Current Trends in Intentional Replantation Treatment Among Endodontists and Postgraduate Students in India, the United States of America, and the United Kingdom: A Cross-Sectional Study.

Objective This study aimed to investigate the knowledge, attitude, and practices (KAP) of intentional replantation among postgraduate students and endodontists in India, the United States of America, and the United Kingdom. Materials and methods The sample size was estimated using G*Power. Based on the pilot study done before with 60 participants, a sample size of 928 was obtained. The survey consisted of 22 questions, which were finalized after content validation by two endodontic experts. It was circulated through multiple online social platforms such as Instagram, Facebook, WhatsApp, and other online dental communities/channels. The respondents were questioned about the case selection, extraction methods, antibiotic therapy, patient acceptance level, operator preference, prognostic indicator, and various other steps in the intentional replantation treatment modality. The data for this KAP survey were organized in an Excel sheet, and statistical analysis was done using the Chi-squared test. Analysis of descriptive and inferential statistics was conducted using SPSS version 20.0 (IBM Inc., Armonk, New York). A p-value of <0.05 was considered significant. Results A strong statistical difference was found in the KAP of the practitioners in different countries. The vast majority (72.7%) considered intentional replantation as an adjunct treatment modality rather than a last resort. A total of 76.5% of the respondents preferred replantation of the tooth into the socket within 15 minutes, and 86.4% of the participants regarded replantation as the most cost-effective treatment modality. Ultrasonics (76.8%) was most commonly chosen for retrograde preparation, and Biodentine (60.1%; Septodont, Saint-Maur-des-Fossés, France) as root-end filling material. Conclusion It can be concluded that a broad majority of practitioners in different countries view intentional replantation as an adjunct treatment modality rather than a last resort. Thus, intentional replantation seems to be a promising option for preserving the natural dentition of teeth with high survival rates and better outcomes.

Influence of Simulated Wound Exudate on the Antimicrobial Efficacy of Various Intracanal Medicaments Against Enterococcus faecalis: An In Vitro Study.

Aim The aim of this study is to compare and evaluate the antimicrobial efficacy of chlorhexidine, calcium hydroxide, and cetylpyridinium chloride against Enterococcus faecalis in the presence and absence of contamination with simulated periapical exudate at different time intervals. Methods Simulated wound exudate and cetylpyridinium chloride gel were prepared prior to testing. The test groups were divided into groups A and B based on the presence and absence of simulated wound exudate. They were further divided into four subgroups as follows: subgroup 1: calcium hydroxide; subgroup 2: 2% chlorhexidine gel; subgroup 3: 0.5% cetylpyridinium chloride gel; subgroup 4: 0.9% saline as control. E. faecalis was inoculated, and the test groups were evaluated at different time periods of six, 12, and 24 hours. Aliquots were then obtained and subjected to 10-fold serial dilutions. A total of 10 µl of individual samples was spread onto the nutrient agar medium using L-rod. The plates were then assessed for colony-forming units (CFU), and the values obtained were subjected to statistical analysis. Kolmogorov-Smirnov and Shapiro-Wilk normality tests were used to check whether the variables follow a normal distribution. For within-group comparison, the Friedman test and the Kruskal-Wallis test were used. For between-group comparison, the Mann-Whitney U test was used. Results Saline had the highest CFU values, while cetylpyridinium chloride had the lowest CFU values in both contaminated and non-contaminated groups. In all the conditions, the CFU values of cetylpyridinium chloride were significantly lowest compared to the other three groups. CFU values of the calcium hydroxide group were significantly high, followed by the chlorhexidine group when compared to cetylpyridinium chloride in both contaminated and non-contaminated groups. Conclusion Within the limitations of the current study, it can be concluded that cetylpyridinium chloride was the most effective intracanal medicament against E. faecalis than calcium hydroxide and chlorhexidine at varying time intervals, even in the presence of a periapical exudate. Thus, cetylpyridinium chloride can be considered an effective intracanal medicament for root canal disinfection.

Evaluation of the Efficacy of Visual, Tactile Method, Caries Detector Dye, and Laser Fluorescence in Removal of Dental Caries and Confirmation by Culture and Polymerase Chain Reaction: An In Vivo Study.

AIM: To determine the degree of association between visual and tactile methods of caries removal compared with caries detector dye and laser fluorescence device (DIAGNOdent), which detects the degree of demineralization; to determine the presence of Streptococcus mutans via culture and polymerase chain reaction (PCR) techniques; and to find a suitable method for caries removal. MATERIALS AND METHODS: A total of 75 patients were divided into three groups: visual and tactile (Group A), visual and tactile with caries detector dye (Group B), and visual and tactile with caries detector dye along with laser florescence readings (Group C). Caries removal was carried out using visual and tactile methods, caries detector dye, and laser fluorescence, and the samples obtained were subjected to culture and PCR. The data obtained were statistically analyzed using Pearson's chi-square test, analysis of variance (ANOVA), and Tukey's post hoc test. RESULTS: Visual and tactile along with caries detector dye and laser florescence (Group C) is the most efficient method for caries removal. CONCLUSION: Caries detector dye along with visual, tactile examination and laser fluorescence is a valuable and superior tool for clinicians that aids in better caries removal and can prevent the overzealous removal of tooth structure.

The Evaluation of Dentin Microhardness After Use of 17% EDTA, 17% EGTA, 10% Citric Acid, MTAD Used as Chelating Agents Combined With 2.5% Sodium Hypochlorite After Rotary Instrumentation: An In Vitro SEM Study.

INTRODUCTION: The smear layer removed during root canal instrumentation enables penetration of irrigant solution and adhesion of root canal sealants providing a fluid tight seal of obturated root canals, necessitating its removal. The aim of the study was to compare the effect of smear layer removal by 17% Ethylene diamine tetraacetic acid (EDTA), 17% Ethylene glycol tetraacetic acid (EGTA),10% Citric acid and (MTAD solution) a Mixture of tetracycline isomer, an acid and a detergent applied as final rinse , when used along with 2.5% (NaOCl) Sodium hypochlorite and its effect on dentin microhardness. MATERIALS AND METHODS: Sixty single-rooted human mandibular premolars with minimum curvature (<5°) were instrumented using rotary instrumentation till apical enlargement size 35 RaCe file 0.04 taper. During instrumentation, the canals were irrigated with 2-mL 2.5% NaOCl. After instrumentation, teeth were rinsed with distilled water and were divided into 5 groups (n = 12) according to final rinse for 1 min with 5-mL 17% EDTA followed by 5-mL 2.5% NaOCl (group 1, control group), 17% EGTA (group 2), MTAD solution (group 3), 10% citric acid (group 4), and 17% EDTA (group 5). Teeth were split through the groove prepared, and one-half of specimen were evaluated for smear layer removal using scanning electron microscopy. A score system was followed to evaluate the images and comparisons among groups were performed using Kruskal-Wallis one-way analysis. Multiple comparisons were performed using Mann-Whitney U test. The other half was evaluated for dentin microhardness using Vickers microhardness testing machine. Microhardness values were statistically analyzed using parametric one-way analysis of variance test. CONCLUSION: Irrigation regimen following the use of 2.5% NaOCl during instrumentation followed by application of 5-mL 17% EDTA solution for 1 min resulted in efficient smear layer removal and less decrease in dentin microhardness compared with 17% EGTA, 10% citric acid, and MTAD solution.

Effect of 2% Chlorhexidine on Resin Bond Strength and Mode of Failure Using Two Different Adhesives on Dentin: An In Vitro Study.

AIM: To evaluate the shear bond strength and failure mode of total-etch and self-etch bonding agents on human dentin with and without application of 2% chlorhexidine gluconate (CHX). MATERIALS AND METHODS: Eighty extracted premolars were chosen and stored in 10% formalin until use. Samples were mounted in cold cure acrylic resin and the occlusal enamel perpendicular to long axis of each tooth was removed using a low-speed diamond saw under water coolant. The prepared teeth were randomly divided into four groups of 20 samples each according to the adhesive system used. Groups 1 and 2 were the control group in which total-etch and self-etch adhesives were applied as per manufacturer's instructions, Groups 3 and 4 were the experimental groups in which 2% CHX was applied and blot dried prior to the application of total-etch and self-etch adhesives. A custom-designed rig was fabricated to place composite on samples. The customized rig comprised a cylindrical mold with height of 3 mm and internal diameter of 2.5 mm. Resin was placed in increments of 1 mm and was cured after each increments. After the composite placements, samples were placed in distilled water at 37°C for 24 h. The samples were then thermocycled between 5°C and 55°C in water with a dwell time of 30 s in each temperature to a total of 10,000 cycles. The shear test was performed using universal testing machine and fracture modes were evaluated using stereomicroscope. RESULTS: Both the experimental total-etch and self-etch groups showed better shear bond strength than the control groups, which was statistically significant, and also the least mode of failure at the adhesive interface was observed in both the experimental groups. CONCLUSION: 2% Chlorhexidine gluconate effectively improved the shear bond strength and helped maintaining the durability of adhesive interface in both total-etch and self-etch adhesives.

Recovery of Mercury from Dental Amalgam Scrap-Indian Perspective.

AIM: The aim is to recycle mercury from dental amalgam scrap using the vacuum distillation method. MATERIALS AND METHODS: A total of 150 g of dental amalgam scrap was taken in a round bottom flask and was subjected to vacuum distillation at 398°C. The vapor of mercury was collected in another round bottom flask. OBSERVATION: The procedure is carried out for mercury recovery using vacuum distillation apparatus, and mercury vapor are collected in a round bottom flask, and the silver is recovered using sucrose as reducing agent. Using 150 g of dental amalgam scrap 50%-80% of silver are recovered, and silver has a purity of 70%-80%. However, the total time required in the reduction process ranged between 303 and 600 min. CONCLUSION: Mercury could be recycled from dental amalgam scrap through vacuum distillation method at 398°C and its implication of dental amalgam scrap in an Indian perspective.

Cracked tooth syndrome: A report of three cases.

Cracked tooth syndrome (CTS), the term was coined by Cameron in 1964, which refers to an incomplete fracture of a vital posterior tooth extending to the dentin and occasionally into the pulp. CTS has always been a nightmare to the patient because of its unpredictable symptoms and a diagnostic dilemma for the dental practitioner due to its variable, bizarre clinical presentation. The treatment planning and management of CTS has also given problems and challenges the dentist as there is no specific treatment option. The management of CTS varies from one case to another or from one tooth to another in the same individual based on the severity of the symptoms and depth of tooth structure involved. After all, the prognosis of such tooth is still questionable and requires continuous evaluation. This article aims at presenting a series three cases of CTS with an overview on the clinical presentation, diagnosis and the different treatment options that varies from one case to another.

Bilateral fusion of mandibular second premolar and supernumerary tooth: A rare case report.

Fusion is the union of two normally separated tooth germs resulting in the formation of a single large tooth. The prevalence of this anomaly is less than 1% and most common in the primary dentition, in the incisor-canine region. Fusions are almost always unilateral, but few cases of bilateral fusions have been reported. The purpose of this article is to report a rare case of bilateral fusion of mandibular second premolar with supernumerary tooth.