Periapical Healing Outcome of Endodontic Re-Treatment Using Calcium Silicates Versus Resin-Based Sealers: A Systematic Review.

Aim: This systematic review was conducted with the purpose of analyzing the effects of root-end sealers in endodontic re-treatment cases and comparing calcium-based sealers with sealers, which were resin-based. Methodology: We conducted this review based on the principles of Cochrane systematic type of studies and also based on guidelines of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). An exhaustive search was conducted across PubMed, Medline, and Embase databases for the studies, which were based on root end sealers in cases of endodontic re-treatments. The data were then analyzed statistically with the help of SPSS 25.0. Results: It was seen that when comparing pain levels in post-obturation cases with these sealers after 24 hours and 48 hours, not much of statistically noteworthy differences were evident. Mean difference (MD) values at 24 hours were -0.20 with confidence intervals between -0.44 and 0.07 and P value of 0.15, whereas in case of 48 hours, MD was -0.36, CI- 0.65, and P value was 0.03. However, the results were slightly better with calcium-based sealers. Conclusion: Calcium silicate-based root end obturation sealers had similar performance when compared to resin-based sealers when we compared variables like pain intensity, etc.

Effect of Sterilization and Irrigating Solutions on Nanostructure Alteration of Ni-Ti Rotary Instruments in Endodontics: An Atomic Force Microscopic Study.

Aim: This study aimed to evaluate the effect of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA) and sterilization on the nanostructural alteration of nickel titanium (Ni-Ti) rotary file systems in endodontics using the atomic force microscopy (AFM). Materials and Methods: The study was performed on four commercially available rotary Ni-Ti files: group I-Vortex Blue (Dentsply), group II-ProTaper Next (Dentsply), group III-Mtwo (VDW), and group IV-iRaCe (FKG). Each group was divided into four subgroups (n = 4), that is, subgroup A-control (new rotary file), subgroup B-subjected for five cycles of autoclave, subgroup C-immersed in 5.25% NaOCl for 5 minutes, and subgroup D-immersed in 17% EDTA solutions for 5 minutes. All the specimens were evaluated with AFM using roughness average (RA) and root-mean-square (RMS) values for surface roughness. Results: Among control groups, Vortex Blue showed the least RA and RMS values; the highest surface roughness was seen with Mtwo files. All the Ni-Ti rotary files showed a statistically significant (P <0.05) increase in surface hardness when subjected to autoclave and treatment with different irrigating solutions. In particular, 17% EDTA caused the highest surface deterioration in all the groups. Conclusion: AFM analysis revealed increased surface roughness values recorded for all the rotary files when treated with irrigating solutions and autoclave cycles.

Outcomes of Regenerative Endodontic Treatment Performed Using Different Magnification Devices: A Systematic Review.

Aim: In this systematic review, we assessed whether the effects of the usage of various devices help with magnification in endodontics and whether they resulted in any significant changes in the clinical result of treatment. Materials and Methods: An exhaustive search was performed across MEDLINE and Cochrane Registers for various clinical studies, which were focused on comparing regenerative endodontic treatment based on the usage of magnification devices. Various terms were used to search these clinical trials such as microscope, regenerative endodontic surgery, apicoectomy, endoscope, and loupes. Results: After scrutinizing the studies, around three clinical trials based on magnification in endodontic surgeries were included in the present review. It was observed that no statistically noteworthy betterment of treatment outcome was seen in patients treated with either of the magnification devices such as loupes and microscope. Conclusion: It was evident that these magnification devices can alter the effectiveness of regenerative endodontic treatment in a very minimal way. However, we believe that more randomized clinical studies should be conducted in this area.

A Comparative Study Evaluating the Efficacy of Lignocaine and Dexmedetomidine with Lignocaine and Adrenaline in Third Molar Surgery.

Aim: The aim of this study was to compare the anesthetic efficacy, duration of action, pain, and cardiovascular effects of dexmedetomidine when added to 2% lignocaine hydrochloride in bilateral symmetrical impacted third molars. Materials and Methods: This study comprised of 40 healthy patients who required extraction of identical bilateral impacted lower third molars. The left side of the patients was designated as test side where patients received local anesthesia with lignocaine plus dexmedetomidine (2% lignocaine + dexmedetomidine 1 µ/ml), and the right side of the patients was designated as control side where patients received local anesthesia with lignocaine plus adrenaline (2% lignocaine in 1:80,000 adrenaline). Both surgical interventions were performed at two different appointments with a minimum time interval of 2 weeks. The time to onset and duration of action were noted as primary outcome variables, while the secondary outcome variables included pain and hemodynamic changes associated with dexmedetomidine if any. Results: Onset of action of the local anesthesia was found to be faster in addition to having a relatively longer duration of action when the newer drug dexmedetomidine was added to lignocaine when compared with the conventional combination of lignocaine and adrenaline (P < 0.05). There were no significant changes in the systolic blood pressure, diastolic blood pressure, and heart rate from the baseline following the injection of dexmedetomidine. Conclusion: The study demonstrated that the combination of dexmedetomidine with lignocaine enhances the local anesthetic potency of lignocaine without significant systemic effects when locally injected into oral mucosa.

Success Rate of Growth Factors for Existing Periapical Lesions in Failed Endodontically Treated Teeth in Adult Population: A Systematic Review and Meta-Analysis.

Introduction: In this study, we investigated the success rate of growth factors for existing periapical lesions in failed endodontically treated teeth in an adult population by systematic review and meta-analysis. Materials and Methods: We conducted an online data search based on preferred reporting items for systematic reviews and meta analyses (PRISMA), from databases PUBMED, MEDLINE, and EMBASE, for the application of various types of growth factors in endodontically failed teeth with periapical lesions in adults. These included the "platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)," blood, etc. The data were meta-analyzed using MetaXL 5.3, and GRADE was used to assess the certainty. Results: We observed that success of 0.95 was achieved by the end of a year's follow-up with the application of growth factors for periodontal lesions. We also observed that the teeth responded to thermal tests, indicating regeneration; however, studies were with bias and lower sensitivity. Discussion: \ Similar to regeneration in immature teeth, growth factors also showed greater success in the treatment of periapical lesions in the failed endodontic teeth in adults.

A Comparative Evaluation between the Use of Buccal Pad of Fat and Bovine Collagen Membrane in the Management of Oral Submucous Fibrosis.

PURPOSE: This study is intended to assess and compare the effectiveness of BFP and BCM as reconstruction materials in treating oral submucous fibrosis (OSMF). MATERIALS AND METHODS: This study comprised twenty patients of 20 and 60 years who were clinically diagnosed with OSMF. All patients were subjected to fibrotomy with reconstruction under general anesthesia. In all the patients, following fibrotomy reconstruction was done using the buccal pad of fat on the left and with the collagen membrane on the right. The temporal muscle insertions were released, and coronoidectomy was performed as and when required. Any third molars if present were removed. All patients were feeded for 7 days by Ryle's tube and were on intravenous antibiotics for 5 days. Clinical evaluation was done at periodic intervals of 7, 30, 90, and 180 days postoperatively for mouth opening, burning, pain on mouth opening, and recurrence. RESULTS: The mean age of patients was 27.3 years. A 12 mm was mean preoperative mouth opening. Intraoperative mouth opening was 37 mm in all the patients and maintained at 36 mm at the 6th-month postoperative period. No significant difference was observed between both sides pertaining to pain on maximal mouth opening, burning sensation, or postoperative infection. However, there was a significant difference in the time taken for epithelization on both sides. CONCLUSION: The results of this study reveal that both Buccal Pad of Fat (BPF) and BCM are viable reconstruction options, but BFP as a reconstruction material exhibited prompt epithelization with the lowest wound contracture.

Regenerative Endodontic Therapy in the Management of Nonvital Immature Permanent teeth: A Systematic Review and Meta-analysis.

This meta-analysis is intended to evaluate the reliability of evidences published in current regenerative endodontic publications in a critical way. This meta-analysis is used to summarize and analyze the various clinical and radiographic findings associated with nonvital immature permanent teeth which have been treated with regenerative endodontic techniques. We also intend to significantly evaluate the worth of facts provided in the previous published literature. A structured electronic search by authors was undertaken in August 2020 using MEDLINE and PubMed search engine. The chosen parameters studied in this systematic review were presented in flowcharts and were summarized. We observed a good accomplishment rates in terms of survival of the treated tooth and also in resolution of any associated pathology in the apical areas; on contrary, our results in relation to apex closure along with constant root development, our findings from various studies were quiet variable. Regenerative endodontic procedures are constantly being restructured and enhanced to benefit present-day dentistry in all likely ways. Still, many factors that are important for the success of regenerative endodontic treatment outcomes still remain unexplained. There are still numerous gaps in our expertise at the present stage of this study.

Comparison of the Success Rate of Mineral Trioxide Aggregate, Endosequence Bioceramic Root Repair Material, and Calcium Hydroxide for Apexification of Immature Permanent Teeth: Systematic Review and Meta-Analysis.

This systematic review aims to compare the success rate of Endosequence bioceramic root repair material (BCRRM), mineral trioxide aggregate (MTA), and calcium hydroxide for apexification of necrotic immature permanent teeth. Indexed Journals such as Google Scholar, PubMed, Scopus, Cochrane, Research Gate, Wiley Online Library, and other related journals were hand searched from inception till November 2020 and articles were selected for review based on PRISMA guidelines. Of the 410 studies that were identified, 150 articles were selected after title/abstract reading. After full-text reading and based on inclusion and exclusion criteria, 9 studies were finalized for systematic review. Clinical, radiographic success, and the time taken for apical barrier formation were reviewed. All the three materials had almost similar success rate in terms of clinical symptoms, but the time taken for apical barrier formation and also single visit treatment makes MTA and Endosequence BCRRM superior to calcium hydroxide. Studies comparing EndoSequence Root Repair Material and MTA are very limited and need further evaluation in the future.

Functional Role of Inorganic Trace Elements on Enamel and Dentin Formation: A Review.

Calcium and phosphate are the major components of hydroxyapatite crystals that form the inorganic portion of the teeth. Apart from these, certain elements are present in little amounts in enamel and dentin of the human teeth. Although they are required in minute quantities, their absence may alter healthy development of enamel and dentin and may result in developmental tooth defects as well as dental caries. Furthermore, excessive intake of some trace elements may inversely affect tooth development and health. The exact of effects that trace elements have on teeth and oral health is still an unexplored territory. The present paper reviews the presence of trace elements in teeth and their role in tooth health and development.

The Sealer Penetration into the Dentinal Tubules: An Appraisal of Different Irrigation Systems: Original Research.

INTRODUCTION: A good endodontic sealer aids in a successful root canal treatment. Sealer in turn depends on the thorough irrigation technique and debris removal. Hence, in the present study, we intend to compare the sealer's dispersion into dentinal tubules of the different irrigation systems by confocal laser scanning microscopy (CLSM). METHODOLOGY: Seventy-six single-rooted, freshly removed human mandibular premolars were taken. They were separated into equal groups as conventional endodontic needle irrigation system, Endovacirrigation, Endoactivator irrigation, and manual dynamic agitation groups. Protaper rotary system was used and obturation was done with gutta-percha. The sealer used was AH Plus labeled with fluorescent dye (0.1% Rhodamine B isothcyanate). Transverse sections from the root apex at the levels of 1 mm, 3 mm, and 5 mm were scanned using CLSM. The sealer's penetration for the depth and the percentage were measured. RESULTS: We observed that endovac irrigation system showed maximum percentage and depth of sealer's penetration compared to endoactivator, manual dynamic agitation, and conventional methods at 1, 3, and 5 mm levels from the apex. CONCLUSION: The irrigation systems significantly influence the penetration of the Sealer into root dentinal tubules. When penetration of sealer at different levels, compared to endoactivator, manual dynamic agitation, and conventional method, significant greater levels were attained with the EndoVac system.

Novel coronavirus- A comprehensive review.

Recently coronavirus outbreak which started in Wuhan, China, has caused international concern that has affected more than 29 lakh people worldwide and with no vaccine or specific antiviral drugs present as well as oblivious testing of carriers who are generally asymptomatic, the use of general health intervention techniques are failing to comply. As compared to other epidemics like severe acute respiratory syndrome-coronavirus (SARS-CoV) and the Middle-East respiratory syndrome (MERS-CoV), coronavirus (also named as COVID-19) exhibit mild symptoms in the majority of cases. But in the case of a vulnerable population, it can prove to be life-threatening. Relying on proper barrier technique, use of chest computed tomography scans, managing co-morbid conditions of susceptible patients, identifying the pattern of disease spread as well as the use of polymerase chain reaction to assess the specificity of cases will eventually prove to be efficacious since most of the positive cases are asymptomatic at the beginning which poses a challenge to the primary health care physicians. The development of vaccines will also take some time so it is better to know about COVID-19 better and also follow quarantine restrictions properly till then. In this review, we try to put forward all the relevant studies which have been published by the end of March 2020 so as to summarize the natural history, diagnosis as well as treatment strategies for eradicating COVID-19, which will help in managing this pandemic.

Endodontic Management of Various Canal Morphologies in Maxillary First Molars: A Series of Four Case Reports.

The success of nonsurgical endodontic management depends on the complete elimination of infection that compromises the tooth function. Thorough knowledge about the root canal anatomy is one of the principal factors in achieving a successful outcome. The morphology of root canals is not always typical. Maxillary molars, known for varied morphology, require advanced imaging modalities such as cone-beam computed tomography. This case report describes a series of four maxillary molars with different forms, numbers, and configurations of root canals and with unusual morphology, including a case of a third mesiobuccal canal, a case of a second mesiobuccal canal with two palatal canals (mesiopalatal and distopalatal), a case of three mesiobuccal canals, three distobuccal canals, and two palatal canals (mesiopalatal and distopalatal), and a case of taurodontism, where different access cavity modifications, diagnostic methods, and magnifications were considered.