Outcome of partial and full pulpotomy in cariously exposed mature molars with symptoms indicative of irreversible pulpitis: A randomized controlled trial.

AIM: The aim of this study was to assess and compare the clinical and radiographic outcome of partial pulpotomy and full pulpotomy using Biodentine in cariously exposed mature molar teeth with symptoms indicative of irreversible pulpitis. METHODOLOGY: This study is an unicentric, double-arm, randomized superiority clinical trial with parallel experimental groups, registered under CTRI (CTRI/2019/12/022559). Fifty mature permanent molar teeth with carious exposures with symptoms indicative of irreversible pulpitis were randomly allocated equally into two groups. Partial pulpotomy (PP) and full pulpotomy (FP) were performed in the first and second group, respectively, following standardized protocols. Exposed pulp tissue was removed up to a depth of 2-3 mm for partial pulpotomy, whereas complete coronal pulp tissue was removed up to the level of root orifices for full pulpotomy. Haemostasis was achieved with placement of 2.5% sodium hypochlorite-moistened cotton pellets placed on amputated pulp tissue for a maximum of 10 min. Biodentine was used as the pulp capping material. Pain scores were evaluated using 11-point Visual Analogue Scale (VAS) preoperatively, at 24 h, 48 h and 7th day after the intervention(s). Clinical and radiographic evaluation was done at 3 months, 6 months and 1 year. The data were statistically analysed using chi-squared test, Mann-Whitney U-test, Friedman's test and Wilcoxon signed-rank test. The significance level was pre-determined at p < .05. Cumulative survival probabilities were assessed at 12 months using Kaplan-Meier analysis. RESULTS: Intra-group analysis of pain scores revealed significant reduction in pain scores preoperatively and at 24 h, 48 h and 7th day in both the groups. However, the difference in the pain score(s) reduction between both the groups was not statistically significant at any time interval (p > .05). At 1-year follow-up, the success rate was 88% (22/25) and 91.6% (22/24) for PP and FP respectively (p > .05). CONCLUSIONS: Partial pulpotomy showed comparable results to full pulpotomy in terms of clinical/radiographic treatment outcome. If the long-term results remain the same, partial pulpotomy can be proposed as an alternative treatment modality for mature teeth with cariously exposed pulp tissue presenting with signs of symptomatic irreversible pulpitis.

Effect of revascularisation and apexification procedures on biomechanical behaviour of immature maxillary central incisor teeth: a three-dimensional finite element analysis study.

OBJECTIVES: This study aimed to assess the effects of revascularisation and apexification procedures on biomechanical behaviour of immature teeth using 3-dimensional finite element analysis (3D FEA). MATERIALS AND METHODS: Five 3D FEA permanent maxillary incisor models were developed from CBCT scans and available literature data: Model MT: Mature tooth, Model IT: Immature tooth (Cvek's stage 3), Model AT: Apexified tooth-mineral trioxide aggregate (MTA) apexification, Model RTB: Revascularised tooth with blood, and Model RTS: Revascularised tooth with supplementary scaffold. Using FEA, a masticatory load of 240N at 120° was simulated, and the Von Mises and maximum principal stresses within the models were evaluated. Failure index (FI) and weakening% were also calculated for each model. RESULTS: On dentinal stress analysis, model MT (96.16MPa) and IT (158.38MPa) had lowest and highest stress values, respectively. Among the experimental groups, model RTS (131.12MPa) had lower stresses than AT (136.33MPa) and RTB (133.7MPa), with no significant difference among the three. Peak dentinal stresses in all the models were observed in the cervical third of the root and near the apical opening in model IT. The extent of high dentinal stress area in model RTB and RTS was lesser than that of AT. The FI and weakening% values were highest for model AT followed by RTB and RTS, among the experimental groups. However, all these treatments strengthened an immature tooth by more than 20%. CONCLUSIONS: AT, RTB, and RTS treatments lowered the stress values and risk of fracture in immature teeth with no significant difference among the three groups. CLINICAL RELEVANCE: Stress distribution evaluation following revascularisation/apexification was essential, with potential to influence clinical decision-making. MTA apexification and revascularisation with blood clot/supplementary scaffold lowered the stresses in immature teeth, with no significant difference among the three.

Analysis of clinical characteristics and management of ectopic third molars in the mandibular jaw: a systematic review of clinical cases.

OBJECTIVE: To perform a systematic review of the characteristics of ectopic mandibular third molar (EMTM) in terms of its clinical presentation, radiographic findings, associated lesions, management and post-operative complications. MATERIALS AND METHODS: We searched the Pubmed, Medline, Embase and EBSCO databases for full-text, peer-reviewed journal publications from January 1965 to August 2020. Data extraction was done using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. RESULTS: Our search yielded 45 case reports involving 48 EMTM teeth. The mean age of the patients was 46.3 years with an age range of 22-80 years. Thirty-two cases were seen in women as compared to 13 cases in men. The majority of the cases (42) were unilateral, with only three bilateral cases. Among the 48 EMTM teeth, 21 were seen in the condylar region followed by 13 in the ramus, seven in the sigmoid notch, three in the angle and two each in the coronoid process and the lower border of the mandible. Twenty-five EMTM teeth had histopathologically confirmed dentigerous cysts, eight teeth had chronic infection/inflammation/granulation tissue, two had radicular cysts, two had infected cysts, two teeth had normal follicular spaces, and associated lesions were not mentioned for nine teeth. The most common symptoms were swelling (33 teeth) and pain (29 teeth), and six teeth were asymptomatic. Surgical removal through intraoral approach was carried out for 27 teeth, while an extra-oral approach was adopted in 15 teeth, a spontaneous regression of the pericoronal radiolucency was noticed in one tooth, four teeth were not treated and choice of treatment was not mentioned for one tooth. Mild transient paraesthesia was frequently observed; however, serious post-surgical complications were not reported. CONCLUSIONS: The present review found that EMTM can present with complex clinicopathological characteristics, with a majority of the cases being asymptomatic in the beginning and turning out to be symptomatic with lesions at later stages, requiring surgical intervention.

Comparison of Plaque Removal and Wear between Charcoal Infused Bristle and Nylon Bristle Toothbrushes: A Randomized Clinical Crossover Study.

AIM: To compare plaque removal and wear between charcoal infused bristle toothbrushes (T1) and nylon bristle toothbrushes (T2) in a randomized clinical crossover study. MATERIALS AND METHODS: A cross-over study was conducted in 2 phases of 6 weeks duration each with an intervening 2-week washout. Twenty-five participants meeting inclusion criteria were randomly allocated into groups A (13) and B (12). In phase 1: group A was assigned T1 and group B was assigned T2. Toothbrushing was advised twice daily for 2 minutes by modified bass technique after meals. At baseline, 3 weeks and 6 weeks the wear index (WI), plaque index (PI) and gingival index (GI) were recorded. Following washout in phase 2 group A was assigned T2 and group B was assigned T1 and the same study protocol was followed. RESULTS: Intra-group comparison between baseline, 3 and 6 weeks by the paired t-test resulted in significant reduction in PI, GI and increase in WI (p <0.05) for T1 and T2. Inter-group comparison using the unpaired t-test resulted in WI for T1 being significantly higher (p <0.05) at 3 weeks and lower at 6 weeks (p <0.05) compared to T2. PI for T1 was significantly higher at 3 weeks (p <0.05) and lower at 6 weeks (p <0.05) compared to T2. No significant difference in GI scores between T1 and T2 at 3 and 6 weeks was observed (p >0.05). CONCLUSION: Charcoal infused bristles demonstrated less wear and more plaque removal compared to nylon bristles. CLINICAL SIGNIFICANCE: Charcoal infused bristles demonstrate less wear compared to nylon bristles.

Effect of physical form of the therapeutic diet on the behaviour of crossbred calves experimentally infected with foot-and-mouth disease virus.

The oral lesions associated with foot-and-mouth disease (FMD) negatively affect animal behavior, which can adversely impact animal production and welfare. Physical form of a therapeutic diet (TD) can improve the feed intake and wellbeing during the acute phase of FMD. Accordingly, we tested the effect of two physical forms of a previously developed TD on the behavior of calves experimentally infected with FMD virus (FMDV). Crossbred Holstein Friesian male calves of 10-12 months (n = 12) were experimentally infected with a virulent strain of FMDV and were offered a TD enriched with 19% CP and 2.9 Mcal ME/kg for 11 days post-FMDV infection. One group received the TD in mash form (TDM) while the other (n = 6/group) received it in cooked form (TDC). A group of four calves served as uninfected control and were fed TDM. The time spent by the calves on certain behaviours was recorded in a pre-set form from 06:00-18:00 h for 10 days from day 2-11 post-FMDV infection. The data was divided into two sessions. Session 1 (06:00-13:00 h) represented after the offering of TD, while session 2 (13:01-18:00 h) represented the data after offering green fodder. Based on exploratory data analysis, data recorded from day 2-7 post-FMDV infection was included in the final analysis. Linear mixed model was used by fitting treatment, day and their interaction as fixed effects while calf as random effect. Orthogonal contrast was applied by comparing the infected TDM with other two groups. The results revealed that the cooked form of TD improved the ingestion time, resting time, sleeping time and licking time from day 2-7 post-FMDV infection as compared with the infected TDM group. Ingestive behaviour was better in the infected TDC than that of TDM group (p < 0.01). The sleeping time was significantly high in the infected groups as compared to the uninfected TDM group (p < 0.01) till day 6 post-FMDV infection. Daily activities such as licking, standing and resting differed significantly between the infected TDM and TDC groups in session 1, but not in session 2. Urination and defecation did not differ significantly between the infected TDM and TDC groups. It was concluded that cooked form of TD remediated the effects of infection with FMDV as evidenced by improvement in the behaviour of the calves.

Effect of C-factor on Micro-tensile Bond Strength of Bulk fill V/S Micro-hybrid Composite in Class II Restorations - An In-Vitro Study.

Background: High Configuration factor (C-factor) results into increased polymerization shrinkage causing stress at resin-dentin interface leading to failure of the restoration. The purpose of this study was to evaluate the effect of C-factor on micro-tensile bond strength (µTBS) of bulk fill composites in class-II cavities when restored in 4mm of bulk as compared to conventional composite. Methodology: A total of 90 carious, crack free extracted human mandibular permanent molars were selected and randomly divided into 3 groups (n=30). On all samples, class II cavities (3.5X 3.5cm) were made by single operator and divided as Gp1 (2.5mm), Gp2 (4mm), and Gp3 (6mm) on the basis of depth of cavities. Sampling units of 30 in each group were further randomly subdivided into 3 subgroups (n=10 each subgroup), according to the type of composite resin systems to be used for restoration. Experimental Subgroup includes SubGp1 restored with SDR Surefil (Dentsply, caulk, USA) and SubGp2 restored with Sonic fill (kerr, orange, CA, USA), whereas SubGp3 restored with FILTEK Z250 served as control. After storage in water at 37◦C, the teeth were sectioned perpendicular to the restorative tooth interface as 1×1 mm non-trimmed rectangular micro-specimens for micro-tensile bond strength (µTBS) testing. Beams (n=30 max) from each SubGp were fixed to a metal jig and subjected to micro-tensile bond strength testing. The data collected for micro-tensile bond strength (expressed in Mpa) were statistically analysed using one way ANOVA and Tukey's post hoc test. Results: In class II cavities with high C-factor, SDR Surefil showed better µTBS than SonicFill and micro-filled composite when filled in bulk of 4mm, as compared to micro-hybrid composite filled incrementally. Conclusion: There is no effect of high C-factor on µTBS of tooth restored with both SDR Surefil and Sonic Fill in class II cavities as compared to microhybrid composites.

Histologic Assessment of Peri-implant Tissues Around Endosseous Dental Implants Placed Along with Intentionally Retained Root Fragment in Animal Models: A Systematic Review.

PURPOSE: To evaluate whether the placement of endosseous dental implants along with intentionally retained root fragments enhances peri-implant histologic characteristics and outcomes in healthy animal models. MATERIALS AND METHODS: Two review authors independently performed electronic literature searches across the PubMed/MEDLINE, LILACS, EBSCOhost, and Science Direct databases by using different keywords and Medical Subject Headings terms to identify relevant articles. Only preclinical animal trials evaluating the histology of peri-implant tissues around endosseous dental implants placed along with intentionally retained root fragments were included in the review. The risk of bias assessment was investigated using the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) tool, and the reporting quality of each trial was evaluated using the Animal Research: Reporting in Vivo Experiments guidelines. RESULTS: Seven preclinical trials including a total of 33 animals and 155 endosseous dental implants were eligible for the analysis. One trial reported the histologic assessment of peri-implant tissues around endosseous dental implants with ankylotic root fragments, whereas the other six studies used nonankylotic root fragments. The effects of the length of retained root fragments on peri-implant tissues were reported in two trials that showed contrasting results. The effects of the width of retained root fragments were assessed in two trials reporting that a remaining thickness < 2 mm and buccal bone thickness > 3 mm favors alveolar bone preservation over a period of 12 weeks. Although the mean quality assessment score for all preclinical trials was moderately high, the summary for the risk of bias presented a high risk. CONCLUSION: Limited data and short-term preclinical evidence showed optimal peri-implant histologic findings of endosseous dental implants placed along with intentionally retained root fragments. However, further preclinical histologic evaluation with homogenous populations and long-term controlled clinical studies are needed to substantiate its applicability in clinical situations.

An Overview of Systematic Reviews and Meta-analyses Evaluating Different Impression Techniques for Implant-Supported Prostheses in Partially and Completely Edentulous Arches.

PURPOSE: To summarize the evidence and determine the most effective impression technique for implant-supported prostheses in terms of accuracy, time efficiency, and patient preference in partially and completely edentulous arches. MATERIALS AND METHODS: The searches were performed independently up to April 30, 2021 by two review authors through the Cochrane Oral Health Review, MEDLINE/PubMed, LILACS, and Science Direct databases. Moreover, manual and gray literature searches were performed to identify further potential reviews. Only English language-based systematic reviews with and without meta-analyses evaluating the different dental implant impression techniques were included. The outcomes assessed were accuracy, time efficiency, and patient preference. The methodologic quality of the included reviews was investigated by using the R-AMSTAR tool, and the degree of overlap of primary studies was assessed by calculating the percentage of corrected covered area (CCA) as proposed by Pieper et al.64 Results: The qualitative analysis included a total of 28 reviews, 8 of which included meta-analyses, published between 2008 and 2021, involving a total of 42 clinical trials and 203 laboratory studies. Digital vs conventional implant impression techniques were compared in 17 reviews, different digital impressions in 3 reviews, and different conventional impression techniques in the remaining reviews. Overall, the methodologic quality assessed by using the R-AMSTAR tool was moderate (mean: 26.7 ± 5.5) with slight overlap of primary studies (CCA; 5.23%). CONCLUSION: Within an overall moderate methodologic quality, the digital implant impressions showed favorable outcomes in terms of accuracy, time efficiency, and patient preference in partially edentulous arches involving three or fewer implants. However, the accuracy of full-arch digital impressions involving multiple implants is not satisfactory and needs significant improvements. Hence, future studies following stringent guidelines and robust methodology are recommended to substantiate the findings of this overview and provide a high level of evidence.

Comparative Evaluation of Dentinal Microcrack Formation before and after Root Canal Preparation Using Rotary, Reciprocating, and Adaptive Instruments at Different Working Lengths-A Micro-computed Tomographic Study.

INTRODUCTION: This study aimed to compare root dentinal microcrack formation after root canal shaping using rotary, reciprocating, and adaptive instruments at different working lengths using micro-computed tomographic imaging. METHODS: One hundred eighty extracted mature mandibular molar mesial roots with 2 separate canals were selected. The mesial roots were resected at the cementoenamel junction and randomly divided into 4 groups (n = 45) based on the nickel-titanium file system used: ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), ProTaper Gold (Dentsply Maillefer), Twisted File Adaptive (SybronEndo, Orange, CA), and Reciproc Blue (VDW, Munich, Germany). Each of the 4 groups were then subdivided into 3 groups (n = 15) depending on the working length used for root canal preparation (ie, instrumentation 1 mm short, flush, and 1 mm beyond the major apical foramen). The roots were imaged with micro-computed tomographic scanning before and after root canal preparation. The cross-sectional images generated were screened to detect the presence of new microcracks. RESULTS: The ProTaper Universal system significantly increased the number of postinstrumentation microcracks at all working lengths (P ≤ .05). No significant increase (P > .05) in postinstrumentation microcracks was observed in the ProTaper Gold, Twisted File Adaptive, or Reciproc Blue groups. CONCLUSIONS: Rotary instrumentation induced a higher number of dentinal microcracks compared with reciprocating and adaptive instruments. Instrumentation at different working lengths did not significantly influence the formation of dentinal microcracks.

Influence of Final Apical Width on Smear Layer Removal Efficacy of Xp Endo Finisher and Endodontic Needle: An Ex Vivo Study.

Objective: Chemical disinfection along with mechanical instrumentation, is required to achieve debridement, especially in apical third of root canal. Thus, this study aimed to compare the influence of final apical width on the smear layer removal efficacy of XP Endo Finisher and Endodontic Needle, in mandibular premolars. Methods: 40 single-rooted mandibular premolars were included in the study, prepared using K3 XF rotary files (SybronEndo, Orange, CA). The samples were equally divided into 4 groups: Group 1: Master apical file 30/0.06 taper, final irrigation with endodontic needle (30G Max I probe, Dentsply International, York PA); Group 2: Master apical file 40/0.06 taper, final irrigation with endodontic needle; Group 3: Master apical file 30/0.06 taper, final irrigation with XP-Endo Finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland); Group 4: Master apical file 40/0.06 taper, final irrigation with XP-Endo Finisher. Smear layer and debris scores were given using SEM. Results: Group 3 and 4 performed significantly better than group 1 & 2 (P<0.05). No significant difference was observed in Group 1&2 (P>0.05); and Group 3&4 (P>0.05). Significantly higher scores were observed in the apical third, as compared to other sections of the root canal, in all the 4 groups. Conclusion: Increase in the final apical width did not significantly improve root canal cleanliness for both XP Endo Finisher and endodontic needle. However, XP endo finisher proved to be significantly better than the endodontic needle.

Evaluation of retention and fracture resistance of different fiber reinforced posts: An in vitro study.

AIM: The aim of this study was to evaluate retention & fracture resistance of different fibre posts. METHODOLOGY: 90 extracted human permanent maxillary central incisors were used in this study. For retention evaluation, after obturation, post space preparation was done in all root canals and posts were cemented under three groups. Later, the posts were grasped & pulled out from the roots with the help of a three-jaw chuck at a cross-head speed of 5mm/min. Force required to dislodge each post was recorded in Newtons. To evaluate the fracture behavior of posts, artificial root canals were drilled into aluminium blocks and posts were cemented. Load required to fracture each post was recorded in Newtons. RESULTS: The results of the present study show the mean retention values for Fibrekleer Parallel post were significantly greater than those for Synca Double tapered post & Bioloren Tapered post. The mean retention values of the Double tapered post & the tapered post were not statistically different. The Synca Double tapered post had the highest mean load to fracture, and this value was significantly higher than those of FibreKleer Parallel & Bioloren Tapered post. The mean fracture resistance values of Parallel & tapered post were not statistically different. CONCLUSIONS: This study showed parallel posts to have better retention than tapered and double tapered posts. Regarding the fracture resistance, double tapered posts were found to be better than parallel and tapered posts.

Evaluation of Biocompatibility and Osteogenic Potential of Tricalcium Silicate-based Cements Using Human Bone Marrow-derived Mesenchymal Stem Cells.

INTRODUCTION: The success of endodontic regeneration lies in the appropriate combination of stem cells and bioactive materials. Several novel dental materials are available on the market in this regard. Hence, the current study aimed to evaluate the proliferation, differentiation, and osteogenic potential of human bone marrow-derived mesenchymal stem cells (hBMSCs) onto biomaterials like ProRoot MTA (MTA; Dentsply Tulsa Dental, Tulsa, OK), Biodentine (BD; Septodont, Saint Maur de Fosses, France), and EndoSequence Root Repair Material (ERRM; Brasseler USA, Savannah, GA). METHODS: Dental cements were formulated into discs and assessed for their biocompatibility. hBMSCs were used to study biocompatitibility and the proliferative and osteogenic potential of these dental cements. A live dead assay was performed using confocal microscopy to study the biocompatibility, proliferation, and cell attachment property of the cements. An 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was also performed on days 1, 3, 5, and 7 to study growth kinetics. The osteogenic potential of these cements was studied by inducing hBMSCs over them using osteogenic differentiation medium (assessed by alkaline phosphatase assay). RESULTS: ERRM and MTA have shown the best biocompatibility among the tricalcium silicate materials used with no significant difference between them. Both have shown significantly higher osteogenic bioactivity than BD. All 3 tricalcium silicate cements support good adherence of hBMSCs. CONCLUSIONS: All of the dental cements used in this study are biocompatible with the potential to induce proliferation and osteogenic differentiation of hBMSCs. Therefore, the newly introduced ERRM can be the material of choice in various endodontic applications.

Multiple talon cusps on maxillary central incisor: A case report.

Dental anomalies affecting the teeth are relatively common. Simultaneous occurrence of multiple dental abnormalities in a single tooth is uncommon and relatively rare. One such abnormality routinely encountered in dental clinics is the talon cusp. It is also referred to as dens evaginatus, characterized by the presence of an accessory cusp-like structure projecting from the cingulum of anterior teeth. It has an increased predilection for maxillary teeth and permanent dentition. Although numerous cases of talon cusp have been reported in the literature, occurrence of multiple talon cusps in maxillary central incisors has not been found in the literature. This case report highlights the presence of talon cusps in maxillary anterior teeth with multiple impacted supernumerary teeth.

Endodontic management of bilateral mandibular canine with type two canals configuration.

Successful endodontic treatment depends upon the clinician's knowledge and ability to manage aberrant anatomy. The mandibular canine normally comprises one canal and one root but 15% may have two canals with one or two foramina and even less frequent may have two roots. This paper presents a case report of bilateral mandibular canine having two root canals which merge into one canal and one foramina.

Anesthetic success of supplemental infiltration in mandibular molars with irreversible pulpitis: A systematic review.

AIM: To systematically review the anesthetic success rates of inferior alveolar nerve block (IANB) injection technique alone with that of combination of IANB and supplemental infiltration (SI) technique when used for pulpal anesthesia of mandibular posterior teeth with irreversible pulpitis during endodontic treatment. SETTINGS AND DESIGN: The study follows a longitudinal study design involving original research. MATERIALS AND METHODS: Electronic databases were systematically searched for randomized controlled clinical studies. Studies were selected by predefined inclusion and exclusion criteria. STATISTICAL ANALYSIS USED AND RESULT: The statistical analysis used was based on the results of the original research. All the included studies showed that there is the difference in the values comparing the two techniques, but the data are not statistically significantly different. CONCLUSION: Based on this review, the better anesthetic efficacy of the SI was observed.

Inhibition of Tongue Coat and Dental Plaque Formation by Stabilized Chlorine Dioxide Vs Chlorhexidine Mouthrinse: A Randomized, Triple Blinded Study.

BACKGROUND: Chlorine dioxide (ClO2) is an oxidizing agent with known bactericidal, viricidal and fungicidal properties. Its efficacy in reducing the halitosis has been established by previous literature. However, data evaluating its antiplaque property is scarce. Chlorhexidine (CHX) is considered as the gold standard and an effective adjunctive to mechanical plaque removal. However, it is associated with few reversible side effects. Therefore a study was conducted to assess the antiplaque property of ClO2 containing mouthrinse against CHX mouthrinse. AIMS AND OBJECTIVES: To evaluate the efficacy of stabilized chlorine dioxide containing mouthrinse and CHX containing mouthrinse in inhibition of tongue coat accumulation and dental plaque formation using a four day plaque regrowth model clinically and microbiologically in a healthy dental cohort. MATERIALS AND METHODS: A Single Center, Randomized, Triple blinded, Microbiological clinical trial was conducted involving 25 healthy dental students volunteers (11 males, 14 females). Two commercially available mouthrinse: Mouthrinse A - Aqueous based ClO2 mouthrinse Freshchlor(®) and Mouthrinse B - Aqueous based 0.2% CHX mouthrinse Hexidine(®) were selected as the test products. Subjects were asked to rinse and gargle for 1 minute with the allocated mouthrinse under supervision after supragingival scaling, polishing and tongue coat removal. After four hours, smears were taken from the buccal mucosa and tooth surface. On the fifth day from baseline of four day non brushing plaque regrowth model the samples were again taken from buccal mucosa and tooth surface followed by recording of plaque scores by Rastogi Modification of Navy Plaque index, extent of tongue coat by Winkel's tongue coating index and measuring tongue coat wet weight in grams. The samples collected were subjected to microbial analysis and the results were expressed as colony forming units (CFUs) per sample. STATISTICAL ANALYSIS: The Data was analysed using SPSS 16.00 and presented using descriptive statistics. Independent t-test was used for the comparison between mouthrinse A groups & mouthrinse B group. RESULTS: The plaque scores and Winkels tongue coat scores, wet tongue coat weight recorded on the fifth day after the use of the two mouthrinse didn't show a statistically significant difference. The CFU per sample from tooth and mucosa after four hours revealed low bacteria count with respect to mouthrinse B however the CFU obtained on the fifth day did not show a statistically significant difference between the two mouthrinse. CONCLUSION: The clinical antiplaque efficacy of CHX and ClO2 mouthwash is comparable and so is the efficacy in reducing the oral bacterial load.

Analysis of C-shaped canal systems in mandibular second molars using surgical operating microscope and cone beam computed tomography: A clinical approach.

AIMS: The study was aimed to acquire better understanding of C-shaped canal systems in mandibular second molar teeth through a clinical approach using sophisticated techniques such as surgical operating microscope and cone beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 42 extracted mandibular second molar teeth with fused roots and longitudinal grooves were collected randomly from native Indian population. Pulp chamber floors of all specimens were examined under surgical operating microscope and classified into four types (Min's method). Subsequently, samples were subjected to CBCT scan after insertion of K-files size #10 or 15 into each canal orifice and evaluated using the cross-sectional and 3-dimensional images in consultation with dental radiologist so as to obtain more accurate results. Minimum distance between the external root surface on the groove and initial file placed in the canal was also measured at different levels and statistically analyzed. RESULTS: Out of 42 teeth, maximum number of samples (15) belonged to Type-II category. A total of 100 files were inserted in 86 orifices of various types of specimens. Evaluation of the CBCT scan images of the teeth revealed that a total of 21 canals were missing completely or partially at different levels. The mean values for the minimum thickness were highest at coronal followed by middle and apical third levels in all the categories. Lowest values were obtained for teeth with Type-III category at all three levels. CONCLUSIONS: The present study revealed anatomical variations of C-shaped canal system in mandibular second molars. The prognosis of such complex canal anatomies can be improved by simultaneous employment of modern techniques such as surgical operating microscope and CBCT.

The role of cone beam computed tomography in the endodontic management of a mandibular first molar with three distal canals.

The presence of three root canals in the distal root of the mandibular first permanent molars is rare; based on in vitro studies its incidence is reported to be between 0.2% and 3%. With the advent of cone beam computed tomography (CBCT) as an adjunctive diagnostic aid, the determination of root canal anatomy in teeth with extra canals and complex canal configurations has become more precise. CBCT provides three dimensional visualization of the pulp canal space, allowing the clinician in determining the spatial relationships of the root canals with each other at various cross sectional levels along the length of the root. The present report discusses the endodontic management of a mandibular first permanent molar with three canals in the distal root, employing CBCT as an adjunctive diagnostic aid to conventional radiography.