In vitro comparative evaluation of apical leakage using a bioceramic sealer with three different obturating techniques: A glucose leakage model.

Context: Bioceramic sealers have improved sealing ability by forming an interfacial apatite layer that chemically bonds the sealer and radicular dentin thus decrease apical leakage. Aim: This study aims to evaluate and compare the apical leakage of Cerafill RCS bioceramic sealer and gutta percha when used with three different obturating techniques. Materials and Methods: Thirty-four extracted single-rooted premolars were decoronated and prepared up to size F3. Then, the specimens were randomly divided into 3 experimental groups (n = 10) cold lateral obturation technique, warm vertical obturation technique, single-cone obturation technique, positive and negative control groups (n = 2), according to the obturation technique used along with a bioceramic sealer. To evaluate apical leakage, all specimens were mounted in a glucose leakage model and assessed at 7 and 14 days using an ultraviolet-visible spectrophotometer. Statistical Analysis: The results were subjected to ANOVA/Kruskal-Wallis ANOVA; followed by post hoc analysis using Bonferroni correction. Results: Significant differences were found in the cumulative leakage of all the three experimental groups. Significantly higher leakage was found in groups obturated using single-cone obturation technique as compared to warm vertical compaction technique at both 7 and 14 days. Conclusions: Warm vertical compaction showed a better sealing result than single-cone obturation techniques at all observation periods.

Conservative Nonsurgical Approach for Management of a Case of Type II Dens in Dente.

Dens in dente is a developmental dental anomaly which poses a challenge for the endodontist due to its complex pulpal anatomy. In this case report, a class 2 dens in dente was managed nonsurgically. A 32-year-old female reported with a palatal swelling and pain in the upper front region of the jaw. On examination, #7 was observed to be malformed and showed a negative pulpal sensibility test. Radiographic and CBCT analysis revealed Ohler's type 2 dens in dente with a periapical radiolucency. In the first visit, invagination was removed using diamond-coated ultrasonic tips, the canal was minimally instrumented, and premixed calcium hydroxide was injected in the canal which accidentally extruded periapically. After two weeks, a draining sinus was observed on the palatal side which when traced, lead to #7. Intracanal dressing was replaced with a mix of powdered calcium hydroxide and saline. The dressing was replaced every two weeks, and radiographs were taken, which revealed the resorption of extruded calcium hydroxide and reduction in the osseous defect. Biodentine was used to obturate the entire canal space. Subsequent follow-up radiographs till 24 months showed significant periapical healing and resorption of extruded calcium hydroxide.

The Role of Quality Improvement Projects in a Complex Abdominal Wall Service.

Background Complex abdominal wall hernias have proven challenging to manage, and such patients often require abdominal wall reconstruction (AWR). However, in the context of a socialist healthcare service, which is required to provide equal and fair healthcare access to all, the heavy resource burden and non-life-threatening nature of complex abdominal wall hernias mean that this patient group may not be prioritised. In this paper, we outline the significant quality of life (QoL) burden on patients requiring AWR and the importance of quality improvement projects (QIPs) in establishing and streamlining their care as a robust, transferable model across centres. Methodology We undertook the creation of a regional AWR multidisciplinary team meeting and referral proforma, establishing a joint clinic between the Plastics and General Surgery teams and registering a standard operating procedure for the use of progressive pneumoperitoneum in a subset of AWR patients. We collected qualitative data using questionnaires sent out to clinicians and patients as well as used recognised outcome scales (pre- and post-operative European Hernia Society Quality of Life score, otherwise known as EuraHS-QoL score, and post-operative Carolinas Comfort Scale score) to assess responses to QIPs. Results Both clinicians and patients reported positive feelings towards the implemented changes, and scores following progressive pneumoperitoneum showed significant improvement. Conclusions Therefore, we propose that QIPs have a significant role in the establishment and streamlining of services for patients requiring AWR. Through the repeated use of QIPs, a robust, transferable model could be produced, which could then be shared with other regional specialist centres nationwide. As such, effective care could be offered equally to AWR patients for improved outcomes and reduced strain on healthcare resources.

A novel current steering method for targeted spinal cord stimulation.

Spinal Cord Stimulation (SCS) with leads embedded in the epidural space has become a recognized and effective clinical therapy for chronic pain relief. Leads with multiple electrodes placed close to the spinal cord allow targeted stimulation. This paper presents a novel current steering method to achieve targeted spinal cord stimulation by determining the optimal current sourced through a set of electrodes to maximize current density in a specified region of the spinal cord. The method provides a flexibility for personalized pain relief therapy, while minimizing stimulation in unwanted regions. The paper proposes a new optimization problem to achieve current steering. The optimization problem uses a solution of the Poisson equation evaluated using Finite Element Analysis (FEA) over a geometric model of the spinal cord and the embedded leads. The solution to the optimization problem determines the optimal current sourced through a set of electrodes to achieve a targeted stimulation.

Magnolol induces cytotoxic autophagy in glioma by inhibiting PI3K/AKT/mTOR signaling.

Glioma is difficult-to-treat because of its infiltrative nature and the presence of the blood-brain barrier. Temozolomide is the only FDA-approved drug for its management. Therefore, finding a novel chemotherapeutic agent for glioma is of utmost importance. Magnolol, a neolignan, has been known for its apoptotic role in glioma. In this work, we have explored a novel anti-glioma mechanism of Magnolol associated with its role in autophagy modulation. We found increased expression levels of Beclin-1, Atg5-Atg12, and LC3-II and lower p62 expression in Magnolol-treated glioma cells. PI3K/AKT/mTOR pathway proteins were also downregulated in Magnolol-treated glioma cells. Next, we treated the glioma cells with Insulin, a stimulator of PI3K/AKT/mTOR signaling, to confirm that Magnolol induced autophagy by inhibiting this pathway. Insulin reversed the effect on Magnolol-mediated autophagy induction. We also established the same in in vivo glioma model where Magnolol showed an anti-glioma effect by inducing autophagy. To confirm the cytotoxic effect of Magnolol-induced autophagy, we used Chloroquine, a late-stage autophagy inhibitor. Chloroquine efficiently reversed the anti-glioma effects of Magnolol both in vitro and in vivo. Our study revealed the cytotoxic effect of Magnolol-induced autophagy in glioma, which was not previously reported. Additionally, Magnolol showed no toxicity in non-cancerous cell lines as well as rat organs. Thus, we concluded that Magnolol is an excellent candidate for developing new therapeutic strategies for glioma management.

Modeling the Impact of the Variation in Peripheral Nerve Anatomy on Stimulation.

Introduction: The peripheral nervous system has a complex anatomical structure. Stimulation of nerve fibers in the peripheral nervous system depends on the fiber diameter and myelination as well as its location within the nerve, packing fraction and fascicle distribution within the nerve bundle. This paper analyzes the impact of the variation in peripheral nervous system anatomy and the distance of the stimulating electrodes on the probability of generating an action potential. Methods: A mathematical model for effective fascicle conductivity has been developed to capture the variation in the packing fraction and fiber diameter. A linear activating function is utilized to analyze the impact of this effective conductivity and fascicle distribution as an indicator of generating an action potential. Results: Finite element simulations are performed for the nerve-electrode configuration to evaluate the electric field. The simulation results are used to analyze the activating function for different packing fractions and type of nerve fibers. The effect of electrode distance on activating function and the total current through a nerve bundle has also been studied. Discussion: The simulation results indicate that the peripheral nerve anatomy and electrode distance have a significant effect on the action potential generation.

Comparison of the penetration depth of five root canal sealers: A confocal laser scanning microscopic study.

BACKGROUND: Sealer penetration into dentinal tubules eliminates the pathways for bacterial leakage and entombs intratubular bacteria. AIM: The aim of this study was to evaluate and compare the depth of radicular dentinal tubule penetration of five root canal sealers using confocal laser scanning microscopy. METHODS: Fifty freshly extracted single-rooted maxillary anterior teeth were used. After decoronation at the cementoenamel junction, they were prepared to ProTaper size F3. After irrigation with 5 mL smear clear, 5 mL 5% sodium hypochlorite and 5 mL distilled water alternatively, the samples were randomly divided into five groups (n = 10) and obturated by lateral compaction technique using the test sealers labeled by fluorescent rhodamine B dye (Mayor Diagnostics, Mumbai, India). Zinc oxide eugenol (ZOE) (Prime Dental Products), EndoREZ (Ultradent), Sealapex (SybronEndo), AH Plus (Dentsply Maillefer), and MTA-Fillapex (Angelus) formed the test groups. Teeth were then positioned in blocks of orthodontic resin. Three horizontal sections of 1-mm representing coronal middle and apical thirds were made and examined with Zeiss (laser scanning microscope [LSM] 780) confocal LSM. Images were analyzed using ZEN 2.1 software. STATISTICAL ANALYSIS: Data were recorded and subjected to statistical analysis using one-way ANOVA test. RESULTS: Maximum penetration depth was demonstrated by AH Plus in the coronal and apical thirds, MTA-Fillapex in the middle thirds, while minimum penetration depth was seen in ZOE in the coronal and middle thirds and Sealapex in the apical thirds. None of the root canal sealers were able to penetrate the complete depth of radicular dentinal tubules. CONCLUSION: While AH Plus and MTA-Fillapex showed the highest penetration into radicular dentinal tubules, ZOE and Sealapex demonstrated the least penetration.

Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome.

BACKGROUND: Severe acute respiratory distress syndrome associated with coronavirus disease-2019 (COVID-19) (CARDS) pneumonitis presents a clinical challenge as regards to the timing of intubation and ambiguity of outcome. There is a lack of clear consensus on when to switch patients from trials of noninvasive therapies to invasive mechanical ventilation. We investigated the effect of the timing of intubation from the time of admission on the clinical outcome of CARDS. AIM AND OBJECTIVE: The aim and objective was to analyze the effect of timing of intubation early (within 48 hours of admission to critical care unit) versus delayed (after 48 hours of admission to critical care unit) on mortality in severe CARDS patients. MATERIALS AND METHODS: A retrospective observational study performed in a 28-bedded COVID-19 intensive care unit of a tertiary care hospital in Pune, India. All patients admitted between April 1, 2020, and October 15, 2020, with confirmed COVID-19 (RT-PCR positive) requiring mechanical ventilation were included in the study. RESULTS: The primary outcome was in-hospital mortality. Among 2,230 patients that were admitted to the hospital, 525 required critical care (23.5%), invasive mechanical ventilation was needed in 162 patients and 147 (28%) of critical care admission were included in the study cohort after exclusion. Seventy-five patients (51%) were intubated within 48 hours of critical care admission (early group) and 72 (48.9%) were intubated after 48 hours of critical care admission (delayed group). With regards to the total of 147 included patients; male patients were 74.1% with a median age of 59 years (interquartile range, 51-68 years). Diabetes (44.9%) and hypertension (43.5%) were the most common comorbidities. Higher admission acute physiology and chronic health evaluation II scores and lower absolute lymphocyte count were observed in patients intubated within 48 hours. The early intubated group had a mortality of 60% whereas the same was observed as 77.7% in delayed intubation group, and this difference was statistically significant (p = 0.02). CONCLUSION: Current study concludes that early intubation is associated with improved survival rates in severe CARDS patients. HOW TO CITE THIS ARTICLE: Zirpe KG, Tiwari AM, Gurav SK, Deshmukh AM, Suryawanshi PB, Wankhede PP, et al. Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome. Indian J Crit Care Med 2021;25(5):493-498.

Raman spectroscopy assisted biochemical evaluation of L929 fibroblast cells on differentially crosslinked gelatin hydrogels.

Biochemical evaluation of cell-matrix interaction using conventional labelling techniques often possesses limitations due to dye entrapment. In contrast, Raman spectroscopy guided approach offers label-free determination of cell-matrix biochemistry. Herein, gelatin (Gel) matrices modified with 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide/ N-Hydroxysuccinimide (EDC/NHS) and glutaraldehyde (GTA) was used as standards for comparative evaluation. Raman spectroscopy was deployed as a label-free approach to investigate interaction of cells with Gel hydrogels. Raman-based approach assisted in evaluation of cell-matrix interactions by identifying key biomolecular signatures retrospecting the fact that L929 fibroblast cells portrayed excellent growth and proliferation kinetics in crosslinked Gel as compared to its bare counterpart. EDC crosslinked hydrogels exhibited superior cell proliferation than its GTA counterparts. Cell proliferation on differentially crosslinked gel was also confirmed using standard MTT Assay and Rhodamine-DAPI staining thus corroborating the fact that Raman spectroscopy can be deployed as a superior label-free alternative towards real-time determination of cell proliferation and growth.

An in vitro investigation on the reinforcing potential of contemporary composites in weakened bicuspids.

Context: This study was carried out to assess the currently available composite systems in India for resistance to fracture in teeth with large cavities. Aim: To evaluate the fracture toughness of weakened maxillary premolars restored by contemporary composites. Settings and Design: In-vitro study was done in the department of conservative dentistry and endodontics. Materials and Methods: Freshly extracted 44 human maxillary bicuspids were randomly divided into four groups where Group I included intact teeth. The teeth in the other three groups were subjected to a standardized mesio-occluso-distal cavity preparation. The cavities were filled in Group II with bioactive, nanohybrid composite with Giomer chemistry (Beautifil II LS, Shofu Inc., Kyoto, Japan), in Group III with highly filled, nanohybrid composite (Prevest Fusion Universal, Prevest DenPro Limited, Jammu, India) and in Group IV with fiber-reinforced composite with optimized fiber-aspect ratio technology (everX Posterior, GC EUROPE N. V., Leuven, Belgium). All the specimens were then subjected to thermocycling followed by incubation procedures. Fracture resistance was measured in Newton (N) using the universal testing machine. Statistical Analysis Used: Data obtained were tabulated and subjected to one-way analysis of variance (ANOVA) test followed by Tukey's test. Results: Highest mean fracture resistance was observed with Group I (2294.06), followed by Group II (1708.72), Group IV (1195.82), and Group III (825.38). One-way ANOVA test showed a statistically significant difference (P ≤ 0.05) between all the four groups. Post hoc Tukey test was used for intergroup comparison and showed significant difference (P ≤ 0.05) in mean fracture resistance between groups. Conclusion: The results suggest that the highest compressive fracture resistance was shown by Group II (Beautifil II LS composite resin).

Adults with Severe Psychiatric Symptoms in a Community Partial Hospitalization Program: Characteristics and Predictors of Clinical Response.

Mental health wellbeing is a critical element in the overall wellbeing of an individual. Severe mental health issues are directly connected with the individual's functioning and negatively impacts the quality of life. Inpatient psychiatric hospitalization does help significantly in stabilizing the acute serious mental health problems; however, the utility of community partial hospitalization program (PHP) has not been studied extensively. We undertook this study to assess the usefulness of community partial hospitalization program (PHP) in reducing severity of psychosomatic symptoms of patients; to study the epidemiology of the referred patients; and to elucidate the characteristics and predictors of psychosomatic symptom response. 164 patients were assessed by a baseline Behavioral and Symptom Identification Scale-32 (BASIS-32) at a tertiary healthcare center, out of which 82 patients subsequently followed up and were assessed using the same scale and the data was then stratified and compiled. Out of the initial 164 patients, at a 50% adherence rate, 13 patients showed an improvement greater than 30% with a significant co-relation to the race of the patients. Partial Hospitalization Program proved to be moderately effective in improving psychosomatic symptoms, with better results noticed in the White/Caucasian race. We need to consider several variables before generalizing this finding and more studies are needed in this area. However, we are able to highlight this valuable tool in addressing the severe mental health issues in a community-based populations.

Comparative evaluation of retreatment techniques by using different file systems from oval-shaped canals.

INTRODUCTION: Endodontic failure resolves after complete removal of obturating material followed by disinfection, cleaning, shaping and three-dimensional obturation. MATERIALS AND METHODS: Seventy single-rooted mandibular premolars, with single oval-shaped root canal were included. They were decoronated at a length of 16 mm from the apex. Shaping and cleaning were performed, and obturation was done using the warm lateral compaction technique. The teeth were divided into seven groups according to retreatment procedures (Hand files; ProTaper Universal retreatment files; MTwo® Retreatment system; R-Endo® Retreatment system; ProTaper Universal retreatment files with solvent and ultrasonics; MTwo® R with solvent, and ultrasonics and R-Endo® with solvent and ultrasonics). The data were obtained and subjected to the statistical analysis. RESULTS: All instrumentation techniques left obturating material with least in Group 6 and maximum Group 5. The mean time taken for complete retreatment procedure was minimum in Group 2 and maximum with Group 1. CONCLUSION: MTwo® R with solvent and ultrasonics, R-Endo®, and R-Endo® with solvent and ultrasonics were effective in gutta-percha removal from coronal third, middle third, and apical third, respectively. Significance: Nonsurgical endodontic retreatment using rotary files helps in gaining access to infected teeth. During retreatment procedure, this helps disinfectant to reach in critical areas of the root canal system, thereby decreasing the microbial load, leading to achieve healthy periradicular tissues.

Tailorable hydrogel of gelatin with silk fibroin and its activation/crosslinking for enhanced proliferation of fibroblast cells.

Gelatin based hydrogel (Gel) possess remarkable cytocompatibility profile rendering it appropriate for tissue engineering applications. Herein, the questionable mechanical property of Gel was tuned by tailoring with different loading concentrations of silk fibroin (SF). The as tailored matrix was reconnoitred for its physico-mechanical, chemical and biological properties in order to investigate the effect of SF loading. Ethanol treatment lead to enhance ß-sheet formation of silk and subsequently, carbodiimide coupling was deployed to covalently crosslink the matrix. Substantial increase in cohesive energy with amplifying concentration of SF in the Gel matrix. As evidenced by Raman spectroscopy, right shift of the Amide I peak and stretching of COO- confirms activation of fibroin moiety along with crosslinking of gelatin, respectively. Moreover, with addition of SF, surface properties were tuned to attain maximum cell adhesion and proliferation. Further, MTT assay corroborated the same with definite increase in mitochondrial activities of L929 fibroblast cells for SF containing matrix as compared to its bare counterfeit while enhanced proliferation was confirmed by Rhodamine-DAPI staining. The alteration in mechanical and textural tribology of SF tailored Gel matrix certainly portrayed improved stability along with excellent cytocompatibility thus making it a plausible alternative in regenerative medicine.

A comparison of two pulp revascularization techniques using platelet-rich plasma and whole blood clot.

AIM: The aim of this preliminary study was to compare outcomes of two regenerative endodontic protocols in necrotic teeth with open apices. METHODOLOGY: Forty teeth with open apices in patients with an age range of 15-54 were randomly distributed in two groups: group 1, with whole blood clot in the canal (n=20) and group 2, whole blood with Platelet rich plasma (PRP) in the canal (n=20). Clinical and radiological follow up assessments were undertaken over a period ranging from 6 months to one year. Radiographic Root Area (RRA) was measured using the freeware ImageJ. Statistical analysis was performed using the independent samples t test and the Chi-squared test, the significance level was set at p=0.05. RESULTS: There was no difference in the percentage change in RRA between the PRP group and whole blood-clot + PRP group. CONCLUSION: Whole blood clot and PRP are comparable on the grounds of percentage change in RRA and there is no statistically significant difference between the two in a follow-up period of up to one year.

Root canal morphology of South Asian Indian mandibular first, second, and third molar: A dye penetration and clearing study.

CONTEXT: Studying in detail the root canal morphology specific to the Indian mandibular molars will help discern whether the root canal anatomy patterns resemble those reported internationally or are different from it. AIM: The aim is to study the root canal anatomy of Indian permanent mandibular first, second, and third molar teeth using a tooth clearing technique. METHODS: The root canals of a total of 300 extracted Indian mandibular molars consisting of 100 first, second, and third molars each were accessed and injected with India ink, after which they were subjected to the clearing technique. STATISTICAL ANALYSIS: Data was analyzed using descriptive statistics for the computation of percentages using SPSS version 21. RESULTS: Of the hundred first molars, 90% of teeth were two rooted with three canals, 79% had two apical foramina. 70% mesial roots of the three-rooted type showed Type I, whereas 100% distal roots and distolingual roots showed Type I Vertucci's anatomy. About 70% mesial roots of two roots showed Type II and 90% distal canals showed Type I configuration. Among the second molars, five (5%) were single-rooted, ninety-one (91%) teeth were two rooted and four (4%) had three roots. Among the mandibular third molars, fifteen (15%) teeth had one root, sixty-three (63%) teeth had two roots, eighteen (18%) teeth had three roots, and four (4%) teeth had four roots. CONCLUSIONS: The root canal anatomic features of mandibular molars showed differences in the frequency of particular anatomic types as compared to mandibular molars from other racial backgrounds. Further comparative studies on inter-racial anatomic characteristics from various geographic locations would be beneficial.

Laparoscopic repair of a combined transmesocolic, transomental hernia.

Transmesocolic and transomental hernias (TOHs) are rare types of internal hernia. Both these hernias occurring concurrently in a patient are even rarer. We report a patient with signs of recurrent small-bowel obstruction who was found to have a dual transmesocolic, TOH. Computed tomography imaging and subsequent laparoscopic exploration identified small-bowel loops passing through a defect in the transverse mesocolon behind the stomach to emerge through the gastrohepatic omentum. This was treated successfully by laparoscopy. To the best of our knowledge, this is the first reported case of a combined transmesocolic, TOH undergoing successful laparoscopic repair.

Polysomnography for the management of oxygen supplementation therapy in infants with chronic lung disease of prematurity.

Aim: Some infants with bronchopulmonary dysplasia (BPD) may require oxygen supplementation at home but a role for overnight polysomnography (PSG) in the management of home oxygen therapy has been rarely described. Methods: Forty-one infants with BPD born at less than 30 weeks gestational age were discharged with continuous home oxygen supplementation therapy between 2010 and 2013. PSG data were recorded on oxygen supplementation versus room air at median corrected age of 2 months (range 1-5 months) (first PSG after discharge to home). Those infants who continued oxygen supplementation therapy at home had at least one more PSG before oxygen therapy was discontinued (last PSG). We also collected PSG data in 10 healthy term infants (median age 3.5 months; range 2-4 months). Results: In infants with BPD in room air, increased numbers of central apneas, hypopneas, and SaO2 desaturations were the predominant PSG features with a median apnea-hypopnea index (AHI) of 16.8 events per hour (range 0-155). On oxygen supplementation therapy, median AHI dramatically improved (2.2, range 0-22; p < .001) and was not different from control infants (2.0, range 0-3.9; p = .31). AHI on room air at the last PSG when home oxygen was ceased was 4.1 per hour (range 0-13.8) slightly higher than in healthy infants. Conclusion: Central sleep disordered breathing in infants with BPD dramatically normalizes with low flow nasal cannula home oxygen therapy and improves with age. Mild central sleep disordered breathing remains detectable, although much improved, when compared with healthy infants at the time when the decision to cease home oxygen therapy was made by the physician.

Effect of ultrasonic activation on calcium ion quantification, smear layer removal, and canal cleaning efficacy of demineralizing irrigants.

BACKGROUND: Effective removal of smear layer ensures better penetration of irrigants ensuring root canal disinfection and has the potential of sealing dentinal tubules during obturation. AIM: The aim of this study is to evaluate the canal cleaning efficacy and calcium ion liberation with the use of demineralizing irrigants, namely, 17% ethylenediaminetetraacetic acid (EDTA), 7% maleic acid, and 10% citric acid with or without ultrasonic (US) activation. MATERIALS AND METHODS: Crowns of 62 extracted maxillary central incisors were decoronated and root canals prepared. Based on the final irrigant teeth were divided into following groups (n = 10), namely, 10% citric acid, 7% maleic acid, 17% EDTA, and 10% citric acid with US activation, 7% maleic acid with US activation, and 17% EDTA with US activation. Irrigants were subjected to inductively coupled plasma-atomic emission spectroscopy followed by debris scoring and scanning electron microscope analysis. STATISTICAL ANALYSIS: One-way analysis of variance with the Bonferroni's correction for multiple testing was employed. RESULTS: About 10% citric acid with US activation liberated the highest calcium ions and removed the maximum smear layer. CONCLUSIONS: Citric acid with US activation is a potentially effective irrigation regimen with sodium hypochlorite.

An in vivo comparison of the antibacterial efficacy of photoactivated disinfection, diode laser, and 5% sodium hypochlorite in root canal disinfection.

BACKGROUND: Pulpal infections are caused by varied number of organisms and are located in various sites of root canal system. Thus, the success of root canal treatment depends on complete eradication of microbiota. MATERIALS AND METHODS: Thirty-two patients were selected and divided into four groups (photoactivated disinfection [PAD], diode laser, 5% sodium hypochlorite [NaOCl], and normal saline). The treatment was done according to groups, following manufacturer's instructions. The efficacies of groups were evaluated using microbial culturing technique. Three samples were taken for each group and were incubated separately for aerobic and anaerobic culture. Microbial counting was done for each sample in the form of colony-forming units. RESULTS: It was evaluated using two-way analysis of variance and Friedman test. All the groups showed reduction in number of bacteria. However, for group A P < 0.0001 when analyzed for aerobic and anaerobic microorganisms, whereas, with Group B and C, P < 0.0001 for aerobic microorganisms. CONCLUSION: PAD, diode laser, and 5% NaOCl showed antibacterial action against aerobic and anaerobic bacteria.