Assessment of Physicochemical Characterization and Mineralization of Nanofibrous Scaffold Incorporated With Aspartic Acid for Dental Mineralization: An In Vitro Study.

Aim The aim of this study was to assess the physicochemical characterization and mineralization of nanofibrous scaffold incorporated with nanohydroxyapatite (nHA) and aspartic acid (Asp) for dental mineralization.  Methodology Three nanofibrous scaffolds were prepared, namely polycaprolactone (PCL), PCL with nHA, and PCL with nHA and Asp. Each scaffold was prepared separately by electrospinning. The physicochemical characterization of the surface of the nanofibrous scaffold was imaged using a scanning electron microscope (SEM), energy dispersive X-ray Analysis (EDX), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR). In vitro mineralization studies were performed by immersing the sample in simulated body fluid (SBF) for 7, 14, and 21 days. The surface of the samples was observed under SEM with EDX. Results SEM analysis of PCL/nHA/Asp revealed that the nanofibers were bead-free, smooth, randomly oriented, and loaded with Asp. The EDX spectra of PCL/nHA/Asp composite nanofibrous scaffold revealed broad peaks and corresponded to the amorphous form, while the sharp peaks corresponded to the specific crystalline structure of nHA. FTIR analysis showed specific functional groups corresponding to PCL, nHA, and Asp. The scaffolds incorporated with Asp exhibited higher mineralization potential with an apatite-like crystal formation, which increased with an increase in the duration of immersion in SBF. Conclusion Physiochemical characterization demonstrated the incorporation of PCL/nHA/Asp in the electrospun nanofibrous scaffold. The mineralization analysis revealed that the presence of Asp enhanced the mineralization when compared with the PCL and PCL/nHA. PCL/nHA/Asp incorporated in scaffold can be a promising material for dental mineralization.

Enhancing Antimicrobial Efficacy and Synergistic Effects of Nano-Silica-Based Combinations With Doxycycline, Metronidazole, and Ciprofloxacin Against Enterococcus faecalis Biofilms.

BACKGROUND:  Enterococcus faecalis biofilm formation within root canals poses a challenging problem in endodontics, often leading to treatment failure. To combat this issue, nanotechnology offers a promising avenue for enhancing antimicrobial efficacy. This study explores the potential synergistic effects of combining nanoscale silica particles with conventional antibiotics, including doxycycline, metronidazole, and ciprofloxacin, against E. faecalis biofilms. The unique characteristics of silica nanoparticles, such as their increased reactivity and ability to be functionalized with other compounds, make them ideal candidates for augmenting antibiotic efficacy. This research investigates the antimicrobial properties of these silica-based combinations and their potential to eliminate or inhibit E. faecalis biofilms more effectively than conventional treatments.  Methodology: The methods involved the preparation of nanostructured silica particles and their combination with doxycycline, Flagyl, and ciprofloxacin at subinhibitory concentrations. These combinations were then tested against E. faecalis biofilms using the agar well diffusion technique. RESULTS: Preliminary results suggested that the synergistic interactions between silica nanoparticles and antibiotics can significantly enhance antimicrobial efficacy. The combined treatment exhibited superior inhibitory effects on E. faecalis compared to antibiotics or silica nanoparticles alone (P < 0.05).  Conclusions: This study sheds light on the potential of nanoscale silica-based combinations to address the challenges posed by E. faecalis biofilms in endodontics. Understanding the mechanisms of synergy between nanoparticles and antibiotics can pave the way for the development of more effective and targeted strategies for root canal disinfection, ultimately improving the success rates of endodontic treatments.

Comparative Evaluation of Solite RS3 and HyFlex Remover Retreatment Files in Conserving Remaining Dentin Thickness During Endodontic Retreatment Using Cone Beam Computed Tomography: An In Vitro Analysis.

Introduction Non-surgical retreatment is seen as a conservative choice for dealing with recurrent infections, instead of opting for periapical surgery. The retreatment processes should be promptly and efficiently carried out, utilizing a suitable armamentarium. The objective of this experiment is to evaluate the quantity of root dentin that remains following the removal of gutta-percha (GP) from the root canal employing two distinct retreatment files. Materials and methods Sixty single-rooted teeth were selected for the examination. The process of shaping and cleaning was performed using the step-back approach, with a master apical file size of 40. The smear layer was effectively eliminated by rinsing with a solution of 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Paper points were employed to desiccate the canals. The obturation process involved the utilization of the lateral compaction technique with the AH Plus sealer (Dentsply Sirona, NC, USA). The teeth were classified into two groups: Group I (n=30) underwent retreatment using HyFlex Remover (Coletene India, Pvt., Ltd.), whereas Group II (n=30) received therapy with Solite RS3 retreatment files (Solite Dental in Chennai, India). The remaining dentin thickness (RDT) was assessed by cone beam computed tomography at levels 3, 6, and 9 mm from the cemento enamel junction after the removal of GP. The acquired data underwent examination using an independent t-test to determine statistical significance. Results The findings demonstrate that the utilization of Solite RS3 files led to a higher level of dentin thickness remaining at 3 mm, 6 mm, and 9 mm on the mesial side in comparison to HyFlex Remover retreatment files. The observed difference was found to be statistically significant at a significance level of p<0.05 on the mesial side. Nevertheless, there was no notable disparity seen between the two file types at these three levels on the distal side (p>0.05). Conclusion Based on the obtained results of the study, it can be concluded that Solite RS3 files show promise in preserving the RDT. However, further studies encompassing diverse parameters are needed to establish a conclusive and definitive conclusion.

Comparative Evaluation of Bacterial Reduction by Laser-Activated Irrigation Technique (LAI) With Conventional Needle Irrigation (CNI) in Single-Rooted Teeth With Pulpal Necrosis: A Single-Blinded Randomized Controlled Trial.

Aim  To compare the bacterial reduction in single-rooted teeth with pulpal necrosis after laser-activated irrigation technique (LAI) and conventional needle irrigation (CNI). Methodology In this clinical trial (CTRI/2021/09/047767), 32 patients with pulpal necrosis were enrolled. Under complete aseptic conditions, access cavity preparation was done and the baseline sample S1 was collected from the root canal using paper points. After chemo-mechanical preparation they were allocated into two groups, following block randomization; Group A - CNI with 27 gauge side-vented needle, Group B - LAI with pulsed Er,Cr:YSGG (erbium, chromium:yttrium-scandium-gallium-garnet) (2780 nm) laser. After irrigant activation, canals were dried and a second sample S2 was taken using paper points. Microbial analysis using quantitative polymerase chain reaction (qPCR) was done to quantify the bacterial reduction among the two groups. Inter-group and intra-group analysis was done using the independent student t-test and Bonferroni test, respectively. The data was represented in terms of quantification cycle (Cq) values, which are inversely proportional to the microbial count.  Results There was no significant difference in S1 between the two groups (mean difference=0.0205; p=0.912). There was a significant difference in S2 between the two groups for the organisms (mean difference=0.8042; p=0.000). The mean percentage of bacterial reduction in CNI was 10.82% and in LAI it was 25.92%.  There was a significant difference in S1 through S2 within the two groups for the organisms (p=0.000). The mean difference of Cq value is high for LAI compared to CNI (1.3494).  The fold change was calculated by taking the ΔCq value and ΔΔCq value after the logarithmic transformation of the Cq value. LAI showed lower levels of DNA at S2 similar to CNI. There is no significant difference in mean fold change between CNI and LAI (p=0.564).  Conclusion This clinical trial concluded that both LAI and CNI were effective in bacterial reduction. There was greater bacterial reduction with LAI (25.92%) than with the CNI (10.82%) in single-rooted teeth with pulpal necrosis using qPCR analysis.

Efficiency of Immediate and Controlled release of Aceclofenac on Post-instrumentation Pain in Root Canal Treatment - A Triple Blind Randomized Controlled Trial.

OBJECTIVE: Patients with moderate to severe preoperative pain have a high incidence of postoperative pain. The objective of this trial was to evaluate the efficiency of oral premedication with Aceclofenac (immediate release and controlled release) in the management of post-instrumentation pain in root canal treatment, in patients with moderate to severe preoperative pain. METHODS: Three-arm parallel, triple blinded randomized controlled trial was planned. Patients with moderate to severe endodontic pain, requiring primary endodontic treatment were enrolled. Aceclofenac 100mg- immediate release (Aceclofenac-IR), Aceclofenac 200mg- controlled release (Aceclofenac-CR), and Ibuprofen 400mg were compared. The tablets were given one hour before the root canal treatment. Postoperatively, patients rated their pain at various time points. The duration of pain relief (primary outcome), the intensity of post-instrumentation pain, and the need for additional medicine were calculated. Statistical analysis was done using Kruskal-Wallis followed by Dunn post-hoc, Chi-square tests, and Binominal logistic regression. RESULTS: Aceclofenac-CR had a statistically significant longest duration of pain relief when compared to Ibuprofen (p=0.037) and Aceclofenac-IR (p=0.026). The intensity of post-instrumentation pain was lowest in Aceclofenac-CR, followed by Aceclofenac-IR and Ibuprofen. Additional medicine was required for only 8% of patients in Aceclofenac-CR group; whereas for 32% in each of Aceclofenac-IR and Ibuprofen groups. The odds of taking additional medicine were reduced to 0.16 in Aceclofenac-CR; increased to 1.05 with age. CONCLUSION: Aceclofenac-CR had the longest duration of pain relief compared to Aceclofenac-IR and Ibuprofen. (EEJ-2022-03-037).

Dental Caries Profile and Associated Risk Factors Among Adolescent School Children in an Urban South-Indian City.

PURPOSE: To study the dental caries experience among adolescent school children in Chennai city using the ICDAS-II scoring system. The secondary objective was to identify associated risk factors to different thresholds of dental caries defined by ICDAS. MATERIAL AND METHODS: Two hundred and thirty-seven children (13-17 years) from five schools across Chennai city were included using simple random sampling. After obtaining assent to participate in the study and satisfying the selection criteria, 200 children were screened for dental caries using ICDAS-II. The population was assessed for the following risk factors: sociodemographic status, habits, diet, plaque and salivary parameters. Prevalence of dental caries was estimated at the following thresholds: normal (ICDAS-0/1), mild caries (ICDAS-2), moderate caries (ICDAS-3/4) and extensive caries (ICDAS-5/6). Backward logistic regression analysis was performed to identify risk factors at different thresholds and crude odds ratio was calculated for statistically significant risk factors. RESULTS: The overall prevalence of dental caries (ICDAS 3-6) was 57.5% (95% CI 48-62%). The proportions of children at different caries thresholds were: ICDAS-2 - 55% (95% CI:48-62%), ICDAS-3/4 - 51% (95% CI:44-58%) and ICDAS-5/6 - 25% (95% CI:19-31%). Reduced pH was statistically significant for moderate and extensive caries (OR 6.24, 95% CI 1.18-32.78 and 1.73, 95% CI 1.18-1.92, respectively) and the quantity of saliva was statistically significant for mild and moderate caries (OR 4.48, 95% CI 2.94-8.23 and 3.97, 95% CI 2.65-7.03, respectively). Low buffering capacity was associated with mild caries OR 5.71, 95% CI 2.82-18.2). Interobserver correlation was 0.91. A non-statistically significant value using Hosmer-Lemeshow Goodness of Fit test indicated that all three models predict the true estimate of the population. CONCLUSION: The proportions of children with mild and moderate caries were high considering their age group. The risk factors associated with mild caries were different from those associated with moderate and extensive caries.

Root canal morphology of permanent maxillary and mandibular canines in Indian population using cone beam computed tomography.

Aim. To investigate the root canal anatomy of single-rooted permanent maxillary and mandibular canines in an Indian population using cone beam computed tomography (CBCT). Methodology. A total of 250 permanent maxillary canines and 250 permanent mandibular canines were selected and scanned using CBCT. The root anatomy of each tooth was evaluated for the following parameters: the pattern of the root canals, anatomic length of the crown and the root, the presence of accessory canals, the shape of the access cavity, the position of the apical foramina, root diameter, and dentin thickness of the root. Results. Majority of the teeth had a Type I canal configuration in both maxillary canines (81.6%) and mandibular canines (79.6%). In maxillary canine the other canal patterns found were Type III (11.6%), Type II (2.8%), Type V (2%), Type XIX (1.2%), and Type IV (0.8%). In mandibular canines the various other canal patterns found were Type III (13.6%), Type II (3.2%), Type V (2%), and Type XIX (1.6%). Apical foramina were laterally positioned in the majority of the teeth, 70.4% and 65.6% in maxillary and mandibular canines, respectively. 12% of the maxillary canines and 12.8% of the mandibular canines had accessory canals. Conclusion. The root canal anatomy of permanent maxillary and mandibular canines varied widely in an Indian population.

Biodentine versus Mineral Trioxide Aggregate versus Intermediate Restorative Material for Retrograde Root End Filling: An Invitro Study.

OBJECTIVE: The aim of this study was to evaluate the marginal adaptation of Biodentine in comparison with Mineral Trioxide Aggregate (MTA) and Intermediate Restorative Material (IRM), as a root end filling material, using Scanning Electron Microscopy (SEM). MATERIALS AND METHODS: Thirty permanent maxillary central incisors were chemo-mechanically prepared and obturated. Three millimetres of the root end were resected and 3mm retro cavity preparation was done using ultrasonic retrotips. The samples were randomly divided into three groups (n=10) and were restored with root end filling materials: Group I - MTA, Group II - Biodentine, Group III - IRM. The root ends were sectioned transversely at 1mm and 2mm levels and evaluated for marginal adaptation using SEM. The gap between dentin and retro filling material was measured at four quadrants. The mean gap at 1mm level and 2mm level from the resected root tip and combined mean were calculated. The data were statistically analyzed, using one-way ANOVA and Tukey's HSD post hoc test for intergroup analysis and paired t-test for intragroup analysis. RESULTS: The overall results showed no statistically significant difference between MTA and IRM but both were superior when compared to Biodentine. At 1mm level there was no statistically significant difference among any of the tested materials. At 2mm level MTA was superior to both IRM and Biodentine. CONCLUSION: In overall comparison, MTA and IRM were significantly superior when compared to Biodentine in terms of marginal adaptation, when used as retrograde filling material.