Antibacterial and Antifungal Efficacy of Platelet-Rich Fibrin and Platelet-Rich Fibrin Matrix against Root Canal Microflora.

BACKGROUND: Binding of such proteins with a developing fibrin mesh or to the extracellular matrix has the ability to create chemotactic gradients aiding the recruitment of stem cells, thereby, stimulating cell migration and differentiation this may promotes repair and regeneration. There is a unique concept in platelet concentrates called platelet-rich fibrin matrix (PRFM) which is processed using higher attraction without the utilization of bovine thrombin. AIM AND OBJECTIVES: The aim of this study is to evaluate the antibacterial and antifungal effects of platelet-rich fibrin (PRF) and PRFM against root canal microflora. MATERIALS AND METHODS: Blood samples were taken from 20 adults, age ranging from 20 to 40 years who were systemically healthy, nonsmokers with no symptoms of infection, or on antibiotics at least 3 months before experiments. The procedures and the protocols involved in the study were accepted by the Institutional Ethical Committee. Written informed consent was obtained from the donors and patients. Approximately 10 ml of blood was collected from each donor. 5 ml of blood was used for the preparation of PRF and 5 ml for PRFM. RESULTS: The antifungal scores among the groups. The highest antifungal scores were seen in metapex followed by PRF and PRFM group. Kruskal-Wallis test was applied to check the statistical difference among the groups, and there was a statistically significant difference seen among the groups (P = 0.00). The antibacterial scores among the groups. The highest antibacterial scores were seen in Metapex followed by PRF group and PRFM group Kruskal-Wallis test was applied to check the statistical difference among the groups, and there was a statistically significant difference seen among the groups. CONCLUSION: PRF demonstrated antibacterial activity against passage isolates but had no antifungal efficacy. This antibacterial property may be a valuable adjunct when using PRF for regenerative procedures in endodontics. Both PRF and PRFM have to be analyzed for antimicrobial properties for extended duration and various other clinical strains with larger sample size.

Shaping Ability of Two-shape and ProTaper Gold Files by using Cone-beam Computed Tomography.

AIM: T-Wire and rotating motion of two-shape (2S), M-wire and rotating motion of ProTaper Gold (PG) are the recent innovations of Nickle Titanium (NiTi) rotary file system by means of thermal treatment. Therefore, a study was planned to assess the shaping ability of 2 Shape and ProTaper Gold using cone beam computed tomography (CBCT) Materials and methods: Thirty freshly extracted mandibular first molars were selected, and Pre-instrumentation CBCT imaging was performed to attain mesial and distal dentin wall measurements followed by chemo-mechanical preparation using the following NiTi files: 2S and ProTaper Gold. Post instrumentation CBCT imaging was performed for evaluation of the volume of removed dentin, apical transportation, and centering ratio. Statistical analysis was confirmed by a suitable analysis test with significance set at 0.05r. RESULTS: In terms of the total volume of removed dentin, apical transportation, and centering ratio there was a significant difference noted between the tow-shape and ProTaper Gold. 2Shape performed better in all aspects compared to ProTaper Gold. CONCLUSION: Two-shape (2S) maintained better original canal anatomy and volume of removed dentin was also less during chemo-mechanical preparation when compared to ProTaper Gold. CLINICAL SIGNIFICANCE: Two-shape (2S) system when used clinically in patients may perform better and produce less canal transportation and canal preparation will be more centered as compared to the ProTaper Gold system.

Comparison of Flexural Strength and Surface Roughness of two Different Flexible and Heat Cure Denture Base Material: An in Vitro Study.

AIM: To Compare and Evaluate the Flexural Strength and Surface Roughness of Lucitone-FRS, Valplast (Flexible Denture Base Materials) and Trevalon (Heat Cure Denture Base Material). MATERIALS AND METHODS: Three stainless steel master dies of dimension 65 × 20 × 3 mm were fabricated and were invested in standard metal denture flask. A total of 60 specimens were fabricated with 20 specimens of each type of denture base material. Fabrication of a Heat Cure Acrylic Denture Base Resin Specimen was Done Followed by Fabrication of Flexible Denture Base Resins Specimen. In the same manner, samples were fabricated for Lucitone-FRS, and Valplast. These specimens were further divided into two subsets; containing 10 specimens each from each group. In one subset, Flexural Strength was Measured while in the other subset, Surface Roughness was measured. The Surface Roughness values were measured using a surface testing machine Mitutoyo-SJ-Series 201 (Japan). The flexural strength of specimens was measured using a 3-point bending test device on universal testing machine. All the results were compiled and Analyzed by SPSS software. RESULTS: Flexural strength was found maximum in the VALPLAST and minimum in LUCITONE. Surface Roughness Test was done on total 10 samples of each material, i.e. Lucitone-FRS, Valplast and Trevalon. Results for Surface Roughness Test are Valplast has maximum Surface-Roughness followed by Trevalon and minimum in Lucitone-FRS on both polished and unpolished surface. CONCLUSION: Trevalon can be ideal in cross-arch stabilization cases and Valplast and Lucitone FRS can be successfully used in cases of small arch complete dentures and removable partial dentures. CLINICAL SIGNIFICANCE: The selection of the right denture base material is imperative as it largely affects the overall clinical outcomes and comforts. Results of the present study would aid the dentist in the selection of ideal denture base materials for specific cases like those requiring Cross Arch Stabilization, Small Arch Complete Dentures, and Removable Partial D entures.

Quantitative Assessment of apically Extruded Bacteria using different Instrumentation Techniques and Preparation Taper.

BACKGROUND: Cleaning and shaping of the pulp canal is one of the most important steps of endodontic therapy. Serious complications occur by the apical extrusion of bacteria during the instrumentation procedures. Both crown-down (CD) and full-length linear motion (FM) techniques are routinely used as a component of taper rotary instrument procedures for achievement of thorough cleaning and shaping of the pulp canal space. Hence, we aimed for this study to assess the change in the amount of apically extruded bacteria using CD and FM instrumentation techniques produced by differences in taper between the instruments used during biomechanical preparation of root canals. MATERIALS AND METHODS: The present study included assessments of 132 extracted maxillary central incisor teeth. To achieve a uniform teeth length of 21 mm, the height of the tooth crown was reduced for preserving the coronal portion of teeth. A modified glass vial model was constructed for the estimation of amount of bacterial extrusion through the apical region. For filling of each pulp canal specimen, 20 mL of Enterococcus faecalis suspension was used followed by the use of a number 10 K-file for carrying the bacteria down the lengths of pulp canals. All the contaminated teeth specimens were divided into six study groups with groups I to III containing specimens prepared in the CD manner, while groups IV to VI contained specimens prepared in the FM manner. Six teeth were taken as negative control with three specimens with each technique, and another six specimens were taken as positive controls. Cultivable bacterial counts were determined by evaluating 100 mL saline solution from each vial followed by its inoculation on blood agar. All the colony-forming unit (CFU) values were log-transformed (base 10), and the results were analyzed by Statistical Package for the Social Sciences software. RESULTS: A significantly lower quantity of CFU values was observed during CD instrumentation procedures with 0.02 files in comparison with all other study groups. However, while comparing both the instrumentation procedures when different taper files, other than 0.02 taper, were used for biomechanical preparation of root canal, nonsignificant results were obtained. CONCLUSION: With 0.02 taper preparations, significantly less amount of extrusion of bacteria is associated when done with CD technique. CLINICAL SIGNIFICANCE: No change in the amount of apical extrusion of bacteria will be seen by changing the type of instrumentation procedures. Amount of bacteria extruded can be minimized using 0.02 taper. Key words: Bacteria, Instrumentation, Taper.

Evaluation of 4% Sodium Hypochlorite in eliminating Enterococcus faecalis from the Root Canal when Used with Three Irrigation Methods: An in vitro Study.

INTRODUCTION: Endodontic treatment removes all pathogens, such as Enterococcus faecalis from pulp and root canals. The aim of this study is to assess the usefulness of sodium hypo-chlorite (NaOCl) in removing E. faecalis from the root canal used with three different irrigation methods. MATERIALS AND METHODS: This study was conducted on freshly extracted maxillary incisors. After biomechanical preparation, root canals were injected with E. faecalis. Three groups were made which contained 30 teeth in each group; 2 mL of NaOCl solution was used for irrigation followed by agitation with K-files in group I; 2 mL of NaOCl solution was used for irrigation and ultrasonic agitation was done in group II. In group III, an alternate irrigation with NaOCl and 3% hydrogen peroxide was done. The fourth group (control) was irrigated with sterile saline solution. E. fae-calis bacteria were sampled to the root canals with paper points and were transferred to tubes that contained 5 mL of brain heart infusion broth. Tubes were incubated and the presence of broth turbidity was suggestive of bacteria remaining in the root canal. RESULTS: All three groups showed no statistically significant difference. However, difference existed between experimental groups and control groups. CONCLUSION: The author concluded that all three methods of application of NaOCl were effective in disinfecting the root canal than the saline solution. CLINICAL SIGNIFICANCE: No single irrigant has 100% efficiency. Thus by this study, a best irrigating solution with maximum properties can be established.

Assessment of Correlation between Clinical Parameters and Pulp Canal Pathogens in Endodontic Pathologies: A Microbiological Study.

INTRODUCTION: Success and failure of root canal therapy is largely dependent on the clinician and the patient. Once the tooth is restored into its functional and esthetic place, the root canal therapy is considered to be complete. It is a well-known fact that root canal space acts as a rich reservoir for microorganisms. Past studies show that root canal harbors an array of different microorganisms. Streptococcus mitis and Enterococcus faecalis have been found to be the most prevalent microorganisms isolated from the infected pulp canal space. Hence, we evaluated the association of endodontic signs and symptoms with root canal pathogens. MATERIALS AND METHODS: A total of 120 patients were selected for the study and divided broadly into two groups: Group I containing patients with primary infection and group II containing patients in which retreatment was required. Both groups contained 60 patients each. Clinical parameters recorded for the study are pain, tenderness on percussion, swelling, periapical radiolucency on radiographic analysis, caries, sinus formation, and tooth mobility. After assessment, opening, and initial filing, sterile paper points were inserted into the root canal space for collection of microbiological sample, which was further send to laboratory for cultural analysis. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Student's t-test and Fisher's exact test were used to evaluate the level of significance. RESULTS: While comparing the mean age of the patients in the two groups, no significant association was seen. Statistically significant results were obtained while comparing the association between pain and S. mitis. Positive correlation was seen on comparing the association between tenderness on percussion and E. faecalis. Also, a positive association was seen between periapical radiolucency and S. mitis. CONCLUSION: Strong positive correlation exists between S. mitis and E. faecalis and endodontic signs and symptoms. CLINICAL SIGNIFICANCE: Sound knowledge regarding the association of microbes of root canal and specific endodontic signs and symptoms could help therapeutic management of root canal infections effectively.

In vitro Comparison of Impact of Different Bleaching Agents on the Microhardness of Enamel.

BACKGROUND: Various agents are used these days for increasing the esthetics. One such procedure is bleaching that offers various advantages, as it is minimal invasive and cheap option to color the teeth and remove stain. The altered enamel after the bleaching process shows surface demineralization and porosities. The present study aimed to evaluate the effect of different bleaching agents on the microhardness of enamel. MATERIALS AND METHODS: A total of 100 freshly human extracted maxillary premolar teeth were selected for the study. Teeth with sound tooth structure were included for the study. All the specimens were randomly divided into four groups with 25 specimens in each group depending upon the type of bleaching agent used: Group A, artificial saliva (Control group); Group B, 35% hydrogen peroxide (HP); Group C, 25% HP; Group D, 10% carbamide peroxide (CP). Knoop Hardness Number (KHN) was calculated at 24, 48-hour, and 7-week interval. RESULTS: Results showed no statistical significant differences between the microhardness of enamel of different groups (p < 0.005). A slight fall in the value of KHN was seen in all the groups, except for the control group, although the results were statistically nonsignificant (p > 0.005). CONCLUSION: Although nonsignificantly, all the bleaching solutions produced some amount of alterations in the microstructure of enamel. More studies with higher study groups and more advanced estimation technologies are required to minimize microstructure alterations and promote for better outcome of bleaching procedures.

Estimation and comparison of serum cortisol levels in periodontally diseased patients and periodontally healthy individuals: A clinical-biochemical study.

INTRODUCTION: Psychological conditions, particularly psychosocial stress have been implicated as risk indicators of periodontal disease. Stress increases cortisol production from the adrenal cortex by stimulating an increase in the release of ACTH from the pituitary gland. Increased cortisol production suppresses the immune response and increases the potential of periodontal tissue destruction. AIM: The aim of the present study was to estimate and compare the serum cortisol levels in periodontally diseased patients and periodontally healthy individuals. MATERIALS AND METHODS: Total of 45 subjects were recruited for this study and were categorized into three groups. Group I - Comprised of aggressive periodontitis patients (n = 15), Group II - Chronic periodontitis patients (n = 15), and Group III - Healthy controls (n = 15). Serum samples were collected from each of the groups and cortisol levels were determined using cortisol immunoassay kit. Clinical examination covered probing depth, gingival index (GI), gingival recession, plaque index, and clinical attachment level. The statistical analysis was done using nonparameteric t-test and Spearman's rank correlation coefficient. RESULTS: With respect to cortisol, the levels were higher in Group-I compared to the other groups. On comparison of mean cortisol levels among the groups, the values were statistically significant between Group-I and Group-III. Group-I showed a significant negative correlation between cortisol levels and GI. CONCLUSION: Within the limits of the study serum cortisol levels was higher in the chronic periodontitis group compared to the other groups. Positive correlation was found between the cortisol levels and other clinical parameters except for the GI.

Clinical Evaluation of Efficacy of CIA and CNA Intrusion Arches.

BACKGROUND AND OBJECTIVES: Excessive overbite is one of the most common problems that confront the orthodontist. Deep bite can be due to infraocclusion of posterior teeth, supraocclusion of anterior teeth or a combination of the two. Correction of same can be carried out by extrusion of molars, intrusion of incisors or by a combination of both respectively. Various intrusion arches are recommended for correcting deep bite by true intrusion of anterior teeth, Utility arches, Segmental arch, Connecticut Intrusion Arch (CIA) and Connecticut New Arch (CNA). The purpose of this study was to evaluate clinical efficacy of CIA and CNA intrusion arches. MATERIALS AND METHODS: Tracings recorded from pre and post-treatment lateral cephalograms of 25 patients treated by CIA (Group I) and another 25 patients treated by CNA (Group II) intrusion arches in deep bite cases after four months of treatment were analysed and findings were recorded. STATISTICAL ANALYSIS: Paired t-test was used to compare pre and post-treatment changes within Groups I and II and unpaired t-test was used to compare treatment changes between Group I and Group II. A P-value of < 0.05 was set for statistical significance. RESULTS: Findings of this study demonstrate that an average of 1mm of intrusion takes place with CIA intrusion arch and 1.3mm with CNA intrusion arch in a period of 4 months. Both intrusion arches do not affect the position of molar in vertical or anteroposterior plane. INTERPRETATION & CONCLUSION: Both CIA and CNA intrusion arches are effective in bringing about intrusion of lower incisors.