Evaluation of detrimental effects of impacted Mandibular third molars on adjacent second molars - A retrospective observational study.

Context: Mandibular impacted third molars are the most frequently impacted teeth in humans and can predispose the adjacent second molar to an array of detrimental effects such as caries, periodontitis, and cervical resorption thus the aim of this study was to determine the same. Subjects and Methods: A retrospective observational cross-sectional study involving patients with orthopantomography presenting with impacted lower third molar. The type, depth, and level of impaction, the extent of caries, periodontal changes, and the presence of cervical resorption were assessed. Statistical Analysis Used: Data were analyzed using SPSS version 21.0. with Chi-square. Results: Mesioangular impaction was most commonly noted. The pattern of impaction had a direct influence in the formation of carious lesions, cervical resorption, and periodontal ligament (PDL) changes. Conclusions: Noting the pattern of third molar impaction helps the clinician to forecast problems that may occur on adjacent teeth and initiate necessary prophylactic treatment.

Influence of three different types of desensitizing agents on bond strength of etch-and-rinse and self-etch adhesive system on dentin: An in vitro study.

Aim: To determine the effect of three different dentin hypersensitivity treatment procedures on the microtensile bond strength of etch and rinse and self-etch adhesive system. Materials and Methods: Eighty extracted intact human permanent lower premolars were decoronated, and dentin was exposed on the buccal surface. The teeth were randomly assigned to two experimental groups of 40 teeth each: etch and rinse system or self-etch system. The 40 samples assigned were further randomly assigned to four desensitizing treatment subgroups: Control, Gluma, NovaMin, and GC tooth Mousse with 10 samples per subgroup. Desensitizing treatment was performed two times each day for 2 weeks respectively. The exposed dentin was subjected to etch and rinse or self-etch adhesive system bonding agent as per the group and restored using composite to 4-mm thickness. Samples were then subjected to universal testing machine for microtensile bond strength. Results: The bond strength to the dentin obtained with etch and rinse adhesive system group where significantly higher (P < 0.05) when compared to self-etch adhesive system. However, there was no significant effect of the desensitizing agent on the microtensile bond strength in its own. Scanning electron microscope imaging reviled tubular occlusion in all specimens treated with desensitizer. Conclusion: The bond strength was majorly impacted by the type of adhesive system used. While the desensitizing agents used in the study had little or no adverse effect on the bond strength of composites to dentin surface.

Assessment of effect of 1% phytic acid and 17% ethylenediaminetetraacetic acid on calcium ion loss of radicular dentin: An ex vivo study.

AIM: The purpose of this study was to evaluate and compare the effectiveness of phytic acid and ethylendiamine tetraacetic acid (EDTA) in the removal of calcium ion from radicular dentin during endodontic procedure. MATERIALS AND METHODS: Twenty-five single-rooted mandibular premolar teeth were decoronated, and the roots were split longitudinally into two halves. Among obtained specimens, 45 specimens were randomly selected and divided into three groups (n = 15): Group 1 - distilled water, Group 2 - 17% EDTA, and Group 3 - 1% phytic acid. Samples in each group were immersed in the test solutions for specific time intervals, after which the same solution samples were subjected for the evaluation of amount of calcium ion release into the solution by Atomic Absorption Spectrophotometer. Data were analyzed using the one-way analysis of variance test. RESULTS: The use of 17% EDTA resulted in more calcium ion loss as compared to 1% phytic acid and distilled water. CONCLUSION: One percent phytic acid seems to be an appropriate irrigating solution because of its less demineralizing effect as compared to 17% EDTA on radicular dentin.

Comparative analysis of smear layer removal by conventional endodontic irrigants with a newly experimented irrigant-fumaric acid: A scanning electron microscopic study.

INTRODUCTION: This study was aimed to evaluate the efficacy of 17% ethylenediaminetetraacetate (EDTA), 7% maleic acid and 0.7% fumaric acid in smear layer removal from the root canal walls. MATERIALS AND METHODS: Forty single-rooted mandibular premolars were collected and prepared till F3 rotary ProTaper file with 1 ml of 3% of sodium hypochlorite after each instrument change. Samples were randomly divided into 4 groups according to the final irrigating solution: 17% EDTA, 7% maleic acid, 0.7% fumaric acid, and 0.9% saline. The samples were prepared for scanning electron microscope analysis to observe smear layer removal at coronal, middle, and apical third level of root canal system. RESULTS: At coronal third level, fumaric acid was equally efficient in smear layer removal when compared to maleic acid and EDTA without any significant difference between them. At the middle third, fumaric acid showed significantly better results than maleic acid followed by EDTA. At the apical third, both fumaric acid and maleic acid were equally effective without any significant difference between them but both showed significantly better results than EDTA. CONCLUSION: Fumaric acid can be tried as a new irrigating agent for smear layer removal in root canal system.

A comparative clinical evaluation of accuracy of six apex locators with intraoral periapical radiograph in multirooted teeth: An in vivo study.

AIM: The purpose of this clinical study was to compare and clinically, to evaluate the accuracy of six apex locators with intra oral periapical (IOPA) radiograph in multirooted teeth. MATERIALS AND METHODS: A total of 90 multirooted teeth (maxillary and mandibular molars) with irreversible, infected or necrotic pulp tissue and completely formed roots were included in this study and were divided randomly into six groups (Root ZX II, Raypex 6, I-Root, Romiapex A-15, Sybron Endo Mini and Root ZX mini). The working length was determined using six different apex locators, and the accuracy of the apex locators was compared with IOPA radiographs, to be categorized as accurate, short, and long or beyond. RESULTS: A total of 270 canals were evaluated, of which 233 (86.3%) canals exhibited acceptable working length, 28 (10.4%) canals exhibited short working length, and only 9 (3.3%) canals exhibited working length beyond the apex. There were a statistically significant results in all the groups (P < 0.05) and the comparison between the groups was statistically insignificant. CONCLUSION: The repeatability with that of apex locators is of great advantage, but the information gained from the radiographs cannot be obtained by any other means. Therefore, it is recommended that radiograph and apex locators are the best combinations in accurately determining the working length and the successful endodontics.

Residual cyst associated with calcifications in an elderly patient.

A residual cyst, as the name implies, is a radicular, lateral periodotal, dentigerous or any other cyst that has persisted after it's associated tooth has been lost. Residual cysts show more predilection in males and they commonly affect the maxillary region. Usually, residual cysts are asymptomatic and calcifications occurring in the residual cysts are quite rare. We are reporting a case of symptomatic residual cyst, associated with calcifications involving the anterior region of the body of the mandible in a 60-year-old male patient. The pathogenesis, clinical, radiological features and differential diagnosis have been discussed.

Survey on restoration of endodontically treated anterior teeth: a questionnaire based study.

BACKGROUND: The aim of endodontic and restorative dentistry is the conservation of natural tooth structure. Endodontically treated tooth (ETT) undergoes loss of tooth structure and changes in physical characteristics. Therefore, proper selection of restoration for ETT is mandatory. The clinical approach of restoring ETT needs taking into considerations several issues. However, the best way to restore teeth after root canal treatment has long been and still a controversial subject to debate. Therefore, this study was carried out to detect the frequency of preferred methods of restoring ETT under different conditions. MATERIALS AND METHODS: A questionnaire was framed and distributed among prosthodontists, endodontist and general practitioners of north India region to find out the frequency of best suitable material and method regarding restoration of ETT. 220 questionnaires were sent by electronic mail out of which 110 were received back. The questionnaire contained different methods of restoration of endodontically treated anterior teeth at different conditions (percentages) of remaining sound tooth structure. Respondents were asked to indicate their preferred method of restoration of those teeth. RESULTS: Results showed that majority of respondents (51.82%) preferred to restore the tooth only with a tooth-color restorative material in condition A. In condition B, majority of respondents preferred to use tooth colored crown (44.55%) and prefabricated post and tooth colored restoration (24.5%). Whereas in condition C, most of the respondents preferred to use a cast post and core/crown (80.91%). CONCLUSION: From the findings of the present study, it can be concluded that the unrestored ETT is susceptible to fracture, which could lead to loss of tooth and that the maximum preservation of healthy tooth structure and use of restorative materials with mechanical properties similar to dental structure favor greater longevity of tooth restoration complex.

Comparison of curcumin with intralesional steroid injections in Oral Submucous Fibrosis - A randomized, open-label interventional study.

INTRODUCTION: Oral Submucous Fibrosis (OSMF) is precancerous condition caused by areca nut chewing characterized by restricted mouth opening, burning sensation and stiffness & blanching of oral mucosa. Complete regression of the condition had not been achieved in all cases with any of the present treatment regimens. Curcumin is (diferuloylmethane), a yellow pigment in curry powder, exhibits anti-oxidant, anti-inflammatory, and pro-apoptotic activities. Hence an interventional study was undertaken to establish the efficacy of curcumin in OSMF patients. SETTINGS & DESIGN: A randomized open label, interventional study was conducted in forty patients with clinically and histologically proven Oral Submucous Fibrosis. MATERIALS & METHODS: Forty patients with clinically and histologically proven Oral Submucous Fibrosis were selected for the study and were randomly divided into 2 groups. The first group was treated with weekly intralesional injection of 4 mg Dexamethasone & 1500 I.U Hyaluronidase and the second group by oral administration of two Curcumin tablets (Turmix 300 mg) per day for 3 months each. Improvement of burning sensation, interincisal distance and tongue protrusion was evaluated on a weekly basis. RESULTS: Burning sensation improved in both the groups from early to late stages. Complete resolution of burning sensation was noted with turmix. The mean increase in interincisal distance was 3.13 mm and 1.25 mm respectively in groups 1 &2. The interincisal distance improved in both the groups, with significant results at the end of first month. Tongue protrusion showed greater recovery at the end of 1st month in group 1 when compared with group 2. CONCLUSION: Turmix is beneficial and effective in reducing burning sensation in early OSMF patients.

Quantitative evaluation of apical extrusion of debris and irrigants using four rotary instrumentation systems: an in vitro study.

CLINICAL SIGNIFICANCE: The apical extrusion of infected debris may have the potential to disrupt the balance between microbial aggression and host defense, resulting in incidents of acute inflammation. During preparation, irrigants and debris, such as bacteria, dentin filings and necrotic tissue may be extruded into the periradicular region leading to periapical inflammation and postoperative flare ups. Using an instrumentation technique that minimizes apical extrusion would be beneficial to both the practitioner and patient. The purpose of the study was to evaluate the weight of debris and volume of irrigant extruded apically from extracted teeth in vitro after endodontic instrumentation using four different rotary root canal instrumentation systems. MATERIALS AND METHODS: Four groups of each 20 extracted mandibular premolars were instrumented using one of the four systems: ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland)), Hero-shaper (MicroMega, Besancon, France), RaCe (FKG Dentaire, La-Chaux-de-Fonds, Switzerland) and K3 (SybronEndo, West Collins, CA). Debris and irrigant extruded from the apical foramen during instrumentation were collected in preweighed test tubes. Volume of irrigant extruded was noted. The containers were stored in incubator at 70° for two days to evaporate the moisture. Weight of dry debris was noted. STATISTICAL ANALYSIS: Data was analyzed using Kruskall-Wallis and Mann-Whitney U test at a significance of 0.001. RESULTS: The results indicated that all of the instrumentation systems tested caused measurable apical extrusion of debris and irrigants. Higher extrusion was observed with Protaper system which was statistically significant with Hero-Shaper, RaCe and K3 systems. There were no statistical differences between Hero-shaper, K3 and RaCe systems (p < 0.05). CONCLUSION: All instrumentation techniques apically extruded debris and irrigant. However, Hero-shaper, K3 and RaCe systems produced less extruded debris and irrigant than the Protaper system.

Dental prosthetic status and prosthetic needs of the institutionalized elderly living in geriatric homes in Hyderabad: a pilot study.

INTRODUCTION: To promote oral health among the elderly, we need to know their prosthetic status and prosthetic need. Hence, a survey of prosthetic status and need of elderly inmates of geriatric homes in Hyderabad was done. MATERIALS AND METHODS: A cross-sectional study was undertaken, and 174 subjects aged 60 years and above were examined of which 103 were male and 71 were female (59.2% males and 40.8% females). The oral examination of the study subjects was carried out using basic oral health surveys, WHO 1997 criteria. RESULTS: Majority of the subjects, 73 (70.8%) males and 53 (74.6%) females had no prosthesis. Only 4.6% had complete dentures and 21.1% had removable partial dentures and 10.9% had single/multiple bridges. Need for any prosthesis was (83.5%) male and 63 (88.7%) female subjects and nearly 82. 8% subjects required one-unit prosthesis. CONCLUSION: Dental prosthetic status of people living in geriatric homes is very poor and there is high unmet need for prosthetic care existed among the institutionalized elderly surveyed.

Antimicrobial effect of conventional root canal medicaments vs propolis against Enterococcus faecalis, Staphylococcus aureus and Candida albicans.

AIM: To evaluate and compare antimicrobial effect of various root canal medicaments against Enterococcus faecalis, Staphylococcus aureus and Candida albicans. MATERIALS AND METHODS: Six root canal medicaments: 2% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) Calcium hydroxide (Ca(OH)2), EDTA, MTAD and propolis and three microorganisms: Staphylococcus aureus, Enterococcus faecalis and Candida albicans were used. These strains were inoculated in brain heart infusion (BHI) and incubated at 37 degrees C for 24 hours. For the agar diffusion test (ADT), petri plates with 20 ml of BHI agar were inoculated with 0.1 ml of the microbial suspensions, using sterile swabs that were spread on the medium, obtaining growth injunction. Paper disks were immersed in the experimental solutions for 1 minute. Subsequently, four papers disks containing one of the substances were placed on the BHI agar surface in each agar plate. The plates were incubated at 37°C for 48 hours. The diameter of microbial inhibition was measured around the papers disks containing the substances. One way ANOVA followed by Tukey's post-hoc test were used. p-value >0.05 was considered statistically significant. RESULTS: Propolis and other irrigants were found to be effective on C. albicans, S. aureus and E. faecalis. CHX and MTAD were found to be most effective amongst all the materials tested followed by propolis. CONCLUSION: Propolis showed antimicrobial activity against E. faecalis, S. aureus, C. albicans. It appears that propolis is an effective intracanal irrigant in eradicating E. faecalis and C. albicans. CLINICAL SIGNIFICANCE: Propolis is an effective intracanal irrigant in eradicating E. faecalis and C. albicans. It could be used as an alternative intracanal medicament.

Do NiTi instruments show defects before separation? Defects caused by torsional fatigue in hand and rotary nickel-titanium (NiTi) instruments which lead to failure during clinical use.

AIMS: Visual and microscopic evaluation of defects caused by torsional fatigue in hand and rotary nickel titanium (NiTi) instruments. MATERIALS AND METHODS: Ninety-six NiTi greater taper instruments which were routinely used for root canal treatment only in anterior teeth were selected for the study. The files taken include ProTaper for hand use, ProTaper Rotary files and Endowave rotary files. After every use, the files were observed visually and microscopically (Stereomicroscope at 10×) to evaluate the defects caused by torsional fatigue. Scoring was given according to a new classification formulated which gives an indication of the severity of the defect or damage. STATISTICAL ANALYSIS: Data was statistically analyzed using KruskallWallis and Mann-Whitney U test. RESULTS: Number of files showing defects were more under stereomicroscope than visual examination. But, the difference in the evaluation methods was not statistically significant. The different types of defects observed were bent instrument, straightening/stretching of twist contour and partial reverse twisting. Endowave files showed maximum number of defects followed by ProTaper for hand use and least in ProTaper Rotary. CONCLUSION: Visible defects due to torsional fatigue do occur in NiTi instruments after clinical use. Both visual and microscopic examinations were efficient in detecting defects caused due to torsional fatigue. This study emphasizes that all files should be observed for any visible defects before and after every instrumentation cycle to minimize the risk of instrument separation and failure of endodontic therapy.

Oral lichen planus - Review on etiopathogenesis.

Oral lichen planus (OLP) is a chronic mucocutaneous disease of uncertain etiopathogenesis. Several factors including stress, genetics, systemic diseases, viruses, dental restorative materials and drugs have been implicated as causative agents. The disease seems to be mediated by an antigen specific mechanism, activating cytotoxic T cells, and non specific mechanisms like mast cell degranulation and matrix metalloproteinase activation. Further clarity on the pathogenesis will aid in modifying therapeutic interventions, thus significantly reducing the morbidity of OLP patients.

A rabbit model for studying hypocholesterolemic effect of drugs and hypocholesterolemic effect of extracts of garlic (Allium sativum).

An experimental model of hypercholesterolemic rabbits suitable for studying the hypocholesterolemic effect of compounds was developed. Rabbits were made hypercholesterolemic by oral administration of cholesterol (100mg/kg body weight/day) suspended in groud nut oil by gastric intubation (Ryle's tube). Cholesterol can be given to rabbits from 10 days to 6 months depending on the degree of hypercholesterolemia required and duration of study of hypocholesterolemic effect. In one month cholesterol feeding experiment, the serum cholesterol level in normal controls (not given cholesterol) was 67±11.3 mg/dl and in cholesterol fed animals 191.3±70.6 mg/dl. In 2 months experiment, besides hypercholesterolemia, abnormal serum lipid profile and increase in lipid content in liver, heart and aorta were also seen. To such animals when water and methanol extracts of garlic were given along with cholesterol, there was significant decrease in serum cholesterol level. The advantage of this method over the method in which cholesterol is mixed with diet to induce hypercholesterolemia is that exactly same and calculated amount of cholesterol can be given for each animal. This minimises the variations in serum cholesterol levels in different animals.

Trifluoperazine and CEF-allicin from garlic (Allium sativum) as potential new antitubercular drugs active against drug resistantMycobacterium tuberculosis.

Trifluoperazine (TFP) and a compound called CEF-allicin purified from garlic (Allium sativum) possess antitubercular activity against both drug susceptible and resistant clinical isolates ofMycobacterium tuberculosis. They are bactericidal in nature with multiple sites of primary action. This new use for known drug TFP was based on our observation that mycobacteria have calmodulin like protein which regulates their metabolism and a calmodulin antagonist has antitubercular activity. The minimum inhibitory concentration (MIC) of TFP againstM. tuberculosis was 4-5 µg/ml. It inhibited considerably by 6hrs, the synthesis of total lipids from(14)C-acetate and proteins and DNA as judged by the uptake of(14)C-glycine and(3)H-thymidine respectively by the bacilli. With 50 clinical isolates from our hospital at Delhi, the MIC was 4µg/ml, for 40% and 8µg/ml, for 50% of the isolates susceptible as well as resistant to one or more of the five drugs isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide. The MIC of CEF-allicin was 25µg/ml, for bothMycobacterium tuberculosis and isoniazid resistant clinical isolate TRC-C 1193. It inhibited in 6hrs or less the synthesis of total lipids completely and proteins and DNA ofM. tuberculosis from its labeled precursors almost completely.

Isolation and characterization of a 70 kDa protein from Mycobacterium avium.

Mycobacterium avium complex (MAC) is an intracellular pathogen which causes disseminated bacterial infection in immunocompromised individuals. This organism predominantly infects macrophages. Attachment of MAC to macrophages is the first step prior to invasion. We have previously shown that a 70 kDa protein of M. avium (Ma) is one of nine monocyte-binding proteins. In the present study, we have purified this protein from sonic extracts of Ma and studied some of its properties. The N-terminal sequence of this protein was identified and found to exhibit a strong homology to the 70 kDa heat shock protein (hsp) of M. leprae (Ml) and M. tuberculosis (Mtb). This protein was found to be present on the surface of the organism and was able to inhibit the attachment of intact Ma to human monocyte derived macrophages (MDM) up to 49% in an in vitro attachment assay using intact fluorescein isothiocyanate (FITC)-labelled Ma. Bovine serum albumin (BSA) and recombinant 70 kDa hsp from Mtb, which were used as controls, inhibited this attachment by 9.8 and 18%, respectively. These results suggest that the 70 kDa protein may have a role in the attachment of intact Ma to MDM. When tested in lymphocyte activation assays, this protein did not appear to significantly stimulate proliferation. However, it was found to stimulate the production of tumor necrosis factor (TNF)-alpha by MDM. This protein may be one of several Ma antigens that trigger host immune response by binding to MDM and stimulating the production of inflammatory cytokines such as TNF-alpha by these cells.