Evaluation of postoperative pain in endodontic retreatment with apical periodontitis using ozonated 2% chlorhexidine and 0.1% octenidine application: A randomized clinical trial.

Introduction: This study aimed to evaluate and compare postoperative pain (PP) in single-visit nonsurgical endodontic retreatment (SV NSER) with 2% chlorhexidine (CHX), 0.1% octenidine (OCT) with or without ozone, and 5.25% sodium hypochlorite (NaOCl). Materials and Methods: In this randomized, parallel, prospective, double-blind, clinical trial, 132 single-rooted, root-filled teeth with symptomatic apical periodontitis (AP) requiring NSER were allocated into six groups randomly (n = 22/group): 2% CHX with NaOCl (CHXH), 2% Ozonated CHX without NaOCl (OCHX), 2% Ozonated CHX with NaOCl (OCHXH), 0.1% OCT with NaOCl (OCTH), 0.1% Ozonated OCT without NaOCl (OOCT), and 0.1% Ozonated OCT with NaOCl (OOCTH). Standard NSER protocol was followed groups were irrigated with 15 ml of ozonated or nonozonated irrigant (CHX/OCT) for 3-5 min with ultrasonic agitation. PP at baseline, after 6, 12, 24, 48 h, and 7 days was recorded using the Visual Analog Scale (VAS). Logistic regression of predictor variables was compared using the Chi-square test. For group-wise and time-wise comparisons, a two-way analysis of variance followed by the post hoc Bonferroni test was carried out. Results: None of the patient-related variables in logistic regression obtained a statistically significant (P > 0.05) role in PP. The VAS score after 6 h was OCHX (4.72) > OOCT (4.42) > CHXH (4.23) > OCTH (3.95) > OCHXH (3.42) > OOCTH (3.21). OOCTH and OCHXH groups demonstrated statistically significant reductions in VAS scores at various time intervals (P < 0.05). Conclusion: SV NSER with ozonated OCT, CHX irrigation, and NaOCl resulted in lesser PP at all time intervals, i.e., 6, 12, 24, 48 h, and 7 days in patients with symptomatic AP.

Does dynamic navigation system preserve more dentine? - A systematic review.

OBJECTIVE: This systematic review aims to comparatively analyse the amount of dentin removal by free hand and static guided endodontics with dynamic navigation system (DNS) in endodontic access cavity preparation. METHODS: The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Based on the structured PICO framework of "Comparative evaluation of dynamic navigation system (I) to freehand (C) and static guided endodontics (C) in endodontic access cavity preparation on the preservation of tooth structure (O) when assessed on permanent human teeth (P)", the keywords were formulated and the articles were retrieved from three databases namely PubMed, Scopus and Embase, based on the keywords from the time of inception of DNS till June 2023. The risk of bias assessment was done using a modified Joanne Briggs Institute checklist, which evaluated domains such as randomisation, sample size, image acquisition using CBCT, angulation, accuracy and time taken. As the data was heterogenous, a quantitative meta-analysis was not performed. RESULTS: Initially, 174 articles were retrieved from the three databases, 30 duplicates were removed, after title check 108 articles were excluded and following abstract check only 10 articles qualified for full text analysis. On reviewing the 10 full text articles, 5 articles were excluded and the remaining 5 articles were subjected to the risk of bias analysis which showed that 2 articles displayed low risk of bias and three articles showed high risk of bias. The RoB analysis revealed that only 2 studies evaluated the preservation of dentin in terms of accuracy, angulation and time taken proving the increased precision with minimal loss of tooth structure using DNS. In both the studies, DNS proved to be superior to free hand technique in terms of precision, accuracy and efficiency in locating the canals during access cavity preparation with maximal preservation of tooth structure. CONCLUSION: With the minimal literature evidences, the present systematic review highlights maximal preservation of dentin using DNS. However, further invitro and invivo studies comparing the free hand, static guided endodontics to DNS must be carried out for its translation into clinical practice. CLINICAL SIGNIFICANCE: Dynamic navigation system provides maximal preservation of dentin during access cavity preparation.

Comparative Evaluation of Different Endodontic Access Cavity Designs with Different Burs-An in vitro Experimental Insight into the Aspect of Fracture Resistance.

Introduction: In vitro fracture resistance of extracted mandibular molars treated with various access cavity designs, including traditional endodontic cavity (TradAC), conservative/contracted endodontic cavity (ConsAC), ninja endodontic cavity (UltraAC), truss endodontic cavity (TrussAC), caries-driven access cavity (CariesAC), and intact teeth, is the focus of this study. Materials and Methods: Six groups of 20 mandibular molars, totaling 120, were used in the investigation. While the other five groups underwent various access cavity preparations, chemomechanical preparation, and obturation procedures before being repaired with composite resin, Group 1 was left unaltered (the control). A 6 mm round head tip was used to apply the fracture force, which was measured in newtons, at a crosshead speed of 1 mm/min until fracture developed. Results: According to the current study, the intact control group had the maximum fracture resistance. The access cavity groups' mean values were maximum in CariesAC followed by ConsAC, TrussAC, UltraAC, and TraditonalAC respectively. Conclusion: While among the four minimally invasive designs, CariesAC showed a higher fracture resistance despite the results being statistically insignificant, TradAC had a significantly lower resistance than other conservative access cavity designs.

Comparative Evaluation of Root Canal Transportation and Centering Ability in Curved Mesiobuccal Canals of Mandibular First Molars after Instrumentation with Different File Systems-An In vitro Study.

Aim: To assess the canal transportation and centering ability in the mandibular first molars' curved mesiobuccal canals after instrumentation with file systems XP endo Shaper, self-adjusting File (SAF), Hyflex EDM, Pro Taper NEXT, WaveOne Gold, and K files with the help of Cone-Beam Computed Tomography (CBCT). Materials and Methods: Ninety recently extracted mandibular first molars with mesiobuccal roots that had a 25-30 degree canal curvature were assessed. Following preoperative CBCT scans, teeth were allocated randomly to six experimental groups of fifteen. After preparation with XP endo Shaper, SAF, Hyflex EDM, Pro Taper Next, WaveOne Gold, and K files, post-instrumentation scans were taken using same parameters as pre operative scans. At 3 mm, 6 mm, and 9 mm from the apex, samples were assessed for canal transportation and centering ratio. Results: Apical transportation was least for XP endo Shaper as compared to other groups except SAF and the results were statistically significant. K file showed the highest apical transportation toward the lateral wall of the root canal. XP endo Shaper was better in maintaining centering ability of middle and apical third of canal and SAF was better in maintaining centering ability of coronal third. Conclusion: In root canal preparation, least apical transportation and better centering ability with XP endo Shaper than other file systems compared. K file showed the highest transportation.

Saliva as a propitious diagnostic biofluid, biomarker, and bodies first line of defense against COVID-19: A review.

This review aims to recognize the role of saliva not just as a transmitting agent of COVID 19, but also comprehend its role in the diagnosis, and as a biomarker. A systematic literature search was performed in the PubMed database and eligible studies were included if they addressed the key issues i.e saliva as a diagnostic aid. As of January 10, 2021, a total of 309 articles across the PubMed database were identified of which 28 studies met the inclusion criteria. They were carefully examined for the type of study, sample size, parameters used, sample collection technique, and conclusions drawn. Diagnostic properties of saliva, the role of ACE 2 receptors, antibody formation ability, and antiviral characteristics were also explored. Comparisons among methods of sample collection like nasopharyngeal swabs and oropharyngeal swabs to saliva were also investigated. The observations and important deductions among the different studies were compared. Results indicated that saliva could be a reliable and financially viable option in both testing viral titers as well as marking for bio analytes due to its propitious specificity and sensitivity results reported in most of the studies. However, the inferences drawn from many of these studies should be interpreted with caution due to small sample sizes, inadequate detailing on the sample handling, laboratory processing, and rush in Corona-related publication. Scientific research with larger sample sizes, in diverse populations and age groups, at different phases of disease progression of COVID-19 are essential to reach any conclusion regarding its multi-facet use in the future.

Endodontic Emergencies Encountered in a Tertiary Dental Hospital during the Periods of Prelockdown, Lockdown, and Sequential Unlock Phases of the First Wave of COVID-19 in Ahmedabad City, India.

INTRODUCTION: With the worldwide spread of SARS-CoV-2 infection, temporary suspension of all the elective dental procedures and an urgent shift to nonaerosol producing dental treatments were observed. This study provides a detailed description of emergency treatments provided in the Department of Endodontics at a tertiary healthcare centre during the period of prelockdown, lockdown, and sequential unlocking from March 1, 2020, to October 31, 2020. METHODS: Access to General and Departmental OPD data along with treatment records was obtained and was segregated based on age, sex, and treatments performed. Treatments were divided into aerosol generating procedures (AGPs) and non-AGPs and further subdivided into palliative treatment (PT), pulp capping (PC), incision and drainage (ID), temporary filling (TF), pulpectomy (PU), and pulpotomy (PO). Data was analysed and subjected to chi-square test. RESULTS: A total of 15052 patients approached general OPD during the period of 8 months of which 5698 (37.86%) were endodontic in origin and treatments offered were PT 858 (15.05%), PO 1560 (27.37%), PU 2018 (35.42%), TF 500 (8.78%), ID 164 (2.88%), and PC 598 (10.94%). Also, more females (57.28% (3264/5698)) visited the department as compared to males (42.72% (2434/5698)). CONCLUSION: The pandemic had turned the tables on over the people around the world, and it has become extremely necessary to rule out the emergencies needed to treat the patients accordingly shifting more towards non-AGPs compared to AGPs among the various age groups of the society.

Mental Nerve Paraesthesia: A Report of Two Cases Associated with Endodontic Etiology.

Paraesthesia of the mental nerve can occur due to various etiological factors. Rarely, dental infections can cause paraesthesia. However, this article discusses two cases of endodontic etiology in the mental nerve region as a causative factor for paraesthesia. In the first case, the patient had severe pain localized to his right mandible, with numbness of his lower lip. Endodontic treatment led to quick regression and resolution of paraesthesia. In the second case, a patient who was referred for retreatment of a mandibular second premolar infection developed profound paraesthesia in the region of the mental nerve distribution following prior therapy. Possible mechanisms responsible for periapical infection-related paraesthesia are discussed here. CBCT imaging may be useful in the diagnosis and management of such conditions.

Evaluation of Ozone Therapy in Endodontic Treatment of Teeth with Necrotic Pulp and Apical Periodontitis: A Randomized Clinical Trial.

INTRODUCTION: The aim of this study was to compare the effect of different application techniques of ozone on the prevalence of postendodontic pain in patients undergoing single-visit root canal treatment. METHODS: hundred eight patients with necrotic pulp in single-rooted teeth and apical periodontitis participated in the trial. A standard single-visit endodontics protocol was followed with 5.25% sodium hypochlorite and rotary nickel-titanium files. After shaping and cleaning, patients were randomly allocated into the following groups: group 1 (n = 21), ozone treatment with no activation (NA); group 2 (n = 22), ozone treatment with manual dynamic activation (MDA); group 3, (n = 21), ozone treatment with passive ultrasonic activation (PUA); group 4 (n = 23), ozone treatment with sonic activation (SA); and group 5 (n = 21), no ozone treatment (the control group). Patient levels of discomfort were recorded at 6 different time intervals using the visual analog scale (VAS). Comparison of the mean difference between the groups and time intervals was performed using 2-way analysis of variance followed by a post hoc Bonferroni test. The level of significance was set at 5%. RESULTS: VAS scores were highest for the control > NA > MDA > SA > PUA groups. A statistically significant reduction in VAS scores was observed in the PUA and SA groups in comparison with the NA, control, and MDA groups. Timewise comparison showed a highly significant decline in VAS scores at all time intervals (P < .001). CONCLUSIONS: Ultrasonic and sonic activation of ozone resulted in less pain in patients undergoing single-visit endodontics compared with no ozone treatment.