Stress analysis of horizontal mid-root fracture managed with different intraradicular fixation protocols: A 3D-finite element study.

The current study evaluated the stress distribution in a maxillary central incisor with mid-root fracture after splinting with different intra-radicular posts using 3D-finite element analysis (FEA). Five 3D-FEA models were constructed. Model 1 was an intact tooth with no fracture, Model 2: A tooth with a horizontal mid-root fracture, with no treatment. Model 3: Same as model 2, and intraradicular splinting using fiber post. Model 4: Same as model 2 and intra-radicular splinting using Protaper Gold file F3. Model 5: Same as model 2, and with intraradicular splinting with Ribbond. The FEA of all models was done to obtain the maximum Von-Mises stress in the root canal space, the dentin, the periodontal ligament, and the bone. The highest Von Mises stresses for the root canal space and the dentin were found in Model 3, followed by models 4, 5, and 2, and least in Model 1. The Von Mises stress of the periodontal ligament was the least in model 1. The Von Mises stress of bone was higher in all experimental models than in the baseline model. The results suggest that in cases where intra-radicular splinting is indicated, fiber posts and Ribbond are better alternatives to endodontic files due to the lower stresses exerted.

Attitude, perception and barriers of dental professionals towards artificial intelligence.

Aim: To know attitudes, perceptions and barriers towards the use of Artificial Intelligence (AI) in dentistry in India among undergraduate and postgraduate students. Methodology: A questionnaire-based cross-sectional study was conducted among participants pursuing graduation and postgraduation. The questionnaire consisted of 23 close-ended and 2 open-ended questions divided into various sections of attitude, perception and barriers. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24.0. Result: Out of 937 responses, 55.2% responded that they get information about AI from social media platforms. 51.3% of respondents have basic knowledge about the use of AI in dentistry. 59.6% agreed that AI can be used as a "definitive diagnostic tool" in the diagnosis of diseases. 66.5% agreed that AI can be used for radiographic diagnosis of tooth caries. 71.3% stated that AI can be used as a "treatment planning tool" in dentistry. 55.7% stated that AI should be part of undergraduate dental training. Conclusion: This study concluded that both dental students are aware of the concept of AI. Participants were positive when asked if AI can increase the efficiency of diagnosis, prognosis and treatment planning procedures as well as in managing patient data. Both participants believed that the barriers to the introduction of AI in dentistry are a lack of technical resources and a lack of training personnel in college.

Effect of amniotic membrane and platelet-rich fibrin membrane on bone healing post endodontic surgery: An ultrasonographic, randomized controlled study.

The use of membrane barriers and bone grafting materials in endodontic surgery promotes healing by regeneration rather than repair by scar tissue. Due to its valuable regenerative and therapeutic properties, the human amniotic membrane can support ideal periapical rehabilitation and promote better healing after surgery. The current trial aimed to evaluate the amniotic membrane's healing potential and compare it with platelet-rich fibrin using color doppler sonography. The current study is a randomized, double-blinded, parallel-group, single-center study. Thirty-four systematically healthy individuals requiring endodontic surgery who fulfilled all inclusion and exclusion criteria were selected and randomly placed in two groups. Surgical curettage of the bony lesion was performed and filled with hydroxyapatite graft. Amniotic membrane (Group 1) and platelet-rich fibrin (Group 2) were placed over the bony crypt, and the flap was sutured back. The lesion's surface area and vascularity were the parameters assessed with ultrasound and color doppler. and observations: The groups found a significant difference in mean vascularity at 1 month and mean vascularity change from baseline to 1 month (p < 0.05). Mean surface area had no statistically significant difference between the groups. However, in terms of the percentage change in surface area, a significant difference was found from baseline to 6 months (p < 0.05). Amniotic membrane was a significantly better promoter of angiogenesis than platelet-rich fibrin in the current trial. The osteogenic potential of both materials was similar. However, the clinical application, availability, and cost-effectiveness of amniotic membrane support it as a promising therapeutic alternative in clinical translation. Further large-scale trials and histologic studies are warranted.

Comparative evaluation of different irrigating and irrigant activation system in removal of gutta-percha/sealer during retreatment: An in vitro Micro-CT study.

Background: The aim of the study was to compare the efficacy of different irrigation and irrigant activation system used as an adjuvant to retreatment rotary files in removal of gutta-percha and sealer from endodontic retreatment using Micro-CT. Method: 64 extracted permanent maxillary central incisor teeth with single canal, were collected and decoronated to standard length of 16 mm. Instrumentation was done using rotary files and obturation was performed using GuttaCore and AH plus sealer. After setting of sealer, initial removal of filling material was performed using ProTaper universal retreatment files (D1, D2, D3). All 64 sample were randomised into four groups (n = 16) Group1: Endodontic syringe irrigation, Group 2: Passive Ultasonic Irrigation (PUI), Group 3: EndoActivator, and Group 4: EndoVac. Micro-CT scanning was performed after obturation, initial removal of filling material by retreatment file and after using experimental protocols of each group, and volume of remaining filling material was calculated using Dolphin software. Statistical analysis performed with one-way ANOVA followed by Tukey's post hoc. Results: A significant reduction in the volume of residual obturation material were found between each group. PUI was superior to the sonic (EndoActivator), negative pressure irrigation technique (EndoVac) and positive pressure irrigation at the coronal, middle third and apical third of the root canal. However, none of the supplementary techniques were able to completely remove the residual obturation material. Conclusion: PUI and EndoActivator were found better in remaining filling material removal, demonstrating clinically useful as supplementary technique in removing remaining obturation material during endodontic retreatment.

Comparative evaluation of remineralizing effect of fluoride and nonfluoride agents on artificially induced caries using different advanced imaging techniques.

Aim: The aim of the study is to evaluate and compare the in-vitro remineralization efficacy of remineralizing agents, i.e., fluoride-free toothpaste, fluoride toothpaste, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), CPP-amorphous calcium fluoride phosphate (CPP ACFP), and silver diamine fluoride (SDF) paste on dentine over time. Methodology: Seventy-five extracted human permanent molars were selected. The buccal section of these samples was shaped into a slab. Artificial caries was induced by dipping the samples into the demineralizing solution (pH 4.5) for 21 days. They were then divided into five groups (n = 15). Each experimental group underwent one of the following treatments: Group 1 - Fluoride-free toothpaste (negative control), Group 2 - Fluoride toothpaste (positive control), Group 3 - CPP-ACP, Group 4 - CPP-Amorphous Calcium fluoride Phosphate and Group 5 - SDF. Postremineralizing treatment, Scanning electron microscope, Energy dispersive X-ray and Quantitative light induced fluorescence imaging were carried out to analyze the remineralizing efficacy. The data obtained was then subjected to statistical analysis using ANOVA and Paired t-tests. Results: It was seen that SDF showed highest remineralization efficacy followed by CPP-amorphous calcium fluoride phosphate, CPP-ACP, fluoride toothpaste and fluoride-free toothpaste. The difference in mean value among the groups was statistically significant (P < 0.001). Conclusion: SDF showed the highest remineralizing potential in scanning electron microscopy and energy dispersive X-ray, followed by CPP-ACFP, CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste. Quantitative light fluorescence analysis showed more fluorescence changes in the CPP-ACFP followed by CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste.

A randomized controlled trial of endodontic treatment using ultrasonic irrigation and laser activated irrigation to evaluate healing in chronic apical periodontitis.

BACKGROUND: Aim of this trial was to evaluate the combined clinical and radiographic success rate of endodontic treatment using passive ultrasonic irrigation (PUI) and laser activated irrigation (LAI) as compared to conventional syringe irrigation. MATERIAL AND METHODS: Permanent incisors and single rooted premolars were assessed for eligibility and 69 patients were randomly divided into three treatment groups (n=23) by allocation concealment method and irrigation was performed in accordance with the allocated group. Teeth were evaluated clinically and radiographically with CBCT after 6 months and 12 months of the treatment. RESULTS: A significant difference was observed in the radiographic healing rates among three groups (χ2=12.29, p=0.05). On comparing the final outcome among the three groups (n=19), it was found that 2 (10.5%) cases of group I(Conventional Syringe irrigation), 7 (36.8%) cases of group II (Passive ultrasonic irrigation) and 8 (42.1%) cases of group III(Laser activated irrigation) were healed while under healing category 13 (68.4%) cases of group I, 12 (63.2%) cases of group II and 11 (57.9%) of group III were observed whereas 4 (21.1%) cases were categorised as diseased in group I only. CONCLUSIONS: LAI and PUI can increase the predictability of the endodontic treatment success in cases of chronic apical periodontitis. Key words:Cone-beam computed tomography, CBCT-PAI, Irrigation, LASER, Radiographic healing, Root canal treatment, Ultrasonic.

"Effect of local application of simvastatin in bone regeneration of peri-apical defects-a clinico-radiographic study.

OBJECTIVE: The present study evaluates and compares the effectiveness of Simvastatin (SIM), Hydroxyapatite (HA), and platelet-rich fibrin (PRF) in bone regeneration of periapical defects. MATERIAL& METHOD: Thirty-nine patients were selected and randomized into three groups, Group 1: HA (n = 13), Group 2: PRF (n = 13), Group 3: SIM (n = 13). After completion of RCT and apicoectomy, the grafts were placed locally in the defect and sutured. RESULTS: At the end of twelve months, postoperative symptoms and radiographic analysis assessed the outcome of the treatment. CONCLUSION: Intragroup analysis of CBCT- Periapical Index (PAI) scores at 6th and 12th month revealed a significant change in the SIM group (p = 0.018 and 0.001 respectively), compared to PRF (p = 0.026 and 0.001 respectively) and HA (p = 0.053 and 0.039 respectively). Intergroup analysis of change in the level of CBCT-PAI score was highly significant (p = 0.003).SIM caused a more considerable change in the level of CBCT-PAI score compared to other groups, thereby indicating a faster rate of bone regeneration.

A relative assessment of essential oil of Chrysopogon zizanioides and Matricaria chamomilla along with calcium hydroxide and chlorhexidine gel against Enterococcus faecalis in ex vivo root canal models.

OBJECTIVE: The objective of this study was to evaluate the antibacterial efficacy of two doses of vetiver and chamomile essential oils compared with chlorhexidine and calcium hydroxide against Enterococcus faecalis. MATERIALS AND METHODS: The growth inhibition and minimum inhibitory concentration of all tested materials were determined ex vivo following agar diffusion and broth dilution assay procedure. Human maxillary anterior teeth were prepared with protaper rotary files, followed by incubation with standard broth of E. faecalis. A total of 140 teeth were included in the study. These teeth are randomized and equally divided into seven groups and were treated with low (1.25 µl) and high doses (2.5 µl) of essential oils of vetiver and chamomile and calcium hydroxide (0.1/1.0 mL), 2% chlorhexidine (2.5 µl). Microbial sampling of six teeth from each group was done with paper points and Gates-Glidden burs at 1, 7, and 14 days and colony-forming unit (CFU)/mL was determined. RESULTS: There was a significant reduction in mean ± standard deviation of CFU (log10) in vetiver oil high dose (3.32 ± 0.036) and chlorhexidine (3.34 ± 0.030), followed by calcium hydroxide (3.46 ± 0.015) and chamomile oil high dose (3.48 ± 0.20) on day 1. On 7th day, a significant reduction was seen in chlorhexidine (2.74 ± 0.212), chamomile oil (2.81 ± 0.035, low dose and 2.97 ± 0.119, high dose), followed by calcium hydroxide (3.25 ± 0.028). However, on 14th day, it was 2.32 ± 0.088 for chlorhexidine, 2.91 ± 0.029 for chamomile oil high dose, 3.15 ± 0.010 for vetiver oil high dose, and 3.09 ± 0.068 for calcium hydroxide. CONCLUSION: The study showed a good effectiveness of chamomile oils in root canal infection of E. faecalis at different time intervals compared to chlorhexidine and calcium hydroxide vetiver oil did not sustain their activity for a longer duration.

A comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis.

AIM: This study aimed for a comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis. METHODS: Thirty single-rooted teeth were taken. Access preparation was done. Biomechanical preparation was done using Protaper universal file till F3. Teeth were decoronated to a standardized root length of 14 mm, and the apical end from outside was sealed using paraffin wax. Teeth were autoclaved under standard conditions and after autoclaving, Phosphate-buffered saline solution was introduced into the roots and was incubated for 24 h to check for the disinfection of roots. Once the disinfection of roots was achieved, the wild strain of E. faecalis, i.e., ATC 29212 strain, was introduced into the teeth and allowed to incubate for 24 h. Following bacterial colonization inside the roots, antimicrobials were introduced and efficacy was checked. The data obtained were subjected to statistical analysis using paired t-test for significance. RESULTS: Significant difference was observed between all the test groups. However, chlorhexidine gel showed the best value of mean difference, indicating it as the best antibacterial medicament. CONCLUSION: Within the limitations of this study, it can be concluded that chlorhexidine gel showed better antimicrobial properties against E. faecalis than other medicaments.

Depth and percentage of resin-based sealer penetration inside the dentinal tubules using EndoVac, EndoActivator, Navi tip FX irrigation system: A confocal laser scanning microscope study.

AIM: This in vitro study was conducted to evaluate the effect of EndoVac, EndoActivator, and Navy Tip FX irrigation system on lateral depth and percentage of sealer penetration into the dentinal tubules using confocal laser scanning microscope. MATERIALS AND METHODS: Forty recently extracted single-rooted mandibular premolars were taken and root canal treatment was performed using three different irrigation system, that is, EndoVac, EndoActivator, and Navi tip FX. The samples were divided into 4 groups according to the irrigation system used: Control or conventional needle (Group I), Navi Tip FX (Group II), EndoActivator (Group III), and EndoVac (Group IV). All teeth were obturated using AH Plus sealer labeled with fluorescent rhodamine B dye. The teeth were sectioned at coronal (5 mm), middle (3 mm), and apical 3rd (1 mm) from the apex. Total percentage and maximum depth of sealer penetration were measured using confocal laser scanning microscopy. The data were evaluated statistically using Kruskal-Wallis test with a 95% confidence level (P = 0.01). RESULTS: EndoVac resulted in more sealer penetration then EndoActivator and Navi Tip FX irrigation system. Endoactivator resulted in more sealer penetration in comparison to Navi Tip FX. CONCLUSION: Percentage and depth of sealer penetration were more at apical and middle 3rd with Endovac system followed by Endoactivator and Navi tip FX system.

Comparative evaluation of antibacterial effect of nanoparticles and lasers against Endodontic Microbiota: An in vitro study.

BACKGROUND: Present study was conducted with the aim of evaluating antimicrobial efficacy of silver (AgNP) and gold nanoparticles (AuNP) with and without Nd: YAG laser (L) irradiation against experimentally inoculated Enterococcus faecalis in infected human root dentin. MATERIAL AND METHODS: 120 extracted single rooted human teeth were prepared and inoculated with E. faecalis for 24 hrs. The teeth were then randomly divided into 4 experimental group: AgNPs group: irrigation for 3minutes with 50 µl of 100 ppm, the AuNPs group: irrigation with 50 µl of 100 ppm, the AgNPs & Nd: YAG lasers group: irrigation with 50 µl of 100 ppm + irradiation with 1.5W laser for 60 seconds, the AuNPs & Nd: YAG lasers group: irrigation with 50 µl of 100 ppm + irradiation with 1.5W laser for 60 seconds. One control group consisting of 2% CHX irrigation for 3 minutes was also there (n = 20). The specimens were collected from the canal before and after irrigation, and colony forming units were observed. RESULTS: Significant difference was found among all the groups in comparison to the control group (p<0.05). The greatest reduction in CFU's was observed with combination of AgNPs & Nd: YAG lasers group. CONCLUSIONS: AgNPs in combination with Nd: YAG laser irradiation has the potential to be used as root canal disinfectant. Key words:Antibacterial efficacy, gold, silver, nanoparticles, lasers, solid-state.

A Scanning Electron Microscopic Evaluation of the Effectiveness of Etidronic Acid, SmearClear and MTAD in Removing the Intracanal Smear Layer.

STATEMENT OF THE PROBLEM: Root canal therapy should not simply be the extirpation of the pulp and widening of the canal. But one should also focus on how to completely remove the loosely-attached smear layer because it has adverse effects on the final outcome of the treatment. PURPOSE: This study compared the efficacy of Etidronic acid, SmearClear and MTAD to remove the smear layer created during instrumentation in different regions of the root canal. MATERIALS AND METHOD: Fifty single-rooted mandibular premolars were decoronated from the cementoenamel junction and instrumented using the ProTaper universal rotary file system along with copious irrigation by 1.0% sodium hypochlorite and distilled water. On the basis of the type of chelating agent used for irrigation, samples (n=10) were then randomized into five groups as: Group I- 9% etidronic acid, Group II- 18% etidronic acid, Group III- SmearClear, Group IV- MTAD and Group V- normal saline. Subsequent to irrigation, all samples were rinsed, dried and sectioned longitudinally for evaluation of the smear layer removal under scanning electron microscope (2000X). Data were statistically analyzed by two-way analysis of variance and Tukey's post hoc test with statistical significance set at p< 0.5. RESULTS: The result showed that SmearClear was the most efficient in removing the smear layer. However, etidronic acid was found inferior than both SmearClear and MTAD. CONCLUSION: Chelators are essential for complete smear layer removal in association with organic solvent.

Comparative evaluation of antimicrobial efficacy of triple antibiotic paste, calcium hydroxide, and a proton pump inhibitor against resistant root canal pathogens.

OBJECTIVE: The objective of this study is to compare the antimicrobial efficacy of triple antibiotic paste (TAP) and a proton pump inhibitor (PPI) (omeprazole) in combination with calcium hydroxide (CH) against Enterococcus faecalis and Candida albicans. MATERIALS AND METHODS: E. faecalis and C. albicans were subcultured and inoculated at 37° overnight and were treated with different dilutions of TAP, 25 µg/ml (Group 1), CH (Group 2, control), CH 16 mg/ml + omeprazole 2 mg/ml (Group 3a) (CH 16 mg/ml + omeprazole 4 mg)/ml (Group 3b) for 24, 48, and 72 h in sterile uncoated 96-well microtiter plates. Minimum concentration at which the medicaments produced least optical density was determined using ELISA reader (ELx 808 BioTek Inc., USA) device set at optical density of 630 nm. Results were analyzed statistically by one-way analysis of variance followed by Tukey's multiple comparison tests. The significance level was set at 0.05. RESULTS: Mean concentration (irrespective of time) for TAP at which mean minimum optical density was recorded at 1.25 µg/ml (1:20 dilution) and 25 µg/ml (0 dilution) against E. faecalis and C. albicans, respectively. Least optical density for CH plus PPI group was obtained 1.6 µg/ml (1:10 dilution) and 16 µg/ml (0 dilution) for E. faecalis and C. albicans, respectively. However, CH alone showed a weaker antimicrobial action against either of the strains even at full concentration. CONCLUSIONS: PPI enhanced the antibacterial efficacy of CH against E. faecalis and C. albicans. However, TAP showed the best antibacterial property followed by CH plus PPIs against both the selected strains.

A systematic noninvasive approach for rehabilitation of traumatized maxillary incisors.

Esthetic and functional impairment due to dental trauma is a major concern for patients. The management of such traumatic cases is complex, and it requires a comprehensive knowledge, diagnosis, and treatment planning. It is also important to take into account the patient's desire as well as economical status. The present case report describes a simple, conservative, and noninvasive approach for the rehabilitation of traumatized maxillary incisors.

Prevalence of Taurodont molars in a North Indian population.

BACKGROUND: It is very important for dentists to be familiar with anomalies of teeth not only for the clinical complications but also their management. Taurodontism also provides a valuable clue in detecting its association with various syndromes and other systemic conditions. The purpose of this study was to assess the prevalence of Taurodont molars among a North Indian population. MATERIALS AND METHODS: A total of 1000 patients' full-mouth periapical radiographs were screened. The radiographs were evaluated under optimal conditions using double magnifying glasses. A total of 7615 molars (including third molars) were evaluated. The relative incidence and the correlations regarding the location of Taurodont teeth (right versus left side and maxillary versus mandibular) were analyzed using the Chi-square test. RESULTS: Twenty-eight patients were found to have a Taurodont molar (11 women and 17 men [P = 0.250]). The prevalence of Taurodont molar was 2.8%. Males had a higher prevalence rate than females (3.4% vs. 2.2%, respectively). A cluster analysis of total Taurodonts in the mandible (45%) versus maxilla (55%) of both males and females combined showed a statistically significant difference (P < 0.05). CONCLUSION: The occurrence of Taurodontism is basically based on racial expression in different populations. These variations in prevalence between different populations may be due to ethnic variations. The occurrence of Taurodont molars among this Indian population was rare.

Oral care needs, barriers and challenges among elderly in India.

OBJECTIVE: This paper presents an approach to the assessment of oral health needs of elderly and barriers to receive oral care in the life course. BACKGROUND: The dental needs of the elderly are changing and growing day by day. The management of older patients requires not only an understanding of the medical and dental aspects of ageing but also provide them good oral health service. In the life course of elderly there are many hurdles to receive proper oral care. The use of an assessment of oral health need will be essential in the development of care pathways to the elderly. METHODS: The proportion of older people is growing faster than that of any other age group. There is no sound database regarding the oral disease burden and treatment needs of the elderly in India. Physical and biological barriers with age can also affect oral health care either directly or indirectly. CONCLUSION: Oral care guidelines designed to assist elderly should consider not only prevention and treatment modalities but also the means of implementing such therapies in varying settings and utilizing the whole dental team.

Management of mucosal fenestration with external root resorption by multidisciplinary approach.

Mucosal fenestration is a clinical condition in which the overlying gingiva is denuded and the root is exposed to the oral cavity. Invasive cervical resorption is an entirely uncommon entity and its aetiology is poorly understood. This case presents an invasive cervical resorption of maxillary right central incisor with fenestration at the cervical third of the tooth. The resorption area was chemomechanically debrided. It was then restored with Mineral Trioxide Aggregate over which pink glass ionomer cement (GC Fuji VII) was placed. Lateral pedicle flap was used to cover the fenestration. The resorptive defect was restored using tooth coloured restorative resin after removal of the pink glass ionomer cement. Orthodontic treatment was continued for correction of malocclusion.

A simplified technique of orthograde MTA obturation on the elected canals of posterior teeth: Two case reports.

This article suggests a simplified technique of orthograde MTA obturation in less accessible canal(s) of posteriors teeth without using costly ultrasonics or specialised carrier. Essentially few finger pluggers, absorbent points and a simple canal projection method were used. The orifice(s) of the elected canal(s) to be obturated with MTA were projected onto the external occlusal surface for easy delivery and predictive instrumentation. The idea was based on 'easy access', 'working one canal with one mix at one time', 'thorough condensation' and 'removal of excess moisture'. In case I, palatal canal of tooth no. 2 with gross apical perforation and suspected VRF was obturated with MTA. And in Case II, tooth no. 19 presented with incomplete furcal fracture extending into the canal was obturated with MTA in all 3 canals unitarily. Dense homogenous MTA obturation was achieved and both cases healed uneventfully.

Clinical negligence or endodontic mishaps: A surgeons dilemma.

Complications may occur during and after endodontic treatment, which may be due to negligence of the operator. The surgical treatment of a case presenting pain and persistent pus discharge and swelling due to the extrusion of the root canal filling to the base of the nasal floor between left maxillary lateral and canine teeth is presented in this report. First, carelessness was during root canal treatment that was over obturated and second time during extraction in which overextended gutta-percha remained in the bone, caused the complications like pain, persistent pus discharge, and headache. Clinicians should be aware of the fact that endodontic instruments and filling materials (solid or liquid) can be extended in such a degree that can lead to neurological or sinus complications.

Dental amalgam: An update.

Dental amalgam has served as an excellent and versatile restorative material for many years, despite periods of controversy. The authors review its history, summarize the evidence with regard to its performance and offer predictions for the future of this material. The PubMed database was used initially; the reference list for dental amalgam featured 8641 articles and 13 publications dealing with recent advances in dental amalgam. A forward search was undertaken on selected articles and using some author names. For the present, amalgam should remain the material of choice for economic direct restoration of posterior teeth. When esthetic concerns are paramount, tooth-colored materials, placed meticulously, can provide an acceptable alternative. All alternative restorative materials and procedures, however, have certain limitations.