Comparative Evaluation of Root Canal Centering Ability of ProTaper, Mtwo, WaveOne, and Reciproc Using Cone-beam Computed Tomography: In Vitro Study.

AIM: To compare the centering ability of rotating (ProTaper and Mtwo) and reciprocating (WaveOne and Reciproc) file systems using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Eighty extracted human mandibular molars with curvature within 15-45° were selected and randomly divided into four groups (n = 20): group I (ProTaper), group II (Mtwo), group III (WaveOne), and group IV (Reciproc). The selected teeth were arranged in a template, and pre-instrumentation and post-instrumentation CBCT scans were taken using Kodak Carestream CS 9300 machine. The centering ability was measured in four planes namely, at furcation, 3 mm apical to furcation (coronal), 6 mm apical to furcation (middle), and 3 mm coronal to the apex (apical), wherein dentin thickness was measured from pre- and post-instrumentation CBCT scans and recorded for each canal (mesiobuccal and mesiolingual) separately and statistically analyzed. RESULTS: Mtwo and Reciproc remained better centered followed by WaveOne and least by ProTaper in different-level comparisons. In the mesiodistal dimension (MD) at the 3 mm, 6 mm, and 3 mm apical level, Mtwo and Reciproc showed better centering, meanwhile, in the buccolingual dimension, only in the 3 mm apical level, Mtwo and Reciproc remain better centered. A significant difference was seen between the group and type of canal. CONCLUSION: Mtwo and Reciproc showed better centered preparation than ProTaper and WaveOne. Significant differences were seen between the groups and types of canal. CLINICAL SIGNIFICANCE: Root canal instrumentation should maintain the original canal anatomy. The proper enlargement keeping in mind the remaining strength in the tooth structure is essentially decided by how the selected instrument is centered. The alloy used for instrument manufacture and its design (taper, cross-section, and tip) will influence the centered preparation. The type of instrument and the instrumentation techniques should be chosen based on root canal anatomy.

Effect of irradiance from curing units on the microhardness of composite - a systematic review.

Purpose The systematic review aims to evaluate the effect of light irradiance from light-curing units on microhardness of composite.Materials and methods The protocol was registered in PROSPERO following which primary search was carried out via MedLine, Scopus and Cochrane Library. A customised tool was used to assess the risk of bias. Among the 303 records retrieved from the databases, only ten articles qualified for qualitative synthesis after meeting all the requirements of the eligibility criteria. Covidence software was used to record the decisions. The studies published until 31 March 2021 were taken up for the review. The articles showed a low-to-moderate risk of bias.Results From a total of 303 articles, ten articles were reviewed for full text. Ten in vitro studies were included for qualitative analysis. There was heterogeneity in sample size, curing time and outcome measured. Therefore, meta-analysis was not performed. Out of ten studies, seven studies reported higher microhardness value for higher intensity than lower intensity of light.Conclusion Despite the fact that the findings of the evaluated studies are quite variable, significant scientific evidence revealed that high light intensity can enhance the hardness of resin composites.

Prevalence and severity of coronal and radicular caries among patients with type 2 diabetes mellitus: A cross sectional study.

Background: Studies among type 2 diabetes mellitus patients have reported total caries experience; however the severity and clinical consequences of untreated dental caries are often ignored. Methods: For this study, 150 well (I) and poorly controlled (II) diabetic participants were recruited. The spectrum of caries was evaluated using DMFT (Decayed, Missing and Filled Tooth) index, Dental Caries Severity Classification Scale, PUFA (Pulpal involvement, Ulceration, Fistula and Abscess) index, RCI (Root Caries Index) and the severity of radicular caries by Root Surface Caries Severity Index. Results: The prevalence of coronal and root caries was 90.7% and 23.3%, respectively. There was significant difference among caries experiences for D, M and DMFT. In group II, severity of coronal caries and mean rank of P, F, A and PUFA scores were higher, so were prevalence of root caries and severity of RD2, RD3 and RD4. HbA1c level had positive correlation with DMFT and PUFA scores (r = 0.458 and 0.522), so was the duration of diabetes with coronal caries, DMFT, PUFA score, root caries and RCI score (r = 0.235, 0.320, 0.273, 0.308 and 0.323). Conclusion: This is probably the first study to examine the severity of coronal caries, prevalence of untreated dental caries and severity of radicular caries in diabetic patients. Uncontrolled diabetes causes substantial increase in prevalence and severity of coronal and radicular caries.

Comparative Evaluation of Microcrack Formation in Different Kinematics Using Rotary and Reciprocating File Systems: An In Vitro Study.

AIM AND OBJECTIVE: To compare r oot microcrack formation after r oot canal preparation using ProTaper Next in r otation or forward r eciprocation and Waveone gold in r everse r eciprocating motion. MATERIALS AND METHODS: Buccal r oots of 60 maxillary premolars with mature apices were selected, for different instrumentation techniques and divided into three groups. Coronal access was achieved and the canals were confirmed for apical patency. The canals were then instrumented using the following instrumentation techniques: ProTaper Next in r otation or forward r eciprocation or Waveone gold in r everse reciprocation. The tooth was then subjected to sectioning using a diamond saw under water cooling and then was visualized under the stereomicroscope for dentinal microcrack. RESULTS: The results showed that the maximum dentinal microcrack formed at apical 3 and 6 mm was in Waveone gold in reverse reciprocation followed by ProTaper Next in forward reciprocation and rotation. However, the p value was found to be not significant at 3 and 6 mm (p value-0.082 and 0.23). CONCLUSION: Nickle titanium rotary instruments tend to induce varied degrees of root dentinal damage during canal instrumentation. ProTaper Next files in rotation as well as forward reciprocation presented with minimal microcrack defects when compared with Waveone gold. CLINICAL SIGNIFICANCE: Root canal preparation, when performed by manual or engine-driven techniques, has shown to produce structural defects in the root dentin. One of the causes of failures in root canal treatment is because of fracture in the dentin that occurs due to these procedures. Though all the motion kinematics caused microcracks in this study, it was seen that rotational motion produced the least structural damage to the dentin.

Effect of Instrumentation Techniques and Kinematics on Apical Extrusion of Debris: An In Vitro Study.

AIM: To evaluate the effect of instrumentation kinematics on debris extrusion by comparing the amount of apically extruded debris after canal preparation using ProTaper next in continuous rotation as well as forward reciprocating motion and WaveOne gold in reverse reciprocating motion. MATERIALS AND METHODS: We randomly divided ninety buccal roots of maxillary bicuspids with fully formed apices into three groups. After achieving the coronal access, the patency of the root canals was established with a size 10 K file. The canals were then instrumented using ProTaper next in continuous rotation or in a forward reciprocating motion and WaveOne gold in reverse reciprocating motion. Eppendorf tubes were used to collect the debris extruded through the apical foramen. The tubes were placed in a -80° freezer for 8 hours and then in a lyophilizer for 24 hours. The quantity of the apically extruded debris was assessed by subtracting the weights of Eppendorf tubes before and after instrumentation. The analysis was done using a one-way ANOVA test and the Bonferroni test to compare the groups. RESULTS: The mean weight of extruded debris with WaveOne gold in reverse reciprocation was significantly lower than ProTaper next in forward reciprocation and ProTaper next in continuous rotation (p value = <0.001). CONCLUSION: WaveOne gold in reverse reciprocation was associated with a significantly lower amount of apical extrusion of debris than ProTaper next rotary files in forward reciprocation and continuous rotation. CLINICAL SIGNIFICANCE: According to the results of this study, reciprocating instrumentation technique was associated with a less amount of debris extrusion compared to continuous rotation.

Effectiveness of silver diamine fluoride application with atraumatic restorative treatment in arresting the progression of dental caries: a systematic review protocol.

OBJECTIVE: This review aims to evaluate the effectiveness of silver diamine fluoride application along with atraumatic restorative treatment in arresting the progression of dental caries when compared with other caries-arresting treatments in children and adults. INTRODUCTION: A combination of silver diamine fluoride with atraumatic restorative treatment is a minimally invasive and cost-effective method to treat dental caries. It offers a solution for the progression of caries and restoration of cavitated lesions in both primary and permanent teeth. A comprehensive summary of the evidence will assist dental clinicians and guide subsequent clinical research. INCLUSION CRITERIA: Randomized controlled trials involving human participants of any age with cavitated dental caries lesions will be included. The intervention arm will evaluate the effectiveness of silver diamine fluoride application with atraumatic restorative treatment in dental caries arrest with a control arm of either atraumatic restorative treatment (ART) or silver diamine fluoride (SDF) application; or composite restoration; or sodium fluoride varnish or a placebo; or a study group with no intervention. METHODS: Systematic searches for relevant studies will be conducted across multiple databases, including MEDLINE, Scopus, Cochrane CENTRAL, Dentistry and Oral Sciences Source, CINAHL, and Web of Science. ProQuest Dissertations and Theses and Google Scholar will also be searched for gray literature. The databases will be searched from January 2016 to the present. No restrictions will be imposed on the country of publication. Data appraisal, extraction, and synthesis will follow JBI guidance for systematic reviews of effectiveness. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system will be used to grade the certainty of evidence, and a Summary of Findings will be prepared. REVIEW REGISTRATION: PROSPERO CRD42023426766.

Effect of Iontophoresis on the Effectiveness of Nano-Hydroxyapatite and Pro-argin in In-Office Treatment of Dentin Hypersensitivity: A Split-Mouth Randomized Clinical Trial.

Background and objectives Dentin hypersensitivity (DH) treatment is one of the main challenges dentists face in their daily clinical practice. Current therapies provide only temporary relief and require multiple applications to exhibit results, and there is a lack of evidence related to the long-term effects of these agents. Nano-hydroxyapatite (n-HA) and pro-argin (8.0% arginine-calcium carbonate) have recently been used for dentin desensitization with a one-time in-office application, but the effects are interim. However, a standard treatment protocol demands definitive or enduring results. Since iontophoresis amplifies the transport of neutral and ionized drugs across a membrane, the use of these desensitizing agents with iontophoresis may be beneficial to accomplish satisfactory results. This study was conducted to evaluate whether iontophoresis could enable better penetration of nano-hydroxyapatite and pro-argin into the dentin, enhancing and prolonging their therapeutic effect. Materials and methods Forty-five participants with dentin hypersensitivity in the age group of 20 to 60 years were included. In each individual, four teeth with cervical lesions (one from each quadrant) were selected and divided randomly into four groups: group I: desensitizing paste containing nano-hydroxyapatite, group II: desensitizing paste containing nano-hydroxyapatite with iontophoresis, group III: desensitizing paste containing pro-argin, and group IV: desensitizing paste containing pro-argin with iontophoresis; followed by one-time application of the agents. Sensitivity was assessed by tactile, air blast, and cold-graded thermal tests (CGTTs) before and immediately after application, after one week, and at the end of the first, third, and sixth months. Statistical analysis Statistical analysis was done by repeated measures ANOVA for within-group comparison. Intergroup comparison was done using one-way ANOVA and Tukey's post-hoc test. Results All the groups showed a statistically significant reduction in dentin hypersensitivity (p<0.001). The reduction in hypersensitivity in various groups can be graded as group II (3.578/1.800/1.556) > group IV (3.367/1.755/1.555) > group I (2.3781/1.022/0.822) > group III (2.222/0.911/0.778) as evaluated by tactile, air blast, and cold-graded thermal tests, respectively. Group II and group IV presented a significant reduction in sensitivity levels consistent for up to six months. Conclusion Nano-hydroxyapatite and pro-argin can be used effectively for reducing dentin hypersensitivity. Iontophoresis can be a valuable adjunct for their improved delivery, enhancing and prolonging their effectiveness.

Evaluation of the efficacy of different intracanal medicaments against Candida albicans and Enterococcus faecalis - An In-Vitro study.

Aim: This study aims to evaluate the antimicrobial efficacy of certain intracanal medicaments against Candida albicans and Enterococcus faecalis. Methods: Freshly extracted 120 single rooted mandibular premolars were selected for the study. Teeth were decoronated and cleaning and shaping was done up to F3 universal protaper system and were divided mainly into two groups: Candida albicans (C. albicans) (n = 60) and Enterococcus faecalis (E. faecalis) (n = 60). The medicaments include: G1: chlorhexidine + calcium hydroxide, G2: sodium hypochlorite + calcium hydroxide, G3: 2% chlorhexidine gel, G4: octenisept, G5: 0.1% octenisept solution + calcium hydroxide, and G6: physiologic saline (n = 5). Teeth were contaminated with Enterococcus faecalis and Candida albicans which were cultured, respectively, in brain heart infusion and Sabouraud's dextrose agar for 21 days followed by intracanal medication and colony forming units were counted on the second and seventh day. Statistical analysis was done using Analysis of Variance (ANOVA) and Tukey's post hoc test. Results: Against C. albicans, CHX + CH, 2% CHX gel, 0.1% octenidine (OCT) gel and OCT + CH showed statistically significant differences on the 2nd and 7th day. But against Enterococcus faecalis, only 0.1% OCT gel and 2% CHX gel showed statistically significant differences on the 2nd and 7th day. Among all the groups, 0.1% OCT gel and 2% CHX gel showed predominant antimicrobial efficacy. Conclusion: From the limitations of the current study, all the medicaments showed antimicrobial effect against Candida albicans and Enterococcus faecalis on the 2nd and 7th day with higher microbial inhibition on the 7th day.

Effectiveness of 38% Silver Diamine Fluoride Application along with Atraumatic Restorative Treatment for Arresting Caries in Permanent Teeth When Compared to Atraumatic Restorative Treatment in Adults-Study Protocol for a Randomized Controlled Trial.

INTRODUCTION: Dental caries in the adult population that require preventive and therapeutic treatment are generally neglected in rural communities. The determination of the effectiveness of the application of 38% silver diamine fluoride (SDF) in arresting caries lesions when combined with atraumatic restorative treatment (ART) is very important, as it serves as a preventive and restorative procedure to regain the function of the permanent dentition. The assessment of optimal SDF application with ART, in comparison with ART alone, in managing cavitated carious lesions in a pragmatic setting, is the need of the hour to recommend optimal dental care, especially in rural settings which have minimal access to comprehensive dental care. METHODS AND ANALYSIS: The clinical trial will enrol 220 adults (18-65 years) with cavitated carious lesions attending the Amrita School of Dentistry in the Ernakulam district, India. This study is a randomized, controlled trial with a 1:1 allocation ratio in two parallel groups. Study arm 1 will receive 38% SDF application and ART, and study arm 2 will receive ART only. A digital radiograph will be taken immediately after restoration (baseline) as well as at the end of the 6th month for evaluation of caries arrest. The assessment of the survival of the restoration will be done on the 7th day, 30th day, and at the end of the 6th month. The final analysis would include both the tooth and person levels. ETHICS AND DISSEMINATION: This trial adheres to the principles of the Declaration of Helsinki and the guidelines of the Indian Council of Medical Research (ICMR). This study protocol has been approved by the Institutional Review Board. This trial has been registered prospectively with the Clinical Trial Registry of India (Registration No: CTRI/2021/12/038816).