Comparative evaluation of the efficacy of diclofenac sodium administered using different delivery routes in the management of endodontic pain: A randomized controlled clinical trial.

INTRODUCTION: Pain of endodontic origin is of concern to both the patient and the clinician. Expectation of a painful experience can increase the patient's anxiety levels, making treatment more difficult. Management of endodontic pain is one of the challenging aspects in endodontics. OBJECTIVE: To evaluate whether the intraligamentary mode of administration of diclogfenac sodium is effective in abating endodontic pain during interappointment visits. AIM: The purpose of this clinical trial is to evaluate the analgesic efficacy of diclofenac sodium administered through oral and intraligamentary routes in reducing postendodontic pain. MATERIALS AND METHODS: Thirty patients were randomly allocated into three groups. Group A - placebo (Vitamin B12), Group B - diclofenac sodium (intraligamentary), and Group C - diclofenac sodium tablets. The tablets were given 30 min before the start of the procedure, while the intraligamentary injection was administered before commencing the endodontic procedure. The visual analog scale was used to evaluate the pain score at baseline and 6, 12, 24, and 48 h postoperatively. RESULTS: Prophylactic intraligamentary injection of diclofenac sodium was found to be highly effective in reducing postendodontic pain than the oral route of administration. CONCLUSION: In patients with low pain threshold, intraligamentary route of administration is effective in controlling pain of endodontic origin postoperatively.

Photoactivation of curcumin and sodium hypochlorite to enhance antibiofilm efficacy in root canal dentin.

BACKGROUND: To test the effect of ultrasonic or light activated curcumin and sodium hypochlorite against Enterococcus faecalis biofilms in vitro. METHODS: E. faecalis biofilms were grown within root canals (n=175) and divided into 7 groups (n=25). Group 1, sterile saline; group 2, 3% sodium hypochlorite; group 3, 3% sodium hypochlorite activated with ultrasonic files (30s cycles for 4min); group 4, 3% sodium hypochlorite irradiated with blue light (1200mw/cm(2) for 4min); group 5, curcumin (2.5mg/mL); group 6, curcumin (2.5mg/mL) activated with ultrasonic files (30s cycles for 4min); group 7, curcumin (2.5mg/mL) irradiated with blue light. The biofilms' ultrastructure was examined using scanning electron microscopy. Bacterial viability was assessed by confocal microscopy. Data were analyzed by one-way ANOVA and Student-Newman-Keuls test (P=0.05). The quantitative analysis of the colony-forming units was carried out from dentinal shaving and analyzed by One-way ANOVA and Tukey multiple comparison test (P=0.05). RESULTS: All treatment groups showed a significantly higher percentage of dead bacteria than the saline control (P<0.05). The percentage of dead bacteria was significantly higher when light activated curcumin was used (P<0.05). At both depths (200 and 400 microns), light activated curcumin showed no growth of bacteria. CONCLUSIONS: Light activation produced significantly higher antibacterial efficacy than ultrasonic agitation, with light activated curcumin producing the maximum elimination of biofilm bacteria within the root canal lumen and dentinal tubules.

Effectiveness of curcumin against Enterococcus faecalis biofilm.

OBJECTIVES: To evaluate the antimicrobial efficacy of curcumin against Enterococcus faecalis biofilm formed on tooth substrate in vitro. Sodium hypochlorite (NaOCl) and chlorhexidine (CHX) served as standards for comparison. MATERIALS AND METHODS: Biofilms of E.faecalis were formed on instrumented, extracted human teeth (n = 96). At the end of the 2nd day, 2nd and 8th weeks, specimens were treated for 30 min with one of the test solutions or saline (control) and the surviving colony-forming units (CFU/mL) was recorded. Results were analyzed by Kruskal-Wallis test and Dunnet test for pair-wise comparison with Bonferroni correction (p = 0.05). RESULTS: Only NaOCl showed complete eradication of bacteria at all time periods. In the 2-day and 2nd week biofilms, curcumin and NaOCl showed complete inhibition, which was significantly lower than the CFU recovered in the CHX and saline groups (p < 0.05). In 8 week biofilms, samples treated with curcumin showed 553 ± 137.6 CFU/mL, which was significantly higher than NaOCl (0 CFU/mL), but significantly lower than CHX (2551 ± 129.8) and saline control (1.42 × 1011 ± 2.12 × 1010; p < 0.05). CONCLUSIONS: Sodium hypochlorite (3%) showed maximum antibacterial activity against E.faecalis biofilm formed on the tooth substrate, followed by curcumin and CHX. Considering the potential for undesirable properties of NaOCl, the use of herbal alternatives in endodontics might prove to be advantageous.

Root and canal morphology of Indian maxillary premolars by a modified root canal staining technique.

The aim of this study was to investigate the root and canal morphology of maxillary first and second premolars in Indians by a modified canal staining and tooth clearing technique. Maxillary first (350) and second (350) premolars were collected, and the morphology and number of roots analyzed. After cleaning, the teeth were immersed in India ink and placed in a hyperbaric oxygen chamber at 0.6 MPa for 2 h. The teeth were then demineralized and cleared. Digital images of the teeth were examined under magnification to evaluate the number of root canals, root canal system configurations, number of apical foramina, and intercanal communications. Root canal configurations were identified based on Vertucci's classification and Gulabivala's additional classes. The most common root morphology of the first premolars was the classical two separate root morphology (a Caucasian trait) and that of the second premolars was a single-root morphology (a Mongoloid trait), though other morphologies such as singlerooted first premolars and three-rooted first and second premolars were also identified. A "radiculous" first premolar was identified in two samples. The buccal roots of the first premolar showed the maximum variation, the most common being type I (Vertucci's classification), followed by type IV. The highest incidence of intercanal communications was found in the single-rooted first premolars. All roots exhibiting type IV and V canal configurations showed two separate apical foramina, while additional type 2-3 canal configurations showed three separate apical foramina. The root number and morphology as well as the canal morphology of Indian maxillary premolars showed both Mongolian and Caucasian traits.

Cone-beam computed tomography study of root and canal morphology of maxillary first and second molars in an Indian population.

INTRODUCTION: The aim of this study was to investigate the root and canal morphology of maxillary first and second molars in an Indian population by using cone-beam computed tomography (CBCT). METHODS: Maxillary first (n = 220) and second (n = 205) molars were collected from an indigenous Indian population and scanned by using a CBCT scanner at a constant slice thickness of 125 µm/slice. Volume rendering and multiplanar volume reconstruction were performed. The number of root canals was examined, and root canal system configurations were classified by using historical and contemporary classifications. RESULTS: Single-rooted first and second molars commonly showed types I, IV (0.5%) and type III (1%) canal systems, respectively. Buccal roots of two-rooted first molars showed 2 canal systems, type I and type IV, whereas second molars with 2 roots showed wide variations in canal anatomy. The most common canal morphology in the mesiobuccal roots of three-rooted first and second molars was type I (51.8% and 62%, respectively), followed by type IV (38.6% and 50%, respectively). The distobuccal and palatal roots of first and second molars showed predominantly type I canal morphology. Additional canal types were identified in 2.2% and 9.3% of the first and second molars, respectively. CONCLUSIONS: The root number, morphology, and canal morphology of Indian maxillary molars showed features that were different from both Caucasian and Mongoloid traits. CBCT is an exciting and clinically useful tool in studying root canal morphology.

Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology.

INTRODUCTION: This study investigated the accuracy of cone-beam computed tomography (CBCT), peripheral quantitative computed tomography (pQCT), spiral computed tomography (SCT), plain (plain digi), and contrast medium-enhanced digital radiographs (contrast digi) in studying root canal morphology. METHODS: The root canal anatomy was analyzed in 95 teeth using CBCT, pQCT, SCT, plain digi, and contrast digi. After flushing out the radiopaque dye, access cavities were sealed, and the teeth were subject to the modified canal staining and clearing technique. The number of root canals (Vertucci classification and Gulabivala's additional classes) was calculated by three calibrated endodontists and two maxillofacial radiologists. Erroneous or unsuccessful identifications of root canals were statistically analyzed by one-way analysis of variance (p = 0.05). RESULTS: The modified canal staining and clearing technique identified an average of 1.8 root canals per mandibular central incisor, 2.3 per maxillary first premolar, 3.9 per maxillary first molar, 3.8 per maxillary and mandibular second molar, and 4.3 per mandibular first molar. CBCT and pQCT were erroneous in 0.29% and 2.05% cases, whereas SCT, contrast digi, and plain digi were unsuccessful in 15.58%, 14.7%, and 23.8%, respectively. There was a significant difference between all the methods (p < 0.05) in the unsuccessful identification of root canals except between CBCT and modified canal staining and clearing technique where there was no significant difference (p > 0.05). CONCLUSIONS: CBCT and pQCT were as accurate as the modified canal staining and tooth clearing technique in identifying root canal systems.

Root and canal morphology of mandibular second molars in an Indian population.

INTRODUCTION: There are no reports on the root canal anatomy of Indian mandibular second molars. The aim of this study was to investigate the root and canal morphology of Indian mandibular second molars by a canal staining and tooth clearing technique. METHODOLOGY: Mandibular second molars (345) were collected for analyzing the morphology of the roots and root canal systems. The teeth were subjected to a canal staining and clearing technique; after which, the following features were examined under magnification: number and morphology of roots, number of root canals, root canal system configurations (Vertucci's classification and Gulabivala's additional classes), number of apical foramina, and intercanal communications. RESULTS: Most of the second molars had two separate roots (87.8%) with three canals. C-shaped canal morphology was observed in 7.5% of the teeth examined. Both the mesial and distal roots of two rooted molars showed wide variations in canal number and configuration. Type IV and type I canal anatomies were most common in the mesial and distal roots of two rooted second molars, respectively. Approximately 54.84% of the teeth showed two apical foramina, and one specimen (3.8%) of the C-shaped roots showed three apical foramina. CONCLUSION: The most common root morphology in Indian second molars is the two rooted morphology with three canals. Both the mesial and distal roots showed wide variations in canal anatomy with type IV and type I canal configuration predominating in the mesial and distal roots, respectively.