Comparative Evaluation of Effectiveness of Nisin, Amoxicillin/Clavulanic Acid (Augmentin) and Chlorhexidine on E. Faecalis as an Intracanal Irrigant: An In-vitro Study.

Aim: The present study evaluated the antimicrobial efficacy of chlorhexidine gluconate (CHX), Nisin, and Amoxicillin/Clavulanic Acid (Augmentin) as an intracanal irrigant against Enterococcus faecalis (EF). Materials and Methods: Minimum Inhibitory Concentration (MIC) for EF against Nisin and Augmentin was determined by microbroth dilution technique. Time kill cycle (TKC) analysis was done for 0 MIC, ½ MIC, 1 MIC, and 2 MIC at 0 hour, 15 minutes, 30 minutes, and 45 minutes. At the end of each time period, dilutions were pipetted and swabs of agar plates were done. Incubation of agar plates was done at 37C for 24 hours. Colonies formed were counted. Results: The time kill curve analysis of EF for CHX, Nisin, and Augmentin at different concentrations and time periods showed a gradual decline in mean bacterial count between 0 and 45 minutes for CHX; this decline increases with increase in concentrations and time. Whereas in group Nisin, not much decline in bacterial count is noted for ½ MIC concentrations but a signification reduction of P < 0.001 after exposure to Nisin at 1 MIC ant 2 MIC concentrations. Group Augmentin showed not much reduction in bacterial count with increase in concentration and time. Conclusion: From this study, Nisin is found to be a promising agent in eliminating EF in comparison to other irrigants tested. However, the systemic effect of this irrigant, its biocompatibility, allergic potential, and bacterial resistance needs further investigation.

Application of platelet-rich fibrin and freeze-dried bone allograft following apicoectomy: A comparative assessment of radiographic healing.

Background: Apicoectomy conceptualizes surgically maintaining a tooth with an endodontic lesion that cannot be resolved by conventional endodontic (re-) treatment. To achieve this, continuous improvement in surgical techniques, materials and instruments is being done to enhance the outcome of periapical endodontic surgeries. The purpose of this study was to compare, radiographically, the healing kinetics of platelet-rich fibrin (PRF) and mineralized freeze-dried bone allograft (FDBA) in patients undergoing apicoectomy. Materials and Methods: Nineteen patients (aged 18-40 years) were included in the study and randomly assigned to groups A or B, where they received PRF or FDBA, respectively. Following apicoectomy, PRF gel and FDBA graft were prepared and placed in the osseous defect followed by placement of PRF membrane for graft stabilization and flap closure. Radiographic follow-up was done at the 1st, 3rd, 6th and 12th months for evaluation of healing using Molven's criteria. Statistical analysis was done with Pearson's and McNemar's Chi-square tests. Results: A highly significant difference (P = 0.002) in radiographic healing was observed at 6 months. Complete healing was observed in 50% of cases in Group A whereas in Group B, none of the cases presented with complete radiographic healing. However, at the end of 12 months, complete radiographic healing was observed in both groups. Conclusion: Our data suggest that PRF accelerates bone healing as compared to FDBA and is both time and cost-efficient.

Noise pollution and effectiveness of policy interventions for its control in Kathmandu, Nepal.

In Nepal, much emphasis has been given to the pollution of air, water, and solid waste both in terms of research and policymaking. Noise is an ignored pollutant, yet a growing public health concern in Kathmandu. This study is aimed at making an assessment of noise pollution in Kathmandu and study the effectiveness of the enforcement of noise standards and No Horn Regulation to control noise pollution. The study was conducted in 23 locations of four different zones (high traffic, low traffic, commercial, and residential) where 12 sites were considered for evaluating the effectiveness of No Horn Regulations. Noise level was studied at five different times of the day using a sound level meter to compute maximum, minimum, equivalent, and average noise level. This study concludes that (i) there is noise pollution problem in Kathmandu, (ii) No Horn Regulation is in place but it has not been strictly followed by the drivers and riders and monitored adequately by concerned authorities, and (iii) the regulation has been effective in reducing the noise level significantly. The average noise level of Kathmandu was recorded as 66.8 dB(A) with the highest noise level in High traffic zones, followed by commercial, low traffic, and residential zones. In 65.2% of the sampled sites, the noise level was beyond the permissible limit of WHO and National Sound Quality Standard of Nepal, 2012. Of the total honking events, 48.1% were against the provision of the No Horn Regulation. After the enforcement of the regulation, noise level was reduced significantly by 2.1 dB(A) in high traffic, low traffic, and residential zones. A comprehensive noise strategy with more emphasis on compliance monitoring and regular noise assessment should be formulated to address environmental noise as a major public health issue.

Endodontic treatment of mandibular molars with atypical root canal anatomy: reports of 4 cases.

The variations in root canal anatomy of multirooted teeth represent a continuous challenge to endodontic diagnosis and treatment. Although the most common configuration of mandibular molars is one containing 2 roots and 3 root canals, there are many different combinations. Very rarely, an additional third (supernumerary) root is seen. When it is located distolingually to the main distal root, this third root is called radix entomolaris (RE), and when it is located mesiobuccally to the mesial root, it is called radix paramolaris (RP). Variations of root canal systems need not always be in the form of extra roots or extra canals. Single roots with single canals can also occur. A general dentist should be aware of these unusual root canal morphologies in mandibular molars for the success of endodontic treatment. These case reports describe the root canal treatment of a case of RE in the mandibular first molar, 2 rare cases of RP (1 each in the mandibular first and second molars), and a mandibular second molar with a single root and root canal.

A rare occurrence of bilateral C-shaped roots in mandibular first and second premolars diagnosed with the aid of spiral computed tomography.

The C-shaped canal system is an anatomical variation mostly seen in mandibular second molars, although it can also occur in maxillary and other mandibular molars. Such variation in the root canal anatomy is uncommon in mandibular first premolars and very rare in mandibular second premolars. The C-shaped canal is so named for the cross-sectional morphology of the root and root canal. The main anatomic feature of C-shaped canals is the presence of a fin or web connecting the individual root canals. Failure of the Hertwig's epithelial root sheath to fuse on the lingual or buccal root surface is the main cause of C-shaped roots, which always contain a C-shaped canal. This case report describes an unusual occurrence of C-shaped roots in mandibular first and second premolars bilaterally, diagnosed with the aid of spiral computed tomography. Key words:Canal configuration, C-shape, mandibular first premolar, mandibular second premolar, spiral computed tomography scans.

Management of a 3-canal mandibular premolar in a patient with unusual root canal anatomy in all mandibular premolars.

Endodontic treatment of mandibular premolars can be difficult due to their aberrant root canal anatomy. Successful nonsurgical root canal treatment requires knowledge of basic root and root canal morphology, and possible anatomical variations of the root canal system. Mandibular second premolars usually have a single root and a single canal, and the presence of 3 canals in separate roots is very rare. Nonsurgical endodontic treatment of such teeth is a challenge. This article presents a rare case of a mandibular second premolar with 3 root canals in separate roots and its endodontic management, with a special emphasis on radiographic interpretation and access refinement during treatment.

Endodotic management of three-rooted maxillary first and second premolars: a case report.

A thorough knowledge of root canal anatomy is essential for successful root canal treatment, because the number of roots and root canals in any tooth can vary. Failing to detect an extra root or canal can cause root canal treatment to fail. It is essential that clinicians interpret radiographs correctly to detect any anatomic variations and treat them successfully. Anatomic variation occur frequently in the root canal system of maxillary premolars; however, the presence of the three separate root canals with three independent roots is rare. This article presents an unusual case of three-rooted maxillary first and second premolars, each with three distinct root canals.

Detection of residual obturation material after root canal retreatment with three different techniques using a dental operating microscope and a stereomicroscope: An in vitro comparative evaluation.

AIM: The study was designed to compare the efficiency of three different methods used for retreatment using a dental operating microscope (DOM) and a stereomicroscope and to evaluate and compare the two methods for detection of residual obturation material after retreatment. BACKGROUND: The DOM can play an important role in the successful retreatment by detecting the remaining obturation material. MATERIALS AND METHODS: Thirty extracted maxillary central incisors were collected and obturated after biomechanical preparation. The samples were divided into three groups depending on the method of retreatment: Group I, H-files; Group II, ProTaper Universal retreatment files; and Group III: H-files + Gates-Glidden drills, with 10 samples in each group. After retreatment, the samples were observed under a DOM for detection of residual obturation material. Later, the teeth were cleared and observed under a stereomicroscope for detecting the remaining filling material. The results were subjected to the Spearman's rank order test and other statistical analysis. RESULTS: The maximum cleanliness of the root canal walls was seen in Group I while Group II showed the least. The difference between the mean scores obtained with a DOM and a stereomicroscope was statistically significant (P = 0.05). CONCLUSION: None of the techniques could completely remove the obturation material. The root canal cleanliness is best achieved when retreatment is performed under a DOM.

Endodontic management of three-rooted maxillary second premolar in a patient with bilateral occurrence of three roots in maxillary second premolars.

The possibility of bilateral maxillary second premolars having three separate roots is quite low; however, it must be taken into account in clinical and radiographic evaluations during endodontic treatment. A correct clinical and radiographic diagnosis based on knowledge of root canal anatomy and critical interpretation of radiographs is necessary for a safer and successful endodontic treatment of these teeth. Failure of root canal treatment can occur due to missed roots/canals and often diagnosed when patient experiences continuous post-operative pain and discomfort. This case report describes the root canal treatment of a three-rooted maxillary second premolar in a patient with bilateral occurrence of three roots in maxillary second premolars. Key words:Anatomic variations, maxillary second premolar, radiculous.

Endodontic management of three-rooted maxillary first and second premolars: a case report.

A thorough knowledge of root canal anatomy is essential for successful root canal treatment, because the number of roots and root canals in any tooth can vary. Failing to detect an extra root or canal can cause root canal treatment to fail. It is essential that clinicians interpret radiographs correctly to detect any anatomic variations and treat them successfully. Anatomic variations occur frequently in the root canal system of maxillary premolars; however, the presence of three separate root canals with three independent roots is rare. This article presents an unusual case of three-rooted maxillary first and second premolars, each with three distinct root canals.