In vitro comparative evaluation of apical leakage using a bioceramic sealer with three different obturating techniques: A glucose leakage model.

Context: Bioceramic sealers have improved sealing ability by forming an interfacial apatite layer that chemically bonds the sealer and radicular dentin thus decrease apical leakage. Aim: This study aims to evaluate and compare the apical leakage of Cerafill RCS bioceramic sealer and gutta percha when used with three different obturating techniques. Materials and Methods: Thirty-four extracted single-rooted premolars were decoronated and prepared up to size F3. Then, the specimens were randomly divided into 3 experimental groups (n = 10) cold lateral obturation technique, warm vertical obturation technique, single-cone obturation technique, positive and negative control groups (n = 2), according to the obturation technique used along with a bioceramic sealer. To evaluate apical leakage, all specimens were mounted in a glucose leakage model and assessed at 7 and 14 days using an ultraviolet-visible spectrophotometer. Statistical Analysis: The results were subjected to ANOVA/Kruskal-Wallis ANOVA; followed by post hoc analysis using Bonferroni correction. Results: Significant differences were found in the cumulative leakage of all the three experimental groups. Significantly higher leakage was found in groups obturated using single-cone obturation technique as compared to warm vertical compaction technique at both 7 and 14 days. Conclusions: Warm vertical compaction showed a better sealing result than single-cone obturation techniques at all observation periods.

Conservative Nonsurgical Approach for Management of a Case of Type II Dens in Dente.

Dens in dente is a developmental dental anomaly which poses a challenge for the endodontist due to its complex pulpal anatomy. In this case report, a class 2 dens in dente was managed nonsurgically. A 32-year-old female reported with a palatal swelling and pain in the upper front region of the jaw. On examination, #7 was observed to be malformed and showed a negative pulpal sensibility test. Radiographic and CBCT analysis revealed Ohler's type 2 dens in dente with a periapical radiolucency. In the first visit, invagination was removed using diamond-coated ultrasonic tips, the canal was minimally instrumented, and premixed calcium hydroxide was injected in the canal which accidentally extruded periapically. After two weeks, a draining sinus was observed on the palatal side which when traced, lead to #7. Intracanal dressing was replaced with a mix of powdered calcium hydroxide and saline. The dressing was replaced every two weeks, and radiographs were taken, which revealed the resorption of extruded calcium hydroxide and reduction in the osseous defect. Biodentine was used to obturate the entire canal space. Subsequent follow-up radiographs till 24 months showed significant periapical healing and resorption of extruded calcium hydroxide.

An in vitro comparative evaluation of intraorifice barriers and bleaching agents on the fracture resistance of the endodontically treated anterior teeth.

Aim: This study aimed to evaluate and compare the impact of different bleaching agents on the fracture resistance of endodontically treated teeth when using either GC Fuji type 2 glass ionomer cement (GIC) or Shofu Glass Ionomer RX EASE as intraorifice barriers (IOB). Materials and Methods: A total of 80 single-rooted human maxillary central incisors were prepared and obturated. Three millimeters of gutta-percha was then removed from the orifice. The specimens were divided into two primary groups based on the type of IOB material used: GC Fuji type 2 GIC and Shofu Glass Ionomer RX EASE (n = 40). Each group was further divided into four subgroups based on the bleaching agent used: Carbamide peroxide (CP) 37%, sodium perborate (SP), hydrogen peroxide (HP) 35%, and distilled water used as the control (n = 10). The teeth were subjected to fracture resistance testing. Results: The study found that the order of root fracture resistance was control > CP > SP > HP. There was no statistically significant difference in fracture resistance between GC Fuji type 2 GIC and Shofu Glass Ionomer RX EASE when used as IOB materials. Conclusion: The study concluded that the choice of bleaching agent significantly affects the fracture resistance of endodontically treated teeth. It was observed that fracture resistance is lowest with HP, followed by SP and CP. Both GC Fuji type 2 Glass Ionomer and Shofu Glass Ionomer RX EASE are effective as IOB.

An in vitro comparison of incisal preparation design on load-to-failure of ceramic veneers.

Introduction: This in vitro study aimed to compare the load-to-failure values of two different ceramic veneers (IPS e.max Press [Ivoclar Vivadent] and Vintage lithium disilicate [LD] press [Shofu]) with incisal preparation designs under standardized conditions. Materials and Methods: Twenty-two intact extracted maxillary incisors were selected and divided randomly into two groups (n = 11). The veneer tooth preparation was standardized in both groups where a butt joint incisal preparation was done along with chamfer margin. Group 1 included veneers made from IPS e.max Press (Ivoclar Vivadent) and Group 2 included veneers fabricated from Vintage LD Press (Shofu). Veneers were luted to their respective abutment teeth using standardized bonding protocols and resin cement for both groups. Later, every specimen was loaded to failure utilizing a universal testing machine, and the outcomes were noted in Newtons (N). Results: The mean load-to-failure value obtained for Group 1 (IPS e.max Press) was 1386.46 N while that obtained for Group 2 was 1777.07 N. Statistically significant difference was found in this intergroup comparison (P = 0.006). Conclusion: The load-to-failure value of Vintage LD Press veneers (Shofu) was greater than that of IPS e.max Press veneers (Ivoclar Vivadent).

Root canal anatomy of human permanent mandibular incisors and mandibular canines: A systematic review.

Mandibular incisors and canines show variations in their root canal anatomy. It is imperative to be aware of these variations to lower the frequency of missed canals. The objective was to systematically review the existing studies to recognize the root and root canal anatomy of the mandibular incisors and canines among the population of various geographical locations, as studied by different methods. This systematic review was registered in the International Prospective Register of Systematic Reviews database under the number CRD42020185146. An exhaustive search was undertaken in three electronic databases - MEDLINE PubMed, EBSCOhost, and Google Scholar - along with hand-searching for the identification of studies. Studies were selected following strict inclusion and exclusion criteria. Selected studies were scored using the Joanna Briggs Institute Critical Appraisal tool for prevalence studies to determine the risk of bias. This review included data from 26 countries including the analysis of 71,404 mandibular anterior teeth. The risk of bias of all included studies was either low or moderate. Overall, it was seen that the percentage of second canals was higher in lateral than in central incisors. Mandibular canines occasionally showed the presence of two roots. Deviations in anatomy were high in the Middle Eastern European countries and the Indian subcontinent. Limitations are as follows: lack of homogeneity across data reported in the studies concerning the methods used to study the root canal anatomy. Diversities seen in the root canal configurations of mandibular incisors and canines vary according to ethnicity, and thus, one must have a thorough knowledge before commencing endodontic treatment.

Comparison of the penetration depth of five root canal sealers: A confocal laser scanning microscopic study.

BACKGROUND: Sealer penetration into dentinal tubules eliminates the pathways for bacterial leakage and entombs intratubular bacteria. AIM: The aim of this study was to evaluate and compare the depth of radicular dentinal tubule penetration of five root canal sealers using confocal laser scanning microscopy. METHODS: Fifty freshly extracted single-rooted maxillary anterior teeth were used. After decoronation at the cementoenamel junction, they were prepared to ProTaper size F3. After irrigation with 5 mL smear clear, 5 mL 5% sodium hypochlorite and 5 mL distilled water alternatively, the samples were randomly divided into five groups (n = 10) and obturated by lateral compaction technique using the test sealers labeled by fluorescent rhodamine B dye (Mayor Diagnostics, Mumbai, India). Zinc oxide eugenol (ZOE) (Prime Dental Products), EndoREZ (Ultradent), Sealapex (SybronEndo), AH Plus (Dentsply Maillefer), and MTA-Fillapex (Angelus) formed the test groups. Teeth were then positioned in blocks of orthodontic resin. Three horizontal sections of 1-mm representing coronal middle and apical thirds were made and examined with Zeiss (laser scanning microscope [LSM] 780) confocal LSM. Images were analyzed using ZEN 2.1 software. STATISTICAL ANALYSIS: Data were recorded and subjected to statistical analysis using one-way ANOVA test. RESULTS: Maximum penetration depth was demonstrated by AH Plus in the coronal and apical thirds, MTA-Fillapex in the middle thirds, while minimum penetration depth was seen in ZOE in the coronal and middle thirds and Sealapex in the apical thirds. None of the root canal sealers were able to penetrate the complete depth of radicular dentinal tubules. CONCLUSION: While AH Plus and MTA-Fillapex showed the highest penetration into radicular dentinal tubules, ZOE and Sealapex demonstrated the least penetration.

An in vitro investigation on the reinforcing potential of contemporary composites in weakened bicuspids.

Context: This study was carried out to assess the currently available composite systems in India for resistance to fracture in teeth with large cavities. Aim: To evaluate the fracture toughness of weakened maxillary premolars restored by contemporary composites. Settings and Design: In-vitro study was done in the department of conservative dentistry and endodontics. Materials and Methods: Freshly extracted 44 human maxillary bicuspids were randomly divided into four groups where Group I included intact teeth. The teeth in the other three groups were subjected to a standardized mesio-occluso-distal cavity preparation. The cavities were filled in Group II with bioactive, nanohybrid composite with Giomer chemistry (Beautifil II LS, Shofu Inc., Kyoto, Japan), in Group III with highly filled, nanohybrid composite (Prevest Fusion Universal, Prevest DenPro Limited, Jammu, India) and in Group IV with fiber-reinforced composite with optimized fiber-aspect ratio technology (everX Posterior, GC EUROPE N. V., Leuven, Belgium). All the specimens were then subjected to thermocycling followed by incubation procedures. Fracture resistance was measured in Newton (N) using the universal testing machine. Statistical Analysis Used: Data obtained were tabulated and subjected to one-way analysis of variance (ANOVA) test followed by Tukey's test. Results: Highest mean fracture resistance was observed with Group I (2294.06), followed by Group II (1708.72), Group IV (1195.82), and Group III (825.38). One-way ANOVA test showed a statistically significant difference (P ≤ 0.05) between all the four groups. Post hoc Tukey test was used for intergroup comparison and showed significant difference (P ≤ 0.05) in mean fracture resistance between groups. Conclusion: The results suggest that the highest compressive fracture resistance was shown by Group II (Beautifil II LS composite resin).

Comparative evaluation of retreatment techniques by using different file systems from oval-shaped canals.

INTRODUCTION: Endodontic failure resolves after complete removal of obturating material followed by disinfection, cleaning, shaping and three-dimensional obturation. MATERIALS AND METHODS: Seventy single-rooted mandibular premolars, with single oval-shaped root canal were included. They were decoronated at a length of 16 mm from the apex. Shaping and cleaning were performed, and obturation was done using the warm lateral compaction technique. The teeth were divided into seven groups according to retreatment procedures (Hand files; ProTaper Universal retreatment files; MTwo® Retreatment system; R-Endo® Retreatment system; ProTaper Universal retreatment files with solvent and ultrasonics; MTwo® R with solvent, and ultrasonics and R-Endo® with solvent and ultrasonics). The data were obtained and subjected to the statistical analysis. RESULTS: All instrumentation techniques left obturating material with least in Group 6 and maximum Group 5. The mean time taken for complete retreatment procedure was minimum in Group 2 and maximum with Group 1. CONCLUSION: MTwo® R with solvent and ultrasonics, R-Endo®, and R-Endo® with solvent and ultrasonics were effective in gutta-percha removal from coronal third, middle third, and apical third, respectively. Significance: Nonsurgical endodontic retreatment using rotary files helps in gaining access to infected teeth. During retreatment procedure, this helps disinfectant to reach in critical areas of the root canal system, thereby decreasing the microbial load, leading to achieve healthy periradicular tissues.

A comparison of two pulp revascularization techniques using platelet-rich plasma and whole blood clot.

AIM: The aim of this preliminary study was to compare outcomes of two regenerative endodontic protocols in necrotic teeth with open apices. METHODOLOGY: Forty teeth with open apices in patients with an age range of 15-54 were randomly distributed in two groups: group 1, with whole blood clot in the canal (n=20) and group 2, whole blood with Platelet rich plasma (PRP) in the canal (n=20). Clinical and radiological follow up assessments were undertaken over a period ranging from 6 months to one year. Radiographic Root Area (RRA) was measured using the freeware ImageJ. Statistical analysis was performed using the independent samples t test and the Chi-squared test, the significance level was set at p=0.05. RESULTS: There was no difference in the percentage change in RRA between the PRP group and whole blood-clot + PRP group. CONCLUSION: Whole blood clot and PRP are comparable on the grounds of percentage change in RRA and there is no statistically significant difference between the two in a follow-up period of up to one year.

Root canal morphology of South Asian Indian mandibular first, second, and third molar: A dye penetration and clearing study.

CONTEXT: Studying in detail the root canal morphology specific to the Indian mandibular molars will help discern whether the root canal anatomy patterns resemble those reported internationally or are different from it. AIM: The aim is to study the root canal anatomy of Indian permanent mandibular first, second, and third molar teeth using a tooth clearing technique. METHODS: The root canals of a total of 300 extracted Indian mandibular molars consisting of 100 first, second, and third molars each were accessed and injected with India ink, after which they were subjected to the clearing technique. STATISTICAL ANALYSIS: Data was analyzed using descriptive statistics for the computation of percentages using SPSS version 21. RESULTS: Of the hundred first molars, 90% of teeth were two rooted with three canals, 79% had two apical foramina. 70% mesial roots of the three-rooted type showed Type I, whereas 100% distal roots and distolingual roots showed Type I Vertucci's anatomy. About 70% mesial roots of two roots showed Type II and 90% distal canals showed Type I configuration. Among the second molars, five (5%) were single-rooted, ninety-one (91%) teeth were two rooted and four (4%) had three roots. Among the mandibular third molars, fifteen (15%) teeth had one root, sixty-three (63%) teeth had two roots, eighteen (18%) teeth had three roots, and four (4%) teeth had four roots. CONCLUSIONS: The root canal anatomic features of mandibular molars showed differences in the frequency of particular anatomic types as compared to mandibular molars from other racial backgrounds. Further comparative studies on inter-racial anatomic characteristics from various geographic locations would be beneficial.

Effect of ultrasonic activation on calcium ion quantification, smear layer removal, and canal cleaning efficacy of demineralizing irrigants.

BACKGROUND: Effective removal of smear layer ensures better penetration of irrigants ensuring root canal disinfection and has the potential of sealing dentinal tubules during obturation. AIM: The aim of this study is to evaluate the canal cleaning efficacy and calcium ion liberation with the use of demineralizing irrigants, namely, 17% ethylenediaminetetraacetic acid (EDTA), 7% maleic acid, and 10% citric acid with or without ultrasonic (US) activation. MATERIALS AND METHODS: Crowns of 62 extracted maxillary central incisors were decoronated and root canals prepared. Based on the final irrigant teeth were divided into following groups (n = 10), namely, 10% citric acid, 7% maleic acid, 17% EDTA, and 10% citric acid with US activation, 7% maleic acid with US activation, and 17% EDTA with US activation. Irrigants were subjected to inductively coupled plasma-atomic emission spectroscopy followed by debris scoring and scanning electron microscope analysis. STATISTICAL ANALYSIS: One-way analysis of variance with the Bonferroni's correction for multiple testing was employed. RESULTS: About 10% citric acid with US activation liberated the highest calcium ions and removed the maximum smear layer. CONCLUSIONS: Citric acid with US activation is a potentially effective irrigation regimen with sodium hypochlorite.

An in vivo comparison of the antibacterial efficacy of photoactivated disinfection, diode laser, and 5% sodium hypochlorite in root canal disinfection.

BACKGROUND: Pulpal infections are caused by varied number of organisms and are located in various sites of root canal system. Thus, the success of root canal treatment depends on complete eradication of microbiota. MATERIALS AND METHODS: Thirty-two patients were selected and divided into four groups (photoactivated disinfection [PAD], diode laser, 5% sodium hypochlorite [NaOCl], and normal saline). The treatment was done according to groups, following manufacturer's instructions. The efficacies of groups were evaluated using microbial culturing technique. Three samples were taken for each group and were incubated separately for aerobic and anaerobic culture. Microbial counting was done for each sample in the form of colony-forming units. RESULTS: It was evaluated using two-way analysis of variance and Friedman test. All the groups showed reduction in number of bacteria. However, for group A P < 0.0001 when analyzed for aerobic and anaerobic microorganisms, whereas, with Group B and C, P < 0.0001 for aerobic microorganisms. CONCLUSION: PAD, diode laser, and 5% NaOCl showed antibacterial action against aerobic and anaerobic bacteria.

Determining predictability and accuracy of thermal and electrical dental pulp tests: An in vivo study.

INTRODUCTION: Pulp sensitivity testing, even with its limitations and shortcomings, has been and still remains a very helpful aid in endodontic diagnosis. Pulp sensitivity tests extrapolate pulpal health from the sensory response. The aim of the present study was to identify the sensitivity, specificity, positive and negative predictive values (NPVs) of thermal and electrical tests of pulp sensitivity. MATERIALS AND METHODS: Pulp tests studied were two cold and heat tests respectively and electrical test. A total of 330 teeth were tested: 198 teeth with vital pulp and 132 teeth with necrotic pulps (disease prevalence of 40%). The ideal standard was established by observing bleeding within the pulp chamber. RESULTS: Sensitivity values of the diagnostic tests were 0.89 and 0.94 for cold test, 0.84 and 0.87 for the heat tests, and 0.75 for electrical pulp test and the specificity values of the diagnostic tests were 0.91 and 0.93 for the cold tests, 0.86 and 0.84 for the heat tests, and 0.90 for electrical pulp test. The NPVs were 0.91 and 0.96 for the cold tests, 0.89 and 0.91 for the heat tests, and 0.84 for electrical pulp test. The positive predictive values were 0.89 and 0.90 for the cold tests, 0.80 and 0.79 for the heat tests and 0.88 for electrical pulp test. The highest accuracy (0.9393) was observed with cold test (icy spray). CONCLUSIONS: The cold test done with icy spray was the most accurate method for sensitivity testing.

Solubility of a new calcium silicate-based root-end filling material.

INTRODUCTION: The purpose of this study was to compare solubility of a new calcium silicate-based cement, Biodentine with three commonly used root-end filling materials viz. glass-ionomer cement (GIC), intermediate restorative material (IRM), and mineral trioxide aggregate (MTA). MATERIALS AND METHODS: Twenty stainless steel ring molds were filled with cements corresponding to four groups (n = 5). The weight of 20 dried glass bottles was recorded. Samples were transferred to bottles containing 5 ml of distilled water and stored for 24 h. The bottles were dried at 105΀C and weighed. This procedure was repeated for 3, 10, 30, and 60 days. Data was analyzed with one-way analysis of variance (ANOVA) test (P < 0.05). RESULTS: Biodentine demonstrated significantly higher solubility than MTA for 30- and 60-day immersion periods. Statistical difference was noted between the solubility values of Biodentine samples amongst each of the five time intervals. CONCLUSIONS: Biodentine exhibited higher solubility in comparison with all other cements.

In vivo antimicrobial efficacy of 6% Morinda citrifolia, Azadirachta indica, and 3% sodium hypochlorite as root canal irrigants.

OBJECTIVE: To evaluate and compare the antimicrobial efficacy of 6% Morinda citrifolia, Azadirachta indica, and 3% sodium hypochlorite (NaOCl) as root canal irrigants. MATERIALS AND METHODS: Thirty nonvital maxillary anteriors were randomly assigned to one of the three groups corresponding to the irrigant to be tested; 6% Morinda citrifolia juice (MCJ) (n = 10), A. indica (n = 10) and 3% NaOCl (n = 10). After the root canal access opening a root canal culture sample was taken with two paper points and cultured under aerobic and anaerobic conditions. Cleaning and shaping were completed with irrigation by 10 mL of respective irrigants and 5 mL of final rinse. The patients were recalled after 3 days and canals were rinsed again with 5 mL of the test irrigants. This was followed by obtaining a posttreatment root canal culture sample and culturing and analyzed by counting the colony forming units (CFUs). RESULTS: Six percentage MCJ, A. indica, and 3% NaOCl showed a significant reduction (P < 0.05) in the mean CFU counts for aerobic and anaerobic bacteria between baseline and 3 days. CONCLUSION: There was no difference in the antimicrobial efficacy of 6% M. citrifolia, A. indica, and 3% NaOCl as root canal irrigants.

A comparative evaluation of endodontic practice trends in India: "the Mumbai study".

INTRODUCTION: Multiple treatment protocols are available to the Indian endodontist. Hence a survey is required to recognize the common trends in endodontics and set a basic standard of treatment. AIMS AND OBJECTIVES: The aim of this article is to present practice trends among Indian endodontists and compare the same with established practice trends internationally through various surveys that have been conducted respectively. MATERIALS AND METHODS: Questionnaires were mailed to 1085 endodontists in dental schools and private practice in India. A response rate of 42% was observed. The data was analyzed and compared with other studies. RESULTS: Most of the endodontists in India follow the basic protocols and techniques in their practices. 40% of the Endodontists preferred digital radiography technique. 2.5% NaOCl is the most preferred irrigant of choice for primary root canal treatment and 2% chlorhexidine in retreatment cases. Calcium hydroxide was the most preferred intracanal medicament in all clinical situations. Lateral compaction (70.8%) was the most widely used method. AH Plus was the most preferred root canal sealer (46.6%). CONCLUSION: Indian endodontists are following the basic protocol but when compared to other studies there were concepts like, the use of rubber dam and microscope which need to be improved and raised to a level that ensures international standards in clinical practice.

Implants in adolescents.

Implants have gained tremendous popularity as a treatment modality for replacement of missing teeth in adults. There is extensive research present on the use of implants in adults, but there is a dearth of data available on the same in adolescents. The treatment planning and execution of implant placement in adolescents is still in its infancy. This review article is an attempt to bring together available literature.