Journal of Conservative Dentistry
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   Table of Contents - Current issue
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May-June 2019
Volume 22 | Issue 3
Page Nos. 215-318

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EDITORIAL  

With sincere prayers to all humanity p. 215
Aditya Mitra, Chandrani Adhikari
DOI:10.4103/JCD.JCD_315_19  PMID:31367100
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REVIEW ARTICLE Top

Gutta-percha in endodontics - A comprehensive review of material science Highly accessed article p. 216
Vijetha Vishwanath, H Murali Rao
DOI:10.4103/JCD.JCD_420_18  PMID:31367101
The complete and three-dimensional fluid tight seal of the root canal system is the final component of the endodontic triad. The long-standing and closest material which has fulfilled this criterion is gutta-percha (GP). Several materials have been tried and tested as an endodontic filling material, of which GP has been most extensively used for years and has established itself as a gold standard. In addition, it has proved itself successful with different techniques of obturation while maintaining its basic requisites. This article deals briefly with the history and evolution of GP, source, chemical composition, manufacturing, disinfection, cross-reactivity, and advancements in the material.
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ORIGINAL ARTICLES: ENDODONTICS Top

Efficacy of different endodontic irrigation protocols on shear bond strength to coronal dentin p. 223
Soley Arslan, Hacer Balkaya, Nazire Nurdan Çakir
DOI:10.4103/JCD.JCD_502_18  PMID:31367102
Aim: The purpose of this study was to evaluate the effect of etidronic acid on bond strength to coronal dentin. Materials and Methods: A total of 75 human mandibular molars were sectioned 3 mm below the occlusal surface and then randomly divided into five groups according to irrigation solution used (n = 15): Group 1: 5 ml 2.5% sodium hypochlorite (NaOCl) +5 ml distilled water; Group 2: 5 ml 2.5% NaOCl + 5 ml 17% ethylenediaminetetraacetic acid (EDTA); Group 3: 10 ml mixture of 5% NaOCl and 18% 1-hydroxyethylidene-1,1-bisphosphonate (HEBP); Group 4: 5 ml mixture of 5% NaOCl and 18% HEBP + 5 ml 17% EDTA; and Group 5: 5 ml mixture of 5% NaOCl and 18% HEBP + 5 ml distilled water. Thereafter, Clearfil SE bond was applied to the dentin surfaces and then, composite build-ups were created using Tygon tubes for the microshear bond strength test. Data were analyzed using the one-way analysis of variance and Tukey test. Results: When compared to Groups 3, 4, and 5, Groups 1 and 2 showed significantly higher bond strength values (P < 0.05). However, there was no statistically significant difference between Groups 1 and 2 and between Groups 3, 4, and 5 (P > 0.05). Conclusion: HEBP adversely affected the bond strength of the tested adhesive to coronal dentin.
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Influence of type of cement and their thickness on stress distribution at dentin-cement interface of computer-aided designed glass fiber post: A three-dimensional finite element analysis p. 228
Sonali Taneja, Pragya Kumar, Nitin Gupta, Rabab Khan
DOI:10.4103/JCD.JCD_457_18  PMID:31367103
Aim: This study aims to evaluate the effect of type of cement, and their thickness on stress distribution at dentin-cement interface of computer-aided designed glass fiber post using three-dimensional finite element analysis. Materials and Methods: Nine 3D models of endodontically treated maxillary second premolar were divided into three groups according to the adhesive cement used PermaCem (Group I), Variolink II (Group II), and ParaCore (Group III). Each group was further divided into subgroup a, b, and c on the basis of the thickness of the adhesive cement 50 μm, 200 μm, and 300 μm, respectively. All the models were simulated to be cemented with computer-aided designed glass fiber post and core followed by zirconia crown. The core was modeled with incomplete ferrule. The load of 200N at 45° at lingual and central fossa was applied. Maximum von Mises stresses distribution was calculated. Results: Maximum and minimum stresses in dentin were seen in the Ic and IIIa, respectively. Maximum and minimum stresses in cement were seen in IIIc and Ia, respectively. Conclusion: The von Mises stresses in dentin can be minimized by keeping the cement thickness minimum and selecting the cement whose modulus of elasticity is closest to that of dentin.
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Morphological measurements of anatomical landmarks in human maxillary first molar pulp chambers and evaluation of number of pulp canal orifices using spiral computed tomography: An in vitro study p. 233
Chakshu Gaba, Anuraag Gurtu, Rashmi Bansal, Pramod Kumar
DOI:10.4103/JCD.JCD_568_18  PMID:31367104
Context: Comprehensive understanding of the anatomic position of pulp canal orifices and the measurements of the molar pulp space may maintain the pulp health during conservative tooth preparation and minimize the possibility of mishaps during endodontic therapy. Aims: The idea of the present study was to analyze the morphological measurements of anatomical landmarks in human maxillary first molar pulp chambers and evaluation of number of pulp canal orifices using three-dimensional spiral computed tomography (SCT). Subjects and Methods: One hundred and thirty extracted intact human adult maxillary first molars were chosen from the North Indian population and were analyzed using SCT in axial and coronal sections. Statistical Analysis Used: Standard deviation, mean, and coefficient of variance were calculated. Interobserver reliability was evaluated using kappa value to avoid any bias. Results: The results from our study showed that 69.23% of the sample teeth had four canal orifices, the mesial and distal pulp horns were present at an average distance of 0.80 ± 0.36 mm and 0.41 ± 0.34 mm, respectively, above the cementoenamel junction (CEJ), and the mean distance from the central groove of central fossa to furcation and the central groove of central fossa to the pulp chamber's roof was 8.37 ± 0.33 mm and 3.87 ± 0.29 mm, respectively. The average distance of the pulp chamber's floor from the furcation was found to be 2.47 ± 0.11 mm. The highest degree of variance was observed in case of relation of CEJ to pulp horns, i.e., 44.85% and 82.60%. Conclusions: The dimensions observed in this study and its resemblance to the various studies reported in literature shift the fundamental anatomic approach to a more systemic quantifiable approach to the endodontic maxillary first molar access preparation.
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In vitro comparison of apical microleakage by spectrophotometry in simulated apexification using White Mineral Trioxide Aggregate, TotalFill Bioceramic Root Repair material, and BioDentine p. 237
M Juez, ML Ballester, E Berástegui
DOI:10.4103/JCD.JCD_19_19  PMID:31367105
Aim: The purpose of this study was to compare the sealing ability of various calcium silicate-based root-filling materials with a glucose leakage model after orthograde obturation using an open apex model. Materials and Methods: Thirty-two recently extracted human maxillary anterior teeth with single, straight root canals were selected and divided into four groups: Group 1 (G1), White Mineral Trioxide Aggregate; the material was delivered into the canal using the MAP system and further compacted with a specific plugger. Group 2 (G2), TotalFill bioceramic Root Repair material: the material was injected directly into the middle half of the root canal. Group 3 (G3), BioDentine; the material was delivered into the canal using the Hawe composite gun and prefitted pluggers. Statistical Analysis: Statistical analysis was performed using the SPSS 23.0 statistical software package. The Kruskal–Wallis nonparametric test was applied to compare the differences in glucose microleakage. Results: There were no significant differences among the three experimental groups. The results showed a tendency for leakage to increase from the 1st day to the end of experimental period. Conclusions: Within the parameters of this in vitro study, it may be concluded that the three materials evaluated present similar apical microleakage when treating teeth with open apices requiring orthograde delivery of an apical barrier.
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Comparing the antimicrobial efficacy of pediocin with chlorhexidine and calcium hydroxide as intracanal medicaments against persistent root canal infections p. 241
Hui Ying Ooi, Wan Yi Tee, Fabian Davamani, Venkateshbabu Nagendrababu
DOI:10.4103/JCD.JCD_521_18  PMID:31367106
Introduction: The aim of this study is to compare the antimicrobial activity of pediocin with chlorhexidine (CHX) and calcium hydroxide (Ca(OH)2) against Enterococcus faecalis and Staphylococcus epidermidis biofilms. Materials and Methods: The prepared root canals of 80 teeth were contaminated with E. faecalis (n = 40) and S. epidermidis (n = 40) for 21 days to create biofilms. The samples in each group were allocated randomly into the following four subgroups (n = 10) according to the decontamination protocol: Group 1: 1% Pediocin, Group 2: 2% CHX, Group 3: Ca(OH)2, and Group 4: saline (negative control). At 5 days, the antimicrobial efficacy of the medicaments against E. faecalis and S. epidermidis was assessed by collecting dentin shavings from the canal walls created using Gates Glidden drill sizes 4 and 5, corresponding to a depth into the root canal walls of 200 μm and 400 μm, respectively. The total number of colony-forming units (CFUs) was counted. The Wilcoxon signed-rank test was used to compare the difference in CFUs between the two depths (P > 0.05). Results: There was no bacterial growth in samples treated with pediocin, CHX, or Ca(OH)2 at either depth. Conclusion: In this laboratory experimental model, pediocin exhibited the same antimicrobial properties against E. faecalis and S. epidermidis as CHX and Ca(OH)2.
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Comparative evaluation of the effect of surface treatment of fiber-reinforced posts and prefabricated metal posts on adhesion of a resin-based luting cement: An in vitro study p. 245
Zarir R Ruttonji, Preethi B Kusugal, Ajaykumar Nayak, Deepa Mahajan, KM Sushma, Viraj N Patil
DOI:10.4103/JCD.JCD_402_18  PMID:31367107
Background: The purpose of this study was to evaluate the effect of surface treatment of fiber-reinforce post and metal post of adhesion of a resin luting cement. Materials and Methods: Sixty methyl methacrylate specimens were fabricated with a customized metal rod. The samples were segregated into six groups (F1, F2, F3, M1, M2, and M3) of 10 specimens (n = 10) each. The first three groups (F1, F2, and F3) were for fiber posts and (M1, M2, and M3) were for metal posts. The postspace preparation was done with dedicated drills supplied by the postmanufacturers to a length of 14 mm. F1 and M1 were the control groups. The posts in F2 and M2 groups were treated with airborne-particle abrasion with 70 μm Al2O3 particles for 5 s at a constant distance of 20 mm, cleaned with alcohol and cemented in the postspace. The posts in the F3 and M3 groups were treated with airborne-particle abrasion followed by primer application. After cementing the posts into the postspace, the acrylic blocks were sectioned with a motor-driven jigsaw to obtain four specimens each of 3-mm thickness. These sections were then subjected to push-out tests on a universal testing machine. Results: There was a statistically significant increase in the bond strength of both fiber and metal posts to resin cement after airborne-particle abrasion with Al2O3 particles and airborne abrasion followed by primer application. Conclusion: There is an increase in the bond strength of the resin cement with the prefabricated posts after the various surface treatments.
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Biocompatibility evaluation of Jordanian Portland cement for potential future dental application p. 249
Abubaker S Qutieshat, Ahmad S Al-Hiyasat, Homa Darmani
DOI:10.4103/JCD.JCD_552_18  PMID:31367108
Background: The demand for novel Portland cement (PC)-based formulations to be used in dental applications is ever increasing in viewing the foregoing knowledge on the favorable effects of these formulations on cellular proliferation and healing, leading to treatment success. Aim: This study investigated the effect of white and gray mineral trioxide aggregate (W-MTA and G-MTA) and white and gray Jordanian PC (W-PC and G-PC) in their raw state on the viability of Balb/C 3T3 fibroblasts using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Materials and Methods: Materials were prepared in the form of disks, with a diameter of 5 mm and a thickness of 2 mm. In the first experiment, Balb/C 3T3 fibroblasts were cultured with the material disks using culture plate inserts. In the second experiment, material elutes were added to cultured cells. The elutes were prepared by adding 2 ml serum-free media to 10 disks of each material and then incubated at 37°C for different time intervals. Material elutes were analyzed using ion chromatography for traces of calcium. The data were analyzed using analysis of variance followed by Dunnett test (α = 0.05) or Tukey test (α = 0.05). Results: In response to material disks, G-PC had a proliferative effect on cells at day 1 and day 2 with a significant difference from the control at day 1. G-MTA reduced cell viability with a significant difference from the control level at day 2. Elutes of PC showed biocompatible and even proliferative effects on Balb/C 3T3 fibroblasts. Calcium ions were found to leach continuously over the measurement period for all the materials tested in this work. Conclusion: Jordanian PC in its raw state was found to be biocompatible, and the results of this work give promise of its wider use as a base for further development to improve the physiochemical and mechanical properties of the material.
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In vitro assessment of interaction between lidocaine hydrochloride and sodium hypochlorite on root canal dentin before and after chemomechanical instrumentation procedures p. 255
Balasubramanian Saravanakarthikeyan, Shari Devarajan, Kolli Sankeerthana, Venkatappan Sujatha, Sekar Mahalaxmi
DOI:10.4103/JCD.JCD_565_18  PMID:31367109
Introduction: To investigate the effect of resultant precipitate formed on interaction between 2% lidocaine hydrochloride with adrenaline (LA) and 2.5% sodium hypochlorite (NaOCl) on root canal dentin before and after chemomechanical preparation, using scanning electron microscopy (SEM). Methods: Sixty mandibular premolars were decoronated, and the root length was standardized. All specimens were randomly distributed into the following three groups: Group I (control): 2% LA mixed with sterile water without root canal instrumentation, Group II: 2% LA with 2.5% NaOCl and no instrumentation, and Group III: 2% LA with 2.5% NaOCl, followed by mechanical instrumentation with rotary files. Teeth samples were sectioned into three parts, split and SEM analysis of the root canal wall was done at cervical, middle, and apical root thirds. Results: SEM images revealed patent dentinal tubules with no precipitate occlusion in the control group, whereas there was occlusion of dentinal tubules with a precipitate in all the specimens in Group II and Group III at all the three root levels studied. Conclusions: The precipitate formed on the interaction between 2% LA solution and 2.5% NaOCl tends to occlude the dentinal tubules at the coronal, middle, and apical root thirds. The chemomechanical rotary instrumentation procedure did not effectively remove the precipitate from all the three levels of the root specimens studied. LA/sterile water group did not result in any precipitate formation on root canal dentin.
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Comparative evaluation of the effectiveness and fracture rate of three pathfinding nickel-titanium rotary instruments, Mtwo, OneG, and ProGlider, in mechanically negotiating moderately curved molar canals to the full working length p. 260
Neelam U Jaiswal, Shivkumar P Mantri, Bonny Paul, Kavita Dube, Vaishnavi Singh, Nupur Bhatnagar
DOI:10.4103/JCD.JCD_487_18  PMID:31367110
Aim: To evaluate the scouting ability of three pathfinding nickel-titanium rotary instruments in moderately curved molar canals. Materials and Methods: Ninety maxillary and mandibular molars were collected and were divided randomly into three groups each having 15 maxillary and 15 mandibular molars. The teeth were mounted on a specific apparatus for simulation of dento-alveolar socket. After access cavity preparation, the canals were negotiated with 08 K-file. Glide path preparation was performed using Mtwo or ProGlider or OneG instruments. The number of teeth in which the file reached the full working length (RFWL), number of passes required, and number of fractured instruments were recorded and subjected to statistical analysis using Chi-square, Kruskal–Wallis, and Mann–Whitney tests. Results: There was a significant difference between the groups (P < 0.05). The RFWL of ProGlider was significantly higher than that of Mtwo (P = 0.005) and OneG (P = 0.037). The percentage of fracture with ProGlider was 6.67% and both Mtwo and OneG had 26.67% frequency. The difference was not statistically significant (P > 0.05). There was significant difference in the number of insertion passes in maxillary distobuccal (P < 0.05), mandibular mesiobuccal (P < 0.01), and distal (P < 0.01) canals. ProGlider was the most effective pathfinding instrument due to its file's design and a progressive taper of 2%–8%. This achieves a greater preflaring of the coronal and middle portions of the root canal, rendering the advance of the instrument toward the apex easier. Conclusion: ProGlider performed more efficiently and with less instrument breakage in scouting moderately curved canals of molar teeth.
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ORIGINAL ARTICLES: CONSERVATIVE DENTISTRY Top

Evaluation of the effect of micro-hydroxyapatite incorporation on the diametral tensile strength of glass ionomer cements p. 266
Farahnaz Sharafeddin, Saeedeh Karimi, Zahra Jowkar
DOI:10.4103/JCD.JCD_6_19  PMID:31367111
Aim: The aim of this study was to evaluate the effect of micro-hydroxyapatite (micro-HAP) incorporation on the diametral tensile strengths (DTSs) of a conventional glass ionomer cement (GIC) and a resin-modified glass ionomer cement (RMGIC). Materials and Methods: Forty disc-shaped specimens (diameter: 6.5 mm, height: 2 mm) were prepared into four groups (n = 10) as follows: group 1, conventional GIC; Group 2, GIC + micro-HAP (15 wt %); Group 3, RMGIC; and Group 4, RMGIC + micro-HAP (15 wt %). All the specimens were stored in distilled water for 24 h at room temperature. The DTSs of the specimens were measured using a universal testing machine. Data analysis was performed using one-way ANOVA and Tukey's test (P < 0.05). Results: No significant difference was found in the DTS of conventional GIC with and without micro-HAP incorporation (P > 0.05). Moreover, the DTS of RMGIC incorporated with micro-HAP was significantly lower than that of RMGIC without micro-HAP incorporation (P < 0.05). Conclusions: Micro-HAP incorporation did not affect the DTS of conventional GIC. The DTS of RMGIC was negatively influenced by the micro-HAP incorporation. Conventional GIC (with and without hydroxyapatite) exhibited a lower DTS than RMGIC (with or without hydroxyapatite).
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The causes of failure and the longevity of direct coronal restorations: A survey among dental surgeons of the town of Abidjan, Côte d'Ivoire p. 270
Marie-Chantal Avoaka-Boni, Stéphane X Djolé, Wendpoulomdé Aimé Désiré Kaboré, Yolande N D. Gnagne-Koffi, Alexandra F E. Koffi
DOI:10.4103/JCD.JCD_541_18  PMID:31367112
Objective: This study aimed to itemize the causes for the failure of direct coronal restorations (DCRs) according to the practitioners of Côte d'Ivoire in order to provide recommendations for good practice. Materials and Methods: A descriptive, self-reporting, prospective survey was carried out among 109 dental surgeons (DSs) in the town of Abidjan based on 587 randomly selected practitioners supplied by the National Board of the Order. Results: The results show that 98.10% of the surveyed DSs had previously encountered cases of failure. Fracturing of the restoration, which is the basis for the hiatus, is the main cause of failure according to 51.40% of the surveyed practitioners, followed by pain “under the restoration” cited by 26.20% of them. Failure occurs within 6 months (30.85% of those surveyed), after 5 years (9.6% of those surveyed) for restorations with composite or glass ionomer cement (GIC), while for DCRs with amalgam, failure occurs within 6 months (28.70%), after 5 years (16%) and beyond 10 years (3.20%). Conclusion: The practitioners often encountered failures of DCRs, with fracture of the restoration as the cause. Dental amalgam appears to have a greater longevity than adhesive restorations. Faced with a failure, they more often opted for a replacement of the DCRs rather than a repair.
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Two years survivability of VITA 3D master shade matching guides after disinfection with isopropyl alcohol: An in vitro study p. 275
MN Hombesh, B Praveen, Harsh Vardhan Sinha, BG Prasanna, Bhuvana Sachin, Shashidhar Chandrashekar
DOI:10.4103/JCD.JCD_573_18  PMID:31367113
Background: Dental shade guides are used before restorative and prosthodontic procedures for the evaluation of tooth color. The spectral coverage of the specific shaded guide and a clinician's experience in shade matching are the two most important factors for a clinically viable shade match of the restoration to the given tooth. Repeated disinfection of the shade guide with disinfectant lead to a clinically significant difference of the shade to be matched, finally resulting in a clinically unacceptable prosthesis. The purpose of this study is to evaluate the effects of disinfection on various shade tabs of VITA 3D Master Shade guide after being subjected to 2 years of simulated disinfection with 70% isopropyl alcohol. Methodology: Two sets of VITA 3-D Master Shade Guides were used. One set of each shade guide was assessed after simulated use and surface disinfection with 70% isopropyl alcohol (test group), while the other full set was subjected to cleansing with distilled water (control group). Spectrophotometer was used to measure each of the shade tabs. Readings were recorded at regular intervals of 120, 240, 360, 480, 600, 720, 840, and 960 disinfection cycles. The ΔE values obtained were used to examine the color difference. Results: There was a significant difference in terms of ΔE between the shade tabs of control and test groups of VITA 3D Master shade guides after 960 cycles of disinfection. The change in mean ΔE was more in the test specimens in the shade tabs of VITA 3D Master Shade Guide tabs than the control specimens. These results are of statistical significance, but they might not be of any clinical significance. Conclusion: There was a statistically significant but clinically nonsignificant color change in the shade tabs of VITA 3D Master shade guides after 2 years of simulated use and disinfection with 70% isopropyl alcohol.
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Efficacy of different remineralization agents on treating incipient enamel lesions of primary and permanent teeth p. 281
Fatih Tulumbaci, Aylin Akbay Oba
DOI:10.4103/JCD.JCD_509_18  PMID:31367114
Aims and Objectives: The aim of this study was to compare the in vitro efficacy of different remineralization (RM) agents on RM of artificial caries by evaluating the density, light reflection, and the crystal size of the newly formed mineral in primary and permanent teeth. Materials and Methods: Caries-free primary and permanent molars were divided into seven groups (n = 20) and treated with: G1 – Deionized water, G2 – Colgate Cavity Protection, G3 – Sensodyne Rapid Relief, G4 – GC MI Paste Plus, G5 – Clinpro Tooth Creme, G6 – Clinpro 5000, and G7 – Sensodyne Repair and Protect. Lesion depths were evaluated using laser fluorescence (DIAGNOdent), and polarized light microscopy (PLM), and the minerals were evaluated using X-ray diffractometry (XRD). Results: The highest decrease in laser fluorescence readings was observed in G6 for both primary and permanent teeth. No significant difference was observed between G2, G4, G5, and G6 in permanent teeth and G4 and G6 in primary teeth (P > 0.05). In PLM analyses, lesions depths were found to be lower in G6 compared to the other groups. No significant difference was observed between G2, G4, and G6 (P < 0.05). XRD evaluation showed that the newly formed mineral in G6 was denser and highly crystallized compared to the other groups. Conclusion: This in vitro study demonstrated that Clinpro 5000 is more efficient in remineralizing incipient enamel lesions compared to the other agents tested.
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Comparison of the fracture resistance of three different recent composite systems in large Class II mesio-occlusal distal cavities: An in vitro study p. 287
Yajuvender Singh Hada, Sumita Panwar
DOI:10.4103/JCD.JCD_225_18  PMID:31367115
Background: The present study was undertaken to evaluate the most suitable recent restorative material for extensively mutilated teeth. Aim: This study aims to evaluate and compare the fracture resistance of maxillary premolars with Class II mesio-occlusal distal (MOD) cavities restored with recent Ever X posterior, bulk-fill composite, and Estelite sigma quick composite systems. Materials and Methods: Sixty human maxillary premolars were selected. Fifteen intact teeth served as positive control (Group 1). MOD cavities were prepared in the remaining 45 teeth with standardized dimensions and were randomly divided into three experimental groups (Group 2, 3, and 4) (n = 15). Teeth in Group 2, 3, and 4 were reinforced with 3M ESPE Filtek Bulk-fill posterior, GC Ever X posterior, and Tokuyama Estelite sigma quick composites, respectively. Fracture resistance was measured in Newton (N). Results: Group 4 (1432.60 N) showed the highest mean fracture resistance followed by Group 3 (1326.20 N), Group 1 positive controls (1288.53 N), and Group 2 (946.66N), respectively. One-way analysis of variance (ANOVA) test revealed a statistically significant difference between all the groups (P = 0.005). Post hoc Tukey test revealed a statistically significant difference in mean fracture resistance between the Group 2 and Group 4 (P = 0.004), as well as between the Group 2 and Group 3 (P = 0.033). However, there were no significant differences among the other groups. Conclusion: Among the experimental groups, Estelite sigma quick composite showed the highest fracture resistance. Statistically, a significant difference was seen between all groups.
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Shear bond strength of composite resin to resin-modified glass ionomer cement using 2-hydroxyethyl methacrylate-based and 2-hydroxyethyl methacrylate-free adhesive system p. 292
Srishti Anil Pandey, Mohini Tukaram Lokhande, Meenal Nitin Gulve, Swapnil Janardan Kolhe, Gayatri Balasaheb Aher
DOI:10.4103/JCD.JCD_456_18  PMID:31367116
Background: Sandwich technique combines the properties of both composite resin and glass ionomer cement to make the most of the physical and esthetic properties of each material. Bonding agents improve the wettability of GIC surface and improves the bond between composite resin and GIC. The aim of this study was to evaluate and compare shear bond strength of composite resin to resin modified glass ionomer cement using HEMA-based and HEMA-free adhesive systems. An in vitro study. Materials and Methods: Total 30 disc-shaped samples were prepared with resin modified glass ionomer cement (RMGIC). Samples were divided into three groups, each group containing 10 samples. Group I (n=10): Nano-hybrid composite resin (NHCR) was bonded to RMGIC without any adhesive system. Group II (n=10): NHCR was bonded to RMGIC using hydroxyethylmethacrylate (HEMA)-based adhesive system. Group III (n=10): NHCR was bonded to RMGIC using HEMA-free adhesive system. The shear bond strength was tested using Universal testing Machine and the results were calculated using one way ANOVA and Post-Hoc test. Results: Maximum shear bond strength was recorded in group III where HEMA-free adhesive used with a mean value of 6.13±1.859 MPa followed by group II where HEMA-based adhesive used with mean value of 4.38±1.533 MPa. The control group showed least shear bond strength. Conclusion: Application of HEMA-free adhesive (OptiBond All-In-One) resulted in greater shear bond strength between RMGIC and composite resin than HEMA-based adhesive (Single bond Universal Adhesive).
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Comparison of fluoride ion release and alkalizing potential of a new bulk-fill alkasite p. 296
Nupur Gupta, Shikha Jaiswal, Vineeta Nikhil, Sachin Gupta, Padmanabh Jha, Parul Bansal
DOI:10.4103/JCD.JCD_74_19  PMID:31367117
Aim: This study was conducted to evaluate and compare fluoride ion release by Cention-N (self-cure and light-cure) and conventional glass-ionomer cement (GIC) at different pH and time intervals. Methodology: Cavities of similar dimensions were prepared in mandibular molars and restored with Cention-N (by self-cure and light-cure techniques) and GIC. Samples were stored in deionized water, and the cumulative fluoride ion release and change in pH were assessed utilizing spectrophotometer and pH meter, respectively, at the end of 7 days, 14 days, and 21 days. The data thus obtained were statistically analyzed. Results: All the tested materials released fluoride ions in both acidic and neutral pH at all time intervals, and the fluoride ion release was significantly higher (<0.05) in acidic pH as compared to neutral pH except in GIC. All the groups showed a statistically significant increase in pH in acidic medium, whereas no significant increase was observed in neutral medium. Conclusions: Cention-N (self-cure) has the highest fluoride ion release and alkalizing potential in acidic pH as compared to Cention-N (light-cure) and GIC.
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Comparative evaluation of effect of chlorhexidine, Azadirachta indica (neem), and Aloe barbadensis miller (Aloe vera) on resin-dentin bond stabilization using shear bond testing: An in vitro study p. 300
Shivika Goel, Dakshita Joy Sinha, Udai Pratap Singh, Urja Ahuja, Nida Haider, Nipun Sharma
DOI:10.4103/JCD.JCD_11_19  PMID:31367118
Introduction: Cavity disinfectants help to remove the microbial remnants; hence, its use prior to any restoration is valuable, and a search for alternative to chlorhexidine (CHX) is required which may be more efficacious and can overcome the drawbacks of CHX. Objective: The aim of this study was to evaluate the effect of application of three different cavity disinfectants in a clinically relevant time period on the immediate and delayed shear bond strengths (SBSs) of an etch-and-rinse adhesive system to dentin. Materials and Methods: For SBS testing, flat coronal dentin surfaces were prepared in two hundred extracted human molars. Specimens were randomly assigned to four groups according to the disinfectant used: Group I: Control (no disinfectant), Group II: 2% CHX solution, Group III: Aloe barbadensis miller (Aloe vera) solution, and Group IV: Azadirachta indica (neem) solution. Specimens were bonded using Prime and Bond NT adhesive which was employed according to the manufacturer's instructions. Resin composite cylinder buildups were done in all the samples. The modes of failure were noted after visual examination using a binocular stereomicroscope. Samples were also analyzed under scanning electron microscope for observation of resin-dentin interface. SBS results were analyzed using one-way ANOVA followed by Tukey's post hoc test. Results: The results showed that CHX, Aloe vera, and neem had improved bond strengths as compared to the control group for both immediate and delayed SBSs. Conclusion: From the results of the study, the authors concluded that Aloe vera and neem can be used as alternative cavity disinfectants to CHX.
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Remineralization potential of fluoride, amorphous calcium phosphate-casein phosphopeptide, and combination of hydroxylapatite and fluoride on enamel lesions: An in vitro comparative evaluation p. 305
Siddhesh Bandekar, Suvarna Patil, Divya Dudulwar, Prashant Prakash Moogi, Surabhi Ghosh, Shirin Kshirsagar
DOI:10.4103/JCD.JCD_13_19  PMID:31367119
Aim: The purpose of this study was to evaluate and compare remineralization potential of fluoride, amorphous calcium phosphate-casein phosphopeptide (ACP-CPP), and combination of hydroxyapatite (HAP) and fluoride on enamel lesions. Materials and Methodology: Ten intact caries-free human premolars were selected. The coronal portion of each tooth was sectioned into four parts to make four enamel blocks. The baseline surface microhardness (SMH) was measured for all the enamel specimens using Vickers microhardness testing machine. The artificial carious lesion was created by immersing the specimens in demineralizing solution for 3 consecutive days at 35° The SMH of each specimen was evaluated. All the four enamel sections of each tooth were subjected to various surface treatments, i.e., Group A – Fluoride varnish, Group B – ACP-CPP, Group C – Combination of HAP and fluoride (Clinpro), and Group D – Control group; no surface treatment. A carious progress test (pH cycle) was carried out which consisted of alternative demineralization (3 h) and remineralization using artificial saliva (21 h.) for 5 consecutive days. After pH cycling, SMH readings of each specimen were again assessed to evaluate remineralization potential of each surface treatment agent. Results: Data obtained were statistically analyzed using one-way ANOVA followed by Tukey–Kramer multiple comparison test which was applied to detect significant differences between different surface treatments at different phases of studies. Conclusion: Fluoride varnish shows higher remineralization potential of early carious lesion compare to ACP-CPP and Clinpro.
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CASE REPORTS Top

Allergic contact dermatitis from resin-modified glass ionomers p. 310
Glynn Dale Buchanan, Sheree Tredoux, Mohamed Yasin Gamieldien
DOI:10.4103/JCD.JCD_69_19  PMID:31367120
Monomers in a variety of dental materials may cause allergic contact dermatitis. While resin materials have been implicated in the onset of this condition, there is a paucity of evidence linking the condition to the resin-modified glass ionomers (RMGIs). This report documents a rare case of a dentist who developed allergic contact dermatitis following exposure to a RMGI. Contact dermatitis occurred despite the use of latex gloves, which were worn during the procedure. Both the acute and chronic stages of the condition were clinically represented. Patch testing was conducted to confirm the diagnosis. A no-touch technique and the routine use of nitrile gloves were subsequently adopted, which resulted in an overall decrease of the condition. Dentists, auxiliary personnel, and students should be aware of the possibility of sensitization to, and the development of allergic contact dermatitis not only from conventional resin materials, but also from the RMGIs.
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Multiple idiopathic cervical root resorption: Diagnosis, clinical/radiographical/histological presentation, and rehabilitation – A 7-year follow-up case report p. 313
Sidhartha Sharma, Pravesh Kumar, Veena Jain, Ajay Logani
DOI:10.4103/JCD.JCD_445_18  PMID:31367121
Multiple idiopathic cervical root resorption (MICRR) is a rare condition. The etiology is unknown and occurs spontaneously in healthy controls in the absence of local, systemic, or any other plausible cause. The teeth themselves appear clinically normal. The pattern of resorption begins in cementoenamel junction and can progress rapidly over a short time. It is a debilitating condition which often leads to extraction of all the involved teeth. This article describes a case of MICRR over a period of 7 years with emphasis on the history, clinical/histological findings, cone beam computed tomographic examination, therapeutic intervention as well as the final prosthodontic rehabilitation with implants.
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ERRATUM Top

Erratum: Dens invaginatus with necrotic pulp in a right maxillary lateral incisor with preserved vitality p. 318

DOI:10.4103/0972-0707.262065  PMID:31367122
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