Analysis of the depth of penetration of an epoxy resin-based sealer following a final rinse of irrigants and use of activation systems: An in vitro study.

Objective: The objective of the study was to compare and evaluate the depth of penetration of an epoxy resin-based sealer following a final rinse of 17% ethylenediaminetetraacetic acid (EDTA) and 18% 1-hydroxyethylidene 1, 1-diphosphonate (HEDP), with diode laser and passive ultrasonic activation (PUI): an in vitro confocal laser scanning microscopy study. Materials and Methods: Fifty-two extracted human mandibular premolar teeth with single root and single canal were selected. They were disinfected in 0.1% thymol solution, cleaned of calculus and soft tissues, and stored in 0.1% thymol solution till use. All teeth were radiographed and selected as per the inclusion and exclusion criteria. The teeth were decoronated using a diamond disk under copious water spray to acquire a standardized root length of 14 mm. Working length was established by inserting a size 10-K file into each root canal until it is visible at the apical foramen and by subtracting 1 mm from the recorded length. Instrumentation of the root canal was done till master apical file size of F3 using ProTaper universal, rotary instruments. The canals were irrigated with 2 mL of 3% sodium hypochlorite between successive files. Teeth were randomly divided into four subgroups n = 12 according to the intervention. Passive ultrasonic irrigation and diode laser were used to activate the irrigants. Final irrigation was performed with distilled water. These specimens were examined using confocal laser scanning microscope (OLYMPUS FLUOVIEW FV 3000) for dentinal tubule penetration of the sealer. Two-way ANOVA test and Tukey's multiple post hoc test were used for statistical analysis. Results: Highly significant difference was seen between the groups with EDTA and HEDP, with HEDP demonstrating the highest penetration. Among the activation techniques used in this study, PUI showed the highest penetration of the sealer. The least penetration was seen with diode laser activation and EDTA. Conclusions: The irrigation activation techniques significantly influence the penetration of sealer into root dentinal tubules. When penetration of sealer with different irrigation techniques and irrigants was evaluated, significant greater level of sealer penetration was attained with PUI activation of HEDP.

Assessing the Efficacy of Anterior Repositioning Splints in the Management of Temporomandibular Disc Displacement: A Systematic Review and Meta-Analysis.

Disc displacement (DD) occurs when the cushioning disc of the temporomandibular joint (TMJ), situated between the jawbone and the skull, is out of position. The condition can be of two kinds: disc displacement with reduction (ddwr) and disc displacement without reduction (ddwor). The present systematic review was undertaken to assess the efficacy of anterior repositioning splints (ARS) for ddwr and ddwor. Three online databases were searched for relevant studies using MeSH keywords and Boolean operators. Initial searches of the databases extracted 552 records. Twelve studies equally representing ARS with ddwr and ddwor were selected. No clear difference could be assessed regarding ARS usage in both conditions. The outcome assessed was the improvement in TMJ symptoms. The results suggested that both ddwr and ddwor were effective in improving temporomandibular joint (TMJ) symptoms in patients who received ARS therapy. Efficacy levels ranged from 71-83% and 50-95% for ARS in ddwr and ddwor, respectively; odds ratio (OR) values ranging from 0.30 and 0.36 were obtained for ARS in both therapies, respectively, indicating similar performance levels. Both ddwr and ddwor respond well to the use of ARS; however, more clinical trials are needed to ascertain and validate the role of ARS as a treatment modality in this regard.

A Clinical Evaluation of Difference in Shades among Maxillary Central Incisor, Canine, and First Molar in a Young Age-group Using Digital Spectrophotometer: An In Vivo Study.

AIM: The aim of this study was to evaluate and compare the most common shades of maxillary central incisor, canine and first molar and to confirm the shade difference between maxillary central incisor and canine in a young population of 18-25 years. MATERIALS AND METHODS: The shade of the maxillary central incisor, canine, and first molar of 100 study participants in a young population between 18 and 25 years were measured by digital spectrophotometer (VITA Easyshade). The shade of each tooth was assessed thrice with a digital spectrophotometer at the center of the tooth. Statistical analysis was performed; Chi-squared test was applied to assess the difference in shades. RESULTS: For the age-group of 18-25 years, the most common shade of maxillary central incisor is A1 and for canine and first molar the most common shade is B3. A highly statistically significant difference (p < 0.001) was observed between teeth, suggesting a definitive shade difference between teeth. CONCLUSION: A definitive shade difference exists between the maxillary central incisor and the canine, with the canine being darker in shade than the central incisor. This result can be implied clinically while restoring maxillary anterior teeth to yield a better esthetic outcome. CLINICAL SIGNIFICANCE: This study reveals that there is a definitive shade difference between the Anterior teeth which should be considered while smile designing to replicate the natural appearance in a patient. Using a digital spectrometer makes the process of shade selection objective thereby eliminating any subjective variations.

Evaluation of the Effect of Long-term Use of Three Intracanal Medicaments on the Radicular Dentin Microhardness and Fracture Resistance: An in vitro study.

OBJECTIVES: The aim of this research was to evaluate the effect of long-term use of three intracanal medicaments on the radicular dentin microhardness and fracture resistance. MATERIAL AND METHODS: A chemomechanical preparation was done using the Protaper rotary instruments up to F3. The teeth were stored in an incubator at 37°C at 100% humidity and were categorized in three groups by random allocation, namely: Triple Antibiotic Paste (TAP), Calcium hydroxide paste (Apexcal) and Ledermix. Following medicament application, the access openings of all teeth were sealed with 4 mm thickness of cavit. The samples were stored for periods of 1 week, 1 month and 3months. Two dentin cylinders measuring 5mm and 3mm were obtained from each sample. The cervical third was used for fracture resistance and the middle third was used for micro hardness evaluation. The microhardness testing was done using a Knoop microhardness tester, and the fracture resistance testing was done using the universal testing machine. RESULTS: Calcium hydroxide showed maximally negative effect on the physical properties of radicular dentin compared to TAP (p= 0.0100 at one month and Ledermix (p=0.0001 at one month). With an increase in the application time, there was an increased deterioration in the physical properties of radicular dentin. CONCLUSION: Long-term placement of calcium hydroxide, Triple Antibiotic Paste, and Ledermix (p= 0.0001at 3 months) significantly affects the microhardness and fracture resistance of radicular dentin.

Comparison of Antimicrobial Efficacy of Diode Laser, Ultrasonic Activated and Conventional Irrigation with 2.5% NaOCl during RCT: An Interventional Study.

AIM AND OBJECTIVE: The aim and objective of the study was to evaluate and compare the antimicrobial efficacy of a diode laser irradiation, ultrasonic activated and conventional irrigation with 2.5% NaOCl on obligatory and facultative anaerobic bacteria in single-rooted canals. MATERIALS AND METHODS: Total of 60 permanent maxillary and mandibular single-rooted (single canal) anterior teeth were selected. First microbial sample (S1) was collected after access opening and working length determination, using a sterile paper point. Cleaning and shaping were performed, with each instrument change accompanied by irrigation using 2 mL 2.5% NaOCl. After cleaning and shaping, disinfection protocol using diode laser (group1), ultrasonic activated irrigation with 2.5% NaOCl (group 2) and conventional irrigation with 2.5% NaOCl (group 3) was performed and second microbial sample (S2) was obtained. The colony characters of each type of growth on each media were noted and the organisms were identified using standard biochemical reactions. RESULT: Gram-positive and gram-negative facultative anaerobe were predominantly isolated from the culture, and the highest reduction of the microbial count was seen in diode laser group with 60.92% followed by the ultrasonic group with 47.22% reduction and least reduction was observed in conventional irrigation with the ultrasonic group with 37.97%. The results were statistically significant with p-value <0.05. CONCLUSION: Diode laser disinfection showed the highest reduction of microbial count compared to ultrasonic activated and conventional needle irrigation with 2.5% NaOCl group. CLINICAL SIGNIFICANCE: This study will help us to choose wisely between various irrigating methods and protocols. Diode laser in our study has shown superior disinfection of the root canals compared to others.

Comparative Evaluation of Efficacy of Calcium Hydroxide, Propolis, and Glycyrrhiza glabra as Intracanal Medicaments in Root Canal Treatment.

AIM: To evaluate and compare the antimicrobial efficacy of Ca(OH)2, 25% propolis, and 25% Glycyrrhiza glabra as intracanal medicaments in root canal treatment. MATERIALS AND METHODS: Total 60 freshly extracted permanent incisors were decoronated and chemomechanical preparation of root canal was performed. Samples were inoculated with a pure culture of Enterococcus faecalis and incubated for 21 days. Colony-forming units (CFUs) were recorded before medication. Incubated samples were randomly categorized into three groups, namely, Ca(OH)2, propolis, and G. glabra, with 20 samples in each group. Antibacterial activity was assessed by evaluating the variance in the CFUs on Day 7. Paired "t" test and Post-hoc Tukey's test were applied to analyze the data. RESULTS: Reduction of CFUs was noticed in all the groups (p <0.001), however the reduction was more predominant in the propolis group. CONCLUSION: Propolis is more effective against E. faecalis, when compared to G. glabra and Ca(OH)2. CLINICAL SIGNIFICANCE: Propolis could be used as an effective medicament in root canal treatment.

Transposition/Fusion: A Clinician's Dilemma and Challenge - 12 Months Follow-up.

Fusion or syndontia is a sequele of the union of two normal and separated tooth buds. Transposition refers to the interchange in the position of two permanent teeth within the same quadrant in the oral cavity. The simultaneous incidence of both these entities is a rare concurrence and warrants endodontic and surgical soft tissue correction. The following manuscript describes a case report of this rare combination and its multidisciplinary management for functional and esthetic correction.

The Effect of Time of Post Space Preparation on the Seal and Adaptation of Resilon-Epiphany Se & Gutta-percha-AH Plus Sealer- An Sem Study.

BACKGROUND: The field of endodontics is dynamic & ever expanding. With the availability of a wide array of products in the dental market it's an absolute necessity to evaluate their efficiency before including them into routine clinical practice.Hence, the purpose of this study is to evaluate the effect of immediate & delayed post space preparation & sealing ability of new root canal filling material & sealers. AIM: The effect of time of post space preparation on the seal and adaptation of Resilon-Epiphany Se & Gutta-percha-AH Plus Sealer - An SEM study. SETTINGS AND DESIGN: Eighty extracted permanent maxillary central and lateral incisors selected for the study were decoronated. Roots canals were prepared and obturated. MATERIALS AND METHODS: Samples were divided into four groups depending on the time of post, space, preparation and obturated material.GROUP I & II: Immediate and Delayed post space preparation respectively with Gutta-percha / AH Plus as obturating material. GROUP III & IV Immediate and Delayed post space preparation with Resilon / Epiphany as the obturating material. The samples were sectioned, then measured and studied by Scanning Electron Microscope. RESULTS: There was a significant difference found between immediate and delayed post space preparation in resilon -epiphany group (p<0.001). Similarly significant difference was seen between immediate and delayed post space preparation in AH Plus-GP group (p<0.001). Difference in the adaptation of the two materials was seen in the delayed group (p = 0.030) but the immediate group showed no signifcant difference (p =0.971). CONCLUSION: Within the limitations of this study, immediate post space preparation shows less leakage in both the groups. Resilon-Epiphany shows better results when post space is delayed amongst the two whereas in immediate post space preparation there is no significant difference.

Evaluation of immediate and delayed post space preparation on sealing ability of Resilon-Epiphany and Gutta percha-AH plus sealer.

AIM: To evaluate the influence of immediate and delayed post space preparation on sealing ability of Resilon-Epiphany and Gutta percha-AH plus. MATERIALS AND METHODS: Eighty extracted permanent maxillary central and lateral incisors were decoronated. Roots canals were prepared and obturated. Samples were divided into four groups depending on the time of post space preparation and obturated material. Group I and II: Immediate and delayed post space preparation respectively with Gutta percha/AH plus as obturating material. Group III and IV: Immediate and delayed post space preparation with Resilon/Epiphany as the obturating material. The samples were kept in methylene blue dye, sectioned and then measured under stereomicroscope and studied under SEM. STATISTICAL ANALYSIS: The data was subjected to statistical analysis using unpaired t-test. RESULTS: There was significant difference found between immediate and delayed post space preparation in Resilon-Epiphany group (P = 0.0109) as well as in AH plus-GP group (<0.0001). Difference in the sealing ability of the two materials was seen in delayed group (P = 0.0202). No statistically significant result was found between the two obturating materials when post space was prepared immediately (P = 0.0875). CONCLUSION: Within the limitations of this study, there was significantly less leakage when post space is prepared immediately in both the groups. Resilon-Epiphany shows better results when post space is delayed amongst the two whereas in immediate post space preparation there is no significant difference.