PCR-based detection of three anaerobic bacteria associated with endodontic-periodontic lesions in type-2 diabetic and nondiabetic subjects.

AIM: The aim of this study is to clinically isolate and detect three anaerobic bacteria associated with endodontic-periodontal lesions in type-2 diabetic and nondiabetic patients using polymerase chain reaction (PCR). MATERIALS AND METHODS: Sixty patients presenting endodontic-periodontal lesions were divided into two groups. Thirty patients with type-2 diabetics (Group 1) and 30 nondiabetic patients (Group 2) were evaluated for the presence of three anaerobic bacteria. Clinical examinations, periapical radiographs, and microbiological sampling from the canal system and periodontal pockets were performed. Qualitative evaluation of bacteria was performed using a multiplex PCR for Porphyromonas gingivalis and Prevotella intermedia. Statistical analysis was performed using Pearson's Chi-square test and Fischer's exact test. RESULTS: Enterococcus faecalis (73.3%) was the predominant bacteria isolated from the root canal in type 2 diabetic patients, followed by P. gingivalis (70%) and P. intermedia (36%) compared to 53.3%, 43.3%, and 23.3%, respectively, among nondiabetic patients. P. gingivalis (73.3%) was the predominant bacteria isolated from periodontal pockets in type II diabetic patients followed by P. intermedia 50% and E. faecalis 30% compared to 36.6%, 33.3%, and 30%, respectively, among nondiabetics. P. gingivalis was detected in the root canal and periodontal pocket in almost similar numbers (70% and 73%), respectively, among type-2 diabetics. CONCLUSION: Detection of P. gingivalis, P. intermedia, and E. faecalis in both root canal and periodontal pocket samples confirm a viable pathway for the spread of infection through dual sites. Since in the present study, P. gingivalis was found to be present in similar numbers in dual sites among type 2 diabetic patients, importance should be given in treating such anaerobic bacteria in immune-compromised patients.

Comparative Evaluation of Cytotoxicity and Genotoxicity of Two Bioceramic Sealers on Fibroblast Cell Line: An in vitro Study.

AIM: The purpose of this study was to evaluate and compare the cytotoxicity and genotoxicity of two bioceramic root canal sealers: EndoSequence BC and iRoot SP with zinc oxide eugenol sealers on fibroblast cell line. MATERIALS AND METHODS: The sealers tested were zinc oxide eugenol, EndoSequence BC, and iRoot SP. Each material was mixed according to the manufacturer's instructions and mounted into sterile polyethylene color-coded rings, for cytotoxicity and genotoxicity evaluation. After 48 hours, the set materials were transferred to previously marked wells and cytotoxicity evaluation to L929 murine fibroblast cells was done by 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. The percentages of viable cells were then calculated and values were statistically analyzed by Kruskal-Wallis test. The evaluation of genotoxicity of the materials to L929 murine fibroblast cells was carried out by Comet assay. To quantify deoxyribonucleic acid (DNA) damage, the following comet parameters were evaluated in the assay using Comet scoring software: tail length, tail moment, and Olive moment. The values were statistically analyzed using Kruskal-Wallis test with a significance value set to p < 0.05. RESULTS: The results of the study showed that both cytotoxicity and genotoxicity evaluation by MTT assay and Comet assay can be done on L929 murine fibroblast cell line. Among the three tested materials, zinc oxide eugenol showed maximum cytotoxicity to the cells (30.64% viable cells), followed by EndoSequence BC (71.33% viable cells) and iRoot SP (75.11% viable cells). The evaluation of DNA damage by genotoxicity assessment showed iRoot SP to be least genotoxic followed closely by EndoSequence BC. Zinc oxide eugenol was genotoxic and induced more DNA damage on the fibroblast cell line studied. The statistical analyses for both the assays were nonsignificant. CONCLUSION: All the three tested sealers showed varying degrees of cytotoxicity and genotoxicity while using fibro-blast cell line. Zinc oxide eugenol was most toxic in both the assays and iRoot SP showed least toxicity, followed closely by EndoSequence BC.

Detection of Adherence of Enterococcus faecalis in Infected Dentin of Extracted Human Teeth Using Confocal Laser Scanning Microscope: An In vitro Study.

AIM: The aim of this study is to detect in vitro adherence of Enterococcus faecalis to the infected dentinal tubules of human extracted teeth using confocal laser scanning microscope. SUBJECTS AND METHODS: Roots from human premolar teeth (n = 40) were infected with E. faecalis strain the American Type Culture Collection 29212 in brain heart infusion for 21 days. After the experimental period, specimens were divided into two groups, Group A (n = 20), Group B (n = 20), and Group A specimens were stained with fluorescein diacetate dye for the detection of viability and adherence Group B were stained with acridine orange dye for detection of metabolic activity and adherence. Samples were washed, thoroughly sectioned and examined by confocal laser scanning microscopy. Computer-assisted determinants of fluorescence, bacterial viability, metabolic activity, and adherence were compared statistically. RESULTS: E. faecalis was able to invade the dentinal tubules to a depth of 1-400 µm and adhere to 1-200 µm depth. Adherence (90%) was significantly higher in 1-100 µm using fluorescein diacetate and acridine orange dye. CONCLUSION: Adherence of E. faecalis as evaluated by confocal laser scanning microscope was highest at the depth of 1-100 µm which may have an impact on the shaping and cleaning procedures on the root canal.

Periapical healing outcome following single visit endodontic treatment in patients with type 2 diabetes mellitus.

BACKGROUND: The prevalence of apical periodontitis in diabetes mellitus patients is high. The altered immunity in diabetes affects the healing process of periapical tissue. Single visit endodontic treatment has shown to increase the periapical healing rate with better patient compliance. Hence the present study aims at evaluating the clinical and radiographic healing outcome of single visit endodontic treatment, in type 2 diabetes mellitus patients with periapical disease. MATERIAL AND METHODS: Eighty patients with periapical disease were divided into 2 groups of 40 each: Group I, Control subjects and Group II, Type 2 diabetics. Glycosylated hemoglobin levels were assessed preoperatively and at follow up intervals in diabetics. Pre-operative assessment of periapical status was done using CPDR (Clinical periapical diagnosis of root), QLDR (Qualitative radiographic diagnosis of tooth) and QTDR (Quantitative radiographic diagnosis of tooth) criteria. Postoperative healing was evaluated following single-visit endodontic treatment by Strindberg criteria. RESULTS: Group 2 subjects had chronic and exacerbating lesions with significantly larger lesions (p=0.029). 100 % clinical healing outcome in diabetic group was seen in two months. Group 2 showed 85% success in one year on radiographic evaluation. Poor controlled diabetics showed failure compared to fair and good controlled. CONCLUSIONS: Type 2 diabetics had chronic and larger sized lesions when compared to control subjects. The periapical lesions in patients with poor diabetic control showed failure. The clinical and radiographic healing outcome of single visit endodontic therapy was delayed in diabetic patients. Key words:Apical periodontitis, diabetes mellitus type 2, endodontics, periapical lesion, strindberg criteria.

Fluoride releasing and uptake capacities of esthetic restorations.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate and compare in vitro the fuoride release and uptake from 5 different esthetic restorative materials. MATERIALS AND METHODS: Materials tested were conventional GIC - Fuji 7, GC (group1), resin modifed GIC - Vitremer, 3M ESPE (group 2), polyacid modifed composite - Dyract, Dentsply (group 3), fuoride releasing composite - Tetric ceram, Ivoclar Vivadent (group 4), Giomer-Beautifl, Shofu (group 5). Fluoride release was estimated at 6th, 24th, 48th hour and weekly interval for 5 weeks. For fuoride recharge, each specimen was exposed to 2 ml of 1.23% APF gel for 4 minutes and fuoride release measured at 1st, 2nd, 3rd day and 7th day. The fuoride release and recharge was measured using fuoride ion specifc electrode. RESULTS: ANOVA and Tukey HSD test were used for statistical analysis. During tested period all materials showed statistically different capability to release and uptake fuoride. Groups 1 and 2 results were comparable in fuoride release. Similarly groups 3 and 5. Groups 1 and 2 vs 3, 4, 5 were statistically very highly signifcant. Only conventional GIC showed initial 'burst effect'. INTERPRETATION AND CONCLUSION: Materials tested showed potential for fuoride release and recharge. Different esthetic materials had variable fuoride release hence selection of materials should be guided by specifc clinical situations.

Dentinal hypersensitivity: A comparative clinical evaluation of CPP-ACP F, sodium fluoride, propolis, and placebo.

BACKGROUND: Dentine hypersensitivity is a transient condition that often resolves with the natural sclerotic obturation of dentinal tubules. A potent topically applied in-office desensitizing treatment is indicated as the choice of treatment when dentine hypersensitivity is localized to one or two teeth. AIM: The present study aimed to evaluate and compare the clinical efficiency of CPP-ACP F, sodium fluoride, propolis, and distilled water that was used as placebo in treating dentinal hypersensitivity. MATERIALS AND METHODS: 120 patients aged 20-40 years reporting with dentinal hypersensitivity in relation to canine, premolar and molars with erosion, abrasion, and gingival recession were randomly assigned to four groups of 30 patients each. Response to air jet and tactile stimuli were measured using visual analogue scale initially on 1st, 7th, 15th, 28th, 60(th), and final assessment was done on the 90th day. STATISTICAL ANALYSIS: A statistical analysis was done using Anova test (Fischer's test) and Tukey HSD test for multicomparison. RESULTS: The teeth treated with the test group showed decrease in the mean hypersensitivity values compared to control group, over a period of three months. The results showed propolis to be most efficient in treating dentinal hypersensitivity and CPP- ACPF showed to be the least efficient. CONCLUSION: All test groups were effective in reducing dentinal hypersensitivity, although they differed in rapidity of action over the period of 3 months. Further studies can be done using advanced materials and techniques. Multiple therapeutic modalities have been developed to treat dentinal hypersensitivity including products that impede nerve conduction of pain stimulus, products that mechanically occlude dentinal tubules, and calcium containing products designed to create plugs in the tubules utilizing a demineralization mechanism.

A radiographic correlation between systemic disorders and pulp stones.

AIM: The purpose of this study was to determine the correlation between pulp stones and cardiovascular disorders, Type II diabetes mellitus, autoimmune disorders and dental wear defects. This study also aims to evaluate the frequency of pulp stone in population of Dakshina Kannada district (Karnataka, India) and to determine association of pulp stones in different sexes, tooth type, dental arches and sides. PATIENTS AND METHODS: A total of 1432 teeth of five groups were examined, comprising of patients with C.V.S. disorders; Type II diabetes mellitus, autoimmune disorders, dental wear defects and control group. Teeth were examined under 2Χ magnification on radio visiograph (RVG) and conventional intra-oral periapical radiograph. The presence or absence of pulp stones were recorded. STATISTICAL ANALYSIS USED: Chi-square analysis was used to compare the frequency of occurrence of pulp stones between sexes, tooth type, dental arches and sides. RESULTS: Pulp stones were found in 134 (9.35%) of 1432 teeth detected. Significantly, higher numbers of pulp stones were recorded in patients with cardiovascular disorder (15.86%) than other groups. The occurrence of pulp stones were significantly higher in molars (18.29%) than premolars (6.6%) and in maxillary arch (12.36%) than in mandibular arch (5.95%). No significant difference was found between sexes and sides. CONCLUSION: Positive correlation was found between systemic disorder and pulp stones. Cardiovascular patients had maximum number of pulp stones followed by dental-wear defects and least number of pulp stones were evident in control group.