Effect of preoperative ibuprofen in controlling postendodontic pain with and without low-level laser therapy in single visit endodontics: A randomized clinical study.

AIM: The aim of this study is to evaluate the effect of low-level laser irradiation and ibuprofen in reducing the onset and severity of postoperative pain following single visit endodontics. MATERIALS AND METHODS: One hundred and twenty patients were recruited for this study. Group A (n = 30) patients were administered 400 mg of ibuprofen orally 1 h before the institution of an endodontic procedure. Group B (n = 30) patients were given irradiation of a low-level laser at 50 Hz for 3 min after the standard endodontic procedure at the periapical region on both buccal and lingual aspect. Group C (n = 30) patients were given preoperative ibuprofen followed with a low-level laser at 50 Hz for 3 min after endodontic treatment. Group D (n = 30) patients were administered no preoperative ibuprofen nor low-level laser irradiation after the endodontic procedure. The patient immediately recorded his/her pain perception on the Heft Parker pain survey after completion of the appointment and at 4, 8, 12, 24, and 48 h postoperatively. Inter group analysis was carried out using the analysis of variances with "least significant difference" post hoc test. For intra group analysis, Student's t-test was used. Chi-square test was applied for nonparametric data. RESULTS: Pain was significantly reduced in all the treatment groups postoperatively. Ibuprofen showed significant pain reduction at 4 h and 8 h period. The combination of low-level laser and ibuprofen showed the best results in terms of postoperative pain reduction. CONCLUSION: This study proved that low-level laser therapy can be an effective alternative for conventional use of nonsteroidal anti-inflammatory drugs in controlling postendodontic pain thereby eliminating the adverse effects of such drugs on the patients.

Effect of diode laser and ultrasonics with and without ethylenediaminetetraacetic acid on smear layer removal from the root canals: A scanning electron microscope study.

AIM: To evaluate the effect of diode laser and ultrasonics with and without ethylenediaminetetraacetic acid (EDTA) on the smear layer removal from root canals. MATERIALS AND METHODS: A total of 120 mandibular premolars were decoronated to working the length of 12 mm and prepared with protaper rotary files up to size F3. Group A canals irrigated with 1 ml of 3% sodium hypochlorite (NaOCl) followed by 3 ml of 3% NaOCl. Group B canals irrigated with 1 ml of 17% EDTA followed by 3 ml of 3% NaOCl. Group C canals lased with a diode laser. Group D canals were initially irrigated with 0.8 ml of 17% EDTA the remaining 0.2 ml was used to fill the root canals, and diode laser application was done. Group E canals were irrigated with 1 ml distilled water with passive ultrasonic activation, followed by 3 ml of 3% NaOCl. Group F canals were irrigated with 1 ml EDTA with passive ultrasonic activation, followed by 3 ml of 3% NaOCl. Scanning electron microscope examination of canals was done for remaining smear layer at coronal middle and apical third levels. RESULTS: Ultrasonics with EDTA had the least smear layer scores. CONCLUSION: Diode laser alone performed significantly better than ultrasonics.

Mineral trioxide aggregate apexification: A novel approach.

The treatment of choice for necrotic teeth with immature root is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide although recently considerable interest has been expressed in the use of mineral trioxide aggregate (MTA). MTA offers the option of a two-visit apexification procedure so that the fragile tooth can be restored immediately. However, difficulty in placing the material in the wide apical area requires the use of an apical matrix. Materials such as collagen, calcium sulfate, and hydroxyapatite have been used for this purpose. This article describes the use of resorbable suture material to form the apical matrix which offers many advantages over the contemporary materials.

Comparative Evaluation of Physical Surface Changes and Incidence of Separation in Rotary Nickel-Titanium Instruments: An in Vitro SEM Study.

INTRODUCTION: The aim of the present study was to comparatively evaluate the physical surface changes and incidence of separation in rotary nickel-titanium (NiTi) instruments using scanning electron microscope (SEM). METHODS AND MATERIALS: A total number of 210 freshly extracted human maxillary and mandibular first molars were selected and distributed between three groups. Three different systems of rotary NiTi instruments, namely ProFile (PF), RaCe (RC) and Twisted File (TF), were used to prepare the canals using crown-down technique. All instruments were evaluated by means of SEM with 500× and 1500× magnifications, at four different stages; before use, after preparation of 7 and 14 canals and after instrument separation. Photomicrographs were also taken. The data was analyzed using the Kruskal-Wallis test and the level of significance was set at 0.001. It was found that H (HAT matrix) was 15.316 with 2 degrees of freedom. Moreover the various groups were compared using the Student-Newman-Keuls test with P<0.05 and it was found that all groups were significantly different. RESULTS: RC showed the maximum wear of the surface followed by TF (P<0.05). PF showed the minimum wear except for its tip. There was no correlation between electropolishing and file fracture. Insignificant difference was observed in the mean number of canals shaped by PF and TF before their separation. CONCLUSION: Clinically, TF performance was superior, followed by PF then RC. RC fracture rate was the greatest after preparing the least number of canals.

Cut off values of laser fluorescence for different storage methods at different time intervals in comparison to frozen condition: A 1 year in vitro study.

AIMS: The aim of the following study is to evaluate the change in laser fluorescence (LF) values for extracted teeth stored in different solutions over 1 year period, to give cut-off values for different storage media at different time intervals to get them at par with the in vivo conditions and to see which medium gives best results with the least change in LF values and while enhancing the validity of DIAGNOdent in research. MATERIALS AND METHODS: Ninety extracted teeth selected, from a pool of frozen teeth, were divided into nine groups of 10 each. Specimens in Groups 1-8 were stored in 1% chloramine, 10% formalin, 10% buffered formalin, 0.02% thymol, 0.12% chlorhexidine, 3% sodium hypochlorite, a commercially available saliva substitute-Wet Mouth (ICPA Pharmaceuticals) and normal saline respectively at 4°C. The last group was stored under frozen condition at -20°C without contact with any storage solution. DIAGNOdent was used to measure the change the LF values at day 30, 45, 60, 160 and 365. STATISTICAL ANALYSIS USED: The mean change in LF values in different storage mediums at different time intervals were compared using two-way ANOVA. RESULTS: At the end of 1 year, significant decrease in fluorescence (P < 0.05) was observed in Groups 1-8. Maximum drop in LF values occurred between day 1 and 30. Group 9 (frozen specimens) did not significantly change their fluorescence response. CONCLUSIONS: An inevitable change in LF takes place due to various storage media commonly used in dental research at different time intervals. The values obtained from our study can remove the bias caused by the storage media and the values of LF thus obtained can hence be conveniently extrapolated to the in vivo condition.

Evaluation of biological, physical and chemical properties of mineral trioxide aggregate mixed with 4-META/MMA-TBB.

AIM: To evaluate the change in physical, chemical and biological properties when mineral trioxide aggregate (MTA) is mixed with a resin 4-methacryloxyethyl trimellitate anhydride (4-META)/methyl methacrylate-tri-n-butyl-borane (MMA)-TBB. MATERIALS AND METHODS: For biological evaluation MTA was inoculated in Wistar rat's subcutaneous tissue and peripheral tissue response was checked after 72 h, 7 days, 15 days and 30 days. Setting time was evaluated using Gillmore needle. The Ca++ release at the end of 24 h was checked using ethylenediaminetetraacetic acid titration method. For all the trials MTA mixed with water was kept as a control and the ratio of MTA with resin was 1:1 by weight. RESULTS: The biological reaction was verified by two observers and their readings were matched using kappa test and there was an excellent relevance. There was no significant difference in the tissue reaction at the end of 30 days where both the groups seemed to show healing. Setting time of MTA with 4-META/MMA-TBB was coming to a mean of 26 min (approx.), which is almost 6 times lesser than that of MTA with water. After applying t test, the difference in Ca++ release was found significant (P = 0.00), with mean of 0.044 and 0.031 mol/L of MTA with water and MTA with 4-META/MMA-TBB respectively. CONCLUSION: Under the parameters of this study, this new experimental cement has better handling, physical and chemical properties. Even its subcutaneous tissue reaction is comparable to MTA mixed with water.

Spiral computed tomographic evaluation and endodontic management of a mandibular second molar with four roots. A case report and literature review.

The vast majority of mandibular second molars have two roots with three root canals; however, variations in molar root canal anatomy are not uncommon. To the best of our knowledge, four rooted mandibular second molar with three mesial roots and one distal root has never been reported. Herein, we present the endodontic management of a four rooted mandibular second molar tooth, diagnosed with the assistance of spiral computed tomography (SCT) with a brief review of literature.

The dissolving ability of different organic solvents on three different root canal sealers: in vitro study.

INTRODUCTION: The purpose of this in vitro study was to evaluate three common gutta-percha solvents' effectiveness in dissolving three different types of root canal sealers. MATERIALS AND METHODS: The solubility of three different root canal sealers (AH Plus, Apexit Plus and Endoflas FS) was assessed in xylene, refined orange oil, tetrachloroethylene and distilled water (control). One-hundred twenty samples of root canal sealers were prepared and then divided into three equal groups (n=40). Each group was further divided into four equal subgroups (n=10) for immersion in the respective solvents for a 10 minute immersion period. The mean amount of weight loss was determined for each material in each solvent during the specified immersion period, and the values were subjected to statistical analysis. RESULTS: Xylene exhibited the greatest dissolving efficacy for AH Plus, followed by refined orange oil and tetrachloroethylene. Xylene was also able to dissolve the greatest amount of Apexit Plus, followed by refined orange oil and tetrachloroethylene which were equally effective in dissolving Apexit Plus. For Endoflas FS, maximum dissolving efficacy was seen with tetrachloroethylene followed by refined orange oil and xylene. CONCLUSION: The results showed that xylene, refined orange oil and tetrachloroethylene can be used for the removal of AH Plus, Apexit plus and Endoflas FS sealers during endodontic retreatment. Further clinical investigations are needed to evaluate the efficacy of these solvents on different sealers.

Dissolving efficacy of different organic solvents on gutta-percha and resilon root canal obturating materials at different immersion time intervals.

UNLABELLED: BACKGROUND AIM: The purpose of this study was to compare and evaluate the dissolving capability of various endodontic solvents used during endodontic retreatment on resilon and gutta-percha at different immersion time intervals. MATERIALS AND METHODS: 160 ISO no. 40 cones (0.06 taper), 80 each of resilon and gutta-percha were taken as samples for the study. Both resilon and gutta-percha were divided into eight experimental groups of 20 cones (four groups each of resilon and gutta-percha) for immersion in xylene, tetrachloroethylene, refined orange oil and distilled water. Each group was further divided into two equal subgroups (n=10) for 2- and 5-minute immersion time intervals at room temperature to investigate the potential of these solvents for clinical use in dissolving resilon and gutta-percha. Each sample was weighed initially before immersing in the solvent on a digital analytical scale. Distilled water served as a control. Samples were removed from the respective solvents after the specified immersion period and washed in 100 ml of distilled water and allowed to dry for 24 h at 37°C in a humidifier. The samples were then again weighed after immersion in the specific solvent on a digital analytical scale. The extent of gutta-percha or resilon removed from the specimen was calculated from the difference between the original weight of gutta-percha or resilon sample and its final weight. Means and standard deviations of percentage loss of weight were calculated at each time interval for each group of specimens. The values were compared by statistical parametric tests using SPSS 16.0 Software. The data was subjected to paired 't' test, independent 't' test, one-way ANOVA test and multiple comparisons with Scheffe's test. RESULTS: There was no significance in the amount of gutta-percha dissolved at 2- and 5-minute immersion time intervals in all groups (P>0.05) except the tetrachloroethylene group (P=0.00). There was a very high significance in the amount of resilon dissolved at 2- and 5-minute immersion time intervals in all groups (P=0.00) except the xylene and distilled water (Control) groups (P>0.05). CONCLUSION: The results showed that xylene, refined orange oil and tetrachloroethylene can be used for softening gutta-percha/resilon during retreatment with various techniques- xylene being the best solvent both for gutta-percha and resilon.

Spiral computed tomographic evaluation and endodontic management of a mandibular first molar with three distal canals.

The use of spiral computed tomography serves as a boon in endodontic diagnosis of complex anatomic variations. The present case demonstrates the spiral tomographic evaluation and endodontic management of a mandibular first molar with 5 canals (2 mesial and 3 distal canals), which is a very rare anatomic variant. Such anatomic variations should be taken into account in day to day endodontic practice to ensure a high degree of clinical success.