Aim: The aim of this article is to review the current literature on the therapeutic uses and efficacy of Triphala. Herbal remedies are among the most ancient medicines used in traditional systems of healthcare such as Ayurveda. Triphala, a well-recognized and highly efficacious polyherbal Ayurvedic medicine consisting of fruits of the plant species Emblica officinalis (Amalaki), Terminalia bellerica (Bibhitaki), and Terminalia chebula (Haritaki), is a cornerstone of gastrointestinal and rejuvenative treatment. Methods: A search of the PubMed database was conducted. Results: In addition, numerous additional therapeutic uses described both in the Ayurvedic medical literature and anecdotally are being validated scientifically. In addition to laxative action, Triphala research has found the formula to be potentially effective for several clinical uses such as appetite stimulation, reduction of hyperacidity, antioxidant, anti-inflammatory, immunomodulating, antibacterial, antimutagenic, adaptogenic, h...

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Therapeutic Uses of Triphala in Ayurvedic Medicine

In Vivo Evaluation of 3 Electronic Apex Locators: Root ZX Mini, Apex ID, and Propex Pixi

Objectives This study evaluated the antimicrobial efficacy of ozone therapy in teeth contaminated with Pseudomonas aeruginosa, Enterococcus faecalis, and Staphylococcus aureus using a mono-species biofilm model. Parallel to this, the study aimed to evaluate the cytotoxicity of ozone for human gingival fibroblasts. Material and Methods: One hundred and eighty single-root teeth were contaminated with a mono-species biofilm of Enterococcus faecalis, Pseudomonas aeruginosa, and Staphylococcus aureus. Groups were formed: Group I – control; Group II – standard protocol; Group III – standard protocol + ozone gas at 40 µg/mL; and Group IV – standard protocol + aqueous ozone at 8 µg/mL. In parallel, human gingival fibroblasts were submitted to the MTT test. Cells were plated, then ozone was applied as follows: Group I (control) – broth medium; Group II – aqueous ozone at 2 µg/mL; Group III – aqueous ozone at 5 µg/mL; and Group IV – aqueous ozone at 8 µg/mL. Data were submitted to the Kruskal Wallis test and Bonferroni post hoc analyses to assess microbiology and cytotoxicity, respectively (p<0.05%). Results The results revealed antimicrobial efficacy by Group IV with no CFU count. The cytotoxicity assay showed Groups III and IV to be the most aggressive, providing a decrease in cell viability at hour 0 from 100% to 77.3% and 68.6%, respectively. Such a decrease in cell viability was reverted, and after 72 hours Groups III and IV provided the greatest increase in cell viability, being statistically different from Groups I and II. Conclusion According to the applied methodology and the limitations of this study, it was possible to conclude that ozone therapy improved the decontamination of the root canal ex vivo. Ozone was toxic to the cells on first contact, but cell viability was recovered. Thus, these findings suggest that ozone might be useful to improve root canal results.

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Ozone therapy as an adjuvant for endondontic protocols: microbiological - ex vivo study and citotoxicity analyses.

Antimicrobial effect of herbal extract of Acacia arabica with triphala on the biofilm forming cariogenic microorganisms.

INTRODUCTION Debridement and disinfection of the root canal is a crucial step in the success of endodontic treatment. Several antimicrobial agents alone or in combination are used to achieve this. The objective of this in vitro study was to assess the antimicrobial efficacy of neem (Azadirachta indica) extract against Enterococcus faecalis. MATERIALS AND METHODS Neem leaf extract, 2% chlorhexidine, 3% sodium hypochlorite were used to assess the antimicrobial efficiency. Agar well diffusion test was used to study the antimicrobial efficacy with saline as control. The zone of inhibition was recorded, tabulated, and analyzed statistically with the help of IBM Statistical Package for the Social Sciences statistics version 20 using analysis of variance test. RESULTS All the three medicaments showed well-defined and comparable zones of inhibition around their respective wells. All values were significantly higher than the control group. Analysis of variance showed significant difference between zone diameters of chlorhexidine, neem leaf extract, and 3% sodium hypochlorite against E. faecalis (p < 0.05). CONCLUSION From the present study, it can be concluded that neem leaf extract shows comparable zones of inhibition with that of chlorhexidine and sodium hypochlorite. CLINICAL SIGNIFICANCE Neem leaf extract has significant antimicrobial activity against E. faecalis and thus opens the perspectives for the use of neem extract as an intracanal medication.

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Antibacterial Efficacy of Neem (Azadirachta indica) Extract against Enterococcus faecalis: An in vitro Study.

Context: Sodium hypochlorite is the most widely used irrigant in endodontic practice, but it has various disadvantages. Literature has shown that herbal products such as Propolis, Azadirachta indica (AI), Triphala, Curcuma longa, and Morinda citrifolia (MC) possess good antimicrobial properties and thus can be used as potential endodontic irrigants. Aim: To evaluate and compare the antimicrobial activity of five herbal extracts, i.e., Propolis, AI, Triphala, C. longa, and MC with that of 2.5% sodium hypochlorite against Enterococcus faecalis. Materials and Methods: E. faecalis American Type Culture Collection 21292 was inoculated onto brain heart infusion agar plate. Discs impregnated with herbal medicaments were placed on the inoculated plates and incubated at 37°C aerobically for 24 h and growth inhibition zones were measured. Statistical Analysis: Mean zone of inhibition in descending order was found as sodium hypochlorite > Propolis > AI > Triphala > C. longa = MC > ethanol. Statistical analysis was performed using one-way analysis of variance which showed a significant difference in the zone of inhibition of sodium hypochlorite and Propolis (P Results: Propolis showed highest zone of inhibition among all the herbal extracts next to sodium hypochlorite. Conclusion: Propolis and AI have significant antimicrobial activity against E. faecalis.

An in vitro evaluation of antimicrobial activity of five herbal extracts and comparison of their activity with 2.5% sodium hypochlorite against Enterococcus faecalis

INTRODUCTION One of the most important goals of restorative dentistry is to restore the patient's aesthetic. Smile analysis is subjective and it differs from person to person. An aesthetic smile involves a harmonious relationship between various parameters including the hard and soft tissues. AIM The aim of the study was to identify the acceptable range of several smiles (alone and in conjunction with the face) by specialists, general dentists as well as lay persons; and to identify the values of different criteria i.e., the Golden Proportion (GP), the Recurrent Esthetic Dental proportion (RED), Width to Height ratio (W/H ratio), the Apparent Contact Dimension (ACD), and lateral incisor position in a smile. MATERIALS AND METHODS Hundred photographs of 50 subjects were taken, 50 of the smile alone and 50 of the individual's frontal view of face. The photographs of the smiles and the faces were assessed for the aesthetic acceptability by 30 evaluators including 10 specialists with advanced training, 10 general dentists and 10 lay persons. Irreversible hydrocolloid impressions were made of the dentitions of all the individuals using stock trays and were poured in dental stone. Measurements were made on the facial surface of the teeth on the models and were recorded in millimeters using a sharp tipped digital vernier calliper. Data was analyzed to evaluate the presence of different parameters assessed in the smiles. Mean and standard deviation values for the percentage of only the agreeable smiles were calculated in both individual smile analysis and in conjunction with the face. The non agreeable smiles were excluded from further statistical analysis. Pearson Correlation Coefficient was calculated to compare the values obtained in all the three groups. RESULTS More number of smiles were considered agreeable by the general dentists when compared to the specialists and the number even increased in case of evaluation by lay persons. Greater number of smiles was found to be agreeable when they were evaluated in conjunction with the face. CONCLUSION Rather than assessment of individual numeric parameter that defines an ideal aesthetic smile, a smile to be aesthetic should harmonize with the composition of the face.

Perception of Acceptable Range of Smiles by Specialists, General Dentists and Lay Persons and Evaluation of Different Aesthetic Paradigms.

Introduction: The aim of the present study was to comparatively evaluate the accuracy of iRoot, iPex II, and Propex pixi apex locator using histological sections as the gold standard. Materials and Methods: Thirty patients indicated for extraction of single-rooted permanent teeth with single canal system were selected. Working lengths (WLs) of teeth were determined using iRoot, iPex II, and Propex pixi. Teeth were then extracted, and the files were reintroduced to the anatomic apex to measure anatomic canal length (ACL) and fixed at the ACL using flowable composite. The apical 4 mm of the roots were longitudinally shaved away to visualize the canal under a stereomicroscope at ×24 magnification. Digital photographs were evaluated to measure the distance between the major diameter and minor diameter. Thus, the WL, that is, the minor diameter length (MDL) was ascertained. Results: Measurements of mean WLs within ±0.5 mm of minor diameter were 90% acceptable for iRoot, 86.66% for iPex II, and 80% for Propex pixi when compared with mean MDL as obtained from the histological sections. Conclusions: All apex locators have been shown to produce acceptable level of accuracy which clearly indicates their reliability in determining the WL.

A comparative evaluation of accuracy of three electronic apex locators using histological section as gold standard: An ex vivo study.

Introduction: To evaluate the incidence of microcrack formation canal preparation with two rotary nickel–titanium systems Mtwo and ProTaper Next along with the self-adjusting file system. Materials and Methods: One hundred and twenty mandibular premolar teeth were selected. Standardized access cavities were prepared and the canals were manually prepared up to size 20 after coronal preflaring. The teeth were divided into three experimental groups and one control group (n = 30). Group 1: The canals were prepared using Mtwo rotary files. Group 2: The canals were prepared with ProTaper Next files. Group 3: The canals were prepared with self-adjusting files. Group 4: The canals were unprepared and used as a control. The roots were sectioned horizontally 3, 6, and 9 mm from the apex and examined under a scanning electron microscope to check for the presence of microcracks. The Pearson's Chi-square test was applied. Results: The highest incidence of microcracks were associated with the ProTaper Next group, 80% (P = 0.00), followed by the Mtwo group, 70% (P = 0.000), and the least number of microcracks was noted in the self-adjusting file group, 10% (P = 0.068). No significant difference was found between the ProTaper Next and Mtwo groups (P = 0.368) while a significant difference was observed between the ProTaper Next and self-adjusting file groups (P = 0.000) as well as the Mtwo and self-adjusting file groups (P = 0.000). Conclusion: All nickel–titanium rotary instrument systems were associated with microcracks. However, the self-adjusting file system had significantly fewer microcracks when compared with the Mtwo and ProTaper Next.

Evaluation of the incidence of microcracks caused by Mtwo and ProTaper Next rotary file systems versus the self-adjusting file: A scanning electron microscopic study.

Introduction: A successful root canal therapy is largely dependent on thorough chemo-mechanical debridement of the root canal space. However, mechanical preparation inadvertently forms an amorphous layer, known as the “smear layer.” Traditionally used irrigants have a deleterious effect over root dentin and thus herbal alternatives can be a better option for smear layer removal with no action on root dentin. Aim: The purpose of the study was to compare the in vitro effectiveness of two potential herbal irrigants: 6% German chamomile extract (GCE) and 6% Morinda citrifolia juice (MCJ), in removal of smear layer. Materials and Methods: Eighty single-rooted human teeth were allocated into two equal groups: one to be instrumented with the self-adjusting file (SAF), while the other with WaveOne (WO). Four subgroups in each group were irrigated with 6% GCE, 6% MCJ, 17% ethylenediaminetetraacetic acid (EDTA) (positive control), and NS (negative control). Scanning electron microscopy (SEM) was used to evaluate the presence of smear layer. Statistical Analysis: As data for smear layer were categorical, Chi-square test was applied for data analysis. P Results: The most effective smear layer removal in the coronal part was observed with SAF-EDTA and SAF-GCE, followed by WO-EDTA. In the middle part, SAF-GCE was equivalent to that of SAF-EDTA, followed by WO-EDTA and WO-GCE. In the apical third, the most efficient smear layer removal was observed with SAF-EDTA, followed by some removal of smear layer by WO-EDTA and SAF-GCE. GCE was as effective as EDTA in removal of smear layer in the coronal and mid-root regions, when used with continuous irrigation.

Divya Saxena

Papers

An in vitro evaluation of antimicrobial activity of five herbal extracts and comparison of their activity with 2.5% sodium hypochlorite against Enterococcus faecalis

Perception of Acceptable Range of Smiles by Specialists, General Dentists and Lay Persons and Evaluation of Different Aesthetic Paradigms.

A comparative evaluation of accuracy of three electronic apex locators using histological section as gold standard: An ex vivo study.

Evaluation of the incidence of microcracks caused by Mtwo and ProTaper Next rotary file systems versus the self-adjusting file: A scanning electron microscopic study.

Efficacy of smear layer removal by two Ayurvedic herbal irrigants, using continuous vs. syringe and needle irrigation