Evaluation of canal patency and cleanliness following retreatment of bioceramic sealer-obturated root canals using three different irrigant activation protocols.

This study evaluated the effectiveness of three different irrigant activation techniques in cleaning and establishing patency during retreatment of root canals obturated with gutta-percha and bioceramic sealer. 60 extracted premolars with oval-shaped canals were instrumented and obturated with gutta-percha and EndosequenceBC sealer using the 'warm hydraulic condensation' technique. The teeth were retreated using Protaper Universal Retreatment and XP-Endo Shaper system and divided into four groups according to the irrigant activation protocol used: control, passive ultrasonic irrigation (PUI), Endovac irrigation (EVI) and XP-Endo Finisher R (XPFR). Apical patency was achieved in all the samples of the XPFR group (100%), which showed a significantly higher success rate compared with the control (73.3%) and EVI groups (73.3%) (p < 0.05). The scanning electron microscopic evaluation revealed significantly cleaner middle and apical third root canals in the PUI and XPFR groups compared with the control group (p < 0.05). These findings suggest that XPFR effectively cleans and establishes patency in root canals filled with bioceramic sealers.

Comparative evaluation of digital radiography, electronic apex locator and simultaneous working length determination on postoperative pain after root canal treatment: a randomized clinical trial.

Purpose: The study aimed to compare postoperative pain after root canal preparation using three different methods of working length determination. Materials and methods: 60 patients diagnosed with symptomatic irreversible pulpitis were randomly divided into three groups based on the method of working length (WL) determination. Group 1: digital radiograph (DRG), Group 2: electronic apex locator (EAL), Group 3: the simultaneous working length control (SLC) method using an endomotor with an integrated apex locator. The root canal treatments were completed in a single visit, and patients were asked to record their pain response using the Visual Analog Scale (VAS) at 6, 24, 48, and 72 hours postoperatively. Results: Group 1 (DRG) recorded the highest postoperative pain score, while the lowest was recorded by Group 3 (SLC). There was a statistically significant difference in the VAS pain scores between DRG and SLC (p<0.05) at 6-, 24- and 48-hour intervals. Conclusion: Within the limitations of this study, it can be concluded that the SLC can be a helpful working length determination technique to reduce postoperative pain.

Characterization and assessment of hydrological droughts using GloFAS streamflow data for the Narmada River Basin, India.

Hydrological droughts severely affect the demand of water for domestic water supply, irrigation, hydropower generation, and several other purposes. The pervasiveness and consequences of hydrological droughts necessitate a thorough investigation of their characteristics, which is hindered due to unavailability of continuous streamflow records at desirable resolutions. This study aims to assess the hydrological drought characteristics and their spatial distribution using high-resolution Global Flood Awareness System (GloFAS) v3.1 streamflow data for the period 1980 to 2020. Streamflow Drought Index (SDI) was used to characterize droughts at 3-, 6-, 9-, and 12-monthly timescales starting from June, i.e., the start of water year in India. GloFAS is found to capture the spatial distribution of streamflow and its seasonal characteristics. The number of hydrological drought years over the basin varied from 5 to 11 during the study duration, implying that the basin is prone to frequent abnormal water deficits. Interestingly, the hydrological droughts are more frequent in the eastern portion of the basin, i.e., the Upper Narmada Basin. The trend analysis of multi-scalar SDI series using non-parametric Spearman's Rho test exhibited increasing drying trends in the easternmost portions. The results were not similar for the middle and western portions of the basin, which may be due to presence of a large number of reservoirs in these regions and their systematic operations. This study highlights the importance of open-access global products that can be used for monitoring hydrological droughts, especially over ungauged catchments.

Assessment of drought trends and variabilities over the agriculture-dominated Marathwada Region, India.

Drought is considered among the most perilous events with catastrophic consequences, particularly from the agro-economic point of view. These consequences are expected to exacerbate under the increasing meteorological aberrations due to changing climate, which necessitates investigating drought variabilities. This study presents a thorough spatiotemporal assessment of drought trends and variabilities over the agriculture-dominated Marathwada Region, Maharashtra, India. The precipitation data is extracted from the India Meteorological Department (IMD) gridded product, whereas actual evapotranspiration (ET) and Evaporative Stress Index (ESI) are obtained from Global Land Evaporation Amsterdam Model (GLEAM) datasets. Standardized Precipitation Index (SPI) is used to characterize drought occurrences at multiple time frames, whereas non-parametric tests, i.e., modified Mann-Kendall (MMK) and Sen's slope (SS) tests, are employed to detect trends. The results reveal the region to be prone to droughts, and SPI at a longer time frame (i.e., 12-monthly moving frame) can capture drought occurrences better than the shorter time frames, which can be attributed to the lesser randomness in the time series in the longer frame. A mix of positive/negative trends of SPI series are found for the monsoonal months; however, they are relatively more concentrated towards negative ZMMK. Hence, the Marathwada Region can be inferred to have exhibited a relatively increased tendency towards drought occurrences. The seasonal differences in mean values and trends of rainfall, ET, and ESI are discussed in detail. Since the Marathwada Region has a monsoon-dominated climate with high agricultural importance, the information reported in this study will help in devising water management strategies to minimize the repercussions of droughts.

Appraisal of historical trends in maximum and minimum temperature using multiple non-parametric techniques over the agriculture-dominated Narmada Basin, India.

In this study, the long-term trends in climatological parameters, viz., maximum temperature (TMAX) and minimum temperature (TMIN), are determined over 68 years (i.e., June 1951 to May 2019) using the gridded observation datasets (1° × 1° spatial resolution) of India Meteorological Department over the Narmada river basin, India. Multiple non-parametric techniques, viz., modified Mann-Kendall (MMK), Sen's slope (SS), and Spearman's rho (SR) tests, are used to determine monthly, seasonal, and annual trends over individual grids. The trends are also analyzed for the climatic variables spatially averaged over the entire basin to draw general conclusions on historical climate change. The results reveal a significant spatiotemporal variation in trends of TMAX and TMIN over the basin. In general, both the parameters are found to be increasing. Furthermore, the hottest months (April and May) have become hotter, and the coldest month (January) has become colder, implying a higher probability of increasing temperature extremes. Furthermore, the entire duration of 68 years is divided into two epochs of 34 years, i.e., 1951-1984 and 1985-2018, and the trend analysis of TMAX and TMIN is also carried out epoch-wise to better understand/assess the signals of climate change in recent years. In general, a relatively higher warming trend was observed in the latter epoch. As a majority of the basin area is dominated by agricultural lands, the implications of the temperature trends and their impacts on agriculture are succinctly discussed. The information reported in this study will be helpful for proper planning and management of water resources over the basin under the changing climatic conditions.

Comparative evaluation of the apical leakage of different bioceramic retrofilling materials with and without smear layer: A stereomicroscopic study.

Objective: Present in-vitro study aimed to evaluate the apical leakage of different bioceramic retrofilling materials with and without smear layer. Materials and Methods: : Sixty human single-rooted teeth were decoronated at a standardized root length of 13 mm, chemo-mechanically prepared and obturated. After obturation, root-end resection was done and root-end cavities were prepared using ultrasonic tips. The specimens with prepared retro cavities were randomly assigned into 2 groups (n = 30) based on the smear layer removal protocol used. Each group was further subdivided into 3 subgroups (n = 10) based on the bioceramic retrofilling material MTA (Mineral Trioxide Aggregate; Proroot Dentsply/Tulsa), CEM (Calcium-Enriched Mixture; Bionique Dent, Tehran) and ERRM (EndoSequence® Root Repair Material; Brasseler USA, Savannah, GA). The extension of dye (2% Rhodamine B) penetration was measured in millimetre using a stereomicroscope at 10× zoom. Results were statistically analysed using one-way ANOVA (analysis of variance) test and unpaired Student's t test. Results: In the presence of smear layer, MTA demonstrated maximum mean apical leakage value (1.70 ± 0.30), followed by CEM (1.40 ± 0.37) and ERRM (1.40 ± 0.23), which was statistically not significant. Without the smear layer, ERRM demonstrated the least mean apical leakage value, which was statistically significant as compared with CEM (P <.05) and MTA (P <.01). Conclusion(s): : All bioceramic retrofilling materials demonstrated apical leakage irrespective of the presence or absence of the smear layer. The presence of a smear layer is beneficial for the sealing ability of MTA and CEM, whereas, the absence of the smear layer is advocated while using ERRM.

A segmental root development as an unusual healing response to the revitalization of mandibular second premolar.

A 15-year-old patient reported persistent pain in the left mandibular second premolar (#35) following a traumatic bite 3 months ago. Clinical examination revealed a fractured central cusp suggestive of dens evaginatus. Intraoral periapical radiograph revealed an immature permanent tooth with a periapical radiolucency. A diagnosis of pulp necrosis with symptomatic apical periodontitis was made. The tooth was treated according to the revised guidelines of regenerative endodontic procedure by the American Association of Endodontics. The follow-up evaluation revealed a complete resolution of periapical pathology. A detached radiopaque tissue was appreciated at the 12-month follow-up. It resembled a broken root tip at the 24-month follow-up. Both the main root body and disjointed root tip developed independently. A cone-beam computed tomography evaluation at the 36-month follow-up confirmed the segmented development of the apical root tip.

Effect of Apical Third Enlargement to Different Preparation Sizes and Tapers on Postoperative Pain and Outcome of Primary Endodontic Treatment: A Prospective Randomized Clinical Trial.

INTRODUCTION: The purpose of this study was to evaluate the effect of apical preparation size and taper on postoperative pain and healing after primary endodontic treatment. METHODS: One hundred and twenty patients with asymptomatic mandibular first molars with radiographic evidence of periapical pathology and with a periapical index (PAI) score ≥3 were randomly assigned to 2 groups, group 1 and 2, based on apical enlargement to 2 and 3 sizes larger than the initial apical binding file (IABF), respectively. Each group was further divided into subgroups A and B depending on the apical enlargement taper of 4% and 6%, respectively. Endodontic treatment was performed, and the final apical enlargement in all the groups was performed as follows: group 1A, 2 sizes larger than the IABF with a 4% taper; group 1B, 2 sizes larger than the IABF with a 6% taper; group 2A, 3 sizes larger than the IABF with a 4% taper; and group 2B, 3 sizes larger than the IABF with a 6% taper. Postoperative pain was assessed at 6, 12, 24, 48, and 72 hours. Clinical evaluation and the change in the PAI score on radiographs were assessed at the 3-, 6-, and 12-month follow-ups. RESULTS: No significant difference in postoperative pain was found. The success rate was lowest (57.1%) in group 1 subgroup A as evidenced by the significant change in the PAI score between group 1 subgroup A and the rest of the groups at the 6- and 12-month follow-ups. CONCLUSIONS: Apical preparation to 2 sizes larger than the IABF with a 4% taper is insufficient and results in significantly lower success rates compared with larger preparation sizes and tapers.

Hemisection as a Conservative Management of Grossly Carious Permanent Mandibular First Molar.

Hemisection of a molar denotes removal or separation of a root along with its accompanying part of crown. It is a suitable treatment option when the caries, resorption, perforation, or periodontal damage is restricted to one root while the other root is relatively healthy. Hemisection of the affected tooth helps to retain the tooth structure, surrounding alveolar bone, and may also facilitate the placement of fixed prosthesis. This case report describes the hemisection as a successful treatment method to save a grossly carious mandibular first molar with periodontal and periapical involvement. Hemisection and prosthetic rehabilitation yielded a satisfactory result. With careful treatment planning and precise surgical management, undesirable consequences of tooth loss were prevented.

Endodontic management of maxillary first molar with atypical canal morphology: Report of three cases.

Maxillary first molar with three roots and 3-4 canals is a common occurrence. However, extreme variations in their canal morphology have been reported ranging from one single canal and one root to as many as eight root canals. This article presents three cases of successful endodontic management of maxillary first molars with atypical canal morphologies, thus highlighting the fact that variations do occur and an endodontist should always be aware of aberrancies in root canal system apart from the knowledge of normal root canal anatomy.

Feasibility of supervised self-testing using an oral fluid-based HIV rapid testing method: a cross-sectional, mixed method study among pregnant women in rural India.

INTRODUCTION: HIV self-testing can increase coverage of essential HIV services. This study aimed to establish the acceptability, concordance and feasibility of supervised HIV self-testing among pregnant women in rural India. METHODS: A cross-sectional, mixed methods study was conducted among 202 consenting pregnant women in a rural Indian hospital between August 2014 and January 2015. Participants were provided with instructions on how to self-test using OraQuick(®) HIV antibody test, and subsequently asked to self-test under supervision of a community health worker. Test results were confirmed at a government-run integrated counselling and testing centre. A questionnaire was used to obtain information on patient demographics and the ease, acceptability and difficulties of self-testing. In-depth interviews were conducted with a sub-sample of 35 participants to understand their experiences. RESULTS: In total, 202 participants performed the non-invasive, oral fluid-based, rapid test under supervision for HIV screening. Acceptance rate was 100%. Motivators for self-testing included: ease of testing (43.4%), quick results (27.3%) and non-invasive procedure (23.2%). Sensitivity and specificity were 100% for 201 tests, and one test was invalid. Concordance of test result interpretation between community health workers and participants was 98.5% with a Cohen's Kappa (k) value of k=0.566 with p<0.001 for inter-rater agreement. Although 92.6% participants reported that the instructions for the test were easy to understand, 18.7% required the assistance of a supervisor to self-test. Major themes that emerged from the qualitative interviews indicated the importance of the following factors in influencing acceptability of self-testing: clarity and accessibility of test instructions; time-efficiency and convenience of testing; non-invasiveness of the test; and fear of incorrect results. Overall, 96.5% of the participants recommended that the OraQuick(®) test kits should become publicly available. CONCLUSIONS: Self-testing for HIV status using an oral fluid-based rapid test under the supervision of a community health worker was acceptable and feasible among pregnant women in rural India. Participants were supportive of making self-testing publicly available. Policy guidelines and implementation research are required to advance HIV self-testing for larger populations at scale.

Community based reproductive health interventions for young married couples in resource-constrained settings: a systematic review.

BACKGROUND: Most pregnancies among adolescent girls and young women aged 15-24 years occur in low- and middle-income countries (LMICs), and do so within marriage. The mortality rates and pregnancy-related morbidities are significantly higher among the women of younger age group in many South Asian and Sub-Saharan African countries. This paper presents a review of the available evidence on the effectiveness of community-based health interventions to improve the reproductive health status of young married couples in LMICs. METHOD: We carried out a systematic review of research studies and evaluation reports of different community-level initiatives in improving access to contraception, pregnancy care and safe abortion services by young married couples, where women were in the age-group of 15-24 years. RESULTS: Of the 14 projects, which met inclusion criteria, eight met the quality criteria and were included in the review (five from India, two from Nepal and one from Malawi). Our analysis shows that community-based interventions consisting of counseling of young married women, and their husbands, family and community members, as well as capacity building of health workers were some of the effective measures in increasing contraceptive use, delaying pregnancy and improving pregnancy care. Stratifying young women in line with their specific reproductive health needs (newly married woman, pregnant woman, mother of one/more children) was found to be a successful innovative strategy. None of these projects explicitly addressed improving access to safe abortion care. CONCLUSION: Our review suggests that multi-layered community-based interventions, targeting young married women, their families and the health system can improve utilization of reproductive health services among young couples in resource-constrained settings. There is less focus on strategies to delay first pregnancy as compared to spacing among young women. Further, family and community level barriers in most of the project settings restricted its effective implementation. The paper emphasizes the need for further research to fill the knowledge gaps that exist about improving utilization of reproductive healthcare services, especially safe abortion care among young married women in LMICs.

Conservative management of grossly carious mandibular first molar with a hemisection approach: a case report.

The term hemisection refers to the removal or separation of a root-with its accompanying crown portion-from a 2-rooted tooth, such as a mandibular molar. A hemisection is considered a conservative treatment option for mandibular molars that would otherwise require extraction. A hemisection of an affected tooth helps to preserve the tooth structure and alveolar bone and is more economical than other treatment options. Therefore, hemisection may be a suitable alternative to extraction and implant therapy and should be discussed with patients during their consideration of treatment options. This case report describes a hemisection procedure in which the grossly carious distal half of an endodontically treated mandibular left first molar was removed.

Management of large preiapical lesion with the combination of second generation platelet extract and hydroxyapatite bone graft: a report of three cases.

The pulp tissue necrosis and extensive periodontal diseases leads to the development of the inflammatory periapical lesion which causes a local response of bone around the apex of the tooth. Depends upon the nature of wound and available biological growth factors the outcome will be either regeneration or repair. Being a rich source of growth factors, platelet rich fibrin (PRF) posses many advantages in bone regeneration. The purpose of this case report is to present an attempt to evaluate the healing potential of the combination of PRF and Hydroxyapatite bone graft as opposed to using these materials alone. A periapical endodontic surgery was performed on three patients with a large periapical inflammatory lesion and a large bony defect. The defect was then filled with a combination of PRF and Hydroxyapatite bone graft crystals. Clinical examination exhibited uneventful wound healing. The HA crystals have been replaced by new bone radiographically at the end of two years in Case 1 and Case 2, Case 3 were followed upto one year. On the basis of our cases outcome, we conclude the use of PRF in combination with HA crystals might have accelerate the bone regeneration.

Management of grossly destroyed endodontically treated teeth with lock and key custom modified cast post and core design: A case series.

The purpose of this paper is to demonstrate a more retentive custom modified lock and key design of metal cast post and core for the restoration of grossly destroyed endodontically treated molar tooth. The lock and key metal cast post consists of two parts, one in the distal canal (primary post) and the other one in mesio-lingual canal (secondary post). The primary post has a lock design, while the secondary post contains the key design, both of which interlock together. Lock and key cast post, mentioned in this report can be an effective design for the management of grossly destroyed molar teeth.