Journal of Conservative Dentistry
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July-August 2020
Volume 23 | Issue 4
Page Nos. 319-427

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EDITORIAL  

From the Desk of the Editor … The new dawn - Hope in the pandemic p. 319
Shishir Singh
DOI:10.4103/0972-0707.307156  
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INVITED REVIEW Top

Preferred Reporting Items for study Designs in Endodontology (PRIDE): Guiding authors to produce high.quality manuscripts p. 320
Venkateshbabu Nagendrababu, Paul M H. Dummer
DOI:10.4103/JCD.JCD_605_20  
Implementing evidence-based dentistry involves a systematic process that includes collecting and analyzing evidence to address a clinical question. However, the inadequacy of many manuscripts and the incomplete and often misleading information they provide when published in healthcare journals are of major concern. The literature confirms that reporting guidelines improve the overall completeness and transparency of manuscripts in the field of oral health research. To improve the overall quality and clinical translation of studies in Endodontology, a new suite of guidelines under the umbrella of the Preferred Reporting Items for study Designs in Endodontology (PRIDE) project has been developed. Under the PRIDE project, five reporting guidelines focusing on specific study designs within the specialty either have or are in the process of being developed: (Case reports: Preferred Reporting Items for Case reports in Endodontics (PRICE); Randomized clinical trials: Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE); Laboratory studies: Preferred Reporting Items for Laboratory studies in Endodontology (PRILE); Animal studies: Preferred Reporting Items for Animal Studies in Endodontology (PRIASE) and Observational studies: Preferred Reporting items for OBservational studies in Endodontics (PROBE). For each guideline, the project leaders (VN, PD) formed a steering committee made up of experts from across the globe. Each steering committee developed an initial draft checklist containing a list of proposed items related to the specific study design to fit the specialty of Endodontology. In addition, a flowchart to graphically illustrate the process involved in the development of a manuscript was created to accompany each individual guideline. Each steering committee then formed a Delphi panel that included approximately 30 experts from across the globe who commented individually and anonymously upon the items to be included in each checklist and flowchart until a consensus was achieved. The draft checklists and flowcharts were then discussed during face-to-face or online meetings of approximately 20 experts to further debate and refine each guideline, which were then piloted by several authors while writing a manuscript. Eventually, each guideline (checklist and flowchart) will be published along with supporting material as well as being freely accessible on the PRIDE website (www.pride-endodonticguidelines.org). The PRIDE guidelines will help authors produce high-quality manuscripts in the discipline of Endodontology.
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REVIEW ARTICLE Top

India's contribution to regenerative endodontics: A bibliometric analysis p. 325
Arunakshi Krishnan, Aakriti Saini, Sidhartha Sharma, Vijay Kumar, Amrita Chawla, Ajay Logani
DOI:10.4103/JCD.JCD_178_20  
Regenerative endodontics (RE) is a dynamic field with widespread global impact. The aim of this bibliometric analysis is to highlight India's contribution in the field. Electronic search was performed in PubMed and Web of Science database till December 2019 using the search terms “Dental pulp regeneration,” “Pulp revascularisation,” “Revitalisation,” “Regenerative endodontic,” and their permutation. Articles of Indian authors with affiliation to Indian institutes were included. The following data were extracted: first author, institute and state of affiliation, year and journal of publication, study design, level of evidence (LOE), and number of citations. A total of 76 articles (case reports [n = 29, 38.15%], review [n = 25, 32.8%]) were published between 2008 and 2019. Majority (42.6%) were categorized as LOE 4. 7.4% articles were in LOE1 category. Eight percent articles had citations above 100 (highest cited-354 citations). The average yearly growth rate between 2011 and 2019 was 33.28% and highest number of publications was in the year 2015. The south zone had the maximum publications. At an institutional level, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, had the maximum publications. Journal of Conservative Dentistry published the highest number of articles. India contributed 7.6% of the global PubMed indexed publications and reported 22% of clinical trials. This analysis reveals increasing trend of research in RE in India. However, it highlights the need to generate articles with higher LOE by conducting quality multicenter trials and promote national and international collaborations.
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ORIGINAL ARTICLES Top

Evaluation of remineralization potential and cytotoxicity of a novel strontium-doped nanohydroxyapatite paste: An in vitro study Highly accessed article p. 330
Ratheesh Rajendran, K Radhakrishnan Nair, Raghu Sandhya, P Mohammed Ashik, Rakhi Pattuvanmar Veedu, Shinu Saleem
DOI:10.4103/JCD.JCD_162_20  
Background: The focus of caries management has shifted to the early detection of caries and noninvasive methods of management of incipient lesions with novel remineralizing agents. Aim: The aim of this study is to evaluate and compare the remineralization potential of a novel laboratory synthesized strontium-doped nanohydroxyapatite (SrnHAp) paste to a commercially available regular dentifrice. Materials and Methods: Sixty enamel specimens (4 mm × 4 mm × 1 mm) were divided into two groups based on the type of dentifrice applied: Group I – regular toothpaste and Group II – SrnHAp paste. Calcium/phosphorous ratio of all sound specimens was evaluated using Scanning Electron Microscopy-Energy Dispersive X-ray analysis. Samples in both groups were subjected to demineralization, and the calcium/phosphorous ratio was analyzed. The samples were then subjected to remineralization using the specific agents in each group, and the mean calcium–phosphorus ratio was assessed. Cytotoxic evaluation of both pastes was done by direct microscopic observation and MTT assay. Statistical Analysis: Comparison of mean calcium and phosphorous values of sound enamel, demineralized, and remineralized specimen in Groups I and II was done using the one-way ANOVA and Tukeys post hoc test. Intergroup comparison after remineralization was done using the Student's t-test. Results and Conclusion: Group II showed higher remineralization potential than Group I and was statistically significant. Cytotoxicity of novel paste was less compared to the regular toothpaste. SrnHAp showed better remineralization than regular toothpaste and can be considered for enamel repair in incipient carious lesions.
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Association of hormonal fingerprints and dental caries: A pilot study p. 337
Akansha Rajawat, Chandrakanth Majeti, Uday Kumar Podugu, Mamta Kaushik, X Nagamaheshwari, Neha Mehra
DOI:10.4103/JCD.JCD_367_20  
Context: Dental caries remains the most widespread oral disease among all age groups. Hormonal fingerprints (second digit: fourth digit ratio or 2D:4D ratio) are biomarkers displaying sexual dimorphism and diverse human phenotypic traits. A person's genetic makeup may influence the occurrence of dental caries. Aim: The present study aimed to evaluate the influence of digit ratio on the incidence of dental caries. Settings and Design: Two hundred patients between 18 and 55 years, reporting for restorations or endodontic therapy, participated in the study. Subjects and Methods: Hormonal fingerprints (2D:4D ratio) were measured with the help of a digital vernier caliper. Caries incidence was recorded using the DMFT index. Statistical Analysis used: Data obtained were tabulated and statistically analyzed using Independent t-test and Chi-square test. Results: Males had a less mean 2D:4D ratio than females, which was statistically significant (p-value = 0.003). Chi-square test was applied, and there was a statistically significant correlation between high digit ratio and caries experience (p-value = 0.002). Females with a high digit ratio and males with a low digit ratio were in the moderate and low caries risk groups with a p-value of 0.029 and 0.001 in the respective risk groups. Conclusion: The present study displayed a correlation between hormonal fingerprints (2D:4D ratio) and dental caries. An indicator of caries risk will help prevent caries by implementing oral hygiene measures, which will reduce its incidence as the most occurring oral disease.
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Influence of desensitizing agents in management of noncarious cervical lesion and bonded restorations: A preliminary 12-week report p. 341
J Joyson Joe Asir, I Anand Sherwood, Bennett T Amaechi, M Vaanjay, S Swathipriyadarshini, P Ernest Prince
DOI:10.4103/JCD.JCD_389_20  
Objectives: The primary objective of this study was to investigate the effectiveness in reducing dentin hypersensitivity in noncarious cervical lesions (NCCLs) by home-based desensitizing toothpaste (TP), in-office Gluma desensitizer application, and resin-modified glass-ionomer cement (RMGIC) restoration. The secondary objective was to evaluate the long-term outcome of the? glass-ionomer cement restoration following the application of bioactive glass-containing desensitizer TP. Materials and Methods: A total of 73 patients or 151 teeth were included in the study and randomly allotted to one of the four different treatment groups. Pre- and postoperative symptom and air-blast/tactile sensitivity scores were recorded for statistical analysis. Postoperative sensitivity was analyzed at 1, 4, and 12 weeks after treatment. Nonparametric statistical tests were employed. Results: Kruskal–Wallis test noted a significant reduction in postoperative sensitivity at all time periods with the RMGIC group compared to other treatment options. Significantly higher patient dropout was observed in desensitizing TP regimen. Conclusions: This interim 12-week report on dentin hypersensitivity management of NCCLs concludes that resin-modified glass-ionomer restoration was able to achieve a significant instant reduction in sensitivity and patient satisfaction compared to other noninvasive at-home and in-office procedures. Clinical relevance: This interim 12-week report on dentin hypersensitivity management of noncarious cervical lesions concludes that resin-modified glass-ionomer restoration was able to achieve a significant reduction in sensitivity, and patient satisfaction was higher compared to other noninvasive at-home and in-office procedures.
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Comparative analysis of platelet.rich fibrin, platelet-rich fibrin with hydroxyapatite and platelet-rich fibrin with alendronate in bone regeneration: A cone-beam computed tomography analysis p. 348
Urvashi Ojha Tiwari, Ramesh Chandra, Supratim Tripathi, Jyoti Jain, Sanjay Jaiswal, Rahul Kumar Tiwari
DOI:10.4103/JCD.JCD_228_20  
Aim: This clinical study was designed to evaluate the volumetric healing of periapical (PA) bone defect after PA surgery, using platelet-rich fibrin (PRF), and its combination with hydroxyapatite and alendronate. Subjects and Methods: Twenty male patients of age between 25 and 35 years, having PA pathology (>5 mm on intraoral periapical radiograph (IOPA)) with intraoral sinus opening, were included in this study. Cone-beam computed tomography (CBCT) imaging of all patients was done. Root canal treatment with PA surgery was done. Patients were divided into four groups (5 in each group), on the basis of material placed in PA bone defect. After 1 year, CBCT imaging was done. Linear measurement of maximal dimensions in all three orthogonal planes was done in both pre- and post-CBCT image. These measurements were used to estimate the volume of the lesion healed after 1 year of surgery. Statistical Analysis: Analysis of variance and Post hoc Tukey's test were used for statistical analysis. Results: Change in volume were significantly different between Group 1 vs Group 3; Group 2 vs Group 3 and Group 3 vs Group 4. The Group Order for change in volume 1 year post surgery Group 3> Group 4 ≈Group 2> Group 1. Conclusions: PA bone healing after surgery is enhanced by placing combination of bone regenerative materials. PRF with hydroxyapatite provides best healing outcomes in comparison to PRF with alendronate or PRF alone.
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Comparative evaluation of platelet-rich fibrin, platelet-rich fibrin + 50 wt% nanohydroxyapatite, platelet-rich fibrin + 50 wt% dentin chips on odontoblastic differentiation - An in vitro study-part 2 p. 354
Kottuppallil Girija, Mahendran Kavitha
DOI:10.4103/JCD.JCD_3_20  
Aim: The purpose of this study was to investigate the effects of platelet-rich fibrin (PRF) modified with bioactive radiopacifiers–nanohydroxyapatite (nHA) and dentin chips (DC) on odontoblastic differentiation in human dental pulp cells (HDPCs). Subjects and Methods: PRF was modified with 50wt% of nHA (G bone-SHAG31, Surgiwear Company) and 50 wt% of DC. HDPSCs differentiation and mineralization by the groups ([Group A - Control (Dimethyl sulfoxide), Group B - PRF, Group C – PRF + nHA, Group D – PRF + DC]) were assessed. ELISA was done to quantify the interleukin (IL)-6 and IL-8 cytokine expression. The odontoblastic differentiation was determined by the expression of odontogenesis-related genes and the extent of mineralization using alizarin red S staining. Statistical Analysis Used: One-way ANOVA with post hoc Tukey-honestly significant difference tests were applied to assess the significance among various groups. Results: The level of inflammatory cytokines (IL-6 and IL-8) expression by Group D (PRF + 50 wt% DC) was higher compared to Group B (PRF) and Group C (PRF + 50 wt% DC). Group C (PRF + 50 wt% nHA) induced more mineralization nodules compared to other groups. The integrated density value for the DSPP and DMP-1 protein expression by Group C (PRF + 50 wt% nHA) and Group D (PRF + 50 wt% DC) was higher compared to Group B (PRF). Conclusions: The results suggest that the addition of bioactive radiopacifiers into PRF has a synergistic effect on the stimulation of odontoblastic differentiation of HDPCs, hence inducing mineralization.
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Evaluation of vascular endothelial growth factor - A release from platelet-rich fibrin, platelet-rich fibrin matrix, and dental pulp at different time intervals p. 359
Shruthi Nagaraja, Sylvia Mathew, Anil Abraham, Poornima Ramesh, Shashank Chandanala
DOI:10.4103/JCD.JCD_465_19  
Background: Lack of collateral blood supply and the low compliance environment of pulp makes its healing, a challenge. Vascular endothelial growth factor (VEGF) is a primary angiogenic growth factor. Knowledge of dose and time-dependent expression of VEGF from platelet concentrates, namely platelet-rich fibrin (PRF) and PRF matrix (PRFM), along with vital pulp can aid in developing strategies to improve the outcome of vital pulp therapy and regenerative procedures. Hence, the aim of this study was to compare VEGF kinetics of PRF, PRFM, and dental pulp. Materials and Methods: The PRF, PRFM, and vital dental pulp were placed in culture media for a week; the supernatant was collected from these samples at days 1, 4, and 7. VEGF-A expression was evaluated using ELISA and compared with the weight of the sample so as to quantify the release of VEGF-A per milligram of sample. Results: PRF exhibited maximum VEGF-A release on day 4 and was sustained till day 7. In contrast, PRFM and dental pulp showed no significant release of VEGF-A till day 7. However, on day 7, there was a rapid increase in VEGF-A expression from dental pulp that was comparable to PRF. On comparing the release of VEGF-A per milligram of tissue, pulp exhibited the maximum values. Conclusion: Among the platelet concentrates, differential expression of VEGF-A was superior in PRF. The use of PRF in partial pulpitis should be explored in order to restore pulp vascularity and hasten pulpal healing.
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Cyclic fatigue, torsional failure, and flexural resistance of rotary and reciprocating instruments p. 364
Carlos Henrique Ribeiro Camargo, Tatiane Sampaio Bittencourt, Amjad Abu Hasna, Renato Miotto Palo, Claudio Antonio Talge Carvalho, Marcia Carneiro Valera
DOI:10.4103/JCD.JCD_409_20  
Aim: The aim was to compare cyclic fatigue, torsional failure, and flexural resistance of NiTi endodontic files: Hyflex CM (HYF), Genius files (GEN), WaveOne Gold (WOG), and ProTaper Universal (PTU). Materials and Methods: Fifteen files of each brand were used in cyclic fatigue test and other fifteen files for flexural test and torsional failure test. To the cyclic fatigue test, used torque limit and revolutions per minute were set according to the respective manufacturer guidelines. The test was performed under deionized water at 36°C, and all files were tested in a 3 mm radius of curvature with an angle of curvature of 60°, time of the fracture was recorded. Torsional fatigue test was performed in the torsional machine (Instron MT, USA), recording the fractured time and torque data by the machine software. Flexural fatigue test was performed in 60° of curvature. All data were statistically analyzed by one-way analysis of variance, and Tukey test for multiple comparisons. Results: Cyclic fatigue (seconds)= HYF: 744.1 ± 231.9/GEN: 477.3 ± 220.5/WO: 278.4 ± 57.0/PTU: 152.4 ± 65.2; torsional failure (N × cm)= HYF: 6.85 ± 1.484/GEN: 6.55 ± 0.828/WOG: 5.73 ± 0.360/PTU: 4.43 ± 0.900; flexural resistance (N × mm)= HYF: 0.33 ± 0.294/GEN: 0.19 ± 0.136/WOG: 0.98 ± 0.216/PTU: 1.85 ± 0.276. Conclusion: HYF and GEN showed the best results for cyclic fatigue, torsional failure, and flexural resistance, followed by WOG and PTU.
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Launching a new fellowship in microrestorative and endodontics for postgraduates in conservative dentistry and endodontics p. 370
Girish Parmar, Shishir Singh, Jayshree Anil Hegde, Mohan Kumar, Sai Kalyan
DOI:10.4103/JCD.JCD_328_20  
Expanding and refining the skill sets of postgraduates specialists is required by the many current and changing demands of dental science education and research. To meet this challenge, the Indian Board of Micro Restorative and Endodontics under the aegis of the Indian Association of Conservative Dentistry and Endodontics has begun a fellowship program in Micro Restorative and Endodontics; the main aim being to improve the knowledge and skills of these specialists empowering them to go a step higher and beyond their areas of specialization. The objectives of the fellowship course are as follows: (1) Achieving necessary skills in managing routine and advanced restorative and endodontic scenarios using modern magnification technology. (2) Constantly enhancing the existing knowledge by pursuing new arenas in magnification technology. (3) Complete understanding and application of cutting edge research in the practice of microrestorative and endodontics. (4) Ensuring the highest possible patient-centric quality of care. Learning experiences shall be provided under the guidance and supervision of competent mentors at predesignated centers all over India. The learning strategies will be through workshops, contact sessions, and learning assignments. The carefully designed curriculum shall prepare the restorative dentists and endodontists, to be an autonomous, effective, safe, and a compassionate professional, who practices collaboratively in a variety of clinical and academic setups, responsive to the current and future needs of the restorative and endodontic health-care system. A passion for microdentistry would be a great way to make a positive difference to your patient care and creative work.
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Comparison of optical performance among three dental operating microscopes: A pilot study p. 374
Poorya Jalali, Charles Kim, Karl F Woodmansey
DOI:10.4103/JCD.JCD_191_20  
Introduction: Two important aspects of the dental operating microscope (DOM) that factor into its overall effectiveness are resolution and depth of field. Therefore, the objective of this study was to evaluate and compare the resolution and depth of field of DOMs from three well-known manufacturers using standardized test targets. Materials and Methods: A resolution test, using the 1951 USAF Hi-Resolution Target (Edmund Optics, Barrington, NJ), and a depth of field test, using the Depth of Field Target 5-15 (Edmund Optics, Barrington, NJ), were performed by two calibrated observers. Three DOM systems such as Seiler IQ (Seiler Instrument Inc., St. Louis, USA), Global G-Series 6 step (Global Surgical Corp., St. Louis, USA), and Zeiss Extaro 300 (Carl Zeiss Meditec AG, Oberkochen, Germany) were used to compare the resolution and depth of field. Results: The Zeiss Extaro 300 showed the highest maximum resolution and maximum DOF (64 lp/mm and 17mm, respectively). The Seiler IQ showed the lowest maximum resolution and maximum DOF (35.9 lp/mm and 11 mm, respectively). Conclusion: Within the limitations of this study, the Zeiss Extaro 300 was superior in terms of resolution and depth of field as compared to the other two DOMs.
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Spectrophotometric analysis of the color stability of white mineral trioxide aggregate in contact with four different irrigating solutions - An in vitro study p. 377
Disha Lalit Mehta, Sathish Abraham, Aradhana Babu Kamble, Sneha Dhruvkumar Vaswani, Harshal B Najan, Puneet Lalit Mehta
DOI:10.4103/JCD.JCD_412_20  
Aims: This study aims to compare the color stability of white mineral trioxide aggregate (wMTA) in contact with four irrigating solutions. Settings and Design: Original research study. Subjects and Methods: Fifty cylindrical discs of wMTA, 10 mm in diameter and 2 mm in height were prepared using a mold. Samples were incubated at a temperature of 37°C and at 100% humidity for the material to reach its optimal mechanical properties. The samples were divided into 6 groups: Group A: dry (n = 5); Group B: distilled water (DW) (n = 5); Group C: 5% sodium hypochlorite (NaOCl) (n = 10); Group D: 2% chlorhexidine gluconate (CHX) (n = 10); Group E: 17% aqueous ethylene diamine tetra-acetic acid (EDTA) (n = 10); Group F: 0.2% Chitosan (n = 10) Each disc was immersed into the irrigating solution for a period of 24 h. All the specimens were photographed using a digital camera before and after immersion. The assessment of color change of each disc of wMTA was conducted by a spectrophotometer. The Commission Internationale de l'eclairage system was used to calculate the differences in color. Statistical Analysis Used: Statistical Package for the Social Sciences version 16.0 (Chicago, IL, USA) at a significance level of P < 0.05 was used. Results: All groups except group A exhibited discoloration of wMTA. The mean values for change in color was highest with Group D, followed by Group C, F, E, B, and group A. Only Group B when compared to group A did not show any statistically significant difference (P = 0.948) whereas all the other four groups showed a highly statistically significant difference (P < 0.001). Conclusions: 2% CHX causes maximum discoloration of wMTA followed by 5% NaOCl, 0.2% Chitosan and least discoloration with 17% aqueous EDTA and DW.
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Evaluation of the cytotoxic and genotoxic effects of different universal adhesive systems p. 384
Derya Surmelioglu, Ceylan Hepokur, Sevim Atilan Yavuz, Ugur Aydin
DOI:10.4103/JCD.JCD_376_20  
Objectives: The objective of this study was to evaluate and compare the cytotoxicity and genotoxicity of different universal adhesive systems in the mouse fibroblast cell line L929. Materials and Methods: L929 (mouse fibroblast) cells were exposed to G-Premio Bond (GPB) (GC Europe, Belgium), Prime&Bond Universal (Dentsply Sirona, USA), Universal Bond Quick (Kuraray, USA), Single Bond (SB) Universal (3M ESPE, USA), and Tokuyama Universal Bond (TB) (Tokuyama, USA). Cell viability was assessed by the 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide test, whereas oxidative DNA damage was assessed by determining the 8-hydroxydeoxyguanosine level using an enzyme-linked immunoassay kit. Statistical analysis was performed by one-way analysis of variance, followed by Bonferroni post hoc tests. Results: Cytotoxic and genotoxic effects of TB and SB Universal groups were significantly higher than the other groups (P < 0.05). Among the adhesives tested, GPB (93.0 ± 1.3) had the least cytotoxicity, while TB (67.3 ± 3.0) had the most cytotoxic effect. In terms of genotoxicity, GPB (2.2 ± 0.3) had the least genotoxic effect, while Tokuyama Bond Universal (4.17 ± 0.4) had the most genotoxic effect. Conclusions: Universal adhesive systems used in dentistry have cytotoxic and genotoxic effects in live cells. Universal adhesive systems should, therefore, be used with caution due to their cytotoxic and genotoxic effects in clinical applications.
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Evaluation of the re-mineralization capacity of a gold nanoparticle-based dental varnish: An in vitro study p. 390
K Ajith Kamath, Iffat Nasim, S Rajeshkumar
DOI:10.4103/JCD.JCD_315_20  
Background: Dental caries is an infectious microbial disease caused by acidogenic bacteria. It leads to the dissolution of enamel, dentin, and cementum. Enamel demineralization is often appreciated as' 'White Chalky lesions or Chalky enamel''. Standard procedures for protection of these teeth are fissure sealing and topical fluoride application. A varnish is generally a material in which a resin such as copal is dissolved within an organic solvent such as ethanol. Gold is one of the most biocompatible dental materials. Gold nanoparticles were biosynthesised using aspartic acid in previous studies. Aim and Objectives: To prepare a gold nanoparticle based dental varnish and to evaluate its re-mineralizing capacity. Materials and Methods: Gold nanoparticle dental varnish was prepared using all the necessary constituents. This newly prepared dental varnish was compared with G.C Fuji/SnF2 dental varnish. Demineralizing capacity of the dental varnishes were analysed. The tooth specimens were prepared according to methodology and mounted on resin blocks. They were subjected to demineralization remineralization cycles. ICP-OES and Knoop Hardness tests were performed. Results: AuNP dental varnish had a satisfactory remineralization effect on demineralised enamel. For calcium analysis, the AuNP group showed significantly more total calcium loss when compared to the SnF2 group (P < 0.05) and was statistically significant. For phosphorus analysis, AuNP group showed significantly greater net phosphorus loss compared to the SnF2 group (P < 0.05) and was statistically significant. It was also observed that the KHN increased more significantly in Group A (SnF2) as compared to Group B (AuNP) and was also statistically significant (P < 0.05). Conclusion: AuNP dental varnish showed considerable re mineralizing property; however, it was not superior to dental varnishes like SnF2 dental varnish. Further research needs to be done in vitro to better modify the AuNP dental varnish before proceeding to in vivo studies. Caries, Enamel Caries, Dental Varnish, Gold nanoparticle, Incipient lesion, Initial Caries, Remineralization
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Comparative evaluation of surface roughness and color stability of nanohybrid composite resin after periodic exposure to tea, coffee, and Coca-cola ” An in vitro profilometric and image analysis study p. 395
Deepshikha Chowdhury, Paromita Mazumdar, Priti Desai, Pallab Datta
DOI:10.4103/JCD.JCD_401_20  
Aim: The aim of this study is to evaluate the surface roughness and color stability of a nanohybrid composite resin after exposure to tea, coffee, Coca-cola, and artificial saliva on the 7th, 14th, and 28th day. Materials and Methods: Forty specimens of nanohybrid composite resin discs of dimension 6 mm × 2 mm were fabricated and were randomly divided into four equal groups based on beverages (Group 1: control group – artificial saliva, Group 2: Tea, Group 3: Coffee, and Group 4 : Coca-cola). Baseline readings of surface roughness (Ra) and color change (ΔE) were obtained by profilometer and digital image analysis technique in CIE l*a*b scale followed by the readings (ΔE) taken on the 7th, 14th, and 28th day of exposure to respective beverages. Statistical Analyses: One-way analysis of variance (ANOVA) followed by post hoc Tukey's test and paired t-test along with Pearson's correlation with a P = 0.05. Results: Overall, highest surface roughness was obtained in the samples exposed to Coca-cola followed by coffee and tea while the least surface roughness was obtained in the samples exposed to artificial saliva (control group) which was statistically significant (P < 0.05). Overall highest color change was obtained in tea followed by coffee and Coca-cola. The least color change was observed in the samples exposed to artificial saliva (control group) (P < 0.05). Conclusion: Surface roughness and color change were time dependent as both increased with time. Furthermore, greater the surface roughness, more was the color change observed in all the groups at all tested time intervals.
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Comparative evaluation of fluoride release and re-release and recharge potential of Zirconomer Improved and Cention p. 402
Saurav Paul, Aakrati Raina, Simran Kour, Swati Mishra, Mukta Bansal, Arijit Sengupta
DOI:10.4103/JCD.JCD_222_20  
Background: The cariostatic action associated with fluoride-releasing restorative materials is mainly attributed to a sustained release of fluoride. This research aims on comparing Cention N and Zirconomer Improved in vitro fluoride release and re-release. Methods: Test materials were grouped into two categories containing 15 samples each. The cumulative fluoride release and re-release measurements was made during 1st, 7th and 15th day. The independent sample t-test and paired t-test was used to check mean differences. The level of significance was kept at p<0.05. Results: At day 1, 7 and 15 the initial fluoride release of zirconomer group was significantly higher (p<0.05) than the cention group. It was found that from day 1 to day 7 the mean initial fluoride release has significantly reduced (p<0.05) for both the groups. Similar results were also seen when comparisons were done between day 7 to day 15 (p<0.05) and day 1 to day 15 (p<0.05) for both the groups. Conclusion: Zirconomer was more efficient in initial and fluoride re-release than the Cention N restorative material. Further in vivo studies with more parameters are recommended to evaluate fluoride release and cariostatic performance of Cention N and Zirconomer in real environmental circumstances.
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Evaluation of the amount of remained sealer in the dentinal tubules following re-treatment with and without solvent p. 407
Emel Uzunoglu-Ozyurek, Sevinc Askerbeyli-Ors, Sevinc Aktemur Türker
DOI:10.4103/JCD.JCD_445_20  
Background: The effect of solvent and sealer type (BioRoot RCS [BRRCS], mineral trioxide aggregate [MTA] Fillapex, and AH26) on the root canal residues was evaluated by confocal laser scanning microscopy (CLSM). Materials and Methods: Distal root canals of 60 mandibular molars prepared up to ProTaper-F4 were filled using one of the sealers labeled with 0.1% rhodamine-B (n = 20 per sealer). Samples were divided into two according to reprocessing methods as follows: ProTaper Universal Reprocessing System (PTUR) or solvent plus PTUR. Samples were sectioned at 2–5 and 8 mm from the apex and the samples were observed under CLSM. Penetration depth, percent penetration depth, and percent penetration into canal walls were evaluated. Statistical analysis was performed using the repeated measures of the two-way ANOVA and Bonferroni post hoc test at P = 0.05. Results: The highest penetration depth was measured in BRRCS in all root canal thirds with or without chloroform addition. Percentage of penetration depth values of MTA Fillapex and BRRCS was statistically similar and higher than AH26 in all sections, except the apical section re-treated with the addition of chloroform. Conclusion: None of the sealers were completely removed. The type of sealant and the use of chloroform changed the amount of sealant remaining in the root canal system.
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The effects of recasting on the cytotoxicity of dental base metal casting alloys p. 412
BT Nandish, K Jayaprakash, Harish Kumar Shetty, Sowmya Rao, Kishore Ginjupalli, H Raghu Chandrashekhar, Sudeendra Prabhu
DOI:10.4103/JCD.JCD_260_20  
Aim and Objectives: In dentistry, base metal casting alloys are extensively used for the fabrication of inlays, onlays, crowns, bridges, partial dentures, etc. During the casting of these alloys, excess amount of material used than needed will be collected as sprue buttons at the end, which is either added to the fresh alloy during casting and reused or disposed of. Materials and Methods: The aim of the present in vitro experimental study was to investigate the effect of the complete recasting of four commercially available cobalt-chromium (Co-Cr) and nickel-chromium (Ni-Cr) base metal casting alloys on their cytotoxicity. During the study, four groups of alloys were subjected to complete recasting up to twenty times without the addition of new alloy. The cytotoxicity assessment of the selected alloys after recasting (Co-Cr and Ni-Cr alloys) was carried out using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Results: The results indicated that Co-Cr alloys exhibit superior cell viability compared to Ni-Cr alloys, and cytotoxic potential of the alloys increased with repeated casting and led to increased cell death. The recasting of alloys in the present study did not show high cytotoxicity even after the 20th recasting. Conclusion: From the results of the present study, it can be concluded that the alloys generated as a waste in the dental laboratory can be safely reused up to five times or at least once before they can be disposed, which reduces the cost of the treatment and also helps in conserving the natural resources.
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CASE REPORT Top

Long-term follow-up of traumatized immature necrotic permanent teeth treated with regenerative endodontic protocol using platelet-rich fibrin: A prospective case series p. 417
Ruchika Roongta Nawal, Shivani Utneja, Vivek Sharma, Sudha Yadav, Sangeeta Talwar
DOI:10.4103/JCD.JCD_460_20  
The purpose of this prospective case series was to report the long-term clinical and radiographic outcomes of regenerative endodontic procedures (REP) using platelet-rich fibrin (PRF), in traumatized immature permanent teeth with necrotic pulps. Six immature necrotic permanent maxillary central incisors from six patients were treated with REP supplemented with PRF. Patients were recalled at 6, 12, 18, 24, 36, 48, and 60 months. Radiographic changes in the radiographic root area (RRA), apical diameter, root thickness, and root length were quantified. Clinically, tooth survival in terms of tooth retention in the arch and absence of any sign and symptoms of endodontic pathology were noted. All the teeth survived and met the clinical criteria for success throughout the follow-up period. Follow-up radiographs at 5 years revealed complete resolution of the periapical lesions in all patients and the average apical diameter decrease was 30.96%. An average increase of 13.18% for root length, 40.20% for root thickness, and 26.35% for RRA were noted.
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CASE SERIES Top

A 5 years' follow-up of root anatomy-based maturogenesis achieved in infected immature molars using regenerative techniques - A case series p. 422
Ankit Arora, Dhvani Bhesania, Sonali Kapoor, Harleen Kaur
DOI:10.4103/JCD.JCD_327_20  
Infected immature molars are commonly encountered but seldom are they treated using principles of regenerative endodontics. The case series describes a feasible technique for attempting maturogenesis based on molar tooth anatomy. A total of 9 infected immature molars in the patients between 6 and 18 years of age were treated as part of this case series. All the canals were disinfected using 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid following minimal instrumentation. After using triple antibiotic paste for 3 weeks, bleeding was induced in mesial or constricted canals and platelet-rich fibrin was placed in distal or open wide canals till the orifice level. Coronal seal was obtained using mineral trioxide aggregate. Outcome was evaluated clinically and radiographically at the periods of 3, 6, 12, 24, 36, and 60 months. All the teeth showed continued root development and maintained functionality but none responded to vitality testing. Anatomical aspects of individual roots within a tooth can be utilized as a guide to decide the appropriate approach for attempting maturogenesis in a molar. Root changes can be expected even if the pulp vitality is not restored.
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