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The most common problem faced by dentists during root canal therapy is instrument separation. Instrument separation leads to the inefficient biomechanical preparation of the canals, which can affect the outcome of the root canal-treated tooth. Hence, bypassing the fractured instrument or removal can be accounted as a viable choice to maintain the structural integrity of the tooth. This article illustrates a case series wherein the fractured instrument was managed successfully with the use of conservative techniques.
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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.
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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.
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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.
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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.
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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.
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Aim The key to the success of a composite restoration lies in the important final step of finishing and polishing. This survey aims to assess the knowledge, attitude, and practice about finishing and polishing in composite restoration among various dental professionals in India. Materials and methods A cross-sectional questionnaire survey was conducted among various dental professionals in India. The participation of dentists was voluntary. A total of 350 responses were received, and the data were converted to Microsoft Excel 2019 program and descriptive statistics were analyzed using SPSS Version 21.0 software. Results Almost 99% of respondents know the importance of finishing and polishing procedures of composite restoration. Overall, 71% of respondents felt it is necessary to remove the surface layer to improve the surface characteristics of the composite restoration, 59.8% of professionals follow the sequential order of abrasives for finishing and polishing of composites, 74.2% use interproximal strips to finish interproximal areas of restoration, and 55.8% of professionals use polishing paste for the final polishing of composite restoration. Only 44.2% are aware of liquid polish/composite glaze, among which 12.4% of practitioners use liquid polish often. Conclusion Most of the respondents were aware of the benefits of proper finishing and polishing of composite restorations. However, still they need to follow proper sequential series of burs, abrasive points, disks, strips, and polishing pastes. The usage of surface sealants should be emphasized for enhanced results.
