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 Table of Contents  
STUDENT ABSTRACTS
Year : 2021  |  Volume : 33  |  Issue : 5  |  Page : 82-334

Student Abstracts


Date of Web Publication08-Jan-2022

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-7212.335251

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How to cite this article:
. Student Abstracts. Endodontology 2021;33, Suppl S1:82-334

How to cite this URL:
. Student Abstracts. Endodontology [serial online] 2021 [cited 2022 Jan 21];33, Suppl S1:82-334. Available from: https://www.endodontologyonweb.org/text.asp?2021/33/5/82/335251




  Abstract 1: Effect of various concentrations of sodium hypochlorite on human whole blood clot structure and kinetics Top


Anisha Mishra, Natanasabapathy Velmurugan, Nandini Suresh

Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India

Aim: The objective of this study was to determine the effect of 0.5%, 3% and 5.25% concentrations of sodium hypochlorite (NaOCl) on human whole blood clot kinetics and structure of blood clot formed.

Materials and Methods: Five healthy volunteers were chosen for the study and whole blood was collected from the antecubital fossa from each volunteer and divided into four groups namely, CG: Control (0.5 mL of blood), BN0.5: 0.5 mL of blood with 0.5 mL of 0.5% NaOCl, BN3: 0.5 mL of blood with 0.5 mL of 3% NaOCl and BN5.25: 0.5 mL of blood with 0.5 mL of 5.25% NaOCl. The study assessed the effect of NaOCl on human whole blood clot kinetics using Thromboelastograph (TEG) and on the structure of human whole blood clot using scanning electron microscope (SEM).

Results: The samples from CG and BN5.25 only made a graphical representation of the clotting kinetics in TEG. Samples from CG and BN3 could only be processed for SEM and the latter demonstrated neither fibrin formation nor branching of fibres either superficially or in the deeper layers. The surface of the Red blood cells was roughened, distorted and clumping of the cells with BN3 was evident.

Conclusion: NaOCl has high oxidative effects on the blood which further lead to the dysregulation of platelet aggregation, thrombin inhibition, erythrocyte lysis, decrease in viscosity and formation of agglomerated, weak and fragile mass of cells. Thus, the use of sodium hypochlorite (in any concentration) as a haemostatic agent in vital pulp therapy must be avoided.


  Abstract 2: Efficacy of three different irrigating needles on elimination of multispecies biofilm: An in-vitro study Top


Shuruthi Jagadeesh, Sangavi Tamizharasan

Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: The aim of the present study is to evaluate the efficacy of three different irrigating needles on elimination of multispecies dentinal biofilm using cryomilling technique.

Materials and Methods: Forty freshly extracted non carious, single rooted mandibular premolars with fully formed apices were selected and divided into three experimental (n=10) and control groups (n=10). Teeth were decoronated to obtain a standard tooth length of 18 mm and inoculated with E. faecalis, P. aeruginosa and S. epidermidis and was incubated for 3 weeks to form multispecies biofilm. The samples were randomly assigned into group 1(Single side-vented needle), group 2(Double side-vented needle), group 3(Open-ended needle) and control group. All the experimental groups were irrigated with 3% NaOCl and 17% EDTA, whereas control group was not irrigated. Cryomilling was performed using a freezer mill operated at liquid nitrogen temperature to cryogenically grind tooth sections. Each specimen was crushed and the pulverized dentin was suspended in 1ml of sterile Mueller Hinton Broth and agitated in vortex for 1 min. Then 10ul were plated onto Enterococcus Differential Agar for enumeration of E. faecalis and MacConkey agar for enumeration of P. aeruginosa and S. epidermidis. Following incubation at 37 C for 24 hours the Colony forming units was enumerated. Statistical analysis was done using one way ANOVA and Post-hoc Bonferroni test.

Results: Single side-vented group showed statistically significant reduction of bacterial counts for all the three bacterial species when compared to control group (p<0.05). Open-ended needle showed significant reduction of E. faecalis and P. aeruginosa only. Significant reduction of bacterial count was not seen for double side-vented group for all the three bacterial species.

Conclusion: Within the limitations of this study, it can be concluded that

  1. Single side-vented needle performed better than open-ended needle and double side-vented needle
  2. Single side vented needle efficiently eliminated all the three tested organisms
  3. Open ended needle was efficient in eliminating E. faecalis and P. aeruginosa but not S. epidermidis
  4. Double side vented was not efficient in eliminating all the three species.



  Abstract 3: Evaluation of synergistic antibacterial effect of different herbal combinations on enterococcus faecalis dentinal biofilm: An in vitro study Top


Megha Ravindranath, Shobhana Ramu

Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: 1. To estimate the synergistic antibacterial activity of herbal extracts (Grape seed (GS), Mango Kernel (MK), Jamun seed (J), Green chiretta leaves (GC), Myrobalan rind (MR), Licorice root (L) and Clove flower bud (CB)) in different combinations on planktonic cells and E. faecalis dentinal biofilm in comparison with calcium hydroxide. 2. To compare the resistance of ATCC strain and the Clinical Isolate strain to antimicrobial agents.

Materials and Methods: 15grams of each herbal powder (45grams per group) was weighed and mixed with 100ml of distilled water. The aqueous solutions were obtained by hot percolation method and were filtered with membrane filters. Zone of inhibition was assessed by agar well diffusion assay and Minimum inhibitory concentration by broth dilution assay. Statistical analysis was done. 60 teeth were inoculated with E. faecalis (ATCC 29212=30, Clinical isolate=30) and were incubated for 6 weeks. The samples were assigned into five groups for intracanal medicaments (n=12; ATCC=6, clinical isolate=6) – Groups B (MK+L+MR), C (GC+MR+L), D (J+MK+GC), E (Ca(OH)2) and F (saline irrigation). The medicaments were placed inside the root canals and incubated for 14 days. E. faecalis sampling was done with paperpoints and cfu/mL were calculated. Statistical analysis was done.

Results: Group A (J+GS+CB) did not show potent antibacterial activity towards E. faecalis planktonic cells in agar diffusion assay. Hence, it was excluded from further analysis. Evaluation of intracanal medicaments on E. faecalis ATCC 29212 showed that there was no statistically significant difference in antibacterial efficacy between the groups B, C, D and E (p>.05). Evaluation of E. faecalis clinical isolate biofilm showed that there was no statistically significant difference in antibacterial efficacy between the groups B, C and E (p>.05). Group D showed significantly less antibacterial efficacy towards clinical isolate strain than Group B (p=0.031) and E (p=0.026).

Conclusion:

  1. Herbal combinations - MK+L+MR, GC+MR+L and J+MK+GC showed synergistic antibacterial activity against E. faecalis biofilm which was equivalent to CaOH.
  2. Clinical Isolate strain was more resistant to J+MK+GC combination when compared to ATCC 29212.



  Abstract 4: Evaluation of the cyclic fatigue resistance of three different controlled memory nickel-titanium rotary file systems: An in vitro study Top


Devakar Rajendran, Saatwika Loganathan

Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: The aim of this study is to compare and evaluate the cyclic fatigue resistance of three different controlled memory Nickel Titanium rotary file systems Trunatomy, Hyflex EDM, and ProTaper Gold by a static method in three different curvatures, namely at 45°, 60°, and 90°.

Materials and Methods: Trunatomy instruments of size 26, 0.04 taper; ProTaper Gold instruments of size 25, 0.08 taper; Hyflex EDM instrument of size 25, variable taper were used. The static cyclic fatigue test was performed using a custom-made jig. The artificial canal is made of stainless steel jig with an inner diameter of 1.5mm, 45°, 60°, and 90°angles of curvature and radii of curvature of 5 mm. All the instruments were rotated according to the manufacturer's recommendations until failure occurred. The time taken to failure was recorded in seconds for each group. The mean time is taken to failure (seconds) and the number of cycles to failure were statistically analyzed using SPSS software 21.0 version (SPSS Inc, Chicago, IL). One-way ANOVA was done to determine significant differences between groups and within groups (p 0.000).

Results: All file systems performed the best at 45° than 60° and 90°. At 45°, 60° and 90° angles of curvature TruNatomy had the highest resistance to cyclic fatigue. At 45°,60° and 90° angles of curvature: TruNatomy>Hyflex EDM> ProTaper Gold.

Conclusion: TruNatomy instruments were more resistant to cyclic fatigue than Hyflex EDM and Protaper gold instruments in single curvature canals. TruNatomy instruments were anticipated to survive with a higher number of cycles than the other tested instruments. TruNatomy instrument had the highest fatigue resistance than the other instruments.


  Abstract 5: Management of mid root fracture and coronal build-up with componeer: A case report Top


Sourabh Sharma

Army Dental Centre (Research and Referral), Delhi Cantt, Delhi, India

Root fractures account for only 0.5–7% among all dental traumatic injuries. Root fractures commonly result from a horizontal impact and are transverse to oblique in direction. Incidences of root fracture are more in the middle third of the root than at the apical and cervical thirds. Management of mid-root fractures presents a formidable challenge for clinicians because of the difficulty of achieving a stable reunion of fracture fragments, periodontal communication, increased mobility, difficulty in negotiating canals of fractured fragments, and continued pulpal infection leading to necrosis. This paper describes an old case of oblique crown fracture of maxillary incisors along with horizontal root fracture at the middle third of maxillary right central incisor along with periapical pathosis. After managing the radicular portion with endodontic treatment, aesthetic rehabilitation of the fractured crown was done with prefabricated composite resin veneers (componeer). Short-term follow-up of this case shows promising results both clinically and radiographically.


  Abstract 6: Optical coherence tomography: A novel three-dimensional biophotonic imaging technique for definitive endodontic diagnosis and predictable treatment outcome: A case series Top


Sumit Sharma

ADC (Research and Referral), Delhi Cantt, Delhi, India

3-D assessing intracanal anatomy in the clinical endodontic practice is always challenging. Although computed tomography could visualize intracanal anatomy, they all use harmful ionizing radiation and presented low sensitivity in the detection of fine canal anatomy images. Optical coherence tomography (OCT) is a high-resolution imaging technique that allows micrometer-scale imaging of biologic tissues over small distances, uses infrared light waves that reflect off the internal microstructure within the biologic tissues and gives high-resolution images. In studies, OCT has previously been shown to be a valuable tool in assessing intracanal anatomy, cleanliness of the canal after preparation, and even perforations. Case series: This paper described 3-D intracanal bioimaging using Optical coherence tomography (OCT) in managing micro-perforations and open root apex cases after traumatic injuries, by designing 3D guides to customized gutta-percha and post endodontic restorations. A 3D OCT pullback scan was made with an endoscopic rotating optical fiber probe inside the root canal and based on the intracanal lumen dimensions a 3D guided stent was fabricated, which serves as a guide for diagnosis and treatment. Based on the dimensions of the OCT scan a customized gutta-percha of the same dimension was fabricated to get apical closure.


  Abstract 7: Comparison of extent of apical penetration of radiopaque contrast agent in root canals prepared using different contemporary endodontic systems: An in vitro study Top


S Gopi Pavan Sudhir

Army Dental Center (Research and Referral), Delhi Cantt, Delhi, India

Aim: To compare the extent of apical penetration of irrigant in canals prepared using different endodontic systems.

Methodology: Study was performed on 60 extracted mandibular premolars with single canals. They were allocated into three groups based on the endodontic systems used for preparation of root canal: group 1 – K3XF, group 2: WaveOne, group 3: SAF. After standardised preparation a radiopaque contrast agent mixed with sodium hypochlorite is used as irrigant, in group 1&2 30G side vented needle was used for irrigant delivery and in group 3 VATEA irrigation system of SAF was used. Then tooth were subjected for radiography and index of infiltration was calculated. Values were tabulated and statistically analysed.

Results: The analysis of variance test (ANOVA) showed statistically significant differences between groups (<0.05). Turkey's HSD post hoc tests showed significant statistical differences between group 1 and group 3 and group 2 and group 3.No significant difference was observed between group 1 and group 2.

Conclusion: Within the limitations of the study, by using vibratory adaptive file system (SAF) for root canal preparation greater apical penetration of irrigants can be achieved. Further correlation can be done with clinical studies to generalise the results.


  Abstract 8: Endodontic management of radix Top


Anubhav Chakrabarty

Army Dental Centre (Research and Referral), , Pune, Maharashtra, India

Background: The main objective of root canal treatment is the thorough mechanical and chemical cleaning and shaping of the root canals. The present study was conducted to assess the knowledge, attitude and practices towards endodontic management of Radix cases amongst clinicians of varied experience including general dentists, specialists and Endodontists.

Materials and Methods: The present study was conducted on 267 participants of both genders. A well - formulated questionnaire of 13 questions was handed to all participants. They were divided into 4 groups. Group I were undergraduate students, group II were postgraduate students, group III were experienced Endodontists and group IV were other specialists.

Results: More than 15 years experience was seen in 29%, maximum RCTs done were 41-50 by 22%, no of Radix till date were >30 by 37%, Radix Entomolaris is more common by 80%, 1st molar is associated with Radix in 96%, 76% not maintaining database, 55.8% feel that accurate diagnosis is management of Radix, 75% feel multiple RVG is pre- operative management, 19% feel CBCT is necessary. The difference was significant (P< 0.05).

Conclusion: The initial diagnosis is of utmost importance, to facilitate the endodontic procedure and to avoid treatment failures. There is a need to improve knowledge and awareness in the management of Radix cases.


  Abstract 9: An evidence-based approach to negotiate and treat calcified canals: A literature review Top


L Shuchitha, Mahajan Shruthika

Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

Human dentition undergoes a continuous change in the internal anatomy by virtue of secondary and tertiary dentin deposition. Sequalae of dentin deposition are calcifications of coronal and radicular pulpal spaces in varying degrees. Endodontic treatment of teeth with pulp canal obliteration presents a challenge given the high likelihood of procedural errors and complications during treatment. Management of calcifications requires adequate knowledge of etiology, pathogenesis, classifications, and management strategies. Calcific deposits blocking access to root canal space could hinder its cleaning, shaping, and obturation. While locating the residual canal, loss of large amounts of radicular dentin increases the risk of root fracture and perforation. Preserving the remaining tooth structure by gaining conservative access and minimal enlargement contributes to the maintenance of the overall fracture resistance of teeth. The advent of science and technology has resulted in various advancements in the field of dentistry, simplifying diagnosis and treatment protocol for clinicians across the world. Artificial intelligence and machine learning also play a significant role in locating calcified canals and instrumenting them efficiently conserving time and resources. This paper aims to review the scientific literature on management strategies for calcified canals, focusing on novel armamentariums and techniques that have grown to become a prime necessity to establish an efficient management strategy that improves the quality of life of clinicians and patients.


  Abstract 10: Intentional replantation “the road less taken:” A case series Top


Aishwarya Singh, Rohit Kochhar, Manju Kumari

I.T.S Dental College, Hospital and Research Centre, Noida, Uttar Pradesh, India

According to Grossman 1966, Intentional replantation is the intentional removal of a tooth and its reinsertion into the socket after either endodontic manipulation or obturation of the canals or both. The first account of Intentional Replantation was given by an Arab physician Abulcasis in the 11th century; following which, the procedure has grown more popular over the years. Although Grossman has referred to intentional replantation only as a “last resort” and his opinion has been echoed by authors such as Weine, recent studies disagree with the aforementioned views and believe it to be an apt conservative treatment modality with a mean success rate of 73-77% [Cho et al, 2017) which may be attributed to better root end filling materials and advancements in endodontic surgery. It is being touted as a cost effective alternative to implants and an attempt to save the hopeless tooth. This case series highlight that Intentional Replantation in hopeless teeth might be a successful approach.


  Abstract 11: Maleic acid in the arsenal of irrigants in endodontics: A literature review Top


Carol Gloria Moras, Archana Ambadas Chavan

Manipal College of Dental Sciences, Manipal, Karnataka, India

The success of endodontic therapy relies on the eradication of micro-organisms that harbour inside the root canal system, via chemo-mechanical means. Employing irrigants ameliorates mechanical debridement of organic and inorganic tissues, which can be attributed to their ability to reach complex intricacies of the root canal space while nullifying microbial toxins incorporated in the smear layer. Although controversial, the presence of smear layer on root canal walls has been known to negatively impact the action of endodontic disinfectants and obturating materials, necessitating its removal with the aid of chelating agents or acids. When EDTA was pioneered into Endodontics, it was appraised as the gold-standard chelant for smear layer removal. Taking into account its drawbacks, the search for newer chelating agents led to the implementation of various chemical agents for the same. After gaining popularity in the field of restorative dentistry as an acid conditioner, Maleic acid was then introduced for smear layer removal in root canal therapy. This mild organic acid holds the potential to bring about the demineralization of dentin, alongside the erasure of bacteria. Over the years, researchers have documented various characteristics of Maleic acid as an irrigant in endodontics. Hence, the basis of this literature review is to explore maleic acid as a root canal irrigant and compare its properties to the existing array of irrigating agents.


  Abstract 12: Comparing the ability of novel chlorinedioxide on smear layer removal against 2.5% sodium hypochlorite and a herbal irrigant - terminalia chebula Top


VB Akshaya

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

Aim: The aim of this in vitro study was to evaluate and compare the efficacy of 0.5% Chlorinedioxide on smear layer removal against 2.5 % sodium hypochlorite and Terminalia Chebula using scanning electron microscope.

Methodology: Thirty single-rooted human mandibular premolar teeth were selected and decoronated.. Working length was established. Biomechanical preparation was done. Teeth were randomly divided into three groups of 10 specimen each according to the final irrigation solution.Group A- 2.5% sodium hypochlorite, Group B- 0.5% Chlorinedioxide, Group C-Terminalia Chebula, The samples in each group were irrigated with 5 ml of each irrigant. Each specimen was split longitudinally into two halves along the prepared groove on the buccal and lingual aspect. For each split half sample, smear layer removal was evaluated at three different levels namely coronal, middle and apical thirds by scoring the amount of smear layer retained and the opening of dentinal tubules under SEM. The values were tabulated and statistically analysed.

Results: No smear layer was noted on the coronal surface of the samples irrigated with Group B (chlorinedioxide). A mild smear layer was seen in middle and apical surface of samples irrigated with Group B. A moderate smear layer was seen in coronal and middle third surface of specimens treated with Group A (NaOCl) and Group C (Terminalia chebula). In the apical section, there was heavy smear layer in both Group A and C. There was a significant difference among the data of groups (P < 0.005).

Conclusion: Within the limitations of the study, it can be concluded that; among the irrigants tested, 0.5% chlorinedioxide showed maximum cleansing effect followed by 2.5% sodium hypochlorite and the herbal irrigant terminalia chebula.


  Abstract 13: Dynamic endodontic navigation system: A narrative review Top


M Mageshwari, A Arvind Kumar, S Ravisankar M, Paulian Benin

Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India

Dentists are in search of newer technologies that would enhance the accuracy of their diagnosis. Endodontists, everyday face clinical problems such as calcified canals, multiple canals, difficulty in locating canals. Many complexities associated with Endodontics can be solved to a greater extent with the introduction of technologies such as the Endodontic microscope and Cone Beam Computed Tomography. There is a need for guiding the Endodontist to navigate the canal complexities. So, the Dynamic Navigation technology used in Implant placement (Navident) came to the attention of Endodontists, this technology could be uniquely suited for the treatment of complex cases of both conventional non-surgical and surgical endodontics. ClaroNav (ClaroNav Inc, Toronto, ON, Canada) has been working at creating a similar application with the Trace Registration method (commercially known as “TaP” = “Trace and Place”) which allows the dentist to register the CBCT onto the patient by selecting three to six radiographically distinct, accessible landmarks on the screen, then tracing them in the patient's mouth. This Real-time (dynamic) navigation is a valuable alternative whereby one can avoid the fabrication of a stereolithographic template resulting in less expensive treatment. So, this system will be a beneficial adjunct for successfully treating root canal complexities, safely and predictably. In addition, this technology can potentially be used to make smaller, less invasive access preparations and can be an effective option in apical surgery also. Hence this non-invasive, digitized, dynamic navigator system will be a promising digital method in times to come. This review presentation shows light on this dynamic navigation system in Endodontics.


  Abstract 14: Indexing the periapex: A review Top


M Niranjana Devi, A Arvind Kumar, P Benin, NJ Nagaraj

Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India

Root canal treatment is in clinical practice for many decades with proven success. Evaluation of the success of any endodontic treatment outcome is primarily based on the efficiency of evaluation tools like clinical and radiographic examinations. But the sad truth behind the evaluation tools used for assessment of the root canal treatment is the lack of advanced evaluation indices as we still follow the same old periapical index which was introduced in the year 1986. The advantage of having a periapical index is that it helps in monitoring the changes along a disease continuum and it would be of interest to know to what extent the periapical healing is at a certain moment of time which will be predictive of the future status of the tooth. With modern science and technology cone beam computerized technology imaging plays an important role in evaluating the periapical status of the teeth. Cone-beam computed tomographic imaging is a technology that provides multiplanar and 3-dimensional reconstruction imaging of dental hard tissues. Nowadays CBCT is recommended for endodontic diagnostic and treatment planning as well as for assessing the outcome of root canal treatment. Using this technology, several investigators have shown the presence of periapical radiolucencies in cases where no radiographic pathosis is observed. Another advantage is the radiological identification and classification of periapical bone lesions in the case of apical periodontitis and in the endodontic treatment quality radiological evaluation. So this review paper is a compilation of the newly introduced indices which are found to be highly efficient, effective and have proven to be the most acceptable evaluation criteria in modern endodontics.


  Abstract 15: Effectiveness of syringe, endoactivator and passive ultrasonic irrigation on smear layer removal and canal cleanliness: An in-vitro stereomicroscopic evaluation Top


B Ooha

HKE'S S. Nijallingappa Institute of Dental Sciences and Research, Kalaburagi, Karnataka, India

Aim: To compare the effectiveness of syringe, endoactivator and passive ultrasonic irrigation methods in removing smear layer from root canal using stereomicroscope.

Materials and Methods: Forty four extracted single-rooted human mandibular premolars were decoronated to a standardized length of 12 mm. Specimens were shaped to F3 (SuperEndo, super gold flex files) and irrigated with 17% EDTA. Teeth were divided into 4 groups (1control group [n = 10] and 3 test groups [n = 10]) according to the final irrigating devices (ie, sonic irrigation, passive ultrasonic irrigation [PUI], or manual irrigation). Root canals were then split longitudinally and observed under stereomicroscope. The presence of debris and a smear layer at coronal, middle and apical third was evaluated. Scores were analyzed by Kruskal- Wallis and Mann-Whitney U tests.

Results: Use of both the EndoActivator and PUI resulted in significantly better scores at all levels. The EndoActivator System (Dentsply Tulsa Dental Specialties, Tulsa, OK) was significantly more efficient than PUI and the control groups in removing the smear layer at the apical third. At the coronal and middle third, Endoactivator and PUI showed similar scores.

Conclusion: In our study, endoactivator removed smear layer completely at the apical third. Sonic and ultrasonic irrigation resulted in better removal of the smear layer in all thirds of root canals than conventional irrigation.


  Abstract 16: Criteria for successful root canal treatment: A review Top


RS Arjun

Ragas Dental College, Thiruvananthapuram, Kerala, India

Studies assessing the outcome of endodontic treatment is an area of interest is extensively studied. Various terminologies have been coined to define success of root canal treatment. However, these terminologies are often confusing to practicing dentists. Clinical examination, radiographic evaluation, and histopathological findings are commonly used methods to determine the success of endodontic treatment. The absence of clinical symptoms and periapical radiolucency is the key outcome measures to indicate the success of endodontic treatment. In recent years, cone beam computed tomography has emerged as a principal tool for diagnosis and treatment planning. The Cone beam Computed Tomography-Periapical index is developed to standardize the assessment of the severity of apical periodontitis by Cone beam Computed tomography. The inconsistency in defining success and failure led to the proposal of other endodontic outcome criteria. American Association of Endodontics,categorized outcomes as “healed”, “non-healed”, “healing”, and “functional”. American association of Endodontics also classified the outcomes of regenerative endodontic procedures based on elimination of symptoms and evidence of bony healing as essential criteria. The evolution of endodontic treatment outcome ranges from Strindberg's criteria to patient-centered values like survival and function of the endodontically treated teeth even in the presence of inflammatory periapical disease. This review paper discusses the various criteria of treatment outcome, providing a better understanding of success and failure of root canal treatment.


  Abstract 17: Nitric oxide in pulp regeneration: A review Top


PS Sreelakshmi

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

Regenerative endodontic therapy incorporates the principles of regenerative medicine and tissue engineering to reproduce functionally viable pulp- dentin complex. According to American Association of Endodontics (AAE), regenerative therapy is indicated for teeth with necrotic pulp, an immature apex, and when post and core is not advised. Regenerative procedures have been attempted on mature permanent teeth with necrotic and vital pulp tissue. Complete disinfection of root canal space is considered as one of the key factors to successful regenerative endodontic treatment. Irrigants, medicaments and antimicrobial agents have been used for canal disinfection. The right concentration of irrigants and medicaments is crucial for the release of growth factors and for the survival and proliferation of stem cells. Nitric oxide is regarded as a potential therapeutic agent for its antibacterial properties and role in wound healing. Nitric oxide releasing nanoparticles can be utilised to combat biofilm associated bacterial infections and are more efficient than other antibacterial agents. Studies are conducted to incorporate nitric oxide to achieve absolute disinfection of the root canal system. Construction of biomimetic microenvironment that mimics native pulp extracellular matrix and delivers selective bioactive molecules like nitric oxide are being explored. This review article discusses the potential of incorporating nitric oxide in a biomimetic nanomatrix gel for pulp tissue regeneration.


  Abstract 18: Pericervical dentin: To remove or to preserve? Top


Sneha Suresh Kumar, Ashima Nadar

Manipal College of Dental Sciences, Manipal, Karnataka, India

Dentistry has clearly shifted from the traditionalist era of extension for prevention to the more novel concepts of preservation and conservation. From Schilder's laws of Endodontic treatment to the more minimalistic concepts provided by Clark and Khademi, endodontics has shifted, one milestone at a time, moving into a world where operator oriented and visibility driven access opening is no longer the norm. We have evolved into a world of minimalism, where the preservation of sound tooth structure takes precedence over achieving a straight line access or other aspects of traditional endodontic treatment. Three major concepts are covered in minimalistic endodontics: Conservation of the Peri-cervical dentin, the 3D ferrule, and the soffit. This triad of minimalism makes for a stronger, more intact tooth, and a successful endodontic treatment in an anatomically intact root canal system. This paper attempts to showcase the importance of preservation of pericervical dentin in maintaining the structural integrity and strength of the endodontically treated tooth and focuses on the developments that pave the path for the future of endodontic therapy.


  Abstract 19: Is endodontically treated teeth a foci of infection for systemic diseases? A review Top


V Jevina Christy

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

A focal infection is a localized or generalized infection caused by the dissemination of microorganisms or toxic products from a distant focus of infection. The concept of focal infection theory was introduced, when W.D.Miller in 1891 identified the human mouth as a focus of infection within the oral cavity. The endodontic focal infection theory stated that bacteria remaining after root canal treatment could lead to systemic diseases like arthritis, kidney and heart diseases. In the 1920s, this theory was widely taught, and edentulous therapy was considered as a solution for preventing focal infection. This led to an era of extraction of teeth and endodontic practice came under particular scrutiny. In the early 1930s well designed scientific studies disproved this concept, as a result, the theory remained criticized and rejected for years. Despite it being disregarded by scientific research, focal infection theory re-emerged in recent years. Reports started to emerge in the early 1990s addressing the association between endodontic pathology (acute and chronic apical periodontitis) and systemic pathologies such as cardiovascular disease, thromboembolic events & atherosclerosis. Much misinformation has spread among dentists and the public because of charlatanism, through the press, television particularly with the use of social media platforms. In the year 2019, the film 'Root Cause' was shown on Netflix claiming that root canal treatment causes cancer but was later removed because of its ill-based concepts. This review aims to highlight the long history of focal infection and recent realistic perspectives to avoid misinformation.


  Abstract 20: Chitosan in regenerative endodontics Top


Devika Jain, Sindhu Muktamath

Manipal College of Dental Sciences, Manipal, Karnataka, India

The most desired outcome of endodontic treatment is when the diseased or non-vital pulp is replaced with healthy pulp tissue that would gradually revitalize the teeth through regenerative endodontics. There are various scaffolds that facilitate the regeneration of different tissues. To ensure a successful regenerative procedure, it is essential to have a thorough and precise knowledge about the required scaffold which will be used in the regenerative procedure. Chitosan is a biopolymer made from the N-deacetylation of chitin, a significant component of arthropod and insect exoskeletons and fungal cell walls. It has antibacterial activity against a number of microorganisms, including Enterococcus faecalis, a pathogen commonly identified in root canal infections. It possesses a high chelating property in acidic conditions in ad¬dition to being biocompatible and biodegradable and lacks human toxicity. Chitosan could thus be a promising antibacterial agent if it retains its antimicrobial characteristics after being incorporated into a fibrin scaffold. Scaffolds made of hydrogel-based injectable materials have been employed in regenerative endodontic procedures. Fibrin gel has been proven to provide superior dental pulp–like tissue development compared to other scaffolds such as self-assembling peptide, collagen, polyethylene glycol–based hydrogel scaffolds. These scaffolds, on the other hand, lack antibacterial characteristics, putting cells at risk of infection. Chitosan has been added to hydrogels to prevent microbes from growing inside the root canal. Research suggests that adding chitosan to a fibrin hydrogel gives it antibacterial characteristics. This could be useful in resolution of endodontic space infections without significantly changing the fibrin scaffold's pro-regenerative qualities. It has also been proven that final irrigation with 1% Chitosan was able to release TGF-β1 from root canal dentin comparable to 17% EDTA with more biological activity. The aim of this review paper is to determine the effectiveness of chitosan scaffolds as well as their ability to stimulate proliferation and mineralization of dental pulp stem cells.


  Abstract 21: Pain after nonsurgical endodontic treatment: A review Top


E Devi Priya

Ragas Dental College, Chennai, Tamil Nadu, India

The primary objective of endodontic treatment is to preserve the natural dentition with complete relief of pain from pulpal/periradicular infections. But sometimes pain is induced by the treatment itself. So it is important for the clinician to understand the mechanism and causative factors of postoperative pain to give proper treatment to patients. Postoperative pain is multifactorial and the causative factors comprise mechanical, chemical and/or microbial injury to the pulp and periradicular tissues, which are induced or aggravated during root canal treatment. It occurs during treatment (interappointment) or persists after completion of endodontic treatment. Pain duration may range from one day to several weeks and its intensity may range from mild to severe. Main causative factors of pain after root canal treatment are extrusion of debris beyond apex during instrumentation, instrumentation leads to change in the microbiota, over instrumentation of the root canal space, extrusion of obturating material beyond apex through the apical foramen, incomplete removal of pulp, method of which pulp is removed, length of obturation, sealer extrusion beyond apex, root fractures, incorrectly measured working length, perforations, secondary endodontic infections, missed canals during root canal treatment, improper post-endodontic restoration. Referred pain due to any other causes like TMJ disorders and occlusal disturbances should also be discussed. Role of antibiotics and analgesics in the management of postoperative pain gives significant results in reducing pain. The aim of this review is to highlight the important causes of pain after non-surgical endodontic treatment and preventive measures to be taken to reduce pain.


  Abstract 22: Revolution in endodontics: Reciprocation – A review Top


M Nagammai, A Arvind Kumar, V Rajesh Gopal, P Benin

Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India

Effective cleaning and shaping of the root canal system will reduce the bacterial load and create a sterile environment which will ultimately lead to better periapical healing and higher success rate of endodontic treatment. In the past, numerous advancements had been developed in endodontic instrumentation to achieve effective shaping and cleaning of the root canals with minimal procedural errors. Introduction of rotary Nickel-Titanium instrumentation has revolutionized the art and science of endodontic practice in the last decade with predictable success. But, the greatest disadvantage of Nickel-Titanium rotary instruments is the risk of instrument separation which could be attributed to its use in continuous rotation. Instrument separation during the canal preparation might impair proper root canal system disinfection and lead to failure of the root canal treatment. A new type of alternative instrument motion has been suggested which is known as reciprocation, this works on the principle similar to that of the Balanced-force technique. Reciprocating Motion is defined as an alternative backward and forward (Clockwise/counter clockwise) movement. The advantages of this technique are a reduced number of instruments, improved instrument fatigue resistance, the elimination of possible cross-contamination by the single use of reciprocating endodontic instruments, shorter treatment time, better cleaning standards, less root canal deviation, reduce operator fatigue, reduce root canal aberration and improve the safety of shaping procedures. The aim of this review is to highlight the importance of reciprocating instrumentation in endodontics.


  Abstract 23: Newer biomimetic materials in direct pulp capping a minimally invasive treatment; preserving vitality for longevity Top


Vinay Tiwari, Pratima Shenoi, Rajesh Kubde, Pratik Burad, Sangham Madakwade, Varsha Uttarwar

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

When affected pulp is beyond repair, the ultimate treatment is to perform endodontic therapy leaving the tooth non-vital. Removal of pulp may make the endodontically treated teeth susceptible to post-operative fractures and re-infection due to coronal leakage or periapical microleakage. Furthermore, the tooth loses its sensation to thermal changes, stimulation and ability to detect secondary infections. The concept of minimally invasive dentistry bridges the traditional gap between prevention and surgical procedures. Preserving tooth vitality is crucial for tooth homeostasis and durability. Thus, there is a critical need for clinical interventions that enable regeneration of the dentin-pulp complex. Such treatment strategies itself is minimally invasive since it preserves the pulp tissue and maintains the vitality. The ability of dentine-pulp complex to form hard tissue against a variety of materials indicates the inherent capacity for cell reorganization, dentin bridge formation and pulpal healing. The fundamental characteristics of Biomimetic materials are their biocompatibility, which includes an antibacterial capacity and properties that induce tissue healing; its cytocompatibility; and its ability to seal the lesion. The objective of using Biomimetic material in vital pulp therapy is to restore the tooth to its function, esthetics, strength and regenerate lost dental tissues. This review will highlight on variety on newly introduced and experimented biomimetic materials which have a significant success on direct pulp capping.


  Abstract 24: Vitality check in traumatic teeth Top


S Roselin

Ragas Dental College, Chennai, Tamil Nadu, India

Traumatic dental injuries may damage hard dental tissues, pulpal and periodontal structures, compromising function and aesthetics. It can be localized to the crown, root in the form of fracture, concussion, subluxation, luxation injuries, intrusion or extrusion. It occur most frequently in children and young adults. Immediately after an acute dental trauma, healing events begin in an attempt to regenerate nerves and vessels and to replace damaged pulpal tissue where dental pulp blood supply might be torn or severed/ ruptured. This could lead to pulpal edema or ischaemic necrosis, which could result in a negative pulpal response just after injury. It takes approximately 10–14 days for a positive pulpal response returns. For pulp sensation in a dislocated tooth with subsequent rupture of the neurovasculature it might take upto 3 months in immature teeth or several years in teeth with closed apex to return. In a traumatized teeth neural regeneration is slower than vascular regeneration. Proper diagnosis, treatment planning and follow-up are very important to assure a favorable result. Sensibility tests (thermal and electrical tests) are the most commonly used but they have limited diagnostic capacity. The factors that interfere with the effectiveness of sensibility tests in newly traumatized teeth are transient paresthesia, subjectivity of the patient's response, alteration of the pain threshold,. On the other hand, pulp vitality tests can suppress such limitations because they are noninvasive methods that evaluate the vascular conditions of the tooth, and these tests provide a more accurate indicator. The most used are pulse oximetry, laser Doppler flowmetry and Cone beam computed tomography. It is generally agreed that Laser Doppler flowmetry assessment for human teeth should be performed at 4 weeks following the initial trauma, and repeated at regular intervals up until 3 months. Hence it is always preferable to check vitality than the sensibility of the pulp.


  Abstract 25: Maxillary sinusitis and endodontic infection: A review Top


K Akil Balaji

Ragas Dental College, Chennai, Tamil Nadu, India

The relationship between dental infections and sinus disease has been widely reported, where the roots of the maxillary posterior teeth lie close to the floor of the maxillary sinus, there is a high prevalence of periapical infection manifesting as maxillary sinusitis. The pathological extension of dental disease into the maxillary sinus was first documented by Bauer in 1943 as maxillary sinusitis of dental origin (MSDO). Dental infections account for approximately 10 to 12% of all cases of maxillary sinusitis. The infections of maxillary posterior teeth have shown maxillary sinus pathology in 60% of the cases and with maxillary sinus mucosal changes in 71.3% of patients with infections originating in the maxillary canines, premolars, and molars. The teeth with an infected necrotic pulp or failure of endodontic treatment will generate Maxillary sinusitis of endodontic origin (MSEO). The current Clinical Practice Guidelines for the Management of Adult Rhinosinusitis was published by The American Academy of Otolaryngology – Head and Neck Surgery Foundation, recommend an endodontic examination to rule out or treat an odontogenic source for sinusitis. Identification of MSEO is important, failure to identify and remove the source of endodontic infections will result in the persistence of sinus diseases and potential advancement to life-threatening craniofacial infections. MSEO are present with repeated episodes of unilateral maxillary sinus infection. The periapical radiographs are not adequate in observing the anatomical relationship between maxillary molars and the sinus floor, CBCT imaging reveal mucosal soft tissue changes or air-fluid levels in the sinus, which are of great diagnostic value in MSEO. The periapical infections manifesting in the maxillary sinus remain under-appreciated and frequently go undiagnosed by dentists, otolaryngologists, radiologists and are often misdiagnosed as sinogenic sinusitis. This review paper describes the diagnosis, pathophysiology, and treatment options for maxillary sinusitis of endodontic origin.


  Abstract 26: Root perforation: A review Top


Corrine Esther Manuel

Ragas Dental College, Chennai, Tamil Nadu, India

Root perforation is an artificial communication between the root canal and the supporting tissues of teeth. It is caused by procedural accidents or pathological alterations. Tooth malposition, pulp stones, resorption, calcifications, and root anatomy may predispose to this pathologic communication. The incidence of root perforations ranges from 0.6% to 17.6% while accidental perforations account for 2%–12%. 73% of perforations occur in the maxillary teeth. The cause for maxillary anterior teeth perforation is the underestimation of the palatal root inclination, while in multi-rooted teeth, furcal perforations occur in an attempt to locate canal orifices. At the site of perforation an acute inflammatory response leads to destruction of periodontal fibres, resorption of the surrounding bone and granulomatous tissue formation. This presents as a radiolucency at the site of middle and apical root perforations. At the supra crestal region there is proliferation of epithelium, resulting in formation of a periodontal pocket and ultimately loss of tooth; therefore, reducing the success of root canal treatment by 56%. Several key factors are associated with the pathological sequelae and the prognosis of the tooth including the site and size of perforation, time of repair and the material used. Perforations at the critical zone, which is the region at the crestal bone and the epithelial attachment, has the worst prognosis due to bacterial contamination from the oral cavity. Perforations coronal and apical to the critical zone are said to have a good prognosis due to their easy accessibility and lower risk of bacterial penetration respectively. The key factor in perforation repair is the ability to seal the perforation and re-establish a healthy periodontal ligament and may be achieved surgically or non-surgically. Historically, various materials such as amalgam, zinc oxide – eugenol cement, calcium hydroxide, gutta percha, glass-ionomer cement, IRM, composite resin and Super EBA cement were used, but with the advancement in material science bioactive material such as mineral trioxide aggregate has provided with best results. This review presents the etiology and highlights the treatment approaches and prognosis of various root perforations.


  Abstract 27: Neural sensibility response of dental pulp to electric stimulus in South-Indian population: A cross-sectional study Top


Srividhya Srinivasan, Sankar Vishwanath, Senthil Kumar Kumarappan, Anupama Ramachandran, Sadasiva Kadandale

Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India

Aim: The aim of this study was to compare and evaluate the pulp sensibility response to electrical stimulus in the South-Indian population with a vitality scanner based on age, gender, and tooth morphotype.

Materials and Methods: Pulp sensibility was determined among 100 individuals- 41 men and 59 women aged 21-61 years. The control group consisted of 50 individuals with the age range of 21-35 years and the study group had totally 50 individuals of the age range 46-61 years. A total of 2666 teeth were screened using Vitality scanner 2006, Sybron Endo model. The test was carried out by positioning the tip at middle third of the teeth in general to evoke the response and the values were thoroughly recorded. The data obtained were analysed using SPSS v.20. and Mann Whitney U test was used for the group comparison. The analysis of Tau-kendall correlation and logistic regression was also used. The significance level was set at 0.05.

Results: The results revealed that there was a statistically significant difference in pulp sensibility scores obtained between the young and aged population groups[P<0.05]. Incidentally, the sensory threshold values of anteriors and premolars in both arches of the elderly population appeared to be lower in comparison with the control group. About gender, there were no statistical significance obtained among males and females. The correlation and regression analysis performed to estimate the association with the manufacturer's said values disclosed that there was a correlation established among all the teeth but the strength of association showed observable variation in different morphotypes of the elderly category.

Conclusion: The differences in the pulp sensibility were found in varying age groups but not in varying gender. From the results obtained in the current study, it is evident that the manufacturer's recommended values might function as an endorsed guide, but not a standard tool of reference owing to individual's variation in different age and tooth morphotype. Further research is necessary to corroborate these observations from the study.


  Abstract 28: Knowledge and perception of general dentist and endodontist towards the use of endodontic spacer in central India Top


Prajakta Ambulkar, Rajesh Kubde, Pratima Shenoi, Ankita Niswade, Himani Thawale, Snehal Sonarkar, Mohit Gunwal

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

Aim: To assess the knowledge and perception of General Dentist and Endodontist towards the use of endodontic spacer in Central India.

Introduction: Endodontic spacers are the integral part of temporary restoration during multivisit root canal therapy. They have traditionally been used below temporary restorations in order to prevent restorative materials from occluding the orifices, and to aid in efficient removal of these materials. Along with the thickness of temporary restorative material, the type of spacer placed beneath the temporary restoration, may also contribute to microbial leakage. Cotton, as an endodontic spacer, still present a clinical problem. To prevail over complications of cotton, many practitioners have incorporated foam pellets and Polytetrafluoroethylene (PTFE) tape, as spacers. So the present study was conducted to assess knowledge and perception of dentist and endodontist towards the use of endodontic spacer.

Methodology: A web based close ended questionnaire survey was conducted among the General Dental Practitioner (GDP) and Endodontists in Central India. The participants comprised of total 288 Dental Health Care Professionals (DHCPs) including General Dental Practitioners (GDP) and Endodontists working in government sector, associated in institutions and having private practice in Central India. The data were statistically analyzed using Pearson Chi square test.

Results: The Endodontist who practiced multivisit endodontics were more likely to use PTFE as endodontic spacer (p<0.001). The General Dentist showed more preference towards use of cotton as endodontic spacer (p<0.001), 59% of them lack knowledge of using PTFE as endodontic spacer.

Conclusion: Endodontic spacers are integral part of multivisit endodontics. Earlier cotton pellets were preferred as an endodontic spacer. PTFE with its unique properties of inertness, non-biodegradable and non-fibrous is preferred over cotton by many Endodontists. In this survey it was seen that GDP lacked the awareness of using PTFE as endodontic spacer.


  Abstract 29: Biocompatibility and anti-inflammatory efficacy of resolvin D2 in healing kinetics of foreign body induced periapical lesion: An animal study Top


SK Swarna, MS Nivedhitha

Saveetha Dental College, Chennai, Tamil Nadu, India

Introduction: Overextension of sealer or gutta percha can occur during obturation or retrieval of GP during re treatment resulting in persisting inflammation and post-operative pain. Resolvin D2 (RvD2) resolves the acute phase of inflammation by targeting the lipid mediators of inflammation. The present study aims to quantify periapical inflammatory reaction induced by foreign body, evaluate the periapical healing and characterize the regulation of pro inflammatory cytokines and Real time PCR to analyze gene expression of GSK 3 β axis following administration of RvD2.

Materials and Methods: 48 Female Wistar Albino rats (Rattus norvegicus) were randomly allocated into 4 groups with n =12 per group. Group – I: Sham Control (Periapical lesion); Group – II: Lesion + GP; Group – III: Lesion + GP + GP solvent; Group – IV: Lesion + GP + GP solvent + Resolvin D2 (0.5μg/ml). Rats were anesthetized, defect was created in the periapical bone, test materials placed and the tissue flaps were sutured. Animals were euthanized at 7th and 14th day. The periapical tissue specimen was processed for histopathological, immunohistochemical analysis and RT- PCR done to study the effect of RvD2 on GSK- 3ß mediated anti-inflammatory response on mouse osteoblast.

Results: At day 7, Group I and II showed infiltration of inflammatory cells, mainly lymphocytes and macrophages. A significant increase (P<0.05) in the number of inflammatory cells and multinucleated giant cells were seen in Group – III. There was a significant decrease (P<0.01) in the inflammatory cells in Group – IV when compared to Group - I. At day 14, Group - IV showed fewer inflammatory cells and evident reparative reaction to tackle inflammatory process confirmed by immunohistochemistry staining using interleukin 6 (IL-6) as an inflammatory marker. The number of inflammatory cells were quantified and graded as per the severity of inflammation. Effect of RvD2 on gene expression of GSK 3 β – mediated anti- inflammatory response on mouse osteoblast was analyzed to reveal the dynamics of RvD2 using Real time PCR.

Conclusion: Resolvin D2 significantly reduced the inflammatory reactions induced by gutta percha and GP solvents in the periapical region in an animal model.


  Abstract 30: Role of human amniotic membrane on early pulp biomineralization Top


Sarath Sarathy, Saumya parashar, U Selvakarthikeyan, Alan Punnose1, Mubeena S1, N Velmurugan, Nandini Suresh

Meenakshi Ammal Dental College, 1Sri Ramachandra Institute of Higher Education, Chennai, Tamil Nadu, India

Aim: The objective of the study was to compare the role of human amniotic membrane (HAM) in early pulp biomineralization in comparison to Biodentine using tooth culture model.

Methodology: Twenty four freshly extracted tooth for orthodontic reasons were transported to biosafety cabinet where the root apex was sectioned leaving 8mm below the CEJ. This was followed by pulp exposure in the central fissure using a No.2 carbide round bur mounted on a slow-speed dental handpiece. Cryopreserved human amniotic membrane was cut into 3x3 mm pieces depending on the size of the exposure and rinsed with saline for 1 minute before placing into the cavity followed by rest of the cavity filled with Biodentine. In group II, the Biodentine was manipulated according to the manufacture instructions and placed over the exposed pulp as a pulp capping agent and was allowed to set for 6 to 9 minutes. At the end of 14 days and 28 days the teeth were fixed using 10 % buffered formalin for three days. Samples were then scanned using the sky scan micro-CT system. Following the micro CT imaging, the histopathology soft tissue sectioning was performed after decalcifying the specimen. The teeth underwent decalcification in a solution containing 10% formic acid with sodium citrate and 5% nitric acid for 20 days. After embedding in paraffin wax, three sections of 3-5μ thickness each was sectioned using a soft tissue microtome. The sections were stained with haematoxylin and eosin for analysis using optika stereo microsocope.

Results: The results of this study suggested HAM produced more reparative dentin in comparison to Biodentine. Newly formed dentin in the amniotic membrane group had the characteristics of homogeneous reparative dentin which was confluent where as specimens of Biodentine had discontinuous foci of mineralisation within newly formed hard tissue.

Conclusion: Within the limitations of the study, the results of this study suggested that Amniotic membrane can induce favourable effects on the reparative process during vital pulp therapy in comparison to biodentine.


  Abstract 31: Proresolving mediators: A future boon to endodontic treatment? Top


Ankita Niswade, Deepika Chandhok, Pratima Shenoi

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

The success of endodontic treatment is dependent on the prevention and healing of Periapical lesions. Many studies have proved that the resolution of acute inflammation is necessary to prevent the development of chronic inflammation and to promote repair or regeneration. One such cell signaling molecules, are Pro-resolving lipid mediators which are specialized molecules (SPMs), derived from polyunsaturated fatty acids (PUFAs) of arachidonic acid and omega-3 fatty acids including lipoxins, resolvins, protectins and maresins. These are associated with some antimicrobial activity and are adjunct to antibiotic therapy. Their foremost mechanism of action is through the resolution of inflammatory pathosis without predisposing the host to an increased vulnerability to infections, which is a typical side effect of anti-inflammatory medications. Other than this, they also regulate tissue homeostasis. Their effect on endodontic treatment, which were evaluated with multiple, sophisticated analyses, displayed a significant decrease in the inflammation at the periapex of the treated teeth. It also reduces the bacterial load of the infected canals along with the decrease in the size of the lesion together with effective hard tissue repair at the root apices. This descriptive review paper will highlight on the treatment outcomes of SPMs on pulpal -periapical tissues inflammation, degree of periapical bone preservation and regeneration. It will also focus on SPM delivery system, for its use as an intracanal medicament to harmonize cellular and molecular events required in root formation.


  Abstract 32: Reinvigorating the tooth by using heparin and nano-hydroxyapatite as pulp capping agent: A case report Top


Daisy Robert, Pavithra Chandrasekaran, Nandhini Ambalavanan, Ramaprabha Balasubramanian, Kavitha Mahendran

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

In this holistic era, there is ever increasing demand for materials that trigger the healing potential of pulp in order to maintain and improve its health; as no root canal treated tooth can match its vital counterpart. Numerous studies have shown that endodontic biomaterials, improved pulp health and improved dentinal bridge formation. Biomaterials being biocompatible and /or bioactive need assistance in assembling the biomolecules and releasing them at appropriate temperospatial dimension in order to mimic odontogenic events and also to suppress untoward events. Bioinspired nano-hydroxyapatite introduced to overcome the limitations of hydroxyapatite (HA) [stoichiometric composition as Ca10(PO4)6(OH)2] has excellent biocompatibility and bioactivity with human teeth and bone. Heparin being a polysaccharide from sulfated glycosaminoglycan family, has shown binding affinities with important proteins, such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and BMP-2. This interaction of heparin with biomolecules allows for their sustained release. Combination of individually tested, nano-hydroxyapatite and heparin will help overcome the limitations of the biomaterial and is hypothesised to improve the treatment outcome. This case report is on management of mandibular molar diagnosed with reversible pulpitis using pulpotomy procedure and a mixture of heparin and nano-hydroxyapatite as pulp capping agent with 6 month follow-up.


  Abstract 33: Nonsurgical management of an extraoral submental sinus tract of endodontic origin: A case report Top


Sangeetha Hariharan, Ramaprabha Balasubramaniam

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

Cutaneous draining sinus tract of dental origin is often a diagnostic challenge, because of its uncommon occurrence and absence of dental symptoms. Delay by attending clinician to correctly diagnose the primary dental etiology of lesion has often resulted in multiple surgical excision, biopsies, long term antibiotic therapy and electrodessication all of which have failed with recurrence of sinus tract. This is a case of 31 year old female referred to our department with the chief complaint of extraoral swelling in her chin region. Past medical history reveals she was treated for the same by a general surgeon by performing surgical excision 15 years and 10 years back. Following this she had recurrence of swelling with multiple episodes of pus discharge for the past 1 year for which she was self-medicating with antibiotics. On Extraoral examination, a small indurated erythematous nodule in submental region was observed, intraoral examination revealed mildly discoloured 31, which was tender on percussion and revealed negative response on pulp vitality testing. Radiographic examination revealed well circumscribed periapical lesion in relation to apical third of root in 31. CBCT revealed complete loss of buccal cortical plate in relation to 31. Diagnosis was chronic suppurative periapical periodontitis with extraoral sinus in relation to 31. Under rubberdam isolation, access cavity preparation, apical patency establishment and pus drainage was done. Canal was thoroughly cleaned and shaped using saline and 1.5% sodium hypochloride as irrigants. Calcium hydroxide mixed in 2% chlorhexidine was placed as intracanal medicament which was changed at an interval of 14 days, twice. By the end of 1month, the patient was asymptomatic and extraoral sinus healing was evident followed by obturation using cold lateral condensation and bioceramic root canal sealer. On 1 year follow-up, the patient was completely asymptomatic and the extraoral skin defect has closed completely. Radiographic and CBCT examination revealed evidence of bone fill in relation to periapical lesion of 31 showcasing the satisfactory healing of the lesion. This report shows that extraoral sinus can be treated conservatively with RCT whereas a delayed diagnosis or misdiagnosis may lead to more complication.


  Abstract 34: Interdisciplinary management of palatogingival groove: A case series Top


Rega Kumar, Ruchika Roongta Nawal, Sangeeta Talwar

Maulana Azad Institute of Dental Sciences, New Delhi, India

The palatogingival groove is a developmental anomaly which is usually found on the palatal aspect of the maxillary incisor teeth, which can be a suitable environment for microorganisms and plaque accumulation. Palatogingival grooves are mostly associated with deep periodontal pockets allied to a periapical lesion. A deep pocket that reaches the apex of the tooth can affect the pulp vitality and causes a combined periodontal-endodontic lesion. Timely diagnosis, prevention and management are highly suggested to prevent tooth loss due to complications arising secondary to palatogingival groove presence. This case series presents the management of three cases of palatogingival groove in maxillary lateral incisor using a combination of endodontic and periodontal therapy.


  Abstract 35: Postoperative pain in nonsurgical endodontic treatment Top


Deepika Rajendiran, Murali Sivakumar, R Kurinji Amalavathy

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

The primary goal of endodontic treatment is preventing and treating apical periodontitis, which involves mechanical and chemical means to debride pulp tissue, reduce microbial load and proper obturation of the radicular spaces. Even when performed with highest standard of care, some patients experience pain or flare up after undergoing root canal treatment. This post-operative pain is not only an unpleasant experience for the patient, it often makes them question the clinician's skill and ability. Therefore, prevention and successful management of post operative pain should be considered as an integral part of any endodontic practice. Post operative pain in non surgical root canal treatment is a multifactorial phenomenon that requires thorough understanding of the potential causes, pre, intra and post treatment factors and host immune response. A number of factors such as gender, type of tooth, preoperative pulpal and periapical status, single/multiple visits, instrumentation and irrigation protocols, obturation techniques and materials etc., have been implicated in the incidence of post operative pain. This review focuses on various factors that influence postoperative pain and treatment protocols that could be best suited to minimize the postoperative pain in nonsurgical endodontic treatment.


  Abstract 36: Continuous chelation-panacea or problem? Top


Ravichandiran Kalpana, R Kurinji Amalavathy, Kothandaraman Sathyanarayanan

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

Endodontic therapy aims to prevent and/or treat apical periodontitis by chemo-mechanical debridement of infected root canal systems using instruments and a combination of root canal irrigants. An ideal irrigant should act on biofilms as well as the smear layer produced during root canal instrumentation. However, traditional irrigation has always combined two or more irrigating solutions, in a specific sequence in order to achieve adequate disinfection & debridement of the root canal system. Sodium hypochlorite in concentrations ranging from 0.5-6%, is irreplaceable as the main irrigant due to its unique tissue dissolution capacity but it only acts on biofilms and organic portions of the smear layer. A chelating agent such as ethylenediaminetetraacetic acid (17% EDTA) is used to remove the inorganic portion of the smear layer. This “sequential irrigation” protocol is the current gold standard but has certain limitations. Interactions between these two solutions result in instant loss of hypochlorite activity due to reduction in free available chlorine content. Hence, remnants of the irrigants need to be thoroughly flushed out in between applications to minimise such reactions, which increases armamentarium and time needed to complete the endodontic procedure. Furthermore, sodium hypochlorite, if used as a final rinse following EDTA, leads to widening of the dentinal tubules & intertubular tunnelling due to dentin erosion. “Continuous chelation”, a novel irrigation protocol, is being proposed as an “all-in-one” solution to these problems. It combines 5.25% sodium hypochlorite and weaker chelators like 1- hydroxyethylidene-1, 1-bisphosphonate (HEDP) or disodium clodronate in a single mixture to be used for the entire duration of instrumentation. They are compatible with sodium hypochlorite & have minimal to no effect on its proteolytic or antimicrobial activity. Being weaker chelators of calcium, it is suggested that they are less aggressive on the dentin. This review paper aims to discuss the various properties, merits and demerits of these combined irrigating solutions in comparison to traditional sequential irrigation protocols.


  Abstract 37: Evaluating the effectiveness of three different irrigant agitation devices in eradicating enterococcus faecalis biofilm in human mandibular premolars: An in vitro study Top


Dhanireddy V Padmaja, R Kurinji Amalavathy, Murali Siva Kumar

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

Objective: To evaluate the effectiveness of different irrigant agitation devices namely EndoActivator (EA), Passive Ultrasonic Irrigation (PUI) and XP-EndoFinisher (XPF) in eradicating E. faecalis biofilm from the root canals by quantifying the cultivable bacteria using colony-forming units (CFU), and to compare live/dead bacteria within the dentinal tubules using confocal laser scanning microscopy (CLSM).

Materials and Methods: The study was conducted after obtaining ethical clearance from the IRB of Sathyabama University (Ref no: IHEC/Study no 042). The sample size estimation was done priori as n= 40, with a power of 0.99. Root canals of 59 human mandibular premolars were inoculated with E.faecalis for 4 weeks and biofilm formation was confirmed through Scanning Electron Microscope (SEM). The root canals were prepared with MTwo NiTi files to size 35/0.04% and the teeth were randomly assigned to 4 groups consisting of different irrigant agitation devices, Group 1- Syringe needle irrigation(SNI), Group 2- EA, Group 3- PUI, Group 4- XPF for canal disinfection. Samples for estimation of CFU (n=10/group) were collected from the root canals before instrumentation (S1) and after instrumentation and irrigant agitation (S2). The ratio of live/dead bacteria within the dentinal tubules in the coronal, middle and apical third at 50μm, 100μm and 150μm into the dentinal tubules were measured post-intervention using CLSM (n=4/group).

Results and Statistical Analysis: The Wilcoxon-signed-rank test revealed that all evaluated irrigant agitation devices produced a significant reduction in the CFU post instrumentation and agitation (P <0.05). Kruskal-Wallis test showed no statistically significant difference in CFU reduction between the groups (P-value 0.67). For CLSM analysis, the Kruskal-Wallis test and Mann-Whitney U test revealed no statistically significant difference in the percentage of live/dead bacteria between and within the groups at coronal, middle and apical third, at all depths into dentinal tubules. Although not statistically significant, SNI showed the least percentage reduction in bacterial count compared to others (EA, PUI, XPF) at all thirds and at all depths.

Conclusion: All irrigant agitation devices significantly reduced the bacterial count from the root canal lumen but none could completely eradicate it. None of the irrigant agitation devices studied demonstrated superiority over the others.


  Abstract 38: A pilot study on awareness, knowledge and attitude towards common traumatic dental injuries among physicians in the emergency rooms in Chennai: A questionnaire-based cross-sectional survey Top


R Kurinji Amalavathy, Hrudi Sundar Sahoo, Narendra Kumar Akshaya, Ravichandran Adisree, Sushmita Shivanna

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

Aim: To investigate the awareness, knowledge and attitude of physicians in the emergency rooms (ER) towards the management of traumatic dental injuries (TDI) in Chennai.

Materials and Methods: The questionnaire containing 22 questions was prepared to assess awareness, knowledge and attitude. The questionnaire was validated by 5 individual experts with an agreement of 80%. The sample size was estimated to be 110 using Open-Epi software with a 95% two-sided significance level (1- alpha). After obtaining approval from Institutional Ethical Committee, (Ref. no – 172/IRB-IBSEC/SIST) the questionnaire was distributed to 200 participants anticipating a response rate of 50%, via google forms and in person. A total of 6 questions with a maximum score of 15 were used to test the knowledge on the most common TDI. The knowledge levels were scored as limited (0-5), moderate (6-10), and high (11-15).

Results: Descriptive statistics were used and cross-tabulations using the Chi-square test (P-value < 0.05) were performed to compare categorical data. Among 110 participants, there were 19% specialists, 36% residents, 32% interns, and 12% duty doctors. Sub-urban private and urban government institutes/hospitals encountered TDI on a daily basis. Overall, 51.8% of the participants exhibited moderate knowledge, 37.3% showed high knowledge, and 10.9% had limited knowledge. Only 30.4% of the participants had received formal TDI education. No significant correlation could be established between knowledge levels, the type, experience, and status of TDI education of the participants. A statistically significant correlation was noted between the knowledge level and the confidence of the participants in handling TDI victims (P-value < 0.001).

Conclusion: Most physicians (89.1%) in hospital ERs of urban and suburban Chennai, possessed moderate to high knowledge levels in managing TDI. The level of knowledge was found to influence the confidence in managing TDI in ERs. Therefore, formal training and continuing medical education in the form of collaborative symposiums and workshops on TDI with the dental faculty may aid in timely detection and management of TDI in emergency rooms.


  Abstract 39: Comparative evaluation of effect of remaining coronal tooth structure on fracture resistance of endodontically treated permanent mandibular molars: An in-vitro study Top


Jaffar Iqbal Mir, Sangeeta Talwar, Ruchika Roongta Nawal, Seema Yadav

Maulana Azad Institute of Dental Sciences, Central Delhi, India

Objective: To compare and evaluate the effect of remaining coronal tooth structure on fracture resistance of endodontically treated permanent mandibular molars restored with short fibre reinforced composite.

Materials and Methods: Forty freshly extracted intact permanent mandibular molars were selected and randomly allocated into 4 groups (n=10). In groups I, II and III, a traditional access cavity was prepared. In group I, all four axial walls were kept intact whereas groups II and III had three remaining walls with missing mesial and buccal wall, respectively. In group IV (control group), teeth were kept intact. In all the samples of group I, II and III, endodontic treatment was performed and were restored with EverX Posterior and composite resin. After thermocycling (5–55°C, 5000cycles), fracture resistance for the samples were tested using Universal testing machine. Statistical analysis was performed using one way ANOVA and Scheffe test.

Results: Group IV (control group) had significantly higher fracture resistance (1956.2522.41 N) than other groups (p<0.05). Among all the experimental groups, group 1 has the maximum fracture resistance. The intergroup comparison showed a statistically significant difference in fracture resistance among all groups except between group I and group II (p>0.05).

Conclusion: Teeth in the control group had statistically significant fracture resistance than teeth in experimental groups. Also, the fracture resistance of endodontically treated teeth with one missing wall was not significantly affected by the site of the missing coronal wall.


  Abstract 40: A stabilized splint on time saves the smile Top


Raina Joshi, Sonali Kapoor, Kesha Vasavada

Manubhai Patel Dental College, Vadodara, Gujarat, India

An external impact causing traumatic tooth lesion leads to luxation injuries displacing the neurovascular bundle and damaging the periodontal fibres. This hampers post-traumatic healing which negatively impacts the quality of life in esthetic, social and functional domains. Thus, emergent and timely stabilization and splinting of luxated tooth leads to revascularization and reinnervation of the pulp as well as reorganisation of periodontal ligament fibres leading to favourable treatment goals and outcomes. Here we present the case of traumatic tooth luxation and novel use of pulse oximetry to assess pulp vitality at long term follow up. A 23year old female presented with pain and displaced tooth in the upper anterior tooth region within 12 hours of an alleged history of collision with the two-wheeler and fall. Clinical Examination revealed sutured lower lip elsewhere and labial luxation of maxillary left central incisor, contusion of surrounding labial gingiva, positive cold test response and tenderness on percussion, widening of periodontal ligament radiographically. As she presented within the “window period” of intervention, immediate treatment by repositioning, stabilization followed by splinting with flexible fibre splint was done. The patient was followed up once weekly to ensure tooth and splint stability and it was removed after 4 weeks. Monthly follow up showed clinically aligned tooth without any discolouration, positive response to pulp sensibility test and radiographically intact lamina dura and healed periodontium. Moreover, Pulse oximetry done at the 10th month of monthly follow up visit revealed that pulp was vital. The patient is asymptomatic at follow up after 2 years. We conclude that immediate repositioning and stabilization with flexible fibre splint followed by scheduled timely re-examination conserve the tooth vitality.


  Abstract 41: Impact of access cavity designs and instrumentation on pericervical dentin thickness: An invitro cbct analysis Top


Aneesha Mary Varghese, Swathy Sukumaran, Rajesh Pillai, A Afzal, Sheila george, Nikhil Murali

PMS College of Dental Science and Reserach, Thiruvananthapuram, Kerala, India

Objective: Primary objective of this invitro study was to determine the effect of mandibular premolar pre and post access cavity preparation and shaping on pericervical dentin thickness [PCD] and the secondary objective was to compare the remaining PCD thickness among experimental groups shaped with different files based on varying cross sectional designs and principles.

Materials and Methods: Twenty seven permanent mandibular first premolar teeth with closed apices were used for the study. Preoperative CBCT scan of each sample was done. PCD thickness was measured at the level of CEJ, as an average of shortest distance from the canal outline to the closest adjacent root surface, measured on facial, lingual, mesial, and distal surfaces. Samples were divided into three groups of nine teeth each. Group 1: Traditional access cavity Group 2: Conservative access cavity Group 3: Ultra-conservative access cavity Each group was again be subdivided into three (three teeth per subgroup). Subgroup 1: K File (Dentsply Maillefer) Subgroup 2: ProTaper Gold (Dentsply Sirona) Subgroup 3: TruNatomy (Dentsply Sirona) Cleaning and shaping of pulp space were done for all the specimens in each group [Subgroup 1 - apical enlargement up to ISO K file size 25 and stepback up to ISO K file size 45, Subgroup 2 – up to ProTaper Gold F2, Subgroup 3 – up to TruNatomy PRIME]. For all groups 3% NaOCl, 17% EDTA and 0.9% Isotonic Saline solution were used as irrigants. Post instrumentation CBCT scans were made and PCD thickness was measured as mentioned.

Statistical Analysis: One-way ANOVA test.

Results: Different access cavity designs and instrumentation impact the remaining PCD thickness. Pericervical dentin was preserved more in ultra-conservative group using TruNatomy file system.

Conclusion: Different access cavity designs and instrumentation impact the remaining PCD thickness. In this study, pericervical dentin was preserved more in ultra-conservative group using TruNatomy file system.


  Abstract 42: Crack formation in root dentin associated with four different rotary instrumentation systems: An in vitro study Top


KG Reshma, PR Sreekala, Rajesh Pillai, A Afzal, Sheila George, Adarsh Jayan

PMS College of Dental Science and Reserach, Thiruvananthapuram, Kerala, India

Objective: The objective of this study was to compare the incidence of crack formation on root dentin after shaping with four shaping files based on offset shape in cross section, thermal treatment, variable cross - section and slim NiTi wire design.

Materials and Methods: Forty freshly extracted permanent mandibular first premolar teeth were selected. Samples were divided into four groups (n = 10), Group 1 – One-curve (Micro-Mega) Group 2 – TruNatomy (Dentsply Sirona) Group 3 – ProTaper Gold (Dentsply Sirona) Group 4 –. ProTaper Next (Dentsply Sirona) Shaping of pulp space were done for all specimens in each group [Group 1 – with One-Curve, Group 2 -TruNatomy PRIME, Group 3 - up to ProTaper Gold F2, Group 4 – up to ProTaper Next X2] Roots were sectioned horizontally of length 4mm, from coronal, middle and apical third using diamond disc. All slices were then viewed under CBCT.

Statistical Analysis: Chi-square test.

Results: TruNatomy files inflicted less dentinal cracks, followed by one curve, ProTaper Next and ProTaper Gold. Crack formation were more in the apical third when compared to middle and coronal thirds.

Conclusion: All shaping files might inflict dentinal cracks. In this study, single file system induced less dentinal cracks in coronal, middle and apical third of the pulp space than multiple file system.


  Abstract 43: Effect of different irrigation agitation techniques on postoperative pain in permanent anterior teeth with symptomatic irreversible pulpitis: A randomized controlled trial Top


Nithyanandam Masilamani, Annapurani Ramdhas, Kavitha Mahendran, P Shakunthala

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

Aim: The randomized controlled trial compared the effect of Conventional needle irrigation (positive pressure irrigation) and EndoVac irrigation (true apical negative pressure irrigation) on the incidence of postoperative pain following biomechanical preparation in the permanent maxillary anterior teeth with symptomatic irreversible pulpitis.

Materials and Methods: Fifty patients of the age group 18-50 years, with symptomatic irreversible pulpitis were selected for the study. The subjects were randomly allocated to two groups, Group 1 (Conventional needle irrigation) and Group 2 (EndoVac irrigation) according to the final irrigation methods performed during root canal preparation. The preoperative pain was assessed prior to the procedure. In group 1, root canal irrigation was performed using a syringe and a 27-G open-ended needle (Dispovan). In group 2, the EndoVac system (Kerr Endodontics) was used for irrigation. Postoperatively, the patients were prescribed ibuprofen 200 mg to take every 8 hours if required. Pain levels were assessed by an analog scale questionnaire after 6, 12, 24, and 48 hours. The amount of ibuprofen taken within these intervals was recorded.

Results: The data were subjected to Mann-Whitney test and Chi-square test for intergroup analysis and Repeated Measures ANOVA for intragroup analysis. At 12-, 24-, and 48-hour time intervals, group 1 patients reported more intense postoperative pain than patients in group 2 (p <.05). There was no significant difference between the 2 groups at the first 6- hour time interval (p >.05), and in both groups the intensity of postoperative pain decreased over time. The number of analgesics taken was significantly higher in the conventional needle irrigation group (p <.05).

Conclusion: The use of the apical negative pressure irrigation system, EndoVac, resulted in significantly less postoperative pain and necessity for analgesic medication than a conventional needle irrigation protocol. From the results of this study, it was concluded that it is safe to use a negative apical pressure irrigation protocol for antimicrobial debridement up to the full working length.


  Abstract 44: Lateral canals and its relation to success in endodontics Top


Sangham Madakwade, chetana Makade, Pratima Shenoi, Rajesh Kubde, Ankita Ramteke, Vidya Mokhade

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

Root canal system comprises of diverse anatomical variations like lateral canals, apical delta/ramifications. Literature reports incidence of lateral canals approximately 8.3 to 19%. The lateral canal is usually reported perpendicular anywhere along the length of the main root canal which are not always detectable radiographically. The detection of lateral canal can only be achieved by advanced modalities like CBCT, Fibreoptic Endoscope and Tuned Aperture Computed Tomography (TACT). Hence for successful endodontic therapy, understanding its complexity and treating them aptly is important. Lateral canals open directly into the periodontium which unlocks a pathway to periodontal as well as endodontic infections. One of the common causes for endodontic reinfection are the presence of residual microbes within the root canal. The propagation of microbes and their by-products occurs not only within the main root canal but also in lateral canals, apical delta/ramification. Insufficient sealing of lateral canals can lead to failure of endodontic treatment which may further require a non-surgical or surgical re- treatment. The discernment of lateral canals, its disinfection and sealing of lateral opening exactly like the main apical foramen will add to the success of root canal treatment. The objective of this narrative review is to highlight the importance of lateral canals in terms of diagnosis, treatment and its significance on success of endodontic therapy.


  Abstract 45: Incidence of postoperative pain following partial and full pulpotomy in cariously exposed mature molars with signs of symptomatic irreversible pulpitis Top


Ashima Jassal

Maulana Azad Institute of Dental Sciences, New Delhi, India

Aim: To evaluate the incidence of post-operative pain following partial And full pulpotomy in cariously exposed mature molars with signs of symptomatic irreversible pulpitis.

Materials and Methods: Fifty mature permanent molar teeth with carious exposures showing signs and symptoms of Symptomatic Irreversible Pulpitis were randomly allocated equally into two groups. Partial Pulpotomy and Full Pulpotomy was performed in the first and second group respectively following standardized protocols. Pain was recorded using 10-point Visual Analogue Scale (VAS) preoperatively and postoperatively at 24 hours, 72 hours and on the 7th day. Use of analgesics, if any, to relieve post-operative pain was also recorded. The data was statistically analyzed.

Results: There was statistically significant reduction noted in both the groups for preoperative and post-operative pain scores. On subsequent days, mean pain scores decreased in both groups, with the full pulpotomy group experiencing slightly less pain compared with the partial pulpotomy group on all days. However, the difference in the pain scores reduction between both the groups was not statistically significant at any time intervals (p > 0.05). 3 patients (12%) and 2 patients (8%) in the partial and full pulpotomy group respectively gave the history of analgesic intake postoperatively (p = 0.6).

Conclusion: Pulpotomy is a viable aid for effective pain relief. Significant reduction in post-operative pain is demonstrated by both the Partial and Full Pulpotomy procedures in cases of Symptomatic Irreversible Pulpitis.


  Abstract 46: Comparative evaluation of efficacy in removal of guttapercha cone and sealer with different rotary and hand instruments: An in vitro study using cone-beam computed tomography Top


G Naveen, Rajesh Pillai, NO Varghese, A Afzal, GS Deepa, Pooja Prakash

PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India

Objective: Inadequately prepared and obturated root canal systems will conceal remaining necrotic tissues or bacteria that may be responsible for periapical inflammation. The aim of the study was to compare the efficacy of hand system, rotary retreatment system and combination of hand and rotary retreatment in removing gutta-percha and sealer from pulp space.

Materials and Methods: 77 single-rooted, non - carious mandibular premolar teeth with similar sizes and mature apices were selected. Pulp space were prepared using Protaper universal system. Canal space was then obturated using the corresponding master cone and AH PLUS root canal sealer. Removal of gutta percha was done using Protaper retreatment universal file in group1, D RaCe in group 2, TF adaptive in group 3, Protaper retreatment universal file and H-file in group 4, D RaCe and H-file in group 5, TF adaptive and H-file in group 6, H-file in group 7 The roots were then scanned using CBCT. The canals were divided into coronal, middle and the apical third and were evaluated separately. The volume percentage of remaining filling material was calculated.

Statistical Analysis: ANOVA and post hoc test.

Results: The results were analysed based on the remaining volume of gutta percha. Protaper retreatment system in combination with hand file was found to be most effective in the coronal aspect of the tooth followed by Protaper retreatment system, D-RaCe and hand file combination, D-RaCe, TF adaptive and hand file combination, TF Adaptive and least was found to be with H-file. Statistically significant result was not seen in the middle and apical third.

Conclusion: It was found that no system was able to completely eliminate filling material from the root canal system.

  • Combination of systems was found to be superior than the individual systems
  • Statistically significant results were obtained between the 7 groups only in the coronal aspect of the tooth
  • Canal cleanliness was showed by middle and apical third but they were statistically insignificant



  Abstract 47: Management of grade 3 furcation with root separation and crown placement Top


Ann Dolly Kuriakose, Preethika Baby, Joy Mathew

Mar Baselios Dental College, Kothamangalam, Kerala, India

The aim of dentistry is to conserve the natural dentition. Modern advances in all phases of dentistry have provided the opportunity to maintain a functional dentition for lifetime. The management and long term retention of teeth with furcation invasions possess a challenge in terms of anatomic particularities of each tooth, bone and gingiva. This case report describes the management of grade 3 furcation with root separation followed by crown placement which provides an overview that regardless of the furcation defects, some teeth can be salvaged and used in oral rehabilitation.


  Abstract 48 Top


Andrew Gnanamuttu, Shamini Sai, P E Mukundan, Veronica Aruna Kumari, S Linda Christabel, Anand V Susila

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

The field of endodontics is constantly evolving to deliver the best possible treatment for the patient. There is a constant look out for new and emerging therapies to make patient's experience and dentist's work as comfortable as possible and Cryotherapy is one such treatment modality. The word “cryo” is derived from the Greek language, which means very cold or ice cold and cryotherapy uses freezing or near freezing temperatures. Historically the use of cold has been practiced for many decades to manage pain and swelling. Cryotherapy slows down neural signals and reduces the release of chemical mediators which are responsible for pain reduction. The application of this property has thus been explored in pain management in endodontics.The common problem faced by patients after root canal procedure is, post-operative pain which ranges from 1.5%‒53%. Studies show that constant intracanal delivery of cold solution reduced the external root surface temperature to produce a local anti-inflammatory effect in periradicular tissues, thereby reducing post-operative pain. The initial physiological response of the tissue to cryotherapy is a drop in local temperature that decreases cellular metabolism, so less oxygen is used. Furthermore, vasoconstriction occurs, which reduces blood flow and limits inflammatory damage. Cryotherapy provides a local anaesthetic effect by lowering the conduction speed of pain signals. Intracanal cryotherapy application is currently being suggested as a simple and cost-effective technique for the management of postoperative pain after endodontic therapy. The temperature of the cryotherapeutic agents used varies between 2°C and 5°C. This review paper describes various cryotherapeutic agents used in root canal therapy and its current standing in clinical practice.


  Abstract 49: Effect of novel intracanal medicament on microhardness of root dentine: An in vitro study Top


Krishnakanth Jaju, Iffat Nasim

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

Aim: To assess the effect of novel intracanal medicaments on the root dentine microhardness.

Materials and Methods: A total of 40 extracted mandibular premolars were standardized and prepared using Protaper Gold rotary files. The premolars were divided into three groups (n 10 each) and one control group (n 10). In three groups, the intracanal medicaments used were combination of calcium hydroxide and silver nanoparticles, combination of graphene oxide and silver nanoparticles, calcium hydroxide respectively and a control group(n=10). After 7 days medicaments were removed using Endo activator. Mean Vickers hardness numbers were calculated after removal of intracanal medicament.

Results: All the group except graphene oxide and silver nano particles showed reduction in mean microhardness and was statistically significant (p < 0.05). Data were analysed using SPSS software version 21. ANOVA test and Post Hoc tukey was used to compare between the groups. p value of less than.05 was considered significant. There was a significant differences among the groups at coronal third, middle third and apical third. (P < 0.05). In between groups the coronal third and middle third region graphene oxide and silver nano particles showed the highest mean microhardness values, In the apical third region control group showed the highest mean microhardness values.

Conclusion: Graphene oxide and silver nano particles shows least effects on microhardness of the root dentin compared to calcium hydroxide and calcium hydroxide with silver nanoparticle based intracanal medicaments.

Clinical Significance: Elimination of most of the bacterial infection from the root canal and very minimum to no effect on the microhardness of the dentin in the root part are the basics of success in any endodontic treatment.


  Abstract 50: Comparative evaluation of marginal adaptability of custom cast post using different pattern material: An in vitro study Top


Shree Shree Ranjan, Manish Ranjan

Saveetha Dental College, Chennai, Tamil Nadu, India

Introduction: Marginal adaptability is of key concern while determining the longevity of a post and core in endodontically treated teeth. The present study compares the two commonly used materials used for fabrication of patterns for custom cast post

Aim: To evaluate the marginal adaptability of custom cast post using inlay wax pattern and resin pattern.

Materials and Methods: 10 single rooted teeth were selected for each group for the study.Teeth were decoronated.The teeth were mounted on wax occlusal rim and were scanned with CBCT in all the planes. Root Canal treatment was done and the canal were prepared for post space.10 Patterns were fabricated with inlay wax and resin pattern respectively and custom made cast post was done for the study once again CBCT was taken to find out the marginal adaptability of cast post to the tooth surface.

Conclusion: The marginal adaptation was analysed in the coronal,middle and the apical third of the prepared post space of teeth. It was found that the marginal adaptation of cast post was more in the coronal and middle third of post space with cast post made by resin pattern compared to the one made with inlay wax pattern.


  Abstract 51: Endocrown: An evidence based update! Top


Sharath Sundar Mahendran

Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India

Post-endodontic coronal restoration has been reported to reduce microleakage and subsequently decrease the risk of endodontic treatment failure, while cuspal coverage and preservation of the remaining coronal tooth structure have been reported to improve fracture resistance and the outcome of the endodontically treated tooth. Endo-crowns are a mono-block type of restoration that use the pulp chamber and remaining coronal tooth structure as a means of retention. Endo-crown appears to be promising conservative restorative option for endodontically treated posterior teeth. However, data on their long-term survival and success rates as compared with conventional crowns are lacking. The purpose of this review is to determine whether endo-crowns are a reliable alternative to full crowns for endodontically treated teeth based on various criteria, such as resistance, clinical longevity, coronal leakage etc.


  Abstract 52: Comparative evaluation of efficacy of herbal irrigants in eliminating enterococcus faecalis colonies from pulp space as against sodium hypochlorite: A fluorescence confocal laser scanning microscope study Top


Pooja Prakash, Rajesh Pillai, NO Varghese, A Afzal, GS Deepa, G Naveen

PMS College of Dental Sciences and Research, Thiruvanathapuram, Kerala, India

Aim: To compare & evaluate antimicrobial efficacy of herbal extracts of Moringa oleifera, a cocktail mix of Ossimum sanctum, Curcuma longa, Allium sativum and Piper nigrum, apple cider vinegar in eliminating E.faecalis as against sodium hypochlorite using confocal laser scanning microscope.

Methadology: Sixty extracted single rooted mandibular premolars were collected and disinfected. Samples were sectioned at the level of CEJ using a sectioning disk. Vertical grooves placed on either side of the tooth samples and sections were made using chisel. Further divided into 5 groups and each group received 12 samples. All the samples were sterilized using autoclave at 120°c for 20 mins. One colony of E.faecalis American Type Culture Collection (ATCC 29212) was raised in Tryptone Bile X-Glucuronide Agar and transferred to 50 ml of all culture media. The culture was allowed to grow overnight under stationary aerobic conditions at 37°C. all the tooth samples were inoculated with the E.feacalis broth using micropipette. Moringa oleifera leaves were collected and ground in a blender, the extract was collected in a ratio of 1:1. Similarly, Ossimum sancum, Curcuma longa, Allium sativum, Piper nigrum were collected and ground to a paste, extract was collected in the ratio of 1:1. Apple cider vinegar was store brought.

Group 1 - Moringa oleifera,

Group 2 - Cocktail mix

Group 3 -Apple cider vinegar,

Group 4 -3% NaoCl

Group 5 - Saline.

following irrigation samples were subjected to staining using fluorescent dyes Propidium iodide and Acridine orange and scanned using CLSM. A qualitative assessment was done depending on remaining biofilm. The results were analyzed using One-way Anova and Tukey Post hoc test.

Results: The CLSM finding reveal that cocktail mix has a comparable result to that of 3 % NaoCl with highest antimicrobial efficacy compared to others. Amongst herbal irrigants, cocktail mix showed highest antimicrobial efficacy followed by moringa oleifera.

Conclusion: Naocl ≥ cocktail mix > moringa oleifera > apple cider vinegar > saline.


  Abstract 53: Vital pulp therapy using bioactive scaffolds: A case series Top


Vishalini Arul, Kavitha Mahendran

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

The maintenance of pulp vitality is paramount to the tooth's long term survival. Vital pulp therapy is a treatment intended to preserve, protect and sustain a healthy pulp that has been compromised by caries, trauma or restorative procedures. It includes direct or indirect pulp capping and pulpotomy. These therapies prevent further pulpal injury from detrimental stimulus. Direct pulp capping is the procedure in which exposed vital pulp is covered with a protective material that is placed directly over the site of pulpal exposure in an attempt to preserve the pulp vitality. A wide range of materials are suggested as pulp capping agents from traditional calcium hydroxide to current biomaterials. The most visible and successful reparative response to pulp exposure is the deposition of reparative dentin induced by the pulp capping material. Recently, a shift towards biomaterial based scaffolds for dental pulp- dentin complex regeneration are been tried due to their biocompatible nature,healing capacity and excellent regenerative potential. These have showed a positive response as the growth factors present in these scaffolds can stimulate dental pulp cells leading to cell growth, differentiation and stimulating odontoblast differentiation,leading to reparative dentin formation. This is a presentation of three cases of direct pulp capping which was carried out in molars, with radiographic evidence of deep caries approximating the pulp chamber and absence periapical pathology. Caries was excavated and the pulp exposure of about 0.5 to 1 mm was capped with either chorion membrane or placental extract gel or mineral trioxide aggregate, over which a glass ionomer cement liner was placed and the final restoration was done with light cured composite. Patients were periodically followed over 3, 6 and 12 months for evaluation and assessment of clinical and radiographic parameters. Cone-beam computed tomography was taken after three months, to assess dentin bridge formation. Thus these bioactive scaffolds showed promising results as direct pulp-capping agents with favorable outcomes and opened a new avenue in vital pulp therapy procedures.


  Abstract 54: Comparative evaluation of the effect of bleaching on enamel with H2O2, aqueous pineapple extract and lemon extract using spectrophotometer: An in vitro study Top


GS Deepa, Rajesh Pillai, NO Varghese, A Afsal, G Naveen, Pooja Prakash

PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India

The aim of manufacturers is to produce a bleaching agent which has minimum side effects on tooth but can produce exemplary results. The aim of the present study was to compare the efficacy of bleaching using 30% Hydrogen peroxide, Pineapple extract, Lemon extract and their combinations as an additive or independently on enamel using spectrophotometer.

Methodology: A total of 54 Maxillary Premolars were collected. They were stained using tea solution for 24 hours and the samples were randomly divided into 6 groups with 9 samples in each group.

GROUP 1- HYDROGEN PEROXIDE

GROUP 2- PINEAPPLE EXTRACT

GROUP 3- LEMON EXTRACT

GROUP 4- HYDROGEN PEROXIDE + PINEAPPLE EXTRACT

GROUP 5- HYDROGEN PEROXIDE + LEMON EXTRACT

GROUP 6 – DISTILLED WATER

The samples in each group were treated with respective bleaching solutions for 30 minutes. The shade of the samples were assessed after staining and after bleaching using vita easy shade spectrophotometer.

The testing will be done with spectrophotometer over a white background, which recorded color variables L*,a*,b*in accordance to CIE L*a*b color system using formula

ΔE= ([ΔL*]2+[Δa*] + [Δb*]2)1/2

Results and Statistical Analysis: It was found that hydrogen peroxide followed by combination of pineapple and lemon extract and pineapple extract independently showed significant results. The data were analyzed based on independent sample t test.

Interpretation and Conclusion: Hydrogen peroxide, (positive control )in this in vitro study showed excellent bleaching.

  • Vegetative enzymes like bromelain in pineapple is responsible for the remarkable bleaching in samples treated with pineapple extract
  • Citric acid is present in higher concentration in lemon extract and this group did not produce any significant results after bleaching and the samples showed decalcification and pitting which may be attributed to higher concentation of citric acid
  • Combination of Pineapple extract & Lemon extract with Hydrogen peroxide produced exemplary results after bleaching and thus adverse effects due to hydrogen peroxide can be lessened
  • Statistically significant results were obtained in Group 1, 4, 5 & 2



  Abstract 55: Flow cytometric analysis on the bactericidal effect of diode lasers of varying wave lengths, octenidine hydrochloride and traditional techniques Top


SJ Rini, Rajesh Pillai, NO Varghese, A Afzal

PMS College of Dental Science and Research, Vattappara, Thiruvananthapuram, Kerala, India

Aim: To evaluate whether the 'photothermal efficacy of Diode lasers' is superior to Sodium hypochlorite and the emerging antimicrobial Octenidine hydrochloride on Enterococcus faecalis eradication.

Materials and Methods: 70 extracted single rooted mandibular premolars were decoronated and standardized to 15mm. The root canals were enlarged up to K-file size 50 and irrigated with 2ml of 2.5% NaOCl followed by 17% EDTA solution and final rinse with normal saline.

Preparation of Inoculation and Contamination of Specimens:

Roots and apical foramina were sealed and all the specimens were placed into Eppendorf tubes and autoclaved. Enterococcus faecalis (ATCC 29212) inoculum was grown in the BHI medium and sterilized tooth samples were placed in the medium and the culture was incubated at 37° Celsius for 21 days.

Group Preparations: 5 groups with 14 specimens.

GROUP-I 810nm Diode Laser

GROUP-II 980nm Diode Laser

GROUP-III 5.25% NaOCl

GROUP-IV 0.1% Octenidine hydrochloride

GROUP-V 0.9% Normal Saline

The apical thirds of the treated roots(5 mm) were obtained and dentin shavings collected were immersed in BHI broth in Eppendorf tubes and vortexed for 2minutes. 10-fold dilutions were prepared and 1ml aliquots were seeded in BHI agar plates for 48hours. Seven samples from each group were subjected to bacterial culture for evaluating the CFU.

For Flowcytometry, seven suspensions from each group were immersed in BHI broth and incubated for 48hours. 1ml samples of bacterial cultures were micro-centrifuged and treated with SYTO 9 nucleic acid stain and Propidium Iodide. 10μL of the microsphere suspension was added to the stained cell samples, mixed well and subjected to Flow Cytometry using 488nm Argon Laser.

Results and Statistical Analysis: The results were expressed as the number of CFU and viability percentage of Enterococcus faecalis bacteria in the apical third of root canal. One-way ANOVA analysis and Tukey post hoc tests were used for intergroup comparison.

Conclusion: Among the various disinfection regimens used in the present study, 810nm Diode Laser exhibited the most efficient bactericidal effect on E.faecalis biofilm, with the lowest viability of 19% followed by 980nm Diode laser, 5.25% NaOCl and 0.1% Octenidine hydrochloride being the least.


  Abstract 56: Effectiveness of various agents on rapid chemical disinfection of gutta-percha cones: An in vitro study Top


Arpit Arora

Manipal College of Dental Sciences, Mangalore, Karnataka, India

Aim: The aim of this study was to evaluate and compare the efficacy of Sodium hypochlorite, Chlorhexidine, Grape seed extract, Aloe vera juice and Saline to disinfect gutta-percha cones.

Materials and Methods: The gutta percha ( GP) cones used in this study were initially contaminated by immersion in a culture of E. faecalis (ATCC 29212). All samples were incubated at 37°C for 72 h. After the incubation period, the cones were dried using sterile gauze and divided into five groups of 10 samples each. In each group, 5 GP cones were immersed for a period of 1 min, which the other 5 were immersed for 10 min. The cones were then dried and inserted individually into test tubes containing sterile BHI broth and incubated at 37°C for 72 h. Bacterial growth was evaluated by the presence of turbidity in the BHI broth and the growth in chocolate agar media. Pearson Chi-Square test was used to assess the effectiveness of the irrigants to decontaminate the GP.

Results: After immersion for 1 min and 10 min, the growth of E.faecalis on the GP cones were significantly reduced in the Sodium hypochlorite group (p < 0.05). The Aloe vera group did not showed any significant effect against E.faecalis, whereas the Grape seed extract showed a moderate ability to reduce the growth, but both were not able to show complete disinfection.

Conclusion: In the present study, Sodium hypochlorite was clearly the most effective of the options for rapid disinfection of gutta percha cones.


  Abstract 57: Antibacterial efficacy of calcium hydroxide combined with lansoprazole and hydroxyapatite nanoparticles against enterococcus faecalis in human root dentin Top


Priyadarshini Mayakrishnan, Nancy Irudayaraj, Ramaprabha Balasubramanian, Kavitha Mahendran

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

Aim: To compare the antibacterial efficacy of Calcium hydroxide with nanohydroxyapatite against E.faecalis in root canal by assessing the Microbial colony count and Zone of Inhibition and assessment of medicament penetration depth via SEM analysis.

Materials and Methods: Forty extracted single rooted maxillary central incisors were decoronated to length of 15mm and biomechanically prepared upto F3 Protaper gold.The root canals were inoculated with E.faecalis to form a 3 weeks biofilm.Based on the medicament placed, the specimens were randomly divided into 3 groups (n=10): Group I-Calcium hydroxide [Ca(OH)2], Group II- Ca(OH)2 with Lansoprazole, Group III- Ca(OH)2 & Lansoprazole with hydroxyapatite nanoparticles.E.faecalis Colony forming units (CFUs) were assessed after 24 hours and 3 days and Percentage reduction of microoragnsisms was calculated for all the groups.SEM analysis was used to assess the penetration of medicaments into the dentinal tubules.Each medicament was placed into five wells, in a total of six E.faecalis inoculated agar plates and incubated at 37°C.Zone of inhibition was measured after 24,48 and 72 hours by Agar well diffusion test.The data were analysed using Kruskal Wallis and One way ANOVA test.

Results: At 24 hours Group III showed least number of CFUs followed by Group II and Group I with significant difference seen between Group I and III only whereas there was significant difference seen in all the three groups with Group III showing the highest percentage of reduction of microorganisms of 99.7% at 72 hours (p<0.05). At 24,48 and 72 hours there was statistically significant growth inhibition in Group III followed by Group II and then Group I (p<0.05).Based on SEM analysis, Group III was more efficient than Group I and Group II in the elimination of E.faecalis in the dentinal tubules.

Conclusion: Placement of medicament in the root canals for 72 hours showed significant increase in the antibacterial activity of all the 3 groups.The Calcium hydroxide & Lansoprazole with hydroxyapatite nanoparticles showed the highest antibacterial efficacy against E.faecalis at both 24 and 72 hours, thus making it as an effective intracanal medicament for dentinal tubule disinfection eliciting a new paradigm shift to nano endodontics.


  Abstract 58: Phytochemical analysis and antioxidant activity of vanilla planifolia leaf extract Top


Ajith Kamath, Iffat Nasim

Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India

Aim: To explore the prospective applications of vanilla planifolia leaf extract as an active ingredient for root canal disinfection.

Materials and Methods: Vanilla planifolia leaves were collected, shade dried and powdered. The powdered leaves (100gm) were then extracted three times by cold percolation method with 300ml Ethanol at room temperature for 72hrs.The filtrates were concentrated under reduced pressure at 40°C and stored in refrigerator at 2-8°C for use in subsequent experiments. The ethanolic extract was tested for various phytochemical agents by reagent method in test tubes. The extract was also tested for antioxidant properties by DPPH radical scavenging activity test and nitric oxide radical scavenging activity. The activity was measured at 550nm and results expressed in percentages.

Results: The ethanolic extracts tested positive for tannins, saponins, flavonoids, alkaloids, Cardiac glycosides, terpenoids and phenols. Quercetin equivalence of given Ethanol extract was 7.08%. Gallic acid equivalence in ethanol was 17.6% and tannic acid equivalence was 3.14%. The extract also showed considerable antioxidant properties. In the nitric oxide scavenging activity test a dose dependent increase in the antioxidant capacity was seen. It was the highest ie.70 % at 0.5mg/ml. In the DPPH scavenging activity test a concentration of 0.3mg/ml showed optimal antioxidant activity. At 0.4 and 0.5mg/ml the antioxidant property remained unchanged.

Conclusion: The extract of vanilla planifolia has a good composition of essential phytocompounds such as Gallic acids. These compounds are known to have a positive and benefitting effect on the oral microenvironment. Additionally, the extract has considerable antioxidant properties that can be beneficial to be used as a root canal disinfecting agent.


  Abstract 59: Current and emerging trends in root canal disinfection Top


Jain Brindha, Sushmita Shivanna, Kurinji R Amalavathy

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

A paradigm shift that reinforces biology in various aspects of endodontics has become the tenet of evolving technology. This evolution happened with the goal of dentin conservation to improve the structural integrity of endodontically treated teeth. The main challenge on the face of these minimally invasive instrumentation systems is in achieving optimum canal disinfection. Mechanical instrumentation can be minimised if an antimicrobial and proteolytic irrigant solution like sodium hypochlorite, can be delivered and evacuated in an effective way throughout the root canal space. The movement and subsequent cleaning of the root canal system produced by the irrigant fluid has found to be more efficient with the use of sonic, ultrasonic, or laser-activated irrigation. The advancements in disinfection of the root canal system to eliminate biofilm present deep within the microtubules, would revolutionize the future era of endodontic practice. The future trend would be to efficiently disinfect the root canal space with minimal intervention that would significantly enhance the clinical outcome of non-surgical endodontic therapy. This review presents an overview of currently available technologies of root canal disinfection that support minimal intervention approach and the potential future directions.


  Abstract 60: Chemokine RANTES as an unknown link between wound healing in the jawbone and systemic disease and prognostic indicator for endodontic therapy Top


Sagar Chaudhary

School of Dental Sciences, Sharda University, Delhi, India

Dental procedures like Root filling and Tooth removal leads to chronic inflammation in jaw bone. Dental clinicians while carrying out theses procedures ignore there connection with inflammatory mediators and become a hidden cause of chronic systemic disease. Incomplete wound healing in the jaw bone might act as a hyperactivated signalling pathway leading to “silent inflammation”. Silent inflammation during root canal therapy, implant procedure etc leads to activation of immune system. The intraoral interferences created by the root canal bacteria, metals produce highly toxic hydrogen sulfide and consist of increased inflammatory mediators like RANTES, FGF-2, IL-1ra. So, assessment of RANTES can be a useful indicator for the identification of patients with poor prognosis.Once a chronic disease has been established because of silent inflammation, it creates a set of pathological condition that worsens the overall condition. Thus, endodontist can help by not only subsiding the symptoms of acute inflammation but can also avoid the devastating effects of chronic inflammation which occur below the threshold of perceived pain and progress silently for years.


  Abstract 61: Evaluating the performance of nickel titanium endodontic post with the conventional stainless steel post: A finite element analysis Top


Sneha Pai, MS Nivedhitha

Saveetha Dental College, Chennai, Tamil Nadu, India

Introduction: Prefabricated metal and fiber posts are commonly being used in clinical practice. Prefabricated metal posts are widely used in posterior teeth and the most common mode of failure of these posts is by the fracture of the root. The reason for this is the mismatch in the modulus of elasticity of both the root dentin and the post. To overcome this failure, a post with modulus of elasticity similar to that of dentin has to be studied and hence this study.

Methods: 4 FEA models were constructed (maxillary and mandibular molars with nickel titanium and stainless steel posts). The material properties were assigned and occlusal load was applied along the long axis of the teeth. Analysis was run and stress distribution patterns were studied on the post, on the tooth-post assembly and at the post-dentin interface.

Results: Stresses exerted on the nickel titanium post, on the tooth-post assembly and at the post-dentin interface were markedly less when compared to its stainless steel counter parts.

Conclusion: Nickel titanium post can be used as an alternative to stainless steel post in endodontically treated teeth in order to minimize failures.


  Abstract 62: Comparative evaluation of calcium ion quantification from radicular dentine with various root canal irrigants using inductively coupled plasma atomic emission spectroscopy: An in vitro study Top


KB Sreejith

NICDS, Thiruvananthapuram, Kerala, India

Introduction: Shaping and cleaning is one of the most important step in endodontic therapy. During this process an amorphous smear layer is produced in root canal. Different root canal irrigants are used to remove organic and inorganic portions of smear layer. Aim of this study is to compare the calcium ion quantifying ability of Sodium hypochlorite,17% EDTA, 0.2% Chitosan, MTAD and QMix using Inductively Coupled Plasma Atomic Emission Spectroscopy.

Methodology: Sixty extracted mandibular premolar teeth were selected for the study. Teeth were decoronated at the cementoenamel junction.Size 10 K file was used to maintain the apical patency and to determine working length. The canal was prepared with rotary instruments using crown down technique and irrigated using NaOCl between each instrument change.The prepared teeth were randomly divided in to five groups and irrigated in such a way that the irrigant flows through entire length of canal and exits through patent apical foramen into the collection tube below. The collected solutions were forwarded for the ICP-AES system to analyze the calcium ions present in each solution.

Results: The mean values of Group 1 (17% EDTA), Group 2 (0.2% Chitosan), Group 3 (MTAD), Group 4 (QMIX), Group 5 (NaoCl) are 35.38, 14.74, 33.8, 22.76, 0.03 respectively.Intergroup comparison shows that the difference in calcium ion quantification values between all groups are statistically significant (p < 0.01) expect between Group 1 (17% EDTA) and Group 3 (MTAD).

Conclusion: 17% EDTA has the maximum calcium ion quantifying ability among the used irrigants.Calcium ion quantifying ability of MTAD was slightly less than that of 17% EDTA but there was no significant statistical difference between EDTA and MTAD groups.Chitosan also showed significant calcium ion quantifying ability, it was lesser than that of QMix group but it was significantly higher than that of sodium hypochlorite. Sodium hypochlorite showed the least amount of calcium ion quantification values implying that it has minimal action on the inorganic portion of the smear layer.


  Abstract 63: Evaluation of root re-inforcement by different cervical restorations for the management of external cervical resorption: An in-vitro study Top


Krisha Doshi, Nivedhitha Malli Sureshbabu, TS Vinoth Kumar1

Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, 1College of Dentistry, Jazan University, Jazan, Saudi Arabia

Aim: To compare and evaluate the fracture resistance of teeth restored with different cervical restorations for the management of external cervical resorption.

Materials and Methods: Forty eight freshly extracted human permanent maxillary central incisors were selected and endodontically treated. Artificial cavities (4mm diameter X 2mm depth) were prepared on the labial root surface near the CEJ according to Patel's Classification (Class 1Bd or 2Bd) and restored with different materials. Teeth were randomly allocated into 3 groups with two subgroups each: Group 1A (Reverse Sandwich Restoration without Thermocycling), Group 1B (Reverse Sandwich Restoration with Thermocycling), Group 2A (Composite Restoration without Thermocycling), Group 2B (Composite Restoration with Thermocycling), Group 3A (Control- No restoration without Thermocycling) and Group 3B (Control- No restoration with Thermocycling). Reverse Sandwich Restoration comprised of 1.5mm composite layer followed by a 0.5mm superficial RMGIC layer. 24 samples from 3 subgroups of 8 samples each were subjected to thermomechanical ageing 2,50,000 cycles of 5kg force and 500 thermal cycles (1 year period). Finally, the fracture resistance to oblique loading at 45° was tested on a Universal Testing Machine. Failure was defined as a first sharp 25% drop in the applied load. The load at failure was measured in Newton. One way ANOVA and Posthoc Tukey test was done for inter-group comparison. Paired t-test was done for comparison within each group. A p value <0.05 was considered statistically significant.

Results: There was a significant difference in the fracture resistance between all the 3 groups. Among the non-thermocycled groups, Group 1A and 2A showed a significantly better resistance to fracture than the control. Group 1A showed significantly better fracture resistance than Group 2A. Thermocycled groups potrayed similar results. The thermocycled groups resulted in a significantly lower resistance to fracture than the non-thermocycled groups.

Conclusion: Reverse sandwich restorations are more fracture resistant even after thermocycling and hence may be considered as a better alternative for management of external cervical resorption defects as compared to composite restorations.


  Abstract 64: Ozone: A revolutionary treatment in conservative dentistry and endodontics Top


Akshay Gomare, Zinnie Nanda

ACPM Dental College, Dhule, Maharashtra, India

In today's world dentistry is quite dynamic as new materials and protocols are developing at a rapid pace. ozone (molecular weight of 47.98 g/mol) is a triatomic, endothermic and thermodynamically highly instable oxygen compound. Ozone therapy is based on the assumption that ozone (O3) rapidly dissociates into water and releases a reactive form of oxygen that may oxidize cells, thus having antimicrobial efficacy without inducing drug resistance. As ozone is a strong oxidant, it can remove proteins from the carious lesion. A minimal amount of carious tissue needs to be removed before the restoration, unlike conventional drill and fill technique. Furthermore, ozone facilitates calcium and phosphate ions to penetrate the lesion and enables the remineralization potential of the carious lesion. Ozone has a broad spectrum antimicrobial activity in water and is biocompatible with human oral epithelial cells and fibroblast cells of gingiva because of this property it can be used to decontaminate the avulsed tooth. Ozone is produced naturally by the following natural methods: - From electrical discharges following thunderstorms. - From ultraviolet rays emitted from the sun. ozone has a high oxidation potential and is effective against bacteria, viruses, fungi, and protozoa. It also has the capacity to stimulate blood circulation, platelets, and immune response. Ozone has limitation as it is irritating to the respiratory system,cause headache, and irritation or dryness of the nose, throat and eyes, lung congestions, oedema, haemorrhage, changes to the blood and loss of vital lung capacity. Contraindications of Ozone incude Pregnancy, Glucose 6 phosphate dehydrogenase deficiency (favism),Hyperthyroidism, Severe anemia, Severe myasthenia. In spite of this, Ozone is used in dentistry in gaseous, ozonated water and as ozonated oils. Ozone was shown to be biocompatible and is used in all aspects of Conservative dentistry and Endodontics. Application of ozone include remineralization of recent caries-affected teeth and is used as a preventive therapy in caries, root caries, and intracanal irrigants in endodontic treatment,Teeth whitening, Periodontitis Peri-implantitis,ANUG, Herpes Labialis,Aphthous Ulcer, Dental Stomatitis,, Osteomyelitis, Cyst, Dry Socket.


  Abstract 65: Evaluation of cyclic fatigue resistance of several endodontic file systems used in continuous and reciprocating motions: An in vitro study Top


Anshu Gupta

M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India

Aim: To compare and evaluate the cyclic fatigue resistance of different continuous motion and reciprocating motion of endodontic file systems.

Materials and Methodology: 60 new rotary Nickel Titanium instruments 25mm in length were selected and were divided into 4 groups (n=15); Group 1: Neolix, Group 2: Hyflex EDM, Group 3: WaveOne and Group 4: WaveOne Gold. Each group was used according to manufacturer's recommendation of specific torque and speed and were then subjected to static loading and tested for instrument fracture using a cyclic fatigue testing device and 16:1 reduction hand-piece powered by a torque-controlled motar. The time and number of cycles to fracture was calculated and analyzed statistically.

Results: Values of mean cyclic fatigue testing showed that the difference between the various study groups was statistically significant (P<0.01).

Conclusion: Hyflex EDM exhibited significantly high cyclic fatigue resistance and WaveOne exhibited least resistance to cyclic fatigue among all the tested groups.


  Abstract 66: Three-dimensional printing in endodontics Top


Mayank Sachdeva, Sonam Sharma

Maharishi Markandeshwar College of Dental Sciences and Research, India

CAD and CAM applications came to the fore in the 1960s and 1970s. CAD and CAM technologies can hold CBCT data for construction of images used in surgical and nonsurgical endodontics. The aim of this article was to review all contemporary applications of 3D printing in endodontics and to think upon future directions for research and clinical use. Current applications of 3D printing in endodontics include guided endodontic access with pulp canal obliteration, surgical guide (stent-guided Endodontic microsurgery), rapid prototyping of anomalous teeth, autotransplantation, educational models and clinical simulation, regenerative endodontics, accurate location of osteotomy perforation sites etc. Attainment of technical expertise within endodontic practices is intimidating hindrance to widespread deployment. As knowledge advances, endodontic postgraduate programmes should think about implementing 3D printing as part of their curriculum. Increased expertise within the specialty will pave the way for a more strong evidence allowing endodontists to make informed decisions regarding implementation in clinical practice. Future research directions should include clinical outcomes evaluation of treatments using 3D printed objects.


  Abstract 67: Guided endodontics as an useful tool for mapping access to success: A case series Top


Jinali Shah, Athulya Pallipurath

AMC Dental College, Ahmedabad, Gujarat, India

Pulp canal calcification is one of the factors that makes endodontic treatment challenging by compromising the sound tooth structure during conventional orthograde root canal access along with the impossibility to disinfect the root canal effectively. Another risk in such cases is a high chance of gouging and root perforations during the search for the root canal in a blinded scenario. Considering these drawbacks, formulating 3D guides by overlaying a Cone Beam Computed Tomography (CBCT) scan and patient's 3D model obtained with a bench scanner seems to be a promising technique. Further, by superimposition of CBCT based on radiographically visible structures, the virtual implant surgery software (DDS Pro in our case) can be programmed to project a physical bur used for access virtually superimposed on PCC. Based on these data, customized 3D guides were prepared enabling us to achieve straight line access to partially/completely obliterated canal. The present case series represents 4 cases of PCC, 2 of them in maxillary lateral incisors, 1 being a Maxillary central incisor and the last one in a maxillary canine using a guided endodontic technique. All cases were treated with different burs and the pros and cons of each of burs actually experienced during performing the cases will be discussed.


  Abstract 68: Synergistic combinations and developments in calcium hydroxide as an intracanal medicament: A narrative review Top


Kotni Sheetal, Pratik Agrawal, Gaurav Patri, Harshita Lath

Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India

The essential towards the success of a nonsurgical root canal treatment depends on the interplay between a good chemico-mechanical preparation and prevention of reinfection between appointments. The role of an intracanal medicament is to achieve this feat besides attaining rapid pain relief post-treatment. Calcium hydroxide(CH) is one of the most favored intracanal medicaments owing to its bactericidal property, stability, and capacity to stop inflammatory exudates compared to other medicaments, especially in multiple-visit endodontics. Its favorable actions are attributed to its alkaline pH (12.5–12.8) and the presence of calcium and hydroxyl ions. However, its difficulty in handling, removal, reported inactivity due to E. faecalis and dentin, and inability to sustain in long-standing cases due to the rapid liberation of ions promoted by the aqueous vehicle in routinely available CH pastes, are concerning and pose a challenge to the clinician. Recently, various combinations of CH have been studied, that enhance its efficacy. However, there is limited literature assessing these combinations together. Hence, there lies a need to evaluate the recent combinations with CH which have a synergistic effect, with levels of evidence. Thus, this review paper describes the three most acceptable combinations with CH and one newer potent addition to CH, namely iodoform, ciprofloxacin, lidocaine hydrochloride and, ozonated olive oil respectively, which have a prospective to be a great addition to the list of medicaments already present.


  Abstract 69: An in-vitro study on biocompatibility of a biomimetic material (pulpotec cement) with immune cells Top


Ankita Mohanty, Swadheena Patro, Antarikshya Das

Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India

Aim: To assess the in - vitro cytotoxicity and biocompatibility of pulpotec cement at cellular levels using immune cells (macrophages).

Materials and Methods: Sample preparation of pulpotec cement was done by mixing, 500 ug of powder with 1000 ul of liquid then dispersing with 9000 ul of distilled water. This solution was then allowed to settle down for 24 hours. Followed by incubation and treating the prepared samples with various antibiotics like penicillin and streptomycin. There after, the supernatant was collected and divided into two groups:

Group I: Control group - untreated RAW 264.7 cells.

Group II: Test group - RAW 264.7 cells treated with pulpotec cement. Group II was further sub-divided into seven sub-groups: X (Original concentration), X/2 (diluted twice), X/4(diluted four times), X/6(diluted six times), X/8(diluted eight times), X/10(diluted ten times), X/20 (diluted 20 times with distilled water).

After cell culture, to assess the morphological changes of RAW 264.7 cells, Vibrant MTT cell proliferation assay kit and bright field microscopy was used. The samples were statistically analysed using Graph Pad Prism v6.1.

To assess the toxicity of the test material, ROS analysis was carried out using DHE stain and flow cytometry and the data was analysed using Facsxpress (Denovo, CA).

Further, apoptosis of the cells were analysed using Acridine orange stain and fluorescent microscope. To evaluate significance of difference two way ANOVA was used.

Results: The survivability of cells found to decrease with increasing concentration. Increase in induction of ROS and increased level of apoptosis in RAW 264.7 cells observed with increasing concentration i.e as we progress from X/20 to bulk concentration X leading to highest permeability of RAW 264.7 cells at X(original concentration).

Conclusion: Within the limitations of this study the following conclusion was drawn, pulpotec cement can be applicable in dentistry majorly for procedures falling under the paradigm of vital pulp therapy in a dose dependent manner.


  Abstract 70: Multifarious bone cement and its applications in endodontics: A review Top


Gudapati Swapnika, Vandanapu Santosh Kumar, R Kalyan Satish, K Madhu Varma, Girija S Sajjan, Sitaram Kumar M

Vishnu Dental College, Bhimavaram, Andhra Pradesh, India

Polymethyl methacrylate (PMMA), commonly known as bone cement, is widely used in orthopedic surgery mainly for prosthesis fixation, stabilizing compressive vertebral fractures or filling bone defects. Bone cement is a potentially new repair material that has been investigated recently in dentistry because of its properties like low cytotoxicity, excellent biocompatibility and resistance to moist environment. In Endodontics, bone cement can be used as a furcation repair material, retrograde filling material and apexification. Modified bone cements are introduced by adding fillers, adhesives, antibiotics or nanoparticles that make it well suited as an endodontic repair material. Bone cement lacks the ability to directly bond with tooth structure and hence needs to be modified by the addition of bioactive filler particles like hydroxyapatite, MTA to incorporate bioactivity in the cement. These bioactive bone cements are osteoinductive and act as a medium for apatite crystal growth and nucleation. They can be effectively used in apical re-surgery cases and furcation perforation repair. Kryptonite is a castor oil-derived polymer adhesive, biocompatible and was developed as radiopaque bone adhesive cement. It provides an optimal seal in 24 hours when used as a retrograde filling material. Kryptonite also possesses osteoconductive properties and does not interfere with normal healing. PMMA bone cements are functionalized with mesoporous silica nanoparticles (MSN) to enable a highly efficient and sustained release of antibiotics upto 80 days. This antibiotic-loaded bone cement with gentamycin can be used in apical re-surgery cases after failed apical surgery as a bone void filler. It provides adequate protection against bacterial infection in all those challenging, at-risk patients supporting the bone healing process. 6-8 gm of gentamycin, cefuroxime or vancomycin can be incorporated into 40 gm of bone cement considering the effectiveness and local concentration of the drug. Bone cement with nanoparticles of magnesium oxide and barium sulphate reduced harmful exothermic reactions of PMMA during solidification and increased radiopacity, respectively. Chitosan, gold and silver nanoparticles are added to the bone cement to improve the antimicrobial properties. This review paper highlights the importance of bone cement and its possible applications in the field of Endodontics.


  Abstract 71: Injectable platelet rich fibrin: The emerging regenerative trend Top


Jinet Joseph, Kavitarani Rudagi, Shweta Lodha

ACPM Dental College, Dhule, Maharashtra, India

Periapical lesions develop as a sequeale to pulpal disease. Elimination of the microorganisms in such cases of periapical lesions, has been a challenge for the clinician. Endodontic therapy has been the conventional treatment option in any situation involving periapical lesion. However there are situations where only root canal therapy does not suffice and disinfect the canal adequately. Such non healing periapical lesions irrespective of mature or immature apices usually have their own challenges. Various methods can be used in the nonsurgical management of periapical lesions like conservative root canal treatment, decompression technique, active nonsurgical decompression technique, method using calcium hydroxide, Lesion Sterilization and Repair Therapy, and the Apexum procedure. Monitoring the healing of periapical lesions is essential through periodic follow-up examinations. Along with this one innovative technique which is drawing attention is the Platelet concentrations therapy. Platelet concentrations have been utilized in dentistry for over three decades as a regenerative tool capable of releasing supraphysiological doses of growth factors responsible for inducing tissue regeneration derived from autologous sources. Various case reports and studies have shown the synergistic effect of PRF and MTA having healing potential in such lesions. MTA seals the apex providing a three dimensional hermetic seal, promotes biologic repair by creating an ideal environment for healing. Injectable Platelet-rich fibrin (i-PRF) developed in France by Choukroun and Dohan represents a new step in the platelet gel therapeutic concept which can be used in mature apices. Dr. Choukroun advocates iPRF as an autologous fibrin containing a large quantity of platelet and leukocyte cytokines, which enhance healing by release of higher levels of growth factors like PDGF-AA, PDGF-AB, EGF, and IGF-1 after 10 days thereby demonstrating its regenerative potential. This paper demonstrates a series of case reports highlighting the nonsurgical management of symptomatic teeth with large periapical radiolucencies using iPRF and MTA as an obturating material to promote periapical healing, with the aim of delivering to clinicians an easy to use platelet concentrate in liquid formulation which forms a therapeutic gel which can be either utilized alone or combined easily with various biomaterials like MTA in healing of periapical lesions.


  Abstract 72: Enhancement of interfacial adhesion by surface modifications of fibre post: A review Top


KS Neeraj, Amirtharaj L Vijay, Sekar Mahalaxmi

SRM Dental College, Chennai, Tamil Nadu, India

Extensive tooth loss after cavity preparation represents a real challenge in the restoration of endodontically treated teeth. In such a specific clinical scenario, the use of intra-canal posts may be indicated to increase the retention of the core and/or of the coronal restoration. Due to the higher rigidity and tendency to cause root fractures on usage of metallic post, recently fiber reinforced composite (FRC) posts have been replaced due to its dentine like elastic modulus and aesthetic properties. Several fibers such as carbon, glass, quartz, E-glass and ultra-high molecular weight polyethylene (UHMWPE) fibers have been used with varying degree of success. One of the most common failures of fiber posts prior to fracture is debonding of the post/core assembly.

The available evidence indicates that the coronal region of the root canal, bonded better to the glass fiber post than apical regions. Among various surface treatment strategies; phosphoric acid, hydrogen peroxide, and silane application enhances the post retentiveness to root dentine.

In light of the current evidence, surface modification strategies increase the bond strength of glass fiber post to root dentine. However, recommendations for standardized testing methodology and reporting of future clinical studies are required to maintain clinically relevant information and to understand the effects of various surface modification of glass fiber post and their bond strength with dentine walls of the root canal.


  Abstract 73: Effect of preoperative administration of corticosteroids in post-operative pain reduction in patients with irreversible pulpitis undergoing endodontic treatment: Systematic review and meta-analysis Top


S Pavithra, Sivakumar Sidharth, Anirudhan Subha, V Prabhakar

Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India

Aim: To evaluate the efficacy of pre-operative use of single dose corticosteroid in reducing post-operative pain in patients with irreversible pulpitis undergoing root canal treatment compared to other pre-operative medications at different time intervals.

Methods: A protocol was prepared and a literature search of studies was conducted using various electronic databases such as PubMed/MEDLINE, Scopus, LILACS, clinicaltrials.gov, CTRI and Cochrane till May 2021. The PICO question for the search strategy was “Does the preoperative use of corticosteroids (I) lead to reduction in post-operative pain (O) in patients with irreversible pulpitis (P) following root canal therapy in comparison to other pre medications (C)? Randomized controlled trials evaluating the efficacy of oral pre medications, whether given alone or in combination, compared with other agents or placebo, in patients before root canal therapy were included. The quality of the studies was assessed using the revised Cochrane risk of bias tool-2 (RoB 2). Meta-analysis of pooled data was conducted for applicable studies and Forest-plot was prepared.

Results: 1381 citations and 26 citations were identified through database search and manual search respectively. After removing duplicates and going through abstracts, 28 full-text articles were chosen and 9 articles met the inclusion criteria. Risk of bias analysis revealed 4 studies had some concerns of bias, 1 study had high risk of bias and 4 studies had low risk of bias. Meta-analysis showed that corticosteroids administered preoperatively alleviated postoperative pain at 6, 12, and 24 hour time intervals compared to placebo. None of the patients in the studies reported adverse effects due to the drug administered.

Conclusion: Pre-operative corticosteroids were more efficacious than placebo in relieving postoperative endodontic pain in patients with irreversible pulpitis undergoing root canal treatment.


  Abstract 74: Removal of calcium hydroxide intracanal medicament from apical third of root by ultrasonically activated irrigation: systematic review and meta analysis of in vitro studies Top


B Lalitha Priya, V Prabhakar, Anirudhan Subha, Suresh Babu Sukruti

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

Objective: The aim of this study was to review systematically the effectiveness of ultrasonically activated irrigation and conventional irrigation technique for the removal of calcium hydroxide from the apical third of the root canal system.

Materials and Methodology: A protocol was prepared and a literature search of studies was conducted using various electronic databases such as PubMed/MEDLINE, Embase, LILACS, TRIP and Cochrane till May 2021. The PICO question for the search strategy was ''Does (I) ultrasonically activated irrigation remove more intracanal Ca (OH)2 than the (C) conventional technique from the (P) extracted fully formed mature human teeth? “Outcome(O): Ca (OH)2 removal from the apical third of the root canal, Study design (S): In vitro studies examining the effects of ultrasonically activated irrigation by comparing with conventional technique. The quality of the studies was assessed using the Joanna Briggs Institute Clinical Appraisal Checklist for Experimental Studies. For relevant studies, a meta-analysis of pooled data was performed, and a forest plot was created.

Results: 953 citations and 9 citations were identified through database search and manual search respectively. After removing duplicates and going through abstracts, 16 full-text articles were read by two reviewers and 7 articles met the inclusion criteria. The overall risk of bias in the selected studies was moderate. The pooled effect size was 0.04 with 95% confident interval of 0.02-0.10 for the included studies. The I2=0%, no heterogenicity was included in the meta-analysis.

Conclusion: Within the limitations of this study, it can be concluded that Passive ultrasonic irrigation technique is more effective than the conventional syringe irrigation technique in removal of Calcium hydroxide from the apical third of root canal system.


  Abstract 75: Three-dimensional printing: A paradigm shift in endodontic treatment planning Top


Jasmit Kaur, Zinnie Nanda

JMF's ACPM Dental College and Hospital, Dhule, Maharashtra, India

Stereolithography or 3D printing was invented by Chuck hall in 1983. Today, in 2021, 3D printing is emerging as a technology available at a fraction of the cost without sacrificing of quality, accuracy, or material versatility. Dental 3D printing is an additive process of layering the material in thin horizontal cross-sections, along with a computer program to print solid objects. The objective of this poster is to discuss the various applications of 3D printing in dentistry and explore in brief the role of Stereolithographic 3D printed guides in management of complex endodontic cases such as dens invaginatus, pulp canal obliterations etc. Apart from stereolithography, 3D printing also encompasses technologies such as fused deposition modelling, multi-jet printing, photopolymer jetting, color-jet printing, digital light processing and selective laser sintering also known as selective laser melting. There are several emerging applications of 3D Printing, specifically in Endodontics such as: to gain guided endodontic access to root canals in complicated cases (Dens invaginatus, pulp canal obliteration, Dens invaginatus), role in regenerative endodontics (3D printing of dentin pulp complex, 3D printed scaffolds), role in surgical endodontics – to determine osteotomy and root resection site, to custom fabricate surgical 3D guides to locate extruded root filling material, separated instrument etc, to fabricate tooth replicas of complex cases for study purpose and as haptic simulators, providing realistic simulation of various surgical and non surgical endodontic procedures. Now, in 2021, we are witness to the rise of material science as a key success driver for the 3D printing in dental industry. Research work is being done in developing biocompatible resins, or plastics that can interact safely with the human body. Focus is on developing Resins that are produced in ISO 13485 certified and FDA-registered facilities and tested for biocompatibility and sterilization compatibility. 3D printing is a boon to dentistry, with yet many more milestones to be conquered in the years to come.


  Abstract 76: Nonsurgical root canal treatment of an anterior tooth with necrotic pulp and an open apex using platelet rich fibrin Top


arindam Banik

Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India

A 32-year old female patient has reported to the Department Of Conservative Dentistry and Endodontics, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India with the chief complaint of having fractured teeth in the upper front tooth region. On examination, the permanent maxillary left central and lateral incisors were found out to be fractured and non-vital. Additionally, the upper left lateral incisor was having an open apex, which was confirmed radiographically. Tenderness on percussion was absent. It was decided to render root canal therapy to both the upper left incisors; placement of Platelet Rich Fibrin (PRF) after complete removal of necrotic pulp from the upper left lateral incisor (regenerative therapy), followed by apexification using Mineral Trioxide Aggregate (MTA). On the first visit, the access cavity was prepared for both the teeth, followed by determination of working length(s) and calcium hydroxide dressings were given and changed after a week. The biomechanical preparations were completed in subsequent visits under local anaesthesia. After three weeks, 12ml blood was drawn intravenously from the patient's right ante-cubital vein and centrifuged under 3000 rpm for 13 minutes to obtain PRF (jelly-like consistency). Under rubber dam isolation, the PRF was then condensed into the cavity using a hand plugger (Dentsply Maillefer, Switzerland). Apexification of the upper left lateral incisor was done with MTA-Fillapex (Angelus Dental, Brazil) to a thickness of 3mm to create the apical barrier, followed by moist cotton pellet and Cavit placement. After one month, the respective obturations were completed, and the coronal sealing was done for both the upper left incisors using GC Fuji II LC (GC India). After 3 months, the patient was recalled, pain and mobility were assessed to be absent. Crown preparations were made for both the upper left incisors and metal-ceramic crowns were seated on both the upper left incisor teeth using GC Gold Label 1 - glass ionomer (Type-1) cement (GC India).


  Abstract 77: Restorative fortification of endodontically treated teeth: A narrative review Top


Harshita Lath, Gaurav Patri, Pratik Agrawal, Kotni Sheetal

Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India

The long-term success of endodontically treated teeth depends upon skilled unification of endodontic and restorative procedures. An adequate post endodontic restoration has a stronger impact upon the prognosis of root canal treatment than the treatment itself. A good coronal restoration prevents the ingress of microorganisms into coronal pulp space, which would lead to re-infection. It also replaces the missing tooth structure and strengthens the remaining, thus restoring the original morphology and function. Endodontically treated teeth exposed to oral conditions without an optimal restoration can result in treatment failure. Loss of tooth structure due to decay, dental procedures and endodontic therapy decreases fracture resistance of the tooth. Poor quality of temporary restoration, delay in permanent restoration and poor marginal integrity of final restoration are some of the causes which can jeopardize the favorable outcomes of an endodontic treatment. Therefore, it is crucial to seal the root canal system during or after treatment. A restorative material which minimized tooth preparation, provided adequate strength to the remaining tooth structure and sealed the cavity from percolation of oral fluids and bacteria was considered ideal. This justified the religious use of resin composites and glass ionomer cements (GIC) for post endodontic restorations. However, blooming advancements in restorative materials provided the clinician with efficient alternatives. Newer formulations with claimed ion release properties have been proposed. These smart materials, apart from catering to the basic needs of a restoration, also have properties that inhibit the growth of S.mutans or prevent biofilm formation, thus decreasing the chances of secondary caries. Based on the evidence available, this review aims to compare the potential use of newer materials like Caredyne Restore (GC Corporation, Tokyo, Japan), Activa BioActive Restorative (Pulpdent Corporation, Watertown, MA, USA), Cention N (Ivoclar-Vivadent, AG, Schaan, Liechtenstein), and Surefil One (Dentsply-Sirona, Konstanz, Germany) while highlighting their bulk-fill properties and ion release abilities to precisely describe their characteristics and their eventual bioactivities.


  Abstract 78: Intentional reimplantation: A salvaging endeavor Top


Nilormi Karmakar, Akansha Tilokani

Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India

Intentional replantation (IR) is considered as a treatment alternative that can maintain the ingenuity of a tooth. IR is an age-old concept and is defined by Grossman (1966) as a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. Many authors consider that IR should be reserved as the last resort to save a tooth after other procedures have failed or would likely fail. Although the success rate is not always high, IR may be a treatment alternative that deserves consideration to maintain the natural dentition and avoid extraction of the tooth. Furthermore, this decade has shown a rising interest in IR with the development of various biomaterials which can be used as root-end filling materials, and periodontal regenerators. This paper highlights an original case report along with a two year follow up of an attempted intentional reimplantation of a maxillary central incisor with a fractured buccal cortical plate which was carried out in an innovative approach. This was carried out successfully as an alternative to extraction, in order to salvage the natural tooth. Atraumatic extraction was performed followed by root canal treatment, along with retrograde filling. Biomodification of the root surface was done preceding reimplantation of the tooth in its alveolar socket which was further treated with bone graft and other biomaterials.


  Abstract 79: In silico analysis: A new age predictor in understanding biocompatibility of a biomimetic material – Pulpotec cement Top


Antarikshya Das, Swadheena Patro, Ankita Mohanty

Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India

Aim: To assess the mechanism of toxicity along with biocompatibility of Pulpotec cement using In silico analysis.

Materials and Methods: Molecular docking studies are used to determine the interaction of the ligand and the protein to know the preferred binding orientations of a ligand that confers a minimum binding energy. The analysis was performed using Autodock 4.2 with pulpotec cement comprising of powder and liquid formulation, wherein the formulation consists of polyoxymethylene, iodoform, dexamethasone acetate, formaldehyde, phenol, guaiacol, and excipient. These constituents are taken as ligand and Sod1, p53 as receptor protein. Sod1 was chosen to understand the influence of Pulpotec on oxidative stress metabolism of cells while P53 was chosen for the effect on Apoptosis.

Chemical structures of ligands and receptor proteins were retrieved from software PubChem and visualized using Chimera and their geometries were optimized using a Gaussian 03 program. The receptor proteins were subjected to energy minimization using the Chimera program. Parameters for the chemical structures were set for Autodock 4.2.

Results: A comparative analysis of bond energies of interaction of different components has been presented. The interacting bond energy was higher in case of Sod1 than P53 interpreting the influential role of interaction leading to determining the levels biocompatibility of Pulpotec with RAW 264.7 macrophages. Upon internalization, pulpotec cement interacts with Sod1 and other proteins influencing their functionality leading to the imbalanced induction of reactive oxygen species. Along with that, the internalized pulpotec also interact with the apoptotic protein like p53 and influence their activities. The combined effect of ROS and malfunctioned proteins, the cells lead to their fate towards apoptosis at higher rate determining levels of toxicity.

Conclusion: The study concluded on the fact that the active mechanism of pulpotec cement is derived from binding of dexamethasone acetate, polyoxymethylene and phenol binding to Sod1 and P53 through Vander wall interaction, and H-bond.


  Abstract 80: Elevating margin to protect core collapsing Top


Saloni Rathi

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

Root canal treatment is incomplete until the tooth has been restored. Bacteria have shown to be etiology of endodontic failure. Goals in restoring tooth after root canal treatment should be to prevent recontamination of root canal system and eliminating chances of fracture because of reduced tooth structure left. In clinical settings, teeth with greatly lost structure are commonly found affecting atleast one proximal area. Reconstruction of such cavities is a challenge in the endodontic and restorative field and also in periodontal field. Endodontically treated teeth are prone to fracture and this is attributed to loss of tissue. Thus, considering the amount of healthy tooth structure remaining in treatment plan is important and crucial to success. Endodontically treated tooth have least structural weakening that has lost roof of pulp chamber with marginal ridge intact when compared with an intact chamber roof with loss of one or both marginal ridges (as class II cavity). Not only dimensions of cavity or lack of tissues, also depth of aggression that reaches periodontal tissue are important key points in restoration. Subgingival position of margin hinders clinical management, and sealing can be challenged by the complexity of the isolation, sometimes becoming almost unreachable. In these extreme cases we perform a deep margin elevation (DME) or periodontal treatments, such as crown lengthening, in an attempt to return a manageable cavity margin and thus aiding in proper isolation, impression taking, and the adhesive procedure required for ideal post endodontic restoration providing proper marginal seal and resistance to fracture. DME is necessary when the healthy tooth remnant is in the sulcus or at the epithelium level. Replacing class II restorations with their larger size and subgingival margins require restorations with inlay/onlay or crowns. Poor isolation may result in a suboptimal marginal seal, which in turn may lead to secondary decay and damage to periodontal tissues. This review will enlighten the importance of DME in post endodontic restoration helping to deal with marginal seal and fracture of endodontically treated teeth with reduced tooth structure.


  Abstract 81: Biomemetic approach: New era in endodontics Top


Mrinali Chaddha

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

Newer scientific technological advancement in dentistry provides an array of projects like cell culturing, tissue grafting, molecular biology and tissue engineering. Conventional root canal treatment, apexification with biomaterials are the procedures of choice to treat a nonvital tooth but they do not give predictable outcomes in pulp tissue regeneration. New technology of minimally invasive biomemetic endodontics, which is photon induced photo acoustic streaming has come into existence these days. The term “bio” means life and “mimetic” means imitate, biomimetics is basically the study of structure formation and function of biologically produced materials and also about the biological mechanisms especially for the purpose of synthesizing similar products by artificial mechanisms which mimic natural ones. Biomimetic materials, with their biocompatible nature and excellent physico-chemical properties are widely used nowadays. They can function as long lasting esthetic and restorative materials, cements, root repair materials, root canal sealers and filling materials, which have the advantages of enhanced biocompatibility, high strength, sealing ability and antibacterial properties. This review paper describes various biomimetic materials including MTA, bioceramic sealers and bioceramic gutta percha and their biological properties in the field of endodontics along with the biomimetic approaches for regeneration as in pulp implantation, root canal revascularization.


  Abstract 82: “The tough gets going” clinical case series on management of complicated crown - root fractures Top


Giftlin Denny Xavier, G Saicharan

Mahe Institute of Dental Sciences, Mahe, Kerala, India

Complicated crown-root fracture is an alarming clinical condition which requires immediate damage assessment of the affected tooth. It accounts for about 2-13% of all traumatic dental injuries. The maxillary central incisors are most prone to the traumatic injuries followed by premolars. The treatment planning and long-term prognosis depend on various factors such as fracture line location and extension, biologic width, root development, alveolar bone fracture, soft-tissue injury, occlusion, and esthetics. Preservation of natural dentition should take precedence over artificial means. It is with this motive that a clinician should take tough challenges and get going. In the presentation we will discuss two complicated crown-root fractures involving the maxillary central incisor and premolar.


  Abstract 83: Recent rotary file design and its impact on separation: A review Top


Simar Kaur Manocha

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

Cleaning and shaping of the root canal system is essential for successful endodontic treatment. The fracture of endodontic instruments is a procedural problem creating a major obstacle to normally routine endodontic therapy. However, despite improvements in file design and metal alloy, intracanal file separation is still a problematic incident and can occur without any visible signs or permanent deformation. With emerging technology, we see endodontics being swept away in the latest wave of technization. There is plethora of different systems available with modifications in the design, manufacturing, thermomechanical and surface treatment of alloys and advancements in movement kinetics which have shown to improve the fatigue properties of the alloys, reducing the incidence of separation. This review will give an account on the advances in NiTi endodontic instruments with an emphasis on metallurgy, mechanical properties and design features and will summarize the most recent trends in NiTi technology. Also, it will enlighten various factors which may have an impact on the fatigue properties of rotary NiTi instruments such as manufacturing process, surface treatment, cross-sectional area, tip, pitch, radial land, rake angle, helical angle, movement kinematics, and will also provide an insight into scientific causes of instrument separation, prevention strategies, and clinical recommendations for safer and efficient rotary endodontics.


  Abstract 84: The diagnostic dilemma –Vertical root fractures: A review Top


Surya Kamali, Rajendran Vikash

Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India

In endodontic therapy, detecting and diagnosing vertical root fracture (VRF) can be challenging, and it's frequently more of a forecast than a diagnostic. Accurate diagnosis regarding the distance and localisation of the separated fragments is required to determine the most appropriate treatment technique. The interpretation of root fracture on radiographs is intricate as two-dimensional intraoral radiography systems fail to provide information regarding teeth and adjacent structures in the third dimension. The inability of conventional imaging techniques to visualise VRFs correctly necessitates the development of alternative imaging systems such as cone beam computed tomography (CBCT) or digital volume tomography. Although CBCT is an innovative and promising technology, a high radiation dose, high cost, and lack of availability might preclude the use of CBCT in some cases. Digital subtraction radiography (DSR) is an imaging technique that determines qualitative changes between 2 radiographs taken at different times. The subtracted image is coloured in neutral Gray and reveals features that differ between the first and the second images. Endodontically treated teeth are at higher risk of experiencing VRFs than vital teeth, most likely because of loss of moisture, excessive root canal instrumentation, excessive pressure during gutta-percha filling, or inappropriate placement of posts. This review paper will brief about the advantages of CBCT and digital subtraction radiography over traditional radiography, particularly in dealing with VRF in endodontically treated teeth and diagnosing VRF way before it becomes severe by using digital subtraction radiography to find the distance between fractured segments.


  Abstract 85: Healing of bony cavities using flavonoids, BMP9, and leptin Top


Priya Jain, Ekta Choudhary

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

Failure of root canal treatment of preexisting periapical lesion or the development of a new one is considered as an undesired, unsuccessful outcome that requires nonsurgical endodontic retreatment or surgical approach which is addressed when Non-Surgical Endodontic Retreatment is not possible. Surgical approaches incorporate debridement of apical lesions with reshaping of the surrounding bone, the establishment of a proper seal between root canal system and the periradicular tissues. Unfortunately, following endodontic surgery, periapical bone healing can be directed toward repair or regeneration, depending on various issues, such as the size of the lesion, the availability of cells from the host and biological factors possibly stimulating the healing process in this area. This has directed researchers to focus on different methods to promote adequate healing by bone regeneration rather than fibrous repair. One of these methods is the usage of bone-replacing biomaterials (bone grafts) as an adjunct to endodontic surgery. However, some cases do not resolve satisfactorily with this technique. For these cases, Morin, a flavonoid having pro-osteogenic efficacy can be used in combination with BMP9 and leptin. Previous studies have shown how Leptin enhanced the activity of BMP9-Induced Osteogenesis and Morin has facilitated osteoblast development, thus resulting in bone healing. Though no such literature has been identified in the Surgical endodontics till now.


  Abstract 86: A cone beam computed tomography analysis of root canal anatomy of permanent mandibular first molars in South Indian population Top


H Karthikeyan, Imran Shaik

Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India

Aim of the Study: The aim of this study was to determine the prevalence of the middle mesial (MM) canal and isthmus and the correlation of middle mesial canal with the presence of extra distal root and the distance between the mesio-buccal (MB) and mesio- lingual (ML) canal orifices in a South Indian population using CBCT imaging modality.

Materials and Methods: CBCT images of 105 patients were randomly selected from a database. Multiplanar images of mandibular 1st molars were examined in a sequential fashion in all 3 dimensions. Teeth with previous root canal treatment and full coverage restorations, open apices, root resorption / calcification were excluded from the study. Age and sex of the patient was recorded. Number of roots and number of root canals in mesial and distal root were determined. The apical confluence between the canals was determined. The distance between the ML and MB canals was calculated from the lingual aspect of the MB canal orifice to the buccal aspect of ML canal orifice. Presence/ absence and location of isthmus was recorded from the axial view. The correlation between the variables was analyzed using Pearson chi- square tests along with post – hoc and Tukey HSD tests and the mean average of variables were calculated using one- way ANOVA tests. The intra- observer and inter- observer reliability were calculated with a Cohen kappa coefficient during the calibration period in the study.

Results: No significant correlations between the variables were found in this study except in the apical third where presence of isthmus was significantly associated with the presence of MM canal.

Conclusion: The prevalence of MM canals in mandibular first molar teeth in south Indian population was 52.41% and had separate exit in 4.6% of the teeth investigated. Presence of isthmus in apical third was significantly associated with presence of MM canal. No significant correlation was found between other factors evaluated in this study.


  Abstract 87: Evaluation of garlic extract as rapid disinfectant for gutta percha cones: An in vitro study Top


Rangarajan Shenbagam, Manali Ramakrishnan Srinivasan, C Nishanthine

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

Aim: The purpose of this study was to compare the efficacy of 20% and 100% garlic extract with 2% Chlorhexidine, 5.25% Sodium hypochlorite and 2% Glutaraldehyde in rapid disinfection of gutta percha cones.

Materials and Methods: The bacterial strains, Enterococcus faecalis and Staphylococcus aureus Scientific Name Search  were grown on Brain Heart Infusion Agar and then sub cultured in BHIA medium. The cell cultures were harvested, washed twice with Phosphate buffered Saline (PBS) and adjusted to 0.5McFarland Standard. Gutta percha cones were immersed in prepared suspensions of Enterococcus faecalis and Staphylococcus aureus. The cones were then immersed in 100% garlic extract, 20% garlic extract, 2% Chlorhexidine, 5.25% NaOCl and 2% glutaraldehyde for 1 minute and 5 minutes separately. After disinfection the cones were then individually transferred to sterile test tubes containing 1ml sterile saline and vortexed vigorously for 5minutes. 100μl of the saline suspension plated onto Brain heart infusion agar by spread plate method. The plates were then incubated for 48 hours at 37°C and the total colony forming units/ml were calculated manually by placing  Petri dish More Details on a grid background.

Results: Among the study groups 2% Chlorhexidine was found to have lesser mean total colony forming units than 5.25% NaOCl, 100% garlic extract, 2% glutaraldehyde and 20% garlic extract. There was no statistically significant difference among 2% Chlorhexidine, 5.25% NaOCl and 100% garlic extract at both the time periods.

Conclusion: Within the limitations of the study, it can be concluded that 100% garlic extract possesses efficient disinfection property similar to 2% Chlorhexidine and 5.25% NaOCl. 100% garlic extract possesses superior disinfection property than 2% glutaraldehyde and 20% garlic extract.


  Abstract 88: Knowledge, attitude and practice based survey on endocrowns among dental practitioners: A cross-sectional survey Top


S Akshai1, Manali R Srinivasan, Diana Davidson

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

Introduction: Post Endodontic restorations should include preservation of tooth structure as well as providing a proper coronal seal to prevent the ingress of microorganisms. Endocrowns are categorized under post endodontic restorations. They provide a good amount of esthetic and functional rehabilitation for grossly damaged teeth. They have a circular butt joint margin preparation without a ferrule thereby preserving the surrounding tooth structure.

Objective: To assess the knowledge, attitude & practice on endocrowns among dental practitioners, endodontists & post-graduate students.

Materials and Methods: A set of 30-closed ended questionnaire was prepared & validated and sent through google forms to the following groups- General dental practitioners (GDP), endodontists, and post-graduate students (endodontics) within Chennai. There were two sections, the first one represented demographic details and the other section included questions on knowledge, attitude & practice towards endocrowns. The questionnaire was sent to 200 dentists of the above-mentioned groups.

Results of the Data and Statistical Analysis: There was a total of 151 responses acquired. Obtained data was formulated and tabulated using MS Excel. Analysis was done using SPSS software. Chi-square test was performed at significant levels. Out of the total respondents, endodontists were well acquainted with endocrowns in contrast to the general dental practitioners (P<0.05) which was statistically significant. 17.3% of endodontists and 13.3 % of general practitioners practiced endocrowns previously.

Conclusion: In the present study, the majority of the endodontists were aware and practiced endocrowns. Within the limits of this study, there was a lack of knowledge and practice among the general dental practitioners on endocrowns when compared to endodontists in the city. If this minimally invasive approach could be discussed more in the curriculum, it would have a better reach among practitioners.


  Abstract 89: Estimation of salivary total protein, flow, and pH in dental practitioners before and after the use of personal protection equipments Top


R Sethupathi, Manali R Srinivasan, D Duraivel

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

Introduction: The physical environment in the dental office is more taxing than ever. Most of dental practitioners are experiencing dehydration and decrease in salivary flow while working with personal protective equipment.

Aim: The Aim of this study was to estimate the change in salivary total protein, flow and pH in Dental practitioners after the use of Personal protective equipment.

Materials and Methods: The unstimulated salivary total protein, flow and pH of 30 Dental practitioners before and after use of personal protective equipment for 3 hours was estimated. The subjects were advised to refrain from intake of any food or beverage one hour before the session. The unstimulated saliva was collected in graduated cups using draining method for 5 minutes. Collected saliva was first estimated for salivary pH using pH meter and then quantity of saliva was noted. Then, collected saliva was estimated for salivary total protein in laboratory. Data was tabulated using MS Excel and the statistical analysis was done using SPSS software. The Wilcoxon Signed-Rank Test was used to compare between the before and after study groups. The statistical significance was kept at p – value less than 0.05.

Results: There was significant reduction in salivary total protein, flow and pH in dentist after using personal protective equipment's for 3 hours (P < 0.05).

Conclusion: Within the limitations of the present study, it can be concluded that use of personal protective equipment showed a reduction in salivary total protein, flow and pH among the dental practitioners. This may be due to dehydration and inadequate intake of fluids.


  Abstract 90: Single-cone with bioceramic sealer obturation on postoperative pain incidence after root canal treatment: A systematic review Top


Kunguma Supraja Krishnamoorthy, Manali R Srinivasan, Saravanan Poorni

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

Objective: To evaluate the influence of single-cone obturation technique using bioceramic sealer (BCS) on postoperative pain after root canal treatment, by systematically reviewing the published literature.

Materials and Methods: Based on the PICOS strategy the research question was formulated. A comprehensive literature search was performed electronically in PubMed, Cochrane Library, Google Scholar and Microsoft Academic by two evaluators independently. A manual search of the reference lists of identified articles was also additionally performed. All randomized clinical trials (RCTS) assessing postoperative pain incidence and intensity following root canal treatment with single cone obturation technique using BCS was identified from 1994 till May 2021. Inclusion and exclusion criteria were applied to the selected articles. A customized data extraction sheet was formulated. The articles selected were then subjected to quality valuation, and assessed concerning the risk of bias using the Cochrane Collaboration's 'risk-of-bias' assessment tool employing RevMan software.

Results: Four studies were included in the qualitative synthesis. Within the 4 studies, 1 study was considered to have “high risk of bias” and the rest 3 studies were considered to have “moderate risk of bias”. The overall certainty of evidence of the included studies was classified as moderate.

Conclusions: Based on the limited quality evidence, the included studies reported no significant increase in incidence and intensity of postoperative pain after single-cone obturation technique with bioceramic sealer. However, paucity of standardized RCTs and lack of standardization in recording of pain scores as well as moderate certainty of evidence of the available studies signposts the need for well-designed RCTs.


  Abstract 91: Broken instrument retrieval: A riddle during endodontic treatment Top


V Ramya

Chettinad Dental College and Research Institute, Tamil Nadu, India

Fracture of endodontic instruments is an annoying complication during root canal treatment. The prevalence is between 1.83% and 3.3%.This is more common among extremely curved canals and retreatment cases. There is limited information based on high-level evidence about the management of separated instruments and this complicates the decision making process. The management of such complications should be based on thorough knowledge of each treatment option, considering the success rates, well balanced against the potential risks of leaving or removing the fragment. The retrieval rate of separated instrument in anterior teeth is 81.8%, for premolars it is 78.6% and for molars it is around 77.3%. This paper clearly reviews about the various techniques that are available till date for the successful retrieval of various endodontic and non endodontic separated instruments within the root canal.


  Abstract 92: Knowledge, attitude, practice in maintenance of dental unit waterlines among dental surgeons: A cross sectional study Top


V Soumya Rajam, Manali R Srinivasan, Saravanan Poorni

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

Aim: This survey aims to assess the knowledge, attitude and practice in Maintenance of Dental unit waterlines among Dental surgeons.

Materials and Methods: A Cross sectional study design was used. Self administered Questionnaire with 30 questions was designed and validated. The questionnaire consisted of questions pertaining to demographic details, knowledge on maintenance of dental unit waterlines (DUWLs), attitude towards maintenance of DUWLs and practice on maintenance of DUWLs. The questionnaire was formulated using google forms and an online link was circulated among 250 participants belonging to 4 categories (undergraduates, postgraduates, BDS practitioners and MDS practitioners). This survey analysed knowledge score, attitude score and practice based on Qualification and Workplace of dental surgeons. Survey data was collected, tabulated using MS Excel and statistically analysed using SPSS software. One-way ANOVA was used for intergroup analysis followed by Post HOC Tukey's test and Kruskal Wallis test was used for evaluating the knowledge and attitude score. Independent t-test for intragroup analysis and Mann Whitney test was used for evaluating the knowledge and attitude score.

Results: Out of 250 participants 238 had responded. The response rate for the survey was 95%. The knowledge score based on qualification, workplace showed statistically significant differences. MDS Practitioners had higher knowledge scores when compared to UG & PG students. Dental practitioners working in both clinic and hospital had more knowledge than non-practitioners regarding maintenance of Dental unit waterlines. There was significant correlation between knowledge and attitude. Whereas there were no statistically significant differences in attitude score and practice.

Conclusion: A larger number of dental surgeons who responded were not familiar with methods for maintenance of DUWLs, but they were ready to follow guidelines if given. Hence, by conducting workshops or continuing dental education programs may improve the knowledge, attitude and practice towards maintenance of dental unit water lines among dental surgeons.


  Abstract 93: Evaluation of smear layer formation following final irrigation activation using XP-endo finisher and passive ultrasonic irrigation device: An environmental scanning electron microscopy study Top


Deepa Mereen Mathew, Aswathy Sreekumar Pillai

Thai Moogambigai Dental College, Chennai, Tamil Nadu, India

Aim: To evaluate whether final irrigation protocol with XP-endo Finisher (XPF) and Passive ultrasonic irrigation (PUI) leads to the formation of smear layer.

Materials and Methods: 20 mandibular premolars (10 samples in each group) were instrumented with Protaper Gold from S1 up toF3 (30.09) and encased in condensation silicone forming a customized flask system providing a closed irrigation and aspiration system. The roots were split open with a chisel to facilitate assembly and reassembly of the specimen and the buccal half of the root was used. Four sequential indentations were prepared from 1mm short of the working length on the inner wall of the root canal. The specimens were agitated in ultrasonic bath initially with 3 % NaOCl and then with 17% EDTA for 1 minute each to enable debris removal, following which samples were washed in running water for 1 minute. Initial images of the observation site were captured with Environmental scanning electron microscopy (ESEM) at 1200X magnification and digitally stored as control group. The same specimens were then reassembled in the flask and subjected to experimental irrigant agitation protocol using XPF or PUI. Following this imaging was done using ESEM to evaluate the formation of smear layer and classified using a 4-point scoring system. The comparison between the groups at any given level was made using Kruskal Wallis Test followed by Mann Whitney U test for the post hoc analysis. P value of <0.05 was considered statistically significant.

Results: XPF group samples presented significantly more amount of smear layer at apical levels compared to the control group. XPF group had significantly more amount smear layer compared to PUI group.

Conclusion: Within the limitations of this in-vitro study smear layer formation was observed in all the samples in both the experimental groups.


  Abstract 94: The ultimate game finisher in endodontics - XP-endo® finisher: A review Top


Abbhinaya Abbhinaya, Kachari Megha

VS Dental College and Hospital, Bengaluru, Karnataka, India

Root canal system is extraordinarily complex with numerous intricacies, including dentinal tubules, accessory and lateral canals, apical ramifications and isthmuses. These complexities allow for multiple spaces to be left untreated. It thereby leaves behind, bacteria and bacterial by-products, smear layer, intra- canal medicament and also obturation material during re-treatment. In spite of using a plethora of endodontic instruments and a combination of chemical agents, till date 100% sterile canals haven't been achieved. This doesn't stop us; rather, drives us to invent newer techniques and instruments to achieve as uncontaminated canals as possible. XP- endo® solutions [FKG Dentaire, La Chaux de Fonds, Switzerland] has delivered three unique instruments made of MaxWire® technology; XP- endo® Shaper, XP- endo® Finisher and XP- endo® Finisher R. They are effective in 3D cleaning and shaping by adapting to the canal morphology and preserving dentin. XP- endo® Finisher is one such instrument which is studied enormously regarding its positive outcomes in various steps of chemo-mechanical preparation of root canal systems. The aim of this review paper is to present and discuss the clinical characteristics of XP - endo® Finisher in terms of smear layer removal, bio-film/ microbial load reduction, activation of irrigants and retreatment.


  Abstract 95: Effect of route of administration of preoperative analgesics on postoperative pain following non-surgical root canal treatment in symptomatic irreversible pulpitis: A systematic review and meta analysis Top


Harini Madhavan, Hari Krishna, Lakshmi Balaji, Rupa Ashok

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

Objective: Post-operative pain after root canal therapy is a major concern for which pre-operative analgesics have been administered through different routes such as oral, intra-ligamentary, sub-mucosal, intra-nasal and transdermal. The aim of this systematic review was to summarize the available clinical evidence to find the effect of route of administration of pre-operative analgesics on pain following non-surgical root canal treatment in patients with symptomatic irreversible pulpitis and to perform a meta-analysis to assess post-operative pain at baseline, 12, 24 and 48 hours.

Materials and Methodology: The formulated PICO was (P) Patients with symptomatic irreversible pulpitis undergoing non-surgical root canal treatment; (I) Pre-operative analgesics administered through parenteral routes; (C) Pre-operative analgesics administered orally and (O) Post-operative pain following non-surgical root canal treatment. An electronic search of the literature was performed from inception till April 2021 in the PubMed, Cochrane and EBSCOhost databases. Quality assessment of the included studies was assessed using the Cochrane Risk of Bias 2.0 tool. A random effects meta-analysis was conducted to assess post-operative pain.

Results: Three articles were included for the qualitative synthesis of which two articles were included for the quantitative synthesis. The included articles highlighted the efficacy of intra-ligamentary and transdermal routes of administration of pre-operative analgesics over the conventional oral route. Meta-Analysis suggested that 12 hours after endodontic treatment, the mean level of post-operative pain was lower in individuals who received pre-operative analgesic through intra-ligamentary route than those individuals who received through oral route.

Clinical Significance: This systematic review showed alternative routes of administration of pre-operative analgesics can be promising in managing post-operative pain following non-surgical endodontic therapy.

Conclusion: Pre-operative analgesics when administered through parenteral routes resulted in less post-operative pain during all time intervals, among which a statistical significance was obtained at 12 hours post-treatment.


  Abstract 96: Prevalence of musculoskeletal disorder among endodontists in India: A systematic review Top


Arathi Ganesh, Rajeswari Kalaiselvam, Manigandan Kuzhanchinathan, Sindhu Saeralaathan, Aafreen Saleem, Akhil Vasudevan

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

Objective: Musculoskeletal disorder (MSD) is significant health problem associated with muscles, tendon, joints, inter-vertebral discs and peripheral nerves. MSD is a work-related well being issue for dental specialists, especially Endodontists who utilize precise, repetitive hand and wrist movements. Hence, the purpose of our systematic review was to evaluate the prevalence of MSD among Endodontists in India.

Materials and Methods: The studies that were included provided the following PEOS components: Population (P): Indian Endodontists; Intervention (I): working conditions/ergonomics/prolong static exposure; Outcome (O): musculoskeletal disorder and Study design (S) – cross sectional studies. The literature search was conducted from inception to April 2021, using the databases PubMed, Cochrane, Google Scholar and hand search from the included articles. Quality assessment of the included studies was performed with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist for cross sectional survey.

Results: A total of 5 studies were included in this systematic review. Among the included articles, 3 studies showed low risk of bias and 2 studies had moderate risk of bias. Prevalence rate of musculoskeletal disorder and pain among Endodontists in India ranged from 8.2% to 88.2%. Among the body region the neck was most commonly affected followed by shoulder and upper back regions. Potential occupational risk factors associated were working posture of operator and the number of patients treated. Due to the heterogeneity of the included studies meta-analysis could not be performed.

Conclusions: Musculoskeletal disorders and pain are significant health burden for dental professionals. Our systematic review showed a high prevalence rate of musculoskeletal disorders among Indian Endodontists with neck and shoulder being more commonly affected.

Clinical Significance: Musculoskeletal disorders is one of the important causes for long-term pain and disability affecting dental professionals. Our systematic review showed a high prevalence rate of MSD associated with several regions of the body among the Endodontists in India. Therefore, suitable interventions for preventing MSD and pain are needed.


  Abstract 97: A canal less known: Assessing the prevalence of canalis sinuosus and its features using cone beam computed tomography Top


Sankkesh Jain

DY Patil University - School of Dentistry, Navi Mumbai, Maharashtra, India

Aim: The aim of this study was to observe and evaluate the prevalence and location of Canalis Sinuosus (CS) and its features in the premaxillary region using Cone Beam Computed Tomography.

Materials and Methods: This study was designed as a retrospective analysis of 100 CBCT images. Patients in age group of 20 to 60 in and around Mumbai were included in the study. A single 360° scan collected the projection data for reconstruction. Only high resolution images were included. The scans were viewed axially and sagittally to identify and locate Canalis Sinuosus and its features. The following parameters were registered: Sex, Presence of CS, location of CS in relation to the nasopalatine foramen, unilateral or bilateral, presence of branches and accessory canals.All the obtained images were evaluated twice by the same observer at a 1-month interval. A Chi-square test was used to analyze obtained values.

Results: 92% of the cases showed presence of CS. All cases showed bilateral occurrence of CS. There was no significant association seen between presence of CS and gender of the patient(p>0.05). A significant difference was seen when related to the position of CS and Gender (p<0.05). The most common location of CS was anterior and lateral to nasopalatine foramen.

Conclusion: CBCT analysis showed a high prevalence of CS with bilaterality and presence of accessory branches in most of the cases.


  Abstract 98: Effect of calcium hydroxide on fracture resistance and microhardness of dentin in human teeth: A systematic review Top


Simar Sethi, Dax Abraham, Arundeep Singh, Alpa Gupta

Manav Rachna Dental College, Faridabad, Haryana, India

Objective: Calcium hydroxide to date is a widely used intracanal medicament during endodontic treatment. The long duration of exposure of dentin to calcium hydroxide may influence the fracture resistance and microhardness of dentin thereby affecting the tooth. This review aimed to identify and systematically analyze the effect of calcium hydroxide on fracture resistance and microhardness of dentin in human teeth.

Methods: Data sources - A PubMed search was performed using keywords 'fracture resistance' and 'microhardness' along with MeSH terms 'Calcium hydroxide' and 'dentin' and 'tooth' from 1956 to 10th June 2021. The search was expanded by the inclusion of the Scopus database using the same keywords and timeline. The reference list of each selected article was also explored to identify additional articles. An inclusion criteria was set that had to be met by each study for it to be selected for the review. The review was conducted according to the PRISMA checklist. Study eligibility and data synthesis – The protocol of the review was registered with Open Science Framework (OSF) with DOI No. 10.17605/OSF.IO/ZU8V4. Ten in-vitro studies that fulfilled the inclusion criteria were included in this review of which, 1 study evaluated both fracture resistance and microhardness, 4 studies evaluated only fracture resistance, and 5 evaluated only microhardness. The eligible studies were then analyzed by two evaluators and subjected to assessment of the risk of bias and data extraction.

Results: Analysis showed that increased duration of exposure of dentin to calcium hydroxide decreased the fracture resistance and microhardness of dentin thereby affecting the fracture resistance of the tooth. Further, 1 week of exposure to calcium hydroxide did not show any significant change in fracture resistance.

Conclusion: Based on the analysis of the studies included in this review, it can be concluded that the increased duration of exposure of dentin to calcium hydroxide negatively affects fracture resistance and microhardness, thereby weakening the tooth.


  Abstract 99: Tooth structure loss associated with different full coverage restorations: A systematic review Top


Meenakshi Ramanathan, Hari Raghavendar, R Mathan Rajan, A Chakravarthy

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

Objective: The objective of this systematic review was to assess the tooth structure loss associated with different full coverage restorations.

Materials and Methods: A systematic literature search was conducted for studies from inception till April 2021, using the electronic databases PubMed, Cochrane, LILACS, Ebscohost and Google Scholar. Hand searching was also performed from the included articles. Both anterior and posterior tooth preparations on extracted human teeth and typhodont teeth were included as population. The outcome evaluated was the amount of tooth structure loss associated with different full crown restorations. A modified Joanna Briggs criteria for in vitro studies was used to assess the quality of the included studies.

Results: A total of nine studies were included in this systematic review. The loss of tooth structure was 24.6% for metal crowns in posterior teeth. For all ceramic anterior crowns, the amount of tooth structure loss ranged from 30.41% to 70%. For posterior all ceramic restorations, amount of tooth structure lost ranged from 21.51% to 72.3%. For anterior porcelain fused to metal crown preparations, the minimum amount of tooth loss was 18.3% and the maximum was 71.9%. For posterior porcelain fused to metal crown, the least amount of tooth structure removed was 44.23% and the maximum amount was 75.6%.

Conclusion: Tooth preparation for a full metal posterior crown resulted in the least amount of tooth structure removal compared to other full coverage restorations. Porcelain fused to metal resulted in the greatest amount of tooth structure loss in both anterior and posterior teeth.

Clinical Significance: The clinician should choose a full coverage restoration whenever possible with a least invasive preparation design to preserve maximum amount of tooth structure that is already weakened by caries/trauma/endodontic intervention.


  Abstract 100: Applications of three-dimensional printing in endodontics Top


Sangita Ilango, Senthil Kumar Kumarappan, Sadasiva Kadandale, K Deepthi

Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India

3D printing is a recent advancement in dentistry utilized for the management of complex cases. In the field of Endodontics, 3D printing aids in preparing access guides to orient burs in obliterated canal spaces, provides preformed 3D guides for accurate auto transplantation of teeth and preparation of surgical stents in periapical surgeries to replicate the preplanned access route in complicated cases. Students, clinicians, and patients often desire for realistic models to understand the clinical scenario. With 3D printing, it is possible to print these models with unusual anatomies for easy perception and better understanding. This review paper explores and discusses the evolution of the printing systems and the current and potential applications of 3D printed models and guides in Endodontics.


  Abstract 101: Management of split tooth: A novel approach Top


K Farjana Begam, Manali R Srinivasan, Diana Davidson

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

Longitudinal fractures of the tooth/teeth are linear fractures that tend to extend over a period of time. Occlusal wedging forces, impact trauma, and dental procedure can result in anterior and posterior teeth fractures. A split tooth falls under the classification of longitudinal fractures. Prognosis and treatment for split tooth depends on the site and extent of the fracture. This case presentation involves the management of split in the maxillary central incisor. This presentation highlights an innovative treatment approach. On clinical examination, 11 exhibited a fracture which was running mesiodistally separating the labial and the palatal fragments, and the fracture extended to the middle third of the root. The fractured coronal segments were approximated using bonded composite. To maintain the canal patency and ensure adequate depth of light penetration, a light transmitting post was used. The tooth was then endodontically treated. After endodontic therapy, a rectangular flap was raised between the distal of 12 to the distal of 21. The entry point was made on the labial side of the tooth. The channel created, transversed through the root canal and involved the entire labial and palatal sides. The bone screw was introduced into the channel and the split was stabilized. The flap was then repositioned with simple interrupted sutures. Follow up was done at 3, 6 and 12month intervals. Considering split in anterior teeth, an attempt to salvage the tooth could be of greater significance if a definitive diagnosis and treatment plan could be achieved.


  Abstract 102: Comparative evaluation of the fracture resistance of re-attached tooth fragment using biological dentin post with fiber reinforced composite post: A pilot study Top


Ansy Hanna Kurian, Alpa Gupta, Dax Abraham, Arundeep Singh, Parul Chauhan, Sucheta Jala

Manav Rachna Dental College, Faridabad, Haryana, India

Aim: To evaluate and compare fracture resistance of reattached tooth fragment using biological dentin reinforcement with fiber reinforced composite post.

Materials and Methods: Three sound permanent maxillary central incisors were selected and mounted in acrylic blocks. Teeth were sectioned through the middle third of the crown at a distance of 3mm from the incisal third using a diamond disc to simulate Ellis Class II fracture and randomly divided into 3 groups (n = 1), Groups A, B and C. In Group A, fractured fragment was reattached using composite. In Groups B and C, two vertical grooves 2 mm deep, 2 mm wide, and 5 mm in length were placed on the palatal surface perpendicular to the fracture line. Group B was restored with two biological dentin reinforcements whereas Group C was restored with two fiber-reinforced composite (FRC) posts. The remaining part of the vertical grooves were filled using composite. The fracture resistance of all the teeth were tested in a universal testing machine with load applied along the long axis of the teeth at a crosshead speed of 1mm/min on the buccal surface. The force required to fracture the reattached teeth were recorded Newton (N).

Results: Teeth in Groups A and C required lesser force to fracture when compared with the tooth of Group B.

Conclusion: This preliminary study indicates that reattachment by vertical grooves with biological dentin reinforcements may help in improving the fracture resistance and can be a preferred method. To the best of our knowledge there is no literature where in attempt was made to reattach fractured fragment using vertical grooves and furthur restoring with dentin reinforcements.


  Abstract 103: Intentional replantation – An intercountry knowledge, attitude and practice survey Top


V Praveen Kumar, Sadasiva Kadandale, SenthilKumar Kumarappan

Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India

Objective: The aim of this study was to examine the practice of Intentional replantation as a treatment modality among Endodontists and postgraduate students in India, United Kingdom and United States of America.

Materials and Methods: The sample size was calculated according to the pilot study with 30 participants and final sample size was obtained as 228. A total of 22 questions were finalized after validation by two endodontic experts. An invitation to participate in the survey along with the weblink was circulated through various online social platforms. Survey participants were asked about the case selection, antibiotic coverage, extraction methods, hydration medium, root end preparation & filling materials, prognostic indicators and patient acceptance level of Intentional replantation treatment modality.

Statistical Analysis: The data was statistically analysed using chi square test. Descriptive and Inferential statistics were analysed by IBM SPSS version 20.0 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Throughout the study, a P value of <0.05 was considered as statistically significant difference.

Results: There was a significant difference (P<0.05) in the knowledge, attitude and practice among the practitioners in different countries. About 72.8% of the respondents view Intentional replantation as another treatment modality. Many participants choose Intentional replantation as a cost effective treatment when compared to extraction followed by single tooth Implants (86.4%).Most of the respondents prefer ultrasonics for root end preparation (75.4%) and commonly used root end filling material was Biodentine (62.3%).Of the total participants, 45.3% have done a case of Intentional replantation with follow up, in which the majority of the participants was from UK followed by USA. Patient acceptance level was found to be better in Western countries when compared to India.

Conclusion: There has been a continuous evolution in techniques of Intentional replantation through the years with consistency in following the modern endodontic surgical principles.The trend over Intentional replantation is slowly blooming as a another treatment modality than last resort with the increased number of practitioners doing cases. There was a increased patient acceptance level shown in UK and USA when compared to India.


  Abstract 104: Comparative evaluation of volumetric substance loss and precision in selective re-treatment of maxillary premolars with guided versus conventional access cavity preparations: An in vitro study Top


Mili Rohra, Purnil Shah, Ankit Arora, Sonali Kapoor, Dipak Vaghamshi, Avani Gorvadiya

Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India

Aim: To compare the volumetric substance loss and breach of dentin in selective retreatment cases between conventional and 3d guided access opening in maxillary premolars.

Materials and Methods: 22 freshly extracted two rooted upper first premolars were selected and divided into two groups. (n=11). Pre-treatment cone beam computed tomography (CBCT) imaging of all teeth were done. Root canal treatment was completed for both the groups and final restoration was done using occlusal stamp technique to obtain the original anatomy.

Group 1: Re-access cavity preparation was done to locate the palatal canal orifice with the conventional method under magnifying loupes.

Group 2: Re-access cavity preparation was done with 3D printed guide devised from pre-operative CBCT and customized bur was used to locate the palatal canal orifices.

After the selective retreatment, post-operative CBCT images were taken for both the groups. Substance loss was measured checked using Ez3D-i-3D software (VATECH) and precision was determined by calculating the number of teeth in which dentin was breached using the same software.

Results: The substance loss was significantly higher in Conventional access opening with a t value of 4.591 & is statistically significant with P value of 0.001. Dentin involvement was significantly higher around 72.7% in conventional access opening with P value of 0.033.

Conclusion: Guided endodontic access along with a customized bur leads to significantly less substance loss. The technique was precise as it prevented breach of dentin during access cavity preparation when compared with the conventional method.


  Abstract 105: Preparation of novel zinc oxide, silver and chitosan based nanocomposite and its antimicrobial effectiveness against enterococcus faecalis: An in vitro evaluation Top


Jerry Jose, Ajitha Palanivelu

Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India

Introduction: The use of green mediated synthesis of nanoparticles in recent era have shown a greater interest for their biocompatibility and reduced overall cost of the production process. The aim of present study was to evaluate a novel nanocomposite made using Zinc Oxide (ZnNP), Silver (AgNP) and Chitosan (CNP) using Lemon as a cross linking agent and to evaluate its antimicrobial effectiveness against Enterococcus Faecalis.

Material and Methods: The nanoparticles were prepared individually and developed to form a nanocomposite. The analysis of the properties of the nanocomposite was done by subjecting it to characterization using UV-Vis Spectroscopy (UV-Vis) and Trans electron Microscopy (TEM). The antimicrobial action was evaluated for minimum inhibitory concentration (MIC) and maximum bacterial concentration (MBC) using Tube Assay. A time kill assay was also done to evaluate the potency against Enterococcus Faecalis at different time intervals. For statistical analysis, Friedman's test was used to compare absorbance at different time intervals.

Results: Novel nanocomposite has shown a homogenous nanoparticle size under TEM and showed an absorption range of 350-420 nm making it similar to the individual counterparts. The MIC was seen at 62.5 mg (p<0.05) and MBC was seen at 250 mg (p<0.05).

Conclusions: Within the limitations of the present study, the novel Silver-Zinc-Chitosan-based nanocomposite (AgZnCNC) showed an improved antimicrobial action against Enterococcus Faecalis than its individual components under-tested laboratory conditions.


  Abstract 106: Impact of chemomechanical preparation of the root canal on periapical healing: A systematic review Top


Aparnna Sreeprakash, GS Aishwarya

Thaimoogambikai Dental College, Chennai, Tamil Nadu, India

Introduction: The extent of preparation during root canal treatment is a matter of debate. Some studies have showed that aggressive preparation can allow better removal of infected dentin, enhance the flushing action of irrigants in the apical region and significantly reduce the bacterial load in the canal system and promote periapical healing.

Aim: The purpose of this systematic review was to determine the effect of chemomechanical preparation on the healing of periapical tissues in patients undergoing root canal therapy. An electronic search was done using PubMed database, Cochrane, Open grey and Scopus. Inclusion criteria were human in vivo studies comparing influence of different root canal treatment protocols on clinical and radiographic outcome of root canal treatment. Exclusion criteria included animal or lab studies. Risk of bias was measured and tabulated using the Cochrane tool.

Results: Based on inclusion and exclusion criteria, 5 articles from a total of 169 articles were identified that met the inclusion criteria. Of these 5 studies, 2 studies showed low risk of bias and 3 studies demonstrated high risk of bias over all.

Conclusion: Evidence from studies with low risk of bias have shown that for patients with necrotic pulps and periapical lesions, chemomechanical preparation of the canal would result in an increased healing outcome in terms of clinical and radiographic evaluations. The results of this systematic review confirmed that more evidence-based research is needed.


  Abstract 107: Accuracy of determination of working length by apex locators: A systematic review Top


S Judith Shereen, Asma Rafiq

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

Introduction: Apical constriction has been proposed as the apical limit for the endodontic working length. This systematic review aimed to evaluate the accuracy of electronic apex locators (EALs) in determining the working length.

Methods: An electronic search in databases was performed for relevant articles. Studies comparing accuracy of electronic apex locators in human teeth were included in the review.

Results: From 193 articles, only 8 studies met the inclusion criteria. The mean distance from apical constriction to major foramen was 0.4mm. Apical foramen more than 1mm was more than 90%. The average apical foramen diameter was 0.45mm and apical constriction diameter was 0.3mm.

Conclusion: There was no significant difference in accuracy of working length determination among the apex locators evaluated.


  Abstract 108: Effect of calcium hydroxide vehicle on post operative pain: A scoping review Top


Kritika Aneja, Alpa Gupta, Dax Abraham, Arundeep Singh, Parul Chauhan, Sucheta Jala

Manav Rachna Dental College, Faridabad, Haryana, India

Objectives: This review aimed to identify the influence of vehicle and its concentration used to carry calcium hydroxide (CH) medicament on post-operative pain.

Methods: The protocol of this study was registered in the open science framework (Registration DOI- 10.17605/OSF.IO/4Y8A9) and followed the Joana Briggs Institute guidelines. Reporting was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The literature search and screening were performed in PubMed/Medline and Scopus, and additional records were analysed manually through various sources. The selected studies were published in English and included the use of any vehicle in adjunct to CH to evaluate post-operative pain with the help of any qualitative and quantitative pain assessment tools. A descriptive analysis was performed to consider the study design, the characteristics of vehicle and the effect of vehicle.

Results: Initial search yielded 6469 studies out of which 10 were included after removal of duplicates and full text screening. On the basis of collected data, the commonly used vehicles for CH were chlorhexidine (CHX), normal saline, Camphorated paramonchlorophenol (CPMC)/ glycerine and lidocaine, which showed a profound effect on post-operative pain.

Conclusion: The majority of studies corroborated a positive effect on use of vehicle on post-operative pain. Although, higher concentrations of vehicles used were found to alter pain levels postoperatively, further randomised controlled trials are required to reach a definitive conclusion. Our scoping review indicates that future studies should focus on using different vehicles at various concentration and application time to check for viable and safe exposure in addition to providing pain relief.


  Abstract 109: The role of cryotherapy in reduction of post-operative pain in patients with irreversible pulpitis and/or apical periodontitis: A randomized controlled clinical study Top


Hemal Patel, Sonali Kapoor, Ankit Arora, Purnil Shah, Tejasvini Prajapati

Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India

Aim: To compare and evaluate the role of cryotherapy in reducing post-operative pain after biomechanical preparation in irreversible pulpitis and/or apical periodontitis.

Methodology: 30 patients with single rooted tooth with irreversible pulpitis and/or apical periododntitis were randomly divided into 2 groups. Group 1(Control group)(n=15) final irrigation done with normal saline stored at room temperature. Group 2(Study group)(n=15) final irrigation done with normal saline refrigerated at 2-5'c. Irrigation was performed with 5ml side-vented 30 gauge needle with sodium hypochlorite and it was warmed using fast-pack device for 5 seconds and final irrigation was performed respectively according to the group. Pain scores were recorded using Heft Parker visual analogue scale pre-operatively, 24 and 48 hours. The data was analyzed with SPSS software version 20.0. Repeated measure ANOVA and unpaired t test was used for inter-group analysis at all three levels:- Pre-operatively, 24 and 48 hours.

Results: Pain reduction was more in study group than control group from pre-operative to 24 and 48 hours period. Statistically significant difference was observed in pain between control and study group.

Conclusion: Using normal saline irrigation stored at 2-5°c as final irrigant reduces post-operative pain in patients with irreversible pulpitis and/or apical periodontitis.


  Abstract 110: Comparative evaluation of gel based regenerative scaffolds in vital pulpotomy procedures on permanent posterior teeth: A randomized controlled clinical study Top


Dilshad Mandviwala, Sonali Kapoor, Ankit Arora, Purnil Shah, Kesha Vasavada

Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India

Aim: To compare the performances of Platelet-rich fibrin (PRF) and Chitosan-Gelatin scaffolds as regenerative agents in pulpotomy procedure for mature permanent posterior teeth with pulpitis.

Materials and Methodology: Forty-eight patients were recruited as per the inclusion criteria of this randomized controlled clinical study. The teeth were divided into two groups: Platelet rich fibrin (PRF) (n=24) and chitosan gelatin scaffold (n=24). Clinical examination after 48 hours, 7 days, 3 months and 6 months and radiographic examination at three months and six months interval were carried out after treatment. Mann-Whitney U test was done for comparison of pain scores between the two groups. The clinical and radiographic outcomes between the two study arms were compared using Pearson Chi-square test.

Results: Visual analogue scale (VAS) for pain revealed higher scores for PRF group as compared to chitosan-gelatin group, however the difference was not statistically significant. Radiographic success rate at three months for PRF and chitosan-gelatin groups were 70.83% and 87.5% respectively and at six months it dropped to 63.6% and 87.5% for PRF and chitosan-gelatin groups respectively (p value: 0.219). Clinical success rate at six months for PRF and chitosan-gelatin groups were 68.18% and 83.3% respectively (p value 0.114). Six months overall success rate for PRF and chitosan-gelatin groups were 65.89% and 85.4% respectively (p value: 0.1376).

Conclusion: Pulpotomy can be considered as a treatment option for permanent teeth with deep caries and diagnosis of reversible or irreversible pulpitis as it has an acceptable success rate. There exists no statistically significant difference between the overall success rates of PRF and chitosan-gelatin groups as pulpotomy agents.


  Abstract 111: Comparison of antibacterial efficacy of madhuca longifolia seed extract and sodium hypochlorite as an intracanal irrigant: A randomized controlled trial Top


Sindhu Ramesh, T Aishuwariya

Saveetha Dental College, Chennai, Tamil Nadu, India

Aim: To compare the antibacterial efficiency of Madhuca Longifolia Saponin seed extract and 3% Sodium hypochlorite as an intracanal irrigant.

Materials and Methods: In this randomized controlled trial, 26 teeth were selected with a mean age group between 18-65 years according to the inclusion and exclusion criteria. Based on block randomization, the teeth were divided into groups. Group I-Madhuca Longifolia Saponin -Test irrigant (n= 13) and Group II-3% Sodium Hypochlorite (n=13). Access cavity preparation was done, working length was determined, pre irrigation sample (S1) was taken, cleaning and shaping was done with the respective irrigants. Later post irrigation samples (S2) were obtained. Samples were sent for microbiological analysis.

Results: Madhuca longifolia group showed 73% and 58% reduction in aerobic and anaerobic groups respectively. Sodium hypochlorite showed 66% and 55% reduction in aerobic and anaerobic groups respectively. The results were not statistically significant.

Conclusion: Within the limitations of this randomized controlled trial we can conclude that Madhuca longifolia saponin seed extract has been proven to have antibacterial effect. However, it was less effective than the Sodium hypochlorite. More clinical trials are required to explore its other properties as an endodontic irrigant and its interactions with endodontic materials.


  Abstract 112: Comparison of intraoral periapical and cone-beam computed tomography for diagnosing horizontal root fractures: Systematic review Top


S Vidya Lourdu Jeeva, Sanjna Yadav

Thai Moogambigai Dental College, Chennai, Tamil Nadu, India

Introduction: Horizontal root fractures (HRF) are the most common type of traumatic injuries. The radiologic evaluation of root fractures is usually performed with periapical and occlusal radiographs. However, the introduction of cone beam computed tomography (CBCT) has created new diagnostic possibilities in dentistry.

Aim: The aim of this review was to compare conventional radiograph and CBCT in diagnosing horizontal root fracture.

Methods: An electronic search was conducted for relevant articles. Studies comparing CBCT and conventional radiograph for diagnosing horizontal root fractures were included and screened.Quality assessment diagnostic accuracy studies-2 tool(QUADAS-2) was used to assess the screened articles

Results: From 326 articles 3 studies met the inclusion criteria. Risk of bias showed 2 articles in patient selection domain had low RB and low applicability concern. All selected articles had unclear RB in index test and with flow and timing.

Conclusion: There is low evidence indicating CBCT being a good tool for diagnosing horizontal root fracture in comparison with IOPA.


  Abstract 113: Autologous demineralized dentin matrix - The game changer in regenerative endodontics Top


Shubham Goyal

Army Dental Centre R&R Hospital, Jaipur, Rajasthan, India

Dental pulp is a loose connective tissue that is encased in a low compliance mineralized tissue. Pulp tissue can be damaged by various routes like bacterial, chemical, and mechanical, and its low compliance against damage results in removal of pulp during the endodontic procedure which makes the tooth fragile. Thus the preservation of pulp vitality is very important for tooth viability as it helps in retaining all its functions, including vascularity, innervation, neurosensory, immuno-competency, and proprioceptive functions of teeth. Over the years various materials like calcium hydroxide and bioceramics are being used for pulp therapies which have certain limitations like tunnel defects and mild to moderate cytotoxic effects when placed in direct contact with the pulp tissues. The most important issues with these materials are the biological response of these materials are reparative rather than regenerative. Hence with the advent of research and technology, there is a dire need of biologically based autologous materials for the repair and regeneration of the dentin pulp complex. An autologous demineralized dentin matrix is a scaffold material with exciting regenerative properties. So this review illustrates the various prospects of the Demineralized dentin matrix and its clinical insight into regenerative endodontic therapy.


  Abstract 114: Phage therapy in enterococcus faecalis colony dysbiosis: An unexplored novel avenue Top


Roma Kotia

Army Dental Centre (R&R), New Delhi, India

Resistance to antibiotics is a fast-growing issue faced by all major sectors of health care, including dentistry. The various recurrent infections related to multidrug-resistant bacteria in hospitals are remediless and question the effectiveness of drugs. Two major causes for these recurrent infections are acquired antimicrobial resistance genes and biofilm formation, although the conventional techniques failed to resolve these issues. Hence, new techniques to resolve antibacterial practice have become inevitable. In dentistry enterococcus faecalis is the most challenging pathogen to eradicate and a major cause of recurrent root canal treatment failures. Bacteriophages (phage therapy) can be an effective remedy for such infections. They are viruses that are skilled to destroy bacteria and were discovered in 1915, but the importance of their study has been limited since the advent of antibiotics. Their use in endodontics is still very limited. Enterococcus faecalis, is the most common threat which is observed in recurrent root canal treatment failures is a hard-to-eradicate pathogen in dentistry of which the most problematic to treat is its biofilm-forming vancomycin-resistant strains. Studies have shown an effective response against such infections by the use of bacteriophages. The potential of bacteriophages, in particular against Enterococcus faecalis biofilms in root canals, is almost unexplored. This article reviews bacteriophage structure, mode of action, use in endodontics and the efforts to develop phage therapy against Enterococcus faecalis biofilm as well as the advantages and limitations of phage therapy.


  Abstract 115: Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with chronic apical periodontitis and open apices: A systematic review Top


Maulee Sheth, Sonali Kapoor, Ankit Arora, Purnil Shah, Hardik Rana

Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India

Regenerative endodontic therapy holds the promise of prolonged use of natural dentition through predictable maintenance of dental root structure. Moreover, the absence of an apical constriction makes root canal treatment problematic because of the difficulty to obtain a seal with conventional obturation methods. Regeneration of an infected immature tooth with apical periodontitis had once been thought to be impossible. However, if a suitable environment could be achieved, i.e. absence of intracanal infection and presence of a scaffold conducive to tissue ingrowth, then regeneration might take place. Mineral trioxide aggregate has been known to show acceptable long term clinical outcomes. However, comparative studies of MTA and Regenerative endodontic treatment in the cases of chronic apical periodontitis are scarce. The aim was to conduct a systematic review of the literature on the role of Regenerative endodontic treatment in treating chronic apical periodontitis and open apices. The literature search was performed in 4 electronic databases PubMed/Medline, Google Scholar, COCHRANE Library, SCOPUS in English language up to December 2020 to include studies that evaluated regenerative endodontic treatment approach in teeth with chronic apical periodontitis and open apex. In this systematic review, any organized attempt to revitalize an immature tooth to induce root development was considered as Regenerative Endodontic Therapy. If the clinician filled the apical part or the entire root canal space with MTA without the intention of revitalizing the tooth, the treatment was considered as MTA Apical Plug.

Results: In all, 1397 studies were identified and after considering the inclusion and exclusion criteria 17 studies were selected for qualitative synthesis. In the Regenerative Endodontic Therapy group, out of 52 teeth (across 13 studies), 43 teeth showed Success & 9 teeth showed Functional Retention whereas in the MTA apical plug group, out of 36 teeth (across 4 studies) 30 teeth showed Success and 6 teeth showed Functional Retention.

Conclusion: Root development is considered a major advantage of Regenerative Endodontic Therapy over apexification using MTA Apical Plug.

Regenerative endodontic therapy could be effective for managing immature permanent teeth with apical periodontitis with appropriate case selection.


  Abstract 116: Comparative assessment of anti bacterial effect of iron oxide nanoparticle with 3%hydrogen peroxide and silver nanoparticle with 3%hydrogen peroxide irrigants against enterococcus faecalis Top


Nandhakumar Jayavel, Suji Selvam, Nandhini Ambalavanan, Kavitha Mahendran

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

Aim: To evaluate and compare the antibacterial efficacy of iron oxide nanoparticle with 3% hydrogen peroxide and silver nanoparticle with 3% hydrogen peroxide irrigants against Enterococcus faecalis in root canal by assessing the microbial colony count.

Materials and Methods: 60 extracted mandibular premolar teeth were decoronated and chemomechanically prepared. Biofilm was allowed to be formed inside the root canals of specimens by incubating it for 21days in BHI broth infected with E.faecalis. Based on the mode of treatment, the specimens were randomly divided into 4 groups (n=15): Group I- Phosphate-buffered saline (PBS) (negative control), Group II- 3% H2O2 (positive control, Group III- Silver nanoparticle with 3% H2O2 (0.5 mg/mL) (Ag-NP+3% H2O2) and Group IV- Iron-oxide nanoparticle with 3% H2O2(0.5mg/mL) (IO-NPs+3% H2O2)). The Samples were obtained by scrapping # 35 Headstrom file inside the root canal, cultured and were subjected to microbiological analysis to count the total number of colony forming units. Inter group comparison was done using ONE WAY ANOVA test. TUKEY'S POST HOC test was used for multiple comparison of colony forming units for each group.

Results: The Ag-NP+3% H2O2 group showed least number of CFUs after irrigation, and was followed by IO-NPs+3% H2O2 group and least effective was 3% H2O2. The saline group exhibited maximum number of CFUs. Between Ag-NP + 3% H2O2 and IO-NPs+3% H2O2 groups, there was no statistically significant difference (P>0.05) in mean colony forming units showing that they have comparable effects. All the experimental groups showed a very significant difference in the mean number of CFUs (p<0.01) when compared to the control group.

Conclusion: The ultilization of silver nanoparticle with hydrogen peroxide and iron oxide nanoparticle with hydrogen peroxide combinations as root canal irrigants proved to be effective against E.faecalis biofilm and could be considered as a promising adjunct in antimicrobial endodontic therapy.


  Abstract 117: Vital pulp therapy: A review of failed cases Top


Vrushti Ramanuj, Sonali Kapoor, Kesha Vasavada, Purnil Shah, Ankit Arora, Hardik Rana

Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India

In contemporary endodontics, vital pulp therapy (VPT) has been considered as an ultra-conservative treatment modality for mature permanent cariously or traumatically exposed teeth that preserves the remaining pulp tissues, but long-term outcomes of the pulp and the restoration are unknown. Based on the level of pulp preservation, VPT includes stepwise excavation, indirect pulp capping (IDPC), direct pulp capping (DPC), miniature pulpotomy (MP), partial/Cvek pulpotomy and coronal/complete pulpotomy (CP).The success rates of vital pulp therapy described in the literature vary significantly, especially for direct pulp capping after carious exposure. The diagnosis and therapy regimen regarding the state of the pulp and the resulting therapy are increasingly questioned, hence, it is required to evaluate the prognostic value of factors with regard to treatment outcome of vital pulp therapy. The aim of this review is to analyze failed cases of vital pulp therapy reported in the literature in terms of case selection, diagnosis, treatment protocols, signs of failure, factors affecting failure and additional endodontic interventions.


  Abstract 118: Incidence of pulpal necrosis in tooth with full coverage restorations: A systematic review Top


Sindhu Saeralaathan, Lakshmi Balaji, Malikka Navayath, Gheeerthana Venkatesh

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

Objective: Full coverage restorations may be given in vital teeth when the tooth is cracked or damaged by extensive decay or when it needs correction of occlusion or to anchor fixed prosthesis in place. The tooth itself having a reduced amount of residual tooth structure, undergoes a stressed pulp syndrome when subjected to further procedures like tooth preparation and impression taking, leading to pulpal necrosis. This loss of vitality is therefore the most common adverse effect of using a full coverage restoration. In this review, we aimed to systematically evaluate the incidence of pulp necrosis and the need for endodontic intervention in teeth that have previously received a full coverage restoration.

Materials and Methods: The systematic review was registered in PROSPERO and conducted following the PRISMA guidelines. The focused research question was framed according to PICOS as 'In human permanent vital tooth undergoing full coverage restoration what is the incidence of pulpal necrosis?' Electronic database and hand search was performed in five databases, MEDLINE PubMEd, Cochrane, LILACS, Scopus and Clinicaltrial.gov to extract published literature from inception to June 2021. The quality of the included studies was assessed systematically using MINORS tool for observational studies and the results will be interpreted and evaluated.

Results: A total of 13 articles were finally included in the systematic review after eligibility assessment. The risk of bias showed high credibility and low risk for all the studies. From the included studies with follow up periods of upto 25 years, it is evident that irrespective of the type of full coverage restoration, the method of preparation, temporisation material and luting cement the incidence of pulpal necrosis remains high.

Clinical Significance: Clinicians should heed caution in each clinical procedure required to deliver a full coverage restoration to avoid pulpal necrosis and extra caution should be taken in cases of a tooth that are restored previously to avoid aggravating an already stressed pulp.


  Abstract 119: Does increase in temperature of sodium hypochlorite have enhanced antibacterial efficacy and tissue dissolution property? A systematic review and meta-regression of in vitro studies Top


Arathi Ganesh, Lokhasudhan Govindaraju, Sowjanyaa Jenarthanan, Shruthi Selvi Thendapani, Desabhotla Yaso Manaswini

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

Objective: Sodium hypochlorite (NaOCl) being one of the most efficient root canal irrigant, has antibacterial and tissue dissolution property and is dependent on the concentration at which the solution is used. Literature has shown that increasing the temperature of NaOCl can accentuate the potency at lower concentrations. So, the aim of this systematic review was to determine whether increase in temperature of NaOCl irrigant improved its antibacterial efficacy and tissue dissolution property.

Methodology: The PICO format being Population(P) - extracted human teeth, bovine tissues and human pulpal tissues. Intervention(I) - increase in temperature of sodium hypochlorite, Comparison (C) room temperature sodium hypochlorite. The outcome(O)- Antibacterial efficacy and tissue dissolution property. To analyse the methodological quality of the selected articles, the critical appraisal checklist for quasi-experimental studies by JBI was modified and evaluated. A meta-regression analysis was performed for the articles evaluating the tissue dissolution property.

Results: A total of 292 articles were obtained after initial screening out of which 11 articles were included in this systematic review; five articles evaluated antibacterial efficacy and six articles evaluated tissue dissolution property. The risk of bias for articles included in both the outcomes was moderate. An increase in temperature of sodium hypochlorite increased the antibacterial efficacy in two of the included studies and three studies showed no statistical significance. Due to the heterogeneity in the included studies for antibacterial efficacy, meta-analysis was not performed. Quantitative analysis and meta-regression performed for articles evaluating tissue dissolution property showed sodium hypochlorite had 2.36-unit times increase in tissue dissolution property with a degree rise in temperature.

Conclusion: Considering the limitations of the included studies, increase in temperature has a positive synergistic effect on sodium hypochlorite's tissue dissolution property and has inconclusive evidence on antibacterial efficacy. Future studies should be performed by standardizing all aspects of irrigation, temperature and evaluation methods for conclusive evidence.

Clinical Significance: Increasing the temperature of NaOCl from room temperature has a better tissue dissolution property. Thereby, clinicians can choose to use a lower concentration of NaOCl at higher temperatures to avoid adverse hypochlorite accidents.


  Abstract 120: The effect of chitosan hydroxyapatite on mechanical properties of dentin Top


Balashankar Ajay, Sridhar Nivashini

Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India

Nanotechnology has been applied to dentistry as an innovative concept for the development of materials and treatment strategies. The potentials of dental nanomaterials are to eliminate biofilms, inhibit demineralisation and promote remineralization, to combat disease causing bacteria and repair previously diseased dentin matrix. Chitosan nanoparticles (CSs),a derivative of chitin (the second most abundant natural biopolymer), are ideal Non collagenous protein(NCP) analogs with advantages such as biocompatibility, antimicrobial property and structural similarity to NCP. Carboxymethyl chitosan (CMCS) is a water-soluble form of chitosan that stabilizes the dentin matrix and can be chemically grafted with molecules of interest to form nanocomplexes, which perform desired tasks in tissue engineering. One such example, chitosan-grafted hydroxyapatite precursor (CS-HA) nanocomplexes, has been previously used to facilitate biomimetic remineralization of collagen matrix, demineralized enamel, and dentin. When applied to dentin, CS- HA not only forms hydroxyapatite on the surface but does so in the reverse fashion as well which allows deeper penetration of mineralization while inducing inter- and intrafibrillar mineralization. In this review we will discuss in detail about CS-HA on the mechanical properties of dentin during conditioning since the mechanical properties of dentin are of paramount importance in all discussions of tooth strength so an understanding of this is essential to the proper interpretation of physical measurements of failure.


  Abstract 121: Regenerative endodontic treatment of an immature tooth with a necrotic pulp and apical periodontitis using blood clot and mineral trioxide aggregate: A case report Top


Harshveer Kaur

Punjab Government Dental College and Hospital, Amritsar, Punjab, India

The management of immature permanent teeth with pulpal necrosis is challenging as the root canal system is often difficult to debride and the thin dentinal walls are at an increased risk of a subsequent cervical fracture. Regenerative endodontic treatment is a biologically based treatment that is designed to replace damaged structures and cells in the pulp-dentine complex with live viable tissue which restores normal physiological functions. This approach unlike apexification and artificial apical barrier techniques allows continuation of root development resulting in an increase in both root wall thickness and the length of the root. This case report presents a Regenerative Endodontic treatment of an Immature tooth with a necrotic pulp and apical periodontitis using blood clot and mineral trioxide aggregate (MTA).


  Abstract 122: Management of vertucci Type V pattern in distal canal of mandibular first molar: A case report Top


Devina Tjokrosoeharto, Bernard O Iskandar, Selviana Wulansari

University Trisakti, Jakarta Barat, Indonesia

Complex anatomy of the root canal should be thoroughly understood for proper management and better diagnosis that will lead to successful root canal treatment. The anatomy and morphology of the root canal can be classified according to the Vertucci root canal classification system. In the Vertucci Yype V classification, apical third of root canal is divided into two separates root canals with two different apical foramen. Possibility of additional canal should be considered even in teeth with low frequency of abnormal root canal anatomy. Case report. The diagnosis of tooth 46 was symptomatic irreversible pulpitis with a normal periapical tissue. In the radiograph, distal canal was observed to be short, subsequently occurrence of another distal canal was suspected. Configuration of the root canal was established as Vertucci Type V. The distal canal orifice was extended buccolingually by using ultrasonic tips ET25 (Satelec) under high magnification dental operating microscope (DOM), thus the other was found in slightly distolingual direction. Bifurcation of the distal canal space was successfully located. Both distal canal was prepared using ProTaper Gold (Dentsply) and was obturated with warm vertical condensation technique, followed by class I composite restoration. Conclusion: Successful endodontic outcome in such case is dependent upon knowledge of root canal anatomy, careful interpretation of angled radiographs, proper access preparation and adequate treatment armamentarium for this anatomical variation.


  Abstract 123: Influence of apical patency in endodontic treatment outcome: A systematic review Top


Balaji A Dhakshinamurthi, Arathi Ganesh, Manigandan Kuzhanchinathan

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

Objective: Apical Patency is a technique where the apical portion of the root canal is maintained free of debris by recapitulation with a small file through the apical foramen. The purpose of this systematic review was to evaluate the influence of apical patency in endodontic treatment outcome.

Materials and Methods: The studies that were included provided the following PICO components: Population (P): patients receiving root canal treatment; Intervention (I): apical patency technique (AP); Comparison (C): non-apical patency technique (NAP); and Outcome (O): assessment of periapical healing. The literature search was conducted from inception to June 2021, using the electronic databases PubMed, Cochrane Library, LILACS, LIVIVO, Open Grey literature and an additional hand search was done from the included articles. Quality assessment of the included studies was performed with Newcastle-Ottawa quality assessment scale.

Results: Initial screening of databases resulted in 616 studies. Following the duplicates removal and abstract screening, 12 studies met the inclusion criteria and were selected for full text reading. Further, 8 studies were excluded since the treatment outcome was not evaluated. A total of 4 studies included in this systematic review for quantitative analysis. Among the included articles, two studies had low risk of bias and 2 had moderate risk of bias. Endodontic outcome was evaluated both clinically and radiographically in the included studies with a follow up period ranging from 1 to 4 years. Maintaining apical patency favored the endodontic treatment outcome by twofold with long term follow up. Due to the heterogeneity of the included studies meta-analysis could not be performed.

Conclusions: Within the limited clinical evidence available, it can be concluded that maintaining the apical patency is likely to enhance the endodontic treatment outcomes. However, more long term prospective clinical studies are required to further evaluate the possible influence of apical patency.

Clinical Significance: Apical patency prevents many complications, thus increasing the clinical survival and periapical healing of endodontically treated tooth. Achieving apical patency at the root canal terminus significantly increased the treatment outcome.


  Abstract 124: Nonsurgical endodontic treatment procedure followed by an intracanal bleaching in nonvital tooth with large radiolucency: A case report Top


Evan Hendra, Bernard Ongki Iskandar, Ade Prijanti Dwisaptaini

Department of Conservative Dentistry, Faculty of Dentistry Universitas Trisakti, Jakarta Barat, Indonesia

Tooth discolouration and a periapical abscess could occur on a non-vital tooth after a traumatic event. Patient's awareness about the change in colour of the tooth usually brought them to the dentist. The absence of pain after a traumatic event involving a tooth may mislead patients to think that their tooth is still vital. Patients often came with large radiolucency on the periapical tissue or after the condition became acute exacerbation. This case report describes the material and techniques utilized for non-surgical endodontic treatment followed by intracanal bleaching and direct composite resin restoration. A 22-year-old woman had a complaint regarding the colour of her upper tooth. She noticed the colour difference three months ago and stated that it had become more apparent. Clinical examination revealed that the tooth had a crown fracture, and a periapical lesion has occurred with a fistule appeared on the apical region of tooth 11. Radiographic examination showed a large periapical lesion occurred in the periapical region of the tooth. Endodontic treatment performed on the tooth using Protaper Next as a mechanical instrument. Chemical irrigant of 5,25% sodium hypochlorite, 17% EDTA and 2% chlorhexidine used with sonic activation. Calcium hydroxide sealer applied using lentulospirals. Canal obturation was performed using the continuous wave compaction technique. Wing barrier using glass ionomer cement was made to prevent leakage of the 35% hydrogen peroxide used for intracanal bleaching. The final restoration was done using direct composite restoration. Periapical healing observed during the final radiograph one month after obturation. Endodontic treatment followed with intracanal bleaching and direct restoration is still viable in managing a single non-vital fractured tooth. Intracanal bleaching using 35% hydrogen peroxide effectively removes discolouration pigments from the tooth when controlled carefully. Direct composite restoration could still be an option for crown-fractured teeth with a satisfactory result. Non-surgical endodontic treatment for a tooth with a large periapical lesion has a great success rate using the latest materials and techniques. Endodontic treatment followed with intracanal bleaching and direct composite restoration is a viable option in managing a single non-vital fractured tooth.


  Abstract 125: Efficacy of autologous platelet concentrates in vital pulp therapy procedures: A systematic review of human studies Top


Dev Veer Vikram Singh, Sonali Taneja, Vidhi Bhalla

I.T.S.C.D.S.R., Muradnagar, Ghaziabad, Uttar Pradesh, India

Introduction: Current systematic review aimed to evaluate the efficacy of the various autologous platelet concentrates compared to other capping agents in vital pulp therapy (VPT) procedures in human teeth.

Methods: After raising a PICO question; review was planned, conducted, and reported in adherence to PRISMA standards of quality for reporting systematic reviews and meta-analyses. Protocol was registered a priori at PROSPERO (CRD42020213072). Electronic search was carried in five databases and three trial registries, published up to 31st December 2020. Protocol registries and references of selected articles were also searched. Data extraction and risk of bias assessment was performed individually by two reviewers using piloted extraction forms and modified ROB tool developed keeping in mind Cochrane checklist as given in Cochrane Handbook for Systematic Reviews of Interventions.

Results: The overall search resulted in six hundred twenty one records; after exclusion, a total of six papers with 276 participants were included in the present review. PRF is the only autologous platelet concentrate studied, with pulpotomy being the treatment modality of choice. Owing to the high heterogeneity of the data set, meta-analysis was not carried out. High risk of bias was found in one study.

Discussion: No significant difference reported in the studies comparing autologous platelet concentrates with other materials in VPT procedures. Limitations of the present review - cost effectiveness was not studied as a parameter and clinical recommendations could not be made.

Conclusion: The number of publications exploring autologous platelet concentrates as capping agents are very limited. In future, more homogenous randomized clinical studies following recommended research protocols should be carried out. Cost-effectiveness analysis with alternative capping agents and treatment options should be carried out rather than analysis based solely on treatment outcomes.


  Abstract 126: Efficacy of sonic activation on irrigant solution for cleaning lateral canals: Case report Top


Daniel Sularso, Meiny Faudah Amin, Anastasia Elsa Prahasti

Department of Conservative Dentistry, Faculty of Dentistry, Universitas Trisakti, Jakarta, Indonesia

Cleaning and disinfecting the root canal system is one of the main objectives in endodontic procedure. Sonic irrigant activation is used to increase the efficacy of irrigant solution to reduce bacteria load, dissolve organic materials and remove smear layer. This method is useful especially because of irregular and complex anatomy of the root canal such as lateral canal. We present an endo-perio case with a lateral canal located on the mesiobuccal root of mandibular first molar and periodontal pocket. The tooth was diagnosed with pulp necrosis; acute apical abscess. Pre-operative radiograph showed a significant bone resorption and periodontium loss along the mesial parts of mesial roots. Root canal therapy and curettage were performed on the same day. Cleaning and shaping of the root canals were followed by irrigation protocol with NaOCl 5,25% and agitation with sonic vibration (EDDY, VDW GmbH). The apical size of mesial roots were 25.06 achieved by VDW Rotate (VDW GmbH). Radiograph, 10 months after treatment, showed an improvement of bone healing. Sonic agitation helps to remove debris, accelerate tissue dissolving capacity, and reach certain areas that are difficult to clean through mechanical preparation only. Sonic agitation is significantly superior to manual irrigation in terms of saving time, cleaning efficacy including lateral canals and create a more predictable outcomes of endodontic treatment.


  Abstract 127: The effect of various irrigation protocols during root canal treatment on periapical healing: A systematic review Top


G Dinesh, R Sharmila

Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India

Introduction: The goal of root canal treatment is to prevent or to treat apical periodontitis; therefore, the microorganisms in both planktonic and biofilm state should be removed from the root canal system. Irrigation procedures could disrupt the biofilm, remove the dentin debris and smear layer from the root canal wall.

Aim: The purpose of this systematic review was to determine effect of irrigation protocols on the healing of periapical tissues in patients undergoing root canal therapy. An electronic search was done using Medline database, Cochrane, Open grey and Scopus. Inclusion criteria was human in vivo studies, studies showing radiographic outcome using periapical radiographs or cone beam computed tomography and studies comparing different irrigation techniques. Exclusion criteria included animal or lab studies, studies with microbial or histological outcomes. Risk of bias was measured and tabulated using the Cochrane RoB 2 tool.

Results: Based on inclusion and exclusion criteria, 2 articles from a total of 501 articles were identified that met the inclusion criteria. Out of the 2 studies, 1 showed low risk of bias and another study demonstrated high risk of bias overall.

Conclusion: Only one study with low risk of bias showed that irrigation using lower concentration NaOCl is adequate for better outcome in teeth with pulpal necrosis and periapical periodontitis. Further studies evaluating microbial analysis along with radiograhic outcome of healing may help better understanding of the biology of healing after endodontic treatment.


  Abstract 128: Evaluation of color change of the tooth after regenerative endodontic procedure using two different scaffolds: An in-vitro study Top


Vimalesh Alagu, Krishnamoorthy Sridevi, Periasamy Ravishankar, Shanmugam Sandhya

Dr. M.G.R Educational and Research Institute, Chennai, Tamil Nadu, India

Aim: Aim of this study was to evaluate the color change of the tooth after regenerative endodontic procedure using two different scaffolds.

Materials and Methods: Mature human maxillary incisor teeth (n=20) were used in this study. To obtain a standardized length, root end was resected with high speed bur and root ends were sealed with composite resin. Access was gained and canals were enlarged and irrigated with 5 mL of 1.5% sodium hypochlorite, 5 mL of 17% EDTA, and a final rinse with 5 mL distilled water. Specimens were randomly divided in to two experimental groups: group 1 (Dentin sealing) and group 2 (without dentin sealing) which was further subdivided in to blood clot group and Platelet rich fibrin group based on the scaffold. Baseline color values were measured before the placement of scaffold and barrier material. Scaffold was then placed below the buccal CEJ and MTA was placed over the Scaffold in both experimental groups. The access cavity was sealed with a temporary restorative material and subsequent color changes (ΔE) were measured using spectrophotometer at different time intervals.

Results: There was reduction in tooth discoloration in sealed groups compared to nonsealed groups although there was no statistically significant difference.

Conclusion: Sealing the pulp chamber decreased the coronal discoloration compared to unsealed group following regenerative endodontic procedure.


  Abstract 129: Effect of biofilm on flexural strength of root canal dentin: A pilot study Top


Tejaswi Bollina, Saranya Dhanapal, Archana Durvasulu, B Santhosh Kumar, Jyothi Lexmi Chetty

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

Aim of the Study: The aim of this study was to evaluate the effect of multispecies biofilm on flexural strength of root dentin in different age groups.

Materials and Methods: 50 single rooted mature, caries free teeth were collected and stored in HBSS solution. Plaque samples from two different donors were used as test organisms. The teeth were cast in a polyester resin foundation to obtain rectangular dentin specimens of dimensions 10 x1.5x 05mm. The dentin beams were cut either in buccal–lingual axis using a numerically controlled slicer/grinder. 60 Dentinal beams were prepared as per the protocol from 50 donors. Group 1 (old) number of beams =20), Group 2 ((young) number of beams, n=20), Group 3 (Control group n=20). Multispecies biofilm was formed on the dentinal beams by placing them in the Thioglycolate broth mixed with the plaque culture for 3 weeks. These samples were then subjected to 4 point cyclic flexure with simultaneous exposure to the oral biofilm. Independent sample t test was used for the analysis (p value was <0.001).

Results: Young dentin showed significantly higher number of cycles to fracture (Nf) when compared to old dentin. The mean Nf in buccal beams of young age group was 3085.19±306.43 which was significantly higher than in old dentin (1981.93134.88).

Conclusion: Younger teeth had significantly higher flexural strength than old teeth in buccal- lingual quarters.


  Abstract 130: Préservation des dents - ensure to insure!! Top


Roshnee Bhattacharya, Sonali Taneja, Sana Fatima

ITS Dental College, Muradnagar, Ghaziabad, Uttar Pradesh, India

“Preservation of life is the only true joy”- Albert Schweitzer

A tooth in itself is an individual full of life and vibrance. A tooth might fall prey to various traumas and infections, leading to its loss. Eventually, the next step to it is replacement of the extracted tooth with a viable replacement. Dentistry has made a huge leap in the replacement of these diseased teeth. With replacements such as implants, comes along its downside like peri-implantitis, mucositis and generally 99% of them are unsuccessful. Hence, rationalized treatment options of preserving the tooth structure and moving for options such as intentional replantation, autoreplantation, decoronation, orthodontic extrusion where extraction can be avoided and interdisciplinary treatment modalities involving both endodontic and periodontal planning should be considered. Rather than extraction for replacement, the motive should be brought down to preservation for success!!


  Abstract 131: A silhouette guide for analyzing and managing tooth loss in post-endodontic treatment: A case series Top


Srujana Hemmanur, Jogikalmat Krithikadatta

Saveetha Dental College, Chennai, Tamil Nadu, India

Carious process and endodontic access cavity preparations result in loss of ample tooth structure. The restoration of endodontically treated teeth (ETT) ensures the survival of teeth and the success of the treatment by preventing reinfection. The choice of post-endodontic restoration must depend on the amount of lost tooth structure, type, form, and location of the teeth, the status of the periodontium, and overall maintenance of the patient. An array of options available as post endodontic restorations are direct composite restorations, indirect esthetic restorations like inlays, inlays using composite or ceramic, veneers, FVCs, and endocrowns. This presentation of three cases helps in designing and fabricating a prototype that analyses the loss of tooth structure percentage of tooth structure available on occlusal, facial, and proximal surfaces and guides towards selecting a suitable post endodontic restoration that is minimally invasive and esthetic.


  Abstract 132: Anti-microbial efficacy of nanoparticles using photodynamic therapy in endodontics: A systematic review Top


S Rene Jochebed, Sayisree Yarlagadda

Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India

Background: Photodynamic therapy (PDT) is the process wherein light of a specific wavelength acts upon a suitable photosensitizing agent in the presence of oxygen resulting in the production of free radicals. When applied in living systems, PDT results in targeted cellular and tissue injury with minimal injuries in the surrounding tissues. Nanoparticles have been used along with PDT to obtain maximum therapeutic effect in the target area. In endodontics, PDT is used to improve root canal disinfection without inducing bacterial resistance. The aim of this systematic review is to assess the anti- microbial efficacy of nanoparticles using photodynamic therapy in endodontics.

Materials and Methods: An extensive literature search was done in three electronic databases: PubMed, Web of Science and Scopus. The search was carried out using the following key words: photochemotherapy, photosensitizing agents, phototherapy, photo activated disinfection, light activated disinfection, endodontics, biofilms, anti-infective agents, nanoparticles. All articles in English language till June 2021 were considered. Out of the 966 articles obtained, 11 articles were selected which fulfilled the inclusion criteria. Quality assessment of the selected articles was done using Joanna Briggs Institute appraisal tool. Data was extracted and descriptive analysis was performed.

Results: Photodynamic therapy was commonly used with silver and chitosan nanoparticles and diode laser at a wavelength of 620- 660 nm. E. faecalis was the most commonly studied organism. Based on the evidence available so far, it can be concluded that nanoparticles in conjunction with photodynamic therapy has significant anti- microbial effect, and hence can be used as an adjunct to disinfection procedures in endodontics.


  Abstract 133: Efficacy of mouthwashes on SARS-CoV-2 viral load in the oral cavity: A literature review Top


Mohit Machiwal, Ruchika Roongta Nawal, Sangeeta Talwar

Maulana Azad Institute of Dental Sciences, New Delhi, India

The presence of SARS-CoV-2 in saliva suggests that the oral cavity is a potential reservoir for transmission of COVID-19. This puts dental healthcare professionals at high risk of nosocomial infections with SARS-CoV-2. Center for Disease Control and Prevention(CDC) recommends preprocedural use of mouthwashes due to their ability to reduce microbial count in the oral cavity. Therefore, this study intends to review the literature regarding current recommendations and effect of four different types of mouthwashes [Povidone iodine(PVP), Hydrogen Peroxide(H2O2), Cetylpyridinium Chloride(CPC) and Chlorhexidine digluconate(CHX)]in reducing SARS-CoV-2 viral load in the oral cavity. Published researches on PubMed and Cochrane databases were reviewed from January 2019 to May 2021. The initial search strategy identified 105 articles on two electronic databases. Clinical trials, Prospective and Observational studies evaluating the virucidal effect of mouth washes in SARS-COV-2 positive cases were included in this review. Only four articles which met the above mentioned inclusion criteria were included. According to the literature reviewed, PVP, CPC was found to be more effective than CHX and H2O2 in reducing the viral load from oral cavity. Suggested concentration of mouth washes are; 1.5 or 3%H2O2, PVP- 0.5 or 1%, CHX-0.12 or 0.2% and CPC-0.05 or 0.07%. On the basis of the outcomes of this review, it can be postulated that CPC and PVP commercial mouth washes may be effective in reducing the SARS-CoV-2 level in COVID-19 patients. The recommendation of a preprocedural mouth rinse with hydrogen peroxide and chlorhexidine digluconate is questionable. Therefore, further research on in vivo use of mouth wash before dental procedures is required to evaluate the antimicrobial efficacy of mouth washes on SARS-CoV-2.


  Abstract 134: Esthetic and functional rehabilitation of post endodontic treatment teeth on four maxillary incisors (a case report) Top


Yunda Witaradya, Tien Suwartini, Dina Ratnasari

Department of Conservative Dentistry, Faculty of Dentistry, Universitas Trisakti, Jakarta Barat, Indonesia

Esthetic and functional restoration of the anterior region is a significant aspect for the patient. Poor restoration and retroclined anterior can affect a patient's appearance and confidence. Esthetic analysis of facial, dentofacial, and dental, is the main key to improve an ideal smile. The gingival contour is also one of the factors that can affect the esthetic. Smile from an uneven gingival contour height or gingival zenith is also considered as an esthetic problem, it can influence the axial inclination and affect the smile's harmony. This case report presents endodontic treatment and restoration on maxillary incisors with compromised crown height, treated with comprehensive endodontic-periodontal-esthetic approaches using digital smile design for improving the esthetic. The digital smile design is used to help the treatment plan and communicate the expected result to the patient and the dental technician. A 31-years-old female patient presented poor restoration anterior teeth maxilla, gingival disharmony, and complained about tenderness when bitting. On clinical examination, there were resin composite restorations on teeth 11, 21, 22, and retroclined on tooth 12. A preoperative periapical radiograph showed a deep proximal secondary carious lesion involving the pulp, apical radiolucency on 12, and poor obturation on 11, 21. The facial harmony, dento-gingival, and teeth dimension were analyzed using digital smile design. The following clinical procedures were performed: endodontic treatment and re-treatment on teeth 12-22, gingivectomy on lateral incisor maxilla (tooth 12) using electrocautery. After three weeks of follow-up, the upper anterior teeth were restored with indirect lithium disilicate crown. The teeth were conditioned with 37% phosphoric acid, followed by washing and rinse. After that, the adhesive was applied to the teeth surface and blasted with air. The intaglio surface of the prosthetic was prepared with 9% hydrofluoric acid, washed with water, continue with the application of silane and adhesive. For the cementation, resin cement was used and photopolymerization was performed. It represents a successful esthetic treatment that improved a harmonious smile.


  Abstract 135: Biomimetic post endodontic crown - mimicking white spot (a case report) Top


Gregorio Davin Lie Usboko, Tien Suwartini, Elline Istanto

Department of Conservative Dentistry, Trisakti University, Jakarta Barat, Indonesia

Enamel decalcification, appearing as white spot lesions (WSLs), is an early lesion that occurs due to the loss of minerals in the enamel tissue. Clinically, it appears as an opaque white and has a softer texture than the surrounding healthy enamel. Oral hygiene is one of the factors that cause these lesions. In some early white spot cases, it can be treated by remineralization alone. However, in other severe white spot cases, lesions will be difficult to remineralization with minimally invasive treatment. A 22-years-old uncooperative female patient presented discomfort on tooth 21 on eating or drinking something cold without a history of trauma. Clinical examination showed tooth 21 had a severe carious lesion close to the pulp from the incisal part, with severe white spots on her surrounding and adjacent teeth. The tooth gave a positive response to the thermal test and was not tender to percussion and palpation. Preoperative periapical radiography showed there is no periapical radiolucency and deep carious lesions close to the pulp. The following clinical procedures: complete caries removal and access cavity preparation, instrumented and cleaning the canal thoroughly in one visit using Mtwo rotary Niti files (VDW) until 50.04. Irrigation was performed using 5.25% sodium hypochlorite at every file change and continued with 17% EDTA for final irrigation. The root canal was obturated with a bioceramic sealer and a fiber post was placed on the canal one week after obturation. The final restoration was using lithium disilicate with white staining on the labial part to mimicking the white spot from surrounding teeth and obtain a natural result. This case report will discuss the manufacture of a ceramic crown that resembles a white spot.


  Abstract 136: Endodontic management of endo-perio lesion restored with indirect restoration in mandibular first molar: A case report Top


Priyanka Azaria Syarif, Meiny Faudah Amin, Taufiq Ariwibowo

Faculty of Dentistry Trisakti University, Jakarta, Indonesia

The relationship between pulpal disease and periodontal disease occurs because of the close anatomical and vascular relationship between the pulp tissue and the periodontal tissue. Endo-perio lesions can occur because there is a connection between the pulp tissue and the periodontal tissue through three anatomic pathways which is, dentinal tubules, lateral canals, and apical foramen. Primary endodontic lesions with secondary periodontal involvement begin with the presence of necrotic pulp that causes an inflammatory response of the periodontal ligament in the area around the apical foramen or lateral canals or additional root canals. The process of spreading the disease will continue resulting in destruction of the alveolar bone in the periapical and furcation areas. Tooth 36 was diagnosed with pulp necrosis with chronic periodontitis. Pre operative radiograph showed large lesion reaching the bifurcation and there is periodontal pocket on the buccal and lingual areas. Scalling, root planning and endodontic treatment was performed, following with root canal sterilization by applying calcium hydroxide to the entire root canal wall and then covering it with temporary filling. The final restoration planned is a cuspal covarage porcelain fussed to metal crown restoration with fiber post. Radiograph after 3 months showed an improvement of the lessions. Most teeth with apical periodontitis are expected to improve after endodontic or nonsurgical treatment.


  Abstract 137: Battling COVID-19 as endodontists!!! Top


Annabelle Primola

Vivekananda Dental College for Women, Namakkal, Tamil Nadu, India

The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in millions of confirmed cases and hundreds of thousands of deaths. Despite all efforts to contain the spread of the disease, the number of infections and deaths continue to rise, particularly in some regions. Given its presence in the salivary secretions of affected patients, and the presence of many reported asymptomatic cases that have tested positive for COVID-19, dental professionals, including Endodontists, are at high risk of becoming infected if they do not take appropriate precautions. The COVID-19 pandemic has led to the absolute requirement for strict and effective infection control protocols beyond those that already exist within the dental setting. The management of endodontic emergencies has been particularly challenging during the COVID-19 outbreak because of the possible generation of airborne particles and aerosols. This review deals on the available endodontic guidelines and the clinical management of endodontic emergencies reported in the literature.


  Abstract 138: Multisonics in endodontics - A review Top


Sasmitha Chandrasekaran

Vivekananda Dental College for Women, Namakkal, Tamil Nadu, India

The endodontic success depends upon the complete eradication of vital and necrotic remanants of pulp tissues, micro-organisms and microbial toxins, although that might be achieved through chemo-mechanical debridement, it remains paradoxical for removal from the tortuous anatomy of the root canal including canal fins and isthumi. Therefore, irrigation with the irrigants meeting all the ideal requisites is the essential part of acheiveing the successful endodontic treatment. Those irrigants has to be activated such that it reaches and reacts within the entire complex anatomical root canal. In the extensive chronicles of irrigation in endodontics, efforts have been ceaselessly made to develop more effective machine- assisted irrigation agitation devices. Also the use of conventional treatment requires the removal of excessive radicular dentin which in turns is necessary for long time success. This however, has an adverse effect on integrity of the root and may lead to root perforations and fracture occurrence. There came the evolution of the novel Gentle - Wave system to the dental market to provide better resolution to all the above mentioned drawbacks and improves the treatment outcome while maintaining the integrity of the tooth structure. This system was designed for endodontist's as an alternative to standard root canal treatment. This literature review emphasis on the major advancements presented by the Gentle - Wave system utilizing multisonic technology with broad spectrum of sound waves within the canal anatomy showing more favourable treatment outcome with regards to tissue dissolution ability, negative apical extrusion, minimal invasion, depth of penetration of irrigants, post operative pain management, effectiveness in removal of separated instrument, healing ability and various properties and purposes throughout the entire root canal system and procedure.


  Abstract 139: Endodontic irrigation – Fluid dynamics: An update Top


Arun Karthika

Vivekananda Dental College for Women, Namakkal, Tamil Nadu, India

Endodontics is the art and science that deals with prevention and treatment of pulp and periradicular diseases. The success of root canal therapy relies on microbial control achieved by chemo mechanical preparation, irrigation and obturation of the root canals. The intricacy of root canal morphology has curved apical third, apical deltas, narrow isthmi, oval and ribbon shaped canals that cannot be mechanically cleaned. Bacteria can flourish in these untouched areas and it turned out to be a challenging objective to endodontists and also remains as a real cause for pulpal and periapical diseases. An interdisciplinary approach involving well- established methods from the field of fluid dynamics can provide new insights into the mechanisms involved in cleaning and disinfection of the root canal system. However, there is no one unique irrigant that can meet all the requirements, even with the use of modifying methods such as lowering the pH, increasing the temperature, as well as addition of surfactant to increase the wetting efficacy of the irrigant. More importantly, these irrigants must be brought into direct contact with the entire canal wall surfaces for effective action, particularly for the apical portions of small root canals. Throughout the history of endodontics, endeavors have continuously been made to develop more effective irrigant delivery and agitation method to achieve mechanical, chemical and microbiological functions, which are prerequisites for obtaining a clean root canal system. For effective debridement of the root canal an improved delivery system for root canal irrigation is highly desirable. Such a delivery system must have adequate flow and volume of irrigant to be effective in debriding the canal system without forcing the solution into periradicular tissue. The equipments are developing with an end goal to better address the difficulties of irrigation. The objective of this review is to present and provide cutting edge information on the latest advancement on the irrigant delivery systems and agitation methods available in endodontic practice.


  Abstract 140: Evaluation of root dentin microcracks caused by three nickel-titanium rotary file systems in mesial roots of extracted human mandibular molars: A micro-computed tomography study Top


R Kurinji Amalavathy, Sankar Aravinthan, Ravichandran Adisree, Dhanireddy V Padmaja

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

Aim: To evaluate the incidence of root dentin microcracks post instrumentation with three Nickel-Titanium (NiTi) rotary file systems in moderately curved mesial roots of extracted human mandibular molars using Micro-computed Tomography (micro-CT) analysis.

Methodology: Sample size (n=30) was estimated using G* power 3.1.9.3 software with the power of 0.09. Thirty freshly extracted human mandibular molars with moderately curved roots that met the inclusion and exclusion criteria were selected. The mesial roots were separated, root length standardized, mounted on custom made putty jig and scanned using a micro-CT device at an isotropic resolution of 18μm. Samples were randomly assigned to three experimental groups (n = 10), Group A: TruNatomy (TRN), Group B: DC-Taper 2H (DCT) and Group C: 2Shape (TS) and instrumented. The roots were remounted on custom jig and scanned. The images were analyzed using software CTAn v.1.18 (Bruker, micro-CT). Two previously calibrated examiners analyzed all pre-operative and post-operative slices (n=19,599), measuring 12mm from root apex for the presence of root dentin microcracks. The frequency and distribution of microcracks in roots were evaluated.

Results: The kappa value of 0.8 was attained indicating good inter-examiner reliability. Shapiro- Wilk's test was done to assess the normality distribution. All inter and intra group analysis was performed using One-way ANOVA and Post-hoc Tukey. Pre-existing microcracks were detected in all groups (P=0.53). All instrumentation systems induced new microcracks with no statistically significant difference between them (p=0.63). The percentage increase in microcracks after instrumentation was 1.04% (TRN), 1.2% (DCT), 1.05% (TS) respectively. 2 shape showed statistically significant increase in the number of post instrumentation microcracks (p=0.01). The frequency of roots exhibiting postoperative microcracks was found to be 60% in TRN and 2S groups and 20% in DCT group. Cracks detected in pre-instrumentation slices were more prevalent in coronal and middle third of the roots (p=0.01) while post-instrumentation cracks showed significantly higher prevalence in middle and apical third (p=0.02).

Conclusion: All instrumentation systems induced some root dentin microcracks in moderately curved mesial roots of human mandibular molars. 2shape NiTi rotary file system caused a significant increase in root dentin microcracks post instrumentation.


  Abstract 141: Nonendodontic lesions mimicking periapical lesions of endodontic origin: A scoping review Top


Padmapriya Ramanujam, Kajal Modi

Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: The aim of this scoping review was to describe the various clinical and radiographic features of non-endodontic lesions (malignant and benign tumors, cysts and infections) mimicking periapical lesions of endodontic origin.

Materials and Methods: Literature search was done in five electronic databases- PubMed, Web of Science, Scopus, Embase and ProQuest to include published cases (case reports, case series and cross-sectional studies) of patients with histologic diagnosis of non-endodontic lesions which were clinically and/or radiographically mimicking periapical pathosis of endodontic origin till April 2021. Animal studies, laboratory based studies, reviews and abstracts of conferences were excluded. Specific strategies were developed for different databases using the following keywords: Periapical disease, non-endodontic lesions, malignant lesions, benign lesions, infectious disease, cysts, tumors, diagnostic error, misdiagnosis, mimicking. A total of 121 articles fulfilling the eligibility criteria were included. Further, data extraction was done and descriptive analysis performed.

Results: The most common benign and malignant lesions mimicking periapical pathosis were found to be odontogenic keratocyst and metastasis (from lung and breast cancers) respectively.

Conclusion: Since a wide variety of non-endodontic periapical lesions mimic that of endodontic pathosis, it becomes imperative for clinicians to be aware of such presentations and consider them in the differential diagnosis of endodontic lesions.


  Abstract 142: Efficacy of walking bleach technique for tooth discoloration in mandibular anterior tooth: A case report Top


Rishellini Rishellini, Wiena Widyastuti, Dina Ratnasari

Department of Conservative Dentistry, Faculty of Dentistry, Trisakti University, West Jakarta, Indonesia

Background: Non-vital anterior tooth discoloration is often perceived as an aesthetic problem. It can be defined as being extrinsic or intrinsic factors, and it occurs as a result of surface stains due to actual changes in tooth or because a combination of both factors. The most common causes for intrinsic tooth discoloration are dental trauma, pulp necrosis, intracanal medicament, obturation material and sealers. One of the commonly used techniques used for bleaching endodontically treated teeth is the 'walking bleach' technique, and it is a minimally invasive method that provides a satisfactory result.

Purpose: Describes the management walking bleach technique for discolored and infected mandibular central incisor.

Case and Management: A 36 years old female patient came with chief complaint of the discolored mandibular central incisor. The periapical radiograph showed that left incisor canal treatment had been done before with non-hermetic obturation and the right incisor with calcified root canal while both had periapical radiolucency. Previous gutta percha filling was removed using hedstroem file and solvent, root canal preparation until size X2 and irrigation with root canal irrigants protocol. For calcified root canal, detection of canal orifice helped by canal detector and C+ file size #6 and #8. The obturation using single cone gutta percha and resin sealer. The next visit removed 2 mm of gutta percha under cemento enamel junction and form mechanical barrier with glass ionomer cement. The tooth bleached using the walking bleach technique with 35 % hydrogen peroxide into the pulp chamber on labial surface for five days. After the second application, the result was achieved, the tooth color was changed for left incisor from B4 to A1 using Vita shade guide and for right incisor from A4 to A1. Then calcium hydroxide applied to neutralize and final restoration with direct composite.

Conclusion: Management of non-vital tooth discoloration with walking bleach technique using 35% hydrogen peroxide, effectively with non-invasive procedures.


  Abstract 143: Indirect pulp capping using Biodentine™ on reversible pulpitis mandibular left permanent molar: A case report Top


Eliza Sarasvati, Dewa Ayu Artiningsih

Universitas Indonesia, Department of Conservative Dentistry, Central Jakarta, Indonesia

Bacteria toxins when reach the pulp will trigger inflammatory response in the pulp, where the severity of pulp inflammation under a carious lesion depends on the degree of depth of bacterial penetration and the formation of sclerosing and/or reparative dentin. In dentistry, vital pulp therapy such as pulp capping has the same goal, using calcium silicate based materials such as MTA (Mineral Trioxide Aggregate) and Biodentine™. These molecules have the potential to exert direct effects on existing odontoblasts or signal recruitment of undifferentiated pulp cells, with the aim of stimulating regeneration of the lost dentin. MTA and Biodentine™ are biomimetic materials that stimulate the production of BMP and TGF-β1 from pulp cells. MTA and Biodentine™ are said to influence the early differentiation of odontoblasts and the initiation of mineralization and synthesis of reparative dentine. This case report discusses the results of indirect pulp capping treatment in a mandibular left permanent molar (37) using Biodentine™. A 37-year-old patient complained of pain in the left mandibular permanent molar when drinking cold and chewing food. Vitality examination positive, sensitive to percussion, no respons to palpation. Radiographic examination showed a radiolucency under the old composite resin filling in the occlusal area, there was widening of the periodontal ligament in the apical 1/3. Biodentine™ material was chosen because it has advantages in terms of material handling, setting time, color and material hardness compared to MTA. Biodentine™ also shows a higher ability to produce apatite crystals and induce mineralization with reparative dentine formation compared to other pulp capping materials such as calcium hydroxide and GIC. Control after 5 months application of Biodentine™ found improvement in apical area, positive pulp vitality and no subjective complaints.


  Abstract 144: Root canal treatment of mandibular first molar with vertucci Type II configuration: A case series Top


Renny Siringoringo, Nurul Ramadiani, Ike Dwi Maharti

Universitas Indonesia, Department of Conservative Dentistry, Jakarta, Indonesia

Root canal is a complex system that varies in anatomy. Based on its orifices and apical root canals, Vertucci classified eight types of root canal configurations. Vertucci type II configuration (two orifices in the pulp chamber that fuse at the apex), is often found in the mesial root canals of mandibular molars (37%). This configuration is commonly caused iatrogenically during root canal treatment, resulting in a non-hermetic obturation and may lead to failure of root canal treatment. Thus, performing optimal root canal treatment is essential yet challenging for the dentists. This case series will discuss the management of root canal treatment of mandibular first molars with Vertucci type II configuration with the use of ProTaper Gold® and warm vertical compaction obturation technique.


  Abstract 145: Treatment of primary endodontic lesion with periodontal involvement in mandibular molar: A case report Top


Nia Agung Lestari, Dini Asrianti

University of Indonesia, Department of Conservative Dentistry, Central Jakarta, Indonesia

Infection from root canal can extend to periodontal tissue and vice versa. A cross infection may occur through the apical foramen, accessory canals, or even through exposed dentinal tubules and form endodontic-periodontal lesion. To overcome this, a combination of endodontic treatment and periodontal treatment is needed. For most cases, root canal treatment is performed first followed by periodontal therapy. Chemo-mechanical preparation is performed to created aseptic conditions in root canal and stimulate healing of the periapical tissue. This followed with periodontal therapy that can increased the prognosis of the tooth by healing of the periodontal structure. This case report will discuss the management of primary endodontic lesions with periodontal involvement in mandibular molar. Endodontic treatment was performed first and followed with periodontal treatment. After two months evaluation, the result revealed no clinical symptoms and no mobility of the tooth supported by the normal pocket depth. Radiographically, there was an increased bone density, extending to the bifurcation area. Six months follow up is still needed to conduct for final healing process.


  Abstract 146: Dentin microstructure and its correlation to the direction of fracture line in mandibular molars of elderly individuals: In vitro study Top


Vinutha Jaganathan, Rega Kumar, Ruchika Roongta Nawal, Sangeeta Talwar

Maulana Azad Institute of Dental Sciences, Central Delhi, India

Aim: The objective of this study is to evaluate the direction of the fracture line in mesial roots of mandibular first molars in elderly individuals.

Materials and Methods: Twenty extracted mandibular first molars from aged individuals (above 45 years) were included in the study. The mesial roots of the mandibular molars were decoronated and embedded in acrylic blocks and subjected to vertical force under a universal testing machine. Then the fractured roots were examined under a stereomicroscope at 10X magnification to determine the location and direction of the fracture line. To evaluate the correlation between the dentin microstructure and the direction of the fracture line, teeth were sectioned and observed under a stereomicroscope at 20X and 40X magnification. Statical analysis was done using Fisher exact test.

Results: Sclerotic dentin distribution was more in the apical area and less in the coronal third of the root. The correlation between the direction of sclerotic dentin and the direction of the fracture line was statistically significant with harder sclerotic dentin impeding the propagation of fracture in the root.

Conclusion: Among the older individuals there was a gradual increase in the prevalence of sclerotic dentin from coronal to the apical direction and the presence of harder sclerotic dentin impeded the propagation of fracture line.


  Abstract 147: No cry- with cryotherapy: Adding a new dimension to endodontic practice! Top


Aastha Dureja

Manipal College of Dental Sciences, Manipal, Karnataka, India

Cryotherapy is originated from the Greek word 'CRYOS' meaning COLD. Do you remember how your pain gradually vanished after you applied an ice pack posts your wisdom tooth extraction? And how your hands got numb on a cold winter morning Cryotherapy, seemingly a complex idea, is actually the simplest in its application, bringing about magnificent effects. This makes it a hot topic in the research and treatment arenas. In Physiotherapy, it means lowering or decreasing the temperature of tissues but in reality, cryotherapy does not implement cold but rather extracts heat. It is effective in reducing edema, pain, inflammation, and recovery time by its inherent nature of vasoconstriction, alteration in nerve conduction, blood flow, and cellular metabolic activity. Though a known technique in medicine, the rapidly growing field of endodontics invited this concept only a few years back. With the introduction of bioceramic materials and the ever-increasing popularity of Regeneration, the concept of Cryotherapy holds the promise of combining the two, in its unique way and giving birth to an innovation called ' BIOACTIVE ENDODONTICS'. Cryotherapy brings conservation and comfort together for both, the patients and the clinicians. Its application in Endodontics is not just limited to Vital Pulp Therapy but also in Post-Endodontic Pain (PEP) Management. Metallurgical Advancements use Deep Cryotherapy to increase the strength, microhardness, and corrosion resistance of metals, and the same concept can be applied clinically on NiTi rotary files by increasing their cyclic fatigue resistance and cutting efficiency. Cryoablation and Cryosurgery are already in practice in the field of Oral Medicine, Oral Surgery, and Periodontics, it won't be long before we start applying the same in Endodontic Surgeries too.The applications of Cryotherapy thus can bring about a paradigm shift in the conventional endodontic practice. Further studies and research is bound to unleash its hidden potentials.


  Abstract 148: Cleaning effectiveness of ultrasonics with and without endodontic solvents on root canal dentin: An in vitro study Top


Eko Fibryanto, Wiena Widyastuti, Adi Hidayat1, Lisiana Hastuty

Department of Conservative Dentistry, Faculty of Dentistry, Universitas Trisakti, 1Department of Public Health, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia

Aim: To compare the ultrasonic effectiveness with and without solvent on the cleanliness of endodontic obturation material in middle third and apical third of the root canal.

Materials and Methods: Eighteen freshly extracted single rooted mandibular first premolars were selected. Teeth were decoronated until they reached a length of 16 ± 0.5 mm. All teeth were prepared and obturated using bioceramic sealer and gutta-percha in single cone technique. Pre-instrumentation Cone Beam Computed Tomography (CBCT) imaging of all teeth were done to get initial volume of the obturation material at middle and apical third levels. After 30 days in incubator, the teeth divided into three groups (n=6). Group 1 was cleaned by ultrasonic with xylene, group 2 was cleaned by ultrasonic with orange oil and group 3 was cleaned by ultrasonic only. Post-instrumentation CBCT were done in a similar method as pre-instrumentation scan. The amount of obturation material removed were calculated using CT Analyser. Two-way ANOVA was used to determine the solvent and location interaction.

Results: There was no significant interaction was found between solvent and location (P > 0.05).

Conclusion: Using ultrasonic with solvent as effective as without solvent in order to clean the obturation material in the middle and apical third.


  Abstract 149: Management of separated instrument in a curved disto-buccal canal of maxillary first molar – A case report Top


Henny Kusuma Latif, Juanita Amaludin Gunawan, Taufiq Ariwibowo

Department of Conservative Dentistry, Faculty of Dentistry, Universitas Trisakti, Jakarta Barat, Indonesia

During root canal therapy, there will always be potential for iatrogenic errors such as an intracanal separation of endodontic instruments hindering cleaning and shaping procedures within the root canal system, which may have an impact on the treatment outcome. This problem can be treated conservatively or surgically, where conservative approaches are considered favorable and preffered whenever possible. Conservative methods include procedures such as leaving the fragment in situ, bypassing the separated fragment or complete removal of the instrument. In addition to experience in handling such cases, it is important for a clinician to know the indications, advantages and disadvantages of each treatment option and technique in order to decide what method will be used to achieve the desired results. This presentation discusses the management of an accidentaly separated file in a curved disto-buccal canal of the maxillary first molar through complete removal of the instrument using ultrasonic technique with predictable results.


  Abstract 150: Ice on endo Top


R Saranya

Vivekanandha Dental College for Women, Namakkal, Tamil Nadu, India

Cryotherapy is derived from greek word “cryos” denoting “cold” and “therapy” denoting “cure. As early as 3000 BC, the ancient Egyptians were the first to apply cold to treat injuries and reduce inflammation. A british physician Arnott reported cryotherapy as early as 1851. In the field of endodontics, cryotherapy is employed in peri-radicular surgeries, root canal treatment, vital pulp therapy, to minimize pain and inflammation and to enhance few physical properties of nickel-titanium endodontic files. In endodontics commonly used cryogens include ice pack, gel pack, ice chips, melted ice water, ice massage, pre-packaged chemical ice pack, liquid nitrogen. The principle of cryotherapy is a rapid cooling and repetition of the freezing process to maximize the tissue destruction for therapeutic purposes. Swelling and or pain to the peri-radicular tissues are caused by various factors such as chemical, mechanical or microbial injury. Though other strategies are employed to reduce the endodontic pain, cryotherapy is also an alternative method. Cryotherapy decreases metabolic activity, blood flow and neural signals by reducing the release of the chemical mediators that are responsible for pain conduction, thereby reducing the conduction velocity. It makes the dental treatment more comfortable for the patient and the dentist. Cryotherapy is used in the various fields of dentistry and it is a new emerging treatment modality in the field of endodontics. Cryotherapy can be considered as a simple, cost-effective and non-toxic therapeutic procedure preoperatively, during the treatment and postoperatively in endodontic pain management. This review paper describes the various advantages of cryotherapy in endodontics.


  Abstract 151: Effect of gutta percha with different sealers on the expression of Enterococcus faecalis virulence factor: A polymerase chain reaction study Top


ST Gowtham, James Vandana, Sundaresan Balagopal, Chandrasekaran Charanya, Nagarajan Geethapriya, Sarath Kumar

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

Objective: To compare and evaluate the effects of Gutta percha with AH plus sealer, Gutta percha with Sealapex and Gutta percha with CeraSeal on E. faecalis virulence factor - E. faecalis endocarditis antigen (efaA) using real time Polymerase chain reaction.

Aim: To evaluate the effect of Gutta percha with different sealers on the expression of Enterococcus faecalis virulence factor (efaA)- using real time polymerase chain reaction.

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 and teeth were autoclaved at 121°C for 20 minutes at 15 psi. 1 mL E. faecalis 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 A- control group, Group B -Gutta percha with AH plus sealer, Group C -Gutta percha with Sealapex, Group D -Gutta percha with CeraSeal. After the obturation procedure, teeth will be sectioned and root filling material will be removed gently with spatula under aseptic condition. Dentin powder will be obtained from the middle third of the root canal from which the DNA sample will be extracted to detect the presence of enterococcus faecalis virulence factor (efaA) using real time polymerase chain reaction.

Results: Gutta percha with Sealapex showed highest antibacterial efficacy against expression of E. faecalis virulence factor(efaA). Gutta percha with AH plus showed the second most effective antibacterial efficacy followed by Guttapercha with CeraSeal. The least antibacterial efficacy efficacy was expressed by the control group

Conclusion: Based on this study it could be concluded that the antibacterial efficacy against the expression of E. fecalis virulence factor (efaA) was highest for the calcium hydroxide based sealer (Sealapex) followed by resin based sealer (AH plus). It was least for calcium silicate based bioceramic sealer (CeraSeal).


  Abstract 152: Comparison of fracture resistance of endodontically treated teeth restored with three different restorative materials: An in vitro study Top


Padmanabhan Keerthi, Nagarajan Geethapriya, Sundaresan Balagopal, Sarathy Sarath, James Vandana, Sebatni Anisha

Tagore Dental College, Chennai, Tamil Nadu, India

Aim: To compare the fracture resistance of three different restorative materials in endodontically treated teeth.

Objective: To compare the fracture resistance of badly mutilated, endodontically treated teeth restored with three different restorative materials- Conventional nano hybrid resin composite (Ivoclar Tetric N-ceram), Nano ceramic composite (ceram.x sphereTEC One, Dentsply) and hybrid glass ionomer cement (GC gold label HYBRID) in MOD cavity.

Materials and Methods: Forty extracted human maxillary premolars were selected.

(GROUP 1): Ten intact teeth served as positive controls.

MOD cavities were prepared for the remaining 30 specimens and access gained using Endo access bur. Instrumentation was done upto F2 (size 25, 8%) ProTaper Gold files. Irrigation was done using 3% NaOCl solution. Root canal obturation was done with gutta percha and bioceramic sealer (Angelus Bio-C sealer). The specimens were then randomly divided into 3 groups of 10 teeth each. The cavities were restored with

GROUP 2: Conventional nano hybrid resin composite (Ivoclar Tetric N-ceram),

GROUP 3: Nano ceramic composite (ceram.x sphereTEC One, Dentsply) and

GROUP 4: Hybrid glass ionomer cement (GC gold label HYBRID).

The restorative procedures were carried out using Tofflemire matrix system for creating the proximal contours. Thermocycling was done for all the specimens (500 cycles). Fracture resistance was measured using Universal testing machine and the force needed to fracture each tooth was measured in Newtons(N).

Results: Fracture resistance was highest with intact teeth (positive control). Nanoceramic composite (cerem. X sphereTEC one, Dentsply) showed the highest fracture resistance among the experimental groups followed by nanohybrid composite (Tetric N- ceram, Ivoclar). The least fracture resistance was showed by hybrid glass ionomer cement (GC gold label hybrid).

Conclusion: Based on this study it could be concluded that, among the experimental groups, the fracture resistance was highest in nanoceramic composite followed by nanohybrid composite and it was least in hybrid glass ionomer cement.


  Abstract 153: Anti Enterococcus faecalis efficacy of astaxanthin as root canal irrigant: An in silico and in vitro study Top


Bhaskaran Bharath Kumar, Shekar Shobana, Sundaresan Balagopal, M Anisha Sebatni, N Geethapriya, S Sarath sarathy

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

Objective: To assess the anti bacterial efficacy of 20% Astaxanthin (ASX) solution as a root canal irrigant against E. faecalis by disc diffusion assay. To assess the potential target sites of ASX against E.faecalis using molecular docking method.

Materials and Methodology: Molecular docking: Mechanism of anti E. faecalis action of astaxanthin was assessed using PyRx software version 0.8 with Auto Vina. Agar Disc diffusion assay: 20% ASX irrigating solution was prepared by dissolving 20 mg of powder in distilled water. 30 Kirby Bauer discs were taken and soaked in the following irrigation solutions till they were completely soaked: Group 1: 1000 μl of 3% NaOCl, Group 2:1000 μl of 2% chlorhexidine, Group 3:1000 μl of 20% ASX (n=10 in each group). The discs were dried and placed in 6 MHI agar plates containing 10μl suspension of E. faecalis (MTCC 439).The agar plates are kept at room temperature for 2 hours for prediffusion of materials and then incubated at 37°C for 24 hours and observed for zones of inhibition.

Statistical Analysis: The results obtained from in vitro study were tabulated on excel sheet and was statistically analyzed for normality using Kolmogorov Smirnov test. Inter group analysis was quantitatively done using Kruskal Wallis ANOVA followed by post hoc test with Mann Whitney analysis. P value of less than 0.05 was considered statistically significant.

Results: Molecular docking revealed ASX targeted four potential sites against E. faecalis namely Nicotinamide adenine dinucleotide hydrogen(NADH), Alanine racemase (AR), Dihydrofolate reductase (DHFR) and Acyl carrier protein (ACP) with affinity values of -9.1, -8.4, -7.3, -4.6 kcal/mol respectively. Disc diffusion assay: NaOCl produced the maximum mean bacterial inhibition zone of (22 mm), followed by chlorhexidine (17 mm) and ASX (15.5 mm) which was statistically significant (NaOCl>CHX>ASX)(p-value<0.05). Post hoc test revealed that NaOCl produced significantly more bacterial inhibition zone in comparison with Chlorhexidine and Astaxanthin (p-value <0.001 &0.05 respectively). However there was no significant different between Chlorhexidine and Astaxanthin as a root canal irrigant. (p-value=0.222).

Conclusion: In vitro and in silico analysis revealed that ASX could be a potential root canal irrigant against E. faecalis comparable to Chlorhexidine.


  Abstract 154: Warm vertical compaction obturation technique of maxillary second premolar with vertucci Type I configuration: Case report Top


Paramita Widyandari, Ratna Meidyawati

Faculty of Dentistry, University of Indonesia, Central Jakarta, Indonesia

Root canal treatment needs an adequate process of cleaning, shaping, and obturation. However, the root canal configuration is a complex system. They can be separated or merge into one canal in the apex. This configuration was explained by Vertucci, who has identified the root canal space into eight configurations system. The Vertucci type I has a 48 percent on maxillary second premolar. The purposes of the obturation process are to seal all the communication from periapical tissue and prevent the bacteria grow in the root canal. Several previous studies have also stated that the single-cone technique cannot provide adequate obturation in oval root canals. For obturation in wide root canals, like the Vertucci type I morphology, the operator should use the warm vertical compaction technique followed by thermoplastic injection. This case report will discuss the right maxillary second premolar with a diagnosis of symptomatic apical periodontitis of a 35th-year-old female patient who had vital root canal treatment. Root canal filling used the warm vertical compaction technique because the tooth has Vertucci type I anatomy. The post-treatment radiograph shows successful obturation. The warm vertical compaction technique resulted in more homogeneous obturation and had a significantly smaller number of voids when compared to the single-cone and lateral condensation techniques. This treatment is successful and shows a healing reaction since the patient has no other complaints. Moreover, there are no periodontal tissue abnormalities clinically and radiographically.


  Abstract 155: Variety of surface engineering techniques of NiTi instruments: A narrative review Top


Jinnie Pandher

Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India

Aim: The aim and objective of this review is to present and discuss the characteristics of NiTi alloys and to present an overview on the variety of surface engineering techniques which may improve cyclic fatigue resistance, hardness and wear resistance while maintaining the torsional resistance and mechanical properties.

Methodology: A literature search for this narrative review was conducted in Google Scholar, PubMed and Web of Science using the keywords NiTi rotary instruments, cyclic fatigue, surface engineering techniques, surface treatment. Over 98 articles were found.

Results: identification of over 98 studies for preliminary analysis. Articles unrelated to the surface treatment of NiTi instruments were excluded. The included articles were checked to identify further relevant literature. Overall, 25 articles were included up to 2018.

Conclusion: This review summarizes that there appears to be a risk of corrosion for NiTi instruments without surface treatments and also the cyclic fatigue resistance of NiTi files is influenced by the surface treatment. Thus by performing various surface engineering techniques, a smooth surface, from which machining defects were removed can be achieved. Hence, improved cyclic fatigue resistance, hardness and wear resistance while maintaining the life of the instruments can be achieved.


  Abstract 156: Techniques for successful management of C-shaped canals: A case report Top


Suresh Krishna, JV Karunakaran

J.K.K. Nattraja Dental College, Komarapalayam, Tamil Nadu, India

The key for successful endodontics usually revolves around adequate knowledge of root canal anatomy and the ability to meticulously perform cleaning and shaping procedures. The variations of canal configuration always present a challenge to endodontic management. A C-shaped canal is one of the variant canal configurations that require special attention and customization of the treatment process. A C-shaped canal presents as a thin fin connecting the canals and is commonly observed in single rooted mandibular second molars. Due to the presence of a high incidence of transverse anastomoses, lateral canals, and apical deltas, cleaning and sealing the root canal system in these teeth becomes difficult. The inaccessible areas and unique canal patterns make the provision of optimum treatment quality a highly challenging proposition. Successful endodontic therapy of this type of canal configuration can be achieved with a combination of rotary and hand instrumentation assisted with ultrasonics. Three-dimensional obturation of the canal system can be achieved by appropriate modifications to conventional obturation techniques. Early recognition of the C-shape becomes imperative for its successful management. This case report presents successful management of a C-shaped canal configuration encountered in a single-rooted mandibular second molar. A thorough Cone Beam Computed Tomographic evaluation was done before access opening to assess the root canal configuration. After access opening adequate cleaning and shaping of the canal was done accompanied with proper irrigation technique. Obturation was done with warm vertical compaction technique and entrance filling was given with composite.


  Abstract 157: Endodontic treatment of maxillary first premolar with Weine's Type IV root canal configuration: A case report Top


Stevan Untono, Ade Prijanti Dwisaptarini, Aryadi Subrata

Department of Conservative Dentistry, Trisakti University, Jakarta, Indonesia

Introduction: understanding of the internal anatomy of teeth is important for clinician before approach to any endodontic procedure. Proper interpretation of radiograph, proper access cavity preparation, detailed exploration with higher magnification and illumination can be useful to recognize and locate root canals. The complexities of root canal should be effectively assessed and efficiently approached for successful endodontic therapy. This case present maxillary first premolar with Weine's type IV root canal configuration.

Case Report: a 59 years old male patient came to Department of Conservative Dentistry and Endodontics, University of Trisakti with chief complaint of uncomfortable dull pain on his upper left side teeth. Clinical examination showed the presence of decay with loss of palatal aspect. The tooth gave negative response to vitality test and was positive to percussion. Radiograph examination confirmed decay has reached the pulp chamber with periapical radiolucency. Crown lengthening was done followed by pre-endodontic build up before endodontic approach. The treatment was done under magnification.

Conclusion: Thorough knowledge of the root canal anatomy, proper radiograph image and interpretation, access cavity preparation and exploration of root canals with help of magnification can identify various internal anatomy of root canals.


  Abstract 158: Management of separated file on mandibular right first molar by bypass technique: A case report Top


Eko Fibriyanto, Dr Lyvia Juliana, Anastasia Elsa Prahasti

University of Trisakt, Jakarta, Indonesia

Background: File separation is an iatrogenic procedure that can occur during cleaning and shaping of the root canal system. Separated file arises primarily as a result of the metal fatigue (cyclic and torsional fatigue) and canal curvature. Correction of this mishap is challenging. Management of fractured files can be either non-surgical or surgical. Non-surgical approach includes the following treatment: bypass, removal, or instrumentation and coronal obturation of the fragment.

Objective: To report the management of separated file on the mandibular right first molar by bypass technique. Case: A male patient, 16 years old, came to the University of Trisakti's dental hospital with a subjective complaint of a cavity on his lower right back tooth. He realized the presence of the cavity for a year. Two weeks ago, he began to experience a sharp pain in the offended tooth. On clinical examination, large caries were found on tooth 46. Percussion, palpation test, and gum boil showed positive. Cold thermal and mobility showed negative. The preoperative radiograph showed a radiolucent area with a diffuse outline on the mesial, distal root, and furcation. Broken file was seen at the middle to the apical third one of the mesial canal. Based on the clinical examination and radiographs findings, pulp necrosis with chronic apical abscess was diagnosed. Bypass procedure was done considering micro-biological and biomechanical aspects. Bypass procedure was initiated with file #06 (Switzerland, Dentsply Maillefer) to cross over the fragment into the apical region. A watch-winding combined with light in and out movement along with multiple root canal irrigation was performed. File #08, #10, and #15 (Switzerland, Dentsply Maillefer) were used for scouting until the full working length and create a smooth apical glide path. Each root canal was prepared by using crown down technique. Post-endodontic treatment restoration was cast-metal onlay. Four weeks follow-up revealed that healing was found to be satisfactory, while percussion and palpation were absent.

Conclusion: Bypass procedure considered to be a conservative technique, with low risk of clinical mishap and acceptable clinical success rates.


  Abstract 159: Deep margin elevation technique to achieve success in post endodontic restoration: A case report Top


Jessica Purnadjaja, Juanita Amaludin Gunawan, Elline Elline

Department of Conservative Dentistry, Faculty of Dentistry Trisakti University, Jakarta, Indonesia

Restoring cavities with subgingival margins may be challenging during rubber dam isolation, dental impression, and delivery of the restoration. These procedures are time-consuming and can cause inappropriate placement of the restoration. The purpose of deep margin elevation technique is to coronally displace proximal margin using a base of composite resin following the placement of a matrix, under rubber dam isolation. The adhesive composite resin base is also used to seal the dentin, reinforce the undermined cusps, fill undercuts, and provide the necessary geometry for inlay or onlay restorations. This case report describes a coronal margin elevation, followed by placement of indirect partial adhesive restoration. A 39-year-old female patient came to the office with a chief complain of a cavity on tooth 35. Clinical examination revealed a class II caries at the distal site of tooth 35 reaching the gingival sulcus. There was no response to cold test, no tooth mobility, and probing depths of 2 mm. Radiographic examination showed the presence of deep distal caries approaching the pulp cavity and an apical radiolucency. The diagnosis of 35 was pulp necrosis, asymptomatic apical periodontitis. Root canal treatment was performed after isolation of the operative field and pre-endodontic build-up. Negotiation of the canal was performed using size 8 and 10 K-file, followed by rotary instrumentation, copious irrigation, and obturation with warm vertical compaction technique. The pre-endodontic build-up was removed, then a basis for restoration was created by elevating the margin of the cavity with composite using sectional matrix, wedge, and ring under absolute isolation. Afterward, bulk-fill flowable composite was used to create a barrier followed by application of packable composite. Vonlay restoration was performed to avoid fracture and correct the slight misalignment. Deep margin elevation is a non-invasive alternative to the surgical procedure in treatment of subgingivally damaged tooth structures.


  Abstract 160: Apicoectomy- A review Top


nishtha Manchanda

Guru Nanak Dev Dental College and Research Institute, Ludhiana, Punjab, India

Apicoectomy also known as root resection is defined as surgical removal of the apex of the root and is a part of surgical endodontics. It includes surgical treatment of area surrounding root and is done when conventional root canal treatment has failed to remove the infection. This procedure includes three important steps to eliminate persistent endodontic pathogens: surgical debridement of pathological periradicular tissue, rootend resection (apicoectomy), and retrograde root canal obturation (root-end filling). There is abundance of literature on the clinical studies and case reports on apicoectomy procedures. Thus, the main aim of this review is to discuss the theoretical and clinical aspects of this procedure.


  Abstract 161: Mandibular first molar with middle distal canal: A case report and review Top


Preetha Chandrasekar, JV Karunakaran

JKKN Dental College and Hospital, Komarapalayam, Tamil Nadu, India

Achieving consistently high levels of success in endodontic treatment requires a thorough understanding of anatomy of root canal and. Associated structures. The root canal system must be effectively debrided, disinfected, obturated and restored post-endodontically. Morphology of permanent mandibular molars are generally described as a group of teeth with two roots and three or four canals. Variations in normal anatomy of permanent mandibular first molar have been extensively reported in literature. The incidence of middle distal canal in the mandibular first molar has been reported as rare with a incidence of between 0.2 to 3 %.This case report describes the pre-operative assessment, diagnosis and techniques for successful management of a case of mandibular first molar with this unusual canal configuration of three distal canals. Morphological variations in pulpal anatomy must always be looked and assessed preoperatively as one of the most common reasons for failure is a missed canal. it is necessary for the clinician to have knowledge of not only the normal anatomy but also its variations. Though frequency of incidence of this condition is low, each case should be evaluated carefully preoperatively and suitable treatment methodologies should be considered when such anatomical variations are found.


  Abstract 162: Successful multidisciplinary management of an endodontic-periodontal lesion in first mandibular molar with radix entomolaris: A case report Top


Valonia Irene Nugraheni, Dini Asrianti Bagio

Faculty of Dentistry, Universitas Indonesia, Central Jakarta, Indonesia

Endodontic-periodontal lesions have a varied pathogenesis ranging from simple to relatively complex one related to the presence of anatomical and vascular relationship between the pulp and periodontium that could facilitate bacterial transportation between the two structures. Diagnosis and management of endodontic-periodontal lesions are often challenging to clinician caused by the similar characteristic of the clinical condition between the primary and secondary lesion and the treatment outcome is not as predictable as lesion of single origin. Accurate identification of the primary etiological factor through a thorough clinical and radiograph examination is important to determine the correct diagnosis and prognosis in endodontic-periodontal lesions. Moreover, the presence of anatomical variation in pulpal and periodontal poses a challenge to the comprehensive management of endodontic-periodontal lesions. This case report presents the successful multidisciplinary management treatment outcome of endodontic-periodontal lesion in first mandibular molar with Radix Entomolaris. A 25 years old female patient was reffered to Departement of Conservative Dentistry Clinic at RSKGM Faculty of Dentistry, Universitas Indonesia with recurrent throbbing symptoms of her lower right molar. The endodontic-periodontal lesion was initially conducted with non-surgical endodontic therapy followed by periodontal treatment using open flap debridement with bone graft application technique. After three-month follow up, patient was completely asymptomatic with an increase of the gingival attachment level, no furcation involvement, and reduction of the lesion size on the radiograph. At six-month follow up, the tooth remained asymptomatic and significant healing of bone defect was presented radiographically.


  Abstract 163: The dislocation resistance of prefabricated aesthetic fibre posts bonded with self-adhesive resin cement following air abrasion: A systematic review and meta-analysis Top


Shweta Jacob

Manipal College of Dental Sciences, Mangalore, Karnataka, India

Background: This systematic review aimed to determine the presence of any in-vitro proof to validate the utilization of air abrasion to advance the bond strength of fibre posts to intra-radicular dentin with self-adhesive resin cement.

Materials and Methods: Laboratory studies that assessed the push-out or pull-out bond strength of prefabricated aesthetic posts whose surface was treated with air abrasion and bonded using self-adhesive resin cement within the root canal model were included for this systematic review. Study reporting was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant articles were identified using a literature database search in Web of Science, Scopus, PubMed, and EBSCO. Besides this hand search was also done to ensure complete capture of the articles.

Results: Six articles were then selected and included in this study out of which one was excluded for meta-analysis due to usage of the artificial substrate. It was shown that an additional step of air abrasion of the aesthetic fibre post did not result in significant improvement in dislocation resistance. Assessment of risk of bias categorized the available research into high risk and medium risk. The results showed heterogenicity.

Conclusion: The use of additional steps such as mechanical post surface treatment does not have any added benefit. However, the results must be interpreted with caution due to methodological shortcomings.


  Abstract 164: Disinfecting efficacy of pomegranate peel extract, garlic, tulsi leaf and clove leaf with autoclaving on dental round burs tested against Enterococcus faecalis Top


Shivangi Shekhar

Manipal College of Dental Sciences, Mangalore, Karnataka, India

Objectives: To compare the disinfecting efficacy of Pomegranate Peel Extract oil, Garlic oil, Tulsi leaf oil and Clove leaf oil with standard autoclaving on dental round burs infected with Enterococcus faecalis.

Materials and Methods: Round dental burs were exposed to Enterococcus faecalis and the disinfecting capability of four different test chemicals against autoclave were evaluated using two different methods- Blood agar streaking method to check for colony forming units and peptone water test was used to check for turbidity which proposed the growth of bacteria. After overnight incubation, gram stain was performed from the colonies grown on Blood agar plate and from the overnight turbid peptone water. The presence of catalase negative gram positive cocci in pairs confirmed the presence of Enterococcus Faecalis and helped to rule out any contamination during the entire experiment.

Results: Clove leaf oil showed the best disinfection efficacy, followed by Tulsi leaf oil comparable to autoclaving, whereas Garlic oil and Pomegranate peel extract oil were significantly less effective against Enterococcus faecalis.

Conclusion: Clove leaf oil and Tulsi leaf oil can be used to disinfect dental burs, as alternatives to autoclaving against the tested organism.


  Abstract 165: Comparative evaluation of volume and homogeneity of obturation with four different obturation systems using microcomputed tomography: An in vitro study Top


V Nagarajan, A Shafie Ahamed, Bhavani Sreekrishnapillai, G Rajaraman, RV Aparajitha

Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India

Aim: To evaluate and compare the volume and homogeneity between Single cone gutta-percha, Beefill 2 in 1, Guttacore and Guttaflow bioseal obturation systems.

Materials and Methods: Twenty four single rooted premolar teeth were selected and decoronated.The roots were instrumented with protaper next upto X3 and divided into 4 groups with 6 samples each (n=6),namely: Group I (Single cone gutta-percha obturation) Group II (Beefill 2 in 1 obturation),Group III ( Guttacore obturation), Group IV (Guttaflow bioseal obturation) and subjected to preoperative MicroCT imaging to evaluate the volume of the prepared root canal space, then the root samples were obturated. The post-obturation MicroCT imaging was taken to evaluate the volume of obturation material in the prepared root canal space and the area of voids in the apical,middle,coronal third sections.

Results: Guttacore obturation showed least mean difference in the volume of obturation and showed least mean area of voids in the apical,middle and coronal thirds with statistically significant difference in the apical and middle thirds (p < 0.05).

Conclusion: All the four groups had difference in volume and showed voids in the obturation at different levels.within limitations of this study it is concluded that the Guttacore obturation occupied the maximum volume of the prepared root canal space with minimum of voids.


  Abstract 166: Unmasking through digital evidence - endodontic imaging in forensics Top


Kumaravel Saranya

Vivekananda Dental College for Women, Namakkal, Tamil Nadu, India

Dental identification of a deceased individual is a core task in Forensic Odontology and plays a vital role in identifying remains when there is a lack of a fingerprint record. The accurate recording of clinical dental procedures has become more critical because of the increasing trend of lawsuits worldwide. Teeth and the facial bones of the human body are considered to endure destruction or decomposition even under temperature variations and may remain intact for many years after a person's death. The classic comparative dental identification uses post-mortem and ante-mortem dental records to determine similarities and exclude discrepancies that are considered essential for both humanitarian and judicial reasons. Dentofacial radiography has become one of the routine procedures in dental and medical hospitals in this digital era as a part of primary investigations. In forensic dentistry, written dental records that comprise documents that attempt to convey in written language, features observed during dental examination are more prone to errors because these records would be written by an individual different from the operator. Such errors may lead to failure to identify individuals correctly. However, radiographic images such as (Periapical radiographs and Three Dimensional Images) display details of the physical features of the item recorded and form accurate records of a person derived directly from that person; they are not surrogate records in the way that written records are. Therefore, dental radiographs play a valuable role as legal tools supporting the criminal demands on the daily forensic practice by providing all necessary information so that legal authorities may recognize malpractice, negligence, fraud or abuse, and identify unknown humans. Nevertheless, these dental radiographs are easily duplicated, stored, or distributed in digital format, making it difficult to guarantee the authenticity of digital images; hence they have to be protected against manipulation. This review explores and highlights the versatile nature of the imaging modality by reviewing its application in the field of forensic dentistry.


  Abstract 167: Effect of intracanal medicaments on radicular dentine: A FTIR spectroscopy analysis Top


Kalyani Behera, Iffat Nasim

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

Objective: This study aims to evaluate the effect of calcium hydroxide, calcium hydroxide combined with silver nanoparticles and graphene oxide combined with silver nanoparticles medicaments on the chemical arrangement of radicular dentine by Fourier-transform infrared (FTIR) spectroscopy.

Materials and Methods: Eighteen mandibular premolars were sectioned to obtain 54 radicular dentine discs and Pre-FTIR analysis was performed for all the samples which served as a control. Calcium hydroxide (CH) paste (Group I), calcium hydroxide combined with silver nanoparticles paste (Group II), graphene oxide combined with silver nanoparticles paste (Group III) medicaments were applied on the pulpal surface of the dentine & placed in a small eppendorf tube and stored at 37 °C for 1 week. After a given time interval, stored samples were taken out and washed thoroughly with deionized water for 15 min to washout treatment paste completely. Using FTIR spectroscopy, Post- FTIR analysis was performed and the Amide/Phosphate ratios were determined.

Results: Statistical analysis of the collected data was performed using SPSS version 23.0.Normality test for the collected data was performed using Shapiro-wilk numerical test & normal curve graphical test. The data was found to be normally distributed. Hence, parametric analysis was performed. Inter-group comparison of mean Amide/phosphate ratio was done using one-way ANOVA with Tukey's pairwise comparison. Intra-group comparison of mean Amide/phosphate was done using paired t test. p value <0.05 was set as statistically significant. There was no significant difference between the groups was seen, though the mean Amide/phosphate ratio was found to be low in group II& III as compared to group I. However, there was a significant difference between Pre-FTIR and Post-FTIR in group I with no significant difference in Pre- FTIR & Post-FTIR of group II & III.

Conclusion: All medicaments caused demineralization of radicular dentine depending on the duration of time. Calcium hydroxide (CH) caused maximum demineralization of radicular dentine as compared to the calcium hydroxide combined with silver nanoparticles and graphene oxide combined with silver nanoparticles.


  Abstract 168: Comparative evaluation of various irrigant activation systems following different tapers of rotary instruments using radiopaque dye: An in vitro study Top


Pradeep, Rama Sowmya

Saveetha Dental College, Chennai, Tamil Nadu, India

Aim: The aim of this study is to comparatively evaluate the various irrigant activation systems following different tapers of rotary instruments using radiopaque dye in single rooted teeth.

Materials and Methods: A sample of twenty single rooted teeth were standardised at the level of CEJ, access cavity preparation was done followed by cleaning and shaping using 4% and 6% taper rotary instruments under irrigation with 3% NaOCl. Radiopaque solution was utilised to measure the depth of irrigant penetration from the apex. The irrigation techniques performed during this study were: (i) sonic activation and (ii)ultrasonic activation. Radiographs were taken after dye injection to measure the length of irrigant penetration in each technique. Results were statistically analysed using SPSS software. One way ANOVA and post hoc Tukey tests were performed.

Results: The depth of penetration from the apex was calculated and the mean values were obtained as: Group 1: Sonic(4% taper)- 2.4+/-0.3; Group 2: Sonic(6% taper)- (1.4+/-0.3); Group 3: Ultrasonic (4% taper)- 1.8+/-0.3 and Group 4: Ultrasonic (6% taper)- 0.8+/-0.3. The study reveals that ultrasonic activation after 6% taper instrumentation was proved to be effective followed by ultrasonic activation after 4% taper instrumentation. The results revealed a highly significant difference between the irrigation techniques.

Conclusion: This study has indicated that ultrasonic irrigant activation proved to be better and an effective technique for cleaning of the root canal.


  Abstract 169: A survey on challenges encountered during rubber dam isolation among Indian dental practitioners Top


Siddhant Hiwale, Pratima Shenoi

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

Aim: To assess the challenges and problems encountered during rubber dam isolation among Indian dental practitioners.

Materials and Methods: A self-administered web-based questionnaire was designed and used for data collection. The participants comprised of total 214 Dental Health Care Professionals including General Dental practitioners, Post Graduates and Endodontists. Information sought included various problems they encounter during rubber dam isolation and description of challenges they face during the same. The data was analyzed using Statistical package for social sciences (SPSS v 26.0, IBM).

Results: 70.1% of respondents encountered problems in selection and adaptation of rubber dam clamp. 82.7% found rubber dam application time consuming whereas 65.4% lack experience/knowledge in placement of rubber dam. 82.2% encountered rubber dam sheet tearing as the main problem while using rubber dam sheet. 69.6% faced impingement of gingival tissue whereas 65.9% faced accidental dislodgement of clamp as main problem(s) with rubber dam clamps. 82.7% encountered difficulty in taking radiographs due to rubber dam frame. 79.4% were aware of modifications in rubber dam frames of which 78.7% are more aware about Nygaard Ostby frame. 71.5% are more aware about Optra-dam as an alternative to conventional rubber dam.

Conclusions: Rubber dam isolation is considered as gold standard for isolation in dental practices and more so in endodontic practices. The Covid pandemic has further stressed its importance and may act as an additional shield to protect the clinician from aerosol generating procedures. It is challenging for most practitioners as it needs skilled expertise for quick and efficient placement. This survey revealed that there is an urgent need to introduce Rubber Dam Isolation at early stages in Dental Education and make it as a mandatory practice. Also research needs to be directed at better, convenient and eco-friendly alternatives to Rubber Dam Isolation.


  Abstract 170: Broken file removal - solve problems as they arise Top


Manisha Ponraj, Divakar Srinivasan, Shafie Ahamed, Bhavani Sreekrishnapillai, Rajaraman Gangadharan

Rajah Muthiah Dental College and Hospital, Chidambaram, Tamil Nadu, India

Once root canal treatment is considered,clinician must be aware of the real possibility that complications and unforeseen accidents can occur.Procedural errors of which instrument fracture is probably the most challenging to manage, can occur during any stage of root canal cleaning and shaping.It compromise and reduces the prognosis of tooth by preventing 3D sealing of canal.The best antidote for a broken file is prevention.Yet,when this procedural accident occur, it is reassuring to know that removal procedures can generally be executed to solve this problem, in times when bypass is not possible.This poster will emphasize the importance of coronal and radicular access,with special focus on the retrieval methods and commercially available retrieval systems that improve safety, efficiency and simplicity when removing intracanal obstructions.


  Abstract 171: Intentional re-implantation: An asset for a hopeless tooth Top


Ritika Chaudhary

Uttaranchal Dental and Medical Research Institute, Dehradun, Uttarakhand, India

Re-implantation means re-insertion of tooth in its socket, after its complete avulsion due to trauma or some other etiologies. Intentional re-implantation is a purposeful extraction of a tooth and its re-insertion into the socket almost immediately after sealing the apical foramen. It is a one stage treatment that maintains the natural tooth aesthetics. The success rate varies between 52-95%. Key points to be considered are, the surgical procedures have to be rigorous, minimum extra-oral time and splint adapted properly. This case was done in the Department of Conservative Dentistry and Endodontics, UDMRI, Dehradun, Uttarakhand. A male patient aged 28 years reported to the department with the chief complaint of pain, swelling, protrusion, mobility in maxillary left central incisor. Clinical examination revealed pathologically migrated tooth 21, with palatal inflammation and grade III mobility. Radiographic examination revealed moderate to severe bone loss and a periapical radiolucency of the affected tooth. The resulting clinical situation had guarded prognosis. The line of treatment was Intentional Re-implantation. Firstly, tooth was extracted atraumatically. The extracted tooth was held with gauze moistened with isotonic saline and root planing was done for removal of necrotic debris adhering to root cementum and granulation tissue. RCT was carried out in the extracted tooth. The socket was then subjected to curettage to remove inflammatory tissue. The root surfaces were treated with tetracycline solution and re-implanted in the alveolar socket with the help of bone graft and splinting. Post-operative radiographs were taken and the patient was recalled for follow up at regular intervals.


  Abstract 172: Comparative evaluation of apical microleakage in immediate and delayed post space preparation using four different root canal sealers by using stereomicroscope: An in-vitro study Top


Basarahalli Radha Madhavi

Navodaya Dental College, Raichur, Karnataka, India

Objective: The aim of the study was to compare and evaluate the apical microleakage in immediate and delayed post space preparation using four different root canal sealers such as zinc oxide Eugenol, Meta ADseal, Endomethasone N, Bioroot RCS by using a stereomicroscope.

Materials and Methodology: A sample of ninety extracted mandibular first premolar teeth were taken and decoronated at cemento-enamel junction. Root canals were prepared and divided into 4 groups. Forty teeth each in group A and B; and 5 teeth each in group C and D.

Group A and B were further divided into 4 subgroups (A1,A2,A3,A4,B1,B2,B3,B4). Obturation was done using gutta percha and respective sealers using single cone technique.

Subgroup A1 and Subgroup B1–Zinc oxide Eugenol

Subgroup A2 and Subgroup B2 –Meta ADseal

Subgroup A3 and Subgroup B3– Endomethasone N

Subgroup A4 and Subgroup B4–BioRoot RCS

Group C – positive control group

Group D – negative control group

Next post space preparation were done immediately for group A and delayed post space preparation were done after a week for group B. All the samples were then placed in 2% methylene blue dye for 3min. The teeth were removed and sectioned vertically and evaluated under stereomicroscope for apical microleakage. Data were analyzed using Mann-Whitney test and Kruskal -Wallis tests.

Results: The post space preparation done immediately using BioRoot RCS sealer showed the least apical microleakage and delayed post space preparation using Zinc oxide eugenol sealer showed the maximum amount of apical microleakage.

Conclusion: Apical microleakage was seen among all the groups. Among the sealers, BioRoot RCS showed the least amount of microleakage, followed by Meta ADseal, Endomethasone N and the highest apical microleakage was exhibited by Zinc oxide eugenol.


  Abstract 173: Comparative evaluation of cutting efficiency, cyclic fatigue, corrosion resistance, autoclave cycle effects of three different file systems: An in-vitro metallurgy analysis Top


JV Eldho, K Vijay Venkatesh

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

Aim: To compare the cutting efficiency, cyclic fatigue, corrosion resistance and autoclave cycle effects of Protaper Gold, TruNatomy and Wave One Gold file systems in-vitro.

Materials and Methods: For evaluating cutting efficiency, mesiobuccal roots of maxillary first molars having similar weights was used. The roots were randomly divided into three groups (n=10 for each); Group A, B, C; Protaper Gold, TruNatomy-Prime and WaveOne Gold- Primary preparations respectively. Hyposol – 3% hypochlorite sodium was used for irrigation. The specimens were weighed using the AUW220D scale (Shimadzu, Kyoto, Japan) before and after instrumentation. Weight of the material removed by each instrument in 240 seconds gives cutting efficiency. For evaluation of cyclic fatigue, corrosion resistance and autoclave cycle effects, files were randomly divided into three groups, Group A, B, C; Protaper Gold-F2, TruNatomy-Prime and WaveOne Gold-Primary (n=10) respectively. For cyclic fatigue testing (3-point bend test) the instruments were firmly held with clamping mechanism with passive adjustment and without pressure in a stainless-steel block containing an artificial canal (Gambarini et al. and Champa et al). The time was calculated in seconds (s) until fracture. The number of cycles to fracture (NCF) was calculated by the following formula: (Resistance (s) x Speed)/60. For evaluation of corrosion resistance, surface topographical analysis was carried out using High resolution SEM in response to three irrigants (5.25% NaOCl, 2% CHX,17% EDTA). For evaluation of autoclave cycle effects, High resolution SEM surface topographical analysis was carried out for 1, 5 and 10 autoclave cycles. Data was analysed using one-way ANOVA followed by multiple comparisons with Bonferroni test (α=0.05). The level of statistical significance were determined at p<0.05.

Results: TruNatomy was the most resistant to cyclic fatigue and Protaper Gold the least. WaveOne Gold removed significantly more dentin and had least corrosion resistance and highest autoclave cycle effects compared to TruNatomy and Protaper Gold.

Conclusion: TruNatomy can be considered as a better file system compared to Wave One Gold and has comparable efficiency with Protaper Gold.


  Abstract 174: Comparison of stress distribution and failure probability of endodontically treated teeth with different computer-aided design/computer-aided manufacturing materials: A finite element analysis Top


KO Shweta, K Vijay Venkatesh

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

Aim: To compare the stress distribution and failure probability of endodontically treated mandibular first molars with different CAD/CAM materials using 3D finite element analysis.

Materials and Methods: Three 3 dimensional models of mandibular first molars were modeled with a CAD software (SpaceClaim 2021 R1). The first model comprised of tooth restored with lithium disilicate crown, the second model comprised of tooth restored with lithium disilicate endocrown and the third model comprised of tooth restored with polymer infiltrated ceramic network (PICN) endocrown. The designed models were imported to Ansys (Workbench 2021 R1) testing software. The mechanical properties including elastic modulus, poissons ratio and density of dental structures and materials were assigned. The three models were obtained from the same mesh design to avoid variations in stress levels among the models. An angular and vertical load of 600N was applied at the occlusal surface. Results were determined by colorimetric graphs of maximum principal stress (MPS). Von mises stress were evaluated and the Weibull function were incorporated with finite element analysis to calculate the long-term failure probability.

Results: Endocrown restorations presented a lower mvM stress level than the conventional crowns. Stress distribution in endocrown restored with polymer infiltrated ceramics (PICN) was lower when compared to endocrown restored with lithium disilicate glass ceramics. Weibull analysis revealed that the failure probability diminished in endocrown when compared to conventional crowns.

Conclusion: Endocrowns can be considered as a conservative, aesthetic and clinically feasible restorative approach for endodontically treated mandibular first molars.


  Abstract 175: Development of novel bioactive glass-tideglusib nanoparticles as a dentine regenerative material Top


Akhil Rao, K Vijay Venkatesh

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

Aim: Primary objective, of this study was to synthesize tideglusib coated nanoparticles incorporated in an experimental calcium silicate-based cement. Secondary objective was to evaluate the physical, mechanical and Cytocompatibility of the newly synthesized experimental cement.

Materials and Methods: Bioactive glass nanoparticle was synthesized by sol-gel method, to these nanoparticles tideglusib (GSK-3 inhibitor) was loaded. Experimental Calcium silicate cement was manufactured by sol-gel method, drug loaded nanoparticles were added to the cement at 5, 10 and 15 weight percentage. Commercial Biodentine (BD), bioactive glass nanoparticles mixed with experimental cement (BgC) and drug loaded bioactive glass nanoparticles mixed with experimental cement (D-BgC) were the three different groups evaluated in this study. Physiochemical properties including initial setting time, compressive strength and alkalinity were evaluated for different weight percentages. Drug encapsulation efficiency and drug release from 2*2mm set D-BgC was analysed. Cytocompatibility was assessed with scratch wound healing assay, transwell migration assay and proliferation assay. Statistical analysis was performed by using one-way analysis of variance (ANOVA) and Tukey's test (p<0.05).

Results: Addition of nanoparticles did not affect the initial setting time, which was comparable to Biodentine (P> 0.05). After 1day, Compressive strength and alkalinity of 15wgt% group of D-BgC was comparable to that of BD (P<0.05). Encapsulation efficiency of the drug was 62.332% and there was an immediate drug release in the initial 6-12hrs followed by a sustained release with tapering percentages up to 48hrs(p>0.05). D-BgC exhibited better wound healing, faster proliferation and better migration of human dental pulp stem cells (hDPCs) than compared to that of BD (p<0.05).

Conclusion: In this study, dentine regenerative potential of drug-loaded nanoparticles incorporated in an experimental calcium silicate-based cement was evaluated, it was found to have comparable physical properties and better regenerative properties than the commercial alternatives, indicating a new direction for regenerative endodontics.


  Abstract 176: Recent advances in repair material for bony defects subsequent to periapical surgery Top


Ankita Kapoor

AIIMS, Jodhpur, Rajasthan, India

According to American Association of Endodontists 2018 the primary objective of endodontic treatment is to prevent and intercept pulpal/periradicular pathosis and to preserve the natural dentition when affected by pathosis. Despite the recent advances in endodontic materials, instruments, and techniques, the complete resolution of periapical pathology is not achieved in some cases. Under such circumstances, the only line of treatment is often surgical intervention. The ultimate goal of endodontic surgery is the predictable regeneration of periapical tissues, including the complete repair of the osseous defects which has an important bearing on tooth retention. The ideal bone replacement material should be clinically and biologically inert, noncarcinogenic, facilitate revascularization, osteogenesis and osteo-induction, provide adequate stability and support and should slowly resorb to permit replacement by new bone. Different types of materials are available for grafting of osseous defects. These include autografts, allografts, xenografts and alloplasts. Calcium hydroxyapatite (HA) and tricalcium phosphate (TCP) have gained much attention and popularity which constitute the ceramic/synthetic grafts. Recently bioactive glass was introduced in the putty form, (NovaBone®) which is a next-generation calcium phospho-silicate bone graft material built from a bioactive glass platform with additives that improve handling characteristics and performance. Some bioactive proteins like Bone Morphogenic Protein, Platelet Rich Fibrin or Platelet Rich Plasma can be used as an adjunct to the bone graft materials. The present review will highlight the recent advances in materials to repair bone defects post endodontic surgery.


  Abstract 177: Comparative evaluation on neutralizing effect of reactive oxygen species of limonene and cytotoxic analysis of citrus sinensis as root canal irrigant on fibroblast cells Top


Keerthana Thangaraj, Sindhu Ramesh

Saveetha Dental College, Chennai, Tamil Nadu, India

Introduction: Resistant microbes always represent a challenge in the treatments of various well-known infections and urges the need for substances with potent antimicrobial properties. Citrus sinensis is known for its medicinal value. ROS are oxygen-containing, chemically reactive molecules which kill microbes but also destroy the adjacent infected host tissues. This study aims to evaluate the cytotoxicity of citrus sinensis against fibroblasts and the neutralizing effect of limonene (orange peel extract) on reactive oxygen species generated by the mixture when used as an intracanal medicament.

Methodology: Citrus sinensis extracts were screened for in vitro cytotoxic activity against L9292 cells using MTT cell viability assay. The microplates filled with 100 μl of L929 Cells and growth medium using micropipette, read on an ELISA reader at 570 nm. Each experiment was carried out in triplicate and the IC50 of the test samples as the percentage survival of the cells was calculated. Group A: 2% CHX gluconate (control group) Group B: A mixture of 125 mg of Ca(OH)2 with 2% CHX gluconate solution. Group C: was a mixture of 125 mg of Ca(OH)2 with 1 mL of 2% CHX gluconate solution and dichloromethane (orange peel extract). The groups were analyzed for ROS formation using the mass spectrometer (JEOL GC MATE II) immediately after preparation.

Results: CSE did not adversely affect the fibroblasts even up to 50% concentration showing a nontoxic effect even till 200 μg/ml dose in comparison with CHX on these cells. The peak value of 3345.6 m/z denotes ROS formation. Limonene reduces the ROS significantly, shows more antioxidant properties when compared with other groups. Addition of natural antioxidants to the Ca(OH)2-CHX mixture increases the antibacterial efficacy and also decreases damage to the host tissue by lowering ROS formation.

Conclusion: Citrus sinensis peels extract demonstrated less cytotoxic activity. The peak value obtained probably originated from the production of reactive compounds. Thus decreased ROS formation was noted in orange peel aqueous extract warranting further in vivo clinical studies to determine the exact dosages and its effectiveness in practical situations.


  Abstract 178: Evaluation of inter-canal distance in mandibular first permanent molar with middle mesial canal amongst Indian sub-population: Cross-sectional cone beam computed tomographic analysis Top


Shruthika Mahajan, Mohammed Ali Mashood, M Lokapriya, L Shuchitha

Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

Aim: Analysis of the inter-canal distance between mesio-buccal (MB) and mesio-lingual (ML) canals in the presence of middle mesial canal (MMC). Categorical assessment of the prevalence of MMC variants in Mandibular First Permanent Molar (MFPM) in an Indian sub-population considering factors of age and gender.

Methodology: Analysis of pre-operative CBCT images was performed on 256 MFPM. MMC when detected, was classified as fin, confluent or independent as per classification given by Pomeranz et al (1981). Orthogonal slices from pulpal floor up to 2mm below root furcation were used to measure mean inter-canal distance from buccal wall of MB to lingual wall of ML canal using CBCT software tool.

Statistical Analysis: Data recorded was subjected to descriptive statistics, Chi-square test and Independent t-test using SPSS software version 23 (p-value ≤0.05).

Results: Occurrence of independent MMC was 4.7% (n=12), confluence 14.6% (n=37) and fin 8.7% (n=22). Mean inter-canal distance measured for the fin variant was 3.12 ± 0.512mm, 3.31± 0.402mm for confluence variant, 3.72 ± 0.493mm for independent MMC and 3.36mm ± 0.579 for two-canal variant. Significant association (p=0.001) was observed between age and gender, and overall detection of MMC, where in presence of fin (8.6%) and confluent (12.9%) configurations was higher (p=0.003) in individuals ≤40 years. There was increased inter-canal distance observed in females (17.9%) than in males (10.3%), for confluent, independent and two-canal configuration (p=0.04; =0.01, =0.001). Decrease in inter-canal distance was observed in individuals aged >40 years for two-canal configurations which was statistically significant (p=0.05).

Conclusion: Pre-operative CBCT assessment of MFPM aids in detection of MMC. According to the results of this study, individuals aged 40 years or less, have shown higher prevalence of fin and confluent variants. Increased inter-canal distance was seen in females for confluent, independent and two-canal configurations. Decreased inter-canal distance was seen in individuals aged more than 40 years having two-canal configuration. Thus, root canal complexities vary with age and gender, and should be taken into consideration prior to endodontic treatment.


  Abstract 179: Clinical presentation of mucormycosis and endodontic diagnosis Top


Rukhsar Anjum

Sharda University, Delhi, India

Objective: Clinical presentation of mucormycosis and endodontic diagnosis.

Description: Mucormycosis, also called zygomycosis or phycomycosis is an uncommon, opportunistic, acute infection with high morbidity rate. It is caused by a certain number of fungi species. Due to Covid 19 pandemic, Mucormycosis has recently come in picture as a serious post covid complication with cases increasing rapidly. Often case of Mucormycosis may manifest with dental pain and apical radiolucency at the initial stage. Lack of proper knowledge and understanding about the condition will turn the situation critical. Due to initial resemblance to an Endodontic lesion, it becomes highly essential for an Endodontist to properly understand the signs and tests to diagnose the condition. The review attempts to express importance of oral signs of condition and alert clinicians to include Mucormycosis in the differential diagnosis for the early management of this life-threatening fungal infection.

Result and Conclusion: Awareness by healthcare professionals is critical for the prompt diagnosis of this rapidly developing and lifethreatening infection.


  Abstract 180: Stereomicroscopic evaluation of pre and post instrumentation surface defects of nickel-titanium instruments in moderately curved root canals: An in vivo pilot study Top


Bushra Almas

D.A.P.M RV Dental College, Bengaluru, Karnataka, India

Objective: To evaluate pre and post instrumentation surface defects of Nickel-Titanium Endodontic Instruments under the stereomicroscope.

Materials and Methods: 40 individuals requiring endodontic treatment and satisfying the inclusion criteria for the study were included. For root canal instrumentation, NiTi endodontic instruments used were Fkg XP Endo Shaper ((FKG Dentaire, La Chaux-de-Fonds, Switzerland) ) and Micro Mega One Curve (Micro Mega, Besancon, France). Pre instrumentation Examination of all the files was done under stereomicroscope to observe for surface defects. 40 subjects were randomly divided into 4 groups having 10 individuals each. Grp 1: Instrumentation of root canal in 10 individuals was done using FKG Endo Shaper for 15 seconds. Grp 2: Instrumentation of root canal in 10 individuals using FKG Endo Shaper for 30 seconds Grp 3: Instrumentation of root canal 10 individuals using Micromega One Curve for 15 seconds.Grp 4: Instrumentation of root canal using in 10 individuals Micromega One Curve for 30seconds. After instrumentation all the files were cleared off the debris using a gauze piece, stabilized using an endo block. Examination was done by a single observer at the apical and middle third of the file under the Stereomicroscope in 40X magnification at 90-360 degrees for the presence of any surface defect or deformity.The observations were recorded and maintained.Scoring of defects was assigned to each file according to the degree of damage.

Statistical Analysis Used: Kruskal Wallis test and Mann Whitney Post hoc test were used to compare the median microscopic scores between different groups at Apical and Middle third region.

Results: Defects were observed on examination under the stereomicroscope than naked eye observation. Apical region showed more defects compared to middle third region. Micromega One Curve file showed less surface defects when compared to FKG XP Endo shaper. None of the files fractured during root canal instrumentation

Conclusion: Niti instruments can be safely used within root canals for duration upto 30 seconds. However, studies with more number of samples are required to confirm.


  Abstract 181: Evaluation of the inhibitory potential of blackseed and brown seaweed against the Enterococcus faecalis biofilm: An in vitro and in silico study Top


S Radha, A Shafie Ahamed, Bhavani Sreekrishnapillai, G Rajaraman, M Chittrarsu1, Vignesh Gupta2

Rajah Muthiah Dental College and Hospital, Chidambaram, 1Vivekanandha Dental College for Women, Tiruchengode, 2Karpaga Vinayaga Institute of Dental Science, Kanchipuram, Tamil Nadu, India

Objectives: To evaluate the inhibitory activity of black seed extract and brown seaweed extract against Enterococcus faecalis biofilm. To investigate the binding interaction between the active components of blackseed and brown seaweed against the Enterococcal surface protein of Enterococcus faecalis through molecular docking.

Materials and Methods: The ethanolic extracts of blackseed and brown seaweed were prepared using the soxhlet apparatus. They were categorised as Group I: Blackseed and Group II: Brown seaweed. The antibiofilm activity was assessed using the crystal violet biofilm assay. Enterococcus faecalis biofilm was sub-cultured on BHI broth. Cell suspension were inoculated with the test compounds in 96 well micro-titre plate. Planktonic cells were removed by washing with PBS. The wells were stained with 125μl of 1% crystal violet and the percentage of inhibtion was evaluated. The molecular docking process was performed using the SWISSDOCK suite. PyMOL version 4.5.0 was used as visualization software. The Enterococcal surface protein (Esp) was selected as the target protein of Enterococcus faecalis due to its primary role biofilm formation. Thymoquinone of Group I and Ledene oxide of Group II selected as ligands based on their chromatographic studies.

Results: The percentage of inhibition of Enterococcus faecalis biofilm analysed through crystal violet assay showed Group I - 52.13 % and Group II 38.31% of antibiofilm activity.The binding energy of thymoquinone (Group I) and ledene oxide (Group II) analysed through molecular docking against the Enterococcal surface protein (Esp) of Enterococcus faecalis showed the delta G value of Group I as -6.90 K cal/mol and Group II as -6.44 K cal/mol.

Conclusion: The blackseed has the higher antibacterial activity against the Enterococcus faecalis biofilm both in microbial inhibition and in molecular interaction when compared to brown seaweed.


  Abstract 182: The mysterious middle mesial canal: An in-vivo analysis Top


Sana Iqbal

I.T.S Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India

Aim: Missed canals are one of the imperative reasons for failure of endodontic treatment of molars. This study aimed to determine prevalence of middle mesial canal (MMC) in mandibular molars (1st and 2nd) in the population of Greater Noida and also to find relationship of intracanal distance between mesiobuccal (MB) and mesiolingual (ML) canals with presence or absence of MMC.

Materials and Methods: Five hundred Cone-beam computed tomography (CBCT) scans of mandibular molars from patients were included. Following data was collected: identification of MMC, the distance between MB and ML orifices, whether MMC was more prevalent in mandibular 1st or 2nd molar, whether MMC was prevalent in mandibular molars of right or left side. The results were analysed using Chi-square test and independent student's t-test.

Results: The overall prevalence of MMC was 21.8% (P < 0.05). MMC was more prevalent in mandibular first molar (29.7%) than mandibular second molar (16%) and overall prevalence of MMC was higher on left side (24.3%) than on right side (18.8%). The mean distance between MB and ML orifices was 2.9 mm and 3.4 mm with and without MMC respectively, (P < 0.05) i.e. the MB-ML orifice distance was inversely related with the presence of MMC.

Conclusion: MMC is a common finding in the population of Greater Noida, and should be negotiated. Along with the use of CBCT, careful exploration of the pulpal floor between canal orifices is crucial to prevent missing the MMC, as this could lead to undesirable clinical outcomes.


  Abstract 183: Silver nanoparticles and its applications in dentistry: A review Top


Rinki Meher

SCB Dental College & Hospital, Cuttack, Odisha, India

Nano particles are small particles that ranges between 1 to 100 nm in size, and it exhibits significantly different physical and chemical properties as compared to their larger counterparts. Silver has been used as an antimicrobial and disinfectant, without any side effects. Silver nanoparticles have antimicrobial, antifungal and, antiviral properties. It has the ability to penetrate bacterial cell walls and, can change the structure of cell membrane which results in cell death. Silver nanoparticles can be incorporated into acrylic resins for fabrication of removable dentures, composite resins, irrigating solutions and obturating material in endodontic treatment, adhesive materials in orthodontic treatment, membrane of guided tissue regeneration for periodontal treatment and, titanium coating in dental implants. Silver nanoparticles are promising with important features as, antimicrobial, anti-inflammatory and antitumor activity and, a potential carrier in sustained drug delivery. The aim of this review paper is to highlight the benefits of application of silver nanoparticles in dentistry, especially in field of endodontics and its safety in clinical aspect.


  Abstract 184: Morphological characteristics of canal convolution in mesial root of mandibular second molars: A three-dimensional analysis using cone-beam computed tomography in Indian population Top


Kavina Desai, Ankit Arora, Purnil Shah, Sonali Kapoor, Hardik Rana, Kesha Vasavada

Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India

Aim: To evaluate the anatomical characteristics of mesio-lingual and mesio-buccal canal through and beyond the confluence in terms of its exit direction,distance and the angle of confluence.

Materials and Methods: The CBCT images of two-rooted fifty mandibular second molars were analysed whereas C-shaped canal configuration and root canal treated teeth were excluded in this study.The course of mesio-lingual and mesio-buccal canals were evaluated in terms of its direction and exit point, angle of confluence and the distance of the confluence from the minor constriction.

Results: The results of the study showed that the mesio-lingual canal was straighter in terms of having a mild curvature and the mesio-buccal canal had an aggressive curvature with the course of the canal beyond the confluence towards the buccal side of the root. The angle of confluence had a median value of 35.64. The distance of the confluence from the minor constriction had a median value of 2.43mm.

Conclusion: The morphological variance noted in mandibular second molars highlights that the mesio-lingual canal continued through and beyond the confluence as a mild curvature when compared to the mesio-buccal canal which exhibited a tortuous course through the confluence.


  Abstract 185: Ideal color match - recent advancement of color science in dentistry Top


Shrutika Goel, Garima Joshi

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

A thing that is not understood often becomes the focus of mystery, fear, indifferent of abject, rejection. Color although a part of nearly every human activity is one of those things is poorly understood and shrouded by misconceptions. Shade selection is one of the important aspect of esthetic dentistry. In the present scenario patient seeks dental treatment under two situations: pain and esthetics. For esthetics every dentist should know the shade matching procedures. Patient are currently demanding esthetic replacement that must match their existing dentition, and are more concerned about the shade match of their restoration rather than the quality of the restoration. To achieve esthetics, four basic determinants are required in sequence; viz, position, contour, texture and color. Shade matching includes knowledge of Color (hue, value, and chroma), Translucency and opacity gloss, Surface toughness, opalescence, iridenscence, fluorescence and Lumniescence Phosphorescence and Metamerism. Just as disharmony is created by a discordant note in a symphony, the wrong shades can destroy the result and thus, this necessitates the thorough knowledge and understanding of the concept of shade selection.


  Abstract 186: Comparative evaluation of fracture resistance of roots after application of three different rootcanal sealers-AH plus, mineral trioxide aggregate fillapex and BioRoot RCS: An in vitro study Top


Manzoor Ahmed Khan

Navodaya Dental College, Raichur, Karnataka, India

Aim: To compare and evaluate the fracture resistance of root dentin following the application of AH-Plus sealer, MTA Fillapex sealer and BioRoot RCS sealer.

Materials and Methodology: Seventy extracted single rooted premolars decoronated at the cementoenamel junction. The samples were divided into 3 experimental and 2 control groups. 14 samples served as negative control (Group 4) which were left unprepared. The remaining 56 samples were prepared using Protaper rotary files up to F3. Roots were obturated using cold lateral compaction using gutta percha and AH Plus sealer (Group 1), gutta percha and MTA Fillapex (Group 2), gutta percha and BioRoot RCS (Group3). Group 5 was left unobturated that served as the positive control group. The roots were then mounted in acrylic resin molds to test for fracture resistance and then subjected to compressive load using Universal Testing Machine until fracture occurred. Data was analyzed using one- way ANOVA with post hoc Tukey test.

Results: The highest resistance to fracture was shown by Group 4 (negative control) followed by Group 1 (AH Plus), Group 3 (BioRoot RCS), Group 2 (MTA Fillapex) and the least by Group 5 (positive control). There was a statistically significant difference between all the groups (p=0.00) except between AH Plus and BioRoot RCS (p>0.05).

Conclusion: Samples in all the groups fractured when vertical force was applied. The maximum resistance to fracture was shown by the roots which were neither instrumented nor obturated. Among the experimental groups, AH plus showed the maximum fracture resistance followed by BioRoot RCS and MTA Fillapex.


  Abstract 187: Comparative evaluation of apically extruded debris with hyflex EDM, Mtwo and self adjusting file systems: An in vitro study Top


Sravya Yerra, Deepa Gandu

Navodaya Dental College, Raichur, Karnataka, India

Objective: To compare and evaluate the amount of apically extruded debris with Hyflex EDM, Mtwo and the Self-Adjusting File systems.

Materials and Methods: Sixty single rooted extracted mandibular teeth with straight canals were selected and access cavities were prepared. All the teeth were mounted in the Eppendorf tubes after obtaining initial weight of the empty tubes. Samples were then divided into three groups (n=20) according to the rotary system used, and instrumented with Hyflex EDM, Mtwo and SAF respectively. The entire stopper assembly was detached from the Eppendorf tube after complete instrumentation. The root surfaces were washed with 1 ml of distilled water to collect the adhered debris, and incubated at 70°C for the next 5 days to evaporate the distilled water. Then, the dry weight of the debris was calculated. Results were analyzed using ANOVA and post hoc Tukey's test.

Results: SAF showed least amount of apical debris extrusion of all, while Mtwo showed maximum apical debris extrusion. The difference between amount of apically extruded debris among all the groups were statistically significant.

Conclusion: The SAF showed least amount of apical debris extrusion when compared to other file systems and Mtwo showed the highest amount of apical debris extrusion.


  Abstract 188: Effect of various root canal disinfection procedures on expression of Enterococcus faecalis virulence factor: A polymerase chain reaction study Top


Manavalan Dheepshi, James Vandana, Sunderasan Balagopal, Sebatni Anisha, Shekar Shobana, Chandrasekaran Charanya

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

Objective: To compare and evaluate antimicrobial effects of 2% Chlorhexidine (CHX) versus 0.1% Octenidine Dihydrochloride (OCT) as root canal irrigant with and without Laser activation against Enterococcus faecalis virulence factor- E.faecalis endocarditis antigen (efaA) using real time polymerase chain reaction.

Aim: To evaluate the effect of various root canal disinfection procedures on expression of Enterococcus faecalis virulence factor (efaA) using real time PCR.

Materials and Methods: Forty single rooted premolars were taken and decoronated to standardize the root length as 14mm. The canals were instrumented up to F3 Protaper Gold and 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% Chlorhexidine, Group - II 2% Chlorhexidine with Laser, Group III –0.1% Octenidine dihydrochloride, Group IV- 0.1% Octenidine dihydrochloride with Laser. After the irrigation protocol, Paper points were used to transfer the contents of the canal. PCR was performed to detect the presence of Enterococcus faecalis virulence factor (efaA).

Results: Octenidine dihydrochloride (0.1%) was more effective than 2% chlorhexidine against E.faecalis. Group II and IV showed significant difference compared to group I and III. Laser activation enhanced the antimicrobial action of the irrigants.

Conclusion: Octenidine dihydrochloride (0.1%) was more effective than 2% chlorhexidine against E.faecalis. Laser activated irrigation proved to enhance the antimicrobial action of the irrigants.


  Abstract 189: Evaluation of apical fit of standardized gutta percha after root canal preparation using four different files: An in vitro study Top


Chandrasekaran Dhatshayani, Nagarajan Geethapriya, Sundaresan Balagopal, Sarathy Sarath, Shekar Shobana, Kumar Sarath

Tagore Dental College, Chennai, Tamil Nadu, India

Aim: To compare the apical fit of standardized gutta-percha after root canal preparation using four different file systems.

Materials and Methods: Forty single-rooted lower premolar teeth were selected. Standard access cavity preparations were made and patency confirmed. Working length (WL) was determined using a 10 size k file. The teeth were then randomly divided into 4 groups with 10 teeth in each group. Instrumentation was done as follows using X-smart plus Endomotor for the first 3 groups:

Group 1- Protaper gold files system up to size F2

Group 2- Hero shaper files system up to size #25/6%.

Group 3 – Wave One Primary file.

Group 4 – Teeth were prepared manually with Hand NiTi files up to a file size #25/2% and “step back” up to size #40/2%.

Irrigation was done using saline. Apical gauging was done. WL was transferred to the corresponding ISO tapered Gutta-percha (GP) using the ruler and pen marker. GP cone was passively inserted as far as it can reach. GP Fitting at the WL or short of the WL or beyond the WL was tabulated and statistically analyzed using the Kruskal-Wallis test followed by Mann-Whitney u test.

Results: Among 4 groups, root canals prepared using waveOne file group showed the maximum number of GP's at the working length and least number of GP's beyond the WL, followed by Heroshaper files > Protapergold files > Hand NiTi files. Root canals prepared using protapergold files group showed a maximum number of GP's short of the WL, followed by Heroshaper files > Hand NiTi files > WaveOne file. Data suggested that WaveOne primary file was the best and Hand NiTi files were the least among the four files in maintaining the apical constriction with statistically significant results (P<0.05).

Conclusion: This “in vitro” study highlights that WaveOne primary file system was the best in maintaining the apical constriction and Hand NiTi files were the least among the 4 groups evaluated.


  Abstract 190: Antimicrobial, antioxidant, anti-inflammatory and cytotoxic activity of silver nanoparticles synthesized using fruit extract of solanum xanthocarpum: An in vitro study Top


UB Swathi, Sindhu Ramesh

Saveetha Dental College, Chennai, Tamil Nadu, India

Aim: The aim of this study was to evaluate antimicrobial, antioxidant, anti-inflammatory and Cytotoxic Activity of Silver Nanoparticles Synthesized using fruit extract of Solanum Xanthocarpum.

Materials and Methods: For this study about 25 grams of dried fruit powder of solanum xanthocarpum was mixed with 250 ml of water. The solution was placed in a rotating shaker at room temperature for 48 hours. After incubation, the extract was filtered in Whatman No: 1 filter paper and the filtrate was allowed to air dry in room temperature and dried powder was stored at 4 degree C. 25 ml of plant filtrate was added into 225 ml of aqueous solution of 1mM silver nitrate for reduction of silver nitrate into Ag+ ions and kept at room temperature for 24 hours in a rotating shaker at 28degree C. After preparation of the silver nanoparticles using Solanum Xanthocarpum fruit extract antimicrobial,antiflammatory activity, antioxidant activity and cytotoxicity was assesed.

Results: Solanum xanthocarpum induced with silver nanoparticles showed good antibacterial activity against oral pathogens and good anti inflammatory activity. The values for antioxidant property of nanoparticles was found to be comparable to the standard values at all concentrations except at 10 and 20 μL and highest at 50 μL.Percentage of inhibition was 49.5% at 10 μL concentration,57.4% at 20 μL,75% at 30 μL,76% at 40 μL and 79.6% at 50 μL.Cytotoxicity study was done against brine shrimp artemia.As the concentration increased the cytotoxicity of the nanoparticles increased.

Conclusion: The use of fruits for the synthesis of silver nanoparticles has many advantages such as, ease with which the process can be scaled up, economic viability and to obtain smaller particle size.According to the results of this study, silver nanoparticles synthesized using the fruit extract Solanum Xanthocarpum showed excellent anti-inflammatory activity,antimicrobial activity,antioxidant activity and the concentration increased the cytotoxicity activity increased.


  Abstract 191: Antibacterial, antioxidant and cytotoxic property of an indegenious herbal extract (Gymnema sylvestre): Can they be a potential alternative in endodontic treatment? Top


Rajamanickam Keerthika, R Sandhya

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

Aim: The aim of this study was to analyse the antibacterial, cytotoxic and antioxidant potential of ethanolic extract of Gymnema sylvestre.

Materials and Methods: The ethanolic extract of Gymnema sylvestre was prepared at different concentrations(10,25,50,100,200μg/ml).The antibacterial activity against E.faecalis and S.mutans was studied by disk diffusion method and compared with 2.5%NaOCl.The antioxidant property was tested using DPPH assay and ABTS radical scavenging activity and reducing power were designated by their IC50 (concentration required to attain 50% radical-scavenging effect) and compared with that of the standards (Ascorbic acid).The cytotoxic potential of the extract was tested on L929 Mice Fibroblast Cell using MTT assay and compared with that of the standards 2.5%NaOCl.The statistical analysis was done using ANOVA and post hoc analysis.

Results: The herbal extract showed concentration dependent antibacterial efficacy against E.faecalis and S.mutans, with maximum zone of inhibition being 12.1 ± 1.1 mm and 13.1 ± 1.1 mm respectively at 50μg/ml ( p<0.001).The antioxidant activity with IC50 was found to be 74.8μg/ml and 83.8μg/ml by ABTS and DPPH assay respectively with p<0.001.The cytotoxicity analysis of the ethanolic extract showed it did not adversely affect the fibroblasts even up to 50% concentration showing a nontoxic effect even till 200 μg/ml dose in comparison with NaOCl on the fibroblast cells with p<0.001.

Conclusion: Within the limitations of the study, the ethanolic extract of Gymnema sylvestre showed maximum antibacterial efficacy against E.faecalis and S.mutans at 50 μg/ml and antioxidant activity with IC50 found to be at 74.8μg/ml and 83.8μg/ml by ABTS and DPPH assay respectively and the extract showed a non toxic effect even till 200 μg/ml dose in comparison with NaOCl on the fibroblast cells.


  Abstract 192: Evaluation of antifungal activity of triple antibiotic paste with epigallocatechin gallate against candida albicans: An in vitro study Top


Anandavelu Sujareetha, Shekar Shobana, Sundaresan Balagopal, Kumar Sarath, James Vandana, Anguswamy Sri Ganesh

Tagore Dental College, Chennai, Tamil Nadu, India

Aim: To evaluate the antifungal activity of Triple antibiotic paste with epigallocatechin gallate against Candida albicans.

Materials and Methods: Disc Diffusion Test: 30 Kirby Bauer discs were soaked in the following intracanal medicaments: Group 1 – Fluconazole: Group 2: +Epigallo catechin gallate( EGCG): Group 3: Fluconazole + EGCG; Group 4: EGCG + TAP (Ciprofloxacin 500mg, Minocycline 100mg, Metronidazole 400mg in 1: 1:1: ratio) using Dimetylsulfoxide carrier. The dried discs were placed in agar plates with 10 μl suspension of C.albicans and incubated at 37 °C for 24 hours and observed for zone of inhibition.

Simulated Dentine Model Study: Forty extracted single rooted teeth were decoronated to obtain uniform samples of 12 mm in length. Biomechanical preparation was done using Nickel-Titanium rotary ProTaper Universal files (Dentsply, Maillefer, Switzerland) up to size F2. Saline was used for root canal irrigation. All teeth were then autoclaved at 121°C. 10 μL culture suspensions of C. albicans was placed into the prepared root canal space of all the teeth. After 2 days of incubation following which intracanal medicament was placed inside the canal using lentulospiral and the samples were incubated for 3 days. After incubation all the samples were irrigated using saline. Sterile absorbent points were inserted in to the root canal of each sample, which were then transferred immediately in to Sabouraud dextrose agar plates and incubated for 48 hours at 37 °C. The Colony forming units (CFUs) were counted using the digital colony counter.

Results: Intergroup analysis was done using Kruskal Wallis test and intragroup analysis with Mann Whitney test. There was a statistically significant difference in the zones of inhibition produced by the medicaments: Group 1 (30mm)> Group 3 (25mm)> Group 2 (17mm) > Group 4 (16mm) (p<0.001). Group 1 and 3 produced significantly greater zones of inhibition when compared to groups 2 and 4 (p= 0.001 and 0.014 respectively). None of the groups showed fungal growth in the dentin simulation study.

Conclusion: C. albicans is susceptible to EGCG. TAP does not interfere with the antifungal property of EGCG and may be used in combination for broader antimicrobial activity.


  Abstract 193: Comparative evaluation of efficacy of endoactivator and laser assisted irrigation on dentinal tubule penetration of newer irrgants: A confocal laser scanning microscopy study Top


Pradnya Nagmode, Abhishek Jagtap, Prachi Janbandhu, Shubham Godge, Harshal Basatwar, Sayali Kamat, Snehal Shinde

S.M.B.T. Dental College and Hospital, Sangamner, Maharashtra, India

Aim: To evaluate and compare the efficacy of Endoactivator and Laser assisted irrigation on dentinal tubule penetration of newer irrgants like Fumaric acid, Ozonated water and Curcumin using confocal laser scanning microscope.

Materials and Methods: Forty Eight freshly extracted single rooted mandibular premolars were selected and divided into two groups (n=24) based on the irrigation method used. Each group was further subdivided into three subgroups (n=8) based on irrigants used. Group IA: Fumaric acid with endoactivator assisted irrigation, Group IB: Ozonated water with endoactivator assisted irrigation, Group IC: Curcumin with endoactivator assisted irrigation, Group IIA: Fumaric acid with LASER assisted irriagation, Group IIB: Ozonated water with LASER assisted irriagation, Group IIC: Curcumin with LASER assisted irrigation. To ensure standardization, the length of the teeth was standardized to 14 mm from the apex under water cooling. Root canal of each tooth was shaped using ProTaper rotary system up to size F3. 2 mL of Normal saline was used to irrigate root canals between each instrument. The root canals were irrigated with 5 mL of 17% EDTA solution after root canal preparation for smear layer removal. Two coats of nail polish were applied around the root surface, and flowable composite was used to seal the apex. All experimental irrigants to be used as final irrigation were mixed with 0.01% fluorescent rhodamine B isothiocyanate to provide visualization within dentinal tubules under confocal laser scanning microscopy. Then root canals were dried using size F3 ProTaper paper points. Roots were mounted vertically in acrylic blocks and sectioned horizontally at 2 mm (apical) and 5 mm (middle) from the apical foramen, removing 1 mm of thickness. The sections were examined using a confocal laser scanning microscope to evaluate dentinal tubule penetration of each irrigant.

Results: The overall results showed that Laser assisted irrigation with Fumaric acid exhibited significantly higher penetration percentage than other groups. Statistically significant differences were also determined between middle and apical section with Tukey's post hoc test (P < 0.05).

Conclusion: Within Limitations of this study it was concluded the Laser assisted irrigation with Fumaric acid showed higher dentinal penetration.


  Abstract 194: Comparative evaluation of the efficacy of four different irrigation devices in the debridement of root canal isthmus: An in vitro study Top


Anila Vinoy

Navodaya Dental College, Raichur, Karnataka, India

Objective: To compare the efficacy of Diode Laser, Endo Activator, Passive Ultrasonic Irrigant and Manual Irrigation Activation in the debridement of root canal isthmus using a stereomicroscope.

Materials and Methods: A total of sixty five (65) extracted mandibular first molars were selected for the study. The access cavity preparation was done and the working length was determined. All teeth were prepared using Pro Taper rotary system up to F2 size and irrigation was done using 5.25% sodium hypochlorite and 17% Ethylene diaminetetraacetic acid. The samples were randomly divided into five groups (n=13) used in the study

Group 1: Diode Laser (n=13): Samples were irrigated using Diode Laser having a wavelength of 980nm.

Group 2: Endo Activator (n=13): Samples were irrigated using Endo Activator sonic device.

Group 3: Passive Ultrasonic Irrigation (n=13): Samples were irrigated using an Ultrasonic device.

Group 4: Manual Irrigation Activation (n=13): Samples were irrigated manually by placing a master gutta percha cone of F2 size.

Group 5: Control (n=13): No activation of irrigant.

Following irrigant activation, the mesial roots were sectioned 4mm from the apex and the isthmus cleanliness was observed under a stereomicroscope at 20x magnification. Statistical analysis was done using ANOVA and post hoc Tukey's test.

Results: Endo Activator showed least amount of debris when compared to Diode laser, Passive Ultrasonic Irrigant and Manual Irrigation Activation at the isthmus level. There was no significant difference between Diode Laser and Passive Ultrasonic Irrigant.

Conclusion: Endo Activator showed the least amount of debris at the isthmus level when compared to diode laser, Passive Ultrasonic Irrigant and Manual Irrigation Actvation.


  Abstract 195: Comparative evaluation of microleakage of biodentine and geristore root end filling materials in dry, saliva and blood contaminated environments: A fluorescent microscope study Top


Anagha Jukanti

Navodaya Dental College, Raichur, Karnataka, India

Aim: Is to compare and evaluate the microleakage of Biodentine and Geristore root end filling materials in dry, saliva and blood contaminated environments using fluorescent microscope.

Materials and Methods: A sample of 90 extracted human maxillary central incisors were taken and decoronated.Their root canals were instrumented and obturated. The apical 3 mm of each root was resected and a standardized root end cavity was prepared using a #8 round bur and restored 45 samples with Biodentine and 45 samples with Geristore. Groups of roots were divided into three equal subgroups for each material and were placed in different environments namely dry, saliva and blood. All samples were immersed in 0.2% Rhodamine B dye for 48 hrs. Roots were sectioned longitudinally and examined under a fluorescent microscope to measure the linear dye penetration. Data was analyzed using ANOVA and post hoc Bonferroni.

Results: Geristore showed higher microleakage compared to Biodentine in dry (0.47±0.516), saliva (1±0.65) and blood (1.27±0.59) sub-groups. Statistical significant difference was seen between dry and blood subgroup in Geristore group, whereas there was no significant difference between any subgroups in Biodentine group.

Conclusion: Microleakage was observed in both the tested groups. Biodentine exhibited the least apical leakage value, while Geristore exhibited the maximum apical leakage value.


  Abstract 196: Cold plasma as an endodontic disinfectant Top


P Soundharrajan

All Indian Institute of Medical Sciences, Jodhpur, Rajasthan, India

The ultimate goal of endodontic treatment is to eliminate bacterial infection in the root canal system and prevent reinfection. However, traditional treatments such as mechanical instrumentation techniques, chemical irrigation, laser irradiation, and ultrasonics cannot achieve a complete elimination of biofilm from endodontic sites because of the complex root canal system and the innate resistance capacity of biofilm. In this situation, more effective disinfection methods are needed to eradicate biofilm from the root canal. In recent years, Cold Atmospheric pressure plasma jets (CAPPJs) have received significant attention because they widen the plasma application range for biomedical purpose. Plasma, the fourth state of matter, is a quasineutral collection, consisting of neutral species and charged particles. CAPPJ's have been used in various biological and biomedical applications such as sterilization, gene transfer to cells, promotion of blood clotting, cell detachment, and inducing tumor cells apoptosis. They have also gained interest in dental applications such as root canal disinfection, tooth bleaching and dental material modification. Portable plasma jet devices like jet needle and plasma pencil have been constructed that can enter the root canal of teeth that have been drilled and mechanically prepared and remove the microorganisms associated with infected root canals. The interaction of plasma jet with wet surfaces generates reactive oxygen (hydroperoxyl, superoxide anion radical, hydroxyl, and ozone) and nitrogen (nitrates and nitrites) species. The reactive oxygen and nitrogen species can easily penetrate into the bacterial cell wall and inactivates the bacteria efficiently by destroying the intracellular components. This review paper describes the components, mechanism and efficiency of cold plasma as a root canal disinfectant in endodontics.


  Abstract 197: A new method of restoring subgingival fracture with a polished collar of custom made post and core Top


Simran Chawla, Tarun Kumar, Sunandan Mittal, Vanita Keshav, Ena Maakhni

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

Traumatic injuries which can occur during falls or accidents are one of the main causes of crown-root fractures. Crown-root fractures most commonly occur in mature permanent teeth with closed apices. Dental trauma in esthetic region especially subgingival fractures pose a great challenge to the dentist. Due to the poor esthetics and functional prognosis such teeth are often indicated for extraction. It not only causes an esthetic and functional breakdown but also psychological breakdown. Various factors influencing treatment depends upon the level of fracture line, root development, type of dentition, periapical status. Numerous treatment modalities like orthodontic extrusion, periodontal crown lengthening are practiced for such cases. In this paper a case report describing a new method of restoring subgingival fracture with a polished collar of custom made post and core will be discussed.


  Abstract 198: Comparative evaluation of sealing ability of mineral trioxide aggregate, biodentine, and new light-cure mineral trioxide aggregate used for furcal perforation repair using scanning electron microscope: An in-vitro study Top


Pradnya Nagmode, Prachi Janbandhu, Abhishek Jagtap, Harshal Basatwar, Shubham Godge, Snehal Shinde, Sayali Kamat

S.M.B.T. Dental College and Hospital, Sangamner, Maharashtra, India

Aim: To evaluate and compare the sealing ability of Mineral trioxide aggregate (MTA), Biodentine, and new light-cure MTA used for repair of furcal perforations using scanning electron microscopy.

Materials and Methods: The study sample comprised 45 extracted mandibular molars. Carious, restored, hypoplastic teeth, fractured teeth, and teeth with root resorption where the furcal area could not be involved were excluded. The teeth were embedded in modeling wax. Standard access cavities were prepared in each tooth using a round bur and non-end cutting bur with a high-speed handpiece with water spray. Furcal perforations were made on the center of the pulpal floor of each tooth using a 0.5mm round bur. The teeth were then randomly divided into 3 experimental groups of 15 specimens each based on the materials used to seal the perforations; Group A: MTA; Group B: Biodentine; Group C: Light cure MTA. All the sealed perforations were compacted with a moist cotton pellet, and the samples were stored in a closed container for 24 hours to allow the repair materials to set completely. After 24 hours, the samples were sectioned longitudinally and the extent of marginal adaptation was measured using the scanning electron microscope. The sealing ability was evaluated by measuring the gap (in microns) between the pulpal floor and the material used for perforation repair. The intramolecular space within each repair material was also examined using the scanning electron microscope.

Results: The overall results showed that the marginal adaptation of light-cure MTA was better than both MTA as well as Biodentine. The mean space between the pulpal floor and the repair material was the least for group C (2.29). Tukey's post hoc test showed that a significant difference (p<0.05) existed between group C & A and group C & B.

Conclusion: Within the limitations of the study, it can be concluded that light-cure MTA exhibits a better sealing ability when compared to conventionally used Biodentine and Mineral Trioxide Aggregate.


  Abstract 199: Comparative evaluation of fluid uptake, solubility and porosity of mineral trioxide aggregate, biodentine and glass-ionomer cement using micro computed tomography: An in vitro study Top


sathish Abraham, Omkar Darade

SMBT Dental College and Hospital, Sangamner, Maharashtra, India

Aim: The aim of this study was to evaluate the solubility and fluid uptake and quantify changes in volume, density, and porosity of Glass Ionomer cement, MTA, and Biodentine in distilled water and butyric acid.

Methodology: According to the three groups i.e Group 1 – GIC, Group 2 – MTA, Group 3 – Biodentine; 4 cylindrical discs were prepared for each group(i.e 24 cylindrical discs in total, including two subgroups) using stainless steel mold. All the cements were manipulated according to the manufacturers instruction. The cylindrical discs had a diameter of 5mm and thickness. After final set the discs were retrieved and then immediately analyzed for volume and porosity using Micro CT. All specimens were scanned and three dimensional micro CT images were constructed using an ex vivo micro CT scanner immediately after initial setting of GIC, MTA, Biodentine. After which the samples from each group were divided into 2 subgroups which included subgroup 1 – Distilled water and subgroup 2 – Butyric acid. The assigned samples were then immersed in respective mediums. The discs were analyzed under Micro CT on 7th, 14th and 28th day for volume loss, porosity, dissolution and fluid uptake. The region of interest was particularized as the surface, density, volume of the discs that were prepared.

Results: The results showed that the final porosity values i.e after 28 days (in comparison to initial porosity values) in distilled water are highest for GIC (27.86) followed by biodentine (26.27) followed by MTA (22.5) and in case of butyric acid the final porosity values are highest for MTA (24.11) followed by GIC (23.07) followed by Biodentine (22.93).

Conclusion: Biodentine showed the least porosity followed by GIC followed by MTA. Solubility, porosity, fluid uptake are related to each other and degrade the quality of restoration. All the cements used in Conservative Dentistry and Endodontics are constantly in contact to variety of fluids of varying nature and pH and it is necessary to know their potential to withstand such environment.


  Abstract 200: Static versus dynamic navigation for endodontic microsurgery: A comparative analysis review Top


TD Geo

Government College of Dentistry , Indore, Madhya Pradesh, India

Digitalization realization of operative procedures through 3D navigation is a remarkable advancement in the field of dentistry which allows precision and accuracy, both, in treating patients. It is as an emerging technology with its wide variety of applications in the dental field. These computer aided 3D systems are being used in the field of endodontics; employed for accessing canals and localizing calcified teeth; for the removal of fiberglass posts; and in apical surgeries. Preservation of important anatomical structures is necessary in case of root end resection or periapical surgeries. However, it is clinically difficult to achieve accurate root–end resection due to limited field of view, the inconvenient perspective, and interferential bleeding, among other factors. 3D guided endodontic plays its role here, Static and Dynamic navigation are the two ways of guided endodontic. There is need to review new evidence comparing the effectiveness of both techniques of 3D guided endodontic navigation system. This review paper describes the comparative evaluation of effectiveness of static as well as dynamic navigation in the field of endodontic microsurgery.


  Abstract 201: Graphene oxide-our next “go” to disinfectant? Top


Harikrishnan Nikhil, Ahmed Shaik Fayaz, Selvakumar Kritika, Sekar Mahalaxmi

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

The primary goal of successful endodontic therapy is the complete elimination of the endodontic biofilm from the root canal system. Extensive research are underway on the search for an ideal material for the eradication of the micro-organisms. In 2004, graphene was isolated for the first time as a single sheet of carbon atoms with a hexagonal honeycomb lattice. Since then, graphene has quickly emerged as a promising material with unique electrical, optical, and catalytic capabilities that has been used for a variety of applications in energy, environment, and biomedical systems. Among the graphene based materials, graphene oxide (GO) is a 2D carbon based material which is a water-soluble graphene derivative with carboxylic groups on the edges and phenol, hydroxyl, and epoxide groups on the basal plane. It has gained popularity in biomedical applications because of its high surface area, high functional groups and cost-effective synthesis in a large scale. When compared to pristine graphene, the hydrophilic groups give GO polarity and improve its dispersity and stability in aqueous conditions, thereby assist it in developing a steady colloid dispersal and makes it cytocompatible. Hence, these products have piqued the interest of biological researchers. In endodontics, graphene-oxide based solutions have demonstrated outstanding antimicrobial and antibiofilm potential with the reduction of total biovolumes and high biocompatibility when used to disinfect the canals. These properties could be improved due to its inherent ability of functionalization with various other materials. Literature reports reveal that the intracellular densities of S. mutans, F. nucleatum and P. gingivalis decreased in the presence of GO nanosheets indicating the loss of intracellular substance. Further, it has proven to decrease the extracellular polymeric substances (EPS) synthesis and increases the susceptibility of E. faecalis biofilms. Thus, the aim of this review is to comprehensively summarise and predict the future scope of this interesting material.


  Abstract 202: Managing large periapical lesions - conservative or surgical approach?: A case report Top


T Sathya, jeyaraman Venkatraman Karunakaran

J.K.K.N Dental College and Hospital, Namakkal, Tamil Nadu, India

Trauma to a tooth can damage the pulpal tissues even if the crown and root are intact. The pulp may survive or undergo necrosis, depending on a number of factors mainly the severity of trauma and the type of inflammatory reaction.This reaction may lead to extensive destruction tissues of the periapical region over a period of time if left untreated. On the basis of histological findings, chronic periapical lesions of the pulpal origin are diagnosed as either periapical granulomas or cysts. In situation like this, most often a surgical approach for therapy of large periapical lesion is advocated when involvement of multiple teeth happens. A conservative approach with an attempt to maximally preserve local tissues, without weakening those fragile teeth can also be done. Basic rationale behind this conservative management is, the body will heal on its own when bacterial load is reduced below critical colonization. So, the current concept and rationale of endodontic treatment of periapical lesion are centered on stopping the bacterial stimulation of the host response at the apical foramen that would allow healing of the lesions. Now, because of improvements in conventional endodontic therapy and a better understanding of the healing potential of periapical tissues, fewer patients need periapical surgery. If a conservative approach fails a surgical management can be done. This case report discusses a large periapical lesions involving 11-14 with destruction of the nasal floor. After treatment with conservative approach the long term 15 month review shows nasal floor reformation and promising healing with asymptomatic teeth.


  Abstract 203: Echoes in endodontics Top


RA Pavithra Monika Devi

Best Dental Science College, Madurai, Tamil Nadu, India

Ultrasound (US) is defined by the American National Standards Institute as “sound at frequencies greater than 20 kHz.” Ultrasound imaging is a radiation-free, minimally intrusive imaging method in which an ultrasonic beam travels through internal tissues and is reflected, absorbed, or transmitted to create an image. It has recently gained traction in the field of dentistry, with applications including the detection of carious lesions, tooth fractures, soft tissue lesions, periodontal bone abnormalities, maxillofacial fractures, salivary gland diseases, and temporomandibular disorders. It does not emit hazardous ionising radiation, unlike X-rays. Both hard and soft tissue can be detected with ultrasound. USG allows echoes to be processed at a fast enough pace to allow motion perception; this is known as real-time imaging. Ultrasound imaging has a promising future as a hard-and soft-tissue diagnostic tool in all dental specialties since it has a lot of progress from two-dimensional to three-dimensional visualization in the evaluation and diagnosis of disorders. The aim of this review is to provide an insight into the applications of Ultrasonography into the field of Endodontics in particular.


  Abstract 204: Guided tissue regeneration and grafts in endodontics Top


Ishika Garg, Mehak Tarwani, Sonali Taneja, Pragya Kumar

ITS Centre for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India

Periradicular surgery has become an established treatment option in endodontic surgery. The major objective of this surgery is to obtain periradicular tissue regeneration, including the formation of a new attachment apparatus, by exclusion of any potentially noxious agent within the physical confines of the affected root. However, in a substantial number of cases, the endodontic lesion has a concomitant marginal periodontal lesion that may complicate the healing success. Performing endodontic surgery has the principal goal of not only maximizing the procedural outcome from an endodontic standpoint but also periodontally, by returning the site to its preoperative periodontal state despite bone removal to access the root end. Because endodontic microsurgery involves a process to stabilize the endodontic status of the tooth while accessing through the periodontal structures that affect the overall status of the tooth, guided tissue regenerative techniques have a place in the wholetooth management of an endodontic surgical case. Guided tissue regeneration is a valuable technique available to the endodontist because the quality, quantity, or extent of bone loss cannot be visualized by the surgeon until the tissue is reflected and the surgical site is exposed. It involves the use of Membrane barriers and/or bone grafts which are often used to enhance periapical new bone formation. This review paper describes the molecular and cellular biologic concepts when using membrane barriers and/or bone grafts in periapical surgery, along with predictable healing and suggested treatment plan for combined endo-perio lesions with specific reference to guided tissue regeneration in periodontal regenerative therapy.


  Abstract 205: Dental pain - causes and management: A review Top


Parvathy D Kumar, Archana N Nair

Government Dental College, Thiruvananthapuram, Kerala, India

Pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. It is a subjective perception. Diagnosis and management of pain is an everyday occurrence in dentistry. It is a perception that dental treatment and pain go hand in hand.So its effective control is essential to ensure the wellbeing of patients. Most tooth-associated pain originates from the dental pulp, a highly vascularized and innervated tissue. Causes of dental pain contains a broad spectrum which needs to analyzed properly before arriving at a diagnosis. Current approaches in the management of dental pulp pain has mostly been the combination of pharmacological management and restorative part. Arrival of new approaches which include modulation of thermo-sensitive transient receptor potential cation channels (TRP),use of novel biomaterials, stem cells, exosomes and physical stimulation to obtain pulp regeneration in regenerative medicine which appears promising. The aim of this review is to assess the causes of underlying dental pain, diagnostic methods and current and newer methods for effective management of pain.


  Abstract 206: A remarkable method toward salvaging a tooth employing intentional replantation Top


Sunandan Mittal, Tarun Kumar, Vanita Keshav, Ikroop Gill, Arshpreet Kaur

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

Intentional replantation is a method involving the deliberate extraction of a tooth, and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back in into its original socket. It is one of the oldest known methods for the treatment of disease of endodontic origin, dating as far back as the 11th century. It is a preferred treatment option when more conventional forms of treatment either fail or are impossible. Recent studies have shown a high success rate of intentional replantation of upto 88% to 95%. Post treatment endodontic disease is one of the most common reasons for intentional replantation. The primary cause has been attributed to the presence of microorganisms in the root canal system and periapical tissue, although additional etiologies, including the presence of cysts, cholesterol crystals and foreign bodies have also been implicated. Because of the difficulty of surgical access and the anatomical limitations, intentional replantation is preferred over apical surgery. The present paper describes a series of cases pertaining to intentional replantation and its success rates.


  Abstract 207: Internal resorption an endodontic challange: A case series Top


Tanu Singh

Bareilly International University, Bareilly, Uttar Pradesh India

Internal root resorption (IRR) is a particular category of pulp disease characterized by the loss of dentine as a result of the action of clastic cells stimulated by pulpal inflammation. This case series present the etiology, the clinical and radiographic features, points helpful for diagnosis, the clinical decision, and the therapeutic management of IRR. Root canal treatment remains the treatment of choice of internal root resorption as it removes the granulation tissue and blood supply of the clastic cells. This case series describe with different clinical cases, ultrasonic improvement of chemical debridement, and the use of alternative materials such as calcium silicate based cements. In these conditions, the prognosis of the conservative treatment of internal resorptions, even if root walls are perforated, is good.


  Abstract 208: Comparative evaluation of the decalcification effect of chitosan, ethylenediaminetetraacetic acid, maleic acid as a root canal irrigant: An energy dispersive X-ray analysis Top


Leelu J Puthumana, Kennet J Chirayath, Mohammed Sagir, Prasanth Dhanapal

Royal Dental College Kerala, Chalissery, Kerala, India

Objective: To evaluate and compare the decalcification effect of 3 different irrigant -0.5% Chitosan,17 % EDTA and 7 % Maleic acid on the root canal dentin using Energy Dispersive X Ray Analysis.

Methodology: Single rooted premolar (n=96) were selected and decoronated at a standard length of 15mm. Patency and working length were established. Canals were prepared to a size F2 using rotary Protaper file employing the accepted protocol. The canals were irrigated with 3% sodium hypochlorite at each change of instrument followed by distilled water. The samples were divided into four groups (each n=24).Group 1: 0.5% Chitosan Group 2:17% EDTA Group 3: 7% Maleic acid Group 4: Control group (Samples without any treatment). Each group were irrigated with respective chelating solution for 1 minute. The root canals were flushed with distilled water and dried with paper points. The roots were sectioned in two halves and one half was used for Energy dispersive X ray analysis to obtain the calcium phosphate ratio. Intergroup results were statistically analyzed using one way ANOVA.

Results: 7% Maleic acid on the root dentin showed significantly higher alteration of calcium phosphate ratio. 0.5% Chitosan showed the least alteration of calcium phosphate ratio of the root dentin.

Conclusion: Within the limitation of the study all the irrigant solutions used altered the calcium phosphate ratio of the root dentin.7% Maleic acid showed the highest decalcification effect and 0.5% Chitosan showed the least decalcification effect on root dentin.


  Abstract 209: Comparative evaluation of sealing ability of calcium phosphate, mineral trioxide aggregate and biodentine as perforation repair material: An in vitro scanning electron microscope study Top


Jewel Mary Jose, Mohammed Sagir, Biju P Babu, Prasanth Dhanapal

Royal Dental College, Chalissery, Kerala, India

Objective: To comparatively evaluate the sealing ability of three different perforation repair material- Calcium phosphate, Mineral Trioxide Aggregate and Biodentin when used to seal a furcal perforation using SEM analysis.

Methodology: Multirooted teeth(n=90) were collected and perforations were made on the centre of pulpal floor using a round bur (0.8 mm).The samples were grouped into three (each n= 30) according to the material used.Group 1 repaired with calcium phosphate, group 2 repaired with MTA and group 3 repaired with biodentine.The perforation repair material was manipulated and mixed using manufacturers instructions and perforation sealed.Specimens were stored in distilled water. Specimens were cut into two equal halves mesio-distally. Two points of the semi circle point A and point B were taken as reference points respectively. The selected points were viewed under SEM (HITACHI -SU6600) at 1000x magnification. Marginal adaptation was assessed by measuring the gap between the tooth and repair material.The results were obtained and statistical analysis was performed using ONE WAY ANOVA.

Results: The highest duncan grading was found to be in calcium phosphate and lowest in mineral trioxide aggregate.The SEM analysis of the specimens showed gap between repair materials and tooth interphase in all the three groups. Mean width of the gap was found to be least in group 1(0.52518) followed by group 3 (0.87548). Group 2 (MTA) exhibited the largest value (2.17189). The values were compared and found to be significant with p < 0.05. The intergroup comparison by pairwise multiple comparison procedures was done using Post hoc tests Bonferroni corrections, and has revealed significant differences between all the three groups.

Conclusion: Within the limitation of the study Calcium phosphate cement performed well as a perforation repair material in terms of sealing ability followed by biodentine.MTA showed the maximum gap between the perforation and repair material among the three material tested.


  Abstract 210: Comparative evaluation of the bond strength of reattached fractured segment of maxillary central incisor using three different methods and materials: An in vitro study Top


Kennet J Chirayath, Prasanth Dhanapal Dhanapal, Akthar Ramees, Mohammed Sagir

Royal Dental College, Challissery, Kerala, India

Aim: To comparatively evaluate the bond strength of re-attached fractured segment of maxillary central incisor using three different methods and materials.

Methods: 90 extracted human maxillary permanent central incisors were collected. Each specimen was sectioned 3 mm from the incisal edge using a diamond disc. Sectioned specimen were equally distributed into three groups(n=30) based on the technique used for re-attachment. Group I-Simple reattachment, Group II-Over contouring, and Group III-Internal dentinal groove. Each group was further divided into two subgroups on the basis of the intermediate restorative material used for reattachment (Hybrid composite, Nano composite). Bond strength of each specimen was determined using universal testing machine and the data collected was analyzed using two-way ANOVA.

Results: The mean value of fracture strength obtained in 3 different groups were Group I: 120.8133N, Group II: 250.6730 N, Group III: 319.6397N, and among the sub-groups Hybrid composite showed fracture strength of 193.5762 N and Nano composite had a fracture strength 267.1744 N.

Conclusion: Within the limitation of the present study the highest fracture strength was obtained when the fragments were reattached using internal dentinal groove technique, which was statistically significant than reattachment by over contouring technique. The least fracture strength was exhibited by simple reattachment technique which was significantly lower than other two techniques. Nano composite was found to have higher fracture resistance compared to hybrid composite but was not statistically significant.


  Abstract 211: Artificial intelligence in endodontics Top


R Shirley Stella Josephine

Best Dental Science College, Madurai, Tamil Nadu, India

The concept of “artificial intelligence” (AI) refers to machines that are capable of doing human jobs. It defines the process of using technology to create software or a machine that can readily mimic human intelligence and execute specified tasks. The utilization of neural networks in dentistry has advanced dramatically as science and technology have progressed. AI has mostly been utilized in dentistry to improve the accuracy and efficiency of diagnosis, which is critical in attaining the most precise diagnosis and enhanced patient care. Artificial intelligence has various applications in dentistry, from taking a patient's history to data processing and then extracting information from the data for diagnosis. Though artificial intelligence will never be able to fully replace the function of a dental surgeon, it is crucial to be aware of the possibilities for incorporating this progress in technology into dental practice in the future. The aim of this review is to track the development of AI applications used in endodontics, as well as to assess their performance in terms of diagnostic, clinical decision-making, and treatment prognosis prediction.


  Abstract 212: Oral health-related quality of life in patients with traumatic dental injury of permanent teeth: A systematic review and meta-analysis Top


Priyankaa Das

Institute of Dental Science, SOA University, Bhubaneswar, Odisha, India

Objective: The objective was to assess the impact of traumatic dental injuries on permanent teeth in children and adolescents on oral health-related quality of life.

Methods: The protocol was registered in PROSPERO. PRISMA guidelines were followed. A focused on structured question using Population(P), Exposition(E), Comparisons(C), Outcomes(O), (PECO) was: “Does traumatic dental injury impact OHRQoL of children and adolescents with trauma of permanent teeth?” A broad search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted and literature was screened via PubMed/MEDLINE, Cochrane, Proquest databases from January 2000 to February 2021. A total of 2677 articles were retrieved from databases, from which only 50 articles were selected on the basis of the title and abstract. The full text of these 50 articles were downloaded and finally 25 studies that fulfilled all the requirements of inclusion criteria were selected for data extraction and review. Evaluation criteria of methodological quality and risk of bias control were applied to selected articles. A fixed effect model was used for the meta-analysis and quality of the evidence was performed using Quality Assessment Checklist for Survey Studies in Psychology (Q-SSP) tool.

Results: 21 studies were of acceptable quality, and 2 studies were considered for meta-analysis. A negative impact on OHRQoL was detected for children mostly in the domain of emotional well-being, oral symptoms, and functional limitations.

Conclusion: Traumatic injuries to the permanent dentition affects not only child but their caregivers or parents too. Timely management of TDI not only improves the child eating and speaking but overall improvement in aesthetics boosts up their self-esteem. Since the majority of studies used a well validated questionnaire tool and were of high-quality it can be concluded that there is a significant association between TDI and OHRQoL.


  Abstract 213: Vital pulp therapy: Restoring the tooth's own heartbeat!!! – A case report Top


Poonam Joshi, Rajesh Shetty

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

Vital pulp therapy (VPT) in mature permanent teeth with carious pulp exposure has been a matter of debate, with root canal therapy being the conventional standard of care. Previously reported negative outcomes for VPT in these teeth were based on data from studies that have used calcium hydroxide in direct pulp capping and partial and full pulpotomy. The introduction of hydraulic calcium silicate-based materials with sealing and bioactive potentials have opened a new era in VPT with more favorable results. Understanding the histopathology and histobacteriology of the cariously exposed pulp and the healing potential of the inflamed pulp could guide the decision-making process toward an ultraconservative management of these teeth. However, proper case selection, strict aseptic condition, capping material, and good coronal seal are crucial for long-term success. The present case report highlights the conservative management of a mandibular molar with deep caries and irreversible pulpitis.


  Abstract 214: Apical end resection followed by root end ultrasonication and sealing with various retrograde filling materials: A case series Top


Arshpreet Kaur, Preetika Kaur, Sunandan Mittal, Tarun Kumar, Vanita Keshav

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

Injury to anterior teeth is a common event. It requires a treatment approach that assures the complete biologic healing and functional restoration of the tooth or teeth involved. A cystic lesion, which is unable to heal nonsurgically, heals well with surgical intervention. Apical surgery is considered a standard oral surgical procedure. It is often the last resort to surgically maintain a tooth with a periapical lesion that cannot be managed with conventional endodontic retreatment. The main goal of root end surgery is to prevent bacterial leakage from the root-canal system into the periradicular tissues by placing a tight root-end filling following root-end resection. The modern surgical approach instills the application of microsurgical techniques in apical surgery, i.e., gentle incision and flap elevation, production of a small osteotomy and the use of ultrasonic driven microtips, which results in less trauma to the patient and faster postsurgical healing. A major step in apical surgery is to identify possible leakage areas at the resected root face and subsequently ensure adequate root-end filling. Only a tight and persistent apical obturation will allow periapical healing with a good long-term prognosis. The present paper describes a case series pertaining to endodontic surgery followed by sealing the apex with various retrograde filling materials.


  Abstract 215: Role of biomaterials as a coronal plug in pulp revascularization of necrotic immature permanent teeth: A systematic review and meta-analysis Top


Shefali Pednecar, Bhavna Sharma, Anand C Patil, Neha Dhaded

KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India

Background: Revascularization technique involves placement of biomaterial after inducing a blood clot within the canal. Its role is to maintain a microorganism free environment, also proliferation and differentiation of stem cells. Various biomaterials which have been put-to use in the revascularization technique are not sufficiently studied. Hence, the aim of this systematic review was to analyze and summarize the clinical and radiographic results after using different coronal plug materials during pulpal revascularization.

Methods: Literature search was conducted on the following databases: PubMed and Cochrane yielded a total of 2836 whereas ProQuest, Science direct and Wiley yielded 954 studies. Among these 1 RCT, 1 NRCT, 2 cohort studies, 2 case series and 6 case reports comparing different outcomes of various biomaterials as coronal plug were selected. Extraction of information and assessment of methodological quality of the included studies was done using Risk of Bias. Meta-analysis using random-effects model was conducted for the outcomes. All studies published till 30th September 2020, conducted among population below 35 years were included. Studies conducted on animals, reviews and systematic reviews, studies with participants above 35 years, studies that did not mention follow up and proper results were excluded.

Results: Total 12 articles were selected for qualitative synthesis of which 6 were analyzed for various parameters using meta-analysis and the results were shown using Forest plot. It was observed that overall, MTA alone or with Collaplug showed better results, that is higher increase in root width and decrease in apical diameter along with resolution of periapical radiolucency than Biodentine which showed least discoloration. I2 value was found to be zero for the parameters of clinical outcome, resolution of periapical radiolucency and root length indicating that variation between the studies was negligible. Meta-analysis of decrease in apical diameter showed a high I2 value indicating a considerable heterogeneity.

Conclusion: There was a good overall clinical outcome (absence of pain, tenderness to percussion and swelling) with MTA alone or with Collaplug. In addition, radiographic findings like increase in root width, root length and decrease in apical diameter too were far better with MTA followed by Biodentine.


  Abstract 216: Survival analysis of endodontically treated tooth with or without full coverage crowns: A systematic review Top


Roja Bastia

Institute of Dental Sciences, Bhubaneswar, Odisha, India

Aim: The objective is to assess the effects of restoration of endodontically treated permanent teeth by crowns versus conventional filling materials.

Materials and Methods: The protocol was registered in PROSPERO. PRISMA guidelines were followed. A focused structured question using Population(P), Intervention(I), Comparison (C), Outcome(O) was designed: “Which type of restoration (direct or indirect) provides a better clinical outcome for endodontically treated permanent teeth?” According to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), a broad search was conducted and literature was screened via the following databases: the Cochrane Oral Health Group's Trials Register, Pubmed, Web of Science, and SCOPUS and Google scholar until May 2021.

Results: A total of 306 articles were retrieved from the databases, from which only 70 articles were selected based on title and abstract. The full text was downloaded for these 70 articles and finally, 6 studies that fulfilled all the requirements of inclusion criteria were selected for data extraction and review. Two review authors independently assessed the extracted data and the risk of bias was assessed.

Conclusion: Indirect restorations consisting mostly of crowns have a higher survival rate than direct restorations using composite or amalgam, but no significant difference was found in short-term (≤ 5-year) restorative success. However, high-quality clinical trials, especially well-designed RCTs with larger sample sizes and longer follow-up duration are needed for a better quality of evidence.


  Abstract 217: Effectiveness of antioxidant dentifrices on cariogenic bacteria: A systematic review Top


Sweta Mishra

Institute of Dental Sciences, Bhubaneswar, Odisha, India

Aim: This study assesses the effect of antioxidants present in dentifrices on cariogenic bacteria and hence preventing the formation of oral microbial biofilm that leads to dental caries.

Materials and Methods: The protocol was registered in PROSPERO, PRISMA guidelines were followed. A focused structured question using Population (P), Intervention (I), Comparison (C), and Outcomes (O) model, PICO was designed: “What is the effect of antioxidants present in dentifrices on cariogenic bacteria?” A broad search according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted and literature was screened via PubMed/MEDLINE, Cochrane and TRIP database till 30th May 2021.

Results: A total of 57 articles were retrieved from which, 10 articles were selected on the basis of the title and abstract that met all the inclusion criteria, were incorporated in this review and selected for data extraction and review. Evaluation criteria of methodological quality and risk of bias control were applied to selected studies.

Conclusion: Antioxidants terminate the chain reaction caused by free radicals of oxidation reaction, thereby preventing cell damage or death of the cells. Antioxidants are widely available in various dentifrices and safety and efficacy of these antioxidants has been proven by clinical research. However, lack of randomised controlled trials in dental research limits their usage. This review highlights the effectiveness of antioxidant therapy to curb oral microbial biofilm formation when used as dentifrices.


  Abstract 218: Revascularization: A boon over apexification Top


Gurudeo Chavhan

S.M.B.T Dental College, Sangamner, Maharashtra, India

For decades, the apexification technique with calcium hydroxide has proven its effectiveness in open apices. It is the most studied to induce a calcific apical barrier with a success rate of 74% to 100%. However, this technique, which is considered a long-term procedure (6 to 24 months to obtain the apical barrier), does not increase the thickness or length of the root wall and make the tooth fragile and susceptible to future fractures. Recently, scientific research had led to the development of a new concept called revascularization to treat necrotic immature permanent teeth. This technique allows the continuation of root edification while the periapical lesion is healing. However, this protocol is not sufficiently studied and required a certain clinical dexterity. The origin and the nature of the tissue formed in the canal are still controversial. Several authors performed a histological study in relation to this topic on both human and animals. Recently, revascularization has been proposed as an improved alternative treatment for irreversibly damaged pulp of immature teeth as it has been shown to preserve the potential for continued root growth in treated teeth. The root canal is cleaned and disinfected by irrigation with sodium hypochlorite and/or chlorhexidine. The second step included the placement of disinfectant paste [Ca (OH)2 or triple antibiotic paste (TAP)], followed by coronal seal and an intermediate restoration of the tooth. In the follow-up appointment, the tooth is reopened and canal over-instrumentation with a k-file is carried out to provoke bleeding from the periapical region. This causes blood cells to be trapped in clot, followed by the induction of angiogenesis and new pulp-like tissue formation over a period of time. MTA is placed over the clot and the tooth is permanently restored. Institution name not given.


  Abstract 219: Irrigation protocols in clinical scenario of separated instruments Top


Aishwarya Wattamwar

SMBT Dental College and Hospital, Sangamner, Maharashtra, India

Complete chemo-mechanical preparation and three-dimensional obturation of root canals are sine qua non (essential) for successful endodontic treatment. Nickel–titanium (NiTi) files are widely preferable to stainless steel files during chemo-mechanical preparation. Although NiTi files have several advantages such as ability to create well-centered and minimally transported root canals with minimal procedural errors, they might be unintentionally separated during different stages of the root canal treatment. This fractured file segment might prevent microbial control beyond the obstruction, especially if it is separated at the onset of treatment without further intervention.

An irrigation solution should reach the apical third by passing the blockage, to improve dentinal tubule penetration and antimicrobial control in the root canal, in the presence of the separated instrument. The combination of sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) is widely used during chemo-mechanical preparation with NiTi files to improve antimicrobial activity. NaOCl is preferred mostly because of its antimicrobial effect, tissue dissolution capacity, and acceptable biologic compatibility when confined to the root canal.

Various devices such as EndoVac, EndoActivator, RinsEndo, etc are manufactured to increase the penetration depth of irrigants into the dentinal tubules and to improve their smear layer removal capacity. Previous studies reported that ultrasonic activation, EndoVac, and RinsEndo have the potential to ensure better microbial control compared to manual needle irrigation. It has been reported that EndoVac prevents apical extrusion of NaOCl. It applies negative pressure, while RinsEndo applies positive pressure and causes apical extrusion in vitro during root canal irrigation. Acoustic energy is delivered to intracanal irrigation solution via a file or special tip to generate acoustic streaming and cavitation in PUI method. Vibringe and EndoActivator sonic irrigation systems are used for sonically activate intracanal irrigants. However, to the best of our knowledge, efficiency of irrigation techniques with regard to removing the smear layer by reaching the apical region of the fragment in the presence of intracanal fractured instruments has not yet been investigated. Thus, this poster emphasizes on efficiency of different irrigation methods in presence of a separated instrument for effective endodontic treatment.


  Abstract 220: Clinical outcome of young immature necrotic permanent teeth treated with regenerative endodontic therapy versus apexification procedure: A systematic review with meta-analysis Top


Pratima Panda

Institute of Dental Science, SOA University, Bhubaneswar, Odisha, India

Objective: To evaluate the effectiveness of regeneration compared to traditional apexification for managing young immature necrotic permanent teeth.

Methods: The protocol was registered in PROSPERO. PRISMA guidelines were followed. A focused structured question using Population (P), Intervention (I), Comparison(C), Outcome(O) was: “Which procedure between the two that is regenerative and apexification has more successful outcome in young permanent non-vital tooth?” The literature was screened via PubMed/MEDLINE, Embase, ProQuest and Cochrane databases from January 2000 to February 2021 to select randomized clinical trials and observational studies that compared pulp revascularization and apexification treatments assessing clinical, radiographic outcomes. Two reviewers independently performed screening and evaluation of articles. A total of 814 articles were retrieved from databases, in which only 46 articles were selected for full-text analyses. After exclusion criteria, six studies were evaluated quantitatively and qualitatively.

Results: The outcomes at postoperative follow-up, such as dentinal wall thickness (DWT), increase in root length (RL), calcific barrier formation (CB), apical closure (AC), vitality response (VR), survival rate (SvR) and success rate (SR) were subjected to both qualitative synthesis and quantitative meta-analysis. The meta-analysis showed that the regeneration procedure showed significantly improved in the increase in RL, DWT, AC, VR than Apexification whereas no significant effect was observed on the survival rate and success rate of necrotic immature permanent teeth treated with both the groups.

Conclusion: Both regeneration and apexification procedure are equally comparable interventions and have over all similar outcomes. Clinicians should consider employing Regeneration treatment in cases when the root development is severely deficient, with insufficient dentin and where tooth prognosis is hopeless even with apexification procedure.


  Abstract 221: Surgical management of a persistent periapical cystic lesion: A case report Top


Tarun Kumar, Sunandan Mittal, Vanita Keshav, Ena Maakhni, Jaskirat Kaur

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

A thorough debridement and mechanical preparation of the root canal followed by filling is required to eliminate infection in conventional endodontic treatment. Though a predictable procedure with a high degree of success, failures can still occur after conventional treatment. The primary mode of management in cases of previous endodontic failures is usually non-surgical revision of root canal treatment. However success of non-surgical retreatment maybe impeded by factors such as a complex root canal system or previous procedural accidents. Periradicular surgery though less often the first choice of treatment in such cases, could be the last hope to save an endodontically treated tooth with non-healing periradicular pathosis. It may be undertaken after unsuccessful retreatment or when retreatment is impossible. This presentation discusses a case of persistent periapical cystic lesion treated with enucleation of the lesion and apicoectomy on a lower right first molar.


  Abstract 222: Comparative evaluation of partial caries excavation and complete excavation in the management of deep carious lesions using different pulp capping materials: A randomized clinical trial Top


S Sharmila

Dr. Ziauddin Ahmad Dental College, Aligarh, Uttar Pradesh, India

Aim: The aim of this study was to compare management of caries removal and pulp capping in a single session that preserves pulp vitality in cases of deep carious lesions.

Materials and Methods: One hundred and ninety eight patients of age group 15-60 years with mature permanent molars having deep carious lesions were divided into two groups: partial caries removal (PCR) and CCR. Each group was further divided into subgroups A and B depending on the pulp capping material. A layer of soft, wet carious dentin was left adjacent to pulpal wall in PCR group, whereas in CCR group, complete infected caries was removed with bur. Teeth were restored with composite resin (Tetric N-Ceram; Ivoclar Vivadent), with base of resin-modified glass ionomer cement (RMGIC) and patients were recalled at 1, 3, 6, 12, and 18. Success was defined as absence of signs and symptoms of irreversible pulpitis (spontaneous pain, fistula, and swelling) and absence of periapical alterations (radiolucency at furcal or periapical region).

Results: Pulp exposure occurred in 15(7.57%) cases of CCR group. Statistical significant difference (P <0.05) in terms of pulp exposure was found between two groups. After 18 months, 176 teeth were evaluated (CCR = 82 and PCR = 94) and the success rate in CCR group (92.21%) and the PCR group (88.53%) did not differ significantly.

Conclusion: PCR could be as an elective treatment option for the mature permanent teeth with deep carious lesions.


  Abstract 223: Comparative evaluation of the colour stability of preheated and conventional composite after immersing in two different potential discolourant solutions: A digital spectrophotometer in vitro study Top


Rs Abijith, Mohammed Sagir, Kennet j Chirayath, Prasanth Dhanapal

Royal Dental College, Chalissery, Kerala, India

Objective: To evaluate and compare the colour stability between preheated composite and conventional composite after immersion in two different potential discolourants.

Methodology: The sample size consisted of 42 composite discs of standard dimension. The samples were divided into 2 groups of 21 discs each. Group 1 was prepared using conventional composite at room temperature and group 2 was prepared by heating composite to 68°C. The composite discs were then light cured and stored in distilled water for 24 hours. The samples in each group were divided into 3 subgroups and immersed for 6 days in 3 different solutions including 2 potential disclourants (coffee solution and tea solution) and one control. The final colours of the discs were measured using Digital spectrophotometer. The difference between the measured colours (CIE-L*a*b* system) were calculated and statistically analyzed using Paired t-test, ANOVA and Tukey's test.

Results: The preheated composites showed significantly lower staining in the coffee solution than the room temperature composites (p<0.05). In contrast, no statistically significant difference was observed for the tea solution (p=.065). The staining of the preheated composites in distilled water was higher than composite made at room temperature, however, the difference was not significant (p=0. 770).

Conclusion: Within the limitation of this study, preheating of composite was found to be effective to improve the color stability of composite resin up on immersion in coffee solution.


  Abstract 224: Prevalence of C-shaped canal in mandibular first premolars in the Indian sub-population: A cone-beam computed tomography cross sectional study Top


Muneer Mehnu Zain, Prasanth Dhanapal, Jojo Kottoor, Mohammed Sagir

Royal Dental College, Palakkad, Kerala, India

Aim of this study was to analyse the prevalence of C-shaped canal and radicular groove (RG) in mandibular first premolars of Indian sub-population using Cone Beam Computed Tomography (CBCT) in vivo. The primary objective of the study was to assess the prevalence of C-shaped canal and radicular groove and secondary objective was to analyse the association between (RG) and C-shaped canal.

Methods: CBCT scans of 220 subjects were retrospectively collected, compiled and analyzed using volume rendering software. Parameters assessed were presence of C-shaped canal, RG, and classification of the C-shaped canal in coronal 3rd, middle 3rd, and apical 3rd. Any correlation between gender, age, and the parameters analyzed were evaluated. Pearson Chi-square test was used to compare the qualitative variables (p <.05 was considered significant).

Results: Prevalence of C-shaped canal configuration in the Indian sub-population was 16.8% with the predominance of C3 configuration in the middle 3rd and C4 configuration in the apical 3rd (p<0.5). There is a significant association between C-shaped canal and RG. Gender and age did not show any assosciation with RG and C-shaped canal.

Conclusions: Mandibular first premolars in the Indian sub-population showed a prevalence of C-shaped canals to be 16.8% and a strong association between RG and C-shaped canals.


  Abstract 225: Comparative evaluation of compressive strength of biodentine and biodentine combined with graphene nanoparticles: An in vitro study Top


Mrunmayee Khare, T Naveen

SRM Kattankulathur Dental College, SRMIST, Chennai, Tamil Nadu, India

Aim: To evaluate the compressive strength of biodentine incorporated with graphene nanoparticles.

Materials and Methods: A total of 36 samples were analyzed. The following experimental groups were established according to the materials to be tested: Group 1: Biodentine mixed with graphene nanoparticles. Group 2: Biodentine To test the compression strength, specimens measuring 12 mm in height by 6 mm in diameter were fabricated. The material was mixed according to the manufacturers guidelines; and placed in the molds. Both the experimental groups included 6 samples each, which were maintained at 37°C under 100% relative humidity until the tests were performed. Each experimental group was subjected to testing at 1 hour and at 24 hours after-manipulation of the cements. The compression strength of each specimen was evaluated using a universal testing machine at a crosshead speed of 1 mm/min. The load was applied along the long axis. All measurements were recorded in megapascal (MPa). Results so obtained were statistically analysed.

Results: The study showed that an increase in compressive strength of biodentine mixed with graphene than biodentine.

Conclusion: Within the limitations of the study, it was concluded that the compressive strength was maximum in biodentine with graphene. In the present study, the materials were tested after their setting, which is not the real clinical scenario, where the tooth is immediately subjected to masticatory stresses. Thus, there is a need to conduct more elaborated studies, considering all the relevant limitations.


  Abstract 226: Comparitive evaluation of the effect of carbonic acid as solvent on the dissolution of mineral trioxide aggregate and biodentin and effect of carbonic acid on root dentin Top


P Athira, Biju P Babu, Mohammed Sagir, Prasanth Dhanapal

Royal Dental College, Palakkad, Kerala, India

Objective: To compare and evaluate the effect of carbonic acid on the dissolution of MTA and Biodentin and the effect of carbonic acid on root dentin.

Methodology: Uniform discs of MTA and Biodentin were prepared under standardized condition following manufacturer's instructions. Dentin disc of standard dimensions were prepared. Preliminary microhardness of all the samples were tested after the initial set. All samples were soaked in carbonic acid for 5 minutes and the microhardness of all samples were tested again. The results were statistically analyzed using paired sample 't' test and the results compared.

Results: Biodentin showed no statistically significant difference in microhardness before and after the exposure to carbonic acid. MTA showed a statistically significant difference in microhardness before and after the exposure to carbonic acid. Root dentin showed significant reduction in the microhardness on exposure to carbonic acid.

Conclusion: Within the limitation of this study, it can be concluded that carbonic acid can be effectively used as an adjunct to dissolve set MTA. The effect of carbonic acid to dissolve Biodentin was minimal. Carbonic acid in contact with root dentin has been found to be detrimental to the microhardness of root dentin.


  Abstract 227: Physics behind disinfecting canals - role of fluid dynamics in endodontics Top


Surmayee Singh

Manipal College of Dental Sciences, Mangalore, Karnataka, India

Endodontic research is focused on finding the clinical procedures and irrigants which can increase the success rate of endodontic treatment by reaching the apical anatomy. The infected root canal contains bacteria, necrotic tissue, organic and inorganic debris. Root canal irrigation along with instrumentation is important for its removal. Apical pressure, shear wall stress, and turbulence are the factors that play a role in deciding the safety and effectiveness of irrigation. In-vivo measurement in a root canal is difficult due to its microscopic size. So Computational fluid dynamics (CFD) allows for numeric simulation of irrigation in root canals in real physical conditions. It is a very powerful tool that can investigate flow patterns of irrigants, with the help of mathematical modeling and computer simulation. It deals with the pattern of irrigant flow, forces, and exchange within the root canal space. Wall shear stress depends on irrigant flow. The geometry of the irrigation needle and the increased flow rates cause the wall shear stress to increase gradually. It has an influence on the debris detachment by mechanical means, removal of tissue remnants, microbes as well as a biofilm. The force that is applied perpendicular to the surface of the apical wall is apical pressure. CFD analysis demonstrated that lowest apical pressure was for side vented closed-ended needle while the highest was for the open-ended needle. To prevent the irrigating solution from reaching the periapical tissues and cause an accident, it is necessary to maintain adequate apical pressure in the root canal. Fluid dynamics play an important role in endodontics and helps in deciding the amount of apical pressure and wall shear stress needed for proper cleaning of the canals and to prevent extrusion of irrigants. This review paper discusses the role of different needle designs in the proper disinfection of root canal with the help of computational fluid dynamics.


  Abstract 228: Influence of disinfecting procedures on the surface characteristics of gutta-percha and resilon points: A systematic review of lab studies Top


Gathani Dash

Institute of Dental Sciences, Bhubaneswar, Odisha, India

Objective: Aim of this study is to discuss about the influence of disinfecting procedures on the surface characteristics of both Gutta-percha (GP) and Resilon (R) cones.

Methods: The protocol was registered in PROSPERO, PRISMA guidelines were followed. To identify studies for this review, a detailed search strategies were developed by using the following electronic databases: Embase, Scopus, MEDLINE (PubMed), Web of Science, Google Scholar, non-indexed citations, reference lists of eligible studies. A broad search strategy was used to include the relevant terms, synonyms and alternatives obtained from MeSH browser related to disinfection of GP/R points. Data extraction was carried from the search results obtained from various databases. It was then exported to EndNote (details), following which, duplicates were removed. The titles and abstracts of the resulting studies was screened by a reviewer to remove papers that are out of scope of the topic in review. Full text of the remaining papers was obtained for further analysis. Two reviewers independently assessed these studies for possible inclusion in this review.

Results: The electronic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) identified 145 articles from which after removal of duplicated articles, the total number of articles were found to be 141. However, after screening of articles based on abstracts and titles, a total of 101 full text eligible articles were downloaded and finally only 24 articles were included in this review. After disinfection, presence of surface deposits with some alterations in physical properties of GP/R cones were detected. But these deposits were seen to be removed when rinsed with distilled water,96% ethyl alcohol,70% isopropyl alcohol. Presence of these deposits were seen to hamper the apical seal at the time of obturation and increase in concentration of disinfectant leads to changes in structural integrity of GP/R cones.

Conclusion: As there are few number of quality invitro studies, so there is a scope for further evaluation and analysis for changes in structural integrity of GP/R both macroscopically and microscopically.


  Abstract 229: Immunomodulation and regeneration properties of dental pulp stem cells: A potential therapy to treat coronavirus disease 2019 Top


Prathamesh Galkar

SMBT Dental College, Sangamner, Maharashtra, India

The coronavirus disease 2019 (COVID-19 is known to cause severe acute respiratory symptoms. The occurrence of a cytokine storm in the lungs is a critical step in the disease pathogenesis, as it causes pathological lesions, pulmonary edema, and acute respiratory distress syndrome, potentially resulting in death. Currently, there is no effective treatment that targets the cytokine storm and helps to regenerate the damaged tissue. Mesenchymal stem cells (MSCs) are known to act as anti-inflammatory/immunomodulatory candidates and activate endogenous regeneration. As a result, MSC therapy is a potential treatment approach for COVID-19. Intravenous injection of clinical-grade MSCs into COVID-19 patients can induce an immunomodulatory response along with improved lung function. Dental pulp stem cells (DPSCs) are considered a potential source of MSCs for immunomodulation, tissue regeneration, and clinical application. Although some current clinical trials have treated COVID-19 patients with DPSCs, this therapy has not been approved. Here, we review the potential use of DPSCs and their significance in the development of a therapy for COVID-19.


  Abstract 230: The effect of different intracanal medicaments on fracture resistance of simulated immature teeth managed by apexification with mineral trioxide aggregate: An in vitro study Top


Manisha Purbai, Joice Johny

Government Dental College and Hospital, Hyderabad, Telangana, India

Aim: The aim of the study is to evaluate the effect of different intracanal medicaments, Calcium hydroxide (Ca(OH)2), combination of Ca(OH)2 with 2% Chlorhexidine solution, modified triple antibiotic paste (mTAP with Cefaclor ) on fracture resistance of simulated immature teeth managed by apexification with MTA.

Materials and Methods: Forty single rooted human mandibular premolars with single root canal were selected. Teeth were sectioned to obtain a standard root length of 14mm followed by working length determination and root canal preparation using Protaper universal rotary file system up to size F3. The prepared canals were then instrumented with peeso reamers number 1 to 4. Number 4 peeso reamer was used 1mm beyond apex to create blunderbuss canal to simulate immature teeth. The specimens were then randomly allotted into 4 groups based on intracanal medicament used: Group I- control group (no intracanal medicament), Group II - Ca(OH)2, Group III - combination of Ca(OH)2 with 2% Chlorhexidine solution, Group IV - mTAP (Cefaclor 100mg+Ciprofloxacin 200mg+Metronidazole 400mg). After one week intracanal medicaments were removed using Ultrasonics and a 4mm MTA plug was placed in apical third of root canal. After 24 hours obturation was done using thermoplastic gutta-percha using Calamus (Dentsply/Tulsa; Tulsa,Okla). Specimens were then embedded in an acrylic cylinder and loaded till fracture using universal testing machine. Data was analyzed using One-way analysis of variance and Tukey's Post Hoc test.

Results: Vertical fracture resistance was highest for control group (Group I) followed by group IV (mTAP). There was no significant difference between group II and group III (Ca(OH)2, Ca(OH)2 +2% Chlorhexidine solution).

Conclusion: Within limitations of the present study, use of Ca(OH)2, Ca(OH)2 with 2% Chlorhexidine solution significantly reduced fracture resistance as compared to mTAP when used as intracanal medicaments in simulated immature teeth managed by apexification with MTA.


  Abstract 231: Nanoparticles as endodontic disinfectants: An emerging trend Top


Snehal Shinde

SMBT Dental College and Hospital, Sangamner, Maharashtra, India

The role of microorganisms as the primary cause of apical periodontitis has been well established, and thereby efforts have been directed toward eliminating them for higher success in endodontics. The disinfection process is challenging because of the complexity of the root canal system and the presence of isthmuses, accessory canals, and dentinal tubules, all of which can harbor bacteria and biofilms. Several studies have shown the presence of biofilm inside the root canal with bacterial penetration into dentinal tubules at varying depths. Mechanical preparation can physically remove tissue remnants, biofilms, and infected dentin. However, large portions of the root canal system after mechanical preparation may remain uninstrumented. Although current chemical irrigants, such as chlorhexidine (CHX) and sodium hypochlorite (NaOCl), are effective antimicrobials, they are still incapable of eradicating bacterial infection with limited efficacy to completely disinfect dentinal tubules.To overcome the drawbacks of the conventional antibacterial agents and to achieve promising results in endodontics, antimicrobial nanoparticles offering numerous advantages like large surface-area-to-volume ratio, ultra-small sizes, and excellent chemical and physical properties have been introduced. Nanoparticles (NPs) provide a new advancement for the prevention and treatment of dental infections. The positive charge and increased surface area of NPs allow them to react with the negatively-charged bacterial cells causing increased antibacterial activity. Furthermore, NPs can be combined polymers or can be coated onto biomaterial surfaces. This was also found to exhibit enhanced antimicrobial property. Nanomaterials (NMs) have recently gained importance in technological advancements due to their superior physical, mechanical, chemical and biological properties. These properties have resulted in better performance as compared to that of their conventional counterparts. Nanomaterials have shown great promise to reduce biofilm formation, enhance remineralization of the tooth structure by inhibiting its demineralization process, and to counteract the caries-related and endodontic microorganisms. These results have been inspiring enough to open the doors for further clinical studies that will allow the therapeutic value of nanotechnology-based materials to be authenticated. This poster highlight's the various nanoparticles used in disinfection of root canal.


  Abstract 232: Morphological and canal variations encountered in permanent mandibular first molars: An overview Top


C Boopathi Raja, JV Karunakaran, N Jayaprakash

JKKN Dental College and Hospitals, Nammakal, Tamil Nadu, India

Adequate knowledge of canal anatomy and morphology plays a vital role in achieving successful outcomes of Endodontic therapy.The incidence of anatomical complexities and variations in canal configuration in the mandibular first permanent molar tooth makes endodontic treatment challenging. One of the main reasons for failures of root canal therapy is inadequate cleansing and a missed canal. It is therefore of utmost importance that the clinician should have thorough knowledge of variations likely to be encountered in the tooth to be treated. The mandibular first molar is one of the earliest tooth to erupt in the oral cavity and is one which is most frequently treated endodontically. This review discusses the variations in morphology and canal configuration commonly encountered in mandibular permanent first molars and also the need for a preoperative knowledge and assessment of the same prior to initiation of therapy.


  Abstract 233: Comparative evaluation of dentinal crack propagation during removal of gutta percha using two rotary instruments: An in vitro study Top


Ankita Singh, Sunil Tejaswi, Suneeth Shetty, UK Ambikathanaya, SN Chandhan, Sachin Manglekar

JSS Dental College and Hospital, Mysore, Karnataka, India

Aim: 1.To evaluate and compare the occurrence of dentinal defects caused by two different rotary file systems and hand files during the retreatment procedure and the efficacy and cleaning ability of rotary file systems and hand file using Scanning Electron microscopy and Stereomicroscope.

2.To evaluate and compare the time elapsed from entering the root canal with the hand file and the nickel-titanium file to the completion of the re-instrumentation.

Materials and Methods: 60 extracted human maxillary first molars with curved roots were mounted on addition silicone set in an aluminium hollow block and instrumented using step-back preparation with 35 #K files and obturated using gutta-percha with AH plus sealer. After the storage period of 14 days, samples were divided into 3 groups- Mani GPR, Endostar Re Endo and H file and subjected to retreatment procedures. Retreatment was considered complete when no filling material was observed on the instrument and canal wall was smooth and free of visible debris. The root was sectioned horizontally into coronal, middle and apical thirds and the sample was examined under a stereomicroscope and Scanning electron microscope and photographs were taken. The number of cracks and percentage of root canal filling material was calculated and time taken recorded in seconds. The data obtained were analyzed using descriptive statistics, ANOVA (Analysis of Variance), chi-square test and Scheffe's post hoc test through SPSS software (version 22.0).

Results: All instrumentation techniques showed similar amount of crack propagation (P>.05) with no statistical difference between the groups. Retreatment done using H Files required more time and removed less material (P<.05). The coronal third showed less amount of gutta-percha remnants than the apical third in all groups (P>.05).

Conclusion: All the groups showed similar amount of crack propagation. Less and more number of cracks were observed in the coronal one third and apical third respectively. Endostar RE Endo rotary instrument proved to be most effective and least time-consuming. H Files required more time and removed less material.


  Abstract 234: Artificial intelligence: The panacea to endodontic dilemmas Top


Parvathi Sudeep, Paras Mull Gehlot

JSS Dental College and Hospital, Mysore, Karnataka, India

In today's world, patients desire to retain their natural dentition, which can be technically demanding in specific challenging scenarios. In this era of advancements in science and technology, it is this increase in awareness among individuals which has revolutionised the field of dentistry. Every branch of clinical dentistry, especially the branch of endodontics, has seen a breakthrough in diagnosis, treatment planning and prediction of prognosis in recent years. Endodontics is an excellent coalescence of art and science, though challenging, which requires a lot of skill and precision for long term success. With the help of picture archiving systems (PACS), advances in artificial intelligence (AI) and computer-aided diagnostic (CAD) systems, dentists have been able to augment the quality of treatment and ensure a favourable outcome by improving and facilitating the delivery of appropriate dental care. Artificial intelligence (AI), consisting of a sequence of algorithms, work on the concept of a neural network architecture pattern similar to the human brain and mimics human thinking. It encompasses a broad spectrum of emerging technologies; starting from booking a patient's appointment in the clinic, taking proper medical and dental history, managing insurance to assisting procedures, diagnosis (radiographs/CBCT), guided access (use of dynamic navigation tools), working length determination (apex locators, determining the apical constriction), irrigation (Gentle wave - irrigation mechanism), and treatment and retreatment procedures (Endomotors/Torque control motors); with which AI accomplishes a remarkable role in simplifying endodontic treatment. It has also been used widely in locating apical foramina, predicting periapical pathologies, detecting and diagnosing vertical root fractures, evaluating the outcome of regenerative procedures and retreatments, assessing root morphologies and difficulties associated with canal preparations. Being a potential game-changer and beginning something called a 'fourth industrial revolution, AI has what it takes to revolutionise endodontics with time. This review paper describes the principles of AI, concepts and development, relevance and how it is currently being used, emphasising the future of inter-professional coordination by bridging the gap between technology and dental medicine for comprehensive and successful endodontic treatment modalities.


  Abstract 235: Bio-printing: Modern era of regenerative endodontics and tissue engineering Top


Pasumarthy Bhargava Sathvika, Ephraim Mampilly Jose, Sekar Mahalaxmi

SRM Dental College, Chennai, Tamil Nadu, India

Bioprinting is an emerging field in regenerative medicine, it is a subcategory of additive manufacturing (AM), also known as three-dimensional (3D) printing. It is the stacking of structures using viable cells, biomaterials and biological molecules using the printing principle. The main technologies used for 3D bioprinting of living and biological materials are inkjet, laser-assisted printing, and micro-extrusion. Presently, bioprinting has been applied to the regeneration and reconstruction of multilayered skin, bone, vascular grafts, tracheal splints, heart tissue, cartilaginous structures, and the retina, among other structures offering great potential to fabricate microstructures that have specific alignment and interactions in different layers of the microstructures. With the development of additive manufacturing and bioprinting techniques, dental tissue research has transitioned from inert synthetic materials to biological and bioactive hydrogels, which can better mimic the 3D dental pulp microenvironment. The fabrication of scaffolds via 3D printing is already being performed extensively at the laboratory bench and in clinical trials; however, printing living cells and matrix materials together to produce tissue constructs by 3D bioprinting remains limited to the regeneration of dental pulp and the tooth germ. Although it remains in its early stages to print living cells and matrix materials together to produce dental tissue constructs, 3D bio-fabrication utilizing photo cross-linkable polymers, such as gelatin methacryloyl (GelMA) hydrogels, has been proven to be promising for the dental pulp and whole-tooth regeneration due to their good biocompatibility and efficient revascularization. In this short review, recent progress and challenges on the emerging strategies to fabricate the dental pulp vascular microenvironment are addressed from a biomaterial and microengineering standpoint.


  Abstract 236: Endodontic management of permanent maxillary second molar with two palatal roots: A report of two cases Top


Asmat Fatima

Dr. Ziauddin Ahmad Dental College, AMU, Aligarh, Uttar Pradesh, India

The maxillary molars are one of the most complex types of teeth by virtue of their multifaceted internal and external anatomy. Their root canal anatomy has been traditionally described as three roots with three canals, with the commonest variation being a second mesiobuccal canal (MB2). The incidence of MB2 has been reported to be between 18% and 96.1%. In vivo studies show that 1.4% of maxillary second molars can present with two palatal roots and two palatal canals. Slowey was the first author to report the endodontic treatment in a maxillary second molar with two independent palatal roots. Complexity of root canal system and variations in internal anatomy of teeth require careful analysis and the clinician must be aware of anatomical variations of the root canal system for the success of endodontic therapy. This presentation of two cases discusses the successful endodontic management of maxillary second molar with two palatal roots.


  Abstract 237: Effect of gutta percha disinfection against Enterococcus faecalis: A systematic review Top


Pooja R Mohanty, Gathani Dash

PGT Institute of Dental Sciences, Bhubaneswar, Odisha, India

Objective: To discuss the effect of gutta percha (GP) disinfection against E faecalis.

Methods: The topic was registered in PROSPERO, PRISMA guidelines were followed. A focused structured question using Population (P), Intervention (I), Comparison (C), Outcome (O) (PICO) was designed: “Does gutta percha disinfection reduces the microbial count of E faecalis?”. To identify studies for this review, a detailed search strategy were developed by using the following electronic databases: Embase, Scopus, MEDLINE (PubMed), Web of Science, Google Scholar. A broad search strategy was conducted to include the relevant terms, synonyms and alternatives obtained from MeSH browser related to the topic. Data extraction was done from the search results obtained from various databases. The titles and abstracts of the resulting studies was screened by a reviewer to remove papers that are out of scope of the topic in review. Full text of the remaining papers was obtained for further analysis. Two reviewers independently assessed the studies for possible inclusion in the review.

Results: The electronic search according to Preferred Reporting Items for systematic Reviews and Meta-Analysis (PRISMA) identified 145 articles. However, after screening of articles based on abstracts and titles, a total of 101 articles were eligible.17 full-text articles were found to be eligible that fulfilled all the inclusion criteria could be assessed for the study.

Conclusion: Most of in vitro studies had moderate risk of bias, however the disinfection protocol of gutta-percha is an effective procedure against E.faecalis.


  Abstract 238: Triumphant fragment reattachment techniques and bonding material Top


Aashima Kulshreshtha

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

Dental trauma is a public health issue due to its high prevalence and because it directly influences the individual's quality of life. It requires a multidisciplinary approach, accurate treatment with simple and suitable techniques to prevent complications. Making a clinical decision to preserve the natural dentition has many treatment options to restore uncomplicated traumatized teeth, including the direct and indirect restorative procedure. This review focuses on attempts being made to overcome complexities in the traumatized tooth. Many techniques have been reported, there is no consensus as to which promotes the better result in increasing the bond strength and fragment reattachment. The tooth fragment bonding technique, frequently used to restore traumatized teeth, may be affected by dehydration/rehydration periods. Rehydrating a tooth fragment before bonding with an adhesive appears to maintain sufficient moisture to increase reattachment strength. Bonding depends on tooth vitality and adaptation of fragments to the remaining tooth structure that will affect the prognosis of teeth. Rehydrating a tooth fragment before bonding with adhesive appears to maintain sufficient moisture to increase reattachment strength. This review will choose tooth fragment reattachment techniques and bonding material for the crown of a fractured anterior tooth.


  Abstract 239: Dental pulp auto-transplantation: A novel approach to regenerative endodontics Top


Amandeep Kaur, Arshdeep Gill

Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India

The advancement of science and technology has huge positive impacts on the present day world. It has contributed immensely to every aspect of our lives, including the medical and dental care. The treatment concepts that were once perceived to be imaginative are today considered achievable. One of such achievement is regenerative therapy. Regenerative therapy promises numerous clinical dental benefits, including biological strategies to repair teeth. Caries is the most common cause of pulp-periapical disease. When the pulp tissue involved in caries becomes irreversibly inflamed and progresses to necrosis, the treatment option is root canal therapy because the infected or non-infected necrotic pulp tissue in the root canal system is not accessible to the host's innate and adaptive immune defense mechanisms and antimicrobial agents. Therefore, the infected or non-infected necrotic pulp tissue must be removed from the canal space by pulpectomy. As our knowledge in pulp biology advances, the concept of treatment of pulpal and periapical disease also changes. Endodontists have been looking for biologically based treatment procedures, which could promote regeneration or repair of the dentin-pulp complex destroyed by infection or trauma for several decades. One such approach to regeneration of dentin- pulp complex is pulp auto-transplantation, which is highly specialised and technique sensitive process. With the help of this review, we want to highlight the potential for clinical application of pulp regeneration using this new modality of endodontic therapy.


  Abstract 240: The effect of different activation techniques on dissolution capacity of pulp tissue in simulated internal resorption cavities Top


Simay Koc, ER Kürşat, Gulchin Hajguliyeva1, DT Ziya Osmanlı1, DT Lala Jabbarova1, Hüseyin Karayılmaz2

Departments of Endodontics and 2Pedodontics, Faculty of Dentistry, Akdeniz University, 1Private Clinic, Antalya, Turkey

Objective: Internal root resorption (IRR) in permanent teeth is a pathological progressive destruction with hard tissue lost in dental hard tissue that occurs because of clastic activation. Although there are advanced endodontic instruments and treatment techniques, bacteria and debris cannot be removed completely due to the complexity of the root canal anatomy. Moreover, there are difficulties in removing the pulp tissue remnants perfectly from the internal resorption cavities (IRC). The aim of this study was to evaluate the effect of different irrigation activation techniques on dissolution capacity of pulp in IRC.

Material and Methods: Ninety freshly extracted human teeth were selected. After decoronation procedure, the roots were split longitudinally, and IRC were prepared in the canals on each half of the roots. Bovine pulp tissue samples were weighed and placed into the resorption cavities. The root fragments were reassembled and cemented to create a circular simulated resorption cavity within the canal. Teeth were divided into six groups (n=15) according to the irrigation protocols: Group 1: sodium chlorur (NaCl) and sonic irrigation (SI), Group 2: sodium hypochlorite (NaOCl) and SI, Group 3: NaCl and passive ultrasonic irrigation (PUI), Group 4: NaOCl and PUI, Group 5: NaCl and laser activated irrigation, Group 6: NaOCl and LAI. After irrigation protocol, teeth were decemented and the tissue samples inside the resorption cavities were weighed. The difference between initial and last measurement was calculated. The obtained data was analyzed statistically using One-way ANOVA test with a significance level of 0.05.

Results: SI has significantly more successful results than PUI and LAI in groups which the irrigation solution was NaCl. There was also a significant difference between LAI and PUI in groups which the irrigation solution was NaOCl (Group 6 > Group 4, p=.003). There was no significant difference between LAI and SI with NaOCl.

Conclusion: LAI with NaOCl was more effective than other irrigation activation system in dissolution capacity of bovine pulp tissue from simulated IRC. However, there is no significant difference between LAI and SI with NaOCl.


  Abstract 241: Effect of glide path files with different metallurgy on intracanal bacterial extrusion by HyFlex EDM files: An in-vitro study Top


Priyanka Soni, Pragya Kumar, Sonali Taneja

ITS CDSR, Muradnagar, Ghaziabad, Uttar Pradesh, India

Aim: To comparatively evaluate the effect of glide path files with different metallurgy on apical extrusion of intracanal bacteria after instrumentation with HyFlex EDM file.

Materials and Methods: Forty human mandibular premolar teeth were selected, decoronated and autoclaved. The specimen were placed in a test apparatus of sterilized glass vials and inoculated with Enterococcus faecalis. The specimens were randomly divided into four major groups depending upon the glide path file used. Group I with Proglider, Group II with Edge GlidePath Files and Group III with Neoniti GPS and Group IV without glide path instruments using HyFlex EDM. After Glide path preparation, final canal preparation was done with HyFlex EDM. 0.1 mL NaCl solution was taken from the experimental vials. The suspension was plated on brain heart infusion agar and bacterial colonies were counted. The results were given as number of colony-forming units (CFU). Statistical analysis was done using SPSS Version 20.0 (SPSS Inc., Chicago, IL, USA).

Results: The group without glidepath preparation showed maximum number of extruded bacteria compared to the other 3 groups (p < 0.05). The groups I and II using glide-path instruments extruded similar amounts of bacteria. The group III showed significantly higher bacterial extrusion than group I and II.

Conclusion: All the instrument systems tested caused a measurable apical extrusion of intracanal bacteria. The group without glide-path preparation showed the highest number of bacteria extruded compared to the other NiTi glide-path establishing instruments.


  Abstract 242: The foot soldiers of the dental pulp: Natural antimicrobials Top


Nikita Sebastian

JSS Dental College and Hospital, Mysore, Karnataka, India

The Dental Pulp is a specialized dental connective tissue which is equipped with its own innate and adaptive immune responses, designed to defend against infections & limit its spread. The innate immune response provides an effective and broad, non-specific first line of defense by combining the phagocytic activity of inflammatory cells like neutrophils & macrophages with the release of certain factors such as antimicrobial peptides that have potent chemotactic, antimicrobial & immune modulatory actions with lower cytotoxic effects on the host cells. These naturally occurring antimicrobial peptides have a broad spectrum of activity against bacteria, viruses & fungi. Within the pulp, these antimicrobial peptides have their origins traced to various resident or recruited components of the dental pulp such as the odontoblasts, neutrophils, fibroblasts, nerves & stem cells. Lately, there is a resurgence of interest in the biological activities of these antimicrobial peptides, largely driven by the need to develop & obtain alternatives to antibiotics & also aiming at the possibility of maintaining the vitality of the dentin-pulp complex. This review would provide an overview of the sources and actions of antimicrobial peptides within the dental pulp & how these factors could avoid antibiotic use, thereby reducing the possibility of antibiotic resistance.


  Abstract 243: Comparative evaluation of antibacterial property of chlorhexidine alone and its combination with calcium hydroxide, chitosan and bioactive glass against Enterococcus faecalis: An in vitro study Top


S Soumya, Faisal MA Gaffoor, Anoop Samuel, Rethi Gopakumar, C Sabari Girish, KB Sreejith

Noorul Islam College of Dental Sciences, Aralumoodu, Thiruvananthapuram, Kerala, India

Aim: The aim of the study is to compare the antibacterial property of Chlorhexidine and other medicaments namely Calcium hydroxide, Chitosan and Bioactive glass and each of its combination with 2% Chlorhexidine gel against Enterococcus faecalis.

Materials and Methods: Eighty permanent maxillary non-carious single-rooted teeth were randomly divided into eight groups of ten teeth each. After debris and smear layer removal, prepared blocks were inoculated with E. faecalis and incubated for seven days for biofilm formation. Medications including 2% Chlorhexidine gluconate gel, Calcium hydroxide, Chitosan, Bioactive glass alone and the combination of CHX with other three medications were placed into the dentin blocks and incubated at 37°C for seventy-two hours. Dentinal shavings were taken and the mean bacterial count was recorded. Statistical analysis Statistical analysis was done using One-way Analysis of Variance (One way ANOVA), Tukey's post hoc test and Unpaired t-test for pairwise comparison. Result The highest reduction in the bacterial count was obtained for Group 1 ( 2% CHX). Compared to Group 2A ( Ca(OH)₂), Group 2B( Ca(OH)₂+ CHX) exhibited more reduction in bacterial count. The effect of Group 2B( Ca(OH)₂+ CHX) was almost similar to Group 1 ( 2% CHX). The difference among these three groups was not statistically highly significant. Group 3A( Chitosan) and Group 3B(Chitosan + CHX) have shown less reduction of the bacterial count. Group 4A ( BAG) reported the highest bacterial count. Group 4B ( BAG+ CHX) was found to decrease the bacterial load and statistically significant differences exist between Group 4A (BAG) and Group 4B(BAG+ CHX). Conclusion Among all the groups, the highest antibacterial property against E. Faecalis was shown by 2% Chlorhexidine gluconate gel alone. Calcium hydroxide when used alone was less effective against E. faecalis. Calcium hydroxide combined with CHX showed almost equal antibacterial property as 2% CHX gel alone. Bioactive glass when used alone was least effective against E. faecalis. When it was combined with Chlorhexidine, its effectiveness improved. The Chitosan was not effective against E. faecalis when used alone. There was no improvement in efficacy when combined with CHX.


  Abstract 244: Effect of various root repair materials on the microhardness of human root dentin in different storage media Top


Aditi Mohan, Sonali Taneja, Sana Fatima

ITS Centre for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India

Aim: Tricalcium silicate cements may improve the physical properties of dentin along with providing bioactivity and biocompatibility. The aim of this study was to evaluate 1) the effect of three calcium-silicate-based cements on the micro-hardness of adjacent dentin, and 2) the effect of phosphate-buffered saline and distilled water on the bioactivity of the materials as storage media.

Materials and Methods: Forty-eight extracted human maxillary first molars were randomly assigned to three groups (n=16). Group 1: Mineral trioxide aggregate (Angelus MTA, Angelus, Londrina, Paraná, Brazil), Group 2: EndoSequence Root Repair Material (ESRRM, Brassler, Savannah, GA, USA) and Group 3: Biodentine (Septodont, Saint-Maur-des-Fossés, France). The palatal roots were sectioned at a standard root length and were subjected to endodontic treatment. Two sections (control and experiment) were obtained from the middle third of each root. The root lumen of the experimental groups was filled with the respective reparative cements. The specimens of each group were further divided into two sub-groups depending upon the storage media (n=8). Subgroup 1: Phosphate buffered saline and Subgroup 2: Distilled water. Mean Vickers' Hardness Values for the specimen were recorded after a storage period of 2 months.

Results: One-way Analysis of variance and Tukey's test showed a statistically significant difference among the three cements (p< 0.05) and the two storage media (p<0.05). ESRRM showed superior micro-hardness values (87.59 ± 9.80) followed by Biodentin (75.29 ± 7.39) and then MTA (65.91± 2.67). Specimens immersed in phosphate-buffered saline showed better increase in micro-hardness values as compared to distilled water irrespective of the type of reparative material used.

Conclusion: Endosequence Root Repair Material resulted in a higher percentage increase in microhardness as compared to Biodentine and MTA. Phosphate-rich media increased the microhardness of adjacent dentin by enhancing the bioactivity of the materials.


  Abstract 245: Comparative evaluation of push-out bond strength of two different perforation repair materials mixed with graphene nanoparticles: An in-vitro study Top


Shyam Ganesh

SRM Kattankulathur Dental College, SRMIST, Chennai, Tamil Nadu, India

Aim: To evaluate the push-out bond strength of different perforation repair materials when mixed with Graphene Nanoparticles

Materials and Methods: A total of 40 freshly extracted human first permanent mandibular molars were taken for the study. To test the push-out bond strength, 40 mandibular molars are decoronated at the level of CEJ. Access opening done using #6 round bur. Perforation was created in the furcation area using the same round bur. Root sections were sliced 5 mm below the furcation using diamond disc. Perforation repaired using the following materials. Samples will then be divided into four groups (n=10)

GROUP 1 - Furcal perforation repair done with MTA.

GROUP 2 - Furcal perforation repair done with Biodentine.

GROUP 3- Furcal perforation repair done with MTA mixed with Graphene Nanoparticles.

GROUP 4 -Furcal perforation repair done with Biodentine mixed with Graphene Nanoparticles.

Push-out bond strength will then be determined by subjecting the samples to universal testing machine, with a cross head speed of 1 mm/min. The load was applied along the long axis of the tooth. All measurements were recorded in megapascals (MPa). Results so obtained were statistically analysed.

Results: The study showed that there is a decreased push-out bond strength of both MTA and Biodentine incorporated with graphene nano-particles than unmixed MTA and Biodentine.

Conclusion: Within the limitations of the study, it was concluded that the push-out bond strength has been reduced in both MTA and Biodentine incorporated with graphene nano-particle. In the present study the samples were tested after setting which is not the real clinical scenario, where the tooth is immediately subjected to masticatory stresses. Thus, there is a need to conduct more studies, considering the limitations.


  Abstract 246: To evaluate and compare the outcome of various pulp capping modalities in complete pulpotomy in mature permanent molars with acute irreversible pulpitis: A double-blinded randomized trial Top


Sneh Mishra, Sonali Taneja, Sana Fatima, Akshay Rathore

I.T.S.C.D.S.R., Ghaziabad, Uttar Pradesh, India

Aim: To evaluate and compare the outcome of various pulp capping modalities after pulpotomy in mature permanent molars with irreversible pulpitis.

Materials and Methods: It is a randomized, superiority, pragmatic, parallel, double-blinded clinical trial registered under the Clinical Trial Registry–India. In total, 120 permanent maxillary and mandibular molars in the age group of 18-45 years with carious exposure and symptoms of irreversible pulpitis were randomized into three groups: Group1: Biodentine, Group 2: Lyophilised freeze-dried platelet-rich concentrate (PRP + Biodentine), and Group 3:Low level laser therapy (LLLT+ Biodentine).Complete pulpotomy was performed followed by hemostasis and further pulp capping was performed in the three groups followed by restoration. The outcome was measured by the time taken for hemostasis, presence/ absence of spontaneous postoperative pain using Visual Analog Scale (VAS) score, mean anti-inflammatory intake, periapical changes using Periapical Index (PAI), tenderness on percussion (TOP), and evidence of internal resorption or furcal radiolucency were assessed at 1 week, 3 months, 6 months and 1 year. Data were analyzed and subjected to statistical analysis. One-way ANOVA and post hoc Bonferroni test were used to analyze post-operative pain and anti-inflammatory intake.

Results: Post-operative pain and anti-inflammatory intake was minimum in the first week in Group 3: LLLT+ Biodentine (0.77±0.847) and (0.03±0.180) respectively followed by Group 2: PRP+ Biodentine (3.24±1.189) and Group 1: Biodentine (3.27±1.07) (p<0.005). The pain was relieved completely by 3rd week in all the groups. There was no difference in any other clinical and radiographic parameters among the groups.

Conclusion: All the three modalities exhibited 100% clinical and radiographic success at 6 months and 1 year with minimum postoperative pain observed in the case of LLLT+Biodentine.


  Abstract 247: A review on application of nanotechnology in endodontics Top


Naga Sai Maruthi Venkanna Gupta

JSS Dental College and Hospital, Mysuru, Karnataka, India

Nanotechnology has been used in different fields like electronic, energy, biomedicine, environment, food industry, textile industries.The use of nanotechnology in different fields has led to its application in dentistry, starting a new era called nanodentistry. Production of different resin based nano composites and bonding agents improved the surface chemistry of materials leading to enhancement of overall performance of the material.one of the reason for the failure of endodontic treatment is incomplete eradication of microbes from the root canal space which further form biofilms.. Diffusion and action of conventional irrigants and intracanal medicaments is limited within the root canal system,however with the incorporation of nanoparticles these properties can be improved such that the microbes present at greater depths in dentinal tubules can be eliminated.Application of nanotechnology in endodontic material science provide quality treatment outcome such as producing target specific drug delivery systems, early regeneration,repair of periapical tissues and enhancing aesthetics. This paper reviews on future prospects of nanotechnology in endodontics like incorporation of nanoparticles in irrigation and intracanal medicaments,in enhancement of the sealing ability of root canal sealers, obturating materials and post endodontic restorations.


  Abstract 248: Setting the stage for a rescue mission! – A case report Top


Dev Soundarya, Veronica Aruna Kumari, S Linda Christabel, Shamini Sai, PE Mukundan, Anand V Susila

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

Successful root canal treatment depends on judicious use of endodontic files and copious irrigation to assist in the cleaning and shaping of the complex root canal system. However, unpleasant mishaps, such as fracture of endodontic instruments may occur and can present as a nightmare to the dentist. Factors contributing for such mishaps most commonly include physical and mechanical properties of instruments, sterilization, irrigant characteristics, operator's negligence and root canal curvature. Broken files affect cleaning, shaping and filling processes of the root canal, thereby causing a potential failure. This is a case report which describes the successful management of a complicated file fracture in the root of lower right first molar tooth. A 39-year-old patient reported with a previously initiated root canal treatment to the post graduate clinic. The re-treatment was initiated and during treatment the rotary file fractured in the middle third of the root of lower right first molar. A staging platform was prepared using GG drills in the mesio-buccal canal coronal to the fragment. Hand instruments were used to penetrate alongside the broken instrument for half the length of the instrument by a #0.8 K-file. This bypass was prepared until a #25 K-file could be inserted. The broken fragment was loosened, dislodged and successfully removed using an ultrasonic U file and copious irrigation under the dental operating microscope. This report explains how an appropriate armamentarium complemented by ultrasonic vibration and magnification helps in successful removal of fractured instruments.


  Abstract 249: Comparative evaluation of the effect of two single file rotary system on peri-cervical dentin removal: An in vitro cone beam computed tomographic study Top


KK Ashique Navas

JSS Dental College and Hospital, Mysuru, Karnataka, India

Aim: To evaluate and compare the effect of Truenatomy, and Hyflex EDM rotary single file system on pericervical dentin (PCD) using con-beam computed tomography (CBCT).

Materials and Methods: Twenty freshly extracted single rooted mandibular premolars were selected and divided into two groups (n=10). Teeth of both groups were mounted on an Alginate template. Preinstrumentation Cone Beam Computed Tomography (CBCT) imaging of all teeth was done at level of CEJ, 4mm above CEJ and 4mm below CEJ. Preinstrumentation cbct was taken. Group 1 was prepared with TruNatomy prime rotary single file and Group 2 was prepared with - Hyflex EDM rotary single file. Post-instrumentation CBCT imaging was done in a similar method as preinstrumentation scan and the amount of pericervical dentin removed was calculated. Student's t-test was used for inter-group analysis at all the three levels

Results: No significant difference between Truenatomy, and Hyflex EDM rotary single files on pericervical dentin removal (P > 0.05).

Conclusion: within the limitations of this study it can be concluded that both the file systems have shown similar results in removing pericervical dentin.


  Abstract 250: Nonsurgical endodontic management of maxillary canine with 3 root canals: A report of sporadic anatomical variant Top


Brindha Murali, Paras Mull Gehlot

JSS Dental College and Hospital, Mysuru, Karnataka, India,

The root canal anatomy varies according to race, ethnic group and gender. These differences should be considered during the pre-treatment evaluation for root canal therapy. It can sometimes be challenging to identify and manage uncommon or complex root canal anatomies. Multiple root canals in single rooted teeth are caused by longitudinally running fins and a network of communication between the canal walls, and these have a high chance of being missed on conventional radiographs. Due to this complexity of root canal anatomy, Weine proposed classification of canal configuration which was further elaborated by Vertucci (for 3 canals configurations). Although most of the canal variations for a given tooth could be categorized under the Vertucci classification, some cases may present with unique configuration that are not reported in previous classifications. Hence, studies by Gulabivala et al and Sert & Bayirli have added more canal variations to the previous classifications. Permanent maxillary canines are considered universally as the ''Corner stones'' of dental arches and are mostly single-rooted, having a single canal with Vertucci type I (81.6%) configuration. Maxillary canine with Vertucci type II (2.8%), type III (11.6%) and type IV (0.8%) canal configuration are also reported. Literature search revealed no case was reported in a maxillary canine with 3 canals joining apically into one. Such a configuration according to Gulabivala et al.'s supplemental classification (to those of Vertucci) is type I (0.7%) in single rooted teeth. This presentation reports the non-surgical endodontic management of non-vital permanent maxillary canine with 3 canals. Awareness of complex root canal anatomy and careful radiographic interpretation are crucial in recognition and successful clinical management of uncommon root canal configurations.


  Abstract 251: Recent advances in obturation Top


Raveena P John

JSS Dental College, Mysore, Karnataka, India

Obturation occupies a prime position in the present endodontic triad. The clinical goal of root canal obturation is to fill the empty spaces, achieve a fluid tight seal and prevent bacterial infiltration into the periapical tissues. Endodontic obturation has witnessed a progression from the contemporary gutta percha to the adhesive bioceramic based hydraulic obturation techniques over the past decades. Traditionally root canal filling predominantly consists of gutta percha core material and accessory cones along with a sealer to fill in the spaces. Sealers ranged from contemporary zinc oxide eugenol sealers, glass ionomer sealers, medicated sealers, resin sealers to the presently available bioceramic sealers. Earlier sealers have a set of limitations restricted to shrinkage, dissolution in oral fluids and its inability to bond to the underlying dentin. With the advent of surface coated and modified gutta percha along with bioceramic sealers, single cone hydraulic condensation techniques forming tertiary monoblocs is now possible. The sealer to gutta percha ratio can now be increased and the sealer now acts as the filling material. Bonded interface has resulted in minimally invasive root canal preparations aiming at tooth preservation. These newer advancements in techniques have helped to achieve better and simpler filling of the canals. This paper will discuss all the newer techniques and material advancements to achieve a successful 3D obturation.


  Abstract 252: Effect of strontium doped fluorophosphate bioactive glass on properties of mineral trioxide aggregate: An in vitro study Top


Kuhu Lunawat

SRM Dental College, Chennai, Tamil Nadu, India

Background: Mineral Trioxide Aggregate (MTA) a bioactive material, necessitate enhanced regenerative potential due to its extended use in the field of endodontics. Phosphate based glass with its unique property of inclusion of therapeutic dopants is extensively used in medicine due to enhanced angiogenesis and bone formation. Hence, 6% strontium doped fluorophosphate bioactive glass (6%Sr-FPG) was incorporated in MTA and evaluated its cytotoxicity and surface characteristics.

Materials and Methods: The experimental groups were based on varying wt% of Sr-FPG added to MTA. Control: M-MTA; Experimental groups: 1SM-1:99 wt %; 5SM - 5:95 wt % and 10SM - 10:90 wt %.The powder was mixed with distilled water to obtain a desired consistency and packed in moulds. Following curing for 3 hrs, samples were immersed in corrected-SBF (c-SBF). MTT assay (mouse fibroblast cells) and Field Emission Scanning Electron Microscopy (FESEM) was done to evaluate cytotoxicity and structural morphology on day 1 and 28. Results of MTT assay was subjected to Kruskal Wallis test followed by Wilcoxon signed rank test.

Results: MTT assay showed significantly increased cell viability for 5SM compared to the other groups on day 28 (p<0.05). FESEM revealed enhanced precipitation of crystals with evident surface morphological changes in all the experimental groups, as the concentration of Sr-FPG increased on day 1 and 28.

Conclusion: Strontium doped fluorophosphate bioactive glass incorporated MTA could be a viable alternative to conventional MTA in various clinical applications.


  Abstract 253: A review of minimally invasive surgical endodontics Top


Paravreet Woodwal

Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India

The role of surgical endodontics comes into play when the conventional root canal therapy fails to resolve the underlying infection and patient remains symptomatic in spite of repeated intracanal dressings. According to protocol, a portion of the buccal bone is removed to get access to the root apices of the infected teeth, and resection is done after the surgical debridement of the peri-radicular area. Length of 3mm of the root end is advocated to be removed in a plane perpendicular to the long axis of the tooth to effectively seal any lateral canals present, minimize microleakage and reduce dentinal tubule exposure. Finally, the site is sutured after obturating the root end with suitable retro filling material. Although the advancements in 3-D technology and introduction of Cone Beam Computed Tomography (CBCT) has allowed personalized and accurate diagnosis in the field of dentistry, with this conventional surgical approach damage to vital structures, the removal of large amount of the buccal bone and prolonged surgical time due to limited visibility is inevitable. Research in this field unequivocally has suggested that modern microsurgical approaches yield higher success rates than traditional ones and it is agreed upon that guided root-end resection is more accurate and efficient than freehand surgery. Modern endodontic microsurgery due to continuous improvements in instruments, materials and techniques has been established as the futuristic method. The review paper aims to discuss the latest advancements in Endodontics with a focus on minimally invasive surgical techniques that would help in reducing the risk of iatrogenic damage to nearby anatomical structures, reduce postoperative discomfort leading to improved healing for the patient.


  Abstract 254: Micro-computed tomography: A revolutionary tool in endodontic research Top


G Akshay, MS Parinitha

JSS Dental College and Hospital, Mysore, Karnataka, India

During the last few decades, numerous technological advancements have led to the development of innovative diagnostic modalities like Spiral CT, MRI, and Ultra Sound which revolutionized dental research, clinical practice, and dental education.Micro Computed Tomography (Micro CT) is an advanced imaging modality based on multiple-slice x ray images which allow three -dimensional reconstructions of the viewed structures.Micro-CT enables the high-resolution radiographic scanning of extracted teeth,which results in detailed 3-dimensional(3D) analyses of their internal anatomy without destroying the specimen.As micro CT creates non-destructive images, the same image can be viewed multiple times and the image remains incessantly for biological and mechanical testing.It has an edge over other techniques as it produces high-resolution and durable images the leading to precise measurement of the subject.It can provide high -resolution images as well as both qualitative and quantitative analysis of teeth,bone, and implants.It is an exciting tool for experimental endodontology and can analyze root canals before and after endodontic instrumentation.It can also evaluate the volume changes in tooth structure following endodontic procedures and post space preparation by 3D volumetric analysis.With further development of Micro-CT systems, a higher resolution will become available for both in vitro and in vivo studies, and it will be a powerful tool in future dental/endodontology research.There is also a need for improvement in mechanical tests in endodontic research which is possible with micro CT -based finite element analysis.This review highlights the significance of micro CT at its wide range of applications in endodontic research and its scope for routine clinical practice in the future.


  Abstract 255: Effect of calcium silicate cements on the physio-chemical properties of root canal dentin in diabetic patients: A narrative review Top


L Sandosh, Kothari Twinkle, S Nagarathinam, B Saravanakarthikeyan, S Mahalaxmi

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

Diabetes Mellitus (DM) affects the outcome of any therapeutic treatment procedure with endodontics being no exception. DM impairs bone formation by interfering with osteoblasts activity and increases osteoblast apoptosis. DM adversely affects the formation of enamel and dentin in the early growth stage. Peritubular dentin is more affected by altered calcification and reduced mineralization in diabetic patients because it results in wider dentinal tubules and higher tubular density. The high tubular density has inverse correlation with the push out bond strength, i.e., in a given area of dentin, when the tubular density is increased, the density and mechanical properties of the surrounding inter-tubular dentin is low, thereby significantly weakening the root dentin. Also, the eradication of entombing bacteria from these dentinal tubules seems to be more difficult resulting in high failure rates. Most preferred endodontic cements for apexification and perforation repair procedures is calcium silicate–based cements (Ca-S )that includes mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM). MTA has shown better sealing ability than other cements in diabetic root dentin. It has been proved that mineralization stimulated by MTA remains unaffected by hyperglycaemic conditions. In order to further increase the fracture resistance of endodontically treated dentin in diabetic patients, a modification of MTA by adding sodium hydrogen phosphate is studied. MTA mixed with phosphate buffered saline was also suggested to increase the bond strength of MTA in diabetic dentin. Also, CEM has significantly formed dentin bridge in diabetic tooth. However, there are no clinical studies so far correlating the significance of Ca-S based cements or their modifications for root canal therapy in diabetic patients. Further studies exploring the push out bond strength, fracture resistance, sealing ability and anti-microbial properties of various endodontic cements is the need of the hour. Hence, our review aims in highlighting the altered physio-chemical properties of radicular dentin following the use of Ca-S cements in diabetic patients.


  Abstract 256: Recent advances in root canal irrigation system: A review Top


Divya M Pradeep

Sriram Chandra Bhanja Dental College and Hospital, Cuttack, Odisha, India

The success of root canal treatment depends on chemo mechanical preparation, irrigation, microbial control and complete obturation of the root canals. However, the current cleaning and shaping techniques fall short of the goal of removal of all microorganisms and debris, due to anatomical complexity, the type of bacteria and resistance. The limitation of rotary instrumentation to remove all tissues from the surfaces during biomechanical preparation and the limited potential of commonly used irrigants to penetrate the dentinal walls also remain as challenges in endodontic disinfection. One way of circumventing such challenges is by combining ideal irrigants with an optimal irrigation technique to achieve maximum reduction of biofilm from the root canal system. The aim of this review is to emphasize on the latest irrigants and irrigation techniques.


  Abstract 257: Evaluation of immediate and delayed push out bond strength of apical plug of MTA mixed with 2% chitosan nanohydrogel: An in vitro study Top


Urvashi Tanwar, Roopa Nadig, Veena Pai

Dayanand Sagar Dental College, Bengaluru, Karnataka, India

Aim: To evaluate and compare the push out bond strength of MTA and MTA incorporated with 2% chitosan nanoparticles at 7 days (immediate) and after a period of 6 months and 1 year (delayed) when used as an apical plug in teeth with open apex.

Materials and Methods: 90 permanent maxillary central incisors were de-coronated and randomly divided into 2 groups (n=45), one into MTA and other into nano-chitosan modified MTA used as apical plug material and further subdivided within each group based on the duration of storage (1 week, 6 months, and 1 year).

  • All the samples were sectioned perpendicular to the long axis to obtain 1mm thick slices.
  • The push - out tests were performed using a universal testing machine.
  • The data was tabulated and statistically analysed.
  • SEM analysis was done for all de-bonded specimens to determine the bond failure pattern.


Results:

  • Under immediate (1 week) and delayed (6 month time and 1 year) interval, nanochitosan modified MTA group showed the statistically significant higher push out bond strength when compared to conventional MTA.
  • The difference in mean Push-Out Bond Strength was found statistically significant between Group 1 and Group 2 for immediate (1week) and 6 months time interval although there was no statistical difference between Group 2 for 6 months and 1 year time interval.
  • The failure mode analysis showed predominantly cohesive failures for nano chitosan modified MTA whereas it showed more of mixed failures for the MTA group


Conclusion: Within the limitation of this in vitro study following conclusions can be drawn:

  1. Statistically significant higher push out bond strength of nano-chitosan modified MTA to root dentin when used as an apical plug at both time intervals tested in the study.
  2. SEM analysis of failed specimens showed mostly cohesive failures in the nano- chitosan modified MTA group at the cement-dentin junction, while MTA showed predominantly mixed failure further substantiating the results of our study.



  Abstract 258: Dynamic endodontic guidance: Navigating into the future Top


S Savitha, S Renjini

Government Dental College, Thiruvananthapuram, Kerala, India

Ideal access preparation is one of the most critical aspects of root canal therapy, as it is the portal through which all instruments, materials, and solutions must pass during treatment. Access into calcified root canal systems is the most anxiety provoking procedure in endodontics. Until recently, access has been done exclusively by freehand methods with a wide range of outcomes, depending totally on the clinician's innate skills, training, and experience. With the advent of “minimally invasive endodontics”, preparation of a minimal access cavity, with decreased risk of iatrogenic damage, and preservation of structural integrity while meeting all the access requirements, is to be welcomed. “Guided endodontics” provides a highly accurate technique for the preparation of minimally invasive access cavities. Essentially there are two types of guidance: static and dynamic. To date, guided endodontics for access cavity preparation and canal location in endodontics has focused on the use of static guides. The utilization of dynamic navigation for guided endodontic access cavity preparation and root canal location is in horizon. No doubt it will take a paradigm shift by endodontists to embrace this potent new tool in managing the most difficult cases we treat. Not withstanding the high cost involved the advantages of using dynamic guidance to cut the Gordian Knot of treating calcified root canal systems far outweigh the same.


  Abstract 259: Is constricted access for restricted use only? Top


Anushka Arora

Manipal Collge of Dental Sciences, Mangalore, Karnataka, India

The success of endodontic treatment depends on three main factors i.e., cleaning and shaping, disinfection, and 3-dimensional obturation of the root canal system. Endodontic access is an important step to facilitate the cleaning and shaping of root canals during root canal treatment. In the last decade, several access cavity designs involving minimal removal of tooth tissue have been described for gaining entry to pulp chambers during root canal treatment. The premise behind this concept assumes that maximum preservation of the pulp chamber roof during access preparation would prevent the fracture resistance of teeth from being compromised. According to several reported studies, the minimally invasive access cavities do make it more difficult to visualize and debride the pulp chamber as well as locate, shape, clean and fill the canals. At the same time, a small access cavity may increase the risk of iatrogenic complications as a result of poor visibility, which may have an impact on the treatment outcome. Overall, the literature search offered limited evidence to support the application of minimal access preparation in cases other than intact teeth. The aim of our review is to evaluate if the concept of modern molar access cavity preparation is really the future of the endodontic clinical practice.


  Abstract 260: Evaluation of stress distribution in endodontically treated teeth restored with only a core: A scoping review Top


Sanket Aras, Neil Lewis, Shalini Aggarwal, Anamika Borkar, Sanchit Mujumdar, Prasanna Dhatavkar

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

Introduction: Endodontically treated teeth are more fragile than vital teeth and are prone to fractures microscopically and morphologically, as they lose tooth structure due to extensive caries and access cavity preparations. The loss of moisture and dentin after endodontic treatment also negatively affects the fracture resistance. Understanding the distribution of stresses in such teeth, would help to improve the clinical outcomes. This scoping review was conducted to evaluate stress distribution in endodontically treated teeth, which had been restored using core build-ups only, without the placement of a post system. A broad search was initiated using the principles of a Scoping Review to elicit studies that had evaluated the stress distribution, both with imaging and Finite Element Analysis. All materials used for core build-ups were included in this review. The aim of this study was to analyze and review endodontically treated teeth restored only with a core, and to review the effects of occlusal forces applied from different directions on stress in teeth and dental tissues that use three-dimensional (3D) Finite Element stress Analysis(FEA) and other methods.

Focused Question: What is the fracture resistance of an endodontically treated tooth to functional stress, when only a core is used as a post endodontic restoration?

  • P - Extracted Human Teeth
  • I -Restoration with a core.
  • C - None
  • O-Stress


Materials and Methods: Relevant articles (in-vitro studies including those of randomized controlled trials and reviews), published over a 5 year period were identified and retrieved from five internet databases:- Pubmed, Cochrane, Scopus, EBSCO and Google Scholar and 10 articles were finally included in the present scoping review.

Conclusions: An examination of the studies examined in this broad search indicates the following:

1- Stress values were found to increase with an increase in the modulus of elasticity of the restorative material

2- FEA was found to be a predictable and reproducible model to predict stress-strain behaviour.

3- Cusp coverage with condensable resin might be a safe option for restoring weakened endodontically treated teeth.


  Abstract 261: Resolution of inflammation via a specialized approach Top


Sunil Pandya Dhvani, Khatri Monisha, Sekar Mahalaxmi

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

The pulp-dentin complex is a dynamic functional structure of the tooth, playing a pivotal role in the defence mechanism against noxious stimuli. When the pulp and periradicular tissues are subjected to injury, the immune system triggers an inflammatory response to minimize this tissue damage by eliminating and digesting invading microorganisms and cellular debris. Inflammation, which is characterized by the sequential release of mediators, results in an immediate influx of polymorphonuclear leukocytes (PMNs), followed by phagocytosis via monocytes-macrophages leading to leukocyte clearance and resolution. However, because of anatomical and physiological constraints, the effectiveness of various processes during inflammation varies. Uncontrolled, excessive, or unresolved inflammation can lead to pulp tissue necrosis and subsequent periapical infections causing apical periodontitis. Thus, target therapy should be employed to neutralize this effect by bringing about the resolution of inflammation. This is brought about by a novel class of lipid-derived endogenous molecules called Specialized Pro- Resolving Lipid Mediators (SPMs). The development of resolution-based pharmacology and lipidomic-based therapies is expected to benefit from these specialized molecules. Interestingly, SPMs have no direct anti-inflammatory actions, but they can actively limit neutrophil recruitment into inflamed tissues while also inhibiting the generation of inflammatory cytokines. Thus, the aim of this review is to unveil the concept of SPMs in targeting the resolution of inflammation in endodontic therapies with a special emphasis of applying a new therapeutic approach adjunct to endodontic treatment. This may open a pathway to a new code of resolution friendly approach that is the key to the process of improving health.


  Abstract 262: Endodontic biofilm: A review of current status and future directions Top


Thakkallapelli Ravali, D Datta Sai Gopikrishna

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

Biofilms and microbial aggregates are the common mechanisms for the survival of bacteria in nature. In other words, the ability to form biofilms has been regarded as a virulence factor. Understanding the virulence of these endodontic microbiota within biofilm is essential for the development of novel therapeutic procedures for intracanal disinfection. It play an essential role in several infectious diseases such as pulp and periradicular pathosis. Successful treatment of these diseases depends on biofilm removal as well as effective killing of biofilm bacteria. However, there is a need for all of this information to be translated into improvements in clinical practice and treatment outcomes. This review paper describes the present status of endodontic microbiology, discusses perspectives for future research and directions, and emphasizes the need for a call to action in the field of applied endodontic microbiology.


  Abstract 263: Nanotoxicity in endodontics - the lurking hazards of nano-medicine Top


Shreya Raj

Manipal College of Dental Sciences, Mangalore, Karnataka, India

Molecular engineering has bought revolution into endodontics. Nanoparticles are particles of 1-100nm in dimension. Their small size, increased surface to volume ratio, specific surface properties and charge produces properties desirable for endodontic usage. It has been incorporated into sealers, obturating materials, restorative materials, disinfectants etc to name a few. However, there is other side to it. These micrometre-sized particles can easily cross biological barriers, and enter into various organ systems in the body causing damage at cellular level. These ultrafine particles can be “Nanotoxic”. Nanotoxicology is the study of the nature and mechanism of toxic effects of nanoscale materials/particles on living organisms and other biological systems. It deals with the quantitative assessment of the severity and frequency of Nanotoxic effects in relation to the exposure of the organisms. As the next generation of endodontics moves towards nanotechnology, it is crucial to develop proper understanding of the processes happening when nanoparticle comes in contact with living system. Biocompatibility is achieved when a material interacts with the body without inducing any toxic, immunogenic, thrombogenic or carcinogenic response. Little is known about the toxicological impact of these nanoparticles. This review paper discusses the mechanism of nanotoxicity, factors affecting it, possible routes of nanotoxicity in endodontics, and its methods of assessment.


  Abstract 264: Management of internal resorption of a maxillary lateral incisor with type I dens-in-dente Top


Anukrati Srivastava

RUHS College of Dental Sciences, Jaipur, Rajasthan, India

Management of internal root resorption is a challenge to the endodontists. It may occur in cases with chronic pulpal inflammation, following caries or due to trauma in the form of an accidental blow. Most cases of internal root resorption are seen in anterior teeth, due to their susceptibility to trauma. However, it may be seen in posterior teeth, most likely because of carious involvement of the pulp. Early diagnosis, removal of the cause, proper treatment of the resorbed root is mandatory for successful treatment outcome. Dens invaginatus, also known as dens in dente, is a rare anomaly affecting human dentition. The condition results in invagination of an amelo-dental structure within the pulp. This case report discusses the current management protocol of dens invaginatus using a minimally invasive and nonsurgical treatment option.


  Abstract 265: Mindful practice in search of missing canals: A rare case report of mandibular molar with five root canals Top


Sonak Sharma

HP Government Dental College, Shimla, Himachal Pradesh, India

The main objective of successful endodontic therapy is thorough mechanical shaping and cleaning of the entire root canal system followed by three-dimensional obturation. Variation of the root canal morphology especially in multirooted teeth is a norm rather than exception and presents a constant challenge for diagnosis and successful endodontic therapy. Mandibular first molar is first to erupt in oral cavity and thus most often requires Endodontic treatment.An awareness and understanding of presence of additional root and unusual root canal morphology is essential as it determines the successful outcome of endodontic treatment. This is a case report of a twenty year old male patient who presented to department of conservative dentistry and endodontics with chief complaint of pain and swelling on right side of face since three weeks. Careful examination with angled radiographs and dental operating microscope revealed five canals ( additional middle mesial and distal canal).


  Abstract 266: Conducive restitution with sonicfill composites Top


Chandini Devi Sridharan, Nandhini Kumar, Shafie Ahamed, Bhavani Sreekrishnapillai, Rajaraman Gangadharan

Rajah Muthiah Dental College and Hospital, Chidambaram, Tamil Nadu, India

Dental research strives by scrutinizing various treatment procedures to perfect it and provide the quality care patients deserve. Posterior Composite Restorations have almost completely replaced Amalgam Restorations. However, the process of placing Posterior Composites is tedious requiring proper Isolation, Adhesive Systems and Composite material that concedes sculpting the Occlusal Anatomy of a compromised tooth. Introduction of Bulk-fill Composites reduced the procedure time and accelerated the Dental Enterprise. Per contra, the higher viscosity of these materials made their adaptation to the cavity walls difficult. Sonic-fill Composite carts this problem off. This Presentation kingpins on the Application of Sonic Activated Composites to sprint the Dental workflow without compromising its caliber.


  Abstract 267: Comparative evaluation of fracture resistance of endodontically treated mandibular premolars after instrumentation with different rotary file systems- An in vitro study Top


Mounika Veeraiyan, Yashas Chikine

Government Dental College and Hospital, Afzalgunj, Hyderabad, Telangana, India

Aim: The aim of the study was to evaluate and compare the vertical fracture resistance of mandibular premolars after instrumentation with K3XF, Hyflex CM, Pro Taper Gold rotary file systems.

Materials and Methods: Sixty human extracted mandibular premolar teeth with single straight canals were divided into four groups (n=15) Group A: Control (Intact teeth), Group B: K3XF, Group C: Hyflex CM, Group D: Pro taper gold. All the sample teeth were instrumented up to 0.06 taper size 20 as per manufacturer's instructions. After obturation and Nano hybrid composite core placement, the teeth were placed in a customized jig mounded on a universal testing machine where vertical force was applied and the force required to fracture the teeth was noted. One way ANOVA and Tukey's post- hoc test were used to analyze the data.

Results: The fracture resistance of roots instrumented with K3XF, Hyflex CM, Pro taper gold was significantly lower than that of the un instrumented control group(1165.90 ± 178.70). Amongst all the instrumented groups, Group B- K3XF ( 920.90± 365.88 ) depicted the highest fracture resistance followed by Pro taper gold( 664.60± 241.22) and Hyflex CM ( 387 ± 140.21 ).

Conclusion: Root canals instrumented with K3XF files have better fracture resistance followed by Pro taper gold and least fracture resistance in Hyflex CM files.


  Abstract 268: Evaluation of stress distribution patterns with different bevel preparations for reattachment of fractured fragments of maxillary central incisors: A three-dimensional finite element analysis Top


K Deepika, Yata Prashanth kumar

Government Dental College and Hospital, Hyderabad, Telangana, India

Aim: To evaluate the stress distribution patterns in reattachment of fractured fragment of maxillary central incisors with different bevel preparations using 3D FEA.

Materials and Methods: Three 3D FEA models of maxillary central incisors were generated using CAD technique. Standardized fracture was prepared on 3 models which were then divided into Group I - No bevel, Group II - Bevel on labial side, GROUP III - Bevel on both labial and palatal sides. All the models were then reattached with Filtek Z350 flowable composite and loaded under 200N at the tip of incisal edge and at an angle of 45 degrees to the longitudinal axis and stress distribution patterns were evaluated.

Results: Finite element analysis revealed that the stress distribution pattern in Group III was greater than that of Group I & II under loading at 45 degrees. There was no evident changes in the pattern and the magnitude of stress distributed in all Groups, when loading was done at the incisal tip.

Conclusion: In the present study, FEA revealed that Group III with labial & palatal bevels had a significant effect in stress distribution patterns of fracture fragment reattachment under loading at 45 degrees when compared to bevel on single side and with no bevel preparation.


  Abstract 269: Evaluation of bacterial reduction at various stages of endodontic retreatment after use of different disinfection regimens: An in vivo study Top


Jaynit Tandon, Sonali Taneja, Vidhi Bhalla, Anshi jain

ITS Dental College, Ghaziabad, Uttar Pradesh, India

Objective: The aim of the present study was to evaluate the presence of E. faecalis, F. nucleatum, Propionibacteria sp., Actinomyces sp., and their reduction at various stages of endodontic retreatment with the use of conventional protocol (5.25 % NaOCl + Ca (OH)2 and advocated protocol ( Smear OFF + CHX gel ).

Methodology: Twenty eight patients fulfilling the eligibility criteria were selected for root canal retreatment and randomly allocated into two groups. Group 1- Final irrigant as SmearOFF + Chlorhexidine as intracanal medicament (n=14). Group 2- Final irrigant as 5.25% Sodium Hypochlorite + Calcium Hydroxide as intracanal medicament (n=14). With aseptic environment, access opening was performed followed by GP removal and sample S1 was collected for bacterial analysis. The biomechanical preparation was done by using Reciproc system and supplementary finishing with XP-Endo Finisher R. Sample S2 was then collected for bacterial analysis after the final irrigation protocol in the respective groups. Intracanal medicaments were placed for one week and sample S3 was collected. All the samples were subjected to qualitative analysis using PCR and quantification was done by Colony Forming Unit (CFU) analysis.

Results: Propionibacterium sp. [20/28], F. nucleatum[24/28] were the most frequently isolated in S1 sample followed by Actinomyces sp. [16/28] and E.faecalis sp. [19/28]. Chemomechanical preparation followed by irrigation resulted in significant reduction of all types of bacteria in both groups. Group-1(SmearOFF as the final irrigant) had significant superior efficacy against E. faecalis and F. nucleatum(p<.05) as compared to Group-2 (NaOCl). Both chlorhexidine gel in group-1 and calcium hydroxide in group -2 caused further reduction in all bacterial subgroups in sample 3 but reduction was insignificant against Propionibacterium sp. And Actinomyces sp. (p>.05).

Conclusion: Chemomechanical preparation followed by irrigation resulted in significant reduction in bacterial load irrespective of the final irrigant. SmearOFF was significantly better than NaOCL in minimizing bacterial load of E. faecalis and F. nucleatum. Chlorhexidine gel and calcium hydroxide were less effective against both Propionibacterium sp. and Actinomyces sp.


  Abstract 270: Biodentine – Apical barrier for immature necrotic permanent teeth: A case report Top


Astha Dhawan

National Dental College, Mohali, Punjab, India

Managing open apex is a constant challenge to an endodontist. One of the aims of root canal treatment is to completely obturate the canal in order to prevent reinfection. But in case of an incomplete root development it becomes difficult to achieve a three-dimensional obturation of root canal system. Apexification has been advocated in cases with open apices or where apical constriction is absent/destroyed. Apexification can be defined as a method to induce calcific barrier in the root with the open apex of an immature, pulpless tooth. Several Materials are now a days available that induce calcific barrier or apical development in root canals with necrotic pulp tissues. MTA is considered as a gold standard however, long setting time, poor handling characteristics, high cost, are some of its disadvantages. A novel Material Biodentine introduced by Septodent in 2010 has proved to have superior properties and easy handling hence considered as best substitute to MTA. This case report describes the management of open apices with periapical radiolucencies in maxillary central incisors by using Biodentine to form an apical barrier.


  Abstract 271: Biomarkers in endodontics: A diagnostic approach for pulpal and periapical inflammation – A review Top


Anbalagan Karthikeyan

Sriram Chandra Bhanja Dental College and Hospital, Cuttack, Odisha, India

Endodontic diagnosis is highly critical and depends on the ability of the clinician to distinguish among the different stages of pulpal and periapical inflammation. At present, endodontic diagnosis is made by clinical symptoms, pulp sensibility tests, and periapical radiographs which have their own limitations as the clinical findings do not always correlate with the histologic status of the pulp or periapical tissue. In clinical practice, the treatment of teeth with necrotic, partially vital, and inflamed vital pulp is the same: complete pulpectomy. The modern understanding of pulp biology and the development of bioactive materials have undoubtedly led to a shift in the management of inflamed dental pulps: pulp capping and pulpotomy. The success rate of pulpotomy in mature permanent teeth with irreversible pulpitis depends on the accurate diagnosis and case selection as inadequate evaluations often result in underestimating inflammation severity and treatment failures. Biomarkers refer to cellular, biochemical and molecular alterations that can be measured in biological fluids as indicators of normal physiological and pathogenic process. Pulpal inflammation is a cellular and molecular mediated process in which the molecular phase precedes the macroscopic and microscopic inflammatory changes. Hence qualitative and quantitative assessment of these biomarkers such as proteases, growth factors, chemokines and cytokines can represent an objective method to obtain valuable information about the pulp and periapical status. The aim of this review paper is to determine the possibility to diagnose the pulpal and periapical inflammation through molecular biomarkers.


  Abstract 272: Metformin: An old drug with new ideas Top


Rahul Radhakrishnan, Radhakrishnan Nair, G Praveena, Princy Paul, Drisya Soman, Mahesh Chandra Mohan, Nisha B Kurup, B Muhsina

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

Metformin has been an important drug for treatment of Type 2 diabetes (T2D) for decades. Numerous studies have shown that metformin not only has hypoglycemic effects, but also modulates many physiological and pathological processes ranging from aging and cancer to fracture healing. Owing to the dual role of metformin in regulating blood glucose and promoting bone regeneration, it is worth exploring its considerable potential in dental tissue regeneration. Stem cell–based therapies are rapidly emerging as a potential strategy for tissue regeneration in many diseases and conditions. Metformin can enhance the odontoblastic differentiation of Dental Pulp stem cells through activation of the Adenosine monophosphate protein kinase (AMPK) signaling pathway and hence play an important pharmacologic role in triggering odontoblastic differentiation, providing new insights into the therapy of pulpal wounds. Anti-inflammatory activity of metformin has also been analyzed. In vitro studies showed that intracanal application of metformin decreased the size of periapical lesion, partially by modulation of osteoblast apoptosis. Recent evidence also suggested that metformin provides a synergistic advantage with chemotherapy or radiotherapy, increases photosensitivity and can be considered as one of the agents involved in the increasing cytotoxicity efficacy of anti microbial photo dynamic therapy (aPDT). This review focuses on the multiple effects of metformin with emphasis on regenerative endodontics, its molecular mechanisms, and clinical prospects.


  Abstract 273: Artificial intelligence in endodontics Top


Sayali Kamat

SMBT Dental College and Hospital, Sangamner, Maharashtra, India

Ever since the field of science has originated, researchers and technologists have been busy in solving the complexity of the human brain that is a maze of neurons interconnected with each other and transmitting signals to the whole body.To design a model that will mimic just like the human brain has remained a big puzzle to solve for the scientific community. Constant effort and hard work of researchers from several years results in the evolution of 'Artificial Intelligence'.The term “artificial intelligence” (AI) was coined in the 1950s and refers to the idea of building machines that are capable of performing tasks that are normally performed by humans. Types of artificial intelligence include Machine learning(ML), Neural network(NN) and Deep learning(DL).Artificial neural network (ANN), a subtype of machine learning is widely used in dentistry. Its applications in Endodontics includes detecting vertical root fractures from periapical and CBCT radiograph from endodontically treated and non endodontically treated tooth, to determine the working length of the tooth using artificial neural network (ANN), locating the minor apical foramen (AF) using feature-extracting procedures from radiographs and then processing data using an artificial neural network (ANN) as a decision making system. Deep Learning (DL) algorithm is used for the automated segmentation of cone-beam computed tomographic (CBCT) images and the detection of periapical lesions. It can also be used in classification of the root morphology. Machine learning is used to generate an algorithm which can help predict the difficulty level of the case and decide about a referral. Increase in the number of researches on the development of artificial intelligence, and introduction of more powerful computing capability may help mature AI in dentistry. We may not have fully automated dental diagnosis and treatment by the computer programs and machines soon, but the future will be more enjoyable when many repetitive and straightforward tasks, not bothering us as clinicians anymore. This may increase and boost productivity as we can spend more time on more complex cases. Artificial intelligence therefore can have a promising future in Endodontics.


  Abstract 274: Endodontic access - conventional versus modern: An overview Top


J Sobiraj, JV Karunakaran, Chris Susan Abraham

JKKN Dental College, Namakkal, Tamil Nadu, India

Access cavity preparation is an important step during endodontic treatment procedures. Main objective of access preparation is to obtain a straight line access to canal orifices. A well-designed access is important for achieving successful treatment outcomes. Inadequate access leads to difficulties in visualization of canal orifices and subsequent negotiation leading to inadequate biomechanical preparation of the root canal system. Overzealous access preparation can lead to excessive removal of sound tooth structure weakening the tooth. Excessive loss of pericervical dentin during access preparation increases the risk of fracture of the tooth post endodontic therapy. Several access preparation modifications have been suggested in modern clinical endodontics. Different access designs with an aim to conserve tooth structure and minimal invasive approach is a new trend in endodontics, and specific nomenclature have been established such as the Traditional Access, Conservative Access, Ultra Conservative Access, Truss Access, Caries Driven Access, and Restorative Driven Access. An adequately prepared access cavity is crucial for effective instrumentation and delivery of irrigants into the root canal system. Equally important is maintaining the structural integrity of tooth. Unnecessary removal of tooth structure weakening the tooth results in fracture and leading to poor prognosis. So that every attempt to preserve tooth structure as much as possible. This review compares the traditional and modern approach to access preparation.


  Abstract 275: A micro-computed tomographic analysis of dentinal microcracks and residual filling material after endodontic retreatment procedures with rotary and reciprocating NiTi file systems Top


Mansi Dhingra

Maharana Pratap College of Dentistry and Research Centre, Gwalior, Madhya Pradesh, India

Aim/Objective: To evaluate the outcome of rotary & reciprocating instruments on dentinal microcracks in mandibular first molars during endodontic treatment & retreatment procedures along with their efficacy of filling removal using Micro-computed Tomography.

Materials and Methods: Twenty moderately curved mesial roots of mandibular first molars having two independent canals were selected and scanned in a micro-CT device. The scanned roots randomly divided into two groups based on the NiTi file systems: Group I = Reciproc Blue (RB) & Group II = ProTaper Gold (PTG), were treated & retreated (Group I with RB and Group II with PTG & ProTaper Retreatment file (PTR)) respective to their NiTi instruments. The samples were subjected to another micro-CT scan after endodontic treatment and retreatment procedures for a 3-D non-invasive image-based analysis of dentinal microcracks after treatment & retreatment and filling removal following retreatment of both the respective groups. Descriptive analysis, Independent t-test, ANOVA and post hoc analysis was used for inter & intra-group comparison and the Chi-square test was used to analyse filling removal after retreatment. The level of significance was set at P≤.05.

Results: New dentinal microcracks were observed in both the RB and Protaper groups after treatment & retreatment procedures. Microcracks in the RB group were significantly more compared to the ProTaper group (P<0.5). Better filling removal was observed in the RB group compared to PTR without statistical significance.

Conclusion: Root canal preparation with PTG & PTR induced fewer microcracks formation than RB. Filling removal was better with the RB system. However, No statistical difference was observed between the techniques for effectively removing filling material from the moderately curved root canals of mandibular first molars.


  Abstract 276: Novel nano-endodontic irrigants: A review Top


P Aishwarya, PS Shivani

Government Dental College, Thiruvananthapuram, Kerala, India

The persistence of endodontic biofilm poses a burden in treatment with recurrent endodontic infections. The conventional endodontic irrigation techniques fail to completely remove and prevent the re establishment of the biofilm in the infected root canals leading to inadequacies in disinfection. With improvements in technology and enhanced irrigant delivery systems, the shortcomings of disinfection can be overcome. Recent advances like the magnetic nanoparticles, nanobubbles etc can be considered as favourable alternative due to their biocompatibility, biodegradability and target- specific action. This paper presents the comprehensive review regarding the novel nano endodontic irrigation systems.


  Abstract 277: Effect of audio-visual distraction on pain during pulp extirpation: A randomized clinical trial Top


B Bharadwaj, P Sahithi

Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India

Aim: To determine the effect of audiovisual distraction (A/V) on pain during pulp extirpation.

Methodology: Sixty patients with acute irreversible pulpitis were selected and randomly allocated into two groups. An informed written consent was obtained from each subject. Assessment of pain threshold was done during pulp extirpation in patients with acute irreversible pulpitis under local anesthesia and rubber dam isolation. The two groups were 1) Control: without A/V-Distraction 2) Test-group: with A/V-Distraction. Pain threshold was analyzed with visual analogue scale (VAS) using Mann-Whitney U Test. The results were then tabulated and statistically analyzed.

Results: The mean VAS score in the group without A/V-Distraction was 1.6 and with A/V-Distraction was 1.1, which was significant (P<0.05) on Mann Whitney U test.

Conclusion: Audiovisual Distraction can result in decreased pain perception during pulp extirpation. The portable video device and music through earphones provides a relaxed environment during treatment.


  Abstract 278: Root canal irrigants: An overview Top


Tamanna Tamanna Kumari, Kalpana Khanoria

Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India

The success of root canal treatment depends on debridement of diseased tissue, elimination of bacteria and prevention of reinfection after treatment. Shaping and cleaning of root canal system along with the preservation of surrounding periodontal tissue is the principal goal of endodontic treatment. Complete disinfection of the pulp space cannot be achieved with instrumentation techniques alone. While most of the attention is paid to the mechanical aspects of the root canal treatment, an essential feature of it is the irrigation. The use of adjunctive aids like endodontic irrigants in achieving this goal is essential. It has several important functions, which may vary according to the irrigant used. It reduces friction between the instrument and dentine, improves the cutting effectiveness of the files, dissolves tissue, and furthermore, it has a washing effect and an anti-microbial/ anti-biofilm effect. Irrigation is also the only way to impact those areas of the root canal wall not touched by mechanical instrumentation. No single irrigating solution that can alone cover all the functions required from an irrigant. The purpose of this review is to discuss various root canal irrigants used in dentistry.


  Abstract 279: Retrieval of separated endodontic instruments: An overview Top


Anish Mohamed Fazaludeen, Affina Naushad, Rajesh Pillai, A Afzal, Sheila George, Adarsh Jayan

PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India

Separated endodontic instruments has always been an enigma to the endodontists. Many of the post graduates, general practitioners try to salvage the instrument fracture at different levels. The biggest challenge is posed by the instruments separated at the commencement of canal curvature, at the junction of middle and apical of one- third, and at the apical one- third and thus disrespectful of the minor diameter and extruding through the periapex. Evaluation of current scientific data has revealed that the approach and mechanism of salvaging separated instruments do vary between different files of varying metallurgical properties, thermal treatments and cross- sectional designs. In most cases fractured instruments do not present diagnostic problems, with the exception of retreatment cases where the fragment in some instances might be “hidden,” obscured by root filling material and not very clearly visible. The recognition of remaining fragments is important for treatment planning. This involves the need to choose between various acceptable nonsurgical orthograde options such as ultrasonics, tube technique, loop techniques, canal finder system, laser techniques, electrochemical dissolution techniques, chemical means, magnets, multisonic ultracleaning system, softened gutta-percha, file removal system, bypassing and incorporation of dental operating microscope and in some specific cases surgical options are indicated. The delicate manipulations necessary for the management of a fractured instrument using an orthograde or a surgical approach include the risk of creating additional complications which includes separation of the ultrasonic tip or file used for bypassing, further separation of the fragment, perforation, ledge, extrusion of file into periapical tissues, tooth weakening due to dentin removal all of which will in turn jeopardize the treatment outcome. Evaluating, analysing, and comparing the performance of the techniques proposed for the management of intracanal fractured endodontic instruments are important prerequisites for the selection of the most appropriate strategy and for the prediction of the outcome. This review, scrutinizes the changes in thought process and methods regarding retrieval of separated instruments.


  Abstract 280: Nanoparticles: The micro-art of regeneration Top


Aabha Dave

Manipal College of Dental Sciences, Mangalore, Karnataka, India

Nanotechnology has essentially progressed in the past decades, giving rise to numerous possible applications in different biomedical fields. In particular, the use of nanoparticles in endodontics has generated remarkable interest due to their unique characteristics. As a result of their nanoscale dimensions, nanoparticles possess many divergent 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. The “ideal” material has yet to be devised. This has led to the development of various experimental nanoparticle-incorporated antibacterial efficacy and bioactivity. Nanoparticle applications also show promise in the field of regenerative endodontics, such as supporting the release of bioactive molecules and amplify the biophysical properties of scaffolds. Applying nano-scaffolds for pulp regeneration is another use of nanotechnology in endodontics that creates stirring development in the reconstruction of pulp structure.. The constantly growing body of research in this field has led to potential translational applications of nanoparticles in regenerative endodontics. This review article aims to study the application of nanoparticles in different stages of regenerative endodontic therapy and provide an overview of its current advancement.


  Abstract 281: Mucormycosis: An endodontic perspective Top


Kiran Panzade

Government Dental College and Hospital, Mumbai, Maharashtra, India

Mucormycosis also known as Zygomycosis or black fungus is a mycotic infection caused by fungi of the order Mucorales. In the recent past, a bizzare variety of post-COVID complication appears to be on rise. In India, post-COVID mucormycosis is a recognized entity and even declared as an epidemic in some states. In the pre-COVID era, mucormycosis was seldom seen in the clinics by medical and dental professionals. However, during this pandemic era, there has been sudden surge in number of patients reporting with mucormycosis and even high degree of fatality is being observed. This life-threatening condition requires early diagnosis for a better prognosis. Mucormycosis is characterized by extensive course of angioinvasion with thrombosis and tissue necrosis. The most common type of mucormycosis, the rhino-cerebral variant comprises of atypical symptoms such as facial pain, earache, nasal or sinus congestion, or odontalgia so, the patients tend to seek dental treatment initially. The available studies on mucormycosis suggest that the rhinocerebral variant may present itself as dental pain, intraoral draining sinuses, swelling and ulceration. This paper aims to present the importance of proper history, clinical examination for oral signs and symptoms to rule out mucormycosis as a differential diagnosis for endodontic infections.


  Abstract 282: Pain again, how to contain? Decoding the enigma of post endodontic pain Top


Abhilasha Gugliani, Divya Mittal, Sonali Taneja, Pragya Kumar, Sana Fatima

ITS Centre for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India

Pain is one of the main reasons behind dental anxiety and it is the responsibility of the dentist to properly manage this pain. However, a common unexpected complication that can undermine the patients confidence in the clinician and acceptance of procedure is the development of Post Operative Pain after Root Canal Treatment. Post Operative Pain after endodontic treatment has a wide range of incidence varying from 3% to 69.3%. It ranges from mild to moderate and occurs even after optimally performing the procedure. It is a multifactorial phenomenon, observed as a result of various intra-operative as well as perioperative factors which have been listed in the literature including age, gender, tooth type, presence of perioperative pain, pulpal status, single / multiple visits, type of instrumentation and even obturation techniques. Management of postoperative pain is challenging and considered an indicator of clinical excellence. This review paper focuses on literature evidence of various factors influencing post obturation pain following non surgical root canal treatment along with numerous strategies and methods that can be applied for effective management of this complication so that the clinician can carry out an evidence based treatment for the same.


  Abstract 283: Lesions of endodontic origin: Could it be a looming threat for cardiovascular diseases? Top


Wendy Maria Vianney Lobo, Abrar Sayed, Kishor Sapkale, Manoj Ramugade

Government Dental College and Hospital, Mumbai, Maharashtra, India

Cardiovascular diseases have vastly affected the global human population and are a major cause of death in developed and developing countries. There has been an alarming increase in the prevalence of coronary heart disease and mortality in India and other South Asian countries over the past two decades with a 4-fold rise in prevalence during the past 40 years. The risk factors commonly associated include diabetes mellitus, hypertension, smoking, hyperlipidemia, obesity, and psychosocial stress. Among the risk factors, Atherosclerosis is the major underlying cause of coronary heart disease. It is a chronic inflammatory state leading to the release of several mediators that play a role in causing endothelial dysfunction, initiation, progression, and rupture of atherothrombotic plaque. Several studies have proven that oral inflammations are potent inducers of systemic inflammation which may increase inflammatory activity in existing atherosclerotic lesions, thereby increasing the risk of cardiovascular diseases. Although researchers believe that there could be an association between lesions of endodontic origin and cardiovascular disease, no causal relationship has been found yet. Considering the prevalence of teeth with radiographic evidence of apical periodontitis as high as 65% in the Indian urban population, it is essential to recognize and address the effects of endodontic lesions on systemic health. Thus, this paper aims to review the current scientific literature about all the probable endodontic factors that could lead to cardiovascular diseases and give an overview of the studies conducted to date to establish this association. This less recognized entity must be assessed more among the dental and medical fraternity so that an integrative approach can be undertaken for the diagnosis and management of chronic diseases which could have shared etiopathogenesis. If a clear correlation or causation is established it could not only help in restoring optimum oral health but also prevent fatally and life-threatening cardiovascular diseases.


  Abstract 284: A systematic review on the role of antimicrobial efficacy of nano irrigants in endodontics Top


Anjali Sankar, Sindhu Ramesh

Saveetha Dental College, Chennai, Tamil Nadu, India

Introduction: The removal of both necrotic and vital pulp substrates and microorganisms and their toxins from the root canal system is the basis for a successful endodontic treatment. It has been shown that endodontic lesions do not develop in the absence of bacteria.Primary infections of the endodontic space are mainly caused by obligate anaerobic species,while the most responsible one for endodontic failure is Enterococcus faecalis.This bacterium is able to withstand many intracanal medications and also represents an important microorganism in the biofilm development.

Objective: To compare and evaluate the antibacterial efficacy of nano irrigants and conventional irrigants against endodontic pathogens.

Search Strategy: The search was performed in electronic database(i.e. PUBMED CENTRAL, COCHRANE, LILAC, SCIENCEDIRECT,MEDLINE,Web of Science) using the following search items alone and in combination by means of PUBMED search builder. There was no restriction in the language.

Selection Criteria: Studies were selected if they met the following criteria:In vitro/ in vivo studies comparing and evaluating the reduction of microbial load on using irrigants containing nano particles.

Data Collection and Analysis: Two review authors independently selected studies, extracted data and assessed the risk of bias. Authors were contacted where further information about their study was required.The data collection form was customized. The primary outcome measure was to evaluate the antibacterial efficacy of nano irrigants and to compare its efficacy with conventional irrigants.

Main Results: The results showed that nano irrigants exerted an almost similar antibacterial effect against Endodontic pathogens when compared with conventional irrigants.

Conclusion: Based on this review, it may be concluded that nano irrigants can be used in place of conventional irrigants in routine endodontic procedures.


  Abstract 285: Removal of a 5 mm long separated endodontic instrument extending beyond the apex of mandibular right first molar using a guided surgical approach Top


R Vignesh

Government Dental College and Hospital, Mumbai, Maharashtra, India

Procedural accidents during endodontic treatment often complicate the overall treatment plan of the patient. Separation of an instrument is one of the most frequently encountered procedural accidents in endodontics. In this case report, a 3-D guided surgical approach was chosen to remove a 5mm long separated endodontic file extending beyond apex of mandibular right first molar. This ultra-conservative approach utilising a 4mm diameter trephine bur through a 3-D printed surgical guide with a 4mm opening for the drill was done to minimise the risk of damaging the underlying inferior alveolar nerve which was in close proximity to the tip of the broken instrument. In the case, we removed the separated file through the 4mm hole with trephine bur after obtaining consent from the patient.


  Abstract 286: Broken instrument retrieval-case series Top


Rajender Singh

Kalka Dental College, C.C.S. University, Meerut, Uttar Pradesh, India

Separated endodontic instruments may adversely affect the outcome of endodontic treatment, as it interferes with proper shaping, debridement and obturation of the root canal portion apical to the level of obstruction. Attempts should always be made to retrieve the separated instrument and if not possible, the instrument should be bypassed. Microscope, ultrasonics and loop devices have made the retrieval of separated instruments very predictable. Although the time needed for retrieval depends on various factors like canal curvature, length of separated instrument and the skill of operator. This presentation of cases shows the successful retrieval of separated endodontic instruments.


  Abstract 287: Comparative evaluation of canal transportation and centring ability of three rotary file systems: In-vitro study Top


K Aravindhan, S Delphine Priscilla Antony, MS Nivedhitha

Saveetha Dental College, Chennai, Tamil Nadu, India

Aim: To compare the canal transportation & centering ability between ProTaper Gold, Trunatomy & Profit S

Materials and Methods: 30 freshly extracted maxillary premolar were included in the study. Pre-operative CBCT and calculation of a1 and b1 at 3,6,9 mm from the apex.Group 1: cleaning and shaping with ProFit S3 up to PF2 file (#25,0.06).Group 2: cleaning and shaping with TruNatomy up to prime shaping file (#25,0.04).Group 3:cleaning and shaping with ProTaper Gold up to F2file (#25,0.08) Post-operative CBCT and calculation of a2 and b2 at 3,6 and 9mm from the apex.

Statistical Analysis: One-way-ANOVA and the independent t-test were done for the pairwise comparison. The significance level was set at P = 0.05; statistical analysis was performed with SPSS statistics version 20.0 (SPSS Inc., Chicago, IL, USA).

Results: There was a significant difference among the three groups. ProTaper Gold showed slightly more canal transportation compared to the other files this could be due to its variable taper (8 % taper). Trunatomy (26, 4% taper) and ProFit S3 (25, 6 % VV taper).There was a significant difference among the three groups. ProTaper Gold showed a lesser centering ratio compared to the other files this could be due to its variable taper (8 % taper). Trunatomy (26, 4% taper) and ProFit S3 (25, 4-8 % VV taper) had no significant difference i.e it had a better centering ratio, this could be due to the taper variations and offset design.

Conclusion: From this study, it can be concluded that Trunatomy and ProFit S3 had lesser canal transportation and a better centering ratio compared to ProTaper Gold rotary file system.


  Abstract 288: Root canal cleanliness and file distortion following three different nickel titanium rotary file systems Top


Selvaraj Harish, Jogikalamat Krithikadatta

Saveetha Dental College, Chennai, Tamil Nadu, India

Aim: This study aims to evaluate the root canal cleanliness and file deformation following instrumentation using three different nickel titanium rotary file systems by Scanning Electron Microscopy.

Materials and Methods: Forty single-rooted human mandibular premolar teeth were selected. Biomechanical preparation was done by using Trunatomy, Herogold and Heroshaper in sequence upto size 30 with a constant speed of 300 r.p.m. The crowns of the prepared teeth were removed and the roots of all the samples were sectioned using a hard tissue microtome. The sectioned samples were observed under SEM at 2000x magnification. The file systems which have been used for 10 samples were observed under SEM and assessed for deformation at 500x magnification. The debris and smear layers were assessed and scored and the files were analysed for the presence of microfractures and cracks. Statistical analysis was done using Kruskal Wallis Test.

Results: No statistically significant differences between the groups were demonstrated for debris and smear layer scores in the coronal, middle and apical parts of the root canals. Herogold and Heroshaper files produced cleaner canal walls than Trunatomy in the Coronal third, however the values were not statistically significant (P>0.05). The surface deformity was least with Trunatomy, while Herogold and Heroshaper files revealed slight metal fold over at the edges.

Conclusion: The files tested were not able to completely remove debris and smear layer. In terms of instrument distortion all the systems were found to be safe following instrumentation in ten canals.


  Abstract 289: The role of substance P in endodontic pain management: A systematic review Top


Nishitha Arun, Sindhu Ramesh

Saveetha Dental College, Chennai, Tamil Nadu, India

Introduction: The aim of endodontic procedure is to reduce the dental pain due to inflamed pulp and periapical tissues. It is difficult to measure the efficacy of endodontic procedures in reducing pain since pain is subjective and its perception varies from person to person. Substance P (SP) is an inflammatory neuropeptide and it is claimed that the level of SP is associated with pain experienced by the patient. Hence, the efficacy of endodontic procedures can be determined by the effect of the procedures on the level of SP.

Objective: To compare and evaluate the efficacy of endodontic procedures in reduction of Substance P level. Search Strategy The search was performed in electronic databases (i.e. PUBMED CENTRAL, COCHRANE, LILAC, SCIENCEDIRECT, GOOGLE SEARCH, WEB OF SCIENCE, MEDLINE) using the following search items alone and in combination by means of PUBMED search builder till February 2021. Selection Criteria Studies were selected if they met the following criteria: In vivo studies comparing the Substance P level before and after various endodontic procedures.

Main Results: Database Search revealed 56 studies out which 8 were included in the systematic review based on the inclusion criteria. Out of the 8 included studies, 5 studies were randomised controlled trials and 3 studies were non randomised controlled trials. The level of SP was measured in GCF, pulp tissue, root canal exudate and saliva.

Conclusion: The present systematic review showed that the level of Substance P reduced after the endodontic procedures in 4 of the 8 included articles and there was no significant change in SP level before and after endodontic procedure reported in 3 studies and 1 study showed photobiomodulation increased SP level. Use of various irrigants or irrigation techniques did not have a significant effect on the level of SP. Pain was significantly reduced following root canal treatment but there was no concrete evidence to establish correlation between pain and level of SP.


  Abstract 290: Management of C-shaped canal system Top


Amit Kumar Gupta

Government Dental College, Jaipur, Rajasthan, India

The C - shaped root canal configuration is an anatomical variation of root fusion and commonly seen in the mandibular second molar. An in depth understanding the root canal anatomy and its variation is an important parameter for determining the clinical success of an endodontic treatment. Radiographical and clinical diagnosis can aid in identification and negotiation of the C - shaped anatomy. Modification in the debridment and obturation techniques will ensure a 3D fill of canal system. This paper present successful endodontic management of mandibular teeth with C - canal system.


  Abstract 291: Regenerative endodontics-to revive and to rejuvenate Top


P Denisha

Vivekanandha Dental College for Women, Namakkal, Tamil Nadu, India

Newer scientific technological advancement in dentistry provides an array of projects such as molecular biology, cell culturing, tissue grafting, and tissue engineering. Conventional root canal treatment, apexification with biomaterials, and extractions are the procedures of choice to treat a nonvital tooth. These treatment options do not give predictable outcomes in the regeneration of the pulp tissue. Regenerative endodontics is defined as biologically based procedures designed to replace damaged tooth structures, including dentine and root structures, as well as cells of the pulp–dentine complex. Regenerative endodontic procedures for immature permanent teeth with apical periodontitis confer biological advantages such as tooth homeostasis, enhanced immune defense system, and a functional pulp-dentin complex, in addition to clinical advantages such as the facilitation of root development. Regenerative endodontics applies the concept of the triad of tissue engineering, stem cells, scaffold and growth factors in the canal space to regenerate the pulp tissue damaged by infection, trauma or developmental anomalies. Clinically, regenerative endodontics was first developed for immature necrotic permanent teeth in order to achieve root end closure, with the additional goal of obtaining continued development of the root and thickening of the canal wall. Subsequently, regenerative endodontics has been performed on necrotic mature permanent teeth, vital mature permanent teeth, teeth that have resorption and for retreatment of teeth obturated with gutta-percha and sealer. Regeneration of the lost tooth structure rather than replacement during treatment will ensure better prognosis and higher rate of success. Hence the future in dentistry would involve the regenerative procedures which could successfully replace lost dentine, cementum and the pulp tissue. Efforts are on through tissue engineering to create a biological tooth substitute that could completely replace the lost tooth structure. The purpose of this review paper is to discuss the current approaches in regenerative endodontics.


  Abstract 292: Management of two variations of middle mesial canals: A case series Top


Anagha Nambiar, Ahammed Moosa, Sreelekshmy Chandrababu, Sangeetha Saji, Rasheeda Shamshu, Radhakrishnan Nair, Praveena Geetha

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

Thorough knowledge of the morphological variations of the root canal system is of paramount importance for successful endodontic treatment and to have a favorable prognosis. Recent imaging systems have shed more light on the possibility of detecting and evaluating such intricate anatomical variations. The mesial root of mandibular molars commonly have two main canals (mesiobuccal and mesiolingual), but the presence of an extra canal in this root, called middle mesial canal has been reported in 0.26% to 46.15% of cases worldwide. Failure to detect & effectively clean these canals can lead to a compromised treatment outcome. The need for the clinician to be aware of such variations and the use of newer technologies like dental operating microscope during treatment is imperative. This case report describes the successful management of three cases depicting the two variations of middle mesial canals. The first two cases depicts Type 2 variation (confluent) and the third case depicts type 3 variation (independent type), which were managed using digital x rays and dental operating microscope. On follow up, patients were asymptomatic and radiographs showed satisfactory healing.


  Abstract 293: Systemic antibiotic therapy in delayed replantation of avulsed tooth: A systematic review Top


Shaili Mehta, Manoj Ramugade, Abrar Sayed, Kishor Sapkale

Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Mumbai, Maharashtra, India

Aim: This Systematic review aimed to analyse the practising trends of clinicians on using Systemic Antibiotic Therapy (SAT) in delayed replantation of avulsed permanent anterior teeth.

Materials and Methods: A search was performed for case reports and case series related to delayed replantation of avulsed permanent anterior teeth on databases like Medline/PubMed, Google Scholar and Cochrane from 2000 to 2020. The Prisma guidelines 2009 were followed and the protocol was registered on Prospero, an International prospective registry for systematic reviews. A total of 9 articles were selected after applying inclusion and exclusion criteria for this systematic review. Data was extracted and analysis was done.

Results: In this study, four case reports showed the primary use of systemic penicillin and others reported different antibiotic combinations in delayed replantation cases. While, only 1 case reported the use of tetracycline as SAT, despite it being the drug of choice as per the guidelines. Five case reports observed Ankylosis, resorption, and infra-occlusion as procedural complications. Successful treatment outcome was highly variable ranging from no complication in 6 months - 2 years period to 1 case that reported complication after 7.5 years.

Conclusion: The clinicians prescribed the same antibiotics for delayed replantation that were prescribed in routine endodontics. The use of these antibiotics in case of avulsion could be attributed to its easy availability, practice and trust of the clinician regarding the dosages and route of administration of these antibiotics and may be lack of knowledge about other antibiotics and their complications. The follow-up period for most of the cases was insufficient to observe the complications. Thus, effect of antibiotics on treatment outcome of delayed replantation of an avulsed tooth mandates more studies with longer follow up period.


  Abstract 294: Efficacy of chemical, mechanical and combination of both means to locate and re-negotiate root canals filled with mineral trioxide aggregate: An in vitro study Top


Sachin Goyal, Akshun S Gupta

Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India

The successful use of MTA in DPC/Pulpotomy/Obturation in endodontics over the years poses a challenge in cases where retreatment is required at a later stage. The retrievability of canals is made difficult by hard set MTA so the question is how to renegotiate canals for retreatment.

Aim: To compare the efficacy of Chemical, Mechanical or Combination of both, for MTA removal while re-negotiating the canals filled with MTA retreatment.

Materials and Methods: 30 freshly extracted human anterior teeth were selected for the study. Access cavity was prepared and coronal flaring was done and root canal preparation was done up to 35-6% Ni-Ti Endodontic rotary files (NeoEndo flex-Orikam). A 3mm MTA (Proroot, Dentsply Tulsa) plug was placed at the root canal orifice and was verified by radiographs. After placement of MTA, a coronal seal was achieved by non-eugenol based temporary restoration (Oratemp-NE) and were stored in 100% humid environment for 1 month. After 1-month temporary restorations were removed. The samples were randomly selected and divided into 3 groups. In group I- 35% HCl was used for 1 minute to remove MTA that was placed in the chamber. In group II- Ultrasonic instrumentation was used for 1 minute and in group-III combination of both the methods was used for 30 seconds each. Following that the sample teeth were subjected to hand filing (K-10 &15 No.) for 60 seconds to negotiate each root canal and re-negotiation of the root canal was noted (Yes/No). The teeth were then sectioned and observed under stereomicroscope with magnification of 40x for amount of MTA left in the root canal.

Results: Data was analyzed with Kruskal-Walls's test. Results showed that the remnants of MTA were present in all groups but Group-III had the least remnants and the root canals were re-negotiated the most. In Group-I canals could not be renegotiated in 60 second time.

Conclusion: It was concluded that though MTA cannot be completely removed from the root canal system by any of the method mentioned above in this study, however a combination of HCl and ultrasonic was best in renegotiate the root canals.


  Abstract 295: Comparative evaluation of canal transportation and centering ability of two off-centered rotary file systems using cone beam computed tomography: An in-vitro study Top


Thomas Helen, D Narendra Nirupama, DN Naveen, Nainan Mohan Thomas, J Sindhu, S Nair Naveen

Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India

Aim: To evaluate the canal transportation and centering ability of Revo-S and TruNatomy file systems using CBCT.

Materials and Methods: Thirty single rooted human mandibular premolars with root curvature of 15°-25° (the Schneider method) were randomly distributed into two groups(n=15). Teeth were decoronated to standardize the working length to 18 mm and mounted on a wax template. Pre instrumentation scanning of all teeth were done at three levels: 3 mm, 6 mm and 9 mm from root apex. Group 1 was prepared with Revo-S file and Group 2 was prepared with TruNatomy file. Post instrumentation CBCT scans were done as similar to pre instrumentation scans. Canal transportation and centering ability were evaluated using CS 3D imaging software, Carestream 9600 s CBCT machine. Mann Whitney test was used for Inter-group canal transportation and centring ability analysis at all the three levels. The level of significance was set at P<0.05.

Results: TruNatomy file showed statistically significant less canal transportation compared to Revo-S file at both mesiodistal region (P=0.007) and buccolingual region (P=0.001) at 3mm, but only at buccolingual region at 6 mm (P<0.001) and at 9 mm (P<0.001) from the apex. There was no statistically significant difference in the canal transportation between the two groups at mesiodistal region at 6 mm(P=0.19) and at 9 mm (P=0.83) from the apex. There was no statistically significant difference between TruNatomy file and Revo-S file for its centering ability at 3mm(P=0.11), 6mm(P=0.36), and 9mm(P=0.49), from the apex.

Conclusion: Within the limitations of this study, TruNatomy file system showed less canal transportation compared to Revo-S file system. There was no significant difference between the two file systems for its centering ability.


  Abstract 296: Knowledge, attitude, and practice-based survey on the protocols followed for pulp capping among postgraduates, general practitioners, and specialists Top


P Niharika, K Sowmya

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

Aim: Pulp capping is a minimally invasive procedure that aims to preserve the vitality of the pulp. Several factors right from the case selection to the type of material may influence the success of pulp capping. The present survey aimed to assess the knowledge, attitude, and practice of the different protocols followed for pulp capping among postgraduates, general practitioners, and specialists.

Materials and Methods: A cross-sectional survey was conducted using a close-ended, multiple-choice questionnaire through Google forms and 209 responses were collected. The data obtained were analyzed using SPSS software. Descriptive statistics and Chi-square tests were done for selected questions to evaluate the association (p value<0.05).

Results: 52.1% of the participants were general practitioners, 22% were endodontists and 21% were postgraduates. Calcium hydroxide was the most commonly used pulp capping agent (56.45%) although the majority of the participants felt MTA had a higher clinical success rate (44%). Chi-square test showed a significant association of the specialty of the participants with the knowledge on indications and contraindications, frequency and material used for pulp capping, and the attitude on rubber dam use and success rate of pulp capping (P<0.05).

Conclusion: Although the participants in this study had a fair knowledge about pulp capping, some key aspects like the indications, case selection, and advances in materials need better clarity. This will encourage more clinicians to perform pulp capping with more predictability.


  Abstract 297: Comparative evaluation of mineral trioxide aggregate and biodentine as dental perforation repair materials in patients undergoing endodontic treatment: A systematic review Top


Surekha Waghmore

YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India

Objective: The root perforation, in spite of being taken as a challenging accident in root canal treatment, has to offer favorable results when exposed to appropriate therapeutic conduct and the usage of materials that have convenient properties. The aim of this systematic review to evaluate and compare case reports which used MTA and Biodentine as treatment modalities for dental perforation repair in teeth indicated for endodontic treatment.

Methodology: A comprehensive search was conducted by using electronic databases (Google Scholar and PubMed use English-language literature) for this systematic review, using specific inclusion and exclusion criteria and keywords. The search lined all articles printed from 2004 to 2020.

Results: Eleven studies were included for the qualitative synthesis. Out of the 11 studies, 8 were randomized controlled clinical trials, 1 was a clinical trial, 1 was a prospective study and 1 was a retrospective study. The success rate was seen as encouraging in all the included studies, most commonly Biodentine gave better results than MTA. Biodentine was the commonly used repair material than MTA as was assessed by the outcome parameters.

Conclusion: Some of the researches have reported that no significant difference between both the agents, and most of the studies proposed better results (both rapid and long lasting) for MTA. However, it can be concluded that, from this study that Biodentine is more commonly used treatment modality giving better results than MTA in treatment of root perforations.


  Abstract 298: Scanning electron microscope evaluation of mineral trioxide aggregate interface upon immediate and delayed (after 24 h) placement of glass ionomer cement and composite: An in vitro study Top


Akanksha Sood, Meghna Shrivastava

Bhojia Dental College and Hospital, Bhud, Baddi, Himachal Pradesh, India

Aim: To evaluate the interface formed by GIC and Composite with MTA, when placed immediately and after 24 hrs.

Methodology: Twenty extracted molars were sampled and divided into four groups with n=5 in each group. GIC and composite were placed as final restorations at two different timings after MTA placement. In group I (n=5), immediate restoration with GIC was done over freshly mixed MTA. In group II (n=5), immediate restoration with light cured composite was done. In group III (n=5), a moist cotton pellet was placed over MTA and a final restoration with GIC was done over MTA after 24 hrs. In group IV (n=5), permanent restoration with light cured composite was done after 24 hrs. The samples were then studied under scanning electron microscope (SEM) for gap and cracks at the interface.

Results: The SEM (at 400x) showed group III had significantly least adhesive separation of 2.13μm at the interface (p value =.005), whereas Group IV showed gap formation of 5.95μm. The specimens in Group I and II showed separation of 6.64μm and 9.12μm respectively. However, Group II showed the highest separation amongst all four groups.

Conclusion: These findings suggest that GIC over MTA is a better option than Composite over MTA whether seen after immediate or after 24 hr placement. Also, overall bond was better when GIC was placed over MTA after 24 hrs rather than immediately.


  Abstract 299: Tooth rift – Repaired in a swift Top


Suvaani Kataria

Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India

During root canal treatment, various procedural errors may occur that lead to the failure of endodontic therapy. Perforation is defined as a mechanical or pathological communication between the root canal system and the external tooth surface, which is caused by caries, resorption or iatrogenic factors (AAE,2003). There are mainly two types of perforations (coronal and radicular) that can occur iatrogenically. Destruction of periodontal tissues occurs as a result of furcation perforation, which may ultimately lead to loss of tooth from the dental arch. The prognosis of tooth depends upon distinct factors, i.e. (i) severity of initial damage to periodontium, (ii) location and size of perforation, (iii) bacterial contamination and (iv) sealing ability and cytotoxicity of the repair materials. This case report delineates the management of repair of iatrogenic furcation perforation with biodentine.


  Abstract 300: Comparative evaluation of smear layer removal by different concentrations of liquid and gel type ethylenediaminetetraacetic acid: A scanning electron microscope study Top


Gagandeep Kaur

Guru Nanak Dev Dental College and Research Institute, Sunam, Punjab, India

Aim: The aim of the present in vitro study was to compare the effectiveness of varying concentrations of liquid and gel type EDTA in removal of the smear layer with the aid of – A Scanning Electron Microscope study.

Materials and Methods: Sixty human extracted single-rooted teeth, with completely formed apices were selected and decoronated with the diamond disc to obtain a uniform root length of 14 mm from the apex. Proper access was established, and the apical patency was determined by inserting a number 10 K-file. All root canals were prepared by rotary file system and thorough irrigation was performed with Sodium hypochlorite after each instrument change. The teeth were then randomly divided into four groups (n=15) as follows:

Group 1: 17% EDTA Gel was used for removal of smear layer.

Group 2: 19% EDTA Gel was used.

Group3: 17% EDTA Solution was used for removal of smear layer.

Group4: 18% EDTA Solution was used.

After cleaning, all teeth were dried using paper points. The samples were sectioned longitudinally and examined under Scanning electron microscope at the coronal, middle, and apical third of the root canal.

Results: The overall minimum mean score of remaining smear layer observed was 1.48 in Group 4 (18% EDTA Solution), 1.91 in Group 3 (17% EDTA solution, 2.55 in Group 1 (17% EDTA gel),), 2.28 in Group 2 (19% EDTA Gel).

Conclusion: Solutions were more efficacious in smear layer removal at all levels as compared with gel type EDTA.


  Abstract 301: Retreatment of young permanent teeth with large periapical lesion Top


Swaathi L Vijay, Salahudheen Nadakkavil, P Veedu R, Geetha, Radhakrishnan Nair, Princy Paul

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

Trauma to the permanent incisors represents about 18-22% of all dental traumatic injuries, among which 96% involve maxillary central incisors. It can result in the interruption of the development of incompletely formed roots in young patients. The biggest challenge while treating teeth with open apex is to successfully obtain an apical seal because of the lack of apical constriction, making it difficult for compaction of obturation material and there is risk of extending materials beyond apex. This can be overcome by apexification procedure. In addition, large periapical lesion makes healing difficult which can be treated thorough disinfection of the canals. In this case report, we are discussing a case with root canal retreatment with respect to 11 and 21.Teeth had open apices with symptomatic apical periodontitis and persistent periapical lesion of 8*6 mm with respect to 11,5*5mmwith respect to 21. Retreatment was planned for both the teeth. Single visit apexification with MTA was done for apical closure and thermoplasticized obturation technique was adopted. During 2 month follow up, patient was found to be free of symptoms following which zirconia crowns were placed. A 2 year follow up was done and there was satisfactory healing on the radiographs.


  Abstract 302: Comparative evaluation of different retreatment techniques in terms of residual root filling material, preservation of root dentin and time using cone beam computed tomography Top


Edappilly Minnuangel Thomas, Nainan Mohan Thomas, N Naveen D, J Sindhu, D Narendra Nirupama, Gagandeep Kaur Chadha

Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India

Aim: To evaluate the performance of ProTaper Universal Retreatment (PTUR) system, PTUR supplemented with XP Endo Finisher-R (XPF-R) and PTUR supplemented with Ultrasonic endodontic retreatment tips (E5 and E4D, Woodpecker) when used with and without solvent for efficiency in removing root canal material, preservation of root dentin and time taken in removal of root canal filling material.

Materials and Methods: 48 single rooted mandibular premolars were selected. The teeth were decoronated up to the cemento-enamel junction so that a working length of 15mm was obtained. All the teeth were mounted on a wax template. Biomechanical preparation was done using ProTaper Gold file system up to No. F2 file. Post-instrumentation Cone Beam Computed Tomography (CBCT) were done for all the teeth. The samples were randomly assigned into 6 groups according to the retreatment protocol used (n = 8): PTUR files with and without orange oil solvent, PTUR supplemented with XPF-R file with and without solvent, and PTUR supplemented with ultrasonic tip with and without solvent. After retreatment, the specimens were rescanned and volumetric analysis of remaining root filling material and volume of the canal space were measured using ITK-SNAP Software Version 3.8.0. All the data were subjected to Kruskal Wallis test followed by Mann Whitney's post hoc analysis with a significance of P<0.05.

Results: There was no statistical significance while using orange oil solvent during the retreatment procedures. PTUR supplemented with XPF-R file and ultrasonic endodontic tips removed statistically significant amount of root canal filling material when compared with only PTUR, even though statistically the supplementary groups required more time to complete the retreatment protocol. PTUR supplemented with ultrasonic tips preserved statistically significant amount of dentin when compared with other supplementary retreatment techniques where XPF-R was used in this study.

Conclusion: PTUR aided with ultrasonic retreatment tips is a promising method for removing root canal obturating material which preserves more amount of root canal dentin than PTUR supplemented with XPF-R.


  Abstract 303: Morphological oddity – An enigma; demystified endodontic management of premolars and molars with unusual canal morphology: A case series Top


Mahesh Chandra Mohan, Drisya Soman, G Praveena, Radhakrishnan Nair, Nisha B Kurup

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

The axiom of endodontic treatment relies in proper debridement, disinfection and obturation of root canal in 3-dimensions to prevent reinfection of the tooth. Comprehensive understanding of variations in root canal morphology is also an important aspect for performing successful endodontic interventions. The presence of an untreated or missed canal is one of the main reasons for failure of endodontic treatment. Most of the time root canals are left untreated because the clinician fails to identify their presence particularly in teeth that have anatomical variation. The concurrent development of better techniques has resulted in greater understanding of the canal anatomy, greater treatment success and a more favourable patient response. The microscope-assisted dentistry enhances the visibility; allows the clinician to precisely locate and negotiate anatomical variations that had previously remained unnoticed. This case series discusses successful endodontic management of premolars and molars with aberrant canal morphology. Each case presented its own morphological configuration and challenges. Correlation between radiographic findings, use of dental operating microscope and knowledge of atypical anatomy helped to identify, locate and successfully treat the unusual morphology of the teeth. Success largely depended on the use of magnification, which aided in identifying the location of root canal orifices; thus emphasizing the need to familiarize ourselves with dental microscopy, to obtain maximal anatomic information in endodontic practice.


  Abstract 304: In-office teeth whitening technique post orthodontic treatment: A case report Top


Warni Eka Muthia Anwar, Juni Jekti Nugroho

Department of Conservative, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia

This case report provides information on the protocol for external bleaching techniques to restore discolored teeth post orthodontic treatment. A 25-years-old female complained yellowish discolororation after using orthodontic braces for ± 3 years, the patient wanted to improve the color of her teeth. After the prophylactic procedure and the assessment of tooth color initiation, a light-cured gingival barrier was applied. Then apply 40% hydrogen peroxide for 20 minutes. There was a change in color that was brighter from a score of 8 to 5 using a shade guide. Tooth discoloration post orthodontic treatment can be treated effectively using in-office external bleaching technique.


  Abstract 305: Effect of polydopamine pretreatment on wettability, surface morphology and shear bond strength of mineral trioxide aggregate to resin composite Top


Arumugam Keerthivasan, Sampath Vidhya, Kothandaraman Rajkumar, Sekar Mahalaxmi

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

Background: The success of vital pulp therapy is crucial to preserve the integrity of teeth and to enable uninterrupted root formation in a young permanent tooth. This warrants an intact permanent seal immediately in contact with the pulp capping material. Mineral trioxide aggregate (MTA) sets by hydration and deters placement of an immediate permanent resin composite restoration over it. The aim of this in vitro study is to evaluate the wettability, surface morphology and shear bond strength (SBS) of polydopamine (PDA)-pretreated MTA to resin composite (RC).

Methods: The contact angle (CA) and morphological changes caused by self-etch (SE) adhesive on untreated and PDA-pretreated MTA was analyzed using contact angle meter and scanning electron microscope (SEM) respectively. To evaluate SBS, 144 MTA samples were prepared using a custom-made mold and were randomly divided into two groups of 72 samples each based on whether their surface was pretreated with PDA or not. Under each group, RC restoration was done either immediately or after a delay of 3 h, 24 h and 96 h. SBS of the MTA/composite assembly was tested in a universal testing machine.

Results: SE adhesive made a significantly lesser contact angle with PDA-pretreated MTA compared to untreated MTA (p<0.05). SEM micrographs showed that while etching with SE primer eroded the MTA surface, PDA coating minimized the erosive effect of the acidic primer and preserved the original crystalline plate-like structure of MTA. At all time intervals, PDA pretreatment significantly increased the SBS of MTA to RC, compared to untreated control. Immediate bond strength of PDA pretreated MTA (26.30 MPa) was equivalent to the SBS value achieved at 96 h with untreated MTA (27.82 MPa).

Conclusion: Within the limitations of this in vitro study, it can be concluded that PDA pretreatment of MTA surface improved its wettability, prevented loss of surface integrity following etching and increased the SBS of MTA to RC.


  Abstract 306: Emerging concept - Magnetic resonance imaging for guided endodontics Top


P Shasidharan, Keerthana Chandran

Sri Venkateswaraa Dental College, Puducherry, India

Root canal treatment is done to treat pulpal and periapical pathosis. The initial step in root canal treatment procedure is access cavity preparation. In situations like calcified root canals, location of canal orifice is difficult and time consuming. Recently guided endodontics has emerged as a new approach to locate the root canal orifice of the teeth with calcified canals. Guided endodontics requires a CBCT with an intraoral scan for template fabrication that aid in positioning the bur towards the root canal orifice in cases of calcified canals. CBCT scan uses the ionizing radiation which can have harmful effect on the patients. To overcome this recently MRI is being probed more as a diagnostic tool in Dynamic navigation technology. The physics of producing image with MRI (Magnetic Resonance Imaging) is different from Computed Tomography (CT) and Cone Beam Computed Tomography (CBCT). Consequently MRI is fast outpacing imaging modality of choice for in vivo representation of hard and soft tissues without any invasive procedure and ionizing radiation. With the development of dental and face specific MRI coils, plus the freedom found in sequence design and image processing, MRI has paved the way for guided endodontics. This review emphasises on the feasibility of using MRI as an alternative to CBCT imaging for guided access cavity preparation which is considered to be safer and effective tool in Dynamic navigation technology.


  Abstract 307: Decision tree analysis on management of calcified canals Top


S Divya, A Hima Sandeep

Saveetha Dental College, Chennai, Tamil Nadu, India

Calcific metamorphosis is also called pulp canal obliteration. Canals can be partially or fully obliterated. Most common reasons for calcified canals are trauma and aging. These calcific deposits can cause a considerable challenge to the dental practitioner in locating the canals, reaching the working length and also cleaning and shaping the canals. Attempt to negotiate the canals and perform biomechanical preparation without proper and thorough knowledge on management of calcified canals can lead to iatrogenic errors caused by the clinician such as perforation, fracture of instrument, transportation etc.Most important thing before attempting to negotiate such calcified canals is to have a thorough knowledge on the normal anatomical form and morphology of the root canal system of the particular tooth. Practicing under dental loupes or microscope can add to the clear vision and aid in locating and negotiating the canal. Different armamentarium is available for this purpose like basic small size k file, c pilot files, Endo guide burs, ultrasonic, chelating agents, endodontic surgery to advanced Guided Endodontics.For proper understanding, based on the extent of calcification, whether One third canal is calcified, two third or fully calcified canals, this decision tree has been made.Though negotiating and managing calcified canals can be challenging, they can be managed if a proper protocol is followed. Positive approach with patience along with Operator's skill, attitude, and a proper armamentarium are the requisites to overcome the difficulties posed by these calcified and obliterated canals for their successful treatment.


  Abstract 308: Managing the complex root canal anatomy: Case report Top


Nabam Yano, Sonam Sah

Kalka Dental College and Hospital, Meerut, Uttar Pradesh, India

Anatomy is the science that deals with morphology. A clear understanding of the anatomy is a prerequisite to perform all kind of dental procedure including the root canal therapy that deals with the internal anatomy of teeth. Simple root canal morphology is a rarity than a norm. The root canal system is complicated and has many anatomical variation including numbers of roots, canals and their configuration. Here this paper presentation highlights cases of Radix Entomolaris,C-Shape canals and Lateral canals. The complex anatomy is possible complication to successful diagnosis management and favorable prognosis.


  Abstract 309: Comparative evaluation of the push-out bond strength and failure mode of bond of fibre reinforced composite posts in endodontically treated teeth: An in-vitro study Top


Surelee Chavan, Simren Bhatia

Y.M.T Dental College and Hospital, Mumbai, Maharashtra, India

Aim: To comparatively evaluate the push-out bond strength and failure mode of bond of four different Fibre Reinforced Composite Posts cemented using a self-adhesive resin cement in endodontically treated teeth.

Materials and Methodology: A total of 20 freshly extracted single-rooted, non-carious human premolars were used for this study. The teeth were decoronated at the Cemento-enamel junction to obtain a minimum root length of 13mm, and standard root canal procedure was carried out. After endodontic treatment, the coronal ends were sealed and the specimens were incubated for one week. Post space preparation was carried out maintaining a 4mm apical seal, following which the sample was divided into four groups: Group 1: Pre-fabricated glass fibre reinforced composite post (control), Group 2: Individually fabricated glass fiber reinforced composite post, Group 3: Individually fabricated fibre reinforced composite post with ultra-high molecular weight polyethylene (UHMWP) fibres and Group 4: Experimentally fabricated fibre reinforced composite post using aromatic polyamide fibres. Post cementation was done using self-adhesive resin cement and teeth were sectioned into coronal, middle and apical discs. The Push-out bond strength was measured using a Universal testing machine for all sections and the failure mode was examined under Stereomicroscope.

Results: After statistical analysis, a significant difference (P<0.05) was found between the push-out bond strength for the fibre reinforced composite posts. Experimentally fabricated fibre reinforced composite post using aromatic polyamide fibres (Group 4) and Individually fabricated glass fiber reinforced composite post (Group 2) showed highest values for bond strength. The failure mode was found to be variable for all specimens with adhesive failure between dentin and luting agent and cohesive failure within the luting cement to be the most prominent.

Conclusion: Experimentally fabricated composite posts using Aromatic Polyamide fibres showed promising results in the field of post-endodontic restoration of teeth. These high-strength tensile fibres hold potential to be incorporated into endodontic posts.


  Abstract 310: Management of necrotic mature tooth with regenerative endodontic procedure: A case report Top


Vivek Thakur

Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India

Regenerative endodontics is defined as “biologically based procedures designed to replace damaged tooth structures, including dentin and root structures, as well as cells of the pulp-dentin complex “. Preservation of the natural dentition remains a primary objective in endodontic practice. When the pulp is diseased or necessitates removal for restorative reasons, it is replaced with an artificial filling material. Endodontists are looking forward to using natural resources instead of artificial ones. The regenerative endodontic procedures are examples of tissue engineering and were limited to immature teeth, but recently, REPs have been extended to treat necrotic mature teeth as an alternative to conventional endodontic treatment. This treatment also resulted in the elimination of clinical signs/symptoms and resolution of apical periodontitis. Conventional endodontic treatment is a major etiologic factor for tooth discoloration and tooth fracture. The difference between conventional root canal treatment and an REP is that the disinfected canals are filled with biocompatible, non-vital foreign materials in the former therapy and vital tissue in the later therapy. Therefore, the gain of nerve function in regenerated pulp tissues and maintaining possible proprioceptive defensive mechanisms of the pulp will provide an alarm system during tissue injury and protect the pulp from further damage or the probability of tooth fracture. Although these tissues are not true pulp tissue, they are host's own vital tissue, which is inherited with immune defense mechanisms to protect itself from foreign invaders. In regenerated tissue natural killer cells, lymphocytes and macrophages are restored by blood vessels and represent an innate immune system. Innate immunity within the root canal, which is disallowed after conventional endodontic treatment and can be restored after regenerative endodontics, may offer the potential to reduce reinfections. Furthermore, regenerated tissue may be structurally more resistant to fracture than endodontically treated teeth. This presentation of a case discuss the management of necrotic mature tooth with regenerative endodontic procedure.


  Abstract 311: Management of mandibular lateral incisor with vertucci's Type IV canal configuration Top


Kamalpreet Kaur

National Dental College and Hospital, Dera Bassi, Punjab, India

The anatomy of the root canal system determines the parameters under which the endodontic treatment will be accomplished and directly affects the success of the root canal treatment. Hence, a thorough knowledge of the root canal morphology, careful radiographic interpretation and access cavity modifications are essentials for enhancing endodontic procedures. Mandibular incisors are recognized as usually having one root and one root canal in most cases, although approximately 36% may have two canals. The main reason for unfavorable outcome in endodontic treatment of mandibular incisor is the inability to detect the presence of second canal. Pain even after extirpation of complete pulp tissue from root canal of vital teeth is the main indication of hidden canals. The present case report is on management of pain because of neglected canal in right mandibular lateral incisor.


  Abstract 312: Biofilm: A plethora of endodontic pathogens – An overview Top


Divya G Satheesh, KK Arun, Rajesh Pillai, Afzal Abdul Salim, Sheila George, Adarsh Jayan

PMS College of Dental Science, Thiruvananthapuram, Kerala, India

Biofilms are models of bacterial growth where sessile cells interact to form dynamic communities linked to a solid substrate, located in a matrix of extracellular polymeric substances. Biofilms provide pathogens a favourable habitat and a more structured metabolic diversity. Besides, these coordinated functional communities offer protection against other competitive microorganisms, antimicrobial agents and host defences, accentuating their pathogenicity. The location of biofilm can be intra-radicular or extra-radicular. More often than not, in 77% of cases, biofilms are intra radicular, while about 6% represents the extra radicular share. Diverse microbial species interact during infection, producing microbial population shifts. The pulp space milieu is particularly conducive to harbour anaerobic bacteria that ferment the available amino acids and peptides for metabolic needs. These microorganisms have distinctive properties, which help them resist the disinfection measures: the ability to form biofilm, to thrive in areas impervious to shaping techniques, synergism, the ability to express survival genes and activate alternative metabolic pathways. To survive in a sealed system, microorganisms have to endure the intracanal disinfection measures and have to adapt to an environment with inadequate nutrients. In addition, bacteria located in areas such as apical deltas, isthmuses, lateral canals, irregularities and dentinal tubules, often escape endodontic disinfection procedures. The objective of this literature review is to identify the key microorganisms that induce & perpetuate endodontic biofilms, nature of biofilms, as well as the reasons that enable them to survive basic disinfection measures. Pertinent microorganisms namely E.faecalis, Actinomyces, Fusobacterium and their state of the art eradication techniques will be appraised. Another important consideration in endodontic treatment is the elimination of fungi from the pulp space. Major proportion of fungal oral micro biota is made up of Candida species. Although studies demonstrated that fungi are atypical members of the micro biota in primary endodontic infections, Candida albicans has been associated with root canal infections resistant to nonsurgical therapy. In this review, we confer the role of microbial biofilms in endodontics and the extermination measures.


  Abstract 313: A blooming boon: Application of Artificial intelligence in endodontics Top


Vyshak K Mohan

Manipal College of Dental Sciences, Manipal Karnataka, India

Dentistry has rapidly developed over the past few years with new inventions that help in improving the quality of treatment. With the advancements in science, newer technologies such as artificial intelligence (AI) have been introduced in healthcare sectors for various purposes. This technology comprises of a neural network architecture similar to the human brain and intern mimics the human thinking. This convolutional network pattern is made up of neurons that have strong interconnections, which mainly operate as a data-processing systems to solve a specific problem. AI has been applied in dentistry mainly for diagnosis of dental diseases, treatment planning, clinical decision-making, and prediction of prognosis of dental treatment. Further, these models have demonstrated various applications in endodontics such as studying root canal system anatomy and assessment of root morphologies, detecting periapical lesions and root fractures, determining working length measurements, predicting the viability of dental pulp stem cells, locating apical foramen, and predicting the success of retreatment procedures. It is also found that artificial neural network is similar or more accurate than the professional experts as it allows better accuracy and precision. However, it is still necessary to further verify the reliability, applicability, and cost-effectiveness of AI models before transferring these models into day-to-day clinical practice. This review paper provides an insight about the potential application, limitation and future of Artificial Intelligence in endodontics.


  Abstract 314: Effect of sodium hypochlorite on the cyclic fatigue resistance of newer nickel-titanium rotary instruments: An in vitro study Top


Vibhuti Kumari, Sonali Taneja, Era Arora

ITS Centre for Dental Studies and Research, Murad Nagar, Ghaziabad, Uttar Pradesh, India

Aim: The study compared the effect of 5.25% NaOCl on the cyclic fatigue resistance of Protaper Gold F2, Hero Gold, and Edge File X3 endodontic files and compared it against distilled water. The surface changes were studied under a scanning electron microscope (SEM).

Materials and Methods: A total of 60 new Protaper Gold F2 (group 1), Hero Gold (group 2), and Edge Taper X3 files (group 3) were selected. There were 20 files of each type, which were further divided into sub-groups of 10 each depending upon the immersion solution (5.25% NaOCl or distilled water). 16mm of the shaft of each instrument was dynamically immersed in the solution for 5 minutes. Cyclic fatigue testing was performed using artificial canals milled in stainless-steel blocks (curvature angle = 60°, a curvature radius = 5 mm, and a center of curvature located 6 mm away from the tip). The number of cycles to failure (NCF), until the instrument broke, was recorded. Data were statistically analyzed by the Mann-Whitney U test and Kruskal-Wallis test. Statistical significance was set at p<0.05.

Results: There was a significant difference between the groups for NCF. The mean and SD of NCF in group 1 was 499.75±46.95, group 2 was 655.33±54.21, and group 3 was 1103.66±135.47. Thus, group 3(Edge Taper X3 files) showed the highest cyclic fatigue resistance among the three groups. There was no difference between the impact of 5.25% NaOCl and distilled water on fatigue resistance. SEM analysis of the fracture fragments showed increased crack initiation areas, fatigue striations, and fast fracture zone with dimples in instruments treated with sodium hypochlorite when compared to saline.

Conclusion: The resistance to cyclic fatigue of Edge Taper X3 files was significantly better than ProTaper Gold F2 and Hero Gold. The NiTi files undergo increased surface changes when immersed in 5.25% NaOCl solution when compared to saline.


  Abstract 315: Assessment of antioxidant and anti-inflammatory activity of a novel intracanal drug: An in vitro study Top


M Shamly, Nasim Iffat

Saveetha Dental College, Chennai, Tamil Nadu, India

Aim: To evaluate the antioxidant and anti-inflammatory activity of green synthesized silver nanoparticle based intracanal medicaments.

Materials and Methods: The experimental groups were calcium hydroxide incorporated silver nano particles and graphene oxide incorporated silver nanoparticles. The control group was calcium hydroxide. The antioxidant activity was checked by DPPH assay and Nitric oxide assay whereas anti-inflammatory activity was checked using Protein denaturation and Xanthine oxidase inhibition assay.

Results: Based on DPPH and Nitric oxide assay, both the experimental groups showed better antioxidant activity compared to the control group. Based on Protein denaturation and Xanthine oxidase inhibition assay, calcium hydroxide incorporated with silver nanoparticles showed better anti-inflammatory activity.

Conclusion: Silver nanoparticle based intracanal medicaments can be used effectively during root canal preparation. It shows effective antioxidant and anti-inflammatory activity compared to traditional calcium hydroxide based intracanal medicaments.


  Abstract 316: To compare the antifungal efficacy of three endodontic sealers with and without the incorporation of oreganum vulgare oil against Candida albicans Top


Rohit Amburle

Swargiya Dadasaheb Kalmegh Smruti Dental College, Mumbai, Maharashtra, India

Aim: The aim of this study was to compare the antifungal efficacy of three endodontic sealers (AH Plus, Sealapex, and MTA Fillapex) with and without the incorporation of oreganum vulgare oil against Candida albicans.

Materials and Methods: In the present study C. albicans were cultured in Potato Dextrose Agar plates. Filter papers (n = 10) were placed in the cultured Petri dishes and the sealers were mixed according to the manufacturer's instructions and placed on the top of the filter papers. Group division of sealers is as follows: Group I – AH Plus, Group II – Sealapex, and Group III – MTA Fillapex. Group IC, Group IIC, and Group IIIC were the addition of 25 μg/ml of oreganum vulgare oil with respective sealers. Plates were incubated for 18 h, and the zone of inhibition was measured with a measuring scale and values (in millimeter) were recorded.

Statistical Analysis: Statistical analysis was done by one-way analysis of variance followed by post hoc multiple pair-wise comparisons.

Results: All the tested groups showed statistically significant difference (P < 0.05) from each other. Essential oil of oreganum vulgare showed superior zone of inhibition compared to sealers used alone. Group IC (16.35 ± 0.71 mm) had the highest zone of inhibition followed by Group I (13.8 ± 0.86 mm). For the remaining groups, the zone of inhibition was in the following order: Group IIC > Group II > Group IIIC > Group III.

Conclusion: AH Plus sealer mixed with oreganum oil showed significantly higher antifungal property. Mixing of oreganum oil with endodontic sealer provides an added advantage so that endodontic re infections can be minimized and will be helpful in retreatment cases.


  Abstract 317: Three-dimensional printing – Digital endodontics Top


T Dharani

Vivekanandha Dental College for Women, Namakkal, Tamil Nadu, India

The ultimate goal of dentistry is to provide finest dental care to satisfy the patient needs. It is necessary to obtain high precision and accuracy for almost all the work carried out intraorally to achieve superior function and esthetic. 3D printing is a budding technology especially in the field of dentistry and is also a rapidly developing technology to provide precision & state of art imaging & scanning methods. Compared to conventional lost wax technique and subtractive manufacturing process like CAD CAM where a block of material is reduced to reproduce the object, 3D printing offers process engineering advantage like additive manufacturing, that involves the actual layer by layer addition of a material to fabricate an object. This technique of digitalization helps to complete task faster, easier, in an accurate manner and permits customization. 3D printing has been used for a number of clinical applications in medicine and dentistry. Digital dentistry assists the dental practitioners in quickly and precisely recording and evaluating the dentofacial structures. This allows us to bypass several manual techniques and replace them by using automated devices, thus minimizing the chance of errors. Today, most dental disciplines utilize the advantage of 3d printing to provide patient-specific custom-made prosthesis and restorations. With persistent efforts among dentists for refining their practice, dental clinics are now upgrading from conventional treatment methods to a fully digital workflow to treat the patients. 3D printing also helps in making precise models for dental education and patient education regarding their treatment plan. In this narrative review, we discuss the evolution and current trends in 3D printing applications in various aspects of endodontics.


  Abstract 318: An in-vitro comparative evaluation of microleakage in Class V cavities restored with conventional and chitosan-modified glass ionomer cement: A stereomicroscopic study Top


Ajisha Raju

Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India

Aim: The aim of this study was to investigate the effect of modifying the liquid phase of conventional GIC with 10% v\v Chitosan on the microleakage property of enamel in comparison to conventional GIC.

Materials and Methods: Thirty freshly extracted human molar teeth were obtained. Two groups of samples were created for the study which comprised of group I (glass ionomer cement—GIC) and group II (Chitosan modified glass ionomer cement). Chitosan modified GIC was prepared by mixing 10% v\v Chitosan into liquid component of GIC, after dissolving it in 1% acetic acid. Class V cavities were prepared on the buccal and lingual surfaces. The prepared cavities were restored and varnish was applied all tooth surfaces except the restoration. The teeth were subjected to thermocycling 1500 cycles at 5 and 60℃, with 20 seconds of dwell time. The samples were then immersed in 2% basic fuschin dye solution for 24 hours. The teeth were sectioned into two halves buccolingually in an occlusoapical direction. Sections were viewed under stereomicroscope and the degree of microleakage was evaluated using specific scoring criteria. For comparative evaluation of microleakage scores between Conventional and Chitosan Modified GIC, a nonparametric Mann-Whitney statistical analysis was done.

Results: Statistical analysis showed no significant differences between groups I and II with the p-value at >0.05.

Conclusion: Chitosan-Modified GIC holds great promise for general dentistry as a future restorative material with properties equivalent to GIC.


  Abstract 319: Bioceramic: A new horizon in endodontics Top


Bijay Raj Yadav, Pooja Kabra, Ekta Choudhary

Sharda University (SDS), Greater Noida, Uttar Pradesh, India

Bioceramics and multi-substituted hydroxyapatite or similar compounds have the ability to induce a regenerative response in the organism, Bioceramics are ceramic compounds obtained both in situ and in vivo, by various chemical processes. Bioceramics exhibit excellent biocompatibility non toxicity, dimensional stability and most importantly being bio-inert due to their similarity with biological materials, like hydroxyapatite In Endodontics, they can be broadly classified into Calcium Phosphate/ Tricalcium/ Hydroxyapatite based, Calcium Silicate based or mixtures of Calcium Silicate and Phosphates. The paper presentation highlights the currently available “BIO-CERAMIC MATERIAL'' in endodontics on their specific characteristics which may over the course of years help us move towards the new era of bio-ceramic dentistry.


  Abstract 320: Influence of irrigation techniques on the dentinal tubular penetration of final irrigants: A confocal laser scanning microscope study Top


Aakriti Raj, Pragya Kumar, Sonali Taneja

ITS Centre for Dental Studies and Research, Murad Nagar, Ghaziabad, Uttar Pradesh, India

Aim: To comparatively evaluate the effect of four different irrigation techniques (Conventional Syringe Irrigation, Passive ultrasonic irrigation, EndoActivator and Pro Agitator Tip System) on the dentinal tubular penetration of two final endodontic irrigants ( 5.25% Sodium hypochlorite, 2% Chlorhexidine)

Materials and Methods: Forty single-rooted mandibular human premolars were decoronated and chemomechanically prepared (ProTaper Gold upto F3). The prepared samples were randomly divided into two groups according to the final irrigants used (n = 20) Group I 5.25% Sodium Hypochlorite, Group II 2% Chlorhexidine. Specimen of each group were further subdivided into four subgroups (n=5), according to the irrigation techniques used during final irrigation: Subgroup A (n=5) Conventional Syringe Irrigation (CSI), Subgroup B (n=5) Passive Ultrasonic Irrigation (PUI), Subgroup C (n=5) Endoactivator (EA), Subgroup D (n=5) Pro agitator Tip System (PATS). The teeth were sectioned at coronal, middle and apical levels and viewed under CLSM to record the penetration depth of NaOCl and CHX. The data were statistically analysed using Independent t test and one way ANOVA.

Results: Intergroup comparison shows that 2%CHX shows statistically significant better depth of penetration than 5.25% NaOCl irrespective of the irrigation technique and root levels. Intragroup comparison showed that PUI showed significantly highest depth of dentinal tubular penetration followed by EndoActivator, PATS and CSI. Coronal third of the root canal showed maximum depth of dentinal tubular penetration followed by middle third and least in apical third with significant differences between them.

Conclusions: Depth of irrigant tubular penetration depends on the type of irrigant, irrigation technique and root levels.


  Abstract 321: Nanotechnology in endodontics: An upcoming era in dentistry Top


Ayyagari Viresh, Sheshadri Ramya

JSS Dental College, Mysore, Maharashtra, India

Nanotechnology is an upcoming field in dentistry leading to a very rapid development which became a important tool in dentistry as well as in field of biomedical sciences. This has a wide application in regeneration of tissues, gene transformation. This review focuses on the concepts of nanotechnology in endodontics. Nanotechnology is used to prepare advanced biomaterials with unique physical, chemical and biological properties termed as “Nanoparticles''. Nanoparticles like graphene, silver, chitosan, hydroxyapatite, titanium dioxide were introduced in the field of endodontics such as irrigating solutions, intracanal medicaments, root canal sealers and obturating materials. Nanoparticles-based treatment strategies have the potential to improve antibacterial/antibiofilm efficacy, showed considerable improvement in bonding and sealing abilities promising better restorative outcome. Thus, this field warrants translational research based on sound scientific and clinical tenants to optimize the potential of nanoparticles in clinical endodontics.


  Abstract 322: Evaluation of biodentine pulpotomy in fractured young permanent anterior teeth: A case series Top


Sheshadri Ramya, Ayyagari Viresh

JSS Dental College, Mysore, Karnataka, India

Traumatic dental injuries occurs frequently in children and young adults, comprising 5% of all injuries. Fracture of maxillary anterior teeth is most common amongst them. Conservative management of these fractures helps in preservation of tooth structure, vitality and esthetics. It depends on multiple factors such as time lapse between trauma and the initiation of treatment, level and position of tooth fracture line, stage of root development, pulpal involvement, availability of displaced tooth fragments and concomitant alveolar bone injury. A conservative approach should be our first choice for treating such fractures owing to advancements in vital pulp therapy and adhesive dentistry. Fracture reattachment is widely accepted technique. It restores the tooth integrity and color by conserving original tooth structure. Vital pulp therapy which includes pulpotomies are conservative treatment for reversible pulpal injuries that promotes pulp tissue healing and stimulates hard tissue formation in order to preserve pulp vitality. Traditionally, calcium hydroxide was the material of choice, Mineral trioxide aggregate is considered as a more suitable option. However, discoloration was a major drawback for its use in anterior teeth. To overcome this recent alternatives such as Biodentine have been introduced. It is a biocompatible and bioactive material that promotes pulp healing when applied directly in contact with the pulp tissue. This case series aims to describe and evaluate the outcome of re-attachment of a fractured segment of a mature anterior tooth with pulpal exposure treated with biodentine pulpotomy followed by immediate restoration. The teeth were assessed clinically through pulpal vitality tests and radiographically for periapical healing. At each recall (24 hours, 1 week, 1, 3 and 6 months) no spontaneous pain was observed, the pulp showed signs of vitality and absence of periapical radiolucency at 6 months. Biodentine pulpotomy is recommended as a treatment option for cases of vital pulp exposure in permanent incisors due to trauma.


  Abstract 323: Vital pulp therapy with bioceramic material: A case report Top


Parvathy Sunny, Khadeeja Muhammed, Amal Devadas, Praveena Geetha, Radhakrishnan Nair

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

Aim of vital pulp therapy is to stimulate the remaining pulp to regenerate dentin pulp complex in order to preserve the functionality and therefore ensuring that a tooth remains in the oral cavity for a long duration. Direct Pulp Capping is a conservative treatment strategy, where the infected coronal pulp can be removed, and the pulp wound is completely sealed off with a bio ceramic material placed in direct contact with the pulp wound to prevent micro leakage and result in the development of a reparative hard tissue bridge to preserve pulp vitality. The case report describes the management of a left mandibular first molar with iatrogenic pulp exposure. Patient reported with the history of fractured restoration and pain on chewing food. Under strict isolation, faulty restoration removal was completed and mesial pulp horn was exposed. A portion of inflamed tissue was curetted under dental operating microscope. Haemostasis was achieved and a calcium silicate liner (theracal) was placed followed by GIC and composite restoration. In five months follow up patient was asymptomatic with intact periapical area.


  Abstract 324: Anatomical variations in mandibular premolars: An enigma to endodontist Top


S Sruthy Raj, MV Noufal, Sreelekshmy Chandrababu, Praveena Geetha, Radhakrishnan Nair

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

Mandibular premolars have earned the reputation of having aberrant anatomy because they are the transitional teeth; they display features of both molars and canines and hence are considered as an enigma to dentist. Though most frequent type of tooth configuration reported in premolars is presence of single root and root canal; root canal morphology can be unpredictable and requires cautious assessment before root canal therapy. The dental operating microscopy facilitated the observation of anatomical landmarks in pulp chamber floor and helped to identify supplementary root canals and root canal aberrations. A thorough knowledge of root canal anatomy and its variations, careful interpretation of the radiographs, close clinical inspection of floor of pulp chamber and proper modification of access opening are essential for a successful treatment outcome. Vertucci determined the incidence of type 2 canal in 4% of cases, type 4 in 24% of cases. This case series consist of three cases with anatomical variations in mandibular premolars with weine's Type II [Vertucci type 2], Type III [Vertucci type 4]and Type IV [Vertucci type 5] canal configurations.


  Abstract 325: SPMs: An ally against inflammation Top


Sonali Sapra

National Dental College, Dera Bassi, Punjab, India

Use of lipid mediator as an anti-inflammatory agent is in consideration for some time in medical science. From past few years its importance in dentistry has come forward. Lipid mediators or referred to as specialized pro-resolving lipid mediators (SPMs) are derived from Poly unsaturated fatty acids. SPMs are not actually anti inflammatory but they act by decreasing the neutrophil infiltration into inflamed tissue, inhibiting cytokine production and increasing bacterial phagocytosis. These include lipoxins, resolvins, protectins and maresins. Now why are we here, talking about these mediators so specifically. Well answer to this lies in the proverb “prevention is better than cure” by which I mean preventing, acute inflammation turning into chronic inflammation. It is better as acute inflammation can be reversed but once chronic inflammation appears it leads to the necrosis of the tissue, here pulpal tissue. For necrosis, the treatment modality is pulp extirpation which makes the tooth non vital and brittle which further has its own complications. SPMs not only help in resolving inflammation, but also as studies are being carried on, has shown that it has effect on pain control and bone regeneration too. Endodontics being the branch that is directly associated with the pulp tissue cannot ignore the benefits of SPMs. Though pulp tissue has its own defence system comprising of immunocompetent cells that help fight against the pathogens, but within certain limit. Early treatment of pulpitis with an agent that can restrict its complication can be a game changer. And for that purpose, this review paper focuses to analyse the involvement and potential of SPMs in endodontic therapies or in general.


  Abstract 326: Protective hood in dentistry Top


Diksha Gupta

National Dental College and Hospital, Dera Bassi, Punjab, India

The ongoing COVID-19 Pandemic, a disease caused by Coronavirus (SARS-CoV-2), has a strong impact on dental healthcare workers. There is high risk of professional contagiousness because of spread of this virus through aerosol and droplet contamination. Oral health care providers (Dentists, dental assistants) are in close proximity to patients' face during dental procedures, use of high-speed handpieces and ultrasonic scalers which produce aerosols of patients' blood and saliva. Also, these aerosols cause contamination of the environment, instruments and various surfaces. Thus, the importance of infection control in dental setup is crucial in limiting effects of virus diffusion. There was a major halt in the dental healthcare facilities provided to the public during the beginning of the pandemic and getting back to patient care is multifactorial. It includes proper patient triage, use of protective personal equipment and mitigating aerosol spread. A reasonable approach for fulfillment of this objective is creation of a physical barrier for protection. The methods already available are not enough and there has been an emerging use of Extraoral suction units which are high airflow vacuum systems intended to scavenge aerosols and droplets from the vicinity of the patient's mouth and trap them by depth filtration for safe disposal. This review paper describes one such device. It has a rigid translucent acrylic structure adjusted to dental chair covering the patients head, neck and chest. There is also a piping system to generate negative pressure for aspiration and filtering of air inside the chamber. The operator will be able to work through three holes provided in the chamber, at 9 to 3 O'clock position. The device is being used and tested by various professionals and has created a possibility for managing infection control during such unpredictable times.


  Abstract 327: Endodontic cryotherapy: The evolving pain relieving therapy Top


Supriya Sangade, Tarun Ahuja

ACPM Dental College, Dhule, Maharashtra, India

The management and prevention of post-endodontic pain is an integral part with patients undergoing endodontic treatment. According to literature, prevalence of pain is estimated to be from 1.5% to 50% or more. Attempts to acquaint the patient with post-operative pain (PEP) and prescribing medications to control it can increase patient confidence in their dentists and ameliorate their attitude towards further dental treatment. According to previously published data root canal treatment (RCT) and pulp therapy, cause more severe and frequent postoperative pain when compared to other dental operative procedure. The utmost priority in such situations would be its management. Premedication with prophylactic antibiotic and analgesics prior to endodontic treatment, occlusal reduction, and administration of long-lasting anaesthesia, are some of the strategies which have been developed for post endodontic pain management. Felho et al. 2005 investigated the use of cryotherapy in the dental field in reducing pain, swelling, and trismus. In the field of endodontics, cryotherapy has been reported to be used after periradicular surgeries and during root canal treatment to minimize postoperative pain and inflammation. The word cryotherapy is originated from the Greek word cryos, meaning ''cold.' Cryotherapy has been reported to be effective at reducing oedema, pain, inflammation, and recovery time with short term applications in orthopaedic, abdominal, gynaecological and hernia operations. An ice pack, gel pack, ice chips, melted ice water, ice massage, prepackaged chemical ice pack, and ice in a washcloth are the modes of cold application.Clinical and physiological evidence suggests that a decrease in the conduction velocity of nerve signals, hemorrhage, edema, and local inflammation can be achieved by applying cold through various methods and is therefore effective in the reduction of musculoskeletal pain, muscular spasm, and connective tissue distension. In dentistry, after intraoral surgical procedures, the cold application has been frequently used for controlling postoperative pain. It has been reported that cryotherapy is a long-established therapeutic method for reducing inflammation, pain, and edema. Cryotherapy could be contemplated as an uncomplicated, harmless, and cost-effective therapy for controlling postoperative pain in single visit root canal treatment.


  Abstract 328: Auto irrigate: The continuous irrigant delivery and aspiration system Top


Ridyumna Garain, M Bharathi, Jibin Karim

Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India

Aim: To compare the delivery of irrigant to the apical third of root canals using a novel ingeniously designed continuous irrigation and intracanal aspiration system to manual dynamic agitation and passive ultrasonic activation.

Materials and Methods: Sixty-six freshly extracted single rooted teeth of similar dimensions with a single straight canal were selected and divided into three groups (n=22) based on the irrigation technique employed – manual dynamic activation (group 1), passive ultrasonic activation (group 2) and the continuous irrigation and intracanal aspiration system designed by the authors (group3). Access cavities were prepared. This was followed by working length estimation by inserting a #15 K-file to the root canal terminus observed under 3.5x magnification with loupes and subtracting 1 mm. Instrumentation was completed using ProTaper F2 rotary files at working length. Each group was irrigated with 2.5% NaOCl and saline, a prefinal rinse with EDTA and a final rinse with saline combined with the respective irrigation techniques. Apical delivery of irrigant for each group was evaluated by flooding the root canals with 1% toluidine blue dye for 30 seconds. The specimens were then decoronated and split vertically in a labiolingual direction using a diamond disc. These sections were visualised under a stereo microscope at 5x magnification and photographed. The digital images were analysed using ImageJ software to measure the unstained apical region. One-way ANOVA with Tukey's post-hoc test was used for statistical analysis of the results (p<0.05).

Results: The ingeniously devised irrigation delivery and intracanal aspiration system showed a significantly higher apical delivery of irrigant as compared to the other methods studied (p<0.001).

Conclusion: This simple root canal irrigating device can be made with materials readily available. Comparing the same to standard passive ultrasonic irrigation and the manual dynamic irrigation techniques showed better delivery of irrigants to the apical region. With further studies planned to evaluate smear layer removal and canal disinfection, we hope that this can serve as an efficient, cost effective novel device that can be easily incorporated into clinical practise.


  Abstract 329: A comparative evaluation of effect of four different methods of surface pretreatment on the push-out bond strength of glass fiber post – In vitro study Top


Sheetal Patekar

G.D. Pol Foundation's Y.M.T Dental College and Hospital, Mumbai, Maharashtra, India

Aim and Objectives: Comparative evaluation of the Push-out bond strength of the glass fiber post when subjected to the following surface pretreatment using universal testing machine:

  • Silane
  • 9% Hydrofluoric acid
  • Airborne-particle abrasion
  • Titanium tetrafluoride


Materials and Methodology: 75 extracted, non-carious, single-rooted permanent human teeth will be decoronated, endodontically treated, post space prepared and divided into five groups (n = 15); according to the method of surface pretreatment applied on the post as follows:

Group 1: Silanization, a silane agent will be applied on the post & air dried for 60 seconds.

Group 2: Etching with 9% Hydrofluoric acid for 1 min

Group 3: Airborne-particle abrasion with Aluminium oxide particles.

Group 4: posts will be treated with TiF4 (4 wt/v% for 4 min)

Each root will be sectioned to get slices of 2 ±0.05mm thickness. Push-out tests will be performed using Universal Testing Machine by applying Load in apical-to-cervical direction at crosshead speed of 0.5 mm/min until failure.

Results: All the tested surface pre-treatments enhanced the bond strength between the post ant the resin cement. It was observed that TiF4 treatment gives comparatively higher bond strength.


  Abstract 330: Three-dimensional dynamic navigation system - digital dentistry's foray in guided endodontics Top


Mehrosh Khan, Samia Shaikh

M.A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India

In root canal treatment access cavity should be prepared minimally and kept as conservative as possible. However, there are some clinical situations that make the tooth conservation aim challenging. For example, Obliteration of the root canal system due to accelerated dentinogenesis and dystrophic calcifications can challenge the achievement of the treatment goals. A novel dynamic navigation method was therefore introduced to attain minimally invasive access cavity preparations and to evaluate its 3-dimensional (3D) accuracy in locating highly difficult simulated calcified canals. In endodontics, it was first introduced by Dr. Charles M. Dynamic Navigation facilitates real-time computer guidance technology using an imported CBCT dataset. Overhead tracking cameras relate the position of the patient's jaw and the clinician's bur in 3- dimensional space. Development of dedicated surgical navigation systems for endodontic surgery could facilitate the operator's maneuvers and reduce the risk of iatrogenic errors.


  Abstract 331: Laser activated irrigation: An innovative tool in modern endodontic practice Top


Vaidehi Kulkarni, Sofia Khan

M A Rangoonwala Dental College, Pune, Maharashtra, India

Endodontics is a dental practice which has evolved over time without a pause. From using clove oil for sedation effect to using lasers and microscopes; we have come a long way. Lasers play a huge role in dentistry as they increase the efficiency, ease, specificity, cost effectiveness, and comfort of the treatment. There have been many recent advances in different steps of treatment, which have enhanced the quality of the treatment and given better results. In the field of endodontics, lasers have been used for a long time for the optimization of endodontic irrigation in particular. The laser-activated irrigation (LAI) technique is based on the photomechanical effects of the lasers at low settings. They create a specific cavitation phenomenon and acoustic streaming in intracanal fluids. More recently, a new technique with a Er:YAG laser has been used with sub-ablative energy (20 mJ, 15 Hz) and ultra-short pulses (50 μs). This leads to intracanal cavitation and shockwaves as a result of photoacoustic and photomechanical effects. This phenomenon is called photon-induced photoacoustic streaming (PIPS). PIPS and Laser activated irrigation are described in the literature as a revolutionary and powerful method to activate the irrigant.


  Abstract 332: Effectiveness of diode laser in the treatment of endo-perio lesions: A clinical and microbiological study Top


Syed Shoaib Quazi, Anam Khan

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

Aim: To evaluate the effectiveness of two different modes of Diode laser on reduction of bacterial load organized in biofilms in teeth with Endo-Perio lesion.

Objective: To evaluate the effectiveness of two different modes of Diode laser on reduction of colony forming units(CFU's) of anaerobic gram negative bacteria present in biofilm of teeth with Endo-Perio lesion.

Materials:

  1. Saliva sample
  2. Robertson's cooked meat medium
  3. Blood Agar
  4. Aerobic jar
  5. Diode Laser


Methods:

Twenty samples of Endo-Perio lesions will be collected from the pockets with the help of paper points. After collection the samples will be transported in Robertson's Cooked meat medium to the microbiology lab within one hour of collection. The samples will the be plated on blood Agar plates following which they would be loaded in the anaerobic jar. After this the CFU's will be calculated in each sample.

The specimens will be randomly divided into two experimental groups as follows:

Group I - Diode Laser used in a continuous mode on CFU's

Group II - Diode laser in a pulsed mode on CFU's

Results: Awaited.

Conclusion: Awaited.


  Abstract 333: Continuous soft chelation in root canal therapy: A review Top


Arya Sinai Khandeparkar, Ida de Noronha de Ataide, Marina Fernandes

Goa Dental College and Hospital, Bambolim, Goa, India

The primary goals of root canal treatment are proper cleaning and shaping of the root canal system followed by three dimensional obturation of the canal space with an adequate apical seal. During root canal preparation, a smear layer of dentin debris, including pulp remnants, bacteria and endotoxins forms on the canal walls. This smear layer prevents the sealer from penetrating the dentinal tubules, increasing the possibility of microleakage. Hence, complete debridement with smear layer removal is advantageous and may aid in the success of the root canal treatment. During root canal therapy, irrigating solutions and chelating agents are used to help remove the smear layer and improve sealer bonding. Although these solutions make root canal instrumentation easier, they also interfere with the chemical structure of dentin, altering the Calcium/Phosphorus ratio of the surface and affecting dentin microhardness, permeability, and solubility.

Ethylenediaminetetraacetic acid (EDTA), a mixture of tetracycline, acid, and detergent (MTAD) and maleic acid are commonly used chelating agents to remove the inorganic phase of smear layer. Etidronate, a new chelating agent has recently been introduced in Endodontics. Etidronate which is also known as Bisphosphonate, Etidronic acid or HEBP (1-Hydroxyethylidene-1, 1-Bisphosphonate) is non-toxic and has been systematically applied to treat bone diseases. It is a soft biocompatible chelating agent effective in smear layer removal with less detrimental erosive effects on root canal dentin, compared with other strong chelating agents like EDTA and citric acid. Etidronate can be mixed with Sodium Hypochlorite (NaOCl) without affecting its antimicrobial or dissolving activity, whereas EDTA retains its calcium-complex when mixed with Sodium Hypochlorite limiting its tissue dissolving capacity. This review paper discusses etidronate as a promising candidate for final irrigation of root canal and a potential replacement for conventional treatment with EDTA.


  Abstract 334: A review on photobiomodulation in endodontics Top


Y Alex Immanuel, Ida De Noronha De Ataide, Rajan Lambor

Goa Dental College and Hospital, Bambolim, Goa, India

PHOTOBIOMODULATION THERAPY (PBMT) can have a significant role in reducing postoperative dental pain after endodontic treatment, increasing depth of anesthesia, improving tooth hypersensitivity, reducing inflammation of the tissue and helping wound healing in endodontic surgery, as an adjuvant in the Direct Pulp Capping (DPC) technique, reducing postoperative sensitivity after bleaching and also influence the outcome of regenerative endodontic procedures. The term ''Photobiomodulation'' (PBM), provides a more accurate interpretation of low-power treatments, because it includes a wide range of electromagnetic wavelengths such as broadband lights, LED and lasers. PBM can have both photostimulation and photoinhibitory effects on target tissues, each of which can be used in therapeutic applications. In the PBM technique (including low-level light/laser therapy and low-level laser irradiation), electromagnetic with visible wavelengths (380–700 nm) or near infrared region (700–1070 nm) are used, which have low absorption in water with 3–15mm depth of penetration in soft and hard tissue. Also, radiation power range of this group of treatments is between 250 and 500mW, or less than 250mW. The basis of the PBM technique involves direct application of light energy with the ability of biological stimulation to cells of the body. Cellular photoreceptors, such as cyto-chromophores and pigments, can absorb this group of radiation and by transferring it to the mitochondria and affecting activity of cytochrome oxidase and the Krebs cycle, can also increase the production of adenosine triphosphate (ATP). Stimulation of ATP production leads to increased cellular activity. These changes affect macrophages, fibroblasts, endothelial cells, proliferation of mast cells, secretion rate of bradykinin, and neurotransmission. Thus, PBM therapy after endodontic treatment showed a significant decrease in prevalence of postoperative pain and may benefit patients who need endodontic treatment and also in endodontic surgery and regenerative endodontic procedures.


  Abstract 335: Nanoparticles in regenerative endodontics: A valuable asset Top


Natasha Raura

Manipal College of Dental Sciences, Mangalore, Karnataka, India

Regenerative endodontics is one of the emerging treatment modalities in dentistry. Endodontic treatment for immature permanent teeth with pulp necrosis/apical periodontitis presents with a challenging clinical situation. The very basis of regenerative endodontics is the tissue engineering concept, which uses stem cells, scaffold, and growth factors to regenerate the pulp–dentin complex. These strategies aim to restore the form and function of a tooth by eliminating infection, promoting the development and closure of immature root apices and re-establishing pulpal vitality. Stem cell dimensions cannot be decreased to a nano size; however nano-based scaffolds and drugs can be applied in regenerative systems. Nanoparticles have been customised to develop various forms of scaffolds, which is a key component of regenerative endodontic therapies. Scaffolds are temporary structures that mimic the extra-cellular matrix to support the growth and differentiation of stem cells and aid the controlled release of drugs and bioactive molecules. They can also be combined with nano-carriers to allow multiple bioactive molecule releasing mechanisms. Nanoparticle-based carrier systems have been proposed as a method for the sustained release of bioactive molecules, which are a crucial component of regenerative endodontics as they modulate cellular activity, such as proliferation, migration and differentiation. As nanoparticles possess enhanced solubility, high surface-area-to-volume ratio and minute dimensions, nanoparticle-based carrier systems may improve the dissolution and absorption of bioactive molecules and drugs. Several nanoparticles like chitosan, bioactive glass, zinc oxide, silver and poly lactic-co-glycolic acid (PLGA) have been incorporated in various aspects of endodontic treatment including irrigation, as intra canal medicaments and in regenerative therapies. Nanoparticle applications show promise in the field of regenerative endodontics, such as supporting the release of bioactive molecules and enhancing the biophysical properties of scaffolds. Given the constantly growing research in this field, it is important to study the current evidence pertaining to the properties and clinical applications of various nanoparticles in regenerative endodontics.


  Abstract 336: Regenerative endodontics – Does it really sprout life in an immature open apex tooth? Top


Anirudh Garg

Manipal College of Dental Sciences, Mangalore, Karnataka, India

The regenerative endodontics has garnered more and more popularity over the recent years. It involves complete regeneration of all original tissues to regain the tooth vitality along with root completion in non-vital immature tooth. It focuses on substituting traumatized and pathological pulp with normal functional pulp tissue. Regenerative endodontics provides hope but still fails to re-establish the original form of pulpal tissue and is known to provide variable results. Presently, many researchers are working to improve the quality and efficiency of the treatment. There are several problems associated with the technique of regenerative endodontics such as extraction, isolation and storage of dental pulp stem cells; handling and placement of scaffold into the canal and identification and positioning of growth factors in the canal. There are also problems associated with the technique of regeneration even after the completion of the treatment such as discoloration, extended duration of therapy, challenging histological outcomes, inadequate development of root, insufficient bleeding during revascularization process, root canal calcification and the unpredictable outcome of the treatment. There are certain loopholes in the existing treatment protocols that might sometimes result in undesired and unstable results. This scientific presentation describes the challenges faced by the endodontist while treating the patient and the final outcome with regards to the regenerative endodontic therapy.


  Abstract 337: Compendium of pain management in endodontics Top


Sumit Sharma, G Bharath

Bangalore Institute of Dental Sciences and Hospital, Bengaluru, Karnataka, India

Pain is one of the primary reasons for patients to seek dental treatment. Though the etiology of pain is multifactorial, the most frequently experienced dental pain is of endodontic origin. Odontogenic toothache is highly unpleasant and causes extreme anxiety for patients requiring endodontic therapy. Therefore, an effective approach to control pain in endodontics poses a significant challenge to the clinician. Pain management comprises of three phases. It begins with an accurate diagnosis, anxiety reduction and a comprehensive history. It is essential for an astute clinician to have a good knowledge about local anesthesia, the steps in endodontic treatment and clinical pharmacology for better pain management. The alternative methods include the use of low power lasers or photobiomodulation and cryotherapy mainly attributed to their painless and non-invasive function. This review highlights the current strategies for managing pain before, during and after the endodontic treatment.


  Abstract 338: Effect of XP-endo Finisher and ultrasonic activation on the push-out bond strength of bioceramic based sealer to root dentin Top


Divya Mandlecha, SR Srinidhi

A.C.P.M. Dental College, Dhule, Maharashtra, India

Aim: To compare the effect of XP-endo Finisher (XP) and passive ultrasonic irrigation (PUI) on the push-out bond strength (POBS) of bioceramic based sealer (Cerafill, Prevest Denpro, India) to root dentin.

Methodology: Twenty four single canalled maxillary anterior teeth were selected and divided into two groups, Group 1- XP (n=12) and Group 2- PUI (n=12). Teeth were decoronated and root length standardized to 16 mm. To simulate a close ended system, the root apex of each tooth was sealed and then embedded in polyvinyl siloxane. All samples were prepared with Protaper Universal files and irrigated with 5.25% sodium hypochlorite & 17% EDTA. In Group 1, samples were subjected to XP at 800rpm for 1 min and in Group 2, samples were subjected to I SuperTip in EMS scaler for 1 min. Specimens were filled with Cerafill and stored in 100% humidity for two weeks. Each specimen was sectioned horizontally with a water-cooled diamond saw at depths of 4, 7 and 10 mm to produce slices approximately 1-mm thick from apical, middle and coronal thirds. The thickness of each slice was confirmed with a digital calliper. The POBS was performed with a universal testing machine at a crosshead speed of 0.5mm/minute from the apical to the coronal direction until bond failure occurred. This was done by applying a continuous load to the apical side of each slice using a 0.5-mm-diameter stainless steel cylindrical plunger for the apical thirds, 0.7-mm for the middle thirds and 0.8-mm for the coronal third slices. The bond strength in MPa was obtained after dividing the load at failure by the area of the bonded interface. Results were tabulated and subjected to post hoc Tukey analysis.

Results: POBS of Cerafill to root dentin of Group 1 was significantly more than that of Group 2 (p≤0.05) at all three levels. In group 1, POBS was significantly more at 4mm compared to 7mm and 10mm (p≤0.05).

Conclusion: Use of XP-endo Finisher after biomechanical preparation improves the POBS of bioceramic based sealer to root dentin.


  Abstract 339: A comparative evaluation of the effect of various chelating agents on the microhardness of root canal dentin: An in vitro study Top


Mineet Kaul, Zinnie Nanda

A.C.P.M Dental College, Dhule, Maharashtra, India

Aim: To compare and evaluate the effect of various chelating agents on the microhardness of root canal dentin.

Materials and Methods: Eighteen freshly extracted single rooted mandibular premolars were selected and divided into 3 groups (n=6). Teeth were decoronated at the cementoenamel junction. The root canals were prepared upto file F3 (ProTaper Universal, Dentsply) and were irrigated using 2 ml of 3% sodium hypochlorite after each instrument. Teeth were sectioned longitudinally into buccal and lingual halves and mounted in acrylic resin blocks while exposing the dentin surface. One half of each tooth served as a control. The test solutions, i.e., 17% liquid Ethylenediaminetetraacetate (EDTA), 10% Citric Acid (CA) and 9% 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) or etidronate were delivered using an open vented needle to cover the entire root canal for 5 minutes. Dentin microhardness was measured with a Vickers indenter at 1000μm, 1200μm, 1400μm from root canal orifice and 100μm from pulp-dentin junction under a load of 50 g and 15 seconds dwell time. Data was analysed statistically by one way ANOVA, post hoc tukey and independent t test at p≤0.05.

Results: At 1000μm distance from root canal orifice, highest microhardness was seen in HEBP group followed by CA and least microhardness was seen in EDTA group. Difference in microhardness at 1000μm among three chelating agents was significant. At 1200μm distance from root canal orifice, highest microhardness was seen in HEBP group followed by CA and least microhardness was seen in EDTA group. Difference in microhardness at 1200μm among three chelating agents was significant. At 1400μm distance from root canal orifice, highest microhardness was seen in HEBP group followed by CA and least microhardness was seen in EDTA group. Difference in microhardness at 1400μm among three chelating agents was significant (p≤0.05).

Conclusion: All chelating agents which were tested reduced the microhardness of the root canal dentin. HEBP caused the least reduction in microhardness, whereas, EDTA reduced microhardness the most followed by CA.


  Abstract 340: Comparative evaluation of push out bond strength of polyetheretherketone and glass fibre posts cemented with different luting cements: An in-vitro study Top


Piyush Raul, Shailee Shah

YMT Dental College, Mumbai, Maharashtra, India

Aim: To Compare and evaluate push out bond strength of Polyetheretherketone (PEEK) and Glass fibre posts cemented with different luting cements-An in-vitro study.

Materials and Methodology: Eighty extracted,non carious single-rooted permanent human teeth were decoronated, endodontically treated, post space prepared and divided into four groups (n = 20); Group I: FRC postec plus post (Ivoclar Vivadent) and RelyX U200 (3M ESPE), Group II: FRC postec plus post (Ivoclar Vivadent) and Variolink N (Ivoclar Vivadent), Group III: PEEK post and RelyX U200 (3M ESPE) and Group IV: PEEK post and Variolink N (Ivoclar Vivadent). Each root was sectioned to get slices of 2 ± 0.05-mm thickness. Push-out tests were performed using a Universal Testing Machine by applying the Load in an apical-to-cervical direction at a crosshead speed of 0.5 mm/min until failure.

Results: Polyetheretherketone (PEEK) showed to have better bond strength than glass fibre post and better bond strength when luted with Variolink N than RELY X U200.


  Abstract 341: To compare the radiographic and clinical outcomes of permanent teeth with open apex, necrotic pulp and periapical lesion with resorption using different regenerative endodontic procedures Top


Sahiba Dadwal, Nisha Garg, Shabnam Negi, Sandeep Gupta

Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India

Aim: To compare the radiographic and clinical outcomes of permanent teeth with open apex, necrotic pulp and periapical lesion with resorption using different regenerative endodontic procedures.

Materials and Methods: 48 cases of permanent single rooted teeth with open apex, necrotic pulp and periapical lesion with resorption were selected and divided into 4 groups: Group 1- Blood clot, Group II- Platelet rich plasma, Group III- Platelet rich fibrin, Group IV- Blood clot along with collagen scaffold. In first appointment: Under local anesthesia (if necessary), rubber dam isolation followed by access cavity was prepared. Irrigation with 1.5% NaOCl (20mL/canal, 5 min) followed by saline (20 mL/canal, 5 min) using closed end side-vent needle was done after minimal preparation. Canals were dried with paper points and ledermix paste was placed in the canal. In second appointment (one to four weeks after first visit), If there were signs/symptoms of persistent infection, additional treatment with antimicrobial was considered. Anesthesia without vasoconstrictor, dental dam isolation' copious irrigation with 20 mL of 17% EDTA was done. Canals were dried. Scaffolds were then placed according to the assigned group: Group I: Bleeding was created by over-instrumentation induced by rotating K-file at 2 mm past the apical foramen, Group II: 5ml venous blood was mixed with citrate dextrose phosphate and centrifuged, Group III: 5ml blood was centrifuged without an anticoagulant, Group IV: collagen fibres were added in blood clot scaffold. Follow up of the patient was done at 3, 6, 9, 12 months. The clinical findings were assessed on the basis of symptoms such as percussion/palpation, resolution of sinus tract and swelling. The radiographic examination was evaluated for an increase in root length, decrease in apical diameter, increase in root thickness, periapical healing.

Results: PRF showed better result with respect to resolution of clinical symptoms, periapical healing, apical closure, increase in root length and thickness than other above-mentioned scaffolds.

Conclusion: Platelet rich fibrin (PRF) was found to be better in successful treatment of permanent teeth with open apex, necrotic pulp and periapical lesion with resorption.


  Abstract 342: Endodontic management of immature open apex with mineral trioxide aggregate and biodentine: A case report Top


Simran Verma, Mandeep Grewal, Anshul Arora

Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India

The completion of root development and closure of the apex happens up to three years after eruption. Causes of an open apex are necrosis of pulp due to caries / trauma before completion of root formation, extensive root end resorption, iatrogenic enlargement of the apex and root end resection during periapical surgery. Teeth with open apices continue to be a challenge for endodontists because obtaining a complete seal of the root canal system is difficult and extravasation of irrigating solutions/ sealer into the periradicular tissues can occur. Therefore, various techniques have been described for safe root canal filling of immature necrotic teeth such as apexification and revascularisation. In single step apexification with MTA / Biodentine, number of patients' visits and total time taken for an apical barrier to form is less when compared with multiple step apexification with calcium hydroxide. This case report describes a split mouth technique of apexification with MTA and Biodentine in a patient who reported with large periapical lesions in the maxillary left and right quadrants.


  Abstract 343: Efficacy of single dose of diclofenac transdermal patch as a postoperative analgesic after single visit root canal treatment Top


Amreen Manes, Sahiba Dadwal

Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India

Aim: To evaluate the efficacy of single dose of Diclofenac Transdermal Patch as a Post-Operative analgesic after single visit root canal treatment.

Materials and Methods: 400 patients with symptomatic irreversible pulpitis were divided into 2 groups, i.e., control and test group (n=200) and single visit root canal treatment procedure was performed in both the groups. The control group (Group 1) was not given any medication whereas the test group patients (Group 2) were administered a transdermal diclofenac patch on the arm. The post-operative pain in both the groups was assessed at baseline, 4, 8, 24 and 48 hours after the treatment using VAS scale.

Results: In test group (Group 2) 167 patients out of 200 reported decrease in intensity of pain as compared to only 27 patients in control group (Group 1). Also, 173 patients of Group 1 had to take oral analgesic to relieve the post-endodontic pain. Inter group difference at different intervals was compared using Mann Whitney U Test.

Conclusion: Diclofenac transdermal patch was effective in allaying the post-endodontic pain experienced by the patients after single-visit root canal treatment up to 48 hours. Tt was easy to use with painless application mechanism and caused no significant systemic adverse effects.


  Abstract 344: Effectiveness of intracanal cryotherapy using different irrigants on reduction of post endodontic pain: A systematic review and meta analysis Top


Janhvi Parekh

YMT Dental College and Hospital, Kharghar, Navi Mumbai, Maharashtra, India

Introduction: Recently the non-pharmacological management of post endodontic pain has been extensively studied. The aim of this systematic review was to evaluate the effectiveness of intracanal cryotherapy in reducing postoperative endodontic pain.

Methods: A comprehensive search was conducted by accessing electronic databases like PubMed, Google Scholar, Google and EBSCO. Articles evaluating the effect of intracanal cryotherapy in reducing postoperative pain using different irrigating agents which were published till November 2020 were included in the study. Risk of bias was assessed using the Cochrane risk of bias criteria. Meta-analysis was performed for ten studies and tested the heterogeneity using I2 index.

Results: Qualitative and quantitative analysis was done for thirteen and ten studies respectively. Intracanal cryotherapy was found to be effective in reducing post-operative pain at 6 hours and 24 hours.

Conclusion: Within the limitations of the study, it can be concluded that intracanal cryotherapy using cold saline or 17% EDTA at a temperature range of 2.5°C to 6°C as final irrigating agent helps in reducing postoperative pain at 6 hrs and 24 hrs following single-visit or multi visit root canal treatment in teeth diagnosed with irreversible pulpitis with apical periodontitis.


  Abstract 345: Management of an intracanal separated instrument in a case of radix entomolaris Top


Chandrabhan Gendley, Rana K Varghese, Minal Khandelwal

New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India

Radix Entomolaris (RE) is one of the anatomical variant found in a permanent mandibular molar and was first described by Carabelli. It is characterized by the presence of an additional or extra third root, which is typically found disto-lingually. Radix Entomolaris can be found in the first, second, and third mandibular molars, occurring the least frequently in the second molar. As like any other tooth in the oral cavity, mandibular first molar is also prone for malformations and anomalies in its development. Mandibular first molars normally have two roots, the mesial and the distal ones. The major variant is the occurrence of a third root, which is often reported in the literature. If this additional root is located mesiobuccally, it is called radix paramolaris and if located distolingually, it is called Radix Entomolaris (RE).The frequency of RE in Caucasians and Africans is <5%, whereas in populations with Mongoloid traits (like Chinese, Inuit, and Native Americans), it occurs with a frequency that ranges from 5% to > 30%.In these populations, it is considered to be a normal morphological variant and can be seen as an Asiatic trait. Otherwise, Radix Paramolaris is very rare and occurs with a prevalence of < 0.5%.The presence of this extra root may lead to missed canal, instrument separation due to severe curvature, aberrations in cleaning and shaping while doing endodontic therapy, and so on. Thus, a very accurate clinical and radiographic diagnostic procedures and meticulous canal preparations are necessary. In the following case report, the endodontic treatment of mandibular first molars with RE and clinical guidelines for successful management are explained.


  Abstract 346: One step apexification with biodentine: A case report Top


Shareen Taj

Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India

Open apices are a constant challenge to an endodontist. The one-step apexification technique in which an apical barrier is placed to achieve an adequate apical stop has become a popular procedure nowadays. With traditional means, induction of an apical barrier, regardless of the material used, takes at least 3–4 months and requires multiple appointments. Patient's compliance with this regimen may be poor and they may fail to return for scheduled visits. Even the temporary seal may fail resulting in reinfection and prolongation or failure of treatment. For all these reasons, one-visit apexification has been suggested. some traditional treatment options have stood the test of time and are still valid until today. Others have been reviewed and modified with the passage of time, as new science and new materials evolve to prove, disprove, or facilitate approaches to the management of these cases. Practitioners always need to be aware of changes that occur from time to time with respect to these recommendations for treatment, and of scientific studies that support or disprove treatment rationales. Novel biocompatible materials such as MTA and BIODENTINE are a boon in effective management of teeth with open apices. This case report describes single visit apexification in maxillary central incisor with necrotic pulp and open apex using Biodentine as an apical barrier with two years follow up.


  Abstract 347: Efficacy of low level laser therapy in the management of post endodontic pain: A systematic review Top


Vishal Phole

YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India

Objectives: The aim of this systematic review is to evaluate the effectiveness of postoperative pain reduction of low level laser therapy for Root canal treatment, Root canal retreatment or endodontic surgery.

Materials and Methods: The PICOS strategy was used to identify randomized clinical trials comparing low-level laser therapy and mock laser therapy to manage postoperative pain after endodontic treatment, retreatment, and endodontic surgery. An electronic search was performed in MEDLINE through PubMed, Web of Science, Scopus and Cochrane Library and Google Scholar. Quality assessment was performed using the Cochrane Collaboration's tool for assessing the risk of bias. The quality of evidence was rated on the basis of the GRADE approach.

Results: Within the 12 studies seven studies were classified as “low risk of bias.” Four studies were considered “unclear risk of bias” because of a lack of information for judgment. One study was considered “high risk of bias” due to the lack of blinding of the patients participating in the study. One study also presented “high risk” in “other bias” because of the significant difference in the number of participants in each group (41 patients in the laser group and 20 patients in mock laser group). Most of the studies reported significantly less postoperative pain after LLLT in different time periods; two studies found no differences. The certainty of evidence was classified as low and very low to treatment / retreatment and endodontic surgery, respectively.

Conclusions: In view of the present literature, the use of LLLT for pain control in post endodontic therapy showed good results and looks promising. The lack of standardization in laser parameters, use of medications and the low certainty of evidence indicate the need for further studies. More high-quality randomized controlled trials are needed.


  Abstract 348: Regenerate to recreate: Novel scaffolding patterns Top


Prerana Choudhury, MJ Ancy Julia

Bangalore Institute of Dental Sciences and Hospital, Bengaluru, Karnataka, India

Root canal therapy has enabled us to save numerous teeth over the years. The most desired outcome of endodontic treatment would be when diseased or non-vital pulp is replaced with healthy pulp tissue that would revitalise the teeth through regenerative endodontics. This approach has generated enormous interest in tissue engineering principles to regenerate the pulp-dentin complex, thereby permitting root development. The American Association of Endodontists Glossary of Endodontic Terms defines Regenerative Endodontics as “biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as cells of the pulp-dentin complex.” The triad of tissue engineering consists of Stem cells, a Scaffold of the extracellular matrix and Growth factors acting as signals for morphogenesis. Scaffolds are the biomaterials that act as carriers for specific cell-type guide and support tissue regeneration. Natural scaffolds including collagen, chitosan, silk, and fibrin, as well as synthetic scaffolds like polyglycolide and polyglycerol sebacate, have been frequently utilised for Regenerative treatments. The use of growth factors and injectable biomaterial scaffolds has improved dental tissue engineering and hastened clinical translation. The absence of an adequate vascularised scaffold to facilitate the development of massive tissue constructions is one of the most prevalent issues with scaffolds. The 3-dimensional (3-D) cell-printing technology allows for precise cell groupings and the creation of tissue constructs that mimics the natural tooth pulp. Utilising this technology, extracellular matrix-like scaffold can be produced with finer details at a micrometer level. Pulp tissues can be supplied to the action site as a 3-D matrix using an injectable scaffold delivery method. Patients and dentists should benefit from employing scaffolds, tissue engineering and growth factors to improve the success of regenerative endodontic procedures. Hence this review highlights recent advances in scaffolds.


  Abstract 349: Biomimetic synthesis of silver nanoparticles using plant extract, characterisation and it's recent applications Top


P Aparna

P.S.M Dental College, Thrissur, Kerala, India

Nanotechnology is a significant rising domain of research. With novel features and properties of nanoparticles, their essential applications are growing on diverse fronts like biomedical, pharmaceutical, drug delivery, etc. Nanoparticles have significant antibacterial performance due to their enormous surface area to volume ratio. Scientists are hoping to overcome the challenges of microbial resistance, with the antimicrobial effect of nanoparticles. Recently Ecobenevolent approaches are becoming more popular as part of green chemistry, where the researchers are becoming more sensible about diverse ecological issues. Silver oxide nanoparticles have been used for various applications including antioxidant, cytotoxic activity, photocatalytic, antibacterial, antifungal agents, etc. The green synthesis of silver oxide nanoparticles has been investigated using plant tissues, bacteria, etc. Various natural bio-compounds in plant broths, such as flavonoids, proteins, and phenols can work as both reducing and/or stabilizing agents for the fabrication of silver oxide nanoparticles. Biomimetic syntheses of silver oxide nanoparticles provide an alternative to the conventional method involving complex chemical reactions. Here, the broth of the plant is simply blended with the water solution of the silver metal salt precursor at normal room temperature. Studies have proved significant antimicrobial performance and photocatalytic activity of such particles. Characterization techniques provide information about the stability, size, shape, surface charge, elemental composition, purity, crystallinity, surface area, and magnetic behavior of the nanoparticles. This article discusses the recent developments for the preparation of the silver oxide nanoparticles using few plant broths and their efficacious applications.


  Abstract 350: Biodentin as retrograde filling material in periapical surgery using cone beam computed tomography: A case report Top


Ayush Tyagi, Sachin Poonia

DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India

This paper reports a case of a periapical cyst treated with enucleation of the lesion, apicoectomy, and root end obturation on a lower left central incisor. The authors have performed root-end resection and root end cavity is prepared using ultrasonic tip under local anesthesia on a lower left central incisor; The root canal filling is placed within the new cavity using biodentine to close the path of communication between the infected root canal system and periradicular structures with an intermediate restorative material. Bony socket is filled with PRF and Bonegraft. The lesion was fully enucleated and sent for histopathology. The 26-year-old male patient was followed up at 2 weeks, 3, 6 and 12 months using CBCT presenting as a functional and symptomless tooth. Radiographic findings showed a clear and progressive refilling of the cavity with bone. All these factors highlight a positive prognosis for the tooth after periradicular surgery, which is now considered a valid treatment to keep the tooth as a functional unit in the oral cavity.


  Abstract 351: Extricating the intricacies of “C” shaped canal Top


Samyukta Dinesh, Sreelakshmi V Menon

Amrita School of Dentistry, Ernakulam, Kerala, India

Root canal system often presents with anatomic variations, one of the most important amongst them being “C” configuration which was first documented by Cooke and Cox in 1979 . ''C” configuration often presents with complex anatomy with irregular areas housing infected tissue remnants and debris thus requiring supplementary effort to accomplish proper root canal treatment. This morphology is uncommon hence a proper diagnosis accomplished with radiographic and clinical aids is mandatory. It can assume many variations hence a comprehensive classification can help in its effective management. The essence of successful endodontics lies in knowledge, respect and appreciation of root canal anatomy and careful , thoughtful and meticulously performed cleaning and shaping procedure. Alternate disinfection techniques with improved irrigant volume and activation using sonics and ultrasonics is recommended to improve cleansability of root canal system. C configuration is known for its challenges in instrumentation and obturation that advocates the application of modified techniques . This paper highlights a case series of three different types of C shaped canals that was effectively and successfully managed in the clinical practice.


  Abstract 352: Regenerative capacity of resolvin D2 on stem cells of apical papilla and a novel combination of resolvin D2 and calcium hydroxide as an intracanal medicament Top


Rukhsaar Gulzar, Manish Ranjan

Saveetha Dental College, Chennai, Tamil Nadu, India

Introduction and Aim: Resolvins are lipid mediators that are released during the resolution phase of inflammation to regulate tissue repair. Previous literature has also identified their antimicrobial potential. The present study was conducted with the aim to evaluate whether resolvin D2 (RvD2) is capable of inducing hard tissue formation by its action on stem cells of apical papilla in comparison to concentrated growth factor (CGF). It was also aimed at evaluating if the combination of RvD2 and calcium hydroxide has any synergistic antimicrobial effect.

Materials and Methods: The root apical papilla tissues were carefully isolated from the root apex. Enzymatic separation was used for the cells of the primary apical papilla. The cells were subjected to the three groups namely RvD2, CGF and a combination of CGF and RvD2. Mineralized nodule formation was analyzed by alizarin red staining and dentin matrix protein 1 secretion was analyzed using ELISA test. The antimicrobial efficacy was evaluated using the agar diffusion test by determining the zone of inhibition. MIC was defined as the minimum concentration of extract that caused 80% inhibition in growth of test microorganism.

Results: The combination of RvD2 and CGF had the highest values for mineralized nodule formation and DMP1 secretion followed by CGF. These were statistically more significant than the control group. However the results for RvD2 alone did not exceed that of CGF. The maximum zone of inhibition was seen around the disc impregnated with a combination of RvD2 and calcium hydroxide (15.4 ± 0.98mm) which was highly significant. The MIC value of RvD2 was 1.5 μg/ml and the MBC value was 2.0 μg/ml.

Conclusion: Although RvD2 possesses regenerative potential and is capable of inducing stem cells of apical papilla for formation of mineralized hard tissue, its potential by itself does not surpass that of CGF. However the combination could be a promising new strategy in the management of immature necrotic permanent teeth with the additional antimicrobial potential of RvD2.


  Abstract 353: Knowledge about management of avulsed teeth among dental professionals in Kerala Top


Archana N Nair, Mali G Nair, Parvathy D Kumar, S Renjini, S Savitha

Government Dental College, Thiruvananthapuram, Kerala, India

Aim: To assess the level of knowledge about the management of avulsed teeth, based on the latest IADT guidelines, among dental professionals in Kerala.

Materials and Methods: A total of 336 dental professionals were sent a questionnaire through email or WhatsApp. The questionnaire based on IADT guidelines 2020 was divided into 4 parts. Part I inquired about personal Information; Part II assessed previous knowledge and experience with dental avulsion whereas Part III and part IV evaluated knowledge on emergency and clinical management of dental avulsion respectively. The questions in part III and part IV were assigned 1 point each for correct answers and 0 points for wrong answers. The maximum possible score was 18 which was graded as poor, satisfactory, good and excellent knowledge. The survey data obtained were analysed using Chi square test and Kruskal Wallis test. The level of significance was set at P< 0.05.

Results: The questionnaires were answered by a total of 336 dental professionals including 244 specialists. Only 56 participants were aware of IADT guidelines 2020. More than half of the dental professionals had only satisfactory knowledge(59.5%). 43.9% specialists had good knowledge while 78.3% of general practitioners had only satisfactory knowledge. Among the specialists, 57.6% and 12.1% of pedodontists had good and excellent knowledge respectively, while 48.3% endodontists had good but 41.6% had only satisfactory knowledge. Even though there was no significant difference in knowledge score among different specialties in emergency management; there was significant difference in clinical management. Majority of dental professionals who have not treated any avulsion cases had only satisfactory knowledge(70.5%) but no significant pattern was observed with more number of cases treated.

Conclusion: Although dentists are supposed to have an advanced level of knowledge, it is found to be only satisfactory. Guidelines for managing tooth avulsion promotes appropriate treatment and is regularly updated, but dentists are not often refreshing their knowledge; only 16% were aware of recent guidelines. Efforts should be focused on how information should be provided to them because an incorrect intervention is an irreversible decision.


  Abstract 354: Evaluation of rotary retreatment file system for removal of gutta percha: A volumetric analysis: An ex-vivo study Top


Pallabi Sarkar

Seema Dental College and Hospital, Rishikesh, Uttarakhand, India

Aim: To evaluate three different rotary retreatment system in removal of gutta percha by analyzing the residual volume of root canal filling material using three dimensional imaging modality i.e. Cone Beam Computed Tomography. The three file systems used were:

  1. Hyflex Remover (Coltene)
  2. R-Endo (Micromega)
  3. Neoniti (Neolix


Materials and Methods: 60 Freshly Extracted Human Permanent Mandibular First Premolars were collected. Roots were decoronated and standardized using diamond disc to the length of 16mm. Working length was radiographically determined and root canal was biomechanically prepared using K hand files by step back technique. The obturation of canals were done using no. 35 (2%) gutta percha cone with AH plus sealer using lateral condensation technique. Coronal access was sealed with temporary filling material. CBCT evaluation of gutta-percha volume in the canal was done. Retreatment procedure was done on the teeth using three different comparison groups of rotary retreatment systems where Group 1 was prepared with Hyflex Remover, Group 2 was prepared with R-Endo and Group 3 was prepared with Neoniti file system. CBCT images after retreatment was taken to evaluate percentage of volume of residual filling material. After completion of the study all the data were collected and subjected to statistical analysis.

Results: Hyflex remover was more efficient in removing gutta percha and had less residual gutta percha volume than the two file systems followed by R-endo and Neoniti.

Conclusion: It was concluded that Hyflex remover was better at removing gutta percha than R-Endo and Neoniti System. However larger sample size along with clinical trials is necessary to validate the results of present study.


  Abstract 355: Comparative evaluation of the fracture resistance of the three different recent composite systems in class 2 mesio-occlusal distal cavities: An in-vitro study Top


Akshay Chaudhari, Kranthikumar Reddy

JMF's ACPM Dental College, Dhule, Maharashtra, India

Objective: To compare the fracture resistance of the three different recent composite systems in class 2 MOD cavities.

Materials and Methods: 36 human permanent posterior teeth were collected. Standardized MOD cavities were prepared using a tungsten carbide straight fissure bur in high-speed water-cooled hand piece, burs were changed after every 10 cavity preparations. Dimensions of cavities was 2 mm ± 0.2 mm pulpal width, 1.5 mm ± 0.2 mm gingival width, and 2 mm ± 0.2 mm buccolingual width and were verified using periodontal probe. Facial and lingual walls of the occlusal segment was prepared parallel to each other with the cavosurface angle at 90°. Teeth were mounted in square blocks of cold cure acrylic resin. Prepared cavities were etched for 10s then cavities were rinsed for 30s and air dried. Bonding agent was applied and cured for 20s. Teeth were then randomly divided into three groups(n=9). Group1 is the positive control. In Group 2 teeth were restored with omnichroma universal resin based dental restorative. In Group 3 teeth were restored with Wonder Bulk flow posterior composite. In Group 4 teeth were restored with fiber reinforced composite GC Ever X posterior. Thermocycling was carried out. The fracture resistance of the teeth was measured using universal testing machine.

Results: Highest fracture resistance was seen in Wonder Bulk Flow material followed by Ever-X posterior. Least fracture resistance was seen in Omnichroma material and difference in fracture resistance among three groups was significant (p=0.018).

Conclusion: Within the limitation of this in vitro study, it can be concluded that Wonder bulk flow composite showed the highest fracture resistance followed by Ever X posterior and least in Omnichroma.


  Abstract 356: Artificial intelligence in endodontics Top


Rishika

Bhojia Dental College and Hospital, Baddi, Chandigarh, India

The goal of endodontic treatment is to provide excellent treatment. To achieve this target, accuracy in diagnosis and clinical decision-making plays an important role. Artificial intelligence, a recent technology imbibed in dentistry uses technology that can replicate human cognitive skills such as problem solving. Artificial intelligence is mostly made up of neural networks that are similar to those found in the human brain. Locating the apical foramen, identifying periapical diseases, detecting and diagnosing vertical root fractures, retreatment predictions, and assessing root morphologies can all be assessed with artificial intelligence. Dental surgeons should be able to forecast prognosis, which necessitates the use of precise clinical decision-making skills. Dentists, on the other hand, don't always have the information to make the best clinical judgement in a short period of time therefore artificial intelligence software can assist them in making better judgments and doing better tasks. This article reviews the use of artificial intelligence in endodontics and to understand its implications.


  Abstract 357: Tooth restorability index Top


Iflah Javed

Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India

The tooth restorability index (TRI) has been designed to describe on a clinical level, the 'practicality' of dental restorative treatment. It provides a framework for evaluating teeth and planning treatment. The TRI, which can be used in regular clinical practice, intends to help clinicians decide when to seek guidance and/or refer a patient to secondary or tertiary dental treatment. This tool is expected to aid in the systematic assessment of dental restorative difficulties, improve communication amongst collaborating practitioners, and help manage patient expectations before restorative treatments are performed. In dental practice, restoring teeth with substantial structural damage is a crucial clinical treatment. Despite the fact that a range of materials, techniques, and research are available in the scientific literature, the criteria for selecting such teeth for restoration remain unclear. If restoration is indicated, it must conserve and protect the remaining tooth structure. The approach to severely compromised teeth should be based on consistent scientific evidence to reduce dental error and improve the prognosis. Clearly, further research is required to establish the clinical usefulness of the proposed index and to clarify the relationship between the TRI sores and subsequent restorative outcomes.


  Abstract 358: Apical fenestrations: The hidden piece of post endodontic pain Top


Ivneet Kaur

National Dental College, Dera Bassi, Mohali, Punjab, India

After a successful endodontic treatment, a patient may return with a complaint of persistent pain particularly on mastication and palpation. After ruling out all the possibilities of post endodontic pain, it is at this time that a clinician may consider the possibility of an apical fenestration with concurrent endodontic pathology. Apical fenestration is an isolated area in which the root is denuded of bone and root surface is covered only by periosteum and overlying gingiva. When the denuded area extends through the marginal bone, the defect is called dehiscence. Fenestrations are seen more commonly in the maxilla and in particular on the buccal aspect of the alveolar bone. It can be because of reasons like buccally inclined roots, thin cortical alveolar bone, chronic periapical inflammation with bone destruction, tooth malposition and orthodontic movement. Although presence of fenestrations does not necessitate treatment, the quantum and magnitude of clinical implications can be avoided in cases of its association with endodontic infections. There are a variety of clinical signs and symptoms that can be seen in patients with apical fenestrations associated with endodontic pathologies; some of them being - traumatic dental injuries, aesthetic concerns, gingival defects or discomfort while some of them may even be asymptomatic. Due to the uncommon association between the two, misdiagnosis and overlooking is a common occurrence. To prevent such situations and to achieve a successful management, a thorough understanding of the lesions and timely diagnosis is pertinent. Because of the variety in clinical signs and symptoms cone-beam computed tomography is adapted as an important tool for diagnosis. The correct approach for the successful management of the lesion should be eradication and controlling of the focus of infection. Nonsurgical root canal treatment is first needed to disinfect and seal the root canal system, whilst subsequent surgical treatment by root-end resection coupled with root debridement of the exposed surface is often necessary to manage an apical fenestration with concurrent endodontic pathosis.


  Abstract 359: Comparative evaluation of effect of various endodontic irrigants on the push out bond strength of mineral trioxide aggregate plus, biodentine, endosequence and theracal lC: An in vitro study Top


Maya R Nair, Faisal MA Gaffoor, Anoop Samuel, Rethi Gopakumar, Sabari Girish, Dr KJ Jijin

Noorul Islam College of Dental Sciences, Thiruvananthapuram, Kerala, India

Aim: The purpose of the study is to compare the push out bond strength of MTA Plus, Biodentine, Endosequence and Theracal LC in the presence of 2.5% NaOCl, 2%CHX using Universal Testing Machine.

Materials and Methods: Midroot dentin of single-rooted mandibular premolar teeth were sectioned into 2-mm-thick slices horizontally. The canal space of each dentin slice was enlarged with a 1.4-mm-diameter diamond bur. The samples were divided into four groups based on the type of perforation repair material placed, ie. MTA Plus, Biodentine, Endosequence, Theracal LC. The samples were wrapped in wet gauge for 10 min, each group is further divided into three subgroups, to be immersed into 2.5% NaOCl, 2% CHX respectively ,for 30 minutes, rinsed with distilled water, and allowed to set for 48 hours at 37C with 100% humidity in an incubator. As a control group, a wet cotton pellet will be placed over each test material without any irrigation. The dislodgement resistance of the samples was measured using a Universal Testing Machine. Outcome variable will be measured in megapascal(MPa) for each group. One specimen from each group will be randomly chosen for stereomicroscope examination at 25x magnification.

Statistical Analysis: Descriptive statistics such as mean and standard deviation will be used for summarizing the collected raw data. Inferential statistics such as Anova and Duncan's test will be used for comparison of various groups based on pushout bond strength.

Results: EndoSequence proved to have the highest push-out bond strength followed by Biodentine, MTA Plus and Theracal LC. In subgroups, 2% CHX increased the push-out bond strength of Endosequence. Biodentine and Theracal LC demonstrated more push-out bond strength with NaOCl when compared to CHX. While analyzing the failure pattern of the samples, MTA Plus groups have adhesive failures, Theracal LC have mixed failures. But cohesive failure mode was found to be present in maximum number in both Endosequence and Biodentine groups predominantely.

Conclusion: Pushout bond strength of EndoSequence was found to be significantly higher than Biodentine, MTA Plus and Theracal LC. Endodontic irrigants influence the resistance to dislodgement of EndoSequence, Biodentine, MTA Plus and Theracal LC.


  Abstract 360: Prions in endodontics Top


Ragavi Ramasamy

Vivekanandha Dental College for Women, Namakkal, Tamil Nadu, India

Prion diseases, also known as transmissible spongiform encephalopathies (TSEs), are degenerative disorders of the nervous system caused by transmissible particles that contain a pathogenic isoform of the prion protein a normal constituent of cell membranes. Stanley B. Prusiner discovered and defined prions as infectious, transmissible proteinaceous particles that lack nucleic acid and are composed exclusively of a modified isoform of the noninfectious cellular prion protein (PrPc). Prion diseases are incurable neurodegenerative conditions affecting both animals and humans. They may be sporadic, infectious, or inherited in origin. Human prion diseases include Creutzfeldt–Jakob disease (CJD), Gerstmann–Straussler– Scheinker disease, Kuru, and Fatal familial insomnia. Periodontal and pulpal tissue exposed by disease or trauma might represent a clinically relevant entry point for prions incorporated orally and thus a possible mode of infection. The unique resistance of prions to classic decontamination methods and evidence that prion diseases can be transmitted iatrogenically by medical devices pose a serious infection control challenge to health care facilities. Because of the widespread tissue distribution of the variant  Creutzfeldt-Jakob disease More Details agent in human beings, new practicable decontamination procedures are urgently needed. Decontamination of instruments is a prerequisite for their potential reuse but may affect surface integrity. Despite meticulous cleaning under laboratory conditions, all solutions used could not completely clean rotary instruments of organic debris. Significant corrosion was observed with NaOCl immersion. Therefore, the single use of rotary instruments is recommended to prevent the transmission of infectious diseases and reduce the hazard of corrosion.


  Abstract 361: A comparative evaluation of incidence of crack formation and microleakage in the resected root end of single rooted teeth with and without retropreparation: An in vitro study Top


Esha Jaiswal, Kavitarani Rudagi

ACPM Dental College, Dhule, Maharashtra, India

Aim: To evaluate and compare the incidence of crack formation and microleakage in the resected root end of single rooted teeth with and without retropreparation using stereomicroscope and spectrophotometer respectively.

Materials and Methods: 30 human maxillary and mandibular single rooted premolars with single canal were selected. Teeth were decoronated at cementoenamel junction and working length was determined. Cleaning, shaping and irrigation was done. Teeth were divided into 2 groups with 15 samples each. In group 1, teeth were apically filled with MTA upto 6mm and backfilled with thermoplasticized gutta percha and AH plus sealer and 3mm of the root was resected at the apex. In group 2, teeth were obturated with thermoplasticized gutta percha and AH plus sealer. Apical 3mm of teeth was resected. Retrograde preparation was done to a depth of 3mm and Root-end cavity was restored with MTA. All the samples were examined under stereomicroscope for cracks at a magnification of 30x . Samples were stored in 100% relative humidity for 24hours (h). Samples were coated with nail varnish leaving apical 3mm. After varnish is dried, each group was placed in separate Petri dish containing rhodamine B dye. All samples were stored for 48 h. Teeth were rinsed under tap water for 30 minutes. Each tooth was stored in a vial containing 5 ml of concentrated nitric acid for 3 days. The solutions thus obtained were centrifuged at 3500 rpm for 5 minutes. Four milliliters of the supernatant liquid was then analyzed in an ultraviolet (UV) visible spectrophotometer. Obtained readings were statistically analyzed using one-way analysis of variance and Tukey multiple comparisons tests.

Results: Teeth treated with root resection alone showed better result as compared to root resection and retropreparation and difference between two groups is statistically significant (p< 0.05)

Conclusion: Apical downpacking of MTA prior combined with root resection alone could be considered as a viable alternative during periapical surgeries.


  Abstract 362: Evaluation and comparison of the push out bond strength of mineral trioxide aggregate fillapex and BioRoot RCS sealers in endodontically treated teeth: An in vitro study Top


George K Jimmy, Maria Jose Jesline, Krishna Manju, Ahamed S Maneesh, Mathew Jain, Theruvil Robin, George Saira

St. Gregorios Dental College, Ernakulam, Kerala, India

Aim: To evaluate and compare the pushout bond strength (POBS) of MTA Fillapex (MF) and BioRoot RCS (BRCS) sealers in endodontically treated teeth – an In vitro study.

Materials and Methods: 60 intact premolars were divided into two groups.

Group A – Bioroot RCS (BRCS) n = 30

Group B – MTA Fillapex (MF) n = 30

All 60 teeth were root canal treated and obturated using warm vertical compaction and then sectioned horizontally at the apical third (1.5 mm thick).

The POBS was studied using a Universal Testing Machine (Autograph AG 1).

The sample size was calculated using the statistical package G * Power (3.1.5).

Results: It was found that the POBS of Group A was significantly higher than the POBS of Group B.

Conclusion: Of the two sealers, it was seen that BioRoot RCS showed the higher Push Out Bond Strength value than MTA Fillapex sealer.


  Abstract 363: Biomimetic microenvironment: Revolutionizing regeneration Top


Mansi Behl, Vedika Talwar, Sonali Taneja, Pragya Kumar

ITS Centre for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India

The natural environment of the dental pulp has been proven to be capable of regulating homeostasis, proliferation, and differentiation of undifferentiated mesenchymal cells. Various approaches have been applied to simulate the natural dental pulp microenvironment optimizing the efficacy of pulp regeneration during endodontic therapy of immature permanent teeth with a necrotic pulp. The biomimetic microenvironment is composed of synthetic nano scaled polymeric fiber structure that functions as a scaffold of pulp dentine tissue complex, recruiting pluripotent stem cells from the vicinity of the apex. The polymeric nanofibers are produced by methods of self-assembly, electrospinning and phase separation. The biomimetic microenvironment mimics the characteristic properties of the natural extra-cellular matrix, self assembles into a 3-Dimensional network and accomplishes the dentin-pulp regeneration by orchestrated efforts of cells, bioactive molecule and extra-cellular matrix that eventually is replaced by host extra-cellular matrix. Encouraging regenerative outcomes achieved by incorporating various moieties and features are mainly developed through peptide amphiphiles, cell homing , stem cells (Stem cells from Human Exfoliated Deciduous teeth, Stem cells from Apical Papilla, Dental Pulp Stem Cells) , growth factors (Bone Morphogenic Protein, Transforming Growth Factor-β, Insulin-like Growth Factor) and scaffolds ( Natural polymer Bioactive molecular carrier systems such as collagen, hyaluronic acid, alginate and chitosan; Synthetic polymer Bioactive molecular carrier systems such as hydrogel and VitroGel 3D). The poster will be focusing on the current prospects of biomimetic microenvironments as a scaffold for neotissue regeneration via current tissue engineering concepts and electronspun polymer nanofibres for intracanal drug delivery. Therefore, we can build up an imperative future stating that vitality is not just an ability to persist but is an ability to start over.


  Abstract 364: Evaluation and comparison of endodontically treated teeth using different irrigants 5.25% sodium hypochlorite, 17% ethylene diamine tetra acetic acid and 0.2% chitosan Top


Ann Mariya Sunny

St. Gregorios Dental College, Ernakulam, Kerala, India

Aim: To evaluate and compare endodontically treated teeth using different irrigants 5.25% Sodium Hypochlorite (NaOCl), 17% Ethylene Diamine Tetra Acetic acid (EDTA) and 0.2% Chitosan.

Materials and Methods: 60 intact premolars were divided into three groups:

Group 1: 17% EDTA + 5.25 % NaOCl (n = 20)

Group 2: 0.2% Chitosan + 5.25 % NaOCl (n = 20)

Control Group: 5.25 % NaOCl (n = 20)

Biomechanical preparation was done using irrigants as per the allotted Groups.

After obturation, the teeth were sectioned at the apical third horizontally (1.5 mm thick).

The POBS was studied using a Universal Testing Machine (Autograph AG 1).

The sample size was calculated using the statistical package G * Power (3.1.5).

Results: Increased chelation was observed in Group 2. It had significantly higher chelating effects than Group 1 and the Control Group.

Conclusion: The irrigation regimen of 0.2% Chitosan with 5.25% NaOCl (Group 2) was found to have better chelating effects and thus in turn better debriding effect on the root canal when compared with 17% EDTA with 5.25% NaOCl (Group 1) and the Control Group.


  Abstract 365: Mature tooth regeneration using umbilical cord stem cells – Cord striking a chord Top


Aman Verma, Jyoti Tyagi

I.T.S.C.D.S.R., Muradnagar, Ghaziabad, Uttar Pradesh, India

Conventional root canal therapy replaces the pulp tissue with artificial means without restoring the function of pulp. Regenerative endodontic procedures (REPs) are biologically based tissue engineering technology which is a remarkable achievement in the field of endodontics to replace damaged structures, including dentin and root, as well as cells of the pulp tissue.REPs are based on 3 principles of tissue engineering: cellular component including mesenchymal stem cells (MSCs), scaffolds (Platelet poor plasma) and growth factors. Mesenchymal stem cells are specialized human cells that have ability to develop into different cell types. Mesenchymal Stem cells are divided into two main forms, Embryonic stem cells (Human Umbilical cord Mesenchymal stem cells) and adult stem cells (Somatic stem cells).Scaffolds promoting cell proliferation are classified as natural or synthetic. Platelet-poor plasma (PPP) is a platelet-derived natural scaffold in blood fraction with a reduced count of platelets. Drawbacks of conventional Adult Stem Cells therapy include; Technical difficulties, ethical concerns, and risk of carcinogenesis with lower capacity of differentiation and can only used in treatment of immature teeth . Human Umbilical cord Mesenchymal Stem Cells hUC-MSCs helps in biomimicking the most immunocompatible odontogenic microenvironment to drive their differentiation towards a specific cell lineage. They can differentiate into odontoblast like cells and functional endothelial cells providing an alternative seed source for angiogenesis and regenerating dentin pulp complex.MSCs from foetal origin, compared to other sources of adult stem cells are non- invasive, shows reduced risks of viral contamination due to protection provided by placental barrier. This poster reviews a different approach to regain vitality in necrotic pulp tissue of mature teeth with the benefits of allogenic therapy which includes isolation of human umbilical cord mesenchymal stem cells, their encapsulation in plasma-derived biomaterial and direct transplantation in mature permanent teeth with apical lesions.


  Abstract 366: Oroactive biomaterials: A promising novel adjunct for endodontics Top


MV Veena

PSM College of Dental Science and Research, Thrissur, Kerala, India

Biomaterials have become the epicentre of modern day medical science. An oroactive biomaterial is defined as any material or device that is used within the confines of the oral cavity for the diagnosis and treatment of diseases, conditions, and disorders. Endodontic biomaterials are used for vital pulp therapies, irrigation, intracanal medicaments, obturation and regenerative procedures. These materials offer several functions including: antimicrobial activity, mechanical reinforcement, aesthetics, and therapeutic effects. Vital pulp therapies have seen an improvement in clinical results with an incremental approach to build on the strengths of past materials such as calcium hydroxide and calcium silicates. While sodium hypochlorite remains the gold standard for canal irrigation, numerous nanoparticle formulations have been developed to promote sustained antimicrobial action. Modern trends across the globe will continue to motivate patient holistic health However, while multiple studies focus on the development of novel formulations containing drugs, glass derivatives or ionic-, polymeric-, or drug- loaded nanoparticles, a lack of reliable and long-term clinical evidence obligates further study as experienced clinicians prefer to use what has worked for decades.


  Abstract 367: Cryotherapy in endodontics Top


Sabatina James

P.S.M. College of Dental Science and Research, Thrissur, Kerala, India

Cryotherapy refers to decreasing the tissue temperature for therapeutic purposes.The concept of cryotherapy actually does not imply cooling the target tissue but rather extracting heat from the tissue of higher temperature to the subject of lower temperature. Three basic physiological tissue effects of cryotherapy are vascular, neurologic, and tissue metabolism. Cryotherapy has been frequently applied in medicine and other fields of dentistry. For the majority of clinicians, it seems that the chief challenge is pain control. Root canal treatment is more frequently associated with severe postoperative pain than other dental procedures. Therefore, management of postoperative pain is crucial in endodontic practice. In the field of endodontics, cryotherapy has been reported to be used after periradicular surgeries and during root canal treatment to minimize postoperative pain and inflammation. Other implementation of cryotherapy in endodontics is deep cryotherapy of nickel-titanium (NiTi) endodontic files, which offered enhanced cyclic fatigue resistance, reducing potential file separation . In addition, irrigation with 2–5 mL cold sodium hypochlorite from the beginning to the end of cleaning and shaping showed the lowest level of interleukin 6 expression.More recently, cryotherapy was successfully tried as a useful adjunct for hemostasis in vital pulp cryotherapy in conjunction with bioceramic materials. Cryotherapy is a simple and cheap supplementary method for minimizing postoperative pain in cases of symptomatic apical periodontitis and for controlling pulpal hemorrhage during vital pulp therapy. Undoubtedly, it is also an indispensable measure for controlling postsurgical swelling and pain after endodontic surgery.


  Abstract 368: End-o-biofilms: The road less taken Top


Aishi Sinha, Mudita Manaktala, Sonali Taneja

ITS Dental College, Ghaziabad, Uttar Pradesh, India

Microbial infection of the root canal system is the primary etiological factor in pulpal and periapical pathology. A multicellular biofilm community is resistant to most antimicrobial agents and hence, poses a considerable clinical challenge. Accordingly, the primary goal of endodontic treatment is to remove biofilms and eliminate microorganisms from the root canal system by instrumentation, irrigation, use of locally intracanal medicaments and antibacterial root filling materials. The use of chemical agents during instrumentation is crucial for the complete disinfection of the root canal system. Sodium hypochlorite (NaOCl) being the most potent, is often used in conjunction with EDTA to remove the smear layer from the root canal surface. However, NaOCl causes dentin collagen denaturation and dissolution, especially at high concentrations. Hence, there is a need to explore alternative novel strategies. Among these, antimicrobial peptides are a wide ranging class of host defence biomolecules that provide the early stage protection against invading microbes. Natural antimicrobial peptides are synthesized in by several cells in pulp as an innate immune response. The fact that these naturally occurring antibacterial peptides are susceptible to degradation by peptidases evokes the need of stabilization of these peptides by formulating synthetic antimicrobial peptides. They can be potential alternatives to conventional irrigants against multitidrug resistant pathogens and biofilm related pathologies. Another emerging modality is the antibacterial nanoparticles which have a wide range of therapeutic efficacy. They target the microbial biofilm and prioritise to render substrate less or non-amenable to microbial adhesion. They facilitate the irrigant to reach specific areas that are inaccessible to conventional instrumentation techniques. Lastly, to combat the existing challenges, probiotics have been recognised to be the next, most important immune defence system as current antibiotics are becoming useless because of the development of bacterial resistance. The organisms that have been used in the past as probiotics are certain strains of Lactobacillus and Bifidobacteria. Instead of attempting to eliminate pathogens by antimicrobial agents, probiotics acts by substituting the microflora by replacement therapy and creating a favourable pathogen free environment. Hence, this poster aims to explore these newer approaches focusing on antimicrobial peptides, nanoparticles and probiotics.


  Abstract 369: Effect of smear layer on push out bond strength of three resin based sealers: An in vitro study Top


shwan Uke, Zinnie Nanda

JMF's ACPM Dental College, Dhule, Maharashtra, India

Aim: To evaluate the effect of smear layer on push out bond strength of three resin based sealers (EpoSeal, Resino-Seal and AH Plus).

Materials and Methods: Sixty single rooted mandibular premolars were assigned for the study. Each tooth was decoronated to maintain the standardized length of 16mm. The root canals were instrumented with a series of ProTaper Universal file system to #40/06 using 2.5% NaOCl. Then prepared roots were randomly assigned to two groups (n=30) as follows:

Group 1: Smear layer were preserved

Group 2: Smear layer were removed by irrigation with 3 mL of 17% EDTA for one minute using a 30-gauge needle inserted to 1 mm short of the working length.

The canals were obturated using single cone technique. Then each group were further assigned to three subgroups (n=10) according to the root canal sealer used.

Under Group 1:

Subgroup A: Gutta percha with EpoSeal sealer

Subgroup B: Gutta percha with Resino-Seal sealer

Subgroup C: Gutta percha with AH Plus sealer

Under Group 2:

Subgroup A: Gutta percha with EpoSeal sealer

Subgroup B: Gutta percha with Resino-Seal sealer

Subgroup C: Gutta percha with AH Plus sealer

The roots were then sectioned horizontally with carborundum disc at depths of 4, 7 and 10mm to produce a slice of approximately 1-mm thick from apical, middle and coronal thirds respectively. These specimens were subjected to push out test using universal testing machine. Results were tabulated and subjected to statistical analysis using One Way ANOVA.

Results: In intergroup comparison, Group 2(smear layer removed) shows better results than Group 1(smear layer preserved) and AH Plus shows significantly better results in Group 1 and Group 2. Intragroup comparison shows highest values of push out bond strength at 4mm from root apex followed by 7mm and 10mm sections.

Conclusion: Removal of smear layer shows significant difference in values of push out bond strength with respect to AH Plus sealer as compared to the group in which smear layer is preserved.


  Abstract 370: Biomechanical properties of first mandibular molars with different endodontic access cavities: A finite element analysis Top


Lakshmisetty Harika

Bangalore Institute of Dental Sciences and Hospital, Bengaluru, Karnataka, India

Aim: The aim of this study was to compare the biomechanical properties of first mandibular molar with different endodontic access cavities using the finite element method.

Methods: Three finite element analysis models of a mandibular first molar were designed and constructed with 3 different types of endodontic access cavities: a truss endodontic access cavity, a conservative endodontic access cavity, and an extended endodontic access cavity. An intact tooth model was used for comparison. Each model was subjected to 3 different force loads directed at the occlusal surface. The stress distribution patterns and the maximum von Mises (VM) stresses were calculated and compared.

Results: The peak VM stress on all models was at the site of the force load. The occlusal stresses were spread in an approximate actinomorphic pattern from the force loading point, and the stress was much higher when the force load was close to the access cavity margin. The peak root VM stresses on the root-filled teeth occurred at the apex and were significantly higher than that on the intact tooth, which appeared on the pericervical dentin. The area of pericervical dentin experiencing high VM stress increased as the cavities extended and the stress became concentrated in the area between the filling materials and the dentin.

Conclusions: The stress distribution on the occlusal surface were similar between the conservative endodontic access cavity, the truss endodontic access cavity, and the extended endodontic access cavity. With enlargement of the access cavity, the stress on the pericervical dentin increased dramatically.


  Abstract 371: Retreatability of bioceramic-based root canal sealers: A review Top


Bondugula Srujana Reddy, B Vijetha, K Pavan Kumar

MNR Dental College and Hospital, Hyderabad, Telangana, India

The application of bioceramics in the field of medicine(kokubo,2008) has greatly expanded. Therefore, the formation of new bioceramic root canal sealers have emerged into existence. Soon, these materials have proven to be an advantageous technology in endodontic practice. The successful outcomes of root canal treatment, also depends upon the prevention of re-infection of root canal space among other multitude of factors. But retreatability of these bioceramic sealers in cases of persistent periapical inflammation or postoperative pain is difficult using the conventional treatment techniques. The aim of this review was to consider laboratory experiments and clinical studies on the retreatability of these bioceramic sealers. An extensive search of endodontic literature was made to identify publications related to retreatment of bioceramic based sealers and the clinical outcomes are assessed.


  Abstract 372: Direct anatomic fiber post in mandibular left second premolar with flared root canals: A case report Top


Meilisa Rachmawati, Aditya Wisnu Putranto

Department of Conservative Dentistry, University of Indonesia, Central Jakarta, Indonesia

The restoration of endodontically treated teeth continues be a challenge to clinicians particularly when there is extensive tooth structure lost. In such cases, the final restoration can be well retained only by means of a post core system. Presently the use of prefabricated fiber post is increasing in restorative dentistry due to its esthetic appearance, flexibility, and similar mechanical properties when compared to that of dentin. This case report describes about a 20 years old female that was indicated for endodontic treatment followed by post, core, and crown restoration for his mandibula left second premolar. Flared shaped canal was detected in this teeth and no prefabricated fiber post could accurately adapted to the canal. This report focuses on the clinical technique of fabricating direct anatomic fiber post as one among the modifications of the fiber post which provides a three dimensional fit to the flared canals. It is obtained through molding and relining the prefabricated fiber directly with composite resin and transferred into the flared root canals. The direct anatomic fiber post was fixed with resin cement. Direct anatomic fiber post was found to be radiographically adapted to the flared root canals creating a uniform and thin layer of resin cement without any voids detected. The anatomic fiber post mimic the flared anatomy of the root canal and adhesively bonded to the tooth structure based on the monoblock concept.


  Abstract 373: Nonsurgical removal of extruded gutta percha in maxillary central incisor endodontic retreatment: A case report Top


Nurul Ramadiani, Ike Dwi Maharti

Department of Conservative Dentistry, University of Indonesia, Central Jakarta, Indonesia

Extruded gutta percha is one of the local contributing factors that can lower the endodontic treatment success rate from 94% to 76%. Endodontic treatment failure can be solved with non-surgical endodontic retreatment, surgical endodontic retreatment, or a combination of both. Non-surgical endodontic retreatment is indicated for inadequate previous endodontic treatment and cases with coronal or apical leakage. The most critical phase in endodontic non surgical retreatment is removing gutta percha and sealer from root canal system. Based on some studies, no single instrument is capable of removing gutta-percha completely from the root canals. Hence, visualization using a dental microscope plays an important role. Removal of extruded gutta percha is a quite challenging procedure with the risk of gutta percha pushed away to the periapical region. This case report will present the non-surgical removal of extruded gutta percha in maxillary central incisor endodontic retreatment.


  Abstract 374: Endodontic management of mandibular second premolar with three root canals and hyper-taurodontism: A case report Top


Rakhmawati Caesaria, Endang Suprastiwi

Department of Conservative Dentistry, University of Indonesia, Central Jakarta, Indonesia

The primary objective of endodontic treatment is to prevent and intercept pulpal/periradicular pathosis and to preserve the natural dentition when affected by pathosis. The variety and complexity of root canals is a challenge and can also make it difficult to achieve successful endodontic treatment. The purpose of the present article is to report a successful retreatment of a mandibular second premolar with three canals and taurodontism. This case report discussed the clinical management of previously treated teeth mandibular second premolar with three canal systems dan taurodontism. Mandibular second premolar commonly have one canal, but at some rare cases it can have more than two canals. This mandibular second premolar have elongated large pulp chamber, apically positioned furcation, short root, dan the three orifice root canals found in apical third. Based on the classification given by Shiffman and Chanannel, the mandibular second premolar was Hypertaurodontism. The post endodontic radiograph shows the successful obturation to working length in all three canals, two canals in distal (distobuccal and distolingual) dan one canal in mesial. This case report highlights the importance of a comprehensive knowledge of variations root canal complexities and morphologies mandibular second premolar to produce an effective and successful endodontic retreatment.


  Abstract 375: Successful nonsurgical management of endodontic-periodontal lesion in mandibular first molar: A 1 year follow-up case report Top


Marissa Dwi Bestari, Aditya Wisnu Putranto

Department of Conservative Dentistry, University of Indonesia, Central Jakarta, Indonesia

In the existence of pulpal problem and inflammatory periodontal disease, the presence of interrelationships between pulp and periodontium could facilitate bacterial transportation between the two structures, resulting in endodontic-periodontal lesion. Diagnosis and management of endodontic-periodontal lesions are often more challenging to clinicians and the treatment outcomes are not as predictable as lesions of single origin. Accurate identification of the primary etiological factor through a thorough clinical and radiograph examination to determine correct diagnosis and prognosis is very vital in the management of endodontic-periodontal lesion. This case report evaluates the efficacy of non-surgical endodontic treatment in the management of bone loss and tooth mobility associated with primary endodontic lesion and secondary periodontal involvement in the right mandibular molar. A twenty-seven years old female patient with endodontic-periodontal lesion was treated with non-surgical endodontic therapy followed by simple hygiene phase therapy. One month after the endodontic treatment was initiated, an increase of the clinical attachment level was found, reduction of the lesion size was identified on the radiograph, and tooth mobility was no longer present. On one year evaluation following the endodontic treatment, the tooth remained asymptomatic and radiographic evidence showed significant resolution of bone defect.


  Abstract 376: Management root canal treatment on mandibular first molar with radix entomolaris: A case report Top


Badrul Qomar Isroi, Aditya Wisnu Putranto

Departement of Conservative Dentistry University of Indonesia, Central Jakarta, Indonesia

The main objective of root canal treatment is preventing periapical infection by disinfection and closure of root canal system with high success rate. The main cause of failure root canal treatment is failure to locate and treat all root canals. Mandibular first molar have the greatest possibility of additional roots and increased risk of missed root canals. Additional roots in mandibular first molars are called as Radix entomolaris and Radix paramolaris. Frequency of entomolar roots is more common in the Mongoloid race which is around 5-30%. This case report will discuss about root canal treatment in a 58 years old female patient of mandibular first molar with an obliterated entomolar root. Entomolar roots are usually not detected when radiograph is taken, due to overlapping of distal root canal. So it is necessary to combine clinical and radiographic examination. Radiographic identification of anatomical variations of the distal root canal was carried out using radiographic angle technique. First molar with Radix entomolaris need special attention during root canal treatment procedures because the auxiliary roots are usually smaller in size than the mesial and distal roots. The majority of entomolar roots also have root canals that form moderate to severe curvature so that the orifice of the root canal will be covered by the canal wall of the pulp chamber which will make it difficult to determine location of the orifice. Magnification and endodontic scalers can assist locating and opening entomolar root orifices. Negotiations and exploration can be done using C+ instrument that has mechanical resistance to torsion and buckling, so it can withstand the forces to gain access to the apical. Knowledge and understanding of identification of the canal and treatment using special instruments such as endodontic scalers, C pilot instruments and magnification in these cases with radix entomolaris are important to reduce the risk of root canal failure.


  Abstract 377: Effect of hyperbaric pressure in diving simulation on fracture strength and fracture pattern of different post system in endodontically treated teeth: An in-vitro study Top


Trimurni Abidin, Wandania Farahanny, Debora Natalyna

Faculty of Dentistry, Universitas Sumatera Utara, Medan, Indonesia

Aim: To evaluate the effect of hyperbaric pressure in diving simulation on fracture strength and fracture pattern of different post systems in endodontically treated teeth.

Materials and Methods: Fourty single root mandibular premolars were decoronated 2 mm above Cemento Enamel Junction and endodontically treated.The teeth were divided into two groups according to post system used (single prefabricated fiber post and anatomic fiber post). The fiber post was cemented with etch-and-rinse adhesive, hand-mixed dual cure resin cement (relyX Ultimate). Half of each groups were subjected to 24 pressure cycles from 1 ATA to 4 ATA. All sample was fractured by compressed loading with Universal Testing Machine (UTM). The mean of fracture strength was calculated and statistically analyzed using ANOVA. The fracture pattern was characterized by observation using dental loupe then statistically analyzed using Kruskal Wallis test (α = 0.05).

Results: Regardless of the pressure, anatomic post achieved the highest fracture strength 668.82 N ± 90.84 compare with single prefabricated fiber post 541.30 N ± 79.50 (p = 0.01). The fracture strength were significantly lower after they were subjected to the pressure cycles which is 482.69 N ± 81.57 for anatomic post and 428.23 N ± 68.34 (p < 0.05) for single prefabricated fiber post. No statistically significant differences (p = 0.958) were found in fracture pattern between all groups and 90% of the fractures were repairable.

Conclusion: Barometric changes in diving may have an adverse effect on retention of fiber post which can reduce the fracture strength of post system. The impact may be caused by the presence of smear layer or the microbubbles when mixing or application of the cement. However the fracture pattern was not be affected by pressure change.


  Abstract 378: Endodontic retreatment of a maxillary second premolar with protaper universal retreatment: A case report Top


Wigiarti, Ratna Meidyawati

Department of Conservative Dentistry, University of Indonesia, Central Jakarta, Indonesia

Understanding root canal morphology and its complexity is essential during endodontic therapy. The anatomy of the root canal has a variety of shapes and configurations and is always accompanied by complex shapes so that at the time of mechanical and chemical debridement and obturation have their own challenges. The purpose of this article is to report the success of root canal retreatment used pro taper universal rotary retreatment. A 40 years old female patient with a diagnosis of chronic apical periodontitis on a previously treated tooth was root canal retreatment. Endodontic retreatment included removal of obturating material, improvement of damage in the root canal, determination of the appropriate working length, obturation, and final restoration. The pro taper universal rotary retreatment system proved to be an efficient and effective method of removing gutta-percha and sealer from the root canal. The rotary movement of engine-driven files produces a certain degree of frictional heat which might plasticize gutta-percha, the plasticized gutta-percha would thus present less resistance and be easier to remove. Pro taper universal retreatment system having larger tapers can be expected to result in a cleaner canal than stainless steel hand files. The better performance of pro taper universal retreatment instrument may be attributed to their design D1, D2 and D3 have three progressive taper and lengths, these features may enable them to cut and full the gutta-percha into the file flutes and direct it toward the orifice. Root fillings were removed with a rotary instrument which was manipulated in a brushing action, the rotational speed was set at 500-700 rpm as recommended. Rotary instrument retreatment pro taper offers a greater benefit and better ability to preserve tissue with minimal invasion and smaller risk iatrogenic, gutta-percha resulted in increase cleanliness and provide a good prognosis. This case report highlights the importance of knowledge and application of root canal re-treatment techniques which play an important role in the success of endodontic retreatment.


  Abstract 379: Rehabilitation of endodontically treated mandibular second premolar using anatomical fiber post: A case report Top


Darin Safinaz, Ratna Meidyawati

Faculty of Dentistry, University of Indonesia, Central Jakarta, Indonesia

After endodontic treatment, it is necessary to select the appropriate restoration based on functional load, the amount of remaining tooth tissue structure, and aesthetic needs. This case report discusses the clinical restoration management of a widened canal space which involved a great loss of crown tissue of the endodontically treated mandibular second premolar. A tooth that has lost more than two crown walls requires a post and core to increase retention and stability of the final restoration. Various types of posts can be used to restore endodontically treated teeth. Glass fiber post is known for its excellent retention by its adhesive cementation system. In addition, it has similar modulus elasticity to dentin which allows better distribution of masticatory stresses and reducing the risk of root fractures. Its translucent color makes it able to transmit light for polymerization of resin luting agents and produces a good aesthetic appearance. In a widened canal space, prefabricated fiber post does not always adapt to the root canal's shape and diameter, which is possible to form a void of resin cement at the interface of the root canal wall. To eliminate this possibility, an anatomical fiber post is used to improve the fitness of the post within the canal. This technique requires the anatomical shaping of the prefabricated fiber posts with a light-cured composite resin into the root canal to achieve a better adaptation and retention of the post. The aim of this clinical case is to describe the usage of anatomical fiber post, highlighting the importance of knowledge and its clinical steps in the management of restoration widened canal space which plays a crucial role in the success of endodontically treated teeth.


  Abstract 380: Hemisection as a management of iatrogenic complication on right mandibular first molar Top


Sammy Henry Lay, Anggraini Margono

Department of Conservative Dentistry, University of Indonesia, Central Jakarta, Indonesia

Iatrogenic complications can occur when performing root canal treatment. Most common iatrogenic complications may occur during endodontic access cavity preparation. Such perforation may compromise the endodontic treatment outcome. However, there are several alternative treatments to correct procedural errors and maintain tooth structure. Hemisection is a procedure that can be performed to maintain tooth structure and function. In this case report, we report the management of hemisection of the mandibular first molar. A 59-year-old female patient came to the Dental Conservation Clinic of RSKGM FKG UI on a referral from a dentist at one of the primary clinics citing limited facilities. The chief complaint was swelling in mandibular molar region since 4 months and pain aggravated during chewing. Clinical findings revealed right mandibular first molar with temporary restoration. The cold thermal test did not elicit a response. The tooth was sensitive to percussion and palpation test. Preoperative radiograph showed radiolucency in the bifurcation area and the apical one third of the distal root. Based on clinical examination and radiographic findings, a diagnosis of chronic apical abscess caused due to pulp necrosis was made. Cone beam computed tomography (CBCT) showed radix entomolaris on distal root and perforation area on bifurcation, CBCT Periapical Index score is 4+ D. Hemisection procedure was done under anaesthesia, vertical cut was made with long shank carbide bur at bifurcation area and distal tooth root was extracted and the socket was irrigated with sterile saline to remove bony chips and sutured with 3.0 nylon sutured. At 4 weeks follow up, healing was found to be satisfactory and mobility was within the normal limits. Also, the tooth was not tender to percussion and palpation tests. Restoration of fixed bridge including retained mesial half and mandibular second molar with sanitary pontic was planned.


  Abstract 381: Management of flare up caused by over instrumentation in root canal treatment of lower molar with chronic apical abscess: A case report Top


Rahmat Ibrahim, Dewa Ayu Nyoman Putri Artiningsih

Departement of Conservative Dentistry, University of Indonesia, Cetral Jakarta, Indonesia

Root canal treatment aims to eliminate microorganisms and debris in the root canal system to prevent and treat periapical infections. Procedures for obtaining patency and cleaning and shaping the root canal may irritate the periapical tissue by bacterial contamination, bacterial by-products, necrotic pulp tissue, or the irrigation fluid's caustic potency. One of the problems during treatment is pain or swelling during or after root canal treatment, called a flare-up. Over instrumentation can push debris infection to periapical tissues, alter the balance between bacteria and the host's immune system, stimulate an acute inflammatory response and cause pain. This case report discusses the management of inter appointment flare-up of mandibular molar in a 28-year-old female patient diagnosed with chronic apical abscess after over instrumentation of the root canal. Flare-up can be managed appropriately by accurate measurement of working length, re-instrumentation of root canals, irrigation and application of intracanal medicament. Evaluation of one day and two weeks did not show any subjective and objective complaints so that the management of flare-ups was a success.


  Abstract 382: Management of pulp canal obliteration in mandibular first molar with periapical lesions by conventional root canal treatment: A case report Top


Rizka Andini Pratiwi, Anggraini Margono

University of Indonesia, Jakarta, Indonesia

Endodontic treatment should be initiated in obliterated canal experiencing tenderness to percussion with a PAI scores ≥ 3 and displaying a negative response to sensibility testing. Treating an obliterated canal can be of a challenge due to the narrowing of the pulp canal which will lead to the difficulty in locating the access of the canal and also during cleaning and shaping. This case report presents a successful completion of the conventional endodontic treatment in pulp canal obliterations of molar with periapical lesions. A 26-years-old man went to RSKGM FKG UI for treating his mandibular first molar that felt chewing discomfort since tooth fracture at lingual and distal side 4 month ago. Radiographs showed radiopaque area from occlusal to pulp chamber floor, obliterated canal and periapical lesions in mesial and distal root. Three obstructed root canal can be done by using C+ files and C-pilot files with chelating agent (EDTA and RC-Prep). Endodontic therapy consisted of rotary instrumentation with ProTaper Gold® (Dentsply Maillefer, was filled by warm vertical compaction) and final restoration of a dowel crown PFM. A one-month follow-up, there were no complaints of pain and periapical radiolucency showing signs of diminution and disappearance.


  Abstract 383: Endodontic treatment of maxillary second premolar with vertucci II canal configuration: A case report Top


Maharina Diyah, Endang Suprastiwi

Departement of Conservative Dentistry, University of Indonesia, Cental Jakarta, Indonesia

Successful endodontic treatment depends on knowledge in root canal morphology, correct access cavity preparation, complete debridement of the root canals, and subsequent obturation to facilitate healing of periapical pathosis. However, this process becomes complicated with the presence of additional root canal systems. The maxillary second premolars usually have one root canal, however in several cases there is more than one root canal with a variety of configurations. This variability of root canal morphology affects the diagnosis, root canal treatment success rate and prognosis that have been always a challenge for a clinician. The purpose of the present article is to report successful endodontic treatment of a maxillary second premolars with two root canals and one apical foramen (Vertucci Type II). The post-treatment radiographs show successful obturation to length in all canals. This case report highlights the importance of knowledge to confirm canals configuration and its application in the management of abnormal anatomic variants which play a crucial role in the success of endodontic treatment.


  Abstract 384: Prefabricated metal post removal in non-surgery endodontic retreatment of maxillary first incisive using ultrasonic instrument: Case report Top


Zahra Khairiza Anri, Ike Dwi Maharti

Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia

Endodontic retreatment often requires intraradicular post removal that is usually difficult and increases the risk of perforation and fractures and weakens the remaining tooth structures. Factors that complicate the removal process are its type, design, depth, and type of cement. There are many techniques used to remove post, including bur, device that grasp the posts so that they can be pulled out of the root, and ultrasonic instrument. In the ultrasonic techniques, the tip of instrument will produce energy that is transferred through the post and break down the cement until the post loosens. This case report will discuss prefabricated metal post removal in non-surgery endodontic retreatment of maxillary first incisive using ultrasonic instrument.


  Abstract 385: Retrieval of broken instrument from apical third of mesiobuccal root of maxillary second molar using bypass technique: A case report Top


Wandy Afrizal Putra, Dini Asrianti Bagio

Department of Conservative Dentistry, Faculty of Dentistry, Universitas Indonesia, Central Jakarta, Indonesia

Fracture of root canal instrument is one of the iatrogenic factor that can affect the prognosis of endodontic treatment. This might be due to the limited physical properties combined with the improper use of endodontic instrument, that can cause deformity on the instrument surface. The bypass technique is one of the minimally invasive options of the broken instrument management. One of the indications is for a case with instrument fragment located in the apical one-third of the curved root which could not be visualised with the aid of magnification. The bypass-technique was done by bypassing the fractured instrument fragment with small file followed with the use of lubricating agent and copious irrigation, negotiation till full working length followed by obturation. This procedure was done under dental operating microscope. Furthermore, the successful management of broken instrument by by-pass technique was achieved by successful bypassing of fractured instrument completely, without pushing the fragment apically. This case report presents the management of broken instrument from the mesiobuccal root of maxillary second right molar of 64 years old male patient that was referred to Department of Conservative Dentistry Clinic of RSKGM Faculty of Dentistry Universitas Indonesia. The management of the broken instrument was completed in one visit and followed by obturation with warm vertical compaction technique. After two months of observation, there are no clinical symptoms and radiographic appearance showed healing of periapical lesion.


  Abstract 386: Management of separated endodontic instrument in middle-third distobuccal root canal of first maxillary molar with bypass technique under dental operating microscope visualization: A case report Top


Deryana Avidhianita, Anggraini Margono

Department of Conservative Dentistry, Universitas Indonesia, Central Jakarta, Indonesia

Instrument separation is a common complication during endodontic treatments. Fragment retrieval success rate is high, but also has a higher risk of removing sound dentin, leading to root perforation and vertical root fracture. Success rate of fragment retrieval and bypassing is approximately two times greater if the fragment was visible. A clinical case of a separated endodontic instrument and treatment using bypass technique under dental operating microscope visualization are presented in this report. A 21 years old woman was referred by an endodontist at a private practice due to lack of facilities. Around one year ago patient had an uncomplete root canal therapy by a general practitioner. Patient had been complaining about chewing discomfort on right upper molar since a month ago. Clinical findings showed a temporary filled tooth with sensitivity to percussion and unsensitivity to cold test and palpation. Preoperative radiographs showed a separated endodontic instrument in the middle third of distobuccal canal and periodontal ligament widening. Based on clinical and radiographic findings the diagnosis obtained was chronic apical periodontitis et causa pulp necrosis and a separated instrument. Therefore, a conventional root canal therapy with bypass technique was done. The result showed hermetically obturated root canals. Post treatment evaluation was carried out two weeks after root canal treatment. All symptoms had disappeared, and the tooth was finally restored with fiber post and Ceramage crown.


  Abstract 387: Nonsurgical endodontic treatment for mandibular second molar with vertucci type II configuration: A case report Top


Elbert Dwi Suma Putra, Denny Nurdin

Departement of Conservative Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia

Root canal treatment for second molar tooth is little bit tricky because type IV and type II Vertucci are the most common types found in mesial roots, while type I Vertucci in distal roots. Therefore, it is necessary to do a proper investigation so that the dentist can determine the root canal configuration before treatment to make successful treatment. This case report discusses the non-surgical root canal treatment of a right lower back tooth with a Vertucci type II configuration with follow-up using a composite overlay and using CBCT to support this treatment.


  Abstract 388: Retrieval of multiple pulp stones and management of calcified root canals: An endodontic treatment challenge Top


Melia Heptania, Wandania Farahanny, Trimurni Abidin

Department of Conservative Dentistry, Faculty of Dentistry, Universitas Sumatera Utara, Medan, Indonesia

Currently canal calcifications is an interesting and challenging case for endodontists. The goal of endodontic treatment is to eliminate microorganisms and their by-products from the root canal system. Calcifications within the pulp may lead to poorer outcome of a root canal procedure, as they can block access to the root canal and hinder cleaning and shaping. Errors in treatment can result in iatrogenic errors that will lead to failure of endodontic treatment. This article describes a case report of a 19-years-old woman with multiple pulp stones in pulp chamber and calcified root canals located in mesio-lingual and mesio-buccal of the left mandibular first molar. Endodontic treatment was performed because the patient had asymptomatic irreversible pulpitis. Several challenges were encountered in this case. The initial challenge encountered was determining the position of the pulp stone in the pulp chamber, which had to be done using radiographs taken from various angles, as well as direct observation of the cavity during access preparation. The pulp stone in this case is of the embedded type, which is retrieved by grinding it using an ultrasonic tips. In addition, another challenge is to avoid perforating the pulp chamber floor when removing the pulp stone, identifying the location of the orifice. Success is achieved with clinical knowledge, magnification aids and ultrasonic tips.


  Abstract 389: Endodontic treatment on second molar mandibular with periapical lesion: A case report Top


Marcelina Wijaya, Denny Nurdin

Departement Conservative Dentistry, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia

The current concept and rationale of endodontic treatment of periapical lesion are centered on stopping the bacterial stimulation of the host response at the apical foramen that would allow healing of the lesions. Some clinical studies have confirmed that simple non-surgical treatment with proper infection control can promote healing of periapical lesions. Up to 85% treatment success has been reported for periapical lesions after non-surgical endodontic therapy which implies that most periapical lesions including abscesses respond to non-surgical endodontic therapy. The success of endodontic treatment in cases of periapical lesions was assessed based on clinical and radiographic criteria. This case report discusses the endodontic treatment of a mandibular second molar with apical abscess.


  Abstract 390: Endodontic treatment of maxillary lateral incisor with periapical lesion: A case report Top


Hendra Dian Adhita Darsono, Mumu Mujahid

Departement of Conservative Dentistry Padjadjaran University, Bandung, Indonesia

Periapical lesions are generally a continuation of untreated teeth with caries and pulp necrosis. Residual pulp tissue and microbial infection in the root canals are the cause of inflammation of the periapical tissues and form periapical lesions. Periapical lesions can be categorized into dental granulomas, periradicular cysts or periapical abscesses. The main goal of root canal treatment is to restore the infected tooth and the decayed tooth to a healthy state and normal function. Conservative nonsurgical treatment is the first choice in treating periapical lesions. Surgical treatment is recommended if the odds are met with failure. This case report describes root canal treatment of maxillary lateral incisor with periapical lesion. A 37-year-old male patient was referred from the prosthodontis to the Department of Conservative Dentistry and Endodontics of Padjadjaran University, with the chief complaint of frequent toothache and pus coming out of the gums. The tooth had been filled several years ago. Clinical examination revealed secondary caries on maxillary left lateral incisor and a fistula in the buccal mucosa of the tooth. Radiographically, overhanging restoration and periapical radiolucency involving half of the root was seen. Treatment was started with removing the previous restoration and performing root canal drainage. The treatment was continued by root canal preparation using a rotary file (Protaper Next ; Dentsply, USA) with crown down technique. Root canal irrigation using sodium hypochlorite (5,25%), EDTA solution (17%) and distillated water. Calcium hydroxide (Calcipex II ; Nishika, Japan) was used as an intracanal medicament for 10 weeks with 6 cycle of applications. Obturation of the root canal was perform after periapical lesion has shrunk, decrease in size and periapical bone started to repair. Obturation was done using gutta-percha points (Protaper Next GP ; Dentsply/Maillefer, Switzerland) and AH plus sealer (Dentsply DE Trey, Konstanz, Germany). Cleaning, shaping and microbial control through irrigation and root canal medication determine success in the treatment of periapical lesions.


  Abstract 391: Endodontic treatment of mandibular first premolar with curved canals: A case report Top


Ika Putri Wiratama, Rahmi Alma Farah Adang

Department of Conservative Dentistry, University of Padjadjaran, Bandung, Indonesia

The curved canals in the posterior teeth often present a major challenge to the clinicians during the endodontic treatments. Periapical radiographs are the most appropriate way to diagnose the presence of curved canals. Careful and meticulous technique will yield a safe and sufficient enlargement of the curved canals. This case report describes the endodontic management of mandibular first premolar with curved canals. A 28 year old female patient came to the Conservative Dentistry Department, RSGM UNPAD with a complaint of fracture in right lower tooth since six months. Clinical examination revealed that tooth 44 had a fracture involving the pulp on the disto-occlusal surface. Vitality, percussion and palpation testing of tooth 44 was non-responsive. The radiographic examination revealed normal periapical region. The diagnosis of tooth 44 was previously initiated therapy with normal apical tissues. The treatment plan was endodontic treatment and full-coverage final restoration. The treatment began with informed consent followed by determination of root canal curvature with Schneider method. Access preparation was done under rubber dam isolation. The canals were instrumented by precurved hand files with balanced force technique and canal preparation using ProTaper Gold instrument with crown-down technique under irrigation with 5.25% sodium hypochlorite. Calcium hydroxide was used as an intracanal medicament. Obturation was performed on the next visit using gutta-percha and AH plus sealer. The tooth was restored using full-coverage restoration (lithium disilicate) with fiber post. Early diagnosis and proper instrumentation techniques would minimize the procedural errors and help to achieve a successful outcome of the endodontic treatment for curved canals.


  Abstract 392: Endodontic treatment of lower right second molar with severely curved canal: A case report Top


Henry Octovianus, Diani Prisinda

Universitas Padjadjaran, Bandung, Indonesia

Endodontic treatment of curved canals in posterior teeth often present a major challenge for the clinicians. Improper instrumentation may develop ledges and fracture instruments which further complicate the endodontic treatment. Knowledge of the root canal morphology and the degree of canal curvature are required for successful therapy. The objective of this case report was to describe the endodontic treatment of lower right second molar with severely curved canal. A 24 year old female patient was referred to Conservative Dentistry Clinic, RSGM Universitas Padjadjaran for endodontic treatment on lower right second molar. Clinical examination revealed large cavity with pulp exposure. Periapical radiographic examination showed a 60 degree curvature in mesial root and a periapical lesion with periapical index score 4 in the distal root. This tooth was diagnosed as pulp necrosis with chronic apical abscess according to American Association of Endodontists. The treatment stages were access opening, root canal negotiation using precurved file (D Finder, Mani), root canal preparation with rotary file (HiFlex CM, Coltene), calcium hydroxide as interappointment medicament, obturation with lateral condensation technique and resin based sealer (AH26, Dentsply) and composite overlay as final restoration . Preoperative assessment of the curved canal and proper instrumentation technique was necessary to avoid procedural errors and successfully treat this case.


  Abstract 393: Intentional endodontic treatment of dens invaginatus Type II in maxillary lateral incisor for orthodontic and aesthetic considerations: A case report Top


Prima Dianiawati Nur Anisa, Hendra Dian Adhita Dharsono

Department of Conservative Dentistry, University of Padjadjaran, Bandung, Indonesia

Dens invaginatus (DI) is a developmental anomaly of a tooth attributed by epithelial invagination in a developing tooth crown and/or the root surface before mineralization. In type II DI, the epithelium invaginates into the root and affects the anatomy of the crown, with high incidence in lateral maxillary incisor. The crown is rather wider and often contributes to anterior teeth shifting and aesthetically disturbed. Orthodontic appliance in conjunction with anatomical correction of tooth with DI can be done to gain anterior space. This case report aims to describe the intentionally root canal treated type II DI of a 25 year old female with midline shifted maxillary anterior teeth. CBCT was taken to capture the anatomy of root canal system. Endodontic treatment was planned with a decision to preserve the dens invaginatus in order to maintain structural strength of the root. The treatment initiated with access opening; four orifices were found, one orifice of the invagination was located in the middle, and three other orifices namely palatal, distal and mesial were located in form of a symmetrical triangle. Subsequently, root canals were cleaned and shaped with step back technique using K-file stainless steel hand instrument (Dentsply), and obturated with warm vertical compaction technique (SybronEndo). Finally, the tooth was coronally sealed with SDR (Dentsply), followed by bulkfill resin composite (3M). The anatomy of the tooth was corrected afterwards, with palatal, mesial and distal tooth reduction to mimic the shape of lateral incisor and to gain space for ideal anterior teeth alignment. Difficulties were encountered during endodontic treatment due to the complexity of root canal anatomy, therefore understanding the tooth anatomy, 3D imaging evaluation using CBCT and working under magnification were essential for successful treatment.


  Abstract 394: Preendodontic evaluation of mandibular premolars: Need of the hour Top


Meenu Elizabeth Saju

Department of Conservative Dentistry and Endodontics, Bangalore Institute of Dental Sciences, Bengaluru, Karnataka, India

Mandibular premolars typically present with a single root and a single canal. However complex anatomical abnormalities have been described in mandibular premolars, rendering them one of the most challenging teeth to treat endodontically. Canal configurations in mandibular premolars may vary significantly with respect to ethnicity, race and sex. Recent imaging techniques and population-based evaluations have provided more information about mandibular premolar architecture and its intrinsic variability. Possible anatomic variations in mandibular premolars are bifurcation of canals (23–30%) terminating in multiple apical foramina (15–20%), as compared to second premolars, second premolars with multiple canals in Caucasian, Indian, and Middle Eastern populations, a deep mesial radicular invagination of first premolars, prevalent type 1 canal configurations in first premolars and association between ethnicity, root canal morphology across population groups in first and second premolars. Fusion or gemination, fusion with adjacent or supernumerary teeth, dens invaginatus, dens evaginatus, taurodontism, C-shaped canals, and supernumerary premolars are some of the other developmental anatomic variants of mandibular premolars. Prior to actually starting root canal therapy, every clinician consults the blueprint of tooth anatomy. The large amount of data on tooth anatomy available to researchers allows for a better knowledge of the internal anatomy of the tooth and its many variants. Thorough preoperative clinical assessment, meticulous observation of the coronal and radicular anatomy and landmarks, accurate straight and angled preoperative radiographs, use of three dimensional imaging for complex root canal anatomies, preparation of a buccolingually directed oval access cavity if a second canal (or bifurcation) is suspected, coronal enlargement, enhanced illumination, and magnification for detecting variations in the morphology are the various aids for a successful endodontic procedure in premolars. Hence to ensure endodontic success, a detailed understanding of normal anatomy and common deviations is essential.


  Abstract 395: A comparative evaluation of cyclic fatigue resistance of hyflex EDM, Plex V and Superendo files in continuous rotary motion : An in vitro study Top


Geetika Sabharwal, Hysum Mushtaq

Divya Jyoti Dental College and Hospital, Modinagar, Uttar Pradesh, India

Aim: The purpose of this study was to evaluate the resistance to cyclic fatigue of Hyflex EDM , Plex V and Superendo files in continuous motion.

Subjects and Methods: A total of 5 new size 25.06 taper Hyflex Edm files, Plex V 25.06 taper files and Superendo 25.06 taper files each were selected. A cyclic fatigue testing device with stainless steel canal with a 90°angle of curvature and 3 mm width; curvature starting at 6 mm from the tip was used. All instruments were rotated till fracture occurred and time till fracture of each instrument was recorded in seconds.

Statistical Analysis Used: Data were analyzed using ANOVA.

Results: All the files showed superior resistance to cyclic fatigue in continuous motion. Hyflex EDM primary files displayed maximum resistance to cyclic fatigue both in continuous motion. Followed by Superendo and Plex V files exhibiting least resistance.

Conclusion: Hyflex EDM files showed better cyclic fatigue resistance at apical curvature compared to other files.


  Abstract 396: Endodontic micro: Robot Top


K Mathan Kumar

Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

Endodontic therapy which is known as the Root Canal Treatment is a process to remove the damaged pulp tissue from the root canal space of the tooth and sealing the root canal to prevent from being a source of infection . The treatment success rate is almost 60-65% by general dentists and 90% by the specialists . The treatment is also time consuming and highly prone to human errors (or) mishaps . The Use of modern machining technology can remove human factors from this process and increase the success quotient through the accuracy inherent in modern machining . This computer controlled machine can be mounted on the tooth of interest within the patient's oral cavity . The help of Online monitoring and intelligent control , this micro machine will be subjected to perform automated probing , drilling , shaping and filling of the root canal . Thus a micro robot has been built . Here , a two dimensional X-rays of tooth can be converted to a Three dimensional (3D) of a root canal path . Built in micro sensors are placed to monitor the actions of the micro – robot . Computer Numerical Code (CNC) code is generated by the CAD/CAM software from these images . This code can then be fed into a CNC code interpreter to drive the micro robot and prepare the root canal .An Endodontic Micro – Robot has to be built mainly for reducing the reliance on the skills of the dentist , minimizing the human errors and thereby offering a method for precise diagnosis and treatment . Three Design concepts were suggested and compared to determine the best efficient working model of an Endodontic Micro – robot . This review paper mainly describes about the Design process , Manufacturing process , assembly and testing . Ultimately , also discusses about Scheduling and the approximate Budget of an Endodontic Micro – Robot .Though this micro – robot has a steep learning curve , there is no doubt that it is going to be the biggest revolution in the field of Endodontics.


  Abstract 397: Efficacy of 70% ethanol in removal of two types of calcium hydroxide intracanal medicament with and without passive ultrasonic irrigation: An in-vitro stereomicroscopic study Top


Nikitha D'souza

Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

Introduction: Calcium hydroxide is often used as intracanal medicament, however, its complete removal from root canal system poses a challenge even today. Studies using 70% alcohol, a known surface tension depressant, with the aim to remove calcium hydroxide from root canals are lacking. Hence, purpose of this study was to assess cleanliness of root canal walls after attempting to remove two types of calcium hydroxide: aqueous-based (Ultracal) and oil-based (Metapex) using 70% ethanol with and without passive ultrasonic irrigation (PUI).

Materials and Methods: 48 single rooted teeth were sectioned to uniform length of 15mm. After root canal instrumentation, tooth samples were divided into 2 groups(n=24) and filled with either Ultracal or Metapex inserted upto 3mm from working length using a Lentulospiral. Samples were incubated at 37°C and 100% humidity for 7 days. The root canal was initially irrigated with 10mL saline solution and reinstrumented with master apical file to remove bulk of placed calcium hydroxide. Samples in each group were then randomly assigned into 2 subgroups(n=12) for irrigation using 70% ethanol with and without PUI. A final flush with 5mL saline solution was performed. The tooth samples were sectioned longitudinally by diamond disk and chisel without entering root canals. Stereomicroscope images at 4.5X magnification were obtained and cleanliness of root canal walls was scored according to the scoring system given by Kuga et al (2010). The data were statistically analyzed by Kruskal–Wallis test, Mann–Whitney U test, Friedman's test and Wilcoxon tests, with significance level set at 5%.

Results: 70% ethanol effectively removed Ultracal from root canals. No significant differences were observed with non-activated or PUI protocols (P<0.05). In Metapex group, 70% ethanol irrigation with PUI showed significantly better cleaning efficiency than non-activated irrigation (P<0.05).

Conclusions: Use of 70% ethanol for removal of aqueous-based calcium hydroxide showed good cleaning efficacy in all thirds of the root canal regardless of irrigant activation. Moderate amount of remnants of oil-based calcium hydroxide were present with non-activated 70% ethanol irrigation but better cleanliness was seen with PUI. Removal of oil-based calcium hydroxide from root canal system is enhanced with 70% ethanol with PUI.


  Abstract 398: Dynamic navigation: Transforming the concept of minimal invasive endodontics Top


Diksha Dubey, Kranthikumar Reddy

JMF's ACPM Dental College, Dhule, Maharashtra, India

With the great growing of digitalization in dentistry, digital technologies have become very common and fundamental in Endodontics. With advancements in computer technology and imaging, the guided surgical procedures are becoming choice with its edge. Essentially there are two types of guidance: static and dynamic. Static guidance refers to utilization of a fixed surgical stent, while Dynamic navigation integrates surgical instrumentation and radiologic images using an optical positioning device controlled by a dedicated computerized interface. A clinical real-time interface displays and guides users to drill into the targeted position through the prefixed trace according to the output of the preoperative planning software. The ideal drill position is planned virtually by the surgeon using the CBCT data set uploaded into the planning software. Sensors attached to the surgical handpiece and the patient's head or teeth transfer 3-dimensional spatial information to a stereotracker. It has been used in number of areas in medicine, in craniofacial surgery and implant dentistry. Dynamic navigation systems (DNSs) were originally introduced in dentistry in the US in 2000 to facilitate insertion of dental implants. High accuracy of dynamic navigation minimizes the potential risk of damage to critical anatomical structure. In endodontics, computer-aided guided navigation systems have demonstrated their potential for clinical practice. Guided endodontics for access cavity preparation and canal location in endodontics has focused on use of guides. DNS is more accurate and more efficient in locating canals in calcified human teeth as compared to free hand technique. This novel system results in significantly less tooth structure removal and a shorter operation time. The dynamic navigation system allows operator to precisely perform a minimally invasive osteotomy and root end resection during endodontic surgery. Dynamic navigation is a promising technology aiming at facilitating enhanced accuracy while performing surgical procedures and reducing the risk of iatrogenic errors. Minimal invasive protocols are the stepping stones to the future of endodontics. Although not much worked upon, DNS is a promising digital alternative management strategy.


  Abstract 399: A review cone beam computed tomography study of root canal morphology of permanent mandibular incisors in Indian population Top


Kualsmita Das

Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

Comprehension of the root canal system anatomy is an essential prerequisite for endodontic treatment. The lack of knowledge regarding morphological and anatomical variations of the root canal system can result in failure to identify all root canals and lead to inadequate instrumentations and consequent failure of endodontic treatment. The root canal anatomy of each tooth has certain commonly occurring characteristics as well as numerous atypical ones, understanding of which can be the road map to successful endodontics. The root canal morphology of permanent mandibular incisors is not simple, as it may be complicated by the presence of a second canal, lateral canals, and apical delta. Ideally, internal anatomical complexities, such as the number of canals, their shapes, and trajectories, including the presence of confluences and bifurcation should be assessed before undertaking instrumentation. The expected root canal anatomy dictates the location of the initial entry of access, dictates the size of the first file to be used, and contributes to a rational approach in solving the problems that arise during therapy. The external and internal morphological features of roots are complex, and several classifications have been proposed to define the various types of canal configuration that occur commonly. Amongst the various methods for assessing root canal morphology, CBCT has recently become the most valuable tool as it reconstructs the projection data to provide the interrelational images in three orthogonal planes (axial, sagittal, and coronal). The aim of this review paper is to evaluate the different root canal morphology and configuration seen in permanent mandibular incisors in the Indian population based on the data collected from the year 2011 - 2021 published results.


  Abstract 400: Dental wings: The butterfly effect Top


Simranjit Kaur

National Dental College and Hospital, Kharar, Punjab, India

The butterfly effect is an optical phenomenon that occurs in transverse sections of roots as different shades of dentin. It is observed for endodontic reasons to measure the density of dentinal tubules .It has been attributed to dentinal tubular sclerosis that causes the light to refract and scatter .In sclerotic dentin, the tubules are occluded with calcified material, as a result the density of dentinal tubules is decreased that causes less light to scatter. Certain cross sections of root exhibit butterfly effect when observed under polarised microscopy because of dentinal translucency . Thus it is one of the significant parameters used for dental age estimation. Root translucency increases with age which signifies that butterfly effect is thus age related. The significance of the direction of butterfly effect correlates with root fracture following root resection and ultrasonic root end preparation. This may explain the prevelance of vertical root fracture that run buccolingually . Dentinal hypersensitivity is directly related to the number of dentinal tubules. The greater number of dentinal tubules in buccolingual surface of teeth makes them more susceptible to hypersensitivity. The presence of butterfly effect also impact sealer penetration into dentinal tubules. Additionally, dentin microhardness value decreases after treatment with calcium hydroxide and antibiotic paste over time intervals. Therefore antibiotic paste should be used with caution in endodontic treatment in teeth exhibiting butterfly effect. This review article thus describes that root sections with butterfly effect have lower density of tubules and thus have much clinical significance in Endodontics . Evaluation of butterfly effect could also be an important additional parameter while estimating adult age.


  Abstract 401: Anaesthetic efficacy of lidocaine as intra ligamentary injection in patients with irreversible pulpitis of mandibular teeth undergoing root canal therapy: A systematic review and meta-analysis Top


Shanmugasundaram Nandhini, Shoba Joy, V Prabhakar, Anirudhan Subha

Sri Ramakrishna Dental College and Hospitals, Coimbatore, Tamil Nadu, India

Aim: To evaluate the efficacy of Lidocaine as Intraligamentary Injection compared to other supplementary anaesthetic methods and solutions in patients with Irreversible Pulpitis of mandibular teeth undergoing Root Canal Therapy.

Methods: A Protocol and search strategy were prepared based on the PICO question.

P- Patients reporting with irreversible pulpitis undergoing root canal therapy of mandibular teeth

I- Intraligamentary Injection with Lidocaine

C-Any other supplementary anaesthetic method

O-Anaesthetic efficacy of the method used

Records were identified through data bases like PubMed/MEDLINE, CTRI, LILACS, clinicaltrials.gov and Cochrane. The quality of the studies was assessed using the revised Cochrane risk of bias tool-2 (RoB 2). Meta-analysis and Forest-Plot of pooled data were conducted for eligible studies.

Results: 667 citations and 9 citations were identified through database search and manual search respectively. After removing duplicates and going through abstracts, 19 full-text articles were chosen and 13 articles met the inclusion criteria. Risk of bias analysis revealed 1 study had some concerns of bias, 4 study had high risk of bias and 8 studies had low risk of bias. Meta-analysis revealed pooled estimate of 0.77 with 95% Confidence Interval of 0-.31-1.91. I square value revealed moderate heterogenity of the studies included in Meta-analysis.

Conclusion: Within the limitations of the study, it was observed that Lidocaine Intraligamentary Injection was more effective in achieving pulpal anaesthesia for patients with Irreversible Pulpitis undergoing Root Canal Therapy compared to other supplementary anaesthetic methods and solutions. However ,there is a need to conduct more Randomized controlled trials to assess the efficacy of Lidocaine Intraligamentary injection compared to other methods.


  Abstract 402: Biological restoration: To reincarnate or emanate? Top


Shanmugam Ragavi

Vivekananda Dental College for Women, Tiruchengode, Namakkal, Tamil Nadu, India

Coronal fracture by trauma is the most frequent type of dental injury in permanent dentition. Most affected teeth are upper incisors due to anterior position and protrusion caused by the eruptive process. The tooth fragments can be obtained from the patient's own teeth or from the tooth bank. The restorations using these teeth are termed Biological restoration. The use of biological restoration with natural crown resulted in clinical success as well as recovered the proper functional anatomy of the tooth. Fragment reattachment using natural teeth provides excellent results regarding surface smoothness and the maintenance of the incisal guide in dental structures that cause physiological wear. Interdental posts of human dentin or “Biopins” are one possible option for permanent anterior vital teeth that require additional retention. Biopins provide a greater level of retention and stability in fractured vital teeth. Extrusion of root filling materials into the periapical tissue causes inflammation, including foreign body reaction, and contributes to poor prognosis. Apical dentin chip plugs used root canal obturation and also in perforation, pulp regeneration, it acts as a reservoir of growth factor in regenerative endodontics. Post and core is the only satisfactory treatment option when more than half of coronal structure loss. Biological or dentinal post made of human extracted tooth provides resilience comparable to the natural tooth. It also provides good adhesion to the tooth structure by composite resin. A biological post is a feasible option for the strengthening of the root canal, because it reduces radicular dentin stress, biocompatible, preserves the internal dentin walls, adapts to canal configuration. This paper is a systemic review of the literature on biological restoration in endodontics.


  Abstract 403: Retrieval of iatrogenic and self-introduced foreign bodies from the root canal: A case series Top


Sneha Susan Santosh

Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India

The diagnosis of foreign bodies lodged inside the root canal and the periapical region is usually accidental. These objects get implanted into the canal when the chamber is exposed due to a large carious lesion, traumatic injury, or in root canals left open for draining. These foreign objects may act as a potential source of pain and infection. The following case series illustrates the successful retrieval of both iatrogenic and self-introduced foreign bodies in order to facilitate non-surgical root canal treatment. The items retrieved from the canal were a metal wire, a stapler pin, pencil lead and an iatrogenically introduced diamond point. Endodontic treatment was successfully completed in all the four cases after the removal of the obstructions.


  Abstract 404: Endodontic management of mandibular premolar with two roots Top


Gautam Kumar Tiwari

Surendra Dental College, Sri Ganganagar, Rajasthan, India

Successful endodontic treatment depends on thorough knowledge in root canal morphology, appropriate assessment of pulp chamber floor, critical interpretation of radiograph, and on biomechanical preparation followed by three dimensional obturation of root canal system. The possibility of additional root /canal should be considered even in teeth a low frequency of abnormal root canal anatomy. Mandibular premolars usually have single root with single root canal system. However numerous studies related to anatomic variations of mandibular premolar have been be reported. The clinician should be aware of the configuration of the pulp system for the successful endodontic treatment. The incidence of two roots in these teeth are quite rare. This report presents the clinical management of mandibular premolar having two roots bifurcated at the midroot level.


  Abstract 405: Proresolving mediators in endodontics: A review Top


CP Revathy

PSM College of Dental Science and Research, Palakkad, Kerala, India

The success of endodontic treatment is related to the prevention and healing of Apical Periodontitis, an inflammatory disease triggered by microorganisms infecting the root canal system after pulpal damage. A delay in the healing of Apical Periodontitis may be because of an imbalance of the cytokines and inflammatory processes. During the inflammatory response, once the clearance of the pathogenic noxa has been achieved, tissue hemostasis is restored by a switch in the biosynthesis of lipid mediators toward the release of immunoresolvant molecules. Proresolving mediators are specialized molecules (SPMs) involved in active resolution of the inflammatory process by regulating tissue homeostasis. SPMs are derived from polyunsaturated fatty acids (PUFAs) of arachidonic acid and omega-3 fatty acids. Their primary mechanism of action is through the resolution of inflammatory pathosis without predisposing the host to an increased vulnerability to infections. They do not block the inflammatory process; instead they regulate inflammatory homeostasis. SPMs attenuate the production of proinflammatory cytokines such as Tumor Necrosis Factor alpha and interferon gamma and inhibit polymorphonuclear neutrophil and T-cell adhesion, infiltration and chemotaxis. The aim of this review is to bring evidence of the future potential application of Proresolving mdiators in the prevention and treatment of endodontic disease. This will open the doors for new therapeutics as an adjunct to endodontic treatment.


  Abstract 406: Patients perception of quality of life post endodontic therapy and rehabilitation: A cross sectional study Top


Anushree Talnikar, Rajesh Kubde, Pratima Shenoi, Pratik Burad, Prajakta Ambulkar, Ankita Ramteke, Varsha Uttarwar

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

Objective: To assess the patient's perception of quality of life post endodontic therapy and rehabilitation. Description of the experimental design and materials and method- 232 adult, patients who underwent endodontic treatment were requested to fill a feedback form. The feedback form had 21 questions, for the patient seeking to assess their experience before, during, and after the endodontic treatment.

Results: The feedback form was filled by 55% females and 45% male patients. 64% of the patients had chief complain of pain, and 30% had swelling before the root canal treatment. 75% of patients had their root canal treatment done in the posterior region and 18% had a root canal treated tooth in the anterior region. 60% of the patients got their root canal treatment done by an endodontist and 30% of patients got it done by a general dentist. 56% of the patients said that they did not experience any pain during the root canal treatment, also almost 80% of the patients were relieved of pain after the endodontic therapy. 95% of patients said that the current status of their root canal-treated tooth is healthy and satisfactory. Only 17% of patients had difficulty in mastication after the root canal treatment and only 12% of patients had difficulty in cleaning their teeth. Others faced no problem in their daily oral functions. 81% of patients think there is a notable improvement in their daily routine and normal oral functions after restoring a tooth/teeth with root canal treatment. 94% of people said that they would recommend their kins to restore their tooth with endodontic treatment instead of extracting it.

Conclusion: It is very apparent that endodontic therapy relieved pain and restored the function of the tooth, thus it improved the quality of life of patients. Patients who experienced pain, swelling, and pus discharge before the endodontic treatment were relieved of the symptoms after the treatment. Thus, we can conclude that patients who underwent endodontic treatment and restored their teeth are satisfied and have a better quality of life.


  Abstract 407: Evaluation and comparison of sealer penetrability and gap formation of ah plus,bioroot rcs and sealapex sealers to root dentin by scanning electron microscope analysis: An in vitro study Top


Pooja Jayan

St. Gregorios Dental College, Ernakulam, Kerala, India

Aim: To evaluate and compare the sealer penetrability and gap formation of root canal sealer to root dentin filled with sealers - AH Plus (Epoxy), Sealapex (Calcium Hydroxide) and BioRoot RCS (Bioceramic).

Materials and Methods: Twenty-seven mandibular second premolars were selected and radiographed at two angulations. The teeth were stored in labelled plastic vials containing artificial saliva and then randomly assigned to 3 groups based on the sealers:

Group 1- AH Plus, n = 9

Group 2- Sealapex, n = 9

Group 3- BioRoot RCS n = 9

Teeth were decoronated and conventional root canal therapy was done with Protaper universal rotary files. The three groups were filled using AH Plus, Sealapex, BioRoot RCS along with single cone technique. 1 mm sections at apical, middle and cervical 3rds were taken using water cooled low speed saw. All specimens were evaluated using Scanning Electron Microscopy.

Statistical Analysis: Statistical analysis was performed using Three Way ANOVA and Post Hoc test. Statistical Analysis was done with the help of SPSS software (version 16.0) for windows.

Results:

  • Sealer penetrability - AH Plus(Group 1) >BioRoot RCS(Group 3) >Sealapex(Group 2).
  • Gap formation - BioRoot RCS(Group 3) < AH Plus(Group 1) < Sealapex(Group 2).


Conclusion:

Best Sealer penetration was seen in AH Plus followed by BioRoot RCS and finally by Sealapex.

  • Penetration for AH Plus and Sealapex was seen at the coronal third than the middle third while BioRoot RCS sealer showed better penetration at the apical third.
  • Minimum gap formation was observed with BioRoot RCS sealers when compared with the other 2 sealers.



  Abstract 408: A review of in vitro and clinical studies for evidence based approach to treat c-shaped mandibular second molars Top


RL Sampath Kumar

Vokaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

C shaped canal, a common root canal variation in mandibular molar are often seen in root canal form having an elongated ribbon shaped arc (C shape). These canals are mostly seen in mandibular second molars as an extensive complex root canal system with the presence of fins or webs that connects individual mesial and distal canals. And hence, these canals presents a challenge in diagnosis, debridement and obturation. Diagnosis of C-shaped canal configuration before treatment can facilitate effective management, which will prevent irreparable damage that may put the tooth in severe jeopardy. For proper diagnosis a clinician must have a thorough knowledge of the anatomy of C-shaped canal and their radiographic interpretations to know which diagnostic tool is effective in diagnosing C-shaped canal. C-shaped canals has extensive canal complexities with the presence of fins and webs, which can pose a challenge for any file systems to instrument all the canal surface effectively, based on the evidence of micro-CT studies evaluating the percentage of un-instrumented areas in C-shaped canal by various file systems will help to discuss the efficacy of these file systems in instrumenting C-shaped canals. Complex anatomy of C-shaped canal makes a complete 3-D obturation very challenging. Based on the evidences of micro-CT, stereomicroscopic and cross-sectional digital photographic studies performed to evaluate the percentages of canal area occupied by gutta-percha, sealers, voids and time taken for filling by various obturation techniques will help to discuss their efficacy in obturating C-shaped canals. Hence, the aim of this review paper will focus on evidences available for diagnosing, instrumenting and obturation of the C-shaped mandibular second molar which would give an insight to the clinicians in their management.


  Abstract 409: Antibacterial efficacy of calcium hydroxide alone and combinations of calcium hydroxide, chitosan and nisin as an intracanal medicament against Enterococcus faecialis: An in vitro study Top


Raksha Kusumbe

SDK Dental College, Nagpur, Maharashtra, India

Objective: The purpose of this study was to evaluate and compare the antibacterial efficacy of Calcium hydroxide alone and combinations of calcium hydroxide, chitosan and nisin as intracanal medicament against Enterococcus faecalis.

Materials and Methods: Intracanal dressings: Group 1 –Calcium Hydroxide , Group 2 – Chitosan +Nisin (1:1),Group 3- Calcium hydroxide ,Chitosan,Nisin (1:1:1) were taken on a culture plate inoculated with E.faecalis. After 24 h of incubation the bacterial colonies were isolated and suspended in 5 ml of infusion broth followed by incubation at 37°C for 4 h. 0.5 McFarland of the bacterial suspension was prepared and then cultured on Mueller–Hinton agar culture medium with the help of a sterile swab. In each culture plate, five wells were created with a sterile pipette for placement of the samples. Antibacterial activity was assessed using Agar diffusion test and results were noted as diameter of growth inhibition zone.

Results: Student-t test is done to analyse the results.Statistically significant difference of combination of calcium hydroxide,chitosan and nisin was observed as compared to the other groups. Antibacterial activity of calcium hydroxide,chitosan and nisin (Group C) (P < 0.001) in combination was more efficacious as compared to calcium hydroxide (Group A) (P < 0.001)alone . Chitosan and nisin (Group B) (P < 0.001) was least capable in elimination of E. Faecialis.

Conclusion: In this present in vitro study , Intracanal dressing with combination of all the three intracanal medicaments calcium hydroxide,chitosan and nisin (1:1:1) showed better results as compared to calcium hydroxide alone followed by chitosan and nisin.Hence it can be estimated that the combination of conventional and newer medicament gives predictable outcome.


  Abstract 410: Assessment of knowledge and practice about management of avulsed teeth with splinting among dentists in central India Top


Pooja Nakate, Gautam Badole, Pratima Shenoi, Rajesh Kubde, Ankita Ramteke, Supriya Parwate

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

Objective: The aim of the study was to assess the knowledge and practice about the management of avulsed teeth with splinting among dentists in central India.

Methodology: A self-administered web-based close-ended questionnaire was conducted among the dentists in central India. The participants comprised of total 219 Dental Health Care Professionals (DHCPs) including General Dental Practitioners (GDPs), Post Graduate Students (PGs), and Specialists. The data were statistically analyzed by the Chi-Square test.

Results: In this survey, among all the participants (61.5%) of GDPs, (87.9%) of PGs, and (95.5%) of Specialists who have knowledge about IADT guidelines regarding the management of avulsed teeth. PGs and Specialists have significantly (p<0.001) better practice for the management of avulsed teeth with splinting than GDPs as they have more traumatic injury cases in practice.

Conclusion: The knowledge level on the management of avulsed teeth with splinting among general dental practitioners in central India needs to be improved. The utilization of International Association of Dental Traumatology guidelines for the management of dental traumatic injury should be recommended to increase the knowledge level and to ensure good treatment outcomes.


  Abstract 411: Cryotherapy: A new paradigm of treatment in endodontics Top


A Lavanya

Dr. Ziauudin Ahmed Dental College, Aligarh, Uttar Pradesh, India

Cryotherapy has been frequently applied in medicine and other fields of dentistry. It refers to decreasing the tissue temperature for therapeutic purposes. The concept of cryotherapy actually does not imply cooling the target tissue but rather extracting heat from the tissue of higher temperature to the subject of lower temperature. It has been primarily used for pain relief in sports injuries, tendonitis, sprains and lower back pain. However, in dentistry, cryotherapy has been used after intraoral excisional surgical procedures, periodontal surgery, and after extractions and implant placement and was found to be effective in reducing swelling and pain. In the field of endodontics, cryotherapy has been reported to be used after periradicular surgeries and during root canal treatment to minimize postoperative pain and inflammation. One important implementation of cryotherapy in endodontics is deep cryotherapy of nickel-titanium (NiTi) endodontic files, which offered enhanced cyclic fatigue resistance, reducing potential file separation. More recently, cryotherapy was successfully tried as a useful adjunct for hemostasis in vital pulp cryotherapy in conjunction with bioceramic materials. The concept of cryotherapy, its mechanism and physiological effect, and different applications of cryotherapy in endodontics are discussed in this review.


  Abstract 412: Assessment of C-reactive protein levels in acute apical abscess due to root canal infection Top


S Pavula

CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India

Acute apical abscess is the most common form of dental abscess and is caused by infection of the root canal of the tooth. Apical abscess may contribute to low grade systemic inflammation associated with a generalized increase in systemic inflammatory mediators such as C-reactive protein (CRP), interleukin (IL)-1, IL-2, IL-6 and Immunoglobulin (IgA, IgG and IgM) levels . Recent studies indicate that apical periodontitis, acute alveolar abscess, and periodontal diseases are associated with elevation of CRP; however, the relationship between periapical abscess and CRP elevation, various treatment modalities and reduction in extra and intra oral swelling, reduction in pain and CRP level are unclear. Objective Aim of this study is to evaluate the serum levels of CRP in patients with acute Periapical abscess before and after Root canal treatment, reduction in extra and intra oral swelling and reduction in pain. Methodology In patients with acute apical abscess C –reactive proteins were evaluated before and after root canal treatment. Incision and drainage was done in whichever case necessary. Intracanal medication was placed. Protaper Gold file was used for biomechanical preparation. PAI score of the corresponding tooth was noted. Pain and swelling reduction after RCT was assessed. Pain was evaluated using visual analogue scale(VAS), regarding swelling reduction patient was asked to evaluate subjectively whether the patient profile has returned to normal after the treatment and they were asked how many days it took for the swelling to resolve completely. Statistical analysis The Normality of variables was derived using Shapiro-Wilks test. As the variables were skewed, Wilcoxon signed rank test was applied to compare mean values between baseline and postoperative CRP levels. Results The present study concluded significant reduction in postoperative CRP levels compared to preop CRP levels after rootcanal treatment for patients with acute periapical abscess.


  Abstract 413: Current trends in the use of irrigant activation techniques among endodontist and general dentists in central India: A knowledge and practice based survey Top


Supriya Parwate, Vandana Kokane, Pratima Shenoi, Rajesh Kubde, Pratik Burad, Pooja Nakate

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

Objective: The objective of this study was to assess the knowledge and practice of Irrigant Activation Techniques among Endodontist and General Dentists in Central India.

Methodology: In this online survey a questionnaire consisting of 14 closed ended questions was distributed among Dental Health Care Professionals including Endodontists and General Dentists. Total 202 Responses were collected through google forms. The questionnaire included questions that are focused on Irrigation activation technique based on the knowledge and practice. Chi square test of proportion was done to assess the difference in proportion of the responses and “unpaired t test” was done to compare between the groups. All statistical analysis was doing using Statistical Packages of Social Science SPSS version 21 and p value less the 0.05 was considered statistically significant.

Results: The usage of irrigation activation technique was more in Endodontists as compared to general dentist. Our data indicated that most of the respondents use sodium hypochlorite (NaOCl) as the primary endodontic irrigant. Most commonly used irrigation activation technique use by participants is manual dynamic agitation . The mean knowledge score was significantly high among Endodontists as compared to the General dentists. (p<0.05)

Conclusion: Irrigation activation techniques improve intracanal cleanliness, has better antimicrobial capacity, tissue dissolving property and smear layer removal therefore, their use is recommended throughout root canal preparation. Vast majority of the Endodontist in Central India use some form of Irrigation activation technique to improve the efficacy of irrigation. Various irrigation devices have been developed to give the effective cleaning and superior debris removal to replace the older needle irrigation method.


  Abstract 414: Caries proportion among diabetic patients under insulin therapy and oral hypoglycemic drugs Top


M Atul Bharath, PG Mahesh

Government Dental College, Kottayam, Kerala, India

Aim: To compare and evaluate caries proportion among diabetic patients under insulin therapy and oral hypoglycemic drugs.

Materials and Methods: A comparative cross sectional study was conducted in the General Medicine out patient division of Government Medical College, Kottayam among 35 – 65 year old adult patients with sample size of 240.120 non diabetic patients were taken as control group; the type II diabetes mellitus group included 60 diabetic patients under insulin therapy and 60 patients under oral hypoglycemic drug therapy. Glycemic status of nondiabetic patients were assessed with glucometer, when no recent reports were available. After getting informed consent, data collection was done using a questionnaire. The dental examination was done using a standard mouth mirror, probe and DMFT score was calculated on each patient; oral hygiene status recorded using OHI-S. Statistical analysis was done by Chi-square test, Independent t-test and ANOVA (one way) test.

Results: Among diabetic patients, patients taking oral hypoglycemic drugs are more caries prone compared to patients under insulin therapy (p-value < 0.05).

Conclusion: Present study results indicate that diabetic patients under oral hypoglycemic drug therapy are at high risk of dental caries. So regular dental visits for diabetic patients under drug therapy are necessary for early detection of dental caries.


  Abstract 415: Guided endodontics – A pocket friendly approach: A case series Top


MR Pradeepa, B Rahul

CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India

Pulp canal obliteration (PCO) is the deposition of hard tissue within the root canal space. It is commonly associated with teeth having a history of trauma . In such cases, if root canal treatment is indicated, the treatment is more challenging compared to a tooth with a patent canal. The access cavity will be difficult to align correctly with loss of pericemental dentin. On the other hand, accessing the apical third of the root during periapical surgery can also be challenging, as it requires precision to reach the apical target without damaging the neighbouring anatomical structures. In cases of calcified canals and endodontic microsurgery, Guided endodontics can deliver more predictable treatment outcomes compared to conventional treatment strategies. It may avoid unnecessary removal of tissue, avoiding complications and therefore, improving the prognosis of treatment. Additive manufacturing, which is more colloquially referred to as 3D printing, is quickly approaching mainstream adoption as a highly flexible processing technique that can be applied to plastic, metal, ceramic, concrete and other building materials. This technology is used in dentistry to make 3D models from the data obtained from CBCT. This presentation of three cases discusses about the use of guided endodontics in the management of pulp canal obliteration in maxillary central incisors and enododontic microsurgeries in an economical way.


  Abstract 416: Confocal laser scanning microscopic evaluation of tubular penetration of MTA fillapex and endosequence bioceramic sealer: An in vitro study Top


Reema Asani

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

Aim: To evaluate and compare the depth of sealer penetration of AH Plus, MTA Fillapex and Endosequence Bioceramic sealer by confocal laser scanning microscopic investigation.

Materials and Methods: 30 maxillary or mandibular single rooted, sound teeth were selected. Samples were decoronated at cementoenamel junction to achieve a standardized root length of 14mm. Access opening and biomechanical preparation was done till #F3. Samples were divided into 3 groups for obturation using following sealers as, Group 1- AH Plus sealer, Group 2 – MTA Fillapex, Group 3- Endosequence Bioceramic sealer. Each tooth was sectioned perpendicular to its long axis in 1-mm-thick sections using a slow-speed handpiece at three different points measuring from the root apex 3, 6, and 9 mm. So three sections were obtained - coronal, middle and apical third of the samples. The depth of sealer penetration into dentinal tubules was calculated using confocal laser scanning microscope.

Statistical Analysis: Was done by using descriptive and inferential statistics using student's unpaired t test, one way ANOVA and Multiple Comparison: Tukey test and software used in the analysis were SPSS 24.0 version and GraphPad Prism 7.0 version and p<0.05 is considered as level of significance.

Results: Significant difference was found in mean depth of penetration between group 1 and group 3 (t=3.05,p=0.007) and no significant difference was found between group 1 and group 2(t=0.2,p=0.7).

Conclusion: The depth of dentinal tubule penetration of sealer appears to be Influenced by the chemical and physical characteristics of the materials. Endosequence Bioceramic sealers displayed deeper and more consistent penetration. MTA Fillapex showed comparable sealer penetration with AH Plus sealer. All the groups showed maximum penetration at coronal third, followed by the middle and apical third.


  Abstract 417: A drop of ink may make a million think!! Top


Mariya Afrin, AS Anusha

Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru, Karnataka, India

The mechanical and biological functions of the body are geometrically controlled by the natural and intricate 3D features of dental and craniofacial tissues. Despite the great need for regenerative strategies, the biomanufacturing methods that are primarily devoted to addressing the regeneration of various dental structures are very limited. For instance, current procedures exclusively rely on evoked bleeding and, the body's own ability to remodel the blood clot in the root canal. The few biofabrication-inspired methods that have been recently proposed are not yet close to being a clinical reality. Conventional biofabrication techniques possess limited reproducibility and versatility in their fabrication procedures because of complex anatomical geometries. Lately, novel 3D bioprinting endowed by the automated deposition process offers high reproducibility and significantly improved control over the architecture of the fabricated tissue constructs. Essentially, bioinks i.e., pre-programmed structures and geometries containing biomaterials and/or living cells, has tremendous potential to address this critical need in regenerative endodontics. These technologies are able to deposit living cells in a layer-by-layer fashion into a desired shape or pattern to produce complex tissue architectures. Recently, the 5D printing technique has been introduced which incorporates 3D printing data with local control composition of the biomimetic materials, and particles distributions to reproduce the real organ response during the physiology studies. Thus, bioprinting strategies have significant potential to improve the efficiency of translating tissue engineering applications into clinical practice. Various 3D printing technologies including microextrusion, inkjet, magnetic levitation, as well as laser and light lithography have been utilized for deposition and patterning of cell-laden bioinks, for precise positioning of cellularized scaffolds on-demand, either embedded in hydrogels or free from scaffold support. Hence, through this review, we aim to gather and share in-depth insights on the bioinks currently employed for regenerative endodontics. In addition, the paper outlines our views on how it impacts future innovations.


  Abstract 418: Rewalling: “Ars clavem” for successful endodontics Top


Merlin Ann Joseph, K Chaitanya

Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India

Aim: The aim of the study was to assess the knowledge, attitude and practice about Pre-Endodontic Buildup among Postgraduates, Academicians and Practitioners who perform root canal treatment in India.

Materials and Methods: A cross sectional online survey was conducted among Postgraduates, Academicians and Private Practitioners who perform root canal treatment in India. About 160 participants enrolled anonymously and their consent was obtained. The information was collected from each participant through structured questionnaires (19 in number) containing answers in the form of multiple choices.

Statistical Analysis: Chi Square Goodness of Fit test was used to compare the distribution in the responses for the study questionnaire by the study participants. The level of significance was set at P<0.05.

Results: The following was inferred from this study:

I. Overall knowledge score towards Pre-endodontic buildup was about 66.3%

II. Knowledge scores significantly differed among Endodontists (89.3%) and Non-endodontists (46.4%)

III. Lower Practice scores among Endodontists and Non endodontists were associated with lack of time while insufficient knowledge was mostly associated with Non endodontists.

Conclusion: The findings of this study suggests that efforts should be made to increase the awareness of Pre-endodontic buildup among Endodontists and Non endodontists to improve their practices and thereby enhance the success of treatment.


  Abstract 419: External cervical resorption: An overview Top


Sayantani Ghosh, Shiv Mantri, Bonny Paul, Kavita Dube

Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India

External cervical resorption (ECR) is an aggressive form of dental hard tissue destruction initiating at the cervical aspect of the root surface, extending apicocoronally and circumferentially inside the dentin. It has an unclear etiology, despite the various case reports and clinical studies that have been conducted so far, exploring ECR. It is relatively uncommon and often misdiagnosed leading to improper management and undesirable outcomes eventually resulting in tooth loss. Over the past two decades, ECR has attracted increased interest. It is partly due to the combination of recent advancements in clinical assessment measures, such as improved radiographic detection with cone-beam computed tomographic imaging, novel micro-CT and histopathological assessment of ECR. This has helped providing additional insights into the nature of the lesion thereby facilitating development and improvement in the existing treatment methods for the condition. This review paper provides an overview of the recent developments pertaining to the etiology, histopathology, predisposing factors, diagnosis and treatment of External Cervical Resorption.


  Abstract 420: Lasers in endodontics: A review Top


Nilopher Sherin

CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India

A laser (Light Amplification by Stimulated Emission of Radiation) is a device which transforms light of various frequencies into a chromatic radiation in the visible, infrared and ultraviolet regions with all the waves in phase capable of mobilizing immense heat and power when focused at close range. Use of lasers within scope of endodontic practice and research has increased significantly in past few years. The frequently used lasers in endodontics are Nd:YAG, Diode laser, Er:YAG, Er Cr:YSGG, He:Ne laser. Laser have been used as coadjuvant treatment in endodontic therapy to improve clinical procedures success rate. The purpose of this review is to summarize the laser application in endodontics such as their use in pulp diagnosis, laser doppler flowmetry, dentinal hypersensitivity, pulp capping, pulpotomy, disinfection of root canals through laser activated irrigation and surgical endodontics. The advantages of laser over currently used conventional methods and techniques are improved disinfection efficacy, more effective root canal cleaning, reduction of permeability, reduction of microleakage and elimination of need to use toxic solvents.


  Abstract 421: Lesions mimicking endodontic radiolucencies of non-endodontic origin Top


Lochan Khullar, Ishani Sengupta

Manipal College of Dental Sciences, Manipal, Karnataka, India

Apical periodontitis lesions generally have an aetiology that is associated with necrosis and infection of the root canal system that manifests itself as the host defense response to microbial challenge. Such lesions are usually identified as radiolucency located at the apex of the teeth on radiographic examinations. These lesions could be chronic (eg, radicular cysts, granulomas, and chronic abscesses) or acute (eg, periradicular abscess or cellulitis) and represent approximately 90% of all periapical lesions. There are lesions of neoplastic sources such as ,cystic lesions of non-endodontic origin like nasopalatine duct cysts and anatomic variations such as a Stafne bone cavity (SBC) that when located in the periapical area of the teeth might radiographically and clinically mimic lesions of endodontic origin, especially when associated with teeth with pulp necrosis or that were previously treated endodontically, leading to misdiagnosis and an ineffective therapeutic protocol. Hence, clinical and radiological aspects as well as analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools to develop a correct diagnosis of endodontic lesions. This narrative review aims to analyse the cases and literature in relation to the lesions located in apical area of teeth with a non-endodontic source mimicking endodontic radiolucencies.


  Abstract 422: Comparative evaluation of degree of post endodontic pain following obturation with cold lateral condensation and thermoplasticized gutta-percha technique: A randomized clinical trial Top


Mandira Gulati

I.T.S Dental College, Greater Noida, Uttar Pradesh, India

Aim: Comparative evaluation of degree of pain post endodontic pain following obturation with cold lateral condensation and thermoplasticized gutta-percha technique.

Materials and Methods: In the present study, thirty molars were included. Case history was recorded. Maxillary and mandibular arch anesthesia was given with 2% lignocaine with 1:80,000 epinephrine local anesthesia . Access cavities were made, Canal orifices were located and canal patency checked with #10 K-file. Coronal and middle third were enlarged with S-X Protaper files. Canal orifices were enlarged with the help of Gates-Glidden drills G1-G3. Determination of working length were made with apex locator and with radiographs. Canals were prepared and shaped using crown down techniques with both manual and rotary instrumentation. During whole instrumentation RC Prep was used as canal lubricant and 2.5% NaOCl as irrigant followed by17% EDTA and final flush with saline. The canals orifices were protected with sterile dry cotton pellet and the access cavities were sealed temporarily with cavit. After one week patients was recalled and the canals were re-opened, and obturation was performed. The root canal fillings were divided into two groups. Group A (n=15) obturation with cold lateral condensation Group B (n=15) obturation with thermoplasticized gutta percha with help of VDW beefill 2 in 1 system. 10-cm visual analogue scale (VAS) was used to record postoperative pain.

Results: The result of visual analogue scale showed that there was more post endodontic pain(PEP) in Cold lateral obturation technique than Thermoplastized GP obturation technique. At 6 hrs Group A had mean value 2.86 whereas Group B had 2.13 which was not significant, but there was significant change (p<0.05) at 12 hrs.

Conclusion: Within the limitation of the study, more post endodontic pain was seen with cold lateral obturation than thermoplasticized obturation. It was seen that females had more PEP than males, symptomatic teeth, teeth diagnosed with apical periodontitis and vital teeth had more PEP.


  Abstract 423: A broad review on arginine and its application in dentistry Top


KV Sangeetha

PSM College of Dental Sciences and Research, Thrissur, Kerala, India

Caries is one of the most common childhood diseases. The disease arises as the result of a complex interaction of many factors. All tooth surfaces are covered with a thin biofilm to which bacteria adhere and mature. As well as substrate in the saliva, the biofilm bacteria may also utilize dietary sugars as a substrate, producing acid, mainly lactic acid. Bacterial activity leads to a drop in the pH, which eventually leads to the dissolution of the hydroxyapatite crystals of the enamel. Arginine is an amino acid that occurs naturally in a range of food products and in the saliva. It is metabolized by arginolytic bacteria which produce ammonia-like substance, which leads to an increase in the pH in the oral biofilm. This thereby counteracts the acidic environment conducive to the growth of acid-resistant bacteria. The ammonia produced by the ADS (Arginine Deiminase System) pathway from arginine helps in reducing caries externally present in saliva. Clinical studies have shown that external supplements of arginine have a profound impact on both non-caries and active caries individuals through ADS activity. Ammonia production from this pathway protects bacteria from lethal acidification, and ATP production provides a source of energy for the cells. The purpose of this literature review is to evaluate the evidence supporting the significance of arginine and its associated mechanism of action, To check its Potential to promote remineralization and decrease dentinal hypersensitivity and to Provide oral health professionals with recommendations for using arginine in clinical practice.


  Abstract 424: Therapeutic effects of curcumin in root canal procedure: A review Top


Pallavi Goel

Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

Endodontic infections are biofilm mediated pathosis. Elimination of this biofilm is essential for successful root canal therapy. But, due to complex structure of the biofilm and anatomic complexities in the root canal, bacteria are resistant to conventional disinfection therapy by sodium hypochlorite. Also, sodium hypochlorite has shown to be cytotoxic and its inability to completely remove the smear layer requires an additional irrigant. Hence, there is a need for a newer irrigant with potential antimicrobial activity and reduced cytotoxicity. Herbal plants and their extracts are considered safe in comparison to synthetic compounds as they lack major side-effects. In this regard, there is relatively little focus on natural medicinal plant extracts. Curcumin, a phytochemical obtained from rhizomes of Curcuma longa shows broad spectrum antimicrobial activity. It is a commonly used spice, colouring and flavouring agent used in South Asian countries. Over the last decade, Curcumin is becoming popular in Endodontics due to its multifunctional effects like antimicrobial, antifungal, antiviral, antiseptic and anti-oxidant properties. Curcumin, a natural photosensitizer also has improved photophysical properties, provides targeted therapy, less cytotoxicity and cost-effective. Several invitro studies are performed which shows Photoactivated curcumin, Curcumin-modified fibers and Nano-curcumin particles to be an effective adjunct in root canal disinfection against resistant gram-positive bacterial species. Recently, Curcumin complexes are proven effective against Candida present in conjugation with these bacterial species in the root canal system. Also, adjunctive Photodynamic therapy with curcumin did not have an impact on the bond strength values of certain sealers to the root dentin. Thus, the aim of this study is to perform a review on the existing literature about Curcumin and its varied applications for root canal therapy.


  Abstract 425: A comparative study on healing outcome in chronic apical periodontitis obturated using bioceramic and zinc oxide eugenol based sealers Top


Anita Abraham

Government Dental College, Kottayam, Kerala, India

Objective: The objective of this study was to compare the incidence of crack formation on root dentin after shaping with four shaping files based on offset shape in cross section, thermal treatment, variable cross - section and slim NiTi wire design.

Materials and Methods: Forty freshly extracted permanent mandibular first premolar teeth were selected. Samples were divided into four groups (n = 10), Group 1 – One-curve (Micro-Mega) Group 2 – TruNatomy (Dentsply Sirona) Group 3 – ProTaper Gold (Dentsply Sirona) Group 4 –. ProTaper Next (Dentsply Sirona) Shaping of pulp space were done for all specimens in each group [Group 1 – with One-Curve, Group 2 -TruNatomy PRIME, Group 3 - up to ProTaper Gold F2, Group 4 – up to ProTaper Next X2] Roots were sectioned horizontally of length 4mm, from coronal, middle and apical third using diamond disc. All slices were then viewed under CBCT.

Statistical Analysis: Chi-square test.

Results: TruNatomy files inflicted less dentinal cracks, followed by one curve, ProTaper Next and ProTaper Gold. Crack formation were more in the apical third when compared to middle and coronal thirds.

Conclusion: All shaping files might inflict dentinal cracks. In this study, single file system induced less dentinal cracks in coronal, middle and apical third of the pulp space than multiple file system.


  Abstract 426: Reattachment of fractured anterior tooth segment: A case report Top


Noopur Mane, Srikurmam Manisha

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

Crown fractures are the most common consequences of traumatic injuries that mainly occur in the anterior teeth, especially maxillary incisors. One of the options for managing coronal tooth fractures when the fragment is available with no or minimal violation of the biological width, is the reattachment of the dental fragment. As the dental bonding technology advances, it is now possible to achieve excellent results with reattachment of dislocated tooth fragments. Furthermore, the use of natural tooth substance eliminates the problems of differential restorative material wear, mismatched shades and difficulty in reproduction of texture and contour. This paper reports a case of a Maxillary Central Incisor with an Ellis Class III fracture, with a mobile tooth fragment. After Endodontic and Periodontic evaluation, the tooth was immediately endodontically treated, and obturation was carried out. This was followed by insertion of pre-fabricated fibre post. Reattachment of the fractured fragment, that was in sound condition, was done using a resin based cement. Final finishing and polishing was carried out of the entire crown structure. A specialized interdisciplinary treatment plan led to the restoration of the original tooth form, function and esthetics.


  Abstract 427: Evaluation of postoperative pain following reciprocating and continuous rotary heat-treated NiTi instrumentation of root canals: A randomized clinical trial Top


CT Valliappan, Melvin Gabriel

CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India

Aim: To evaluate post-operative pain following continuous vs reciprocating rotary motion in maxillary premolars with acute irreversible pulpitis.

Materials and Methods: A total of 180 patients were shown to be sufficient for detecting statistically significant difference with G*Power software 3.1.9.2 (Universtät Kiel, Germany) (effect size-0.3, α error prob – 0.05 and power0.95). After obtaining the institutional ethical committee clearance and registered with ClinicalTrails.gov (NCT04655105) the patient recruitment was initiated. Patient were randomly assigned into four groups, group 1) Truanatomy,2) Hyflex EDM 3) Edge endo (reciprocating motion),4) Protaper gold. Pre-treatment pain were categorized on a 10-point visual analog scale (VAS) with 1- 3 as mild; 4-7 – moderate; and 8-10 – severe pain. Root canal treatment was completed in single appointment, sodium hypochlorite 3 % was used as irrigant and irrigant activation was done with manual dynamic agitation, obturation was done with zoe sealer using single cone obturation technique and GIC entrance filling was given in same appointment. The post-operative pain levels and the need for analgesics were recorded after 24, 48 hrs and 7 days by telephoning each patient to question them. Post-operative pain triggering mechanism was ascertained whether it was spontaneous, or stimulus based. The post-operative pain was evaluated with same 10-point VAS used earlier.

Statistical Analysis: normality of variables was assessed, and pre-op & post-op pain was compared using Kruskal wallis test.

Results: post-operative pain reduction was near significant in reciprocation mode (edge endo file) when compared to other continuous file rotation groups. Regarding post-operative analgesic intake there is significant difference between Tru-anatomy and Edge-Endo group regarding number of dose and need for analgesic intake with least post-operative analgesic intake in the latter.


  Abstract 428: Cyclic fatigue testing of three different NiTi endodontic instruments in simulated curved canals: In vitro study Top


Bezawada Bharath, Kritika Data

Kalka Dental College, Meerut, Uttar Pradesh, India

Aim: Present study was to evaluate and compare the cyclic fatigue resistance of three different types of nickel titanium endodontic (NiTi) rotary files ( Hyflex CM, Hyflex EDM, ProTaper Gold) in simulated Curved (abrupt) canals and Double curved (S-shaped) canals.

Materials and Methods: Sixty rotary nickel titanium instruments were used for analysis in this study. They divided into three groups based on the different cross sections. Three groups were further divided into two sub groups based on radius of curvatures. Ten files were tested in each sub-group. Continuous rotation motion using a X-SMART PLUS motor set at continuous rotation mode with recommended torque control setting and at a constant speed of 500 rpm, 400rpm, 300rpm and 2.5 N.cm torque to obtain the number of cycles to fracture (NCF) for each instrument.

Results: One Way ANOVA and Post Hoc Tukey Analysis to find the difference between the groups. Comparing the cyclic fatigue resistance of three different types of nickel titanium endodontic (NiTi) rotary files Hyflex CM (Group A), Hyflex EDM (Group B), ProTaper Gold (Group C), in single curvature, Hyflex EDM (Group B) is having highest mean +/- SD of 10238.51±556.56 followed by Hyflex CM (Group A) with mean +/-SD of 7689.99±769.41 and ProTaper Gold (Group C)with the mean +/-SD of 3047±2384.15 whereas in double curvature, Hyflex EDM (Group B) is having highest mean and SD of 6148.84±920.48 followed by Hyflex CM (Group A) with 1896.86±339.18 and ProTaper Gold (Group C) with the mean±SD of 1086.21±1491.30.

Conclusion: Hyflex EDM (Group B) exhibited highest cyclic fatigue resistance followed by Hyflex CM (Group A) and ProTaper gold (Group C) NiTi rotary files in both single curvature and double curvature.


  Abstract 429: Current trends and future prospective of vital pulp therapy: A literature review Top


B Kiran, L Awanthi

Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

Dental pulp is a unique connective tissue and is enclosed within mineralized structures of tooth. Embryologically, histologically and functionally the dentin and the pulp are the same, hence referred as “the dentin-pulp complex”. As pulp tissue is enclosed within hard tissues, it has low compliance against trauma such as dental caries, bacteria, restorative materials, which results in frequent removal of pulp for endodontic therapy. Loss of pulp tissue frequently leads to fragility of tooth and eventually deterioration in patient's quality of life. Vital pulp therapy aims in maintaining the vitality of dental pulp and also to stimulate the remaining pulp to regenerate the dentin- pulp complex. Currently the bio-ceramic cements with better biocompatibility and sealing properties, has the ability to chemically stimulate dental pulp for dentinogenesis, and has made vital pulp therapy more predictable. Also, with the advances in pulp biology, novel ideas for preservation and regeneration of dental pulp using new biomaterials which can naturally induce the process of dentinogenesis has been proposed in the literature. Repair of human dental pulp is a complicated cellular and molecular process and various growth factors such as transforming growth factor beta (TGF-b), bone morphogenic proteins (BMPs), insulin-like growth factors, fibroblast growth factor, and platelet derived growth factors, may take part in these processes. Transforming growth factor beta-1 (TGF-b1) is an important factor involved in dental pulp tissue repair by stimulating cell proliferation, cell migration, and type I collagen synthesis, as well as mineralization. Current direct pulp capping is the reaction of dental pulp to the chemical stimulation. But ideal direct pulp capping materials/agents which induce dentinogenesis similar to natural biological process in pulp, can be effective strategies in future. Additionally application of anti-stimuli and/or anti-inflammatory agents i.e., pre-treatment agents in combination with direct pulp capping materials/agents may also be required along with strategies which uses biological markers, has considerable promise in dentin regeneration. This review will focus on current treatment strategies and potential approach for dental pulp preservation.


  Abstract 430: The review of antibiotics during course of endodontic treatment by dentists in India: A comprehensive survey Top


Bharati Lisam

Surendera Dental College and Research Institute, Sri Ganganagar, Rajasthan, India

Aim: To describe an overview of prescribing antibiotics during endodontic treatment based on reports of Indian dentists.

Materials and Methods: A link for an online questionnaire consisting of two parts; the first part including personal information like name, age, designation of endodontontic practice; the second part containing the questions related to decision about antibiotic while treating endodontic infections, was sent to dentists through google form. The data was analysed by applying appropriate statistical tests using SPSS v21.0 software.

Results: A total of 124 members responded to the questionnaire so far. The majority of the participants were general dentists (56.5%) while 4.8% were Endodontists. Majority of respondents (50%) reported duration of antibiotics prescription for 5 days followed by 3 days prescription (41%). Amoxicillin + Clavulanic acid was the first choice of antibiotic for 90.3% of the respondents. For patients allergic to penicillin, 38.7% of respondents prescribed Erythromycin followed by prescription of Cephalosporins by 23.5% of respondents. From the analysis, 30.6% respondents prescribed antibiotics to control spread of infections, and 4.8% respondents for swelling and pain. Study further revealed that dentists (39%) prescribed antibiotics for condition such as pulpitis where it was not indicated.

Conclusion: From this findings, antibiotics are overprescribed for the endodontic infections treatment, reinforcing the need for education regarding the use of antibiotics.


  Abstract 431: Genotoxicity of root canal sealers Top


KM Raihan

PSM College of Dental Science and Research, Thrissur, Kerala, India

Root canal sealers are widely used in endodontics to prevent reinfection and growth of surviving microorganisms. Genotoxicity is defined as toxicity that affects DNA structure, causing DNA lesions. Not all genotoxins act directly on the DNA molecule. Some genotoxins interact with DNA repair proteins, increasing mutation rate, or mitotic spindle proteins, leading to chromosomal misaggregation or even with proteins involved in the cell cycle, increasing the proliferation rate. Genotoxicity is a critical issue in determining the safety of agents that might contact biological structures and should be considered within a biological risk assessment process. Mutagens or genotoxic substances induce DNA damage directly or indirectly through inactivation of enzymes involved in the maintenance of genome integrity. The potential health risks of genetic damage is intimately linked to diseases such as cancer. Dental materials persist in the oral cavity for long periods which imply that risk assessment is required to ensure the safety profile of such materials. Due to the current demand of enhanced clinical performance of dental materials, the number of commercial products is continuously increasing. Physical properties, biocompatibility, sealing ability, adhesion, solubility, and antibacterial efficacy results are abundant for root canal sealers. However, genotoxic stress as a reaction to endodontic sealers is also an important parameter to be assessed to validate the safety of biomaterials in clinical practice.


  Abstract 432: Rise in post covid complications and role of a dentist: A review Top


kasturi Biradar, Ambika Belam

H.K.E'S S. Nijalingappa Institute of Dental Sciences and Research, Gulbarga, Karnataka, India

The COVID-19 pandemic has hit the world in 2019 and since then the global population is widely affected. Changing trends and the unpredictable nature of the coronavirus have made it essential for the health care workers to give attention to the occurrence of newer manifestations for a longer duration of time, post-recovery. Post-Covid complications continue to trouble many, even days after recovering from COVID-19. The available data regarding the short-term and long-term consequences is still insufficient. This review article aims to provide information about the occurrence of newer signs and symptoms, aggravation of pre-existing oral conditions post-recovery, oral manifestations of coexisting systemic complications for early recognition and prevention of severity of the condition. These include serious opportunistic fungal infections such as COVID-19 associated mucormycosis (CAMCR), candidiasis, xerostomia, taste dysfunctions, Herpetic infections, vasculitis, hyperinflammatory response, aphthae like lesions/ulcers and erosions, white/red plaque, erythematous lesions, angina bullosa like lesions. That might be attributed to occur as a consequence of disease, pre-existing systemic conditions, steroid therapy, multidrug-resistant infections, intensive care therapy, overuse of antibiotics, and other invasive and non-invasive protocols for treatment of COVID-19. A dentist's prime role is to look for these manifestations to provide early diagnosis and dental care with a multidisciplinary approach, leading to serious complications if not watched out for.


  Abstract 433: Bond strength and microleakage of nanocomposites: A systematic review Top


Nishmitha N Hegde

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

Objective: For resin–dentin bonding,the depth of demineralization and completeness of monomer infiltration into this calcium-depleted zone are two important factors believed to affect the quality of dentin bond.The present review aims to establish a systematic review to describe the Bond strength and microleakage of Nanocomposite materials to enamel and dentine.

Methods: An electronic search was conducted in PubMed, Scopus, and Google scholar database.The MeSH terms were “ nanocomposites “, “bond strength”,”microleakage”, “enamel”,”dentin”,”polymerisation shrinkage”. The database extracted was limited to the studies published between 2015-2020 and only human extracted teeth in-vitro studies were included. The PRISMA 2010 checklist was used to analyze the studies which were included in the systematic review.

Results: A total of 350 articles were retrieved through an electronic database, out of which 150 were excluded based on its title and abstract. After evaluating the article for its full-text articles,12 studies were included in the systematic review, these articles were then assessed for its risk of bias according to the modified Cochrane risk of bias tool.

Conclusion: It could be concluded that the mechanical properties of nanocomposite are superior to those of traditional composites, nanofiller particles are radically different from filler particles in standard composites may be the explanation for this. In traditional composites, the primary particles tend to assemble into fibrous, low-density structures. Traditional composites' fibrous structure restricts filler loading and causes poor handling. The filler loading in nanocomposites is more consistent and have more compact filler particles, which allows for a greater volume of resin to be added. As a result, the mechanical properties of nanocomposites are found to be superior to those of traditional composites.


  Abstract 434: A novel bio-ceramic healing material for endodontic management: A review Top


Pratheek Shanbhag, Mithra N Hegde

AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Mangalore, Karnataka, India

The review investigated a new bio-ceramic repair material, Bio-C Repair (Angelus, Londrina, PR, Brazil), silicate-based hydraulic cement that is available in a ready-for-use format that does not need to be manipulated, with several clinical applications. Some of the advantages of Bio-C Repair material include its good physical properties and its ability to stimulate tissue regeneration as well as good pulpal response. According to the manufacturer, it exhibits excellent consistency that is easy to be applied, acts as a barrier against microorganisms, stimulates tissue healing, and does not contribute to discoloration. Bio C Repair has cytocompatibility, good biocompatibility, and a bio-mineralization potential that is comparable to Mineral Trioxide Aggregate. This review discusses the availability, composition, properties, and clinical applications of Bio-C Repair Material in Endodontic practice.


  Abstract 435: Redox potential of saliva in dental caries: A systematic review Top


Sannidhi Gothe, Mithra Hegde

AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India

Antioxidants play a vital role in our everyday life. They help in neutralizing or destroying ROS (Reactive Oxygen Species), RNS (Reactive Nitrogen Species) which cause oxidative stress. Oxidative stress is a state in which the free radicals in our body outnumber our antioxidant defences. This oxidative stress can affect the initiation and progression of many inflammatory and infectious diseases including dental caries. Saliva acts as the first-line defence against dental caries. The role of salivary antioxidants has been studied, and it was identified that an imbalance between free radicals and antioxidants in saliva might play a significant role in the onset and progression of dental caries. This paper elaborates on the action of salivary Total Antioxidant Capacity and vitamin C and their levels in dental caries.


  Abstract 436: Influence of irrigation systems on dentinal tubule penetration of bioceramic sealers: A review Top


Sarvesh Ram Logandha, Gowrish S Bhat, Mithra N Hegde

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

Bioceramic sealers gained popularity in the field of endodontics since 2009. Since then, the classic endodontic triad of Clean, Shape and Pack has been strongly accompanied by an additional factor encompassing the sealer material used to obturate the root canal. Bioceramic sealers act by diffusing the sealer particles in to the dentinal tubules to produce mechanical interlocking bonds, establishing a mineral infiltration zone by virtue of their alkalinity through collagen denaturation, formation of Hydroxyapatite along this mineral infiltration zone. The mechanism of action signifies the importance of dentinal tubule penetration of calcium silicate-based materials. On a parallel track, irrigation systems have been improved constantly in order to ensure complete disinfection of the deeper and inaccessible areas of the root canal. Various techniques like the positive pressure and negative pressure irrigation systems have been employed in the field to achieve better disinfection. The current study aims to review the literature available to measure the influence of irrigation systems on the depth of penetration of different bioceramic sealer materials.


  Abstract 437: Ozonated water as an irrigant in disinfecting root canal systems: A systematic review Top


Nihar Shetty, Tony Mathew, Aditya Shetty, Mithra Hegde, Shruthi Attavar

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

Objective: To evaluate the efficacy of ozonated water as an irrigant in the disinfection of the root canal system.

Materials and Methods: The search was carried out on electronic databases PubMed and Google Scholar, ScienceDirect within the last 15 years. The systematic review was conducted according to PRISMA guidelines and methodological studies was assessed through the Cochrane risk of bias tools.

Results: Pinherio et al, ozonated water reduced microbial count by 98.02%. Recai zan et al, aqueous ozone 10ml/min for 4 and 5 mins showed no statistical difference while aqueous ozone 10ml/min for 3 and 5 mins showed the most statistical difference. SEM analysis indicated intertwined bacteria in the dentinal tubules and with 5 mins exposure to aqueous ozone showed fewer bacteria and intertubular surface showed roughness. Zeynep Goztas et al, there was no difference between 2.5% NaOCl and aqueous ozone. Estrella C et al, out of all the groups none of the Irrigants produced any antibacterial effect on E. faecalis over 20 mins contact time within infected root canals. Huth et al, Ozonated water eliminated nearly all E. faecalis, C. albicans as compared to gaseous ozone however none of the irrigants offered complete elimination of the microbial species as compared to NaOCl. Cardoso et al, first sampling revealed ozonated water reduced CFU of E. faecalis and C. albicans when compared to the control group. However, on second sampling, number of microorganisms had increased, also ozonated water had no effect in the neutralization of endotoxins. Hubbezoglu et al, manual irrigation with NaOCl offered 100% reduction of CFU while ozonated water reduced only 91.4 % of the CFU however on ultrasonic activation, the CFU reduced by 100% with both NaOCl and ozonated water.

Conclusion: It could be concluded that ozonated water is not a better disinfe