Efficacy of Tooth Bleaching With Prior Application of Two Different Desensitizing Agents: An In Vitro Study.

Objective To compare and evaluate the efficacy of tooth bleaching with prior application of two different desensitizing agents such as sodium fluoride and 5% potassium nitrate. Materials and methods A total of 108 extracted human maxillary central incisors were stained in black coffee solution and stored in artificial saliva for colour stabilization. The specimens were randomly divided into three groups (n = 36) according to the following protocols: (a) bleaching without desensitizer, (b) bleaching with prior application of sodium fluoride, and (c) bleaching with prior application of 5% potassium nitrate. After fabricating customized trays, desensitizers were applied for 10 minutes followed by 16% carbamide peroxide bleaching gel, which was in contact with the teeth for three hours. The bleaching efficacy was evaluated at baseline (after staining), 3rd day, 7th day, and 14th day using a digital spectrophotometer. Results There was an increase in the overall colour change (∆E) from baseline to 14th day, which was statistically significant at cervical, middle, and incisal thirds of the teeth between the three groups with the sodium fluoride group showing decreased ∆E. Conclusions Carbamide peroxide (16%) showed improved whitening efficacy from baseline to the 14th day with increasing median values at all time periods. The sodium fluoride group showed decreased ∆E value when compared to other groups.

Current Trends in Intentional Replantation Treatment Among Endodontists and Postgraduate Students in India, the United States of America, and the United Kingdom: A Cross-Sectional Study.

Objective This study aimed to investigate the knowledge, attitude, and practices (KAP) of intentional replantation among postgraduate students and endodontists in India, the United States of America, and the United Kingdom. Materials and methods The sample size was estimated using G*Power. Based on the pilot study done before with 60 participants, a sample size of 928 was obtained. The survey consisted of 22 questions, which were finalized after content validation by two endodontic experts. It was circulated through multiple online social platforms such as Instagram, Facebook, WhatsApp, and other online dental communities/channels. The respondents were questioned about the case selection, extraction methods, antibiotic therapy, patient acceptance level, operator preference, prognostic indicator, and various other steps in the intentional replantation treatment modality. The data for this KAP survey were organized in an Excel sheet, and statistical analysis was done using the Chi-squared test. Analysis of descriptive and inferential statistics was conducted using SPSS version 20.0 (IBM Inc., Armonk, New York). A p-value of <0.05 was considered significant. Results A strong statistical difference was found in the KAP of the practitioners in different countries. The vast majority (72.7%) considered intentional replantation as an adjunct treatment modality rather than a last resort. A total of 76.5% of the respondents preferred replantation of the tooth into the socket within 15 minutes, and 86.4% of the participants regarded replantation as the most cost-effective treatment modality. Ultrasonics (76.8%) was most commonly chosen for retrograde preparation, and Biodentine (60.1%; Septodont, Saint-Maur-des-Fossés, France) as root-end filling material. Conclusion It can be concluded that a broad majority of practitioners in different countries view intentional replantation as an adjunct treatment modality rather than a last resort. Thus, intentional replantation seems to be a promising option for preserving the natural dentition of teeth with high survival rates and better outcomes.

Influence of Simulated Wound Exudate on the Antimicrobial Efficacy of Various Intracanal Medicaments Against Enterococcus faecalis: An In Vitro Study.

Aim The aim of this study is to compare and evaluate the antimicrobial efficacy of chlorhexidine, calcium hydroxide, and cetylpyridinium chloride against Enterococcus faecalis in the presence and absence of contamination with simulated periapical exudate at different time intervals. Methods Simulated wound exudate and cetylpyridinium chloride gel were prepared prior to testing. The test groups were divided into groups A and B based on the presence and absence of simulated wound exudate. They were further divided into four subgroups as follows: subgroup 1: calcium hydroxide; subgroup 2: 2% chlorhexidine gel; subgroup 3: 0.5% cetylpyridinium chloride gel; subgroup 4: 0.9% saline as control. E. faecalis was inoculated, and the test groups were evaluated at different time periods of six, 12, and 24 hours. Aliquots were then obtained and subjected to 10-fold serial dilutions. A total of 10 µl of individual samples was spread onto the nutrient agar medium using L-rod. The plates were then assessed for colony-forming units (CFU), and the values obtained were subjected to statistical analysis. Kolmogorov-Smirnov and Shapiro-Wilk normality tests were used to check whether the variables follow a normal distribution. For within-group comparison, the Friedman test and the Kruskal-Wallis test were used. For between-group comparison, the Mann-Whitney U test was used. Results Saline had the highest CFU values, while cetylpyridinium chloride had the lowest CFU values in both contaminated and non-contaminated groups. In all the conditions, the CFU values of cetylpyridinium chloride were significantly lowest compared to the other three groups. CFU values of the calcium hydroxide group were significantly high, followed by the chlorhexidine group when compared to cetylpyridinium chloride in both contaminated and non-contaminated groups. Conclusion Within the limitations of the current study, it can be concluded that cetylpyridinium chloride was the most effective intracanal medicament against E. faecalis than calcium hydroxide and chlorhexidine at varying time intervals, even in the presence of a periapical exudate. Thus, cetylpyridinium chloride can be considered an effective intracanal medicament for root canal disinfection.

Antibiotic Prescription Patterns for Endodontic Procedures in India: A Knowledge, Attitude, and Practices (KAP) Survey.

Objective The purpose of this study is to evaluate the antibiotic prescription patterns of endodontists, general dentists, and other dental specialists for endodontic procedures in India by using the knowledge, attitude, and practices (KAP) survey method. Methods This cross-sectional study was carried out from February 2022 to May 2022 and involved dentists across India. A self-made questionnaire survey was created to judge the knowledge of various dental practitioners, which includes general dentists, endodontists, other dental specialists, and post-graduates with regard to antibiotic usage guidelines for endodontic purposes. A total of about 310 dental practitioners were surveyed across India. The questionnaire was circulated via social platforms such as WhatsApp, Instagram, and Facebook Messenger. Statistical analysis Data for KAP regarding antibiotic prescription patterns among general dentists, endodontists, other dental specialists, and postgraduates were entered into Microsoft Excel and analyzed using IBM SPSS Statistics for Windows, Version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). Descriptive statistics of the study population were examined. The level of statistical significance was determined at p<0.05. Results For the percentage of patients who were prescribed systemic antibiotics every day for endodontic reasons, about 38.6% (119) responded 0-10% and 27.3% (84) responded 10-30%. For the order of antibiotics that they prefer from most to least, about 85.4% (263) responded amoxicillin > metronidazole > doxycycline > azithromycin > clindamycin > ciprofloxacin. For the question of whether they use local antibiotics, about 35% answered yes of which 25% were endodontists, 2% were general dentists, 5% were other dental specialists, and 3% were post-graduates. About 77.3% of the total participants were unaware of the antimicrobial stewardship concept and AwaRe classification from WHO. About 53.2% (164) attended CDE programs with regard to antibiotic usage. Conclusion It is evident from the results of the present study that there is over-prescription of antibiotics by practitioners especially by general dentists without following proper guidelines for endodontic treatments. More emphasis should be made on the proper prescription pattern of antibiotics, proper understanding of endodontic diagnosis, and the need for antibiotics at the undergraduate level. In addition, proper awareness, as well as proper prescription of antibiotics, should be made for existing dental professionals.

Comparative Evaluation of Retention of Fiber Posts in Different Dentin Regions Using Various Bonding Techniques: An In Vitro Study.

Aim This study aims to evaluate the retention of fiber posts in the coronal, middle, and apical dentin regions with various bonding techniques by using fifth, sixth, and eighth-generation bonding agents and self-etch adhesive cement. Materials and methods For this study, 96 freshly extracted human incisors with straight roots were selected. Endodontic treatment of the specimens was performed. The post spaces were created immediately after obturation and the posts were luted with three different bonding agents and self-adhesive resin cement and the specimens were divided into four groups. Approximately 3 mm thick sections were made from different dentin regions of the post space and were tested for three subgroups: Subgroup I: Coronal, Subgroup II: Middle, Subgroup III: Apical. The specimens were tested on a universal testing machine. Results Statistical analysis was done using one-way analysis of variance (ANOVA) and Tukey's post hoc test using SPSS software version 17.0 (SPSS Inc., Chicago ). The intra-group comparison showed that the bond strength was more in the fifth-generation bonding agent (Cervical- 8.2574± 1.49034, Middle- 11.4800± 2.59938, Apical- 14.7108±1.82931), followed by the sixth (Cervical- 9.102± 2.76119, Middle-9.3152±2.11585, Apical- 12.9478±4.69404) and eighth-generation bonding systems (Cervical- 9.0938±2.77537, Middle- 7.1585±1.97601, Apical- 9.3726±0.73720) and the self-etch adhesive dental resin cement (Cervical- 5.1004±2.17389, Middle- 4.1574±1.28664, Apical-7.8884±1.90078). The inter-group comparison showed that the bond strength was higher in the fifth-generation bonding agent followed by sixth-generation, eighth-generation, and self-adhesive resin cement. Conclusion The present study reveals that the highest push-out bond strengths were obtained in apical sections followed by the middle and cervical areas. The bond strength was higher when using the fifth-generation bonding agent followed by the sixth, eighth, and self-adhesive resin cement. Despite many advancements, the fifth-generation bonding agent still showed superior retention in different dentin regions among various other bonding techniques.

Comparative Evaluation of Outcome of Natural Antioxidants on Shear Bond Strength of Composite Bonded to Bleached Enamel: An In vitro Study.

Background: The depletion of bond strength after the bleaching procedure has resulted in the usage of several antioxidants to get rid of discharging oxygen from residual peroxides before any adhesive restorations. Aim: The in vitro study aimed to compare and evaluate the shear bond strength of composite after application of three over-the-counter natural antioxidants on bleached enamel. Materials and Methods: Thirty-six extracted human anterior teeth were decoronated at the level of cementoenamel junction and implanted into self-cure acrylic resin exposing the labial surface alone. The embedded specimens were categorized into six groups of six teeth each, and the groups were as follows: Group I: unbleached + composite bonding, Group II: bleaching + delayed composite bonding, Groups III, IV, and V: bleaching + antioxidants - olive oil/Vitamin E oil/propolis + immediate composite bonding, and Group VI: bleaching + immediate composite bonding. The shear bond strength analysis was performed with the help of the universal testing machine, and the values obtained were statistically analyzed using IBM SPSS for Windows, v. 21.0. Results: The results obtained from the study reveal that all the three experimental groups showed an increase in the shear bond strength in comparison to Group VI (positive control) and the difference in the bond strength between the experimental groups and positive control is also statistically significant. Conclusion: Within the limitations of this study, although the bond strength of composite resin after application of the three natural over-the-counter antioxidants falls very closely, the usage of oil-based antioxidants had been found to perform less effectively in improving the shear bond strength.

An Interdisciplinary Management of Avulsed Maxillary Incisors: A Case Report.

The current case report presents a case of a road traffic accident comprising dental avulsion of maxillary incisors. A 30-year-old male reported missing teeth following trauma in his upper front tooth region. The avulsion of maxillary right central and lateral incisors along with laceration in upper and lower lips was evident. The avulsed teeth were stored in milk after a brief extra-oral dry time of one hour and were carried to the department with a one-hour delay. After clinical and radiographic investigations, no mobility or fractures were apparently noticed. The avulsed 11 and 12 had closed apices with intact crown and root surfaces. Following an extra-oral endodontic therapy, immediate replantation was scheduled. Subsequently, the alveolar sockets were irrigated with saline to dislodge the clot and any gross debris that was present. Teeth were reimplanted into the socket after placement of PRF membrane around the root surface. A semi-rigid wire and composite splinting were done for a span of two weeks and antibiotics were prescribed. An exploratory CBCT taken revealed a cortical bone loss in the buccal region of 12 and 11. An interdisciplinary approach to regenerate the osseous defect was then carried out. A follow-up of two weeks, four weeks, three months, six months, and a year was done. Evaluation performed after a year revealed the absence of clinical symptoms and satisfactory healing with no signs of resorption radiographically.

Comparative Evaluation of Smear Layer Removal in Apical Third Using Four Different Irrigants With Ultrasonic Agitation: An In Vitro Scanning Electron Microscopy (SEM) Analysis.

Aim This study aims to compare and evaluate the efficacy of four different irrigating solutions like sodium hypochlorite, ethylenediaminetetraacetic (EDTA), Oxum, and ozonated water with ultrasonic agitation in removing the smear layer in the apical third of root canals using Scanning Electron Microscopy (SEM). Materials and methods For the study, 50 freshly extracted human mandibular premolars with single well-developed roots without any curvatures were taken. The teeth taken were decoronated to obtain a uniform working length of 15 mm, and the samples were instrumented using a ProTaper Gold rotary file system (Dentsply Maillefer, Ballaigues, Switzerland) up to F2 size, along with irrigation of 1 ml of 3% sodium hypochlorite (NaOCl) in between instrumentation. The samples were randomly divided into five groups with 10 samples each, according to the final irrigant used. Group I-EDTA 17%, Group II-NaOCl 5%, Group III-Oxum, Group IV-ozonated water, and Group V-normal saline. In all groups, ultrasonic agitation of the irrigating solution was performed using a size 20 file, held passively inside the root canal. Then the samples were flushed with distilled water, dried with paper points, split into two halves, and subjected to SEM analysis. SEM images of the apical third region of root samples were taken at 5000X resolution and scored on a scale of 1 to 4. Results Statistical analysis was done using one-way ANOVA followed by Tukey's post hoc test using software version SPSS software version 17.0 (SPSS Inc., Chicago). The results showed that the 17% EDTA group showed the least smear layer scores when compared to other groups with statistical significance. This was followed by the Oxum group and 5% NaOCl group, whereas the ozone water group and saline control group showed the highest smear layer scores. Conclusion The present study reveals that the EDTA is the superior irrigant in the elimination of smear layer in root canal treatment. Newer irrigants, such as Oxum, can be used as an alternative to EDTA for smear layer removal while remaining biocompatible with dentin. Whereas ozone can be combined with other irrigants for synergistic action of enhanced antimicrobial property and smear layer elimination in the future.