Showing papers in "Journal of Conservative Dentistry in 2017"

Incremental techniques in direct composite restoration

Abstract: Polymerization shrinkage is one of the dental clinician's main entanglements when placing resin-based composite restorations. None of the method can assure a perfectly sealed restoration for adhesive restorative materials; clinicians must abode problems of polymerization shrinkage and its possible ill effects. The objective of this article is to review different incremental techniques that can ruin the polymerization shrinkage stress of direct composite restoration.

A comparison of human dental pulp response to calcium hydroxide and Biodentine as direct pulp-capping agents

Abstract: Context: Direct pulp capping involves the placement of a biocompatible agent on pulp tissue that has been inadvertently exposed from traumatic injury or by iatrogenic means. Aim: To compare the human pulp response to calcium hydroxide and Biodentine as direct pulp-capping agents. Materials and Methods: Pulp exposures were performed on the pulpal floor of forty human permanent premolars. The exposure sites were dressed with either Dycal or Biodentine as pulp-capping materials. After 45 days, teeth were extracted and processed for histological examination. Statistical Analysis: The histological data were subjected to Wilcoxon rank-sum test. Results: The dentinal bridges in teeth that were capped with Biodentine were significantly thicker (P Conclusion: Based on the result of this study, Biodentine can be suggested as the material of choice for direct pulp capping procedure instead of Dycal. However, further long-term follow-up in vivo human studies using Biodentine on cariously exposed pulpal teeth are warranted to derive a definite conclusion.

Clinical evaluation of mineral trioxide aggregate and biodentine as direct pulp capping agents in carious teeth

Abstract: Background: Root canal treatment has been a routine treatment option for carious exposure of the dental pulp. In the context of minimally invasive dentistry, direct pulp capping (DPC) procedure with a reliable biomaterial may be considered as an alternative provided the pulp status is favorable. Mineral trioxide aggregate (MTA), a bioactive cement with excellent sealing ability and biocompatibility is capable of regenerating relatively damaged pulp and formation of dentin bridge when used as DPC agent. Biodentine is comparatively a new biomaterial claimed to possess properties similar to MTA and is currently explored for vital pulp therapy procedures. Aim: The aim of the present study was to evaluate the clinical response of pulp-dentin complex after DPC with MTA and biodentine in carious teeth. Subjects and Methods: Twenty-four permanent molars with carious exposure having no signs and symptoms of irreversible pulpitis were selected and assigned to one of the two groups, Group I - MTA and Group II - biodentine. Patients were recalled at 3 weeks, 3 months, and 6 months for clinical and radiographic evaluation. Fisher's exact test was used along with Chi-square test for statistical analysis. Results: Over a period of 6 months, MTA and biodentine showed 91.7% and 83.3% success rate, respectively, based on the subjective symptoms, pulp sensibility tests, and radiographic appearance. Conclusion: MTA and biodentine may be used as DPC agents when the pulpal diagnosis is not more than reversible pulpitis.

Shear bond strength of different restorative materials to mineral trioxide aggregate and Biodentine.

Abstract: Significance of Study: Mineral trioxide aggregate (MTA) and Biodentine (calcium silicate-based materials) have great importance in dentistry. There is no study comparing the bond strength of Biodentine and MTA for composite, compomer, and compomer or resin-modified glass ionomer (RMGIC). Although many advantages of Biodentine over MTA; in this study, MTA has shown better shear bond strength (SBS) to restorative materials. Aim: Recently, a variety of calcium silicate-based materials are often used for pulp capping, perforation repair, and endodontic therapies. After those treatment procedures, teeth are commonly restored with composite resin, (RMGIC materials in pediatric dentistry. The aim of this study was to evaluate the SBS of composite resin (Filtek™ Z250; 3M ESPE, USA), compomer (Dyract XP; LD Caulk/Dentsply, USA), and resin-modified glass ionomer (Photac-Fil Quick Aplicap; 3M ESPE, USA) to white MTA and Biodentine. Materials and Methods: Ninety acrylic cylindrical blocks were prepared and divided into two groups (n = 45). The acrylic blocks were randomly allocated into 3 subgroups; Group-1A: MTA + composite (Filtek™ Z250), Group-1B: MTA + compomer (Dyract XP), Group-1C: MTA + RMGIC (Photac-Fil Quick Aplicap), Group-2A: Biodentine + composite, Group-2B: Biodentine + compomer, Group-2C: Biodentine + RMGIC. The specimens were mounted in Universal Testing Machine. A crosshead speed 1 mm/min was applied to each specimen using a knife-edge blade until the bond between the MTA/Biodentine and restorative material failed. Failure modes of each group were evaluated under polarized light microscope at ×40 magnification. Results: There was no statistically significant difference between MTA + Composite resin with MTA + Compomer; and MTA + RMGIC with Biodentine + RMGIC (P > 0.05). There were statistically significant differences between other groups (P Conclusions: The results of the present study displayed that although many advantages of Biodentine over MTA; MTA has shown better SBS to compomer and composite resin materials than Biodentine.

Apical extrusion of debris during root canal preparation using a novel nickel-titanium file system: WaveOne gold

Abstract: Aim: This study was intended to evaluate the amount of apically extruded debris following root canal preparation with three different instrumentation systems. Materials and Methods: Sixty mandibular incisor teeth were selected and randomly divided into three groups (n = 20/group) according to the instrumentation system used: the ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), the Twisted File Adaptive (TFA; SybronEndo, Orange, CA, USA), and the WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland). All apically extruded debris was collected and dried in preweighed glass vials. The mean weight of the apically extruded debris was obtained using a microbalance. The time for root canal preparation was also recorded. The data were analyzed using a one-way analysis of variance. Results: The mean weights of apically extruded debris were 0.00035 ± 0.00014 g (PTN); 0.00023 ± 0.0001 g (TFA); and 0.00019 ± 0.0001 g (WOG) (P Conclusions: The PTN system extruded more debris than the TFA and WOG systems. The TFA and WOG systems were faster than the PTN system.

Comparing the effectiveness of four desensitizing toothpastes on dentinal tubule occlusion: A scanning electron microscope analysis.

Abstract: Introduction: Dentin hypersensitivity (DH) is a sudden short sharp pain best explained by hydrodynamic theory. Several agents are available throughout the market that can treat DH either by blocking the nerves that helps in conducting pain or by blocking the open dentinal tubules. The aim of the present study was to compare the tubule occluding efficacy of four different desensitizing dentifrices under scanning electron microscope (SEM). Materials and Methods: Sixty-two dentin blocks measuring 5 mm × 5 mm × 3 mm were obtained from extracted human molar teeth and were randomly divided into five groups: Group 1 – no treatment (control, n = 2); Group 2 – Pepsodent Pro-sensitive relief and repair (n = 15); Group 3 – Sensodyne repair and protect (n = 15); Group 4 – Remin Pro (n = 15); Group 5 – Test toothpaste containing 15% nano-hydroxyapatite (n-HA) crystals (n = 15). The specimens were brushed for 2 min/day for 14 days and stored in artificial saliva. After final brushing, specimens were gold sputtered and viewed under SEM at ×2000 magnification. Results obtained were statistically analyzed using nonparametric Kruskal–Wallis test and least significant difference post hoc test. Results: All test groups showed significant increase in dentin tubule occlusion as compared to control group. The highest percentage of tubules occluded was shown by Group 4 and Group 5 which was significantly different from other groups (P ≤ 0.05), and there was no significant difference in tubule occlusion among them. Conclusion: Newer desensitizing dentifrices containing 15% n-HA and Remin Pro can provide effective tubule occlusion and thereby reduce the pain and discomfort caused by DH.

Efficacy of two rotary retreatment systems in removing Gutta-percha and sealer during endodontic retreatment with or without solvent: A comparative in vitro study.

Abstract: Objectives: The aim of this in vitro study was to compare the efficacy of two retreatment rotary systems in the removal of Gutta-percha (GP) and sealer from the root canal walls with or without solvent. Materials and Methods: Forty-eight extracted human mandibular first premolars were prepared and obturated with GP and AH Plus sealer. Samples were then randomly divided into four groups. Group I was retreated with MtwoR rotary system without solvent, Group II was retreated with MtwoR rotary system with Endosolv R as the solvent, Group III with D-RaCe rotary system without solvent, and Group IV with D-RaCe rotary system and Endosolv R solvent. The cleanliness of canal walls was determined by stereomicroscope (×20) and AutoCAD software. Kruskal–Wallis test and Mann–Whitney U-test were used to compare the data. Results: Results showed that none of the retreatment systems used in this study was able to completely remove the root canal filling material. D-RaCe with or without solvent showed significantly (P > 0.05) less filling material at all levels compared to MtwoR with/without solvent. Conclusion: Within the limitation of the current study, D-RaCe rotary retreatment system is more effective in removing filling material from root canal walls when compared to MtwoR rotary retreatment system.

Clinical evaluation of flowable resin composite versus conventional resin composite in carious and noncarious lesions: Systematic review and meta-analysis.

Abstract: The purpose of this systematic review was to evaluate clinical performance of flowable composite in carious and noncarious lesions. An electronic search was conducted using specific databases (PubMed, Embase, Cochrane Library, and LILACS) through March 2017. Clinical trials for restoration of carious and noncarious lesions were included with no date restrictions; follow-up was 6 months at least and dental restorations were evaluated using the United States Public Health Service criteria. The systematic search generated 908 papers, of which 35 papers were included for full-text review. Inclusion criteria were met by eight papers, six papers were for noncarious lesions and two papers were for restoration of carious lesions. The results of this review have shown no statistical or clinical difference between flowable and conventional composites for all tested outcomes in both carious and noncarious lesions. Both materials have shown clinically acceptable scores for all criteria, with no evidence of clinically unacceptable scores except in retention, with a retention rate of 83% in both materials after 36 months. Flowable composites had clinical efficacy after 3 years of service similar to that of conventional composite in both carious and noncarious lesions, these results are based on low quality of evidence. Based on the available literature and the best available evidence, flowable composites can be used in restoration of noncarious cervical lesions and minimally invasive occlusal cavities.

Comparative evaluation of three different rotary instrumentation systems for removal of gutta-percha from root canal during endodontic retreatment: An in vitro study.

Abstract: Context: Endodontic retreatment is performed in teeth with endodontic failures. The main goal of retreatment is cleaning and shaping of the root canal with removal of old root filling material. Hand instruments and rotary instruments are mainly used for removing this filling material. Aim of Study: To compare the relative efficacy of three rotary instrumentation systems for removal of gutta-percha from root canal during endodontic retreatment. Objective of Study: To find out which NiTi system is more efficacious in retreatment and to check out the efficacy of retreatment with and without use of solvent. Materials and Methods: Sixty freshly extracted, single-rooted human mandibular premolars were instrumented with K-files, and each root canal was filled with gutta-percha and AH Plus (Dentsply Detrey, Konstanz, Germany) sealer using lateral compaction. Specimens were then divided into three experimental groups with twenty specimens each. Groups were then subdivided into ten specimens each. Groups were then retreated either with or without solvent. The removal of gutta-percha was performed using ProTaper retreatment files, Mtwo retreatment files, and R-Endo files after 2 weeks. The amount of root canal filling material remnant in the coronal, middle, and apical thirds was measured using stereomicroscope and computer image analysis program. Statistical Analysis Used: Data were evaluated statistically using analysis of variance. Results: ProTaper group was found to have less remnant filling material as compared to the other groups in coronal and middle thirds, but a significant difference was observed between ProTaper and Mtwo and Mtwo and R-Endo in the nonsolvent groups (P Conclusions: Both nickel–titanium systems and ProTaper and Mtwo retreatment file systems, were found to be effective in the removal of root canal filling material. However, complete removal of gutta-percha from root canals did not occur with any of the experimental groups.

Comparative evaluation of apical microleakage in immediate and delayed postspace preparation using four different root canal sealers: An in vitro study.

Abstract: Background: Endodontically treated teeth often lack sufficient support for a permanent restoration. During post space preparation, it is important not to disturb the integrity of the apical seal. Aim: This study compared the effect of immediate versus delayed post space preparation on the apical seal using four different sealers. Materials and Methods: One hundred and thirty single rooted teeth were biomechanically prepared and obturated with single cone gutta-percha and 4 sealers: Endoflas FS, AH Plus, Gutta flow and MTA. Teeth were divided randomly into eight groups, post spaces were prepared using Gates Glidden drills immediately for group I, III, IV and VII. For groups II, IV, VI and VIII prepared after storage of the specimens in 100% humidity for one week. The samples were kept in methylene blue dye, centrifuged at 3000 rpm for 3 min sectioned and then measured under stereomicroscope for apical leakage. Statistical Analysis: The data was analysed using one way ANOVA and post hoc Tukey test. Results: All the specimens showed dye leakage, and a statistically significant difference was seen among all the groups (P > 0.05) except Gutta flow. Conclusion: Less leakage is seen when post space is prepared immediately.

Antimicrobial activity of root canal irrigants against biofilm forming pathogens- An in vitro study

Abstract: Aims: The aim of the study was to check the antimicrobial activity of the 5% Sodium hypochlorite, 2% Chlorhexidine, 0.10% Octenidine (OCT), and 2% Silver Zeolite (SZ) at different time intervals against a single species biofilm of Enterococcus faecalis, Staphylococcus aureus, and Candida albicans model prepared on a nitrocellulose membrane. Settings and Design: In vitro nitrocellulose biofilm model was used to check antibacterial efficacy of root canal irrigants. Materials and Methods: The in vitro nitrocellulose biofilm model was used to check the antibacterial activity of root canal irrigants. Single species biofilms were suspended into 96-well microtiter plate and treated with root canal irrigants for 1, 5, 10, 15, 30, and 60 s, respectively. The remaining microbial load in the form of colony-forming unit/ml after antimicrobial treatment was tabulated and data were statistically analyzed. Statistical Analysis: SPSS version 17, Kruskal–Wallis ANOVA, Mann–Whitney U-test, and Wilcoxon matched pair test (P Results: All tested microorganisms were eliminated within 30 s by all the antimicrobial substances tested except normal saline. 2% chlorhexidine and 0.10% OCT were equally effective against C. albicans at 30 s. Conclusion: The newly tested irrigants have shown considerable antibacterial activity against selected single species biofilm. OCT (0.10%) can be used as an alternative endodontic irrigant.

Comparative evaluation of smear layer removal by chitosan and ethylenediaminetetraacetic acid when used as irrigant and its effect on root dentine: An in vitro atomic force microscopic and energy-dispersive X-ray analysis.

Abstract: Aim: This study was undertaken to evaluate the efficacy of smear layer removal and nanostructural and chemical changes caused by chitosan and ethylenediaminetetraacetic acid (EDTA) on tooth surface using atomic force microscopic analysis and energy-dispersive X-ray (EDX) analysis. Methodology: Forty single-rooted premolars were decoronated to a standard length of 15 mm and enlarged to Protaper F3 with irrigation of 1 mL 1% NaOCl and deionized water. Specimens were then divided into 4 groups with 10 samples each and subjected to final rinse with 17% EDTA solution, 0.2% and 0.5% chitosan solution for 1 min. Samples were sectioned into 2 halves. One half of sample from each group were subjected to EDX analysis to check the calcium/phosphate (Ca/P) ratio. The second half of sample from each group subjected to atomic force microscopy (AFM) analysis to study the smear layer removal and nanostructural changes. Statistical analysis was done using ANOVA and Chi-square test. Results: The AFM images showed no difference in the elimination of smear layer. The quantitative analysis using AFM showed EDTA group had significantly higher surface alteration than chitosan. EDX analysis showed that the Ca/P ratio of root dentine in EDTA group is significantly lower than chitosan group. Conclusion: Chitosan is an effective chelating agent with less alteration in radicular dentine.

Remineralization ability of sodium fluoride on the microhardness of enamel, dentin, and dentinoenamel junction: An in vitro study.

Abstract: Aim: Dental tissues such as enamel, dentinoenamel junction (DEJ), dentin, and root dentin can react differently to demineralization and remineralization. The aim of this study was to evaluate the remineralization ability of sodium fluoride on the microhardness of enamel, dentin, and dentinoenamel junction. Materials and Methods: Ten extracted third molar teeth were sectioned mesiodistally to form control and test groups. For the test group, initial demineralization was done with acetic acid for 24 h followed by remineralization for 28 days by application of sodium fluoride (226 ppm) for 2 min twice a day. Vickers microhardness test was done to control and test groups at different sites after initial demineralization and on the 3rd, 5th, 7th, 14th, and 28th day of remineralization. Statistical Analysis Used: Data were analyzed with one-way analysis of variance and post hoc test with a significance level of P Results: Microhardness values in the demineralization group were significantly lower than controls (P Conclusion: Long-term repeated application of sodium fluoride (226 ppm) can improve the microhardness of demineralized dental tissues on enamel, dentin, and DEJ-axial zone, except in the DEJ-cusp tip and DEJ-center of fissure.

Canal transportation and centering ability of protaper and self-adjusting file system in long oval canals: An ex-vivo cone-beam computed tomography analysis.

Abstract: Context and Aims: The purpose of this study was to compare and evaluate the shaping ability of ProTaper (PT) and Self-Adjusting File (SAF) system using cone-beam computed tomography (CBCT) to assess their performance in oval-shaped root canals. Materials and Methods: Sixty-two mandibular premolars with single oval canals were divided into two experimental groups (n = 31) according to the systems used: Group I – PT and Group II – SAF. Canals were evaluated before and after instrumentation using CBCT to assess centering ratio and canal transportation at three levels. Data were statistically analyzed using one-way analysis of variance, post hoc Tukey's test, and t-test. Results: The SAF showed better centering ability and lesser canal transportation than the PT only in the buccolingual plane at 6 and 9 mm levels. The shaping ability of the PT was best in the apical third in both the planes. The SAF had statistically significant better centering and lesser canal transportation in the buccolingual as compared to the mesiodistal plane at the middle and coronal levels. Conclusions: The SAF produced significantly less transportation and remained centered than the PT at the middle and coronal levels in the buccolingual plane of oval canals. In the mesiodistal plane, the performance of both the systems was parallel.

Reliability of cone beam computed tomography as a biopsy-independent tool in differential diagnosis of periapical cysts and granulomas: An In vivo Study.

Abstract: Background: Differential diagnosis of periapical cysts and granulomas is required as their treatment modalities are different. Aim: The aim of this study was to evaluate the efficacy of cone beam computed tomography (CBCT) in the differential diagnosis of periapical cysts from granulomas. Settings and Design: A single-centered observational study was carried out in the Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, using CBCT and dental operating microscope. Methods: Forty-five lesions were analyzed using CBCT scans. One evaluator analyzed each CBCT scan for the presence of the following six characteristic radiological features: cyst like-location, shape, periphery, internal structure, effect on the surrounding structures, and cortical plate perforation. Another independent evaluator analyzed the CBCT scans. This process was repeated after 6 months, and inter- and intrarater reliability of CBCT diagnoses was evaluated. Periapical surgeries were performed and tissue samples were obtained for histopathological analysis. To evaluate the efficacy, CBCT diagnoses were compared with histopathological diagnoses, and six receiver operating characteristic (ROC) curve analyses were conducted. Statistical Analysis Used: ROC curve, Cronbach's alpha (α) test, and Cohen Kappa (κ) test were used for statistical analysis. Results: Both inter- and intrarater reliability were excellent (α = 0.94, κ = 0.75 and 0.77, respectively). ROC curve with regard to ≥4 positive findings revealed the highest area under curve (0.66). Conclusion: CBCT is moderately accurate in the differential diagnosis of periapical cysts and granulomas.

Evaluation of new technique of sterilization using biological indicator.

Abstract: Background: A novel technique of sterilization of endodontic files is introduced in this article. Aims: Newly introduced sterilization unit, named “SteriFast” is compared with autoclave and glass bead sterilizer using biological indicator. Materials and Methods: Spore strips of Bacillus pumilus were cultured in nutrient broth. This cultured media was used to contaminate the experimental samples of endodontic files. These contaminated files were sterilized using three different techniques. The sterilized files were transferred into nutrient medium under aseptic condition. The results were observed after 24 h, 48 h, and 7 days. Results: The results showed that autoclave and new sterilization device (SteriFast) showed complete sterilization. The files sterilized using glass bead sterilizer showed bacterial growth (80%). Conclusions: Thus, it proves that autoclave and SteriFast are ideal techniques of sterilization of endodontic files. Glass bead sterilizer does not completely sterilize the files. The article also compares SteriFast and autoclave in other aspects such as its design, basic principle, advantages, and disadvantages. The article also describes features and design of SteriFast, used for all kind of small dental instruments.

Comparison of canal transportation and centering ability of Twisted Files, HyFlex controlled memory, and Wave One using computed tomography scan: An in vitro study

Abstract: Aim: The aim of the present study was to compare the canal transportation and centering ability of three rotary nickel-titanium (NiTi) systems (Twisted Files [TF], HyFlex controlled memory [CM], and Wave One [WO]) in curved root canals using computed tomography (CT). Materials and Methods: Sixty freshly extracted single-rooted teeth having curved root canals with at least 25–35 degrees of curvature were selected. The teeth were randomly divided into three experimental groups of twenty each. After preparation with TF, HyFlex CM, and WO, all teeth were scanned using CT to determine the root canal shape. Pre- and post-instrumentation images were obtained at three levels, 3 mm apical, 9 mm middle, and 15 mm coronal above the apical foramen were compared using CT software. Amount of transportation and centering ability were assessed. The three groups were statistically compared with analysis of variance and post hoc Tukey's honestly significant difference test. Results: Least apical transportation and higher centering ability were seen in HyFlex CM file system in all the three sections followed by TF. WO file system showed maximum transportation. Conclusions: The canal preparation with HyFlex CM file system showed lesser transportation and better centering ability than TF, WO file system.

Evaluation of antibacterial efficacy of biosynthesized silver nanoparticles derived from fungi against endo-perio pathogens Porphyromonas gingivalis, Bacillus pumilus, and Enterococcus faecalis.

Abstract: Background: Even after rapid progress in contemporary dental practice, we encounter the failures due to endodontic, periodontal, or combined lesions. Complex anatomy of tooth and resistant microbes demands the development of new treatment strategies. Aim: The aim of this study is to biosynthesize silver nanoparticles (AgNPs) using fungi and determine the antibacterial efficacy against Porphyromonas gingivalis, Bacillus pumilus, and Enterococcus faecalis. Materials and Methods: Fungi isolated from healthy leaves of Withania somnifera were used to biosynthesize AgNPs. The biosynthesized AgNPs were characterized by different methods, and antibacterial efficacy was evaluated by agar well diffusion method measuring the zone of inhibition. Test microorganisms were divided as Group 1: B. pumilus 27142 (American Type Culture Collection [ATCC]), Group 2: E. faecalis 29212 (ATCC), and Group 3: P. gingivalis 33277 (ATCC). Agents used for antibacterial efficacy were grouped as: AgNPs: A (20 μl), B (40 μl), C (60 μl), D (80 μl), E (100 μl), F (0.2% chlorhexidine [CHX]), G (2% CHX), H (Ampicillin), and I (sterile distilled water). Results: Characterization studies showed the color change from colorless to reddish brown color; ultraviolet spectrum showed peak at 420 nm, transmission electron microscope revealed the particles spherical in shape and 10–20 nm size. Fourier transform infrared spectroscopy analysis revealed the presence of functional groups. Data collected for antibacterial efficacy were analyzed using one-way ANOVA and post hoc Tukey's multiple shows no significant difference among three groups (P Conclusion: Biosynthesized AgNPs showed efficient antibacterial efficacy. Therefore, it creates a new horizon in the management of endodontic, periodontal, and combined lesions.

Comparative evaluation of chlorhexidine, grape seed extract, riboflavin/chitosan modification on microtensile bond strength of composite resin to dentin after polymerase chain reaction thermocycling: An in vitro study.

Abstract: Aim: The purpose of this study was to evaluate the influence of chlorhexidine (CHX), grape seed extract (GSE), riboflavin/chitosan modification on microtensile bond strength (μTBS) of composite resin to dentin after polymerase chain reaction (PCR) thermocycling. Materials and Methods: Forty extracted human molars were used and a flat surface was then prepared by removing the occlusal one-third. The teeth were randomly assigned into four groups - Group I in which self-etch adhesive (Adper Easy One) was applied and Groups II, III, IV were pretreated with 2% CHX, 6.5% GSE, and 1% riboflavin/chitosan, respectively, before the application of self-etch adhesive. Composite build-ups were constructed, and PCR thermocycling (5000 cycles) was performed. The μTBS was evaluated using the universal testing machine. Data were analyzed using one-way analysis of variance and Tukey's test. Results: The mean μTBS values for Group I (control), Group II (CHX), Group III (GSE), and Group IV (riboflavin/chitosan modification) were 30.81, 43.15, 38.79, and 35.07 MPa, respectively. Conclusion: Pretreatment with CHX and GSE leads to a significant increase in μTBS of composite resin to dentin.

Influence of root canal obturation using gutta-percha with three different sealers on root reinforcement of endodontically treated teeth. An in vitro comparative study of mandibular incisors.

Abstract: Aim: The purpose of this in vitro study was to evaluate the vertical force required to fracture mandibular incisor teeth, obturated using gutta-percha with three different sealers. Materials and Methods: Seventy-five extracted mandibular incisors with intact and fully formed apices, exhibiting single root and canal were acquired. The teeth were decoronated obtaining a root segments of 15 mm and were divided into five groups (n = 15). Group 1: left uninstrumented and unfilled (negative control). For groups 2–5, samples were instrumented using Protaper NEXT (X1 and X2). Group 2: left unobturated (positive control). Groups 3–5 were obturated using lateral compaction by gutta-percha and three sealers (AH Plus®, Apexit®, and EndoSequence® BioCeramic™). All the samples were prepared for fracture testing and vertical load was applied till fracture. Statistical analysis was performed using ANOVA and Tukey's post hoc test, for the data recorded of the force required in Newton (N). Results: The load required to fracture exhibited a significant difference. The intergroup analysis revealed, samples obturated using bioceramic sealer exhibited higher fracture resistance (P Conclusion: The use of gutta-percha and a root canal sealer reinforces the root dentin, leading to increased fracture resistance against vertical forces. Bioceramic sealer group in them exhibited better results.

Effect of obturating materials on fracture resistance of simulated immature teeth.

Abstract: Aim: The aim of this study was to evaluate the fracture resistance of simulated immature teeth, when the root canals were completely filled either with mineral trioxide aggregate (MTA) or Biodentine, comparing with that of roots filled with apexification procedure. Materials and Methods: Sixty mandibular premolar teeth with single, straight canals decoronated at cementoenamel junction were divided into five groups (n = 12 each). Group 1 samples served as negative control and remaining four groups root samples were shaped and cleaned using ProTaper rotary files. To simulate immature roots, a #5 Peeso reamer was passed beyond the apex so that apices were enlarged to a diameter of 1.5 mm. Group 2 and 4 samples were filled with 5 mm of MTA or Biodentine apical plug and backfilling with gutta-percha using AH Plus sealer. Group 3 and 5 root samples were completely obturated with MTA and Biodentine, respectively. All the teeth were loaded vertically until fracture, using the universal testing machine. Statistical Analysis: Forces at which fracture of the roots occurred were subjected to statistical analysis using SPSS/PC version 2 software, and the results were analyzed with the one-way analysis of variance and Newman–Keuls multiple post hoc test. Results: Complete root canal obturation with MTA or Biodentine has shown significantly higher fracture resistance (P Conclusion: Obturation of the root canals with bioactive materials has shown highest fracture resistance when compared to apexification groups.

Grape seed extract: An innovation in remineralization

Abstract: Aim: The aim of this study was to determine remineralizing potential of grape seed extract (GSE) compared to casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and calcium glycerophosphate (CaGP) through pH-cycling model and subsequent evaluation using polarized light microscope (PLM). Subjects and Methods: Twenty sound human teeth fragments of ten teeth were obtained from the cervical portion of the roots and were stored in demineralizing solution for 96 h at 37°C to induce artificial root carious lesion. The sections then were divided into four treatment groups including: 6.5% GSE, CPP-ACP, 0.5% CaGP, and control group (no treatment). The demineralized samples were then pH cycled through treatment solutions, acidic buffer, and neutral buffer for 8 days at six cycles per day. The samples were subsequently evaluated using PLM. Statistical Analysis Used: Data were analyzed using ANOVA and Scheffe post hoc comparison test (P Results: PLM data revealed a significantly thicker mineral precipitation band on the surface layer of the GSE-treated lesions compared to the other groups (P Conclusion: GSE positively affects the demineralization and/or remineralization processes of artificial root caries lesions.

Retrievability of calcium hydroxide intracanal medicament with three calcium chelators, ethylenediaminetetraacetic acid, citric acid, and chitosan from root canals: An in vitro cone beam computed tomography volumetric analysis.

Abstract: Aim: This study compared the amount of aqueous-based and oil-based calcium hydroxide remaining in the canal, after removal with two different chelators 17% EDTA, 20% Citric acid and 0.2% Chitosan in combination with ultrasonic agitation. Methods and Material: Cleaning and shaping of root canals of 28 mandibular premolar was done and canals were filled either with Metapex or Ca(OH)2mixed with distilled water. Volumetric analysis was performed utilizing cone beam-computed tomography (CBCT) after seven days of incubation. Ca(OH)2was removed using either 17% EDTA, 20% Citric acid or 0.2% Chitosan in combination with ultrasonic agitation. Statistical analysis used: Volumetric analysis was repeated and percentage difference was calculated and statistically analyzed using Kruskal-Wallis and Mann-Whitney U test. Results: All the three chelators failed to remove aqueous-based as well as oil-based Ca(OH)2completely from the root canal. Aqueous-based Ca(OH)2was easier to be removed than oil-based Ca(OH)2. 0.2% Chitosan in combination with ultrasonics performed better than 17% EDTA and 20% citric acid in removal of Ca(OH)2. Conclusion: Combination of 0.2% Chitosan and ultrasonic agitation results in lower amount of Ca(OH)2remnants than 17% EDTA, 20% Citric acid irrespective of type of vehicle present in the mix.

Effect of saliva and blood contamination on the shear bond strength of fifth-, seventh-, and eighth-generation bonding agents: An in vitro study.

Abstract: Aim: To evaluate the bond strength of different adhesives after contamination with saliva and blood at various steps of application. Materials and Methods: Buccal surfaces of 180 human premolars were sliced to expose dentin. The specimens were randomly divided into six groups (n = 30), in which saliva and blood were used as contaminants in three groups each. The groups were further divided according to the generation (fifth – OptiBond Solo Plus Kerr, USA; seventh – OptiBond All-In-One Kerr, USA; eighth – Futurabond DC, Voco, Germany) of the adhesive used. Effect of contaminant application both before and after polymerization of the adhesive was evaluated. Composite cylinders were fabricated on exposed dentinal surfaces and were subjected to shear bond strength test. The results were subjected to one-way analysis of variance and t-test. Results: The eighth-generation adhesive showed the highest mean shear bond strength, followed by fifth- and seventh-generation adhesive. Salivary contamination resulted in greater decrease of bond strength when contaminated before polymerization. However, the results were vice versa when blood contamination was done, except in the case of fifth-generation adhesive. Blood contamination produced the lowest shear bond strength in all conditions. Conclusion: The eighth-generation adhesives showed the highest and blood contamination the lowest bond strength in all conditions.

Clinical applications of ferric sulfate in dentistry: A narrative review.

Abstract: Ferric sulfate (FS) has been commonly used as a local hemostatic agent for more than three decades in dentistry. Even though the hemostatic mechanism of FS is questioned, it seems that agglutination of blood proteins occurs due to the reaction of blood with ferric and sulfate ions in acidic pH. FS has gained widespread importance as a pulpotomy medicament in contemporary dentistry; nevertheless, it has several applications in different fields of dentistry which was paid little attention. Hence, the purpose of this paper is to review the various applications of FS in dentistry, along with restorative dentistry and endodontics.

Endodontic treatment of chronically infected primary teeth using triple antibiotic paste: An in vivo study.

Abstract: Aim: Maintenance of primary dentition is imperative for the development of arch form, esthetics, function, mastication, and normal eruption of permanent teeth. Premature loss can cause various problems such as ectopic eruption, space loss for the successor permanent teeth, alterations in speech, and impairment of function. Hence, decayed primary teeth should not be extracted and treated whenever possible. Pulpectomy is generally recommended as a treatment of choice in such cases. The purpose of this study was to evaluate the clinical and radiographic success of pulpectomized primary teeth with chronic infection using a mixture of metronidazole, ciprofloxacin, and minocycline (3MIX)-MP as an intracanal medicament before the obturation. Methodology: Sixty primary teeth were selected, which were randomly divided into two groups (Group A and Group B) with thirty teeth in each group. In Group A, 3MIX-MP was used as intracanal medicament whereas in Group B, conventional pulpectomy was performed. Resolution of clinical signs and symptoms were evaluated within 2 weeks after the treatment and at recalled 3rd, 6th, and 12th month intervals. The treated teeth were evaluated clinically and radiographically. Results: High success rate was observed in Group A samples both clinically and radiographically. Although the difference in clinical success was not statistically significant, the difference in radiographic success was statistically significant. Conclusion: All the primary teeth with chronic infection which were treated using 3MIX-MP, followed by the instrumentation and obturation provided excellent clinical and radiographic success when compared to conventional pulpectomy and noninstrumentational lesion sterilization tissue repair therapy.

An analysis of cyclic fatigue resistance of reciprocating instruments in different canal curvatures after immersion in sodium hypochlorite and autoclaving: An in vitro study.

Abstract: Aim: The aim of this study is to assess the effect of sodium hypochlorite and sterilization on the cyclic fatigue resistance of two reciprocating nickel-titanium files using a rotary and a reciprocating motor. Materials and Methods: Totally, 160 Reciproc and Wave One files were tested. The eighty files of the same brand were assigned into four groups (n = 20). These four groups were further divided into two subgroups, 1a and 1b, 2a and 2b, 3a and 3b, 4a and 4b consisting of ten files in each group. 2.5% NaOCl for 5 min, 2.5% NaOCl for 5 min + 1 cycle of autoclave sterilization, 2.5% NaOCl for 5 min + 5 cycles of autoclave sterilization, no sterilization (control). Groups 1a, 2a, 3a, and 4a were subjected to 30° and Groups 1b, 2b, 3b, and 4b were subjected to 60° canal curvature. Results: Intergroup comparison reveals that there is an increase in cyclic fatigue resistance from the first cycle to the fifth cycle of autoclave which is statistically significant. Conclusion: Reciproc and Wave One showed reduced cyclic fatigue resistance on immersion in NaOCl for 5 min. Multiple autoclaving cycles significantly increased the cyclic fatigue resistance of Reciproc file system in both the curvatures. There was a decrease in cyclic fatigue resistance for Wave One after multiple autoclaving at 60° curvature which was statistically significant.

Fracture resistance of posterior teeth restored with high-viscosity bulk-fill resin composites in comparison to the incremental placement technique.

Abstract: Aim: Comparative evaluation of the fracture resistance of maxillary premolar teeth restored with two high-viscosity bulk-fill composites and incrementally placed composite. Materials and Methods: Seventy-five freshly extracted maxillary premolar teeth were selected. Fifteen specimens served as positive control (Group 1). Mesio-occluso-distal cavity preparation was prepared on the rest of the specimens. These specimens were further divided into four groups: unrestored teeth (Group 2), teeth restored with incrementally placed nanocomposite (Group 3), teeth restored with high-viscosity bulk-fill giomer (Group 4), and teeth restored with high-viscosity bulk-fill nanocomposite (Group 5). The specimens were then subjected to compressive axial load using Instron universal testing machine. Data were analyzed using data were analyzed using Statistical package for social sciences software (SPSS v 20.0, IBM Corp.). Results: The positive control group exhibited highest fracture resistance (1104.70 ± 122.2 N). There was no statistically significant difference seen in between the incrementally placed nanocomposite and high-viscosity nanocomposite (P > 0.05). The fracture resistance values displayed by the high-viscosity bulk-fill giomer were found to be statistically lower than the other two groups. Conclusion: High-viscosity bulk-fill nanocomposite may substitute incrementally placed nanocomposite with respect to fracture resistance.

To evaluate and compare the effect of different light-curing modes and different liners on cuspal deflection in premolar teeth restored with bulk filled or incrementally filled composite measured at different time intervals.

Abstract: Aim: The aim of this study is to evaluate and to compare the effect of different light-curing modes and different liners on cuspal deflection in premolar teeth restored with bulk filled or incrementally filled composite measured at different time intervals. Materials and Methods: The study was divided into two parts (Part 1-different curing modes, Part 2-different liner) each with sixty extracted human upper premolar teeth with standardized large mesio-occlusal-distal cavities prepared. Each part was divided into two groups according to the composite used (Group A-Filtek Z350 XT, Group B-Sonic fill). Each group was then divided into three subgroups according to the light-curing modes (soft-start, pulse, and continuous curing mode) and liner (Filtek Z350 XT Flowable, Vitremer) used. The cuspal deflection was then measured with a digital micrometer gauge and subjected to statistically analysis using analysis of variance and Tukey's post hoc test. Results: Sonic fill composite, resin-modified glass ionomer cement (RMGIC) liner and curing with soft-start/pulse curing mode had significantly lower cuspal deflection compared to Filtek Z350 XT, flowable liner, and continuous curing mode, respectively. Conclusion: Sonic fill composite, RMGIC liner under the restorations and composites cured with soft start/pulse curing mode resulted in reduced cuspal deflection.

Prevalence of C-shaped canals in mandibular second and third molars in a central India population: A cone beam computed tomography analysis.

Abstract: Introduction To evaluate the prevalence of C-shaped root canals in mandibular molars using cone beam computed tomography (CBCT) in a subpopulation of Central India. Materials and methods CBCT scans of patients from diagnostic imaging center were selected in accordance with the criteria given by Fan et al. (2004) for C-shaped canals. A total of 238 CBCT scans fulfilled the inclusion criteria and thereby divided into two groups: Group 1: Images showing C-shaped canal configuration in mandibular second molars. Group 2: Images showing C-shaped canal configuration in mandibular third molars. The frequency and distribution of canals and their configuration along with the position of lingual/buccal grooves in the images were evaluated, and the data was analyzed. Results CBCT evaluation showed that 9.7% of second molars and 8% of third molars had C-shaped canals. A prominent buccal groove was seen in these teeth. The data showed a significant difference (P = 0.038) for the presence of such anatomy on the right side for mandibular third molars. Conclusion The study showed a significant prevalence of C-shaped canal configuration in the subpopulation studied.