Comparative evaluation of bond strength of diode and neodymium-doped:Yttrium aluminum garnet-assisted bleached enamel with nanofilled composite: An in vitro study.

Background: The world of esthetic dentistry is constantly making efforts toward the management of tooth staining. Laser-assisted bleaching is needed before adhesive restorations and has become common and advantageous as it accelerates bleaching action, reduces postoperative sensitivity, and promotes recrystallization of enamel. Aim: The study aimed to evaluate and compare the bond strength of diode (Biolace: EpicX) and neodymium-doped:yttrium aluminum garnet (Nd:YAG) (LightWalker, Fotona, Slovenia) assisted bleached (Pola Office, SDI) enamel with nanofilled composite (GC Solare Sculpt). Materials and Methods: The samples were divided into three groups (n = 11): Group A - Conventionally bleached enamel, Group B - Diode laser-assisted bleached enamel, Group C - Nd:YAG laser-assisted bleached enamel. After storing samples in Artificial Saliva for 2 weeks, bonding was performed, and nanofilled composite resin was applied through an incremental method. Samples were subjected to shear bond strength (SBS) analysis. Conclusion: The use of Nd:YAG laser on bleached enamel significantly increases the bond strength with nanofilled composite resin.

Comparative evaluation of the effect of two natural collagen cross-linkers on microtensile bond strength of self-etch adhesive system to dentin after contamination with blood and hemostatic agent: An in vitro study.

Background: Cavity preparation often causes gingival bleeding which can be controlled by hemostatic agents (HAs). These along with blood act as contaminants and hamper the bonding mechanism. Collagen cross-linkers (CCLs) are agents known to increase the bond strength (BS) to dentin. Hence, the purpose of this in vitro study was to determine the effect of two different CCLs, proanthocyanidin (grape seed extract [GSE]) and hesperidin on the microtensile BS (µTBS) of a self-etch adhesive (SEA) system to dentin which was contaminated with blood and a HA. Materials and Methods: Thirty-six extracted human molars were collected, and their occlusal surfaces were sectioned to expose the dentin. The teeth were randomly divided into four groups: Group I - Control, Group II - Contamination with blood and HA, Group III - Application of GSE after contamination, and Group IV - Application of hesperidin extract after contamination. The SEA was applied, followed by the use of a nanocomposite. Dentin-composite rods were obtained from each group, and µTBS testing was done. The fracture pattern was visually classified as an adhesive failure at the interface, cohesive failure in composite, or dentin. The scanning electron microscope (SEM) analysis was done for two samples from each group. Statistical analysis was done using the Student's unpaired "t" and ANOVA test. Results: Group II showed a statistically significant reduction in µTBS in comparison to Group I. This was overcome in Groups III and IV. Hesperidin showed marginally better results than GSE. Conclusions: The use of GSE and hesperidin increases the µTBS of composite resin to dentin postcontamination with blood and ViscoStat Clear with Single Bond Universal Adhesive.

Comparative Evaluation of Debris Extrusion, Remaining Dentin Thickness and Fracture Resistance of Endodontically Treated Teeth Using Rotary and Reciprocating Endodontic File Systems: An In Vitro Study.

BACKGROUND: Preventing the apical extrusion of debris during instrumentation is of paramount importance to reduce the occurrence of flare-ups in endodontically treated teeth. Furthermore, an essential requirement for the longevity and strength of an endodontically treated tooth and its ability to resist fracture is the preservation of residual dentin thickness during instrumentation. The aim of this study was to compare the amount of debris extrusion, remaining dentin thickness at the coronal third, middle third, apical third, and the fracture resistance of the teeth using rotary (TruNatomy; Dentsply Sirona, Charlotte, NC) and reciprocating (WaveOne Gold; Dentsply Sirona) endodontic file systems. METHODS: An in vitro study included 52 single-rooted, oval canal shaped teeth that underwent exploration and initial cleaning with a no. 15 K-file. The prepared canals were then randomly assigned to two groups: Group I, with instrumentation with the TruNatomy rotary file (n=26) and Group II, with instrumentation with the WaveOne Gold reciprocating file. Parameters like debris extrusion, remaining dentin thickness, and fracture resistance were evaluated in both the groups. Analysis was performed using a paired t-test for the assessment of difference between groups and one-way ANOVA test followed by the post-hoc Tukey test for difference between the coronal, middle and apical third for each study group. RESULTS: The results revealed no significant difference (t=0.454, p=0.652) between the TruNatomy rotary file and WaveOne Gold reciprocating file in apical extrusion of debris after their use in root canal therapy. For the remaining dentin thickness, a significant difference was present between the TruNatomy rotary file and WaveOne Gold reciprocating rotary file at the coronal (t=5.766, p<0.0001) and middle (t=3.690, p=0.001) levels. The mean fracture resistance was significantly more (t=15.877, p<0.0001) with the TruNatomy rotary file compared to the WaveOne Gold reciprocating rotary file. CONCLUSION: The TruNatomy rotary file system outperformed the WaveOne Gold reciprocating file system in terms of maintaining the remaining dentin thickness and providing improved fracture resistance. Nevertheless, debris extruded apically was comparable between the TruNatomy rotary file system and the WaveOne Gold reciprocating file system.

Evaluation of Giomer Using Eighth Generation Bonding Agent and Resin-Modified Glass Ionomer Cement Restoration in Non-Carious Cervical Lesions.

INTRODUCTION: Non-carious cervical lesions (NCCL) raise a considerable restorative challenge for the dentist in bonding, as adhesion is not as strong and predictable as enamel bonding. A critical factor for restorative success is the selection of restorative material. Clinicians have tried many restorative materials and techniques to obtain the best performance. The aim of the present study was to evaluate and compare the clinical outcome of a Giomer and Resin modified glass ionomer cement (RMGIC) restoration in NCCL using united states public health service (USPHS) criteria at baseline, 3, 6 and 12 months. MATERIALS AND METHOD: Patients from age 25 - 50 years having non-carious cervical lesions on both the sides and requiring restorations were screened. 20 patients were selected and further divided into 2 groups using simple random sampling technique. Group A- Beautifil II restoration using G-Premio bond (n = 10) and Group B- Ketac N100 restoration (n = 10). Restorations were done according to manufacturer's instructions and consequently evaluated at baseline, 3, 6 and 12 months using the USPHS criteria for marginal discolouration, marginal integrity, surface texture, colour match, gross fracture and post-operative sensitivity. RESULTS: Giomer restorations showed better results than RMGIC. There was decrease in alpha ratings in both the study groups i.e., Giomer and RMGIC from 6 to 12 months. DISCUSSION: The overall findings suggest that both Giomer and RMGIC gave satisfactory clinical results when used to restore non-carious cervical lesions. Both the materials can successfully be used since there was no statistically significant difference in the clinical outcome.

Comparative evaluation of eighth-generation bonding agent modified with 7% arginine and 0.12% chitosan for antibacterial property and microtensile bond strength.

Aim: The aim of this study was to evaluate and compare eighth-generation bonding agent (G-Premio BOND) modified with 7% arginine and 0.12% chitosan for antibacterial property and microtensile bond strength. Methods: To evaluate antibacterial property, the sterile 96-microtiter plate was taken. The sidewalls of nine wells were coated with 15 µl of adhesive from each group. Suspension of Streptococcus mutans bacteria was placed on each group of adhesive and antibacterial property was checked using Spectrophotometer. Thirty-three healthy extracted premolars were taken and adhesive from each group was applied on the exposed surface of dentin, and the specimens were tested using a universal testing machine at crosshead speed of 1 mm/min. Results: The least antibacterial efficacy was seen with unmodified eighth-generation bonding agent. This result was statistically significant when all study groups were compared. Microtensile bond strength was evaluated and the highest mean value (5.07) was seen with adhesive modified with 7% arginine, followed by adhesive modified with 0.12% chitosan (mean value: 4.14), and unmodified adhesive had the lowest mean bond strength value (4.07). Conclusions: The eighth-generation bonding agent modified with 7% arginine and 0.12% chitosan showed antibacterial efficacy against S. mutans. In addition to this, they also had higher tensile bond strength values as compared to unmodified adhesive.

Comparative Evaluation of Microleakage of Flowable Composite Resin Using Etch and Rinse, Self-Etch Adhesive Systems, and Self-Adhesive Flowable Composite Resin in Class V Cavities: Confocal Laser Microscopic Study.

The essential factor in determining the preservation of restoration is the marginal seal. Restoring cervical lesions with a resin composite has always been a challenge. Composite resins with various viscosities and different bonding systems are being researched to reduce the microleakage. Confocal laser scanning microscopy (CLSM) is the latest non-destructive technique for visualizing the microleakage. Objectives: To evaluate and compare the microleakage of Universal Flo composite resin (G-aenial) using etch and rinse adhesive system ER-2 steps (Adper Single Bond 2), self-etch adhesive system SE-1 step (G-Bond), and self-adhesive flowable composite resin (Constic) in Class V cavities using a confocal laser scanning microscope. Materials and Method: Class V cavities were prepared on 27 caries-free human extracted premolar teeth on the buccal and lingual surfaces with standardized dimensions of 2 mm height, width 4 mm, and a depth of 2 mm. After the cavity preparation, all teeth were randomly divided into three groups, namely Group-I: G-aenial Universal Flo with Single Bond 2 (n = 9 teeth); Group-II: G- aenial Universal Flo with G-Bond (n = 9 teeth), and Group-III: Constic (n = 9 teeth). The prepared and restored specimens were then subjected to thermocycling for 500 cycles in a water bath at 5 °C and 55 °C with a dwelling time of 30 s. The specimens were placed in 0.6% aqueous rhodamine dye for 48 h. Sectioning was carried out bucco-lingually and specimens were evaluated for microleakage under a confocal laser scanning microscope. Results: There was a significant difference (p = 0.009) in microleakage when comparing total etch and rinse, specifically between Adper Single Bond 2 ER-2 steps (fifth generation) and self-adhesive flowable composite resin, which is Constic. There was more microleakage in the self-etch bonding agent, particularly G-Bond, SE-1 step (seventh generation), when compared to ER-2 steps (fifth generation bonding agent); however, the results were not statistically significant (p = 0.468). The self-adhesive flowable composite resin showed more microleakage than SE-1 step and ER-2 steps. Conclusions: None of the adhesive systems tested were free from microleakage. However, less microleakage was observed in the total etch and rinse, especially Adper Single Bond 2 (ER-2 steps), than the self-etch adhesive system SE-1 step and self-adhesive flowable composite resin. Clinical significance: Constant research and technological advancements are taking place in dentin adhesives to improve the marginal seal. This has led to the evolution of total acid-etching dentin bonding agents termed as etch and rinse (ER)-2 steps (fifth generation dentin bonding agents) and self-etching (SE) 2 steps, and SE-1 step dentin bonding agents termed as the sixth and seventh generation bonding agents, respectively.

Comparative Evaluation of Anesthetic Efficacy of 4% Articaine and 2% Lidocaine for Buccal Infiltration in Adult Patients with Irreversible Pulpitis of Maxillary First Molar: A Prospective Randomized Study.

Objective: The purpose of this prospective, randomized study was to evaluate and compare the anesthetic efficacy of 0.8 ml of 4% articaine and 1.6 ml of 2% lidocaine administered through buccal infiltration (submucosal) only in adult male and female patients with irreversible pulpitis of maxillary 1st molar. Study Design: Two hundred patients with irreversible pulpitis of the maxillary first molar were divided into four study groups and received only buccal infiltration of either 0.8 ml of 4% articaine or 1.6 ml of 2% lidocaine. Endodontic access was begun 7 min after the solution deposition. The success was defined as "no pain (0 mm)" or "weak/mild pain (>0 mm and ≤54 mm)" during access opening, and during the first file insertion till working length. Results: The compiled data of the number of failed cases were analyzed by two sample proportion test and of mean pain scores were analyzed by Student's unpaired t-test. P < 0.05 was taken as statistically significant. No significant difference was found in the number of failed cases on using 4% articaine and 2% lidocaine (P > 0.05). Moreover, no significant difference was found in the number of failed cases between the genders in Group I (4% articaine with 1:100,000 epinephrine) and also in Group II (2% lidocaine with 1:80,000 epinephrine). On comparing the mean pain scores of failed cases, it has been found that females experience more pain than males in Group I (not significant) and Group II (significant). Conclusion: The efficacy of 4% articaine with 1:100,000 epinephrine has been found to be better than 2% lidocaine with 1:80,000 epinephrine, as only 0.8 ml of 4% articaine with 1:100,000 epinephrine was effectively used as compared to 1.6 ml of 2% lidocaine with 1:80,000 epinephrine. Furthermore, females experience more pain as compared to males.

Evaluating fluoride uptake of dentin from different restorative materials at various time intervals - In vitro study.

BACKGROUND: Glass ionomer cement is very popular in clinical practice due to their antibacterial and cariostatic properties, which is totally dependant on the amount of fluoride release and uptake by dentine. The short-term and long-term fluoride uptake by dentine from commercially available restorative materials like nano-ionomer, zirconia reinforced glass ionomer cement and flowable composite is of clinical interest. OBJECTIVE: To evaluate and compare Nano-ionomer, Zirconia reinforced glass ionomer, and flowable composite resin for the fluoride uptake by dentin at different time intervals. RESULTS: One-way ANOVA (Tukey-Kramer Multiple Comparison Test) was applied to test the comparison of mean values of all parameters compared together. The student's paired 't' test was applied to compare groups. The fluoride uptake was evaluated at 3 days and 42 days. At 3 days dentin showed higher fluoride uptake with Zirconomer (Group Z) as compared to Ketac N100 and SDR Composite which was statistically significant. At 42 days higher fluoride uptake was seen in Ketac N100 (Group K) as compared to Zirconomer and SDR composite which was also statistically significant. CONCLUSION: Fluoride uptake by dentine was seen in all study materials. Fluoride uptake by dentine at 3 days was seen maximum in Zirconomer, whereas fluoride uptake at 42 days was more in Ketac N100.

Interdisciplinary Management of Teeth With a Complicated Crown Fracture: A Case Report With Follow-Up Checklist.

Traumatic injuries resulting in damage to the teeth and associated structures have a grave psychological impact on the patient and hence, these require timely intervention. The fracture extent determines the appropriate treatment plan for the patient. Crown fractures can be treated aesthetically without the invasion of the biological width with meticulous interdisciplinary management. The objective of this article is to report a case of a 27-year-old Indian male patient who presented to our hospital the following day, post-trauma to the anterior teeth. On clinical examination, two teeth were found to have undergone fracture that involved the pulp chamber. Considering the overall oral health, pulpal and periodontal health, availability of the fragments, and invasion of the biological width, a tailor-made treatment plan was devised. The fractured crown fragments were reattached surgically, using a glass fiber post that resulted in an aesthetic biological restoration. This treatment has been successfully managed by an interdisciplinary approach. At the 18th-month follow-up, clinical and radiological examinations suggest a successful outcome.

Effect of total-etch and self-etch adhesives on the bond strength of composite to glass-ionomer cement/resin-modified glass-ionomer cement in the sandwich technique - A systematic review.

The success of the sandwich technique depends on the bond strength of composite to glass-ionomer cement (GIC)/resin-modified glass-ionomer cement (RMGIC). Currently used adhesives employ the total-etch and the self-etch techniques. The total-etch system is technique sensitive, whereas the self-etch system is popular for its ease of use. The aim of this systematic review is to compare the effect of total-etch and self-etch adhesives (SEAs) on the bond strength of composite to GIC/(RMGIC) in the sandwich technique. A literature search was conducted using electronic databases (PubMed, Web of Science, Ebscohost, and Scopus) limiting the year of publications from January 1, 2000, to September 30, 2018, to identify the relevant studies. All the cross-references of the selected studies were also screened. In vitro studies on extracted human teeth were selected. A total of 10 articles were included in this review. A conclusion was drawn that SEAs when used in the sandwich technique resulted in greater bond strength in comparison to total-etch adhesives. Moreover, increased bond strength was achieved when the primer was employed on unset GIC as compared to set GIC. Furthermore, the application of SEAs over uncured RMGIC (co-curing technique) resulted in better bond strengths as compared to their application over cured RMGIC.

Comparative evaluation of flexural fracture resistance of mandibular premolars after instrumentation with four different endodontic file systems: An In Vitro study.

BACKGROUND: Under axial loading, there is stress concentration around the cervical areas especially in the premolars because of their location in the arch. AIM: To evaluate and compare flexural fracture resistance of mandibular premolars after instrumentation with ProTaper®Universal, ProTaper Next®, OneShape®, and WaveOne® endodontic file systems. METHODS: Seventy-five mandibular premolar teeth with single straight canals were divided into five different groups (n = 15): Group A: Control, Group B: ProTaper Universal (PTU), Group C: ProTaper Next (PTN), Group D: OneShape, Group E: WaveOne. The teeth were instrumented as per the manufacturer's instructions. After obturation and core placement, the teeth were placed in a customized jig mounted on a universal testing machine where force was applied at 45° on the buccal cusp and the force required to fracture the teeth was noted. RESULTS: Amongst all the instrumented groups, WaveOne showed the highest resistance to fracture (1065.56 ± 175.05) and the control group was 1104.13 ± 188.42. All groups showed a significant difference in the fracture load values with the control group. However, there was a statistically significant (P < 0.05) difference seen with WaveOne vs PTU and WaveOne vs OneShape. CONCLUSIONS: Root canals instrumented with reciprocating motion have better flexural fracture resistance than continuous rotary motion. Mandibular premolars when instrumented with ProTaper Universal and OneShape endodontic files showed similar fracture resistance, proving that dentin removal does not depend on the number of files used.

Assessing the effect of ceramic additives on the physical, rheological and mechanical properties of conventional glass ionomer luting cement - An in-vitro study.

AIM: To evaluate the effect of the addition of conventional ceramics on the physical, rheological and mechanical properties of conventional glass ionomer luting cement. MATERIALS AND METHODS: 5%, 10%, 15% and 20% (w/w) of Enamel and Body conventional ceramic additives (E44 Enamel and B96/c4 Body) were reinforced in the two commercially available glass ionomer luting cement - GC Fuji I (GC Corporation Tokyo, Japan) and Ketac Cem Radiopaque (3M ESPE AG). Setting time, film thickness and compressive strength of the cement was measured according to the American Dental Association Specification number 96 for luting cement. Enthalpy change of the cement reaction was measured with the help of Differential Scanning Calorimetry analysis. Compatibility between the sizes of powder particles was measured with the help of a particle size analyzer. RESULTS: 5% of ceramic additive could not improve much of the compressive strength. Compressive strength increased significantly (p < 0.05) with the addition of 10% of ceramic additive, beyond which, there was a gradual decrease in strength. Although the setting time and film thickness were also shown to increase due to the additive, the former did not exceed the limit specified by the American Dental Association Specification number 96 (2-8 min for setting time and 25 microns for film thickness). CONCLUSION: Addition of 10% of conventional ceramics resulted in a significant increase in the compressive strength of GIC Luting Cement without any significant compromise in its setting time. The substantial increase in film thickness is a major limitation. Use of ceramic additives with physical properties compatible with that of the glass ionomer cement may aid in increasing the compressive strength without compromising its setting time or film thickness.

Relationship between periodontitis and systemic diseases: leptin, a new biomarker?

BACKGROUND: Leptin is a polypeptide hormone associated with the occurrence of legion of diseases including obesity, cardiovascular diseases, and diabetes. Periodontitis, that is, inflammation of the periodontium has also been linked to a number of systemic manifestations. AIM: The aim of the present study was to analyze the role of leptin as a biomarker linking periodontitis with obesity, cardiovascular diseases, and diabetes. SETTING AND DESIGN: The inclusion criteria included, clinical trials available in English language; studies involving human participants; studies relating leptin and periodontal diseases to either obesity, cardiovascular diseases or diabetes. Exclusion criteria enlisted manuscripts in language other than English; if they were case reports, narrative reviews, personal communication, conference presentations, editorial and expert opinion; experiments not involving humans. METHODS: We performed a literature search encompassing the time period from January 2000 to May 2013. A systematic search of the Cochrane Library and the Medline through PubMed was performed using the selected keywords/phrases "leptin and periodontitis," "leptin and periodontal diseases," "leptin, periodontitis and obesity," "leptin, periodontitis and cardiovascular diseases," and "leptin, periodontitis, and diabetes." RESULT: A total of 23 studies was obtained using the selected keywords/phrases. On screening, the chosen studies seven fulfilled the inclusion criteria. Four demonstrated association of leptin with periodontitis and obesity. One study associated cardiovascular diseases and periodontitis through leptin whereas two were found linking leptin, periodontitis, and diabetes mellitus. CONCLUSION: We could find some positive consociation between the serum concentration of leptin, periodontitis, and systemic diseases including obesity and cardiovascular diseases. The results were conflicting when its relation with diabetes mellitus type 2 was examined, as one study favored the association whereas the other one claimed that there was no effect on the levels of leptin.

A review on different modes and methods for yielding a pentose sugar: xylitol.

Xylitol, a five-carbon polyalcohol, holds a substantial place in the cure and prevention of a number of diseases. The foremost reason for its lesser usage in day-to-day practice is its cost. The method employed on large scale production of this polyol, i.e. chemical reduction, uses extensive machinery and expensive chemicals thus increasing the basic cost of the sugar. Yield of xylitol by other methods including fermentation and enzymatic production is far less than chemical reduction. We did a literature analysis and briefed out the various experiments carried out till date and concluded on the required studies for improving its production and lowering down its cost.

Prevalence of and factors affecting post-obturation pain following single visit root canal treatment in Indian population: A prospective, randomized clinical trial.

AIM: This prospective randomized clinical study (1) investigated the prevalence of post-obturation pain after single visit root canal treatment and (2) evaluated the influence of factors affecting the pain experience. MATERIALS AND METHODS: One thousand three hundred and twenty eight (1328) patients were included in this study. Conventional single visit root canal treatment was carried out. The chemicomechanical preparation of root canals was done by a rotary protaper system with a combination of hand instruments. Post-operative pain was recorded by each patient by using visual analogue scale in well-defined categories at three time intervals, 12 h, 24 h, and 48 h. The data were analyzed using Fisher's exact test. RESULTS: The prevalence of post-obturation pain (severe) within 48 h after treatment was 4% (n = 54) but less as compared to the pain experienced after 12 h (9%) and 24 h (8.6%). The factors that significantly influenced post-obturation pain experience were: Age (Fishers exact test = 46.387, P = 0.0), gender (Fishers exact test = 23.730, P = 0.0), arch (Fishers exact test = 11.710, P = 0.001), and presence of pre-operative pain (Fishers exact test = 67.456, P = 0.0). CONCLUSION: The presence of post-operative pain was low (4%). The important prognostic determinants of post-obturation pain were: Old age, female, mandibular teeth, and presence of pre-operative pain. The vital condition of the tooth does not affect the intensity and frequency of post-obturation pain.

Smile enhancement the conservative way: Tooth whitening procedures.

This article presents clinical cases in which different bleaching modalities have been used to successfully treat unsightly teeth. Depending upon the type and severity of discoloration, in-office vital and nonvital bleaching procedures were carried out. Discoloration of a single tooth has been managed using nonvital bleaching alone or with a combination of other minimally invasive modalities for an acceptable esthetic outcome. The case selection was done by considering the patient's needs and expectations, the type and cause of discoloration and patient economics. Moreover, prime importance was given to the conservation of the existing tooth structure and acquiring a complete change in the shade of teeth, which was comparable to that of the adjacent teeth. The desire to have a bright smile has become an important esthetic need of patients. The article explores various forms of bleaching and their successful usage in day-to-day clinical practice.