Regenerative biomineralization potential of commercially available remineralizing agents as a preventive treatment approach for tooth erosion - An in vitro laser-induced breakdown spectroscopy analysis.

Context: In today's era, erosion is the most prevalent type of tooth wear. The prevention of demineralization with biomineralization is the most desired treatment. Aim: The aim of this study is to evaluate and compare the surface remineralization potential of two remineralizing agents - self-assembling peptide P11-4 (SAP P11-4) and calcium silicate plus sodium phosphate (CSSP) salts on intact and demineralized enamel using laser-induced breakdown spectroscopy (LIBS). Subjects and Methods: Sixteen maxillary premolars were decoronated and split into buccal and palatal halves embedded in acrylic resin with a total sample size of 32 designated into Group 1 (intact teeth) and Group 2 (demineralized teeth). Further subdivision into Groups 1a and 2a (SAP P11-4 group [n = 8]); Groups 1b and 2b (CSSP group [n = 8]), Group 2 was first exposed to Coca-Cola. Then, all groups were subjected to experimental LIBS. Groups 1a and 2a were treated with SAP P11-4 based product, i.e., CURODONT™ PROTECT gel. Groups 1b and 2b were treated with CSSP-based products regimen, i.e., REGENERATE Enamel Science™ Advanced Toothpaste and Advanced Enamel Serum. The LIBS assessment was redone for all groups to attain a change in Ca and P values. Statistical Analysis Used: Inferential statistics were done using Wilcoxon signed-rank test (Before-After product application) and Mann-Whitney U-test (between the groups). Results: According to the statistical evaluation there was a statistically significant difference (P < 0.05), in Ca and P values in demineralized teeth when both SAP P11-4 and CSSP groups were evaluated. Although Ca values exhibited a significant difference in intact teeth, P did not exhibit a significant difference on the application of both remineralizing agents. The remineralizing potential between the two agents, SAP P11-4 and CSSP groups. There was no statistically significant difference ( P <0.05) observed between the two agent's remineralization potential for intact and demineralized teeth. Conclusion: SAP P11-4 and CSSP have the potential to remineralize both intact and demineralized enamel. There was increased remineralization in demineralized samples subjected to erosion.

Recommended clinical practice guidelines of aesthetic dentistry for Indians: An expert consensus.

Objective: The research for analyzing the smile characteristics in the Indian population has been limited with contradictory outcomes. This consensus statement aims to critically review the literature and provide basic practice guidelines on dental aesthetics related to the Indian population. Clinical Considerations: 9 clinicians and 6 resource persons from dental colleges in India collaborated in this consensus statement which covered 6 topics along with 6 introductory and 6 conclusive remarks. The statement was developed through a colloquium conducted on topics; global aesthetics: different smile design proportions and guidelines, patient perspective towards aesthetic dentistry in India, a literature survey of aesthetic dentistry for the Indian population, macro and micro-aesthetics, multidisciplinary approach in aesthetic dentistry, inclusion of high-end technologies in Indian modern-day practice, followed by a panel discussion to devise and establish the practice guidelines of aesthetic dentistry in India. The Consensus Statement has been formulated according to AGREE Reporting checklist. Conclusion: The experts and panelists reached a Consensus on protocols to institute clinical practice guidelines of aesthetic dentistry for Indians. However, based on all available literature from India, further research is required to investigate many questions that have not been previously considered.

Comparative Evaluation of Surface Roughness of Resin- Modified Glass Ionomer and Glass Hybrid Restorative Materials Simulated by Tooth Brushing: An in-Vitro Study

ABSTRACT Objective: Tocompare the effect of tooth brushing on surface roughness of Resin-Modified Glass Ionomer Cement (RMGIC; GC Gold label 2LC Light Cured Universal Restorative) and Glass Hybrid (GH; GC EQUIA SYSTEM- EQUIA Forte™ Fil and EQUIA Forte™ Coat) restorative material at 1- and 3-months interval simulated by tooth brushing. Material and Methods: RMGIC and GH material specimens (20 each) were prepared according to manufacturer instructions in 10mm × 2 mm dimensions using a mylar strip. A specially designed toothbrush simulator was used along with Oral B Pro 2 2000N powered toothbrush and Colgate Total dentifrice (Colgate-Palmolive India limited; Relative dentin abrasivity - RDA:70- Low abrasive) to perform brushing strokes. Specimens were subjected to surface roughness analysis before and after simulated tooth brushing at baseline, 1, and 3 months. Results: The intragroup comparison was done using repeated-measures ANOVA. Intergroup comparisons were done using an independent sample t-test and General Linear Model (ANCOVA). Surface roughness increased from baseline through 3 months in both RMGIC and GH groups. The mean surface roughness in RMGIC group was significantly higher than GH group at baseline 1 and 3-months, respectively (p<0.001, <0.001, and <0.001). Interaction between group and baseline surface roughness was not significant (p=0.466). The estimated marginal means were significantly higher in RMGIC than GH group (p=0.008). Conclusion: The surface roughness of both RMGIC and GH restorative increased from baseline to 1 month and 3 months after the simulated toothbrushing protocol. GH exhibited significantly lower surface roughness than RMGIC at all the tested intervals.

A Comparative Study of the Quality of Apical Seal in Resilon/Epiphany SE Following Intra canal Irrigation With 17% EDTA, 10% Citric Acid, And MTAD as Final Irrigants - A Dye Leakage Study Under Vacuum.

INTRODUCTION: Adequate apical sealing ability of the root canal filling material is an essential requisite for a successful endodontic therapy. Various endodontic irrigants are used for the removal of smear layer before obturating with a solid core material, thereby, reducing microleakage and improving apical seal. Resilon, a synthetic material was developed as an alternative to replace the conventional gutta-percha (standard root canal filling material) and traditional sealers for the obturation of endodontically treated teeth. AIM: To evaluate and compare in-vitro, the post obturation apical seal obtained with Resilon /Epiphany SE (Self Etch) sealer following irrigation with 17% Ethylenediamine Tetra-Acetic Acid (EDTA), 10% citric acid, and MTAD (a mixture of doxycycline, citric acid, and a detergent, Tween 80), as final irrigants in combination with Sodium hypochlorite (NaOCl) using dye leakage under vacuum method. MATERIALS AND METHODS: Fifty five single rooted human maxillary central incisors were subjected to root canal instrumentation. Based on the final irrigation solution, samples were divided into three experimental groups (n=15); (I) 17% EDTA + 1.3% NaOCl, (II) 10% citric acid + 1.3% NaOCl, (III) MTAD + 1.3% NaOCl and two control groups (positive and negative) with 0.9% normal saline as a final irrigant. The samples were obturated with resilon/epiphany SE sealer according to manufacturer instructions and placed in 2% rhodamine B dye solution under vacuum pressure for 30 minutes and allowed to remain in the dye for seven days. All samples were then longitudinally split and examined for dye leakage under stereomicroscope and the data were statistically analysed using one-way ANOVA and post hoc tukey test. RESULTS: Statistically significant difference (p=0.001) was observed in the mean apical leakage between the experimental and the control groups. However, there was no significant difference (p>0.05) observed in the mean apical leakage amongst the three experimental groups. CONCLUSION: 17% EDTA, 10% citric acid, and MTAD were equally effective in achieving the post-obturation apical seal with resilon/epiphany SE sealer when used as a final irrigant in combination with NaOCl.

Isolated mucosal fenestration with localized gingival recession: Closure with an acellular dermal graft. A rare case report with two years' follow-up.

Mucosal fenestrations are rarely encountered in clinical practice, and as such their management is not often reported. Their treatment might be further complicated due to a communication with the oral environment, making them more susceptible to accumulation of debris, plaque, and calculus, thereby reducing the probability of mucosal renewal. The aim of the present case report is to highlight one such rare clinical scenario and its apt and effective management. Surgical management of an uncommon presentation of concomitant gingival recession with an isolated mucosal fenestration in an atypical location, with an allograft matrix is presented here with 2 years' follow-up. A review of the literature reveals no previous application of AlloDerm graft for the management of a similar situation.

Endodontic treatment of a mandibular first molar with 8 canals: a case report.

Presented here is a case where 8 canals were located in a mandibular first molar. A patient with continuing pain in mandibular left first molar even after completion of biomechanical preparation was referred by a dentist. Following basic laws of the pulp chamber floor anatomy, 8 canals were located in three steps with 4 canals in each root. In both of the roots, 4 separate canals commenced which joined into two canals and exited as two separate foramina. At 6 mon follow-up visit, the tooth was found to be asymptomatic and revealed normal radiographic periapical area. The case stresses on the fact that understanding the laws of pulp chamber anatomy and complying with them while attempting to locate additional canals can prevent missing canals.

A comparative evaluation of propolis and 5.0% potassium nitrate as a dentine desensitizer: A clinical study.

AIM: The purpose of this clinical study was to evaluate the efficacy of saturated ethanolic solution of Propolis for the treatment of dentin hypersensitivity. MATERIALS AND METHODS: Ten patients aged 20-40 years with 156 hypersensitive teeth were selected for a 3-month study. Each patient was subjected to treatment with saturated ethanolic solution of Propolis, 5% potassium nitrate and distilled water. The patients were recalled at seventh day, 2 weeks and 4 weeks for the application of the agent and re-evaluation. The final re-evaluation of the patients was done after 3 months from the first application. The responses of the patients to the test temperatures were converted to a ranking and data was statistically analyzed. A statistical analysis was done using ANOVA and Bonferroni test and Tukey HSD test for multicomparison. RESULTS: The results between the Propolis group and the potassium nitrate group showed no significant difference in the immediate post-treatment period; however, the results were significant at the end of first week and second week. At 4 weeks and 3 months period, a comparison between the groups again showed no significant difference. CONCLUSION: It was concluded that Propolis was more effective than 5% potassium nitrate in relieving dentinal hypersensitivity and had an immediate and sustained effect.

A clinical report demonstrating the significance of distinguishing a nasopalatine duct cyst from a radicular cyst.

Endodontic diagnosis is challenging and depends on the organisation of information from the patient history, clinical examination and analysis of the pulp, radiographic and histopathological assessment. A 35-year-old man was endodontically treated for radiolucency in relation to the roots of maxillary central incisors as it was a provisionally diagnosed case of radicular cyst. Since the palatal swelling persisted, the lesion was re-evaluated using relevant diagnostic aids and a diagnosis of nasopalatine duct cyst (NPDC) was made, which was missed during the initial assessment. An erroneous interpretation of cystic radiolucency in relation to maxillary central incisors can often lead to inappropriate treatment planning. This case highlights the relevant aspects in the diagnosis of NPDC when it is mistaken for a radicular cyst and emphasises the need for thorough clinical examination and relevant investigations for periapical radiolucencies of questionable origin before initiating endodontic therapy.

Technique to incorporate mathematical principles into esthetic dentistry.

Space closure in the maxillary anterior segment using direct composite is one of the most challenging esthetic procedures. The challenge lies in determining and achieving the correct dimensions. Various mathematical principles that have been observed in esthetically pleasing smiles can be applied to simplify the procedure and achieve symmetry while treating spaced dentition. The aim was to devise a technique for simplifying the application of mathematical principles in esthetic dentistry and improve the predictability and accuracy of the procedure of space closure using direct composite.

Dilemmas pertaining to three canals in the mesiobuccal root of a maxillary second molar: a case report.

The mesiobuccal root of the maxillary molars is well known to pose a hindrance during endodontic therapy. Presented here is a case of a maxillary left second molar where three canals were located in its mesiobuccal root with the use of visual and diagnostic aids. Difficulties encountered during the process of unveiling the tooth's internal anatomy were discussed. The dilemmas encountered pertained to the root canal configuration, the nomenclature of the extra canals, and the justification for the presence of a third canal. The root canal configuration of 3-2-1 was confirmed for the mesiobuccal root using information gained from clinical, radiographic, and multi-detector computed tomography (MDCT) scan findings. This case demonstrates the need for efforts to locate extra canals in the mesiobuccal root of the maxillary molars as their internal anatomy remains a mystery.

Mandibular lateral incisor with four root canals: A unique case of double tooth diagnosed using multidetector computed tomography.

Double tooth is a dental anomaly consequent to fusion of two or more teeth or gemination of a single tooth. This report describes a unique case of double tooth in relation to a mandibular lateral incisor exhibiting the presence of four root canals. The role of conventional radiography and advanced three-dimensional imaging techniques in the better assessment of complex root canal systems and their aid in endodontic management has also been highlighted.

Sound levels in conservative dentistry and endodontics clinic.

AIM: To evaluate the sound levels generated in dental clinics of conservative dentistry and endodontics. MATERIAL AND METHODS: A decibel-meter with digital readout was used to measure sound levels at different time intervals at the chairside and at the center of the clinic. Minimum and maximum readings during a 3 min interval were recorded. RESULTS: In the post-graduate (PG) clinic, there was significant difference in noise levels between the chairside (66-81 dB[A]) and the center of the clinic (66-67 dB[A]) at certain times. In the under graduate (UG) clinic, noise levels with suction and either high/slow speed handpieces (67-80 dB[A]) were significantly higher than the center of clinic. Suction alone in the UG clinic (63-75 dB[A]) was significantly quieter than in the PG clinic (69-79 dB[A]). CONCLUSIONS: (1) Mean sound levels in the working clinics ranged from 63.0 dB[A] to 81.5 dB[A]. These are within the recommended range for dental equipment. (2) With suction and either low/high speed handpiece combination, the PG clinic was significantly noisier than the UG clinic at several time periods.

Lobodontia: the unravelling of the wolf teeth.

Abnormalities of tooth shape and size generally coexist, as both are determined during the morphodifferentiation stage of odontogenesis. This report describes a case of lobodontia exhibiting multiple dental anomalies of which, "fang like" cuspids, multituberculism of molars, hypodontia along with severe generalized microdontia are distinctive. Radiographic features, diagnostic convolutions, differential diagnosis and clinical significance have also been highlighted.

A self-designed instrument to evaluate cavosurface angle for class I amalgam cavity preparation: A learning aid.

Fighting the controversies, amalgam, as a posterior restorative material has survived till date. The fate of amalgam restoration is determined by geometry of the cavity preparation and cavosurface angle is one integral part of the cavity, which decides the marginal characteristics of the restoration and health of the tooth. Low edge strength of amalgam highlights the importance of cavosurface angle. However, at the same time conservation of the tooth also should be considered. This article presents a self-designed instrument to evaluate and obtain a cavosurface angle close to 110°. The design of the instrument also helps in evaluating parameters, such as depth of the cavity, undercut angle, and allows finishing of the buccal or lingual walls.

Effect of alcoholic and non-alcoholic beverages on color stability and surface roughness of resin composites: An in vitro study.

BACKGROUND: Consumption of certain beverages may affect the esthetic and physical properties of the resin composite, thereby undermining the quality of restorations. AIM: To analyze the effect of three beverages (Whiskey, Coca-Cola, and Nimbooz) on color stability and surface roughness of two different types of resin composites at various time intervals in vitro. MATERIALS AND METHODS: A methacrylate-based nanofilled composite and a silorane-based microhybrid composite were used. Each material was randomly divided into four equal subgroups of 10 samples each according to the beverages used (Whiskey, Coca-Cola, Nimbooz, and Distilled water). The samples were immersed in each beverage for 10 minutes each day for 56 days. Color change and surface roughness measurements were noted at the baseline - the seventh, fourteenth, twenty-eighth, and fifty-sixth day. STATISTICAL ANALYSIS USED: RANOVA and Bonferroni tests were used to find the difference in color change and surface roughness in the two resin composites when immersed in different beverages. The Pearson Correlation test was carried out to test if any correlation existed between color change and surface roughness. RESULTS: Silorane-based resin composites were more stable in different beverages over time. CONCLUSION: The effect of interaction of different resin composites, various beverages, and time depended on a multitude of factors.

Multiple idiopathic cervical resorption: a diagnostic dilemma.

Multiple idiopathic cervical resorption is an uncommon condition, the etiology of which remains unknown. The case of a 36-year-old woman with idiopathic resorption in the cervical areas of multiple teeth is presented. Her medical history was noncontributory, but her dental history was valuable in reaching a diagnosis. Hematologic and endocrinal investigations were unremarkable, but a computed tomography scan revealed relevant information. The progression of the lesion and involvement of multiple teeth without any pattern or chronology are challenges faced when diagnosing and treating this condition.

A comparative evaluation of dentinal hypersensitivity and microleakage associated with composite restorations in cavities preconditioned with air abrasion - An ex vivo study.

BACKGROUND AND OBJECTIVE: Enormous advances have been made in adhesives; however, the problem of post-operative sensitivity has dragged along. Enough literature exists on the effect of air abrasion over bond strength of composites. However, not much is reported on its relation with microleakage and post operative sensitivity. Therefore, the aim of the study was to compare and evaluate dentinal hypersensitivity and microleakage associated with composite restorations in cavities preconditioned with air abrasion. STUDY DESIGN: Fifteen patients were selected for the study who had to undergo extractions of both maxillary first premolars. On each patient, occlusally placed Class V cavities were made using rotary burs on both the premolars. On the right side premolar, restoration was done using total etch technique. On the left side premolar, restoration was done in similar way after preconditioning of the cavity with air abrasion. Sensitivity levels were recorded on a modified visual analogue scale preoperatively and post operatively at 1 week and one month time period. Following extraction, dye penetration test was done and 1 sample each from one group was subjected to Scanning Electron Microscope for evaluation of tooth restoration interface. RESULTS: Clinically significant difference was there in post operative sensitivity levels after one month between the two groups. Increase in sensitivity was less in teeth restored after preconditioning with air abrasion. Dye penetration was also less in teeth restored after preconditioning with air abrasion. However, penetration at the gingival wall was more than the occlusal wall in both the groups. CONCLUSION: The study consolidates the fact that microleakage and post operative sensitivity are linked directly. It also proves that air abrasion can help in reducing the post operative sensitivity to a level; however, a larger sample size would be needed to obtain more robust results with stronger validation.

Conservative approach for esthetic repair of fractured ceramic facing in ceramic-fused-to-metal crowns: a case series.

The new era of dentistry works on the principle of conservation and minimal intervention for treatment of any dental pathology. Thus, there is greater emphasis on repair procedures than on replacement protocols required. The following article outlines a common conservative repair protocol for fractured ceramic facings of ceramic-fused-to-metal (CFM) crowns. It also includes brief descriptions of several patients treated using the same basic protocol along with modifications as per the case requirement.