Dental practice management during COVID-19 times-Now and beyond.

AIM: Coronavirus disease 2019 (COVID-19) being declared a global public health emergency has become a significant challenge for all healthcare workers, including dentistry, recognised as a high-risk profession during these times. This consensus statement aims to highlight and provide guidelines necessary to be implemented for a clinical dental practice. MATERIALS AND METHODS: A total of nine conservative Dentists and Endodontists and one Oral and Maxillofacial Surgeon; with four panelists from government dental colleges, one each from the North, South, East and West India and six resource persons from private colleges in South India, all of them being clinicians and administrators practicing dentistry since the inception of the pandemic, collaborated in this consensus statement. The consensus statement was developed through a symposium conducted on the topics; general dental practice during COVID-19 times, the importance of aerosols in clinical dental practice in the spread of COVID-19, effective standard operating protocols for clinical dental practice and Institutional settings with scientific evidence-based justifications, followed by a panel discussion with to devise mandatory protocols to be followed in clinical and institutional settings. The symposium was attended by 46 practitioners who participated in the deliberation. RESULTS: This consensus statement provides clinicians and researchers with protocols for the dental practice, agreed upon by experts in the field. The Consensus Statement has been formulated according to the AGREE Reporting checklist for the formulation of guidelines. CONCLUSION: The experts and panelists reached a Consensus on the protocols and guidelines for the safe clinical and institutional dental practice.

Efficacy of Endo-Ice followed by intrapulpal ice application as an adjunct to inferior alveolar nerve block in patients with symptomatic irreversible pulpitis-a randomized controlled trial.

OBJECTIVE: The purpose of the present study was to evaluate the effect of Endo-Ice followed by intrapulpal ice application for reducing pain during pulp extirpation in mandibular molars with symptomatic irreversible pulpitis. MATERIALS AND METHODS: Sixty patients diagnosed with symptomatic irreversible pulpitis participated in the present study. Subjects were randomly allocated to any one of the following groups: control group-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000), articaine group-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + Buccal infiltration with articaine (4%) with adrenaline (1:100000); or cold group-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + cold application. The outcome assessor measured the level of pain during access opening and pulp extirpation using the visual analogue scale. The anxiety level of the patient was also measured. RESULTS: During access opening, there was a significant difference in the pain reduction in the articaine group when compared to cold and control group (p value = 0.02). During pulp extirpation, cold group and articaine group showed a significant reduction in pain levels as compared to the control group (p value = 0.001). There was no difference in the pain level during pulp extirpation among the two test arms (articaine and cold) (p value = 0.99). Further, cold significantly reduced the level of anxiety when compared to the articaine or control group (p value = 0.001). CONCLUSION: Hence, cold is a simple, supplementary technique in reducing pain during pulp extirpation. CLINICAL RELEVANCE: Application of cold may help in minimizing the fear of additional injection in managing pain during endodontic treatment.

The Outcome of GaAlAs Diode Laser (980 Nm) Pulpotomy in Patients with Symptomatic Irreversible Pulpitis Assessed Using CBCT - Randomised Controlled Trial with an 18-Month Follow-up.

OBJECTIVE: To evaluate the effect of diode laser (GaAlAs-980 nm) for full coronal pulpotomy (FCP) compared to conventional crown pulpotomy (CCP) in mature teeth with symptomatic irreversible pulpitis (SIP) and assess dentine bridge formation after FCP using CBCT. METHODS: A total of 86 patients (43 per group) with SIP in permanent mandibular molars were included. Access opening and FCP were done, after which haemostasis was achieved with 2.5% NaOCl in the CCP group and a diode laser (GaAlAs-980 nm) in the laser crown pulpotomy group (LCP). Biodentine (Septodont, Saint-Maur-des-Fossés, France) was placed, and the cavity was sealed. Clinical and radiographic follow-ups were done at 6, 12, and 18 months, with additional CBCT evaluation at 18 months. Statistical analysis was performed using the Mann-Whitney U test, and survival rates were assessed using Kaplan-Meier analysis. The Cox proportional model was used to determine the effect of possible covariates on pulpotomy outcomes. P<0.05 was considered to be statistically significant. RESULTS: The overall success rate for CCP and LCP at 18 months was 88.4% and 93% respectively. At the end of 18 months, 8 cases (5 in CCP, 3 in LCP) failed. The postoperative pain score at 48 hours was significantly higher for CCP (mean +- standard deviation: 1.7+-1.4; p<0.001). CBCT analysis at 18 months revealed thicker dentine bridge formation for LCP (Median & IQR: 0.89, 1.06) compared to CCP (p=0.0479). The Kaplan-Meier curve showed a more rapid decline in the survival rate of CCP (0.89) compared to that of LCP (0.93). Postoperative pain at 48 hours, PAI scores at 6, 12, 18 months, and age were found to affect the hazard ratio based on the Cox regression model. CONCLUSION: Within the limitations of this trial, there was no significant difference in the outcome between diode laser and conventional pulpotomy. However, LCP resulted in lesser postoperative pain at 48 hours and thicker dentine bridge formation at 18 months, with a longer estimated survival rate. (EEJ-2023-01-011).

Green Synthesis of Ganoderma Lucidum-Mediated Silver Nanoparticles and its Microbial Activity against Oral Pathogenic Microbes: An In Vitro Study.

Nanotechnology is developing into a fast-expanding discipline with applications in science and technology, and nanostructures are a crucial research tool in many fields. Due to their remarkable electrical, optical, magnetic, catalytic, and pharmacological capabilities, metal and metal oxide nanoparticles (NPs) have drawn study interest. Natural elements (plants, microorganisms, fungi, etc.) are utilized in a chemical-free, environmentally benign way to synthesize metals and metal oxides. The optical, electrical, and antimicrobial qualities of silver nanoparticle (AgNP) make them a popular choice. More than 200 active ingredients, including water-soluble, organic-soluble, and volatile chemicals, are found in Ganoderma. The main components are polysaccharides, adenosine, and terpenoids, each of which has exceptional therapeutic properties. This article explains the synthesis of Ag NPs by Ganoderma lucidum and tests the antibacterial effectiveness for use in biological applications.

Influence of Minimally Invasive Access Cavity Designs on the Fracture Resistance of Endodontically Treated Mandibular Molars Subjected to Thermocycling and Dynamic Loading.

INTRODUCTION: The aim of this study was to investigate the fracture resistance of endodontically treated and restored permanent mandibular molars with minimally invasive access cavities subjected to thermocycling and dynamic loading. METHODS: Forty first and second mandibular molars were randomly assigned to 4 groups (n = 10/group) as follows: group 1, control (intact teeth); group 2, traditional access cavity (TradAC); group 3, conservative access cavity (ConsAC); and group 4, truss access cavity (TrecAC). After endodontic treatment, teeth were restored with SDR core (Dentsply Caulk, Milford, DE) and subjected to thermocycling followed by dynamic and static loading with a multiaxial fatigue testing machine (Instron, Canton, MA). The maximum load to fracture and pattern of failure (restorable/unrestorable) were recorded. Data were evaluated with analysis of variance and the Tukey post hoc test for multiple comparisons. RESULTS: Fracture resistance of the samples in the control group were higher than those in the experimental groups (P < .005). TradAC exhibited the least resistance to fracture (P < .005). There was no statistically significant difference in the fracture resistance of ConsAC and TrecAC (P = .361) Unrestorable fractures were more frequent in the TradAC group compared with all other groups. CONCLUSIONS: Mandibular molars with ConsAC and TrecAC exhibited superior fracture resistance compared with TradAC. TradAC had the highest number of unrestorable fractures.

Endodontic management of a mandibular second premolar with four roots and four root canals with the aid of spiral computed tomography: a case report.

Aberrations in the root canal anatomy are a commonly occurring phenomenon. A thorough knowledge of the basic root canal anatomy and its variations is necessary for successful completion of the endodontic treatment. Mandibular second premolars usually have a single root and a single root canal. The incidence of three separate roots itself in this tooth is quite rare, and the presence of four separate roots and four distinct root canals has never been reported in literature so far. The use of spiral computed tomography scan in this rare case greatly contributed towards making a confirmatory diagnosis and successful nonsurgical endodontic management thereafter.

An in vitro study to assess the setting and surface crazing of conventional glass ionomer cement when layered over partially set mineral trioxide aggregate.

The aim of our study was to assess the setting time and surface crazing of glass ionomer cement when layered over partially set mineral trioxide aggregate (MTA). To assess setting time, 40 hollow, cylindrical stainless steel molds were taken and equally divided into 4 groups. In groups I, II, and III glass ionomer cement was layered over partially setting MTA at 45 minutes, 4 hours, and 3 days, respectively. Group IV was used as a control. An additional 50 specimens were prepared for assessment of surface crazing. Twenty specimens (groups I and II) were prepared to study normal and desiccated patterns of conventional glass ionomer cement, respectively. Thirty specimens (groups III, IV, and V) were prepared by layering glass ionomer cement over partially set MTA at various time intervals. All the specimens were stained with red ink and analyzed for craze lines by light microscopy. From our study, it was observed that there was no statistical difference in setting time of glass ionomer cement when layered over partially set MTA in comparison to that of the control group. No craze lines were observed in those specimens (groups III, IV, and V) when viewed under staining and light microscopy. It could be concluded that conventional glass ionomer cement might be layered over partially set MTA after 45 minutes and could be used for single visit procedures.

Two-rooted mandibular second premolars: case report and survey.

Mandibular premolars have earned the reputation for having an aberrant anatomy. Literature is replete with reports of extra canals in mandibular second premolars, but reports about the incidence of extra roots in these teeth are quite rare. This paper attempts at explaining a rare case of successful endodontic management of a two-rooted mandibular second premolar with diagnostic, inter-operative and postoperative radiographic records along with a substantial data on the incidence of extra roots in these teeth. The standard method of radiographic appraisal was maintained as the criteria for determining the presence of extra roots. Totally, 600 patients were examined for a period of four months by three endodontists. Out of them, eight patients had an extra root in one of the mandibular second premolars and three patients showed a bilateral presence of two roots.

Influence of glass-ionomer cement on the interface and setting reaction of mineral trioxide aggregate when used as a furcal repair material using laser Raman spectroscopic analysis.

The prolonged setting time of mineral trioxide aggregate (MTA) is the main disadvantage of this material. This study analyzes the influence of glass-ionomer cement on the setting of MTA using laser Raman spectroscopy (LRS). Forty hollow glass molds were taken in which MTA was placed. In Group I specimens, MTA was layered with glass-ionomer cement after 45 minutes. Similar procedures were done for Groups II and III at 4 hours and 3 days, respectively. No glass ionomer was added in Group IV, which were then considered as control samples. Each sample was scanned at various time intervals. At each time interval, the interface between MTA and glass-ionomer cement was also scanned (excluding Group IV). The spectral analysis proved that placement of glass-ionomer cement over MTA after 45 minutes did not affect its setting reaction and calcium salts may be formed in the interface of these two materials.

Endodontic management of a fused mandibular second molar and paramolar with the aid of spiral computed tomography: a case report.

Fusion and gemination are developmental anomalies of the dental hard tissues that might require endodontic and surgical treatment for functional, orthodontic, or esthetic reasons. In this article, we report a rare case of successful endodontic management of unilateral fused mandibular second molar with a paramolar. The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to diagnose and treat. The use of high-end diagnostic imaging modalities such as spiral computed tomography can help the clinician in making a confirmatory diagnosis and determining the treatment plan before undertaking the actual treatment. This case report highlights the usefulness of spiral computed tomography in accurate diagnosis and endodontic management of these unusual cases.

Assessment of the role of cross section on fatigue resistance of rotary files when used in reciprocation.

OBJECTIVE: The purpose of this study was to assess the role of cross section on cyclic fatigue resistance of One Shape, Revo-S SU, and Mtwo rotary files in continuous rotation and reciprocating motion in dynamic testing model. MATERIALS AND METHODS: A total of 90 new rotary One Shape, Revo-S SU, and Mtwo files (ISO size 25, taper 0.06, length 25 mm) were subjected to continuous rotation or reciprocating motion. A cyclic fatigue testing device was fabricated with 60° angle of curvature and 5 mm radius. The dynamic testing of these files was performed using an electric motor which permitted the reproduction of pecking motion. All instruments were rotated or reciprocated until fracture occurred. The time taken for each instrument to fracture was recorded. All the fractured files were analyzed under a scanning electron microscope (SEM) to detect the mode of fracture. Statistical analysis was performed using one-way ANOVA, followed by Tukey's honestly significant difference post hoc test. RESULTS: The time taken for instruments in reciprocating motion to fail under cyclic loading was significantly longer when compared with groups in continuous rotary motion. There was a statistically significant difference between Mtwo rotary and the other two groups in both continuous and reciprocating motion. One Shape rotary files recorded significantly longer duration to fracture resistance when compared with Revo-S SU files in both continuous and reciprocating motion. SEM observations showed that the instruments of all groups had undergone a ductile mode of fracture. CONCLUSION: Reciprocating motion improved the cyclic fatigue resistance of all tested groups.

Mandibular first molar with a single root and single canal.

Successful endodontic management of mandibular first molar with a single root and single canal is diagnosed with the aid of dental operating microscope and multiple angled radiographs. In addition all the mandibular molars and premolars were single rooted on either side.

Effectiveness of four different final irrigation activation techniques on smear layer removal in curved root canals : a scanning electron microscopy study.

OBJECTIVE: The aim of this study was to assess the efficacy of apical negative pressure (ANP), manual dynamic agitation (MDA), passive ultrasonic irrigation (PUI) and needle irrigation (NI) as final irrigation activation techniques for smear layer removal in curved root canals. MATERIALS AND METHODS: Mesiobuccal root canals of 80 freshly extracted maxillary first molars with curvatures ranging between 25° and 35° were used. A glide path with #08-15 K files was established before cleaning and shaping with Mtwo rotary instruments (VDW, Munich, Germany) up to size 35/0.04 taper. During instrumentation, 1 ml of 2.5% NaOCl was used at each change of file. Samples were divided into 4 equal groups (n=20) according to the final irrigation activation technique: group 1, apical negative pressure (ANP) (EndoVac); group 2, manual dynamic agitation (MDA); group 3, passive ultrasonic irrigation (PUI); and group 4, needle irrigation (NI). Root canals were split longitudinally and subjected to scanning electron microscopy. The presence of smear layer at coronal, middle and apical levels was evaluated by superimposing 300-µm square grid over the obtained photomicrographs using a four-score scale with X1,000 magnification. RESULTS: Amongst all the groups tested, ANP showed the overall best smear layer removal efficacy (p < 0.05). Removal of smear layer was least effective with the NI technique. CONCLUSION: ANP (EndoVac system) can be used as the final irrigation activation technique for effective smear layer removal in curved root canals.

Endodontic management of maxillary second molars fused with paramolar tubercles diagnosed by cone beam computed tomography - two case reports.

The main objective of nonsurgical endodontic treatment is to eliminate micro-organisms from the root canal system. Adequate knowledge of the root canal morphology and its complexities is essential to render successful endodontic treatment. Variations in tooth form and morphology may be found in the form of anomalous cusps in the crown region or additional roots. In permanent molars, changes in the crown morphology may occur either in the form of an additional tooth (paramolar) or supernumerary cusp termed as "paramolar tubercle".

Efficacy of passive ultrasonic irrigation with natural irrigants (Morinda citrifolia juice, Aloe Vera and Propolis) in comparison with 1% sodium hypochlorite for removal of E. faecalis biofilm: an in vitro study.

AIM: Present study evaluated the efficacy of natural derivative irrigants, Morinda citrifolia juice (MCJ), Aloe Vera and Propolis in comparison to 1% sodium hypochlorite with passive ultrasonic irrigation for removal of the intraradicular E. faecalis biofilms in extracted single rooted human permanent teeth. MATERIALS AND METHODS: Biofilms of E. faecalis were grown on the prepared root canal walls of 60 standardized root halves which were longitudinally sectioned. These root halves were re-approximated and the samples were divided into five groups of twelve each. The groups were, Group A (1% NaOCl), Group B (MCJ), Group C (Aloe vera), Group D (Propolis) and Group E (Saline). These groups were treated with passive ultrasonic irrigation (PUI) along with the respective irrigants. The root halves were processed for scanning electron microscopy. Three images (X2.5), coronal, middle and apical, were taken for the twelve root halves in each of the five groups. The images were randomized and biofilm coverage assessed independently by three calibrated examiners, using a four-point scoring system. RESULTS: 1% NaOCl with passive ultrasonic irrigation (PUI) was effective in completely removing E. faecalis biofilm and was superior to the natural irrigants like MCJ, Aloe vera and Propolis tested in this study. CONCLUSION: 1% NaOCl used along with passive ultrasonic irrigation was effective in completely removing E. faecalis biofilm when compared to natural irrigants (MCJ, Aloe Vera and Propolis).

Comparative evaluation of the antimicrobial activity of natural extracts of Morinda citrifolia, papain and aloe vera (all in gel formulation), 2% chlorhexidine gel and calcium hydroxide, against Enterococcus faecalis: An in vitro study.

AIM: A comparative evaluation of the antimicrobial activity of natural extracts of Morinda citrifolia, papain, and aloe vera (all in gel formulations), 2% chlorhexidine gel and calcium hydroxide, against Enterococcus faecalis-an in vitro study. MATERIALS AND METHODS: The antimicrobial efficacy was assessed in vitro using dentin shavings collected at 2 depths of 200 and 400 µm. The total colony forming units at the end of 1, 3, and 5 days were assessed. RESULTS: The overall percentage inhibition of bacterial growth (200 and 400 µm depth) was 100% with chlorhexidine gel. This was followed by M. citrifolia gel (86.02%), which showed better antimicrobial efficacy as compared with aloe vera gel (78.9%), papain gel (67.3%), and calcium hydroxide (64.3%). There was no statistical difference between data at 200 and 400 µm depth. CONCLUSION: Chlorhexidine gel showed the maximum antimicrobial activity against E. faecalis, whereas calcium hydroxide showed the least. Among the natural intracanal medicaments, M. citrifolia gel consistently exhibited good inhibition up to the 5(th) day followed by aloe vera gel and papain gel.

Four-rooted maxillary first molar having C-shaped palatal root canal morphology evaluated using cone-beam computerized tomography: a case report.

The aim of this article was to present an endodontically managed maxillary first molar with unusual C-shaped palatal root morphology confirmed by cone-beam computerized tomography (CBCT) images. CBCT axial images showed the presence of C-shaped palatal root canal anatomy with a palatal root bifurcation at the apical third. The evaluation of CBCT images can result in better understanding of root canal anatomy, which enables the clinician to investigate the root canal system and to clean, shape, and obturate it more effectively.

Comparison of Endovac irrigation system with conventional irrigation for removal of intracanal smear layer: an in vitro study.

AIM: This study comparatively evaluated the efficacy of Endovac irrigation system with conventional needle irrigation in removing smear layer from the root canal. STUDY DESIGN: Thirty permanent maxillary central incisors were divided into 3 groups of 10 teeth each. In group I, the teeth were instrumented and irrigated by conventional irrigation using 27-gauge irrigation needle. In group II, irrigation was done using Endovac irrigation system. In group III (negative control) chemomechanical preparation was performed using saline solution. Scanning electron microscope evaluation was done for assessment of smear layer removal in the coronal, middle, and apical thirds. RESULTS: Data were analyzed using post hoc test and Kruskal-Wallis test for significance at P < .05. Statistically significant difference was seen between the 2 test groups in smear layer removal from the apical third (3 mm) of the root canal, although no significant difference was seen in the coronal and middle thirds. The most efficient smear layer removal was seen in group II (Endovac) compared with other groups (P < .05). CONCLUSIONS: The study showed significantly better removal of smear layer from the apical third of root canal using Endovac compared with conventional needle irrigation.