Evaluating the Concentration of MMP-9 and TNF- α in Pulpal Blood at Various Stages of Pulpal Inflammation in Diabetics: A Cross Sectional Study.

OBJECTIVE: To investigate the concentration of Matrix metalloproteinases-9 (MMP-9) and Tumor necroses fac- tor-alpha (TNF- α) in pulpal blood at various stages of pulpal inflammation in diabetics and to establish the relationship between these two biomarkers. METHODS: 77 patients, each having a tooth with pulpal exposure due to caries presenting with distinct stages of pulpitis were grouped into 2 main study groups as based on the HbA1c Levels-Group 1: Non-Diabetics (Control Group) (HbA1c < 5.6%) and Group 2: Type 2 Diabetics (Experimental Group) (HbA1c>6.5%; Random Plasma Glucose > 200) and diabetes mellitus with less than 10-year history. Depending on the radiological and clinical diagnosis, these two groups were again sub-divided into 2 subgroups: Sub-group A: Tooth with Symptomatic Irreversible Pulpitis. Sub Group B: Tooth with Reversible Pulpitis. Thus, for comparison purposes, a total of 4 sub-divisions were formed: Sub-group 1A- Non-Diabetic, Symtomatic Irreversible Pulpitis, Sub- group 1B: Non-Diabetic, Reversible Pulpitis, Sub-group 2A: Diabetic, Symptomatic Irreversible Pulpitis, Sub- group 2B: Diabetic, Reversible Pulpitis. Blood sample was collected from pulp chamber after partial pulpo- tomy was done. The total levels of MMP-9 and TNF-α were assessed by enzyme linked immunosorbent assays (ELISA). Inter-group comparison in levels of MMP-9 and TNF- α were conducted using the Kruskal Wallis test and pairwise comparison was done Mann-Whitney U test. RESULTS: The inter-group comparison in levels of MMP-9 and TNF- α were conducted using the Kruskal Wallis test and pairwise comparison was done using Mann-Whitney U test. Pearson correlations were conducted in order to investigate correlations between the paired TNF-α and MMP-9 values and also their correlation with the blood sugar levels within the pulp diagnosis groups. MMP-9 and TNF-α levels were significantly higher (p<0.005) in irreversible pulpits than reversible pulpits and also in Type-2 diabetics than non-diabetics. High- est level of MMP-9 and TNF-α was found in Group 2A (Diabetic, symptomaticirreversible pulpitis) and lowest in Group 1B (Non-Diabetic, reversible pulpitis). There exists a very high significant positive correlation between MMP-9 and TNF-α (p<0.005). CONCLUSION: These findings show that the inflammatory mediators MMP-9 and TNF-α are significantly in- creased in pulpal blood samples of diabetic patients. Also, in diabetic patients diagnosed with reversible pul- pitis, higher levels of inflammatory pulpal biomarkers were reported that could compromise the success of Vital Pulp Therapy (VPT) and may necessitate endodontic intervention. MMP-9 and TNF- α were reported to have a positive correlation. (EEJ-2023-01-04).

Assessment of pulp vitality: a review.

BACKGROUND: One of the greatest diagnostic challenges in clinical practice is the accurate assessment of pulp status. This may be further complicated in paediatric dentistry where the practitioner is faced with a developing dentition, traumatized teeth, or young children who have a limited ability to recall a pain history for the tooth in question. A variety of pulp testing approaches exist, and there may be confusion as to their validity or appropriateness in different clinical situations. AIM: The aim of this paper is to provide the clinician with a comprehensive review of current pulp testing methods. A key objective is to highlight the difference between sensitivity testing and vitality testing. A biological basis for pulp testing is also provided to allow greater insight into the interpretation of pulp testing results. The rationale for, and methods of, assessing pulpal blood flow are described.

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.

Comparison of electrical, thermal, and pulse oximetry methods for assessing pulp vitality in recently traumatized teeth.

Pulse oximeter is a well-established and noninvasive method for measuring vascular health by evaluating oxygen saturation. This study compared the efficacy of a custom-made pulse oximeter dental probe with the electric pulp testing and thermal testing for measuring pulp vitality status of recently traumatized permanent teeth. Readings for pulp vitality for 17 recently traumatized maxillary incisors were taken with custom-made pulse oximeter dental probe (group 1), electrical pulp tester (group 2), and thermal testing (group 3) over a 6-month period. The proportion of recently traumatized teeth showing a positive responsiveness in thermal/electric pulp tests increased from no teeth showing responsiveness on day 0 to 29.4% teeth on the 28th day, 82.35% of teeth at 2 months, and 94.11% teeth at 3 months. However, pulse oximeter gave positive vitality readings that remained constant over the study period from day 0 to 6 months in all patients.

Evaluation of efficacy of a new custom-made pulse oximeter dental probe in comparison with the electrical and thermal tests for assessing pulp vitality.

Pulse oximetry is a noninvasive method of measuring vascular health by evaluating oxygen saturation. This study evaluated the efficacy of a new custom-made pulse oximeter dental probe in comparison with the electrical and thermal tests for assessing pulp vitality. Sensitivity, specificity, negative predictive value, and positive predictive value for each test were calculated by comparing the test results with the actual pulpal status, as evaluated by direct visual inspection. The sensitivity of the pulse oximeter was found to be 1.00, as compared to 0.81 with the cold test and 0.71 with the electrical test. The specificity of the pulse oximeter was 0.95, as compared to 0.92 with the cold and electrical pulp tests. Thus, the custom-made pulse oximeter dental probe is an effective, accurate, and objective method of evaluating pulp vitality.

Preexisting Dentinal Microcracks in Nonendodontically Treated Teeth: An Ex Vivo Micro-computed Tomographic Analysis.

INTRODUCTION: This study evaluated the prevalence, location, and pattern of preexisting dentinal microcracks in roots of extracted teeth without endodontic treatment in patients from 2 age groups using micro-computed tomographic imaging. METHODS: Six hundred thirty-three nonendodontically treated teeth extracted using an atraumatic procedure because of reasons unrelated to this study were collected and divided based on the patient age. Teeth were scanned with micro-computed tomographic imaging (resolution of 26.7 µm) to examine the presence of preexisting dentinal microcracks in roots. The characteristic features of preexisting dentinal microcracks determined were location, extent, length, and coronoapical distribution. Chi-square bivariate analysis was performed to assess the association between various parameters. RESULTS: Forty-five of 633 nonendodontically treated teeth exhibited preexisting microcracks in roots with a prevalence of 7.1%. The prevalence of preexisting microcracks was found to be 8.3% in older patients (40-70 years) compared with 3.7% in younger patients (20-39 years) (P < .050). A significant association was found between the preexisting microcracks in mandibular teeth (10.3%) when compared with maxillary teeth (2.9%) (P < .001). All preexisting microcracks were located mesiodistally; 66% occurred in the cervical and middle thirds of root. Only 33% of the preexisting microcracks were complete in nature, showing canal involvement. Complete dentinal microcracks exhibited a mean length of 6.9 mm, whereas incomplete cracks had a mean length of 3.75 mm (P < .001). CONCLUSIONS: Preexisting dentinal microcracks in roots of nonendodontically treated teeth occurred more often in older patients (40-70 years) in the mesiodistal direction. They were predominantly found in the cervical and middle thirds of root and were more likely to be incomplete in nature.

Endodontic management of a maxillary first molar with a single root and a single canal diagnosed with the aid of spiral CT: a case report.

The aim of this article is to present an endodontically managed maxillary first molar with an unusual morphology of a single root and a single canal, which has not been reported in the literature so far. An accurate assessment of this unusual morphology was made with the help of a Spiral computed tomography. This report extends the range of known possible anatomical variations to include teeth with lesser number of roots and canals. This report also highlights the role of Spiral computed tomography as an objective method to confirm the three-dimensional anatomy of teeth.

Coronal sealing ability of three sectional obturation techniques--SimpliFill, Thermafil and warm vertical compaction--compared with cold lateral condensation and post space preparation.

The purpose of this study was to evaluate the effect post space preparation has on the coronal seal of root canals obturated with cold lateral condensation of gutta-percha compared with the corsonal sealing ability of three sectional obturation techniques not requiring post space preparation. Sixty-eight human maxillary central incisors were divided equally into four groups: cold lateral condensation (Group I), SimpliFill (Group II), Thermafil (Group III) and warm vertical compaction (Group IV). After coronal flaring, all four groups were cleaned and shaped with Lightspeed rotary instruments to a size 60 master apical rotary. After obturation Peeso Reamers were used to create a post space for Group I, while Groups 2, 3 and 4 incorporated the post space in the obturation (sectional technique) and did not require making a post space after obturation. The teeth were then stored in 100% humidity for 1 week and then kept in rhodamine B fluorescent dye for 3 weeks. The teeth were then split open, and the linear dye penetration from a coronal to apical direction (coronal seal) was evaluated with a fluorescent light microscope. Statistical analysis showed that Group I (cold lateral condensation followed by post space made with Peeso Reamers) leaked significantly more (P < 0.05) than the remaining three sectional obturation groups. It was concluded that stresses generated during post space preparation might be detrimental to the seal obtained by the obturation. Sectional obturations with their superior sealing ability offer a viable alternative.

An in vivo assessment of the influence of needle gauges on endodontic irrigation flow rate.

AIM: The aim of this clinical study was to assess the influence of irrigation needle gauge on endodontic irrigation flow rates. SETTINGS AND DESIGN: In vivo assessment. MATERIALS AND METHODS: Five specialist endodontists performed intracanal irrigation procedures on 50 mesiobuccal canal of mandibular first molars using three different irrigation needle gauges. Data of time taken for irrigation was recorded by an irrigation testing system and analyzed using independent sample "T" test and one-way analysis of variance (ANOVA) test. The level of significance was set at P < 0.05. STATISTICAL ANALYSIS USED: The following tests were used for the statistical analysis: Independent sample "T" test, one-way ANOVA test, and post hoc multiple comparison was carried out using Tukey's honest significant difference (HSD) test using Statistical Package for the Social Sciences (SPSS) version 16 for Windows. RESULTS: The average flow rate of 26 gauge was 0.27 mLs(-1), of 27 gauge was 0.19 mLs(-1), and of 30 gauge was 0.09 mls(-1). There was statistical significance among the gauges (P < 0.001). 26 gauge had highest flow rate when compared with other groups followed by 27 gauge and 30 gauge respectively. The operator variability for flow rate of three endodontic irrigation needle gauges (26 gauge, 27 gauge, and 30 gauge) was found to be not significant. CONCLUSIONS: Needle gauge has significant influence on endodontic irrigation flow rate.

Endodontic management of a hypertaurodontic tooth associated with 48, XXYY syndrome: A review and case report.

Taurodontism is a developmental anomaly of a tooth characterized by large pulp chamber and short roots. Patients with multiple taurodontic teeth are associated with the probability of a systemic syndrome or chromosomal anomaly. This is the first reported incidence of the endodontic management of a hyper taurodontic mandibular second molar in a patient diagnosed with 48, XXYY syndrome.

Prevalence of periradicular radiolucencies and its association with the quality of root canal procedures and coronal restorations in an adult urban Indian population.

AIMS: The aim of this cross-sectional study was to determine the prevalence of periradicular radiolucencies (PR) from an urban adult Indian population and to investigate the quality of root canal procedures and coronal restorations and their association with prevalence of PR in root-filled teeth. SETTINGS AND DESIGN: Cross-sectional study. MATERIAL AND METHODS: A total of 1,340 subjects (18+ years of age) who reported for non-emergency dental care to 5 different dental care centers had their panoramic radiographs taken during the period from January to December 2013. The periradicular status of 30,098 teeth in these radiographs was evaluated using the Periapical Index Score (PAI). The assessment of the technical quality of the procedure was evaluated based on the criteria of root canal filling length and quality of coronal restoration. STATISTICAL ANALYSIS USED: The data was analyzed statistically by chi-squared test and odds ratio. RESULTS: PR was found in 65% of subjects (n = 865) and 5.8% (n = 1,759) of the 30,098 teeth evaluated (4.30% untreated teeth and 1.53% were root-filled teeth). In all, 4.1% of the teeth (n = 1,234) had some filling material in the root canal(s) and the prevalence of PR in these root-filled teeth was 37.4%, while the remaining 62.6% of root canal-filled teeth showed no evidence of PR. PR occurred significantly more often in teeth where root canal filling was filled more than 2 mm short of radiographic apex or when root filling extruded through the apex. CONCLUSIONS: The prevalence of PR in teeth with untreated root canals in India is 4.30%, which is more than twice the weighted world average, while the prevalence of root-filled teeth (4.1%) is lower than the world average (9.6%). The prevalence of PR in root-filled teeth in India is comparable to that in other populations. Inadequate root canal treatment and poor quality of coronal restoration were associated with increased prevalence of PR.

Erratum: Smile rejuvenation: A case report: Erratum.

[This corrects the article on p. 495 in vol. 17, PMID: 25298657.].

Erratum: Comparative evaluation of the effects of multiple autoclaving on cyclic fatigue resistance of three different rotary Ni-Ti instruments: An in vitro study: Erratum.

[This corrects the article on p. 323 in vol. 16, PMID: 23956534.].

CRIS Guidelines (Checklist for Reporting In-vitro Studies): A concept note on the need for standardized guidelines for improving quality and transparency in reporting in-vitro studies in experimental dental research.

In vitro studies form a pivotal role in dental research contribution to a substantial evidence base. The reporting standards of these studies are not uniform thus resulting in lacunae in evidence reported. The effort of this concept note is to propose a Checklist for Reporting in vitro Studies (CRIS guidelines) that would promote quality and transparency in reporting in vitro studies.

Influence of temperature and concentration on the dynamic viscosity of sodium hypochlorite in comparison with 17% EDTA and 2% chlorhexidine gluconate: An in vitro study.

AIMS: The aim of this study was to assess the influence of temperature and concentration on the dynamic viscosity of sodium hypochlorite in comparison with 17% EDTA and 2% chlorhexidine gluconate. SETTINGS AND DESIGN: In vitro. MATERIALS AND METHODS: Dynamic viscosity measurements of sodium hypochlorite [NaOCl (5.25%, 2.6%, 1.25%)], EDTA (17%), and chlorhexidine gluconate [CHX, 2%] were measured using a rotational digital viscometer at room temperature (25°C). The influence of temperature (45°C, 60°C) and concentration (5.25%, 2.6%, and 1.25%) on the dynamic viscosity of NaOCl was also evaluated. The measurements were performed using a circulating water bath calibrated with a thermostat, and the dynamic viscosity measurements were noted in Centipoise (Cps). STATISTICAL ANALYSIS USED: The tests used for the statistical analysis were Kolmogorov-Smirnov and Shapiro Wilk tests, one-way ANOVA, and independent sample t-test. RESULTS: Viscosity statistically increased with NaOCl concentration and decreased with increasing temperature. Amongst the tested NaOCl groups, 5.25% NaOCl at room temperature was significantly the most viscous (µ =1.5300 Cps) while 1.25% NaOCl at 60°C was significantly the least viscous (µ =1.1800 Cps). CONCLUSIONS: 5.25% NaOCl and 17% EDTA are significantly viscous at room temperature. Elevating the temperature of 1.25% NaOCl to 60°C significantly reduces the viscosity of the NaOCl.

Effects of multiple root canal usage on the surface topography and fracture of two different Ni-Ti rotary file systems.

AIM: The purpose of this study was to evaluate the effect of multiple root canal usage on the surface topography and fracture of Twisted File (TF) and ProTaper (PT) rotary Ni-Ti file systems, using scanning electron microscope (SEM). MATERIALS AND METHODS: Ten sets of PT and TF instruments were used to prepare the mesial canals of mandibular first molars. TF 25, 0.06 taper and PT F1 instruments were analyzed by SEM when new and thereafter every three root canal usages. This sequence was repeated for both the TF and PT groups until 12 uses. Two images of the instrument were recorded, one of the instrument tip and the other 5 mm from the tip, both at × 100 magnification. The sequential use was continued till the instrument fractured and the number of root canal usages for the file to fracture was noted. All fracture surfaces were examined under the SEM. RESULTS: Fresh TF instruments showed no surface wear when compared to PT instruments (P < 0.05). Spiral distortion scores remained the same for both the groups till the 6 th usage (P > 0.05), while at the 9 th usage TF showed a steep increase in the spiral distortion score when compared to PT (P < 0.05). PT instruments fractured at a mean root canal usage of 17.4, while TF instruments showed a mean root canal usage of 11.8. Fractographically, all the TF instruments failed due to torsion, while all the PT instruments failed because of cyclic fatigue. CONCLUSION: PT instruments showed more resistance to fracture than TF instruments.

Irrigation protocol among endodontic faculty and post-graduate students in dental colleges of India: A survey.

BACKGROUND: Irrigation protocol is the most critical step during the disinfection of an infected root canal system. AIM: The purpose of this study was to determine the root canal irrigation trends being practiced among the endodontic teaching faculty and post-graduate students in the dental colleges present in India. MATERIALS AND METHODS: A postal invitation to participate in this national survey was sent to the Department of Conservative Dentistry and Endodontic of 294 Dental Colleges present in India. A total of 2389 forms were successfully delivered out of which 794 duly filled forms were received back. Survey participants were asked about their irrigant selection, irrigant concentration, smear layer removal protocol, and use of adjuncts during irrigation. RESULTS: This survey elicited a positive response rate of 33.23%. Our data indicated that 92.8% of respondents use sodium hypochlorite (NaOCl) as the primary endodontic irrigant, with 26 gauge needle being most preferred for syringe irrigation, with 49.3% of them using it at a concentration of 2.6-4.0%. 68% of our respondents aim to remove the smear layer during the endodontic treatment while 47% reported using ultrasonic activation as an adjunct during their irrigation protocol. CONCLUSIONS: The findings of this survey are that the majority of teaching institutions in India are employing NaOCl (2.6-4.0%) as the primary endodontic irrigant. The concept of smear layer removal is high (68%), and there is a general trend (78%) to modify the irrigation protocol according to the status of the pulp, status of the periapex and in retreatment cases.

Dentinal defects before and after rotary root canal instrumentation with three different obturation techniques and two obturating materials.

AIM: To evaluate the role of rotary root canal instrumentation followed by obturation with three different techniques and two different materials on the incidence of dentinal defects. MATERIALS AND METHODS: One hundred and sixty mandibular premolars were divided into eight groups (n = 20). Group I was left untreated and served as control. The other seven groups were prepared with profile rotary instruments till #40.06 taper. After preparation, group II was left unfilled, groups III, IV, and V were obturated with Gutta-percha and AH Plus sealer using passive technique, lateral compaction and warm vertical compaction, respectively. Groups VI, VII, and VIII were obturated with Resilon and Realseal sealer using passive technique, lateral compaction, and warm vertical compaction, respectively. Roots were then sectioned at 3, 6, and 9 mm from the apex and inspected under a stereomicroscope (50×) for dentinal defects. Chi-square test was performed to compare the incidence of dentinal defects between the groups (P < 0.05). RESULTS: The unprepared control group had no dentinal defects. The instrumentation group (group II) and the obturation group (groups III-VIII) showed significantly more defects than the uninstrumented control group (group I) (P < 0.001). There was no significant difference between the root canal obturating techniques (group III-VIII) when compared with the instrumentation group (group II). On inter group comparison among the obturation groups the number of defects after lateral compaction with Gutta-percha (group IV) was significantly larger than passive Gutta-percha obturation (group III) (P < 0.05). CONCLUSIONS: The results suggest that root canal instrumentation significantly influenced the incidence of dentinal defects or fracture. Dentinal defects were more significantly attributed to the role of root canal instrumentation rather than the type of obturation technique or material. Lateral compaction with Gutta-percha significantly produces more defects than passive Gutta-percha obturation.

Prevalence of white spot lesion in a section of Indian population undergoing fixed orthodontic treatment: An in vivo assessment using the visual International Caries Detection and Assessment System II criteria.

BACKGROUND: Enamel demineralization resulting in White Spot Lesion (WSL) is one of the most common disease outcome associated with fixed orthodontic therapy with high prevalence rates in western countries. However, no such studies have been done on Indian population. AIM: The aim of this study was to evaluate the prevalence of WSLs in a section of urban Indian population between the age group of 12-20 years undergoing fixed orthodontic therapy for a period of 12-15 months. MATERIALS AND METHODS: 180 patients who qualified for this study were examined and evaluated for WSLs: Group I (test group) comprised of 90 subjects who were undergoing orthodontic treatment for a period of 12-15 months; Group II (control group) comprised of 90 subjects who were in need of orthodontic treatment. RESULTS: The result showed a high prevalence rate of 75.6% in Group I compared to 15.6% in Group II. CONCLUSIONS: The study elicited significantly higher prevalence rate of WSLs in Indian patients undergoing fixed orthodontic treatment.

Evaluation of the effect of MTAD in comparison with EDTA when employed as the final rinse on the shear bond strength of three endodontic sealers to dentine.

The purpose of the study was to evaluate the effect of MTAD in comparison with EDTA as a final rinse on the shear bond strength of Kerr, Apexit and AH plus. Dentine surfaces of 135 extracted human non-carious maxillary premolars were divided into three groups (n = 45). Groups I and II were conditioned with 1.3% NaOCl for 20 min, followed by a final rinse of 17% EDTA for 1 min and MTAD for 5 min respectively. Group III was treated with distilled water. Each group was further divided into three subgroups (n = 15). Subgroup 1: Kerr, Subgroup 2: Apexit and Subgroup 3: AH plus. Three-millimetre-long sections of polyethylene tubes were filled with freshly mixed sealer and placed on the dentine surfaces. The bonding between the sealer and dentine surface was evaluated using shear bond testing. The values were statistically evaluated using one way anova followed by Tukey's test. Significant difference was found among the bond strength of the sealers and irrigating regimes. AH plus showed superior bond strength among the tested sealers, when EDTA was employed as the final rinse (P < 0.05). MTAD as a final rinse affected the bond strength of AH plus and Apexit, which were significantly lower than the control group.