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   Table of Contents - Current issue
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July-September 2021
Volume 33 | Issue 3
Page Nos. 119-186

Online since Thursday, September 30, 2021

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EDITORIAL  

Endodontology is now a scopus-indexed journal p. 119
Gopi Krishna
DOI:10.4103/0970-7212.327277  
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ORIGINAL ARTICLES Top

Evaluation of two conservative different treatment protocols for symptomatic proximal deep caries management in molar teeth; an 18-month clinical report Highly accessed article p. 120
I Anand Sherwood, B Divyameena, T Ramyadharshini, V Subashri, Avijit Banerjee
DOI:10.4103/endo.endo_68_20  
Aim: The primary aim of this clinical trial was to observe the clinical success in conservative management of symptomatic deep proximal caries in permanent molar teeth with two treatment pulpotomy with Biodentine and indirect pulp capping with calcium hydroxide. Materials and Methods: A total of 71 patients who reported to department for the management of symptomatic proximal deep carious lesions in molar teeth participated in the trial. Posttreatment clinical success at 18 months was defined as asymptomatic teeth positively responding to cold pulp sensibility test (only in indirect pulp capping) and absence of periapical infection. Chi-squared test and Kaplan–Meier survival analysis were done. Results: Chi-squared test revealed no significant association between pulp status and posttreatment follow-up in both the treatment groups. Kaplan–Meier survival analysis showed mean survival of pulpotomy procedure for moderate and ambiguous pulp as 66.16 and 67.77 weeks, respectively, with no significant difference for two different pulp statuses. In indirect pulp capping procedure, there was significant difference (P = 0.038) (Log-rank Mantel-Cox) between the two pulp status category with moderate pulpitis having mean survival period of 69.27 weeks and ambiguous pulp with 42.83 weeks. Conclusion: Pulpotomy with Biodentine yielded better results than compared to indirect pulp capping.
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Apical debris extrusion of single-file systems in curved canals p. 128
Ecehan Hazar, Olcay Özdemir, Mustafa Murat Koçak, Baran Can Sağlam, Sibel Koçak
DOI:10.4103/endo.endo_105_21  
Objectives: The aim of this study was to compare the apical debris extrusion after using three different single-file systems. Materials and Methods: Mesial roots with curved canals of extracted mandibular molar teeth were randomly divided into three experimental groups according to preparation techniques: the XP-endo Shaper, WaveOne Gold, and One Curve. Previously weighed Eppendorf tubes were used to collect the debris which was placed in a 35°C hot water bath. The weight of the empty tube was subtracted from the final weight after instrumentation and recorded as the amount of extruded debris. The data were analyzed using the Kruskal–Wallis test at a 5% level of significance and compared all groups. Results: XP-endo Shaper presented less debris extrusion than WaveOne Gold and One Curve (P < 0.05). There was no significant difference between the WaveOne Gold and the One Curve files (P > 0.05). Conclusions: All the tested file systems caused debris extrusion. XP-endo Shaper caused less debris extrusion than WaveOne Gold and One Curve files.
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Analysis of root and canal morphologies of maxillary second molars in a South Indian population using cone-beam computed tomography: A retrospective study p. 133
Hannah Rosaline, Arivunithi Kanagasabai, Athira Shaji, Shreya Bose, Sindhu Saeralaathan, Arathi Ganesh
DOI:10.4103/endo.endo_93_21  
Aim: The aim of the present study was to analyze the morphological variations and complexities in root canal systems of the maxillary second molars in South Indian population, using cone beam computed tomography (CBCT). Subjects and Methods: The CBCT images of 500 participants were examined at different slice thickness of 125 micrometers. Root canal systems of the 500 maxillary second molars were analyzed according to Vertucci, HMA Ahmed et al., and Kim et al. classifications in the Indian subpopulation. Statistical Analysis Used: Interobserver variability was analyzed using Kappa statistics. Results: Among the tooth analyzed, 63% had three roots, with a single canal in each root in 65.2% tooth. About 41.8% of the tooth had fusion of mesiobuccal and distobuccal roots. The most commonly found root canal configuration was Type I (65%) according to Vertucci's classification. According to HMA Ahmed et al. classification, 67.9% tooth had the configuration of 327 MB1 DB1 P1/317 MB1 DB1 P1. Nearly 20.8% tooth had MB2 canal. The most common isthmus type was Type II (55.2%) according to Kim's classification, and the prevalence of isthmus was 2–5 mm from the root apex. Conclusions: The number of roots, canals, their configuration, and occurrence of isthmus has not been reported in the South Indian population. The importance of understanding the knowledge of the anatomy of teeth during the treatment of maxillary second molars would contribute to successful endodontic outcomes.
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Microbiologic evaluation of cotton, polytetrafluoroethylene tape, and foam as an endodontic spacer material in permanent premolars and molars: An ex vivo study p. 139
Nidhi Surendra Pisal, Nimisha Chinmay Shah, Meetkumar S Dedania, Namrata Anil Bajpai, Namita Gandhi
DOI:10.4103/endo.endo_127_20  
Aims: Microbiologic evaluation of cotton, polytetrafluoroethylene (PTFE) tape, and foam as an endodontic spacer material in permanent premolars and molars – an ex vivo study. Subjects and Methods: After ethical approval, 72 patients who signed the informed consent form participated in the study. Following access opening and biomechanical preparation, the teeth were randomly assigned to cotton (n = 24), PTFE tape (n = 24), and foam group (n = 24). Samples obtained from the access cavity at baseline (sample one – S1) and after seven days (sample two – S2) were checked for an increase in the microbial load. They were placed on brain-heart infusion agar plates, incubated aerobically for 48 h, and the colony-forming units were calculated. Statistical Analysis: One-way analysis of variance and Tukey's post hoc test were used and a P < 0.05 was considered statistically significant. Results: There was a statistically significant difference in all the three groups concerning baseline and after Seven-day mean values. An intergroup comparison revealed a statistically significant difference in the mean difference values between the cotton and PTFE tape group. Whereas, there was no statistically significant difference in the mean difference values between the cotton and foam and PTFE tape and foam group. Conclusions: Within the limitations of the study, it can be stated that the PTFE tape and foam group performed better than cotton.
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Evaluation and comparison of the apical seal obtained with Biodentine after conditioning of root end with three different solutions using ultraviolet-visible spectrophotometer: An in vitro study p. 144
Sethuparvathi Anitha, Liza George, Josey Mathew, Sinju Paul, Tom Varghese, RV Vineet
DOI:10.4103/endo.endo_119_20  
Aim: The aim of the study is to evaluate and compare the apical seal obtained with Biodentine after conditioning of root end with three different solutions (HEBP, chitosan, and ethylenediaminetetraacetic acid [EDTA]). Materials and Method: Forty-eight maxillary incisors were selected and decoronated. Instrumentation was done with protaper rotary files up to F4 file and obturated with AH plus sealer (Dentsply, Germany) and Protaper gutta-percha cone using lateral condensation technique. The apical part of each root was resected at 90° to the long axis of the root for 3 mm, and retrograde cavity preparation was done in standardized dimensions. The teeth were randomly divided into four groups with 12 samples in each group and later subjected to a standard regimen of 3 ml of respective solutions for 5 min: Group I – 18% HEBP, Group II – 0.2% chitosan, Group III – 17% EDTA, Group IV – saline (control). All teeth were then restored with Biodentine (Septodont, USA). Samples were coated with two coats of nail varnish except in the apical 3 mm which will be immersed in 5 ml of 2% methylene blue dye and stored in incubator for 72 h. The nail varnish will be removed later, and the teeth will be immersed in 35% nitric acid for 72 h. The solutions were then filtered using a fine-grit filter paper and centrifuged at 2000 rpm for 1 min. The solutions thus collected will be used to determine absorbency in ultraviolet-visible spectrophotometer. Results: The mean values of absorbance were greatest for Group IV (saline) followed by Group III (17% EDTA), Group II (0.2% chitosan), and Group I (18% HEBP). Group IV (saline) and Group III (17% EDTA) have got statistically significant difference with all the other groups. Group II has got statistically significant difference with all the other groups except Group I. Conclusion: Within the limitations of the study, it was concluded that irrigation with newer agents significantly influenced the sealing ability of biodentine. Root-end irrigation with 18% HEBP and 0.2% chitosan showed the least microleakage when compared to 17% EDTA.
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Spectrophotometric analysis of crown discoloration induced by various intracanal medicaments: An in vitro study p. 149
Amishi Amit Parikh, DN Nirupama, DN Naveen, J Sindhu, Mohan Thomas Nainan
DOI:10.4103/endo.endo_59_19  
Aim: The aim of the study was to assess discoloration potential of four different intracanal medicaments. Materials and Methods: Thirty single-rooted extracted bovine incisors were sectioned to a standardized root length, accessed, instrumented, and placed with temporary filling and cotton pellet. The specimens were divided into five groups (n = 6): Control group with no intracanal medicament and four groups with the following medicaments, i.e., calcium hydroxide (Ca(OH)2), calcium hydroxide with chlorhexidine (Ca(OH)2 with CHX), triple antibiotic paste (TAP), and silver diamine fluoride (SDF), respectively. Calorimetric evaluation, according to CIE L*a*b* system, was performed at pretreatment, on day 1, 7, 14, and 21. Data were analyzed using One-Way ANOVA and Repeated ANOVA. P <0.05 was considered statistically significant. Results: The greatest color change (ΔE*) was observed at day 21 in TAP group (P < 0.001) followed by SDF group (P < 0.013), whereas Ca(OH)2 and Ca(OH)2 with CHX groups did not induce visible coronal discoloration. Conclusions: Ca(OH)2 and Ca(OH)2 with the CHX groups showed the smallest coronal discoloration during the experimental time, whereas TAP and SDF groups showed the highest coronal discoloration.
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Evaluation of root canal morphology of mandibular premolars using cone-beam computed tomography in Rajasthan subpopulation - A retrospective study p. 153
Neha Mittal, Prachi Mital, Ashwini B Prasad, Deepak Raisingani, Lalita Poonia, Garima Udawat
DOI:10.4103/endo.endo_103_20  
Aim: The purpose of this study was to evaluate root canal morphology in mandibular first and second premolars among Rajasthan subpopulation in Jaipur city using cone-beam computed tomography (CBCT). Materials and Methods: CBCT scans of 740 fully erupted mandibular first and second premolars were taken and assessed by two endodontists. Inter-examiner reliability was determined. Results: The root canal morphology of 380 permanent mandibular first premolars was assessed which showed canal configurations of Type I in 73.5%, Type V in 11.57%, Type IV in 8.42%, Type III in 2.63%, Type II in 2.1%, Type VII in 2.1% and Type VI and VIII 0% of the scans. The root canal morphology of 360 permanent mandibular second premolars was assessed which showed canal configurations of Type I in 88.88%, Type II in 7.77%, Type IV in 2.2%, Type III and Type V in 0.55%, Type VI, VII, VIII in 0% respectively of the scans. Conclusion: The majority of the population in Rajasthan have Vertucci's Type I configuration in both mandibular first and second premolars. However, other canal configurations can also be found in these teeth.
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Evaluation of root canal anatomy of maxillary premolars in a North Indian subpopulation using cone-beam computed tomography p. 158
Sushila Kumari Malik, Rakesh Singla, Gurdeep Singh Gill, Namita Jain, Tarun Kumar, Suraj Arora
DOI:10.4103/endo.endo_128_21  
Aim: The aim of the present study was to investigate the root canal anatomy of maxillary premolars in a North Indian subpopulation using cone-beam computed tomography (CBCT). Materials and Methods: CBCT images of 101 extracted maxillary first and second premolars were analyzed, and data were recorded to determine length of the tooth, number of roots, bifurcation level in double rooted teeth, number of apical foramina, and anatomy of the root canal system. Results: Most maxillary first premolars were double rooted (57.7%), while maxillary second premolars were predominantly single rooted (83.6%). The average length of the maxillary first premolar was 21.6 mm and second premolar was 21.3 mm. All double-rooted maxillary premolars had two canals. Single canal (at apex) was more prevalent in single-rooted maxillary premolars (86% in first premolar and 73% in second premolar). In double-rooted maxillary first premolar, the most prevalent canal type was Type IV (34.6%), followed by Type I (23.1%) and Type V (17.3%), and in maxillary second premolars, the dominant canal morphology was Type II (32.6%), followed by Type IV (22.4%) and Type I (20.4%). Conclusion: In North Indian subpopulation, most maxillary first premolars have double roots with two root canals, while second premolars are predominantly single rooted with single canals. Maxillary premolars can show all types of Vertucci's root canal anatomy with most prevalent being Type IV in double-rooted maxillary first premolars, Type I in single rooted maxillary first premolars, and Type II in maxillary second premolars.
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Comparative evaluation of pull-out bond strength of fiber post using different luting cements in endodontically treated teeth: An in-vitro study p. 165
Neha Singh, Ashima Garg, Rakesh Mittal
DOI:10.4103/endo.endo_7_20  
Aim: This study was aimed to evaluate and compare the pull-out bond strength of fiber post using glass ionomer cement (GIC), resin-modified glass ionomer cements (RMGIC), self-etch adhesive resin cement, and self-adhesive resin cement in endodontically treated teeth. Materials and Methods: Forty single-rooted teeth with single canal were decoronated, endodontically treated, post space were prepared and divided into four groups (n = 10) based on the cement used for luting the fiber post. Group 1: GIC, Group 2: RMGIC, Group 3: Self etch adhesive resin cement, Group 4: Self-adhesive resin cement. Pull-out test was evaluated for the prepared samples. Statistical analysis was performed using analysis of variance and Tukey's test (P = 0.05). Results: The mean pull-out bond strength of Group 4 was statistically higher than Group 1,2 and 3. Group 1 showed the least bond strength among all the groups. Conclusion: Within the limitation of this study, self-adhesive resin cements provide better bond strength of fiber post to root canal compared to self-etch adhesive resin cement and glass ionomer based cements.
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Comparative evaluation of sealing ability of three bioactive obturation materials: A bacterial leakage study p. 170
Meenu G Singla, Sakshi Panghal
DOI:10.4103/endo.endo_90_20  
Aim: The aim of this study was to evaluate and compare the sealing ability of three obturating materials used with single-cone technique: C Point/Endosequence BC sealer, gutta-percha/Endoseal MTA and gutta-percha/GuttaFlow bioseal using bacterial leakage model with Enterococcus faecalis. Materials and Methods: Seventy-six extracted human single-rooted mandibular premolars with straight canals prepared using Hyflex CM up to 45/04 and assigned to 3 experimental groups according to the root canal filling material as Group A - C Point/Endosequence BC sealer; Group B - guttapercha/Endoseal MTA; Group C - guttapercha/GuttaFlow bioseal. Split-chamber bacterial leakage model was prepared and microleakage analysis was made every 24 h for up to 9 weeks. The presence of E. faecalis was confirmed by light microscopy and Gram staining. Results: A survival analysis was performed using Kaplan–Meier plots and a log-rank test and it was found that Group A showed the best apical seal followed by Group C and then Group B at the end of the observational period. The difference in bacterial leakage among Group A and C versus Group B was statistically significant (P < 0.05), but there was no significant difference between Group A and Group C. Conclusion: C Point/Endosequence BC sealer and GP/Guttaflow bioseal sealer has shown better apical seal with single-cone technique as compared to GP/Endoseal MTA.
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Comparison of fracture resistance of endodontically treated mandibular first molars restored with different reinforcing materials with and without cusp capping p. 176
Vaishnavi J Singh, Shivkumar P Mantri, Bonny Paul, Kavita A Dube, Nishikumari Gupta, Sayantani Ghosh
DOI:10.4103/endo.endo_91_21  
Aim: This study aims to estimate and compare the fracture resistance of endodontically treated mandibular first molar restored with reinforced composite resin or cusp capping. Materials and Methods: Seventy-five freshly extracted intact mandibular molars were randomly divided into five groups. The teeth were embedded vertically into the self-cure acrylic lined with elastomeric impression material to a level 1 mm apical to the cement-enamel junction. Group 1 included intact teeth. After access preparation in Groups 2–5, canals were negotiated with 10 K file, cleaned shaped using K3XF NiTi rotary files, 17% Ethylenediaminetetraacetic acid, and 3% sodium hypochlorite. After drying, the canals were obturated with gutta-percha and Sealapex sealer. Group 2 teeth were restored using Cavit. In Groups 3–5, the access cavity floor was lined by resin-modified glass-ionomer cement. After etching, rinsing, and bonding, teeth were restored. Group 3 teeth with everX posterior as a base and 1.5 mm of occlusal nanohybrid composite. Group 4 teeth were restored with nanohybrid composite after bonding Interlig fiber circumferentially in the access cavity. In Group 5, after 2 mm cusp reduction, etching, and bonding, teeth were restored by cusp capping using nanohybrid composite. All specimens were subjected to a fracture test. The peak-load fracture value in Newton was recorded. Results: One-way analysis of variance test for intergroup comparison revealed a statistically significant difference between the groups (P = 0.011). Post hoc Tukey's test showed a significant difference (P = 0.005) between everX posterior and Cavit specimens. The Chi-square test results revealed that there is a significant difference (P = 0.0276) in the fracture pattern between the groups. Conclusion: It is concluded that restoration using short fiber-reinforced composite improved the fracture resistance of endodontically treated mandibular molars. Cusp-capped teeth exhibited more favorable fractures. The combined use of fiber-reinforced composite and capping the cusps using nanohybrid composite could be a viable option to restore molar favorably.
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Tomographic analysis of the apical anatomy of mandibular first and second premolars in central India population p. 182
Ruchi Verma, Suparna Ganguly Saha, Arati Chaudhary, Anuj Bharadwaj, Shrija Paradkar, Sheetal Khandelwal
DOI:10.4103/endo.endo_85_21  
Aim: Aim of the present study was to evaluate the distance of the apical foramen in relation to the anatomical apex of mandibular premolars by Cone Beam Computed Tomography (CBCT) in a selected population of Central India. Objectives: To evaluate and compare the distance between the apical foramen and the anatomic apex of the mandibular first and second premolars of both the sides of mandible and in both the genders in a selected population of Central India. Material and Methods: In this cross-sectional study, screening of total 250 CBCT scans of patients with a minimum age of 20 years, were evaluated and only 170 CBCT images (88 males and 82 females) were considered for the study based on the inclusion criteria. Furthermore, scans were observed in axial, sagittal and coronal planes. Results: Average (±SD) distance from apical foramen to the anatomic apex of first and second premolars in male was 0.61 - 0.62 mm and for females was 0.58 - 0.60 mm. No statistical significant difference was found between right and left quadrant and in males and females. Conclusion: The study demonstrated that minimum 1mm of distance from the anatomic apex in mandibular premolars could be appropriate for root canal therapy.
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