The aim of this case series was to determine the clinical and radiographic success rate of pulpotomy, with new endodontic cement (NEC), in human mature permanent molar teeth. Twelve molars with established irreversible pulpitis were selected from patients 14 - 62 years old. The selection criteria included carious pulp exposure with a positive history of lingering pain. After isolation, caries removal, and pulp exposure, pulpotomy with NEC was performed and a permanent restoration was immediately placed. At the first recall (+1 day) no patients reported postoperative pain. One wisdom tooth had been extracted after two months because of failure in coronal restoration. Eleven patients were available for the second recall, with a mean time of 15.8 months. Clinical and radiographic examination revealed that all teeth were functional and free of signs and symptoms. Histological examination of the extracted teeth revealed complete dentin bridge formation and a normal pulp. Although the results favored the use of NEC, more studies with larger samples and a longer recall period were suggested, to justify the use of this novel material for treatment of irreversible pulpitis in human permanent molar teeth.

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Context : Vital pulp therapy has been known as one of the treatment options to preserve pulp after being exposed by trauma or caries. Aim : To investigate human pulpal response to white and grey mineral trioxide aggregate (WMTA, GMTA) and Dycal (MTA) as pulp capping agents. Setting and Design : Human volunteers were participated in this randomized clinical trial. Materials and Methods : This study was conducted on 90 intact first and second premolars of human maxillary and mandibular teeth. The teeth were randomly assigned into three groups of 30 each. Under local anesthesia, teeth were exposed and capped either with GMTA, WMTA, or Dycal. After 30, 60, and 90 days 10 teeth of each group were extracted and prepared for histologic observation. Statistical Analysis : Histopathologic data were analyzed by χ², Kruskal Wallis and Mann Whitney tests. Results : the calcified bridge in teeth that were capped with GMTA was significantly thicker than Dycal at 30 and 60 days (P= 0.015 and P=0.002, respectively); whereas WMTA showed significantly thicker calcified bridge than Dycal at 90 days (P=0.02). In addition, GMTA specimens showed significantly less inflammation compared to Dycal samples at 90 days interval (P=0.019). No significant difference was found between GMTA and WMTA in terms of calcified bridge thickness and pulp inflammatory response to the capping materials (P>0.05). Conclusions : Based on the result of this study, both types of MTA can be suggested as the materials of choice for direct pulp capping procedure instead of Dycal as hard setting calcium hydroxide cement.

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Aim: This in vitro study was conducted on enamel blocks of human premolars with the aim of evaluating the remineralization potential of fluoride and ACP-CPP and the combination of ACP-CPP and fluoride on early enamel lesions. Materials and Methods: Fifteen intact carious free human premolars were selected. The coronal part of each tooth was sectioned into four parts to make 4 enamel blocks. The baseline SMH (surface microhardness) was measured for all the enamel specimens using Vickers microhardness (VHN) testing machine. Artificial enamel carious lesions were created by inserting the specimens in demineralization solution for 3 consecutive days. The SMH of the demineralised specimens was evaluated. Then the four enamel sections of each tooth were subjected to various surface treatments , i.e. Group 1- Fluoride varnish, Group 2- ACP-CPP cream, Group 3- Fluoride + ACP-CPP & Group 4- Control (No surface treatment). A caries progression test (pH cycling) was carried out, which consisted of alternative demineralization (3hours) and remineralization with artificial saliva (21 hours) for five consecutive days. After pH cycling again SMH of each specimen was assessed to evaluate the remineralization potential of each surface treatment agent. Then, to asses the remineralization potential of various surface treatments at the subsurface level, each enamel specimen was longitudinally sectioned through the centre to expose the subsurface enamel area. Cross-sectional microhardness (CSMH) was evaluated to assess any subsurface remineralization Results: Statistical analysis using one-way ANOVA followed by multiple comparisons test was applied to detect significant differences at P ≤ 0.05 levels between various surface treatments at different phases. Conclusions: With in the limits, the present study concludes that; ACP-CPP cream is effective, but to a lesser extent than fluoride in remineralizing early enamel caries at surface level. Combination of fluoride and ACP-CPP does not provide any additive remineralization potential compared to fluoride alone. Fluoride, ACP-CPP and their combination are not effective in remineralizing the early enamel caries at the subsurface level.

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Regeneration of pulp-dentin complex in an infected necrotic tooth with an open apex is possible if the canal is effectively disinfected. The purpose of this case report is to add a regenerative endodontic case to the existing literature about using Platelet Rich Fibrin (PRF). A nine year old boy who accidently broke his immature maxillary central incisor tooth, developed pulpal necrosis with apical periodontitis. After the access cavity preparation, the canal was effectively irrigated with 20 ml of 5.25% sodium hypochlorite solution and 10ml of 0.2% chlorhexidine solution and dried with paper points. Triple antibiotic paste was placed inside the canal and left for 21 days. 12 ml of whole blood was drawn from the patient's right antecubital vein and centrifuged for 10 minutes to obtain the Choukroun's PRF. After the removal of the triple antibiotic paste, the PRF was placed into the canal till the level of cementoenamel junction and 3mm of grey MTA was placed directly over the PRF clot. The setting of MTA was confirmed 3 days later and the tooth was double sealed with GIC and Composite restoration.After 1 year the clinical examination revealed negative responses to percussion and palpation tests. The tooth responded positively to cold and electric pulp tests. Radiographic examination revealed continued thickening of the dentinal walls, root lengthening, regression of the periapical lesion and apical closure. On the basis of the results obtained in our case report we conclude that revitalization of necrotic infected immature tooth is possible under conditions of total canal disinfection and PRF is an ideal biomaterial for pulp-dentin complex regeneration.

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Various authors have demonstrated the regenerative process in immature, non vital teeth by revascularization induced maturogenesis. The aim of this case report is to compare calcium hydroxide apexification and pulp revascularization induced maturation procedures in the same patient, in two different teeth. The right maxillary central incisor in this individual was treated with conventional calcium hydroxide induced apexification procedure followed by guttaperchaobturation, and the left maxillary central incisor was treated by pulp revascularization induced maturation procedures. 24 months follow-up shows root elongation and apical closure in the tooth treated with revascularization induced maturation procedures. Revascularization induced maturogenesis, where indicated, can provide several advantages over conventional apexification procedures.

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Aim: The aim of this study was to evaluate a very short-term in vitro and in situ effect of 2% chlorhexidine-digluconate-based (CHX) cavity cleanser on the disinfection of dentin demineralized by cariogenic bacteria. Materials and Methods: Human dentin slabs were randomly allocated and used in 2 distinct phases, in vitro and in situ, for obtaining demineralized dentin. In vitro, the slabs (n=15) were immersed for 5 days in BHI broth inoculated with Streptococcus mutans CTT 3440. In situ, a double-blind design was conducted in one phase of 14 days, during which 20 volunteers wore palatal devices containing two human dental dentin slabs. On 5 ^th day in vitro and 14 ^th day in situ, the slabs were allocated to the two groups: Control group (5 μl of 0.9% NaCl solution) and CHX group (5 μl of 2% chlorhexidine digluconate solution, Cavity Cleanser™ BISCO, Schaumburg, IL, EUA), for 5 minutes. The microbiological analyses were performed immediately before and after the treatments. Results: The log reductions means found for CHX treatment on tested micro organisms were higher when compared to Control group either in vitro or in situ conditions. Conclusions: Our results showed that CHX was effective in reducing the cultivable microbiota in contaminated dentin. Furthermore, although the use of chlorhexidine-digluconate-based cavity disinfectant did not completely eliminate the viable microorganisms, it served as a suitable agent to disinfect tooth preparations.

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The choice of an impression material for a particular situation depends on the treatment being provided, operator preference, and so on. Even with the introduction of more advanced and more accurate rubber base impression materials, irreversible hydrocolloid impression materials have stood the test of time. This article gives a detailed perspective of how best to make alginate impressions.

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Aim: The purpose of this study is to examine the intensity of light curing units and factors affecting it in dental offices. Materials and Methods: The output intensity of 200 light curing units in dental offices across Maharashtra were examined. The collection of related information (thenumber of months of use of curing unit, the approximate number of times used in a day, and presence or absence of composite build-ups) and measurement of the intensity was performed by two operators. L.E.D Radiometer (Kerr) was used for measuring the output intensity. The average output intensity was divided into three categories (<200 mW/cm ² , 200-400 mW/ cm ² and >400 mW/cm ² ). Results: Among the 200 curing units examined, 81 were LED units and 119 were QTH units. Only 10% LED machines and 2% QTH curing units had good intensities (>400 mW/cm ² ). Conclusion: Most of the examined curing lights had low output intensity ranging from 200 to 400 mW/cm ² , and most of the curing units had composite build-ups on them.

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Aim : Our study aimed to analyze the microleakage of silorane-based composite in comparison to two homologous methacrylate-based composites. Materials and Methods : Standardized class I cavities (4 × 2.5 × 3 mm) were prepared on extracted human premolars and randomly assigned into three groups (N = 15) as follows: Group A, Filtek P90 (silorane) with its dedicated adhesive system (P90 system adhesive); Group B, Adper SE Plus with Filtek Z250; Group C, Peak SE with Amelogen Plus. The teeth were subjected to thermocycling regime (200×, 5-55°C) and dye penetration of tooth sections were evaluated following 30 minute immersion in 2% Methylene Blue dye. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney U test at 95% significance level. Results : Silorane exhibited significantly decreased microleakage compared with any other resin based composite (RBC). The cavities restored with Amelogen Plus displayed nonsignificantly higher microleakage than with Filtek Z250. Conclusion : Although all of the restorative systems had microleakage, silorane technology showed less microleakage comparable to clinically successful methacrylate-based composite. This will improve the clinical performance and extend the composite durability.

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In comparison to the conventional apexification using calcium hydroxide, artificial apical barrier technique is more valuable and less time consuming. This article describes successful use of calcium-enriched mixture (CEM) cement as an artificial apical barrier in open apices. In this study, 13 single-rooted teeth with necrotic pulps and open apices were treated non-surgically. After copious irrigation of the root canals with NaOCl 5.25% and gentle filing, based on need for interappointment dressing, treatments were followed by CEM cement (BioniqueDent, Tehran, Iran) apical plug insertion in the first or second appointment. All cases were then permanently restored. All subjects were followed until radiographic evidence of periradicular healing was seen (mean 14.5 months). Clinically, all cases were functional and asymptomatic and complete osseous healing was observed in all the teeth. Considering the biological properties of CEM cement, this new endodontic biomaterial might be appropriate to be used as artificial apical barrier in the open apex teeth.

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Mineral trioxide aggregate (MTA) is composed of Portland cement, with 4:1 addition of bismuth oxide added so that the material can be detected on a radiograph. The cement is made up of calcium, silicon and aluminium. The main constituent phases are tricalcium and dicalcium silicate and tricalcium aluminate. There are two commercial forms of MTA, namely the grey and the white. The difference between the grey and the white materials is the presence of iron in the grey material, which makes up the phase tetracalcium alumino-ferrite. This phase is absent in white MTA. Hydration of MTA occurs in two stages. The initial reaction between tricalcium aluminate and water in the presence of calcium sulphate results in the production of ettringite. Tricalcium and dicalcium silicate react with water to produce calcium silicate hydrate and calcium hydroxide, which is leached out of the cement with time.

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The longevity of dental restorations is dependent on many factors, including those related to materials, the dentist, and the patient. Dental amalgams have successfully served the profession for over a century. The main reasons for restoration failure are secondary caries, fracture of the bulk of the restoration or of the tooth, and marginal deficiencies and wear. The importance of direct-placement, aesthetic, tooth-colored restorative materials is still increasing. Amalgam restorations are being replaced because of alleged adverse health effects and inferior aesthetic appearance. All alternative restorative materials and procedures, however, have certain limitations. This article will attempt to critically analyse both amalgams and resin based composites, through an evaluation of scientific literature.

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Objective: The purpose of this in-vitro study was to evaluate the surface roughness of two direct resin composites polished with one-step and multi-step polishing systems. Materials and Methods: The resin composites examined in this study include minifill-hybrid composite Esthet-X (DENTSPLY/Caulk, Milford, DE, USA) and packable composite Solitaire II (Heraeus Kulzer, Inc., Southbend). A total of 42 discs (10 3 2 mm), 21 specimens of each restorative material were fabricated. Seven specimens per composite group received no polishing treatment and served as control. For each composite group, the specimens were randomly divided into two polishing systems: One-step PoGo (Dentsply/Caulk, Milford, DE, USA) and multi-step Super Snap (Shofu, Inc. Kyoto, Japan). Polishing systems were applied according to the manufacturer's instructions after being ground wet with 1200 grit silicon carbide paper. The surface roughness values were determined using a profilometer. Results: Data was subjected to student's t test at a significance level of 0.05. The smoothest surfaces were achieved under Mylar strips in both the composite groups. Mean Ra values ranged from 0.09 to 0.3 mm for Esthet-X group and from 0.18 to 0.3 mm for Solitaire II with different polishing systems. The ranking of the order of surface roughness on the basis of the type of composite was as follows: Esthet-X , Solitaire II for PoGo system and Esthet-X 5 Solitaire II for Super Snap; and the ranking for the polishing system was: PoGo , Super Snap (P # 0.05). Conclusion: The one-step polishing system (PoGo) produced better surface quality in terms of roughness than the multi-step system (Super Snap) for minifill-hybrid composite (Esthet-X), and it was equivalent to Super Snap for packable composites (Solitaire II). Minifill-hybrid presented a better surface finish than Solitaire II when PoGo polishing system was used. No significant difference was present in surface roughness between both the materials when Super Snap system was used.

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Objective: To evaluate the depth of penetration of three resin-based root canal sealers into the dentinal tubules at the cervical, middle and apical third of the root canal. Materials and Methods: Root canals of 32 extracted human mandibular premolar teeth were prepared and obturated using EndoREZ + resin-coated gutta-percha points (group A), Epiphany + Resilon points (group B), or AH Plus + gutta-percha (group C). The teeth were split longitudinally in bucco-lingual direction and viewed under scanning electron microscope. Photographs were taken at cervical, middle and apical levels for all samples and corresponding measurements were made. The data obtained was statistically analyzed using one-way ANOVA and the post-hoc Bonferroni test for inter-group comparison. Results: The results showed that the greatest penetration into dentinal tubules was by EndoREZ sealer (525.2 μ, 327.802 μ and 198.36 μ at cervical, middle and apical third), followed by Epiphany sealer (479.7 μ, 297.212 μ, and 182.22 μ), and the least penetration was seen with AH Plus sealer (224.2 μ, 65.419 μ, and 40.7 μ). The penetration of sealer into the dentinal tubules was statistically significant between each group at each level and between different levels within each group (P<.05). Conclusion: The penetration depth of EndoREZ and Epiphany into the dentinal tubules is significantly greater than that of AH Plus.

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Aim: The current in vitro study evaluated Vickers hardness (VK) and depth of cure (hardness ratio) of six resin composites, polymerized with a light-emitting diode (LED) curing unit by different polymerization modes: Standard 20 s, Standard 40 s, Soft-start 40 s. Materials and Methods: Six resin composites were selected for the present study: three microhybrid (Esthet.X HD, Amaris, Filtek Silorane), two nanohybrid (Grandio, Ceram.X mono) and one nanofilled (Filtek Supreme XT). The VK of the surface was determined with a microhardness tester using a Vickers diamond indenter and a 200 g load applied for 15 seconds. The mean VK and hardness ratio of the specimens were calculated using the formula: hardness ratio = VK of bottom surface / VK of top surface. Results: For all the materials tested and with all the polymerization modes, hardness ratio was higher than the minimum value indicated in literature in order to consider the bottom surface as adequately cured (0.80). Curing time did not affect hardness ratio values for Filtek Silorane, Grandio and Filtek Supreme XT. Conclusion: The effectiveness of cure at the top and bottom surface was not affected by Soft-start polymerization mode.

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Aim: To evaluate the disinfection of dentinal tubules using calcium hydroxide with propylene glycol and calcium hydroxide with iodoform in silicone oil, as compared to 2% chlorhexidine gel. Materials and Methods: The antimicrobial efficacy of the medicaments against E.faecalis and C.albicans were assessed in vitro, using a dentinal tubule model at depths of 200 μm and 400 μm in extracted single rooted teeth. Saline was taken as the negative control (Group I) Results: All three medicaments used in this study exerted antibacterial and antifungal activity. Group II (calcium hydroxide with propylene glycol) and Group IV (2% chlorhexidine gel) had the highest antimicrobial activity and the differences between their antibacterial activities were not statistically significant. Group III (calcium hydroxide with iodoform in silicone oil) and Group IV had the highest antifungal activity and the differences between their antifungal activities were not statistically significant. The inhibition of growth at 200 μm and 400 ΅m was uniform, with no statistical difference. Conclusions: Two percent chlorhexidine gel was effective against both E.faecalis and C.albicans. Calcium hydroxide with propylene glycol was the most effective intracanal medicament along with 2% chlorhexidine against E.faecalis, whereas, calcium hydroxide with iodoform in silicone oil was the most effective intracanal medicament along with 2% chlorhexidine against C.albicans.

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Dentinal hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. It can affect patients of any age group and most commonly affects the canines and premolars of both the arches. This article concisely reviews the patho-physiology, mechanism and clinical management of the DH. Treatment of DH should start with an accurate diagnosis. Differential diagnosis should be made and all other probable causes should be excluded. An often neglected phase of clinical management of DH is the identification and treatment of the causative factors of DH. By removing the etiological factors, the condition can be even prevented from occurring or recurring. There are various treatment modalities available which can be used at home or may be professionally applied. The "at home" desensitizing agents include toothpastes, mouthwashes or chewing gums and they act by either occluding the dentinal tubules or blocking the neural transmission. This article also discusses the recent treatment options like bioglass, Portland cement, lasers and casein phosphopeptide.

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Aim: The purpose of this paper is to review the literature on the clinical effectiveness of contemporary resin-based dentin bonding agents primarily focussing on the longevity of restoration. Materials and Methods: The literature published from June 2004 up to September 2010 was reviewed for clinical trials that tested the effectiveness of dentin bonding agents in the longevity of noncarious class V restoration. Results of each study reported using the USPHS criteria for clinical assessment of restoration were included and tabulated. The American Dental Association guidelines for dentin and enamel adhesives were used as a reference to compare the performance of individual bonding agents. Kruskal-Wallis followed by Mann-Whitney U was done to compare the mean Alfa score percentage for the three categories of bonding systems [etch-and-rinse (ER), self-etch primer (SEP), and self-etch-adhesive (SEA)]. Results: A comparison of the mean Alfa score percentages revealed no difference between the ER, SEP, and SEA categories of bonding systems except for marginal adaptation where ER was found to be superior to SEA. Conclusion: The clinical effectiveness of resin-based bonding agents is comparable among the three categories.

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In the last few decades, there have been tremendous advances in the mechanical properties and methods of fabrication of ceramic materials. While porcelain-based materials are still a major component of the market, there have been moves to replace metal ceramics systems with all ceramic systems. Advances in bonding techniques have increased the range and scope for use of ceramics in dentistry. In this brief review, we will discuss advances in ceramic materials and fabrication techniques. Examples of the microstructure property relationships for these ceramic materials will also be addressed.

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Root canal therapy has been practiced ever since 1928 and the success rate has tremendously increased over the years owing to various advancements in the field. One main reason is the complete understanding of the microbiology involved in the endodontic pathology. This has helped us to modify the conventional treatment plans and effectively combat the microorganisms. Now, studies are aiming to explore the characteristics of the "most" resistant organism and the methods to eliminate them. This article gives an insight of the microbiology involved in endodontic pathology and discusses its role in our treatment procedure. Information from original reviews listed in PubMed, published from 1995 to 2010, has been mainly included in this review.

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Supernumerary paramolars are the rare anomalies of the maxillofacial complex. These are more common in the maxilla than in the mandible. This article reviews the etiology, frequency, classification, complications, diagnosis and management of supernumerary teeth (bilateral maxillary paramolars)

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Aim: To evaluate and compare the amount of debris and irrigant extruded quantitatively by using two hand and rotary nickel-titanium (Ni-Ti) instrumentation techniques. Materials and Methods: Eighty freshly extracted mandibular premolars having similar canal length and curvature were selected and mounted in a debris collection apparatus. After each instrument change, 1 ml of distilled water was used as an irrigant and the amount of irrigant extruded was measured using the Meyers and Montgomery method. After drying, the debris was weighed using an electronic microbalance to determine its weight. Statistical analysis used: The data was analyzed statistically to determine the mean difference between the groups. The mean weight of the dry debris and irrigant within the group and between the groups was calculated by the one-way ANOVA and multiple comparison (Dunnet D) test. Results: The step-back technique extruded a greater quantity of debris and irrigant in comparison to other hand and rotary Ni-Ti systems. Conclusions: All instrumentation techniques extrude debris and irrigant, it is prudent on the part of the clinician to select the instrumentation technique that extrudes the least amount of debris and irrigant, to prevent a flare-up phenomena.

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While the regeneration of a lost tissue is known to mankind for several years, it is only in the recent past that research on regenerative medicine/dentistry has gained momentum and eluded the dramatic yet scientific advancements in the field of molecular biology. The growing understanding of biological concepts in the regeneration of oral/dental tissues coupled with experiments on stem cells is likely to result in a paradigm shift in the therapeutic armamentarium of dental and oral diseases culminating in an intense search for "biological solutions to biological problems." Stem cells have been successfully isolated from variety of human tissues including orofacial tissues. Initial evidence from pioneering studies has documented the likely breakthrough that stem cells offer for various life-threatening diseases that have so far defeated modern medical care. The evidence gathered so far has propelled many elegant studies exploring the role of stem cells and their manifold dental applications. This review takes you on a sojourn of the origin of stem cells, their properties, characteristics, current research, and their potential applications. It also focuses on the various challenges and barriers that we have to surmount before translating laboratory results to successful clinical applications heralding the dawn of regenerative dentistry.

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Background and Aim: Rising demand for aesthetic adhesive restorations has led to wide use of composites. A multilayer technique is recommended for success of these restorations. The surface layer of composite coming in contact with air forms a superficial sticky layer called oxygen inhibited layer, upon polymerization, allowing resins from both sides to cross the interface and form an interdiffusion zone. The present study was sought to test whether oxygen inhibited layer increases or decreases the shear bond strength at the interface of composites. Materials and Methods: A microhybrid composite Esthetic -X (Dentsply, Caulk) was used in this study. A cylindrical mold of composite, five mm thick and eight mm long, was prepared and embedded in acrylic resin molds after curing. This was placed in distilled water for two hours and sheared in universal testing machine at a cross head speed of one mm/sec. Statistical Analysis: Data analyzed statistically to determine the significant difference between the groups. Mean and standard deviation values were estimated for the study groups and compared by one way ANOVA. Results: No significant difference in shear bond strength of composites cured with and with out oxygen inhibited layer. Conclusions: The presence or absence of oxygen inhibited layer made no significant difference in shear bond strength of composite resins.

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Aim: The study aims to evaluate and compare marginal microleakage in deep class II cavities restored with various techniques using different composites. Materials and Methods: Sixty freshly extracted teeth were divided into six groups of 10 teeth each. Standardized class II cavities were made and were restored using composites of different consistencies with different placement techniques. Group 1 with Microhybrid composite, Group 2 with Packable composite, Group 3 Microhybrid composite with a flowable composite liner, Group 4 Packable composite with a flowable composite liner, Group 5 Microhybrid composite with precured composite insert in second increment and Group 6 Packable composite with precured insert in second increment. Specimens then were stored in distilled water, thermocycled and immersed in 50% silver nitrate solution. These specimens were sectioned and evaluated for microleakage at the occlusal and cervical walls separately using stereomicroscope. Results: The results demonstrated that in the occlusal wall, packable composite, showed significantly more marginal microleakage than the other groups. In the cervical wall, teeth restored with a flowable composite liner showed less marginal microleakage when compared to all other groups. Conclusion: Based on the results of this study, the use of flowable composite as the first increment is recommended in deep class II cavities.

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