Effect of adhesive strategy of universal adhesives in noncarious cervical lesions - an updated systematic review and meta-analysis.

OBJECTIVE: To determine the effect of adhesive strategy (total etch or self-etch) of universal adhesives in non-carious cervical lesions. DATA SOURCE: A search was made in PubMed, Scopus, Cochrane, Web Of Science, Open Gray, Clinical Registries. DATA SELECTION: Randomized Controlled Clinical Trials, studies on non-carious cervical lesions restored using Universal Adhesives, and studies in which universal adhesives have been used in total etch and self -etch strategies were included in this systematic review. DATA EXTRACTION: A total of 17 articles were included in the systematic review and 13 in the meta-analysis. Meta-analysis was conducted to assess the clinical performance of NCCLs in terms of retention, marginal adaptation, marginal discoloration, secondary caries and post-operative sensitivity at 18, 24, 36 month follow-up using USPHS as well as FDI criteria, separately. DATA SYNTHESIS: Overall there was no significant difference between total etch and self etch adhesive strategies for any of the five outcome measures using either the FDI or the USPHS criteria. p > 0.05, 95% CI, I2 value of 0%. A strongly suspected publication bias in the retention domain was seen at 18 month follow up under FDI criteria. CONCLUSION: Most universal adhesives show acceptable clinical performance. There is no significant effect of the adhesive strategy of universal adhesives on their clinical performance according to the results of our meta-analysis.

Centric versus eccentric engine-driven endodontic instrument design for microbial load reduction-A systematic review and meta-analysis of randomised clinical trials.

This systematic review assessed the clinical influence of centric and eccentric engine-driven instrument design for reduction in microbial load in infected root canal system. The literature search was conducted in electronic databases (PubMed, Cochrane Library, Scopus, Lilacs and Google Scholar) and grey literature till June 2022. The search strategy followed the PRISMA 2020 guidelines. Qualitative and quantitative synthesis was conducted based on the guidelines of the Cochrane Handbook. The risk of bias was assessed using the revised Cochrane criteria and quality of evidence was conducted using the Grading of Recommendation Assessment, Development and Evaluation tool. Out of 28 papers, only five papers met the inclusion criteria of this review. Studies showed reduction in microbial load after instrumentation using centric or eccentric instruments with no statistically significant difference in the meta-analysis. In conclusion, there is low-grade evidence suggesting that microbial reduction is similar using centric and eccentric instruments.

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.

Comparison of postoperative pain reduction using continuous rotation glide path system with other methods of glide path creation - a systematic review / Comparação de sistema de glide path rotatório contínuo com outros métodos de criação de glide path na redução de dor pósoperatória ­ uma revisão sistemática

Objective: Various glide path preparation techniques have been introduced, providing easiness to the practitioners. Recent literature has shown that glide path preparation influences the levels of postoperative pain occurrence in individuals receiving endodontic therapy. This systematic review aims to compare the different glide path preparation system in reduction of postoperative pain. Material and Methods: Electronic databases such as PubMed, Scopus, Cochrane Library, LILACS, Google Scholar, and European PMC were searched for published articles until July 2020. The studies included were randomized control trial (RCT) studies published during this time frame with comparison of continuous glide path system with various other glide path systems in reducing postoperative pain. The studies were reviewed using Preferred Reporting Items for Systematic reviews and Meta­Analyses (PRISMA) guidelines. The studies were reviewed independently by two reviewers who had assessed the included studies, extracted data and the quality using the Cochrane risk of bias assessment tool. Results:544 studies were received from the initial search, 11 articles were included in full text appraisal, 4 studies were obtained for qualitative analysis. Mean VAS Scores showed an increased reduction of postoperative pain in continuous glide path treated individuals (1.90-0.20) compared to reciprocating glide path (2.00-0.50) and manual glide path (3.80-0.85). The consumptions of analgesics were seen to be as follows; Manual Glide Path > Reciprocating Glide Path > Continuous Glide Path. Three out of four studies showed an overall "high" risk of bias and another study showed an overall "unclear" bias. Conclusion: From the achieved results, continuous glide path with 5.25% NaOCl irrigation has shown better reduction of postoperative pain compared to other glide path systems. Individuals who had undergone manual glide path preparation showed higher incidence of postoperative pain compared to other systems. The consumption of analgesics was seen to be higher in manual glide path prepared individuals followed by reciprocating glide path and least being continuous glide path.(AU)

Objetivo: Várias técnicas de preparação do glide path têm sido introduzidas, permitindo maior facilidade aos profissionais. A literatura tem mostrado que a forma de preparação do glide path influencia nos níveis de dor pós-operatória em indivíduos que recebem tratamento endodôntico. Esta revisão sistemática tem como objetivo comparar os diferentes sistemas de preparação do glide path na redução de dor pós-operatória. Material e Métodos: Bases de dados eletrônicas como PubMed, Scopus, Cochrane Library, LILACS, Google Escolar, e European PMC foram utilizadas para pesquisar artigos publicados até Julho de 2020. Os estudos incluídos foram ensaios clínicos randomizados controlados (ECRC) publicados até este período de tempo que compararam sistema de glide path contínuo com outros sistemas de glide path na redução de dor pós-operatória. Para revisão dos estudos, foi utilizado o 'Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines'. Dois revisores analisaram, independentemente, os estudos incluídos, os dados extraídos e a qualidade através da ferramenta de avaliação de risco de viés da Cochrane. Resultados: 544 estudos foram encontrados na pesquisa inicial, 11 artigos foram selecionados para avaliação de texto completo, 4 estudos foram obtidos para a análise qualitativa. A pontuação média do VAS mostrou um aumento na redução de dor pós-operatória em indivíduos nos quais foi utilizado o sistema de glide path rotatório contínuo (1.90-0.20) quando comparados àqueles nos quais foram utilizados o glide path reciprocante (2.00-0.50) e o glide path manual (3.80-0.85). A utilização de analgésicos foi vista da seguinte forma: Glide path Manual > Glide Path Reciprocante > Glide Path Contínuo. Três dos quatro estudos apresentaram um "alto" risco de viés geral e o outro estudo apresentou risco de viés geral "incerto". Conclusão: O glide path contínuo com irrigração de 5.25% de NaOCl mostrou a melhor redução de dor pós-operatória comparado aos demais sistemas de glide path. Indivíduos que foram submetidos à preparação de glide path pelo sistema manual apresentaram a maior incidência de dor pós-operatória. O consumo de analgésicos foi maior diante do uso do glide path manual, seguido pelo glide path reciprocante, e por último pelo glide path contínuo. (AU)

Qualitative Assessment of the Surface Topographic Changes of XP-endo Shaper and TruNatomy files after exposure to Sodium Hypochlorite and Ethylenediaminetetraacetic Acid.

OBJECTIVE: TruNatomy and XP-endo Shaper are recently introduced file systems showing increased fatigue resistance rate. The present study aims to evaluate the surface topographic changes and nickel (Ni) and titanium (Ti) elemental loss of XP-endo Shaper (XPS) and TruNatomy (TN) files on exposure to conventionally used root canal irrigants; [5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA)] at a 10 minute time frame using atomic force microscopy (AFM) and energy dispersion X-ray spectroscopy (EDX) analytical techniques. METHODS: Twelve samples for each of XPS (30/.04 taper) and TN (26/.04 taper; prime) instruments were dynamically exposed to 5.25% NaOCl, 17% EDTA separately for 10 minutes and in combination of 5.25% NaOCl (8 minutes)+17% EDTA (2 minutes) for a total of 10 minutes. Post exposure, the files were subjugated to AFM and EDX analysis. Independent t test and one-way ANOVA were used for statistical analysis, and the level of significance was set at 0.05. RESULTS: XPS and TN showed a significant increase of surface roughness (Ra) and roughness mean square (RMS) on exposure to various irrigants (P<0.05) using AFM analysis. Increased overall roughness was observed with TN in comparison to XPS (P<0.05). Elements Ni and Ti loss was found in both XPS and TN files using EDX analysis. Both files exhibited Ni and Ti loss with the loss of Ni content higher for TN after exposure to 17% EDTA. Loss of Ti was seen for both files on exposure to a combination of 5.25% NaOCl+17% EDTA. CONCLUSION: After exposure to root canal irrigants, the surface roughness was lesser in XPS compared to TN files. 17% EDTA caused significantly higher surface roughness in both file systems when compared to 5.25% NaOCl. TN exhibited overall higher elemental (Ni and Ti) loss on exposure to 17% EDTA and 5.25% NaOCl+17% EDTA in comparison to XPS files.

The Antimicrobial Effect of Pomegranate Peel Extract versus Chlorhexidine in High Caries Risk Individuals Using Quantitative Real-Time Polymerase Chain Reaction: A Randomized Triple-Blind Controlled Clinical Trial.

The aim of the present study was to compare the antibacterial effectiveness of chlorhexidine and PPE oral rinse on S. mutans, Lactobacilli, and Veillonella, in clinical salivary samples of patients with advanced stages of dental caries at baseline and two and four weeks with PCR technique. This triple-blind randomized clinical trial involved 60 high caries risk adult patients, 19-59 years of age, randomly allocated into two groups of 30 subjects each. The intervention group received pomegranate peel extract mouthwash, whereas the control group received chlorhexidine mouthwash. Unstimulated pooled saliva was collected from the floor of the mouth before and after the intervention. The quantitative real-time polymerase chain reaction was employed to analyze the bacterial copies of each salivary sample at baseline and two and four weeks. The significance level was fixed at 5% (α = 0.05). Overall comparison of antimicrobial effectiveness across both groups revealed insignificant outcomes. The control group evinced a significant reduction in S. mutans between a specific time, i.e., baseline and 4 weeks (p=0.043). PPE oral rinse as a natural product or ecological alternative was effective in disrupting activity across all microorganisms tested in this triple-blind RCT; however, the nutraceutical, when compared to chlorhexidine, was not as effective against S. mutans.

Management of Intracanal Separated File Fragment in a Four-Rooted Mandibular Third Molar.

The success of endodontic therapy is attributed to complete arbitration of the bound entities concealed within the complexity and absolute disinfection of the root canal system, thus, deeming it mandatory to effectively negotiate and overcome the challenges posed by obstruction, either iatrogenic or anatomic. To achieve this, considerable depth of knowledge and expertise with reference to variations in root canal morphology and clinical mishap management is substantially as important as developing fine observation skills in conjunction with an appropriate armamentarium and a keen sense of determination, thereby enhancing one's clinical acumen by several folds. In the present case, following rubber dam isolation, the temporary restoration was removed, and the remaining carious dentin was excavated. Endodontic access cavity was refined and explored with a DG-16 probe, following which three separate canal orifices were identified in the pulp chamber floor (mesiobuccal, mesiolingual, and distal). On further observation under a surgical operating microscope and continuous exploration with the DG-16 probe, a fourth canal was found in the mesial aspect of the tooth (middle mesial). With instrumentation, it was confirmed that a fractured object was indeed present at the apical third of the mesiolingual root of tooth 38. Bypassing of the fractured fragment was initiated with a size 10 SS K-file coupled with copious irrigation with 3% sodium hypochlorite. In the present case report, four distinct canals comprising 3 mesial and 1 distal canal were recognized, and the fractured instrument in one of the canals was bypassed successfully.

Comparison of postoperative pain reduction using continuous rotation glide path system with other methods of glide path creation - a systematic review / Comparação de sistema de glide path rotatório contínuo com outros métodos de criação de glide path na redução de dor pós-operatória ­ uma revisão sistemática

Objective: Various glide path preparation techniques have been introduced, providing easiness to the practitioners. Recent literature has shown that glide path preparation influences the levels of postoperative pain occurrence in individuals receiving endodontic therapy. This systematic review aims to compare the different glide path preparation system in reduction of postoperative pain. Material and Methods: Electronic databases such as PubMed, Scopus, Cochrane Library, LILACS, Google Scholar, and European PMC were searched for published articles until July 2020. The studies included were randomized control trial (RCT) studies published during this time frame with comparison of continuous glide path system with various other glide path systems in reducing postoperative pain. The studies were reviewed using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The studies were reviewed independently by two reviewers who had assessed the included studies, extracted data and the quality using the Cochrane risk of bias assessment tool. Results: 544 studies were received from the initial search, 11 articles were included in full text appraisal, 4 studies were obtained for qualitative analysis. Mean VAS Scores showed an increased reduction of postoperative pain in continuous glide path treated individuals (1.90-0.20) compared to reciprocating glide path (2.00-0.50) and manual glide path (3.80-0.85) The consumptions of analgesics were seen to be as follows: Manual Glide Path > Reciprocating Glide Path > Continuous Glide Path. Three out of four studies showed an overall "high" risk of bias and another study showed an overall "unclear" bias. Conclusion: From the achieved results, continuous glide path with 5.25% NaOCl irrigation has shown better reduction of postoperative pain compared to other glide path systems. Individuals who had undergone manual glide path preparation showed higher incidence of postoperative pain compared to other systems. The consumption of analgesics was seen to be higher in manual glide path prepared individuals followed by reciprocating glide path and least being continuous glide path (AU)

Objetivo: Várias técnicas de preparação do glide path têm sido introduzidas, permitindo maior facilidade aos profissionais. A literatura tem mostrado que a forma de preparação do glide path influencia nos níveis de dor pós-operatória em indivíduos que recebem tratamento endodôntico. Esta revisão sistemática tem como objetivo comparar os diferentes sistemas de preparação do glide path na redução de dor pós-operatória. Material e Métodos: Bases de dados eletrônicas como PubMed, Scopus, Cochrane Library, LILACS, Google Escolar, e European PMC foram utilizadas para pesquisar artigos publicados até Julho de 2020. Os estudos incluídos foram ensaios clínicos randomizados controlados (ECRC) publicados até este período de tempo que compararam sistema de glide path contínuo com outros sistemas de glide path na redução de dor pós-operatória. Para revisão dos estudos, foi utilizado o 'Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines'. Dois revisores analisaram, independentemente, os estudos incluídos, os dados extraídos e a qualidade através da ferramenta de avaliação de risco de viés da Cochrane. Resultados: 544 estudos foram encontrados na pesquisa inicial, 11 artigos foram selecionados para avaliação de texto completo, 4 estudos foram obtidos para a análise qualitativa. A pontuação média do VAS mostrou um aumento na redução de dor pós-operatória em indivíduos nos quais foi utilizado o sistema de glide path rotatório contínuo (1.90-0.20) quando comparados àqueles nos quais foram utilizados o glide path reciprocante (2.00-0.50) e o glide path manual (3.80-0.85). A utilização de analgésicos foi vista da seguinte forma: Glide path Manual > Glide Path Reciprocante > Glide Path Contínuo. Três dos quatro estudos apresentaram um "alto" risco de viés geral e o outro estudo apresentou risco de viés geral "incerto". Conclusão: O glide path contínuo com irrigração de 5.25% de NaOCl mostrou a melhor redução de dor pós-operatória comparado aos demais sistemas de glide path. Indivíduos que foram submetidos à preparação de glide path pelo sistema manual apresentaram a maior incidência de dor pós-operatória. O consumo de analgésicos foi maior diante do uso do glide path manual, seguido pelo glide path reciprocante, e por último pelo glide path contínuo. (AU)

Evaluation of push-out bond strength of BioRoot RCS and AH Plus after using different irrigants: An in vitro study.

AIM: The aim of this study was to compare push-out bond strength of root canal spaces filled with AH-Plus and BioRoot RCS after using different irrigants. MATERIALS AND METHODS: Eighty single-rooted teeth were decoronated and endodontically treated by crown-down technique using ProTaper Universal rotary files progressively till F4 (40/0.06). Samples were divided into two groups according to the sealer (n = 40): Group A = BioRoot RCS, Group B = AH Plus, further subdivided into four subgroups according to irrigation protocol (n = 10): Group 1A, 1B - 0.9% saline, Group 2A, 2B - 5.25% NaOCl + 17% EDTA, Group 3A, 3B- 17% EDTA +2% chlorhexidine, and Group 4A, 4B - 17% EDTA + 3% green tea extract. Samples were obturated with sealers and prepared for push-out test with root slices of 2 mm thickness using universal testing machine. Data were statistically analyzed using two-way ANOVA, Bonferroni's post hoc analysis, and independent Student's t-test. RESULTS: BioRoot RCS exhibited significantly higher push-out bond strength (n < 0.001). The interaction between irrigants and sealer showed higher bond strength for BioRoot RCS when 17% EDTA+ green tea was used. CONCLUSION: Within the limitation of the study, it was concluded that bond strength of a sealer was influenced by the irrigants used.

Comparison of antibacterial effectiveness of three rotary file system with different geometry in infected root canals before and after instrumentation-a double-blinded randomized controlled clinical trial.

INTRODUCTION: To compare the antibacterial effectiveness of three rotary file systems i.e., ProTaper Next, ProTaper Gold and XP-endo Shaper in root canals of teeth with asymptomatic apical periodontitis by using the real-time polymerase chain reaction. MATERIALS AND METHODS: Root canals from single or multi-rooted teeth (straight canals) with necrotic pulps and asymptomatic apical periodontitis were instrumented using either ProTaper Next (n = 20), ProTaper Gold (n = 20) and XP-endo Shaper (n = 20) under irrigation with 3% sodium hypochlorite. Samples obtained before and after instrumentation were subjected to DNA extraction, amplification and quantitation of total amount of bacteria by using the real-time polymerase chain reaction. RESULTS: Samples were taken before preparation (S1) were positive for presence of bacteria, with mean numbers of 9.94 × 107, 20.4 × 107 and 9.20 × 107 bacterial cells for the ProTaper Next, ProTaper Gold and XP-endo Shaper groups, respectively. After preparation (S2) with ProTaper Next, ProTaper Gold, and XP-endo Shaper, root canals still had bacteria with mean counts of 11.8 × 105, 87.2 × 105 and 4.52 × 105 bacterial cells, respectively. Both XP-endo Shaper (99.50%) and ProTaper Next (98.81%) were effective in reducing total bacterial count, and there was no statistically significant difference between them (P > 0.05). XP-endo Shaper succeeded in reducing total bacterial count than ProTaper Gold (95.72%) and there exists statistically significant difference between them (P < 0.05). CONCLUSIONS: XP-endo Shaper was highly effective in reducing total bacterial count from root canals of teeth with asymptomatic apical periodontitis than ProTaper Gold. ProTaper Next also showed improved microbial reduction percentage as compared with ProTaper Gold.

Clinical Quantitative Antibacterial Potency of Garlic-Lemon Against Sodium Hypochlorite in Infected Root Canals: A Double-blinded, Randomized, Controlled Clinical Trial.

INTRODUCTION: Sodium hypochlorite for endodontic treatment has been shown to exhibit significant antimicrobial properties, with adverse effects such as sodium hypochlorite accidents. Natural irrigants have shown significant antimicrobial action and the added advantage of being biocompatible. This study proposes an alternative intracanal irrigant made from Garlic-Lemon (Ga-Li) extract. AIM: To evaluate the antimicrobial action of 1.8% Garlic-Lemon (Ga-Li) mixture in contrast to 3% sodium hypochlorite in a tooth diagnosed with asymptomatic apical periodontitis. MATERIALS AND METHODS: Thirty patients were randomly allocated into two groups: Group A, 3% sodium hypochlorite and Group B, 1.8% Garlic-Lemon. Single- or multirooted teeth root canals were instrumented and prepared by using ProTaper Gold. Root canal samples were taken both pre- and postinstrumentation. These samples were subjected to DNA extraction, amplification, and quantification by using a real-time polymerase chain reaction (qPCR). RESULTS: Samples before preparation (S1) were tested positive for microbial presence, with mean numbers of 7.0 ×107 and 12.4 ×107 bacterial cells for the sodium hypochlorite and Garlic-Lemon groups, respectively. Postpreparation (S2), in sodium hypochlorite and Garlic-Lemon groups, bacterial counts were still present with mean counts seen at 27.4 ×105 and 7.7 ×105 bacterial cells, respectively. Intergroup comparison resulted in a statistically insignificant difference (P > 0.05). CONCLUSION: Garlic-Lemon has shown microbial load reduction that is as effective as sodium hypochlorite, with the highest mean bacterial reduction percentage. The results of the present randomized, controlled clinical trial suggest that Garlic-Lemon is a potential new alternative as an endodontic irrigant.

Quantitative analysis for detection of toxic elements in various irrigants, their combination (precipitate), and para-chloroaniline: An inductively coupled plasma mass spectrometry study.

INTRODUCTION: Chlorhexidine (CHX) interacts with sodium hypochlorite (NaOCl) and herbal irrigants such as neem and tulsi to form precipitate which contains para-chloroaniline (PCA). No studies till date have reported about metal elements present in this combination as well as in irrigants. AIM: The aim of this study was to evaluate the precipitate formed on combination of different irrigants, weigh the amount of precipitate formed, and to analyze 35 different metal elements in each irrigant, precipitate formed as well as in PCA. MATERIALS AND METHODS: Seven irrigants, namely 2% CHX gluconate, 3% NaOCl, 17% ethylenediaminetetraacetic acid (EDTA), 5% neem, 5% tulsi, 5% Aloe vera, and 5% garlic were taken in different test tubes. Group (1-6): 1 ml of CHX is mixed with 1 ml of 3% NaOCl/17% EDTA/5% neem/5% tulsi/5% A. vera/5% garlic. Group (7-11): 1 ml of 3% NaOCl is mixed with 1 ml of 17% EDTA/5% neem/5% tulsi/5% A. vera/5% garlic. Group (12-15): 1 ml of 17% EDTA is mixed with 1 ml of 5% neem/5% tulsi/5% A. vera/5% garlic. Group (16-18): 1 ml of 5% neem is mixed with 1 ml of 5% tulsi/5% A. vera/5% garlic. Group (19 and 20): 1 ml of 5% tulsi is mixed with 5% A. vera/5% garlic. Group 21 includes 1 ml of 5% A. vera and 5% garlic. Each group is observed for any precipitate formation, and precipitate formed was weighed. Samples such as 2% CHX gluconate, 3% NaOCl, 17% EDTA, 5% neem, 5% tulsi, 5% A. vera, PCA, and precipitate formed in each group were analyzed for 35 different metal elements using inductively coupled plasma mass spectrometry (ICP-MS). STATISTICAL ANALYSIS: One-way ANOVA and Post hoc Tukey's test for the precipitate formed. RESULTS: Precipitate formation was seen in CHX + NaOCl (reddish-brown), CHX + EDTA (white), CHX + neem (light green), CHX + A. vera (green), CHX + tulsi (dark green), CHX + garlic (beige). ICP-MS analysis showed the presence of International Agency for Research on Cancer Group 1 carcinogens in NaOCl, CHX, EDTA, and PCA. CONCLUSION: Carcinogenic metals are undetected in herbal irrigants which is found to be risk free alternatives in near future.

Effectiveness of rotary and reciprocating systems on microbial reduction: A systematic review.

INTRODUCTION: The role of microorganism and their products in the initiation, propagation, and persistence of periradicular periodontitis has been established. One of the major goals of the treatment of infected root canals of teeth with apical periodontitis is to promote maximal reduction in the intracanal bacterial populations. Engine-driven nickel-titanium instruments possess the latest generation of root canal instruments. The possible benefit of rotary instrumentation over other instrumentation techniques regarding cleaning and disinfecting effects would be irrigant warming and/or turbulence caused by the mechanical rotation of instruments. Furthermore, reciprocating instrument has been introduced for root canal preparation. It has been shown that instruments subjected to reciprocation have increased resistance to fatigue and longer usual life when combined with instruments used in continuous rotation motion. The reciprocating system uses single-file instrumentation technique which can shape and clean the canal in a shorter period and together with the lesser amount of antimicrobial agent. OBJECTIVE: The objective of this study is to compare and evaluate the microbial reduction of rotary and reciprocating systems on microbial reduction. SEARCH STRATEGY: A search was performed in Electronic databases (i.e., PubMed, Cochrane library, Science direct, Lilac, Sigle) using following search terms alone and in combination by means of PubMed search builder from January 1985 to December 2017. SELECTION CRITERIA: Studies were selected if they met the following criteria: In vivo studies comparing rotary and reciprocating system in asymptomatic apical periodontitis patients. MAIN RESULTS: The results showed that the reciprocating system exerted an almost similar antibacterial effect when compared with the rotary system. CONCLUSION: The present systematic review does not provide concrete evidence to show increased antibacterial efficacy of reciprocating system as compared to the rotary system. Furthermore, clinical trials are required to evaluate the efficacy of various instrumentation systems in reducing bacteria from the root canal system.

Qualitative and quantitative analysis of precipitate formation following interaction of chlorhexidine with sodium hypochlorite, neem, and tulsi.

INTRODUCTION: The interaction between chlorhexidine (CHX) and sodium hypochlorite (NaOCl) yields a thick precipitate capable of occluding dentinal tubules. Previous studies are unclear as to the above-mentioned precipitate contains para-chloroaniline (PCA) or not. PCA is a known toxic and carcinogenic compound which may lead to methemoglobinemia in humans. AIM: This study aims to evaluate the precipitate formed on combination of different irrigants, weigh the amount of precipitate formed and to analyze the precipitate for PCA by using thin layer chromatography (TLC), high performance liquid chromatography (HPLC), column chromatography (CC), electron spray ionization mass spectrometry (ESI-MS), Ultraviolet (UV), and nuclear magnetic resonance (1H-NMR and C-13 NMR). MATERIALS AND METHODS: Four different irrigants namely 2% CHX gluconate, 3% NaOCl, 5% neem and 5% tulsi were taken in different test tubes. Group 1, 2 and 3 included 1 ml 2% CHX combined with 1 ml each of 3% NaOCl, 5% neem and 5% tulsi. Group 4 and 5 comprised of 1 ml 3% NaOCl in combination with 1 ml 5% each of neem and tulsi. Finally, group 6 constituted 1 ml 5% neem mixed with 1 ml 5% tulsi. Each group was observed for 2 min for the formation of any precipitate, and the formed precipitate was weighed and analyzed using 1H-NMR and C-13 NMR, TLC, CC, HPLC, ESI-MS, and UV. STATISTICAL ANALYSIS: One-way ANOVA and Post hoc-Tukey test were used. RESULTS: Presence of PCA was detected in group 1 (CHX + NaOCl), group 2 (CHX + neem) and group 3 (CHX + tusli) in all the sensitive methods employed. CONCLUSION: The presence of PCA in precipitate was confirmed by TLC, CC, HPLC, ESI-MS, and UV. Based on the results of the present study, we assume that components in CHX are responsible for precipitate formation which contains PCA as well. Extrusion of precipitate beyond the apex may cause periapical tissue damage and delay wound healing at the same time.