Clinical correlation of salivary alpha-amylase levels with pain intensity in patients undergoing emergency endodontic treatment.

BACKGROUND: Pain is usually subjective and thus it is challenging to describe its characteristics such as nature, intensity, and origin. Non-invasive methods such as assessing salivary alpha-amylase (SAA) may aid the practitioner to evaluate the pain intensity. Hence, the current study aimed to correlate the levels of SAA with the pain intensity in patients presenting with varied endodontic pain levels. METHODS: Sixty patients who presented with varied intensities of endodontic pain were selected for the present study out of which seven patients were excluded/dropped, leaving a total sample of fifty-five patients for assessment. Mandibular molar with symptomatic irreversible pulpitis without periapical pathology were included in the study. A 5ml of un-stimulated was obtained from the patients, following which the local anesthesia was administered. Root canal treatment was then performed and the pain scores at pre-operative and post-operative were recorded. Additionally, salivary samples were collected after emergency endodontic treatment and sent for sialochemical analysis. IBM.SPSS statistics software 23.0 was employed to assess the obtained data. RESULTS: A statistically significant drop in the pain score (P < 0.001) and SAA levels (P < 0.001) were observed post-operatively in the contract to pre-operative state. A strong positive correlation was reported between SAA levels and pain scores in patients undergoing emergency endodontic treatment at both time intervals namely pre-operative (P < 0.001) and post-operative (P < 0.001). CONCLUSION: The results of this preliminary showed a strong association between the pain score and SAA levels in patients undergoing an emergency endodontic treatment.

Designing Novel Multi-Epitope Vaccine Construct against Prevotella intermedia-Interpain A: An Immunoinformatics Approach.

Background and Objectives: Periodontitis is a chronic multifactorial inflammatory infectious disease marked by continuous degradation of teeth and surrounding parts. One of the most important periodontal pathogens is P. intermedia, and with its interpain A proteinase, it leads to an increase in lethal infection. Materials and Methods: The current study was designed to create a multi-epitope vaccine using an immunoinformatics method that targets the interpain A of P. intermedia. For the development of vaccines, P. intermedia peptides InpA were found appropriate. To create a multi-epitope vaccination design, interpain A, B, and T-cell epitopes were found and assessed depending on the essential variables. The vaccine construct was evaluated based on its stability, antigenicity, and allergenicity. Results: The vaccine construct reached a more significant population and was able to bind to both the binding epitopes of major histocompatibility complex (MHC)-I and MHC-II. Through the C3 receptor complex route, P. intermedia InpA promotes an immunological subunit. Utilizing InpA-C3 and vaccination epitopes as the receptor and ligand, the molecular docking and dynamics were performed using the ClusPro 2.0 server. Conclusion: The developed vaccine had shown good antigenicity, solubility, and stability. Molecular docking indicated the vaccine's 3D structure interacts strongly with the complement C3. The current study describes the design for vaccine, and steady interaction with the C3 immunological receptor to induce a good memory and an adaptive immune response against Interpain A of P. intermedia.

A Comparative Evaluation of Antimicrobial and Cytotoxic Efficacy of Biosynthesized Silver Nanoparticles and Chemically Synthesized Silver Nanoparticles Against Enterococcus faecalis: An In Vitro Study.

Introduction Effective root canal cleaning and sealing are essential for a successful endodontic procedure. For the purpose of disinfecting root canals, both herbal and non-herbal medications are recommended. This study aimed to analyze the antimicrobial and cytotoxic properties of biosynthesized silver nanoparticles (AgNPs) synthesized from Azadirachta indica/neem and chemically synthesized AgNPs from trisodium citrate (TSC) against oral pathogens to be further used as an irrigant in endodontic treatment. Materials and methods To synthesize A. indica AgNPs, powdered fresh A. indica leaves were weighed, added to double distilled water, heated for 30 minutes, and then combined with silver nitrate solution. TSC was also used to create TSC AgNPs. X-ray diffraction (XRD), scanning electron microscopy (SEM), ocular observation, and the ultraviolet-visible light (UV-vis) spectrum were used to characterize the AgNPs. Studies were conducted on the extract's characteristics, including its cytotoxicity and antibacterial activity. Results The hue shift and peak on the UV-vis spectrophotometer were signs that AgNPs were forming. The XRD pattern showed that the sample included crystalline AgNPs, mostly spherical ones. By using SEM, the presence of AgNPs was also verified. AgNPs that were synthesized showed antimicrobial efficacy against Enterococcus faecalis. Compared to chemically synthesized AgNPs, A. indica AgNPs showed lower minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values, a bigger zone of inhibition (ZOI), and less cytotoxic action. Conclusion This study demonstrates the minimal cytotoxicity and antibacterial activity of A. indica AgNPs against E. faecalis. This suggests that they might also be employed as root canal cleaners. Before experimenting with animals or cell lines in clinical trials for endodontic treatment, further research should be done.

Assessment of Apical Pressures in Single and Joining Canals - An Ex Vivo Study Based on Computational Fluid Dynamic Analysis.

OBJECTIVE: Computational fluid dynamic analysis (CFD) is claimed to be a reliable tool for analysing the fluid flow and the generated apical pressures in the simulated root canal. The current study aimed to analyse the apical pressures in extracted teeth with single and joining canals. METHODS: Forty-six freshly extracted teeth were collected for the present study. The power was set at 95%, with an effect size of 0.55 (1-ß=95%, α=0.05). Once the root canal anatomy was confirmed with cone-beam computed tomography (CBCT), they were divided into two groups: group I: mandibular second premolars with Vertucci type-I (n=23), and group II: maxillary second premolars with Vertucci type-II (n=23). The instrumentation of the specimens was carried out to a 0.04-taper using rotary instruments. A post-instrumentation CBCT was obtained, and computer-aided design models were obtained. The CFD simulations were then con- ducted with simulated 30-gauge side vented needles at 25, 50, and 75% short of the working length (WL). RESULTS: Group I recorded significantly (p<0.05) higher apical pressures at needle positions 25% short of the WL. However, no significant differences were elicited in the groups at other needle positions. CONCLUSION: Single canal specimens recorded higher apical pressures at needle positions 25% short of the WL. However, no differences were elicited between single and joining canals at higher needle positions.

Assessment of Anatomical Dentin Thickness in Mandibular First Molar: An In Vivo Cone-Beam Computed Tomographic Study.

Aim: To determine the minimum dentin thickness in the mesial and distal walls of the mesiobuccal (MB) and mesiolingual (ML) canals of the mandibular first molars using cone-beam computed tomography (CBCT). Materials and Methods: CBCT examinations of 624 mandibular first molars from an Indian subpopulation were analyzed. The mesial and distal minimum dentin thickness was evaluated in 1 mm intervals apical to the furcation area. Independent t-test was used to analyze the data (α = 0.05). Using Cohen's kappa coefficient, the interexaminer and intraexaminer reliability was evaluated. Results: The mesial dentin thickness was significantly higher than the distal dentin thickness for MB and ML canals (P=0.01). The average dentin thickness in the distal and mesial plane of the MB canal was 1.15 ± 0.15 mm and 1.52 ± 0.19 mm at the 1 mm level and 0.83 ± 0.13 and 1.08 ± 0.18 at the 5 mm level, respectively. For the ML canal, the average dentin thickness in the distal plane and the mesial plane was 1.24 ± 0.18 mm and 1.44 ± 0.21 at the 1 mm level and 0.91 ± 0.16 and 1.01 ± 0.17 at the 5 mm level, respectively. Statistical analysis between the MB and ML canals showed significant differences in the dentin thickness at 4 and 5 mm levels in both the distal and the mesial planes (P=0.01). In more than 85% of the cases, the minimum dentin thickness was seen at the 5 mm level in both the distal and mesial planes in MB and ML canals. Conclusion: The distal planes of the mesiolingual and mesiobuccal canals were thinner in most cases, making the distal surface more prone to iatrogenic perforations. Considerably, at 4 and 5 mm from the furcation, the distal wall was significantly thinner than the mesial walls. Understanding the anatomy of the danger zone in the mesial roots of the mandibular first molars may serve to minimize the risk of endodontic mishaps such as strip perforations.

An in vitro evaluation of microtensile bond strength of resin-based sealer with dentin treated with diode and Nd:YAG laser.

BACKGROUND: Smear layer is a negative factor which prevents adhesion of the filling material to the dentinal walls. Recent advances in dental research have incorporated lasers as a potential adjunct in root canal treatment by removing the smear layer before filling the root canal system, enhancing the adhesion of sealers to dentin and improving the sealing ability. AIM: To evaluate the microtensile bond strength of AH-Plus resin-based sealer to dentin after treatment with 980 nm diode and 1,064 nm neodymium-doped:yttrium aluminum garnet (Nd:YAG) laser in vitro. MATERIALS AND METHODS: Thirty specimens prepared for three groups namely group I (control), group II (980 nm diode-lased specimens) and group III (Nd:YAG-lased specimens). One tooth from each group was observed under scanning electron microscope for evaluation of intracanal root dentin morphology. Remaining specimens were used for making microsections by hard tissue microtome. Specimens for groups II and III were lased with 980 nm diode and 1,064 nm Nd:YAG laser. AH Plus sealer was applied onto specimens and mounted onto Instron universal testing machine for microtensile bond strength testing. Results were subjected to statistical analysis using one-way analysis of variance (ANOVA) and Tukey's test. RESULTS: Group III Nd:YAG had maximum mean microtensile bond strength values (11.558 ± 0.869), followed by group II diode (9.073 ± 0.468) and group I control (6.05 ± 0.036). Statistically significant differences were seen among all the groups. SEM analysis shows removal of smear layer in both groups II and III. CONCLUSION: Both Nd:YAG and diode laser were more effective than control group in improving the microtensile bond strength of AH Plus sealer to dentin. CLINICAL SIGNIFICANCE: Lasers have the potential to increase the adhesiveness of root canal sealer to dentin surface, thereby improving the quality of root canal obturation.

Biomechanical Performance of Mandibular Molars with Deep Mesio-Occlusal-Distal Cavities Rehabilitated with Horizontal Posts: A 3D Finite Element Analysis.

Aim: To compare and contrast by three-dimensional finite element analysis the biomechanical performance of deep mesio-occlusal-distal cavities of mandibular molars reinforced by different sizes of horizontal fiber posts. Materials and Methods: The finite element (FE) stress analysis was performed with the ANSYS, a commercial finite element method package. Based on the evidence-based scientific data and on the mechanical properties of materials, i.e., Young's modulus and Poisson ratio, the model of a mandible and mandibular first molar was replicated. The mandibular molar models replicating the clinical scenarios were simulated, designed, and built, assuming all materials to be homogenous, isotropic, and linearly elastic as follows: Model 1 control: the model of an intact first mandibular molar. Model 2: the prepared cavity mesio-occlusal-distal is replicated by the subtraction Boolean method. The remaining thickness of dentin is 1 mm. Model 3: these were rehabilitated by three different diameters of two horizontal fiber posts. Model 3A: fiber post diameter 1 mm, Model 3B: 1.5 mm and Model 3C: 2 mm. The dimensions of the cavity, the intercuspal distance between buccal walls and lingual walls, and the distance of placement of the post from occlusal reference points were all kept constant for all three subgroups of Model 3. The cavities of Model 3 were restored with Filtek bulk-fill posterior composite. After meshing the models, loads were defined on the buccal and lingual distal cusps with a constant value of 600 N and at an angle of 45°. Results: The results of finite element analysis are expressed as stresses, i.e., tensile compressive, shear, or a combination known as von Mises stresses. The overall von Mises stresses were as follows: Model 1:154.83 Mpa; Model 2: 376.877 Mpa; Model 3A: 160.221 Mpa; Model 3B: 159.488 Mpa; Model 3C: 147.231 Mpa. Statistical analysis of the compiled data was carried out. It was seen that there was a significant difference in stress values from the intact tooth Model 1 and cavity Model 2 (p < 0.05) with means values of 53.1 and 139.22, respectively. The means of all subgroups were comparable but there was a statistically significant difference between Model 3, i.e., 3A (67.74), Model 3B (60.47), Model 3C (53.70), and Model 2. Model 1 and Model 3C had comparable mean values. Conclusion: Rehabilitation of deep mesio-occlusal-distal cavities of molars with intact buccal and lingual walls with the aid of a horizontal post of any diameter has a similar stress distribution to an intact tooth. However, the biomechanical performance of a 2 mm horizontal post was exacting of the natural tooth. Horizontal posts can be included in expanding our restorative option for rehabilitating grossly mutilated teeth.

Endodontic retreatment efficacy with and without solvents: A systematic review.

Introduction: This systematic review investigates the crucial need for solvent use in root canal retreatment, as it effectively removes filling materials, reduces apical debris extrusion, and alleviates postoperative pain, ultimately enhancing treatment success. The review aims to assess the success rates, compare outcomes, explore benefits and drawbacks, and identify subgroups where solvent use may be more effective during root canal retreatment. Materials and Methods: The search was performed in PubMed Central, Scopus, Cochrane, LILAC, ScienceDirect, Google Search, Web of Science, and manually using the search items alone and in combination by means of PUBMED search builder. The studies were assessed for eligibility according to the eligibility criteria by two independent reviewers. Groups containing solvent with nonsolvent groups and randomized control trials were included and in vitro studies, retrospective studies, and animal studies were excluded from the study. Quality assessment was performed using the risk of bias (RoB) 2.0 tool. Results: Out of the 596 articles obtained, 14 were shortlisted for full-text reading and finally two articles were included in the study. The studies were assessed for quality, and data were extracted in a tabulated form. Overall RoB is low, but due to the lack of homogeneity, meta-analysis could not be conducted. Conclusion: The use of solvent does not cause any significant difference in the postoperative pain levels or analgesic intake for retrieval of gutta-percha in cases of root canal retreatment. Due to the limited number of studies available and the lack of clinician-related outcomes such as time taken to retrieve the gutta-percha, these results should be taken into consideration with caution.

Clinical Assessment of Moringa oleifera as a Natural Crosslinker for Enhanced Dentin Bond Durability: A Randomized Controlled Trial.

BACKGROUND: Dentin biomodification is a biomimetic approach that strengthens the collagen network, making it less susceptible to enzymatic degradation and improving the durability of bonded restorative materials, using collagen crosslinkers. OBJECTIVE: This study aimed to assess the effectiveness of Moringa oleifera as a natural crosslinker in improving the clinical success of resin-dentin restorations. METHOD: A double-blind, controlled, randomized clinical trial was conducted in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines, with 50 adult participants with initial carious lesions (ICDAS 4 and 5) enrolled. Participants were randomly assigned to either the experimental group (which received Moringa oleifera as a pretreatment liner) or the control group (standard restorative procedures without a liner). Functional and biological outcomes were assessed at baseline, six months, and 12 months using the FDI criteria. Statistical analysis included Fisher's exact test, Wilcoxon sign rank test, and Mann-Whitney U test. RESULTS: Both groups exhibited excellent functional properties and marginal adaptation at baseline and six months. At the 12-month mark, the test group displayed clinically better functional properties (97.9%, n=47) compared to the control group (95.8%, n=46), but there was no significant difference (p-value>0.05). Marginal gaps were observed in both groups at six and 12 months (8.3%, n=4), with no significant inter-group variation (p-value>0.05). Radiographic examination showed a harmonious restoration-to-tooth transition. Patient satisfaction remained high, with the test group 4.2% (n=2) and control 2.1% (n=1) reporting minor issues at 12 months, though not statistically significant (p-value>0.05). Postoperative sensitivity was minimal, and tooth integrity was well-preserved. CONCLUSION: Moringa oleifera, as a pretreatment liner, showed promise in enhancing the clinical success of resin-dentin restorations. Despite minor reported issues, the groups had no statistically significant differences regarding functional and biological outcomes.

Natural Polyphenols From Moringa and Centella Extracts as Collagen Cross-Linkers and Matrix Metalloproteinase (MMP) Inhibitors in Dentin Preservation: An In Vitro Study.

Background In adhesive dentistry, creating a long-lasting bond between resin composite and dentin is crucial. The durability of this bond dramatically depends on the structural integrity of collagen fibrils present in the hybrid layer. However, matrix metalloproteinases (MMPs) can degrade collagen fibrils, compromising the bond's longevity. Aim The objective is to evaluate the potential effectiveness of natural extracts from Moringa and Centella in preventing collagen degradation caused by MMPs. Material and methods The phenol and flavonoid content of the extracts were evaluated. Dentin beams were demineralized and pre-treated with 1% or 5% Moringa, 1% or 5% Centella, or 2% chlorhexidine (CHX) (five minutes), with untreated beams as control. Beams were incubated in calcium- and zinc-containing media (CM) at pH 7.2 and 37°C for one, 10, 20, and 30 days, and C-terminal cross-linked telopeptide of type I collagen (ICTP) release (collagen telopeptide) was assessed using an enzyme-linked immunosorbent assay (ELISA) kit after 30 days. Results Data were analyzed with a one-way analysis of variance (ANOVA). All test groups showed a different dry mass loss. The control group had the highest loss, followed by CHX, with the least loss in the 5% Moringa and Centella groups. ICTP release ranged from 1.781 ± 0.319 to 3.146 ± 0.684, with 5% Moringa showing the most negligible release. Conclusion The group that received 5% Moringa exhibited the most effective reduction in collagen degradation compared to all the other groups.

Knowledge, attitude, and practice of ultrasonics in endodontic treatment: A Survey among general practitioners and endodontists.

The use of ultrasonics (US) has greatly expanded in the field of dentistry. Over the past few decades, the application of US has increased substantially in endodontics owing to the predictable prognosis and ease of operation. The objective of this survey was to determine the knowledge, practice, and attitude of US in endodontics among the general practitioners, postgraduates, and endodontists. An electronic questionnaire containing 16 questions regarding the knowledge, attitude, and practice of US in endodontics was circulated among the general dentists, postgraduates, and endodontists and the responses were collected online. Data were statistically examined using IBM SPSS software. A total of 202 dentists (general dentists = 92, endodontists = 77, and postgraduates = 33) participated in the survey. Eighty-nine percent of them were aware of the use of US in endodontics, 36.1% of them preferred using US in the removal of pulp chamber calcifications, pulp stones, access refinement, and troughing hidden canals, and 61.4% chose <3% sodium hypochlorite for root canal irrigation with US. The cost of the ultrasonic unit and heat generation during procedures were considered the greatest limitation in using the US. The majority of the dentists were well aware of the use of US and its advantages in various endodontic procedures but they did not use it routinely in their practice. The use of US has been reported to have greatly increased the predictability of endodontic treatment.

Comparative Evaluation of Preemptive and Preventive Analgesic Effect of Oral Ibuprofen in Single Visit Root Canal Treatment- A Prospective Randomised Pilot Study.

OBJECTIVE: Adequate pain management is an essential key to success in endodontics. The present study aimed to evaluate the postoperative pain levels and analgesic intake on preemptive versus preventive oral administration of ibuprofen in single visit root canal treatment. METHODS: A total of 100 participants presented with symptomatic irreversible pulpitis and with severe baseline pain scores were selected for the study. The participants were randomly allocated into two groups as follows: Group I: preemptive group (n=50), Group II: preventive group (n=50). Participants in group I were administered preoperatively with 600 mg of ibuprofen tablet 1 hour before the procedure, whereas in group II, participants were administered only with a placebo preoperatively. The treatment was finished in a single visit, and 200 mg ibuprofen tablet was administered every eight hours in both groups. The participants were asked to take tablets only when required and evaluated for pain scores and analgesic intake at 6, 24, 48, 72 hour intervals. RESULTS: There was a statistically significant decrease (P<0.05) in both the pain levels and tablet intake in the preemptive group compared to the preventive group at 6, 24, 48 and 72 hours. Preemptive group was beneficial in reducing postoperative pain scores and analgesic intake at all time intervals. CONCLUSION: Preemptive analgesic administration seems beneficial in reducing postoperative pain levels and analgesic intake in single visit root canal treatment.

Role of Natural Cross Linkers in Resin-Dentin Bond Durability: A Systematic Review and Meta-Analysis.

BACKGROUND: The role of endogenous Matrix Metallo Proteinases in resin dentin bond deterioration over time has been well documented. The present study aimed to systematically review the literature; in vitro and ex vivo studies that assessed the outcomes of natural cross-linkers for immediate and long-term tensile bond strength were included. METHODS: The manuscript search was carried out in six electronic databases-PubMed/MEDLINE, LILACS, SciELO, Cochrane, Web of Science and DOAJ, without publication year limits. Only manuscripts in English (including the translated articles) were selected, and the last search was performed in December 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. RESULTS: From the 128 potentially eligible studies, 48 full-text articles were assessed for eligibility. After eligibility assessment and exclusions, 14 studies were considered for systematic review and seven studies for meta-analysis. Amongst the selected studies for meta-analysis, three had a medium and four had a low risk of bias. CONCLUSIONS: It was evidenced by the available data that Proanthocyanidin is the most efficient natural cross-linker to date, in preserving the bond strength even after ageing.

Comparative Study Assessing the Canal Cleanliness Using Automated Device and Conventional Syringe Needle for Root Canal Irrigation-An Ex-Vivo Study.

The success of endodontic treatment relies on both apical and coronal sealing. To achieve a good three-dimensional seal, the removal of the smear layer becomes mandatory. This study aims to assess the difference in debris accumulation and smear layer formation while using automated root canal irrigation and conventional syringe needle irrigation. Single-rooted human mandibular premolar teeth (n = 30) which were indicated for orthodontic extractions were selected. An endodontic access cavity was prepared, and a glide path was created. Based on the irrigation protocol decided upon for the study, the teeth were randomly allocated into three study groups, namely Group 1, where the manual syringe needle irrigation method was adopted; Group 2, in which automated root canal irrigation was undertaken; and Group 3, in which teeth remained un-instrumented as it was considered the Control group. The teeth were decoronated at the cement-enamel junction (CEJ) and were subjected for scanning electron microscopy (SEM) examination. Debris and smear layers were viewed in 1000× magnification and scored. A statistically significant (p < 0.05) lower mean debris and smear layer score (p < 0.05) was observed in both study groups when compared with the control group. However, no significant difference (p > 0.05) in the debris and smear layer was observed between the manual syringe needle irrigation and automated irrigation, although automated irrigation devices can be a potential alternative. The present study concluded that the efficacy of smear layer removal remained the same with both automated irrigation and manual syringe irrigation.

Nonsurgical Management of Strip Perforation Using Platelet-Rich Fibrin and MTA by Matrix Concept - A Case Report with One Year Follow-up.

Iatrogenic errors happen especially during endodontic treatment even with the experienced clinicians. It is impossible to predict the occurrence of an event. Although many of them can be corrected and managed successfully, few conditions might have the worst prognosis leading to uneventful extraction. The present case report highlights a 1-year follow-up of managed strip perforation in mesial canals of mandibular first molar, nonsurgically using MTA obturation. The present challenging case gives an insight on the importance of regenerative capacity and osteogenic potentiality of bioactive materials, when appropriate tissue engineering concepts are applied.

Comparative evaluation of ropivacaine and lidocaine as dental pulp anaesthesia.

Root canal therapy linked to pulpal diseases or trauma is common in modern dental care. The 2% Lidocaine which is considered as the gold standard has some drawbacks in pulpal anaesthesia. Ropivacaine has beneficial anaesthetic effects on pulpal anaesthesia. Therefore, it is of interest to compare and evaluate the pulpal aesthetic effect using 0.5% Ropivacaine and 2% Lidocaine in symptomatic irreversible pulpitis. A double blinded randomized controlled clinical trial consisting of 110 lower molar and premolar tooth with irreversible pulpitis cases for root canal therapy were selected and randomly divided into 2 groups. Group A: 2% lidocaine with epinephrine and Group B: 0.5% ropivacaine. The pulp sensibility tests with heat test, cold test and electric pulp test were completed. The preoperative pain score was measured with Visual Analogue Scale (VAS) pain scale. The classical inferior alveolar nerve block (IANB) technique was administered to all patients by a single operator. Subjects were asked for lip numbness and presence or absence of lip numbness. Postoperative pain scores were recorded during access opening and on placing files in the canal. There is no statistical difference between the groups during pre operative conditions. The mean pain scores within group A and group B is recorded. The difference was found to be statistically significant with p value ≤ 0.05. Significant difference between the mean values after and before the treatment is observed. However, there is no statistical significance between the mean pain scores between the access and pulp. The 0.5% Ropivacaine and 2% Lidocaine with epinephrine does not have any significant difference during access opening. However, 0.5% Ropivacaine groups were effective while placing the file in the canal. Thus, 0.5% Ropivacaine showed better results even though it was not statistically significant for further consideration in this context.

Assessment of irrigant flow and apical pressure in simulated canals of single-rooted teeth with different root canal tapers and apical preparation sizes: An ex vivo study.

Background: Irrigation dynamics vary in optimally shaped canals. Various factors combine to create a stress-induced environment leading to a dynamic irrigant flow. Aim: The aim of the study is to evaluate the irrigant flow and apical pressure using 30G open-ended needle in virtually created root canal model of single-rooted teeth. Materials and Methods: Sixty extracted single-rooted premolars were selected and prepared using a single rotary instrument Hyflex CM and grouped as - Group I: 30 size 0.6% taper (n = 15), Group II: 30 size 0.4% taper (n = 15), Group III: 25 size 0.6% taper (n = 15), and Group IV: 25 size 0.4% taper (n = 15). Postinstrumentation imaging was carried out using cone-beam computed tomography, and computer-aided design models were obtained. Subgrouping was done based on the nozzle position, and computational fluid dynamic analysis was carried out for the respective parameters assessed. Results: Statistical significance was elicited in all the groups at different nozzle positions analyzed (P < 0.05). A post hoc test revealed significance in the mean flow rate and flow velocity in Group I at low nozzle position (P < 0.05) as compared to others. Conclusions: 30 size 0.6% tapered preparations proved efficient irrigant flow and least apical pressures at all nozzle positions.

Antibacterial activity of triclosan incorporated glass ionomer cements--an in vitro pilot study.

OBJECTIVES: The aim of this pilot study was to evaluate the antibacterial activity of glass ionomer cement impregnated with different concentrations (0.5%, 1.25% and 2.5%) of a non releasing bactericide--Triclosan (TC) against two common cariogenic bacteria - Lactobacillus acidophilus and Streptococcus mutans; and to compare Triclosan incorporated GIC with chlorhexidine (CHX) incorporated GIC (2.5%) in terms of Antibacterial activity. METHODS: Chlorhexidine or Triclosan were added to glass ionomer cement powder to achieve 2.5% CHX--GIC (positive control--Group II), 0.5%, 1.25% and 2.5% TC-GIC (experimental groups III, IV and V respectively) formulations. Restorative glass ionomer cement (Fuji IX GC--Group I) served as negative control. The powder and liquid were mixed and inserted into the wells punched in agar plates (10 mm x 4 mm). The agar diffusion method was used to determine the antibacterial activity of the cements after 1, 7 and 30 days. Mean values were compared between different study groups using One-way ANOVA and Tukey's HSD procedure at a significance level of 5%. RESULTS: Triclosan incorporated GIC was more effective against L. acidophilus and S. mutans than Chlorhexidine incorporated GIC. Triclosan at a concentration of 2.5% was more effective than at lower concentrations. At all time periods studied, the maximum zone of inhibition against L. acidophilus was produced by Group V. Against S. mutans, on days 1, 7 and 30, there was no significant difference between Groups II and IV (p > 0.05), while the other groups showed significant differences. CONCLUSION: The use of triclosan as an antibacterial additive in GIC holds promise and further clinical research is needed in this direction.

Systematic review on alternative methods for caries removal in permanent teeth.

INTRODUCTION: Dental caries is the most common chronic dental disease in the world. It is defined as a multifactorial microbial infectious disease characterized by demineralization of the inorganic and destruction of the organic substance of the tooth. The host, flora, and the substrate should be there for the formation of dental caries. There are various microorganisms responsible for caries. The treatment for caries is essential to prevent teeth from involving pulp, leading to further damage. There are various methods in removing caries such as minimally invasive technique, rotary method with different types of burs, chemomechanical caries removal, and lasers. There are no data in literature for various methods of removing caries in permanent teeth. MATERIALS AND METHODS: Research question was formulated based on the PICO strategy. A comprehensive electronic literature search was conducted, independently by two reviewers. Based on the specified inclusion and exclusion criteria's, the selected articles were subjected to quality assessment and the risk of bias was evaluated. OBJECTIVE: The objective of this study was to evaluate the efficiency of caries removal by various methods in permanent teeth. SEARCH STRATEGY: A search was performed in electronic database (i.e. PubMed and Medline) using search terms alone and in combination by means of PubMed search builder from January 1985 to January 2018. SELECTION CRITERIA: Studies were selected if they met the following criteria: in vivo studies comparing various methods of caries removal in permanent teeth. RESULTS: The search identified 338 publications, out of which 328 were excluded after examination of the title and 2 were excluded after examination of the abstract. Through the hand search, three articles were included. Eight articles were retrieved for more detailed evaluation from the search. A total of 11 publications fulfilled all the criteria for inclusion. CONCLUSION: With the available evidence, this review concludes that the studies included in this review have a high risk of quality evidence.

Influence of two natural cross-linkers on microtensile bond strength durability ­ An in vitro study / Influência de dois reticuladores naturais na durabilidade da resistência de união à microtração ­ Um estudo in vitro

Objective: to investigate the effect of two natural cross-linkers on microtensile bond strength (µTBS) and evaluate their influence on the durability of the resin dentin bonds. Material and Methods: the Moringa oleifera and Centella asiatica plant extracts were qualitatively tested with high-performance thin layer chromatography (HPTLC) for the presence of phenols. The phenolic content ranged from 27 to 30 gallic acid equivalents (GAE), µg/mg of dry weight. After etching, two concentrations (5% and 1%) of these two extracts were prepared and used as pretreatment liners on dentin. They were applied for a min. After restoration with resin composite, dentin resin beams were prepared. The study groups were 5% Moringa, 1% Moringa 5% Centella 1% Centella, and control (without cross-linker application). For each group, half of the samples underwent µTBS testing after 24 hours, while the remaining half were immersed in artificial saliva to assess the bond's longevity after 6 months of ageing. Statistical analysis was performed using one-way ANOVA followed by Tukey's post hoc test. Results: both 5% and 1% Moringa showed a significant difference (p<0.05) compared to the other groups at both intervals. However, after ageing, the specimens in the control and 1% Centella groups resulted in a significant decrease in µTBS. Conclusion: overall, both concentrations of Moringa (5% and 1%) were effective in stabilising the bond during both intervals.(AU)

Objetivo: investigar o efeito de dois reticuladores naturais na resistência de união (µTBS) à microtração e avaliar sua influência na durabilidade da adesão da resina à dentina. Material e Métodos: extratos das plantas Moringa oleifera e Centella asiatica foram qualitativamente testados através de cromatografia em camada fina de alta performance (HPTLC) para a presença de fenóis. O conteúdo fenólico alcançou entre 27 a 30 equivalentes de ácido gálico (GAE), µg/mg de peso seco. Após o condicionamento, duas concentrações (5% e 1%) dos extratos foram preparadas e utilizadas como forros de pré-tratamento em dentina. Eles foram aplicados por um minuto. Após a restauração com resina composta, palitos de dentina e resina foram preparados. Os grupos foram 5% Moringa, 1% Moringa, 5% Centella, 1% Centella e controle (sem aplicação de reticulador). Para cada grupo, metade das amostras foram submetidas ao teste µTBS após 24 horas, enquanto a outra metade foi imersa em saliva artificial para avaliar a longevidade adesiva após 6 meses de envelhecimento. Foi realizada análise estatística através de ANOVA 1-fator, seguido do teste post hoc de Tukey. Resultados: ambas as concentrações de 5% e 1% de Moringa demonstraram diferença significativa (p<0.05) comparadas aos outros grupos em ambos os intervalos. No entanto, após o envelhecimento, os espécimes dos geupos controle e 1% de Centella resultaram em uma redução significativa de µTBS. Conclusão: no geral, ambas as concentrações de Moringa (5% e 1%) foram efetivas em estabelecer a adesão em ambos os intervalos (AU)