Incidence of Post-Operative Pain following a Single-Visit Pulpectomy in Primary Molars Employing Adaptive, Rotary, and Manual Instrumentation: A Randomized Clinical Trial.

Background and Objectives. To differentiate the intensity of postoperative pain after primary molar pulpectomy employing manual instrumentation versus two single-file systems with different kinetics (the XP-Endo shaper file with adaptive instrumentation vs. the Kedo-SG blue file with continuous rotation instrumentation). Materials and Methods. This three-arm, single-blind, randomized clinical trial included assessing 75 healthy children between 4 to 9 years who required pulpectomy for primary molars (mandibular first and second). The three groups each had an equal number of children. Children in Group 1 had their teeth instrumented with the XP-endo Shaper, children in Group 2 had their teeth instrumented with the Kedo-SG Blue file, and children in Group 3 had their teeth instrumented manually using K-files. The degree of postoperative pain was measured using a four-point pain scale at 6-, 12-, 24-, 48-, and 72-h following therapy. Each participant's parent received five flashcards with four faces and a word characterizing each face. The data were analyzed using Kruskal-Wallis and chi-square tests. The level of significance was set to 5%. Results. During the follow-up period, there was a significant difference in postoperative pain intensity between the three groups. The XP-endo shaper was associated with considerably decreased post operative at the 6- and 12-h interval followed by Kedo-SG. The highest post-operative discomfort across the groups was related to the patients who underwent manual instrumentation. Conclusion. In comparison to rotary and manual instrumentation, postoperative pain severity was reduced with adaptive instrumentation.

Morphologic variations in mandibular premolars: a report of three cases.

AIM: To report cases with morphologic variations in mandibular premolars. BACKGROUND: Mandibular premolars have earned the reputation for having aberrant anatomy. The occurrence of three canals with three separate (type V, Vertucci) foramina in mandibular premolars is very rare. In this report, three cases are presented involving the root canal treatment of mandibular premolars with three different root and canal configurations. The present report also emphasizes the use of the dental operating microscope to enhance visualization. CASE DESCRIPTION: Correlation between radiographic findings, use of dental operating microscope and knowledge of aberrant anatomy helps to identify, locate and treat the aberrant anatomy of the tooth. CLINICAL SIGNIFICANCE: The treatment was successful as all canals were identified and filled and also as evidenced by relief of symptoms. CONCLUSION: Success is largely dependent on the use of magnification, which aided in identifying the location of the three individual root canal orifices; thus emphasizing the need to familiarize ourselves with dental microscopy, to obtain maximal anatomic information in endodontic practice.

Endodontic management of mesiobuccal-2 canal in four-rooted and five-canalled mandibular third molar.

AIM: A case of unusual Root morphology is presented to demonstrate anatomic variations in mandibular third molar. BACKGROUND: The most common configuration of mandibular third molar is two Roots and three canals; however they may have many different combinations. Endodontic treatment was performed in mandibular third molar having aberrant anatomy. CASE DESCRIPTION: Four Root canal orifices were located with the aid of dental operating microscope (DOM) and three separate Roots were diagnosed with radiographs. Spiral computed tomography (SCT) showed the presence of an extra canal and extra Root, indicating a rare anatomic configuration. Looking for additional canals and Roots are important part of successful endodontics, as the knowledge of their existence enable clinicians to treat a case successfully that otherwise might end in failure. CONCLUSION: The use of DOM and SCT in this case greatly contributed toward making a confirmatory diagnosis and successful endodontic treatment of four-rooted and five-canalled mandibular third molar. CLINICAL SIGNIFICANCE: Variation in Root canal anatomy is very common. Knowledge of these variations is very essential for successful Root canal outcome, inability to do so can lead to missed canals and failures. Hence, thorough knowledge of Root canal anatomy and advances in diagnostic aids are essential.

Reinforcement of Teeth Having Reenacted Perforating Internal Resorption Cavities After Repair Using Different Calcium Silicate-based Cements and Backfilling Materials: An In vitro Study.

To evaluate the fracture resistance (FR) of the teeth having reenacted perforating internal resorption cavities repaired by distinctive calcium silicate-based cements (CSCs) specifically: Endocem MTA, Biodentine, NeoMTA Plus, and backfilling materials. Ninety-six freshly extracted human mandibular premolar teeth were selected. Twelve roots were used as the negative control group. Rotary files were used to complete the final irrigation and root canal preparation on the remaining teeth. Following that, burs were used to make standardized internal resorption chambers in the middle part of the roots. Twelve of these samples were used as positive control samples. The remaining 72 root canals were obturated in the apical 4 mm using a single-cone approach, and they were separated into 6 groups based on the CSCs used to fill voids and the materials used as backfilling. Group 1: Endocem MTA (resorption) + Endocem MTA (coronal), Group 2: Endocem MTA (resorption) + Gutta-percha/sealer (coronal), Group 3: Biodentine (resorption) + Biodentine (coronal), Group 4: Biodentine (resorption) + Gutta-percha/sealer (coronal), Group 5: NeoMTA Plus (resorption) + NeoMTA Plus (coronal), and Group 6: NeoMTA Plus (resorption) + Gutta-percha/sealer (coronal). Specimens were inserted in acrylic resin and then subjected to fracture testing. Fracture strength tests were performed using a Universal Testing Machine. The force was employed vertically with a consistent speed of 1 mm/minute. The results were analyzed with Variance and Bonferrini tests at P < 0.005. The mean force of fracture values were 447.00, 201.25, 318.75, 187.50, 596.58, 258.75, 347.50, and 298.75 N for Group 1, 2, 3, 4, 5, 6, 7, and 8, respectively. "There was a significant difference (P < 0.001) between the experimental groups and the control group". Group 5 showed the highest FR as compared to other groups. Backfilling with CSCs appears to be a better material than a gutta-percha/sealer combination. Neo MTA plus furthermore appeared the highest fracture-resistant material, while Biodentine + Gutta percha/sealer showed the least FR.

Effectiveness of traditional band and loop space maintainer vs 3D-printed space maintainer following the loss of primary teeth: a randomized clinical trial.

This study evaluates the efficacy of 3D-printed band and loop space maintainers (3D-BLSMs) to mitigate concerns caused by early primary tooth loss in children when compared to their conventional equivalents. Over 9 months, 62 participants aged 6 to 12 years participated in a randomized clinical study. This study evaluated their failure rates (de-cementation, debonding, solder breakage, loop breakage, band breakage, and abutment tooth fracture), gingival health, and patient overall satisfaction. Random assignments were made to place the participants in two groups: traditional band and loop space maintainers or the 3D-BLSMs. The findings show that at 9 months, 3D-BLSMs provided significantly higher survival rates (77.4%) than conventional maintainers (51.6%, p < 0.01). Gum inflammation was mild in both groups, highlighting the need for good oral hygiene. In both groups, patient satisfaction exceeded 90%. Although there was some pain at first with 3D-BLSMs, this eventually subsided and aesthetic preferences disappeared. There were no negative consequences noted, and both groups needed ongoing dental treatment. In conclusion, with excellent patient satisfaction in both groups, 3D-printed space maintainers offer greater long-term durability in reducing dental concerns following early primary tooth loss.

Comparison of Postoperative Pain After the Utilization of Different File Systems in Single Visit Endodontics.

Purpose: This prospective single-blind, parallel-group, randomized clinical trial was aimed to compare the effect of three different rotary instrumentation systems ProTaper Next (PTN), Self-Adjusting File (SAF) and XP-endo Shaper (XPS) on postoperative pain and analgesic intakes. Patients and Methods: A total of 159 molars diagnosed with symptomatic irreversible pulpitis were randomly divided into three study groups according to the instrumentation techniques: PTN (n = 54), SAF (n = 52), and XPS (n = 53). The preoperative pain scores were taken before the onset of treatment in the groups. After a single appointment for root canal treatment, the patients were asked to rate the level of their pain according to the Visual Analog Scale (VAS) of 100 mm at 6, 24, 48, and 72-hour post-treatment intervals. Ibuprofen was prescribed to be taken while experiencing pain; patients were requested to note the number of pills consumed at intervals after treatment. Results: The patients in SAF and XPS groups had lower mean VAS scores than the PTN group at 24-, 48-, and 72-hour intervals (p < 0.05). The most common analgesic intake was optimally seen in the PTN group at a 6-hour interval. All shaping procedures caused postoperative pain, whose intensity decreased with time. Conclusion: The SAF and XPS groups had a lesser intensity of pain as well as minimum analgesic intakes as compared to the PTN group. All instrumentation systems moderately caused pain, and the PTN group experienced the highest pain among others.

LPS-Induced Neuron Cell Apoptosis through TNF-α and Cytochrome c Expression in Dental Pulp.

OBJECTIVES: Inflammation of the dental pulp tissue caused by bacteria, creating an immunology response of death of the dental pulp, is called apoptosis. The Porphyromonas gingivalis that cause apoptosis is lipopolysaccharide (LPS) through toll-like receptor (TLR) via two different mechanisms, intracellular and extracellular pathways. This study analyzed the role of LPS exposure of neuron cells, tumor necrosis factor-α (TNF-α), and cytochrome c (cyt-c) expression in the dental pulp to predict the possible mechanism of apoptosis. MATERIALS AND METHODS: The lower tooth of Sprague Dawley rats was opened and exposed to LPS for 48 hours. Then the neuron cell analyzed histopathology using hematoxylin-eosin, whereas the TNF-α and cyt-c expression with indirect immunohistochemistry using a light microscope. The relationship between neuron cells with TNF-α and cyt-c was analyzed using stepwise regression linear analysis. RESULT: The LPS exposure showed a lower number of neuron cells and had a relationship with TNF-α expression but not with cyt-c, while compared with control, both TNF-α and cyt-c expression were higher in neuron cells. CONCLUSION: LPS exposure in dental pulp is possible to stimulate the apoptosis process through extracellular pathways marked by higher TNF-α expression.

Estimation of Age implementing pulp tooth volume ratio in maxillary canines of an Indian population by means of CBCT scans.

BACKGROUND: Forensic odontology is a subfield of forensics that can assist in determining age, gender, and other demographic factors. OBJECTIVE: The focus of this research is to ascertain age by tooth volume ratio of permanent maxillary canines using a CBCT scan. METHODS: In this retrospective investigation, 1000 CBCT images were gathered and focused on only fully developed maxillary canines. For each of the maxillary canines, the researchers measured and calculated the volume of the pulp chamber, root canal, and entire tooth using the ITK Snap programme. The pulp volume to tooth volume ratio was computed. The equation AGE = 59.208 - (583.652 x pulp volume/tooth volume) was then used to compute age. The samples were divided into 5 age groups; 13-20, 21-30, 31-40, 41-50, and 51-60. The age was calculated for samples in each group and it was compared to the actual age. RESULTS: Between individuals' actual age and computed age, the study discovered a statistically significant positive association. While groups 3, 4, and 5 demonstrated positive but weaker correlations (r= 0.854, r= 0.658, and r= 0.612, respectively), groups 1 and 2 displayed statistically significant strong positive correlations (r= 0.987 and r= 0.923, respectively). The average total discrepancy between the age that was computed and the actual age was 2.45 1.344. CONCLUSION: The study found a statistically significant positive correlation between computed age and actual age, with the younger age groups 1 (13-20) and 2 (21-30) showing the strongest relationships. This underlines its potential success in court, particularly when dealing with young criminals.

The potential of eggshell hydroxyapatite, collagen, and EGCG (HAp-Col-EGCG) scaffold as a pulp regeneration material.

Background: Hydrogel scaffold is a biomaterial that can facilitate cells in forming a tissue structure. It can promote cell adhesion, migration, and proliferation. Further research to find a new scaffold from natural resources is challenging, so this study aimed to characterize a hydrogel composite scaffold, which has the potential to be used as a regenerative material. Methods: The formulation of HAp-Col-EGCG was mixed with different ratios of 1%, 2%, and 4% hydroxyapatite. We analyzed its injectability, pH, and gelation time. Scanning electron microscopy (SEM), energy X-ray Spectroscopy (EDX), and Fourier-transform infrared spectroscopy (FTIR) were used to evaluate the surface morphologies, element composition, and chemical properties of HAp-Col-EGCG. Results: The results showed that the injectability test was almost 90 % in all groups. There was no significant difference in the median value of the pH at 0, 20, and 60 min in all groups, but there was a significant difference at 40 min. The average gelation times in all groups were not significant. SEM-EDX showed a microporous scaffold, with the HAp particles well distributed in the collagen pores at a ratio of 1.9, 2.29, and 1.89 Ca/P. The FTIR results showed intermolecular bonds in the HAp-Col-EGCG scaffold. The X-ray diffraction analysis showed that collagen and EGCG did not affect the crystal structure and size of HAp. Cytotoxicity test showed more dental pulp cell viability at the 4 % HAp concentration at 514.35 ± 15.45. Conclusion: This study indicates that hydrogel scaffold from eggshell hydroxyapatite, collagen, and EGCG has a high potential for pulp regenerative therapy.

Can Type of Instrumentation and Activation of the Final Irrigant Improve the Obturation Quality in Oval Root Canals? A Push-Out Bond Strength Study.

To appraise the outcome of file systems and activation of the final irrigant on the push-out bond strength of root fillings in oval canals. Single-rooted mandibular premolars (n = 180) with oval canals were divided into three groups (n = 60) for instrumentation: ProTaper Next (PTN), WaveOne (WO), and Self-adjusting File (SAF). The specimens were further divided into subgroups (n = 20) and subjected to final irrigation with activation by EndoActivator or passive ultrasonic irrigation or without activation. Then, the specimens were again subdivided (n = 10) and obturated with gutta-percha and AH Plus (GP-AH) or C-Point with EndoSequence bioceramic sealer (C-EBC). One-millimeter-thick horizontal slices were cut from the apical third of the root, 5 mm from the apex, and subjected to push-out bond strength (BS) testing. Specimens for which SAF was used exhibited higher BS values than those for which PTN or WO was used (p < 0.05). Activation of the final irrigation did not affect the BS of the root fillings. Root fillings made of C-EBC presented a higher BS than those made of GP-AH (p < 0.05). Adhesive failure was more common with specimens instrumented using PTN and WO. Root canals instrumented with SAF, showed the highest bond strength values for both root filling materials. The C-EBC produced significantly higher bond strength values than those of the GP-AH.

Severity of Post-Operative Pain after Instrumentation of Root Canals by XP-Endo and SAF Full Sequences Compared to Manual Instrumentation: A Randomized Clinical Trial.

This investigation aimed to examine the post-operative pain experienced following single-visit root canal treatment using the XP-endo shaper sequence (XPS), full-sequence self-adjusting file (SAF), and manual K-files (HKF). A randomized equivalence parallel design, double-blinded clinical study was conducted on 120 patients with symptomatic irreversible pulpitis, with or without clinical signs of apical periodontitis. Only teeth with fully formed roots and no periapical lesions were incorporated in the study. Patients were apportioned to one of three groups (n = 40) randomly: Group 1-XPS, Group 2-SAF, and Group 3-HKF. Pre- and post-instrumentation pain was rated utilizing Visual Analog Scale (VAS) with a spectrum of 0-100 mm. The descriptive statistics and one-way ANOVA with 95% confidence intervals were used for statistical analysis. The mean VAS scores before instrumentation were consistent in all three groups. At 6, 24, 48, and 72 h, patients with root canals instrumented by SAF had the lowest post-instrumentation mean VAS score, followed by XPS. For all time intervals, the patients in the HKF group had the highest VAS score. The full-sequence SAF instrumentation resulted in less post-operative pain than the XP-endo plus protocol, while manual instrumentation with K-files resulted in the highest post-operative pain.

Location angle of second mesio-buccal canal in maxillary molars of an Indian population: an in vivo retrospective CBCT evaluation and proposal of a new classification.

Background: The current investigation was designed for predicting the location angle of second mesio-buccal root canal in permanent maxillary (first and second) molars with the aid of proposed measuring points and line using cone beam computed tomography in an Indian population. Methods: Three-hundred and twenty-four scans of permanent maxillary (first (n = 162) and second (n = 162)) molars with mesio-buccal 2 root canals and unassociated to the current evaluation were acquired. The maxillary molars were viewed with CSI imaging software. The images were captured and were further assessed using 3D Slicer. The assessment included of measuring the distance between the main mesio-buccal and mesio-buccal 2 canal and the angle at which the MB2 it is located utilizing proposed lines joining the disto-buccal and palatal canals. The data was tabulated for the incidence of various angles where the MB2 is located and MB-MB2 distance was determined. The angles denoted were either positive; I (0.1° to 1.9°), II (2° to 4°), III (>4°) or negative I (-0.1° to -1.9°), II (-2° to -4°), III (>-4°). On the data tabulated a new Banga Vhorkate and Pawar's (BVP's) angular classification for maxillary molars was proposed. Results: The existence of positive angle III was found in 41.35% of maxillary first molars (36 right and 31 left of 162), whereas positive angle II appeared in 41.98% of maxillary second molars (32 right and 36 left of 162). The MB1-MB2 in maxillary 1st molar is seen to be 3.12-3.31 mm and this distance in maxillary 2nd molar is 2.8-3.1 mm. The disto-buccal to palatal canal orifice mean distance was 5.06-5.22 mm in maxillary first molars and 4.9-5.8 mm in maxillary second molars. Conclusion: Accurate diagnosis of the location of second mesio-buccal canal increases the success rate of endodontic treatment and a better prognosis. The new proposed classification may be considerably helpful in the urge to locate the mesio-buccal 2 canal.

The Multifaceted Influence of COVID-19 on Indian Dentists: A Cross-Sectional Survey.

Introduction: COVID-19 has had a new challenge on dental workers, radically altering clinical and personal management. The cross-sectional survey sought to examine and comprehend the influence of COVID-19 on Indian dentistry practitioners. Methods: A 38-item questionnaire-based survey was communicated to Indian dental practitioners through a web-based form (Google form). The questionnaire was categorized into four sections: (i) Personal protective equipment (PPE), (ii) dental treatments, (iii) auxiliary management, and (iv) personal impact. The findings were examined and studied in order to comprehend the repercussions of COVID-19. The questionnaire was completed by 513 of the 1129 dentists to whom it was delivered. Results: For the current questionnaire, a response rate that we received was 45.44%. When compared to the pre-pandemic era, the use of PPE has increased dramatically (95.7%). The use of PPE alleviated dental practitioners' and patients' doubts about viral transmission. The epidemic prompted the Ministry of Health and Family Welfare (MoHFW) to issue specific recommendations for dental treatments, which were followed by 92.5% of dentists. The majority of dentists reported a considerable impact on both financial and mental health concerns. Teleconsulting and distant learning gained greater prominence. The COVID-19 epidemic affected the lives of dental professionals both within and outside of the dental setting, as well as the auxiliary. Conclusion: COVID-19 has left a trail of devastation in its aftermath. Dentists were affected both emotionally and professionally. Dentists rapidly and uniformly followed the revised recommendations.

A Statistical Analysis of Impact of COVID19 on the Global Economy and Stock Index Returns.

The outbreak of pandemic COVID-19 across the world has completely disrupted the political, social, economic, religious, and financial structures of the world. According to the data of April 22nd, 2020, more than 4.6 million people have been screened, in which the infection has made more than 2.7 million people positive, in which 182,740 people have died due to infection. More than 80 countries have closed their borders from transitioning countries, ordered businesses to close, instructed their populations to self-quarantine, and closed schools to an estimated 1.5 billion children. The world's top ten economies such as the United States, China, Japan, Germany, United Kingdom, France, India, Italy, Brazil, and Canada stand on the verge of complete collapse. In addition, stock markets around the world have been pounded, and tax revenue sources have fallen off a cliff. The epidemic due to infection is having a noticeable impact on global economic development. It is estimated that by now the virus could exceed global economic growth by more than 2.0% per month if the current situation persists. Global trade may also fall from 13 to 32% depending on the depth and extent of the global economic slowdown. The full impact will not be known until the effects of the epidemic occurred. This research analyses the impact of COVID-19 on the economic growth and stock market as well. The aim of this research is to present how well COVID-19 correlated with economic growth through gross domestic products (GDP). In addition, the research considers the top five other tax revenue sources like S&P500 (GPSC), Crude oil (CL = F), Gold (GC = F), Silver (SI = F), Natural Gas (NG = F), iShares 20 + Year Treasury Bond (TLT), and correlate with the COVID-19. To fulfill the statistical analysis purpose this research uses publically available data from yahoo finance, IMF, and John Hopkins COVID-19 map with regression models that revealed a moderated positive correlation between them. The model was used to track the impact of COVID 19 on economic variation and the stock market to see how well and how far in advance the prediction holds true, if at all. The hope is that the model will be able to correctly make predictions a couple of quarters in advance, and describe why the changes are occurring. This research can support how policymakers, business strategy makers, and investors can understand the situation and use the model for prediction.

A comparative evaluation of the effect of three different concentrations of in-office bleaching agents on microhardness and surface roughness of enamel - An in vitro study.

BACKGROUND: To evaluate the changes in the micro-hardness and surface roughness of enamel treated with three different concentrations of in-office bleaching agents. MATERIALS AND METHODS: In this in vitro study, 60 human incisors were divided into two groups (Group A and Group B). To obtain the baseline values, a Vickers tester was used to determine the surface microhardness in Group A, and a Surtronic tester was used for evaluation of surface roughness in Group B. Each group was then further subdivided into three subgroups and subjected to bleaching with Dash (Groups A1 and B1), Pola Office (Groups A2 and B2), and Opalescence Boost (Groups A3 and B3) containing 30%, 35%, and 40% hydrogen peroxide (HP), respectively. Samples were again subjected to testing to obtain the postbleaching values. Pre- and postbleaching data were analyzed by paired t-test. Intergroup comparison was carried out using one-way ANOVA (P ≤ 0.05). RESULTS: A significant decrease in microhardness values was observed following bleaching in all the three groups, with Group A1 showing maximum percentage decrease (2.58%), followed by Group A2 (1.23%) and Group A3 (0.73%). Furthermore, an increase in surface roughness was observed following bleaching, with Group B1 showing maximum percentage increase (14.80%), followed by Group B2 (8.25%) and Group B3 (5.79%). However, there was no significant difference in either microhardness or surface roughness when comparing the postbleaching values among the three bleaching agents. CONCLUSION: In-office bleaching agents may adversely affect the microhardness and roughness of enamel surface which are not related to the concentration of HP used.

Effect of Adaptive, Rotary, and Manual Root Canal Instrumentation in Primary Molars: A Triple-Armed, Randomized Controlled Clinical Trial.

This clinical trial focused on collating the instrumentation time and quality of root canal obturation in primary molars treated with three instrumentation techniques: adaptive, rotary, and manual. A triple-armed, randomized controlled clinical trial was performed on 75 primary molars requiring pulpectomy treatment, divided into three groups (n = 25 per group). The teeth in Group 1 were instrumented with an adaptive technique (XP-endo Shaper, FKG Dentaire, La Chaux-de-Fonds, Switzerland), Group 2 with pediatric rotary files (Kedo-S; D1 and E1), and Group 3 with a manual technique (hand K-files). The apical size of the final instrumentation was maintained at #30 for all groups. Instrumentation time and the grade of the root canal obturation were evaluated. Instrumentation duration was recorded, employing a digital stopwatch from the insertion of the first file until the completion of final irrigation. Obturation quality was assessed using radiographs. The criteria taken as a reference for obturation were: optimal (1 mm short of the apex), underfilled (2 mm short of the apex), or overfilled (beyond the apex). The use of an adaptive technique was associated with the lowest instrumentation time (p < 0.0001) when used for instrumenting primary molars and with the highest root canal filling quality of the three groups. The application of the new concept of adaptive instrumentation for pulpectomy of primary molars was a favorable technique, considering the significant reduction in instrumentation time and better obturation.

Apical debris extrusion during instrumentation of oval root canals in primary teeth using manual versus motorized files: an ex vivo study.

This study aimed to assess the apical extrusion of debris during instrumentation of primary canines using three endodontic file types. Forty-five extracted primary canines were randomly assigned to three instrumentation groups (n = 15): Hand K-files; and the motorized Kedo-S files and XP-endo Shaper files. The apically extruded debris produced during the procedure was collected and dried in pre-weighed Eppendorf tubes, and the mass of debris was calculated. The time required for the endodontic procedure was also recorded. Analysis of variance (ANOVA) and Tukey's post hoc test were used with a significance level set at 5%. XP-endo Shaper and Kedo-S files extruded significantly less debris compared with hand K-files with means of 0.84 ± 0.31 and 1.20 ± 0.67 mg respectively, compared to 2.13 ± 0.31 mg (p < 0.0001). No significant difference was found between the two motorized files. Less time was required to complete the procedure with the XP-endo Shaper compared to the hand K-files (p < 0.0001) and Kedo-S files (p < 0.0001). Within the limitations of the present study, it may be concluded that motorized files extruded less debris and required less instrumentation time compared to traditional K-files, which could benefit paediatric patients with root canal treatment needs.

Deficiencies in Root Canal Fillings Subsequent to Adaptive Instrumentation of Oval Canals.

The purpose of this study was to explore the influence of instrumentation and the potential for debris deposition using XP-endo shaper plus (XP-SP) and full-sequence SAF (F-SAF) on the adaption of thermoplastic root canal fillings in oval canals. Following the manufacturer's instructions, ninety human permanent mandibular incisors with a single oval canal 6 mm from the apex (verified using pre-operative CBCT scanning) were instrumented with XP-SP and F-SAF. Obtura III Max apparatus was used for root canal obturation without the use of a root canal sealer. The roots were then sectioned 6 mm from the apex and examined with a digital stereomicroscope at x25 magnification to assess the root canal fillings. The F-SAF was associated with a significantly higher (p < 0.01) percentage of entire adaptation of the root fillings (76%) compared to the XP-SP (57%). Furthermore, the XP-SP group was also associated with higher (p < 0.01) defective obturation with debris at 17% and with voids at 26%. However, the F-SAF had lower percentages of defective obturations (7% with debris and 17% with voids). The quality of obturation of oval canals instrumented using full-sequence SAF was better.

Differences in endodontic emergency management by endodontists and general dental practitioners in COVID-19 times.

The aim of this study was to assess the differences, if any, between general dental practitioners (GDPs) and endodontists, in the diagnosis and treatment of endodontic emergencies during the worldwide outbreak of COVID-19. An online questionnaire was randomly sent by social media to clinicians in different countries from 24 April, 2020 to May 4, 2020. The survey consisted of a series of questions about demographic characteristics, endodontic emergency diagnoses, approaches to prevent aerosol formation, drug prescriptions in case of symptomatic irreversible pulpitis, and the ways in which dentists managed endodontic emergencies during the COVID-19 lockdown. A total of 1,058 dentists responded to the questionnaire; 344 (32.6%) of the participants were endodontists. Slightly less than half of the participants (n = 485, 45.8%) worked during the lockdown, but only 303 participants (28.6%) treated endodontic cases/emergencies. The responses showed agreement between endodontists and GDPs regarding the diagnosis of symptomatic irreversible pulpitis (SIP), symptomatic apical periodontitis (SAP), reversible pulpitis, and asymptomatic irreversible pulpitis (AIP). SIP and SAP were considered an emergency, whereas reversible pulpitis and AIP were not considered an emergency (p > 0.05). Non-aerosol-generating procedures and treatment approaches differed between the groups (p < 0.05). One-third of the participants did not use rubber dam (p > 0.05). Ibuprofen and amoxicillin-clavulanic acid were the most frequently prescribed drugs for pain associated with SIP. In conclusion, the most relevant findings in our survey were the differences between endodontists and GDPs in diagnosis, precheck triage, deep caries excavation procedures, and endodontic emergency pain relief strategies.

Comparative evaluation of the effect of decontamination protocol on the shear bond strength of eighth generation bonding agent to contaminated dentin: an in vitro study.

INTRODUCTION: This in vitro study aims to evaluate and compare the effect of decontamination protocol - based on sodium hypochlorite - NaOCl, as a decontaminating agent, followed by the application of a collagen cross-linking agent like sodium ascorbate or Proanthocyanidin on the shear bond strength of eighth generation bonding agent to contaminated dentin (saliva, blood and blood followed by hemostatic agent). METHODS: The buccal surfaces of extracted premolars were flattened to expose the dentine. The teeth were then randomly divided into 3 groups based on the contaminant used (saliva, blood and blood followed by hemostatic agent). Decontamination protocol was carried out with sodium hypochlorite followed by application of either of the two collagen cross-linking agents (sodium ascorbate/proanthocyanidin) in each group. FuturaBond DC (eighth generation) bonding agent was used to bond composite to dentin surfaces which was subjected to shear bond strength testing. Data was analyzed by one-way ANOVA and Tukey test. RESULTS: All the groups (contaminated with saliva, blood, or hemostatic agent) showed a decrease in shear bond strength of composite resin to dentin. The shear bond strength of composite resin to dentin was least affected by contamination with saliva followed by contamination with blood and was most affected by contamination with a hemostatic agent.The decontamination protocol carried out showed that the combination of NaOCl and Proanthocyanidin improved the shear bond strength of composite to dentin significantly more than the combination of NaOCl and sodium ascorbate or of sodium hypochlorite used alone.