Effect of guided conservative endodontic access and different file kinematics on debris extrusion in mesial root of the mandibular molars: An in vitro study.

Background: Guided conservative endodontic access is a novel technique and the influence of such access cavities on apical debris extrusion (ADE) can have a significant effect on postoperative pain. Objective: This study compared ADE and preparation time (PT) in the mesial canals of the mandibular first permanent molars in different access cavity designs and the amount of sodium hypochlorite in the extruded debris using attenuated total reflection-Fourier transform infrared spectrometer (ATR-FTIR). Materials and Methods: Human mandibular first permanent molars (N = 72) were selected and randomly divided into six groups (n = 12) based on type of cavity design and files used: Group 1, Conservative Access Cavity [ConsAC])-WaveOne Gold; Group 2, ConsAC-Mtwo; Group 3, ConsAC-XP-endo shaper; Group 4, Traditional Access Cavity [TradAC])-WaveOne; Group 5, TradAC-Mtwo; and Group 6, TradAC-XP-endo shaper. All the ConsAC were prepared with a customized template fabricated using cone beam computed tomography. ADE evaluation was done using the Myers and Montgomery set up. All the instruments were used according to the manufacturers' instructions, followed by a final irrigation using Endoactivator. The time taken for preparation was calculated using a digital watch. Five samples in each group was taken and subjected to ATR-FTIR analysis. Results: There was no significant difference between the groups with respect to ADE (P > 0.05). Whereas, a statistically significant difference was seen in PT between the TradAC and ConsAC (P < 0.05). Using ATR-FTIR, it was found that all the samples of extruded debris had the presence of sodium hypochlorite. Conclusions: All instrumentation systems produced ADE irrespective of access cavity design. The time taken for preparation of canals in ConsAC was significantly longer compared to TradAC. Clinical Relevance: ADE can translate clinically as postoperative pain. Assessing the ADE in ConsAC could shed light on the type of file systems that can be used in such cavities in order to minimize postoperative pain clinically.

Do Calcium Chelators Play a Role in the Removal of Calcium Hydroxide From Root Canals? A Systematic Review of Laboratory Studies.

OBJECTIVE: To identify whether root canal irrigants with calcium chelation ability play a role in the removal of calcium hydroxide (CH) from the root canals when compared to non-chelators. METHODS: The protocol is registered in the Open Science Framework registry (doi 10.17605/OSF.IO/CHG2Q). PubMed, Scopus, Embase, Cochrane Library, ProQuest, Google Scholar, Science direct and open grey databases were searched until March 2021. Laboratory studies comparing the effectiveness of calcium chelators in the removal of CH with non-chelators delivered using needle irrigation, irrigation agitation or instrumentation techniques were included. The quality of included studies was appraised using a modified Joanna Briggs Institute critical appraisal checklist for a randomised clinical trial. Two independent reviewers were involved in study selection, data extraction, appraising the quality of studies. Any disagreements were resolved by a third reviewer. RESULTS: The current review included 17 studies, with 16 being of "moderate" quality and one of "low" quality. Due to methodological differences within the included studies, quantitative analysis was not performed. Laboratory studies were only included in the current review because no clinical study exists on this topic. Evidence from the review indicates that calcium chelators are superior to non-chelators in the removal of CH when used with needle irrigation, passive ultrasonic irrigation and instrumentation techniques. CONCLUSION: Calcium chelators are superior in the removal of CH from the root canal system over non-chelators.

Full counterclockwise rotary motion kinematics enhances the removal of gutta-percha and bioceramic sealer from root canals: A computed tomographic study.

Background and Aim: Complete removal of gutta-percha and sealer is an important step during retreatment. The aim of this study was to assess the efficacy and time taken by full counterclockwise rotary motion of a reciprocating file in the removal of gutta-percha and BioRoot™ RCS bioceramic sealer. Materials and Methods: Thirty-six extracted human mandibular premolars were instrumented with Mtwo rotary files and obturated using lateral condensation technique with gutta-percha and BioRoot™ RCS bioceramic sealer. The teeth were divided into three retreatment groups (n = 12) based on the kinematics used: Group I, Mtwo retreatment (Mtwo-R) files; Group II, Reciproc files used in reciprocation mode (Reciproc-R); and Group III, Reciproc files used in full counterclockwise motion (Reciproc-CCW). The efficacy of gutta-percha and bioceramic sealer removal was assessed by volume of gutta-percha removed using cone-beam computed tomography and area of remaining gutta-percha and bioceramic sealer using ImageJ software after longitudinal sectioning. Statistical analysis was done by one-way analysis of variance test and Tukey's multiple post hoc tests. Results: Reciproc-CCW motion was significantly efficient in the removal of gutta-percha and bioceramic sealer in comparison to Mtwo-R files and Reciproc-R. The time taken for gutta-percha and sealer removal was least for Reciproc-R (325.5 ± 101.68 seconds) and was statistically significant in comparison to the other groups. Conclusion: Within the limitations of the study, Reciproc-CCW was an effective method of removal of gutta-percha and bioceramic sealer during retreatment.

Retrievability of bioceramic-based sealers in comparison with epoxy resin-based sealer assessed using microcomputed tomography: A systematic review of laboratory-based studies.

Aim: The objective was to evaluate the retrievability of bioceramic sealers in comparison with epoxy resin-based sealers assessed using microcomputed tomography. Materials and Methods: Four reviewers independently conducted a systematic literature search in four electronic databases. The risk of bias was assessed using modified Joanna Briggs Institute Critical Appraisal tools for Quasi-Experimental Studies. Results: Ten articles were included in this review and all had a moderate risk of bias. The results across the included articles were inconsistent with some indicating easier/difficult removal of bioceramic sealers, while others indicate no difference. The studies varied in terms of the type of bioceramic sealer used, root canal anatomy, and retreatment techniques followed. Due to heterogeneity, only a qualitative analysis was performed and no meta-analysis was conducted. Conclusion: The quality of evidence is low and no definitive conclusion could be derived regarding the retrievability of bioceramic sealer/AH plus sealer from the root canals during retreatment procedures.

Species distribution and antifungal susceptibility among clinical isolates of Candida parapsilosis complex from India / Distribución de especies y sensibilidad antimicótica de aislamientos clínicos del complejo Candida parapsilosis en India

Background: Candida parapsilosis is recognized as a species complex: Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis are three distinct but closely related species. Aims: To determine the species and antifungal susceptibility of members of the C. parapsilosis complex, isolated from clinical samples. Methods: Isolates identified as C. parapsilosis complex by VITEK(R) 2 system were included. Antifungal susceptibility test was done using the VITEK(R) 2 semi-automated system. The distribution of the species in the complex was determined by multiplex PCR. Results: Among the seventy-seven C. parapsilosis complex isolates, C. parapsilosis sensu stricto (57.1%) was the commonest species, followed by C. orthopsilosis (40.2%) and C. metapsilosis (2.5%). All three species were susceptible to amphotericin B, caspofungin and micafungin. Among C. parapsilosis sensu stricto isolates, 16% were resistant to fluconazole while 2.2% showed dose dependent susceptibility. Also, 18.2% of C. parapsilosis sensu stricto isolates showed dose dependent susceptibility to voriconazole. Conclusions: C. parapsilosis sensu stricto was the most commonly isolated member of the C. parapsilosis complex and it showed high resistance to fluconazole. A high prevalence of C. orthopsilosis (40.2%) was also noted

Antecedentes: Candida parapsilosis se reconoce como un complejo de especies compuesto por Candida parapsilosis sensu stricto, Candida orthopsilosis y Candida metapsilosis, tres especies distintas pero estrechamente relacionadas. Objetivos: Establecer las especies y la sensibilidad antifúngica de aislamientos del complejo C. parapsilosis procedentes de muestras clínicas. Métodos: Se incluyeron los aislamientos identificados como complejo C. parapsilosis por el sistema VITEK(R) 2. El estudio de la sensibilidad antimicótica se realizó mediante el sistema semiautomático VITEK(R) 2. La distribución de las especies del complejo se estableció mediante PCR múltiple. Resultados: Entre los 77 aislamientos del complejo C. parapsilosis, C. parapsilosis sensu stricto (57,1%) fue la especie más común, seguida por C. orthopsilosis (40,2%) y C. metapsilosis (2,5%). Las tres especies fueron sensibles a anfotericina B, caspofungina y micafungina. Entre los aislamientos de C. parapsilosis sensu stricto, el 16% fue resistente al fluconazol, mientras que el 2,2% mostró sensibilidad dependiente de la dosis. Además, el 18,2% de los aislamientos de C. parapsilosis sensu stricto mostró una sensibilidad al voriconazol dependiente de la dosis. Conclusiones: C. parapsilosis sensu stricto fue la especie más aislada del complejo C. parapsilosis y mostró una elevada resistencia al fluconazol. C. orthopsilosis fue también aislada con una alta prevalencia (40,2%)

Species distribution and antifungal susceptibility among clinical isolates of Candida parapsilosis complex from India.

BACKGROUND: Candida parapsilosis is recognized as a species complex: Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis are three distinct but closely related species. AIMS: To determine the species and antifungal susceptibility of members of the C. parapsilosis complex, isolated from clinical samples. METHODS: Isolates identified as C. parapsilosis complex by VITEK® 2 system were included. Antifungal susceptibility test was done using the VITEK® 2 semi-automated system. The distribution of the species in the complex was determined by multiplex PCR. RESULTS: Among the seventy-seven C. parapsilosis complex isolates, C. parapsilosis sensu stricto (57.1%) was the commonest species, followed by C. orthopsilosis (40.2%) and C. metapsilosis (2.5%). All three species were susceptible to amphotericin B, caspofungin and micafungin. Among C. parapsilosis sensu stricto isolates, 16% were resistant to fluconazole while 2.2% showed dose dependent susceptibility. Also, 18.2% of C. parapsilosis sensu stricto isolates showed dose dependent susceptibility to voriconazole. CONCLUSIONS: C. parapsilosis sensu stricto was the most commonly isolated member of the C. parapsilosis complex and it showed high resistance to fluconazole. A high prevalence of C. orthopsilosis (40.2%) was also noted.