Knowledge and Awareness of Role of Endodontics in Forensic Odontology- A Questionnaire Based Survey among Postgraduate Students

The unique nature of human teeth has always been a special aid in personal identification throughout history.[1] Forensic odontology is a branch of dentistry that deals with the application of dental knowledge to those criminal and civil laws that are enforced by the investigative agencies in a criminal justice system.[2] Dental tissues are the strongest tissues in the human body and therefore their characteristics remain unchanged even in extreme environment and can survive long periods in conditions like burial under soil, fire and exposure to any biological agents in the environment.[3] Therefore, the importance of teeth in forensics is profoundly increasing. Endodontics in particular plays a pivotal role in forensic investigation by providing adequate knowledge of root canal anatomy, periapical radiographs, dental restorations, which favour comparison and personal identification of a deceased person.[1]We wanted to evaluate the knowledge and awareness of the role of endodontics in forensic odontology among postgraduate students enrolled in the specialty of Conservative Dentistry and Endodontics.METHODSA standardized web-based questionnaire survey was conducted in a group of post graduate students n=306 (endodontists) in which 20 questions related to the role of endodontics in forensic odontology were included. The responses were recorded, and the data was analyzed using statistical analysis. Based on the responses obtained, data was analysed, and the frequencies and percentages were calculated.RESULTSThe results of the present survey revealed that 6% of total participants had good awareness (>16 Qs), 62% of total participants showed moderate awareness (10-16 Qs) and 32% of total participants had poor awareness (<10 Qs)CONCLUSIONSThis survey was conducted to assess the knowledge and awareness on practical usefulness of endodontics in forensic odontology. By considering the present expansion in field of forensic odontology, endodontists should be knowledgeable of the role and importance of their specialization in personal identification.

Evaluation of surface integrity of root end cavities prepared using conventional and piezoelectric devices: A scanning electron microscopy study

Introduction: An array of factors control the success of endodontic surgery. One of them is the technique used to prepare the root end cavities which is conventionally being done with burs. In past decades, ultrasonic instruments have been introduced for the same. Studies comparing these instruments on root surface integrity are scarce. Thus, an in-vitro Scanning Electron Microscopy study was designed to evaluate the surface integrity of root end cavities prepared using conventional and piezoelectric devices. Methodology: Twelve single-rooted human intact mandibular premolar teeth were endodontically treated and included in the study. They were divided into two groups. In the first group, 3 mm root-end cavities were prepared using conventional retro preparation burs and in the second group, 3 mm root-end cavities were prepared using piezoelectric retro-tips. The specimens were coded for blind evaluation and analysed under scanning electron microscope at 100x, 500x and 1000x magnification for smear layer and debris. Gutmann's scoring criteria was followed to score the specimens. Statistical analysis was carried out using Shapiro Wilk test and the independent sample t-test was used to check mean differences between variables. Results: It was noted that significant statistical differences existed in mean debris and smear layer scores (p<0.001) between the two groups. In the piezoelectric group, significantly lower debris layer and smear layer was found, compared to the conventional bur group. Conclusion: Root-end cavities prepared using piezo retrotips produced cleaner, well-centered and more conservative surface with minimal debris & smear layer, compared to root-end cavities prepared using conventional burs.

Reverse rotary instrumentation in the apical third of the root canal system: An scanning electron microscope analysis

The aim of the present study was to evaluate the efficacy of reverse rotary instrumentation in disinfection of the root canal at the apical third and qualitative confirmatory analysis using the scanning electron microscope (SEM). Subjects and Methods: Sixty single-rooted mandibular premolars were instrumented up to Protaper rotary file size F2 and contaminated with a known species of Enterococcus faecalis (ATCC 29212). The samples were then divided into three groups; Group 1: Experimental group-irrigation by agitation of 1% NaOCl with reverse rotary instrumentation; Group 2: Negative control-no irrigation; and Group 3 positive control-irrigation with 1% NaOCl using a 30-gauge needle. The colony forming units of all the groups were checked. SEM analysis of the samples was focused on the apical third to confirm the absence of E. faecalis biofilms. The data obtained were statistically analyzed by the Fisher's exact test and Pearson's Chi-square test. Results: Group I and III showed significant reduction in the growth of E. faecalis (P ≤ 0.001). SEM confirmed dense bacterial colonies in the Group II consistent with biofilm formation and reduction in bacterial colonies in Group I and II. Conclusion: Agitation with reverse rotary instrumentation in the apical third of the root canal along with 1% sodium hypochlorite proved effective in disinfection of the apical third of the root canal, which was further confirmed by scanning electron microscopic analysis. Hence, it can be used as an adjunct during rotary instrumentation in efficient cleansing of the root canal system in the apical third of the root canal system.

Comparative Evaluation Of The Effect Of Various Remineralizing Agents On Root Dentin: An In Vitro Study

50 root dentin sections were obtained from 25 extracted premolars and divided randomly into 5 groups of 10 samples each. Except group 1, all the other group specimens were demineralised by immersing in a demineralising solution for 96 hours at 370C. The specimens were then subjected to surface treatment with grape seed extract, silverdiamine fluoride and calcium sucrose orthophosphate complex according to the groups. The samples were stored in artificial saliva during the intervals and subjected to pH cycling and evaluated using SEM-EDAX and the results statistically compared. The tested remineralizing agents showed statistically significant increase in remineralization when compared to the demineralized group. Calcium sucrose orthophosphate showed the highest Ca/Pvalues followed by Silver diamine flouride and grape seed extract

Comparative Evaluation of Smear Layer Removal Efficacy Using QMix 2in1, Chitosan, Smear Clear and Glyde.

Aim and Objective: The effects of four endodontic irrigants and on a smear layer created by hand and rotary instrumentation were evaluated in vitro in the middle and apical thirds of root canals. Materials and Methods: Forty eight mature extracted mandibular premolar teeth with a single root canal and a closed apex were distributed randomly into four groups of 12 teeth each. Whilst cleaning and shaping up to size F5 using Protaper Universal System, the root canals were irrigated with 3 mL of 5.25% NaOCl, between each file size. Group 1 (G1) were irrigated with a final flush of QMix 2in1. The teeth in group 2 (G2) were irrigated with a final flush of 0.2%Chitosan, group 3 (G3) with Smear Clear and group 4 (G4) with Glyde. The teeth were split longitudinally and prepared for examination by scanning electron microscopy. Results: Specimens irrigated with a final flush of Glyde (G4) or 0.2%Chitosan (G2) were cleaner than with QMix and Smear Clear, showing very clean root canal surfaces in the middle one-third but in the apical one-third the smear layer was not completely removed, especially at the openings of the dentinal tubules. Statistical analysis showed no significant difference in the cleanliness of root canal wall between G1, G2, G3 and G4. Conclusion: Irrigation with QMix 2in1, Smear Clear, 0.2%Chitosan, and Glyde and 6% did not remove all the smear layer from the root canal system. All these irrigants showed less effectiveness in removal of smear layer from apical 3rd. Glyde showed maximum efficacy in removal of removal of smear layer followed by 0.2%Chitosan, Smear Clear and then QMix 2in1.

Strains and Sprains in Dentistry.

Dental clinicians are routinely exposed to various occupational hazards; chemical, biological and legal as well as ergonomic, which contribute to musculoskeletal disorders (MSD). The aim of the present study was to evaluate the prevalence of musculoskeletal disorders among dentists in South Kanara population and to determine the specialties associated with the highest risk of developing MSD. A total of 100 clinicians participated in the study which included a self assessed questionnaire to determine the site of pain and symptoms associated with it which was followed by the clinician assessed RULA questionnaire (Rapid Upper Limb Disorder Assessment) to determine the posture during their work, the risks associated and finally the need to improve the condition. According to the questionnaire survey, MSD’s were more prevalent among prosthodontists, endodontists, pedodontists & orthodontists compared to the other departments. According to RULA assessment endodontists and prosthodontists were at the maximum risk of developing MSD’s. Severe pain was due to high level of the RULA score; indicating that dentists with higher RULA scores needed to affirm to appropriate working postures. The study concluded that appropriate measures need to be taken into consideration to reduce the prevalence of musculoskeletal disorders to educate the dentists about the right ergonomic positions, awareness about work related risk factors and taking measures to lead a healthy life.

Prevalence of Tooth Wear Due to Dietary Factors in South Canara Population.

Aims: The aim of the study was to determine the prevalence of tooth wear due to dietary factors in South Canara population. Place and Duration of Study: Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Deralakatte Mangalore and the rural satellite centers. Duration of the Study: June 2014 - July 2014 (1 Month). Methodology: 2000 patients were evaluated using diagnostic instruments for presence of attrition, erosion, abrasion and abfraction, followed by the questionnaire which evaluated the prevalence of tooth wear due dietary factors in South Canara Population. Collected data were statistically analyzed using the “Statistical Package for the Social Sciences” (SPSSv16.0) software. Statistical Analysis: Data obtained was statistical analyzed using Statistical Package for the Social Sciences (SPSSv16.0). Differences between variables were analyzed using Pearsons Chisquare test. Results: Total prevalence of tooth wear in the study population is 58.7% out of which attrition (18.9%), abrasion (25.1%) erosion (3.8%) and abfraction (10.9%) was observed. A significant increase of tooth wear in males (85.45%) was observed. In the present study prevalence of tooth wear was significant in age group of 56-65 years (68.9%) whereas attrition (57.40%) in age group >=66 and abrasion (47.42%) was significantly more in age group of 56-65 years respectively. Erosion is significantly high in age group of 26-35 years (7.2%), abfraction in age group of 36-45 years (10.3%). Nonvegetarians (32%) showed increased tooth wear with urban population having the highest prevalence (74.9%) and alcohol consumption being a major cause for erosion (57.33%). Tooth wear is an irreversible, non carious, destructive process, which results in a functional loss of dental hard tissue. Dietary factor is one of the etiologies of tooth wear, the role of acidic foods and drinks are probably important for the progression of tooth wear. Conclusion: The response to this current study conducted to evaluate the prevalence of tooth wear due to dietary factors in south canara population stated that tooth wear was more prevalent in males and most affected age group was 56-65 years. Non-vegetarians showed increased tooth wear and alcohol consumption being one of the major cause for erosion.

BisGMA and TEGDMA Elution from Two Flowable Nanohybrid Resin Composites: An In vitro Study.

Aim: The aim of our study was to evaluate the amount of release of BisGMA and TEGDMA from two commercially available enamel replacement composites; Tetric N-Flow™ and G-aenial Universal Flo™ over a period of 24 hours after polymerization with a standard LED Curing Unit. Methods and Materials: Two flowable nanohybrid composite materials; Tetric N-Flow™ (Ivoclar Vivadent AG, Liechtenstein) and G-aenial Universal Flo™ (GC, India) were investigated and grouped into two groups. Ten samples from each group were prepared by inserting the material into a standardized Teflon mould of size 2x2x2 mm. Each sample was cured with a LED curing unit for 20 seconds and was stored in 2 ml of Ethanol at room temperature. After 24 hours, the samples were removed from the storage medium (ethanol) and prepared for measurements. A reverse phase HPLC unit was used to detect the release of BisGMA and TEGDMA monomers from the prepared samples. The acquired measurements were obtained after testing them in a High Liquid Performance Chromatography Unit. The data obtained was statistically analyzed and the results revealed significant amount of release of TEGDMA as well as BisGMA Results: G-aenial Universal Flo™ showed significant release of both TEGDMA as well as BisGMA as compared to Tetric N- Flow™. The increase was by 0.5 units. Conclusion: Significant amount of release of TEGDMA as well as BisGMA was seen in both the composite materials after HPLC Unit analysis. This can help in the evaluation of cytoxicity to the soft tissues in the oral environment.

Effect of Electron Beam Irradiation or Flexural Strength of two Nanocomposites-an In vitro Study.

Aim: The aim of this study is to investigate whether dental nanocomposite Filtek Z350 XT and Ceram X-duo can benefit from electron beam irradiation in order to achieve increased flexural strength Place and Duration of Study: Department of Conservative Dentistry and Endodontics, A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Deralakatte, Mangalore, India and Microtron Centre; Department of Physics Mangalore University; Mangalore, India between May 2011 to March 2014. Materials and Methods: Materials were prepared on rectangular bar shaped specimens of 25-×2-×2-mm according to ISO standard -4049. Electron beam irradiation dose selected for the study were 1KGy, 3KGy and 5KGy. In total, 48 specimens were fabricated and divided into 4 groups based on radiation dose group I (non-radiated), group II (1KGy), group III (3KGy), group IV (5KGy) with 12 specimens in each. After 24 hours, specimens were subjected to 3-point bend test on a universal uniaxial servo mechanical testing machine. Statistical Analysis: Performed using one way ANOVA and inter group comparisons were done using tukeys multiple comparision. ‘P’ value<0.05 was considered statistically significant. Results: Flexural strength of Filtex Z350 XT before radiation was170.89±9.07.Flexural strength of Filtex Z350 XT after irradiation with 1KGy, 3KGy and 5KGy was found to be 269.06±94.91, 326.53±54.74 and 377.64±74.5 respectively. P value statistically significant (P<0.0001). Flexural strength of Ceram X duo before radiation was120.14±7.12.Flexural strength of Ceram X duo after irradiation with 1KGy, 3KGy and 5KGy was found to be 206.27±76.38, 177.31±67.35 and 229.33±59.15 respectively. P value statistically significant (P<0.0001). Conclusion: It can be concluded that electron beam irradiation can be used as a tool to modify the present day dental materials for enhancing their mechanical properties.

Effect of four different intracanal medicaments on the apical seal of the root canal system: A dye extraction study.

Aim: The aim was to determine the effect of four different intracanal medicaments on the apical seal of the root canal system in vitro. Methodology: Fifty freshly extracted intact human permanent maxillary central incisors were collected, stored and disinfected. The root canals were prepared to a master apical size of number 50 using step back technique. Depending upon the intracanal medicament used, the teeth were divided randomly into five groups of 10 teeth each including one control group and four experimental groups. Group A: No intracanal medicament. Group B: Calcium hydroxide powder mixed with distilled water. Group C: Calcium hydroxide gutta percha points (calcium hydroxide points). Group D: 1% chlorhexidine gel (hexigel). Group E: Chlorhexidine gutta percha points (Roeko Activ Points). The medication was left in canals for 14 days. Following removal of the intracanal medicament, all the groups were obturated with lateral compaction technique. The apical leakage was then evaluated using dye extraction method with the help of a spectrophotometer. Results: Results were statistically analyzed using Kruskal-Wallis and Mann-Whitney U-test, which showed statistically significant difference among the five groups tested. Conclusion: It can be concluded from this study that the control group showed least amount of leakage, whereas the 1% chlorhexidine gel group showed maximum amount of leakage. Apical leakage was observed with all the experimental groups with little variations in between them. Under the parameters of this study, it can be concluded that use of intracanal medicaments during endodontic treatment has a definite impact on the apical seal of the root canal system.

Correlation between Dental Caries and Salivary Albumin in Adult Indian Population– An In Vivo Study.

Aim: To analyze the relationship between dental caries, albumin in young adults between the age group of 20 to 30 years from South Canara district, Karnataka with varying caries experience as determined by their caries progression Methods and Materials: Eighty subjects from the outpatient department ranging between 20 to 30 years of age were screened and evaluated for their caries experience. Based on their level of caries a total of 80 subjects were selected and divided into four groups of 20 subjects each as follows; Group 1: enamel caries, Group 2: dentinal caries, Group 3: pulpal caries, Group 4: control group. The saliva was collected and analyzed for the presence of albumin levels in saliva and correlated to the same levels in serum. The statistical analysis was done using one way ANOVA test. Results: According to the present study there is an increase in the levels of caries with decrease in the levels of albumin. Serum albumin levels were also found to be decreased in caries prone individuals, hence showing a significant correlation between serum and salivary albumin levels. Conclusions: In the present study we found an inverse relationship between the levels of albumin in saliva and dental caries confirming the importance of albumin levels in inhibiting caries progression. Besides a correlation was also found between the levels of albumin in saliva and serum. Hence it can be used as a biochemical indicator in evaluating the susceptibility of caries.

Electron Beam Irradiation of Resin Luting Agents - a Cytotoxic Evaluation on Dental Pulp Cells.

Aim: The aim of this study was to evaluate the cytotoxicity of three resin luting agents Rely X luting cement, Rely X luting 2 cement and Clearfil SA luting cement before and after electron beam irradiation. Materials and Methods: Growth and maintenance of cell cultures of human pulp cells was done in Dulbecco’s modified Eagle’s Medium (DMEM). The test samples were divided into two Categories: Irradiated Category and Non-radiated Category. Samples in Irradiated category were exposed to electron beam radiation at 200Gy. Three subgroups of radiated category and non radiated category were made. All the samples were subjected to MTT assay and spectrophotometric analysis and their cytotoxicity was assessed. Statistical analysis was done using t test. Results: Evaluation of Rely X luting Cement showed that radiated samples of powder, liquid and set cements showed decreased cell viability than non radiated samples. In Case of Rely X luting 2 cement, radiated samples showed increased cell viability for Paste A and Paste B samples. But in set material, irradiated samples showed decreased cell viability as compared to non radiated samples. For Clearfil SA luting Cement, Paste B showed increased cell viability for radiated samples. Paste A and Set cement of radiated samples showed decreased cell viability than non radiated samples. Conclusion: In the present study , the increased cytotoxicity of irradiated samples may be due to increase in the release of unbound monomers which may be due to chain breakage after irradiation and a reduction in the cytotoxicity which may be due to the cross linking of unbound monomers during irradiation.

Bioceramic Technology in Endodontics.

Bioceramics include ceramic materials specifically designed for use in medicine and dentistry. These materials are mainly alumina, zirconia, bioactive glass, glass ceramics, coatings, composites, hydroxyapatite and resorbable calcium phosphates. Dental applications include dental implants, in periodontal treatment, alveolar ridge augmentation, maxillofacial surgery, pulp capping and apexification. The use of alumina and zirconia can be seen for prosthetic devices although calcium phosphate based materials are used for filling bone defects. Bioceramics are biocompatible, non–toxic, do not shrink and are chemically stable within the biological environment. Bioceramic sealers allow the enhanced use of bioceramics. The future of bioceramics is very promising. Recently, bioceramic putty has been introduced for primary teeth along with other fast repair materials.

Evaluation of total antioxidant capacity of saliva and serum in caries-free and caries-active adults: An in-vivo study.

Context: Oxidative stress is defined as an imbalance between the production of reactive oxygen species and antioxidant defense systems which are widely recognized as an important feature of many diseases including dental caries, suggesting that total antioxidant status may be of importance in determining the progression of caries. Aim: The aim of this study was to estimate the total antioxidant capacity (TAC) in saliva and serum of caries-free and caries-active adults and to correlate the TAC level with DMFT index (D = decayed, M = missing, F = filled, T = teeth). Settings and Design: The present study included 100 healthy adults who were divided into four groups: Control, group I, group II, and group III, with a DMFT index 0, <3, <10, and >10, respectively. Materials and Methods: Saliva and serum samples were collected from all the four groups. The TAC of saliva and serum was estimated by phosphomolybdenum method. Statistical Analysis Used: One-way analysis of variance (ANOVA) was used to compare the TAC of saliva and serum. Only differences with "P" < 0.05 were considered statistically significant. Results: The mean TAC level of both saliva and serum increased significantly (P < 0.001) with the DMFT index. Conclusion: Total antioxidant capacity of saliva has a linear relation with caries, i.e., as the severity of caries increases, the TAC level also increases.