Periapical Healing following Root Canal Treatment Using Different Endodontic Sealers: A Systematic Review.

The healing of the periapical tissues is crucial to the success of root canal treatment. The review studies effectively examine various endodontic root canal sealants in terms of periapical healing. This systematic review was formulated following the PRISMA 2020 guidelines and registered in the international prospective register of systematic reviews (PROSPERO) number-CRD42021239192. To find relevant articles, PubMed Central and Medline databases (until February 2022) were searched. Studies that evaluated healing following the application of different endodontic sealers were analysed. A primary outcome measure was the resolution of periapical lesions following the endodontic treatment. In vivo studies comparing radiographic treatment outcomes and articles with a minimum of 6-month follow-up were included. A total of 9 clinical trial studies that met all the inclusion criteria were included in the analysis. The overall risk of bias was high in four studies out of nine studies. Periapical lesions showed significant healing after endodontic treatment regardless of sealer type, although bioceramic and bioactive sealers had shown better results.

Analgesic efficacy of corticosteroids and nonsteroidal anti-inflammatory drugs through oral route in the reduction of postendodontic pain: A systematic review.

Analgesic medications in dentistry are indicated for the relief of acute pain, postoperative pain, chronic pain as well as controlling adjunctive intraoperative pain. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has shown an effective reduction of postendodontic pain by action on the cyclooxygenase pathway. Another medication which is used recently is corticosteroid which enables the reduction of pain. They are hormones secreted from the adrenal gland and have strong anti-inflammatory actions. This review aims to compare the analgesic efficacy of NSAIDs and corticosteroids when administered through oral route for reducing postendodontic pain. The secondary objective was to assess the anesthetic effect of the nerve block when an oral premedication of NSAIDs or corticosteroids was administered. The databases of PubMed, ScienceDirect, LILACS, and Cochrane were searched for related topics from 1983 to April 2020. Bibliographies of clinical studies were identified in the electronic search. Clinical studies with postendodontic pain reduction using NSAIDs and corticosteroids were selected. Clinical studies that met all inclusion criteria were reviewed. Data extraction was performed independently by two reviewers. All individuals who administered single dose analgesic (NSAID or corticosteroid) before initiating root canal treatment were taken into inclusion criteria. All the relevant data were extracted from the selected studies were reviewed by two independent reviewers using a standardized data collection form, and in case of disagreement, a third reviewer was enquired to achieve a consensus. Risk of bias of the selected studies was done using Cochrane Risk of Bias Tool (version 1). Mean pain score levels at various time intervals showed an increased analgesic success rate for corticosteroids ( 32-1) in comparison to NSAIDs ( 32-21.4). Anesthetic effect of the nerve block administered was seen to be better when an oral premedication of corticosteroids (38.2%-80.8%) was given in comparison to NSAID (25.5%-73.1%). From the present study, it can be concluded that oral administration of corticosteroids provides a better analgesic efficacy when compared to NSAIDs as an oral premedication for postoperative pain reduction. It can also be concluded that corticosteroids when used as an oral premedication provide a better anesthetic effect of the nerve block administered when compared to NSAIDs given as an oral premedication. These findings could help the clinician determine which pretreatment analgesic would have a better effect in reduction of pain posttreatment as well as increasing the anesthetic efficacy of administered block. Systematic Review Registration Number: CRD42021235394.

Preparation of a Novel Nanocomposite and Its Antibacterial Effectiveness against Enterococcus faecalis-An In Vitro Evaluation.

The interest in the use of green-mediated synthesis of nanoparticles (NPs) is shown to have increased due to their biocompatibility and reduction of overall production costs. The current study aimed to evaluate a novel nanocomposite (NC) prepared by using a combination of zinc oxide, silver and chitosan with lemon extract as a cross-linking agent and assessed its antimicrobial effectiveness against Enterococcus faecalis (E. faecalis). The NPs and NC were prepared individually using a modification of previously established methods. Ananalys is of the physiochemical properties of the NC was conducted using ultraviolet-visible spectroscopy (UV-Vis) (Shimadzu Corporation, Kyoto, Japan). and transmission electron microscopy (TEM) imaging(HR-TEM; JEOL Ltd., Akishima-shi, Japan. The microbial reduction with this novel NC was evaluated by measuring the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) using a tube assay analytic technique. A time-kill assay analysis was conducted to evaluate the kinetic potential against E. faecalis at different time intervals. The novel NC showed a homogenous nanoparticle size under TEM imaging and under UV-Vis established an absorption range of 350−420 nm making it similar to its individual counterparts. The MIC and MIB were measured at 62.5 ± 20 mg/L (p < 0.05) and 250 ± 72 mg/L (p < 0.05), respectively. A time-kill assay analysis for the NC showed 5 h was required to eradicate E. faecalis. Based on the achieved results, it was seen that the novel NC using a combination of silver, zinc oxide and chitosan showed improved antimicrobial action against E. faecalis compared with its individual components under laboratory conditions. A complete eradication of 108 log units of E. faecalis at 250 mg/L occurred after a total of 5 h. These preliminary results establish the use of lemon extract-mediated silver, zinc and chitosan-based NC had an antibacterial effectiveness against E. faecalis similar to the individual counterparts used for its production under laboratory conditions.

Comparative evaluation of postoperative pain and periapical healing after root canal treatment using three different base endodontic sealers - A randomized control clinical trial.

BACKGROUND: The aim of the present study was to evaluate and compare the postoperative pain and periapical healing after root canal treatment using three different base endodontic sealers. MATERIAL AND METHODS: Primary root canal treatment was initiated in 63 patients diagnosed with necrotic pulp and apical periodontitis, cleaning and shaping was completed in two visit and different base endodontic sealers were used for obturation were selected based on the random allocation of the participants to the following groups; Tubli-Seal, AH Plus and BioRoot RCS. Postoperative pain was recorded by using 100 mm visual analog scale at 24 h, 48 h, 72 h and 7 d after obturation. Digital periapical radiographic evaluation was done to assess rate of periapical healing at baseline, 1, 3 and 6 months. Statistical analysis was done using Kruskal Wallis test and one-way ANOVA. RESULTS: The mean difference in the size of periapical lesions for Tubli-Seal (6.27, 13.41), AH Plus (3.86, 9.80) and BioRoot RCS (4.05, 10.22) at 3 months and 6 months respectively. The mean pain scores at 24 h for Tubli-Seal (17.94 ± 11.35), AH Plus (11.57 ± 11.18), BioRoot RCS (4.73 ± 7.72). At 48 h, Tubli-Seal (5.26 ± 9.04), AH Plus (1.57 ± 3.74) and BioRoot RCS (1.57 ± 3.74) respectively. The mean pain score at 72 h for Tubli-Seal was 2.63 ± 7.33 whereas none of the patients had reported pain in AH Plus and BioRoot RCS group. None of the patients had pain after 7 d of treatment. CONCLUSIONS: BioRoot RCS showed less postoperative pain compared to AH Plus and Tubli-Seal and showed better periapical healing compared to AH Plus and Tubli-Seal at 3 and 6 months intervals respectively. Key words:BioRoot RCS, root canal obturation, root canal sealers, periapical periodontitis, Periapical healing, postoperative pain.

Cytotoxicity evaluation of calcium hypochlorite and other commonly used root canal irrigants against human gingival fibroblast cells: An in vitro evaluation.

BACKGROUND: The conventional endodontic therapy primarily focuses on biomechanical preparation, which is achieved by the application of various intracanal irrigants and intracanal medicaments. One of the most commonly used intracanal irrigants - sodium hypochlorite (NaOCl) - has already been proven to have an antimicrobial effect as well as the ability to dissolve tissues in the areas where files cannot reach. One of the recently used irrigants having a promising effect is calcium hypochlorite (Ca(OCl)2), which has been shown to be relatively more stable than NaOCl and has much more chlorine ions. OBJECTIVES: The aim of this study was to assess the individual cytotoxicity of various root canal irrigants and the combined cytotoxicity of NaOCl and Ca(OCl)2 with ethylenediaminetetraacetic acid (EDTA) against human gingival fibroblast (hGF) cells. MATERIAL AND METHODS: The evaluation of the individual cytotoxicity was carried out with regard to the following root canal irrigants: NaOCl; Ca(OCl)2; and chlorhexidine (CHX). The evaluation of the combined cytotoxicity regarded NaOCl/EDTA and Ca(OCl)2/EDTA. The concentrations used were 0.025%, 0.050%, 0.10%, and 0.20%. The cytotoxicity against hGF cells was examined within a timeframe of 6 h and 24 h with the use of the sulforhodamine B (SRB) assay. RESULTS: It was observed that Ca(OCl)2 had a mean absorbance rate of 0.315 ±0.02, 0.294 ±0.03, 0.265 ±0.03, and 0.240 ±0.02 at 0.025%, 0.050%, 0.10%, and 0.20%, respectively. In combination with EDTA, the mean absorbance rate was 70.12 ±2.9, 67.42 ±4.3, 64.35 ±3.6, and 61.58 ±4.1 at 0.025%, 0.050%, 0.10%, and 0.20%, respectively. The cytotoxic effect of the root canal irrigants on hGF cells was observed to be statistically significant (p < 0.05). CONCLUSIONS: Calcium hypochlorite is less cytotoxic than NaOCl, and when used in combination with EDTA, it was shown to have its cytotoxic effect on hGF cells reduced to a great extent.

Diagnostic accuracy of dental pulse oximeter with customized sensor holder, thermal test and electric pulp test for the evaluation of pulp vitality: an in vivo study / Precisão diagnóstica do oxímetro de pulso odontológico com suporte de sensor personalizado, teste térmico e teste elétrico da polpa para avaliação da vitalidade pulpar: um estudo in vivo

Background: the efficiency of the diagnostic aids plays an important role in the treatment plan. This study aims to assess the diagnostic accuracy of dental pulse oximeter with a customized sensor holder, thermal test and electric pulp tester in assessing the actual pulp status and to evaluate the oxygen saturation level in control healthy teeth, non-vital and teeth with irreversible pulpitis. Material and methods: thirty-seven single canal teeth requiring endodontic therapy were included in the study. The selected teeth were tested with dental pulse oximeter, electric pulp test, cold spray, and heated gutta percha stick. Between each test a time lag of 2 minutes was allowed for the central sensitization to occur. Three blinded operators were involved in the study. The actual status of the pulp was evaluated after the initiation of endodontic treatment, by direct visual examination of the accessed cavity. The data was statistically analysed using (ANOVA) Analysis of Variance and Post-hoc Tukey test. Results: sensitivity of pulse oximeter, heat test, cold and electric pulp test, was 100, 25, 50, and 12, respectively. The specificity of these tests was 100, 72 81, and 77, respectively. The ANOVA showed that there was statistical difference between all the groups (p=0.0005). Post-Hoc Tukey revealed that there was statistical difference among all the groups, nonvital group (p=0.0005), control group (p=0.01) and for irreversible pulpitis (p=0.01). The overall diagnostic accuracy of pulse oximeter was 100% followed by cold test 66%, heat test to be 49% and electric pulp test to be 45%. Conclusion: the custom-made holder used in the present study aided in providing accurate response for pulp vitality testing. In this study the diagnostic accuracy was high with dental pulse oximeter followed by cold, heat and the least was electric pulp tester in different pulpal conditions. (AU)

Fundamentação: a eficiência dos meios de diagnóstico desempenha um papel importante no plano de tratamento. Este estudo tem como objetivo avaliar a precisão diagnóstica do oxímetro de pulso odontológico com um suporte de sensor personalizado, teste térmico e testador de polpa elétrico na avaliação da condição pulpar e na avaliação do nível de saturação de oxigênio em dentes controle saudáveis, não vitais e dentes com pulpite irreversível. Material e métodos: trinta e sete dentes de canal único que necessitavam de terapia endodôntica foram incluídos no estudo. Os dentes selecionados foram testados com oxímetro de pulso, teste pulpar elétrico, spray frio e bastão de guta-percha aquecido. Entre cada teste, foi permitido um intervalo de tempo de 2 minutos para a sensibilização central ocorrer. Três operadores cegos foram envolvidos no estudo. A condição real da polpa foi avaliada após o início do tratamento endodôntico, por meio de exame visual direto da cavidade de acesso. Os dados foram analisados estatisticamente pelo teste de Análise de Variância (ANOVA) e pelo teste Post-hoc de Tukey. Resultados: a sensibilidade do oxímetro de pulso, teste de calor, de frio e teste pulpar elétrico foi de 100, 25, 50 e 12, respectivamente. A especificidade desses testes foi de 100, 72 81 e 77, respectivamente. O teste de ANOVA mostrou que houve diferença estatística entre todos os grupos (p = 0,0005). O teste Post-Hoc de Tukey revelou que houve diferença estatística entre todos os grupos, grupo não-vital (p = 0,0005), grupo controle (p = 0,01) e pulpite irreversível (p = 0,01). A precisão diagnóstica geral do oxímetro de pulso foi de 100%, seguida pelo teste a frio de 66%, o teste de calor a 49% e o teste pulpar elétrico a 45%. Conclusão: o suporte personalizado utilizado no presente estudo ajudou a fornecer uma resposta precisa para o teste de vitalidade pulpar. Neste estudo, a precisão diagnóstica foi alta com o oxímetro de pulso dental, seguido do teste com frio e calor, sendo o teste elétrico o menos eficaz nas diferentes condições pulpares testadas.(AU)

Correlation Between Dental Caries And Salivary Albumin In Adult Population In Chennai: An In Vivo Study / Correlação entre cárie dentária e albumina salivar na população adulta de Chennai: um estudo in vivo

Objective: To evaluate the relationship between dental caries and levels of salivary albumin in unstimulated saliva of adults between the age group of 18 and 40 years from Chennai with varying caries experience as determined by their Decayed Missing Filled Teeth (DMFT) scores. Material and Methods: The study was conducted on 60 healthy adult subjects with age group between 18 and 40 years. The healthy subjects without any chronic diseases, gingival or periodontal problems were selected. The patients were divided into four groups according to DMFT status as Group 1, DMFT 0; Group2, DMFT 1 5; Group 3, DMFT 6 10; and Group 4, as DMFT above 10. Unstimulated saliva samples were collected from each subjects and the salivary albumin levels were estimated using the bromocresol green method (albumin colorimetric test). The obtained data was statistically analysed using one way ANOVA and Tukey`s Honestly Significant Difference test. Results: The mean salivary albumin levels for the groups 1, 2, 3 and 4 were .086 ± .009 mg/ ml, .083 ±.006 mg/ml, .070 ± .008 mg/ml and .056 ±.009 mg/ml respectively. There was an increase in incidence of caries with decrease in salivary albumin level. There was a statistically significant difference among the groups except group 1 and 2. Conclusion: There is a significant relationship between the salivary albumin level and the incidence of dental caries. An increase in incidence of caries with decrease in salivary albumin levels was seen suggestive of its importance in maintenance of tooth integrity. (AU)

Objetivo: Avaliar a relação entre cárie dentária e níveis de albumina salivar na saliva não estimulada de adultos entre a faixa etária de 18 e 40 anos da população de Chennai com experiência de cárie variável, conforme determinado pelos escores do índice de dentes cariados, perdidos e obturados (CPOD). Material e Métodos: O estudo foi realizado em 60 indivíduos adultos saudáveis com faixa etária entre 18 e 40 anos. Os indivíduos saudáveis sem doenças crônicas, problemas gengivais ou periodontais foram selecionados. Os pacientes foram divididos em quatro grupos de acordo com o status CPOD como Grupo 1, CPOD 0; Grupo 2, CPOD 1 5; Grupo 3, CPOD 6 10; e Grupo 4, como CPOD acima de 10. Amostras de saliva não estimuladas foram coletadas de cada indivíduo e os níveis de albumina salivar foram estimados usando o método de bromocresol verde (teste colorimétrico da albumina). Os dados obtidos foram analisados estatisticamente usando one way ANOVA e teste de Tukey. Resultados: Os níveis médios de albumina salivar para os grupos 1, 2, 3 e 4 foram de 0,086 ± 0,009 mg / ml, 0,083 ± 0,006 mg / ml, 0,070 ± 0,008 mg / ml e 0,056 ± 0,009. mg / ml, respectivamente. Houve aumento na incidência de cárie com diminuição do nível de albumina salivar. Houve diferença estatisticamente significante entre os grupos exceto grupo 1 e 2. Conclusão: Existe uma relação significativa entre o nível de albumina salivar e a incidência de cárie dentária. Um aumento na incidência de cáries com diminuição nos níveis de albumina salivar foi visto como sugestivo de sua importância na manutenção da integridade dentária.(AU)

Evaluation of the apical sealing ability and adaptation to the dentin of two resin-based Sealers: An in vitro study.

AIM: To quantitatively evaluate the apical sealing ability and adaptation of two resin-based sealers to dentin. MATERIALS AND METHODS: Fifty freshly extracted mandibular first premolars were taken and sectioned at the cemento-enamel junction. Thirty teeth were subjected to a leakage study by the resin infiltration method with two groups of 10 teeth each. Group I teeth were obturated with methacrylate resin-based sealer (EnoRez) and Group II teeth were obturated with epoxy resin-based sealer (AH Plus). The remaining 10 teeth were used as controls (positive and negative of five teeth each). Twenty teeth were divided into two groups and obturated as in the leakage study and subjected to a scanning electronic microscopy (SEM) analysis for adaptation and resin depth penetration. RESULTS: Both the sealers produced apical leakage to a certain extent. The adaptation and resin sealer penetration in the coronal and middle thirds was better than in the apical third of the root canal under SEM observation. The hybridized resin sealer tags in the coronal and middle thirds of Group I were much longer than that shown by Group II. CONCLUSION: We conclude that the physical integrity of the sealer matrix may also be important in providing resistance to leakage.