Comparative evaluation of the marginal fit of computer-aided design-computer aided manufacturing fabricated crowns from direct and indirect digital impression - A systematic review.

The accuracy of the digital impression method is responsible for fabricating crowns with adequate marginal fit which in turn determines the postendodontic prognosis. This systematic review was undertaken to identify the influence of the two digital impression techniques in producing full coverage crowns with better marginal fit. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A detailed search was done in electronic databases (PubMed, EBSCOhost, LILACS, Cochrane) along with hand searches of reference articles. In vivo crossover studies comparing the marginal fit of the computer-aided design-computer-aided manufacturing (CAD-CAM) fabricated crowns from direct and indirect digital impressions published from inception till July 2023 were included in this review. The quality assessment of the included articles was done based on a modified Cochrane collaboration tool for crossover studies. A total of 280 articles were identified, after duplicate removal, title and abstract screening, and full-text evaluation, 7 articles were included in this systematic review. The overall quality of evidence is moderate. The CAD-CAM crowns fabricated from direct digital impressions exhibited a better marginal fit than those crowns fabricated by indirect digital impressions. The overall quality of evidence is moderate. Further clinical studies has to be conducted for evaluating the latest technologies towards achieving the misfit of zero.

Evaluation of Effect of Natural Extract Sodium Gluconate on Smear Layer and Dentine Decalcification Compared with EDTA - An In-vitro Study.

OBJECTIVE: Mechanical instrumentation of the root canal system generates a smear layer on the canal walls which are removed most commonly with the help of chelators such as ethylenediaminetetraacetic acid (EDTA) but can potentially cause severe dentinal erosion. Considerable research has been conducted to find an al- ternative to EDTA which removes the smear layer without causing dentinal erosion. The current study aimed at evaluating the ability of sodium gluconate compared with that of 17% EDTA in smear layer removal along with its effect on dentine decalcification when used as a final irrigant. METHODS: Twenty single-rooted mandibular premolars were collected and prepared based on the pre-set criteria. Following preparation, the specimens were exposed to the test solutions as a final irrigant. Then the specimens were subjected to (Scanning electron microscope) SEM analysis at 1000x for evaluating the smear layer and 5000x for evaluating the dentinal erosion, and a Vickers microhardness tester was used for evaluat- ing the reduction in dentine microhardness post-treatment. The values obtained were analysed using SPSS software for a statistically significant difference with Mann-Whitney U test for evaluating of smear layer remov- al and dentinal erosion and using one-way (Analysis of variance) ANOVA test for microhardness evaluation. RESULTS: The smear layer removal capability of sodium gluconate was as effective as EDTA on the contrary so- dium gluconate did not cause any dentinal erosion compared to EDTA with a statistically significant difference (p=0.002 in middle third and p=0.001 in apical third of the canal). Microhardness reduction caused by sodium gluconate was less compared to EDTA, however, no statistically significant difference (p=0.113) was noted. CONCLUSION: Sodium gluconate, therefore, can produce a balance between smear layer removal and dentinal decalcification and can be considered a potential alternative to EDTA. (EEJ-2023-01-017).

Evaluation of Root Dentin Thickness and Smear Layer Removal Efficacy of Two Novel Nickel Titanium Rotary Instruments - An In Vitro Cone-Beam Computed Tomography and Scanning Electron Microscopy Study.

OBJECTIVE: This study aimed to compare the two nickel-titanium (NiTi) instruments on root dentin thickness using cone-beam computed tomography (CBCT) and ability to remove the smear layer using scanning electron microscope (SEM). MATERIALS AND METHODS: The effect of two NiTi rotary instruments such as XP Endo shaper and ProTaper Gold (PTG) in retaining adequate dentin thickness and debridement (i.e., removal of smear layer) was evaluated in vitro using CBCT and SEM. After cleaning and shaping of the root canal with adequate irrigation, the effect of two NiTi instrument systems at 3 mm (apical), 6 mm (middle), and 9 mm (coronal) levels on buccal, lingual, mesial, and distal aspects in terms of amount of dentin removal and smear layer removal was evaluated. The data were analyzed using student's unpaired t-test with a significance of P ≤ 0.05. RESULTS: Both NiTi instrument systems had no statistically significant difference in amount of dentin removal at all three levels and on all four aspects. In smear layer removal, PTG had significantly better efficacy compared to XP Endo shaper at the coronal third of root canal. CONCLUSION: Instrumentation with XP Endo Shaper and PTG showed a similar amount of dentin removal. PTG has a significant effect on smear layer removal compared to XP Endo Shaper only at the coronal third of root canal.

Comparative Evaluation of the Efficacy of Novel Root Canal Irrigation Techniques on Reduction of Enterococcus faecalis Count: An In Vitro Study.

AIM AND OBJECTIVE: To compare the effectiveness of three irrigation systems, namely, Endovac system, Max I probe, and Navitip FX, in reduction of Enterococcus faecalis population from the root canal using agar diffusion method. MATERIALS AND METHODS: Sixty extracted intact human permanent maxillary anterior teeth were selected for this study. In group I, root canals were irrigated using brush covered 30-gauge NaviTipFX. Ultradent in group II root canals was irrigated using brush covered 30-gauge Max-I-Probe Dentsply. In group III, root canals were irrigated using Endoactivator, Dentsply. In group IV, root canal was irrigated by using the Endovac system Sybronendo. The steps followed in the study include preparation of specimen, contamination of the samples followed by conduction of testing procedures with implementation of appropriate irrigation protocols, and sampling procedures. RESULTS: Data were subjected to statistical analysis to interpret the significant differences among various irrigation systems. One-way analysis of variance, Post hoc Tukey tests were used for statistical analysis in the present study. Among the experimental groups, group IV showed statistically significant difference in reduction of E. faecalis. There were no statistical differences between them in reduction of E. faecalis in group I and group II compared and represented in Tables 1 and 2. CONCLUSION: All four irrigation delivery systems have been found to be effective in the reduction of E. faecalis. Endovac showed comparable efficacy in reduction of colony-forming units to that of other delivery systems used in the study. The result has to be validated with in vivo studies and clinical trials of larger sample size. CLINICAL SIGNIFICANCE: Selection of appropriate irrigation system capable of disinfection of canal complexities in apical third with less adverse effects is essential for good clinical success of endodontic treatment.

Smear Layer Removal and Microhardness Alteration Potential of a Naturally Occurring Antioxidant - An In Vitro Study.

INTRODUCTION: It is well-known in the field of endodontics that the presence of a smear layer in the root canals can harbor bacteria and limit the penetration of irrigating solutions and intracanal medications into the dentinal tubules which, in turn, causes the failure of endodontic treatment. Removing the entire smear layer throughout the root canal is essential for the success of endodontic treatment and these chemical agents that facilitate the removal of the smear layer are called chelating agents. Ethylenediaminetetraacetic acid (EDTA), being the most widely used chelating agent, brings about increased reduction in the microhardness of the root dentin, thereby making it friable. N-acetyl cysteine (NAC) is naturally occurring antioxidant that has various beneficial properties for the human being. Several studies have been done in determining the antimicrobial efficacy of NAC against various endodontic pathogens and concluded NAC to be advantageous. The chelating property of NAC has been utilized in heavy metal detoxification, where it binds to the metal ion and removes them from the human system. However, this chelating property has not been explored in the field of endodontics. AIM: This study was aimed to compare the ability of N-acetyl cysteine with the conventional chelating agent in the removal of the smear layer and in altering the microhardness of root dentin. MATERIALS AND METHODOLOGY: A total of 84 single-rooted human mandibular premolars with relatively similar dimension and morphology, freshly extracted with closed apices, were collected from adult patients. The crowns of all specimens were cut transversally at the cementoenamel junction (CEJ) with the double-faced diamond disc at low speed, with water coolant, to obtain a 12 mm root length. The root canals were randomly divided into three equal groups according to the final irrigation solutions: Group I: 17% EDTA, Group II: 20% NAC, and Group III: distilled water (control). They were then randomly divided into two parts: scanning electron microscope (SEM) analysis for the extent of smear layer removal and microhardness evaluation using the Vicker's hardness test. RESULTS: The smear layer removal ability of EDTA and NAC were more effective in the coronal and middle thirds of the root canal. However, both groups showed less smear layer removal in the apical region. Specimens treated with distilled water showed the least reduction in the smear layer throughout the length of the root canals. Regarding the evaluation of microhardness, both EDTA and NAC had a significant reduction in root dentin microhardness. However, the percentage of dentin microhardness reduction was significantly more in the EDTA group (p < 0.05) than N-acetyl cysteine in the coronal, middle, and apical third of the root canals. CONCLUSION: The chelating property of NAC is equally effective to that of EDTA in the smear layer from the root canal, and it induced a significantly lesser reduction in microhardness of root dentin than EDTA.

Comparative Evaluation of Depth of Penetration of Root Canal Irrigant After Using Manual, Passive Ultrasonic, and Diode Laser-Assisted Irrigant Activation Technique.

AIM: The aim of this study was to compare and evaluate the penetration depth of irrigant after using manual, passive ultrasonic, and diode laser-assisted irrigant activation technique. MATERIALS AND METHODS: Ninety extracted single-rooted human mandibular premolars were selected (N = 90). Teeth were decoronated and working length was standardized for 12 mm. Root canals were shaped using ProTaper Universal F3. Saline was used as an irrigant in between every successful instrumentation. After completion of chemomechanical preparation, root canals were filled with Rhodamine-B-labeled sodium hypochlorite (3%). Teeth samples were divided into three experimental groups. In Group 1 (n = 30), manual irrigant activation was performed for 30 seconds with master cone gutta-percha (F3) in gentle up and down motion. In Group 2 (n = 30), ultrasonic irrigant activation was performed using passive ultrasonic endo tips for 30 seconds. In Group 3 (n = 30), laser activation was performed using diode laser for 30 seconds with 200-µm tips. Transverse sections were made at 2, 5, and 8 mm from the root apex and were observed under confocal laser scanning microscopy. Maximum penetration depth of irrigant was recorded and statistically analyzed. RESULT: In the all three groups, coronal third (sections at 8 mm from root apex) showed the highest penetration depth of irrigant. Laser activation (Group 3) showed the highest penetration depth in all the three sections when compared with manual and passive ultrasonic irrigant activation. One-way analysis of variance and post hoc test showed there were significantly high differences among all the three groups and also at all three levels (P < 0.05). CONCLUSION: Diode laser-assisted irrigant activation technique had better penetration depth in all the three aspects of root dentin.

Comparison of penetrating depth of chlorhexidine and chitosan into dentinal tubules with and without the effect of ultrasonic irrigation.

BACKGROUND: Long term success of root canal treatment depends on complete removal of micro-organisms and their by-products. This can be effectively achieved by the ability of the irrigant to penetrate into the dentinal tubules, which is limited in the conventional mechanical debridement of the root canal system. Irrigant activation technique aids in movement of irrigants into the dentinal tubules. AIM: To compare the depth of penetration of root canal irrigants into the dentinal tubules with and without ultrasonics using light microscope. MATERIALS AND METHODS: Forty noncarious mandibular premolars were used, all the tooth specimens were inoculated with an ATCC 29212 strain of E.faecalis and incubated under nutrient rich aerobic conditions at 37°C. Teeth were sectioned below the cementoenamel junction to obtain a standard length of 8 mm and instrumented with K-files, irrigated with 5.25% sodium hypochlorite and a final rinse of 17% EDTA. Teeth were divided into four groups of ten each. Group IA was irrigated with 2% Chlorhexidine (CHX) and agitated ultrasonically, Group IB was irrigated with 2% Chlorhexidine, Group IC was irrigated with 2% Chitosan and ultrasonically agitated, Group ID was irrigated with 2 % Chitosan. The tooth specimens were sectioned and subjected to gram staining and viewed under 100X oil immersion microscope. A micrometer grid was attached to the eyepiece to enable measurement of the depth of penetration of the irrigants. Group IA (2% Chlorhexidine with ultrasonic agitation) showed better penetration into the dentinal tubules as compared to Groups IB, IC, ID. RESULTS: Irrigation with 2% Chlorhexidine with ultrasonic agitation had depth of penetration into the dentinal tubules upto 2350 µm. 2% Chlorhexidine without ultrasonic agitation penetrated upto 1800 µm. Chitosan with ultrasonic agitation penetrated upto1250 µm and Chitosan without ultrasonic agitation penetrated upto 44.80 µm. CONCLUSION: 2% Chlorexidine as irrigant with ultrasonic agitation was found to have maximum depth of penetration into the dentinal tubules when compared with Chitosan.