Assessing the Efficacy of Cold Laser Therapy vs. Traditional Methods in Managing Post-Endodontic Pain: A Randomized Controlled Trial.

The background of the study highlighted the common occurrence of post-endodontic pain and the need for effective pain management strategies. Materials and Methods: Fifty patients were randomly assigned to two groups: the cold laser therapy (CLT) group and the traditional methods group (TMG). The CLT group received laser treatment at the affected area immediately following endodontic treatment, whereas the TMG received standard pain management techniques such as analgesics. Pain levels were assessed using a visual analog scale at baseline and at 6, 12, 24, and 48 hours post treatment. Pain scores were analyzed using appropriate statistical methods, including analysis of variance, and P values were calculated to determine the significance of differences between groups. Results: This study found significant differences in post-endodontic pain levels between CLT and standard procedures. At 6 hours post treatment, the CLT group had a mean pain score of 2.1 ± 0.8, whereas the TMG had a mean pain score of 3.8 ± 1.2 (P = 0.012). Pain levels in the CLT group decreased with time, with scores decreasing to 1.5 ± 0.6 at 12 hours, 1.2 ± 0.5 at 24 hours, and 0.9 ± 0.4 at 48 hours post treatment. In contrast, the TMG had greater pain scores at each time point: 3.2 ± 1.0, 2.9 ± 1.1, 2.5 ± 0.9, and 2.1 ± 0.8 at 12, 24, and 48 hours post treatment, respectively. At 12, 24, and 48 hours post treatment, P values of 0.021, 0.036, and 0.004, respectively, indicated significant differences. Conclusion: In managing post-endodontic pain, CLT demonstrated superior efficacy compared to traditional methods.

Assessment of Various Reciprocating System in the Extrusion of Debris from Curved Root Canals: An Original Study.

Introduction: The endodontic preparation depends largely on the file systems that are used in the canal preparations. The amount of the intracanal debris that is extruded from the apex may be influenced by the file systems. Hence, the present in vitro study evaluated the amount the debris that is extruded for the two file systems at different working lengths. Methods: Forty human mesiobuccal canals of the first molars were collected that were extracted for various causes. They were equally divided to four groups of Reciproc (full length), Reciproc (short by 1 mm), WaveOne Gold (full length), and WaveOne Gold (short by 1 mm). Routine crown-down technique was followed for the canal preparation with the intermittent irrigation. The extruded debris was weighed and compared for the significance. Results: The amount of the debris that was extruded weighed similarly in all the four groups with no significant variations. The Reciproc extruded lesser material than the WaveOne Gold. Conclusions: The file systems seem not to affect the debris extrusion irrespective of the files' physical properties. Further studies in a clinical setup are warranted.

In vivo Study to Evaluate the Effect of Instrument Size on the Accuracy of Three Different Apex Locators when Various Irrigation Solutions are used in Vital and Non-Vital Teeth.

Introduction: Root canal success requires working length (WL) optimization. The current study examined how different apex locators on vital and non-vital teeth responded to instrument size. Materials and Methods: Three hundred patients (180 men and 120 women) receiving root canal therapy at the department of Conservative Dentistry and Endodontics were evaluated. Therefore, we determined that 200 of the patients' teeth (100 vital and 100 non-vital teeth from the upper and lower jaws' first molars) qualified for inclusion in our study. The pulp chamber was accessed using a sterile round bur. The coronal region of the root canal was preflared with successive Gates Glidden drills (Mani Inc. Japan) and irrigated with any one of the solutions 3% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), or 17% ethylenediaminetetraacetic acid (EDTA) solution after checking canal patency with a size #10 K file, where (#-number). Later, the working length was established using Ingle's technique and a radiovisiograph (RVG) 0.5 mm short of the radiographic apex. Two endodontists approved this RVG. Results: Overall, the #15 K file and apex locators did not differ from Ingle's method. While the #8 K file differs significantly from all apex locators, the #10 K file showed a significant difference with all apex locators except Root ZX with 2% CHX (P = 0.06). Irrigation didn't influence apex locators' accuracy. Conclusion: Even in the presence of irrigating solutions, electronic apex locator (EAL) can be utilized to calculate the working length with accuracy. The apex locators #15 k files, #10 k files, and #8 k files showed the most promising results.

Evaluation of obturation techniques in primary teeth among Indians.

Evaluation of four distinct obturating methods namely endodontic pressure syringe (n=40), reamers (n=40), Lentulo spirals driven through slow-speed handpiece (n=40) and incremental filling technique (n=4) using zinc oxide eugenol (ZOE) paste as obturating material in deciduous teeth is of interest to dentist. Hence, we are interested determining the effective obturation methodology using CBCT. Handpiece driven lentuspirals helped in optimum obturation in high percentage of root canals. Low percentage of optimally filled root canals was observed in reamers technique. Moreover, under filled root canals was low in lentuspirals technique of obturation. Thus, overfilled root canals were high in endodontic pressure syringe and reamers obturation technique.

Comparison of Cleaning Efficiency of Root Canal Using Different Rotary NiTi Instrumentation System: A Scanning Electron Microscopic Study.

BACKGROUND: To ensure that endodontic treatment is as effective as possible, it is important to remove any smear layer that forms as part of the instrumentation procedure. This layer might reduce the overall effectiveness of endodontic therapy. AIM OF THE STUDY: For this research, two distinct types of rotary NiTi files were compared: WaveOne Gold (WOG) (Dentsply Maillefer, Ballaigues, Switzerland) and F360 (Komet Brasseler GmbH & Co., Lemgo, Germany) for its capacity to eliminate trash and the smear layer. MATERIALS AND METHODS: Two groups (n=20 each) of 40 mandibular second premolar teeth were employed in this investigation, with each group receiving a random allocation of teeth. The F360 system and the WaveOne Gold system are two sets of instruments. The samples were irrigated with a mixture of sodium hypochlorite (NaOCl) (5.25%) and citric acid (40%). Finally, all samples in the centre of the coronal, middle, and apical thirds were examined by scanning electron microscopy (SEM). Mann-Whitney U tests were used to analyse the data. RESULTS: F360 instrument showed a statistically significant difference for smear layer removal among all thirds of the root canal whereas WOG resulted in a significant difference when the apical third was compared to the middle and coronal third. Significant differences were found in the middle and apical third in terms of smear layer removal between the two groups. Both F360 and WOG instruments showed statistically significant differences for debris removal among all thirds of the root canal. No significant differences were found in the coronal, middle, and apical third in terms of debris removal between the two groups. CONCLUSION: WOG resulted in cleaner canals compared to the F360 file system at coronal, middle, and apical third.

Enhancement of Odontoblastic Differentiation of Stem Cells from Exfoliated Deciduous Tooth Using N-acetylcysteine-An In Vitro Study.

AIM AND OBJECTIVE: The study was conducted to evaluate the effects of N-acetylcysteine (NAC) on the propagation and differentiation of stem cells from human exfoliated deciduous teeth(SHED). MATERIALS AND METHODS: SHEDs were isolated by explant culture method and characterized for stem cell properties using flow cytometry method. MTT assay and Cell Counting Kit-8 (CCK-8) assay were used to examine the viability and proliferation of the SHEDs. The effects of NAC-induced osteo/odontoblastic differentiation of SHEDs were determined by functional staining for mineralization, and the gene expression of osteo/odontoblastic transcription factors and proteins was evaluated by real-time quantitative reverse transcription-polymerase chain reaction(qRT-PCR) analyses. Protein levels of collagen type 1 (COL1), dentin sialophosphoprotein (DSPP), and dentin matrix acidic phosphoprotein 1(DMP-1) were calculated by the Western blot method to assess the osteo/odontogenic differentiation. RESULTS: SHEDs presented mesenchymal stem cell (MSC)-like characteristics on flow cytometric analysis. The cell viability and metabolic activity of SHEDs were increased with an increase in the concentrations of NAC from 0.5 to 10 nM. However, the concentrations of NAC from 0.5 to 2.5 mM did not affect cell proliferation. NAC incorporated at a concentration of 2.5 mM showed higher mineralization and considerably increased gene expression levels of runt-related transcription factor 2 (RUNX2), COL1A1, DSPP, and DMP-1. It significantly increased the protein expression of odontoblast-related matrix proteins like COL1, DSPP, and DMP-1. CONCLUSION: NAC regulates the healthy propagation of dental stem cells in vitro. Its effects on the differentiation of dental pulp SHEDs remain unidentified. This study explores that NAC can encourage the mineralization of SHEDs and differentiate them into the odontoblastic lineage. CLINICAL SIGNIFICANCE: The results propose that NAC could have a significant pharmacological role in activating and enhancing odontogenic differentiation of dental stem cells and possibly a prospect in regenerative dentistry.

Evaluation of Antibacterial Properties of Organic Gutta-percha Solvents and Synthetic Solvents Against Enterococcus faecalis.

BACKGROUND: The use of solvents is necessary to remove remnants of filling materials within dentinal tubules to allow penetration of irrigating solution within the tubules. AIM AND OBJECTIVES: We aimed at determining the antibacterial effect of various gutta-percha (GP) solvents against Enterococcus faecalis (E. faecalis). MATERIALS AND METHODS: An in vitro study was conducted by measuring the zone of inhibition using the disk diffusion method. The test organism used for the study was E. faecalis, and the solvents were divided into five groups: eucalyptus oil, chloroform, turpentine oil, xylene, and orange oil. About 500 µL of the suspension was spread over the agar plates, and the empty sterilized disks were impregnated with 10 µL of pure essential oils (EOs). The inoculated plates were incubated at 37°C for 18 to 24 h. The antimicrobial activity of each solvent was expressed and measured in terms of the mean diameter of the zone of inhibition (in mm) produced by each solvent at the end of the incubation period. ANOVA was used for intergroup comparison. The P-value of <0.05 was considered significant. RESULTS: The mean zone of inhibition for E. faecalis was 24.00 ± 1.21 for eucalyptus oil, 16.30 ± 0.92 for chloroform, 26.50 ± 1.24 for turpentine oil, 13.70 ± 1.26 for xylene, and 19.80 ± 1.32 for orange oil. The difference between the groups was statistically significant (P < 0.001). CONCLUSION: This study demonstrated that the use of turpentine oil during endodontic retreatment significantly reduced the levels of E. faecalis as compared with other solvents.

The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of silver nanoparticles against Staphylococcus aureus.

AIM: To determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of silver nanoparticles against Staphylococcus aureus (S. aureus).Methodology: The antimicrobial efficacy of the silver nanoparticles was determined by the standard methods of Clinical and Laboratory Standards Institute (CLSI). Different concentrations of silver nanoparticles were prepared, and MIC was calculated by tube macro-dilution method. The MBC was determined by the lowest concentration that kills 99.9% of the initial bacterial population. The data were analyzed by ANOVA and Tukey's post hoc test using SPSS software. RESULTS: The MIC and MBC of silver nanoparticles against S. aureus was found to be 0.625 mg/ml. CONCLUSION: The result obtained from this study shows that silver nanoparticles have potential bactericidal effects against S. aureus at a concentration of 0.625 mg/ml. Silver nanoparticles can be incorporated in the root canal medicaments, sealers and irrigants as it possess potent antimicrobial efficacy against S. aureus.

Homeopathic consideration for resistant endodontic bacteria Enterococcus faecalis: An in vitro comparative disc diffusion study.

BACKGROUND: Homeopathy is one of the commonly used systems of complementary or alternative medicine. The present study was conducted with an aim to compare the antibacterial efficacy of two commonly used homeopathic medicaments acid benzoicum 30C (SBL Pvt Ltd) and silicea 6C (SBL Pvt Ltd) with that of calcium hydroxide (Deepti Ltd) as intracanal medicament against Enterococcus faecalis (ATCC-29212). MATERIALS AND METHODS: The test organism used for the study was E. faecalis. Petri plates with 20 ml of sheep blood agar were inoculated with 0.1 ml of the microbial suspensions. The medicaments to be tested for antimicrobial efficacy against E. faecalis were divided into three groups: Group A (acid benzoicum), Group B (silicea), and Group C (calcium hydroxide). The antimicrobial activity of each medicament was measured and expressed in terms of the mean of the diameter of zone of inhibition (in mm) produced by each extract at the end of the incubation period. ANOVA and Tukey's honestly-significant difference posthoc test were used for the intergroup comparison. P < 0.05 was considered statistically significant. RESULTS: Group A (acid benzoicum) showed the maximum zone of inhibition against Gram-positive E. faecalis (17.2 ± 0.65), and the difference between the groups related to the antibacterial activity was highly significant (P < 0.001). A statistically significant difference was observed between the three groups on the intergroup comparison (P < 0.001). CONCLUSION: In the present in vitro study, antimicrobial activity of the acid benzoicum extract was the highest followed by silicea extract and then calcium hydroxide.

Abnormal mitral valve apparatus in a case of hypertrophic obstructive cardiomyopathy: Intraoperative transesophageal echocardiography.

Hypertrophic obstructive cardiomyopathy is a relatively common disorder that signifies asymmetric hypertrophy of interventricular septum causing obstruction of the left ventricular outflow tract (LVOT). However, more recent studies have shown that during ventricular systole, flow against an abnormal mitral valve apparatus results in drag forces on the part of the leaflets. The mitral leaflet is pushed into the LVOT to obstruct it. We present a case where intraoperative transesophageal echocardiography played a crucial role in defining the etiology of LVOT obstruction that subsequently helped in deciding the surgical plan.

A Comparative Evaluation of the Retention of Tooth Coloured and Stainless Steel Endodontic Posts: An In-vitro Study.

AIMS: This in vitro study evaluated: a) the retention of stainless steel posts of 1.5 mm diameter which were cemented with Zinc Phosphate cement versus Glass fiber posts with 1.1 mm, 1.3 mm and 1.5 mm diameters which were cemented with resin cement and b) the effect of change in diameter on the retention of Glass fiber posts with 1.1 mm, 1.3 mm and 1.5 mm diameters. MATERIALS AND METHODS: Sixty extracted mandibular premolar teeth were endodontically treated and randomly assigned to four groups of fifteen teeth each. In Groups I, II and III glass fibre posts with diameters 1.1 mm, 1.3 mm and 1.5 mm were cemented by using resin cement. In Group IV, stainless steel posts with diameter 1.5 mm were cemented by using zinc phosphate cement. The specimens were tested for tensile loading at a cross head speed of 2.0 mm/min, on a universal testing machine. STATISTICAL ANALYSIS USED: One way analysis of variance and Tukey's (post-hoc) test. RESULTS: Mean tensile strength from highest to lowest was in the order of Group IV, Group II, Group III, Group I. Statistically significant differences were observed between the mean tensile strengths between Groups I and II, Groups I and III, Groups I and IV, Groups II and IV, Groups III and IV, while non significant differences were observed between Groups II and III. CONCLUSION: Stainless steel posts were more retentive than glass fibre posts. Glass fibre posts with 1.3 mm or 1.5 mm diameters provided significantly greater retention as compared to 1.1 mm diameter posts.

Managing curved canals.

Dilaceration is the result of a developmental anomaly in which there has been an abrupt change in the axial inclination between the crown and the root of a tooth. Dilaceration can be seen in both the permanent and deciduous dentitions, and is more commonly found in posterior teeth and in maxilla. Periapical radiographs are the most appropriate way to diagnose the presence of root dilacerations. The controlled regularly tapered preparation of the curved canals is the ultimate challenge in endodontics. Careful and meticulous technique will yield a safe and sufficient enlargement of the curved canals. This article gives a review of the literature and three interesting case reports of root dilacerations.