Background: Irrigation protocol is the most critical step during the disinfection of an infected root canal system. Aim: The purpose of this study was to determine the root canal irrigation trends being practiced among the endodontic teaching faculty and post-graduate students in the dental colleges present in India. Materials and Methods: A postal invitation to participate in this national survey was sent to the Department of Conservative Dentistry and Endodontic of 294 Dental Colleges present in India. A total of 2389 forms were successfully delivered out of which 794 duly filled forms were received back. Survey participants were asked about their irrigant selection, irrigant concentration, smear layer removal protocol, and use of adjuncts during irrigation. Results: This survey elicited a positive response rate of 33.23%. Our data indicated that 92.8% of respondents use sodium hypochlorite (NaOCl) as the primary endodontic irrigant, with 26 gauge needle being most preferred for syringe irrigation, with 49.3% of them using it at a concentration of 2.6-4.0%. 68% of our respondents aim to remove the smear layer during the endodontic treatment while 47% reported using ultrasonic activation as an adjunct during their irrigation protocol. Conclusions: The findings of this survey are that the majority of teaching institutions in India are employing NaOCl (2.6-4.0%) as the primary endodontic irrigant. The concept of smear layer removal is high (68%), and there is a general trend (78%) to modify the irrigation protocol according to the status of the pulp, status of the periapex and in retreatment cases.

Aim: This in vitro investigation examined the effect of early coronal flaring (CF) and late CF on the working length (WL) in curved root canals. Background: The objective of this study was to determine if canal length is altered as a result of CF in curved canals of molar roots. Study Design: The conditions compared were combinations of (a) stainless steel hand files using Gates Glidden (G. G.) drills (SS) versus nickel-titanium rotary files (Ni-Ti); and (b) early CF (flaring completed before WL determination) versus late CF (flaring completed after WL determination). Selected were 90 canals of extracted maxillary or mandibular first molars (mesial root of mandibular molars and the mesiobuccal root of the maxillary molars) from three groups. CF was accomplished for the SS group using G. G. drills and for the Ni-Ti group using rotary ProTaper and Hero Shaper files. WL was determined by a digital vernier caliper before CF, immediately after CF, and again after canal preparation. Statistical Analysis: A repeated measures analysis of variance (ANOVA) test and a Tukey's multiple prosthoc test were used for this study. Results: Results indicated that WL decreased for all canals as a result of canal preparation. The mean decrease in WL was significantly greater for the SS group (−0.77 ± 0.42 mm) than for the Ni-Ti groups (−0.33 mm ± 0.44). Less change in WL occurred in all groups when initial WL was determined after CF. Conclusion: WL in curved canals consistently decreases during the course of instrumentation. Clinician should keep this in mind for better treatment outcome.

Background: Ideal access cavity assures unobstructed straight-line access to the apical third of the root canal and preserves tooth structure. Aim: The aim of the study was to determine the location and dimensions of access cavity with straight-line access in incisors, canines, and premolars and to evaluate the largest diameter of their root canals in the mesiodistal and vestibulooral direction. Materials and Methods: Twenty extracted teeth of each group were randomly selected and digitally radiographed from the mesiodistal and vestibulooral direction. Position of the straight-line access midline in relation to anatomical landmarks (incisal edges, fissures, and cusps) was recorded. The largest diameters in mesiodistal and vestibulooral direction were measured. Relative frequencies of access position and mean and standard deviation of both diameters were calculated. Results: For the anterior teeth, the predominant location of straight-line access was from incisal edge, except for maxillary central incisors, where location was equally distributed between incisal edge and oral surface. In mandibular premolars, the straight-line access was positioned vestibular from central fissure. In mesiodistal direction, the largest diameter was found for maxillary central incisors and canines (1.54 mm), while the smallest diameter was found for mandibular incisors (0.64 mm). In vestibulooral direction, the largest diameter was found for maxillary first premolar (5.28 mm), while the smallest diameter was found for maxillary lateral incisor (1.39 mm). Conclusions: Knowledge of location and size of access cavity facilitates achieving balance between straight-line access to the apical third of the root canal and preservation of tooth structure.

Aim: The study was designed to investigate the sealing ability of two obturation systems (cold laterally compacted gutta percha and Obtura II) over different apically separated rotary nickel-titanium files (RACE and K3 system) using dye extraction method. Materials and Methods: Sixty-two mandibular premolars were divided into 2 groups of 30 teeth each, and 2 teeth served as negative controls. In Groups A and B, roots were prepared using RACE and K3 system, respectively, and were further subdivided into 4 subgroups. In subgroups A1, B1 and A2, B2 (n = 10 each), files were separated at 3 mm from the tip in apical 3 ^rd of the canal. In subgroups A3, B3 and A4, B4 (n = 5), instruments were not separated. Subgroups A1, A3, B1, B3 and A2, A4, B2, B4 were obturated by lateral condensation method and Obtura II techniques, respectively. The sealing ability of the obturated specimens were tested using dye extraction method. The values for each group were recorded and analysis of variance (ANOVA), Student "t" test (two-tailed, independent), and Leven's test were performed. Results: Group A1 showed significantly less leakage than B1. No statistical significant difference between Groups A2 and B2 and Groups A3 and B3, respectively, were observed. Group A4 showed significantly less leakage than B4. Conclusion: Groups obturated with Obtura II showed less leakage than the lateral condensation technique irrespective of presence or absence of fractured NiTi rotary system.

Aim: Endodontic treatment generally reduces the fracture resistance of teeth. The purpose of this study was to evaluate the fracture resistance and the mode of fracture of endodontically treated human premolars with different amounts of remaining tooth structure. Materials and Methods: Seventy non-carious human premolars were randomly assigned into 7 groups. Group 1 (ST) did not receive any preparation. The teeth in groups 2-7 received root canal treatment and different preparations. Group 2 (MO-NF): Mesio-occlusal preparation without filling; Group 3 (MOD-NF): Mesio-occluso-distal preparation without filling; Group 4 (MO-F): Mesio-occlusal preparation with direct composite restoration (Z250); Group 5 (MOD-F): Mesio-occluso-distal preparation with direct composite restoration (Z250); Group 6 (CC-D): Mesio-occluso-distal preparation with cusp reduction and direct composite restoration (Z250); Group 7 (CC-InD): Mesio-occluso-distal preparation with cusp reduction and indirect composite restoration (Gradia GC). The fracture resistance (N) was assessed under compressive load in a universal testing machine (Zwick) perpendicular to the occlusal surface at a cross-head speed of 1 mm/min, and the mode of fracture was assessed under stereomicroscope. Statistical analysis: Data was analyzed by Kruskal - Wallis and Mann - Whitney tests and the mode of fracture was analyzed by Chi-square test (P < 0.05). Results: Statistical analysis showed that MO and MOD cavity preparations significantly reduced the fracture resistance of sound teeth. Direct composite restorations can improve the fracture resistance, and Groups 7 and 6 presented the highest fracture resistance values. Conclusions: Teeth with adhesive restorations showed significantly higher fracture resistance values as compared with the non-restored ones.

Aim: Adhesives may change their mass due to water sorption or dilution of components after curing. The aim of this study was to evaluate the influence of air-drying time and water storage on mass changes (MC) of three adhesives; Adper Single Bond2 (ASB), One-step plus (OSP), Clearfil S ³ Bond (CSB). Materials and Methods: Rectangular-shape samples from each adhesive were prepared and cured for 120 s with a halogen light curing unit. Prior to curing, their solvent was evaporated by means of three different procedures depending on the passive air-drying time (i.e., no air drying, equal to active air drying, complete evaporation after 3 h). Each group was further divided into two subgroups based on the time of water storage (1-day, 7-days), prior to measurement of MC (n = 10). The data were analyzed using a three-way ANOVA. Results: Adhesives showed different patterns of MC in relation to air drying and water storage; (P < 0.05). In OSP and CSB with increasing water storage and air drying, the MC increased significantly (P < 0.01). Conclusion: The highest MC in the etch-and-rinse adhesives was observed when the adhesive was not dried, while in the self-etch adhesive the highest changes were observed when the adhesive was completely dried.

Aims and objectives: Isolation, characterization and differentiation of dental pulp stem cells (DPSCs) and stem cells from exfoliated human deciduous teeth (SHED). Methods: The pulp tissue was digested in collagenase and cultured in DMEM Dulbecco's Modified Eagle's Media). The stem cells were identified and isolated. Surface characterization of cells was done with flow cytometer using surface markers. An immuno cytochemistry analysis was done. Differentiation potential was analyzed using various differentiation markers. Results: Flow cytometry analyses for various CD markers showed similar results for both DPSCs and SHED. The cells showed positive expression for pluripotent, ectodermal and mesodermal markers. Cells differentiated into osteoblasts and adipocytes. Conclusion: The study demonstrated that stem cells existed in deciduous and permanent pulp tissue. The stem cells present in pulp tissue can be isolated, cultivated and expanded in vitro. Both DPSCs and SHED show almost a similar expression pattern profile for variety of antigens tested.

Aim: The aim of this in vitro study was to evaluate the effect of two different chemomechanical caries removal (CMCR) agents on dentin microhardness. Materials and Methods: In this study, the crown portion of ten carious-free and ten caries-affected teeth were selected. In carious-free samples, the teeth were decoronated at the level of cemento - enamel junction. Only the crown portion of the teeth was selected. Occlusal one-third of the crowns were cross-sectioned and discarded to expose the dentin, and it was divided into two groups, five teeth in each group. Then, they were further sectioned longitudinally through the centre. In one group, no agent was applied on one half and Carisolv was applied on other half. In another group, no agent was applied on one-half and Carie-Care was applied on the other half for 1 min. In carious samples, the crowns were sectioned through the centre of carious lesion. Carisolv was applied on one-half and Carie-Care was applied on the other half. After using CMCR agents, surface hardness of dentin was examined using Vickers hardness number (VHN). Statistical Analysis and Results: The data were analyzed using t-test and one-way analysis of variance (ANOVA). There were no significant difference among normal dentin (62.91 ± 2.76), Carisolv-treated normal dentin (61.72 ± 2.89), and Carie-Care-treated normal dentin (61.90 ± 3.19). In carious samples, the results of Carisolv-treated dentin (58.57 ± 2.62) was not statistically significantly different from those of the Carie-Care-treated dentin (56.77 ± 4.41). Conclusion: In conclusion, neither of the CMCR methods caused a significant change in the microhardness of normal dentin and the treated carious dentin.

Introduction: As the search for a better biocompatible medicament is on, aim of the present study was to evaluate the pulpal response to collagen particles impregnated in antibiotics (Biofil ^TM -AB) and new commercially available cement (Pulpotec) that can be used as pulpal medicament. Materials and Methods: Total sample of 40 teeth from 20 children in the age group of 7-10 years which are noncarious having bilateral retained primary teeth were enrolled for the study. Nine teeth each were treated with collagen particles (group I) and Pulpotec cement (group II), and the remaining samples were discarded due to various reasons. Both groups were randomly subdivided into three teeth each that were extracted after 7, 15, and 30 days intervals and examined histologically. Results: Moderate to severe inflammatory cells with newly formed blood vessels and disorganized odontoblastic cell layer was observed in group I after all three intervals with dentinal bridge formation in two specimens. On contrary, none of the specimens in group II showed any signs of inflammation, but there was a discontinuity in the odontoblastic layer lining along the dentin walls. Conclusion: Both materials were proven to be promising alternatives as pulp medicaments. However, collagen was found to be a better material.

Objectives: This study comparatively evaluated the efficacy of self-adjusting file (SAF), Endovac, and CanalBrush irrigant agitation protocols in removing calcium hydroxide (Ca(OH) ₂ ) from the root canals. Materials and Methods: Sixty extracted human mandibular canine teeth were instrumented with ProTaper rotary instruments to size #40 and dressed with Ca(OH) ₂ . The roots were randomly assigned to four groups according to irrigant agitation protocol used (n = 15). In Group 1: Conventional syringe irrigation (no activation, control); Group 2: Rotary brush agitation (CanalBrush); Group 3: Apical negative pressure irrigation (EndoVac system); and Group 4: Sonic agitation (SAF) were used. Scanning electron microscopic (SEM) evaluation was done for assessment of Ca(OH) ₂ removal in the coronal and apical thirds. Statistical analysis was performed by Wilcoxon and Kruskal-Wallis tests. Results: There were statistically significant differences among the groups (P = 0.218). A statistically significant difference was seen between the test groups in Ca(OH) ₂ removal from the apical third of the canal (P < 0.05). In the coronal third, there was no difference between the groups (P > 0.05). The most efficient Ca(OH) ₂ removal in apical third was recorded in Group 3 (EndoVac) and Group 4 (SAF) (P < 0.05). In Group 4 (sonic agitation), there was no significantly difference between Ca(OH) ₂ removal in coronal and apical thirds. Conclusions: SAF and EndoVac showed significantly better performance than CanalBrush and conventional syringe irrigation in removing Ca(OH) ₂ from apical third of the root canals.

Introduction: The concept of using a "post" for the restoration of teeth has been practiced to restore the endodontically treated tooth. Metallic posts have been commonly used, but their delirious effects have led to the development of fiber-reinforced materials that have overcome the limitations of metallic posts. The use of glass and quartz fibers was proposed as an alternative to the dark color of carbon fiber posts as far as esthetics was concerned. "Debonding" is the most common failure in fiber-reinforced composite type of posts. This study was aimed to compare the push-out bond strength of a self-adhesive dual-cured luting agent (RelyX U100) with a total etch resin luting agent (Variolink II) used to cement two different FRC posts. Materials and Methods: Eighty human maxillary anterior single-rooted teeth were decoronated, endodontically treated, post space prepared and divided into four groups (n = 20); Group I: D.T. light post (RTD) and Variolink II (Ivoclare vivadent), Group II: D.T. light post (RTD) and RelyX U100 (3M ESPE), Group III: Glassix post (Nordin) and Variolink II (Ivoclare vivadent) and Group IV: Glassix post (Nordin) and RelyX U100 (3M ESPE). Each root was sectioned to get slices of 2 ± 0.05-mm thickness. Push-out tests were performed using a triaxial loading frame. To express bond strength in megapascals (Mpa), load value recorded in Newton (N) was divided by the area of the bonded interface. After testing the push-out strengths, the samples were analyzed under a stereomicroscope. Results: The mean values of the push-out bond strength show that Group I and Group III had significantly higher values than Group II and Group IV. The most common mode of failure observed was adhesive between dentin and luting material and between post and luting material. Conclusions: The mean push-out bond strengths were higher for Groups I and III where Variolink II resin cement was used for luting the fiber post, which is based on the total etch adhesive approach. In most of the samples, failure was observed between cement-dentine interface, followed by post-cement interface, which shows difficulty in bonding between post-cement-dentine interface.

Aim: To quantitatively evaluate the apical sealing ability and adaptation of two resin-based sealers to dentin. Materials and Methods: Fifty freshly extracted mandibular first premolars were taken and sectioned at the cemento-enamel junction. Thirty teeth were subjected to a leakage study by the resin infiltration method with two groups of 10 teeth each. Group I teeth were obturated with methacrylate resin-based sealer (EnoRez) and Group II teeth were obturated with epoxy resin-based sealer (AH Plus). The remaining 10 teeth were used as controls (positive and negative of five teeth each). Twenty teeth were divided into two groups and obturated as in the leakage study and subjected to a scanning electronic microscopy (SEM) analysis for adaptation and resin depth penetration. Results: Both the sealers produced apical leakage to a certain extent. The adaptation and resin sealer penetration in the coronal and middle thirds was better than in the apical third of the root canal under SEM observation. The hybridized resin sealer tags in the coronal and middle thirds of Group I were much longer than that shown by Group II. Conclusion: We conclude that the physical integrity of the sealer matrix may also be important in providing resistance to leakage.

Introduction: The Enterococcus faecalis biofilm in the root canal makes it difficult to be eradicated by the conventional irrigants with no toxicity to the tissues. Hence, plant products with least side effects are explored for their use as irrigants in the root canal therapy. Aim: To evaluate and compare the antibacterial efficacy of Mangifera indica L. kernel (mango kernel) and Ocimum sanctum L. leaves (tulsi) extracts with conventional irrigants (5% sodium hypochlorite (NaOCl) and 2% chlorhexidine) against E. faecalis dentinal biofilm. Materials and Methods: Agar diffusion and broth microdilution assay was performed with the herbal extracts and conventional irrigants (2% chlorhexidine and 5% NaOCl) against E. faecalis planktonic cells. The assay was extended onto 3 week E. faecalis dentinal biofilm. Results: Significant reduction of colony forming units (CFU)/mL was observed for the herbal groups and the antibacterial activity of the herbal groups was at par with 5% NaOCl. Conclusions: The antibacterial activity of these herbal extracts is found to be comparable with that of conventional irrigants both on the biofilm and planktonic counterparts.

Objective: To compare the efficacy of an integrated apex locator and an apex locator and endodontic motor assembly in maintaining the working length when operated under autoreverse mode. Study Design: Thirty distobuccal roots of intact maxillary first molars were taken and access cavities were prepared. The teeth were divided into Group I: Prepared with TCM Endo V and Group II: Prepared with ProPex and NSK assembly. The instrumentation was ended in ProTaper F3 file, which was cemented in the canal. The roots were sectioned, observed under a stereomicroscope and the distance from instrument tip to the apical foramen was measured. Results: Mean difference in the deviation of two groups was 0.075 mm, P = 0.34 (>0.05) which was statistically insignificant when assessed with unpaired t-test. Conclusion: The assembly of ProPex-NSK Endo-mate DT and the apex locating endomotor TCM Endo V Nouvag are clinically acceptable.

Purpose: Few studies have comparatively evaluated the push-out bond strength of different calcium silicate-based materials (CSMs) used in furcal perforation repair. The objective of this in vitro study was to comparatively evaluate the push-out bond strength of commercially available CSMs used as furcation repair materials, in the presence of blood contamination. Materials and Methods: Furcal perforations were made in 120 molars and were divided on the basis of the repair material used (ProRoot MTA, Biodentine, and MTA Plus), blood contamination, and duration of setting time (24 h vs. 7 days). Push-out bond strength was measured and analyzed by three-way analysis of variance (ANOVA) test. Results: Push-out bond strength increased with time. The 24-h push-out strength of MTA was less than that of Biodentine. Blood contamination affected the push-out bond strength of MTA Plus irrespective of the setting time. Conclusion: Caution should be taken while condensing restorative materials over furcation repair materials.

Aim: The aim of this in vitro study was to evaluate and the compare antibacterial efficacy of four dentin bonding system against Streptococcus mutans, Streptococcus salivarius and Lactobacillus acidophilus over a period of three months using agar disk diffusion test. Methodology: All the three standard bacterial strains were inoculated into BHI broth and incubated at 37°C for 48 hours. A 100 μl of broth suspension containing aliquots of S. mutans, S. salivarius and L. acidophilus were spread onto M-H agar medium using sterile cotton swabs. The experimental groups were as follows: GROUP A: Test conducted for evaluation of antimicrobial efficacy against S. mutans MTCC 497, GROUP B: Test conducted for evaluation of antimicrobial efficacy against S. salivarius MTCC 1938, and GROUP C: Test conducted for evaluation of antimicrobial efficacy against L. acidophilus MTCC 447. For sample preparation, 20 μl bonding agent was dropped with micropipettes on paper disks, and blown dry for 10 seconds. Then it was light-cured at 2 mm for 20 sec using a QTH visible light curing unit. For first reading, the sample disks were placed over the freshly inoculated agar plates and then incubated at 37°C for 48 hours. The rest of the paper disks were stored in dark, submerged in distilled water at 37°C. They were placed on freshly inoculated spread plates after specific time intervals- 1 day, 1 week, 2 weeks, 1 month and 3 months after ageing in PBS. After incubation, the diameters of zones of inhibition around the plates were measured.The experiment was performed twice in triplicate. The data was then statistically analysed using Two way ANOVA test and post hoc. Results: Results showed that Xeno III had the maximum antibacterial efficacy over a period of three months, followed by XP bond. This antibacterial activity was maximum against Streptococcus mutans, followed by Lactobacillus acidophilus and least against Streptococcus salivarius. Adper Easy One and G bond had minimal effect against the test bacteria during the test period. Conclusion: The antibacterial effect decreased over a period of three months for all the dentin bonding systems.

Successful root canal treatment depends on adequate cleaning, shaping, and filling of the root canal system. The presence of middle mesial (MM) root canal of mandibular molars has been reported by various authors. But incidence of four canals in mesial root of mandibular molar is very rare. The aim of this case report is to present and describe the identification and management of a mandibular first molar with four canals in the mesial root and single canal in the distal root.

The discovery of foreign bodies in the teeth is often diagnosed accidentally. It is commonly seen in children. These foreign objects may act as a potential source of infection and may later lead to a painful condition. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, and location of the foreign body, and the difficulty involved in its retrieval. This paper discusses the types of foreign objects found in and around the teeth and reports an unusual case of a stapler pin in the root canal of a tooth, its retrieval, and associated management of the involved teeth.

The term taurodontism is derived from the Latin word tauros, for "bull," and the Greek term odus, for "tooth," or "bull tooth." Taurodontism is a morpho-anatomical developmental anomaly, which is seen infrequently in teeth only. It is characterized by a deficiency in the constriction at the cement-enamel junction, with lengthened pulp chambers and apical displacement of the pulpal floor. This gives the tooth a quadrilateral or cylindrical look. This report presents a case of multiple bilateral taurodontism and the successful endodontic treatment of the tooth that had hypertaurodontism. A male patient was referred to the endodontic clinic with decayed left maxillary first molar. Hypertaurodontism was confirmed after clinical and radiographic examination. Panaromic X-rays revealed that all of the patient's molar teeth were taurodontic. Taurodontism offers challenges to the practitioner during shaping and disinfection and at the time of filling the root canals.