Journal of Conservative Dentistry
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   Table of Contents - Current issue
January-February 2020
Volume 23 | Issue 1
Page Nos. 1-112

Online since Saturday, October 10, 2020

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From the Desk of the Editor… p. 1
Shishir Singh
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Systematic review on alternative methods for caries removal in permanent teeth p. 2
Vijayapriyangha Senthilkumar, Sindhu Ramesh
Introduction: Dental caries is the most common chronic dental disease in the world. It is defined as a multifactorial microbial infectious disease characterized by demineralization of the inorganic and destruction of the organic substance of the tooth. The host, flora, and the substrate should be there for the formation of dental caries. There are various microorganisms responsible for caries. The treatment for caries is essential to prevent teeth from involving pulp, leading to further damage. There are various methods in removing caries such as minimally invasive technique, rotary method with different types of burs, chemomechanical caries removal, and lasers. There are no data in literature for various methods of removing caries in permanent teeth. Materials and Methods: Research question was formulated based on the PICO strategy. A comprehensive electronic literature search was conducted, independently by two reviewers. Based on the specified inclusion and exclusion criteria's, the selected articles were subjected to quality assessment and the risk of bias was evaluated. Objective: The objective of this study was to evaluate the efficiency of caries removal by various methods in permanent teeth. Search Strategy: A search was performed in electronic database (i.e. PubMed and Medline) using search terms alone and in combination by means of PubMed search builder from January 1985 to January 2018. Selection Criteria: Studies were selected if they met the following criteria: in vivo studies comparing various methods of caries removal in permanent teeth. Results: The search identified 338 publications, out of which 328 were excluded after examination of the title and 2 were excluded after examination of the abstract. Through the hand search, three articles were included. Eight articles were retrieved for more detailed evaluation from the search. A total of 11 publications fulfilled all the criteria for inclusion. Conclusion: With the available evidence, this review concludes that the studies included in this review have a high risk of quality evidence.
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Ex vivo ability of a noninstrumentation technique to disinfect oval-shaped canals Highly accessed article p. 10
Ghassan Yared, Ghada Asmar Ramli
Context: Oval-shaped canals represent a challenge in endodontics. Infected tissue may remain in their recesses. This concern may be more critical with minimally instrumentation techniques. Aims: The present study evaluated the disinfection ability in oval-shaped canals of a noninstrumentation technique using ultrasonic agitation and intracanal heating of sodium hypochlorite (NaOCl) compared to rotary canal preparation and ultrasonic agitation with and without heating of NaOCl. Settings and Designs: Sixty extracted mandibular incisors were included. The teeth had pulp necrosis and apical periodontitis and oval-shaped canals. They were divided into three groups depending on the treatment protocol: (1) IHAN: intracanal heating and ultrasonic agitation of NaOCl only, (2) R-IHAN: Rotary preparation followed by IHAN, and (3) R-passive ultrasonic agitation (PUA): Rotary preparation and ultrasonic agitation of NaOCl. Methods: Root canal samples were taken before (S1) and after (S2) the endodontic procedures were completed and cultured anaerobically. Statistical Analysis Used: Wilcoxon tests were performed to compare colony-forming units (CFUs) before and after the endodontic procedures for the three groups. The percentage of variation of CFUs was compared among the three groups using Kruskal–Wallis tests, followed by Mann–Whitney U-tests. Results: All S1 samples were positive. All S2 samples showed bacterial growth in R-PUA compared to 17 in R-IHAN. None of the S2 samples in IHAN were positive. Bacteria reduction was significant in each group (P < 0.001). The percentage of bacteria reduction was highest for IHAN and lowest for R-PUA (P < 0.001). Conclusions: Intracanal heating and ultrasonic agitation of NaOCl without instrumentation completely eliminated bacteria from infected oval-shaped canals.
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The effect of adding graphene oxide nanoplatelets to Portland cement: Potential for dental applications p. 15
Abubaker S Qutieshat, Ahmad S Al-Hiyasat, Mohammad R Islam
Background: The potential of graphene-based materials to improve the physiomechanical properties of Portland cement-based materials without compromising biocompatibility is of interest to dental researchers and remains to be discovered. Aim: This study investigated the effects of adding graphene oxide nanoplatelets (GONPs) on the surface microhardness and biocompatibility of Portland cement. Materials and Methods: Three prototype Portland cement powder formulations were prepared by adding 0, 1, and 3 wt % GONPs in powder form to Portland cement. Prototype cement specimens were in the form of disks, with a diameter of 10 mm and a thickness of 2 mm. In experiment 1, surface microhardness was measured using the through indenter viewing hardness tester, 20 surface hardness values were obtained from all specimens. In experiment 2, Balb/C 3T3 fibroblasts were cultured with the material disks and the viability of cells was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Statistical Analysis: The data were analyzed using the analysis of variance followed by Dunnett test (α = 0.05) or Tukey test (α = 0.05). Results: In response to material disks, the addition of 1 wt % GONPs had a proliferative effect on cells at day 3 and day 7 with a significant difference from the control. The addition of 3 wt % GONPs showed a remarkable increase in surface microhardness; however, it exhibited initial cytotoxicity. Conclusions: The addition of 1 wt % GONPs to Portland cement improved surface microhardness without compromising biocompatibility; therefore, it has a greater potential for dental applications. The results of this work give other researchers leads in future assessments of this prototype material.
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The incidence of nickel-titanium endodontic hand file fractures: A 7-year retrospective study in a tertiary care hospital p. 21
Arun Kumar Patnana, Ankita Chugh, Vinay Kumar Chugh, Pravin Kumar
Aim: The present retrospective cross-sectional study aims to evaluate the incidence and factors associated with nickel-titanium hand file fractures in root canal-treated teeth in a tertiary care hospital of western India. Methodology: The diagnostic records of intraoral periapical (IOPA) radiographs were analyzed to check for file fractures in the root canal-treated teeth. As a part of standardized departmental protocol, Hand ProTaper Universal file system (Dentsply, India) was used for chemomechanical preparation for root canal treatment. The file fractures were analyzed with reference to age group, type of teeth, curvature of the canal, site of file fracture in the canal, length of file fracture, level of file fracture, distance of the file fracture from the apex, and obturation status of the file-fractured tooth. Chi-square test was applied to assess the significance difference between the tested groups. Results: A total of 19,810 IOPA X-rays were screened and 2728 root canal-treated teeth were found and of these 2728 cases, 109 file-fractured teeth were observed. Conclusion: The total incidence of file fractures was 3.9/100 root canal-treated cases, and mandibular molars with severely curved canals (>25°) had shown the maximum incidence of file fractures.
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Evaluation of push-out bond strength of BioRoot RCS and AH Plus after using different irrigants: An in vitro study p. 26
Ankita Srivastava, Deepa S Yadav, Murali Rao, H Murali Rao, A Arun, Riluwan Siddique
Aim: The aim of this study was to compare push-out bond strength of root canal spaces filled with AH-Plus and BioRoot RCS after using different irrigants. Materials and Methods: Eighty single-rooted teeth were decoronated and endodontically treated by crown-down technique using ProTaper Universal rotary files progressively till F4 (40/0.06). Samples were divided into two groups according to the sealer (n = 40): Group A = BioRoot RCS, Group B = AH Plus, further subdivided into four subgroups according to irrigation protocol (n = 10): Group 1A, 1B – 0.9% saline, Group 2A, 2B – 5.25% NaOCl + 17% EDTA, Group 3A, 3B– 17% EDTA +2% chlorhexidine, and Group 4A, 4B – 17% EDTA + 3% green tea extract. Samples were obturated with sealers and prepared for push-out test with root slices of 2 mm thickness using universal testing machine. Data were statistically analyzed using two-way ANOVA, Bonferroni's post hoc analysis, and independent Student's t-test. Results: BioRoot RCS exhibited significantly higher push-out bond strength (n < 0.001). The interaction between irrigants and sealer showed higher bond strength for BioRoot RCS when 17% EDTA+ green tea was used. Conclusion: Within the limitation of the study, it was concluded that bond strength of a sealer was influenced by the irrigants used.
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Influence of operator experience on bond strength of different adhesives to dentin p. 32
Neslihan Arhun, Bercem Kalender, Duygu Tuncer, Begum Berkmen, Cigdem Celik
Aim: Application of adhesive systems on dentin is a multistep, technique-sensitive procedure. Thus, the aim was to assess the effect of operator experience on the shear bond strength of an etch-and-rinse adhesive system and a self-etch adhesive system on dentin. Materials and Methods: Forty-eight extracted human molar teeth were used in the study. They were embedded in an acrylic resin after cutting off the roots. The mesial and distal enamels of the teeth were removed to expose dentin surfaces. The samples were allocated to four groups (n = 12): Group 1: restorative dentistry specialist with 13 years of experience, Group 2: with 6 years of experience, Group 3: postgraduate operator with 2 years of experience, and Group 4: undergraduate student with 1 year of experience and familiar with adhesive with systems. Each operator applied an etch-and-rinse adhesive system (Adper Single Bond 2) to mesial surface and a self-etch adhesive system (Clearfil SE Bond) to distal surface (n = 12). Then, a composite resin (Filtek Z250) was inserted with the aid of a plastic ring (2 mm × 2 mm) and light polymerized. The specimens were stored in distilled water before shear bond strength test. A two-way ANOVA test was used for statistical analysis. Results: No statistically significant difference was found between each operator type with respect to etch-and-rinse adhesive system (P > 0.05); however, the undergraduate student performed better than 2-year experienced operator with respect to self-etch system application (P < 0.05). Conclusion: The shear bond strength of a self-etch system might vary according to the operator's experience.
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Bonding performance and mechanical properties of flowable bulk-fill and traditional composites in high c-factor cavity models p. 36
Leticia Virginia Freitas Chaves, Rodolfo Xavier de Sousa Lima, Lucas José de Azevedo Silva, Roberta Caroline Bruschi Alonso, Saulo Geraldeli, Boniek Castillo Dutra Borges
Objectives: The aim of this study is to evaluate bond strength (BS), shrinkage stress (SS), flexural strength (FS), and elastic modulus (E) of three flowable bulk fill in comparison with conventional composites. Materials and Methods: Three bulk fill (Filtek Bulk Fill Flow, Surefil SDR, X-tra Base) and three conventional composites (Filtek Z250 XT, Grandioso, Dentsply TPH3) were used. For BS, conical cavities (n = 10) were prepared in bovine dentine and restored with materials and were analyzed through push-out test in a universal testing machine (UTM). For FS/EM, 60 (n = 10) bar specimens (7 mm × 2 mm × 1 mm) were prepared and evaluated with a UTM. SS was measured in UTM coupled to an extensometer (n = 5). The data were statistically evaluated using one-way ANOVA/Tukey tests (P < 0.05). Results: Conventional composites showed higher E when compared to bulk-fill composites. Regarding FS, they showed similar results, except for (XBF) Xtra Bulk Fill that was inferior. SS and BS of bulk-fill composites were significantly lower and higher than conventional composites, respectively, except for XBF, which showed similar BS to conventional ones. Conclusions: Flowable bulk-fill composites, except XBF, showed higher BS, lower SS, similar FS, and lower E when compared to conventional ones.
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Assessment of the viability of human periodontal ligament cells in black tea, lime juice, and passion fruit concentrate – A comparative in vitro study p. 42
K Deepthi, Bikash Jyoti Borthakur, B Swathika, S Ganesan
Background: Tooth avulsion is considered as a severe form of dental trauma, causing damage to the periodontium. Hence, the preservation of healthy periodontal ligament (PDL) cells in the storage medium are pivotal for the success of replantation. Aim and Objective: The aim of this study is to assess the viability of human PDL cells in black tea, lime juice, and passion fruit concentrate. Methods: Human periodontal cells were cultured and stored in three experimental media – black tea, lime juice, and passion fruit concentrate and subjected to 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay for 1 h and the cell viability was determined. Mean and standard deviation were statistically analyzed using one-way analysis of variance to identify the significant groups. Results: The human PDL cells showed 100% viability in lime juice and passion fruit concentrate, followed by 98% viability in black tea. Conclusion: Black tea, lime juice, and passion fruit concentrate can be used effectively as storage media for maintaining PDL cells viability in avulsed teeth, with 100% viability exhibited by lime juice and passion fruit concentrate.
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Comparative evaluation of substantivity of two biguanides - 0.2% polyhexanide and 2% chlorhexidine on human dentin p. 46
Rita Chandki, Vineeta Nikhil, S Sai Kalyan
Background: Substantivity is one of the desirable characteristics of root canal irrigants. Among conventional endodontic irrigants, only chlorhexidine (CHX) is known to exert significant substantivity on root canal dentin. This study explored the substantivity activity of a polymeric biguanide-poly hexamethylene biguanide (PHMB). Aim: The aim of this study was to determine the substantivity of a polymeric biguanide - 0.2% PHMB and compare it with that of 2% CHX. Materials and Methods: To evaluate and compare the substantivity of 0.2% PHMB and 2% CHX on root canal dentin, dentin disks were prepared and substantivity after 1 h, 24 h, 7 days and 21 days was measured using spectrophotometry. Statistical Analysis Used: The data so obtained were analyzed, and the intergroup comparison was made using unpaired t-test. Results: The results of this study indicated that 0.2%. PHMB exerts significantly greater substantivity than 2% CHX on human dentin. Conclusion: Within the limitations, this study supports the use of 0.2% polyhexanide as an endodontic irrigant based on its property of substantivity.
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To assess the occurrence of middle mesial canal using cone-beam computed tomography and dental operating microscope: An in vitro study p. 51
Manjiri Nagesh Honap, Darshana Devadiga, Mithra N Hegde
Introduction: Failures of root canal treatments are mainly attributed to missed canals and ignorance about the complex anatomy of the root canal system. One such example of anatomic variation is the middle mesial canal (MMC) in mandibular molars which is often missed, and literature on methods for identifying them is limited. Aim: This in vitro study aimed to assess the occurrence of MMCs with cone-beam computed tomography (CBCT) and then under magnification in the mandibular first and second molars. Materials and Methodology: A total of 120 extracted intact human permanent mandibular first and second molars were selected. These were subjected to CBCT imaging and magnification for the detection of MMCs. The percentage of incidence in the detection of MMC was compared between these two methods. Results: The incidence of MMC detected in mandibular molars using CBCT was 13.33% (16 of 120 teeth), while using a dental operating microscope, the incidence was 18.33% (22 of 120 teeth) and the comparison between the two methods was statistically not significant. Conclusions: Since the incidence of MMC was higher with the use of a microscope, it is preferred to use simpler, chairside aids like magnification and ultrasonic troughing. On the other hand, one should be judicious while subjecting a case to preoperative CBCT evaluation owing to its ionizing radiation.
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Surface quality and color stability of posterior composites in acidic beverages p. 57
Chappidi M Meenakshi, Kantheti Sirisha
Context: Consumption of acidic beverages has been reported to alter the physical and esthetic properties of resin composites, which in turn can affect clinical success. Aims: This study aimed to evaluate the effect of acidic beverages on surface roughness and color stability of Filtek™ Bulk-Fill posterior restorative composite in comparison with Filtek P60 posterior restorative composite. Settings and Design: Ninety composite discs were used for surface change analysis and another ninety were used for color change analysis. Materials and Methods: Ninety Filtek P60 and Filtek Bulk-Fill composite discs were fabricated and divided into three subgroups according to the solutions – artificial saliva (control group), orange juice, and Coca-Cola® (test groups). The samples were immersed in each beverage for 10 min each day for 56 days. To measure the surface roughness, a profilometer was used, and the surface was qualitatively analyzed using a scanning electron microscope. A reflectance spectrophotometer was used for assessing the color change. Statistical Analysis Used: Two-way analysis of variance was used to compare the surface alteration and color change values between the two composite groups and their respective three subgroups. Tukey's multiple post hoc test was performed for pair-wise comparison. Results: Filtek P60 had exhibited higher color change than Filtek Bulk-Fill in all immersion solutions. Coca-Cola resulted in highest staining in both the composites. Conclusions: The surface roughness and color change of both composites increased significantly in acidic beverages and more in Coca-Cola. Bulk-fill exhibited better surface quality and color stability than P60.
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Sealing ability of three different root repair materials for furcation perforation repair: An in vitro study p. 62
Abhijeet K Kakani, Chandrasekhar Veeramachaneni
Aim: The present study aimed to evaluate and compare the sealing ability of mineral trioxide aggregate (MTA)-Angelus, Biodentine™, and EndoSequence cement in furcation perforations using protein leakage assessment. Materials and Methods: The present study was conducted using seventy extracted human maxillary and mandibular molars with intact furcation. The samples were randomly allocated into three groups (n = 20) based on repair material used: Group 1 – MTA-Angelus, Group 2 – Biodentine™, and Group 3 – EndoSequence. Two additional groups served as positive and negative controls (n = 5). Using the leakage assessment apparatus, the presence of protein was detected with a reagent (Coomassive Brilliant Blue) every day for 60 days. One-way ANOVA and post hoc Tukey's test were used for statistical analysis using SPSS software. Results: All the groups exhibited protein leakage from day 1. Biodentine showed minimum (0.1201 mg/ml), MTA showed maximum (0.3738 mg/ml), and EndoSequence had intermediate (0.2465 mg/ml) leakage. None in the negative control and all of the positive control specimens leaked during the experimental period of 60 days. Conclusion: The newer biomaterials, Biodentine and Endosequence with better handling properties, could be used as alternatives to MTA-Angelus while repairing furcation perforations.
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Comparative evaluation of the effect of 10%, 20%, and 30% guava seed extract on reversing compromised resin bond strength after enamel bleaching in 120 min, 10 min, and 5 min: An in vitro study p. 66
Mohnisha Shahi, G Ratna Velugu, Ekta Choudhary
Background: Bonding of composite with enamel and dentin gets compromised if the tooth is restored with composite immediately post bleaching. The application of antioxidants has shown to have a positive effect on it. Aim: The aim of this study was to evaluate and compare the effect of guava seed extract solutions in various concentrations on the shear bond strength (SBS) of composite resin to bleached enamel when applied for 5 min, 10 min, and 120 min. Materials and Methods: Fifty-five maxillary incisors were procured, and labial surfaces of 50 specimens were bleached with 37.5% hydrogen peroxide. These specimens were divided into 3 experimental groups: Group 1–3 comprising 15 specimens each (n = 15), and the remaining specimens were divided into two groups: Group 4 (positive control group) and Group 5 (negative control group). Groups 1–3 were further divided into 3 subgroups according to the application period of antioxidant: subgroups A, B, and C. Specimens were stored in distilled water for 24 h. SBS testing was done using the universal testing machine. Data were tabulated and subjected to statistical analysis using a three-way analysis of variance with post hoc Tukey's test. Results: Guava seed extract showed a complete reversal of the compromised bond strength, and promising results were seen with increased concentration. Conclusion: The use of antioxidants effectively reversed the compromised bond strength of bleached enamel, and an increase in the concentration of antioxidants reduces the duration of its application.
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A comparative evaluation of smear layer removal by using ethylenediamine tetraacetic acid, citric acid, and maleic acid as root canal irrigants: An in vitro scanning electron microscopic study p. 71
Ravneet Kaushal, Ramta Bansal, Sunil Malhan
Introduction: Irrigants remove or dissolve smear layer formed during instrumentation. Thus it is important to study the effect of different irrigant solutions on smear layer removal. Objectives: The aim of this study is to determine which irrigant effectively removes the smear layer from the coronal, middle, and apical third of the root canal. Materials and Methodology: One hundred and twenty single-rooted mandibular premolars were decoronated and biomechanical preparation was done through hand instrumentation up to size 40 k file with 2.5% NaOCl irrigation between each successive filing, followed by irrigation with 5 ml of saline. The teeth were divided into Groups I, II, III, and IV containing 30 samples each and irrigated with 5 ml of 17% ethylenediamine tetraacetic acid (EDTA), 10% Citric acid, 7% Maleic acid and normal saline respectively for 1 min and final irrigation was done with 5 ml of distilled water of each sample. The canals were dried with 2% absorbent paper points. The roots were then split with a chisel and mallet. One-half of each tooth was selected and then was analyzed using a scanning electron microscope. The dentinal surfaces were observed at the cervical, middle, and apical third with ×2000 for the smear layer. The scores were attributed, according to Torabinejad et al. rating system. Results: 7% maleic acid and 10% citric acid both are equally effective in smear layer removal from coronal and middle third, but in apical third 7% maleic acid is more effective than 10% citric acid. Between citric acid and EDTA, both are equally effective in smear layer removal from coronal and middle third, but in apical third, 10% citric acid is more efficacious than 17% EDTA. Conclusion: Within the limitations of the study, it can be concluded that all three tested irrigants removed the smear layer from coronal, middle, and apical third. However, in apical third 7% maleic acid is the most efficacious irrigant in smear layer removal.
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Novel bioactive caries-detecting dye solution: Cytotoxicity, antimicrobial activity, scanning electron microscope, and stereomicroscopic analysis in diagnosis of dental caries p. 79
Govind Shashirekha, Amit Jena, Neeta Mohanty, Sushanta Kumar Kamilla
Aim: The aim was (1) to study the cytotoxicity of novel Bioactive Caries-detecting Dye solution (BCD) and its antimicrobial activity against Streptococcus mutans, Lactobacillus acidophilus, Actinomyces naeslundii, and Candida albicans and (2) comparative assessment of BCD and Carie-Care for efficient removal of caries (stereomicroscope) and dentin tubule occlusion (scanning electron microscope [SEM]). Materials and Methods: For BCD cytotoxic study (direct contact method), colorimetric MTT assay, and cell line study(L929 mouse fibroblast NCTC clone 929 strain L) was performed. Xenetix 350, chitosan, nanohydroxyapatite (nHA), BCD, and Carie-Care solutions were subjected to the antimicrobial activity through blood agar well diffusion method, and the minimum inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were determined. On 20 extracted human carious teeth a comparative pilot study was done for BCD (Group A, n = 10) and Carie-Care (Group B, n = 10), and evaluated visually and radiographically. After mechanical excavation of caries with a spoon excavator, teeth sectioned longitudinally and stereomicroscopically were evaluated (8x–40x) by two observers. The percentage of dentinal tubule occlusion was evaluated with SEM for both solutions. Statistical kappa analysis of agreement was 0.7–0.8 (P < 0.01). Mann–Whitney test ranks and Wilcoxon signed-rank test (P = 0.01) were applied. Results: Cytotoxicity test revealed BCD to be nontoxic and biocompatible. Antimicrobial tests (zone of inhibition) showed BCD > chitosan > chlorhexidine > Carie-Care > Xenetix 350 > nHA. MIC and MBC values suggested chlorhexidine > BCD > Carie-Care. Stereomicroscopic analysis showed effective mechanical removal of caries in BCD without residual dye in the dentinal tubules as compared to Carie-Care. Dentinal tubule occlusion (SEM analysis) was 80%–85% for BCD and 10% for Carie-Care. Conclusions: Profound synergistic effect for BCD was observed with advantage of radiographic assessment.
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An in vitro evaluation of dentinal tubule occlusion using three desensitizing methods: A scanning electron microscopic study p. 86
Rosemary Corneli, Advith Kolakemar, Aftab Damda, Rajaram Naik
Aim: The aim is to compare the effects of diode laser, GC tooth mousse, and sodium fluoride (NaF) varnish on dentinal hypersensitivity by scanning electron microscopic (SEM) evaluation. Materials and Methods: Forty extracted human maxillary first premolar teeth were selected to prepare dentin disc of 2 mm thickness. The specimens were divided into four groups of 10 discs each-Group 1: Negative control, Group 2: Diode laser, Group 3: GC tooth mousse, and Group 4: NaF varnish. Diode laser and NaF was exposed on dentin disc for three consecutive days. GC tooth mousse was applied twice a day for 1 week. All the specimens were examined under SEM at a magnification of ×1500. The standardized SEM microphotographs were analyzed according to the scoring criteria. Statistical Analysis: Friedman test with post hoc Wilcoxon sign rank test for pair wise comparison at different time intervals within the group was computed using SPSS version 20. A P < 0.05 was regarded as statistically significant. Results: The results showed that the use of diode laser was able to achieve complete occlusion of dentinal tubules followed by the use of GC tooth mousse and that of NaF varnish while control group showed completely open tubules. Conclusions: Irradiation of dentinal tubules using diode laser could be effective for routine clinical treatment of dentinal hypersensitivity compared to NaF and GC tooth mousse.
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Comparative evaluation of retreatment techniques by using different file systems from oval-shaped canals p. 91
Rucheet Purba, Snehal S Sonarkar, Rajesh Podar, Shishir Singh, Shashank Babel, Gaurav Kulkarni
Introduction: Endodontic failure resolves after complete removal of obturating material followed by disinfection, cleaning, shaping and three-dimensional obturation. Materials and Methods: Seventy single-rooted mandibular premolars, with single oval-shaped root canal were included. They were decoronated at a length of 16 mm from the apex. Shaping and cleaning were performed, and obturation was done using the warm lateral compaction technique. The teeth were divided into seven groups according to retreatment procedures (Hand files; ProTaper Universal retreatment files; MTwo® Retreatment system; R-Endo® Retreatment system; ProTaper Universal retreatment files with solvent and ultrasonics; MTwo® R with solvent, and ultrasonics and R-Endo® with solvent and ultrasonics). The data were obtained and subjected to the statistical analysis. Results: All instrumentation techniques left obturating material with least in Group 6 and maximum Group 5. The mean time taken for complete retreatment procedure was minimum in Group 2 and maximum with Group 1. Conclusion: MTwo® R with solvent and ultrasonics, R-Endo®, and R-Endo® with solvent and ultrasonics were effective in gutta-percha removal from coronal third, middle third, and apical third, respectively. Significance: Nonsurgical endodontic retreatment using rotary files helps in gaining access to infected teeth. During retreatment procedure, this helps disinfectant to reach in critical areas of the root canal system, thereby decreasing the microbial load, leading to achieve healthy periradicular tissues.
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A comparative evaluation of the antibacterial efficacy of Thymus vulgaris, Salvadora persica, Acacia nilotica, Calendula arvensis, and 5% sodium hypochlorite against Enterococcus faecalis: An in-vitro study p. 97
Divya Gupta, Sharad Kamat, Santosh Hugar, Girish Nanjannawar, Ravindra Kulkarni
Objectives: The aim of this study is to evaluate and compare the antibacterial efficacy of Thymus vulgaris, Salvadora persica, Acacia nilotica, Calendula arvensis, and 5% sodium hypochlorite against Enterococcus faecalis. Methodology: Herbal extracts of T. vulgaris, S. persica, A. nilotica and C. arvensis were prepared. Tryptone soya broth was used to grow E. faecalis and agar plates were prepared. The tested solutions (Group A: 5% NaOCl, Group B: 20% T. vulgaris, Group C: 12.5% S. persica, Group D: 10% A. nilotica, Group E: 10% C. arvensis) were added to the wells made on agar media. Agar diffusion test was performed. Plates were incubated at 37°C for 24 h. Bacterial zones of inhibition were recorded. Results: The data were analyzed statistically by Analysis of Variance (ANOVA) and post hoc comparison by Tukey's t-test. The highest zone of inhibition against E. faecalis was shown by 5% NaOCl, followed by 10% C. arvensis, 20% T. vulgaris and 10% A. nilotica showed similar comparable antibacterial activity. The least zone of inhibition was showed by S. persica. Conclusion: 5% NaOCl showed the maximum antibacterial activity, and herbal products demonstrated significant antibacterial activity against E. faecalis and can be employed as an alternative to NaOCl.
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Management of root canal stenosis and external inflammatory resorption by surgical root reconstruction using biodentine p. 102
Vineet Suresh Agrawal, Sonali Kapoor
Root canal stenosis and external inflammatory root resorption are potential consequence of trauma that can occur depending on the severity of the injury. Luxation injuries induce reduced blood supply to the pulp, which leads to calcification/narrowing of root canals leading to root canal stenosis. External inflammatory cervical resorption occurs when there has been the loss of cementum due to damage to the external surface of tooth root during trauma, plus root canal system becoming infected with bacteria. External inflammatory resorption can ultimately lead to loss of tooth if it is not managed in a timely manner. The treatment should aim toward the complete suppression of all tissues undergoing resorption and the reconstruction of the resorptive defect by the placement of a suitable bioactive material. This case report presents the management of root canal stenosis in the maxillary left central incisor in 35-year-old female and management of Class IV external invasive cervical and apical inflammatory resorption in maxillary right central incisor, both of which were diagnosed with the help of cone-beam computed tomography scan. The treatment of external inflammatory resorption included surgical excision of granulation tissue and root reconstruction with Biodentine. Twelve months follow-up showed successful outcomes for both the teeth treated for root canal stenosis and external invasive inflammatory resorption leading retention of the traumatized teeth with otherwise poor prognosis.
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Rehabilitation of a mutilated maxillary central incisor using autogenous dentin post Highly accessed article p. 107
Sudha Kakollu, Murali Mohan Thota, Sravanthi Tammineedi, Lakshman Chowdary Basam
Ideal coronal restoration that provides satisfactory esthetic and functional outcome for endodontically treated and extensively damaged teeth is still an arduous task for restorative dentistry. None of the available post systems have all the ideal biological and mechanical properties. Biological dentin posts are considered as a good alternative to conventional post systems as they preserve dentin walls, which results in better distribution of forces along the root surfaces in the compromised tooth. This case report is an attempt to detail “autogenous dentin post” which serves as a homologous unit for the reinforcement of endodontically treated tooth by virtue of its biomimetic property.
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Textbook of conservative and restorative dentistry p. 111
Arpit Sikri, Jyotsana Sikri
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Erratum: A comparative evaluation of fracture resistance of endodontically treated teeth using four different intraorifice barriers: An in vitro study p. 112

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