Journal of Conservative Dentistry
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March-April 2019
Volume 22 | Issue 2
Page Nos. 107-214

Online since Friday, May 3, 2019

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EDITORIAL  

Editorial p. 107
Aditya Mitra, Chandrani Adhikari
DOI:10.4103/JCD.JCD_198_19  
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INVITED REVIEW Top

Evaluation of the actual chlorine concentration and the required time for pulp dissolution using different sodium hypochlorite irrigating solutions Highly accessed article p. 108
Alfredo Iandolo, Alberto Dagna, Claudio Poggio, Ismail Capar, Alessandra Amato, Dina Abdellatif
DOI:10.4103/JCD.JCD_165_19  
Introduction: The goal of root canal treatment is to shape and clean the endodontic space, reducing the bacterial load and removing the pulp tissue. Obviously, the action of the endodontic instruments is limited to the main canals, regardless of the complexity of the endodontic space. Consequently, finding the best possible cleaning technique, which can be obtained chemically using irrigation solutions, is a fundamental aid in endodontic therapy. One of the most commonly used root canal irrigants is sodium hypochlorite (NaOCl), available in various commercial formulations. The effectiveness of NaOCl is undeniable. However, the action of dissolution of the pulp tissue is merely dependent on the concentration and the characteristics of the irrigant itself. Aim: The aim of this study is to evaluate the effective concentration of different commercial formulas of NaOCl, by evaluating the percentage of total chlorine in each product. The dissolution capacity of the pulp tissue of each of the tested products was then analyzed by measuring the required time. Materials and Methods: Three commercial types of NaOCl were selected for this study: 5% NaOCl (ACE, Procter and Gamble), 5% NaOCl (N5, Simit Dental), and 6% NaOCl (CanalPro, Coltene). For each product, 10 packages were used, from which samples of the product were taken and 30 ml × 5 ml tubes were filled. All samples were divided into three groups and were analyzed using the DIN EN ISO 7393-2 method and the percentage of total chlorine (expressed as a percentage) was calculated. Forty samples of vital pulp were obtained from teeth freshly extracted for periodontal reasons and stored in physiological solution. In order to unify the size and weight of the samples (0.0001 mg), a microtome and a precision balance (Pro Explorer Ohaus) were used. Each sample, carefully examined by stereomicroscope (×40), was placed in artificial plastic containers and submerged in 0.1 ml of irrigating solution at room temperature (26°C). A fourth control group used saline solution as irrigant. Simultaneously with the insertion of the irrigating solution, a digital stopwatch was activated and the time necessary for the complete dissolution of the pulp sample was measured. The data obtained was subjected to statistical analysis. Results: The average percentages of chlorine detected for each group were: 4.26% (ACE), 5.16% (N5), and 5.97% (CanalPro). The Kruskal–Wallis test showed statistically significant differences between the different commercial formulations of hypochlorite (P < 0.05). CanalPro showed the lowest values, whereas ACE showed the highest values of dissolution time of the pulp. Discussion: The analysis of the total chlorine percentage found that the actual concentration of the NaOCl in the samples is close to the values declared by the manufacturers both in the case of N5 and CanalPro. On the contrary, the concentration detected in the samples of common bench bleach (ACE) is significantly lower, which has average values <5%. This explains the longer time taken for the complete dissolution of the pulp tissue. The average dissolution time of the pulp samples was in fact inversely proportional to the concentration detected in the tested irrigants and hence that a lower time corresponds to a higher concentration.
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REVIEW ARTICLES Top

Effectiveness of rotary and reciprocating systems on microbial reduction: A systematic review Highly accessed article p. 114
Riluwan Siddique, Malli Sureshbabu Nivedhitha
DOI:10.4103/JCD.JCD_523_18  
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.
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Probiotic Streptococcus strains in caries prevention: A systematic review p. 123
Saravanan Poorni, Manali Ramakrishnan Srinivasan, Malli Sureshbabu Nivedhitha
DOI:10.4103/JCD.JCD_505_18  
Objective: The aim of this article is to review the published literature with the purpose of knowing the importance of using various probiotic Streptococcus strains as a preventive and therapeutic method for dental caries management. Materials and Methods: Research question was formulated based on the PICO strategy. A comprehensive electronic literature search was conducted across PubMed/Medline, Scopus, and EBSCOhost databases independently by two reviewers. All papers published from 1989 to December 2017 that focused on the use of probiotic Streptococcus strains for caries prevention were included in this review. Inclusion and exclusion criteria were applied to the selected articles, and a customized data extraction sheet was formulated. The selected articles were subjected to quality assessment, and the risk of bias in selected studies was evaluated. Results: A total of five articles were included. The overall risk of bias of the selected clinical trials was found to be high risk, and the overall level of evidence of the selected in vitro studies was moderate. Conclusion: The two included clinical studies on the use of probiotic Streptococcus strains for caries prevention had high risk of bias. Although in-vitro studies showed promising results, clinical studies have not demonstrated clear clinical outcomes. Thus, there is a vast scope for future research in this field. Clinical Relevance: Application of oral probiotics will help reinstate a balanced microbiota and thereby improving oral health. This systematic review focused on evaluating the role played by probiotic Streptococcus strains in the carious lesion incidence.
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ORIGINAL ARTICLES: ENDODONTICS Top

Success or failure of endodontic treatments: A retrospective study p. 129
Airton Oliveira Santos-Junior, Lidiane De Castro Pinto, Jose Francisco Mateo-Castillo, Claudia Ramos Pinheiro
DOI:10.4103/JCD.JCD_507_18  
Context: Well-conducted endodontic therapy is necessary for the dental rehabilitation of the individuals with cleft lip and palate. Aim: The aim of this study was to verify the success and failure index of endodontic treatments performed in the Endodontic Sector of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, (HRAC/USP), Bauru, Brazil. Materials and Methods: The preservation records (at least 2 years) of the endodontic treatments performed in the HRAC/USP were verified, indicating the success or failure of the treatment, and these treatments were divided into three groups (vital pulp, necrotic pulp, and endodontic retreatment). The Chi-square statistical test was applied with a significance level of 5%. Results: A total of 1216 endodontic treatments were quantified with a minimum of 2 years of prenatal care at HRAC/USP. The vital pulp group had a success rate of 99.4% (535 treatments) and 0.6% failure (3 treatments), 98.6% of success in the necrotic pulp group (577 treatments) and 1.4% failure (8 treatments), and 95.6% success rate (89 treatments) and 4.4% failure (4 treatments) in the endodontic reintervention group. Conclusion: From the results found, we can conclude that there was a high success rate in the treatments and endodontic retreatments performed in the Endodontics Sector of the HRAC/USP, considering that well-conducted endodontic therapy is extremely important in the oral rehabilitation of individuals with cleft lip and palate.
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Racial predilection of C-shaped canal configuration in the mandibular second molar p. 133
Aishwarya Roy, Madhusudan Astekar, Rashmi Bansal, Anuraag Gurtu, Mrityunjay Kumar, Lalit Kumar Agarwal
DOI:10.4103/JCD.JCD_369_18  
Aim: The purpose of this article is to determine the racial predilection of C-shaped canal configuration in a mandibular second molar. Background: Unusual root canal anatomy always poses a diagnostic and treatment challenge. Identification of such variation is important for the success of root canal treatment outcome. C-shaped canal configuration is such an aberrant morphology of molar teeth that vary in different population and is commonly seen in a mandibular second molar. Thus, knowledge of racial predilection of C-shaped canal configuration in different population for early diagnosis is obligatory. Materials and Methods: An exhaustive search was undertaken to identify published research articles related to C-shaped canal configuration in mandibular second molars. Forty-three research articles were analyzed which included 12,481 mandibular second molars. Chi-square test using value of P < 0.05 was performed to assess the statistical significance of this anomalous anatomic variation among the different population. Results: Statistical test revealed a significant variation between the Asian and nonAsian population. The highest incidence of racial predilection was observed in China (Asia) with 93.1%, and the minimum was observed in America with 2.7%. Conclusion: This research reported that racial predilection of C-shaped canal configuration in mandibular second molar varies significantly.
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Evaluation of the relationship between the maxillary sinus floor and the root apices of the maxillary posterior teeth using cone-beam computed tomographic scanning p. 139
Svetlana Razumova, Anzhela Brago, Ammar Howijieh, Ashot Manvelyan, Haydar Barakat, Malina Baykulova
DOI:10.4103/JCD.JCD_530_18  
Background: The relationship between the maxillary sinus (MS) and the root apices of the posterior teeth is of clinical relevance in diagnosing and treatment planning in the posterior area of the maxilla. This study aimed to assess the relationship between the MS floor and the root apices of the posterior teeth using cone-beam computed tomography (CBCT) scanning. Materials and Methods: 325 CBCT scans of patients aged 20–70 years were analyzed. Patients were divided into three age groups: young group (20–44 years), middle age group (45–59 years), and elderly group (60–70). The distance from the MS floor and the root apices of posterior teeth was measured in each group. The relationship between the MS and the posterior roots was also recorded according to Kwak classification. The results were analyzed by IBM statistic SPSS. Results: Type II was most commonly seen in the first and second molars. For premolars, Type I was often observed. The shortest distance to the floor of MS was recorded for the mesiobuccal root of the second molar and the longest distance for the palatal root of the first and second molars. No statistical differences were found between age groups (P > 0.01). Conclusion: The anatomical relationship between the MS and the root apices of the posterior teeth is of clinical importance and should be taken into consideration during surgical or endodontic treatment.
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Effect of proanthocyanidin and bamboo salt on the push-out bond strength of an epoxy resin sealer to sodium hypochlorite-treated root dentin: An in vitro study p. 144
Palmoor Santosh Kumar, Anand Meganathan, Shanti Shriram, Vidhya Sampath, Mahalaxmi Sekar
DOI:10.4103/JCD.JCD_377_18  
Background: In endodontic therapy, final irrigation is often done with sodium hypochlorite (NaOCl). This jeopardizes the bond strength between the epoxy resin sealer, used subsequently in obturation and radicular dentin. This study aimed to analyze the effect of natural antioxidants, 6.5% proanthocyanidin (PA) and 25% bamboo salt (BS) on the reversal of NaOCl-induced reduced bond strength of an epoxy resin sealer to dentin. Materials and Methods: Thirty-three single-rooted extracted human teeth were randomly divided into three groups based on the final irrigation protocol: group 1 (saline), Group 2 (6.5% PA), and Group 3 (25% BS). The canals were cleaned, shaped, and obturated with gutta-percha and AH Plus sealer. 1.5 mm-thick root slices made from coronal, middle, and apical thirds of the canal were subjected to push-out bond strength (PBS) testing. The data were statistically analyzed using Kruskal–Wallis and Dunn's post hoc test (P < 0.05). Results: 5.25% NaOCl significantly decreased the bond strength of AH Plus to dentin (P < 0.05). Both 6.5% PA and 25% BS were capable of reversing the compromised PBS of AH Plus to NaOCl-treated dentin. Conclusion: Final irrigation with antioxidants such as PA and BS eliminates the risk of reduced bond strength of AH Plus to root canal walls, which ensues following the use of NaOCl as an irrigant.
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Scanning electron microscopic evaluation of smear layer removal at the apical third of root canals using diode laser, endoActivator, and ultrasonics with chitosan: An in vitro study p. 149
Sathish Abraham, Sneha Dhruvkumar Vaswani, Harshal Balasaheb Najan, Disha Lalit Mehta, Aradhana Babu Kamble, Salil Dinesh Chaudhari
DOI:10.4103/JCD.JCD_337_18  
Aim: The aim of this study was to compare the effect of diode laser, endoActivator, and passive ultrasonics for smear layer removal at the apical third from root canals with 0.2% chitosan. Materials and Methods: A total of 40 mandibular premolars were decoronated to establish a working length of 12 mm and shaped with ProTaper rotary files up to size F3. In Group A, canals were irrigated with 1 ml of 0.2% chitosan. In Group B, canals were initially irrigated with 0.8 ml of 0.2% chitosan and the remaining 0.2 ml was activated with diode laser. In Group C, canals were irrigated with 1 ml of 0.2% chitosan which was activated with endoActivator. In Group D, canals were irrigated with 0.2% chitosan and activated with passive ultrasonics. All samples were finally flushed with 3 ml of distilled water. The percentage of smear layer removal was analyzed with a scanning electron microscope examination at ×1000 and ×3000. Data were analyzed using Statistical Package for the Social Sciences version 16.0 (SPSS Inc., Chicago, IL, USA) at a significance level of P < 0.05. Results: The mean value for Group B when compared to Group C for the removal of smear layer was higher, but there was no statistically significant difference between the two groups (P < 0.068 and P < 0.295). Both Group B and Group C showed a statistically significant difference (P < 0.001) when compared to Group A and Group D for the removal of smear layer. Conclusion: Diode laser and endoActivator with 0.2% chitosan proved better in the removal of the smear layer when compared to passive ultrasonic irrigation.
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Efficacy of passive ultrasonic irrigation, continuous ultrasonic irrigation versus irrigation with reciprocating activation device in penetration into main and simulated lateral canals p. 155
Caio Cesar Souza, Carlos Eduardo Bueno, Augusto Shoji Kato, Ana Grasiela Limoeiro, Carlos Eduardo Fontana, Rina Andrea Pelegrine
DOI:10.4103/JCD.JCD_387_18  
Context: The use of chemicals solutions and means of activation is of utmost importance in endodontic treatment. Aims: This study compared three activation techniques used in the final irrigation of the endodontic treatment. Subjects and Methods: Eighty uniradicular teeth were instrumented with the Protaper Universal system up to F4 file. After decalcification, the teeth had artificial lateral canals created at 2, 4.5 and 6 mm from working length (WL). The groups were randomly divided into four groups (n = 20): control group (C), passive ultrasonic irrigation (PUI) group, continuous ultrasonic irrigation (CUI) group, and easy clean (EC) group. The penetration of the irrigant into the samples was evaluated using image observation using the Image J program. Statistical Analysis Used: The level of agreement among the observers was determined by the Cronbach's alpha test. The likelihood ratio test was used to evaluate possible differences between the groups and the Kendall's W statistic test to verify possible differences between the irrigant penetration levels in the lateral canals. The Fisher's exact test was applied to verify differences by the studied group considering the WL variables and lateral canals. Results: The results showed no statistical difference in the penetration of the irrigator in the main canal when compared to the C, PUI, CUI, and EC groups (P > 0.05). Conclusions: The method using a positive syringe and needle pressure was not able to effectively carry the irrigator to the artificially made lateral canals, whereas PUI, CUI, and EC were equally efficient in this regard (P < 0.01).
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Cytotoxicity evaluation of fungal-derived silver nanoparticles on human gingival fibroblast cell line: An in vitro study p. 160
Kiran R Halkai, Jayashree A Mudda, Vasundhara Shivanna, Veena Patil, Vandana Rathod, Rahul Halkai
DOI:10.4103/JCD.JCD_518_18  
Background: Biosynthesized silver nanoparticles (AgNPs) have been proposed as effective antimicrobial agents against endo–perio pathogens. Determination of cytotoxicity is important for effective clinical use. Aim: The aim is to determine the cytotoxicity of fungal-derived AgNPs on human gingival fibroblast (HGF) cell line using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Materials and Methods: HGF cell cultures were trypsinized and adjusted to 5 × 103 cells/ml and 100-μl cell suspension (50,000 cells/well) and were added to 96-well plate. After 24 h, 100 μl of AgNPs (8–512-μg/ml concentrations) was added and incubated at 37°C for 24 h in 5% CO2atmosphere. Controls were used without AgNPs. MTT (1 mg/ml) was added and incubated for 4 h at 37°C in 5% CO2atmosphere. Microscopic examination was done, and absorbance was measured using a microplate reader at a wavelength of 540 nm. Percentage growth inhibition was calculated, and the concentration of AgNPs needed to inhibit cell growth by 50% (CTC50) was generated. Results: CTC50was found at a concentration of 260 μg/ml. AgNPs exerted less cytotoxicity against HGF cell line and increased with increase in the concentration of AgNPs. Conclusion: Fungal-derived AgNPs are safe to healthy cells at a concentration <260 μg/ml. Therefore, they can be effectively used for the treatment of endo–perio lesions.
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Assessment of tooth discoloration induced by biodentine and white mineral trioxide aggregate in the presence of blood p. 164
Alireza Adl, Samane Javanmardi, Abbas Abbaszadegan
DOI:10.4103/JCD.JCD_466_18  
Introduction: In clinical dental application, using silicate-based cements is extremely popular. These materials come into direct contact with blood during or after placement and may cause tooth discoloration. Objectives: The purpose of this study was to compare the coronal tooth discoloration induced by white mineral trioxide aggregate (MTA) and biodentine in the presence of blood. Materials and Methods: Seventy specimens were chemomechanically prepared and divided into four experimental and two control groups. In the experimental groups, the pulp chambers were filled with white MTA angelus or biodentine. Blood or saline saturated cotton pellets were placed within the canals. Saline or blood alone was used in the control groups. Color was assessed with a spectrophotometer at baseline, 1 week, and 1 and 3 months, and color change values were calculated. Tukey's honestly significant difference and Sidak tests were used for statistical analysis. Results: The color change was significantly less with biodentine/saline than MTA/saline and MTA/blood (P < 0.05). Regardless of the material type and blood presence, discoloration increased after 3 months (P < 0.05). Conclusion: Discoloration induced by biodentine/saline may not be clinically noticeable and it was less than MTA-containing groups. Irrespective of blood presence or absence, MTA caused perceptible color change.
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ORIGINAL ARTICLES: CONSERVATIVE DENTISTRY Top

Antibacterial activity of high-molecular-weight and low-molecular-weight chitosan upon oral pathogens p. 169
Zeinab Abedian, Niloofar Jenabian, Ali Akbar Moghadamnia, Ebrahim Zabihi, Hamed Tashakorian, Mahdi Rajabnia, Farahnaz Sadighian, Ali Bijani
DOI:10.4103/JCD.JCD_300_18  
Context: One of the common oral bacterial infectious diseases is dental caries. Control of dental plaque formed by Streptococcus mutans and Streptococcus sobrinus leads to prevention and treatment of caries. Chitosan (1-4, 2-amino-2-deoxy-b-D-glucan), a deacetylated derivative from chitin, is an antimicrobial polysaccharide that exerts broad-spectrum activity against pathogenic bacteria and has been suggested as a preventive and therapeutic material for dental caries. Aim: The aim of this investigation is whether chitosan has effective antimicrobial and antibiofilm properties against common cariogenic microorganisms. Materials and Methods: The effect of 0.019–5 mg/ml of high-molecular-weight (HMW) and low-molecular-weight (LMW) chitosan on S. mutans and S. sobrinus was evaluated, and minimal inhibitory concentration (MIC) and minimal bactericide concentration (MBC) were determined. In addition, the effects of HMW and LMW of chitosan on bacterial adhesion to surfaces and biofilm formation were assayed by tube method. Results: The results showed that chitosan is capable of inhibiting S. mutans and S. sobrinus growth (P = 0.001). MIC of HMW chitosan for S. mutans and S. sobrinus was 0.62 mg/mL and MIC of LMW chitosan for S. mutans and S. sobrinus was 0.62 mg/mL, 1.25 mg/mL, respectively. MBC of HMW chitosan for S. mutans and S. sobrinus was 1.25 mg/mL, respectively, and MBC of LMW chitosan for S. mutans and S. sobrinus was 1.25 and 2.5 mg/ml, respectively. On the other hand, HMW chitosan was more effective than LMW chitosan. In addition, S. mutans showed equal MIC and MBC values for both MWs chitosan, but S. sobrinus was more resistant to LMW chitosan. Regarding biofilm growth, chitosan inhibited S. mutans and S. sobrinus adhesion and biofilm formation. The results of tube test showed weak adherence and biofilm formation in concentration of 0.312 and 0.625 mg/ml, but 1.25 and 2.5 mg/ml concentrations of both MWs could completely inhibit biofilm formation. Conclusion: These results display the potential of chitosan to be used as an effective antibacterial and antibiofilm agent for oral hygiene and health care.
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Comparative evaluation of color stability of three composite resins in mouthrinse: An in vitro study p. 175
R Jaya Shree Roja, Narayanan Sriman, V Prabhakar, Koshy Minu, Anirudhan Subha, P Ambalavanan
DOI:10.4103/JCD.JCD_241_18  
Aim: The aim of this study was to compare the effect of chlorhexidine mouthrinse on the color stability between three different types of composites. Materials and Methods: A total of 30 samples of size 10-mm length, 1-mm width, and 1-mm thickness were prepared on a customized microglass slide from each of the composite materials and immersed in 20 ml of distilled water followed by incubation at 37°C for 24 h. The samples were divided into three groups (n = 10) – Group I: A nanofilled composite, Filtek Z350XT (3M ESPE, St. Paul, USA); Group II: A microhybrid composite, Polofil Supra (Voco GmbH, Germany); and Group III: A nanoceramic composite, Ceram.x Sphere TEC (Dentsply, Konstanz, Germany). Baseline color values were recorded using a spectrophotometer (V-770 UV-Visible/NIR Spectrophotometer, Easton, Maryland, USA) according to the laboratory scale. After baseline color measurements, ten randomly selected specimens from each group were immersed in 20 ml of 0.2% chlorhexidine mouthrinse (Rexidin Plus, Aurangabad, India) for 24 h. The postimmersion color values of the samples were then recorded, respectively, using the same spectrophotometer. Statistical Analysis Used: The statistical analysis was done using one-way ANOVA followed by Tukey's post hoc test. Results: Statistically significant difference was observed between the mean color change values in the three groups (P < 0.05) with the highest color change (delta E [ΔE]) in Group III (Nanoceramic composite). The ΔE for Group I (Nanofilled composite) was 3.16, Group II (Microhybrid composite) was 3.32, and Group III (Nanoceramic composite) was 3.51. Conclusion: All the three types of composites displayed color changes after immersion in mouthrinse, but the color shift depended on the material used, and the nanofilled composites (Filtek Z350XT, 3M ESPE, St. Paul, MN, USA) had higher color stability.
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Comparison of the effectiveness of three different desensitizing toothpastes in reducing dentin hypersensitivity: A 4-week clinical study p. 181
Prem Prakash Kar, Zeba Afroz Shaikh, Anand M Hiremath, M Vikneshan
DOI:10.4103/JCD.JCD_304_18  
Aim: To compare the effectiveness of three different desensitizing toothpastes containing potassium salt, natural ingredients, and 8% arginine in reducing dentin hypersensitivity (DH). Materials and Methods: A 4-week study was conducted on 45 adult patients suffering from hypersensitivity associated with cervical abrasion of two or more teeth anterior to the molars. Patients were divided into three toothpaste groups as follows: Group I: potassium salt, Group II: herbal desensitizing paste containing natural ingredients, and Group III: 8% arginine. Using tactile stimulus and air stimulus, the sensitivity scores were recorded using Visual Analog Scale (VAS) at baseline, immediately after application, after 1 week, after 2 weeks, and after 4 weeks. Statistical Analysis: One-way ANOVA test and post hoc Tukey's test were used, and P≤ 0.05 was considered statistically significant. Results: Group III showed significantly better reduction in DH at all time intervals when compared with Group I. Group III was significantly better than Group II at 1, 2, and 4 weeks. Conclusion: Desensitizing toothpaste containing 8% arginine was found to be the most effective in the reduction of DH after a single application up to a period of 4 weeks followed by herbal desensitizing toothpaste and potassium salt-containing toothpaste.
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CRA Grid - A preliminary development and calibration of a paper-based objectivization of caries risk assessment in undergraduate dental education p. 185
Sathyanarayanan Ramarao, Usha Sathyanarayanan
DOI:10.4103/JCD.JCD_389_18  
Context: Caries risk assessment (CRA) varies between students and faculty due to the subjectivity inherent in the process as well as in the critical thinking skills required for the processing of information. Aims: The aim was to develop a paper-based, grid system, CRA-Grid, to objectivize and standardize risk assessment and to assess its rating agreement with the critical thinking process of the teachers. Settings and Design: The CRA-Grid was developed and tested in a clinical study, in Indira Gandhi Institute of Dental Sciences, Puducherry. Materials and Methods: Based on the currently available evidence, specific weightages were assigned to the risk factors in an existing CRA form. A 10 × 10 paper grid was created incorporating these weightages. Shading and summing up the respective squares in the grid provided a percentage score. The class interval of percentage indicating the risk status was determined using historical clinical data. After training, the students performed CRA of 57 patients by using the CRA-Grid. Six faculties were blinded to these scores and assessed the risk by critical thinking process. Statistical Analysis Used: Cohen's weighted kappa (k) for inter-rater agreement was run using Graph Pad QuickCalcs. Results: Cohen's weighted kappa for agreement at 95% confidence interval, between the CRA-Grid and critical thinking process, ranged from “gooda” to “very good.” Mean percentage of agreement of the six faculty was 79.6%; and with caries grid, was 80.5%. Conclusions: Risk assessment with the paper-based, objectivized, CRA-Grid matched that done by critical thinking process.
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Effect of four different dentifrices applied by customized automated brushing device on enamel surface abrasion: An in vitro profilometric study p. 191
Paromita Mazumdar, Deepshikha Chowdhury, Saikat Chatterjee, Namrata Jajoo
DOI:10.4103/JCD.JCD_392_18  
Aim: The aim of this study is to evaluate the enamel surface abrasion using four different dentifrices and a customized automated brushing machine under a profilometer. Materials and Methods: A total of 30 enamel blocks (9 mm × 9 mm × 2 mm) were prepared from freshly extracted maxillary central incisors which were randomly divided into five equal groups (Group 1: specimens brushed with Colgate Total, Group 2: specimens brushed with Colgate Lemon and Salt, Group 3: specimens brushed with Colgate Visible White, Group 4: specimens brushed with Colgate Sensitive, and Group 5: intact enamel surface). Samples were brushed using a customized automated toothbrushing machine for 60 min. A profilometric read out (Ra value) was taken for each group subjected to brushing and also for the control group. Statistical Analysis: Statistical analysis used in this study was one-way analysis of variance followed by post hoc Tukey's test. Results: Statistically significant differences (P < 0.05) were observed in the values of enamel abrasion (Ra) among Group 1–Group 4 whereas Group 5 (control group) had no significant difference in enamel abrasion (P > 0.05). Conclusion: The highest enamel abrasion was observed in the group with Colgate Visible White toothpaste, and the least enamel abrasion was seen in the group with Colgate Sensitive Plus.
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The effect of curing time by conventional quartz tungsten halogens and new light-emitting diodes light curing units on degree of conversion and microhardness of a nanohybrid resin composite p. 196
Saijai Tanthanuch, Boonlert Kukiattrakoon
DOI:10.4103/JCD.JCD_498_18  
Background: Little is known about the relationship between the minimal light-curing time required for proper polymerization on various quartz–tungsten–halogen (QTH) and light-emitting diode (LED) light-curing units that have different light intensities. Aim: To evaluate the effects of curing time by QTH and LED light-curing units on the degree of conversion (DoC) and surface microhardness of a nanohybrid resin composite. Setting and Design: Experimental design. Materials and Methods: One hundred and twenty cylindrical specimens (4.0 mm in diameter, 2.0 mm thick) of shade A2 resin composite were prepared and polymerized with either QTHs or LEDs for 20 and 40 s. The DoC and the top and bottom surface microhardness were recorded. Statistical Analysis Used: Two-way analysis of variance, Tukey's test, and the t-test (α = 0.05) were used. Results: Surface microhardness and DoC values were affected by light intensity and curing time (P < 0.05). In terms of microhardness and DoC, LED groups gave significantly more values than QTH groups (P < 0.05). Conclusion: Curing time affected surface microhardness and DoC values of a nanohybrid resin composite in both conventional QTH and new LED light-curing units.
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Effect of silver diamine fluoride-potassium iodide and 2% chlorhexidine gluconate cavity cleansers on the bond strength and microleakage of resin-modified glass ionomer cement p. 201
Jaivrat Gupta, Manuel S Thomas, M Radhakrishna, N Srikant, Kishore Ginjupalli
DOI:10.4103/JCD.JCD_485_18  
Background: Disinfection of the prepared cavity can be a crucial step in the longevity of restorations. The objective of this study was to compare the antimicrobial action (AMA) of silver diamine fluoride-potassium iodide combination (SDF-KI) with 2% chlorhexidine gluconate (CHX) and to compare the alteration in bond strength and microleakage while using SDF-KI and CHX as cavity cleansers in resin-modified glass ionomer cement (RMGIC) restorations. Materials and Methods: Samples were grouped as follows: Group 1: Polyacrylic acid (PAA), Group 2: CHX, Group 3: SDF-KI, and Group 4: Distilled water (CTRL). AMA was assessed by measuring the zone of inhibition of the above-mentioned materials by dispensing them into the punch hole prepared on agar plates with an inoculum of Streptococcus mutans. For assessing the effect of the cavity cleansers on the bond strength of RMGIC, they were applied to the dentinal samples prepared from freshly extracted noncarious molars. After the surface was treated, cylindrical restoration of RMGIC was placed and allowed to set. The shear bond strength was then evaluated using a universal testing machine. Rhodamine-B dye penetration was viewed under a fluorescent microscope to evaluate the microleakage of RMGIC following surface treatment of the standardized cavities prepared on the cervical third of freshly extracted noncarious premolars. Results: SDF-KI (34 ± 0.8 mm) showed potent AMA followed by CHX (23.9 ± 0.7 mm) and PAA (12.7 ± 0.8 mm). SDF-KI showed a drastic increase in the bond strength when compared to the PAA, CHX, and CTRL groups. Although the application of SDF-KI showed the least microleakage among all the groups, it was not statistically significant. Conclusion: The application of SDF-KI and CHX is useful against S. mutans in an in vitro study. Although SDF-KI group showed the least microleakage among the groups, it was not statistically significant. SDF-KI application has shown a drastic increase in the bond strength of RMGIC although further research is required for the suitable reasoning of the phenomenon.
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CASE REPORT Top

Maintenance of cell viability in extraoral conditions for a case of intentional replantation to retrieve a separated endodontic instrument p. 207
Neha M Deshpande, Dipali Shah, Swati Wadekar
DOI:10.4103/JCD.JCD_461_18  
Intentional replantation has been used as an alternative treatment modality to tooth extraction and prosthetic replacement when conventional endodontic treatment modalities are unfeasible or contraindicated. This case report presents a successful case of intentional replantation for the mandibular first molar with an endodontic mishap. An endodontic instrument was separated in the apical third of the root canal and extended beyond its mesiobuccal root apex. Intentional replantation served as a means to remove the separated instrument. The periodontal ligament (PDL) cells were kept viable throughout the endodontic treatment using a distinctive technique, wherein a preoperative impression is used for continuous wetting with saline. Platelet-rich fibrin (PRF) was shredded and placed in the alveolar socket to enhance PDL cell reattachment and prevent ankylosis. The 2-year successful follow-up reinforced that intentional replantation can be a viable option for removal of separated instruments that lie beyond the root apex. The use of these techniques to keep PDL cells viable and the use of PRF can aid in prevention of ankylosis.
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SHORT COMMUNICATION Top

Management and 5-year follow-up of tooth with bilateral cemental tear and complete pulp canal obliteration p. 213
Swati Atul Borkar, Ida de Noronha de Ataide
DOI:10.4103/JCD.JCD_370_18  
The aim of this study is to report a rare case of bilateral cemental tear in a completely calcified tooth with successful dental management. A 60-year-old male reported with pain in the upper right central incisor. Radiographic examination revealed complete calcific obliteration of the root canal, inflammatory root resorption of apical third, and bilateral cemental tear and traumatic occlusion. Tooth mobility was within physiologic limits and 3-mm probing depth. Endodontic treatment of the tooth was carried out with intracanal calcium hydroxide therapy. The tooth was relieved of traumatic occlusion, scaling and root planning was carried out. As the tooth did not have any periodontal pocket, the maintenance phase was advised, and the tooth was kept under observation. After a follow-up of 5 years, the nonsurgical periodontal therapy showed satisfactory clinical and radiographic outcome.
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