Real-time guided endodontics: A case report of maxillary central incisor with calcific metamorphosis.

Dental trauma results in various complications and poses an enigma to the practitioner. Calcific metamorphosis is one of the sequelae of trauma. A female patient of 35 years visited the specialty clinic of endodontics for the management of a discolored tooth. Clinically, discolored 21 was observed with no pain on palpation and percussion. The pulp sensibility test revealed a negative response. Radiographic examination revealed pulp canal obliteration with an apical radiolucency of Peri Apical Index (PAI 4). The tooth was diagnosed as necrotic pulp with asymptomatic apical periodontitis. Attempt to negotiate the canal under a Dental Operating Microscope (LABOMED, Los Angeles, CA, USA) and ultrasonics (Satelec, Acteon, France) was futile. Cone-beam computed tomography image revealed a patent canal in the apical third. Using real-time guided endodontics with a dynamic navigation system (Navident, ClaroNav, Toronto, ON, Canada), the protocol of plan, trace, and place was followed, and successful canal negotiation was achieved. After radiographic confirmation, root canal treatment was completed.

Evaluation of the Effectiveness of Video-based Intervention on the Knowledge of Infant Oral Health among New Mothers.

Background and objectives: Infant oral health is the foundation upon which preventive dental health education must be built to enhance the conditions for a disease-free oral cavity. Majority of the mothers are ignorant about their oral health and also about the fact that their oral health status affects that of their babies. Educational videotapes have proved to be effective in educating mothers on various child health issues. So the objectives of this study were to educate the mothers about the need for infant oral health care, compare the level of mother's knowledge on infant oral health before and after the video presentation and assess the effectiveness of the presentation. Methodology: An interactive educational video presentation containing evidence-based information about infant oral health care and prevention was developed. This presentation was based upon information provided by the American Academy of Pediatric Dentistry (AAPD) on anticipatory guidance. It includes the persuasive message on maternal oral health during preconception and pregnancy and its implication on birth outcomes, vertical transmission of Streptococcus mutans, infant oral health, the risk for early childhood caries (ECC), and increased caries experience on permanent teeth if primary teeth are affected. Emergency care for infant oral trauma, consequences of traumatic injuries to the primary dentition from an aspect of possible damage to the developing tooth, dietary habits, and oral hygiene behaviors. It also emphasizes the timing of the first dental visit and the periodicity of dental screenings. The survey was designed to compare the effectiveness of instructional videotaped persuasive messages by using pre- and post-questionnaires. Two hundred mothers of infants below the age of 12 months were included in the study. They were asked to fill out the questionnaires before and after the presentation on the same visit. Results: The results showed a highly significant improvement in knowledge (p< 0.05) as assessed by the proportion of correct responses following a single viewing of the AV-aid. Conclusion: The knowledge of new mothers on infant oral health care was inadequate, and there was an improvement in their knowledge of infant oral health care after the instructional video presentation. An instructional video presentation is an effective tool for improving the oral health knowledge of new mothers. Significance: By this study, we want to inculcate the habit of oral hygiene maintenance among the mothers, which indirectly affects the infant's oral health. Through this study, we educated the mothers regarding infant oral health care, which significantly improved their knowledge. How to cite this article: Singh R, Patil SS, K Madhu, et al. Evaluation of the Effectiveness of Video-based Intervention on the Knowledge of Infant Oral Health among New Mothers. Int J Clin Pediatr Dent 2022;15(3):280-286.

Comparative evaluation of the effect of adhesive restorative composite resins on the reinforcement of peri-cervical dentin: An in vitro study.

Background: Peri-cervical dentin (PCD) and its reinforcement play a crucial role in the fracture resistance of root canal-treated teeth. Aims: The aim of this study was to compare the fracture resistance of dual-cure, nano-hybrid, and short-fiber reinforced composite resins restored PCD with conventional hybrid composite (CHC) resin restored endodontically treated mandibular premolars. Settings and Design: Academic, in vitro study. Materials and Methods: The prepared mandibular premolar samples were randomly divided into five groups of 10 each. In Group 1, teeth were left intact. The remaining 40 teeth were endodontically treated and obturated as follows: In Group 2, teeth were obturated with gutta-percha till cementoenamel junction and restored with CHC. Teeth in Groups 3, 4, and 5 were obturated to a depth of 5 mm from the cervical line and restored with dual-cure, nano-hybrid, and short-fiber reinforced composite resins, respectively. Fracture resistance was tested using a universal testing machine. Statistical Analysis Used: One-way analysis of variance and post hoc Tukey's test. Results: Short-fiber reinforced composite resin showed a significantly higher mean fracture resistance value compared with other experimental groups. The mean fracture resistance values were obtained as Group 1 > Group 5 > Group 4 > Group 3 > Group 2. Conclusions: Reinforcement with short-fiber reinforced composite showed significantly higher fracture resistance compared with nano-hybrid and dual-cure composite resins.

One-year clinical evaluation of bulk-fill composite resin restorations plasticized by preheating and ultrasonics: A randomized clinical trial.

Introduction: Bulk-fill composite restorations displayed substantial annual failure related to imperfect marginal adaptation. Although preheated composites improved, marginal adaptation demonstrated early loss of plasticity. A new technique of ultrasonics plasticization was used for fabricating restorations. Aim: The aim of this study was to assess the clinical behavior of bulk-fill composite resin restorations plasticized by preheating and ultrasonics. Methodology: Randomized split-mouth double-blinded clinical trial was designed. Bulk-fill composite resin (Tetric N-Ceram Bulk Fill Ivoclar Vivadent products, Delhi) was used to fill 56 cavities. In 28 restorations, composite resin was plasticized by preheating in composite warmer (Delta Co., India) and remaining were plasticized with modified ultrasonic-retreatment tip-RT No 2 (Cricdental, India). Clinical follow-up assessments were done at 6 and 12 months using Ryge's criteria. Mann-Whitney U-test was used for statistical analysis with P < 0.05 and effect size of 0.61. Results: Hundred percent clinical success with ultrasonic plasticized group and 95.2% success with preheated composite resin group were observed without statistical significance. Conclusion: The ultrasonics plasticization of composite resin demonstrated comparable results with that of preheated composite resin after 6- and 12-month recall. Use of vibration energy utilizing the thixotropic effect might have resulted in better clinical performance.

Comparative evaluation of efficacy of three single file retreatment systems for removal of gutta percha and assessment of root canal transportation - An In Vitro study.

Background: In comparison to multiple file systems, recent advancements in single file retreatment systems had reduced the working time and ease of operation for clinicians. Aim: To compare the efficacy of retreatment systems compared with hand instrumentation, by evaluating their removal efficacy, time required for retreatment and assessment of canal transportation. Methods and Material: Forty premolars were instrumented using ProTaper Gold gold files. Post instrumentation, scan was taken, obturated using warm vertical compaction technique, and stored in artificial saliva for three months and randomly divided into four groups for retreatment. Hand instrumentation (Hi), Neoniti (Nn), Mtwo R (Mt), WaveOne Gold (Wg). Post retreatment, scan was taken. Teeth were sectioned longitudinally and photographed under the stereomicroscope. Retreatment time was recorded, and canal transportation was calculated. Statistical Analysis: The results were analyzed using one-way analysis of variance (ANOVA) followed by Tukey's post hoc test at 95% confidence level. Results: The retreatment time was significantly longer in the Hi group. Within the test groups, a significantly longer time has been taken by Wg (p < 0.05) compared to Mt and Nn. There was no difference in the canal transportation between the single file systems at 3 mm, 6 mm and 9 mm from the apex, there was statistically significant higher transportation for the Hi group at 9 mm from the apex (p < 0.05). Conclusions: All techniques were effective in removal of filling material with minimal canal transportation. Wg system was shown to increased time compared to Nn and Mt systems. Hi group was slowest with maximum canal transportation at 9 mm from the apex.

An In Vitro Evaluation of the Remineralizing Efficacy of Two concentrations of Silica Doped Nanohydroxyapatite on Bleached Enamel

@#Introduction: Vital bleaching of teeth is associated with mineral loss and surface roughness leading to hypersensitivity. Aesthetic restorations are recommended after one week. Search is on for a suitable remineralizing material, which helps in instant adhesive bonding. Hence objective of the study is to evaluate the remineralizing efficacy of two concentrations of Silica doped Nanohydroxyapatite on bleached enamel. Methods: Enamel surfaces of 30 extracted human central incisors were divided into Part A: Unbleached enamel, Part B: Bleached enamel, Part C: Remineralized enamel. The samples were randomly divided into, Group 1: MI Paste Plus (Recaldent, USA), Group 2 and 3 for application of Dentin bonding agents (Tetric- n-bond, Ivoclar, Vivadent) mixed 0.2% and 0.8% Silica doped Nanohydroxyapatite (Sigma Aldrich, Bangalore, India). Post bleaching remineralizing agents were applied on part C. Surface roughness was evaluated with contact stylus profilometer and mineral content was evaluated with Energy dispersive X-Ray spectroscopy for three parts. Data were analysed using ANOVA and Post Hoc Tukey test with p ≤ 0.05. Results: Surface roughness values (Ra) were increased, and mineral loss (Ca:P) was observed after bleaching. After application of remineralizing agents, surface roughness was decreased with no significant value (p > 0.05) and a significant increase in mineral content of all three groups with a p < 0.05 was observed. Conclusion: Application of dentin bonding agent mixed with Silica doped Nanohydroxyapatite decreased surface roughness and improved remineralization of bleached enamel.

Effect of indirect ultrasonic activation of modified bioceramic materials on the bond strength and tubular penetration in root canals.

BACKGROUND: To maintain the integrity of the interface between root canal filling and radicular dentin an ideal endodontic biomaterial should have good adhesion. This study was aimed to evaluate the bond strength and tubular penetration of modified bioceramic materials by indirect ultrasonic activation. MATERIALS AND METHODS: In the present in vitro experimental study, 120 coronal root slices of 2 mm were prepared from mandibular premolars and randomly divided into six groups (n = 20) in accordance to placement techniques: Group I: Nano Biodentine-manual, Group II: CaCl2 modified ProRootMTA-manual (MM), Group III: Biodentine-manual, Group IV: Nano Biodentine: Ultrasonic, Group V: CaCl2 modified ProRootMTA-ultrasonic, and Group VI: Biodentine-ultrasonic (BDU). The samples were kept in humidifier for 4 days at 37°C and push out bond strength, sealer penetration were evaluated using an universal testing machine and confocal laser scanning microscope respectively. Data were subjected to statistical analysis using SPSS software by using One-way ANOVA for overall significance and Tukey's multiple post hoc test for intergroup comparison (P < 0.05). RESULTS: Highest push out bond strength and greater tubular penetration were observed with Group VI (BDU), while the lowest bond strength and tubular penetration were associated with Group II (MM). CONCLUSION: Within the limitations of current study it was observed that Biodentine with indirect ultrasonic activation has resulted in highest pushout bond strength among all the study groups.

An exploratory qualitative study of the prevention of road traffic collisions and neurotrauma in India: perspectives from key informants in an Indian industrial city (Visakhapatnam).

BACKGROUND: Despite current preventative strategies, road traffic collisions (RTCs) and resultant neurotrauma remain a major problem in India. This study seeks to explore local perspectives in the context within which RTCs take place and identify potential suggestions for improving the current status. METHODS: Ten semi-structured interviews were carried out with purposively selected key informants from the city of Visakhapatnam, Andhra Pradesh. Participants were from one of the following categories: commissioning stakeholders; service providers; community or local patient group/advocacy group representatives. Transcripts from these interviews were analysed qualitatively using the Framework Method. RESULTS: Participants felt RTCs are a serious problem in India and a leading cause of neurotrauma. Major risk factors identified related to user behaviour such as speeding and not using personal safety equipment, and the user state, namely drink driving and underage driving. Other reported risk factors included poor infrastructure, moving obstacles on the road such as other vehicles, pedestrians and animals, overloaded vehicles and substandard safety equipment. Participants discussed how RTCs affect not only the health of the casualty, but are also a burden to the healthcare system, families, and the national economy. Although there are ongoing preventative strategies being carried out by both the government and the community, challenges to successful prevention emerged from the interviews which included resource deficiencies, inconsistent implementation, lack of appropriate action, poor governance, lack of knowledge and the mindset of the community and entities involved in prevention. Recommendations were given on how prevention of RTCs and neurotrauma might be improved, addressing the areas of education and awareness, research, the pre-hospital and trauma systems, enforcement and legislation, and road engineering, in addition to building collaborations and changing mindsets. CONCLUSIONS: RTCs remain a major problem in India and a significant cause of neurotrauma. Addressing the identified gaps and shortfalls in current approaches and reinforcing collective responsibility towards road safety would be the way forward in improving prevention and reducing the burden.

Effect of 17% ethylenediaminetetraacetic acid and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate: An in vitro study.

AIM: The purpose of this study was to evaluate the effect of 17% ethylenediaminetetraacetic acid (EDTA) and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate (MTA). MATERIALS AND METHODS: Midroot dentin of single-rooted human canine teeth were sectioned into 2-mm-thick slices horizontally (n = 60). The canal space of each dentin slice was enlarged with a 1.3-mm-diameter diamond bur. The samples were divided into two groups (n = 30) based on the type of perforation repair material placed, i.e., Biodentine and ProRoot MTA. The samples were wrapped in wet gauge for 10 min, and based on the type of chelating agent used for removal of smear layer, each group is further divided into three subgroups (n = 10), to be immersed into saline (control), 17% EDTA and 0.2% chitosan for 30 min, and a wet cotton pellet was placed over each test material. After 48 h of incubation, the dislodgement resistance of the samples was measured using a universal testing machine. STATISTICAL ANALYSIS: Data were analyzed using one-way analysis of variance and post hoc Tukey tests. The level of statistical significance was set at 0.05. RESULTS: Biodentine showed significantly higher pushout bond strength than ProRoot MTA. Biodentine and ProRoot MTA lost strength when exposed to 0.2% chitosan. CONCLUSION: Biodentine showed considerable performance as a perforation repair material than ProRoot MTA even after being exposed to various endodontic chelating agents.

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.

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.

Surgical management of lateral incisor with type II dens invaginatus and a periapical pathosis: A case report with 1-year follow-up.

Dens invaginatus is a relatively common dental malformation resulting from an infolding of enamel organ into the dental papilla varying in depth into the tooth tissues. Complex morphological anatomy associated with the pulpal pathology presents inaccessibility to completely remove the necrotic pulp tissues and hence poses challenges in rendering endodontic treatment. A combination of nonsurgical and surgical management in treating such cases is advisable depending on the presented variations. The present case reports the surgical endodontic treatment of an immature maxillary lateral incisor with type II dens invaginatus and periapical pathology.

A comparative evaluation of the increase in root canal surface area and canal transportation in curved root canals by three rotary systems: A cone-beam computed tomographic study.

AIM: The aim of this study was to measure the increase in root canal surface area and canal transportation after biomechanical preparation at 1, 3, and 5 mm short of the apex with three different rotary systems in both continuous rotary and reciprocating rotary motions. MATERIALS AND METHODS: Sixty freshly extracted human mandibular molars with mesial root canal curvatures between 20° and 30° were included in the study. Teeth were randomly distributed into three groups (n = 20). Biomechanical preparations were done in all the mesial canals. In Group 1, instrumentation was done with ProTaper universal rotary files, Group 2, with K3XF rotary files, and Group 3, with LSX rotary files. Each group was further subdivided into subgroups A and B (n = 10) where instrumentation was done by continuous rotary and reciprocating rotary techniques, respectively. Increase in root canal surface area and canal transportation was measured using the preoperative and postoperative cone-beam computed tomography scans. STATISTICAL ANALYSIS: The data were analyzed by one-way ANOVA followed by Tukey pairwise multiple comparison tests. RESULTS: Increase in root canal surface area was significantly more (P < 0.05) in ProTaper and K3XF groups when compared to LSX group. Canal transportation was significantly more (P < 0.05) in ProTaper group when compared to K3XF and LSX groups. There was no significant difference (P > 0.05) in increase of root canal surface area and canal transportation between continuous rotary and reciprocating rotary techniques for ProTaper Universal, K3XF and LSX groups. CONCLUSION: LSX rotary system showed minimal increase of root canal surface area and minimal canal transportation when compared to ProTaper and K3XF rotary systems.

Evaluation of the Quality of Obturation with Obtura at Different Sizes of Apical Preparation Through Microleakage Testing.

INTRODUCTION: Obturation of the root canal system is required to prevent recontamination of the root canal after cleaning and shaping procedures and to seal the root canal completely, both the apical and coronal avenues of potential leakage and to maintain the disinfected status. AIM: The aim of this study was to determine the microleakage by dye leakage method at 1mm, 3mm and 5mm short of the apex with different sizes of apical preparation, obturated by Obtura. MATERIALS AND METHODS: Sixty freshly extracted human single rooted teeth were randomly distributed into six equal groups. Group I (control group) was obturated by lateral compaction technique. Group II to VI were experimental groups (apical preparations done upto ISO sizes 20, 30, 40, 50 and 60 respectively), obturated by Obtura technique. After storing the samples at 100% humidity for seven days and one day in 2% methylene blue, the roots of the teeth were sectioned at 3mm short of the apex. They were observed under stereomicroscope at 20X magnification and the images were analysed for microleakage using the scoring criteria. The data obtained were analysed by One-way ANOVA followed by Tukey pair-wise multiple comparison test and p ≤ 0.05 was considered as the level of significance. RESULTS: The lowest mean microleakage score was seen in Group VI (0) and the highest mean leakage score was seen in Group II (1.5). There was statistically significant difference between Group II and Group V (p = 0.044), Group II and Group VI (p = 0.013). There was no significant difference between all the other groups (p> 0.05). CONCLUSION: Comparison of microleakage between different groups from ISO sizes 20-60 recommends a minimum apical preparation of ISO size 30.

A novel approach for restoration of hemisectioned mandibular second molar with modified tunnel restoration: a case report.

Hemisection refers to sectioning of a mandibular molar into two halves followed by removal of the diseased root and its coronal portion. Hemisection of a mandibular molar may be a suitable treatment option when the decay is restricted to one root and the other root is healthy. The retained root is endodontically treated and the furcation area is made self-cleansable. Retained tooth structure is restored as premolar which helps to reduce the masticatory load. Hemisection of mandibular molar was often referred to as premolarization. Studies showed that the remaining coronal structure influenced the fracture resistance of endodontically treated maxillary first premolars. Clinical experience showed the viability of tunnel restoration as an alternative to class II conventional cavity preparation in initial proximal lesion. This article discusses a case that presents the novel technique involved in restoration of the remaining hemisected tooth using modified tunnel restoration.

Oral Health Coalition: Knowledge, Attitude, Practice Behaviours among Gynaecologists and Dental Practitioners.

OBJECTIVES: Every expectant mother should receive a comprehensive oral health education & risk assessment. Numerous reports have shown association between oral diseases and preterm, low birth weight and gestational diabetes. The purpose of this study is to understand the attitude, knowledge regarding prenatal and perinatal oral health care among obstetricians and knowledge, attitude & practice skills of dental professionals. MATERIALS AND METHODS: The study involved a survey of 36 each gynaecologists and general dental practitioners. The pre tested questionnaire on oral health for expectant mothers was used to collect data related. The data collected was subjected to statistical analysis using frequency of responses and standard deviation. RESULTS: Analysis of data demonstrated that 98% of general dental practitioners felt that delay in dental treatment effect both the mother and the child. 85.7% (p>0.05) of gynaecologist never examined the oral cavity of the patient during routine checkup. CONCLUSION: The findings of this survey with dentists and gynaecologist showed that dental management during pregnancy still presents some deviations from scientific literature recommendations, indicating the need to update these health care professionals in order to establish guidelines for prenatal dental care. How to cite this article: Patil S, Thakur R, Madhu K, Paul S T, Gadicherla P. Oral Health Coalition: Knowledge, Attitude, Practice Behaviours among Gynaecologists and Dental Practitioners. J Int Oral Health 2013; 5(1):8-15.

A comparative evaluation of efficacy of protaper universal rotary retreatment system for gutta-percha removal with or without a solvent.

AIM: The aim was to evaluate and compare the efficacy of ProTaper Universal rotary retreatment system with or without solvent and stainless steel hand files for endodontic filling removal from root canals and also to compare retreatment time for each system. MATERIALS AND METHODS: Thirty extracted mandibular premolars with single straight canals were endodontically treated. Teeth were divided into three major groups, having 10 specimens each. Removal of obturating material in group 1 by stainless steel hand files with RC Solve, group 2 by ProTaper Universal retreatment instruments and group 3 by ProTaper Universal retreatment instruments along with RC solve was done. Retreatment was considered complete for all groups when no filling material was observed on the instruments. The retreatment time was recorded for each tooth. All specimens were grooved longitudinally in a buccolingual direction. The split halves were examined under a stereomicroscope and images were captured and analyzed. The remaining filling debris area ratios were considered for statistical analysis. RESULTS: With ANOVA test, statistical analysis showed that there was statistically no significant difference regarding the amount of filling remnants between the groups (P < 0.05). Differences between the means of groups are statistically significant regarding the retreatment time. CONCLUSION: Irrespective of the technique used, all the specimens had some remnants on the root canal wall. ProTaper Universal retreatment system files alone proved to be faster than the other experimental groups.

Development and validation of HPTLC method for the determination of mycophenolate mofetil in bulk and pharmaceutical formulation.

AIM: Described in this manuscript is the first ever reported, new, simple, high-performance thin-layer chromatographic method for the determination of mycophenolate mofetil in bulk and tablet dosage form. MATERIALS AND METHODS: The drug was separated on aluminum plates precoated with silica gel 60 F254 with toluene, acetone, and methanol in the ratio of 6:2:2 (v/v/v) as the mobile phase. Quantitative analysis was performed by densitometric scanning at 254 nm. RESULTS: The method was validated for linearity, accuracy, precision, and robustness. The calibration plot was linear in the range of 100-500 ng band(-1) for mycophenolate mofetil. The method was successfully applied to the analysis of the drug in a pharmaceutical dosage form.