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 Table of Contents  
Year : 2021  |  Volume : 33  |  Issue : 5  |  Page : 5-87

Delegate Abstracts

Date of Web Publication08-Jan-2022

Correspondence Address:
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-7212.335250

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How to cite this article:
. Delegate Abstracts. Endodontology 2021;33, Suppl S1:5-87

How to cite this URL:
. Delegate Abstracts. Endodontology [serial online] 2021 [cited 2023 Jan 28];33, Suppl S1:5-87. Available from: https://www.endodontologyonweb.org/text.asp?2021/33/5/2/335250

  Abstract 1: Healing pattern of horizontal root fracture – A systematic review Top

Nandini Suresh, Anisha Mishra, Velmurugan Natanasabapathy, VenkateshBabu Nagendrababu1, Aswathi Varghese

Meenakshi Academy of Higher Education and Research, Chennai Tamil Nadu, 1University of Sharjah, Sharjah, Sharjah

Aim: To analyse the healing outcomes(O) of teeth with horizontal root fracture (P) treated with splinting, non-surgical root canal treatment and surgical root canal treatment (I) in comparison to self-healing (C).

Methods: Systematic literature review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, on clinical case report / series and prospective / retrospective clinical studies that evaluated the healing of horizontal root fracture treated with various techniques in comparison to self-healing. This review was registered with PROSPERO database A literature search in Pubmed, Proquest, Open grey, Web of science, Cochrane database of systematic review and Cochrane central register of controlled trials databases.

Results: The search retrieved 9360 articles from all the electronic databases. After elimination of duplicates and reading full texts, 56 case reports with more than 4 year follow up and Twenty retrospective and prospective studies were included based on inclusion and exclusion criteria. A total of 2409 teeth were assessed. Quality assessment was done using Newcastle-Ottawa Scale for observational studies and JBI tools for case report and case series. The clinical prospective and retrospective studies showed that the healing pattern was predominantly Type II for factors like tooth type (41%), root development (40%), fracture location (50%). Based on the treatment modality, splinting type (40%) and splinting duration also showed Type II healing (44%). Over-all, type II healing pattern (33%) was observed followed by type I (28%), IV (19%) and III (16%) after a HRF. However, the healing pattern observed in case reports showed 68% Type 1 healing pattern.

Conclusion: Based on the analysis of clinical cases, hard tissue healing is observed in 68% of HRF. However, with prospective and retrospective studies show 33% connective tissue healing. The assessment of case reports needs to performed cautiously because of possibility of including publication bias of well healed cases and minimal publishing of negative results / failures.

  Abstract 2: Bibliometric analysis of articles published on use operating microscopes for endodontic surgery from 1992 to 2020 Top

Saravanan Poorni, Manali Ramakrishnan Srinivasan

Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: Although there have been important developments in Endodontic Microsurgery in recent years, there is no current and comprehensive bibliometric analysis in the literature. Hence the current bibliometric analysis was done to analyse the number of research articles per year, active authors, organizations and the countries of the first authors involved in the research domain of Endodontic Microsurgery.

Materials and Methods: Dimensions Database was used to search data published in Endodontic Microsurgery. Only article published between 1992 to 2020 were included for the study. The data from all the articles included in the study was extracted using Dimensions. VOS viewer was used to develop analysis tables and visualisation maps.

Results: A total of 2560 publications were identified related to Endodontic microsurgery. Bibliometric analysis was performed for 1707 articles. There was a steady increase in the number of articles published every year from 1992 till 2020 and the year 2020 being the most contributing year. The most active countries in this field was United States. The most active authors were Euiseong Kim, Massimo Del Fabbro, Silvio Taschieri. Maximum number of articles in this domain was published in Journal of Endodontics and International Endodontic Journal. The authorship pattern showed an interdisciplinary and collaborative researches.

Conclusion: The current analysis shows an increasing trend of published articles. However, it highlights the need for publishing quality data to promote availability of quality evidence for clinical practice.

  Abstract 3: Comparative evaluation of the effect of mixing and placement techniques on physical, mechanical, and chemical properties of mm-MTA and manually mixed MTA Top

Kalaiselvam Rajeswari, Rudra Konindala, G. Arathi, Kandaswamy Deivanayagam, Ramesh Seshan Rakkesh

Sri Ramachandra Dental College, Chennai, Tamil Nadu, India

Aim: To evaluate the effect of mixing and placement techniques on sealing ability, push out strength and calcium release, alkalinity and solubility in open apex situations.

Materials and Methods: One twenty human maxillary anterior teeth with mature roots extracted for periodontal reasons were selected to analyse the sealing ability and push-out strength at the root dentin-material interface. The teeth were decoronated with a diamond disc standardizing the root length to 15mm. To simulate immature open apices, the apical 3mm of the roots were removed and canals were widened with Gates Glidden drills size 4 to obtain 0.5-1.5mm dentinal walls. After shaping and cleaning the canals, the teeth were assigned to four experimental groups. Mechanically mixed MM- MTA and manually mixed MTA were placed using the manually or ultrasonically agitation technique. Sealing ability was analysed by measuring the depth of Rhodamine B dye penetration and Push-out strength was measured using the universal testing machine at the root dentin-material interface. Sixty plastic moulds of 5mm length and 5mm diameter were prepared. MM-MTA and MTA were manually or ultrasonically placed as per the assigned groups. After filling, the moulds were weighed to check the standardization of the amount of material in each mould. The moulds were split open and each specimen was immediately immersed in tubes containing 10 ml of deionised water at 37°C throughout the study period. The pH was measured using a pH meter, atomic absorption spectrophotometry was used to quantify the calcium release and the solubility was volumetrically analysed by weighing the percentage of weight loss at 3, 24, and 168 hours. X-ray diffraction analysis was performed to confirm the presence of added accelerators such as calcium carbonate in MM-MTA. The results were statistically analysed using the One-way ANOVA and Tukey's HSD test.

Results: MM-MTA placed using ultrasonic agitation technique (Group A) performed significantly better when compared to other groups in terms of sealing ability, push out strength, amount of calcium release, pH and solubility of the material.

Conclusion: The inherent composition of the MM-MTA, encapsulation and ultrasonic placement leads to superior physical properties, mechanical properties and chemical properties.

  Abstract 4: Comparative evaluation of depth of penetration of chlorhexidine using Er, Cr: YSGG laser using confocal laser scanning microscope: An in-vitro study Top

Prem Kumar, Lakshmi Balaji1, Rupa Ashok1, Kandaswamy Deivanayagam1

Panimalar Medical College and Hospital and Research Institute, 1Sri Ramachandra Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Aim: This study aimed to compare the depth of penetration of irrigant using Passive Ultrasonic Irrigation, Diode Laser and Er, Cr: YSGG Laser into dentinal tubules at the coronal, middle and apical third of the root canal by using Confocal Laser Scanning Microscope.

Materials and Methods: Sixty extracted non-carious teeth were selected and were decoronated at the cemento- enamel junction. Shaping and Cleaning were performed using Nickel-titanium instrumentation with intermittent irrigation. The final irrigant used was 2% Chlorhexidine labelled with Rhodamine B dye. The specimens were randomly assigned into four groups (n= 15), Group I - Manual Irrigation, Group II - Passive Ultrasonic Irrigation, Group III - Diode Laser, and Group IV Er, Cr: YSGG Laser. Specimens were then sectioned at 3mm, 6mm and 12 mm from the apex in 1mm thick sections and they were viewed under Confocal Laser Scanning Microscope. Statistical analysis was done using one-way ANOVA with Tukey's Post- Hoc test to compare 2% chlorhexidine penetration into the dentinal tubules in the coronal, middle and apical third of the root canal.

Results: The group with Er, Cr: YSGG Laser showed the statistically significant depth of penetration of 2% Chlorhexidine at the coronal, middle and apical third of the root canal compared to the other groups- Diode laser and Passive ultrasonic Irrigation.

Conclusion: Er, Cr: YSGG Laser activation showed better depth penetration of Chlorhexidine in the dentinal tubules of root canals, which would help to minimize the persistent microbial count inside the dentinal tubules, thereby facilitating successful root canal treatment.

  Abstract 5: Bio-printing –The future facet of dentistry Top

Mensudar Radhakrishnan, Vinoo Subramaniam Ramachandran1

Sree Balaji Dental College and Hospitals, 1Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Advancements in 3D printing have revolutionized dentistry. With the advent of scientific technology and tissue engineering, 3D bioprinting have opened up newer possibilities to print living tissues. Bioprinting is an additive manufacturing process similar to 3D printing – it uses a digital file as a blueprint to print an object layer by layer with cells and biomaterials, which create organ-like structures that promotes regeneration. Bioprinting works by taking bioink – ink which is made of essential cells of the organ that wanting to be reproduced, taken from the patient themselves and are later placed inside a 3D printer. This review paper emphasizes the application of bioprinting, highlighting the recent advancement and its future impact to produce a customized patient-tailored quality of treatment.

  Abstract 6: Comparative evaluation of the cytotoxicity of ozonized and non-ozonized sodium hypochlorite using 3-(4,5-dimethylthiazol- 2-yl)-2,5-diphenyl tetrazolium bromide assay: An in-vitro study Top

Arasappan Rajakumaran, Karthick Soundararajan, Arathi Ganesh, Arivunithi Kanagasabai

Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India

Objective: It has been well documented in the endodontic literature that Sodium hypochlorite (NaOCl) is an effective antimicrobial agent when used at concentrations ranging from 0.5% to 8%, in endodontic therapy with the antimicrobial efficacy increasing with the increase in concentration. The major disadvantage of this irrigant was its cytotoxicity when injected inadvertently into periradicular tissues particularly with the increased concentrations.) Ozonizing sodium hypochlorite has been shown to increase its antimicrobial efficacy, but the effect on its toxicity remains unknown. Hence aim of this study was to comparatively analyse the cytotoxicity of ozonized and non-ozonized sodium hypochlorite at various concentrations by evaluating the cell viability of NIH 3T3 fibroblast cells.

Materials and Methods: The mouse fibroblast cells [NIH 3T3] were revived from storage and subculture for 72 hours. Approximately 5000 cells will be seeded in 96 - well flat- bottom microtiter plate and incubated for 24 h. The 1%, 2.5% and 5.25 % ozonized and non-ozonized sodium hypochlorite, along with the control groups were added to the respective groups of well plate and incubated for 24 hours. Then the MTT solution was added to each group and incubated in dark for three hours for the formation of purple formazan. Viability of each well will be determined using the microplate reader based on its absorbance value at 540 nm.

Results: Though there was decrease in cell viability indicating an increase in cytotoxicity when comparing mean values of all the three concentrations of both ozonized and non-ozonized sodium hypochlorite there was no statistical difference in both inter and intra group comparison.

Conclusion: Ozonisation does not significantly increase the cytotoxicity of sodium hypochlorite irrespective of the end products.

Clinical Significance: There is a definitive role for the use of ozonized sodium hypochlorite in non-surgical root canal therapy and in regenerative endodontics, in teeth with immature apices by taking advantage of its enhanced antimicrobial property without any increase in cytotoxicity.

  Abstract 7: Effect of various root canal irrigation activation techniques on expression of enterococcus faecalis virulence factor – reverse transcription polymerase chain reaction study Top

Sundaresan Balagopal, James Vandana, Chandrasekaran Charanya, Shekar Shobana, Nagarajan Geethapriya, Sebatni Anisha

Tagore Dental College, Chennai, Tamil Nadu, India

Aim: To evaluate the effect of various root canal irrigation activation techniques on expression of Enterococcus faecalis virulence factor - E.faecalis endocarditis antigen (efaA) using RT-PCR study.

Materials and Methods: Fifty human single rooted premolars were decoronated to standardize the root length to 14 mm. The canals were instrumented up to F3 Protaper Gold instrument. Irrigation was done with 2 mL of 3% NaOCl and 2 ml of 17% EDTA during canal enlargement. Final rinsing was done with 2ml of saline for 30 secs. The teeth were dried with paper points and autoclaved at 121°C for 20 minutes at 15 psi. 10μL suspension of E. faecalis was injected into the root canals, and the samples were incubated at 37°C and 100% humidity for 21 days. The specimens were randomly divided into 5 groups: Group 1 – No Activation; Group 2 – Manual Dynamic Agitation (MDA) with F3 GP point; Group 3 – Passive Ultrasonic Activation (PUA); Group 4 – Sonic activation (SA); Group 5- LASER Activation (LA). The E faecalis biofilm infected canals were rinsed with 2 ml of 3% NaOCl for 30 seconds. The irrigant was activated with the agitating device tip 1mm shorter to the WL in 3 cycles. Final rinsing was done with 2 mL of distilled water. Paper points were used to transfer the contents of the canal. RT-PCR was performed to detect the presence of Enterococcus faecalis virulent factor (efaA). Student's t-test and ANOVA were used for inter-group and intra group analysis.

Results: It was observed that Laser activated Group 5 showed better efficacy in decreasing virulence of E. faecalis followed by Group 3 (PUA), Group 4 (SA) and Group 2 (MDA). The least efficacy was seen in the control Group 1.

Conclusion: Using Laser to activate irrigant in canal decrease the virulence of remnant E faecalis.

  Abstract 8: Endo implants the redeemer of the moribund?: A long-term clinical appraisal Top

Sonali Sharma

Army Dental Corps, Delhi, India

The case series of Endo Implants aims in breaking the impasse on the ongoing debate of endodontics versus implants.

A fundamental principle in dentistry has been the preservation and rehabilitation of natural teeth, especially in trauma. One of the major debatable decision-making issues a contemporary dental surgeon faces daily is whether to extract a tooth followed by placement of a dental implant or to preserve the natural tooth by endodontic therapy. Implant dentistry and endodontics have steadily undergone paradigm shifts both in philosophy, concept and management strategies. This case series explores modalities, which opens up avenues to preserve and rehabilitate teeth. It also provides a much-needed impetus to innovate and add a new dimension to this ongoing age-old controversy. The case series showcases the use of endo implant in seeming doomed clinical scenarios: in expanding our restorative option, in maintaining crown root ratios and in the management of horizontal root fractures. The clinical outcome of this innovative modality is assessed by a long-term clinical appraisal of 5-10 years.

A partisan approach in any field curbs its growth. Exploring, experimenting and debating on viable treatment options will lead to the growth of any discipline. Endo implant is one such modality that aids in rehabilitating teeth with a seeming guarded prognosis.

  Abstract 9: Use of antibiotics among dentists for root canal treatment: A questionnaire based survey Top

Nagarajan Geethapriya, Sundaresan Balagopal, Sarathy Sarath

Tagore Dental College, Chennai, Tamil Nadu, India

Introduction: The overuse of antibiotics and the emergence of antibiotic-resistant bacterial strains is always a global concern. The potential contribution of dental profession to the development of antibiotic resistant bacteria cannot be under estimated. As per the recent AAE guidelines 2017, overuse and misuse of antibiotics leads to development of multidrug resistant bacteria which are not susceptible to any antibiotics.

Aim: This study aims to assess the knowledge, attitude and practice in usage of antibiotics among dentists following root canal treatment.

Materials and Methods: A cross-sectional survey was done among various dental fraternities using a pretested, structured, validated questionnaire. The validity of the questionnaire was confirmed using a content validity index by distributing among 6 experts. The study was approved by Institutional Ethical Committee. The questionnaire was distributed through electronic media to dental practitioners, post graduates and academicians from various specialties in dentistry. Descriptive statistics was used for representing each category of response. The associations between scope of practice, various clinical situations and frequency of antibiotics prescribing were assessed using Chi-square test (p = 0.05).

Results: A total of 400 participants took part in the survey out of which 37.7% suggested that root canal treatment always requires antibiotic regime and 54.6% of them suggested that sometimes it is required. 55.4% of them suggested that antibiotics help in faster healing. Only 37.7% of them accepted that antibiotics prescription in RCT contributes to development of antibiotic resistant strains. 53.8% of them prescribed both analgesics and antibiotics as pre-medication for all RCT cases. 70% of them prescribed antibiotics for 3 days and 26.2% for 5 days. 31.5% of them always prescribed antibiotics for Re-RCT, whereas 40.8% prescribed when toxic symptoms were there. The commonly prescribed antibiotics were, amoxicillin with metronidazole 56.5%, followed by amoxicillin with clavulanic acid 52.9%.

Conclusion: Though the participants are aware of the prevailing concern over antibiotic resistance, there is no common consensus among them regarding the justification for the usage of antibiotics for root canal treatment. The dose, frequency and duration are not standardized, thereby conferring increasing potential for the development of more serious antimicrobial resistant microbes.

  Abstract 10: Micro computed tomographic evaluation of dentin loss upon endodontic separated instrument retrieval using three recently practiced techniques: An experimental study Top

Sangeeta Talwar, Ruchika Roongta Nawal, Amit Malhotra, Rajeev Kapoor

Maulana Azad Institute of Dental Sciences, New Delhi, India

Aim: To assess and compare the loss of dentin from the root canal upon successful removal of endodontic separated instruments.

Methodology: 60 extracted intact mandibular Ist molars were collected and ultrasonically cleaned before storing it in thymol solution. The teeth were access opened and biomechanical preparation till S2 file of Protaper rotary system (Dentsply Maillefer) was performed in all three canals. Rotary protaper F1 was then notched at 4mm and introduced into the mesiobuccal canal and rotated until separated in middle third region. The teeth were then mounted in wax and subsequently positioned on a fixed customized platform made of self cure resin and placed in an adequately sized well. All samples were scanned using the Micro CT system (μCT 50, Scanco Medical, Brüttisellen, Switzerland) in a guided repeatable position for pre-experimentation evaluation. The samples were divided equally into four groups with three test and one control group. Subsequently each tooth was mounted separately and assigned a number to be taken up for retrieval on randomised basis using three techniques viz Ruddle technique with ultasonics alone (Group 1;); Terauchi technique using Terauchi file retrieval kit (Group 2); Technique using Endo Removal system Pro (Group 3). The Micro CT scan was then repeated post retrieval and change in root canal volume was assessed using morpho mapping algorithm/technique devised for measuring areas and volume of shapes with non linear dimensions.

Results: The pre- and post-instrumentation changes in root canal volume within each group were statistically analyzed using paired t-test at p<0.05. The Ultrasonic group showed a mean volume increase of 82.52%; with terauchi and ERS technique showing an increase of 55.35% and 46.18% respectively.Intergroup comparison by Student t test showed that the technique using only Ultrasonics had a statistically significant increase in volume as compared with Terauchi and ERS systems (p<.05).

Conclusion: All techniques of endodontic instrument retrieval lead to statistically significant loss of sound root dentin; results showed ultrasonic alone caused more severe destruction as compared to terauchi and ERS technique.

Funding Source: Department of Science & Technology (DST), Government of India.

  Abstract 11: Regenerative restorative materials and biological procedures: Happily they lived ever after!! Top

Sameer Makkar

Bhojia Dental College, Baddi, Himachal Pradesh, India

Preservation and maintenance of pulpal vitality is one of the prime objectives of clinical Endodontics. This has been made possible with the introduction of savior approaches namely the “Regenerative Procedures” and Regenerative Restorative materials like MTA, Biodentin etc. These procedures are defined as “Biological Based Procedures” designed to replace damaged structures, including dentin and root structures, as well as the Pulp-Dentin complex. This new paradigm advocating the complete replacement of comprised tissue is based on tissue engineering rather than traditional restorations. MTA was introduced to dentistry in 1993 by Torabinajad and Biomimetic materials have been established as a gold standard for procedures like pulp capping and pulpotomy since then. These materials have been used in vital therapies like Indirect Pulp Capping, Direct Pulp Capping, Pulpotomy, Furcation Repair and Revascularization etc in which they will promote the regeneration of Dental Pulp, Periodontal Ligament and Periradicular tissue. The long-term follow ups of these cases have validated the success of Biological based procedures. This presentation aims to share few such cases and their follow up, thus underlining the successful use of regenerative restorative materials in Endodontics.

  Abstract 12: Photo-documentation under magnification: Exploring the new frontiers Top

Amit Patodiya

Meera Dental Hosptial, Jaipur, Rajasthan, India

In persuasion of academics there is a continuous need for documentation especially for paper publications. In today's electronic media driven world there has been an upsurge of desire to showcase our work to the world which again demands good documentation. Photography has been an important component of process of documentation of our cases.

With more companies offering microscopes there has been a rise in number of endodontists who are shifting to micro-endodontics, there by using microscopes for more n more of their cases. Thereby the desire of capturing micro-details also has increased with it.

This paper is an attempt to help endodontists in choosing right configuration for implementing magnification in their practise so as to help them in good documentation with it. Also methods are elaborated on how to get best pictures with existing available options of magnification.

  Abstract 13: Comparative evaluation of biomechanical stress analysis in root canal treated tooth improved with biomimetic restorative approach: A computerized finite element study Top

M Neeta Doss, D Kandaswamy, G Arathi, R Mathan Rajan, Chakravarthy Arumugam

Sri Ramachandra Faculty of Dental Sciences, SRIHER, Chennai, Tamil Nadu, India

Aim: This study aimed to evaluate the biomechanical stress in a root canal treated tooth restored with a novel biomimetic restorative approach using finite element analysis.

Materials and Methods: Three-dimensional model of mandibular first molar was designed, and further variation in the tooth model were designed and allotted to three different groups –

  1. Group 1- Natural tooth (Control)
  2. Group 2 - Traditional Endodontic Access Cavity
  3. Group 3 - Contracted Endodontic Access Cavity
  4. Group 4 - RCT tooth restored with composite resin as access restoration
  5. Group 5 - RCT tooth restored with biomimetic approach for access restoration

The designed model is meshed accordingly with the adaptive meshing and subjected to compressive load in the range of 100-800N. The maximum principle stress values determined from the FEA were submitted to statistical analysis.

Results and Statistical Analysis: More level of stress distribution was seen in enamel at CEJ in all teeth except Group 4. In group 4 maximum stress was concentrated at the occlusal enamel of the tooth model irrespective of the applied load. Statistically significant difference was observed in group 4 when compared to natural tooth (p value 0.015) and group 5 (p value 0.021). However, no significant difference (p value 0.878) in stress value were observed between the groups 1 and 5.

Conclusion: The novel biomimetic approach can serve as a potential method for restoration of endodontically treated teeth irrespective of applied load.

Clinical Significance: When considering restoration of endodontically treated teeth, the clinicians can consider this novel biomimetic approach to achieve optimal stress distribution which will lead to enhanced longevity of the endodontically treated tooth.

  Abstract 14: Ethics in endodontics – An overview Top

Shakunthala Pasupathy, Kavitha Mahendran

Tamilnadu Government Dental College and Hospital, Chennai, Tamil Nadu, India

Ethics is a moral concept that has been considered worthy of major contemplation since the beginning of human life on earth. Ethics derived from the greek word. 'Ethos' meaning custom a character. The provision of dental treatment should be founded not only on clinical need but also on legal rules and additionally principles governing the individual clinicians ethical behaviour. Dental malpractices are a careless, unintended act of dental professional who fails to follow the standards of care resulting in harming the patient.

Approximately 14% to 17% of all dental malpractices comprise of endodontic malpractice, despite of having a growing number of latest techniques and novel inventions to improve the efficiency of endodontic treatments. Recent years, an increasing number of negligence cases have also been reported. Whilst legal issues in Endodontics have received attention, ethical principles are scarcely discussed. With the dramatic increase in litigation there is a need to summarise legal as well as ethical principles related to Endodontics. Consequently the purpose of this paper is to review the major ethical issues in Endodontic treatment procedures.

  Abstract 15: Endodontic-periodontal management of concurrent buccal and palatal radicular grooves associated with accessory root in maxillary central incisor using cone-beam computed tomography as a diagnostic aid: A case-report Top

Paras mull Gehlot

JSS Dental College and Hospital (JSSAHER), Mysore, Karnataka, India

Maxillary incisors are susceptible to developmental anomalies and aberrant anatomical variations in the number of roots and root canals. A radicular groove is a developmental groove that is usually found on the palatal or lateral aspects of the maxillary incisor teeth. The occurrence of the palatal radicular groove in maxillary central incisors has been reported to vary from 0.28-3.4%, and that of the buccal radicular groove is 0.3-1.6%. An accessory root/supplemental root refers to the development of an additional number of root/s in teeth compared with that described in dental anatomy. Concurrent occurrence of buccal radicular groove, palatal radicular groove, and accessory root is uncommon and rarely reported in the literature. Diagnosing these anomalies is important clinically, since these may be associated with food lodgement, plaque, and calculus deposition in the depth of the groove leading to endodontic-periodontal lesions. Incorrect or missed diagnosis is often associated with treatment failure. Although accessory roots located on mesial or distal aspects are easily identifiable on conventional radiographs, the labial or lingual position of the accessory roots may usually need an angled radiograph or cone-beam computed tomography (CBCT) imaging. This presentation reports successful endodontic-periodontal management of a case with the concurrent occurrence of buccal and palatal radicular grooves associated with an accessory root, using CBCT as a diagnostic aid. At an 18-month follow-up, the patient was asymptomatic, and the radiograph revealed satisfactory healing.

  Abstract 16: Evaluation of the apical sealing ability of BioRoot RCS with various gutta percha cones using spectrophotometer: An in-vitro study Top

Vinutha Manjunath, Natasha Habib, BR Chandrashekar

JSS Dental College and Hospital, JSSAHER, Mysore, Karnataka, India

Aim: To evaluate the apical sealing ability of BioRoot RCS with various coated gutta-percha cones using Spectrophotometer.

Materials and Methods: 48 extracted single rooted human premolars were employed and randomly assigned into four groups (n=12) based on obturation material. Group 1: Bio Root RCS/ Bioceramic coated Gutta-Percha points, Group 2: Bio Root RCS/ ActiV GP points, Group 3:Bio Root RCS/EndoREZ points, Group 4: BioRoot RCS/ Gutta-Percha. The teeth were flattened, access opening done and cleaned till size F3 using crown down technique. Irrigation was done using 5.25% NaOCl and 17% EDTA followed by a final rinse of distil water. Obturation was done using single cone cold hydraulic technique. After restoring the orifice with composite resin, teeth were stored in incubator at 37°C for 1 week prior to subjecting it to thermocycling for 500 cycles. The teeth were covered with nail varnish leaving behind 2mm of apical area prior to immersing in 1% Methylene blue dye for 24 hrs. Microleakage was assessed using dye extraction method and optical density quantitatively measured using a Spectrophotometer. Data was statistically analyzed using one-way ANOVA and Tukey's post hoc test (p< 0.05).

Results: BioRoot RCS/ BC coated Gutta-Pecha points showed least leakage value (p < 0.05) and BioRoot RCS/ Gutta-Percha showed highest microleakage. Whereas, BioRoot RCS/ ActiV GP points and BioRoot RCS/ EndoREZ points did not show any significant difference (p > 0.05).

Conclusion: All the combinations of Bioceramic sealer and core material leaked failing to attain a complete fluid tight seal.

  Abstract 17: Management of endodontic mishaps/procedural mishaps – Case series Top

Shashirekha Govind

Institute of Dental Sciences, Siksha “O” Anusandhan University, Bhubaneswar, Odisha, India

Endodontic therapy consists of a cascade of evidence-based technical procedures. The assortment of technical accidents during root canal therapy can complicate and influence the prognosis and prejudicing of the possibility of success. Poor knowledge of procedure or compromise in following the set protocol can lead to a high chance of procedural mishaps which can collectively be called endodontic Mishaps. These incidences can occur during stages of diagnosis, LA administration, Isolation, access preparation, cleaning and shaping, irrigation, obturation, and post -space preparation. Endodontic mishaps may have dentolegal consequences. Knowing and understanding the relation between these factors may help in increasing the chances of preventing possible endodontic treatment complications. Thus, their prevention is the best option both for the patient as well as the dentist. Recognition of a procedural accident is the first step in its management. Thus this presentation highlights the cases encountered with mishaps and its management.

[TAG:2]Abstract 18: Tissue inflammation, healing and regeneration: Exploring translational opportunities in vital pulp therapy: A narrative review [/TAG:2]

R Kurinji Amalavathy

Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India

Recent advancements in techniques that encompass microbial influence, magnification, asepsis and pulp capping materials that harness the bioactivity of dentin have undoubtedly improved the outcome of Vital Pulp Therapy (VPT) in cariously exposed permanent teeth. However, the current VPT procedures are limited by the inability to accurately diagnose the inflammatory status of the pulp, reliance on non-specific actions of the capping materials and the limited understanding of the intricate cascade of molecular and cellular events that control the fate of the Dental Pulp Cells (DPC) and the type of response to insult. To further the progress in this field, it is imperative to focus on biological research that identify critical molecular modulators of pulpal disease, repair and regeneration, combined with clinical translational approaches that might enable targeted tissue repair and regeneration. This paper is a narrative review of potential future pulp therapies that are aimed at targeted tissue repair and regeneration such as epigenetics, cell therapy, cellular markers and inflammatory modulators that present exciting opportunities in the development of next generation dental biomaterials.

  Abstract 19: Microendodontic and surgical management of maxillary central incisors with multiple challenges with a follow-up of two years: A case report Top

Lalit likhyani, Vipul choudhary1

Ruhs College of Dental Sciences (GDC), 1Indian Railways Hospital, Jaipur, Rajasthan, India

In clinical endodontics, the integrated use of magnification and cone-beam computed tomography (CBCT) results in optimum treatment outcomes. The present case report highlights the micro endodontic and surgical management of maxillary central incisors with multiple challenges in a patient undergoing orthodontic treatment. Clinical and radiographic examination revealed the presence of sinus concerning #11, #21, calcified canals in #11, #21, perforation till the middle third of the root of #21, and resorptive changes in the middle third (mesial aspect) of root #21. After CBCT evaluation, a combined approach of nonsurgical root canal treatment and surgical intervention employing biomaterials to correct the defects resulted in successful management. A periodic follow-up of two years revealed satisfactory clinical and radiographic findings along with the completion of orthodontic treatment.

  Abstract 20: Assessment of intratubular penetration of calcium silicate-based sealer in root dentin after three moisture control techniques and its relation to pushout bond strength Top

Pratima Shenoi, Himani Thawale, Shriya Shahu, Rajesh kubde, Vinay Tiwari, Siddhant Hiwale, Gautam Badole

VSPM Dental College and Research Centre, Nagpur, Maharashtra, India

Aim: The purpose of this study was to assess the Intratubular penetration of calcium silicate -based sealer (BioRootRCS) applied to root canals after use of three different moisture control techniques and its relation to the post obturation pushout bond strength.

Materials and Methods: 30 premolars, having single root and canal were selected.All samples were decoronated to standardized length of 15mm using diamond disc.The pulps were extirpated and the root canals instrumented (ProTaper Next). Copious irrigation with 5.25% sodium hypochlorite was done throughout and the final irrigant was distilled water.Samples (n=10) were distributed according to moisture control technique used; Paper Points(Grp1),70% Isopropyl Alcohol (Grp2) and ROEKO Surgitip-Endo(Grp3].All the samples were then coated with BioRoot RCS followed by single-cone GP obturation technique. Specimens were sectioned horizontally at coronal,middle and apical third. Each section was evaluated under Confocal Laser scanning microscopy for intratubular penetration of sealer and Universal testing machine was used to assess the push-out bond strength. The collected data was analyzed using ANOVA and tukey's post hoc test.

Results: Highest depth of intratubular penetration (1080.94μm) and maximum mean Push out bond strength (4.53MPa) was seen with calcium silicate-based sealer after using Isopropyl alcohol (p<0001). The lowest depth of intratubular penetration (319.12 ± 217.65μm) and minimum push out bond strength (2.95±0.61MPa) was seen with ROEKO Surgitip-Endo. The coronal and middle sections showed statistically significant difference as compared to apical third in all three groups.

Conclusion: Three dimensional impervious obturation of the rootcanal system is of prime clinical importance for the long-term success of endodontic treatment. Recently calcium silicate-based materials have attracted considerable attentions because of their good bioactivity and handling properties including use in wet canals. Our experiment showed that moisture control with Isopropyl Alcohol significantly improved the depth of penetration and bond strength of this sealer. On other hand,excessive or inadequate drying may have detrimental effect on intratubular penetration and push out bond strength. This may clinically present as loss of critical monoblock seal, compromising the success of endodontic therapy.

  Abstract 21: A cross sectional survey on awareness of general dental practitioners towards regenerative endodontic procedures Top

Snehal Sonarkar, Pratima Shenoi

VSPM DCRC, Nagpur, Maharashtra, India

Aim: To analyse the knowledge and awareness of regenerative endodontic procedures (REPs) amongst general dental practitioners.

Materials and Methods: Thirty Four questions were prepared which was internally and externally validated by the subject expert. Following validation institutional ethical committee approval was taken. The Questionnaire was broadly divided in various sections: a) general information; b) awareness of Regenerative Endodontic Procedures (REPs); c) REPs Protocol; d) Recall; e) Success & Failures; f) Barriers and Regulatory support. The questions were sent through electronic form to 2000 (N) General dental practitioners irrespective of their experience in clinical practice. The data was tabulated and percentage of responses of individual was calculated.

Results: Overall, 891 (n; 44.55%) participants responded to questionnaire. This obtained data was tabulated according to the sections mentioned. Of the responses obtained 49.38% (n = 440) were clinicians, and only 28.40% (n = 253) have performed the REPs. Most of the participants have used endodontic file for induction of bleeding as compared to others. Triple antibiotic paste was the preferred intracanal medicament to carry out REPs. Many of the participants (96.07%) insists on recall after doing treatment procedure. Around 48.15% (n=429) participants mentioned that the criteria's like asymptomatic tooth, narrowing of apex, increase in root length and open apex with no clinical symptoms are considered as parameters for the success/failure of the REPs. Further, the participants think that REPs is the need of the hour as a treatment option. The participants are supportive and optimistic towards the formation of regulatory body for REPs.

Conclusion: General dentist are the first point of contact of patient for seeking dental treatment. According to our study, Dental practitioners have limited knowledge about advanced Regenerative Endodontic Procedures (REPs). Further our study has also shown that, 80.47% of General dental practitioners think that the REPs is the need of hour. Therefore, more training in the form of CDE, Workshops and Conferences should be targeted by endodontic society towards them.

  Abstract 22: Are gutta percha cones contaminated? An Assessment of microbial contamination using 16S rDNA sequencing Top

Chetana Makade, Pratima Shenoi, Bhoomendra Bhongade1, Mohit Gunwal

VSPM Dental College and Research Center, Nagpur, Maharashtra, India, 1RAK Medical and Health Sciences University, Ras Al Khaimah, UAE

Aim: To evaluate Microbial contamination of Gutta percha(GP) cones from sealed packs and those exposed to dental operatory.

Materials and Methods: Random allocation of GP Cones from manufacturers' sealed boxes, Group IA(n=10) and those exposed to clinical environment, Group IB(n=20) were transferred under aseptic conditions from 1.5ml tubes to 50ml tubes containing nutrient broth, sealed with paraffin tape.They were incubated at 37°C and monitored for upto 21 days to observe presence of any turbidity. Tubes without any cones were used as controls. Samples from tubes with visible turbidity were further streaked on nutrient agar plates and incubated at 37°C for around 3-5 days and studied for morphological analysis and number of colony forming units. The positive samples were further subjected to bacterial DNA isolation using16S rDNA gene fragment sequencing based on molecular techniques and computational analysis using Basic Local Alignment Search Tool (BLAST) to confirm bacterial species identification.

Results: Group IA showed no growth whereas Group IB showed microbial contamination with 2(10%) tubes. Among the two positive cultures, growth in one tube (7B) was found after 24hrs, while the other (10B) took 4 days to show visible turbidity. Morphological analysis: Tube 7B was associated with medium size, round, mucoid yellow pigmented colonies, while the xother positive tube (10B) showed gray-white round, opaque, flat, drying, medium-size colony. CFU analysis(CFU/ml) for 7B and 10B revealed Log10CFU of 1.8±0.07 and 2.5±0.2 respectively. 16SrDNA gene fragment: Both bacterial isolates were analyzed for the percentage of sequence matching for all closely related data and the search conducted for homology using BLAST. Bacterium isolate of 7B showed high similarity with Cellulomonas flavigena and bacterium isolate 10B showed high similarity with Bacillus cereus based on nucleotide homology.

Conclusion: This study reveals 10% microbial contamination of GP cones exposed to dental operatory. BLAST analysis confirmed microbial contaminants like Bacillus cereus and Cellulomonas flavigena from GP cones exposed to dental operatory, which may be a new interesting research area as they can become potential endodontic pathogens.

  Abstract 23: Evaluation of the sealing ability of gutta percha with bioroot RCS, MTA fillapex and sealapex: An scanning electron microscopy study Top

Rajasekaran Meenakshisundaram, veni Ashok Baskaran, Anitha Varghese, anil Kumar Ramachandran

Ragas Dental College, Chennai, Tamil Nadu, India

To evaluate the sealing ability of three endodontic sealers, BioRoot RCS (a tricalcium silicate based sealer), MTA Fillapex (a salicylate resin based sealer) and Sealapex (a calcium hydroxide based sealer) with gutta-percha cones to the dentinal walls, using scanning electron microscopy (SEM).

Materials and Methods: 40 human mandibular premolars were used. The root canals were instrumented through crown-down technique with Protaper Universal rotary files until the working length. The canals were irrigated with 2ml of 5% sodium hypochlorite during instrumentation and finally rinsed with 2ml of 17% EDTA. Then, the teeth were randomly divided into 4 experimental groups (Group1 BioRoot RCS, Group 2 MTA Fillapex, Group 3 Sealapex, Group 4 was control group with ZOE sealer). Obturation was done with gutta percha and the corresponding sealer. Each root was cross sectioned using a diamond disk on a slow speed hand piece to obtain the dentin- root canal filling interface at the cervical, middle and apical thirds of the root under water coolant spray. All the sectioned specimens were washed in 17% EDTA solution and methanol, and then blot dried, which was then gold sputtered and observed under SEM. The values obtained from the analysis were subjected to statistical analysis – One Way ANOVA and post hoc test.

Results: The mean and SD of the gap formation at the gutta-percha sealer interface to the dentinal wall in each group was assessed. The ZOE showed the highest mean value [4.613(±1.0745)μm], [5.707(±1.020)μm], [9.970(±1.158)μm], followed by Sealapex [1.593(±0.172)μm], (2.720(±0.396)μm], [5.249(±0.669)μm], MTA Fillapex [1.612(±0.213)μm], [2.312(±0.270)μm], [4.088(±0.464)μm] & BioRoot RCS[0.747(±0.177)μm], [1.309(±0.208)μm], [2.417(±0.351)μm] at cervical, middle and apical thirds respectively.

Conclusion: Bioceramic sealers showed higher penetration at the apical third and overall minimum gap formation was seen for the Bioceramic sealers, better than MTA Fillapex and Sealapex. All tested sealers showed significantly better adaptation and sealing ability at the cervical and middle thirds than the apical third. All the tested sealers had better adaptation compared to ZOE.

  Abstract 24: Discriminatory performance of pulpal inflammatory biomarkers-interleukin-8 and tumour necrosis factor-α for diagnosis of reversible and irreversible pulpitis: An exploratory study Top

Ruchika R Nawal, Sudha Yadav Aishvarya Kaushik, Sangeeta Talwar, Vijay, BC Koner1, Hal Duncan2

Maulana Azad Institute of Dental Sciences, 1Maulana Azad Medical College, New Delhi, India, 2Endodontics, Dental Science, Trinity College Dublin, Ireland

Introduction: The success of vital pulp therapy procedures in endodontics is dependent on accurate diagnosis, which is difficult with existing diagnostic tools. Inflammatory biomarkers can give a precise idea of the degree of pulpal inflammation. Therefore, the aim of the study is to quantify the level of inflammatory biomarker- Interleukin-8 (IL-8) and TNF-α in patients with reversible pulpitis (RP), irreversible pulpitis (IP) and normal pulp (NP) and investigate the performance of IL-8 & TNF-α to accurately discriminate between reversibly and irreversibly inflamed pulp.

Materials and Methods: Seventy patients with extremely deep carious lesion were recruited for the study after establishing the clinical diagnosis of RP (n=42), IP (n=22) and NP (n=08). 50μL of pulpal blood sample was collected from all the patients using micropipette after pulpal exposure. Level of IL-8 & TNF-α was assessed in pg/μl using Enzyme-linked immunosorbent assay. Mann Whitney U test was applied to establish the a)ssociation between IL-8/TNF-α level and the degree of pulp inflammation. Receiver operating curve (ROC) analysis was done to calculate area under the curve (AUC) for RP Vs IP. The cut-off values were established for IL-8 using Youden's index.

Results: IL-8 and TNF-α levels showed significant difference between RP and IP (p≤ .001). The median value of IL-8 in RP and IP group was 259.80 [187.50 to 310.04] and 1357.8 [1036.7 to 2177.6]. The AUC-ROC curve for RP Vs IP was 0.997 with a sensitivity and specificity of 95.5% and 99.76% respectively. The median value of TNF- α in RP and IP group was 75.42 [62.71 to 95.76] and 157.6[94.07 to 347.3]. The AUC-ROC curve for TNF- α was 0.812 with a sensitivity and specificity of 59.1% and 92.1% respectively. The level of both biomarkers was below the limit of detection in normal pulp.

Conclusion: Between IL-8 and TNF-α, IL-8 showed excellent discriminatory performance for RP Vs IP. However, sensitivity and specificity of IL-8 was higher than TNF-α. Future studies should correlate the level of IL-8 with the treatment outcome of vital pulp therapy.

  Abstract 25: Development and characterization of antibiotics-releasing nanofibrous scaffolds for predictable regenerative endodontics Top

Ambar Raut, Pratima Shenoi1

Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, 1VSPM's Dental College and Research Centre, Nagpur, Maharashtra, India

Objectives: The prerequisite for successful regeneration in regenerative endodontic procedures is complete eradication of residual infection, which is achieved by placement of triple antibiotic paste in root canal prior to regenerative endodontic procedures. However, high concentration of antibiotics in triple antibiotic paste has demonstrated to result in stem cell toxicity and reduction in release of growth factors, thereby limiting the treatment outcome. The objective of the study was to develop antibiotics-based polymeric nanofibrous scaffolds as drug delivery system and to evaluate the characteristics of these scaffolds.

Materials and Methods: Three different antibiotics were added to a polymer solution to obtain antibiotics-based scaffolds using electrospinning. Parameters of the electrospinning process (i.e., the flow rate, distance between the needle and collector, electric voltage, and solution viscosity) for fabrication of scaffolds were standardized. Scanning electron microscopy (SEM) was done to study the morphology of the developed scaffolds and diameter of the developed nanofibers were measured using NIH Image J software. Further characterization of the scaffolds was done using transmission electron microscopy (TEM), contact angle analysis, water uptake and drug distribution. Descriptive statistics – mean and standard deviation, were used to summarize fiber diameter values.

Results: The optimum parameters for developing antibiotics-based nanofibrous scaffolds using electrospinning were: flow rate - 0.5 mL/h, distance – 18 cm, and electrical voltage -12-13 kV. The scanning electron microscopic evaluation showed the fabrication of nanofibers with smooth surface and the size of nanofibers in nanometer range. The mean fiber diameter for antibiotics-based scaffolds was found to be 195.26±42.6 nm. The TEM micrograph also confirmed visually smooth surfaces with no aggregation of drugs. Contact angle and water uptake analysis confirmed the hydrophilic nature of developed nanofibers. The electrospun fibers exhibited string-like green fluorescent signals, indicating a homogenous drug distribution in the developed nanofibers.

Conclusions: Antibiotics-releasing nanofibrous polymeric scaffolds were developed using electrospinning and hold great potential for application in regenerative endodontics. Further studies involving extensive characterization and evaluation of antimicrobial efficacy of the developed scaffolds can be performed.

  Abstract 26: Effect of photo-activated disinfection on the antibacterial efficacy of chitosan nanoparticles and sodium hypochlorite against 6 week enterococcus faecalis biofilms: An in vitro study Top

Vandana Gade

Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India

Aim: To Compare The Antibacterial Efficacy Of Sodium Hypochlorite And Chitosan Nanoparticles With Conventional Irrigation And Photo-Activated Disinfection Against 6 week Enterococcus Faecalis Biofilms.

Methodology: Access opening and biomechanical preparation were performed on 102 freshly extracted mandibular second premolars. The specimens were sterilized; 15 μm of E. faecalis was inoculated into each canal and incubated at 36°C for 6 week. Later, specimens were randomly divided into 6 groups of 17 each and the following procedures was carried out: (i) Conventional irrigation with Normal saline (ii) Conventional Irrigation with 3%NaOCl (iii) Conventional Irrigation with Chitosan nanoparticle (iv) PAD with Normal Saline (v) PAD with 3%NaOCl and toluidine blue photosensitizer (vi) PAD with chitosan nanoparticles. Samples were collected from each canal using sterile paper points which were deposited in brain heart infusion broth, and microbiological evaluation was carried out. STATISTICAL ANALYSIS Analysis of the data was done by using descriptive and inferential statistics both. The software used in the analysis was SPSS 24.0 and Graph Pad Prism 5.0 version and p<0.05 is considered a level of significance. The statistical tests used for the analysis of the result were Students' unpaired t-test, One way ANOVA, Multiple Comparisons: Tukey Test.

Results: Mean percentage of reduction in total colony-forming unit count in Conventional irrigation (group A) with Normal saline (subgroup A1) it was 22.19±3.07, in Conventional irrigation by 3% Sodium hypochlorite (subgroup A2) it was 82.10±1.46 and in Conventional irrigation, by Chitosan nanoparticles solution (subgroup A3)it was 95.44±0.46. The mean percentage of reduction in total colony-forming unit count in Photo Activated disinfection group by Normal Saline (subgroup B1) was 52.47±6.76, in PAD by 3% Sodium hypochlorite (subgroup B2) it was 99.01±0.48 and in PAD by Chitosan nanoparticles solution (subgroup B3) group it was 99.90±0.00

Conclusion: Within the limitation of this study, it was found that

  1. PAD was more effective than Conventional irrigation in reducing E. faecalis.
  2. Maximum disinfection was found in Chitosan Nanoparticle with PAD group.

  Abstract 27: Effect of acidic saliva on surface deterioration of endodontic access cavity restorative bulk fill composite: An in vitro study Top

Gautam Badole, Pratima Shenoi

VSPM Dental College and Research Centre, Nagpur, Maharashtra, India

Aim: To evaluate and compare the surface roughness and microhardness of Bulk-Fill composite for three different salivary pH at various time interval.

Methodology: 45 discs of 10mm diameter and 4mm thickness of Bulk-Fill composite resin were fabricated and polished from both the sides. Discs were divided into three groups according to pH of artificial saliva i.e. 5.5, 6.5 and 7. Each Group further subdivided into three Subgroups according to time intervals of 7, 15 and 30 days. Discs were immersed in artificial saliva for respective pH and time intervals. After every 24 Hours, artificial saliva was changed with new one and samples were kept in an incubator. Before and after immersion into artificial saliva surface roughness and microhardness of samples were recorded. Data were statistically analyzed by applying ANOVA f and tukey post hoc test.

Results: All groups showed that the change in difference of surface roughness of bulk fill composite before and after immersion were significantly decreased with increase in salivary pH. Also change in differences in surface roughness were significantly increased when the duration of exposure was increased. Maximum difference was seen for 30 days exposure at 5.5 pH and was minimum with 7 days exposure at 7 pH. For microhardness, all the groups showed that there was significant decrease of change in difference in microhardness of bulk fill composite before and after immersion with increase in salivary pH. Also change in differences in microhardness were significantly increased with increasing the days of exposure. Maximum difference was seen for 30 days exposure at 5.5 pH and was minimum with 7 days exposure at 7 pH.

Conclusion: In our study acidic salivary pH influences the surface roughness and Microhardness of bulk-fill composite. Since all small cavities, especially on lingual surface of incisors are sealed with bulk filled composite. Acidic saliva commonly reported in diabetic patient, pregnancy, acidic refluxes and on consumption of acidic beverages may directly affect the coronal seal of post endodontic restorations ultimately causing the failure of endodontic therapy. So in such cases post endodontic restoration should be evaluated six monthly for deterioration.

  Abstract 28: Effect of dentin modifiers on adhesive bond strength of luted fiber posts: An in vitro study Top

Rajesh Kubde, Pratima Shenoi, Dr Prajakta Ambulkar, Anushree Talnikar, Mohit Gunwal

VSPM Dental College, Nagpur, Maharashtra, India

Aim: Effect of dentin modifiers on quality of Resin-dentin interface (RDI) and its relation to push-out bond strength: An In-Vitro Study.

Methodology: Freshly extracted 100 permanent mandibular first premolar with single canal were selected for the study. All the samples were decoronated 15±1 mm from the apex to obtain a standardized length. Biomechanical preparation with ProTaper Universal rotary files to size 40, 0.06 taper was done. Sectional obturation was done till 5 mm length from the apex. After standardized post space preparation, samples were divided into four groups(n=25) depending upon different modifiers used namely Saline (control group), 17% EDTA, 7% maleic acid and 0.2% chitosan. After luting post with adhesive resin luting system, all the were mounted in acrylic block and sectioned at 1, 4, and 7 mm from CEJ. Samples were evaluated for number of resin tags and push out bond strength under confocal laser scanning microscope and universal testing machine respectively. The comparison of means was performed using a one-way analysis of variance (ANOVA). The pair-wise comparison of means between groups was carried out using Tukey's post-hoc test.

Results: Highest number of rein tag formation (25.12 mean value) and value for push out bond strength (12.23 mean value) were obtained in maleic acid group. The difference was highly significant when compared with other three groups (p – value <0.0001).

Conclusion: The quality of resin-dentin interface and push-out bond strength directly reflects the quality of adhesive bond. In our study Maleic acid showed better quality of resin-dentin interface and higher bond strength when used as a dentin modifier. Therefore, application of dentin modifiers after irrigation protocol may enhance the adhesive bond in luting of fibre post. This is clinically relevant for enhancing the success of post endodontic restoration.

  Abstract 29: Diagnosis and management of a large Endo-Perio lesion in mandibular second molar with C shaped canal, mimicking vertical root fracture Top

Shalu Mahajan

Private Practitioner, Moradabad, Uttar Pradesh, India

Diagnosis is the art and science of identifying a disease or distinguishing one disease from another by careful considering the history, symptoms and signs. Very commonly in our clinical practice we encounter cases with challenging diagnosis where signs and symptoms mimic two or more clinical conditions that might have entirely different treatment approach. Vertical root fractures of endodontically treated teeth are one of the most challenging clinical problems to diagnose and treat. Since, vertical root fractures almost exclusively involve endodontically treated teeth; it often becomes difficult to differentiate them with endodontically failed teeth and also to those having concomitant endodontic-periodontal involvement. Radiographic presentation of vertical fracture of root and endo-perio lesion is also quite similar. With the advent of magnification and CBCT the diagnosis of such challenging cases has become more predictable. This case report presentation will showcase a endodontically treated tooth that presented with clinical and radiographic signs and symptoms mimicking VRF. This case was accurately diagnosed and managed as a primary endodontic and secondary periodontal lesion with excellent healing during the 4 year follow up period.

  Abstract 30: Clinical and radiographic assessment of factors responsible for primary endodontic treatment failure: A cross sectional study Top

Jyoti Wankhade, Siddhi Hathiwala, Manjusha Warhadpande, Sulabha Radke, Yogesh Rathod

Government Dental College and Hospital, Nagpur, Maharashtra, India

Aim: To Assess Clinically and Radiographically - Factors Responsible for Primary Endodontic Treatment Failure in Permanent Dentition.


  1. To evaluate Patients complaints, Reasons for failure and Treatment Options for failed Primary root canal treatment.
  2. To Compare the factors responsible for failure of primary root canal treatment among different age group.

Materials and Methods: In the present in vivo cross-sectional study, total of 166 failed primary endodontically treated teeth in 112 patients, were included as sample. The study subjects were divided into three groups on the basis of their age. After approval from Institutional ethical committee, Informed consent was taken from the study subjects and the study was conducted from Dec 2018– Feb 2019. Clinical examination was done to evaluate restoration, secondary caries, tooth fracture, overlying mucosa and tenderness on percussion. Radiographic assessment was done by using RVG. Reason for failure of RCT were recorded as PA lesion, underfilled or overfilled obturation, missed canal, recurrent caries, dislodged/ fractured restoration, instrument separation, perforation, ledge, tooth fracture, etc. Descriptive analysis was followed by Chi-square test to determine statistical significance between different parameters.

Results: 98 individuals had RC failure in single tooth, followed by 2 teeth affected in 34. Most common chief complaint was pain (42%) followed by difficulty in mastication (25.9%). Mandibular molar is most commonly involved tooth followed by Maxillary molars. Silver Amalgam (62%) was seen as commonly used post endodontic restoration. Most of the tooth had underfilled obturation (67%) and ledge (52%). Over 79% of teeth needed a non-surgical re-treatment. It was found that underfilled canal, recurrent caries and dislodged restoration were significantly high among 21-30 years, underfilled canal, instrument separation and ledge formation was significant cause of failure among the 41-50 years old group. Also, treatment outcome is predictable in 64% of failed primary endodontic cases.

Conclusion: More than one factor is responsible for Primary endodontic treatment failure. Giving attention to details not only improves the finesse of the endodontic quality but also maximizes the success. Regular follow ups aid in assessing the outcome and helps in future treatment planning and patient care.

  Abstract 31: Awareness of sterilization of gutta percha points before obturation among endodontic faculty and post graduate students of dental colleges of central India: A survey Top

Priyatama Meshram

Government Medical College and Hospital, Gondia, Maharashtra, India

Background: Gutta Percha Points (GPP) are manufactured and packed under sterile conditions. When sterile packet is opened they get contaminated with exogenous microorganisms through contaminated aerosols and physical sources during storage period. It is non ethical to use infected GPP in the clean and disinfected root canal system. Hence a fast chairside chemical disinfection is required. The natural contaminants of the gutta percha points are mainly vegetative bacterial cells rather than resistant bacterial spores.

Aim: The purpose of this survey is to determine awareness of GPP disinfection trends practiced among the PG students and the endodontic faculty in the Dental Colleges present in Central India.

Materials and Methods: 342 Endodontist and PG students participated in this survey. Survey participants were asked about disinfection of GPP, handling and reuse of GPP, effect of sodium hypochlorite on GPP. Data was analysed using Chi-square test and Pearson's correlation coefficient. The level of significance was set at P< 0.05.

Results: The respondent of our survey, consists of 62.5% post graduate students, 30.7% teaching faculty with 1 to 10 years of experience and 6.8% were faculty with 10-20 years of experience. Among all experience groups, our data indicate 92% of respondents know that GPP gets contaminated during storage period but 76% do not disinfect it before obturation. 75.6% participants handle GPP with tweezers. 91 % participants knows that sodium hypochlorite used for disinfection have effect on GPP. 74 % of participants use GPP directly from box. 20% disinfect with sodium hypochlorite (SH), 3 % with chlorhexidine digluconate,1.7 % use herbal disinfectant aleo vera gel. 87% of respondents know that SH can affect adhesion or bond strength with endodontic sealer. Surprisingly 16% of respondent reuse GPP tried in one tooth into another tooth.

Conclusion: The findings of this survey are that the majority of participants are aware that GPP gets contaminated but very few of them disinfect it. Maximum of them handle GPP with sterilized tweezer and aware of the effect of sodium hypochlorite on GPP.

  Abstract 32: Comparative evaluation of 5.25% sodium hypochlorite and 2% chlorhexidine as dentinal pre-treatment agents on shear bond strength of etch-and-rinse and self-etching adhesives: An in-vitro study Top

Anuja Ikhar

Sharad pawar Dental College, DMIMS, Wardha, Maharashtra, India

Dentinal pre-treatment is performed to eradicate micro-organism left in cavity wall. The additional properties of most commonly used disinfectants such as NaOCl and CHX are expected to have effect on bond between tooth and adhesives. Therefore, present study was conducted to assess outcome of these pre-treatment agents (CHX and NaOCl) on bonding efficacy of etch-and-rinse adhesive (5th generation) and self-etch adhesives (8th generation). Method- Thirty Six human permanent molars were sectioned to form 2mm disc and poured using acrylics. The samples were divided randomly to 2 groups according to adhesive systems (n=18) - Group A - 5th Generation Bonding Agent (3M ESPE Adper Single bond 2) and Group B – 8th Generation Bonding Agent (Ivoclar Vivadent Tetri N Bond). Further sub-grouped as Group A1/B1: Without pre-treatment, Group A2/B2- Pre-treatment with 5.25% NaOCl, Group A3/B3- Pre-treatment with 2% Chlorhexidine with respective adhesives. Cavity disinfectants were applied for 60 second followed by respective adhesives application. Composite Restoration was done using a plastic tube of 2 x 3 mm and light cured for 40 seconds. Subsequent to thermocycling, shear bond strength test for every specimen was performed using universal testing machine with cross section area of 12.56 mm2 and speed of 1 mm/min, till failure occurred. Result –The mean values of bond strength was in order A3>A1>A2 for group A and B3>B1>B2 for Group B. Significant results were obtained when A1 and B1, A2 and B2 and A3 and B3 was compared. Conclusion- Cavity disinfectant had influence on shear bond strength depending on adhesives used. Chlorhexidine increased the shear bond strength of both adhesives.

  Abstract 33: Detection and successful manegement of two canals in all mandibular incisors in same patient Top

Vandana Kokane

VSPM Dental College, Nagpur, Maharashtra, India

Knowledge of the normal and unusual anatomy of the pulp and possible variations is highly essential for success in root canal treatment. Missed canal can be one of the main reason for unfavorable outcome in endodontic treatment of mandibular incisors.

Pain during or immediately after treatment,even after complete extirpation of pulp tissue from root canal of vital teeth is the main indication of presence of additional canal.Present case report is also on pain because of missed another canal in all mandibular incisors in same patient and treatment of these canals lead to complete clinical and radiographic healing.

  Abstract 34: Radiological appraisal of biodentine and pulpotec individually or in combination with PAD as pulp capping cements in mature teeth: An in vivo study Top

Gaurav Patri

kalinga institute of dental sciences, Bhubaneswar, Odisha, India

Introduction: Success of vital pulp therapy for pulpal preservation of the tooth require a suitable bioactive cement and bacterial decontamination of the cavity.

Aim and Objective: To evaluate and compare radiographically, Pulpotec cement and Biodentine as direct pulp capping agents in mature teeth, individually and in combination with PAD.

Materials and Methods: In the present study, 80 mature teeth were selected for direct pulp capping procedure and randomly assigned to one of the four groups (Biodentine, Pulpotec, Biodentine + PAD and Pulpotec + PAD) allocating 20 teeth to each group. Direct pulp capping and cavity disinfection was performed based on the group allotted followed by permanent restoration with composites. The teeth were evaluated radiographically (densitometric analysis) at intervals of three, six and twelve months.

Statistical Analysis: The radiographic grey values obtained at follow-up periods for each group were subjected to two way ANOVA with repeated measures.

Results: There was a significant improvement (p value < 0.0001) in the scores of all the groups at follow-ups as compared to the baseline. There was a significant difference between Group I / Group II with Groups III & IV (p value = 0.000) with group 4 scoring highest at all follow ups. However, the difference between Groups I / II and Groups III / IV was non significant.

Conclusion: Biodentine and Pulpotec can be used for direct pulp capping of mature teeth. Furthermore, PAD prior to material application appeared to significantly improve the success of Biodentin and pulpotec radiographically.

Funding sources: self-funded.

  Abstract 35: An endeavour to conserve Top

Kanwalpreet Kaur Bhullar

Sri Guru Ram Das Institute of Dental Science and Research, Amritsar, Punjab, India

Histological investigations on the response of healthy human pulps to three direct pulp capping agents: a randomized clinical controlled study.

Aim: The present randomized clinical controlled study was conducted to evaluate pulp tissue reactions histologically in terms of dentin bridge formed subsequent to placing calcium hydroxide, MTA and bioceramics as direct pulp capping materials on iatrogenically exposed caries free human premolars.

Materials and Methods: Thirty young male and female patients were enrolled with a total of one hundred and twenty non carious, fully erupted, sound human maxillary/mandibular premolars, scheduled to undergo orthodontic extractions. Patients were randomly allocated into three experimental groups (I-III), depending upon the type of the pulp capping agent used. Each group was further subdivided into four subgroups (A-D) depending upon the time for which the respective pulp capping material was placed. Class I cavities were prepared followed by an iatrogenic pulp exposure. All pulpal exposures were capped and the cavity floors were sealed using Type II Glass Ionomer Cement. Finally, cavities were restored using light curing radiopaque Hybrid composite as final restorations, clinically reviewed and extracted after number of predetermined intervals (1 day, 1 week and 4weeks). The specimens were fixed, decalcified, subdivided axially into 2 halves in the oro-buccal (lingual-buccal) plane, embedded in plastic, serial sectioned and evaluated histopathologically with appropriate statistical evaluation of the qualitative data.

Results: Complete dentin bridge formation was seen in 20%, 30% and 30% in Group I, II and III respectively.

Conclusion: Results showed inferior performance of calcium hydroxide as compared to MTA and bioceramics.

  Abstract 36: Interdisciplinary endodontics: Case reports Top

Vijayshankar L Virupaksha, Saketh Rama Rao1

M R Ambedkar Dental College and Hospital, Bengaluru, Karnataka, 1Hi Tech Dental College and Hospital, Bhubaneswar, Odisha, India

Endodontically treated teeth can be a missing link between the success and failure of the interdisciplinary treatment plan. Sequential treatment planning of fractured teeth is based on Biological, Structural and Aesthetic considerations of the teeth and its periodontium. Interdisciplinary Endodontic treatment including Periodontal, Orthodontic and Restorative therapy seem to be an effective method in the management of traumatically injured teeth. These case reports describe a comprehensive interdisciplinary approach in the aesthetic and functional restoration of fractured maxillary anterior teeth.

  Abstract 37: 'C' shaped 'C'anals, Proceed with 'C'aution! Top

Saurabh Doshi, Dr. Vivek Hegde1

Dr. Doshi's Speciality Dental Clinic and Root Canal Centre, Baramati, 1M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India

A thorough knowledge of the root canal morphology is required for successful endodontic therapy. One of the most important morphological variation is the 'C' shape configuration of root canal system. The main anatomic feature of this is presence of fins or webs connecting individual mesial or distal canals. Such type of canal configuration presents a challenge in debridement and obturation. Careful assessment of preoperative radiograph is a key step for its subsequent management and this assessment has a high impact on the treatment outcomes. This presentation includes case series of 'C' shaped canals in mandibular right and left second molar which were diagnosed and managed successfully.

  Abstract 38: Deep margin elevation Top

Niranjan Vatkar

Private Practitioner, Pune, Maharashtra, India

Subgingival interdental margins may be encountered when replacing large proximal lesions. In the past, due to the need to respect biologic width, clinicians were used to surgical crown lengthening in order to prevent tissue loss, root exposure, opening of the proximal area and poor esthetics. An alternative to this was explained by Dietschi and Spreafico in 1998, where a base of composite resin is placed coronal to the displaced proximal margins underneath indirect bonded restorations. This procedure is known as deep margin elevation (DME). Today, with this more conservative approach to restorative dentistry, former subtractive procedures are being replaced with additive ones. In view of this, one could propose DME instead of crown lengthening as a change of paradigm for deep cavities. This presentation of cases discusses the management strategies for performing DME.

  Abstract 39: Ergo - Endo (ergonomics in endodontics) Top

Lisha Gangwal

M.A. Rangoonwala Dental College , Pune, Maharashtra, India

Dentists are at high risk for musculoskeletal disorders (MSDs) due to the nature of their work. High MSDs afflict dental professionals since early training years, which are specialty specific. Endodontics is a speciality involving high intensity of repetitive work with hands demanding high precision and flexion of the wrist. There is limited range of motion and isometric muscle contraction due to confined working area. The key to preventing work-related musculoskeletal disorders is ergonomics - the science of fitting the work environment to the worker. In dentistry, ergonomics involves the design, selection, adjustment, and modification of operatory layouts, delivery systems, and most importantly dentist, assistant and patient positioning with regards to safety measures. Literature has shown more than 65% of the dentists suffer from musculoskeletal complaints varying in severity but accompanied with pain, discomfort, hindrance in functioning and loss of working time. Self-assessment of identified risk factors and preventive philosophy is the key to success. The aim of this presentation is to improve dentist performance and reduce occupational pain by focusing on proper body mechanics, workstation layout and preventive exercise to safeguard against injuries, thereby practicing pain-free dentistry for a healthy successful dental career.

  Abstract 40: Guided endodontics - A guide to the end Top

S Srilatha

M.A.Rangoonwala Dental College and Hospital, Pune, Maharastra, India

The intervention of science and technology has revolutionized not only the way we think, but it has also remodelled our field of Endodontics. The introduction of artificial intelligence has made it possible to handle complexities in the root canals. The negotiation of calcified canals which would be otherwise strenuous and result in various mishaps like perforation, excessive removal of root dentin etc, are more predictable to achieve using 'Guided Endodontics' - which creates a road map and serves as a guide to the apical end. The digital 3D scanning of the patient's model is merged with pre operative cbct scan. The DICOM files are converted to STL (stereolithic) files and static navigation stents are fabricated. The access cavity is prepared with the help of the orientation provided by the stents coupled with the miniaturised conventional instruments. This paper presents a case series of successful management of calcified canal using Static Guided Endodontics.

  Abstract 41: Traumatic injuries to the anterior teeth and their management: A case series Top

Nehakumari Desai

Private Practitioner, Neha Dental Care, Surat, Gujarat, India

Trauma of anterior teeth is quite a common occurrence in both children and adults. Various degrees of trauma leading to fracture may affect teeth in different ways depending on the age of the patient and extent of fracture and several other factors. Guidelines have been given as to how each of these situations should be treated. However, each case is different and presents a unique restorative challenge.Presenting a case series of 3 patients within the age range of 9 to 86 years,who reported to our clinic with Maxillary central incisor fractures of varying complexities, their conservative management by reattaching the fragment and long term follow ups. A 9 years old boy presented with a complicated crown fracture involving pulp.MTA pulpotomy was performed and the fragment was reattached after creating internal grooves. A 20years old boy presented with a complicated crown root fracture at the cervical 3rd level with 11 and Elli's class II with 21. Splinting was done followed by endodontic therapy with 11 and an intermediate composite restoration with 21.After splint removal,E max crown was placed with 11 and composite restoration was repeated to match 11. An 86 years old lady reported with a horizontally fractured crown 11 at gingival level. Reattachment of the fragment after endodontic treatment of the root stump and fibre post as an anchorage was planned.It was further splinted with the adjacent teeth with a fibre splint due to the occlusal forces present.

  Abstract 42: Phytosphingosine as a dentin collagen biomodifier Top

Kothandaraman Rajkumar, Sekar Mahalaxmi

SRM Dental College, Ramapuram, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India

Phytosphingosine (PHS) is a structural analogue of sphingolipids that are found naturally in the human body distributed in saliva, oral mucous membrane and epidermis. It was shown to have potent anti-erosive, anti-adherence and anti-biofilm activity. PHS possess potent anti bacterial activity against S. aureus, S. sanguinis, S. mitis, E. coli, F. nucleatum, C. bovis, C. striatum and C. jeikeium. PHS also exhibits pro collagen synthesis which was evaluated by Cho et al., emphasising on its use in restorative dentistry and endodontics. PHS when used as a pre-treatment agent on coronal dentin, exhibited increased depth of penetration of the adhesive and improved flexural strength of dentin. PHS pre-treatment on root canal dentin showed increased push out bond strength of the glass fibre posts. A significant advantage of PHS over PAC is its colourless nature as compared to PAC which can cause discolouration of the restoration. Hence, PHS can be considered as a promising dentin collagen stabiliser.

  Abstract 43: The role of an endodontist during the pandemic Top

Asha Narde

Private practitioner, Mumbai, Maharashtra, India

Globally the spread of SARS-COV-2 has thrown up immense challenges to the dental fraternity to provide oral health care in a timebound manner objectively to keep patients symptom-free and restore the diseased dentition to normal function. While triaging and setting up a safe and secure dental office is of paramount importance, the health provider has to maintain a flow chart/ road map to keep the patient asymptomatic. Patients are divided into three categories: a) Those requiring emergency treatment due to excruciating pain, swelling, trauma or bleeding gums b) Those needing urgent care with broken fillings, crowns, dentures and cavities c) Those needing elective treatment. The endodontist has become a frontline worker in providing relief to scores of patients in severe discomfort, who otherwise are apprehensive to step out of their homes. The responsibility of the endodontist cannot be overemphasized, the critical role is to make a sound differential diagnosis, a proper treatment plan and execution of the endodontic procedure with scientific principles that bring about healing.The commonly seen endodontic emergencies that surfaced during the lockdown were: a) Irreversible pulpitis/ acute apical periodontitis necessitating immediate endodontic intervention b) Delayed routine endodontic therapy or pre-pandemic incomplete procedures resulting in cystic lesions needing non-surgical/ surgical endodontic treatment and at times extraction and enucleation. c) Trauma to teeth due to exercising within the confines of the home, cycling, subconscious stress related vertical or horizontal fractures in the crown and root necessitating endodontic therapy with buildups or maybe extraction. d) Differential diagnosis of non-endodontic pain due to trigeminal neuralgia, recurrent sinusitis, and maybe an odd case of infarcts of the brain or COVID related mucormycosis. Case reports of patients in the above-mentioned categories are presented to attest the necessity of keeping the dental office of an endodontist open and accessible for patients to find relief and restore their oral health back to normal.

  Abstract 44: Comparitive evaluation of microleakage of biodentine as dentin substitute in cervical lining restorations with different bonding agents and composite: In vitro study Top

Namith Rai

Manipal College of Dental Sciences, Manipal, Karnataka, India

Background: The sealing efficacy of materials used to restore teeth is considered to be one of the main factors affecting the longevity of restorations. The setting characteristics and mechanical behaviour of Biodentine make it an acceptable material as a dentin substitute. Various authors have evaluated the microleakage where resin modified Glass ionomer cement has been used as a cervical lining restoration, but a literature survey reveals limited studies on the microleakage analysis of similar restorations with Biodentine.

Aim of the Study: (1)To evaluate the marginal sealing efficacy of Biodentine at the cervical margins of proximal cavities placed in molars compared with resin modified Glass Ionomer Cement (Fuji II LC). (2) To evaluate and compare the use of Biodentine in combination with an etch and rinse or self etch dental adhesive and a composite;

Methodology: Fifty cavities are to be prepared on proximal surfaces of fifty extracted human molars which were divided into groups of five with ten cavities each. (G1) Biodentine (G2) Fuji II LC as a filling material, (G3] Biodentine as a base+Prime and Bond NT+Ceram X Mono, (G4) Biodentine as a base + Adper Single Bond + Ceram X Mono, (G5) Biodentine as a base +G Bond + Ceram X Mono composite.The samples were thermocycled and then coated with nail polish and immersed in methylene blue dye and then sectioned and viewed under a stereomicroscope. The microleakage was scored at the occlusal, cervical and interfacial surfaces.and the results were statistically analyzed using ANOVA test.

Results: No statistically significant difference was observed between the five groups in the occlusal and cervical margins and between the total etch and the self etch adhesives in the occlusal, cervical and interfacial margins.

Conclusion: Within the limits of this in vitro study, Biodentine can be used as a cervical lining restoration.

  Abstract 45: Management of separated file in a root canal beyond the curvature in a mesially tilted right lower molar: A case report Top

Sourav Banerjee

Private Practitioner, Bistupur, Jamshedpur, India

Separated file in an endodontic root canal act as an impediment and hinder the cleaning, shaping and disinfection of the canal beyond the level of the lodged segment thereby compromising on the biologic objective of the endodontic therapy.

Objective: This particular case emphasize on how a broken file lodged beyond the curvature of the root canal in a mesially tilted lower molar tooth was removed using ultrasonic instruments under the dental operating microscope.

Case Report: A 28yr old male patient reported to my practice with symptomatic apical periodontitis. A diagnostic IOPAR revealed a broken file in the mesial root of the right lower second molar. On clinical examination it was confirmed that the broken file was lodged in the MB canal. The added challenges in the case were; fracture of the segment beyond the curvature of the canal, considerable mesial tilt of the tooth and the non-visibility of the broken file under the dental operating microscope initially.

Conclusion: It is possible to remove broken file effectively, safely and predictively with ultrasonic instruments and ergonomic use of the dental operating microscope.

  Abstract 46: Management protocols of hot tooth – A knowledge, attitude and practices survey among general dentists and endodontists Top

Anupama Ramachandran

Chettinad Dental College, Chennai, Tamil Nadu, India

Background: Successful and effective anesthesia is critical for endodontic treatment. However, achieving profound anesthesia is a challenge in some cases of irreversible pulpitis resulting in “Hot tooth”. Although, several authors suggest various strategies to overcome anesthetic failure of hot tooth, the actual protocols for management in clinical practice are quite ambiguous.

Aim: The main objective of the study is to assess the knowledge and to determine the clinical protocols of “hot tooth” management followed among general practitioners and specialists.

Methodology: The sample population of this study was general dentists and endodontists. A KAP questionnaire on hot pulp and its management was prepared (Google forms) which was circulated using various social media platforms. Validation was done by an internal pre-testing on a small group of representatives of the population. Independent variables such as demographic details were recorded. Questions were based on the awareness of different strategies of managing “hot tooth”, the attitude regarding the different anesthetic techniques and lastly the clinical protocols they followed in its management. Descriptive statistics was applied for the variables; chi-square tests were applied at a level of significance of 5% (P < 0.05).

Results: 94 General dentists and 112 specialists responded to the questionnaire. The general dentists were most proficient with infiltration and inferior alveolar techniques whereas among the specialists, pulpal and PDL anesthesia proficiency was also seen. Increasing the amount of anesthetic solution by again administering the primary anesthetic technique was the most significant mode of “Hot Pulp” management among general dentists (86.5%). An overwhelming percentage (92%) of general dentists also admitted to using pulp-devitalizing agents. A significant number of endodontists (72%) also used pre anesthetic medications to manage “Hot Pulp” along with supplemental techniques like intra-ligamental and higher nerve blocks. Only 2.6% of endodontists practiced intra osseous technique.

Conclusion: The current survey demonstrates that there is a significant lacuna in the knowledge of supplemental anesthetic techniques among general dentists. Also, both the endodontists and the general dentists need to be trained in Intra osseous anesthetic injection techniques in order to widen their repertoire of local anesthesia in case the primary technique fails.

  Abstract 47: Does neurotic personality trait serve as a predictor in prognosis of postendodontic restorations? Top

Sulthan Ibrahim Raja Khan

Pacific University, Chennai, Tamil Nadu, India

Background: The longevity of the root canal treatments does not depend on the endodontic treatment solely. For the treatment to be successful, a dentist should take into consideration the importance of the post-endodontic restorations. The role of personality traits in modulating the incidence and progression of medical disease condition and the treatment prognosis are well documented, however, there is a paucity of information of its effects on dental health conditions and specifically on the prognosis of post-endodontic restorative treatment procedures.

Objective: This study aims to review the literature available regarding the potential influence of neurotic personality traits on the clinical prognosis of post endodontic restorations.

Methods: An online search from literature sources identified through PubMed, PsychINFO, Web of Science, and Scopus revealed many studies on the influence of personality on prognosis of medical disease conditions. Also there are few studies which explain the negative effects of bruxism (a common manifestation of neuroticism personality trait) on the prognosis of dental restorative procedures, however there are no literature sources available which explain the influence of neurotic personality traits on prognosis of post endodontic restorative procedures. Few studies linking neurotic traits to dental restoration related risk factors were available and this literature review extrapolates those findings which can be applied in treatment planning of post endodontic restorations.

Results: 'Neuroticism' trait individuals had higher incidence of parafunctional habits such as bruxism, dental caries, poor gingival and periodontal health and are more commonly associated with adverse habits (increased amount of smoking and alcohol addiction), poor oral hygiene, increased occlusal bite force and higher restoration deterioration and fracture.

Conclusion: Assessment of personality traits would aid clinicians in estimating the risk factors involved with certain personality traits that may negatively affect the prognosis of post-endodontic restoration and may serve as a useful tool during treatment planning and follow up. It can aid the dentist in choosing suitable restorative dental material and prosthesis design according to individual patient's physiological and functional needs, thereby overall improving the quality of treatment provided.

  Abstract 48: Speed and torque in endodontics: A narrative review Top

Chandrakanth Majeti, E Soujanya, Neha Mehra, Mamta Kaushik, X Naga Maheshwari, P Uday Kumar

Army College of Dental Sciences, Secunderabad, Telangana, India

The success of endodontic therapy relies on thorough cleaning and shaping of root canal system. The advent of engine driven Nickel Titanium instruments enhanced the quality and predictability of root canal preparation with significant reduction in procedural errors. It also decreases the operating time and enhances comfort both to the patient and operator. To improve the speed and efficacy of the endodontic treatment, there has been a resurgence of different speed and torque controlled mechanized or automated systems and Nickel Titanium instruments. The cutting efficiency of Ni-Ti instrument invariably depends on the balance between the parameters like speed and torque. These parameters allow the dentists to adjust the unit's feel and develop the appropriate degree of fineness during endodontic procedures. Thorough knowledge of speed and torque which are inversely proportional parameters and their movement kinetics is of significant importance while preparing complex or unusual root canal anatomies like curved canals, calcified canals etc.. to avoid procedural errors. This review provides an insight into the basic science of speed and torque, their interrelationship and clinical significance of these parameters for a safer, effective and efficient endodontic therapy.

  Abstract 49: Hypothesis of developmental disturbance on root formation of maxillary central incisor: A case report Top

Leburu Ashok

Karpaga Vinayaga Institute of Dental Sciences, Chennai, Tamil Nadu, India

The success of endodontic treatment requires the knowledge of tooth morphology and its variations. The lack of knowledge about all possible root canal anatomical configurations can lead dentists to leave remaining necrotic tissue and toxic products used during endodontic procedures in the additional non-treated canal, resulting in an unsuccessful endodontic treatment. This case report shows an unusual root canal configuration is detected in a maxillary central incisor with two root canals, demonstrated by radiographic and computerized tomography.

Knowledge of endodontic anatomy as well as the obtainment of both preoperative radiographs and tomography is important to detect abnormal tooth morphology.

  Abstract 50: Comparison of flow patterns of three different irrigant delivery systems in the root canal isthmus region: A computational fluid dynamics analysis Top

Ranjith Kumar Sivarajan, Anchu Rachel Thomas1, Sihivahanan Dhanasekaran

SRM Kattankulathur Dental College and Hospital, SRMIST, Chennai, Tamil Nadu, India, 1Faculty of Dentistry, Manipal University College, Bukit Baru, Malaysia

Aim: The aim of this study was to evaluate the irrigation dynamics of three different irrigant delivery systems in the root canal isthmus region of mandibular premolar using a computational fluid dynamics model.

Materials and Methods: A CFD model of the mandibular premolar with root canal isthmus was created using scanned micro-CT images. Using this CFD model, the irrigant flow in the root canal isthmus region was calculated and visualized. The irrigation dynamics of three irrigant delivery systems – Group 1: Syringe irrigation (open-ended), Group 2: EndoVac irrigation system(microcannula) and Group 3: Modified EndoVac system were studied.The wall shear stress, streamline of the irrigant in the isthmus region and irrigant velocity were evaluated and compared.

Results: Group 1 (Open-Ended needle) presented with the highest wall shear stress compared to other groups, restricted to the apical third. All groups exhibited maximum velocity at the region of irrigant exit followed by a gradual decline in the isthmus and coronal region and it was observed that only in the Group III (Modified EndoVac) a significant flow of irrigant was observed in isthmus region.

Conclusion: The Modified EndoVac system was efficient in delivering the irrigating solutions to the isthmus region.

  Abstract 51: Successful management of a rare complicated crown-root fracture associated with horizontal mid root fracture of maxillary central incisor-3 year follow up: A case report Top

Buvaneshwari Arul, Sarath Sarathy1, Nandini Suresh, Velmurugan Natanasabapathy

Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, 1Tagore Dental College, Rathinamangalam, Tamil Nadu, India

Complicated crown-root fracture (CCRF) usually involves enamel, dentin, pulp and cementum and accounts for 5% of injuries to the permanent dentition. Whereas, CCRF along with horizontal root fracture (HRF) are rarely reported in literature. Management of a tooth with CCRF is challenging due to various factors namely, the extent of fracture, endodontic involvement and restorability of the tooth. Various studies have reported successful outcomes after fragment reattachment in CCRF of anterior teeth. It is a valuable treatment strategy, as it an immediate, cost effective procedure which can re-establish the esthetics and function. Nevertheless, fragment reattachment in a tooth with multiple fractures of root has not been reported till date. This report describes the minimally invasive approach in management of left maxillary central incisor with CCRF with additional HRF. The clinical examination revealed an oblique fracture line involving pulp and extending subgingivally on the palatal surface with the mobile fragment held by gingival tissue. Multiple angulated radiographs revealed oblique fracture line associated with CCRF and an HRF in the middle third of the root with no associated periapical pathology. Fragment reattachment with prefabricated fiber-reinforced post was planned. The mobile crown-root fragment was removed and stored in distilled water. Then the stabilization of the tooth was performed using semirigid splinting. Endodontic treatment was done only in the coronal fragment till the HRF followed by 5mm of Biodentin placement. The apical fragment was left untreated. Fibre-reinforced post was bonded in the canal and fragment was reattached using self-adhesive resin cement. Post-operative CBCT [3 years) revealed accurate approximation of fractured fragment with the remaining tooth without bone loss. The healing pattern of HRF was by interposition of connective tissue without any lesion along the fracture line and no periapical pathology. The International Association of Dental Traumatology guidelines recommends root canal treatment and restoration, surgical /orthodontic extrusion or intentional replantation as treatment options for CCRF. Still, fragment reattachment was performed in this case as the patient desired immediate cost-effective treatment. The treated tooth was functioning normally 36 months after the procedure without any restorative, periodontal or endodontic complications.

  Abstract 52: In vitro study to compare the diagnostic efficacy of cone-beam computed tomography and dental operating microscope with canal staining and clearing technique in detecting middle mesial canal Top

Manjiri Honap

Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India

Aim: An in vitro study to compare the diagnostic efficacy of Cone beam Computed Tomography (CBCT),Dental Operating Microscope (DOM) with the reference standard method of canal staining and clearing in detecting middle mesial canal (MMC) in mandibular molars in Indian population.

Materials and Methods: 120 extracted human permanent mandibular first & second molars were analysed in this study.The incidence of MMC was recorded using three methods, first method was CBCT imaging, second method was detection using ultrasonic guided troughing with the aid of dental operating microscope while the third method was canal staining and clearing technique. The diagnostic efficacy of CBCT and DOM was evaluated in comparison to reference standard method of canal staining and clearing technique. The incidence of middle mesial canal using these three methods was tabulated and subjected to statistical analysis.

Results: Dental Operating Microscope identified 21.66% (26 out of 120) of the MMCs, while CBCT analysis identified 15.83% (19 out of 120) of the MMCs, with canal staining 23.33 %(28 out of 120). The statistical analysis was performed using Chi square test. There was a statistically significant difference between DOM & Canal staining and clearing technique (p value .040) & also between CBCT & Canal staining and clearing technique (p value .040). Sensitivity of DOM was 35.7% while of CBCT 28.6%. The specificity of CBCT and DOM was 88.0% and 82.6%respectively. The positive predictive value of DOM was 38.5% and for CBCT it was 42.1%. The negative predictive value was 80.2% and 80.9% with CBCT and DOM respectively.

Conclusion: Higher magnification and guided troughing plays an important role in locating middle mesial canal. Judicious use of CBCT can be a boon to study the canal trajectories & aid in detecting accessory canals.

Funding Source: None.

  Abstract 53: Bactericidal effect of lasers in endodontics Top

Vidyaa Hari Iyer

Private Practitioner, Smile Dental Clinic, Chennai, Tamil Nadu, India

Conventional root canal therapy has its own disadvantages as reduction of the bacterial load within the root canal system is still an enigma which becomes the primary cause of root canal failure. Lasers are used for access cavity opening; removal of the pulp and organic debris, cleaning and disinfecting of the canal. Lasers are fast, effective, minimally invasive and pain-free method that uses thermomechanical ablation to bring about desired laser tissue interaction. Lasers have a scientific evidence-based bactericidal effect and hence has a promising prognosis in Laser assisted endodontics. This paper highlights the effective use of bactericidal property of Lasers in endodontics.

  Abstract 54: Current trends in observing endodontic procedures and their influence on inter appointment pain Top

Rachna Dhani Singh

Indira Gandhi Goverment Dental College and Hospital, Jammu, Jammu and Kashmir, India

Pain during or after endodontic procedures is an undesirable occurrence for both patients and clinicians. Acute periradicular (periapical) inflammation is the most common cause of inter appointment or postoperative pain. The causative factors of inter appointment pain comprise mechanical, chemical, and/or microbial injury to the pulp or periradicular tissues, which are induced or exacerbated during root canal treatment. The use of an antimicrobial intracanal medicaments are important tool in controlling endodontic infection.Pain management in endodontic treatment is an important clinical consideration. In the present study reply to planned questionnaire from 173 dentist obtained after getting due ethical clearance. Frequency of preferred methods used by dentists in endodontic treatment was obtained and then the relationship between each endodontic step and inter appointment pain was analysed statistically. The study was done to get insight into the factors that can positively influence in controlling inter appointment or post endodontic pain.

  Abstract 55: Noninvasive management of extensive root resorption using MTA monoblock: A case series Top

Anupreeta Anwarullah, Lakshman Varma Uppalapati

GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India

Root resorption is either a physiologic or a pathologic phenomenon resulting in progressive loss of dental hard tissues by the action of osteoclasts. Resorption in permanent teeth is an unfavourable pathological process resulting in irreversible damage to the tooth. Based on the location of the defects pathological root resorption is classified as external or internal resorption. Furthermore, external resorption is categorized into surface resorption, inflammatory resorption, cervical resorption and replacement resorption. Root resorption requires two phases; injury and stimulation. Injury phase is initiated by damage to the nonmineralized tissues like precementum, predentin and the odontoblasts. Subsequent stimulation of macrophage-like resorbing cells is due to chronic inflammation. The etiological factors can be mechanical, chemical or thermal, which include; trauma, caries, orthodontic treatment, periodontal therapies, bleaching, operative procedures and pulp therapies. With regard to management, orthograde obturation with mineral trioxide aggregate represents a contemporary version of the primary monoblock. The sealing quality, bioactive properties and the tooth strengthening potential of MTA monoblocks are advantageous in treating extensive resorption cases. Research demonstrated that root canals obturated with MTA exhibit higher fracture resistance. Further, on the long-term, it increases strength of the tooth with time. Among different types of resorptions, inflammatory root resorption is of major concern due to the aggressive nature and possibility of causing more severe signs and symptoms. Long standing resorptive defects with extensive root dentin loss show high incidence of root fracture leading to extraction of the tooth, which is catastrophic in young individuals. Hence all efforts should be made to diagnose and efficiently treat these conditions at the earliest. Thus, this presentation focuses on conservative management of cases of perforating internal resorption and an extensive external resorption with long term follow up and CBCT evaluation.

  Abstract 56: Graphene – Its role in endodontics Top

Divya Kunam

Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

With the advent of newer biomaterials into the field of dentistry, nano biomaterials are gaining popularity in recent times due to their superior properties. An integration of nanotechnology with biomaterials can result in value added products to enhance the properties of existing materials and also help in bringing new materials into use. Graphene is a prominent two-dimensional nanostructure, which is the thinnest and strongest material in existence. Graphene has attracted a lot of attention from diverse scientific fields for applications in sensing, catalysis, nanoelectronics, material engineering, energy storage and biomedicine. Use of graphene-based nanomaterial in dentistry has been tested and proven to be biocompatible. Graphene-coated scaffolds allow the growth and proliferation of human mesenchymal stem cells (MSCs), resulting in a quicker differentiation into osteoblasts. Graphene has a great antibacterial ability on bacteria and bacterial biofilm. Studies show nano silver - graphene oxide has antibacterial effect on endodontic biofilms. Reduced graphene oxide-curcumin photodynamic inactivation (rGO-Cur-PDI) showed dual inhibitory effects on biofilm formation ability and virulence activity of E. faecalis with potential clinical applications for infection control in endodontics. This review paper describes the role of graphene and graphene based nanobiomaterials in Endodontics.

  Abstract 57: Nanoscience and pulp regenerative therapy: A review Top

Shobana Krishna Kumar, Rekha Mani, Vijay Venkatesh

SRM Kattankulathur Dental College and Hospital, Kancheepuram, Tamil Nadu, India

Regeneration of the dental pulp and restoring its function is the ultimate goal of regenerative endodontic procedures. Application of Nanoscience concepts to Dentistry has opened up gates for ample research opportunities in the field. Literature on how the implementation of nanotechnology can boost dental pulp regeneration is quite limited. The biomimetic modifications brought about by nanotechnology, when applied to the triad of tissue engineering, has demonstrated increased success rates in dental pulp regeneration. This review highlights the important research activities in the field of Regenerative Endodontics with the application of Nanotechnology. The classical triad of regeneration is composed of stem cells, scaffolds and growth factors. Stem cells can be directed towards a definite site and function by designing artificial stem cell niches using Nanotechnology, tracked in vivo using magnetic nanoparticles and labeled with light-emitting nano-particles (Q dots). Stem cells can even be modified using nano-particles for intra cellular gene delivery and made to differentiate into the required cell types. Nanotechnology also supports the synthesis of biomimetic nano-fibrous scaffolds which not only support endodontic regeneration but also act as reservoirs of growth factors, anti-inflammatory and antibacterial molecules. Nano-fibrous scaffolds have superior surface area to volume ratio and promising microstructural properties, exhibiting highly interconnected porous networks. Recently, antibiotic nano-fibrous-scaffolds fabricated by electrospinning has shown to disinfect root canals more efficiently owing to the slow but effective release of antibiotics and also continue serve as matrix for seeding of stem cells from apical papilla after induced bleeding. Finally, thanks to Nanotechnology, it is now possible to precisely deliver, track and induce highly specific differentiation of stem cells with an appropriate biological seat for seeding them. However, one should accept the fact that these research activities, may take quite some time to be translated to our dental clinics.

  Abstract 58: Cytotoxicity evaluation of BioRoot RCS, MTA Fillapex and AH-Plus root canal sealers by microscopic and methyl-thiazoldiphenyl-tetrazolium assay Top

Shalan Kaul, Ajay Kumar

Indira Gandhi Govt Dental College, Jammu, Jammu and Kashmir, India

Aim: This study was performed to compare the cytotoxic effect & cell morphology changes due to calcium silicate based (Bio Root RCS) and MTA based (MTA Fillapex) root canal sealers to a widely used resin –based sealer (AH Plus).

Materials and Methods: A total of 27 samples (n=27) divided into three groups with three sealer samples per time period of 0h,24h & 7 days were taken. The sealer extract was made in cell culture medium using Eagle's minimum essential Medium (MEM,USA). After mixing, premeasured volume of each sealer was dispensed as round disc like specimens into preweighed autoclaved glass vials, the vials with 100mg ± 2mg weight samples were taken for the study. The cytotoxicity of the sealers were evaluated using a methyl-thiazoldiphenyl-tetrazolium (MTT) assay & changes in the cell morphology were observed under inverted phase contrast microscope, during different time periods of 0h,24h & 7 days after mixing. The values obtained are analyzed statistically using parametric test like one way ANOVA followed by Duncan's s multiple range test.

Results: Bio Root RCS shows reduction in cytotoxicity from severe at 0 hrs to no cytotoxicity at 24 hrs & 7day time period. For AH Plus the cytoxicity remained severe at all the three time periods.MTA Fillapex sealer showed sever cytoxicity at 0 hrs & 24 hrs but it decreased to moderate at 7day. The differences between groups were statistically significant (p < 0.05).

Conclusions: The sealers which have resin constituents (AH Plus, MTA Fillapex) appear to show severe to moderate toxicity potential at different time periods. Bio Root RCS was relatively biocompatible sealer as compared to other two sealers which were cytotoxic at their initial stages, however, they became less cytotoxic with time.

Funding: Self funding.

  Abstract 59: Guided endodontics: A novel method to treat teeth with pulp canal calcification, perforation and instrument separation Top

Jatin Gupta

Private Practitioner, Muzaffarnagar, Uttar Pradesh, India

Aim: To present a novel and minimally invasive treatment approach for root canal location in maxillary right central incisor tooth with pulp canal calcification (PCC), instrument separation and cervical perforation.

Case: A 44 old female patient presented with pain of her upper right central incisor. The patient had a history of trauma 25 years ago. Tooth was tender to percussion and had a yellow discolouration. The thermal and electrical test were negative. Periapical radiograph showed severe pulp canal calcification, instrument separation and root perforation along with sign of periapical periodontitis. Due to complexity of case a cone beam tomograph (CBCT) and intraoral model were recorded, scanned and aligned using special software for virtual implant planning. Position of the drill was planned on CBCT for root canal treatment, a virtual template was designed, data were exported as an STL file and sent to a 3D printer for template fabrication. The template was positioned on the anterior maxillary teeth. A long shank drill along with drill extender was used to penetrate through the obliterated part of the root canal, by-passing the separated instrument and obtain straight line access to the apical part of the canal. The root canal was accessible at 10 mm distance from the apex. Further root canal preparation was carried out using an endodontic rotary instrumentation system. The root canal was filled with warm vertical compaction gutta-percha using an Ah-plus sealer. The access cavity and cervical perforation were restored with a composite material. After 12 months, the patient was clinically asymptomatic with no pain on percussion. The radiograph showed no apical pathology.

Conclusions: Guided endodontic treatment approach is a safe and clinically feasible method to locate root canals and treat them in teeth with PCC, perforation and instrument separation.

  Abstract 60: Influence of diabetes on vertical root fracture Top

Angambakkam Rajasekaran PradeepKumar, Sundaramurthy JothiLatha1, Muralidhar Lavanya2

Thai Moogambigai Dental College and Hospital, 1Tamil Nadu Government Dental College and Hospital, 2Private Practice, Chennai, Tamil Nadu, India

Aim: To evaluate the influence of diabetes mellitus on vertical root fracture in endodontically treated teeth.

Materials and Methods: 80 teeth with vertical root fracture were compared with 80 teeth without vertical root fracture after matching for age, gender, tooth type, and time period from canal filling. The association of diabetes mellitus type II with teeth with or without vertical root fracture was evaluated and the odds ratio was calculated.

Results: The mean age of the cases was 51.67± 10.69 years, with 42.5% males and 57.5% females. There was significant difference in the distribution of diabetics between cases and controls (<0.001). The odds ratio was 3.32 (CI- 1.7 to 6.48).

Conclusion: Presence of diabetic mellitus in the patients was associated with vertical root fracture.

  Abstract 61: Comparative evaluation of shear bond strength of composite and RMGIC to mineral trioxide aggregate mixed with water and water-based gel: An in vitro study Top

Rudra Kaul

Indira Gandhi Government Dental College and Hospital, Jammu, Jammu and Kashmir, India

Aim: MTA plus (Prevest Denpro, India) mixed with distilled water or water-based gel is often used for pulp capping, apexogenesis and perforation repair. After these treatment procedures, teeth are commonly restored with composite resin and resin modified glass ionomer cement. The aim of this study was to evaluate the Shear bond strength (SBS) of composite resin (Filtek™ Z250; 3M ESPE, USA) and resin-modified glass ionomer cement RMGIC(GC Fuji II LC, JAPAN) to MTA plus mixed with distilled water (MTAw) and water-based gel (MTAg).

Materials and Methods: Jammu and Kashmir, Forty acrylic cylindrical blocks were prepared and divided into two groups (n = 20). The acrylic blocks from each group were randomly allocated into 2 subgroups of 10 samples each; Group-1A: MTA plus + distilled water + composite (Filtek™ Z250), Group-2A: MTA + distilled water + RMGIC (GC Fuji II LC, JAPAN), Group-2A: MTA + polymer + composite, Group-2B: MTA + polymer+ RMGIC. The specimens were mounted in Universal Testing Machine. A crosshead speed 1 mm/min was applied to each specimen using a knife-edge blade until the bond between the MTA in both forms (distilled water/gel) and restorative material failed.

Results: There was statistically significant difference between MTAw + Composite resin with MTAg + Composite resin; but no statistically significant difference between MTAw + RMGIC with MTAg + RMGIC (P > 0.05). There were statistically significant differences between composite and RMGIC groups within the same MTA type. (P < 0.05).

Conclusions: The results of the present study displayed that MTAg has shown better SBS to composite resin and RMGIC materials.

Funding: Self funded.

  Abstract 62: Assessment of the impact of primary root canal treatment on the perceived oral health-related quality of life: A prospective cohort follow up study Top

Shivkumar Mantri

Hitkarini Dental College, Jabalpur, Madhya Pradesh, India

Aim: To determine and compare the pre-and post-operative impact of primary root canal treatment on patient's oral health-related quality of life.

Materials and Methods: Institutional ethical committee clearance was obtained. A total of 107 patients seeking primary root canal therapy consented to participate in this study. Healthy adults of Indian ethnicity aged 18–60 years who could read and understand Hindi were included. Patients with systemic disease, physical disabilities, communication difficulties, poor oral hygiene, undergoing Orthodontic treatment, and taking antibiotics and/or analgesics were excluded. OHRQoL was assessed by OHIP-17, a validated Hindi version questionnaire preoperatively. The patients were treated by primary root canal therapy utilising rotary NiTi and hand K files, sodium hypochlorite, EDTA, saline irrigation and lateral compaction obturation technique. The teeth were restored using adhesive composite restoration and/or crown. The impact of treatment on OHRQoL was evaluated postoperatively and after six months. The impact prevalence and mean score were calculated and tabulated. The data were subjected to descriptive and inferential statistics using the Chi-Square test.

Results: There was a significant difference (P = 0.001) in pre-and post-operative prevalence. Root canal therapy has a significant (P = 0.001) impact on the conceptual dimensions of OHRQoL.

Conclusion: Oral health-related quality of life of patients improved after primary root canal therapy.

  Abstract 63: Long term observation of endodontically treated teeth with resin-based root canal sealer extrusion into the periapical area: A case series Top

Mukesh Kumar Hasija, Babita Meena, Deepti Wadhwa1

Faculty of Dentistry, Jamia Millia Islamia, Delhi, 1Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India

Non-surgical endodontic treatment is performed to clean the root canal system, alleviate pain, and remove the infection from the affected tooth. The obturating material in root canal treatment should reach the radiographic apex without extruding into the periapical area. However, irrespective of the obturating technique used, some unintentional extrusion of sealer material occurs in few cases. Although small sealer extrusions are generally well tolerated by the periradicular tissues and get dissolved or phagocytized. The present case series evaluated the treatment outcome of unintentionally extruded resin-based sealer with a clinical and radiographic follow-up of more than two years. In the current case series, teeth with and without pre-existing periapical pathologies were included. Non-surgical root canal treatments performed by a single operator and cases exhibiting unintentional extrusion of resin-based sealer in the post-obturation radiograph were followed. The treatment outcome and fate of extruded sealer material were judged clinically and using intraoral radiographs. It has been found that periapical tissues tolerated extruded resin-based sealer very well in all the cases. Some extruded sealer gets cleared from the periapical area with time, but no recurrence of pathology was found in any case. Unintentional sealer extrusions after endodontics treatment should be followed up for a long time to judge the treatment outcome.

  Abstract 64: Comparative study of dental pulp RNA obtained from cryo preserved (−80°C) extracted human teeth with four different storage times Top

Babita Meena, Mukesh Hasija, Kapil Dev, Sahar Rafat

Jamia Millia Islamia, New Delhi, India

Aim: To evaluate the effect of cryo-storage of extracted teeth with various storage time protocols on quality of RNA obtained from human dental pulps.

Materials and Methods: 20 healthy third molars without any pulpal involvement were selected for this study. All 20 teeth were stored at -80 degrees centigrade in Dulbecco's Modified Eagle Medium (DMEM) and kept in OSKO ultra freezer unit and randomly divided into 4 groups (n=5) based upon following storing time protocols- Group I- teeth stored for 1hour, Group II- teeth stored for 24hours, Group III- teeth stored for 48hours, Group IV- teeth stored for 72hours. After completing their respective cryo-storage time protocol each tooth was thawed at room temperature and sectioned with the help of diamond disc and split longitudinally using a chisel. The pulp tissue was carefully removed from the teeth, RNA was isolated from dental pulp tissue using TRIzol reagent. Total RNA extracted was pooled for each storage time group, to minimize individual patient differences and to provide sufficient RNA for analysis. The total RNA of each group was quantified using a Nanodrop One Microvolume UV-Vis spectrophotometer.

Results: All four groups demonstrated preserved RNA integrity and purity. Purest form of RNA obtained from Group I- teeth stored for 1hour.Quality of mRNA degraded slightly with increasing storage time (group I > group II > group III > group IV).

Conclusions: In this study, we investigated how much cryo-storage duration of human teeth affects the qualities of RNA. For RNA, storage duration within 24 hours is critical for collecting high-quality RNA samples for further assays. Therefore, immediate storage of extracted human teeth at -80 degrees in ultra-freezers until they can be homogenized is mandatory to avoid human tooth disposal, which might be used in various pulp tissue related studies.

  Abstract 65: Survey on knowledge of pandemic-related protocol, changes in clinical workflow and professional and personal life of endodontists during COVID-19 pandemic in India Top

Remya Cauvery, Meenu Madhukumar1, Radhakrishnan Nair, Praveena Geetha2

Azeezia College of Dental Sciences and Research, 1KIMS Health, Thiruvananthapuram, 2Azeezia College of Dental Sciences and Research, Kollam, Kerala, India

The objective of the study is to analyze the knowledge relating to COVID-19 protocols, changes in the clinical administration and management, and its impact on the personal and professional life of endodontists in India. The survey was conducted online using google forms. It consisted of 6 questions on demographics and 28 questions relating to the impact of COVID-19 pandemic. Participation in the survey was anonymous and completely voluntary. Practising endodontists were contacted through email and other social media. 71 endodontists participated in our survey which included 56.3% females and 43.7% males. This cohort included 11 solo practitioners, 9 in group practice, 25 visiting consultants, 21 college-based and 5 hospital-based practitioners across India. 62% of the endodontists were attending emergencies throughout the initial lockdown. Emergencies were ranked as extra-oral swellings, intra-oral swellings and then pain, eventhough pain(42.3%) was the main emergency treated in operatories, followed by swelling(26.8%). Emergency questionnaires were used in 38% operatories to assess true emergencies. Screening protocols adopted by clinics include temperature recording(91.5%), COVID history questionnaire (88.7%) and, detailed medical history (81.7%), where as rapid antigen testing/RTPCR were used by only 29.6% endodontists. Most common change in workflow was ramping up of PPE(85.9%) followed by change in clinical layout (53.5%). For aerosol generating procedures, 54% endodontists used separate respirators, while 40.8% used separate operatories and 38% scheduled AGPs as the last appointment for the day. 63.4% endodontists felt that the change in clinical workflow made them better equipped to treat patients during the second wave of the pandemic in 2021. Out of the 87.3% who reported loss in income, 35.2% were visiting consultants. 68.9% were worried about their future financial situation, this included 49.3% practicing for less than 10 years. All these professional changes affected 87.2% endodontists in their personal life too. Fear of cross infection to family (68.1%) and restrictions in travel (53.6%) were major concerns. Most of the endodontists surveyed are aware of COVID-19 related protocols and have incorporated it in their clinical practice. Even with the fear of cross-infection and loss of income, many operatories were open for emergencies during the peak of the pandemic.

  Abstract 66: Polyethylene glycol stabilized silver nanoparticle colloid as a root canal irrigant Top

Vivek Aggarwal

Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India

Aim: The silver nanoparticles (AgNaPs) have shown a potent antibacterial efficacy. They can be prepared using various methods, both chemical and biological/green. The AgNaPs are coated by polymer to prevent aggregation and improve the stability of the solution. The stabilizer has an important effect on the physical and biological properties of the AgNaPs. The purpose of the present study was to stabilize the chemically prepared silver nanoparticles with polyethylene glycol and its evaluation against a microbial biofilm.

Materials and Methods: The AgNaPs were prepared by adding 10 mL of 1% trisodium citrate in 50 mL of 1mM silver nitrate. The solution was mixed under magnetic stirring at 80°C for 10 min. The color of the solution turned amber yellow, indicating the formation of AgNaPs. A 5%w/w solution of polyethylene glycol was made by dissolving PEG-400 in 50mL deionized water. Twenty-five mL of silver colloid solution was added to 50 mL of PEG solution. The solution was continuously stirred for another 6h at 80°C. The PEG-coated AgNaP solution was cooled down to room temperature and was stored in light-sealed dark glass bottles for further use. The nanoparticles were physically characterized by UV-vis spectroscopy and scanning electron microscope (SEM). The AgNaP colloid was evaluated against an E. faecalis biofilm model prepared on a sterile collagen membrane. Sterile saline and 2.5% sodium hypochlorite were kept as control. After 48h the collagen membrane was imaged under a scanning electron microscope for the evaluation of biofilm.

Results: The data from UV-Vis spectroscopy and scanning electron microscope analysis revealed the formation of 5-10nm-sized silver nanoparticles. The particles were well stabilized with minimal aggregation. The sodium hypochlorite and AgNaPs colloid solutions reduced the biofilm on the collagen membranes.

Conclusions: The polyethylene glycol-coated silver nanoparticles have an antibacterial effect against the biofilm of E. faecalis and can be used as a root canal irrigant.

The study has been supported by an extramural grant from the SERB-DST (CRG/2018/000033].

  Abstract 67: Assessment of antibacterial efficacy of “Activ Points” for combating enterococcus faecalis in endodontic infections Top

Harpreet Singh

BJS Dental College and Hospital, Ludhiana, Punjab, India

Aim: To evaluate the antibacterial efficacy of chlorhexidine releasing 'Activ Points' against Enterococcus faecalis.

Materials and Methods: Ten McKonkey agar plates were inoculated with Enterococcus faecalis(ATCC; MTCC 2729) and were divided into two groups of five each. Test specimens (paper points soaked in chlorhexidine releasing 'Activ points' and 2% chlorhexidine solution; 10 each) were placed in the plates. The zone of inhibition was measured around the specimens after 24 and 48 hrs using digital vernier calliper. The results so obtained were subjected to statistical analysis.

Results: The mean zone of inhibition for Activ points at 24 hours and 48 hours was found to be 5.1 and 6.1 respectively while that of chlorhexidine group was observed to be 0.0 and 1.5 at 24 and 48 hours. When analysed, the results were found to be statistically significant at 24 hours (p= .037) and at 48 hours (p=0.001) indicating the higher efficacy of Activ points.

Conclusion: The findings of the present study suggest that 'Activ points' can be used safely as an alternative to 2% chlorhexidine solution as intra canal medicament with the additional advantage of availability of these points in ISO standard sizes, radiographic visibility, easy placement up to the root apex and easy retrieval from the root canal system.

  Abstract 68: A suggested new nomenclature for powered endodontic instruments Top

H Murali Rao, Vijetha Vishwanath, Megha Rao

D. A. Pandu Memorial RV Dental College and Hospitals, Bengaluru, Karanataka, India

The last two decades have contributed to tremendous innovations in terms of materials and instrumentation to the field of Endodontics. They have made learning and practice of Endodontics much more predictable by addressing the needs of better magnification, precise diagnostic imaging, effective instrumentation and optimum use of new bioactive materials. Of the above mentioned, the ones that have grown and progressed exponentially in terms of number and diversity are the powered instruments for cleaning and shaping. Currently, there is no standardised protocol which classifies, designates and helps identify the powered Endodontic instruments. It is of utmost importance to clearly identify a specific instrument for a definite communication universally. This paper attempts to group, classify and annotate powered Endodontic instruments. This method is based on clinical scenarios and specific features of individual instrument systems. These details will be inscribed on the instrument for easy identification during, before or after their use in routine clinical situations.

  Abstract 69: Rotary physics of recent single NiTi file systems and their clinical significance: A review Top

Deepti Pitalia, Rolly S Agrawal

Index Institute of Dental Sciences, Indore, Madhya Pradesh, India

The nickel–titanium (NiTi) rotary instruments have highly improved the quality of cleaning and shaping of the root canal system in endodontics. With the advancements in design, movement and material of files root canal preparation focus on the use of single file systems which are cost effective and time saving The purpose of this article is to review the design features, instrumentation kinematics of recent single rotary file systems and their effect on clinical performance at the same time comparing them. Important design features include the variability of taper, rake angle, cross-sectional geometry, tip configuration, design of blades, helical angle and pitch. These design features influence flexibility, cutting efficiency and safety. While kinematics include different motions of endomotor to use this instruments. An understanding of the properties of these new NiTi instruments available in the market and their effect on the clinical performance of root canal preparation enables the clinicians to select the instruments that provide optimal clinical outcome.

  Abstract 70: Cryotherapy in endodontics: A review Top

Dhanalakshmi Subramanian, Sudharshana Ranjani Muthukrishnan, Kavitha Mahendran

Tamilnadu Government Dental College and Hospital, Chennai, Tamil Nadu, India

Cryotherapy is a simple, cost effective treatment involving application of cold. This established therapeutic procedure is widely used in sports medicine and in surgery for postsurgical management of pain and swelling. Literature suggests that cold therapy in various forms can reduce inflammation, haemorrhage, musculoskeletal pain, muscle spasm and connective tissue distension thereby allowing its application in various specialities of medicine. The analgesic and anti-inflammatory effect of cryotherapy has led to its application in endodontics to reduce postoperative pain following root canal treatment. Intraoral cryotherapy application was reported to have a synergistic effect in increasing the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. Cryogenic treatment of endodontic rotary Nickel Titanium files has been found to improve the cyclic fatigue resistance. Recently, cryotherapy has been suggested to achieve hemostasis in vital pulp treatment. However, the type of cold agent used, mode of application, duration of application differs in diverse applications. This comprehensive review aims at presenting the mechanism of action, physiological effect and highlights the various applications and limitations of cryotherapy in modern day endodontic practice.

  Abstract 71: Association between ABO blood group and intra-operative pain after initiation of root canal therapy in patients with pain of endodontic origin: A preliminary study Top

Shekar Shobana, Sundaresan Balagopal, Sekar Mahalaxmi1

Tagore Dental College and Hospital, 1SRM Dental College and Hospital, Chennai, Tamil Nadu, India

Objective: 1. To assess the association between ABO blood group and pain of endodontic origin in adult patients requiring root canal therapy. 2. To assess the association between intra-operative pain and ABO blood group after initiation of root canal treatment.

Methodology: This triple blinded, prospective observational cohort study was conducted in adult patients, 18-45 years of age of either gender requiring root canal treatment. Patients reporting with reversible pulpitis, abscess and/or signs of systemic infection, previously root canal initiated cases, analgesic premedication, and patients on anti-depressants were excluded from the study. Blood group estimation based on ABO blood group system was done for all the patients by a trained auxiliary personnel. Based on the blood grouping, the patients were divided into the following groups: O group n=29), 2: B group (n=21), 3: A group (n=10) and 4: AB group (n=0). Patients were sensitized to 10 point Heft-parker Visual analogue scale and pre-operative pain score was recorded for each patient. Under Lignocaine with Adrenaline (1:80,000), access opening was done by a single experienced endodontist, cleaning and shaping was done with Mtwo 6% 25 instrument with EDTA lubrication, 3% NaOCl working solution and intermittent copious saline irrigation. The access cavity was temporized using sterile cotton and temporary filling material (ZOE). Patients were tendered the HP-VAS scale again and pain score following cleaning and shaping was recorded 6 hours after treatment. Medications taken within this time duration was recorded.

Results: Data was tabulated on excel sheet and statistically analysed using Chi square test for comparison within and between the groups. There was no statistically significant difference in the pre and post-operative pain scores between O, A, and B groups (p=0.49 & 0.473 respectively). There was no statistically significant difference in pre and post-operative pain scores within the groups. (p= 0.165, 0.755, 0.446 for O, B and A respectively).

Conclusion: Based on the results of this preliminary study, it can be concluded that there was no association between severity of pain and blood groups. Further analysis needs to be done to check for the influence of other individual variables on pain score.

  Abstract 72: Efficacy of ultrasonics in root canal irrigation: An umbrella review Top

Anirudhan Subha, Chinni Suneelkumar1

Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India, 1Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Aim: To provide a clear evidence-based decision on efficacy of ultrasonic irrigation during nonsurgical root canal treatment.

Methods: The research question was based on the PICO format 'Does the use of ultrasonic irrigation (I) provide a better treatment outcome (O) when compared to other irrigation devices (C) in adult patients undergoing root canal treatment (P)?'. A protocol for this umbrella review was registered in PROSPERO (CRD42020169677). A search of Pubmed/Medline, Cochrane, Epistomonikos, Science Direct and JBI Database of Systematic Reviews was done to identify the reviews. Manual search of references of selected articles was also done. The standardized JBI data extraction tool was used to extract data from included reviews. “JBI critical appraisal tool” consisting of 11 items for evaluation of methodological quality of systematic reviews was used by two reviewers independently.

Results: 356 abstracts from database and manual search articles were screened following which 18 full-text articles were assessed. Finally, six systematic reviews were included for the present umbrella review. The number of studies included in each systematic review ranged from 3 to 48 and included samples ranged from 152 to 1436. Four reviews compared ultrasonic irrigation with syringe irrigation, and other two reviews compared ultrasonic irrigation with sonic, Endovac and syringe irrigation. With the JBI methodological quality tool, four reviews scored 'Yes' for all 11 quality indicators, one review scored 'Unclear' in one domain and one review scored 'unclear' in two domains. Only two reviews conducted a meta-analysis on canal disinfection of randomized trials.

Conclusion: Ultrasonic irrigation provides similar outcome in root canal disinfection compared to other irrigation methods. The use of continuous ultrasonic irrigation achieves better post-operative pain reduction when compared to syringe irrigation.

  Abstract 73: Comparison of postoperative pain following single visit and multi visit root canal treatment in diabetic and nondiabetic patients with irreversible pulpitis: In vivo study Top

Koshy Minu, Varghese Remya, CS Anagha1

Sri Ramakrishna Dental College and Hospital, Coimbatore, 1JKK Natraja Dental College, Komarapalayam, Tamil Nadu, India

Aim: The Aim of this study is to evaluate and compare the pain following obturation in single visit and two-visit endodontic therapy in controlled Type II Diabetes Mellitus patients and Non Diabetic individuals.

Materials and Methods: 90 patients with irreversible pulpitis (30 type II Diabetic (Group A) and 60 Non-Diabetic patients (Group B)] were included in this study. Each group was further subdivided into two subgroups; single visit (subgroup A) and two visit (subgroup B) by using a set of random numbers. The standard procedures performed for both the groups during the first visit included administration of local anesthesia, rubber dam isolation, and standard access cavity preparation. Canals were prepared using hand files (K files, Mani) and ProTaper (DENTSPLY) rotary Nitti files using the hybrid technique. Teeth in single visit group were obturated in the initial appointment using gutta-percha and ZOE sealer and those in two visit group were recalled for the second appointment one week later for obturation. The evaluation of post obturation pain was done at 6h, 12h, 24h, 48h, 72h and 1week with visual analogue scale (VAS) and converted to numerical rating scale. The results were statistically analyzed using chi-square test, Kolmogorov Smirnovtest and Shapiro-Wilk tests.

Results: Type II controlled diabetic patients with irreversible pulpitis experienced more pain after single visit root canal treatment in the first 12 hours when compared to non-diabetic patients. Though the incidence of pain was more in diabetic group after single visit root canal treatment, there was no statistically significant difference in overall pain experienced by single visit and two-visit in diabetic group

Conclusion: Within the limitations of the study, it can be concluded that in diabetic patients with good glycemic control, the disease does not effect the post-operative pain after single or two-visit root canal treatment. Therefore it may not be necessary to modify routine root canal treatment plan for controlled diabetic patients compared to healthy non-diabetic patients.

  Abstract 74: Two palatal canals in maxillary first molar: An underestimated truth Top

Velayudham Sekar, Bakthavatchalam Balakrishnan, Kavitha Mahendran, Nandhakumar Jayavel, Annapurani Ramdhas, Gokul Nath Muniyandi Udhayakumar

Tamil Nadu Government Dental College, Chennai, Tamil Nadu, India

A clear understanding of the root canal anatomy is an essential pre-requisite to achieve successful root canal treatment outcomes. Failing to detect the aberrant canals is one of the main causes for endodontic failures. Maxillary molars have one of the most complex root canal anatomies. The incidence of aberrant canals in Mesiobuccal (MB) root is 69.6 % & Distobuccal (DB) is 39 % whereas the occurrence in palatal root is 2 to 5 %. Eventhough there are several studies swaggering upon the canal aberrancies in MB & DB roots, only a very few articles are available for unperceived palatal root aberrancies. In this case series we will highlight four patients with following findings. Case (1) 2 Mesiobuccal, 2 Distobuccal, 2 Palatal canals. Case (2) 2 Mesiobuccal, 1 Distobuccal, 2 Palatal canals Case (3) 2 Mesiobuccal, 1 Distobuccal, 2 Palatal canals.. Case (4) 1 Mesiobuccal, 1 Distobuccal, 2 Palatal canals were found. All 4 patients had 2 palatal canals merging at the apex (Vertucci type II) in common. During the clinical evaluation all these patients gave suspicious findings like oversized crown and increased mesiodistal width of palatal root on radiograph. Access opening was done circumspectically for grappling the 2nd palatal canal which were successfully managed. The occurrence of 2 palatal canals in maxillary first molar could be much more than estimated. Since only a few case reports are available more studies including staining and clearing techniques, root sectioning are required in future among Indian population to ascertain exact prevalence of 2 or more palatal canals.

  Abstract 75: Assessment of the quality of root canal obturation by three different sealers using micro-computed tomography Top

Neetha Shenoy, Karthik Shetty1

Manipal College of Dental Sciences, Affiliated to Manipal Academy of Higher Education, Manipal, 1Manipal College of Dental Sciences, Affiliated to Manipal Academy of Higher Education, Mangalore, Karnataka, India

Aim: The present study aimed to evaluate the quality of root canal obturation by three different sealers: Kerr pulp canal sealer, GuttaFlow2 sealer and BioRoot RCS in-vitro under Micro Computed Tomography, focusing on the presence of voids in obturation.

Materials and Methods: Thirty freshly extracted single-rooted anterior teeth with a single canal system were selected for the study. They were decoronated to obtain a uniform root length of 14 mm. The root canals were chemomechanically prepared using ProTaper Universal rotary files (Dentsply, Maillefer). Specimens were assigned into three groups based on the three sealers used. Each specimen was then scanned using a Micro Computed Tomography device. Three-dimensional reconstruction and volumetric analysis was done using Thermo Scientific™ Amira-Avizo software following which, the proportion of sections with voids and the percentage volume of voids were calculated. The data were statistically analyzed using one-way ANOVA and Tukey's Post Hoc test to determine any significance (P<0.5).

Results: The Micro CT evaluation showed no significant difference between the three groups in the proportion of sections with voids. However, BioRoot RCS group showed the lowest percentage volume of voids which was statistically significant (P<0.5) compared to the other groups and the Guttaflow2 sealer group showed the highest mean percentage volume of voids.

Conclusion: GuttaFlow2 sealer exhibited more percentage of volume of voids compared to other two groups. BioRoot RCS exhibited the lowest percentage of the volume of voids compared to other groups, thus producing more dense and homogeneous obturation.

  Abstract 76: Postoperative pain following root canal treatment: An observational study Top

Rangappa Anithakumari, Nivedhitha Mallisureshbabu1

V.S. Dental College and Hospital, Bengaluru, Karnataka, 1Saveetha Dental College, Chennai, Tamil Nadu, India

Aim and Objectives: Aim and objective is to evaluate the incidence of post obturation pain 48 hours following root canal treatment in patients with pulpal and periapical diseases and correlate the pain with different variables.

Methodology: The study was conducted on 100 patients with multi rooted teeth with pulpal and periapical diseases undergoing Root canal treatment. Age, gender, maxillary or mandibular teeth, diagnosis of pulpal and periapical disease, medications taken and pre-operative pain before obturation were recorded for each patient. The presence or absence of post obturation pain for 48 hours following RCT was recorded. Data were analysed using Descriptive statistics with Chi square test by using SPSS 20.

Results: Post-op pain was present in 19 Male and 20 Female patients. 12 patients in 15-30 years, 21 patients in 31-50years and 6 patients in more than 50years of age group reported post-op pain. 10/22 in Asymptomatic Apical Periodontitis, 15/27 in Symptomatic Apical Periodonditis, 3/15 of Symptomatic Irreversible Pulpitis and 11/36 in Asymptomatic Irreversible Pulpitis reported post-op pain. 21 mandibular teeth out of 50 and 18 Maxillary teeth out of 50 reported post-op pain. 10/46 patients who had taken analgesics before treatment and 22/41 patients who had not taken analgesics before reported post-op pain. 22patients out of 46 patients who had pain before the treatment and 13 patients out of 53 patients who didn't have pain before treatment had reported post-op pain.

Conclusion: 35% of patients experienced post-op pain,48 hours following Endodontic treatment. Post-op pain was less in patients who had taken analgesics before root canal treatment. Patients who had pain before root canal treatment had high incidence of post-op pain than who didn't have pain.

  Abstract 77: Long term follow-up evaluating treatment outcome of regenerative endodontic procedure in an immature permanent mandibular premolar using three-dimensional imaging: A case report Top

saummya Singh

Institute of Dental Sciences, Bareilly, Uttar Pradesh, India

In recent times, compared to the several endodontic treatment options like apexification or apical barriers, available for an immature permanent tooth with pulpal necrosis, regenerative endodontic procedures (REP) have evolved as a promising treatment modality. Despite the technical challenges confronted with REP, the benefit of being minimally invasive, having the ability to stimulate further root development and chances of gaining pulp vitality are the sole reason for this change. Moreover, the advent of modern amenities like three–dimensional radiographic imaging have provided with standardization of radiographic images and thus, better quantification of data, thereby providing ease to evaluate the changes occurring in the radicular area of teeth treated with REP. This case report presents the long term clinical and radiographic treatment outcome of regenerative endodontic procedure in an immature permanent mandibular premolar. The tooth was treated by standard revascularization protocol using sodium hypochlorite, ethylene diamine tetra acetic acid, triple antibiotic paste and minimal instrumentation, followed by mineral trioxide aggregate and composite placement to achieve coronal seal. Clinically, tooth survival, resolution of signs and symptoms and responsiveness to pulp vitality tests were assessed. Radiographically, apical closure, changes in root length and root thickness were quantified using three dimensional imaging over a follow up period of 30 months from baseline. The follow up showed complete resolution of clinical signs and symptoms and continued root development evaluated through 3D imaging.

  Abstract 78: Antibiofilm potential and substantivity of a polyhexanide solution as a root canal irrigant: A laboratory study Top

Vineeta Nikhil

Subharti Dental College, Meerut, Uttar Pradesh, India

Background and Introduction: Enterococcus faecalis is the most commonly isolated organism in endodontically failed cases. Eradication of root canal flora is limited by the complex anatomical structure of the root canal system and existence of bacteria in biofilm. Chemomechanical preparation stays as the cornerstone of root canal therapy to reduce bacterial burden and achieve a sterile root canal space. Current root canal irrigants have limited efficacy against bacteria in biofilms. Hence, this study was aimed to evaluate the antimicrobial activity, antibiofilm potential and substantivity of a polyhexanide based root canal irrigant.

Methodology: The study involved determination of minimum inhibitory concentration of polyhexanide using criteria's laid down in DIN 58940-7 and 58940-8 and the corresponding supplementary sheets. Serial dilutions of PHMB were tested against E. faecalis in 96-well microtitre plates and MIC was read as the minimal concentration that allowed no visible growth. An Enterococcus faecalis biofilm was developed on extracted human root canal samples and subjected to treatment with three different irrigants- 0.2% polyhexanide, 2% chlorhexidine and 5% sodium hypochlorite. Bacterial viability was checked using 'Live and Dead BacLight bacterial viability kit' and observed using confocal laser scanning microscope. To evaluate and compare the substantivity of 0.2% polyhexanide and 2% chlorhexidine on root canal dentin, dentin disks were prepared and substantivity after 1 hr, 6 hr, 7 days and 21 days was measured using spectrophotometry. The data so obtained was statistically analysed.

Results: The results of this study indicated that 24 hr minimum inhibitory concentration of polyhexanide against Enterococcus faecalis is 0.2%. At this concentration, it was found to possess significantly higher anti-biofilm activity than 2% chlorhexidine and 5% sodium hypochlorite and significantly greater substantivity than 2% chlorhexidine.

Conclusion: Within the limitations, this study supports the use of 0.2% polyhexanide as endodontic irrigant to eliminate Enterococcus faecalis biofilms from root canal space.

  Abstract 79: “OSX” A new horizon in regenerative endodontics: A review Top

Jayakumar Srilekha

Sri Venkateshwaraa Dental College, Ariyur, Puducherry, India

Development of tooth is a complex process that is coordinated precisely by several signalling pathways and transcription factors. Tooth formation occurs from oral epithelium and underlying mesenchymal cells. A string of epithelial-mesenchymal cross-talks and interactions occur, which regulate tooth morphogenesis and differentiation of cell types that are specific for tooth formation. Formation of crown is mastered with the interaction between the dental lamina and the mesenchyme located in the dental papilla. The extension of Hertwig's epithelial root sheath (HERS) following crown formation is responsible for root development. The signalling molecules to promote the differentiation of mesenchymal cells are hidden in the HERS which is the main knob for root formation. The crown is formed early embryonically, whereas the root is formed through the later embryonic to the postnatal stage. This indicates a significant genetic difference exist between root and crown dentin formation. Osterix (Osx), a zinc finger-containing transcription factor, constitute of 431 amino acids including a Smad-binding domain and a proline-rich region. Osx was first discovered and considered as a bone morphogenetic protein-2 inducible gene in mesenchymal stem cells. Osterix plays an essential role in both bone and tooth formation and is recognized to be a downstream target of Runt-related transcription factor 2 (Runx2). Recently, unique role of Osx in tooth root formation has been extensively studied. Runx2 and Osx are both highly expressed in the dental mesenchyme at early stages when the crown develops. However, from the bell stage to postnatally, only Osx was expressed (i.e during root development) while the expression of Runx2 declined. Hence Osx influence the root dentin formation rather than crown dentin. Osterix is vital transcription factor that regulates odontoblast cell differentiation and recent studies also suggest Osx has a considerable role in cementoblast differentiation. Understanding the tooth developmental process and the role of essential regulators and transcription factors will pave the way for regeneration of dental tissues. Understanding the role of Osx and promoters (Teriparatide, Simvastatin, Berberine, Osthole, Vitamin C) that increases the Osx expression would provide a promising future in Regenerative Endodontics.

  Abstract 80: Artificial intelligence: A promising pathfinder for endodontic future ahead Top

Chokkalingam Manivasagam

Private Practitioner, Salem, Tamil Nadu, India

Artificial Intelligence along with the field of Robotics, Virtual reality, Data science, Big Data and IoT has greatly influence the contemporary research in the field of medicine and dentistry. This has been aptly documented by the spurt of articles in the corresponding fields throughout the world. The field of Endodontics is no exception. The application of Artificial Intelligence can be widespread ranging from diagnosis, anomaly detection, treatment planning, decision making, improvement of instrumentation, outcome of treatment and patient care. Machine Learning algorithms either individually or as an ensemble techniques have been effectively utilized in providing answers to the long standing problems faced by the clinicians in day to day dentistry. This review paper describes the current developments in the field of artificial intelligence with respect to Endodontics and explores the scope of promising future that lies ahead.

  Abstract 81: Current and future perspectives of photodynamic therapy with nanoparticles for endodontic disinfection: A review Top

Smitha Reddy, Thakur Veerandar Singh

Sri Sai College of Dental Surgery, Vikarabad, Telangana, India

The presence of biofilms in conjunction with the complex nature of root canal system, pose a significant challenge for root canal disinfection. Considerable research has been done to effectively disinfect the root canals for eradicating biofilms without inducing bacterial resistance. Some effective and advanced methods include use of antimicrobial photodynamic therapy, nanoparticles, ozone, herbal and enzyme alternatives. Photosensitizers used in conventional photodynamic therapy have certain limitations like restricted penetration depth. Nanoparticles are found to be ideal carriers of photosensitizers. Recent data reveals that combination of nanoparticles with photosensitizer molecules has found to give promising results. The review will focus on significant potential of photodynamic therapy using nanoparticles for endodontic disinfection and future outlooks in nanosized-platforms design and performance.

  Abstract 82: Interdisciplinary management of a severely dilacerated impacted maxillary incisor: A case report Top

Pooja Dudeja

ESIC Dental College and Hospital, Rohini, New Delhi, India

Unerupted maxillary incisors have a major impact on dental and facial aesthetics and tend to adversely affect the orofacial, nutritional and psychosocial well-being of the patient. One of the causes of permanent central incisor eruption failure is crown or root dilaceration. A dilacerated tooth can lose its eruptive pathway, becoming ectopic and even unerupted. A broad range of treatment options employed for dilacerated teeth includes surgical extraction accompanied by orthodontic space closure or fixed prosthesis, auto-transplantation or forced eruption using a surgical-orthodontic approach. Orthodontic traction following surgical exposure accompanied by endodontic therapy has proved to be a viable treatment option in carefully/appropriately selected cases. Despite being a favoured/preferred treatment option, the orthodontic management of an impacted incisor with severely dilacerated root often poses a diagnostic, management and prognostic challenge to the clinician. It requires an interdisciplinary approach with meticulous treatment planning. This is because the risks of ankyloses or eruption in an awkward/inappropriate position with compromised aesthetic results are often involved. Moreover, penetration of the labial cortical plate by the curved root, loss of attachment or external root resorption are other unfavourable sequelae compromising the aesthetic and functional results. These potential complications further compound the challenging dis-impaction process and adversely affect the patient's compliance. The main purpose of this presentation is to report the interdisciplinary strategies adopted for successful management of a horizontally upward impacted and severely dilacerated maxillary central incisor. The patient was treated by surgical exposure combined with orthodontic traction and endodontic therapy. Furthermore, guidelines for obtaining desirable outcomes with endodontic management are proposed.

  Abstract 83: Influence of cavity design and ceramic material on the stress distribution patterns in endodontically treated maxillary first premolars: A three-dimensional finite element analysis Top

Vemparala BP Suryakumari, Y Pallavi Reddy

Government Dental College and Hospital, Hyderabad, Telangana, India

Aim: The aim of this study was to evaluate stress distribution patterns in endodontically treated maxillary first premolars restored with ceramic Onlays of Conventional and Conservative designs.

Methodology: A 3Dimensional Model of Endodontically treated Maxillary First premolar was generated from a CBCT scanning of an extracted sound Maxillary first Premolar. A Standardised Endodontic Access cavity design with dimensions of mesiodistal width 3mm, buccolingual width 5 mm and depth of 6 mm was simulated. Four models based on the design of Onlay – Conventional and Conservative designs and the ceramic materials tested - Lithium di silicate and Leucite were generated from the above model. A total load of 200N divided as 40 N each at five specified points on occlussal surface was applied perpendicular to the occlusal surface. The von Mises stresses and Minimal principal stresses generated in the tooth as well as the Onlay restoration were evaluated for both the designs and materials tested.

Results: The von Mises stresses generated in tooth (Enamel, Dentin and Cementum) were lesser for Conservative design as compared to Conventional design for both the ceramic materials. The Minimal principal stresses in Enamel were similar for both the designs and materials analysed. The distribution and magnitude of von Mises stresses in the Onlay were similar in both the Conventional and Conservative Onlay designs restored with both the Ceramic materials. The von Mises and Minimal Principal Stresses generated in Conservative Onlay was 39.2 MPa and 37 MPa for Lithium Di Silicate and Leucite Ceramics respectively as against Conventional Onlay of 21.1 and 19.3 MPa respectively for Lithium Di Silicate and Leucite Ceramics.

Conclusion: Within the limitations of the present study the stresses generated were within the allowable range of Yield stresses for all the models tested. Thus at the load tested, Ceramic Onlays both Conventional and Conservative designs prove to be a promising permanent Post endodontic restoration for Maxillary First Premolars emphasizing the preference of Onlay over Full crown.

  Abstract 84: Role of antibiotics in single - visit root canal treatment: A prospective randomized double blind, placebo controlled crossover study Top

Neha Mehra, Mamta Kaushik, Neha Prashar, Chandrakanth Majeti, Roshni Sharma2

Army College of Dental Sciences, Secunderabad, Telangana, 1Armed Forces Medical College, Pune, Maharashtra, 2Clinican, Mysore, Karnataka, India

Aim: This prospective randomized controlled trial aimed to evaluate the role of antibiotics in controlling post-operative pain/flare-up following single-visit root canal treatment.

Materials and Methods: Twenty-five patients reporting to the Department of Conservative Dentistry and Endodontics, with bilateral posterior teeth with symptomatic irreversible pulpitis, pulpal necrosis, apical periodontitis, periradicular pathology who met the inclusion and exclusion criteria, were recruited for this study after obtaining written informed consent. Single visit root canal treatment was performed by a single operator at a gap of three weeks between the two sides. Any tooth meeting complications of working length over-estimation, overfilling, or sealer extrusion was excluded from the study. Every patient was prescribed 600 mg of ibuprofen three times a day for two days besides the test medicine. The pharmacist dispensed the test and pain medications to the patients in sealed containers as per their random allocation. Patients were instructed to mark the pain intensity on Heft-parker Visual Analogue Scale at 6 hrs, 1 day, 3 days and 5 days after endodontic treatment. The data was tabulated in a structured format. The independent student's -test and one- or two-way variance test were used to compare the continuous variables between groups. Chi-square was used to compare frequencies of categorical variables. Differences were considered significant when probabilities were less than 0.05.

Results: There was no statistical significant difference (p > 0.05) between the two groups with respect to age, gender, tooth type and pulpal and periradicular disease. The groups were considered homogenous and the results were compared. The success rate for single visit root canal therapy was 90.4% and 85.7% in antibiotic and placebo groups respectively, which was not a statistically significant difference (p > 0.05).

Conclusion: This study presents evidence verifying that antibiotics do not contribute to the success/ failure of single visit root canal treatment. The secondary observation was that preoperative pulpal diagnosis is an important criteria influencing case selection for single visit root canal treatment.

  Abstract 85: Granulomas or cysts …………are you sure? Top

Kavita Dube

Hitkarini Dental College, Jabalpur, Madhya Pradesh, India

A 38 year old male patient reported to the Endodontic clinic with discolored upper front tooth. On examination the tooth no. 21 was discolored with history of endodontic treatment. The Endodontic treatment was carried out about 15 years back. The labial gingiva adjacent to 21 appeared thickened. Preliminary investigations with digital radiographs and CBCT scans revealed a hypo dense lesion with embedded bony spicule /filling material labial to maxillary left central incisor. A provisional diagnosis of Granuloma? was made and the treatment plan included orthograde retreatment followed by Endodontic surgery to remove the lesion. The patient refused any invasive treatment, however he returned back after 2 years with no change. Orthograde Endodontic retreatment was carried out and Endodontic surgery performed. The lesion was excised/ curetted and sent for routine Histopathology reporting(HPR). The HPR showed epithelial islands suggestive of a neoplasm and the blocks were further evaluated by Immunohistochemistry which was positive for CK7 and S100 and a diagnosis of mucinous carcinoma favoring primary mucosal origin was established. The findings of this case emphasize the fact that routine submission of biopsies is required to establish a specific diagnosis anytime a tissue is removed from the surgical site. In addition to dictating further management HPR helps to rule out uncommon lesions.

  Abstract 86: Intrapulpal tranexamic acid to arrest bleeding on access cavity preparation: A randomised controlled trial Top

Roshni Roshni, Mamta Kaushik1, Neha Mehra1

Private Practice, Mysore, Karnataka, 1Army College of Dental Sciences, Secunderabad, Telangana, India

Aim: Bleeding from the pulp on access cavity preparation is common, especially in multi-rooted molars. This hinders visibility, confounds orifice location and extirpation of pulp. Irrigation with sodium hypochlorite and local anesthetic solutions are currently used in overcoming this problem with inconsistent success and safety profile. Exhaustive medical research has established the safety and efficacy of topical application of hemostats like Tranexamic acid. However, it's application in the pulp chamber or root canal has not been studied. The primary objective of this clinical trial was to evaluate hemostatic effect of Tranexamic acid (TX) on pulp during access preparation and instrumentation in molars Secondary objective was to compare the hemostatic effect of Tranexamic acid with Sodium hypochlorite (NaOCl) and Local anaesthetic (LA).

Methodology: Inclusion criteria Patients with pulpal bleeding on access preparation. Exclusion criteria Medical contraindication to usage of TX No pulpal bleeding on access preparation Single-arm pilot established the effect and clinical procedure for use of Tranexamic acid. Subsequently, a randomized controlled study compared the equivalence of TX with NaOCl and LA.

Results: Single arm trial involving 44 patients indicated at 95% Confidence Interval with P 0.0008 that TX significantly stops bleeding upon access irrespective of age, gender or bleeding status. Randomized controlled trial on 49 patients established the equivalence of TX to NaOCl and LA in controlling hemorrhage from the pulp.

Conclusion: 1a. Topical application of 0.3 ml, 0.1%, Tranexamic acid solution soaked in sterile cotton pellet for 5 minutes stops pulpal bleeding from molars. b. Tranexamic acid reapplied in increments of 0.2 ml with a cotton pellet controls bleeding on re-instrumentation. 2. Tranexamic acid is equivalent to Sodium hypochlorite and local anesthetic in controlling pulpal bleeds. 3.Future research can investigate the use of Tranexamic acid to control bleeding in vital pulp therapy The trial is registered with CTRI with number CTRI/2018/01/011557 and has not received any funding.

  Abstract 87: Scanning electron microscopic analysis of white mineral trioxide aggregate - dentin interface following contact with 3% sodium hypochlorite, 2% chlorhexidine and 17% ethylenediaminetetraacetic acid Top

Raghu Sandhya

Saveetha Dental College and Hospital, SIMATS, Chennai, Tamil Nadu, India

Aim: To the analyze the WMTA dentin interface following contact with 3% sodium hypochlorite, 2% Chlorhexidine and 17% EDTA.

Materials and Methods: 16 freshly extracted human mandibular premolars were collected. The teeth were sectioned buccolingually to obtain 32 root dentin samples. 1 mm depth and 1 mm diameter cylindrical cavities were prepared on the root dentin and restored with WMTA. 32 samples were randomly divided into four groups. Group A – 3% Sodium hypochlorite (n=10), Group B – 2% Chlorhexidine (n=10), Group C – 17% EDTA (n=10), Group D – Distilled water (n=2). Each group had two sub groups. The samples were placed in the test tube with corresponding solution for 5 minutes. Subgroup 1 (A1, B1, C1, D1) were placed in the test solution at 24 hours, subgroup 2 (A2, B2, C2, D2) were placed at 48 hours, respectively. The samples were subjected to SEM analysis to measure the gap between WMTA – dentin interface. The data was statistically analyzed using one – way ANOVA.

Results: The gap at WMTA-dentin interface was identified in all the groups at 24 hours and 48 hours. At 24 hours, WMTA – dentin interface was measured to be 1.92+_61 μm (A1), 6.63+_ 3.7 μm (B1), 25.9+_ 9.27 μm (C1), 1.77 μm +_0.8 (D1). P < 0.05, significant. At 48 hours, the interface was measured to be 2.16+_0.81 μm (A2), 1.63 +_ 0.72 μm (B2), 3.39 +_ 1.1 μm (C2), 1.02 +_ 0.3 μm (D2). P < 0.05, significant.

Conclusion: Within the limitations of the study, it can be concluded that gap between WMTA – dentin interface was identified in all the groups. At 24 hours, the gap formation was maximum when exposed to 17% EDTA followed by 2% chlorhexidine, 3 % sodium hypochlorite. At 48 hours, the maximum gap was identified with 17 % EDTA, followed by 3% sodium hypochlorite, 2% chlorhexidine. There was significant reduction in the gap formation when exposed to 2% chlorhexidine and 17% EDTA after 48 hours.

  Abstract 88: Polymeric nano-biomaterials: A boon in regenerative endodontics Top

N Sridevi

Rama Dental College, Hospital and Research Center, Kanpur, Uttar Pradesh, India

Regenerative dentistry signifies a new method including biomaterials, several molecules and mesenchymal stem cells, partly derived from oral tissues. There are different varieties of scaffolds used in regenerative endodontic therapy like host-derived, naturally-derived, and manufactured scaffolds. Nanomaterials have a beneficial role in fabricating tissue engineering scaffolds due to great surface area and surface energy. Application of nano-scaffolds for pulp regeneration is another use of nanotechnology in endodontics that creates impressive development in reconstruction of pulp structure. Different polymeric nanoparticles have different advantages and disadvantages but the point is the superiority of nanomaterials in comparison with conventional ones. Using polymeric nanoparticles is a new concept in endodontics' procedures, which could take part as a promising method rather than conventional root canal therapy. There are several types of nanoparticles: Polymeric nanoparticles, ceramic nanoparticles, silica nanoparticles, metallic nanoparticles, magnetic nanoparticles, carbon nanoparticles, liposome nanoparticles. Two main divisions in nanoparticles are organic and inorganic nanoparticles. Polymeric nanoparticles were covered in both groups. Numerous studies have discussed the polymeric nanoparticles and their benefits in dentistry and endodontics. This review paper describes the application of polymeric nanoparticles in regenerative endodontic therapy.

  Abstract 89: Platelet concentrates in pulp-dentin complex regeneration: Appraisal of available evidence Top

Rolly Agarwal

Index Institute of Dental Sciences, Indore, Madhya Pradesh, India

Regenerative endodontics is a therapeutic aid in addition to the conventional treatments for management of deeply carious and damaged teeth. Direct pulp capping is a healing procedure intended to preserve pulp vitality by applying a biocompatible material over the area of exposure during the removal of dental caries or accidental trauma. Recently, platelet concentrates like concentrated growth factor (CGF) and platelet- rich fibrin(PRF) are being increasingly used in dentistry. Their utilisation is based on their ability to stimulate odontoblastic differentiation, leading to reparative dentin formation. This review is focused on the use of platelet concentrates in vital pulp therapy and discusses the acceptance and challenges for utility in clinical endodontics.

  Abstract 90: An ancient remedy with a modern touch! Antibacterial efficacy of various solutions as endodontic irrigants against clinical isolates of porphyromonas gingivalis in endodontic - periodontal lesions Top

Drisya Soman, Moksha Nayak1, L Krishna Prasada1, G Praveena, Mahesh Chandra Mohan, V Krishnan2, Radhakrishnan Nair, Nisha B Kurup

Azeezia College of Dental Sciences and Research, Kollam, 2Amrita School of Dentistry, Kochi, Kerala, 1KVG Dental College and Hospital, Sullia, Karnataka, India

Aim: To compare and evaluate the antibacterial efficacy of 5.25% of Sodium hypochlorite, Microcyn superoxidized solution, and Arimedadi ayurvedic preparation as endodontic irrigants against Porphyromonas gingivalis detected from root canals of patients with endodontic-periodontal lesions.

Materials and Methods: Root canal samples from patients with endodontic-periodontal lesions requiring endodontic treatment were collected and placed in reduced transport media for identification of P.gingivalis and antibacterial sensitivity testing. Fifteen root canal samples positive for P.gingivalis species confirmed by culture were considered for the study. Endodontic irrigants to be evaluated for antimicrobial activity against P.gingivalis were divided into four groups: Group 1: 5.25% Sodium hypochlorite, Group 2: Microcyn super oxidized solution, Group 3:Arimedadi ayurvedic preparation and Group 4: Metronidazole (Control). Antimicrobial assay against isolated pathogenic strain of P.gingivalis was performed by Kirby Bauer disc diffusion method. After 24 hours of incubation, each plate was examined for inhibition zones. The results were assigned and statistical analysis was performed using Chi-Square test, Kruskal Wallis test, and Mann Whitney U test. (P < 0.05).

Results: All three tested irrigants exhibited antibacterial sensitivity against P. gingivalis in patients with endodontic–periodontal lesions. Metronidazole control group showed the maximum antibacterial sensitivity with a mean inhibition zone of 51.87mm. Sodium hypochlorite of 5.25% concentration exhibited larger inhibition zones of 16.47mm followed by Arimedadi ayurvedic preparation (10.67mm) and Microcyn superoxidized solution (2.27mm).

Conclusion: Sodium hypochlorite of 5.25% concentration still remains one of the most promising endodontic irrigant. Arimedadi ayurvedic preparation revealed acceptable efficacy to eradicate P.gingivalis in endodontic-periodontal lesions while Microcyn superoxidized solution exhibited the least antibacterial efficacy against P.gingivalis. Overall, results revealed the probable use of natural products as economical and suitable adjuvant to synthetic medicines and compounds. Judicious dealing of such natural products not only help to inhibit the side effects of synthetic chemicals but also prove to be cost effective, especially in developing economics.

  Abstract 91: Retrieval of a tooth from inside the tooth: Endodontic management of dens in dente Top

Praveena Geetha, Mahesh Chandramohan, Drisya Soman, Meenu Madhukumar1

Azeezia College of Dental Science and Research, Kollam, 1KIMS Health, Thiruvananthapuram, Kerala, India

Dens invaginatus is a developmental malformation occuring due to an infolding of enamel organ into the dental papilla. Teeth with such complex root canal morphology often require a specialised treatment approach to achieve a predictable treatment outcome. Endodontic clinical management of a tooth with dens invaginatus might include using cone-beam computed tomography (CBCT) to aid in the diagnosis and treatment-planning phase and use of the dental operating microscope in performing the clinical phase of treatment. This case report describes management of a Oehlers Type III B Dens in dente in a permanent maxillary right lateral incisor with a large periapical lesion in a 50 year old female. A limited FOV Cone beam computed tomography (CBCT) was performed in order to visualize the full extent of the morphology of the root and the large periapical lesion.Nonsurgical endodontic treatment was performed with the aid of a dental operating microscope. Final segment of invagination was removed like a root stump from inside the tooth.A biodentine apical seal was given and the tooth was reinforced with multiple fiberpost and resin cement.A 12 months follow up showed satisfactory healing.

  Abstract 92: Evaluation of the root and canal morphology of the maxillary first premolars in an Indian dravidian subpopulation using cone-beam computed tomography Top

Karthik Nath, Karthik Shetty

Manipal College of dental sciences, Mangalore, Karnataka, India

Aim: To analyse the root morphology and canal configuration of the maxillary first premolars in an Indian Dravidian Subpopulation using Cone Beam Computed Tomography.

Materials and Methods: A retrospective analysis of 200 CBCT records and total of 400 maxillary first premolars was carried out in which the number of roots as well as root canal configuration in accordance with Vertucci's classification was studied. The differences and frequency in the root number and canal anatomy was statistically interpreted using the Student's T test with the significance level set at p < 0.05.

Results: Of the 400 maxillary first premolars, 116 teeth (29%) displayed single root morphology while 284 teeth showed two roots (71%).There was an overall predominance of type I (74.8%) followed by type IV (20.6%) configurations among the studied teeth., while Types I, III, and V configurations were in sparse occurrence. The study of the individual canal configurations in the two-rooted Maxillary first premolars revealed a complete presentation of Type I configuration in 100 % of the canals whereas among the single-rooted teeth, 53.4% had type II configuration, 20.6% presented ype IV and type I configuration was seen in 12.9% of the teeth. Types III and V configurations together were observed in 12.83% of the teeth. Assessment of the right and left teeth did not show any significant difference in terms of single rooted first premolars (p>0.05) or the double-rooted first premolars (p>0.05). The overall Kappa value for inter-examiner agreement was 0.89 indicating a very good agreement between the two examiners.

Conclusion: The maxillary first premolars studied predominantly showed the two rooted morphology with independent canals in each root. There was no significant difference between the teeth on either side of the same arch.

  Abstract 93: Platelet-rich fibrin mediated regenerative treatment of an immature apex in mandibular premolar with dens evaginatus and chronic periapical lesion: Clinical case report with histological analysis Top

Abhishek Mysore Anil, Preetesh Shetty1, Raksha Bhat1, Aditya Shetty1, Mithra N Hegde1, Namrata Khanna2

Clinician, Bengaluru, 1A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, 2Clinician, Pune, Maharashtra, India

A 26 year old male patient with history of incomplete root canal treatment (1 year since initial treatment) of mandibular left second premolar, reported for completion. Radiographic examination revealed thin-walled immature root with huge periapical radiolucency and dense intracanal radiopaque material. Clinically, the tooth was buccally tilted with severe lingual gingival recession, loss of lingual cortical plate, but no signs of mobility. Diagnosis of dens evaginatus with chronic periapical granuloma was made. Treatment options were discussed. Patient decided to save the tooth as it served as an abutment for removable prosthesis, until a permanent replacement was planned. The existing restoration was removed, and canal flushed with low concentration sodium hypochlorite and saline, to effectively remove old intracanal medicament. No instrumentation was done to preserve remaining dentin thickness. Instead, passive ultrasonic irrigation was performed for debridement. Calcium hydroxide-iodoform paste was placed, and access cavity sealed with PTFE and temporary restorative material. After a month, the canal was flushed with saline and 17% EDTA, and activated as earlier. Radiograph revealed marked reduction in lesion size. Modified triple antibiotic paste (cefaclor instead of minocycline) was placed in canal using lentulospirals. The patient was recalled after 3 weeks. Whole blood was collected and centrifuged to obtain platelet-rich fibrin clot. Canal was irrigated with 17% EDTA. A thin, sharp spreader was inserted beyond apex to induce bleeding. PRF clot was placed inside the canal, and ProRoot MTA (Dentsply, Tulsa Dental, OK, USA) was placed directly over PRF clot. The tooth was restored permanently with glass ionomer and fibre reinforced composite. The 14 and 20-month follow-up radiographs revealed thickening of dentinal walls, partial closure of apex and reduction in periapical bone defect, with positive response to pulp tests. The tooth was extracted for placement of implant, and specimen sent for histological analysis. 1 year follow-up of implant placement (44 months since root canal treatment was initiated) revealed rebuilt bone architecture and stable implants. Regenerative endodontics has paved a biological way to repair and replace lost tissues and additionally, in this case, create a favourable environment for the placement of implants without the need for bone graft.

  Abstract 94: Comparative evaluation of cytotoxicity and antimicrobial efficacy of a novel herbal sodium hypochlorite, herbal mixture, freshly prepared sodium hypochlorite, commercially available sodium hypochlorite Top

Saritha Vallabhaneni

PMNM Dental College, Bagalkot, Karnataka, India

Aim: Evaluation of cytotoxicity and antimicrobial efficacy of a novel herbal sodium hypochlorite, herbal mixture, freshly prepared sodium hypochlorite, commercially available sodium hypochlorite.

Materials and Methods: Eighty extracted human single rooted anterior teeth with matured apices were selected. They were then immersed in saline solution till use. Clinical crowns were cut at cementoenamel junction. The root canals were prepared using protaper rotary files till F2 as the master apical file. The specimens were then autoclaved for 30min at 121 C and 15 lb of pressure to ensure complete sterilization within the canal space.The specimens were inoculated with Enterococcus faecalis (E.faecalis) and Candida albicans suspension and incubated for 3 days. Samples were divided into four groups (n=20) and each group was further divided in to five sub groups containing ten teeth (n=10). Extracts of freshly prepared NaOCl, herbal NaOCl and herbal mixture were used as irrigating solution against E.faecalis and Candida albicans. Dentinal shavings were collected using Gates glidden drills, number of colony forming units (CFUs) were counted on Brain Heart Infusion (BHI) agar and Sabouraud dextrose agar plate. Statistical analysis was performed by using Kruskal Wallis Test and Mann Whitney Post hoc Test.

Results: Multiple comparison of mean CFUs of E. Faecalis between 4 study groups showed that, Group 1 showed significantly least mean CFUs as compared to Group 2, Group 3 and Group 4 at P=0.001, P=0.003 and P<0.001 respectively. Multiple comparison of mean CFUs of C. Albicans between 4 study groups showed that Group 1 showed significantly lesser mean CFUs as compared to Group 3 at P=0.002 which was followed by Group 2 showing lesser mean CFUs as compared to Group 3 at P=0.009.

Conclusion: Sodium hypochlorite remains the gold standard for irrigation in endodontic infections which are dominated by organisms like E. faecalis and C. albicans. Freshly prepared NaOCl and Herbal NaOCl also showed good efficacy against E. faecalis and C. albicans followed by herbal mixture.

Funding source: self.

  Abstract 95: Effectiveness of autologous platelet concentrate compared to blood clot in patients with necrotic immature permanent teeth: An umbrella review Top

MS Nivedhitha, N Velmurugan, S Pradeep, Delphine Priscilla Antony

Saveetha Dental College, Chennai, Tamil Nadu, India

Background: Endodontists come across several challenges in managing necrotic immature permanent teeth (NIPT). Recently, revascularization has been recommended as a viable treatment option for these teeth. Regenerative endodontic procedures improve the clinical outcome by increasing the root length, thickening the dentinal wall, and achieve apical closure.

Aim: To identify whether autologous platelet concentrate (APC) or blood clot (BC) is an appropriate scaffold for teeth with NIPT undergoing regenerative endodontic treatment.

Data Source: The protocol of this umbrella review is registered in the OSF database. PubMed, Cochrane, Web of Science, and Scopus databases were searched until June 2021.

Study Eligibility Criteria: Systematic reviews published in English comparing the effectiveness of autologous platelet concentrates (APC) or blood clot as scaffolds in necrotic immature permanent teeth (NIPT) were included. Two independent reviewers selected the studies and carried out the data extraction and the appraisal of the included reviews. Disagreements were resolved in consultation with a third reviewer.

Study Appraisal and Synthesis Methods: The quality of the included reviews was appraised by two independent reviewers using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews). Each of the 16 AMSTAR 2 items was answered as Yes, Partial yes, or No.

Results: Four systematic reviews and one systematic review with meta-analyses were included. The overall confidence rating of the included articles was “critically low”.

Limitations: Systematic reviews published only in the English language were included.

Conclusions: There is no conclusive evidence that APCs are better than blood clots to improve the clinical outcome of regenerative endodontic procedures.

  Abstract 96: Praveen's microtube, a novel device for instrument retrieval: A case series Top

Rajesh Praveen

Indira Gandhi Institute of Dental Sciences, SBV University, Chennai, Tamil Nadu, India

Instrument separation has tormented even best of the clinicians over the years. Although ultrasonic techniques can retrieve shorter and loosely bound instrument fragments, instrument retrieval devices (extractors) are required for the rest. Instrument retrieval devices such as Masseran's, IRS, Yoshi's Loop, Endocowboy, BTR pen, etc can grasp and retrieve the fragment loosened prior by ultrasonics. However, each technique has a critical caveat such as the fragility of loop device (only minimal forces may be applied to pull out the fragment) or the unnecessary dentin sacrifice with micro-trephines of the microtube techniques (Masserans, IRS, Zumax). The Praveen's Microtube (PMT) Device (patent pending) is a modified microtube-plunger system that grasps the instrument fragment tight enough to exert exceptional pulling forces with minimal radicular dentin sacrifice. Aim of this report is to present instrument retrieval using Praveen's Microtube (PMT) device in three non-surgical repeat root canal cases with a separated instrument fragment. The PMT device consists of 2 components: (1) Custom microtube (2) Plunger. After about 1 mm of instrument head (inner wall only) exposure by ultrasonics, the custom microtube is selected, modified and fitted. An IOPAR is taken to check the fit and the appropriate size plunger is chosen. After obtaining adequate grip, the device is pulled out with the instrument fragment. All the three cases were previously root treated with separated fragments tightly bound that did not loosen with ultrasonic troughing. Each of the three cases had the fragments at different locations in the canal, coronal, middle and apical thirds respectively. All the three fragments were successfully retrieved. At follow up, all teeth responded favourable to the treatment. To conclude, the PMT device may present a suitable addition to the operator's armamentarium when a tightly wedged fragment needs removal. It is completely manufactured in India, making it considerably cost effective compared to other instrument extraction systems.

  Abstract 97: Case reports on regenerative endodontic procedures Top

Paromita Mazumdar

Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India

Obturation of the cleaned and shaped root canal space has been performed for many years using a core of gutta-percha rubber cones combined with various formulations of sealer cements. This step in root canal treatment is an effort to create a root canal system that is sealed from re-infection resulting from coronal and apical leakage, and to entomb residual bacteria and their by-products remaining in the roots following cleaning and shaping procedures. Obtaining a feasible alternative to gutta percha is of prime importance, achieving a biological seal, should be hence preferable over an artificial barrier of sealer and guttapercha cones at the apical end of root canal system. With the success achieved with “revascularization” in healing of periapical lesions and hard tissue deposition at apical and lateral walls of the root canals (maturogenesis) in immature teeth, the processes involved in the healing mechanism are now better understood. The regenerative potential of platelets has been deliberated. A new family of platelet concentrates called the platelet rich fibrin (PRF) and concentrated growth factor (CGF) has been recently used by several investigators and has shown application in regenerative endodontics. The concept of 'Seal Bio' put forward in the year 2009, aimed at creating a biologic barrier in mature teeth with closed apices composed of of fibrous or cementum tissue over the root apex (which is considered the most desirable outcome of conventional endodontic treatment) without obturation of root canals. Several reports have described regenerative endodontic treatment as a simple, efficient, biocompatible and cost effective alternative in both mature and immature teeth. The eight case reports presented will show successful results including the resolution of periapical lesions, continued root development, and even the recovery of tooth sensibility on a six month followup.

  Abstract 98: Retrospective analysis of fallouts of patients undergoing multi-visit root canal therapy at a tertiary health care centre situated in the most backward district of India Top

Meenu Dhiman

Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India

Aim and Objective: To evaluate pattern of patients undergoing multi-visit RCT in NUH district of the country.

Materials and Methods: A retrospective analysis of the hospital records of patients who attended the department of Dentistry from July 2020 to March 2020 for multi-visit root canal therapy (RCT) was done. The clinical and demographic data were obtained from the patient's records and analyzed using the SPSS software.

Results: There were 362 patients comprising 226 (62.43%) females and 136 (37.57%) males. A total number of 401 teeth were treated. Highest incidence of endodontic disease (35.64%) was seen in 20-29 years age group. Maximum patients discontinued further treatment following bio-mechanical preparation stage. First molars were the most frequently treated tooth type whereas mandibular lateral incisors were least commonly treated.

Conclusion: More females compared to the male population and a younger age group demanded RCT. Finally, just 25% patients completed the treatment. There's a need to promote an awareness amongst the people with regards to treatment compliance in the area.

  Abstract 99: Comparison of postinstrumentation pain following the use of twisted file adaptive system and self adjusting file system: A randomized clinical trial Top

Kumar Ohm Nijandhan, Durvasalu Archana1

Adhiparasakthi Dental College and Hospital, Chengalpattu, 2Thaimoogambigai Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: To assess the post instrumentation pain using two different root canal instrumentation procedures Twisted file adaptive system (TFA) and Self Adjusting File (SAF) using visual analogue scale (VAS).

Materials and Methods: Following sample size calculation sixty patients between the age group of 18 to 60 years diagnosed with pulpal necrosis in maxillary 1st or 2nd premolars were included in this trial. The visual analogue scale (VAS) scoring system was used for assessment of pre- and post instrumentation pain. Before initiating treatment, baseline parameters such as age, gender, pulp status, number of cavity wall defects, and presence of periapical lesion, root canal curvature, diagnosis and pre-instrumentation pain scores were recorded. Root canal procedures were carried out in two appointments with either SAF /TFA system based on manufactures instructions. Pain score was assessed in both groups in 2,4,6,8,12,24 and 48 hours. Mann-Whitney test was done to analyze the pre and post operative pain scores.

Results: The post-instrumentation pain for TFA and SAF at 2nd and 4thhour were statistically significant (p<0.001). From 6th to 12th hour the pain gradually reduced and pain was absent at the 24th and 48th hour recall.

Conclusion: The incidence of post-instrumentation pain at different time intervals in patients undergoing root canal treatment was similar for both the SAF and TFA systems.

  Abstract 100: Antimicrobial efficacy of calcium hydroxide with plant essential oregano oil, thyme oil and basil oil as a vehicle against enterococcus faecalis: An in-vitro study Top

Chandrasekaran Charanya, Sundaresan Balagopal, James Vandana, Sebatni Anisha

Tagore Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: To evaluate the antimicrobial efficacy of calcium hydroxide with plant essential oils as a vehicle against Enterococcus Faecalis using RT-PCR.

Materials and Methods: Fifty single rooted premolars were taken and decoronated to standardize the root length as 14 mm. The canals were instrumented up to F3 Protaper Gold instrument. Irrigation was done with 2 mL of 3% NaOCl and 2 mL of 17% EDTA during canal enlargement. Final rinsing was done with 2 mL of saline for 30 secs. The teeth were dried with paper point and autoclaved at 121°C for 20 minutes at 15 psi. 10 μL bacterial suspension was obtained from an overnight culture of E. faecalis in brain heart infusion broth, which was injected into the root canals, and the samples were incubated at 37°C and 100% humidity for 21 days. The samples were then randomly divided into five groups: Group 1 - Oregano oil with Calcium hydroxide; Group 2- Thyme oil with Calcium hydroxide; Group 3 - Basil oil with Calcium hydroxide; Group 4 - Calcium hydroxide with saline; Group 5 – no treatment. Powder liquid ratio was standardized by mixing 0.2 gm of calcium hydroxide powder with 0.07cc of oil/ saline on sterile dry glass slab using the sterile cement spatula. The medicaments were placed inside the root canal and the samples were incubated again at 37°C and 100% humidity for 7 days. After 7 days incubation, the tooth was longitudinally sectioned into two halves using chisel and mallet. Dentin powder was obtained from middle third and RT-PCR was performed to detect the presence of Enterococcus faecalis virulence factor (efaA).

Results: Data was analysed using one-way ANOVA at p<0.05 significance level. Group 1 (Oregano oil with calcium hydroxide) showed statistically significant antimicrobial efficacy followed by group 2, 3 and 4. The least was observed in negative control.

Conclusion: Oregano oil with calcium hydroxide showed significant antimicrobial efficacy against E.faecalis compared to the other groups. This may be due to Carvacrol and high monoterpene hydrocarbons such as α-pinene and linalool present in the Oregano oil which increases the permeability and depolarises the cytoplasmic membrane.

  Abstract 101: Target therapy with chemical cocktails - “Small-molecules” in dentistry Top

Selvakumar Kritika, S Kavitha, Sunil Pandya Dhvani, Harikrishnan Nikhil, N Ravikumar, Sekar Mahalaxmi

Department of Conservative Dentistry and Endodontics, SRM Dental College, Ramapuram, SRM Institute of Science and Technology, Ramapuram Campus, Bharathi Salai, Ramapuram, Chennai, Tamil Nadu, India

Regenerative dentistry is gaining momentum amongst researchers, predominantly in light of its translational and promising remedial methodology. Recently, a new approach has been developed to directly reprogram cells using chemical cocktails namely “SMALL-MOLECULE”. Owing to their small size, these molecules have the advantage of passing through cell membranes to reach targets, rendering them suitable for many target-specific therapies by regulating their biological processes. Small-molecule (synthetic/chemical) compound-based strategies are designed to activate specific genes involved in the differentiation process. They are reported to have several intrinsic advantages namely (a) target specific (b) controlled (c) reversible and more importantly safer compared to the genetic manipulation approach in which some oncogenic pathways may be activated. These molecules would potentially reduce the variability, enhance the replicability and increase the stemness of the stem cells. This approach bypasses the high risks and high level of economical and time investment that are usually required in novel drug discoveries/genetic manipulation approach. Thus, the aim of this review is to unveil the concept of Small-Molecule Cell Reprogramming in dentistry. This novel approach may make our life exciting and interesting, by making impossible things possible.

  Abstract 102: Preoperative and intraoperative assessment tools for identification, access and negotiation of Middle mesial canals in mandibular molars: An overview Top

Darshana Devadiga

A.B. Shetty Memorial Institute of Dental Sciences, Nitte Deemed-to-be University, Mangalore, Karnataka, India

A comprehensive knowledge of normal and aberrant pulp space anatomy is imperative towards success in clinical endodontics and long term prognosis; as the failure to identify and locate all the canals may provide a persistent source of microbial contamination which exponentially increases the possibility of developing a post endodontic lesion. While the most frequently treated Mandibular molars show several anatomical variations, the success in accessing and negotiating Middle mesial canal (MMC) is poor due to its intercanal and intracanal communications. The MMC orifice is usually small with a mean minor diameter being three times smaller (0.16 mm) than the main mesial canals (0.50 mm) that lies underneath the dentinal projections which needs to be uncovered and hence is a technical challenge. The operator must frequently explore the mesial sub-pulpal groove and troughing in apical direction to visualize the mesial isthmus to detect and negotiate this accessory canal with an endodontic instrument. CBCT-based imaging technology overcomes many of the disadvantages of dental radiography. In this method, the operator can visualize the anatomy of the specimen in three-dimensional slices without destruction of specimen with greater image accuracy and resolution offering a minimal X-ray dose and decreasing in imaging errors such as artifacts and superimposition. Dental Operating Microscope (DOM) is another device that can enable the visualization and location of root canals as a result of its clear magnification, illumination, and significant field of view. It facilitates improved intraoperative accessory canal identification and evaluation of root canal systems which gives it an edge over other routinely used methods such as clinical examination, dye tracing, or magnification using loupes. This review paper discusses the use of the above stated contemporary aids as single or in combination; to achieve long term success during routine endodontics.

  Abstract 103: Artificial intelligence in endodontics: Present scenario and future possibilities Top

Poornima Ramesh

Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India

Artificial Intelligence (AI) is prevalent and potentially dominating every aspect of human life including health sciences. Integrating AI based technologies in medical sciences offers a host of advantages including enhanced efficiency and precision. In the field of dentistry, it is currently being explored for enhancing accuracy in diagnosis, which in turn could positively influence clinical decision making. Case documentation, caries diagnosis on radiographs, decision making for orthodontic treatment planning, prognosis of periodontally compromised teeth, cancer detection, forensic odontology are some areas in which AI models have shown promise. Specifically, in Endodontics, where accuracy is essential for a successful treatment outcome, use of AI needs to be considered. Studies have found a consistent accuracy of about 96% by using artificial neural network system for working length determination, which is possibly higher than which could be achieved by many professional Endodontists. They are also incredibly effective in detecting vertical root fractures on CBCT images, that may go unnoticed by the human eye. The reliability of such models in detecting periapical pathosis was found to be almost 92%. It is also being explored as a potentially effective tool for identification of root morphologies, which will aid the Endodontist during canal preparation. AI-based endomotors that integrate location of apical constriction are also currently available. These applications can be of great assistance in enhancing clinical outcomes. This paper will explain the scope and usage, current shortcomings, and future possibilities of AI in endodontics.

  Abstract 104: Management of external invasive cervical resorptive defect of tooth using biodentine and bony defect with platlet rich fibrin along with bone graft Top

Monika Choudhary

Surendra Dental College, Ajmer, Rajasthan, India

Invasive cervical resorption (ICR)of tooth is relatively uncommon and aggressive destructive form of external tooth resorption, which sometimes misdiagnosed and can lead to improper treatment or tooth loss.Early diagnosis,complete debridement of all resorbing tissues and reconstruction of resorptive defect by suitable sealing material can result in a successful outcome and long term retention of tooth.CBCT appears to be a promising diagnostic tool for distinguishing between the external cervical resorption from internal root resorption.This imaging also beneficial in determining the real extent and location of resorption and possible points of communication with the periodontal space.This case report describes the surgical management of external invasive cervical resorption of maxillary left central incisor followed by reconstruction of cervical tooth defect with Biodentine and bony defect with bone graft mixed with PRF.

  Abstract 105: Management of dental pulp stone: Alternative method Top

Dinesh Kalasaiaha, Kavimalar Ravichandran, Shruthi Nagaraja, Poornima Ramesh, Nithin Kumar Shetty, Swaroop Hegde

Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India

Pulp stones are discrete calcification that occurs in the pulp chamber of a tooth. Occasionally, pulp stones can be diffuse calcifications, such as dystrophic calcifications. Pulp stones can range in size from a single large stone to multiple smaller stones occluding the pulp space, posing difficulties for endodontists. While pulp stones are most frequently encountered in the coronal pulp chamber, they can also be found in the radicular pulp chamber. The mechanism by which pulp stones form is poorly understood. Numerous factors contribute to this, including age, orthodontic tooth movement, restorations, genetic predispositions, and pulpal circulatory disturbances. Pulp stones, regardless of their size or number, present an added challenge to endodontists. Effective pulp stone removal is required to avoid root canal treatment failure. The most frequently used method of managing pulp stones is manual removal with an explorer/excavator. Other methods, such as ultrasonic and magnification, are effective but require an expensive armamentarium that not all practitioners possess. As a result, we developed a novel pulp stone dissolution agent capable of softening the pulp stone and allowing the clinician to easily remove it. This paper is an endeavor to show case the alternative management strategy for effective removal of pulp stone.

  Abstract 106: In vitro characterization of fresh and cryopreserved human dental pulp stem cells derived from third molar teeth: A comparative study Top

Raksha Bhat, Preethesh Shetty, Shishir Shetty, B Mohana Kumar1, Shama Rao1

A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), 1Nitte University Centre for Stem Cell Research and Regenerative Medicine (NUCSReM) K. S. Hegde Medical Academy (KSHEMA), Nitte (Deemed to be University), Mangalore, Karnataka, India

Aim: Human dental pulp stem cells (DPSCs) have drawn more attention in the field of regenerative medicine because of their accessibility, plasticity and high proliferative ability.Cryopreservation is proposed as the most effective method for storing the cells for prospective clinical applications. The aims of the present study were to freshly establish DPSCs in vitro and compare their cellular and biological characteristics with DPSCs cryopreserved for 6 months.

Materials and Methods: Pulp tissues were collected from extracted tooth of healthy subjects for the establishment of primary cultures under in vitro conditions. Freshly isolated DPSCs and cryopreserved DPSCs for 6 months using 10% dimethyl sulfoxide as a cryoprotective agent in liquid nitrogen were assessed on their morphology, viability and proliferation rate.Further, in vitro differentiation ability of DPSCs into osteocytes and adipocytes was also assessed by induction in specific media for 3 weeks.

Results: Primary cultures of DPSCs were successfully established and cells exhibited a characteristic fibroblast-like morphology. During culture expansion, homogenous cell population was observed with comparable morphological features. Viability of >95% was found in freshly established DPSCs from passage zero to five, and it was slightly lower with around 80% in cryopreserved cells immediately after thawing at passage two. However, viability was increased in cryopreserved DPSCs at later passages. Both the cells were highly proliferative and showed a population doubling time (PDT) ranging between 39.30 hrs and 47.60 hrs. Further, fresh and cryopreserved DPSCs for 6 months were capable of differentiating in vitro into osteocytes and adipocytes after three weeks of induction in specific media. Formation of mineralized calcium deposits in osteocytes was confirmed by Alizarin red staining. Later, secretion of lipid globules in adipocytes was identified by Oil O red staining.

Conclusion: Freshly isolated and cryopreserved DPSCs for 6 months showed largely comparable cellular features and both cells were able to undergo mesenchymal lineage differentiation. However, freshly isolated DPSCs exhibited slightly higher growth kinetic properties with no noticeable differences in differentiation ability into osteocytes and adipocytes. Hence, cryopreserved DPSCs might serve as an important autologous source for potential therapeutic applications.

Funding source: Faculty Research Grant, Nitte (Deemed to be University).

  Abstract 107: Guided endodontics: The future of endodontics Top

Nithin Kumar Shetty, Poornima Ramesh, Dinesh Kalasaiaha, Swaroop Hegde

Faculty of Dental Sciences, M.S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India

Management of calcified canals, its location and negotiation has been a challenge for the Endodontist. Although, integration of magnification aids and cone beam computed tomographic imaging has enhanced precision, access cavity preparation of cases with pulp canal obliteration carries a significant risk of procedural mishaps. There could be substantial loss of dentin through free hand access cavity preparation in such cases, thereby compromising the prognosis and longevity of the tooth. 3D printed static guides have been used to accurately prepare surgical and non-surgical cavities in the field of implant dentistry. This concept has been applied in Endodontics and there are a few recent case reports and in-vitro studies proposing the use of a static computed tomographic–based stereolithographic drill guide systems. They allow appropriate positioning and angulation of slow speed drills, for access cavity preparation of cases with calcific metamorphosis. However these static systems have limited applications in posterior teeth due to the lack of interocclusal space, inability to change pre-determined drill paths and the lack of visualization. However, the advent of novel dynamic navigation systems allows the endodontist to not only visualize the positioning and angulation of drills, but also allows real time feedback and adjustment. These systems have proven to be far more precise in locating obliterated canals. Dynamic navigation technology has also proven to be effective in delivery of intra-osseous anesthesia and has higher safety and accuracy as compared to traditional free hand techniques. Adopting these guided systems will positively enhance treatment outcomes even in cases classified as those with high level of difficulty. This paper will review the process and advantages of guided systems and the need to integrate them in clinical endodontics.

  Abstract 108: Polyvinyl alcohol hydrogel nanocomposite: Insights Top

Gowrish S Bhat, Vandana Sadananda

A. B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India

Polyvinyl alcohol hydrogels (PVA-H) exhibit excellent biocompatibility, bioinertness and mechanical properties. PVA-H has been extensively researched and commercialized for various purposes such as drug delivery and tissue engineering in the field of medicine. However, until now, PVA-H has not been used in specific clinical applications in Endodontics. Endodontic management of necrotic teeth, roots with blunderbuss apices, internal and external resorption still pose a challenge with the current approaches requiring a long time to deliver treatment. Covalent crosslinking of PVA-H can be achieved by high-energy radiation. In contrast to photopolymerization, this method does not require a photoinitiator whose toxicity may be of issue in clinical applications. Effective and practical delivery of any biocompound is pivotal for clinical usage. PVA-H can be functionalized to play the role of a scaffold or carrier to tailor the needs of sustained drug delivery, dentine biomodification/stabilization or as a matrix in perforation repair. This review will give an insight regarding the prospects of PVA-H nanocomposites as an extremely promising material for various Endodontic clinical applications depending on ideas and ingenuity.

  Abstract 109: Novel ways to combat the endodontic micro-kingdom of slime Top

Bettina Ashwini Vergis, Sonia Preshma DSouza1

Srinivas Institute of Dental Sciences, 1Consultant Endodontist, Mangalore, Karnataka, India

Endodontic slime or biofilm refers to the well-structured organization of bacterial colonies along the walls of the root canal system, existing in dormant yet viable states, resistant to the action of conventional instrumentation, irrigation and antimicrobials. Various factors such as the impenetrable EPS matrix, reduced growth rate, horizontal gene transfer, drug-efflux pumps, and persister cell nature in biofilm, have contributed to the virulence of this dynamic microstructure, creating the need for exploring newer ways to combat it. While mechanical instrumentation techniques have displayed their shortcomings in eliminating biofilm, newer methods of instrumentation have been explored such the Self-Adjusting-File and XP-Endo Finisher. Similarly, various methods of improving the efficacy of irrigants via fluid dynamics and increased shear wall stress have been established such as ultrasonic irrigation, LAI (laser-activated irrigation), PIPS (Photon- Induced Photoacoustic Streaming), Multisonic Systems like Gentlewave and High Intensity Focused Ultrasound. Antibiofilm nature of irrigants have been employed through methods like continuous chelation with sodium hypochlorite and clodronate, natural therapeutic agents like propolis, neem, tea tree oil, turmeric, enzymatic irrigation using trypsin and ultrasound, use of D-amino acids like D-leucine. Nanoparticles and their role in reducing bacterial adhesion and bringing about killing, have been put to use in the form of irrigants, sealers and in combination with photodynamic therapy.

At the molecular level, various antibiofilm strategies have been tested: surface treatment in the form of antimicrobial coating and biosurfactants, encouraging bacterial repellence by employing co-adhesion inhibitors and probiotic bacteria, blocking communication via quorum sensing inhibitors and quorum quenchers in the form of phytochemicals, newer weapons like Specifically targeted Anti-Microbial Peptide (STAMP) and combination therapy including antimicrobial peptides or phytocompounds with antibiotics. While the challenge of complete disinfection of complex root canal systems still exists, breaking down this deadly slime layer into defeatable portions is now achievable because of the aforementioned techniques. A combination of methods could be worked out to destroy biofilm and regain periapical health. In vivo studies are warranted to ascertain their efficacy in clinical scenario. Moreover, additional research and trials are essential to make newer antibiofilm strategies more flexible and feasible for regular use.

  Abstract 110: Successful management of a very large periapical lesion in mandible by surgical and endodontic treatment: A case report with two year follow up Top

VJ Vivek, Sasikumar Prem1, Kala Revathy1

KMCT Dental College, Kozhikode, Kerala, India

Odontogenic kerato cyst has high recurrence rate and has various treatment modalities. In case of very large lesions, to decompress and enucleate is an acceptable treatment option instead of radical resections. In this case report a 23 year old female reported with a complaint of painless swelling in the right lower jaw, since last 4 months. OPG examination revealed a periapical radioluscency extending from tooth no 43 to 47. There was resorption of roots in all involved teeth, thinning of inner border of mandible and complete loss of mandibular canal outline. Incisional biopsy was done and was indicative of OKC. Treatment was initiated immediately, to prevent any further progression that may lead to pathological fracture of mandible.Root canal treatment of all non vital tooth was initiated. Every week patient was recalled for changing calcium hydroxide dressing, with mild decompression. Surgical removal of 46 was done after 5 weeks, due to poor prognosis. post extraction marsupialization was done and root canal visits were continued for 5 more weeks. After 5 weeks the root canals could be completely dried and so obturations were carried out. Same day complete excision of the remaining cyst, which had greatly reduced in size,was done and was sent for biopsy. Histopathology features were now suggestive of infected cyst(radicular). Marsupialization converts the the thin friable OKC wall to thickened hard type and felicitated it's complete removal. Histologically the orthokeratinized epithelium changes to hyperplastic stratified non keratinised squamous epithelium. Two year follow up OPG of the asymptomatic patient shows healing of lesion with increased thickness of lower border of mandible, reappearance of mental foramen and mandibular canal. There are no signs of recurrence currently. The case report clearly shows the advantage of decompression, prior to excision, in treating OKC conservatively,with more predictable results.

  Abstract 111: An over view - concurrent protocols and viable options in treatment of irreversible pulpitis Top

B M Annapoorna

JSS Dental College and Hospital, Mysore, Karnataka, India

Pulp is the vital organ covered calcified dentin and enamel tissue of tooth. Maintaining its vitality is paramount: whence it sets in concrete, the integrity of tooth structure and anchors the multiple facets of oral health. Pulpotomy is traditional vital pulp therapy indicated in pulp exposure due to caries or trauma in asymptomatic reversible inflammatory status of pulp in tooth with immature/mature root apex. The pulp when subjected to irreversible inflammation, invasive procedure of root canal was the traditional consensus; but vigorous research in biological tissue management coupled with advances in biomaterial sciences has enhanced the clinical procedures in repairing and regenerating the diseased pulp. Hence pulpotomy procedure for irreversible pulpitis bring in multiple benefits such as preservation of vital tissue, single clinical session, noncomplex procedures, maintain tooth strength, prevention of collagen dehydration, and pocket friendly single line treatment, minimal invasive and maintain the sensitivity which is defensive against external invasion. Pulpotomy for tooth with mature root apex has generated umpteen white papers, thus stratifying safe clinical procedures. Best practices legitimate today enables the trained professionals to analyze the benefits vis a vis – classical root canal procedure with enhanced vital pulp therapy. In this regard presentation enables re-view of various data concerning: age of the patient, appropriate diagnostic procedures, selection of the tooth and therapeutic biomaterial, the type of pulpotomy and restoration, evaluation period, percentage of success and failure compare with invasive Root Canal Treatment.

  Abstract 112: A prospective randomised control trial for evaluating the efficacy of pretreatment analgesia using two nonsteroidal anti-inflammatory drugs in patients undergoing pulpotomy of permanent teeth Top

Ambica Khetarpal, Priyanka Kathuria1

PDM Dental College and Research Institute, New Delhi, 1All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Aim: To evaluate the efficacy of single oral dose of 400 mg of Ibuprofen, or 10 mg of ketorolac as a pretreatment analgesic for the prevention and control of postoperative endodontic pain in patients with symptomatic irreversible pulpitis undergoing pulpotomy of permanent molar teeth.

Materials and Methods: Sixty emergency patients with moderate to severe pain, diagnosed with symptomatic irreversible pulpitis were randomly allocated to either group 1 (placebo), group 2 (Ibuprofen) or group 3 (ketorolac). For groups 2 and 3, medications were administered 30 min before beginning of the pulpotomy procedure. Patients recorded pain intensity on Wong-Baker faces pain rating scale (Wong-Baker FPRS) at 4 hours, 8 hours, 12 hours, 24 hours and 48 hours post-treatment.

Results: The mean pain score at 4 hours, 8 hours, 12 hours and 24 hours was significantly higher among group 1 compared to groups 2 and 3. One way ANOVA with post hoc Bonferroni multiple comparisons test was applied to compare the incidence of postoperative pain, the level of significance adopted was 5% (P < .05).

Conclusion: Single oral dose of 10 mg of ketorolac and 400 mg of Ibuprofen as a pre treatment analgesic significantly reduced postoperative pain after pulpotomy in patients with symptomatic irreversible pulpitis when compared to placebo.

  Abstract 113: Management of vertical root fractures: – An endodontic challenge: A case series Top

Neeraj Kumar

Armed Forces Dental Clinic, New Delhi, India

Vertical root fractures (VRF) have been described as longitudinally oriented fracture of root, extending from root canal to periodontium, occur primarily in endodontically treated teeth, although occurrence in non-restored teeth has also been described. It is usually directed buccolingually and may involve one proximal surface or both proximal surfaces. Early recognition of root fractures early is very important. Undiagnosed, root fracture can not only cause endodontic treatment to fail, it also can be responsible for extensive periradicular bone loss. Diagnosis of VRF has been a great challenge especially in initial stage. Since, VRF generally involve endodontically treated teeth; it often becomes difficult to differentiate a tooth with this condition from an endodontically failed tooth/ with concomitant periodontal involvement. Recognition of such a defect is critical and important, especially because of its diagnostic complexity and its further consequences. Prognosis of VRF is poor and tooth extraction is usually the only treatment option, however root resection/ amputation, bicuspidization and orthodontic banding are the various methods which can facilitate the successful endodontic treatment in these cases. Key to saving these teeth is to identify and classify cracks; characteristic signs and symptoms; and its early detection. Radiographs and CBCT are valuable diagnostic tools to diagnose and determine the presence of a root fracture. Therefore, if a VRF is suspected, steps should be taken immediately to confirm the presence of a crack, determine the type and formulate an appropriate treatment plan to conserve the natural dentition. This case series discusses the management strategies for different types of vertical root fractures and further substantiate the requirement of quick action by the clinician which can improve chances of saving the teeth.

  Abstract 114: The effect of storage medium on anterior teeth fragment reattachment: A bibliometric analysis Top

C Nishanthine

Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India

Introduction: Fracture of anterior teeth is a common type of traumatic injury in the permanent dentition. The advent of adhesives and bonded composites made it possible to restore such fractured teeth. Literature search reveals that, the influence of different storage media enhance the bond strength of reattached fragment.

Objective: The objective of this study was to perform bibliometric analysis on the basis of the number of research articles per year, active authors, organizations and the countries of the first authors involved in the evaluation of effect of storage medium on anterior teeth fragment reattachment.

Materials and Methods: Dimensions Database was used to search data published on the effect of storage medium on anterior teeth fragment reattachment. Article published between year1990 to year 2020 was included for the study. The data from all the articles included in the study was extracted using Dimensions. VOS viewer was used to develop analysis tables and visualization maps.

Results: A total of 195 publications were identified related to effect of storage medium on anterior fragment reattachment. Bibliometric analysis was performed for 195 articles. Most active journal are operative dentistry and dental traumatology. Active country involved in the study are Brazil,India & Australia and the most active authors are Celso Koogi Sonoda, Wilson Roberto Poi and Sônia Regina and the number of research articles published had sharp tick earlier around 2015 is now with an uneven growth.

Conclusion: The current analysis shows a steady decline in the number of publications pertaining to this topic. This necessitates more insight to this field of research.

Keywords: Incisor fracture and storage media and reattachment

  Abstract 115: An insight into the endodontic failures Top

A Shafie Ahamed, R Vignesh Gupta1, J Siva Kumar2, M Chittrarasu2, K E Selvendran1, K Gokulapriyan3

Rajah Muthaiah Dental College and Hospital, Annamalai University, Chidambaram, 1Karpaga Vinayaga Institute of Dental Science, Kanchipuram, 2Vivekanandha Dental College for Women, Tiruchengode, 3CSI Institute of Dental Sciences and Research, Madurai, Tamil Nadu, India

Root canal treatment consists of proper access cavity preparation, cleaning and shaping followed by 3 dimensional filling of the root canal system, with a biologically compatible material to establish an adequate seal. Endodontic failure is defined as a recurrence of clinical symptoms along with the presence of periapical radiolucency. Therefore, endodontic failure is evaluated on the basis of clinical signs and symptoms, as well as radiographic findings of the treated tooth. Nair et al 2006 stated that six biological factors contribute to the persistence of periapical radiolucency after RCT.

  1. Intraradicular infection persisting in the complex apical RC system.
  2. Extraradicular infection.
  3. Extruded root canal filling/ other exogenous materials.
  4. Accumulation of endogenous cholesterol crystals that irritate periapical tissues.
  5. True cystic lesions.
  6. Scar tissue healing of the periapex.

Residual microbes in the apical portion of the root canal system is the major cause of persistent apical periodontitis both in poorly and properly treated case.

Results of Washington study by Ingle et al 1985 showed that 91 to 95% of all endodontic treatments have a successful outcome. He explained causes of endodontic failures into three main groups.1.Apical Percolation- 63 % 2.Operative Errors- 15% and 3. Faulty case selection- 22%.

Sjogrens et al 1990 stated that 96% success rate if the teeth has vital pulps prior to treatment, 86% if the the pulp were necrotic and the teeth had periradicular lesions, 62% if the teeth had been retreated. Sundqvist et al 1998 stated that Enterococcus faecalis was found in 38% of failed root canals. Increased proportions of E.faecalis in teeth lacking adequate seal during treatment.

Neelakandan et al 2017 stated that, the complexity and variability of the root canal system, together with the multi-species nature of biofilms, make disinfection of this system extremely challenging. Microbial persistence appears to be the most important factor for failure of root canal treatment and this could further have an impact on pain and quality of life.

So an Endodontist should have through knowledge of the anatomic complexities, diagnosis, treatment planning to attain the long term success of the treatment.

  Abstract 116: Scout till you have doubt: Discover the hidden anatomy Top

Sanil Natekar

Private Practitioner, The Smile Design, Sawantwadi, Maharashtra, India

We were taught in our dental school, if we clean the main canal, we can expect the success rate of 95%. does anatomy of the system makes any impact on the outcome, or your clinical success rate? root canal system is very complicated, transverse anastomosis, fins, deltas, lateral and accessory canals, makes it harder to disinfect or clean the entire system completely. can we reach these anatomies with our instruments? my paper will go through many cases, where mechanical debridement was done in these complex anatomies to make sure our irrigant can work efficiently. scouting is an old concept, but its a small attempt to modify the protocol and reach those complex structures in a predictable way. The goal is to lower the bacterial count, and scouting the complex structures will ensure the same. i will be presenting series of case reports to explain my scouting principles and technique.

  Abstract 117: Good bugs versus bad bugs: Antimicrobial activity of probiotics against endodontic pathogens, a preliminary study Top

Aarti Bohora

SMBT IDSR Dhamangaon, Nasik, Maharashtra, India

Introduction: This study aimed to evaluate the antibacterial effectiveness of probiotics Lactobacilli and Bifidobacterium groups against Enterococcus faecalis and Candida albicansin both planktonic and biofilm stages.

Material and Methods: Phase 1 of the study was conducted by agar well diffusion method. Test pathogen culture (0.5 ml) was inoculated in 20ml of molten agar and allowed to solidify. Four to five circular wells of diameter 8–10mm were punched in each poured plates, and 150 μl of diluted test samples were added to the wells. Phase 2 was deferred antagonism test wherein purified culture of pathogen strain was streaked at a right angle to the original producer growth and incubated at 37°C for 24 h. Zone of inhibition was measured for both the phases. Phase 3 biofilm stage evaluation was conducted by mixing 9 ml of 30% poloxamer 407 and MRS broth in a test tube with 500 μl of either pathogen, together with 500μl of test probiotic strains and incubated (37°C, 48 h), followed by serially diluting the mixture by adding poloxamer mix (1ml) into 9.0ml sterile saline till 108 dilutions for evaluation of CFU/ml counts. Controls were endodontic pathogens in 30% poloxamer with MRS broth and no probiotics.

Results: Results were evaluated and statistically analysed using one-way analysis of variance and unpaired t-test. In the planktonic stage, probiotics showed inhibitory activity against endodontic pathogens with valid statistical significance (P<0.05), while there was no activity by deferred antagonism method. In the biofilm stage, all three probiotics showed growth reduction for E. faecalis, while Lactobacilli showed reduction in C. albicans colonies.

Conclusion: This preliminary study demonstrated that probiotics are effective for preventing the growth of endodontic pathogens in vitro. Poloxamer could be utilised as an ideal delivery vehicle for probiotics.

  Abstract 118: Evaluation of the effect of three different irrigation protocols on the removal of smear layer from narrow root canals: A scanning electron microscopic study Top

Sunil M Eraly

Malabar Dental College and Research Centre, Ernakulam, Kerala, India

Aim: To evaluate the effect of three different irrigation protocols on the removal of smear layer in narrow root canals using a scanning electron microscope (SEM).

Materials and Methods: Forty-eight freshly extracted single rooted human mandibular premolars were selected, access cavity prepared and shaping done to size 26 (4%) (TruNatomy Prime, Dentsply Sirona) and the teeth were randomly divided into the following four groups based on the irrigation protocol used, Group 1(Control group): Saline + Positive pressure; All experimental groups were irrigated of 5.25% Sodium Hypochlorite (NaOCl) followed by 17% Ethylenediaminetetraacetic acid (EDTA) and activated with the following activation protocols; Group 2: Sonic activation; Group 3: Negative pressure irrigation, Group 4: Combination technique: alternate use of sonic activation followed by negative pressure irrigation. All samples were sectioned, dried, gold sputtered and evaluated under SEM. The results observed at all the three levels i.e., coronal, middle and apical third, were analyzed using Mann Whitney U test and Wilcoxon Sign Rank test.

Results: At the coronal and middle thirds, there was no significant difference between the groups studied. At the apical third, the combination technique removed significantly more smear layer than the other two techniques (P < 0.05).

Conclusion: The combination technique with the alternate use of sonic activation followed by negative pressure irrigation was more efficient than both sonic irrigation and negative pressure in removal of smear layer from the apical third of the root canal system, which is a crucial area for disinfection.

  Abstract 119: Evaluation of retreatment efficiency of hyflex remover along with supplementary methods in removing obturating material through traditional and conservative access cavity designs using cone-beam computed tomography Top

Pradnya Nagmode, Varsha Tambe, Nitin Lokhande, Balaji Kapse, Abhishek Jagtap, Snehal Shinde

SMBT Dental College and Hospital, Sangamner, Maharashtra, India

Aim: To Evaluate and compare the Retreatment Efficiency of Hyflex Remover along with supplementary methods, Passive ultrasonic irrigation and XP Endo finisher R file in removing obturating material through Traditional and Conservative Access Cavity Designs using Cone Beam Computed Tomography.

Materials and Methods: Forty Eight therapeutically extracted human single rooted Premolar teeth were divided into two groups of 24 teeth each. In Group I, Traditional Access cavity preparation and in Group II, Conservative Access Cavity Preparation was done. The root canals of all the teeth were prepared by using Hyflex CM file system up to size 30, 4%. Obturation was completed and all 48 samples were scanned using CBCT and the total volume of obturated material was calculated. Each group is then subdivided into 3 groups, Group IA(N=8) and Group IIA(N=8) retreated using Hyflex remover files, Group IB(N=8) and Group IIB(N=8), retreated using Hyflex remover files along with passive ultrasonic irrigation and Group IC (N=8) and Group IIC(N=8) retreated using Hyflex remover files along with XP Endo finisher R file. After retreatment CBCT was taken to access the total volume of the remaining filling material and the same was calculated. CBCT taken after obturation and after retreatment was compared for removal of filling material. Intergroup comparison between two groups was done using unpaired 'T' test and Intragroup comparison was done using a one way ANOVA followed by Post hoc Tukey's test.

Results: Hyflex Remover file along with supplementary methods, XP Endo Finisher R file and passive ultrasonic irrigation performed better than Hyflex Remover alone through Traditional Access cavity design than Conservative access cavity design.(P<0.05)

Conclusion: Though conservation of tooth structure is important for increasing the fracture resistance of tooth, Retreatment is difficult through conservative access cavity designs. Hyflex Remover along with XP Endo finisher R File performed better through Traditional access cavity design than Conservative access cavity design but was not able to completely clean the root canal system.

Funding Source: This Research is partly funded by SMBT Dental College and Hospital, Sangamner, Maharashtra, India.

  Abstract 120: Evaluation of antimicrobial effect of mangosteen triphala mix, chlorhexidine against dual species Enterococcus faecalis and candida albicans biofilm Top

Vinoo Subramaniam Ramachandran, Mensudar Radhakrishnan1, Venkatesh Alagarsamy1

Bharath Institute of Higher Education and Research, Chennai, 1Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India

Objective: To evaluate the efficacy of Chlorhexidine and combination of Mangosteen Triphala mix used as intracanal medicament against mature dual species interkingdom biofilm of E. faecalis and C. albicans.

Materials and Methods: Total of 48 single rooted teeth free of caries and cracks were selected for the study. Teeth were decoronated below the cementoenamel junction to get standardized length of 12mm and canals were prepared to apical size 30 by using a protaper F3 (ProTaper; Dentsply Maillefer, Switzerland).Canals were irrigated using 2.5% NaOCl and 17% EDTA solution. The roots were sterilized and microbial suspension of mixed culture of the test microorganisms were inoculated and incubated for 21 days for biofilm formation. The infected root canals were then divided equally into 3 groups (n=16) according to the medicament used. Group A: sterile distilled water; Group B: 2% Chlorhexidine; Group C: Mangosteen and Triphala combination. At the end of 1, 5 days the antimicrobial efficacy of medicaments against dual species interkingdom biofilm were assessed. For the quantitative assessment dentine shavings were collected at two time intervals and total numbers of colony forming units (CFU) was determined.

Statistical Analysis: The data was analysed by post hoc Tukey multiple comparison means to check the difference in bacterial inhibition between groups (P<0.05). Wilcoxon signed rank test was used to check for differences in growth at different time intervals.

Results: The reduction in number of colony forming units was statistically significant in all groups compared to the control group (distilled water). 2% Chlorhexidine gel exhibited the maximum antibacterial activity at both time intervals. Mangosteen plus triphala combination was not as effective as chlorhexidine.

Conclusion: Natural medicaments can be considered as alternative medicament option due to its less toxic property. However long term clinical studies and its effect on root dentin needs to be evaluated.

  Abstract 121: Effect of various root canal irrigation techniques on expression of Enterococcus faecalis virulence factor: A reverse transcription polymerase chain reaction study Top

Anisha Sebatni, Sundaresan Balagopal, James Vandana, Chandrasekaran Charanya

Tagore Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: To evaluate the effect of various root canal irrigation techniques on expression of Enterococcus faecalis virulence factor - E.faecalis endocarditis antigen (efaA) using RT-PCR study.

Materials and Methods: Forty single rooted premolars were taken and decoronated to standardize the root length as 14 mm. The root canals were negotiated and instrumented to a 15 K file without irrigation. The teeth were autoclaved at 121°C for 20 minutes at 15 psi.10μL of bacterial suspension obtained from an overnight culture of E. faecalis was injected into the root canals and the samples were incubated at 37°C and 100% humidity for 21 days. The samples were randomly divided into four groups:

Group I - Single Side Vent Rounded Irrigation needle [Neo-endo] - NE

Group II - Single plane Double Vented needle [Irriflex] - IR

Group III - Two side Vented needle [TruNatomy] - TN

Group IV - Single Side Vented Needle [Navitip Fx] - NF

The root canals were instrumented till F3 using Protaper Gold Rotary System. Irrigation was done with 2 mL of 3% NaOCl using the respective Irrigation needles at the end of each instrumentation. The position of the needle was ensured to be 2 mm short of apex and moved in up and down motion to prevent the extrusion of the solution. After final Instrumentation, Irrigation was done with 2 ml of 3% NaOCl, followed by 2 ml of 17% EDTA and a final flush with 2 ml of distilled water. Paper points were used to transfer the contents of the canal. RT-PCR was performed to detect the presence of Enterococcus faecalis virulent factor (efaA).

Results: Data was analysed using one way ANOVA where p<0.05 was considered to be significant. The results showed that Group III [TN] showed maximum antimicrobial activity followed by Group II [IR],Group IV[NF] and Group 1[NE].

Conclusion: Root canal Irrigation with the aid of two side vented Irrigation Needle [Group III] showed better antibacterial efficacy against E.faecalis virulence factor(efaA) because of its superior flexibility and efficacy in delivering the irrigants to the entire root canal system.

  Abstract 122: Comparison of fracture strength of endodontically treated posterior teeth restored with direct composite with and without horizontally placed glass fibre posts: An in vitro study Top

Rahul Rao, Ashish Jain, Trupti Jagtap, Amit Patil, Nitesh Dahiya, Ashima Jakhar

Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India

Aim: To assess fracture strength of endodontically treated premolars and molars with and without reinforcement with horizontally placed glass fiber posts (GFP) and restored with composite resin.

Materials and Methods: 108 extracted teeth were randomly assigned to Group 1: Control group, no intervention (n=12), Group 2: MOD+ Endodontic treatment (ET)+ composite (n=48), Group 3: MOD+ ET+ Fiber posts of 1.1mm diameter + composite (n=48). In Group 2 and 3, MOD preparations were standardized to 2/3rd intercuspal width and 4mm depth with a common floor in mesiodistal direction using a 2143 diamond bur for the entire preparation. In Group 2 and 3, teeth were treated endodontically using flexofiles in stepback technique and obturated with gutta percha using AH Plus sealer Group 2 was restored with Filtek Z350 composite and Prime & Bond NT adhesive. In Group 3, SF11 bur was used to create perforations on buccal and lingual aspect of premolars to receive the GFPs which were luted in place after silanation, in the horizontal and buccolingual direction using dual-cure cement and restored similar to Group 2. Fracture strength was compared between groups using ANOVA with group as a factor and tooth type as a covariate. Post-hoc Tukey's test was used for pairwise comparison.

Results: In Group 1, highest and lowest values for fracture resistance of premolars was 1890.4 and 1499.8N and for molars was 3400.9 and 2690 N respectively. Mean value was 2345.02. In Group 2, it was 1458.8 and 1057, 2893 and 1221.8, respectively. Mean value was 1535.19. In Group 3 it was 1982 and 616.5, 2949.2 and 1087N, respectively. Mean value was 1676.31 N. There was a statistically significant difference between Group 1 and 3(p<0.0001), while there was no significant difference between groups 2 and 3(p<0.2629).

Conclusion: Presence of a single GFP decreased the fracture strength of premolars. Luting 2 GFPs may improve the fracture strength of endodontically treated molars when compared to those without posts.

  Abstract 123: Role of adjuvants in local anesthesia in endodontic pain management: A literature review Top

L Vijay Amirtharaj

SRM Dental College and Hospital, Ramapuram, Chennai, Tamil Nadu, India

In day to day specialty practice, we commonly use peripheral nerve blocks using short acting local anesthetic (LA) agents like lignocaine or articaine with or without adjuvants like adrenaline. Long acting LA such as bupivicaine or ropivicaine may be used, if the treatment procedure is of longer duration. Since most of the endodontic procedures are shorter duration and does not require motor blockade, analgesic adjuvants to LA agent will be a promising effect in pain management. Moreover, it also reduces the unpleasant taste perception numbness of lips caused by long acting LA. With the development of multimodal analgesia, studies have aimed at prolonging the time of analgesia. The main area of focus has been the addition of adjuvant medications to LA to improve the quality of anesthesia and prolong the duration of analgesia. Adjuvants or additives produce a synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of LA too. This includes novel approaches like using charged molecules to produce LA action, delivery mechanisms for prolonged bioavailability, and the addition of other drugs.

This literature review is aimed at discussing the various adjuvants used with LA that can prolong the duration of analgesia thereby avoiding the use of systemic or oral analgesics postoperatively.

  Abstract 124: Comparative analysis of postinstrumentation pain using multiple versus single rotary file systems in single visit endodontics: A randomized clinical trial Top

Nishtha Patel

College of Dental Science and Research Center, Ahmedabad, Gujrat, India

Objectives: To compare and evaluate the intensity of post instrumentation pain using the single newer file systems(F-ONE) with multiple file system(PTG,PTN) for single visit endodontic treatment.

Materials and Methods: 120 patients were selected for endodontic treatment with chief complain of pain in maxillary and mandibular molars. Then they were divided into three groups: Group 1 (PTG), Group 2 (PTN), Group 3 (F-One). Single visit root canal treatment was carried out under local anaesthesia. The severity of post endodontic pain was assessed using visual analog scale score after 24, 48, 72 hrs and 1 week. Finally, the data was tabulated and statistically analysed.

Results: Post endodontic pain was less in Group 3(F-One) and Group 2(PTN) when compared with Group 1(PTG) at 24,48 hrs and statistically significant (p<0.05). There was no statistically significant difference was found between PTN and F-One.

Conclusion: All file systems showed post endodontic pain but the intensity of pain was minimum in F-One single file rotary systems than PTN and PTG multiple file systems.

  Abstract 125: Nonsurgical management of periapical lesions using a novel herbal intracanal medicament (calendula officinalis): A case series Top

N Ravikumar, N J Nagaraj

SRM Dental College, Chennai, Tamil Nadu, India

Aim: This case series aims to report the management of periapical lesions using Calendula officinalis (CO) as a novel alternative intra canal medicament in non surgical endodontic treatment of teeth with periapical lesions and healing evaluation using Cone beam computed tomography-periapical index (CBCT-PAI).

Materials and Methods: Four patients with pulp necrosis and periapical lesion were chosen based on the inclusion and exclusion criteria and were managed by two visit non surgical endodontic treatment with interim intracanal placement of CO medicament. Treatment was then completed once patient remained asymptomatic. Preoperative and postoperative lesion sizes were measured with the help of CBCT and CBCT-PAI scores were assigned to all the four cases. Progressive healing of periapical lesions were observed at 1 year follow up examination.

Results: CBCT taken at 1 year follow-up showed reduction in the periapical lesion size in all the four cases reviewed.

Conclusion: This case series confirms that for management of periapical lesions, CO proved to be an effective herbal medicament against pathogenic microbes and for healing of periapical lesions.

  Abstract 126: Comparative evaluation of antimicrobial efficacy of herbal irrigants (aloe barbadensis miller, curcuma longa and Azadirachta indica) against Enterococcus faecalis – reverse transcription polymerase chain reaction study Top

Vandana James, Sundaresan Balagopal, Anisha Sebatni, Charanya Chandrasekaran

Tagore Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: To evaluate the effect of various herbal irrigants (Aloe barbadensis miller, Curcuma longa and Azadirachta indica) on the expression of Enterococcus faecalis virulence factor using RT-PCR.

Materials and Methods: Forty single rooted premolars were taken and decoronated to standardize the root length as 14 mm. The canals were instrumented up to F3 Protaper Gold. Irrigation was done with 2 ml of 3% NaOCl and 17% EDTA during canal enlargement. Final rinsing was done with 2 ml of saline and canals were dried with paper points. The teeth were autoclaved at 121°C for 20 minutes at 15 psi. 1 mL of the bacterial suspension was injected into the root canals, and the samples were incubated at 37°C and 100% humidity for 21 days. The samples were randomly divided into four groups: Group I: 2.5% NaOCl (n=10), Group II: Curcuma longa extract (n=10), Group III: Azadirachta indica extract(n=10), Group IV: Aloe barbadensis miller (n=10). After the irrigation protocol, paper points were used to transfer the contents of the canal. RT-PCR was performed to detect the presence of Enterococcus faecalis virulence factor (efaA).

Results: Were tabulated and statistical analysis was done with one-way ANOVA with p value < 0.05. Azadirachta indica extract group (Group III) showed the maximum antimicrobial potential comparable to 2.5% sodium hypochloride followed by Curcuma longa (Group II) and Aloe barbadensis miller (Group IV). Conclusion Herbal irrigants had good efficacy in reducing the expression of E.faecalis virulence factor (efaA). The high antibacterial activity of Neem might be due to presence of triterpenoids, phenolic compounds, carotenoids, steroids, valavinoids, ketones and tetratriterpenoids azadirachtin.

  Abstract 127: Next generation sequencing for endodontic microbial analysis: A review Top

Jyoti Mandlik

Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India

The demand for accurate, faster and inexpensive sequencing of deoxyribonucleic acid (DNA) is increasing and is driving the emergence of next generation sequencing (NGS) technologies. The sequencing technologies have evolved from the first generation to NGS and recently to third-generation technologies. NGS technology is getting researchers' attention, especially during the current viral pandemic, as it can be a valuable tool for the characterization and detection of viruses in the environment, animals, and humans. In life sciences, the next generation high throughput techniques of DNA sequencing are opening fascinating opportunities by helping researchers and clinicians develop customized treatment options. NGS can identify and characterize the microbial species more comprehensively than culture-based methods. Through the advancements in the next-generation sequencing (NGS) technologies, microbiome research has allowed deeper analysis of the microbial communities living in human hosts. Thousands of diverse species of microorganisms colonize the human oral cavity. A mixture of 775 species from culture isolates and molecular clonings from the oral microbiome are identified using NGS technology. In contrast to the oral cavity, a root canal environment is unique with highly diversified canal morphologies. Currently, the microbiome profiles associated with different endodontic conditions are not well characterized. Thus, to better understand the ecologic aspects of different types of root canal poly-microbial communities, the deep-sequencing NGS approaches can be applied. The objective of this presentation is to review use of different NGS technologies to assess the diverse and complex root canal microbiota. Additionally, the NGS platforms that are currently widely used and are available will also be reviewed. Here, previous studies that used NGS to profile the microbial communities of root canals will be reviewed.

  Abstract 128: The effect of pranayam-yoga on anxiety during COVID-19 pandemic amongst dental practitioners in local select population Top

Sanjyot Mulay

Dr D Y Patil Dental College, Pimpri, Pune, Maharashtra, India

Aim: The purpose of the present study was to assess the effect of pranayam-yoga on anxiety during COVID-19 pandemic amongst dental practitioners in local select population.

Settings and Design: A sample of 286 dental practitioners (125 males and 161 females) with age 23 to 69 years was selected by convenience sampling method. It was a descriptive cross-sectional questionnaire design.

Materials and Methods: The variables were studied by using Anxiety and Pranayam-yoga questionnaire (2020) by Mulay and Ubhe (2020).

Statistical Analysis: Chi-Square and Pearson's correlation method was used for statistical analysis.

Results: The results showed that the percentage of dental practitioners having anxiety was 20%, those maybe having anxiety were 27% and 53% were not having anxiety. Those practicing pranayam-yoga were 59%, whereas 41% were not practicing pranayam-yoga. There was negative correlation ('r'=-0.305**) found between anxiety and dental practitioners practicing pranayam-yoga, and positive correlation ('r'=0.198*) found between anxiety and dental practitioners not practicing pranayam-yoga. No difference was found in anxiety (X2=1.64) and pranayam-yoga practice (X2=0.28) amongst those working in different dental practice settings. There was difference found in anxiety (X2=16.43**) and pranayam-yoga practice (X2=21.06**) amongst those with varied years of dental work experience. However, difference was found in anxiety (X2=46.03**) and no difference was found in pranayam-yoga practice (X2=2.12) amongst those back in dental practice categories.

Conclusion: The dental practitioners should regularly practice pranayam-yoga to manage any anxiety and stress related to profession.

  Abstract 129: Comparative finite element analysis of the mechanical behavior of three rotary file systems Top

S Delphine Priscilla Antony, Deepak Selvam, MS Nivedhitha

Saveetha Dental College, Chennai, Tamil Nadu, India

Aim: To evaluate and compare the mechanical properties of ProTaper Gold(PTG), ProTaper NEXT (PTN) and ProFit S3(PS3) rotary file systems on displacement during bending and torsional forces accumulated in the files using finite element analysis.

Materials and Methods: Using Reverse Engineering techniques all the files have been converted in CAD Model.The 3D CAD Modelling of all files has been generated using solidworks software of Hyrax.Once the 3D model was ready, it was converted to FE Model using Hypermesh software, All the preprocessing were carried out in Hypermesh software. The mechanical behavior of the different models under bending and torsion was analyzed mathematically.Once the 3D model was ready, it was converted to FE Model using Hypermesh software, All the preprocessing were carried out in Hypermesh software. The mechanical behavior of the different models under bending and torsion was analyzed mathematically.

Results: Under bending conditions, the maximum Von Misses stress value was related to ProFit S3 at 1149.4 Mpa followed by ProTaper Next 1161.26Mpa and ProTaper Gold at 980.67 Mpa for bending test. Which had a displacement of 13.12 mm in ProFit S3, 10.82mm in ProTaper Next and 5.23MM IN ProTaper Gold. During Torsion test the Von Misses stress values were 256.64Mpa for ProFit S3, 266.08Mpa for ProTaper Next and 71.16Mpa for ProTaper Gold.

Conclusion: Metallurgical improvement of rotary files resulted in increasing the flexibility and the torsional resistance of these files. The alloy used in the manufacturing process has a greater influence on its mechanical properties. The heat-treated blue file ProFit S3 FE model and ProTaper Next FE model showed the highest flexibility during bending test and torsional resistance was better in ProTaper Gold compared to the other two FE models.

  Abstract 130: Management of procedural mishaps: A case report Top

Swaroop Hegde, Soumyadeep Ghosh, Nithin Kumar Shetty, Poornima Ramesh, Dinesh Kalasaiaha, Shruthi Nagaraja

Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India

Calcific metamorphosis or pulp canal obliteration requiring endodontic intervention can be quite challenging. Inappropriate positioning of drills or lack of thorough knowledge could lead to inadvertent mishaps such as gouging, perforations or instrument separations. Such procedural errors in Endodontics could significantly impact the clinician's ability to thoroughly disinfect the root canal system, which in turn will compromise the longevity and success of the treatment. Management of such mishaps along with aberrant root canal anatomies may be challenging at most times, even for an experienced clinician. The presence of multiple mishaps in the same tooth would further compromise the prognosis of the tooth. The success of endodontic treatment depends on the clinician's ability to effectively negotiate the canals, perform thorough three-dimensional disinfection and achieve a good coronal and radicular seal. The advent of magnification, ultrasonics and newer biomaterials, has made possible attempting the repair and successful management of such challenging scenarios. This paper will discuss the management of a case with canal calcification featuring perforation repair and instrument retrieval along with a one year follow-up.

  Abstract 131: Evaluation of the clinical efficacy of local anesthetic adjuvants combined with 2% lignocaine-epinephrine solution in patients receiving a classical inferior alveolar nerve block for endodontic surgeries Top

Kavitarani Rudagi, Saikalyan Choudhury1

ACPM Dental College, Dhule, Maharashtra, 1Berlin School of Health Sciences, Jammu, Jammu and Kashmir, India

Aim: The aim of this double-blind randomized controlled clinical trial was to evaluate and compare clinical efficacy of two local anaesthetic adjuvants- Sodium bicarbonate 8.4 percent and 4mg Dexamethasone, when combined with 2% Lignocaine-Epinephrine solutions in patients receiving a classical inferior alveolar nerve block for endodontic surgeries.

Methods: This prospective, randomized, double blinded controlled clinical trial was approved by Institutional ethical committee and followed good clinical practice guidelines of WHO. A written informed consent was obtained from all the subjects involved in the study. A total of 60 patients posted for endodontic surgeries involving mandibular teeth were included in the study and divided into three different groups as follows: Group 1: Commercially available Lignocaine solution containing 1:100000 Epinephrine. (Control group) Group 2: Lignocaine solution containing 1:100000 Epinephrine buffered with 8.4% sodium bicarbonate solution. (Experimental group) Group 3: Lignocaine solution containing 1:100000 Epinephrine mixed with Dexamethasone. (Experimental l group) A Modified Heft parker visual analog scale was chosen for pain measurements Patients rated pain on deposition of solution and postoperative pain after a period of 24 hours. Onset & Duration of anaesthesia and incidence of postoperative swelling was recorded by a trained consultant.

Results: Sodium bicarbonate buffered lignocaine reduced the pain on deposition of local anesthesia (P < 0.05). It also reduced the time of onset and in addition, prolonged the duration of anesthesia (P < 0.05). Dexamethasone-Lignocaine combination prolonged the duration of action of anesthesia and reduced post-operative pain and swelling (P < 0.05).

Conclusion: Addition of adjuvants like Sodium bicarbonate and Dexamethasone is a simple and effective chair side procedure that can effectively enhance the clinical efficacy of lignocaine and reduce post-surgical pain and swelling.

  Abstract 132: Seal to heal horizontal root fracture: A case report with 9 years follow up Top

Swapnil Kolhe

MGV's KBH Dental College and Hospital, Nashik, Maharashtra, India

Horizontal root fractures occur in less than 3% of all dental injuries of which the most common were fracture at the middle third of the root (57%). Maxillary central incisors have shown more prevalence for root fracture due to their anatomic position in the arch. Delayed reporting of patient for the same requires meticulous diagnosis, treatment planning & long term follow up. Based on the available literature various bioceramic materials have a broad range of possible clinical applications such as sealers, root-end filing, open apex management or perforation repair, vital pulp therapy as well as regenerative endodontics. EndoSequence Root Repair material (ERRM) was introduced as a white premixed cement for both permanent root canal repairs and apico retrofillings. The purpose of this case report having long term follow up of 9 years is to present the use of ERRM to enhance the healing of the horizontally fractured maxillary central incisor evaluated through CBCT.

  Abstract 133: Management of nonvital discolored tooth associated with radicular cyst: A multidisciplinary approach Top

Richa Gupt

Army Dental Centre, Research and Referral Hospital Dhaula Kuan, Delhi, India

The radicular cyst arises from proliferated epithelial cell rests of malassez when they get stimulated by an inflammatory process originating from pulpal necrosis of a nonvital tooth. The associated tooth is usually asymptomatic and may result in swelling of the soft tissues and mobility of the teeth involved. The typical radiographic description of the lesion is a round or oval, well-circumscribed radiolucency involving the apex of the tooth. Radicular cysts can be managed either surgically or nonsurgically. The nonvital, discolored anterior tooth associated with the lesion is a common esthetic concern for patients. It can effect their self-confidence and employability. Discolored nonvital teeth are frequently compromised due to root canal treatment, previous trauma, or caries. Invasive treatment options like crowns or veneers further weaken the tooth structure. This case report presents the successful surgical management of a radicular cyst associated with a nonvital discolored anterior tooth. This will also include the technicalities involved in the inside/outside nonvital bleaching technique.

  Abstract 134: Evaluation of setting time, flow and antibacterial activity of nanoparticle incorporated cyanoacrylate sealer Top

Chitaranjan Shetty, Aditya Shetty

A.B. Shetty Memorial Institute Of Dental Sciences, Deralakatte Mangalore, India

Aim: To determine the setting time, flow and antibacterial activity of nanoparticle incorporated cyanoacrylate sealer.

Materials and Methods: To determine the setting time, sealer materials were mixed and packed into the stainless-steel ring molds of specific dimensions and were placed on a glass plate. The whole assembly was stored at 37°C,>95%relative humidity for at least 1hour. To measure the setting time, the needle of a custom-made Gilmore apparatus was adjusted vertically onto the surface of the sealer. To determine the flow, a volume of 0.05 ml mixed sealer was dropped on a glass plate. At 3 minutes after the onset of mixing, a second glass plate of 20 gram (g) weight was placed on the sealer and a 100 g weight was added to make a total mass of 120g. The 120g weight was unloaded after 10 minutes from the start of mixing. The minimum and maximum diameters of the sealer discs were measured by a digital caliper with a resolution of 0.01mm. The antibacterial activity was determined by agar disc diffusion method.

Results: Nanoparticle-modified cyanoacrylate cement has an initial setting time of 40 minutes and a final setting time of 75 minutes. Whereas the initial setting time for the AH Plus sealer is 238 minutes and the final setting time 480 minutes. The formulated nanoparticle incorporated cyanoacrylate sealer has a flow of 23.5mm which is within the acceptable limits of ISO specification. Nanoparticle incorporated cyanoacrylate sealer has better antibacterial activity than other commercially available sealers.

Conclusion: The nanoparticle incorporated cyanoacrylate sealer had better setting time and flow within the limit of ADA specification and the antibacterial activity of the sealer is comparatively better.

  Abstract 135: Efficacy of preprocedural mouth rinse in reducing aerosol contamination produced during single visit root canal therapy Top

Debanjan Das

Haldia Institute of Dental Science and Research, Haldia, West Bengal, India

Aim: Aerosols and droplets contaminated with bacteria and blood are produced during root canal therapy. This study aims at evaluation of effect of pre-procedural mouth rinse in reducing aerosols contamination during single sitting root canal therapy.

Materials and Methods: This was a cross-sectional, single centre,triple blinded randomised controlled trial. 120 systemically healthy subjects (25-55 yrs) diagnosed with irreversible pulpitis and undergoing root canal therapy in maxillary and mandibular anterior and posterior teeth were randomly allocated into four groups of 30 subjects each. Group 1 - 0.12% Chlorhexidine, Group 2- 1.5 % Hydrogen Peroxide, Group 3-1% Povidine Iodine and Group 4-distilled water, 15 ml as a preprocedural rinse for 1 minute. The aerosol generated while performing access opening was collected at patient's chest area, doctor's chest area, and assistant's chest area on blood agar plates in all groups. The blood agar plates were incubated at 370C for 48 hours for aerobic culture, and the total number of colony-forming units (CFUs) was counted. Comparison of CFUs among the groups at all the three locations was done using Analysis of variance (ANOVA).Mean differences between groups 1, 2 and 3 was done using ANOVA. P values <0.05 were considered statistically significant.

Results: The results showed that CFUs in groups 1, 2 and 3 were significantly reduced compared with group 4 (p <0.001). Also, CFUs in group 1 were significantly reduced compared with group 2 and 3 (p<0.001). The numbers of CFUs were highest at the patient's chest area and lowest at the assistant's chest area.

Conclusion: Routine use of preprocedural mouthrinse as a measure to reduce microbial aerosols generated during root canal therapy.0.12% chlorhexidine gluconate is more effective than 1.5%hydrogen peroxide,1% povidine iodine and distilled water.

  Abstract 136: Prevalence of coronal pulp stones in relation to cardiac and thyroid disorders: A survey in Gujarat state population Top

Krushnangi Yagnik

College of Dental Sciences and Research Centre, Manipal, India

Aim: To investigate the prevalence of coronal pulp stones in relation to Cardiac and Thyroid Disorders amongst Gujarat state population.

Materials and Methods: Patients with cardiac disorders and patients with thyroid disorders of various parts of the Gujarat state, were involved in the study. Proper clinical history was recorded and after fulfilling the inclusion criteria, obtaining ethical clearance and patient's consent, the respective patient was included in the study for collecting the required data. Only the First Molars of all the four quadrants were considered for the study. A digital radiograph, (RVG) of all the first molars, of each patient, was recorded to check for the coronal pulp stones. The Data obtained was recorded and documented followed by statistical analysis using Chi Square Test with the help of SPSS Software.

Results: The result values obtained were statistically significant (p<0.05), for both patients with cardiac disorders and patients with thyroid disorders.

Conclusion: Thus, it can be concluded that patients with cardiac disorders and patients with altered levels of thyroid hormones, do have a correlation with the prevalence of coronal pulp stones, in the Gujarat state population.

  Abstract 137: Storage media and its impact on the histomorphology of teeth: A scoping review Top

Kiran Keswani1,2, Shalini Aggarwal2, Prasanna Dhatavkar2, Neil Vincent Lewis2

1D. Y. Patil Dental School, Lohegaon, 2Dr. D. Y. Patil Dental College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

To assess clinical performance of dental materials, clinical studies, as well as in vitro studies, are needed. Use of extracted teeth in these tests is common. Although a lot of attention has been showered upon the standardization of the actual testing, not many studies can be found on the effect that storage media has upon the micromorphology of the enamel, dentin or even radicular dentin, thus making it a neglected variable. This then brings into question the veracity of the results gleaned from the in vitro tests on radicular dentin. This Scoping Review was conducted with a view to collect information about the various storage media used for storing extracted human teeth, prior to their being tested, in vitro.

Focused Question: What effect do Storage media have on the Micromorphology of Radicular Dentin of extracted human teeth?

  • Population (P) - Extracted Human Teeth
  • Intervention (I) - Effect of storage media on properties of dentin
  • Comparison (C) - Comparison of the various storage media with each other for their effect on properties of dentin
  • Outcome (O) - Which storage media helped the teeth to retain their physical properties?

Materials and Methods: Relevant articles (randomised controlled trials, reviews, observational studies, and clinical case reports) published over a 10-year period were identified and retrieved from four internet databases: PubMed, Wiley online Library, Cochrane library, Google Scholar and manual search.

Results: By title and abstract screening and after removing duplicates, 15 articles were finally included in the present scoping review. According to the extracted data, the following storage media were found to be commonly used: 10% Formalin, Thymol, Gluteraldehyde, Vinegar, 1% Chloramine, distilled water, refrigeration etc.

Conclusions: No universal storage media has been proven in current literature. However, 10% Formalin seemed to be the most common storage medium. The selection of the ideal storage medium appears to finally depend upon the type of test being conducted. Longer storage durations seem to adversely affect the properties of teeth with shorter durations being acceptable. If needed, storage should be for least number of days (3-4 weeks or two months maximum).

  Abstract 138: Nanotherapeutics for endodontic biofilms: A review Top

Sonam Muthiyan, Sarvesha Bhondwe

Yashwantrao Chavan Dental College, Ahmednagar, Maharashtra, India

Despite of the established high success rate of the root canal treatment, failure still occurs due to inability to eradicate endodontic biofilms located in the anatomical complexities and uninstrumented portions of the root canal system. Bacterial biofilms are responsible for both primary as well as secondary infection of the root canal. They are highly resistant to disinfecting agents used in endodontic treatment. Current antibiofilm strategies have limitations, so advanced disinfection strategies are developed. Over the last decade, Nanotechnology is an emerging science that has myraid applications in dentistry. Nanomaterials are natural or synthetic materials with external dimensions between 1nm to 100nm. As a result of their nanoscale dimensions, nanoparticles possess unique physicochemical properties such as enhanced antibacterial activity, large surface area, increased chemical reactivity and the capacity to be functionalized with other reactive compounds. They have demonstrated significantly superior properties as compared to their bulk counterparts. This article will review about the current knowledge and research findings as well as the clinical applications, their advantages and limitations of the antibacterial nanoparticles. It will overview the different nanomaterials used in endodontic irrigation techniques, photodynamic therapy, intracanal medicaments, sealers and obturation materials that would improve antimicrobial efficacy and thus the success of endodontic treatment.

  Abstract 139: Root anatomy and canal configuration of human permanent mandibular second molar – A systematic review Top

Rajesh Shetty, Poonam Joshi

Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India

Objective: To review the literature on root anatomy and canal configuration in permanent mandibular second molar based on Vertucci classification.

Methods: Online electronic databases such as PubMed-Medline, Embase, Scopus, and Cochrane Library were searched using appropriate keywords from the earliest available date till 10th November 2020 without restriction on language. Additional sources like Google Scholar, major journals, unpublished studies, conference proceedings, and cross-references were explored. Information curated for data extraction included methodology, population, sample size(number of teeth), number of root canals, and type of root canal configuration.(RCC).

Results: 36 articles were selected with a total of 12293 permanent mandibular second molar teeth. In the mesial root, type IV canal configuration with 37.6% was more frequent, having two canals with 70.4%. In the distal roots, one canal was more prevalent with 77% occurrence and type I canal configuration was more frequent with 85.2%.

Conclusion: Comprehensive knowledge of tooth anatomy and root canal morphology is crucial to root canal treatment. Therefore, an understanding of the canal configuration and anatomy is necessary for the dentist to enhance successful endodontic treatment. Our systematic review findings reveal a wide variety of possible canal configuration among human permanent mandibular second molar while the number of canals ranged from 1 to 5 in number. The evidence is intended to help dental practitioners to avoid mishaps like perforation and missing canals and anticipation of potential complications during treatment.

  Abstract 140: Pain perception and vital signs during inferior alveolar nerve block with conventional syringe versus computer controlled anesthesia delivery technique: A randomized split-mouth clinical trial Top

Neha Deshpande, Dipali Shah, Ashwini Dadpe, Omkar Balsaraf, Ajit Hindlekar, Swati Wadekar

Sinhgad Dental College and Hospital, Pune, Maharashtra, India

Aim: The aim of this split-mouth, single- blind randomized clinical trial (RCT) was to comparatively evaluate the pain perception and effect on vital signs during conventional local anaesthesia (CLA) and computer-controlled local anaesthesia delivery (CCLAD) techniques using 4% Articaine with 1: 100,000 epinephrine for inferior alveolar nerve block (IANB) in mandibular molars requiring restorative treatment.

Materials and Methods: One hundred and fifteen adult patients with reversible pulpitis in contralateral mandibular first/second molars were enrolled for this study. Each patient served as his/her own control being subject to two anesthesia techniques: CLA and CCLAD. The IANBs were administered using 1.7 ml of 4% Articaine with 1:100,000 epinephrine. A split-mouth design was adopted wherein each tooth undergoing conservative restorative treatment received anesthesia using each of the two techniques at 2-week interval. Patients' pain perception was determined using the Heft- Parker visual analog scale (VAS) before and during the administration of IANB injection. Haemodynamic parameters were measured. Pulse oximeter was used to monitor the pulse/heart rate(HR) and oxygen saturation(SO2) of the patients at the beginning of injection, after 30 seconds from the start of the injection and at the end of injection. Blood pressure (systolic-SBP and diastolic-DBP) was recorded using a digital sphygmomanometer at baseline and during the injection in both the techniques. The differences in assessment of pain perception, vital parameters (HR, SBP, DBP and SO2) were analyzed using Student's t test (p value<0.001). Data were analyzed using Student t test, one-way ANOVA followed by post-hoc Tukey test and Pearson's correlation test.

Results: CCLAD showed significantly lower pain scores compared to CLA. The HR, SO2 and SBP showed significant increase in their means over baseline, during the CLA compared to the CCLAD technique. Pearson's correlation was not significant for all vital sign parameters except for SO2 in the CLA group (p < 0.05), where a correlation was noted.

Conclusions: Within the limits of this study, patients experienced lesser pain with CCLAD than CLA for IANB using Articaine. Also, vital signs showed a significant increase in mean HR, SO2 and SBP from baseline readings when CLA was used in comparison to CCLAD.

  Abstract 141: The effect of autoclave sterilization on the cyclic fatigue resistance of nickel-titanium rotary files: An in vitro study Top

Sonia Preshma D'souza, Bettina Ashwini Vergis

Srinivas Institute of Dental Sciences Mukka, Mangalore, India

Objectives: To compare the cyclic fatigue resistance of Hyflex CM and Protaper Next Ni-ti files and evaluate the effect of autoclave sterilization on the cyclic fatigue resistance of Ni-ti instruments.

Materials and Methods: The cyclic fatigue testing was performed under two main groups. Hyflex CM and Protaper Next (PTN). The files in each group were further randomly divided into four groups each with same size and taper. Customized simulated canal was fabricated with 3mm radius and a curvature of 60°. The samples were tested under the following four conditions: a) no sterilization, b) sterilization 10 times before cyclic stress, c) sterilized at the start and after each cyclic stress at 25%, 50%, 75% and d) no sterilization at start, only after each cyclic stress. Time to failure was determined using a digital stopwatch and the number of rotations was calculated to evaluate cyclic fatigue resistance. One way ANOVA and Tukey multiple comparison tests were used to find the difference between the groups. A value of p < 0.05 was considered to be statistically significant.

Results: The study showed increased fracture resistance in Hyflex CM group when compared to Protaper Next group. Autoclave sterilization significantly increased the Mean cycle to failure (MCF) both before and after the files was subjected to cyclic stress.

Conclusion: Autoclave sterilization prior to their use significantly increased their cyclic fatigue resistance. Hyflex files made up of controlled memory wire technology were more resistant to cyclic fatigue compared to Protaper Next files. Funding source: This research was not funded by any external sources.

  Abstract 142: Comparison of diode laser with maleic acid and ethylenediaminetetraacetic acid on smear layer removal from root canals: A scanning electron microscope study Top

Shahnaz Nabi

Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India

Aim: To evaluate the effect of diode laser with maleic acid and ethylenediaminetetraacetic acid (EDTA) on the smear layer removal from root canals.

Materials and Methods: A total of 160 mandibular premolars were decoronated to working the length of 12 mm and prepared with protaper gold rotary files up to size F3. Group 1 canals irrigated with 1 ml 17% EDTA followed by 3 ml of 3% NaOCl. Group 2 canals were initially irrigated with 0.8 ml of 17% EDTA the remaining 0.2 ml was used to fill the root canals, and diode laser application was done followed by 3 ml of 3% NaOCl. Group 3 canals were irrigated with 1 ml of 7 % maleic acid followed by 3 ml of 3% NaOCl. Group 4 canals were irrigated with. 8 ml of maleic acid and remaining. 2 ml was used to fill canal and activated by diode laser.followed by 3 ml of 3% NaOCl. Scanning electron microscope examination of canals was done for remaining smear layer at coronal middle and apical third levels.

Results: At the coronal third level, Group 3 followed by Group 4 had the least smear layer scores with no significant difference between them. This was followed by Group 2 and Group 1 with a significant difference between Group 3 and Group 1. At the middle third level, Group 3 followed by Group 4 had the least smear layer scores with a significant difference between Group 3 and Group 1. This was followed by Group 2 and Group 1 with a significant difference between them. The highest smear layer scores were observed in Group 1 and Group 2. At the apical third level, the lowest smear layer scores were observed in Group 3, followed by Group 4, Group 2, and Group 1, with a significant difference between them.

Conclusion: Within the limitations of the current study, all the tested groups were able to remove the smear layer from the prepared root canals to different degrees. Maleic acid alone or its combination with diode laser showed significantly better smear layer removal than EDTA alone.

  Abstract 143: Antimicrobial efficacy of irrigants and irrigating device in disinfection of root canal system: An ex vivo study Top

Shruthi H Attavar

A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India

Aim: The aim of the present study is to determine the antimicrobial efficacy of Irrigants and irrigating devices in eradication of endodontic microorganism from the root canal system.

Materials and Methods: Ninety patients who visited department of Conservative Dentistry and Endodontics for root canal treatment were included in the study. Each patient having an intact non vital tooth with any of the following symptoms, spontaneous pain, pain on percussion or swelling were included in the study. After rubber dam isolation access cavity preparation was done using endo access bur, immediately after working length determination, the first bacterial sample was collected using sterile paper point size 25. Each paper point was retained near the apex for 1min. The collected root canal sample was transferred into a PBS containing vials. The samples were then streaked on BHI agar plates to check for E-faecalis colony forming unit. Cleaning and shaping of the root canal was done using Protaper Universal file, following which the root canals were irrigated with GROUP I- 5 ml of 3 %sodium hypochlorite + Passive ultrasonic activation, GROUP II- 5 ml of 3 % sodium hypochlorite +Endoactivator, GROUP III - 5 ml of 2% chlorhexidine+ Passive ultrasonic activation, GROUP IV -5ml of 2%chlorhexidine +Endoactivator Group V -5 ml of 3 %sodium hypochlorite+laser GROUP VI-5 ml of 2 %Chlorhexidine +laser disinfection. Second sample was collected after disinfection process using paper points retained near the apex for 1 min. The samples were stored in PBS solution. The samples were then streaked on BHI agar plates to check for the E faecalis colony forming unit. Confirmatory analysis for E faecalis was done using Gram staining, bile esculin agar test and PCR.

Results: Sodium hypochlorite along with laser activation showed reduced bacterial colony count with p value <0.001.

Conclusion: Within the limitation of this sodium hypochlorite along with laser activation can be a used as an irrigation protocol for disinfection of root canal system.

  Abstract 144: Unusual anatomy of a mandibular first premolar with four canals: A case report with 3 year follow up Top

Garima Poddar

Shanti Memorial Hospital Pvt. Ltd., Cuttack, Odisha, India

The root canal system is much more complex than what is seen by naked eyes, at first glance. One of the reasons for failure of root canal treatment is missed canal. In the literature, different canal configurations have been reported. Sometimes, a rare canal morphology could be encountered in a case. Careful identification of such unusual anatomy is helpful in preventing missing a canal in such cases. Premolars often present with challenging and unusual root canal morphology, and many a times have multiple canals. This case report discusses one such rare complexity of root canal morphology, in tooth #44, of a 69-year-old male patient, that had two separate roots and four distinct root canals (mesiobuccal, mesiolingual, distobuccal, and distolingual). The treatment was carried out under magnification, using a dental operative microscope. Periodic follow ups have been carried out for the case for last three years.

  Abstract 145: Demystifying missed canals: A micro-endodontic case series Top

Ushaina Fanibunda1,2

1YMT Dental College and Hospital, 2Dr. Fanibunda's Specialty Dental Care, Mumbai, Maharashtra, India

The outcome of endodontic therapy is directly dependent on the ability of the clinician to locate and 3-dimensionally clean 'all' canals of the root canal system. Untreated canals are a major cause of endodontic failure. Canal complexities, anatomic variations and pulp space calcifications can render canal identification extremely challenging even for the most astute clinician. Micro-endodontic treatment, with the powerful magnification and illumination of the dental operating microscope, can greatly aid in canal identification by visualization of subtle colour changes and other visual clues within the access cavity and when coupled with ultrasonics provides a means for precise, limited dentine removal. Pre-operative 3-dimensional visualization of pulp space anatomy using CBCT is revealing and the potential to translate this information into guided clinical endodontics may also enable the precise location of calcified canals, with the avoidance of iatrogenic errors. A series of cases is presented which highlights different clinical steps and micro-endodontic techniques to uncover hidden anatomy and face the challenges of the pulp space confidently and correctly.

  Abstract 146: Restoration of endodontically treated teeth: Everything we do will eventually fail Top

Aparna Gupta

Kolkata, West Bengal, India

The traditional wisdom for the restoration of Endodontically treated teeth has been at the Biological expense of the tooth. Most of the teeth that are root canal treated are molars,damaged with the loss of 1 or 2 marginal ridge, effectively a mesio-occlusal or a disto-occlusal cavity or MOD. Does that justify cutting away of the other tooth surfaces, merely to replace them with metal & ceramic? Are we postulating that metal & ceramic are equal, if not better than Enamel & Dentin? The question that we as clinicians should be asking is whether the failure of our restorations is favourable? When our post endo restorations fail, will the tooth below remain saveable? With the revolution that adhesion brought, structurally damaged endodontically treated teeth can be treated effectively, conservatively,comparatively inexpensively & with a favorable failure mode, with Direct Composite onlays. This paper discusses & questions the traditional crowns as means of reinforcing coronal tooth structure and proposes an evidence based approach for direct composite onlays, which saves time & money for the clinician & patient.

  Abstract 147: Non surgical management of a large periapical lesion using two different intracanal medicaments – Cone-beam computed tomography case reports Top

Pradeep Shetty, Sanket Sawant, Ronit Shinde, Eshani Shah, Noopur Mane, Piyush Oswal, Soumya Shetty, Himali Desai

Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India

Periapical lesions occur because of endodontic infections, which may be due to caries or trauma and manifest itself as a host response to microbial challenge in the root canal system, The ultimate aim in endodontic treatment is to return the involved teeth to a healthy as well as functional condition without any involvement of surgical procedures. At first, the treatment plan of all the inflammatory periapical lesions should comprise of a conservative nonsurgical approach. If success is not achieved by nonsurgical techniques, commencement of surgical techniques is indicated. Sterilization of root canal space is foremost for the success of the endodontic treatment which is usually carried out with intracanal irrigants and medicaments. Triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) and calcium hydroxide is used to achieve sterilization and healing of periradicular area. Prolonged debate about the management of large cystic lesions has been observed, with some clinicians stating that true cysts cannot be treated successfully by non-surgical methods. However, some clinicians believe that after nonsurgical root canal treatment a large majority of cysts can be healed. Since prerequisite of endodontic surgery also suggests about good endodontic treatment, as a true clinician we should try minimally invasive dentistry by giving an genuine effort for non surgical treatment of large periapical lesions and assess the healing periodically with good diagnostic methods. Considering few limitations on conventional radiography for detection of periapical bone lesions, advanced imaging methods such as CBCT might add benefits to endodontics and offer a higher quality for the diagnosis, treatment planning, and prognosis. This paper presents two case reports of healing of periapical lesion using two different intracanal medicaments and assessed with CBCT.

  Abstract 148: Management of large periapical lesions with palatal perforations: A case series with surgical technique modification Top

Pravin Kumar

A.I.I.M.S Jodhpur, Rajasthan, India

The success of the surgical intervention in cases with periapical lesions with either nasal or palatal perforations depends not only on proper case selection but also on the surgical skills of the operator and the materials used to fill in the enucleated periapical defect if at all. From the times of having a pool of congealed blood in the bony defect to the placement of platelet-rich plasma (PRP), then the use of various kinds of bone grafts, and now to the use of platelet-rich fibrin (PRF) in the bony defects has become the accepted standard of care in surgical endodontics and has been well documented in literature. The platelet-rich concentrates aid in the release of platelet-derived proteins and growth factors (GFs) which promote the cell chemotaxis, angiogenesis, and wound healing of the periapical lesions. Bone grafts are the most widely used to repair the bony defects as they have osteogenic, osteoinductive and osteoconductive properties. Though the efficacy of platelet-rich fibrin or bone graft materials with or without membranes is well documented in the healing of large peri-apical bony defects, their efficacy in the treatment of either nasal or palatal perforation repairs is not widely studied or documented. Thus, the present case series presents the successful treatment of ten patients, highlighting the modifications in treatment modality needed to adapt while managing large periapical lesions with palatal perforations. Subsequent to the mucoperiosteal flap elevation, curettage and complete removal of peri-apical lesion contents, manipulation of the root apex and placement of a retrograde restoration, the repair of palatal perforation bony defect was carried out. Bone graft in putty form was carefully adapted to the palatal perforation defect to act as a scaffold. Platelet-rich fibrin (PRF) was then placed over the bone putty thus filling in completely the peri-apical bony defect completely. Following PRF placement, the mucoperiosteal flap was closed, sutures placed and periodontal dressing (COE-PAK) was given. The patient was recalled after 4 days for evaluation and suture removal. The patient was kept under regular follow-up for 6 months and the peri-apical healing was assessed using radiographic means.

  Abstract 149: External root resorption: Hypoxia related changes expression of dec1 and dec2 genes of human cementoblast cells can give us a clue Top

Nitesh Tewari, Ujjal Bhawal, Vijay Mathur, Li Xiaoyan

Centre for Dental Education and Research, All India Institute of Medical Sciences, Delhi, India

Aim: To evaluate the effect of hypoxia on expression of DEC1 and DEC2 genes along-with proliferation and migration of human-cementoblasts.

Materials and Methods: An in-vitro experimental study was conducted using immortalised human-cementoblast cell-lines (HCEM-2). Hypoxia was created by using Mitsubishi AnaeroPack-anaero in airtight container, incubated at 37-degree centigrade with 5%CO2 in a humidified atmosphere. Effect of hypoxia was studied at periods of 24 hours, 48 hours and 72 hours using MTS assay for cell proliferation, wound healing assay (Ibidi, Germany) for cell motility and RT-PCR for gene expression of DEC1 and DEC2. HCEM2 under normoxia were taken as control. The experiments were performed in triplicate and statistical analysis was done using STATA-16.

Results: Cell proliferation was significantly reduced due to hypoxia at all times. It was less than half of that of normoxia after 72 hours. Wound healing assay revealed cementoblast motility to be reduced by hypoxia with a uniform trend from 24 to 72 hours. Expression of DEC1 and DEC2 was negligible in normoxia at 24 hours which further reduced at 48 hours and was absent at 72 hours while their expression was significantly high at all times in hypoxia.

Discussion: Cementoblasts comprise of lesser studied cell line which forms the basis of attachment of periodontal ligament fibres to the tooth, maintaining the homeostasis of periodontium. Compression and mechanical tear after luxation injuries, peri-radicular lesions and cysts secondary to trauma cause hypoxia. The present study observed its detrimental effects on cementoblasts causing up-regulation of circadian-clock genes linked with autophagy and energy metabolism. These pathways need to be understood to develop tissue engineering based solutions for managing external root resorptions.

Conclusions: Cementoblasts showed decrease in proliferation, reduced motility and up regulation of DEC1 and DEC2 genes.

  Abstract 150: Endodontic and periodontal treatment of invasive cervical resorption in a maxillary right central incisor Top

Katsuhiro Takeda, Hideki Shiba

Department Of Biological Endodontics, Graduate School Of Biomedical And Health Sciences, Hiroshima University, Dentist, Hiroshima, Japan

Invasive cervical resorption (ICR) is a relatively uncommon form of external resorption. This externally resorptive process is characterized by a cervical location and leads to progressive and destructive loss of tooth structure. A 43-year-old female patient visited Hiroshima University Hospital with a chief complaint of occlusal pain and discomfort around the gum of the maxillary right central incisor. She had no history of trauma and orthodontic treatment. There was no relevant medical history. The patient had good oral hygiene and her gingiva on all areas of the mouth except the maxillary right central incisor was healthy. The pocket probing depth on the maxillary right central incisor was 2 mm except 6 mm of the central part of the palatal site. On the probing, bleeding and pus discharge were observed and fibrous tissue was touched by the probe tip. The tooth responded positively to thermal and electric pulp vitality tests by PULPER® (GC, Tokyo, Japan) and Digitest® (Parkell, Farmingdale, NY, USA). There was no spontaneous pain. This presentation describes combined endodontic and periodontal approaches that led to a favorable outcome for the maxillary right central incisor which was diagnosed as ICR (Heithersay Class 3, Patel 3Ad).

  Abstract 151: Platelet rich fibrin and its role in endodontics: A literature review Top

Meenu Madhukumar, Remya Ganesh, Praveena Geetha

Kerala Institute of Medical Sciences Health, Thiruananthapuram, Kerala, India

One of the great challenges in clinical research is the development of bioactive surgical additives to regulate inflammation and to speed up healing process. Platelet concentrates are concentrated suspension of growth factors which act as bioactive surgical additives that are applied locally to induce wound healing. Platelet rich plasma is the first generation platelet concentration technique developed in the 1970s. Platelet rich fibrin is a second generation platelet concentrate first described by Choukroun in 2001.Both PRP and PRF are used to accelerate soft and hard tissue healing.Compared to platelet rich plasma,platelet rich fibrin involves only one centrifugal cycle,no blood additives and also there is continuous release of growth factor during and for more than 7 days. Because of its unique properties, it is used as a tissue-engineering material with a wide range of dental applications.It is not only used as a scaffold but also as a reservoir to deliver certain growth factors at the site of application.In regenerative endodontics, it is used as a scaffold and also as an apical plug. It is used as a graft material in guided tissue regeneration of furcal and apical surgery like root resection,root end ressection. The soft tissue application of PRF as a membrane include sinus augmentation and soft tissue thickening in areas of prosthetic and periodontal consideration. The benefits of platelet derived blood products also extend to hard tissue applications. This comprehensive review of literature aims at presenting about the evolution,science, preparation,its clinical applications in endodontics and advantages and disadvantage of using it in clinical applications.

  Abstract 152: Clinical management of isthmus using ultrasonic files in mesial root of mandibular second molar: A case report Top

Hidetaka Ishizaki1,2, Morio Okaguchi1, Shizuka Yamada2, Atsutoshi Yoshimura2

1Okaguchi Dental Clinic, Tokyo, 2Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences, Japan

Introduction: Isthmus is a narrow, ribbon-shaped communication between two root canals and contains necrotic pulp tissue, microbial populations and their byproducts. The aim of this presentation was to report an effective management of isthmus in the mesial root of mandibular molar.

Case: A 64-year old male patient visited Okaguchi dental clinic in Tokyo, Japan with a chief complaint of gingival swelling of his mandibular right second molar. In the periapical radiograph, periradicular lesion was observed. The affected tooth was sensitive to percussion and didn't react to electric pulp test. In the CBCT image, mesial root had two canals, isthmus and one apex. Root canal treatment was performed under the diagnosis of pulp necrosis and chronic apical abscess. Although mesial root canals and distal root canal were prepared with Ni-Ti files, infected debris remained inside the isthmus. Therefore, it was treated with U-files and root canal was irrigated with XP endo finisher. Then root canals were filled with MTA. Eight months after root canal filling, periradicular lesion disappeared.

Discussion: The aim of infected root canal treatment is to reduce the number of bacteria in root canal system. Because the root canal morphology is complicated, infection source remaining after root canal treatment may lead to endodontic failure. When root canal is prepared with hand or Ni-Ti rotary files, these instruments don't reach to isthmus. In general, sonic, ultrasonic, conventional syringe or negative pressure irrigation is performed for disinfection of isthmus. However, it isn't easy to remove debris sufficiently from the isthmus with these methods. In this case, it was suspected that isthmus was infected. Therefore, it was prepared with ultrasonic files and root canal was irrigated with Ni-Ti irrigation files. There are pros and cons regarding the necessity for preparation of isthmus. It has a risk of perforation, but ensure the greater reduction of disinfection from the root canal system.

Conclusion: Although various techniques are used for reduction of microbial populations in isthmus, the effective method is still not established. If isthmus is prepared safely with ultrasonic files, it would be provided as an effective technique for the disinfection of isthmus.

[TAG:2]Abstract 153: Evaluation of characteristics and clinical implications of endodontic emergencies at army dental centre, research and referral (Adc R and R), Delhi during Covid-19 disease outbreak [/TAG:2]

Seema Chaudhary

Army Dental Corps, New Delhi, India

Introduction: Spread of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) was detected in China in the late 2019, which later spread to other parts of the world. Affected persons present with symptoms mainly dry cough, malaise and a high fever. During the time of this pandemic several patients with endodontic emergencies presented to Army Dental Centre Research & Referral (ADC R & R). This study aimed to analyse the nature of these emergencies.

Methods: Information about patients was collected and systematized by date of visit, gender, age, and diagnosis. Only the patients with endodontic emergencies were included in the study. Emergencies were divided into three Groups: Group I: Preoperative, Group II: Intraoperative and Group III: Postoperative. These groups were further stratified according to the type of diagnosis received. A 0- 10 numerical rating scale (NRS) was used to record pain levels.

Results: A total of 4274 patients visited with endodontic emergencies. The most common age group for endodontic emergencies was 30-39 years (37%). 57 % patients presented with the diagnosis of symptomatic irreversible pulpitis. Patients who were diagnosed with symptomatic irreversible pulpitis showed higher pain levels as compared to the others, although the difference was not statistically significant (P value > 0.05).

Conclusion: Endodontic emergencies comprise a high proportion of dental emergencies visiting a dental centre with symptomatic irreversible pulpitis being the most common. No set guidelines exists for management of emergencies during outbreak of pandemic. Proper history taking about covid-19 along with use of personal protective equipment should be done to avoid chances of cross contamination. Pharmacologic management can be done is certain cases.

  Abstract 154: Minimally invasive restoration of endodontically treated posterior teeth – A review Top

Sowmya Kavoor, Hima Sandeep Adimulapu

Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India

The survival of an endodontically treated tooth depends on the quality of the post endodontic restoration given as much as it depends on the quality of the root canal treatment, if not more. Contrary to popular belief that root canal treated teeth are more brittle, several studies have concluded that the loss of coronal tooth structure either by means of caries excavation, access preparation or restorative procedures in a root canal treated tooth contributes far more to the eventual loss of tooth rather than the endodontic treatment itself. Conventionally, root canal treated teeth have been restored with full coverage crowns. This practice is however slowly but steadily changing with the recent emphasis on minimally invasive concepts and advances in adhesive systems. Several newer treatment options are available that are more conservative, less time consuming and economical compared to full crowns. This review paper explores and emphasizes on the different minimally invasive restorative treatment options available for the restoration of endodontically treated posterior teeth.

  Abstract 155: Photodynamic therapy as adjunct in endomicrosurgery for nonhealing periapical lesion in anterior teeth: A clinical report Top

Sandeep Singh Reyal, Vijaya Kumar Rajamani, Parag Dua

Department of Dental Surgery and Oral Health Sciences, Armed Forces Medical College, Pune, Maharashtra, India

Timely supervision of dental traumatic injuries is compulsory in order to avoid subsequent periapical pathological changes. Such injuries can lead to calcific metamorphosis, pulpal death or chronic and cystic apical periodontitis if left untreated. Endomicrosurgery (EMS) along with retrograde Mineral trioxide aggregate (MTA) restoration may be considered a valid treatment option when such cases get complicated with large non healing periapical lesions. In recent times, Photodynamic therapy (PDT) has appeared as a powerful tool for conventional treatment, capable of exterminating antibiotic resistant microorganisms in endodontic microflora. This article illustrates a case in which PDT was used as an adjunct to traditional EMS. PDT was done with medical handheld battery-operated diode laser HELBO® 'TheraLite Laser'. The use of PDT augmented the successful management of the patient with shorter healing period.

Keywords: Dental traumatic injuries, endomicrosurgery, photodynamic therapy (PDT)

Key Messages:

  1. Timely supervision of dental traumatic injuries is compulsory in order to avoid subsequent periapical pathological changes.
  2. Persistent antimicrobial resistance has been resulted due to inadvertent use of antibiotics.
  3. PDT has a role in eradicating microorganisms in endodontic microsurgical treatment as it augments additional benefits in treating long standing non healing periapical lesions.

  Abstract 156: Bonding of resin adhesives to endodontically treated teeth Top

Seema Yadav

Maulana Azad Institute of Dental Sciences, New Delhi, India

The bonding of resin composites to endodontically treated teeth presents special problems. The outcome of endodontic treatment depends mainly on the success of restorative and endodontic treatment. Endodontically treated teeth undergoes structural changes in the tooth substrate and are considered brittle. These teeth are affected by moisture loss and collagen alteration. There is loss of large amount of tooth structure and tooth stiffness reduction after treatment. The medicaments,irrigants and temporary restoration used during endodontic procedure also alters the physical properties of dentin. Moreover, the loss of proprioception of these teeth will result in decrease capacity to withstand the increased load. Minimal tooth intervention during endodontic procedure and use of resin adhesive techniques during restorative procedure allows preservation of tooth structure and sustain these teeth for prolonged period. The restorative procedures will establish normal form and functions,occlusal stability and provides protection from subsequent failure.The restoration of endodontically treated teeth using resin adhesive materials has become popular in clinical practice. Clinical research showed promising results however failure can occur in clinical situations due to debonding of the adhesives. This review paper will focus on factors associated with effectiveness of bonding of resin adhesives to endodontically treated teeth and their application to maximize their retention.

  Abstract 157: Is antimicrobial photodynamic therapy efficacy better than that of sodium hypochlorite and chlorhexidine in endodontic re-treatment cases? Top

Ramesh Bharti, Aseem Prakash Tikku

King George's Medical University, Uttar Pradesh, Lucknow, India

Aim: The purpose of this in vivo study was to evaluate the efficacy of photodynamic therapy (PDT) for eradication of microorganisms from previously filled infected root canals.

Materials and Methods: The study consisted of 120 randomly selected patients with previously root canal treated teeth with chronic apical periodontitis either on maxillary or mandibular anterior teeth. Patients were divided into three groups according to the disinfection protocol. Microbiological samples from the root canals were collected after removing the gutta percha from the root canal and following the endodontic re-treatment with the 5% sodium hypochlorite (Group I), 2% Chlorhexidine gluconate (CHO) (Group II) and PDT procedure (III) for 1 minute. During instrumentation, the root canals were irrigated with 5% sodium hypochlorite (NaOCl), and the final irrigation protocol included 17% ethylene diamine tetra acetic acid followed by NaOCl. Microbiological samples from the root canals were cultivated on selective plates to assess the presence or absence of microbial growth and determine the average reduction of viable microorganisms.

Results: There was a significant difference in reduction in total bacterial count in all the three groups at post treatment (p < 0.001). PDT was statistically more effective (p < 0.001) in reducing the bacterial species. PDT provided statistically higher (99.74%) elimination of Enterococcus faecalis in comparison to NaOCl (95%) and CHO (88%).

Conclusion: The results of this study showed that the use of the PDT to the endodontic re-treatment led to the significant reduction of the remaining bacterial species. So PDT can be use as a routine endodontic disinfection tool in failed root canal cases.

Keywords: Antimicrobial, disinfection, endodontics, re-treatment

  Abstract 158: Management of iatrogenic root perforation in mandibular molars by mineral trioxide aggregate: Case reports Top

Varun Rana

MDC Jabalpur, Madhya Pradesh, India

Perforation in endodontics is an artificial communication between the root canal system and supporting tissues of the teeth. Root perforations are undesired complications of endodontic treatment. In the recent literature, Mineral Trioxide Aggregate (MTA) has been regarded as an ideal material for endodontic perforation repair. This case report describes two case reports where an iatrogenic perforation was repaired successfully with mineral trioxide aggregate (MTA).

Keywords: Mandibular molars, MTA, perforation

  Abstract 159: Comparative evaluation of periapical healing and postoperative pain after root canal treatment using three different endodontic sealers: A randomised controlled trial Top

Akshay Khandelwal

Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: To evaluate and compare the healing of periapical lesions and postoperative pain after root canal treatment using BioRoot RCS, AH Plus and Tubliseal endodontic sealers.

Methodology: 63 single rooted teeth with periapical index (PAI) score of >2, underwent root canal treatment. The sealers were randomly chosen and allocated into 3 groups; Group 1 - Tubliseal (Zinc Oxide Eugenol based sealer), Group 2 - AH Plus (Epoxy Resin based sealer) and Group 3 - BioRoot RCS (Tricyclic silicate sealer). Postoperative pain was recorded by a visual analog scale (VAS) at 24 hours, 48 hours, 72 hours, and 7 days after obturation and subjected to statistical analysis. Radiographic evaluations for the area of periapical lesions were made at baseline, one month, three months and six months and subjected to statistical analysis.

Results: The mean pain score at 24 hrs was 17.94±11.35, 11.57±11.18 and 4.73±7.72; at 48 hrs was 5.26±9.04, 1.57±3.74 and 1.57±3.74; at 72 hrs for was 2.63±7.33,0 and 0 for group I, II and III respectively. Statistically significant reduction in the area of periapical lesions was noticed in all the three groups at 3 and 6 months (p <0.05). The mean difference in the area of periapical lesion for group 1, 2 and 3 were 4.05, 3.86 and 6.27 and 10.22, 9.80 and 13.41 at 3 months and 6 months respectively.

Conclusion: Within the limitations of this study, BioRoot RCS showed lesser post-operative pain compared to AH Plus and Tubliseal. There was no significant difference in post-operative pain based on the extrusion of sealer except for BioRoot Rcs at 48 hrs. Bioroot RCS showed better periapical healing compared to AH Plus and Tubliseal at the 3 and 6 months interval. A minimum time period of 3 months is required for significant periapical healing.

  Abstract 160: Effect of different concentrations of sodium hypochlorite used as hemostatic agent on outcome of pulpotomy in mature permanent teeth with irreversible pulpitis: A systematic review Top

Vijay Kumar, Aakriti Saini, Amandeep Kaur1, Sidhartha Sharma, Amrita Chawla, Ajay Logani

All India Institute of Medical Sciences, New Delhi, 1Regional Institute of Medical Sciences, Imphal, Manipur, India

Objective: What is the outcome of full pulpotomy when haemostasis is achieved by 2.5% sodium hypochlorite compared to other concentrations of sodium hypochlorite in the management of mature permanent teeth with irreversible pulpitis?

Materials and Methods: The systematic review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three electronic bibliographic databases and two clinical trial registers were searched by two independent authors up to 31st May 2021 using broad keywords and relevant MeSH terms. The search was limited to literature in the English language. Two authors independently evaluated the titles and abstracts for suitability of inclusion and performed data extraction independently in custom-designed excel sheets. Extracted data included type of study, demographic details, the status of root maturation, diagnosis, intervention, haemostatic agent and its concentration, duration of application of haemostatic agent, pulp capping material, permanent restoration, the timing of post endodontic restoration, follow up period and clinical and radiographic success. Newcastle Ottawa Scale and the Cochrane risk of bias tool were used for quality assessment. The success rate for coronal pulpotomy was calculated for each study.

Results: Initial literature search yielded a total of 861 articles. After removing duplicates, the titles and abstracts of 444 articles were screened, and 431 were deemed ineligible based on the selection criteria. The full texts of 11 articles were evaluated and a total of 4 articles were included in the systematic review. Three were single-arm prospective studies on pulpotomy, while one was a randomized control trial comparing pulpotomy and root canal treatment. Amongst, three studies using 2.5% sodium hypochlorite as a haemostatic agent, a combined success rate of 93% from 117 teeth was reported. Only one study used 5% sodium hypochlorite as a haemostatic agent and reported a success rate of 100% (n=6).

Conclusions: There is lack of studies comparing different concentration of sodium hypochlorite as a haemostatic agent. Randomized controlled trials to study the method of hemostasis (compression vs irrigation) and concentration of sodium hypochlorite on the outcome of pulpotomy are needed.

Funding source: Nil.

  Abstract 161: Treatment outcome of regenerative endodontics in mature permanent teeth: A systematic review and meta-analysis Top

Sidhartha Sharma, Divya Nangia, Aakriti Saini, Perumal Vanamail, Vijay Kumar, Amrita Chawla, Ajay Logani

All India Institute of Medical Sciences, New Delhi, India

Aim: In mature permanent teeth, regenerative endodontic procedures (REP) have the advantage of reestablishing vital pulp-like tissue within the root canal, thereby restoring the root canal's native defense ability and reducing the likelihood of reinfection. The purpose of this review was to determine the overall clinical and/or radiographic success rate (O) of regenerative endodontic procedures (I) in mature permanent teeth (P) and to compare it (C) to the success rate of conventional nonsurgical endodontic treatment (NSET).

Methods: Sources: PubMed, Web of Science, Embase, EBSCO, Cochrane Central Register of Controlled trials, ClinicalTrials.gov, Clinical Trials Registry-India and OpenGrey until October 2020, and updated in March 2021. Inclusion: Randomised clinical trials and single-arm prospective studies in the English language evaluating the treatment outcomes of REPs (cell-based or cell homing) in mature permanent teeth. The Cochrane risk of bias 2.0 and ROBINS-I tools were used to assess risk of bias. The risk difference (R.D.) between NSET and REPs was determined using meta-analysis of the included randomised clinical trials. Overall impact of REPs on success rate was calculated using data from both randomised clinical trials and single-arm prospective studies. Sensitivity analysis was performed. A subgroup analysis was carried out based on the following criteria: stem cell strategy, biomaterial type, intracanal medicament and final irrigant.

Results: This systematic review included ten studies with a total of 552 patients (n). The R.D between REP and NSET was 0.032 (95% C.I: 0.023 - 0.087) indicating no significant difference (P=0.258). The overall success rate of REPs was found to be 96.0% (95% CI: 94-98%). Consistent results were obtained in the sensitivity analysis (P=0.551). No significant difference was found in any of the sub-group analysis.

Conclusions: Based on a limited number of comparative studies, REPs have a similar success rate to NSET in mature permanent teeth.

Funding Sources: Nil.

  Abstract 162: The effect of different intracanal medicaments on periodontal and periapical healing in mature permanent teeth having concurrent endodontic-periodontal lesion with/without communication: A systematic review Top

Amrita Chawla, Sarita Gill, Krunal Tabiyar, Sidhartha Sharma, Vijay Kumar, Harsh Priya, Ajay Logani

All India Institute of Medical Sciences, New Delhi, India

Aim: To identify the effectiveness of intracanal medicament on periodontal and periapical healing of concurrent endodontic-periodontal lesion with/without communication in mature permanent teeth.

Methods: A literature search of articles published from January 2014 to January 2021 was conducted using MeSH and free terms in PubMed, Scopus, Cochrane, Web of Science, Embase, Gray literature and hand search. The search was restriction to English language only. Clinical trials (randomized or non-randomized), cohort studies, case-control studies evaluating effect of different intracanal medicaments (ICMs) on the outcome of periodontal and endodontic healing were included. Case series and single case reports were excluded. Two independent reviewers were involved in study selection, data extraction and appraising the included studies; disagreements were resolved by a third reviewer. The revised Cochrane risk of bias tools for randomized trials (RoB 2) and Newcastle-Ottawa Scale (NOS) were used to assess the risk of bias. Overall impact of ICM on healing was reviewed and critically evaluated.

Results: Initial screening of databases resulted in 15,324 studies. However, based on the inclusion criteria, only three randomized clinical trial, two prospective cohort and one retrospective case-control study with a total of 315 patients were included for full-text reading. As the treatment protocols rendered and quality of reporting were different, heterogeneity was seen among studies. Calcium hydroxide (CH) was the most commonly used ICM followed by chlorhexidine gel in two studies. Periodontal therapy was performed as initial scaling and root planning (SRP) in all studies. Open flap debridement (OFD) was done in two randomized clinical trials. The time lapse between two treatment protocols varied between 1 week to 3 months. All the studies showed decreased probing depth (PD) after completion of endo-perio treatment. Majority of studies exhibited low risk of bias on analysis.

Conclusion: This systematic review indicates that there was an improvement in clinical periodontal parameters following placement of CH as ICM in concurrent endodontic-periodontal lesions. However, the results were inconclusive regarding influence on periapical healing.

  Abstract 163: Prodigious material in surgical endodontics: A case report Top

Ritu Sharma

School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India

An innovation that is promising in the field of surgical dentistry is the play of platelet-rich fibrin (PRF). PRF can escalate tissue healing mechanisms and also truncate inflammation. Mineral trioxide aggregate (MTA) induction of calcification facilitates biological sealing. The present case report strives clinical circumstances in which diverging treatment modalities were considered to treat a large radicular cyst.

  Abstract 164: Successful surgical breakdown of replacement resorption using biodentine and aesthetic correction in an avulsed re-implanted Infra occluded permanent maxillary central incisor: A case report Top

Harakh Baranwal

IMS, BHU, Varanasi, Uttar Pradesh, India

An avulsed permanent tooth is one of the few real time dental emergencies, where in a potential unscheduled diagnostic and treatment decision outside the regular practice experience of the dentist awaits him. Prognosis is dependent on the decisions taken in the “Golden Hour” after the accident. Re-implantation is the treatment of choice as there are chances of successfully saving a tooth. The condition is compounded by the lack of public awareness. In case if the periodontal ligament dries due to increased extraoral time then an increase in external inflammatory root resorption leads to ankylosis and replacement resorption.There is no definite treatment and protocol for prevention of replacement resorption. This article discusses the successful surgical management of replacement resorption by using biodentine and aesthetic correction by using composite resin and metal ceramic crown attach with gingival ceramic with 5 year followup of a 19 year old male patient with complaint of discoloration and poor appearance of maxillary right central incisor.

  Abstract 165: Postobturation symptoms: A comparative evaluation of single visit and multiple visit root canal treatment Top

Tarun Kumar, Sunandan Mittal, Vanita Keshav

Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India

Aim: 1.To compare the incidence and intensity of post obturation pain and flare ups in single vs multiple visit root canal treatment.

2. Compare the incidence of pain in root canal therapy with hand instruments and rotary instruments in both groups.

3. Compare the frequency of post obturation pain in vital and non-vital pulps.

Materials and Methods: 200 teeth were treated and divided into 4 groups- Group A-Single visit H and Instrumentation (50 teeth), Group B- Single visit Rotary Instrumentation (50 teeth), Group C- Multiple visit Hand Instrumentation (50 teeth), Group D- Multiple visit Rotary Instrumentation (50 teeth). Each group was further subdivided into vital (25 teeth) and non-vital groups (25 teeth). The evaluation of post-obturation symptoms experienced by the patients was done with a Verbal Descriptor Scale (0-3) on 1st, 7th and 30th day of treatment. Although no systemic medication was prescribed, the patients were instructed to take 650 mg Paracetamol only if they experienced pain. Data collected was subjected to statistical analysis. The comparisons between different groups and subgroups were made using the Non-parametric 'Mann Whitney u' test.

Results: When incidence and intensity of post-obturation pain was compared between single and multiple visit root canal treatment, multiple visit group showed lesser pain compared to the single visit group on all three days and the difference was also statistically significant on 1st day of obturation. When hand and rotary instrumentation were compared for postoperative pain, no significant difference was found between the two groups. When vital and non-vital pulps were evaluated for post-obturation pain, non-vital group resulted in lesser pain compared to vital group on the three days and the difference was also statistically significant on 1st day of obturation.

Conclusion: Based on these results it could be concluded that multiple visit root canal treatment regimen results in lesser post-obturation symptoms compared to single visit treatment regimen and hence should be preferred.

  Abstract 166: Comparative evaluation of fracture resistance of endodontically treated teeth restored with glass fiber post and a novel prefabricated edelweiss post and core system Top

Dhanya Gangadharan, Meena Naganath1

Bangalore Institute of Dental Sciences and Hospital, 1VS Dental College and Hospital, Bengaluru, Karnataka, India

Introduction: The restoration of endodontically treated teeth with compromised crown structure requires the fabrication of a post and core with modulus of elasticity similar to that of dentin. Tooth colored post such as Glass fiber posts with similar modulus of elasticity to dentin are used commonly by the clinicians to improve the fracture resistance and reduce the risk of root fractures. These glass fiber post requires a separate core build up. Recently tooth colored post such as prefabricated Edelweiss composite post with core as a single unit system is available in market. Current literature provide less evidence on the comparison of fracture resistance among these post system. Hence the aim of this study was to assess and compare the fracture resistance and failure mode of glass fiber post with composite core build up and prefabricated Edelweiss post &core single unit.

Methods: 40 human extracted mandibular premolars were used for the study. The teeth were randomly divided into two groups and were subjected to root canal treatment. After post space preparation in teeth under Group 1(n=20) glass fiber post(TENAX® FiberTrans) was placed and a separate composite core build up was done. In Group 2 (n=20) resin composite post and core single unit (Edelweiss post system) was placed. All samples were subjected to thermal cycling.The fracture resistance was tested using a compressive load in an Universal testing machine. The fracture force was measured in Newtons and failure patterns were analyzed using stereomicroscope.

Results: The statistical test using independent t test to analyse the fracture resistance revealed a statistical significant difference between the two group (p<0.05).

Conclusions: The fracture resistance of prefabricated Edelweiss resin composite post and core was statistically significant than the Glass fiber post. The failure pattern observed in Glass fiber post were non catastrophic core fracture, post debonding, post fracture and tooth fracture while in Edelweiss post system showed non catastrophic core and tooth fractures. There was no post debonding or post fracture in Edelweiss post system.

  Abstract 167: Comparison of pre-treatment Gabapentin and Pregabalin to control postoperative endodontic pain following single visit endodontics: A double blind, randomised clinical trial Top

Jayeeta verma

MGM Dental College, Navi Mumbai, Maharashtra, India

Aim: The aim of this study was to evaluate the analgesic effect of pre- treatment with 600 mg Gabapentin or 75mg Pregabalin in reducing post endodontic pain when compared with a placebo.

Materials and Methods: Ninety patients who needed root canal treatment, with an initial Verbal Rating Scale (VRS) pain score of more than 4 were randomly divided into three groups (n=30). The baseline values were measured (T0). The patients were then administered either 600 mg Gabapentin (group A) or 75mg Pregabalin (group B) or Placebo (group C), 30 minutes prior to the start of the endodontic treatment. Single visit endodontics was performed by a single operator and pain evaluation was done post endodontic treatment immediately (T1), at 4 hrs (T2), 8 hrs(T3), 12 hrs(T4), 24 hrs(T5), 48hrs(T6) and 72hrs (T7) using the VRS. Tab Ibuprofen /Paracetamol 400mg/325mg was administered as a rescue dose, if needed.

Results: Pregabalin showed statistically significant results when compared to Gabapentin at all time intervals except after 72hours (p=0.170). The placebo group showed significantly greater pain scores when compared with the other two groups. The percentage of pain relief was maximum for Pregabalin group (92.1%) followed by Gabapentin (87.6%) and then the placebo group (69.1%).

Conclusion: This study shows that pre-treatment, single dose of Pregabalin and Gabapentin both showed greater analgesic effects when compared with a placebo. They can be used effectively in reducing post treatment endodontic pain.

  Abstract 168: Evaluation of ozone therapy in endodontic treatment of teeth with necrotic pulp and apical periodontitis: A randomised clinical trial Top

Nidhi Sinha

Pacific Dental College and Hospital, Udaipur, Rajasthan India

Aim: To compare the effect of different application techniques of ozone on the prevalence of post endodontic pain in patients undergoing single-visit root canal treatment.

Materials and Methods: Adult patients with necrotic pulp in single-rooted teeth and apical periodontitis were selected. Following local anesthesia and rubber dam isolation, access cavities were prepared. Working length was established using an electronic apex locator. Cleaning and shaping were carried out using sodium hypochlorite following standard rotary files. Patients were randomly assigned into groups-

Group 1- Ozone treatment with no agitation.

Group 2- Ozone treatment with manual agitation.

Group 3- Ozone treatment with ultrasonic agitation.

Group 4 - Ozone treatment with sonic activation (Pro agitator tip system).

Group 5 - No Ozone treatment (Control Group).

Each group was irrigated with 15 ml of ozonated water for 3-5 minutes with different or no agitation techniques. Obturation and core built-up were completed at the same appointment. The level of discomfort at baseline, after 6, 12, 24, 48 hours, and 7 days were recorded on the Visual Analogue Scale. Pain levels were recorded, tabulated, and subjected to statistical analysis using a one-way analysis of variance followed by the Tukey post hoc test.

Results: Ultrasonic and PATS groups showed significantly less pain at 6, 12, 48 hours, and 7 days (P < 0.05).

Conclusion: It could be concluded that in single visit endodontics of teeth with necrotic pulp and apical periodontitis, ozone treatment with ultrasonic activation or sonic activation resulted in lesser pain compared to patients with no ozone treatment.

  Abstract 169: Management of Type III B dens invaginatus in maxillary central incisor Top

Sangeetha saji, G Praveena

Azeezia College of Dental Sciences and Research, Meyannoor, Kollam, Kerala, India

Dens invaginatus is a rare malformation of teeth,resulting from an infolding of the dental papilla during tooth development. The cause for dens invaginatus is unclear,however some evidence suggest a hereditary component.The teeth most affected are maxillary lateral incisors in 47%.Rarely involved are maxillary central incisor,cuspids,premolars. Due to the irregular anatomy and limited access,complete debridement of this root canal system is difficult.Limited knowledge of the complex anatomy can predispose to procedural accidents such as instrument separation, further complicating the management.This case report describes Oehler's Type III B Dens in dente in a permanent maxillary central incisor with periapical lesion in an adolescent female with previously initiated endodontic therapy. With the help of a limited FOV CBCT,a better understanding of the internal anatomy was possible.The tooth had multiple instrument separations within the invagination that was sucessfuly retrieved during the course of removal of invagination.Due to the immature apex,an apical barrier was created with MTA and the tooth was reinforced with multiple fibre post and dual cure resin cement.

  Abstract 170: Effect of ibuprofen - paracetamol combination and diclofenac sodium on endodontic diagnosis tests in patients with irreversible pulpitis Top

Aditya Shinde

MGM DCH, Navi Mumbai, Maharshtra, India

Most patients with acute dental pain try to relieve their pain with over-the-counter analgesics, before they approach the dental clinician. Such patients have reduced pain intensity or complete pain relief when they are examined by the dentist. Such cases are difficult to diagnose as patient is no longer symptomatic, which leads to challenge for the clinician. Hence this double-blind study was undertaken to assess effect of Ibuprofen+Paracetamol combination & Diclofenac Sodium on masking endodontic diagnosis.

  Abstract 171: The enigma of minimally invasive access cavity preparation: A review Top

Sushmita Debnath

Army Dental Corps, Bengaluru, Karnataka, India

Access cavity preparation is the first objective procedure done on an endodontically compromised tooth. The main aim of this preparation is to enable direct access to the apical foramen by an endodontic instrument. Contemporary endodontic therapy places a premium on the meticulous cleaning of radicular spaces. This denotes the need for a proper access opening, since without proper access, the root canal system cannot be properly negotiated, and therefore, treated. In recent times, focus has shifted to maximum preservation of pulp chamber roof to maintain fracture resistance of teeth subsequent to root canal treatment. This has led to the concept of minimally invasive access cavity preparation. However, there are a number of difficulties associated with small access cavities, such as accurate visualization and debridement of pulp canal spaces. Also, the risk of iatrogenic errors may have an adverse impact on treatment outcome. This review highlights the various studies on this topic that has sparked intense interest globally and discusses the various cavity designs, their merits and demerits, their influence on fracture resistance of treated teeth, and armamentaria required as aids for minimally invasive access cavities. In conclusion, this review identifies the lacunae in scientific evidence for favouring minimally invasive access preparation and underlines the need for future research in this field.

  Abstract 172: Holistic patient management skills among post graduates in conservative dentistry and endodontics – A questionnaire-based survey Top

Rekha Mani, Vijay Venkatesh, Arunkumar Saravanakumar, Shobana Krishnakumar

SRM Kattankulathur Dental College and Hospital, Potheri, Kattankulathur, Tamil Nadu, India

Background: The idea behind this study roots from an article published in 2004 by Bertolami et al, who had identified three specific weaknesses in typical ethics curriculum one of which states that “Failure to recognize that more education is not an answer to everything. “ The dental postgraduate curriculum is one such entity making students to focus more on one particular specialty, making them seek answer to all dental problems from their own specialty rather than having a bird's eye view. This often leads to wrong diagnosis and even patients undergo unnecessary treatment procedures without resolution of their symptoms.

Aim of the Study: Therefore, the aim of this study is to assess whether postgraduate dental students from various dental schools were able to assess the overall needs of a patient and devise appropriate treatment plan irrespective of their specialty.

Objective: To identify whether post graduate training is narrowing down their overall patient management skills when they enter a clinical setup.

Materials and Methods: A pre-validated survey comprising of 10 closed- ended questions prepared using google forms and mailed to post graduates in Conservative Dentistry & Endodontics.

Sample Size: 100 (Method: Convenient sampling)

Statistical Analysis Used: Chi-squared test.

Results and Conclusion: Results showed that more than 60% of post graduate dental students appreciate treatment options which are more relevant to their specialty. This study underlines the need for dental postgraduates to develop comprehensive knowledge in dental patient management irrespective of their specialty for the benefit of the patient and the society.

Funding source: Self funded.

Keywords: Dental patient management, dental schools, post graduate survey, treatment planning

  Abstract 173: Nonsurgical endodontic treatment of mandibular right first molar with periodontic-endodontic lesions – A case report Top

Diatri Nariratih, Rahmi Alma Farah Adang

Universitas Padjadjaran, Bandung, Indonesia

Endodontic-periodontic lesions due to inflammatory products found in varying degrees in both the periodontium and the pulpal tissues. The course of the disease may be separate or concurrent for symptoms can complicate the diagnosis and treatment planning. Therefore, by comprehensive understanding of the pathogenesis and examination, the clinician can make a correct diagnosis, formulate an appropriate treatment plan and assess the prognosis of these lesions. A 29 years-old male patient presented with throbbing pain and recurrent swollen gingiva in the mandibular right posterior region for three weeks and the tooth had been treated with periodontal surgery in Periodontics Department two months ago. Clinical examination showed that there was a permanent filling of the mandibular right first molar and swollen gingiva on the lingual side of the tooth. CBCT radiographs revealed radiopaque image from occlusal enamel to dentin, widening of the periodontal ligament, uncontinous lamina dura, and radiolucent area involving the apices of both the mesial and distal roots. Severe alveolar bone destruction was seen on the mesial root side causing perforation of the buccal bone. The disease was diagnosed as primary periodontal lesions with a secondary endodontic involvement, hence a non-surgical endodontic treatment was performed. An open access preparation was carried out on tooth 46, four root canals were cleaned and shaped using a rotary nickel titanium instrument with a crown down technique and obturated. The lesions were healed without further symptoms and there was no surgical intervention needed. Definitive restoration was done by a class I direct composite restoration. Detailed examination combined with a thorough understanding and knowledge of the anatomy, etiological factor, and pathogenesis provides an optimum treatment plan and reliable prognosis of the disease. This case report showed that the non-surgical management of tooth with periodontic-endodontic lesions can promote healing of periapical lesions with a high success rate.

Keywords: Nonsurgical endodontic treatment, periodontic-endodontic lesions

  Abstract 174: Retrieval of separated nickel titanium rotary endodontic files using the principle of electrochemical dissolution: An ex vivo study Top

Diana Davidson, Rajamani Indira, M Ramakrishna Srinivasan

Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India

Objective: To evaluate the retrieval of separated NiTi rotary endodontic file fragments using two different concentrations of electrolyte and to quantify the potential difference, current and time required for the partial dissolution of separated file fragments.

Materials and Methods: Twelve single rooted human mandibular premolars extracted for orthodontic purpose were used in this study. The specimens were categorized into two groups (n=12). Access opening, patency filing and working length were performed for the two groups (Group I and II). Coronal enlargement was done using GG drills #1 and 2. Pro Taper (universal) F2 (length 25 mm, size 25/.08) rotary endodontic files were intentionally wedged and separated in the middle-thirds of the root canal system for all specimens.12g NaF + 1g NaCl /500ml and 24g NaF + 2g NaCl /500ml, were the two different concentrations of electrolytes used for partial dissolution of the separated file fragments. A customized microprobe with free ended electrodes (anode and cathode) was designed for this procedure. All specimens were passively filled with the electrolyte. The cathode and the working electrode were made to contact the electrolyte and the wedged file fragment respectively. An anodic potential from the power supply variable unit was delivered. The power was cut off when the file fragments were able to be bypassed or retrieved. The potential difference, current and duration for the electrochemical dissolution were recorded The values were statistically analyzed using Student's t-test.

Results: Electrical power and current values for the partial dissolution of the separated Pro Taper file fragments showed no significant statistical difference between the two groups. Group I required a mean of 35 minutes, in contrast to Group II which required a mean of 22 minutes for partial dissolution(P<0.001) which was highly significant statistically.

Conclusion: The rate of dissolution of the file fragment was directly proportional to the electrolyte concentration. Within the limitations of the present study, this non- invasive method could be a possible alternative to the mechanical methods of instrument retrieval as it targets the separated file fragment and not the root dentin.

Funding source: Non funded.

  Abstract 175: Impact of E learning and predictable practical learning expectations during COVID-19 pandemic on dental graduates Top

Amulya Vanapatla, Tulasi Priya

Government Dental College and Hospital, Hyderabad, Telangana, India

Introduction: The impact of the COVID19 pandemic was evident on various walks of life all around the world. All medical and dental institutions had been closed down because of the pandemic. It resulted in shift of dental education from traditional teaching methods to E learning system. Hence the aim of this study is to investigate the impact of quarantine on the self-perceived preparedness of dental graduates and to explore the efficacy of online education from students' perspectives.

Methods: The questionnaire distributed to dental graduates, comprised of three main sections. The first section covered the online education experience, second section measured the level of self-perceived preparedness for a range of cognitive, communication and professional skills, and the third section measured the practice readiness.

Results: The survey yielded a response rate of 72%. The majority of students (90%) strongly agreed that they missed educational experiences as a result of the lockdown. More than half of them (53%) believed that online assessment is not a good method for evaluation. A high percentage of the students (66%) thought that online group discussions had a positive value. Majority of the students (74%) positively responded towards their clinical training. In general, students showed satisfactory self-perceived preparedness related to a range of attributes and professional skills.

Conclusions: The data showed that students partially preferred the online system, whereas they did not consider it a substitute for face to face clinical practice. The overall self-perceived preparedness level was promising; however students are not confident enough for the independent practice following graduation.

Keywords: COVID-19, dental education, E-learning, practice readiness, preparedness

  Abstract 176: Various irrigants used with self adjusting file system on smear layer removal: An in vitro scanning electron microscope study Top

Divya Batra, Manu Rana, Manpreet Kaur

National Dental College, Chandigarh, Punjab, India

Objective: To check the efficacy of various irrigants used with SAF system on smear layer using scanning electron microscope: an in-vitro study.

Methodolgy: 40 extracted intact human permanent single rooted teeth were collected and decoronated. Working length of all tooth samples were determined by #10 K-file, preparing a glide path upto the apical file size of #20 K-file at the working length and then prepared with SAF system using four different irrigants. The samples were divided into following groups:

Group I: using neem extract,

Group II: using 17% EDTA,

Group III: using 5.25% NaOCl + 20% citric acid,

Group IV: using 5.25% NaOCl,

All roots were sectioned buccolingually and subjected to scanning electron microscopy.

Results were subjected to statistical analysis.

Results: Comparison between same thirds of group showed statistically significant difference in coronal and middle parts. Group 3 showed the best results for smear layer removal. Group 4 showed least efficacy of smear layer removal.

Conclusion: Group 3 showed the best removal efficacy followed by group 2 and 1 with least being for group 4.

  Abstract 177: Evaluation of amniotic membrane in the healing of apicomarginal defects using two-dimensional and three-dimensional imaging modalities: A randomized controlled trial Top

Ritika Yadav

Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India

Aim: The study aimed to evaluate healing in apicomarginal defects with amniotic membrane (AM) using 2-dimensional (2D) and 3-dimensional (3D) imaging modalities.

Methodology: Thirty-four patients with symptomatic apical periodontitis and apicomarginal communication were allocated to either the AM or control group. Clinical and radiographic assessment was performed at base line and at 12 months using Molvens criteria, modified PENN 3D criteria RAC scoring and B index.

Results: There was no significant difference in the healing outcome in 2D imaging (93.3% control and 86.7% AM) and 3 D imaging (80% control and 53.3% AM) between both the groups. With RAC scoring maximum percentage of unhealed cases were observed in cortical plate. Regeneration of buccal bone in the 3D imaging was evident only in 6 cases.

Conclusion: In conclusion despite of good clinical healing buccal bone regeneration and complete formation of cortical plate was not evident in 3D imaging in most of the cases.

  Abstract 178: Exploring vedic medicinal plant resources for endodontic use: A review Top

Bikash Jyoti Borthakur

Mahatma Gandhi PG Institute of Dental Sciences (Government of Puducherry Institution), Pondicherry, India

Veda is the ancient literature of the world representing Indian culture, philosophy and civilization. There are four Veda viz. 1) Rig-Veda 2) Yajur Veda 3) Sāma Veda and 4) Atharva Veda. Besides all aspects of life, Veda also deals with scientific study of plants and their medicinal uses. Usage of plant as medicine was first described in Rig-Veda. There are no plants in the world without any medicinal property. The first evidence of systemic and scientific classification of plants was given in Rig-Veda. The Ousadhi sukta of Rig-Veda gives authentic knowledge about the plants in Vedic age. Each of the Veda mentioned plants for various purposes including medicinal use. Ancient medical tradition is constituted directly or indirectly from Vedic literature. Achyranthes aspera (Apāmargā), Ficus religiosa (Aśvattha), Calotropis gigantea, (Arka) Terminalia arjuna (Arjuna), Commiphora mukul (Guggulu), Nygrodha (Ficus benghalensis), Parṇa (Butea monosperma), Tila (Sesamum indicum) are few examples of medicinal plants mentioned in Veda. Recently, there is a trend of using medicinal plant resources in endodontics. “Triphala”(combination of Terminalia chebula,Terminalia bellirica & Emblica officinalis), Morinda citrifolia, (Noni), Aloe vera, Azadirecta indica (Neem),Curcuma longa,(Termeric), Vitis vinifera (Grapes) seed, Camelia sinensis (tea) etc. found place in endodontics due to exploration of our traditional knowledge and assimilation of the same with modern parameters. Although Vedic knowledge is full of medicinal plant resources, this treasure is yet to be explored for endodontic use. This paper highlights the medicinal plant resources available in Veda with the following objectives

  1. Know the Vedic, botanical & local names of the plants.
  2. To find out the existing use of these plants if any.
  3. To find out the active ingredients of those plants.
  4. To explore the potentiality of using them in endodontics.

The plants mentioned in Veda are being tabulated with Names (Vedic, Botanical and local names) along with existing traditional use, active ingredients and potential future use in endodontics.These medicinal plant resources from Veda can be utilized for many novel endodontic applications. Conglomerations of this ancient Vedic knowledge with recent technology will definitely give a new thrust to Endodontics.

  Abstract 179: Pathway to predictable anaesthesia Top

Tanvi Satpute

M.G.M Dental College and Hospital, Kamothe, Navi Mumbai, Mumbai, Maharashtra, India

Many patients fear endodontic procedures due to a concern about pain. Even though pain is well managed in many endodontic patients, there exists a group of patients, with whom achieving adequate anaesthesia can be quite a challenge. Conventional anaesthetic techniques do not always provide profound pulpal anaesthesia during and/or after endodontic treatment or in patients with pre-existing hyperalgesia who may be unable to tolerate any noxious input. As professionals, the question we need to ask ourselves is: What is an acceptable level of anaesthesia failure, and what should we do about it? It is imperative to know some possible causes of local anaesthetic failure in patients undergoing root canal therapy, since appreciation of all of these aspects of local anaesthesia and local anaesthetic techniques in endodontics will better prepare the operator for predictably safe and effective patient care. This article reviews the various factors of local anaesthetic failure and management of specific endodontic situations and focuses on available evidence for developing effective and efficient approaches in local anaesthesia along with recent advances.

  Abstract 180: Application of propolis in conservative dentistry and endodontics: A review Top

Anita Kale (Thenge)

Conservative Dentistry, MIDSR Dental College, Latur, Aurangabad, Maharashtra, India

The medicinal value of natural substances derived from the environment has been acknowledged for ages. Propolis is natural substance that can be commonly found in the environment. The main components of propolis are: resin (50%-70%), oil and wax (30%-50%), pollen (5%-10%) and other chemical compounds including: amino acids, minerals, sugars, vitamins B, C and E, flavonoids, phenol, as well as aromatic compounds It has long been used in medicine for its beneficial properties, including antimicrobial, anti-inflammatory, antidiabetic and local anaesthetic effects. In conservative dentistry, propolis has been used for the prevention of dental caries, cavity disinfection solutions, Pulp capping agent and reduction of dentinal hypersensitivity. Propolis extract-containing products have been effective in reducing and/or inhibiting the growth of S. mutans and other caries-causing bacteria; Two mechanisms of action have been associated with the anti-caries and antiplaque properties of propolis: the first is the antimicrobial activity against cariogenic bacteria and the second is the inhibition of glucosyltransferase enzyme activity. There are various possibilities for applying propolis based medicaments in endodontic treatment of root canals, and what is particularly emphasized is potential effectiveness against resistant microorganisms such as E. faecalis and C. albicans, as well as biocompatible to the periapical tissues in comparison with the most commonly used agents. It aims at microflora which is difficult to eliminate, and their medicinal properties, including anti-inflammatory, antifungal and antiseptic properties, make it suitable for use in endodontic treatment. Due to the potential side effects of commonly used synthetic drugs and other safety related reasons, natural alternatives for endodontic usage are continuously explored and tested. The paper presents the possibilities of applying propolis in operative and endodontic treatment on the basis of chosen articles published in recent years.

  Abstract 181: Root canal disinfection with antibacterial nanoparticles: An evidence based review Top

Era Arora

ITS - Centre for Dental Studies and Research, Ghaziabad, Noida, Uttar Pradesh, India

Nanomaterials are natural, incidental or synthetic materials that contain particles in unbound states, aggregates or agglomerates, and of which 50% or more of the particles possess external dimensions between 1 nm to 100 nm. Nanoparticles possess several properties that may enhance the treatment of endodontic infections, such as heightened antibacterial activity, increased reactivity and the capacity to be functionalized with other reactive compounds. Effective disinfection and sealing of the root canal system are the hallmarks for successful endodontic treatment. However, the presence of bacterial biofilms and resistance to endodontic disinfectants pose a significant challenge to this goal. This has encouraged the investigation of antibacterial nanoparticle-based irrigants and intracanal medicaments, which may improve the elimination of endodontic infections. In addition, photosynthesizer-functionalized nanoparticles could also serve as a worthy adjunct to root canal disinfection strategies. Over the last decade, the use of nanoparticles in endodontics has attracted significant attention from researchers. Nanoparticles of various elements, antibiotics and natural plant extracts have been tried as endodontic disinfectants. Since their introduction, our collective understanding of this field has grown substantially, with new studies constantly adding to the existing knowledge. Hence, the aim of this review is to summarize, compile and integrate the current literature on the effectiveness of nanoparticles in disinfection of root canals.

  Abstract 182: Vertical root fracture: A Diagnostic challenge Top

Jigyasa Duhan

Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India

Vertical root fracture usually are characterised by an incomplete or complete fracture line that extends through the long axis of the roots. The prevalence of vertical root fracture is reported between 3-13%. Early diagnosis of VRF could pose a true challenge as the related clinical and radiographic signs are not pathagnomic. The limitations of perapical radiography in detection of VRF have been emphasized in literature. Cone beam computed tomography is a promising diagnostic tool for early detection of VRF and the associated bone changes. But limited spatial resolutions and artifacts could hinder with the quality of images resulting in reduced sensitivity. This paper highlights the detection of two interesting cases of VRF with CBCT which could not be detected on periapical radiographs with the emphasis of the inherent pros and cons of diagnostic imaging techniques.

  Abstract 183: Bioactive glass applications in endodontics Top

Sunanda Gaddalay

Maharashtra Institue of Dental Science and Research College, Latur, Maharashtra, India

Bioactive glasses (BG) were introduced in the early 1970s by Larry Hench and the first commercialized glass was named Bioglass® 45S5. BG are excellent materials for clinical applications due to their high biocompatibility and bioactivity. The bioactive properties are influenced by the structure and composition of the glass, manufacturing techniques, and rate of ionic dissolution. Most bioactive glass has a superior surface area with a higher dissolution rate and thus faster apatite formation to increase the mechanical properties to provide biomimetic nano-structuration enhancing cell adhesion. BG, as well as some crystalline ceramics like hydroxyapatite and tricalcium phosphate, are osteoconductive and bond to the bone without any fibrous connective tissue interface. The bioactive properties make BG applicable to several clinical applications involving the regeneration of hard tissues in medicine and dentistry. Biomaterials used in dental treatments are expected to have favorable properties such as biocompatibility and an ability to induce tissue formation in dental pulp and periapical tissue, as well as sealing to block external stimuli. In dentistry, its uses include dental restorative materials, mineralizing agents, as a coating material for dental implants, pulp capping, root canal treatment, and air-abrasion, and in medicine it has its applications from orthopedics to soft-tissue restoration. It is of particular interest for endodontic care because of its biocompatibility, regenerative and antimicrobial properties as well as chemical composition that closely resembles the mineral make-up of human bone and dentine. Initial studies suggested that bacteria-tight sealing within the entire root canal system can be achieved and successfully maintained after orthograde treatment. There are two well-known commercialized root canal sealers that include BG. One is GuttaFlow Bioseal (GFB) (Coltène/Whaledent AG, Altstätten, Switzerland), which is composed of gutta-percha, polydimethylsiloxane, platinum catalyzer, zirconium dioxide, and BG. The second product is Nishika Canal Sealer BG (CS-BG). Promising results have also been obtained in conjunction with microsurgical techniques, with the aim of enhancing wound healing and positively influencing bone regeneration. However, the widespread use of these inorganic biomaterials, as well as their suitability for load-bearing applications, is still limited by their inherent brittleness and low fracture toughness (typically below 2 MPa m1/2).

  Abstract 184: The elusive MB2 canals Top

Hetal Buch

Sanjivani Advanced Implant and Microscopic Dental Clinic, Rajkot, Gujarat, India

Root canal treatment has become much more predictable with higher success rates with the advent of Dental operating Microscope. As we see better we can detect extra canals with routine use of magnification. Especially in Maxillary molars the elusive Mb2 canals are not always detected easily. Though the prevalence of MB2 Canals in Maxillary molars is 92% it is not always easy to detect elusive MB2 canals. We know Mb2 canal is supposed to be present along the line connecting from MB1 to palatal canal but dentinal map with overhangs, cervical triangle, mesial placement of the canal along the axial wall of the pulp chamber, pulp stones make detection of MB2 canals very difficult without magnification. In this clinical case report upper left second molar is described to have MB2 in the axial wall of the pulp chamber and subsequent cases describes the use of ultrasonic, dye, Champagne test, microscopic vision etc to detect the elusive Mb2 canal. This makes the clinician aware about the different techniques with which elusive Mb2 can be cleaned and shaped thus giving predictable treatment outcome.

  Abstract 185: Compressive strength and solubility of calcium silicate-based cement combined with composite resin core using various bonding systems Top

Kim Dayoun, Kim Miri, Ko Hyunjung

Asan Medical Center, Seoul, South Korea

Aim: To evaluate the compressive strength and solubility when the root canal or pulpal floor is filled with ProRoot MTA(Mineral Trioxide Aggregate) or Biodentine, followed by the restoration of the pulp chamber using a composite resin core applied using various bonding systems.

Materials and Methods: For compressive strength measurements, specimens were prepared in cylindrical shapes (diameter: 7 mm, height: 3mm) with ProRoot MTA (MTA/Dentsply/USA) or Biodentine (BDN/Septodent/France). Forty samples were divided into five groups (n=8, each). All specimens were set at room temperature for a week. After 7 days, the following adhesives were applied to the surface of MTA or Biodentine: three-step (Scotchbond Multi-purpose/3M/ USA), two-step (Clearfil SEbond/Kurary/Japan), two single-step adhesive (Single Bond universal/3M/USA, Single Bond2/3M/USA), and a control (no adhesive). Then, LuxaCoreZ Dual-blue (DMG/Germany) was added to the adhesives into a cylindrical shape (diameter: 7 mm, height: 3mm) and cured for 20 s under the light of a light-emitting diode unit. Compressive strengths were measured using a universal testing machine (TW-2000/ Taewontech/South Korea; crosshead speed: 1-mm/min). The maximum load required to fracture each specimen was determined. Failure mode was detected—mixed failure, cohesive failure in MTA (BDN or resin), and adhesive interfacial failure. For the solubility test, five sample groups were prepared as stated above (n=5). All specimens were immersed in 10 mL distilled water for 7 days, and changes in the weight were measured. ANOVA test was used for statistical analysis. (P < 0.05).

Results: All experimental groups had higher compressive strength than the control group. Although the three-step adhesive group presented the highest compressive strength, all bonding systems showed no significant differences (P > 0.05). Specimens that used Biodentine failed cohesively in Biodentine or adhesively at the interface. However, those that used MTA failed cohesively in MTA. No significant difference was detected among groups regarding the solubility test.

Conclusion: When ProRoot MTA or Biodentine is filled within the root canal or pulpal floor with resin core above it, all bonding adhesive systems yielded a higher compressive strength than the control group. However, there was no significant difference in the solubility and compressive strength among the bonding systems.

  Abstract 186: Comparative evaluation of postoperative pain and analgesic intake after root canal treatment using three bioceramic sealer: An in-vivo study Top

Sukhbir Kour

Indira Gandhi Government Dental College and Hospital, Jammu, Jammu and Kashmir, India

Aim: To evaluate the occurrence and intensity of post operative pain & number of analgesic tablets intake after single visit endodontic treatment using three different Bioceramic sealers.

Materials and Methods: 45 single rooted teeth diagnosed with asymptomatic irreversible pulpits requiring endodontic treatment were randomly assigned to three groups (n=15) according to sealer used during obturation. To avoid bias in post operative pain perception, each sealer is evaluated in three different single rooted teeth of the same patient. The different groups are Group 1-MTA-Fillapex, Group –II Cerafill RCS, Group-III BioRoot RCS. Single visit Endodontic treatment was performed and teeth were obturated using cold lateral compaction and different root canal sealers with no radiographic material extrusion beyond the apex. Severity of post obturation pain was assessed by Visual Analog Scale (VAS) with score ranging from 0 to 10 at 6hrs, 12 hrs, 24 hrs and 48 hrs intervals. The need for analgesic (Tab. Aceclofenac 100 mg) intake was also recorded. Differences in incidence of postoperative pain were analyzed using the Kruskal Wallis test followed by Mann Whitneys Post Hoc to compare the mean VAS score & number of analgesics taken between three groups at different time intervals (p<0.05).

Results: MTA Fillapex shows statistical significant difference in mean VAS score (more pain) at 6 hrs, 12hrs (p value < 0.001) & at 24 hrs (p<0.005) than Cerafill RCS and BioRoot RCS. There is statistical significant difference in the no. of analgesic intake for MTA Fillapex i.e. more tablets taken by the patient to relive pain (p<0.001) as compared to Cerafill RCS and BioRoot RCS. The decrease in pain was statistically significant for each time intervals from 6 hrs to 48 hrs for all the three groups.

Conclusion: The teeth of the patients where MTA Fillapex sealer was used as a sealer in the obturation showed significantly more pain at 6hrs & 12 hrs and needed to take more analgesics than teeth obturated with other two sealers. This probably could be due leaching out of resin constituents from MTA Fillapex.

Funding: Self funded.

  Abstract 187: Rehabilitation of a fractured incisor with an orthodontic extrusion, endodontic retreatment and an all ceramic crown: A case report Top

Duška Stopar, Tine Malgaj

Department of Prosthodontics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

The survival of an endodontically treated tooth depends on the appropriate endodontic treatment and its further restoration. When a tooth can not be conservatively restored, a prosthetic rehabilitation with a crown is indicated for achieving satisfactory functional and esthetic results. Often a post and core are needed to provide sufficient restoration retention. However, to increase the resistance of the restored tooth to vertical root fracture, the ferrule effect, maintaining the crown dentin of at least 1.5 mm height, is required. When this condition is not present, a surgical extension of the clinical crown, surgical extrusion of the tooth, or orthodontic extrusion are required. The latter is less invasive and provides more predictable esthetic results. Endodontic retreatment, orthodontic extrusion, and prosthetic treatment of the fractured tooth 12 in a 36-year-old patient are presented. Periapical radiograph of tooth revealed inadequately endodontic treatment and a horizontal fracture line 2mm above crest bone level. Clinically, the fracture line extended subgingivally on the buccal side. not providing the ferrule effect. After a build-up and endodontic retreatment, the tooth was extruded with orthodontic elastics: two fiber-reinforced composite (FRC) post were adhesively bonded and served as anchors for orthodontic elastics. The first FRC was bonded coronary on the fractured tooth perpendicular to the tooth's longitudinal axis in bucco-palatal direction. The second FRC was bonded on adjacent teeth in the coronary third of the crown. Coronary displacement of soft tissues during extrusion was prevented by fibrectomy of the alveolar ridge. Patient replaced orthodontic elastics daily, and 2 mm of dentin ring above gum level was achieved within 1 month. After 2 months of tooth immobilization, preventing intrusion, the tooth was restored with a fiber-reinforced-composite post and an all-ceramic crown. The presented method is a predictable and esthetically more acceptable alternative to surgery, maintaining the initial height of the periodontal tissues. Compared to non-removable orthodontic appliances, this method offers a more comfortable and affordable, time-efficient, less invasive solution that can also be performed by a general practitioner.

  Abstract 188: Management of inflammatory root resorption and apical third horizontal root fracture of the mandibular incisor- four year follow-up Top

Hitesh Chander Mittal

PDU Medical College Churu, Panipat, Haryana, India

External inflammatory root resorption (EIRR) especially lateral type is often extensive, quite rapid and may cause complete root destruction within few months. Lateral EIRR has not been reported in literature to best of the author's knowledge in cases of horizontal root fracture; except for limited literature on apical type of EIRR at root fracture site. The purpose of this report is to describe a case of progressive EIRR due to delayed diagnosis as well as management of horizontal root fracture of the mandibular incisors and its adequate management resulted in favorable outcome with hard tissue healing. There was history of missed root fracture during management of maxillofacial fracture initially and was diagnosed when the tooth became symptomatic. The case was treated with disinfection of root canals, the patient became asymptomatic at 4 weeks, and MTA (mineral tri-oxide aggregate) plug extending up to approximately half length was placed for tooth no 31,41,42. The apical fragments were left untreated for 31,41. The periodic radiographic examination revealed arrest of resorptive process and repair and regeneration of fracture site with hard tissues over a period of 4-year follow up.

Conclusion: It was found that MTA obturation can be a viable option that can improve the healing outcomes in cases of external inflammatory root resorption in young permanent teeth when used in conjunction with adequate disinfection of root canal system. The present case also highlights the need to screen all the maxillofacial trauma cases for dental trauma because the delayed intervention may lead to inflammatory root resorption.

  Abstract 189: Oral health related quality of life: An insight Top

Souparna Madhavan, Lavanya Varma

Srinivas Institute of Dental Sciences, Mangalore, Karnataka, India

The concept of quality of life and more specifically health related quality of life refers to physical, psychological and social domains of health influenced by a person's experience, beliefs, expectations and perceptions of health. There has been greater focus on quality of life since two decades and these changes has led to measure the aspects of quality of life related to health. But during the last decade, particular attention has been given towards the incorporation of quality of life parameters in clinical trials involving certain methodological considerations to select these quality of life measures. Thus this paper will provide an overview on oral health related quality of life, assessment with methodological considerations and implication of the same in future.

  Abstract 190: Effect of nonthermal atmospheric plasma on the dentinal tubule penetration of two different root canal sealers: A confocal laser scanning microscopy study Top

Roopadevi Garlapati, Nagesh Bolla

Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India

Aim: The aim of this study was to evaluate the effect of nonthermal atmospheric plasma (NTAP) on the dentinal tubule penetration of Bioceramic, Epoxy resin based root canal sealers.

Materials and Methods: Forty freshly extracted (n=40) single rooted mandibular premolar teeth were selected and the root canals were prepared with ProTaper Gold rotary nickel-titanium instruments. Samples were then divided into 4 groups (n=10) based on the sealer used and NTAP application. Group 1: Bioceramic sealer (BioRoot RCS) without NTAP application Group 2: Epoxy resin based sealer (AH Plus) without NTAP application, Group 3: Bioceramic sealer (BioRoot RCS) with NTAP application for 30 sec, Group 4: Epoxy resin based sealer (AH Plus) with NTAP application for 30 sec. After NTAP application in group 3 and 4, all the samples were obturated using sealers according to their grouping protocols. 2 mm slices were obtained from middle third of the root from each sample by using hard tissue microtome, which were examined under confocal laser scanning microscopy (CLSM). Data were subjected to statistical analysis using one-way analysis of variance (ANOVA) followed by the Mann Tukey Post hoc test. The level of statistical significance was set at p<0.05.

Results: The dentinal tubule penetration values were observed to be significantly higher in Bioceramic sealer with NTAP application (Group 3) followed by epoxy resin based sealer with NTAP application (Group 4).

Conclusion: Nonthermal atmospheric plasma application enhanced the dentinal tubule penetration of Bioceramic (BioRoot RCS) and Epoxy resin based (AH Plus) sealers compared to their control groups.

  Abstract 191: Nonsurgical retreatment of postsurgical persistent apical periodontitis: Case reports Top

peeyush Pathak

Army Dental Centre Research & Referral, New Delhi, India

Endodontic treatment failure is usually characterised by the presence of post-treatment apical periodontitis. Persistent intraradicular infection is one of the most common aetiology for post-treatment apical periodontitis. Understanding the causes of endodontic treatment failure is of paramount importance while choosing non- surgical or surgical treatment options. This presentation of two cases focuses on the aetiological factors of post-surgical apical periodontitis and discusses the indications and basics of the procedures for optimal clinical management of such conditions.

  Abstract 192: Evaluation of efficacy of 5.25% sodium hypochlorite, 2% CHX, Aloe vera juice, Ocimum sanctum oil in disinfection of gutta-percha cones at different time intervals Top

Deepashri Tekam

VYWS Dental College and Hospital, Amravati, Maharashtra, India

The success of endodontic treatment is to eliminate as much bacteria as possible, reaching a point where the organism is able to remain free of the infectious process. Gutta-percha cones are one of the most biocompatible dental materials, mostly used for obturation of the root canal. Although gutta-percha cones are manufacture under aseptic conditions they can be contaminated by aerosols, improper storage, and physical handling of cones hence, the objective of the present study was to investigate the efficacy of 5.25% sodium hypochlorite, 2% CHX, Aloe vera extract, Ocimum sanctum in the disinfection of gutta-percha cones at a different time interval.

Methodology: 80 Gutta-percha cones were contaminated with Staphylococcus aureus and they remained in contact with the microbial suspension for 6 hours in order to promote surface contamination. Then they were treated by immersion in respective solutions for 30 seconds,1 minute, and 5 minutes. The treated cones were then culture on medium nutrient agar to verify the existence and proliferation of microorganisms followed by gram staining for colony confirmation.

Results: 5.25% sodium hypochlorite was effective in disinfection of gutta-percha cones at 1 min and 5 mins time interval followed by 2% CHX and Aloe vera juice at 5mins. Ocimum Sanctum proved least effective in eliminating Staphylococcus aureus on gutta-percha cones at 30sec,1 min, and 5 mins time intervals.

Conclusion: 5.25% NaOCl, 2% CHX, and Aloe vera juice can be an effective agent for the rapid disinfection of gutta-percha cones.

  Abstract 193: Interfacial interactions of dentin replacement materials: A scoping review Top

Anuradha Patil, Divya Naik, MV Sumanthini

MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India

Traditional Calcium hydroxide cement and Tricalcium silicate-based materials such as Mineral trioxide aggregate, Biodentine, and Theracal LC are popular dentin replacement materials. They are used in cases of perforation repair, pulp capping, and external cervical root resorption. These materials are placed on dentin and layered with a glass ionomer cement or composite resin restorative material. Microleakage caused by poor bonding of these restorative materials to underlying dentin replacement material may affect the treatment outcomes. The bonding between restorative and dentin replacement material is paramount for the success of restorations. The interface is the interdiffusion layer between two different materials, which can be assessed by various methods such as Laser Raman spectroscopy, needle indentation (Gilmore), X-ray diffraction (XRD), energy dispersive X-ray analysis (EDAX), and micro internal Fourier transformation infrared spectroscopy (FTIR). Mineral infiltration zone, tag–like structures, gap formations are observed at the interfaces. There is a controversy regarding restorative material to be placed over tricalcium silicate-based cement and also the time of an adhesively bonded restoration. The purpose of this review is to enable the clinician to decide upon the type and final restoration placement when such dentin replacement materials are used. Bonding of glass ionomer cement or composite resin to novel dentin replacement materials requires adequate research on the material interactions and interfacial characteristics. This scoping review has summarized the evidence from research papers, to investigate the current practice, interactions of dental materials at interfaces, and its adverse risks.

  Abstract 194: Diagnosis and treatment techniques for gingivo-osseous pathologic fenestrations with endodontic diseases: An overview Top

Divya Naik, Anuradha Patil, MV Sumanthini

Mahatma Gandhi Mission Dental College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India

Endodontic treatment may give rise to persistent pain whose origin is sometimes difficult to determine. Gingival fenestration defects are unusual, pain may occur due to fenestrations following endodontic treatment. Break in the continuity of the cortical plate often leads fenestration alveolar defects. Fenestrations occur in both the maxilla and mandible and many studies have reported geographical variations with overall prevalence ranging from 0.23% to 69.57% for fenestration observed in the skulls. Gingival fenestration means the exposure of the tooth root due to loss of the overlying bone and gingiva. Clinicians may consider the possibility of a fenestration with coexisting endodontic pathology when patients present with non-healing sinus tracts, exposed tooth apices and/or persistent pain after endodontic treatment, particularly on palpation and mastication. The diagnosis of fenestration can be a great challenge. In some cases, it can easily be unnoticed or misdiagnosed as persistent apical periodontitis. These alveolar defects profoundly affect the prognosis of both periodontal and endodontic treatment outcomes; therefore, a thorough understanding of these lesions is important for appropriate diagnosis and successful management to increase the long-term prognosis of the tooth. The literature on determination methods and several treatment approach of fenestration associated with endodontic diseases is case dependent. Mostly it is an inter speciality decision and can be managed non-surgically. Thus further research is needed to develop evidence-based guidelines for the diagnosis and management of these lesions. The current presentation will illustrates a complete insight of various diagnostic aids and management techniques for these defects.

  Abstract 195: Volumetric assessment of efficacy of various calcium hydroxide removal techniques using cone beam computed tomography: An in vitro study Top

Deebah Choudhary

Institute of Dental Sciences, Jammu, Jammu and Kashmir, India

Aims: The aim of the study is to compare the efficacy of H-file, NAVI TIP FX and Canal Brush in the removal of Calcium hydroxide intracanal medicament from root canals.

Materials and Methods: Thirty single-rooted mandibular premolar teeth were decoronated at CEJ to maintain the length to 14 mm. Working length was determined followed by cleaning and shaping of all the specimens using ProTaper Rotary Files. Intracanal medicament was placed and canals were sealed by GIC. The specimens were placed at 37±1°C and 100% relative humidity for 30 days. Medicament was then removed by three different protocols: H-file, Navi Tip FX and Canal brush. Assessment of residual volume of medicament left in the canal was measured using CBCT. Removal efficiency of each technique was determined using a formula and results were statistically analysed using Tukey and ANOVA tests (p<0.05).

Results: The result of the present study showed that Canal Brush removed maximum calcium hydroxide medicament in the Apical Third of the roots of the premolar followed by NAVI TIP FX, then H-file. In the middle third of the roots of the Premolars NAVI TIP FX removed more medicament then Canal Brush followed by H-files. On comparing the calcium hydroxide medicament retrieval between the groups as well as within the groups. It showed that none of the technique is capable of removing all the Metapex from the roots of the premolar. As P>0.05.

Conclusion: The present study demonstrated that Canal Brush showed superior results of retrieval of calcium hydroxide medicament from the apical third of the roots whereas NAVI TIP FX removed more medicament from Middle third of the roots, but H-file showed the least efficacy in retrieval of the intracanal medicament.

  Abstract 196: Endodontic treatment of mandibular premolars with complex anatomy: Case series Top

Ronit Khade

MDS Government Dental College, Mumbai, Maharashtra, India

Mandibular premolars are usually thought to be easy to treat endodontically but variations in its anatomic configuration makes them a difficult task to accomplish. The possibility of additional root canals should always be kept in mind when performing endodontic treatment with such cases. Adequate knowledge of pulp canal anatomy, proper radiographic interpretation, incorporation of CBCT and dental operating microscope are prerequisite for best possible outcome in complex root canal treatment. This case series presents relatively uncommon clinical case of mandibular premolars with two and three canal configuration managed with the help of DOM.

  Abstract 197: Immediate autotransplantation of horizontally impacted third molar: Case report Top

Hyewon Jeon, Miri Kim, Hyunjung Ko

Asan Medical Center, Songpa Gu, Republic of Korea

A horizontally impacted third molar can increase the risk of caries and resorption of the adjacent second molar. These problems can make the tooth unrestorable and lead to tooth extraction. Usually, both teeth are removed together and implant is considered for prosthetic rehabilitation. However, autotransplantation of the third molar which caused such problems can be an alternative treatment. These two cases present the autotransplanatation of the horizontally impacted third molar for replacing the unrestorable second molar with distal area defects. The mandibular second molar was removed and the recipient site was prepared. The donor tooth, the horizontally impacted third molar, was also carefully extracted and replanted at the recipient site. Extra-oral time was less than 5 minutes, and the tooth was splinted for additional stability. Root canal treatment was performed within 2 weeks after surgery. Patients were recalled for post-operative evaluation, and clinical/radiological examinations were performed. During the follow up, favorable results were obtained in both cases, and no pathological signs were observed. In autotransplantation, it is necessary to reduce the extra-oral time and minimize the damage of the donor tooth for periodontal ligament cell preservation. The pre-position of the horizontally impacted tooth should be considered as it is related to distal bone healing. With proper case selection and surgical procedures, autotransplantation of the horizontally impacted third molar can be successful and prolong the function of the natural tooth.

  Abstract 198: Endodontic microsurgery: An overview Top

Apurva Sharma

SCPM College and Hospital, Gonda, Uttar Pradesh, India

Endodontic surgery is a facet of comprehensive root canal treatment, which can resolve pathological lesions that cannot be eliminated by nonsurgical procedures. The requisite to eliminate disease at the root end, the need to obtain a clearer, better understanding of the pulpal complexities, the use of enhanced magnification, specially designed instruments, improved root end filling materials all contributed to the contemporary concept of microsurgical endodontics. In this review emphasis is given to most current techniques, instruments and materials used during microsurgical endodontics.

  Abstract 199: C shaped canal system: A curious paradox – A case series Top

Gayatri Majumder

Haldia Institute of Dental Science and Research, Kolkata, West Bengal, India

Thorough knowledge of the root canal anatomy and its variations is important for achieving success in root canal therapy, along with diagnosis, treatment planning, and clinical expertise. One such variation of the root canal system is the C-shaped canal configuration. It is termed so because of the C-shaped cross-sectional anatomical configuration of the root and root canal. Numerous incidence studies prove the racial predilection of this variation. Again, though most commonly found in mandibular second molars, the C-shaped canal configuration may also occur in mandibular premolars, maxillary molars, and mandibular third molars. The C-shaped canal configuration presents variations in both the number and location of the canal(s), as the canal(s) courses from the coronal to the apical third. The complexity of this canal configuration proves to be a challenge concerning debridement and obturation and possibly the prognosis during root canal therapy. In this case series, four different types of C-shaped canal system in the lower mandibular second molar are diagnosed with the help of radiographs and CBCT along with their management strategies for root canal treatment is discussed.

  Abstract 200: Tooth fragment reattachment – A biologic restoration with minimal intervention: A case series Top

Vallari Jain

Indian Army, Jalandhar, Punjab, India

Dental traumatic injuries causing coronal fractures of the anterior teeth require immediate intervention, being an esthetically critical area. The treatment options vary from simple composite restorations to complex endodontic treatment followed by full coverage prosthesis. Apart from the conventional line of treatment, the use of tooth structure as a restorative material should always be considered as the first treatment alternative. If the original tooth fragment is retained following fracture, biological restoration using tooth fragment offers a viable option for the clinician because it restores tooth function and esthetics with the use of a very conservative and cost-effective approach. This case series reports management of complicated anterior crown fractures in young adults that were successfully treated and rehabilitated by reattachment of the original tooth fragment using a fiber post and adhesive resins.

  Abstract 201: Inflammatory biomarkers – An overview: Potential endodontic diagnostic tool Top

Nirupama D. N

Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India

Endodontic diagnosis is made based on symptomatic history, pulp sensibility tests, and periapical radiographs of the patient. The clinical terms, reversible and irreversible pulpitis merely express whether to perform vital pulp therapy or root canal treatment depending on the pulp status. However, it is impossible to clinically assess the true histologic state of the pulp. The role of several players of the host response in pulpitis may serve as biomarkers that indicate the stages of the pulp inflammation. This review paper describes invasive & non-invasive analytes, their molecular analysis, its clinical correlation and challenges, to serve as a reliable biologically sound chair side diagnostic tool to assess the true status of the pulp.

  Abstract 202: Comparative evaluation of clinical performance of endodontically treated teeth restored with short-fiber reinforced and zirconia reinforced composite as core material – A clinical study Top

Meganathan Anand, Kittappa Karthikeyan, Sekar Mahalaxmi

Sri Venkateswara Dental College and Hospitals, Chennai,

Tamil Nadu, India

Objective: The aim of the study was to comparatively evaluate the clinical performance of endodontically treated teeth restored with short -fiber reinforced (SFC) and zirconia reinforced composite (ZRC) resin as core build-up materials.

Materials and Methods: After obtaining ethical clearance, a total of 100 patients (aged 16 to 45 years) were enrolled for the study. Patients were randomly allocated to 2 groups of 50 patients each. After root canal treatment, post endodontic restoration was performed using short fiber reinforced composite resin (Group 1) [Sub group A (Class I) & Sub group B (Class II) cavity] and zirconia reinforced composite resin (Group 2) [Sub group A (Class I) & Sub group B (Class II) cavity]. The restorations were reviewed clinically at 1month, 3months and 6 months' interval using modified United States Public Health Service (USPHS) criteria. Evaluation of the functional restorations was done in terms of marginal discoloration and adaptation, secondary caries and tooth/restoration fracture.

Results: Results of 6 months' evaluation showed that the clinical performance of the tested materials had no statistically significant difference among the 1month, 3months and 6 months' recall periods in all the evaluation criteria in both materials. There was no statistically significant difference between group I versus group II at all follow up periods.

Conclusion: Within the limitation of this in vivo study we can concluded that direct composite restorations reinforced with SFC and ZRC show a good clinical performance in 2 years evaluation period, hence this reinforced composite can be used as a final restoration of endodontically treated teeth.

  Abstract 203: Artificial neural network in endodontics Top

P Rajani

Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India

In the recent years, with the development of newer technological concepts, the quality and predictability of the treatment outcome in the field of endodontics has tremendously improved. Artificial neural network (ANN), a subfield of Artificial intelligence (AI) has gained attention of researchers all over the world. Artificial neurons are the major components of this system which were used to develop a mathematical model influenced by the human neuron. AI has been shown to have wide clinical applications in dentistry, especially endodontics. A major advantage of these systems is their ability to resolve the complex issues which are difficult to solve using the conventional methods. It helps from the basic step of history taking, diagnosis to image specific tasks like locating the apical foramen and canals during endodontic therapy. In endodontics, Deep learning (DL) with Convolutional neural networks (CNNs), are commonly used to design AI models which help the clinician to detect and diagnose the periapical lesions which may be not be identified with conventional diagnostic equipment, prioritize risk factors thereby predict the level of difficulty of cases requiring endodontic therapy thereby improving the prognosis of the treated tooth. Despite of its wide application and advantages, its use in dentistry has both technical and ethical challenges. Being a machine-based system, it cannot completely replace the role of clinician but can be an excellent adjunct in reducing the chances of human errors. Further research is needed in the development of AI models that includes human element. This review paper focuses on the progress, potential clinical applications and limitations of ANN in the field of endodontics as well as their impact on clinicians.

  Abstract 204: Comparative evaluation of the effectiveness of XP-endo finisher and passive ultrasonic Irrigation on dentinal tubule penetration of irrigants: A confocal laser scanning microscopy study Top

Ajay Singh Rao

K M Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India

Aim: The aim of this in vitro study was to comparatively evaluate the Effectiveness of XP-endo Finisher and Passive Ultrasonic Activation on Dentinal Tubule Penetration of Irrigation Solution: A Confocal Laser Scanning Microscopy Study.

Methodology: In this study, 40 extracted single rooted human mandibular canines and premolars were instrumented up to size 40/06 taper and randomly divided into 2 groups (n = 20) based on the activation technique of the final irrigation solution as follows: GROUP A: passive ultrasonic activation and GROUP B: XP- endo finisher activation. In each group, 5 mL of 5% NaOCl labeled with fluorescent dye was used during the activation as the final irrigation solution. Specimens were sectioned at 2, 5 and 8 mm from the apex and then examined under a confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using Tukey's post hoc tests (P = 0.05).

Results: Passive ultrasonic activation exhibited a significantly higher penetration area than the XP- endo finisher activation (P < 0.05). Additionally, all the thirds of passive ultrasonic activation had significantly higher penetration than the sections activated by XP- endo finisher. Statistically significant differences were also found between each root canal third (coronal > middle > apical) (P < 0.001)

Conclusion: The results from the present study support the use of passive ultrasonic activation to improve the effectiveness of the final irrigation procedure by increasing the irrigant penetration area into the dentinal tubules. Clinical relevance: The activation of the irrigant and the creation of the streaming with the passive ultrasonic activation have a positive effect on the irrigant penetration.

  Abstract 205: Comparative evaluation of transdermal patches of diclofenac sodium and ketoprofen with oral diclofenac sodium tablet in managing endodontic pain: An in vivo study Top

Rupam Kaur Virk

Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab, India

Aim: To compare the efficacy of transdermal analgesic patches of diclofenac and ketoprofen with oral diclofenac sodium table in relieving pain of endodontic origin.

Materials and Methods: In the present study, patients with chief complaint of pain were diagnosed and their pain scale was recorded according to VAS scale. 45 patients with provisional diagnosis of irreversible pulpitis and having initial pain score of more than 5 were chosen. The selected patients were randomly divided into three groups. Group A included 15 patients who were given tablet diclofenac sodium 50 mg orally, Group B had 15 patients on whom dicloplast (diclofenac) transdermal patch was applied on hairless area of upper arm (Zuventus 100mg) for 24 hours and in Group C 15 patients with ketoprofen transdermal patch (Zuventus 20mg) was applied for 24 hours. The pain score of all the patients was recorded by the investigator who was unaware as to which experimental group patient belongs to, at time intervals of 4, 8, 12 and 24 hours respectively by using the VAS scale. The results obtained were analyzed using ANOVA and Tukey's post hoc statistical tests.

Results: All the three groups showed reduction in pain scores after 4 hours and 8 hours. Group A (oral diclofenac tablet) showed statistically significant reduction in pain as compared to dicloplast and ketoplast groups after 8 hours (p<0.0001). However, after 24 hours mean reduction in pain score was significantly more with dicloplast and ketoplast patches as compared to the oral diclofenac sodium tablet (p < 0.0001). Between dicloplast and ketoplast patch groups there was statistically insignificant difference in reduction in pain scores (p>0.05) after 24 hours.

Conclusion: Transdermal patches of diclofenac and ketoprofen can provide significant relief of pain after 12 hours due to sustained release of drug overtime. They can be used as alternatives to oral analgesic medication after initial endodontic therapy in patients with reduced renal clearance, peptic ulcers, gastrointestinal bleeding and other systemic complications.

  Abstract 206: Efficacy of antimicrobial photodynamic therapy as an adjunct to the conventional endodontic retreatment – A systematic review and meta-analysis Top

Kiranmayi Govula

Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Objective: The systematic review and meta-analysis objective was to evaluate the antimicrobial effectiveness of photodynamic therapy [PDT] in reducing the bacterial load from the previously endodontically treated teeth. The systematic review was registered in the PROSPERO database with registry number: CRD42019133426 and was conducted following the PRISMA statements.

Materials and Methods: The search strategy included randomized clinical trials and clinical studies from the databases of PubMed Central, Cochrane, EBSCO, and MEDLINE from January 1998 to April 2019. A total of four clinical trials that met all inclusion criteria were included in the systematic review. The primary outcome was the reduced bacterial load in root canals, reduction in the number of CFUs, and the elimination of the remaining bacterial species [CFU/ml]. It was estimated by collecting microbial sample following the removal of gutta-percha, after chemo mechanical preparation and after the application of Photodynamic therapy.

Results: In the included four trials, three studies were judged as low risk and one as medium risk of bias using the Cochrane risk of bias tool. The results of four studies showed a significant reduction of microbial load in the root canals after photodynamic therapy. The meta-analyses showed a significant difference before and after PDT. For the total viable bacteria count per canal analyses, mean difference and 95% confidence interval was 0.19 [0.10, 0.34]; statistically significant (p < 0.00001).

Conclusion: Compared with calcium hydroxide, PDT leads to a more significant reduction in E faecalis count in infected root canals stating that it is an efficient adjunct in reducing resistant microbial load. Based on these findings, this systematic review and meta-analysis is scientific evidence that emphasizes the effectiveness of PDT as an effective adjunct in reducing microorganisms in endodontic retreatment cases.

  Abstract 207: Minimally invasive approach in endodontics: A review Top

Neetu Jindal

Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India

With the extensive research, it is seen that it is virtually impossible to render root canal systems of teeth bacteria-free. The objective of root canal treatment is eliminating micro-organisms and pathological debris from the root canal systems and preventing re-infection. In the quest of eliminating the microorganisms from the canal system one should also make sure that there is no extensive loss of tooth structure in the process, which is achieved by the shift of endodontics from extension for prevention to the minimal invasion with the systemic respect of original tissue. This review compares the various methods of minimally invasive treatment approaches with traditional approaches in Endodontics.

  Abstract 208: Separation a nightmare in endodontics: Managing instrument separation in root canals using bypass technique – A case series Top

Raja Chandrasekaran

Army Dental Corps, Secundarabad, Telangana, India

The separation of an endodontic instrument instantly transforms a case, from whatever level of difficulty it was preoperatively, to a new level of severity. The consequences of file separation are significant as separation may lead to accompanying un cleaned and unfilled spaces within the root canal system as well as unnecessary removal of excess dentin during removal procedures, which otherwise would not be required had separation not occurred in the first place. This removal of dentin can predispose a clinical case to perforation, root fracture, and difficulty in locating canals even if the file fragment is removed. This case series includes three cases describes the conservative approach (bypass technique) to deal with broken instruments which was accidientally broken during cleaning and shaping of the root canal with minimum armamentaria.

  Abstract 209: The effect of commercially available calcium silicate-based cements on osseous healing: A systematic review and meta-analysis Top

Sudha Yadav, Ruchika Roongta Nawal, Sangeeta Talwar, Rajeev Kumar Malhotra1, Preeti Jain Pruthi, Shruti Goel

Maulana Azad Institute of Dental Sciences, 1All India Institute of Dental Sciences, New Delhi, India

Introduction: Osseous healing is an important criterion to judge endodontic treatment outcome. Hence, the purpose of this systematic review was to evaluate the effect of commercially available calcium silicate-based cements (CSBCs) on peri-radicular osseous healing in human permanent teeth when used as root-repair material.

Methods: A comprehensive literature search of the Pubmed, Embase and Cochrane Library was performed until June 2020. Clinical studies wherein CSBCs were used as root-end filling (REF) material, perforation repair cement and/or orthograde filling material as apical-plug were included. Only studies with minimum 1-year follow-up and sample size of at least 20 were included. Risk of bias (ROB) was assessed using Cochrane's ROB tool and NIH quality assessment tool. The Meta-analysis was performed using STATA version-12.0 and R-software version-3.6.1. Subgroup analyses were performed based on the study design and treatment group.

Results: Out of 39 eligible studies included in systematic review, 32 were included in meta-analysis: 16-low ROB, 09-moderate ROB, 01-uncertain ROB and 06-high ROB. The pooled success rate for CSBCs was calculated by random-effect method as 90.49% [95%Confidence Interval(CI):88.49-92.34,I2=54%]. Majority of the studies used mineral trioxide aggregate (MTA) with pooled success rate of 90.13% [95%CI: 87.82-92.23,I2 =54%]. Newer CSBCs had a pooled-success rate of 92.32% [95%CI: 88.98-95.14,I2=23%]. On subgroup analysis, no significant difference was noted based on treatment rendered or study design. The pooled success rate in REF, apexification and perforation repair subgroup was 90.48% [95%CI:88.01-92.72,I2=55.9%], 92.09% [95%CI:88.3-95.27,I2=33.1%] and 86.8% [95%CI:76.1-94.9,I2=81.8%] respectively. Eleven studies compared CSBCs with other traditional materials. Overall, use of CSBCs significantly enhanced the osseous healing than traditional materials with OR=2.15 (95%CI:1.57-2.96).

Conclusion: From the available evidence, it may be concluded that use of CSBCs enhanced periradicular ossous healing as compared to other traditional materials. The level of the evidence was 'high' for MTA. However, high quality studies are required for the newer CSBCs to further establish their clinical performance.

  Abstract 210: A comparative evaluation of cyclic fatigue resistance of protaper next and flexer files in rotating motion – An in vitro study Top

R Sanjana Paul, Vijay Mathai1, Rajesh Sasidharan Nair1, Jeyabalaji Mano Christaine Angelo1

Sri Ramakrishna Dental College and Hospital, Coimbatore, 1Sree Mookambika Institute of Dental Sciences, Kanyakumari, Tamil Nadu, India

Aim and Objectives: To evaluate the Cyclic Fatigue resistance of ProTaper Next and Flexer endodontic files in simulated root canals.

Materials and Methods: Two groups of 20 endodontic files each of ISO size 25,6% taper were selected. Group I consisted of Protaper Next files (n=20) and Group II consisted of Flexer files (n=20). Cyclic Fatigue testing was conducted in a custom made device with 60 degree angle of curvature and 3mm width with curvature starting at 5mm from the apex. Using X Smart Plus motor, Protaper Next files were used in rotating motion (300 rpm and 2Ncm torque) while Flexer files were used in rotating motion at 400 rpm. All the files were rotated until fracture occurred. The time till fracture in seconds will be recorded using a stop watch. The number of cycles to fracture (NCF) which is indicative of cyclic fatigue resistance was calculated by multiplying the time (seconds) to fracture by the number of rpm regardless of rotational direction.

Results: Flexer (180.60±40.37) files showed more cyclic fatigue resistance than Protaper Next (100.60±24.71*) files. The statistical analysis revealed a statistically significant difference (P = 0.001) between the two groups.

Conclusion: Flexer (Heat activated Monel metal) have better cyclic fatigue resistance when compared with Protaper Next (M wire). However further research is needed to conclusively prove in clinical practice.

Funding Source: Nil.

  Abstract 211: Effect of ionizing radiation on the dislocation resistance of root canal sealers to dentin and sealer dentin interfase Top

Pallavi Yaduka

Saveetha Dental College, Chennai, Tamil Nadu, India

Objectives: Ionizing radiation used in radiation therapy for head and neck cancer patients has direct and indirect detrimental effects on dental tissues. There is limited literature regarding the effect of therapeutic radiation on the bonding ability of different root canal sealers. Therefore, the aim of the study was to evaluate and compare the effect of ionising radiation on the dislocation resistance of AH Plus and BioRoot RCS to dentin and sealer-dentin interface.

Materials and Methods: Thirty single rooted teeth were randomly assigned to 2 groups (n = 15 each): Group 1: AH Plus (Dentsply) and Group 2: BioRoot RCS (Septodont). Each group was subdivided to control and experimental groups. The experimental group was subjected to a total radiation dose of 60Gy. Root canals of all samples were cleaned, shaped and obturated using the single cone obturation technique depending on the group they belonged to. Dentin slices (1mm) were sectioned from each root third for the push-out test and scanning electron microscopy (SEM) was done to examine the sealer-dentin interface. Failure mode was determined using a stereomicroscope. Bond strength data were analysed by independent t test, ANOVA and Tukey's post hoc test. The level of significance was set at p<0.05.

Results: Irradiated teeth showed significantly lower bond strength compared to non-irradiated teeth, in the AH Plus group (p < 0.001). BioRoot RCS showed no significant reduction in bond strength (p=0.146) and showed the highest bond strength after irradiation. SEM revealed slightly larger gaps at the sealer-dentin interface in irradiated specimens of both groups.

Conclusion: The dislocation resistance of BioRoot RCS was not significantly affected after irradiation. Therefore, BioRoot RCS may be the sealer of choice for root canal treatment in patients undergoing radiation therapy.

  Abstract 212: A comparative evaluation of cyclic fatigue resistance of ProTaper Gold, Dia-X and ZenFlex nickel–titanium rotary files in the canals with different angles of curvature Top

Kavitha Anantula, Bhavana Vankayala

Government Dental College and Hospital, Hyderabad, Telangana, India

Aim: To evaluate and compare the cyclic fatigue resistance of ProTaper Gold (PTG, Dentsply Tulsa Dental Specialities Inc, USA), Dia-X (DX, Diadent Group International, Europe) and ZenFlex (ZF, Kerr Corporation, USA) nickel–titanium rotary files in simulated curved canals with two different angles of curvature.

Materials and Methods: A total of 60 new nickel-titanium files (n=20) with triangular cross-section, 21 mm length and size #20 PTG, DX and ZF were used for cyclic fatigue testing. A stainless steel block having simulated canals with two different angles of curvature (60 degree curvature with 5mm radius and 90 degree curvature with 2mm radius) was used. 10 files for each curvature were used. The number of cycles to fracture (NCF) and the fracture length (FL) of the fragment was recorded. The data was statistically analyzed using one-way ANOVA followed by Post hoc Tukey test.

Results: Statistically significant difference was found between all the three groups (p < 0.05). The PTG files showed greater resistance to cyclic fatigue in both the curvature angles of 60 degree and 90 degree followed by DX and ZF. In addition, the length of fracture fragment was insignificant in all the three instruments tested (p > 0.05).

Conclusion: The PTG showed greater resistance to cyclic fatigue than DX and ZF instruments in both the apical curvatures.

  Abstract 213: Clinical management of early reimplantation of an avulsed maxillary central incisor Top

Tarun Kumar Singh

All India Institute of Medical Sciences, Bathinda, Punjab, India

Avulsion of a tooth is defined as the complete displacement of a tooth out of its socket. It is associated with severed periodontal ligaments and may be associated with fractures of the alveolar socket. The prognosis of teeth with this traumatic injury depends on appropriate management at the place of accident or the extra-alveolar time immediately after the avulsion. When replantation occurs within 20 min or if the avulsed tooth is placed in a suitable storage medium until a dentist can replant the tooth, chance for successful treatment of the tooth is maximized. This case report describes the early replantation of an avulsed maxillary central incisors that had an extraoral dry time of 30 minutes.

  Abstract 214: Charisma of three-dimensional imaging in mishaps Top

Ruchi Shah

K M SHAH Dental College and Hospitals, SVDU, Vadodara, Gujarat, India

Dental pulp is prone to dystrophic mineralization with a challenging anatomy; this mineralization can be so extensive that the entire root canal system is obliterated; As a result, root canal treatment becomes a difficult task. Also conventional 2D radiographs does not provide sufficient information on the location of calcified canal orifices due to limitation in bucco-lingual view. In an effort to treat a tooth in that condition, the endodontist faces a great challenge that might end up in an accidents such as root perforation and missed canals. Careful approach through dense calcified deposits in the pulp chamber and into the canal may uncover a treatable apical canal remnant. This presentation of two clinical cases discusses a successful diagnosis and treatment of a radiographically mis-leaded perforation with calcified canal and successful endodontic treatment of a missed 5th canal in maxillary third molar with help of a Cone Beam Computed Tomography.

  Abstract 215: Regenerative endodontic procedures in necrotic immature teeth with satisfactory periapical healing but no other favourable outcomes: Report of two cases Top

Marina Fernandes, Ida De Ataide

Goa Dental College and Hospital, Panjim, Goa, India

Introduction: Regenerative endodontic procedures (REPs) are the preferred treatment of choice for immature permanent teeth with periapical lesions as compared to the traditional apexification procedures. Although the aim of REPs is to achieve three main goals: periapical healing, increase in dentinal wall thickness and/ or increase in root length and a positive response to vitality testing, this may not always happen. Two REP cases are presented in this article which showed periapical healing but with no other favorable regenerative outcomes, on follow-ups. The possible ways to achieve more predictable effects were also analyzed.

Methods: Case 1: A 17-year-old male patient reported with a chief complaint of pain in tooth 11 and history of trauma. After clinical and radiographic examination, diagnosis of necrotic pulp with an acute periapical abscess was made for tooth 11. Following triple antibiotic paste placement for a total of 4 weeks, platelet rich fibrin (PRF) was condensed in the canal followed by placement of mineral trioxide aggregate (MTA) and then a composite restoration at a later visit. Patient also underwent an intracoronal bleaching procedure. Case 2: A 19-year-old male patient was referred for discoloration of tooth 11. The diagnosis was pulpal necrosis with chronic apical abscess with previously initiated treatment. Similar treatment procedure as in case 1 was carried out.

Results: In case 1, there was periapical healing and only a slight increase in canal wall thickness in the apical third of the root. In Case 2, there was periapical healing and a 1mm calcific barrier formation was evident below the MTA at a 1 year follow up. However, following intracoronal bleaching the patient presented with a swelling indicating that the tooth was re-infected. The pulp space was then rehabilitated with a bioceramic material. While case 1 was considered a REP with unsatisfactory clinical outcomes, case 2 was considered to be a “failed” case of REP since the tooth got re-infected.

Conclusions: Recent treatment protocols like appropriate chemical disinfection, combining traditional REP method with PRF, placing double seal coronal restorations along with careful case selection can help attain more promising results in REP procedures.

  Abstract 216: Evaluation of postoperative pain and bacterial load after the application of different irrigation methods: A randomized controlled trial Top

R Jaya Shree Roja, S Sakthivel, Palanisamy Revathi, Anirudhan Subha

Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India

Aim: To compare the incidence of post- operative pain and bacterial load after the application of different irrigation methods during root canal therapy.

Materials and Methods: Eighty patients with irreversible pulpitis or pulpal necrosis in single rooted teeth were selected and randomised into two groups according to the method of irrigation used; Group A(n=40)- Side-vented needle irrigation and Group B(n=40)- Passive ultrasonic needle irrigation using Irrisafe tips). Under isolation, bacterial samples were obtained twice, S1- after initial access cavity preparation and S2- after standard endodontic instrumentation (using ProTaper till F2 file size) and irrigation in both the groups respectively using sterile paper points. Bacterial culturing was done on MacConkey and Blood agar plate and assessed for bacterial growth. Pain was recorded by using visual analogue scale 30 minutes pre-operatively and 6, 12, 24 and 48 hours post operatively. The bacterial load and incidence of post- operative pain were statistically assessed using Chi-square test and Paired-t test, respectively.

Results: Passive ultrasonic irrigation group (Group B), resulted in significant reduction in post- operative pain at 6 and 12 hours period and more bacteria free samples when compared to Side-vented needle irrigation (Group A).

Conclusion: Passive ultrasonic irrigation with Irrisafe tips is more effective in reduction of post-operative pain at 6 hours after root canal therapy than side vented needle irrigation. Irrisafe ultrasonic tip irrigation when compared to Side-vented needle irrigation is more efficacious in reduction of bacterial load in root canals undergoing endodontic treatment.

  Abstract 217: Comparative evaluation of different irrigating system in removal of gutta-percha/sealer during retreatment: An in vitro micro-computed tomogrsphy study Top

Rakesh Kumar Yadav

Faculty of Dental Sciences, KGMU, Lucknow, Uttar Pradesh, India

Aim: The aim of the study was to compare the efficacy of different irrigation system used as an adjuvant to retreat rotary files in removal of gutta-percha and sealer from root canal walls during endodontic retreatment using Micro-CT.

Materials and Methods: 64 extracted permanent maxillary central incisor teeth with single oval canal, were collected and decoronated to standard length of 16mm. Instrumentation was done using rotary files and carrier based obturation was performed using GuttaCore and AH plus sealer. After setting of sealer, initial removal of filling material was performed usingProTaper universal retreatment files (D1, D2, D3) in a progressive crown-down manner. GROUP 1: Positive pressure irrigation using 30G Side vented needle (n = 16), GROUP 2: Passive ultrasonic irrigation (n = 16), GROUP 3: EndoActivator (n = 16), GROUP 4: EndoVac negative pressure irrigation (n = 16). Micro-CT scanning was performed after obturation, initial removal of filling material and after using experimental groups. The volume of obturation material and remaining obturation material was calculated using Dolphin software. Statistical analysis of variance was performed with one-way ANOVA followed by Tukey's post hoc test to evaluate exact differences amongst the groups.

Results: The supplementary techniques of irrigation used in conjunction with rotary retreatment file resulted in significant reduction in the volume of residual obturation material. Passive ultrasonic irrigation was superior to the sonic (EndoActivator) and negative pressure irrigation technique (EndoVac) and positive pressure irrigation at the coronal, middle thirds and apical third of the root canal. EndoVac and conventional needle irrigation showed most amount of residual obturation material and no significant difference was seen (p<0.001). However, none of the supplementary techniques were able to completely remove the residual obturation material.

Conclusion: PUI and EndoActivator improved the filling material removal including the apical third, demonstrating clinically useful for supplementary technique in removing remaining obturation material during endodontic retreatment.

  Abstract 218: Do light cured temporary restorative materials show reduced microleakage when compared to contemporary temporary restorative materials during interappointment endodontic procedures: A systematic review Top

Preethi Varadan, Sindhu Saeralaathan, Akhil Vasudevan, Manigandan Kuzhanchinathan, Arathi Ganesh

Sri Ramachandra Faculty of Dental Sciences, Chennai, Tamil Nadu, India

Objective: The primary requirement of a temporary restorative material during endodontic treatment is to provide adequate coronal seal during inter-appointment, preventing potential contaminations until completion of procedure. This systematic review was aimed at comparing the microleakage associated with light cure temporary restorative materials as compared to contemporary temporary restorative materials when used for inter-appointment procedures.

Materials and Methods: The focussed review question constructed for the systematic review in PICO format was “In tooth undergoing root canal treatment (Population), do light cure temporary restorative materials (Intervention) when compared to contemporary temporary restorative materials (Comparison) show reduced microleakage (Outcome)?”. A comprehensive search was done using PubMed, Cochrane, Scopus, Ebscohost and LILACS to obtain articles that met the eligibility criteria. The quality of included studies were evaluated by the guidelines previously reported for in-vitro studies and was modified following CRIS guidelines.

Results: A total of 79 articles were identified from the initial search, out of which 18 articles were included for qualitative analysis. The included articles had a moderate risk of bias. Due to heterogeneity in included studies, meta-analysis could not be done. From this systematic review, it can be concluded that light cured temporary restorative materials showed similar microleakage when compared to other materials.

Conclusion: Within the limitations of this systematic review, there was no significant difference in microleakage between light cured and other contemporary temporary restorative materials. All the materials showed considerable marginal deterioration post thermocycling. More clinical trials and in-vitro studies under similar controlled study settings should be conducted to extrapolate results of this systematic review.

Clinical Significance: Materials that provide adequate coronal seal should be considered for inter-appointment restoration, since it determines the outcome of the endodontic procedure and the importance of this step should not be underestimated.

Keywords: CAVIT, endodontics, IRM, light cure temporary material, microleakage

  Abstract 219: Clinical applications, accuracy and limitations of guided endodontics Top

Kaluva Kolanu Sreeha

KIMS Dental College and Hospital, Amalapuram, Andhra Pradesh, India

Guided endodontics, a technology-driven, contemporary treatment approach that represents a paradigm shift in endodontics. In this method, Computer designed guides are utilized for access cavity preparation and endodontic surgeries to achieve predictable and safe results. This novel concept may avoid unnecessary removal of tissues thereby improving the prognosis of the treatment. A review on guided endodontics analyzing its accuracy, assessing the literature regarding the clinical applications, and its limitations focusing specifically on guided endodontic access and guided endodontic surgery may help every endodontist utilize this artificial intelligence and incorporate it in clinical practice and achieve predictable results even in complicated cases.

  Abstract 220: Comparative analysis of antimicrobial effect of different conventional and herbal intracanal medicaments on external root surface – An endo-perio study Top

Neha Prashar

Armed Force Medical College, Pune, Maharashatra, India

Aim: It has been demonstrated that some of intracanal medicaments can diffuse through the dentinaltubules and reach the external surface of the root,and that root canal could be used as slow releasingdevice to apply specific antimicrobial drugs to the periodontium. Therefore, this study was designedto identify conventional and herbal alternatives to be used as intracanal medicaments for effective rootdisinfection and aid to achieve a sound periodontal tissue health. This would augment the treatment methodology in cases of Endo -Perio origin that fail to resolve with conventional therapy.

Methodology: Eighty-eight single-rooted mandibular premolar extracted teeth were randomly assigned into eight groups —Calcium hydroxide, 2% CHX with Ca (OH) 2, Tetracycline hydrochloride, Azadirachta indica (Neem), Ocimum sanctum (Tulasi), Triphala (Terminalia bellerica+ Terminalia chebula+Emblica officinalis), Liquorice (Glycyrrhiza glabra) and control (saline solution) respectively. Aftersealing the apical end and placement of intracanal medicaments, the coronal openings were sealed.The samples were placed on semisolid media and seeded with Micrococcus luteus for 48 hours. The,zones of inhibition were measured after incubation period and were analysed using one way ANOVA post HOC test.

Results: Antimicrobial activity was exhibited by all the samples having medicaments used except control group.The antimicrobial effects of the medicaments were ranked in the following descending order of antimicrobial efficacy: Tetracycline, 2%CHX+Ca (OH) 2, Azadirachta indica, Ca (OH) 2, Ocimum sanctum, Triphla, Liquorice. Based on statistical analysis following groups have shown to have similar antimicrobial activity 1) Tetracycline, 2%CHX+Ca (OH) 2, Azadirachta indica 2) Ca (OH) 2, Ocimum sanctum 3) Triphla, Liquorice.

Conclusion: All the medicaments used, diffused through the dentin and cementum to reach the outer surface,showing antimicrobial action. Based on the results of study conducted, it can be concluded that herbalintracanal medicaments can be used as potential root canal medicaments to support periodontal therapy in cases of Endo-Perio origin where local drug delivery is required for complete elimination of the pathogenic microbes.

  Abstract 221: Management of rare case of C-shaped Canal with trifurcation using cone-beam computed tomography assisted three-dimensional virtual model Top

Parth P Patel

K. M. Shah Dental College, Vadodara, Gujarat, India

The mandibular second molar shows difficulty due to limited access and canal variation. C –shaped canal is one of the most common variation seen clinically. This case report discusses the endodontic management of a mandibular second molar with two fused roots and single C-shaped canal trifurcating at the middle and apical region. For a proper understanding of the complexities of C-shaped canals, 3D virtual and physical model was fabricated using limited FOV CBCT. This 3D model was used to examine the exact anatomy and trifurcation level of the canal. CBCT volume was also used for treatment planning and measuring the length and angulation of the canal. To negotiate all the trifurcating canal, novel customized chair side micro-debrider was used. The anatomy was such that all the protocols of canal negotiation, cleaning and shaping and obturation were bit modified. Use of Magnification, CBCT, 3 D printing, Ultrasonics, thermo plasticized gutta percha and customized micro opener was the key for the successful management of this challenging case.

  Abstract 222: Assessing occurrence and detection of radix entomolaris or paramolaris in mandibular molars in Vadodara district from cone-beam computed tomography scans: A retrospective study Top

Meetkumar Dedania

K.M. Shah Dental College and Hospital, Vadodra, Gujarat, India

Aim: The aim of the study is to Assess the occurrence and detection of Radix Entomolaris or Paramolaris in mandibular molars of patients in Vadodara district, Gujarat, India from CBCT scans.

Materials and Methods: After obtaining ethical approval the study was initiated. A total of 200 CBCT scans of fully mature mandibular teeth were obtained according to inclusion and exclusion criteria. Initially 15 CBCT scans were allotted to another investigator and was interchanged to check for intra-examiner and inter-examiner variabilities (kappa ≥ 0.81). It was done until it reached its Kappa value. Further, 185 scans were evaluated by both the investigators. Each observer assessed presence and type of radix entomolaris or paramolaris in axial, coronal and sagittal section. Presence of radix entomolaris or paramolaris on scans was evaluated and if present type of the radix was also further evaluated by both the investigators. The results obtained were tabulated and prevalence rate of its presence was calculated.

Results: Among all the studied CBCT scans; CBCT images of 8 patients showed an additional root. The prevalence of patients with three-rooted mandibular molars was 4% (radix entomolaris); with the highest prevalence rate of Type -A (3%), whereas Type B and Type C had the same prevalence rate of 0.5%.Prevalance rate of radix paramolaris is 0 %. Statistical analysis Used:- Kappa test

Conclusion: The possibility of encountering RE in the population of Vadodara district of Gujarat was noted in the present study. The total prevalence rate of radix entomolaris is 4% among Vadodara population. Thus, it should be detected properly and managed adequately.

  Abstract 223: Advancement in the diagnostic aids in endodontics: A review study Top

Gitanjali Singh

Sharda School of Dental Sciences, Aligarh, Uttar Pradesh, India

The aim of the study is to seek new diagnostic tools to differentiate between the normal pulpal stem cells and inflammed pulpal stem cells. Thus, in order to fulfill the purpose of the study, it is important to minimally invade the coronal as well as radicular pulpal tissues. Therefore, it is important to determine the type of pulpal stem cells; whether it is physiological or pathological and to treat the affected tooth/teeth accordingly. Thus, with the evolution of technology it is a need of an hour to keep seeking for new techniques and thereby, enhancing the overall oral health of the patient. Hence, in the above study we directed towards the use of litmus paper or new diagnostic tools and to promote regenerative endodontics.

  Abstract 224: Evaluation of flow, pH and solubility of a new calcium silicate based sealer: A comparative in-vitro study Top

Ashish Choudhary, Rudra Kaul

Indiragandhi Government Dental College, Jammu, Jammu and Kashmir, India

Objective: This study aimed to compare a new calcium silicate based sealer (Ceraseal) with established root canal sealers on the basis of their flow, alkalinity and solubility.

Materials and Methods: The tested sealers were 2 bioceramic sealers (Ceraseal and MTA Fillapex) and an epoxy resin sealer (AH Plus). Flow measurements were evaluated according to ISO 6876:2012 standards. Alkalinity was evaluated by filling polyethylene tubes with sealers which were later immersed in 10ml of distilled water. Following experimental periods of 3hrs, 24hrs, 72hrs and 168hrs, the samples were measured regarding pH with a digital pH meter. Solubility was determined using similar specimens of sealers which were prepared in custom made stainless-steel ring moulds with an internal diameter of (20 ± 1) mm diameter and a height of (1.5 ± 0.1) mm and digitally weighted to register the mass of each specimen before and after immersion in distilled water. Solubility was assessed by mass loss (%) after 24hrs.

Results and Statistical Analysis: The results were evaluated for significance by using Tukey HSD Post Hoc test and t test (p < .05). The mean flow values were 22.97 mm for Ceraseal, 25.18mm for MTA Fillapex and 27.67 mm for AH Plus, satisfying the ISO standardization. Ceraseal and MTA Fillapex showed significantly high alkaline pH over time (p < .05). Ceraseal showed significantly higher solubility (p < .05) whereas MTA Fillapex and AH Plus fulfilled the requirements of solubility of the ISO 6876 standards demonstrating a weight loss of less than 3% at 24hrs.

Conclusion: Within the limitations of this study, we concluded that Cersaeal showed adequate flow and alkanization abilty but higher solubility than the standard set by ISO 6876:2012.

Funding: Self-funded.

  Abstract 225: Mandibular second premolar with inverse molar canal configuration: A case report Top

Preeti Mishra

Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India

Root canal morphology of mandibular premolars can be highly variable and it is often a challenging task to carry out successful endodontic therapy with such teeth. A thorough knowledge of the root canal anatomy is a basic requirement for successful endodontic treatment. The presence of an untreated or missed canal may be a reason for failure of endodontic treatment. The mandibular second premolar is typically described in textbooks as single rooted tooth with a single canal system. The incidence of extra roots in mesio-distal location in mandibular second premolar is uncommon. This presentation reported a case of mandibular second premolar with two roots and three canals in inverse mandibular molar configuration. Clinically canal orifices were present like inverse mandibular molar canal configuration. There was a single large mesial canal orifice and two distally placed orifices. All three canals mesial, distobuccal and distolingual were independent and had separate apical exit. Precise inspection of root canal configuration can be done through discrete diagnostic methodologies such as magnifying loupes, dental microscope, judicious interpretation of angled radiographs and auxiliary diagnostic aids like CBCT. CBCT not only aided the clinician to understand the complex root canal morphology but also help in treatment planning, thereby protecting the patient from further unnecessary iatrogenic complications. The clinicians should be aware of the anatomical variations of root canal configuration of mandibular premolars to improve the predictability of root canal therapy and must use all the available tools to detect and manage their clinical cases successfully. Although the presence of two roots and three canals is rare but can exist. Higher imaging techniques like CBCT may be helpful to understand the internal anatomy of such variations.

  Abstract 226: Conserving the vitality with platelet-rich fibrin and mineral trioxide aggregate: A case report Top

Renu Aggarwal

Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India

The goal of restorative therapy is not only to restore the tooth to proper form and function but also aims to preserve the pulp vitality. Vital pulp has several important functions which include induction, formation, nutrition, defense, and sensation. Vital pulp possesses the capacity to produce secondary, tertiary, and reparative dentin to the external stimuli. Preservation of pulp vitality is of paramount importance because, a vital functioning pulp is capable of initiating several defense mechanisms to protect the body from bacterial invasion; it is beneficial to preserve the vitality and health of an exposed pulp rather than to replace it with a root filling material following pulp exposure. Partial pulpotomy is a form of vital pulp therapy that consists of the surgical amputation of 2 to 3 mm of damaged, inflamed, coronal pulp tissue, followed by placing a biocompatible agent to promote healing and maintain vitality of the remaining pulp tissue. PRF gave best re-mineralising and healing outcomes. Several in vitro and in vivo studies have reported that MTA alone and in combination with PRF is biocompatible with tissue. MTA also provides a very good seal, has excellent marginal adaptation, and maintains a high pH for a long period of time. In this case report effect of MTA and PRF has been seen in case of partial pulpotomy, which gave promising results.

  Abstract 227: Endodontic management of mandibular premolars with variable canal anatomy: A case series Top

Sushmita Shivanna, Ranjith Kumar Sivarajan1, R Kurinji Amalavathy, Gunaseelan Rajan2

Sathyabama Dental College and Hospital, 1SRM Katankulathur Dental College and Hospital, 2Rajan Dental Institute, Chennai, Tamil Nadu, India

The prerequisite for a successful endodontic treatment requires thorough knowledge of the root canal anatomy to locate the canals, clean and shape and follow it up with a three dimensional obturation. Identification of the aberrant anatomy and treating it has been a significant challenge for the clinicians. Failure to recognize a variation could result in missed canals and resultant failures of the endodontic treatment. The mandibular premolars on several occasions pose a major challenge for the clinician, due to its canal variations. The mandibular first and second premolars have higher failure rates compared to the other teeth due to difficulty in identifying the complex canal morphology and accessing the additional canals for treatment. Moreover, its inconspicuous nature and apical third variations are factors that test the clinician's skill. This case series presents successful management of mandibular first and second premolars with variable anatomy, its relative challenges and clinical consideration associated with it.

  Abstract 228: A comparative evaluation of smear layer removal in apical thirds of root canals of mandibular first premolar using four different irrigation techniques: A scanning electron microscopy study Top

Kanchan Bhagat

Indira Gandhi Government Dental College and Hospital, Jammu, Jammu and Kashmir, India

Aim: This study was conducted to compare smear layer removal by four different irrigation techniques—manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), sonic irrigation (SI), and negative apical pressure (NAP).

Materials and Methods: Fourty freshly extracted mandibular first premolars were cleaned and shaped by One Curve rotary files and 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. The samples were divided into four equal groups (n = 10), according to the final irrigation activation technique: Group I, MDA; Group II, PUI; Group III, SI; and Group IV, NAP. The samples were prepared and observed under a scanning electron microscope. The photomicrographs were recorded and evaluated with a scoring system. Data were statistically analyzed with tests for normality (Kolmogorov-Smirnov and Shapiro-Wilk tests), Levene's test, Kruskal-Wallis test, and Dunn's post hoc test using Statistical Package for the Social Sciences (SPSS) software, version 18.0 (IBM, Armonk, New York), and the statistical signicance was set at P < 0.05.

Results: Group I had the highest scores, which showed a statistically significant difference between the other groups (P < 0.05). This was followed by PUI, NAP, and SI.

Conclusion: Within the limitations of this in vitro study, it can be concluded that none of the irrigation techniques completely removed all the smear layer from root canal walls at the apical part of the canal. Final irrigation activation with SI and NAP resulted in the better removal of smear layer when compared to that with other groups. However, EndoActivator showed a superior smear layer removal than MDA, PUI, and NAP systems.

Keywords: EndoActivator, EndoUltra, EndoVac, manual dynamic activation, scanning electron microscopy, smear layer

  Abstract 229: Effect of cryotherapy, low-level laser therapy, and intraligamentary injection of dexamethasone on post-treatment pain after single-visit root canal treatment: A double-blind, randomized controlled trial Top

Sana Fatima, Sonali Taneja

ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India

Aim: This single-centered, double-blinded, randomized controlled clinical trial was designed to compare the effect of intracanal cryotherapy, low-level laser therapy, and intraligamentary injection of dexamethasone on the onset and intensity of post-treatment pain after single-visit root canal treatment.

Materials and Methods: This trial is reported according to CONSORT (CONsolidated Standards of Reporting Trials) 2010 guidelines and the protocol was registered at the clinical trial registry, India. In total, 100 patients (presenting with a diagnosis of symptomatic apical periodontitis and a preoperative visual analog scale score-VAS above 7) were randomly allocated into four groups, group1: Control/placebo, group2: Intraligamentary injection with dexamethasone, group3: Intracanal cryotherapy, and group4: Low-level laser therapy (LLLT). The postoperative pain score was recorded after 6, 12, 24, 48, and 72 hours using VAS (10cm) scale. Intergroup comparison of pain intensity was performed using Kruskal-Wallis tests with posthoc analysis using Friedman test. Comparison of the incidence of postoperative pain and the requirement of painkillers between groups while controlling for any other possible confounding factor was done using linear regression analysis.

Results: All adjuvant therapies resulted in a significant decrease in pain intensity and frequency of medication intake after 6, 12, 24, 48, and 72 hours as compared to the placebo group (p< .05). The Intracanal Cryotherapy group showed the least pain and analgesic usage followed by LLLT and Intraligamentary injection of dexamethasone, respectively. After 24 hours only the placebo group showed analgesic consumption of 4%. After 48 and 72 hours, there was no analgesic consumption in any group.

Conclusion: Non-pharmacological adjuvant therapies like intracanal cryotherapy and LLLT effectively reduced the incidence of postoperative pain and the need for medication intake better than an invasive, pharmacological pain management technique like intraligamentary injection with dexamethasone.

  Abstract 230: Future of regenerative endodontics from a machine learning perspective Top

Veena Jayadevan, Jayakrishnan Ajayakumar1, Vinoo Subramaniam Ramachandran2

Private Practitioner, Alappuzha, Kerala, 2RVS Dental College and Hospital, Coimbatore, Tamil Nadu, India, 1Case Western Reserve University, Cleveland, USA

In the recent times, there is a proliferation of evidence based studies in the management of immature non vital tooth using Regenerative Endodontic therapy (RET). Irrespective of the study design, the goal is to understand the changes in root length, width and healing of the periapical lesion. Machine learning (MI) is a branch of Artificial intelligence which deals with analysis of statistical data and pattern identification. MI is extensively used in health care for diagnostics, medical imaging, medicine precision, patient monitoring etc on a large scale. In dentistry, it is used in identifying dental caries, identifying anomalies in the tooth structure and reading two dimensional and three dimensional data. These studies sheds light in RET by improving case selection, helps in cost reduction by enabling efficient two dimensional image analysis when compared to costly three dimensional images and targeted drug delivery.

  Abstract 231: Histological analysis of human pulp following direct pulp capping with different materials: An ex vivo study Top

Kundabala Mala, Neeta Shetty, Udeeksha Nangia

Manipal College of Dental Sciences, Mangalore, Karnataka, India

Aim: To evaluate histologically, the effectiveness of hard setting Calcium Hydroxide (Dycal), Mineral Aggregate (ProRoot MTA) and a dentin bonding agent (3M ESPE ADPER SINGLE BOND 2 ADHESIVE) when used as direct pulp capping (DPC) agents in mechanically exposed non inflamed adult pulp tissue.

Materials and Methods: Pulpal exposures were made in forty five intact human from 17 patients(15-25 yrs) premolars, scheduled for extraction due to orthodontic purpose, through occlusal surface. Teeth were divided into three groups and were capped with hard setting calcium hydroxide, Mineral trioxide aggregate and Dentin bonding agent. Final restoration was done with posterior resin composite (3M Filtek 350)using Resin modified glass ionomer cement as a base. About half the number of teeth from each group were extracted after 15days and the remaining after 45 days. Extracted teeth were then sectioned and evaluated histologically under light microscope for inflammatory cell response and dentin bridge formation according to the criteria described by Cox et.al.

Statistical Analysis: The inflammatory and dentin bridge formation was evaluated using Chi square test and p value = <0.05 was considered significant.

Results: MTA as DPC agent showed milder imflammatory response compared Dycal and Single bond. The quality of bridge formation by MTA was similar to Dycal. However, Dycal took the least time for initiation of bridge formation. Adper single bond plus showed a significantly higher degree of pulpal inflammation similar to Dycal. Among all the direct pulp capping materials used, Adper single bond plus took the longest time for both the resolution of pulpal inflammation and improvement of the quality of bridge formation.

Conclusion: Based on the result, it can be concluded that Dycal and MTA produce similar type of dentin bridge formation of good quality, when used as direct pulp capping agents. Inflammatory cell response of MTA was milder compare to Dycal. Adper single bond 2 has the potential to be used as direct pulp capping agents, but it takes longer time for resolution of inflammation and dentin bridge formation.

Funding sources: Self funded.

  Abstract 232: Modified treatment protocol for apical root augmentation of nonvital immature permanent anterior teeth Top

Vishal Kumar, Ajay Logani, Amrita Chawla, Vijay Kumar, Siddhartha Sharma

All India Institute Of Medical Sciences, Delhi, India

Objective: This case series aimed to evaluate the outcome of a modified treatment protocol on apical augmentation of non-vital immature permanent anterior teeth.

Materials and Methods: Twelve patients between 8-18 years with traumatized non-vital immature permanent maxillary anterior teeth (with and without apical periodontitis) were treated. The modified protocol entailed minimal instrumentation two mm short of the working length, negative pressure irrigation with 1% sodium hypochlorite and 17% EDTA followed by a low-level diode laser irradiation (980 nm, 1.25 W, 5 s). The access cavity was double sealed with Cavit and light-cured glass ionomer cement in same visit. The cases were followed up at 6 and 12 months. Radiographs were evaluated for periapical healing (PH), dentinal wall thickening (DWT), root lengthening (RL), and apical closure (AC). The tooth was re-accessed, and formation of the apical barrier was physically verified with an ISO size # 70 gutta-percha point.

Results: Radiographically, PH, DWT and RL were appreciated in 70%, 23% and 15.3% teeth respectively. AC was appreciated in 53.8% teeth on radiographs; however, it could only be confirmed physically in 30.7 % teeth.

Conclusion: The modified treatment protocol can be explored for management of non-vital immature permanent anterior teeth as an alternative treatment strategy.

  Abstract 233: Evaluation of different chelating agents complemented with passive ultrasonic irrigation on the removal of calcium hydroxide from treated root canals: An in-vitro study Top

Anila Bandlapally Sreenivasa Guptha, SP Manjula1

Sibar institute of dental sciences, Guntur, 1AECS Maaruti College of Dental sciences and Research centre, Bengaluru, Karnataka, India

Aim: To evaluate the efficacy of 0.5% Peracetic acid (PAA), 1% Peracetic acid, 17% Ethylene diamine tetra acetic acid (EDTA), 10% Citric acid (CA) and 3% Sodium hypochlorite (NaOCl) in the removal of calcium hydroxide (Ca(OH)2) from the treated root canals, coupled with Passive ultrasonic irrigation (PUI).

Materials and Methods: Sixty extracted single rooted teeth were selected and decoronated to standardize the root length to 12mm. Biomechanical preparation was performed using Protaper NiTi rotary files up to size F4 and irrigated with 3% NaOCl followed by 17% EDTA and filled with calcium hydroxide. The samples were divided into 7 groups according to protocol followed for removal of Ca(OH)2: GROUP I:Calcium hydroxide is removed with distilled water; GROUP II: Teeth not filled with calcium hydroxide; GROUP III: 3ml of 17% EDTA with PUI; GROUP IV: 3ml of 3% NaOCl with PUI; GROUP V: 3ml of 0.5% PAA with PUI; GROUP VI: 3ml of 1%PAA with PUI; GROUP VII: 10% Citric acid with PUI. The roots were split longitudinally and viewed under stereomicroscope at 50X magnification.

Results: Kruskal Wallis test was applied to find out significant difference between the study groups. Intragroup comparison was done using Friedman's test. Small amounts of calcium hydroxide residue was seen in 1% PAA group, in comparison to other groups in coronal, middle and apical third of the root canals.

Conclusions: 1% PAA with PUI was effective while 3% NaOCl being the least effective in removal of Ca(OH)2 from treated root canals. Passive ultrasonic activation seems to be a promising adjunctive method for the removal of calcium hydroxide from the root canal.

  Abstract 234: Antibacterial effect of diode laser on Enterococcus faecalis and Peptostreptococcus species in endodontic retreatment cases with apical periodontitis: An in-vivo study Top

Vidhya Shenoy, Moksha Nayak

KVG Dental College and Hospital, Sullia, Karnataka, India

Aim: To evaluate in-vivo antibacterial effect of diode laser on Enterococcus faecalis and Peptostreptococcus species in endodontic retreatment cases with apical periodontitis detected using PCR.

Materials and Methods: Patients aged 25 to 65 years requiring endodontic retreatment were selected for this study. During endodontic retreatment, the root filling material was removed using ProTaper retreatment files and Hedstrom file (H file) without the use of solvent. The canals were sampled as per Moller's criteria using sterile paper points and root canal samples positive for Enterococcus faecalis (E. faecalis) (Group 1 (n=14)) and Peptostreptococcus micros (P. micros) (group 2 (n=12)) using conventional PCR were divided into two groups. Disinfection using 810 nm diode laser at 1.2 W for 10 sec each for 40 sec was carried out in both the groups and samples were collected for analysis. Evaluation of both the organisms were performed using semiquantitative conventional PCR. Statistical analysis was performed using Wilcoxon signed rank test, Chi square test, Fisher's exact test and Mann Whitney U test.

Results: Irradiation using 810 nm diode laser significantly reduced the mean CFU to 0 in group 1, while the mean CFU in group 2 was 8.58 x 102.

Conclusion: Complete eradication of E. faecalis was achieved using 810nm diode laser, whereas a reduction of 99.97% was achieved against Peptostreptococcus species. Diode laser has high potential for use in endodontics for achieving the goal of complete eradication of pathogenic bacteria from root canals of teeth with persistent apical periodontitis thus increasing the success of endodontic retreatment.

  Abstract 235: Effect of LASER application with NaOCl and ethylenediaminetetraacetic acid irrigation on bond strength of endodontic sealer to root canal dentine: An in vitro study Top

Vijay Kumar Shakya, Dhruv Gupta

King George's Medical University Lucknow, Uttar Pradesh, India

Objective: The aim of the study was to determine the effect of LASER application on adhesion of endodontic sealer to dentine.

Materials and Methods: 34 extracted human maxillary anterior teeth were decoronated to a standardised length, prepared up to F 3 Protaper Rotary file and randomised to 2 equal groups, Group I - Irrigation was done by 3% NaOCl and 17% EDTA solution alternatively. In Group II, Er-YAG laser was applied with the same irrigation protocol as in group I. All the samples were obturated with gutta percha and epoxy resin-based sealer and stored for a week. After 7 days, the samples were sectioned and push out bond strength was measured by Universal testing machine (Model No. 3382 Instron Corp., USA). The obtained data was subjected to statistical analysis. Two samples from each group were observed under scanning electron microscope for evaluating the mode of bond failure.

Results: Statistically significant difference was observed between the two groups in terms of mean bond strength which was higher in Group II. Cohesive type of bond failure mode was observed in Group I and mixed type (Cohesive and Adhesive) found in Group II.

Conclusion: LASER application before Obturation of root canal can be a better alternative to enhance the bond strength off endodontic sealer with root canal dentine.

  Abstract 236: Venturing into the venturi effect in endodontics: A narrative review Top

Shadab Ahmed

Sri Siddhartha Dental College and Hospital, Tumkur, Karnataka, India

“The beginning is the end the end is the beginning” such is the philosophical metaphor which describes a root canal beginning from the orifice and terminating at the root apex. A successful endodontic treatment is a venture which comprises of many challenges. The uncertainty, the mystery of newer discoveries is what makes the specialty of endodontics an enigma. The initiative of a root canal treatment and various modalities undertaken to effectively disinfect and seal it determines a successful endodontic treatment. Along the course of treatment, the clinician is confronted with many challenges which can pose a hindrance to conventional modalities of treatment like anatomical factors which include various types of morphological variations of root which involves C shaped canals, curved canals, lateral and apical communications with periodontium. Microbiological aspects include the ability of microorganisms to get lodged to the relatively inaccessible areas of the root canal and develop as biofilms which tend to become persistent and resistant as they grow in colonies. To overcome these challenges Irrigation is one of the most important contributory factor in essential disinfection and removal of necrotic remnants and debris from the root canal. However, to achieve a successful irrigation several factors come into play. One such factor is the fluid dynamics and the changes occurring at the apical third of the root apex. The phenomenon of Venturi effect was named after its discoverer Giovanni Battista Venturi. It is one of the principles of fluid dynamics which is often overlooked during irrigation. It is physical principle coupled with pressure, force, velocity and fluid dynamics which is applied in dentistry and endodontics. This narrative review aims in exploring the concept of fluid dynamics in endodontics and dentistry, the various clinical aspects and related physical principles which contribute the success or failure of an endodontic treatment.

  Abstract 237: Comparison of ability of two apex locators to locate the apical foramen in the presence of irrigants: An in vitro study Top

Shrikant Shingane

Vyws Dental College, Amravati, Maharashtra, India

Aim: Comparison of Ability of Root ZX and Propex II to locate the apical foramen in the presence of irrigants.

Materials and Methods: 60 freshly extracted human single rooted mandibular premolars were selected for the study. The teeth were verified radiographically as having single straight patent canal. Teeth with fully formed apices, intact root with no calcification, no internal resorption & no previous root canal treatment were included in the study. Teeth were stored in 2.5% sodium hypochlorite solution for 6 hours to remove organic debris and disinfected samples stored in sterile 0.9% saline until use. -Teeth were decoronated at CEJ with a diamond disk to provide constant reference point for all measurements. Teeth were numbered 1 to 60 and randomly selected for measurement using a #10 K-File (Mani) with double stoppers, tip of the file could be visualized just within the apical foramen under 5x magnification. Three plastic rectangular boxes, were used for preparing this model. Alginate was poured in each of these boxes that act as an electroconductive medium. Two apex locators were chosen for this study, Root ZX (J. Morita) and Propex II (Dentsply). Each tooth among the 60 samples were subjected to electronic working length measurement using both apex locators in the presence of irrigants i.e. 2.5% sodium hypochlorite, normal saline & 17% liquid EDTA.

Results: The result obtained in mm for each electronic apex locators was recorded in independent tables. Paired t test was used to stastically analyze the significance of the mean differences between the electronic length & acutal length and between the two apex locators.Result shows that there is no statistically significance difference in locating apical foramen (p>0.05) in the presence of irrigants.

Conclusion: Under the condition of this in vitro study. There is no stastically significant difference in Comparison of Root ZX & Propex II in locating the Apical foramen in the presence of irrigants. Funding Source: N.A.

  Abstract 238: Comparison of sealing ability of three different obturating systems to intra radicular dentin: An in vitro stereomicroscopic study Top

Nimeshika Ramachandruni

Mallareddy Dental College For Women, Hyderabad, Tellangana, India

Aims and Objectives: To evaluate the marginal leakage of three different obturating materials and techniques using stereomicroscope.

Materials and Methods: A total of 30 freshly extracted maxillary anterior teeth were collected and randomly divided into three groups of 10 each. Biomechanical preparation was done in all the teeth. The teeth were then assigned into 3 experimental groups according to the obturation material and technique used, Group I: gutta-percha with AH plus root canal sealer (Lateral Condensation): Group II: Thermoplasticized gutta-percha technique - Non carrier based (Calamus) with AH plus sealer (Backfill): Group III: C point (Self-sealing root canal obturating system) with Bioceramic sealer (Single cone). Each specimen was subjected for testing apical sealing ability. The values of micro-leakage associated with different root canal sealers were evaluated using a stereomicroscope.

Results: There was no statistically significant difference in the mean scores of apical dye penetration/leakage among all the three groups (p=0.091). Whereas Group I showed a higher degree of apical leakage than the other techniques tested.

  Abstract 239: Role of glycogen synthase kinase 3 inhibitor in reparative dentin formation: An in vitro tooth culture study Top

Selvakarthikeyan Ulaganathan, Sarath Sarathy1, Nandini Suresh, Saumya Parashar, Alan Mathew Punnoose2, Paramesh2, Velmurugan Natanasabapathy

Meenakshi Ammal Dental College, 2Sri Ramachandra Institute of Higher Education and Research, 1Tagore Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: The aim of this study was to assess the ability of a glycogen synthase kinase (GSK) enzyme inhibitor that influences Wnt/ β-catenin pathway for reparative dentin synthesis using a human tooth tissue culture model.

Methodology: Twenty Four premolars or molars freshly extracted for orthodontic reasons were included in the study. Class I cavities were prepared to expose the pulp and direct pulp capping was performed with either GSK 3 inhibitor or Proroot MTA. The tooth was then suspended by a rubber dam sheet in the culture wells filled with DMEM. The samples were incubated at 37 degree Celsius and cultured for either for 14 or 28 days. At the end of 14/28 days the samples were processed & fixed in 10% formalin and decalcified using mixture of nitric acid and formic acid for histopathology. Micro CT scan (SkyScan 1272; Bruker- MicroCT) were taken to analyze the morphometry. The data were reconstructed using Instarecon software (version Images were transferred to the CTAn software (version 1. 13, Bruker-MicroCT) to provide qualitative and quantitative analysis. The assessment of early mineralization from the micro CT data was done to find the mean volume of mineralization; the mean distance between the pulp capping material and the reparative dentine formation; the mean Hounsfield unit; the thickness of mineralization observed were analyzed using chi square test followed by post hoc analysis test using R project version 3.5.

Results: The inter group comparison between the 14 and 28 days showed that MTA had a significantly higher thickness of mineralization formed than GSK group(p<0.05).There was a significant difference when volume of mineralization was assessed between GSK and MTA at 28 days. The histological picture showed a tubular matrix mineralization in the 28 day MTA samples. The pulp architecture was well maintained by the GSK group at both time interval.

Conclusion: The glycogen synthase kinase 3 inhibitor when used as a direct pulp capping agent in the three dimensionally cultured entire tooth model showed continuous dentin bridge formation. The architecture of the pulp was maintained when compared to MTA.

Keywoards: MicroCT, reparative dentin, tideglusib, WNT pathway

  Abstract 240: Gutta-percha removal efficiency of rotating and reciprocating nickel titanium files Top

Fatma Furuncuoğlu, Aysenur Kamacı Esen, Taha Özyürek

Sakarya University, Sakarya, Turkey

Objective: The purpose of this study was to evaluate the efficiency of T-Endo Must, Protaper Retreatment Files, and Hyflex Remover instruments for removal of gutta-percha during retreatment and compare the required time for root canal filling removal.

Materials and Methods: Forty five mandibular premolar teeth were selected and the root canals were prepared with step back technique. The canals were enlarged up to a size 40 K file as a master apical file and flared to a size 60 K file. Root canals were obturated using a cold lateral compaction technique with gutta-percha cones and a resin-based sealer. The specimens were randomly divided into 3 groups (n=15). The root filling material was removed with the following retreatment systems and T- Endo Must (Dentac, Istanbul, Turkey) reciprocating system: Group A: ProTaper R (Dentsply Sirona, Ballaigues, Switzerland), group B: Orifice Opener and Hyflex Remover (Coltene/Whaledent, Altstatten, Switzerland) group C: T-Endo Must. After retreatment procedures, groups enlarged up to size #50 for each system which are ProTaper Next X5 (Dentsply Sirona), Hyflex EDM (50 .03) (Coltene/Whaledent), and T Endo Must M50, respectively. The required time to remove root filling material, establish apical patency and final preparations were all recorded for each root canal. Whole procedures were performed with an operating microscope (Zumax OMS2350; Zumax Medical Co. Ltd, Jiangsu, China) under x20 magnification by a single endodontist. After preparations, the samples were radiographed and evaluated for residual filling material by 3 different experienced examiners. One-way analysis of variance complemented by the Tukey test was used to perform the statistical analysis (p, .05).

Results: There are significant differences between groups (p < 0.001). Hyflex Remover system required less time for retreatment than T-Endo (p = 0.001), and ProTaper (p =0.007). There is no significant difference between groups in terms of residual filling material (P > 0.05).

Conclusion: Hyflex Remover retreatment system with Hyflex EDM finishing file system provides rapid retreatment and root canal preparation then T-Endo Must Reciprocating system and Protaper retreatment system using operation microscope under in-vitro conditions.

  Abstract 241: Controlled drug delivery in tubular disinfection: A narrative review Top

V Sujatha, S Nagarathinam

SRM Dental College, Ramapuram, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India

Owing to the diversity of the intracanal microorganisms, addressing radicular microbiota is of great challenge in root canal disinfection. In necrotic and infected root canals, since there is a lack of blood supply, drug delivery to the damaged sites through systemic approaches can be demanding. In recent years, controlled and site specific drug delivery has attained great interest, since they show efficient accessibility to intricacies and distant areas of the root canal system. Several materials such as natural or synthetic polymers and inorganic materials have been used as nanocarriers for drug delivery. Once these nanocarriers reach the desired tissue, release of the drug may occur by desorption, diffusion through the nanoparticle matrix or polymer wall or nanoparticle erosion. Various literature evidence prove that, controlled release of biomolecules from the nanocarriers is an important requisite for the successful translation of tissue engineering approaches and disinfection of root canal system. One such emerging material is calcium phosphate nanoparticles (CaP NPs). They are the promising vectors for drug delivery as variety of bioactive molecules can be loaded on their surface or encapsulated within the particle, thus protecting the therapeutic agent from degradation. Hence, the aim of this review to give an overview on the recent work and evolving applications of CaP nanocarriers in tubular disinfection using controlled drug delivery system.

  Abstract 242: Comparison of the cutting efficiency of two single file system using cone beam computed tomography: An in vitro study Top

Swikriti Agrawal

Practitioner, Satna, Madhya Pradesh, India

Aim: This study aimed to compare the cutting efficiency of two single file system using Cone Beam Computed Tomography.

Methodology: Thirty freshly extracted single rooted mandibular premolars were selected and divided into 2 groups (n=15). Teeth were decoronated at cemento-enamel junction. Samples of both groups were mounted on wax template. Pre instrumentation Cone Beam Computed Tomography imaging of all tooth were done at apical, middle and coronal third. Measurement were taken in middle of each section. Group 1 were prepared with Reciproc file and Group 2 were prepared with Wave One file. Post instrumentation Cone Beam Computed Tomography imaging were done in a similar method as Pre instrumentation scan using iCAT software version.

Results: Reciproc instrument recorded a statistically significant (p<0.05) higher cutting efficiency than Wave One instrument.

Conclusion: Reciproc instrument demonstrated statistically higher cutting efficiency as compared to WaveOne instrument.

  Abstract 243: Golden mediums in endodontics Top

K Revathi

KGF College of Dental Sciences, Karnataka, India

Golden mediums are the intermediate file sizes which play a pivotal role in Endodontic instrumentation. This presentation highlights the rationale behind the use of intermediate file sizes which do not confine to the standardization of endodontic instruments given by Ingle and Levine in 1950''s. Also discusses the points to be pondered during usage of these instruments. This presentation also narrates various golden mediums files available in the market.

  Abstract 244: Management of mutilated tooth with orthodontic extrusion and crown lengthening Top

Kamal Bagda, Mihir Pandya, Anjali Mairal Oak, Rimil Nayak, Usha Balchandani, Charvisha Agarwal

Goenka Research Institute of Dental Science, Ahmedabad, Gujarat, India

“Revert the Destruction”. Restoration of mutilated tooth is always challenging due to its more favourable biomechanical failure than a healthy tooth. The loss of tooth structure is severe so that makes the longevity of the tooth questionable. Several studies have shown that, provided most of its tooth structure remains, an endodontically treated tooth can be successfully restored by partial coverage. The ideal final restoration for an endodontically treated tooth should restore function and esthetics, protect the remaining tooth structure and resist marginal microleakage and fracture. In this case report, orthodontic extrusion movement was carried out which involves applying traction forces in all regions of the periodontal ligament to stimulate marginal apposition of crestal bone. Because the gingival tissue is attached to the root by connective tissue, the gingiva follows the vertical movement of the root during the extrusion process. Similarly, the alveolus is attached to the root by the periodontal ligament and is in turn pulled along by the movement of the root and therefore was followed by crown lengthening procedure. Few criteria were also set such as. Root length, the Root form, the Importance of Tooth, the Esthetics, and the Endodontic and Periodontic prognosis. Treating such cases needs a sincere multidisciplinary approach and is a key factor to a successful prognosis, orthodontic extrusion is a simple treatment but needs skills to perform and minimal materials are required for it. The endodontic therapy performed should be outstanding as secondary infection might take place there, with periodontal therapy intervention followed by a suitable and sustainable prothesis.

  Abstract 245: Comparative analysis of solubility, gap volume after retrofilling of three root end filling materials in distilled water and synthetic tissue fluid: In vitro study Top

Sharva Nayak

Goa Dental college, Margao, Goa, India

Aim: To evaluate solubility and gap volume after retrofilling of three root end filling materials viz. Proroot MTA, Biodentine and Endosequence in different media.

Materials and Methods: 60 freshly extracted human single rooted teeth were selected and stored in buffered saline. Biomechanical preparation was done to a master apical size of #30 (F3) in a crown-down fashion and 0.5 mm short of the apical foramen and obturated. The root tips (3 mm from the apex) were resected at 90 degree to the longitudinal axis of the teeth with a tapered diamond abrasive. A root-end cavity of 3-mm depth was prepared with a tapered diamond bur. The retrofilling materials were mixed and applied according to the manufacturers' instructions. Evaluation of gap volume: To evaluate the sealing ability of the root-end filling materials, the gap between the tooth surface and the root-end filling material was examined using CBCT imaging. Evaluation of Solubility: 60 bottles were dried and weighed to record the initial dry weight (IDW). 30 samples (10 from each group) were then transferred to individual bottles containing 5 ml of distilled water. Remaining 30 samples were transferred to individual bottles containing synthetic tissue fluid (STF). Each bottle was then individually weighed and recorded as final dry weight (FDW). Solubility was determined as a difference in dry bottle weights before and after incubation of the tooth in the respective media.

Results: The gap volume percentage was the highest with MTA followed by Biodentine. The least value was shown by Endosequence. Solubility values were insignificant at day 24, day 7 and day 15 among the tested materials. At day 30, highest solubility was seen with Biodentine followed by Endosequence. The least solubility was seen with MTA.

Conclusion: Endosequence Root Repair Material can be considered as a better root end filling material with least gap volume and moderate solubility compared to Biodentine and MTA.

  Abstract 246: Analysis of failures in regenerative endodontics Top

B Jyothi Lekshmi, Geetha Ramachandran

PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India

Regenerative endodontics is one of the most exciting developments in dentistry today and endodontists are at the forefront of this cutting-edge research. Regenerative endodontics uses the concept of tissue engineering to restore the root canals to a healthy state, allowing for continued development of the root and surrounding tissue. Regenerative treatments in necrotic immature teeth are recommended as alternatives to conventional multiple or single-step apexification procedures. There has been an ongoing debate about Regenerative Endodontic procedures which stems from the success rates for this procedure, which varies. Even though case series provide hopeful results, the treatment protocol is not yet fully established and regenerative procedure might fail. Aim of this review is to analyse failed cases of regenerative endodontic treatment (RET) reported in the literature in terms of etiology, diagnosis, treatment protocols, signs of failure etc.

  Abstract 247: Clinical evaluation of three different retrograde filling materials (MTA, bioceramic, biodentine) in case of endodontic surgery by using cone-beam computed tomography (in vivo study) Top

Sagarika Muni

Hitech Dental College, Bhubaneswar, Odisha, India

Aim of the Study: The purpose of this In Vivo study is to compare the three different retrograde filling materials (MTA, Bioceramic, Biodentine) following endodontic surgery by using cone beam computed tomography.

Materials and Methods: In our study, pateints with periapical lesion were considered irrespective of site, age and sex. After incision, flap elevation was done. Osteotomy was performed using no. 4 carbide bur, in order to gain access to the apical region. Apicoectomy was performed followed by retrograde filling with three different materials. Nova bone putty was used as a bone graft material at the lesion site. The flaps were then sutured. Preoperative and postoperative CBCT was done to determine the size of radiolucent area or the periapical lesion.

Results: Bioceramic showed the best results, with maximum decrease in size of the lesion, followed by Biodentine and MTA.

Conclusion: Within the limitations of this study, it was shown that Bioceramic surpassed the rest as a retrograde filling material.

  Abstract 248: Root canal curvature assessment of labial versus lingual access cavity preparation in mandibular incisors Top

A Arvind Kumar, Paulaian Benin

Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India

Background: The conventional access preparations in mandibular incisors are from the lingual aspect. Numerous data suggests that the lingual access preparations cause loss of tooth structure and will not provide a straight line access to apical one third of the root canal system.An alternative approach is to prepare the access from the labial aspect. This in vitro evaluation compares the labial and lingual access cavity preparations in mandibular incisors having single or two canals and evaluating the mean curvatures using digital radiographs and image analysis software.

Materials and Methods: 40 mandibular incisors (Group 1) having single canal and 40 incisors (Group 2) having two canals were selected. Samples were randomly divided into subgroups A and B. Subgroups 1A (n=20) and 2A (n=20) were subjected to labial access preparation and subgroups 1B (n=20) and 2B (n=20) were subjected to lingual access preparations.A15 size K-file was introduced into the canal and digital image was taken from the proximal aspect. And two lines were drawn, line A being parallel to the cervical cuvature and line B parallel to the apical curvature.The angle formed was measured withVixWin Pro digital image analysis software. Statistical analysis was performed using non parametric Mann-Whitney U test.

Results: Labial access in single canalled teeth (Group 1A) had a curvature of 8.90±4.80 and lingual access (Group 1B) had a curvature of 12.60±4.50. The p value was statistically significant. Labial canal in labial access cavity preparation (Group 2A) had a curvature of 14.40±4.60while the lingual canal had a curvature of 16.450±4.80. In lingual access (Group 2B), the labial canal had a curvature of 21.450±8.50 and lingual canal had a curvature of 20.40±6.20

Conclusion: Based on the results, it could be concluded that, labial access cavity preparations in mandibular incisors can provide straight line access to the apical one third of the canal compared to the lingual access cavity preparations.

  Abstract 249: Prevalence of dens invaginatus in maxillary lateral incisors: A retrospective cone-beam computed tomography based pilot study in North Indian population Top

Mayank Arora

Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India

Aim: To study the prevalence of Dens Invaginatus in maxillary lateral incisors in North Indian population.

Methods: This study is based on the retrospective evaluation of CBCT, performed in collaboration with D R Diagnostix, Faridabad (Haryana). It is a pilot part of the project aimed to study the prevalence of Dens Invaginatus in a large sample size of north Indian population. High-quality images of CBCT scans having permanent maxillary lateral incisors with complete root formation were included. Dens Invaginatus was classified according to the Oehlers classification system and association with any periapical pathosis was also noted.

Results: 161 lateral incisor teeth from CBCT scans of 100 individuals were examined. The prevalence of Dens Invaginatus was found to be 11% (15 teeth from 11 individuals) with Oehler's type 1 DI being the most frequent (87%). Tooth level prevalence was found to be 9.3% (15 out of 161 teeth). Thirteen teeth (8.07%) were found to be associated with periapical pathosis.

Conclusions: We found a high prevalence of dens invaginatus in maxillary lateral incisors in north Indian poulation as compared to global prevalence. This study is still under continuation and will include larger sample size to more accurately determine the association between apical periodontitis and dens invaginatus.

  Abstract 250: Posturodontics for successful endodontics! Top

Ida De Ataide De Noronha, Namrata Prabhu

Goa Dental College and Hospital, Bambolim, Goa, India

Ergonomics as per International Ergonomics Association(IEA) is the scientific discipline concerned with the understanding of the interactions among humans and other elements of a system, and the profession that applies theoretical principles, data and methods to design, in order to optimize human well-being and overall system performance. Poor practice of ergonomics by dental professionals has led to high prevalance of musculoskeletal disorders with endodontists among the most affected. Prolonged working time in static position, repetitive movement carried in restricted area, uncomfortable position, limited access, vibrations restricted view makes them particularly vulnerable. Correct application of ergonomics in dentistry helps prevent musculoskeletal disorders and injuries along which eventually increases productivity and work satisfaction. Use of dental equipments and instruments that satisfy basic ergonomic principles are hence recommended to be incorporated in daily practice. Dental operating microscope is one such aid that helps the clinician to carry out root canal procedure with ease and comfort to one's utmost satisfaction. A review of current literature has been made to analyse the risk factors for musculoskeletal disorders and the preventive measures that can be taken up by the dental professionals.

  Abstract 251: Coronal pulpotomy in permanent teeth with irreversible pulpitis: A case series Top

Pankaj Sangwan

PGIDS, Rohtak, Haryana, India

Coronal pulpotomy has traditionally been considered as a treatment modality to manage traumatic pulp exposures, carious pulp exposures in primary and young immature permanent teeth, as well as emergency management of dental pain. With scientific advancements and better understanding of pulp biology, it is gradually establishing itself as a successful alternative to the traditional, but more invasive, root canal treatment. This case series focuses on one year outcomes of 5 cases of coronal pulpotomy in mature permanent teeth with irreversible pulpitis.

  Abstract 252: Fracture resistence of roots instrumented with three different rotary instruments Top

Margareta Rinastiti, DDS Rhona Mariana Untari, Wignyo Hadriyanto

Department of Conservative Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia

Aim: To evaluate the fracture resistance of endodontically treated roots using different NiTi rotary instruments including Protaper Next, Protaper Gold and Hyflex CM.

Materials and Methods: Thirty recently extracted premolars with a single straight root canal were selected. The coronal portions of all teeth were removed near the cemento-enamel junction leaving the root segment of nearly 12 ± 1 mm length. Roots were randomly divided into 3 groups (n=10). According to the instrument used in root canal preparations, Group I: proTaper Next, Group II: proTaper Gold and Group III: Hyflex CM. The preparation was done for 1 minute and irrigated using 2.5% NaOCl and saline. The force was applied at a crosshead speed of 1 mm/min until fracture occurs and this force was recorded in Newton.

Results: No significant difference among those three rotary instruments was recorded (p=0.066). However based on post-hoc test analysis, fracture resistance of root canal prepared using Hyflex CM was higher than proTaper next and proTaper gold.

Conclusion: All rotary files showed the same fracture resistance values, however Hyflex CM lead to minimal reduction in the fracture strength.

  Abstract 253: The reproducibility of three-dimensional printed replicas of a maxillary premolar with a type II canal: A micro-computed tomography study Top

Kyeol Koh, Sung-Eun Yang1

Department of Conservative Dentistry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1Department of Conservative Dentistry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Background: The aim of this study was to evaluate the reproducibility of three-dimensional (3D) printed maxillary premolar replicas.

Methods: An extracted maxillary first premolar with a type II canal (Vertucci classification) was enlarged using Ni-Ti rotary files. Cone-beam computed tomography was used to scan the tooth and collect data for 3D printing. Thirty-four 3D-printed tooth replicas were scanned with micro-computed tomography (micro-CT). Reproducibility was evaluated in terms of the total volume and three area measurements by the ratio of the difference between the measured value and average reference value. The data were statistically analyzed using the Kruskal-Wallis test with the Bonferroni correction.

Results: The ratio of the difference between the measured and reference values was significantly lower in the main area (10.31%) than in the lateral canal (44.21%) or isthmus (45.49%) (p<0.001). Upon a further subdivision, the differences for the entire canal (19.92%) and main canals (10.31%) were significantly lower than those for all other parts: coronal (43.06%), middle (50.26%), apical (47.92%), subleft (40.01%), and subright (46.55%) (p<0.001). Significant differences were found for the middle and subleft areas (p=0.005).

Conclusion: Although reproducibility was relatively low in narrow areas, 3D-printed replicas can be usefully applied in further experiments on teeth with various root canal systems.

Keywords: 3D-printed tooth replica, micro-CT evaluation, reproducibility, type II canal

Acknowledgements: This work was supported by a National Research Foundation of Korea grant funded by the Korean government (No. NRF-2019R1A2C1005247) and Research Fund of Seoul St. Mary's Hospital, The Catholic University of Korea.

  Abstact 254: Comparison of Antimicrobial Efficiency of a Novel Antibiotic root canal irrigant with Sodium hypochlorite and Chlorhexidine: An in-vitro study. Top

K Anjaneyulu

Saveetha Dental College, Chennai, India

Aim: To compare Antimicrobial Efficiency of a Novel Antibiotic root canal irrigant with Sodium hypochlorite and Chlorhexidine.

Materials and Methods: Forty extracted single rooted maxillary and mandibular canines were selected and divided into four groups (n=10) based on the irrigant used. Teeth were decoronated at the cemento-enamel junction and all the root lengths were standardised to 16mm. All the teeth were cleaned and shaped with Protaper gold files and were autoclaved before they were inoculated with Enterococcus Faecalis. After inoculation teeth were incubated for 21 days for the formation of Enterococcus Faecalis biofilm. After 21 days the teeth were irrigated with the respective irrigants and the dentine samples from the root canals were collected and analysed for the presence of bacteria using microbial turbidity test. The following irrigant was used among the 4 groups. Group 1- Irrigation with saline, Group 2- Sodium Hypochlorite, Group 3- Chlorohexidine and Group 4 - Experimental antibiotic irrigant. Chi square test was performed to check the association between irrigant and turbidity.

Results: Novel antibiotic irrigant showed significantly more antibacterial efficacy compared to the other three irrigants(P < 0.05).

  Abstact 255: Middle Mesial Canal Variations in mandibular molar - A case Series Top

Pradeep S

Saveetha Dental College, Chennai, India

The main aim of any root canal treatment is the complete removal of pulp and necrotic tissues along with the debris from the canal system and to fill the entire canal three-dimensionally. The presence of aberrant anatomy, fins, communication amongst the canal system makes the treatment extremely challenging. The existence of confluent canals within the same roots can increase the chances of ledging, fracture of instruments and perforation leading to a poor prognosis. These anatomical variations can be identified with the help of dental operating microscopes and various radiographic techniques. The identification of these complex variations needs adequate knowledge, complete debridement of all canal systems, and sealing all portals of exit using three-dimensional filling materials. This case series explains variations of the middle mesial canal in mandibular molar.

  Abstact 256: Comparative evaluation of flowability of various root canal sealers under ISO standardisation - An In vitro Study Top

Manish Ranjan

Saveetha Dental College, Chennai, India

Introduction: Flow is the ability of a sealer cement to penetrate into irregularities and accessory canals of the root canal system, and it is considered to be a very important property. The greater the flow, the greater the ability to penetrate into irregularities. The following study evaluates the flowability of root canal sealer

Materials and Methods: The study was carried out by a single operator , the ISO guidelines to evaluate the flowability of the sealer under the ISO standardisation 9002 is followed. In this study 10 samples of each sealer were recorded of the following sealers - AH plus , Bioroot RCS and Meta fill apex and the data was recorded on the excel sheet and subjected to statistical analysis using the IBM SPSS statistical software version 22.0

Results and Discussion: The data was subjected to the Tukey post hoc test. The results obtained were not statistically significant.Within the limitations of this in vitro study, it was concluded that all of the tested endodontic sealers presented greater flow than the minimum recommended in the ADA 57 specification. The recently developed Bioroot RCS sealer had better flowability properties as compared to other sealers.

  Abstact 257: Repair and regeneration of large periapical lesion using a novel platelet concentrate followed by esthetic rehabilitation - a case report Top

surendar Sugumaran, Nivedhitha Malli Suresh Babu, Subash Sharma, Deepak Selvam

Saveetha Dental College, Chennai, India

Regenerative medicine is one of the most dominant objectives of today's rehabilitation therapies. Growth factors are bioactive proteins that control the wound healing process. The platelet-containing preparations derived from human blood such as platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF) are used to reconstruct bone defects. One of these products, the concentrated growth factor (CGF) is a novel 2nd generation platelet concentrate. CGF is a fibrin rich organic matrix which contains growth factors, platelets, leukocytes, stem cells. Regional CGF administration increases the growth factors release, which plays an active role in angiogenesis, as well as enhancing neutrophil migration by performing integrin release.It has been reported that CGF contains more growth factors than other platelet preparations. This paper discusses a report with four year followup healing pattern in an interdisciplinary approach which has utilised this novel platelet concentrate as an adjunct with bone grafts to accelerate the healing of periapical lesions and esthetic management using full veneer crowns and no prep veneers to promote health, function and aesthetics of the oral tissues and positive impact on the quality of life of the patient.

  Abstact 258: Biosynthesis of nanoparticles and assessment of their cytotoxicity and anti microbial activity Top

Iffat Nasim

Saveetha Dental College, Chennai, India

Aim: To synthesise graphene oxide coated silver nanoparticles using plant extract and assess their cytotoxicity and antimicrobial activity.

Materials and Methods: Synthesis of graphene coated silver nanoparticles was done by utilising plant extract of Ocimum sanctum Linn and Andrographis paniculata as reducing agents.The characterisation was done by UV-vis spectrophotometer Analysis, Transmission electron microscopy, FTIR Analysis and X-ray Diffraction assay. Antimicrobial activity was assessed by measuring the zone of inhibition.Assessment of cytotoxicity was done by Brine shrimp lethality assay and MTT assay.

Results: The synthesised silver nanoparticles with an average size of 11-20 nm were uniformly dispersed on graphene sheets.The nanoparticles exhibited minimal cytotoxicity and good antimicrobial properties

Conclusion: Combination of Ocimum sanctum Linn and Andrographis paniculata were effective to be used as reducing agents for the synthesis of graphene oxide decorated silver nanoparticles.The synthesised nanoparticles appear as promising agents to be used as antimicrobial agents with minimal cytotoxic effects.

  Abstact 259: Management of Simple and Complex Ellis Fracture Cases - A Case Series Top

Subash Sharma, Surendar Sugumaran, Deepak Selvam, Vignesh S

Saveetha Dental College, Chennai, India

Crown and root fractures are the most common form of dental trauma that mainly affects children and adolescents. Fracture of anterior teeth is a tragic experience for young patients and it needs immediate attention. Hence traumatic injuries are considered as emergency treatment in dental office. Tooth fractures occurs mainly in maxillary central and lateral incisors. Post-and-core placement using prefabricated posts and composite resin plays a significant role in management of trauma cases. Radicular fractures are one such entity which is very challenging due to its various complications. This presentation of four cases discusses the management strategies for various simple Ellis fracture cases with composite stratification technique and complex Ellis fracture cases like root fracture and crown en-mass fracture with post and core build up followed by e max crowns and veneers.

  Abstact 260: Effect of Radiation on Dentine Structure – An in-vitro study Top

Mithra N Hegde

A B Shetty Memorial institute of Dental Sciences Deralakatte Manglore D.K Karnataka

The study aimed to evaluate the effect of radiation on the structure and properties of mineralized and non-mineralized components of dentine. Materials and Methods: The effect of radiation on the structure and properties of mineralized and non-mineralized components were analyzed as follows: Micro-hardness evaluation by Vicker's micro-hardness test, Scanning Electron Microscope to observe the physiological changes, and X-ray diffraction analysis to distinguish chemical properties. Each of these observations was recorded prior to and subsequent to radiation exposure of the human dentine samples. Results: Loss of structural capacity of dentine was observed with a reduction in the mechanical strength. Conclusion: In-depth understanding of the effect of radiation treatment on teeth will facilitate the apt selection of restorative materials for improved oral hard tissue rehabilitation.

  Abstact 261: Evaluation and Comparison of systemic oxidative stress Pre and Post root canal using MDA as salivary biomarker in Post and Non COVID patients: Pilot study Top

Anu Vashisht, Ekta Choudhary

Sharda University, Delhi, India

Overview: As we enter our second year of the pandemic and various restrictions for Sars-CoV-2 (COVID-19), oxidative stress in the oral cavity has increased exponentially in the public. There are several hypotheses and some preliminary research indicating oral mucositis may occur in COVID-19 patients either because of damage to reactive oxygen species triggered by the virus, or because of opportunistic infections due to dysregulation of the immune system.

Materils and Methods: • Patients reporting to OPD of Department of Endodontics were selected.

• Type of study – A Comparative study ;In vivo study.

Group 1 : ( n = 5) Post COVID patients with chronic apical periodontitis in bi/muti rooted tooth

Group 2 : ( n= 5 ) Non COVID Patients with chronic apical periodontitis

Group 3: (n=5) Patients with no sign of chronic apical periodontitis and are healthy

MDA Levels in saliva were assessed in all groups.

The endodontic treatment of patients in “Group 1& 2” was performed conventionally 7 days later

T1: All “Group 1 & 2” patients called back for clinical and radiographic evaluation 30 days after the completion of the endodontic therapy .

Saliva samples were collected for group1 ,2 &3to assess MDA levels

T2: evaluation of of patients recruited in “Group 1 & 2” was carried out conventionally 60 days after T1 (T2), and saliva samples were taken from both the groups and will be evaluated for MDA .

Oxidative stress will be evaluated in all groups after 3 months using MDA as salivary Biomarker

Results: Initial Oxidative stress levels were higher in Post COVID Patients as compared to Non COVID and healthy group ;however Oxidative stress declined post proper root canal therapy on follow up in both Group 1&2 .

Conclusion: Careful assessment of patients who have been diagnosed or had symptoms of COVID-19 should be conducted to address mucositis and other potential issues related to oxidative stress in the oral cavity.

  Abstact 262: Effect of Four Different Intra Canal Medicaments on The Push Out Bond Strength of Root Canal Sealers Top

Vijaya Dhar Bhatt

Dental Specialist, Noida, India

Aim: The aim of this study was to compare the effect of four different intra canal medicaments on the push out bond strength of AH plus And MTA Fillapex sealers.

Materials and Method: A total of 100 single-rooted premolar extracted human teeth were divided into 5 (n=20) experimental groups including one control group. After the cleaning and shaping, the root canals were filled with Ca(OH)2, tri antibiotic paste (TAP), Metapex or 2% chlorhexidine gel for two weeks. Then, intracanal medicaments were rinsed away and the samples in the sub-groups were obturated with gutta-percha and AH plus or MTA Fillapex sealers. After two weeks incubation, 2-mm-thick middle section of each root was then evaluated for push-out testing. Data were analyzed with two-way ANOVA and LSD test.

Result: Overall mean bond strength values were found to be significantly raised with AH plus compared to MTA Fillapex (P<0.05) in all medicament groups. Based on the result AH plus had higher bond strength than MTA fillapex. AH plus and MTA fillapex had the higher bond strength in the presence of calcium hydroxide and CHX respectively

Conclusion: A comparison of the push-out bond strength shows that irrespective of the root canal segment or the final irrigant used, AH Plus® showed higher values among all the groups. Under the limitations of the present study, the effect of TAP on the bond strength of endodontic sealers was not negative.

  Abstact 263: Clinical and Radiographic Evaluation of Periapical Healing using Triple Antibiotic Paste & Chitosan Mixed With Ca(OH)2 used as an Intracanal Medicament– In vivo Study Top

Soumya Shetty, Anita Sanap-Tandale, Piyush Oswal, Ladusingh Rajpurohit, Sharath Shetty, Rajesh Shetty

Dr.D.Y.Patil Dental College & Hospital, Dr.D.Y.Patil Vidyapeeth, Pune, India

Aim: To evaluate and compare the healing of periapical lesions usingTriple Antibiotic Paste & Chitosan mixed with Calcium hydroxide used as intracanal medicament at 3,6 and 12 months.

Methodology: 20 adult patients having periapical lesions in single rooted teeth were selected in this study after being assessed using the PAI index. Written informed consent was obtained and patients were randomly assigned to: Group - I (n=10) Chitosan with Ca(OH)2 and Group - II (n=10) Triple Antibiotic paste (TAP) After access opening ,cleaning and shaping was done in the first visit, the pertinent intracanal medicaments were placed depending on the patient group. After 4 weeks, on the second visit, the medicament was removed and obturation was done in the asymptomatic teeth. Both clinical and radiographic endodontic evaluation was done at 0 month, 3 months, 6months and 12months using the same parameters. Radiographic evaluation was done using the PAI Index and scores were compared at 0, 3, 6and 12 months after treatment. Z Test was used for inter-group analysis.

Results: The group in which Chitosan was mixed with Ca(OH)2 (Group -1) showed a statistically significant radiographic healing after 12 months, when compared to the Triple antibiotic paste(TAP)Group. There was a statistically significant healing, observed in Group II (TAP) at the 3rdand 12thmonths. But there was no significant healing discernible at the 6th month. Whereas Group I showed a significant healing at all the time intervals (3rd, 6th and 12th months).

Conclusion: Within the limitations of this study, this Paper concludes that Chitosan mixed with Ca(OH)2 showed better healing than TAP. Chitosan, which is known to have antimicrobial effects against broad spectrum of bacteria and fungi, can additionally promote collagen build-up when used as an Intracanal medicament. As an endodontist it is vital for us to reduce the bacterial load in order to enhance periapical healing. Chitosan has been known to promote healing by haemostasis and accelerates tissue regeneration.This study also demonstrates that PAI is a reliable parameter to judge healing.

  Abstact 264: To evaluate the role of contributing factors and its association towards failure of endodontically treated teeth in a transitional population- a cross- sectional study. Top

Anamika Borkar, Shalini Aggarwal,

Anmol Mathur, Sanket Aras, Sanchit Mujumdar, Sayali Maral

Dr. D. Y. Patil Dental College and Hospital, Pune, India

Aim: To evaluate the role of contributing factors and its association towards failure of endodontically treated teeth in a transitional population.

Objectives: Advances in endodontics, over decades has seen an increase in the incidence of success in endodontics. Despite the current high success rate of endodontic treatment, failures do occur in a significant number of cases, and are attributed to different clinical causes, ranging from avoidable operator errors to unforeseen circumstances. Hence the study was conducted with following objectives.

  1. To determine the causative factors for failure of endodontically treated teeth.
  2. To establish a correlation between post endodontic restorations and failures of endodontically treated teeth.

Methodology: 117 patients were included in the study, who fulfilled the pre-determined inclusion criteria and were ready to be included as subjects. These were selected amongst a population visiting the OPD over a period of one year. Written and oral informed consent was obtained and detailed case histories were taken. Information regarding the reason for failure, was recorded for each patient. Descriptive statistics with number and percentages were calculated.


  1. A total of 145 teeth included in the study, 40.68% were purely endodontic failures, 27.58% were restorative failures and 31.72% were both.
  2. Amongst the causes for failure, endodontic were the most frequent, followed by restorative ones.
  3. There was a strong positive co-relation between the loss of coronal seal and failure of the endodontic treatment.
  4. Teeth showing highest percentage of failures were molars, and the least were seen in premolars.
  5. The most common reason for extraction of endodontically treated teeth was the loss of tooth structure after the RCT, leading to insufficient tooth structure for further restorative procedures.

Conclusion: This study demonstrates that in spite of the leaps and bounds seen in the field of endodontics, basic operator errors and non-compliance of the patient could lead to failure of endodontic therapy.

  Abstact 265: Comparative effects of final canal irrigation with Pentetic acid and Ethylenediaminetetraacetic acid Top

Dipali Shah, Gayatri Patil, Niranjan Desai, Ashwini Dadpe, Nishant Vyavhare, Pratibha Shetkar

Sinhgad Dental College and Hospital, Pune, India

Introduction: Pentetic acid is an FDA-approved chelating agent with antimicrobial properties that has not yet been explored in endodontics.

Aim and Objectives: The aim of this study was to compare the effect of 5% pentetic acid (diethylenetriaminepentaacetic acid) with ethylenediaminetetraacetic acid (EDTA), as final chelating agents on the pushout bond strength of AH Plus sealer to dentin and the microhardness of root dentin.

Materials and Methods: Single-rooted mandibular premolars (n = 160) were collected. The canals were instrumented and were randomly divided into four groups (n = 40) according to the final irrigation protocol followed, Group I: distilled water, Group II: 3% NaOCl and distilled water final rinse; Group III: 3% NaOCl and 17% EDTA as the final irrigant, and Group IV: 3% NaOCl and 5% pentetic acid as the final irrigant. Further 20 teeth of each group were randomly selected, their canals dried and filled with AH Plus sealer. Roots were sectioned transversely at 4 mm from apex, with 1 mm thickness, and tested for pushout bond strength. Failure modes were tested at 24X magnification. The rest of the 20 teeth in each group were split longitudinally and the surface hardness of the root dentin was determined using the Vickers hardness tests. Results were analyzed using analysis of variance and post-hoc Tuckey's test (P<0.05).

Results: Highest Pushout bond strength was achieved with 5% pentetic acid final rinse (0.84 ± 0.35 MPa), followed by 17% EDTA (0.83 ± 0.47 MPa), 3% NaOCl (0.68 ± 0.6 MPa), and distilled water (0.52 ± 0.24). However, the results were not statistically significant (P < 0.05). Groups III and IV had mixed failures and Groups I and II had predominantly adhesive failures. However, microhardness reduction was more significant in groups III (27 ± 0.66) and IV(30.44 ± 0.42) than Group I (39 .78 ± 0.33).

Conclusion: Within the limits of the study, 5% pentetic acid was as effective as 17% EDTA with regards to the variables studied and hence can be considered as a potential chelating agent in endodontic therapy.


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