Efficacy of Smear Layer Removal of Human Teeth Root Canals Using Herbal and Chemical Irrigants: An In Vitro Study.

Objectives Over many years, many intracanal irrigants have removed smear layers during routine root canal therapy. The efficacies of conventional endodontic chemical irrigants are documented, but limited research is available on herbal irrigants' role in the endodontic therapy irrigation protocol. This study aimed to evaluate endodontic irrigants' smear layer removal efficacy, namely, 3% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), green tea extract, and Triphala extract, using scanning electron microscopy (SEM) analysis. Methods Fifty freshly extracted human permanent maxillary and mandibular single-rooted teeth were collected from the Oral Surgery Department of Regional Dental College (RDC), Guwahati, India. The samples were divided into five groups with 10 teeth each: Group A: sterile distilled water (negative control), Group B: 3% NaOCl, Group C: 17% EDTA, Group D: green tea, and Group E: Triphala (citric acid). Each tooth was then longitudinally split and prepared for SEM inspection under 1000X magnification. The comparison of smear layer removal scores between the groups was done by the Kruskal-Wallis test and Mann-Whitney test, with the significance level set at p<0.01. Results The comparison of the overall mean smear scores and those at different root portions shows that Group C has the lowest mean score, followed by Group E. The pairwise comparison shows that the difference in the mean smear scores between Group C and the other four groups is statistically significant (p-value<0.05). Moreover, the difference in the overall, coronal, middle, and apical mean smear scores between Group A and Group E was highly significant (p-value<0.001). Conclusions The highest smear layer removal efficacy was observed in the samples treated with 17% EDTA. Moreover, the clearing efficacy of Triphala is significantly better than that of distilled water in smear layer removal.

Replantation of an Avulsed Tooth: A Case Report.

Avulsion is a rare and serious traumatic dental injury that needs immediate and complex management. This case report highlights the successful management of an avulsed maxillary central incisor by replantation after a lapse of 120 minutes of being in an extra-oral environment and preserved in milk. A female patient aged 17 years presented with a traumatic dental injury sustained to the anterior maxillary region due to an accidental fall. Clinical examination revealed an avulsed tooth 21 that was replanted according to the International Association of Dental Traumatology (IADT) guidelines and stabilised in place with splinting. Conventional root canal therapy was initiated one week post-replantation. The root canal treatment was completed two weeks post-replantation followed by removal of the splint. Follow up done at regular intervals of one, three, six, and 12 months showed a lack of clinical signs and symptoms and no resorption on radiographic interpretation.

Comparative evaluation of calcium ion release, pH change, and dentinal tubule penetration of four different formulations of calcium hydroxide-based intracanal medicaments - An in vitro study.

Aim: The aim of the study was to evaluate and compare the release of calcium ion, pH change, and dentinal penetration depth of four different formulations of calcium hydroxide-based intracanal medicaments. Materials and Methods: Eighty mandibular single-rooted premolar teeth were divided into four groups (n = 20): Group 1 - calcium hydroxide (CH) + distilled water (DW), Group 2 - nanocalcium hydroxide + DW, Group 3 - calcium hydroxide + chitosan, and Group 4 - calcium hydroxide + 2% chlorhexidine gluconate. Biomechanical preparation was done till the F2 rotary ProTaper system and intracanal medicaments were placed. Calcium ions and pH were assessed at 24 h, 7 days, 15 days, and 30 days using an ultraviolet spectrophotometer and pH meter, respectively. The evaluation of tubule penetration was scanned under a field emission scanning electron microscope. Results: A significant difference was seen in calcium ion release and pH change among the four groups at 24 h, 7 days, 15 days, and 30 days as well as depth of dentinal penetration. Conclusion: Calcium hydroxide mixed with 2% chlorhexidine gel showed alkaline pH and the highest calcium ion release as well as significant dentinal tubule penetration among all the four groups under observation. Both combinations can enhance antimicrobial effectiveness as intracanal medicaments. Further clinical study should be carried out to optimize its use as an alternative treatment modality.