The Comparison of the Anti-inflammatory Efficacy of Phytochemical Extracts in Punica granatum and Lawsonia inermis Among Patients Diagnosed With Chronic Periodontitis.

Introduction The oral cavity is the gateway to the human body. Periodontitis is a common inflammatory condition affecting the oral cavity and a known etiological cause of tissue destruction, discomfort, and halitosis. Pomegranate (Punica granatum) and henna (Lawsonia inermis) are herbs known to mankind from time immemorial whose extracts are proven to fight inflammation. The current study was done to evaluate the phytochemical anti-inflammatory efficacy of Punica and Lawsonia in patients with chronic periodontitis and test the potency of herbal mouthwashes in fighting the inflammatory condition affecting the oral cavity using distilled water as a control group. Materials and methods A double-blinded randomized control trial was conducted on 60 patients who were recruited and divided into three groups, in which 20 patients were prescribed with pomegranate (Punica: n=20) mouthwash and 20 patients with henna (Lawsonia: n=20) mouthwash along with distilled water (n=20). All patients were randomly allocated using the coin toss method and advised to use the prescribed mouthwash for a period of two weeks. Unstimulated saliva was collected before using the mouthwash, and salivary enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) and their levels were assessed spectrometrically using the infrared spectrophotoscopy (IFSC) method. Each patient was assigned a mouthwash and recalled after two weeks. Unstimulated saliva was again collected, and salivary activity levels of enzymes AST, ALT, and LDH were analyzed after using mouthwash in a similar method as done before. Later on, the salivary levels of enzymes AST, ALT, and LDH were compared before and after the usage of mouthwashes. Statistical significance was seen in the salivary enzymatic activity of AST, ALT, and LDH before and after using Punica and Lawsonia mouthwashes due to their potent phytochemical action in fighting inflammation. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 22 (IBM SPSS Statistics, Armonk, NY). The Shapiro-Wilk test was used to determine the normality and significance; intragroup comparison was done using the Wilcoxon signed-rank test and Mann-Whitney U test. Intergroup comparison was done using the Kruskal-Wallis test. Results Punica patients had much lower levels of salivary AST and ALT (p<0.001) and a decrease in LDH (p=0.002) after the usage of mouthwash for a period of two weeks. Also, patients using Lawsonia as herbal mouthwash had reduction in the values of AST (p=0.001) and LDH (p=0.003) and prominent reduction in ALT (p<0.001) after a period of two weeks. But in the case of patients using distilled water, there was an increase in the salivary enzymatic activity of AST and ALT, which was statistically significant (p<0.001), and LDH (p=0.006) depicting the disease progression even after using mouthwash for the given time period of two weeks. Conclusion This study demonstrated that both Punica and Lawsonia were effective in reducing the inflammation in patients diagnosed with chronic periodontitis. However, when intergroup comparison was done, the anti-inflammatory efficacy was superior in Punica with significant reduction in the parameters such as of AST, ALT, and LDH when compared to Lawsonia owing to its potent phytochemical constituency in cutting down the inflammation. Hence, Punica can be used as an implicated effective anti-inflammatory herbal mouthwash.

Effect of 17% ethylenediaminetetraacetic acid and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate: An in vitro study.

AIM: The purpose of this study was to evaluate the effect of 17% ethylenediaminetetraacetic acid (EDTA) and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate (MTA). MATERIALS AND METHODS: Midroot dentin of single-rooted human canine teeth were sectioned into 2-mm-thick slices horizontally (n = 60). The canal space of each dentin slice was enlarged with a 1.3-mm-diameter diamond bur. The samples were divided into two groups (n = 30) based on the type of perforation repair material placed, i.e., Biodentine and ProRoot MTA. The samples were wrapped in wet gauge for 10 min, and based on the type of chelating agent used for removal of smear layer, each group is further divided into three subgroups (n = 10), to be immersed into saline (control), 17% EDTA and 0.2% chitosan for 30 min, and a wet cotton pellet was placed over each test material. After 48 h of incubation, the dislodgement resistance of the samples was measured using a universal testing machine. STATISTICAL ANALYSIS: Data were analyzed using one-way analysis of variance and post hoc Tukey tests. The level of statistical significance was set at 0.05. RESULTS: Biodentine showed significantly higher pushout bond strength than ProRoot MTA. Biodentine and ProRoot MTA lost strength when exposed to 0.2% chitosan. CONCLUSION: Biodentine showed considerable performance as a perforation repair material than ProRoot MTA even after being exposed to various endodontic chelating agents.

Effect of NaOCl and EDTA Solutions on Topography of ESX, TruShape and ProTaper Gold NiTi Rotary Instruments - An Atomic Force Microscopic Study.

AIM: The study was aimed to evaluate the effect of 5.25% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA) Solutions on Surface Topography of ESX, TruShape, and ProTaper Gold nickel-titanium (NiTi) Rotary Instruments using Atomic Force Microscope (AFM). MATERIALS AND METHODOLOGY: A total of 27 each of three commercially available brands of endodontic NiTi instruments were analyzed, which were divided into three groups as follows: Group I: ESX (Brasseler, USA) Group II: Tru shape (Dentsply Tulsa, USA) Group III: Pro Taper Gold (Dentsply Tulsa, USA). These files were further divided into three subgroups containing nine files each, no immersion, immersion in 5.25% NaOCl for 5 min, and immersion in 17% EDTA for 5 min. Surface areas along 3 mm sections at the tip of the files (perfect squares of 10 µm × 10 µm) were analyzed using AFM operating in contact mode under ambient conditions. STATISTICAL ANALYSIS: Data were analyzed using two-way ANOVA and pairwise comparison of three main groups with respect to Ra and RMS by Tukey's multiple posthoc procedures. RESULTS: Three-dimensional AFM images of the surface of all the rotary NiTi instruments, including new and those immersed in 5.25% NaOCl and 17% EDTA solutions, revealed topographic irregularities at the nanometric scale. Ra and RMS values of instruments treated with 5.25% NaOCl and 17% EDTA solutions were statistically higher than that of the new ones (P < 0.05). CONCLUSION: Using AFM for analysis indicated that short-term contact between 5.25% NaOCl and 17% EDTA solutions and NiTi instruments caused alterations in the topography of instruments.

One-year comparative evaluation of Ketac Nano with resin-modified glass ionomer cement and Giomer in noncarious cervical lesions: A randomized clinical trial.

AIM: The purpose of this study was to evaluate the clinical performance of Ketac Nano (Ketac™ N100), RMGIC (Fuji Filling™ LC), and Giomer (Beautifil® II) in noncarious cervical lesions (NCCLs). MATERIALS AND METHODS: One operator restored 120 NCCLs in 20 subjects, with at least two lesions restored with one of the restorative materials: RMGIC (control group), Giomer and Ketac Nano (experimental groups). Two observers evaluated retention, marginal discoloration, marginal adaptation, color match, surface roughness, and postoperative sensitivity using modified USPHS criteria at baseline, 6, and 12 months. STUDY DESIGN: Double-blinded randomized clinical trial (RCT). STATISTICAL ANALYSIS: Kruskal-Wallis test, Mann-Whitney U-test, Wilcoxon matched-pairs test. RESULTS: There was statistically significant difference observed between Giomer, Ketac Nano and RMGIC after 12 months (P < 0.05). There was a significant decrease in retention rates for Giomer (P = 0.0050), increased marginal discoloration and color mismatch for Ketac Nano (P = 0.0025, P = 0.0053), increased surface roughness and color mismatch with RMGIC (P = 0.0022, P = 0.0077) from baseline to 12 months. CONCLUSION: Within the limitations of this RCT of 12 months, Ketac Nano and RMGIC restorations were better retained in NCCLs while superior color match and surface finish were observed with Giomer restorations.

Scanning electron microscopy (SEM) evaluation of sealing ability of MTA and EndoSequence as root-end filling materials with chitosan and carboxymethyl chitosan (CMC) as retrograde smear layer removing agents.

AIM: The purpose of this study was to evaluate the sealing ability of mineral trioxide aggregate (MTA) and EndoSequence with chitosan and carboxymethyl chitosan (CMC) as retrograde smear layer removing agents using scanning electron microscopy (SEM). MATERIALS AND METHODS: Forty human single rooted teeth were taken. Crowns were decoronated and canals were obturated. Apically roots were resected and retrograde cavities were done. Based on the type of retrograde material placed and the type of smear layer removal agent used for retrograde cavities, they were divided into four groups (N = 10): Group I chitosan with EndoSequence, group II chitosan with MTA, group III CMC with EndoSequence, and Group IV CMC with MTA. All the samples were longitudinally sectioned, and the SEM analysis was done for marginal adaptation. STATISTICAL ANALYSIS: Kruskal-Wallis and Mann-Witney analysis tests. RESULTS: SEM images showed the presence of less gaps in group III, i.e., CMC with EndoSequence when compared to other groups with statistically significant difference. CONCLUSION: Within the limited scope of this study, it was concluded that EndoSequence as retrograde material showed better marginal sealing ability.

Comparative evaluation of antimicrobial efficacy of triple antibiotic paste and calcium hydroxide using chitosan as carrier against Candida albicans and Enterococcus faecalis: An in vitro study.

AIM: To analyze the sustained release of intracanal medicaments with or without a carrier and testing their antimicrobial efficacy in root canal against Candida albicans and Enterococcus faecalis. MATERIALS AND METHODS: A total of 80 single-rooted anterior teeth were selected, root canal preparation was done, and teeth were divided into two halves and contaminated with C. albicans and E. faecalis, which were further divided into four test groups each according to intracanal medicaments used. Chitosan was used as vehicle for triple antibiotic paste (TAP) and calcium hydroxide and antimicrobial assessment was performed on second and seventh day. Dentine samples were collected after each. RESULTS: All four medicaments used in this study showed antifungal and antibacterial activity. Group II (TAP + chitosan) and Group III (Ca(OH)2 + chitosan) had the higher antifungal and antibacterial activity compared with two other groups. CONCLUSION: Combination of TAP + chitosan and Ca(OH)2 + chitosan produced better results compared with the combination of medicaments with saline.