (AMSA) injection in single-visit endodontic therapy, an in vivo study. MATERIALS AND METHODS: Teeth in the maxillary anterior segment (N = 60) requiring single-visit endodontic (SVE) therapy were selected. A conventional syringe with 26-guage needle containing 1.5 ml lignocaine with 1:80,000 epinephrine was used for the AMSA injection. The SVE therapy was performed using standard protocol. Profoundness of anesthesia during therapy was evaluated at 15-, 30-, 60-, and 90-min intervals using pain rating score and marked on visual analogue scale. In patients who reported pain/ineffectiveness of anesthesia during the course of endodontic therapy, additional supplemental anesthesia (buccal/labial infiltration) was administered. Depending on effectiveness of anesthesia with the AMSA injection alone or the need for additional supplementary injections, patients were divided as: group I-only AMSA and group II-AMSA with one or two supplemental anesthesia. RESULTS: The AMSA injection was effective in 91.67% of the patients undergoing the SVE therapy and the duration of anesthesia for the AMSA injection alone was adequate until the completion of the SVE therapy. Supplementary injections were required in 8.33% of cases at 15-min interval to achieve profound anesthesia. CONCLUSION: The AMSA injection technique could be used as an alternative to the conventional infiltration technique for anesthetizing teeth in maxillary anterior segment during the SVE therapy. CLINICAL RELEVANCE: The AMSA injection provides profound pulpal anesthesia of teeth in maxillary anterior segment during endodontic therapy.

"Evaluation of shear bond strength of a composite resin to white mineral trioxide aggregate with three different bonding systems"-An in vitro analysis.

BACKGROUND: Mineral trioxide aggregate (MTA) is a biomaterial that has been investigated for endodontic applications. With the increased use of MTA in pulp capping, pulpotomy, perforation repair, apexification and obturation, the material that would be placed over MTA as a final restoration is an important matter. As composite resins are one of the most widely used final restorative materials, this study was conducted to evaluate the shear bond strength of a composite resin to white mineral trioxide aggregate (WMTA) using three different bonding systems namely the two-step etch and rinse adhesive, the self-etching primer and the All-in-one system. MATERIAL AND METHODS: Forty five specimens of white MTA (Angelus) were prepared and randomly divided into three groups of 15 specimens each depending on the bonding systems used respectively. In Group A, a Two-step etch and rinse adhesive or 'total-etch adhesive', Adper Single Bond 2 (3M/ESPE) and Filtek Z350 (3M ESPE, St Paul, MN) were placed over WMTA. In group B, a Two-step self-etching primer system, Clearfil SE Bond (Kuraray, Medical Inc) and Filtek Z350 were used. In Group C, an All-in-one system, G Bond (GC corporation, Tokyo, Japan) and Filtek Z350 were used. The shear bond strength was measured for all the specimens. The data obtained was subjected to One way Analysis of Variance (ANOVA) and Scheffe's post hoc test. RESULTS: The results suggested that the Two-step etch and rinse adhesive when used to bond a composite resin to white MTA gave better bond strength values and the All-in-one exhibited the least bond strength values. CONCLUSIONS: The placement of composite used with a Two-step etch and rinse adhesive over WMTA as a final restoration may be appropriate. KEY WORDS: Composite resins, dentin bonding agents, mineral trioxide aggregate, shear bond strength.

Comparison of third generation versus fourth generation electronic apex locators in detecting apical constriction: An in vivo study.

AIM: The aim of this in vivo study was to compare the accuracy of Root ZX and Raypex 5 in detecting minor diameter in human permanent single-rooted teeth. MATERIALS AND METHODS: Thirty-one patients with completely formed single-rooted permanent teeth indicated for extraction were selected for the study. Crown was flattened for stable reference point and access cavity prepared. Working length was determined with both apex locators. A 15 K file adjusted to that reading was placed in the root canal and stabilized with cement. The tooth was then extracted atraumatically. Following extraction apical 4 mm of root was shaved. The position of the minor diameter in relation to the anatomic apex was recorded for each tooth under stereomicroscope at ×10. The efficiency of two electronic apex locators to determine the minor diameter was statistically analyzed using paired sample t-test. RESULTS: The minor diameter was located within the limits of ±0.5 mm in 96.6% of the samples with the Root ZX and 93.2% of the samples with Raypex 5. The paired sample t-test showed no significant difference. CONCLUSION: On analyzing the results of our study it can be concluded that Raypex 5 was as effective as Root ZX in determining the minor diameter.

Interdisciplinary management of an isolated intrabony defect.

The treatment of intrabony defects is a real challenge in molar teeth as it is chronic, slowly progressing disease which needs timely intervention. Periodontal inflammation associated with intrabony defect is not a separate entity as it secondarily affects the pulp causing retrograde pulpitis. However, treatment of these lesions will be complicated due to extensive bone loss. The tooth was endodontically treated followed by periodontal surgery to eliminate the deep periodontal pocket and promote bone fill in osseous defect. PepGen P-15 composited with platelet rich plasma was utilized for enhancing bone formation. The combination of these graft materials provides synergistic effect on bone regeneration.

Evaluation of antimicrobial efficacy of calcium hydroxide paste, chlorhexidine gel, and a combination of both as intracanal medicament: An in vivo comparative study.

AIM: To compare the antimicrobial efficacy of calcium hydroxide (CH), 2% chlorhexidine gel (CHX) and a combination of both, on obligate anaerobes, facultative anaerobes and Candida spp . MATERIALS AND METHODS: 90 single rooted permanent teeth were included in the study. After complete disinfection and access opening, the first microbiological pre-treatment sample (S1) was collected. After completion of instrumentation, a post-instumentation sample (S2) was taken and the teeth were divided into three groups: Group I: CH, Group II: 2% CHX, Group III: 2% CHX with CH. After 1 week, a post-medication sample (S3) was collected. RESULTS: All three medicaments were effective in the elimination of obligate anaerobes. CHX and combination showed higher antimicrobial effect against facultative anaerobes and Candida spp. in comparison with CH. But there was no statistical significant difference between Group II and Group III. CONCLUSION: CHX with or without CH was more effective than CH alone against all the tested micro-organisms.

Root canal treatment of a mandibular second premolar with three roots and canals - an anatomic variation.

Dental anatomical variations play a significant role in the diagnosis and a successful treatment outcome in endodontics. It is essential for the clinician to have a clear picture and understanding of the pulpal anatomy and its variations. In a mandibular second premolar, it is rare to find extra roots and canals. The aim of the present article is to report a case about the successful diagnosis, and clinical management of a three-rooted mandibular second premolar with three independent roots and canals.

Evaluation of the effect of concentration and duration of application of sodium ascorbate hydrogel on the bond strength of composite resin to bleached enamel.

AIM: The effect of different concentrations of hydrogel of sodium ascorbate on bond strength of bleached enamel for varying periods of time and the mode of failure was evaluated. MATERIALS AND METHODS: Seventy enamel surfaces were obtained from 35 human extracted premolars. Specimens were divided into four groups: no bleaching (control), bleaching with carbamide peroxide gel, bleaching and application of 10% / 20% sodium ascorbate hydrogel for 30, 60, 120 min. Surfaces were bonded with a total etch bonding system and composite resin. Specimens were tested for shear bond strength. Mode of failure was determined by stereomicroscope. Data were analyzed using a two-way analysis of variance, and Scheffe's post hoc test. RESULTS: Sodium ascorbate hydrogel application following bleaching increased the resin-enamel bond strength and was directly proportional to its duration of application. However, there was no difference in bond strength with an increase in the concentration of sodium ascorbate hydrogel. CONCLUSION: Immediate bonding of composite resin to bleached enamel is possible after treatment with antioxidant sodium ascorbate hydrogel.

Management of intrusive luxation of maxillary incisors with dens in dente: a case report.

Intrusive luxation is one of the most severe types of dental traumatic injuries. The risk of occurrence of pulpal necrosis and inflammatory or replacement resorption is high. In an attempt to prevent or delay the appearance of such lesions, endodontic intervention is required soon after the occurrence of trauma. A 17-year-old boy reported to the Department of Conservative dentistry and Endodontics, KLE VK Institute of Dental Sciences, Belgaum, 2 days after a fall from a bicycle. Clinical and radiographic examination revealed an intrusive luxation of the left maxillary central incisor and lateral incisor. There were complicated crown fracture with the right maxillary central incisor and uncomplicated crown fracture with the left maxillary central incisor. Also, all the incisors showed the presence of Oelhers type II Dens-in-dente. The management was hence challenging. Immediate surgical repositioning was performed and the teeth were stabilized with a composite resin splint. Endodontic therapy was initiated with the right maxillary central incisor, and the canal was sealed with calcium hydroxide dressing. After 3 weeks, pulp sensitivity was repeated with the maxillary left central and lateral incisors. The result was negative. Considering the incidence of pulp necrosis and root resorption in intruded teeth with complete root formation, they also were dealt in a similar manner as the maxillary right central incisor. The splint was removed after 1 month. After 6 months of calcium hydroxide therapy, there was a satisfactory apical and periodontal healing. At this stage, the teeth were obturated and the fractures were restored with composite resin. A 1-year follow up revealed a satisfactory clinical and radiographic outcome.