Microbiological Effectiveness of Sodium Hypochlorite Gel and Aqueous Solution When Implemented for Root Canal Disinfection in Multirooted Teeth: A Randomized Clinical Study.

The aim of endodontic therapy is to use various antimicrobial medications for proper cleaning and shaping to create an environment free of microorganisms by eradicating as many as possible from the root canal space. Even although it is a gold standard irrigant, sodium hypochlorite (NaOCl) is known for its cytotoxic effects on vital periapical tissues, making its higher concentrations inappropriate for use in conditions such as wide, underdeveloped, or damaged apices and in cases of perforations. Consequently, if it is ascertained that a gel form of sodium hypochlorite has equivalent antibacterial activity to the aqueous solution form, it could be employed in such situations. The aim of this study was the microbiologic evaluation of 5.25% sodium hypochlorite gel and aqueous solution as root canal disinfectants in multirooted teeth with primary endodontic lesions. Following ethical approval and CTRI registration, 42 patients who gave their consent and had multirooted teeth with pulpal necrosis and asymptomatic apical periodontitis were considered for the study. Following the opening of the access, pre-endodontic build up in case of class-II cavities and working length determination, a pre-operative sample (S1), which was regarded as the pre-operative microbial load of that canal, was acquired from the largest canal using a sterile paper point while maintaining strict isolation and disinfection. The computer randomization approach was used to divide the teeth into two groups at random just before beginning of chemo-mechanical preparation: Group A (n = 21)-canal disinfection with 5.25% sodium hypochlorite gel; Group B (n = 21)-canal disinfection with 5.25% sodium hypochlorite aqueous solution. Following the canal disinfection, a post-operative (S2) sample which was regarded as the postoperative microbial load of that canal was collected from the same canal using a sterile paper point. The Colony-Forming Units (CFUs) for the S1 and S2 samples were determined after 48 h aerobic incubation on Brain Heart Infusion (BHI) agar plates. The patients and the microbiologist were blinded throughout the procedure. Using SPSS 20.0 software (USA), the Shapiro-Wilk test and the Lilliefors Significance Correction were used for normality, followed by the Mann-Whitney U test which was used to compare the CFU difference (×105) between the two groups. A p value of <0.05 was perceived as statistically significant. The mean colony-forming units count difference between the 5.25% sodium hypochlorite gel and aqueous solution groups did not differ in a manner that was statistically significant (p = 0.744). In multirooted teeth with primary endodontic lesions, the 5.25% sodium hypochlorite gel and the aqueous solution demonstrated comparable antimicrobial effectiveness when implemented as root canal disinfectants.

Comparative evaluation of the effect of calcium silicate and epoxy resinbased root canal sealers on postoperative pain in patients with primary endodontic lesion: A randomized clinical study.

Introduction: This study's objective was to assess and compare postoperative pain response between bioceramic sealer (Nishika BG) and epoxy resin based (AH Plus) in patients with primary endodontic lesion at time interval of 24 h, 48 h, and 7 days using the Visual Analog Scale (VAS). Materials and Methods: The study included 40 individuals with necrotic pulp and apical periodontitis. Calcium hydroxide was administered as the intracanal medication during the two-visit endodontic therapy. They were subsequently allocated randomly to either the AH Plus root canal sealer or the Nishika Canal Sealer BG, with a total of 20 participants in each group. Patients were told to use a VAS to rate their postoperative pain severity as none, minimal, moderate, or severe after 24 h, 48 h, and 7 days following obturation using the appropriate sealers. Results: Nishika Canal Sealer BG (CS-BG) has a lower pain score as compared to the AH Plus group at 24-h time point. VAS ratings for both the groups decreased over time. According to the intergroup analysis, there was a significant difference in postoperative pain at the 24 h (P = 0.022), but not at the 48 h or 7 days (P > 0.05). Conclusion: Although bioceramic sealer (Nishika Canal Sealer BG) resulted in significantly lower levels of pain as compared to epoxy resin-based sealer (AH Plus) at 24-h interval, there was no significant difference of postoperative pain at 48-h interval and 7-day period.

Impact of contracted endodontic cavities on instrumentation efficacy-A systematic review.

The aim of the present systematic review was to summarise and evaluate the studies comparing the role of contracted endodontic cavities (CECs) and traditional endodontic cavities (TECs) in terms of instrumentation efficacy. The present systematic review comprised of a search of the online databases of Cochrane, PubMed, Google Scholar and grey literature. The articles which were pertaining to instrumentation efficacy in contracted and traditional endodontic cavities were selected based on the PRISMA checklist. Out of the 660 articles which were obtained, irrelevant articles were excluded and a total of 17 articles were selected for this systematic review which assessed the instrumentation efficacy. Eleven studies compared the volume of dentin removed and canal transportation ability. Four studies compared the pulp debridement, and two studies compared the anti-bacterial efficacy between the two groups. The extrusion of debris between the groups was compared by one study. Out of the 17 studies included, 11 studies proved that contracted endodontic cavities negatively impacted the instrumentation efficacy. Hence, the data suggest that the traditional endodontic access cavities have better results when comparing the instrumentation efficacy.

Comparison of pulp sensibility test responses in normotensive and hypertensive individuals: A clinical study.

Background: Pulp sensibility testing is an essential part of the diagnostic process in the assessment of pulpal health. Several lines of evidence suggest an interaction between control of blood pressure and pain regulatory mechanisms. Aim: The aim of the study is to compare pulp sensibility test responses in normotensive and hypertensive individuals. Materials and Methods: Ninety-eight patients participated in the study, with 49 individuals each in the hypertensive and normotensive groups. A minimum of 4 and maximum of 8 sound teeth were included in the study each from the anterior, premolar, and molar, i.e., 4 teeth from either arch. A total of 832 teeth were tested. The value and time when the responses evoked for electric pulp test (EPT) and cold test were recorded respectively. Statistical Analysis: For intergroup and intragroup analyses, independent t-test and paired t-test were utilized. Results: A statistically significant difference was noted in values for EPT as well as cold test responses when both the groups were compared (P < 0.01). Higher values were obtained with the hypertensive group. Conclusion: Patients with established hypertension showed an increased threshold to electric pulp testing and cold stimulus as compared to normal healthy individuals.

Effect of chromotherapy on the anxiety level in the patients undergoing endodontic treatment: A randomized clinical study.

Background: Incorporation of chromotherapy is an established modality in medical science. However, its use in adult dentistry is an unexplored area. Aim: This study aimed to clinically evaluate and compare the effect of chromotherapy on anxiety levels in patients undergoing endodontic treatment. Materials and Methods: Using computer randomization, the included 90 patients were divided into three groups: Group - 1: Blue, Group - 2: Pink, and Group - 3: Control. Patients were given a preoperative Modified Dental Anxiety Scale questionnaire. Preoperative assessment of heart rate, systolic blood pressure (BP), and diastolic BP was followed by color therapy. Assessment of all the parameters was done at three levels, i.e., preoperative, post chromotherapy session, and after endodontic treatment. Statistical Analysis: Obtained data were tabulated and subjected to ANOVA and post hoc Tukey's test, with P < 0.05 considered statistically significant. Results: The present study demonstrated that patients subjected to blue and pink color therapy had a statistically significant reduction in anxiety as compared to the control group after chromotherapy and post endodontic treatment (P < 0.05). However, between the pink- and blue-colored groups, no statistically significant difference was found (P > 0.05). Conclusions: Chromotherapy plays a pivotal role in anxiety reduction before and during the dental treatment procedure and can be effectively incorporated during routine practice.

Comparative evaluation of biodentine and endosequence root repair material as direct pulp capping material: A clinical study.

Aim: The study was designed to clinically evaluate biodentine and endosequence root repair material (ERRM) as direct pulp capping agent at 3 months, 6 months, and 12 months intervals. Materials and Methods: Sixty permanent posterior teeth with deep caries, without any signs of irreversible pulpitis were allotted into two experimental groups: Group I -Biodentine, Group II-ERRM. Follow-up evaluations were done. Every 24 h for 7 days, the pain was assessed using visual analog scale. Statistical Analysis: Paired t-test along with Pearson's Chi-square test was performed. Results: The success rate of clinical assessment at 12 months for biodentine group is 78.60% and ERRM Group is 64.70%. Conclusion: Biodentine group performed superior than ERRM group clinically at all-time interval and hence it can be successfully used to restore exposed vital tooth.

Comparison of fiber-reinforced composite and nanohybrid resin impregnated with glass fibers as postendodontic restoration in molars - A clinical study.

Background: Restoration of endodontically treated teeth is one of the most challenging part of operative dentistry. The introduction of fiber-reinforced composite has provided a considerable opportunity to modify material's behavior and to enhance the response of existing materials. Aim: The aim of the study is to comparatively evaluate the efficacy of fiber-reinforced composite resins and nanohybrid resin impregnated with glass fibers as postendodontic restoration in molars. Materials and Methods: Fifty patients with deep occlusal carious lesion requiring root canal treatment were selected and treated. For postendodontic restoration, it was divided into Group A (Interlig) and Group B (ever-X posterior) which were eventually restored according to the manufacturer's instructions. Patients were recalled for evaluation at 3-, 6-, 12-month interval. The restorations were evaluated according to modified United States Public Health Service Criteria. Statistical Analysis: Chi-square test was used for intergroup comparison. Results: A statistically significant difference was noted in terms of fracture of tooth and ever-X posteriors proved to be a superior material and no statistically significant difference observed for marginal discoloration, marginal integrity, fracture of core-build up and secondary caries at the evaluation period of 1 year. Conclusion: Ever-X posteriors performed better than Interlig group as postendodontic restoration after 1 year of evaluation.

Comparative evaluation of effect of chloroquick irrigating solution on push-out bond strength of endoseal mineral trioxide aggregate and endosequence root repair material when used as furcal perforation repair material: An in vitro study.

AIM: The purpose of this study was to comparatively evaluate the effect of Chloroquick irrigating solution on push-out bond strength of Endoseal mineral trioxide aggregate (MTA) and endosequence root repair material (ERRM) when used as furcal perforation repair materials. MATERIALS AND METHODS: Forty human extracted mandibular molars were collected. A standardized endodontic access cavity was prepared in 40 samples, and intentional perforation of 1.32 mm in diameter was created on the pulpal floor. Teeth were randomly divided into four groups: Group A: EndoSeal MTA with irrigation, Group B: ERRM with irrigation, Group C: EndoSeal MTA without irrigation (Control group), and Group D: ERRM without irrigation (Control group). The samples were subjected to universal testing machine then examined under a stereomicroscope at × 40 to determine the nature of the bond failures. RESULTS: EndoSeal MTA with Chloroquick irrigating solution irrigation showed the highest push-out bond strength (MPa) with a statistically significant difference among all the groups (P = 0.003). The majority of the samples exhibited cohesive and mixed types of failures. CONCLUSION: Chloroquick irrigating solution irrigation has no adverse effect on the push-out dentin bond strength of Endoseal MTA and ERRM.

Comparative evaluation of sealing ability of calcium sulfate with self-etch adhesive, mineral trioxide aggregate plus, and bone cement as furcal perforation repair materials: An In vitro dye extraction study.

AIM: The aim of this study was to determine the sealing ability of three different materials mineral trioxide aggregate (MTA) Plus, bone cement, and calcium sulfate with self-etch adhesive (SEA) for the repair of furcal perforation, using dye extraction method. MATERIALS AND METHODS: Forty-eight extracted human permanent first and second molars were included and randomly divided into four groups: Group 1, n = 12, negative control, perforation not repaired with any material, Group 2, n = 12, perforation repair material used, MTA Plus, Group 3, n = 12, perforation repair material used, calcium sulfate with SEA, Group 4, n = 12, perforation repair material used, bone cement. The teeth were then coated with two coats of clear nail varnish immersed in methylene blue dye for 24 h, kept in 65% concentrated nitric acid for 3 days. Dye leakage was measured with the dye extraction method using a spectrophotometer at 550 nm. RESULTS: The negative control showed the highest mean values of dye absorbance (1.45). Bone cement (0.94) came second. Calcium sulfate with SEA (0.58) and MTA Plus (0.32) had no significant difference in their dye absorbance values. CONCLUSION: Within the limitations of the study, MTA Plus showed the least microleakage followed by calcium sulfate with SEA which has shown promising results and can be used as an alternative followed by bone cement which showed the highest microleakage.

An in vitro comparative evaluation of commonly consumed catechu and catechu with lime on surface roughness and color stability of the conventional nano-hybrid composite.

AIM: Comparative evaluation of commonly consumed catechu and catechu with lime on surface roughness and color stability of the conventional nano-hybrid composite. METHODOLOGY: A total of 50 uniform cylindrical disks of 10-mm diameter and 2-mm thickness prepared from the nano-hybrid composite were used in the study. Each sample was randomly divided into three subgroups of 20 samples each in two experimental groups (catechu, catechu, and lime) and 10 samples in the control group (artificial saliva). The samples were immersed in each agent for 15 days. Surface roughness and color changes measurements were noted at the baseline and 15th day by two-dimensional profilometer and spectrophotometer, respectively. RESULTS: It was found that nano-hybrid composite resin showed more surface roughness and color change when immersed in catechu and catechu with lime as compared to the control group. Intergroup comparison showed statistical significant increase in surface roughness and color change in the catechu group followed by the catechu with the lime group and artificial saliva. CONCLUSION: Within the limits of the present study, it can be concluded that all experimental specimens showed discoloration. At the end of 15th day, among the groups, catechu showed more surface roughness and color change followed by the catechu and lime and the control group.

Herbal medicaments in endodontics - Current guidelines for in vivo studies in India.

Elimination of bacteria from infected root canal systems is a challenging task. Various techniques have been described to reduce the number of bacteria within the root canal system, which include chemomechanical instrumentation, use of various irrigants to remove or dissolve organic and inorganic debris, and to destroy bacteria. The intracanal medicament plays a key role in the success of root canal treatment. With the rise in bacterial resistance to antibiotics, there is considerable interest in the development of other classes of antimicrobials for the control of infection. Natural products are known to play an important role in human life. The use of herbal products as mouthwash has been tried and tested in the literature. However, the use of herbal intracanal medicament has been shown promising results when used under in vitro conditions, but in vivo studies are very scarce. This may be due to the limited supporting literature available to use it as intracanal medicament in patients due to the ethical concern. Hence, the purpose of this review is to highlight the current guidelines (laid by the drugs and cosmetics act as per the Gazette of India) regarding the use of herbal medicaments for the clinical trials in endodontics.

Efficacy of Removal of Calcium Hydroxide Medicament from Root Canals by Endoactivator and Endovac Irrigation Techniques: A Systematic Review of In vitro Studies.

INTRODUCTION: The aim of this systematic review was to systematically evaluate and summarize the outcomes of in vitro studies comparing Endoactivator irrigation and Endovac irrigation techniques for removing calcium hydroxide (Ca[OH]2) medicament from the root canals. MATERIALS AND METHODS: The research question was developed according to the population, intervention, comparison, and outcome strategy. A computerized literature search was conducted in Medline, PubMed, Google Scholar, and Embase. A hand search of the reference lists of identified articles was performed to separate relevant articles. Two reviewers critically assessed the studies that fulfilled the inclusion criteria and processed. Evaluation of the risk of bias of the studies was performed independently by the two reviewers. RESULTS: After study selection, 61 were assessed for eligibility. Of these, 13 met the inclusion criteria and were included in the systematic review. Since significant heterogeneity was found in the methodologies, it was not possible to conduct a meta-analysis. CONCLUSIONS: On the basis of available evidence, we determined that Endoactivator irrigation technique showed better performance in removing Ca(OH)2 intracanal medicaments from middle third and coronal third area of the root canals and Endovac irrigation technique showed better performance from the apical third area of the root canals. Due to the limitations, small sample sizes, and low number of included studies, further research is needed to confirm our results.