Comparative evaluation of calcium hydroxide and other intracanal medicaments on postoperative pain in patients undergoing endodontic treatment: A systematic review and meta-analysis.

Aim: The aim of this study was to evaluate the effect upon postoperative pain in teeth of patients suffering from apical periodontitis or necrotic pulp when treated with calcium hydroxide and compare it with other intracanal medicaments. Materials and Methods: MEDLINE database, PubMed and Google Scholar databases were searched based on the filters and inclusion and exclusion criteria. The screening was done to finally acquire 9 articles from the mass of searched articles. The data extraction followed the screening process, and qualitative and quantitative data were recorded. The risk of bias was conducted with the Cochrane Collaboration tool, and meta-analysis was done using Review Manager version 5.3. Results: A total of 9 studies over the past five decades met the inclusion criteria for full-text reading, and all 9 of them were included for further analysis. When we assessed for pain outcome, in comparison with CHX and Ca(OH), the cumulative mean difference was -4.57 (confidence interval: -16.25, 7.11). The heterogeneity was significant I2 = 95%, hence we applied the random effects model. The mean difference showed that the mean pain outcome was more in the control (Ca(OH)) group, as compared to the intervention group. Conclusion: Calcium hydroxide is effective in reducing posttreatment pain when it is used alone, but its effectiveness can be increased when used in combination with other medicaments such as chlorhexidine.

Morphology-driven preparation technique for posterior indirect bonded restorations.

Restorative treatment in recent times has seen a paradigm shift due to minimally invasive adhesive dentistry. With advent of material science, bonding mechanisms, and superior isolation techniques, treatments based entirely on adhesion are effectively attainable. The choice between direct and indirect restorative technique, mainly in posterior areas, is still a challenge and involves biomechanical, anatomical, functional, esthetic, and economic considerations. The rationale of this case report is to demonstrate a revised cavity design based on morphological principles in terms of geometry (height of contour and cuspal inclines) and structure (dentinoenamel junction morphology) inspired from conventional preparation techniques.

Microgap Evaluation of Novel Hydrophilic and Hydrophobic Obturating System: A Scanning Electron Microscope Study.

INTRODUCTION: The purpose of an endodontic obturation is to obtain a fluid tight hermetic seal of the entire root canal system. There has been an evolution of different materials and techniques to achieve this desired gap free fluid tight seal due to presence of anatomic complexity of the root canal system. AIM: To compare the microgap occurring in root canals obturated with hydrophilic versus hydrophobic systems using scanning electron microscope. MATERIALS AND METHODS: Sixty extracted human single-rooted premolars were decoronated, instrumented using NiTi rotary instruments. The samples (n=20) were divided into three groups and obturated with Group A - (control group) gutta-percha with AH Plus, Group B - C-point with Smartpaste Bio and Group C - gutta-percha with guttaflow 2. The samples were split longitudinally into two halves and microgap was observed under scanning electron microscope in the apical 3 mm of the root canal. RESULTS: Group A (control) showed a mean difference of 8.54 as compared to 5.76 in group C. Group B showed the lowest mean difference of 0.83 suggesting that the hydrophilic system (C-point/Smartpaste Bio) produced least microgap as compared to the hydrophobic groups. CONCLUSION: Novel hydrophilic obturating system (C-points/ Smart-paste Bio) showed better seal and least microgap as compared to gutta-percha/guttaflow 2 and gutta-percha/ AH plus which showed gap at the sealer dentin interface due to less penetration and bonding of these hydrophobic obturating system.

Fracture resistance of posterior teeth restored with high-viscosity bulk-fill resin composites in comparison to the incremental placement technique.

AIM: Comparative evaluation of the fracture resistance of maxillary premolar teeth restored with two high-viscosity bulk-fill composites and incrementally placed composite. MATERIALS AND METHODS: Seventy-five freshly extracted maxillary premolar teeth were selected. Fifteen specimens served as positive control (Group 1). Mesio-occluso-distal cavity preparation was prepared on the rest of the specimens. These specimens were further divided into four groups: unrestored teeth (Group 2), teeth restored with incrementally placed nanocomposite (Group 3), teeth restored with high-viscosity bulk-fill giomer (Group 4), and teeth restored with high-viscosity bulk-fill nanocomposite (Group 5). The specimens were then subjected to compressive axial load using Instron universal testing machine. Data were analyzed using data were analyzed using Statistical package for social sciences software (SPSS v 20.0, IBM Corp.). RESULTS: The positive control group exhibited highest fracture resistance (1104.70 ± 122.2 N). There was no statistically significant difference seen in between the incrementally placed nanocomposite and high-viscosity nanocomposite (P > 0.05). The fracture resistance values displayed by the high-viscosity bulk-fill giomer were found to be statistically lower than the other two groups. CONCLUSION: High-viscosity bulk-fill nanocomposite may substitute incrementally placed nanocomposite with respect to fracture resistance.

Ultrasonic versus sonic activation of the final irrigant in root canals instrumented with rotary/reciprocating files: An in-vitro scanning electron microscopy analysis.

AIM: To compare the smear layer and debris removal in root canals instrumented with two different kinematic motions after ultrasonic and sonic irrigation activation. MATERIALS AND METHODS: Eighty freshly extracted teeth were selected for the study and randomly divided the samples into two groups (n = 40) for instrumentation with either rotary ProTaper NEXT (PTN) or reciprocating WaveOne (WO) file systems. These (n = 40) were further divided into two groups (n = 20) where the final irrigant was activated using either Ultrasonics (Passive Ultrasonic Irrigation; PUI) or Sonics (EndoActivator; EA). Group 1: PTN + EA; Group 2: PTN + PUI; Group 3: WO + EA; and Group 4: WO + PUI. During instrumentation, a total of 4 ml of 5.25% NaOCl was used for irrigation. The final irrigation protocol included NaOCl and Smear Clear Solution. The samples were processed by scanning electron microscopic examination for debris and smear layer scoring, and statistical analysis was done. RESULTS: The mean debris and smear layer score was less in the group instrumented by PTN with sonic activation of the irrigant. CONCLUSION: A combination of PTN instrumentation with sonic irrigation activation by EA is more effective in debris and smear layer removal in the groups tested.

Effect of intracanal medicaments on push-out bond strength of Smart-Seal system.

AIM: To evaluate the effects of calcium hydroxide (CH), triple and double antibiotic pastes (DAPs) on the bond strength of Smart-Seal obturation, C-points with Endosequence Bio-ceramic (BC) sealer to the root canal dentin. MATERIALS AND METHODS: Sixty-four freshly extracted single-rooted human mandibular premolars were de-coronated and prepared using rotary Pro-taper system with full sequence till F3. The specimens were randomly divided into a control group (without intracanal dressing) and 3 experimental groups that received an intracanal dressing with either CH, DAP, or triple antibiotic paste (TAP) (n = 16). The intracanal dressing was removed after 3 weeks by rinsing with 10 mL 17% ethylenediaminetetraacetic acid, followed by 10 mL 3% sodium hypochlorite. The root canals were then obturated with C-points and Endosequence BC sealer. A push-out test was used to measure the bond strength between the root canal dentin and the obturating system. The data were analyzed using two-way analysis of variance and Tukey post-hoc test. RESULTS: The push-out bond strength values were significantly affected by the intracanal medicaments (P < 0.001), but not by the root canal thirds (P > 0.05). In the middle and apical third, the bond strength of the TAP group was higher than those of the CH and DAP groups (P < 0.05). CONCLUSIONS: The DAP and CH did not affect the bond strength of the novel hydrophilic obutrating system. TAP improved the bond strength of Smart-Seal system in the middle and apical thirds.

Fracture resistance of roots obturated with novel hydrophilic obturation systems.

AIM: Comparative assessment of fracture resistance of roots obturated with three hydrophilic systems - novel CPoint system, Resilon/Epiphany system, and EndoSequence BC sealer; and one hydrophobic gold standard gutta-percha/AHPlus system. MATERIALS AND METHODS: Ninety freshly extracted, human, single-rooted mandibular premolars were selected. The specimens were decoronated and standardized to a working length of 13 mm. The teeth were randomly divided into six groups (n = 15). In Group A, teeth were left unprepared and unfilled (negative control). Rest of the groups were prepared by using ProTaper system up to a master apical file F3; followed by which Group B was left unobturated (positive control); Group C, novel CPoint System; group D, Resilon/Epiphany system, Group E EndoSequence BC sealer, and Group F gutta-percha and AH Plus. Specimens were stored for 2 weeks at 100% humidity. Each group was then subjected to fracture testing by using a universal testing machine. The force required to fracture each specimen was recorded and the data was analyzed statistically using analysis of variance (ANOVA) test and Tukey's post-hoc test. RESULTS: The hydrophilic obturation systems have shown to exhibit significantly higher fracture resistance as shown by the values in Groups C, D, and E (P < 0.05) when compared with Group F. Within hydrophilic groups there was significant difference between Group D and Groups C and E (P < 0.05), while Groups C and E had no significant difference (P > 0.05). CONCLUSION: In contrast to hydrophobic systems, hydrophilic systems showed higher fracture resistance in a single-rooted premolar.

Sealing ability of three hydrophilic single-cone obturation systems: An in vitro glucose leakage study.

AIM: The aim of this study is to compare the corono-apical sealing ability of three single-cone obturation systems using a glucose leakage model. MATERIALS AND METHODS: A total of 90 freshly extracted human maxillary single-rooted teeth was selected, and their crowns were cut. The root canal of each sample was instrumented using a rotary crown down technique and then divided into four experimental (n = 20 each) and two control groups (n = 5 each). Samples in the experimental groups were filled as follows: Group 1, cold lateral condensation using gutta-percha/AH Plus; group 2, single-cone C-points/smart-paste bio-sealer; group 3, single-cone bio-ceramic (BC) impregnated gutta-percha/endo-sequence BC sealer; group 4, single-cone Resilon/RealSeal SE after 7 days, the sealing ability of root canal fillings was tested at different time intervals using glucose leakage model. Glucose leakage values were measured using a spectrophotometer and statistically analyzed. RESULTS: The four experimental groups presented significantly different glucose leakage values at all test periods (P < 0.05). At the end of the observation period, the cumulative glucose leakage values of groups 2 and 3 were significantly lower than those of groups 1 and 4 (P < 0.05). CONCLUSION: C-points/smart-paste Bio and BC impregnated gutta-percha/endo-sequence BC sealer combinations provided the superior sealing ability over the lateral condensation technique.

Sealing ability of a novel hydrophilic vs. conventional hydrophobic obturation systems: A bacterial leakage study.

AIM: Comparative assessment of apical sealing ability of a novel Smart-Seal System, Resilon, and conventional Gutta-Percha system using a bacterial leakage model. MATERIALS AND METHODS: Seventy freshly extracted human single rooted teeth with fully formed apices were randomly divided into three groups (20 each) and two control groups (5 positive and 5 negative). Teeth were de-coronated, and roots were standardized to a working length of 16 mm. Root canal preparation was done with rotary pro-taper file system in all groups. Group A was obturated using Smart-Seal system (Hydrophilic), Group B using Resilon/Epiphany system (Hydrophilic), and Group C using Gutta-Percha (GP)/AH plus system (Hydrophobic) in a single cone technique. Using Enterococcus faecalis, a split chamber bacterial leakage model was developed to evaluate the sealing ability of three obturation systems. Samples will be monitored every 24 hours for 60 days. RESULTS: All three groups have shown leakage. Novel Smart-Seal System and Resilon have shown similar results and relatively lesser samples leaked in comparison to GP obturations at the end of the observation period. There was no significant difference amongst Resilon and Smart-Seal System (P > 0.05) but there was a significant difference amongst them when compared to GP obturations (P < 0.05). CONCLUSION: Hydrophilic obturations of the root canal shows a better resistance to bacterial leakage as compared to hydrophobic obturations.

Effect of advanced irrigation protocols on self-expanding Smart-Seal obturation system: A scanning electron microscopic push-out bond strength study.

INTRODUCTION: The aim of this study was to evaluate the effect of different final irrigation activation techniques affect the bond strength of self-expanding Smart-Seal obturation at the different thirds of root canal space. MATERIALS AND METHODS: One hundred single-rooted human teeth were prepared using the Pro-Taper system to size F3, and a final irrigation regimen using 3% sodium hypochlorite and 17% EDTA was performed. The specimens were randomly divided into five groups (n = 20) according to the final irrigation activation technique used as follows: No activation (control), manual dynamic activation (MDA), CanalBrush activation, ultrasonic activation (UA) and EndoActivator. Five specimens from each group were subjected to scanning electron microscopic observation for assessment of the smear layer removal after the final irrigation procedures. All remaining roots were then obturated with Smart-Seal obturation system. A push-out test was used to measure the bond strength between the root canal dentin and Smart-Seal paste. The data obtained from the push-out test were analyzed using two-way analysis of variance and Tukey post-hoc tests. CONCLUSIONS: It was observed that UA improved the bond strength of Smart-Seal obturation in the coronal and middle third and MDA/EndoActivator in the apical third of the root canal space.

Fracture resistance exhibited by endodontically treated and retreated teeth shaped by ProTaper NEXT versus WaveOne: An in vitro study.

AIM: To compare the fracture resistance exhibited by teeth after primary endodontic treatment and retreatment. MATERIALS AND METHODS: One hundred freshly extracted human teeth were selected. 20 samples served as control (untreated). Eighty experimental samples were divided into two groups (n = 40) for instrumentation using rotary Protaper NEXT (PTN) or reciprocating WaveOne (WO) files and obturated using warm lateral compaction. Half of the samples (n = 20) from each group were subjected to a load. The remaining half were subjected to retreatment using Protaper universal retreatment files (RFs) followed by a file larger than the master apical file used in groups 1 and 2 and reobturated. Group A: Control, Group B: PTN + obturation, Group C: WO + obturation, Group D: RF + PTN + obturation and Group E: RF + WO + obturation. The retreatment specimens were also subjected to load and the readings acquired were statistically analyzed. RESULT: When compared between the groups, control group exhibited the highest fracture resistance (P < 0.01). When multiple tests were performed, Group E exhibited significantly less fracture resistance (P < 0.01). CONCLUSION: Endodontic treatment and retreatment both results in lowering the fracture resistance of a tooth.

Comparative evaluation of a novel smart-seal obturating system and its homogeneity of using cone beam computed tomography: In vitro simulated lateral canal study.

AIM: The aim was to evaluate and compare a novel polyamide polymer based obturating system and Gutta-percha and sealer in filling simulated lateral canals and their homogeneity when used for obturating the root canals. MATERIALS AND METHODS: A total of 60 freshly extracted human single rooted teeth with fully formed apices were selected for this study. Teeth were de-coronated, and roots were standardized to a working length of 15 mm. Root canal preparation was carried out with rotary Protaper file system in all groups. The specimens were then randomly divided into three groups A, B, and C (n = 20). Ten samples from each group were decalcified and simulated lateral canals were made at 2, 4, and 6 mm from the root apex. Remaining ten samples from each group were maintained calcified. Group A was obturated with SmartSeal system (Prosmart-DRFP Ltd., Stamford, UK). Group B was obturated with sectional backfill method. Group C was obutrated with cold lateral compaction method (control). Decalcified samples from the respective groups were analyzed with digital radiography and photography and the measurement of the linear extension and area of lateral canal filling was done using UTHSCSA (UTHSCSA Image Tool for Windows version 3.0, San Antonio, TX, USA) software. Calcified samples were subjected to cone beam computed tomography image analysis sectioned axially. RESULTS: Group A 92.46 ± 19.45 showed greatest extent of filling in lateral canals and denser homogeneity of oburation, followed by Group B 78.43 ± 26.45 and Group C 52.12 ± 36.67. CONCLUSIONS: Polyamide polymer obturation proved to have greater efficiency when compared with Gutta-percha system, when used for obturation with regards to adaptation of the sealer and penetration into the simulated lateral canals.