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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 34 | Issue 2
Page Nos. 71-140

Online since Friday, July 1, 2022

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GUEST EDITORIAL  

Endodontic therapy: Stop ringing the alarm; it is time to get out of the building! p. 71
Anil Kishen
DOI:10.4103/endo.endo_159_22  
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REVIEW ARTICLE Top

Revisiting the future of root canal obturation Highly accessed article p. 73
James L Gutmann, Vivian Manjarrés, Catalina Méndez De La Espriella
DOI:10.4103/endo.endo_142_22  
The techniques for root canal obturation have undergone several changes in the last 10 years. While warm vertical compaction had been the major method of filling the canal, which included the use of core carriers made of structurally stable gutta-percha, recent developments in the manufacturing of precision-tapered, gutta-percha cones and the use of bioceramic root canal sealers have become the clinician's choice in the past few years. The impact of these revolutionary changes is explored with open ended questions and challenges for the reader.
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ORIGINAL ARTICLES Top

Cytotoxicity of two different intercanal medicaments on human gingival fibroblasts - A Laboratory study p. 76
Behnaz Barakatein, Alireza Farhad, Elham Shadmehr, Hamidreza Mohammad Sharifi, Masoud Mohammadi Hamidreza Mohamad Sharif, Amin Davoudi
DOI:10.4103/endo.endo_107_20  
Aim: Intracanal medicaments are often recommended during endodontic sessions to eliminate the necrotic debris and microorganisms. The aim of the present study was to observe the cytotoxicity of calcium hydroxide (CH) and colchicine (COL), at different concentrations, on human gingival fibroblast cells. Materials and Methods: Human gingival fibroblasts were cultured on plastic flasks containing RPMI 1640 media and fetal calf serum 10% supplemented with antibiotic agents. Trypsin/ethylenediaminetetraacetic acid 0.2% enzyme was used to isolate the cells, and the suspension was transferred to tubes for centrifuging. Conventional CH and COL were separately mixed with sterile saline solution to prepare a stock media. By serial dilution of stock media, desired concentrations were prepared at 2, 1.75, 1.5, and 1.25 mg/ml, separately. After considering a control group, the cells were exposed to test materials. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was conducted at 24 h, 72 h, and 7 days later. Optical density (OD) was evaluated to attain cell viability percentage. Finally, the recorded data were analyzed by Kruskal–Wallis and Mann–Whitney tests using SPSS software version 19 at a significant level of 0.05. Results: The highest (1.40 ± 0.66) and lowest (0.15 ± 0.00) ODs were observed in CH 1.25 mg/ml and COL 1.5 mg/ml after 72 h, respectively. All of the concentrations of both CH and COL showed significant OD differences with the control group (all P = 0.001). Conclusion: Both CH and COL manifested similar cytotoxicity on human gingival fibroblast cells.
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Quantitative evaluation of apically extruded debris during root canal preparation with reciprocating single file system, continuous rotary multiple file system and manual technique: An in vitro study p. 80
Pratima Mohana, Dax Abraham, Alka Gurawa, Alpa Gupta, Parul Chauhan, Arundeep Singh, Sucheta Jala
DOI:10.4103/endo.endo_167_21  
Aim: The aim of the study is to evaluate and compare the quantity of apical debris extrusion from the root canals during biomechanical preparation by various rotary (reciprocating, Protaper Next [PTN] continuous) and manual hand filing system and by means of Crown-Down and Step Back techniques. Materials and Methods: Eighty mature, human mandibular premolars with single canals were randomly divided into four groups of twenty teeth each. Each group was instrumented using one of the four instrumentation systems: Group A: WaveOne, Group B: PTN, Group C: Hand file with Crown Down, Group D: Hand file with Step Back. Extruded debris was collected in preweighed Eppendorf tubes and the extruded irrigant was evaporated. The weight of the dry extruded debris was established by comparing the pre and post-instrumentation weight of Eppendorf tubes for each group. Results: Mean comparison of groups in different instrumentation by ANOVA presented that hand file with Step-Back technique is showed maximum amount of apical extrusion debris and continuous rotary file system showed the minimum amount of extrusion debris (P < 0.001). Conclusions: The current ex vivo study demonstrated reciprocating single file WaveOne and continuous rotary multiple file system lead to significantly less debris extrusion than manual hand file techniques. Reciprocating single file WaveOne extruded more debris than continuous rotary PTN multiple file system. More amount of debris was extruded in the group with Step-Back hand filing than Crown-Down technique.
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Confocal laser scanning microscopic evaluation of sealing ability of bone cement, mineral trioxide aggregate and biodentine as root-end filling materials: An in vitro study p. 86
Shalin Ann Saji, Tony Mathew, Aditya Shetty, Gurmeen Kaur, Sunheri Bajpe
DOI:10.4103/endo.endo_203_21  
Aim: To compare the sealing ability of polymethylmethacrylate (PMMA) bone cement, mineral trioxide aggregate (MTA), and Biodentine as root-end filling materials by assessing the degree of microleakage through confocal laser scanning microscopy. Materials and Methods: Thirty extracted maxillary incisors were root canal treated using the rotary ProTaper system. Apical root resections followed by retrograde cavity preparation were done. The teeth were divided into three groups and filled with the 3 tested materials (PMMA bone cement, MTA, and Biodentine). Samples were coated with nail varnish, immersed in 0.5% aqueous solution of rhodamine B dye for 24 h, and rinsed with water to remove excess dye. Samples were horizontally sectioned at 1 mm intervals into three using a diamond disk and were labeled A, B, and C and considered first, second, and third, respectively, based on their distance from the apex. Each slice was divided into four equal parts and evaluated using a confocal laser scanning microscope. Dye penetration was scored based on the amount of microleakage. The data were analyzed using one-way analysis of variance. Results: Intergroup comparison of the mean scores of dye penetration among the three materials showed that there is a statistical difference between PMMA bone cement, MTA, and Biodentine, in sections B and C (P ≤ 0.05). The three groups showed no statistical difference in dye penetration scores in section A. Conclusion: The microleakage is least with PMMA bone cement followed by Biodentine and MTA. Microleakage was least in section C followed by sections B and A.
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Proximity of the mandibular anterior root apices to the buccal bone surface: A cone-beam computed tomographic study p. 91
Isha Gupta, Neeta Shetty, Junaid Ahmed, Kundabala Mala, Srikant Natarajan, Neetha J Shetty
DOI:10.4103/endo.endo_183_21  
Aim: The aim of this study is to evaluate the distance from the buccal cortical bone surface to the root apex in the anterior mandibular teeth using cone-beam computed tomography (CBCT) and to correlate it to various associated factors (tooth type, gender, and age). Materials and Methods: CBCT images of mandibular anterior teeth from 120 patient records with a sample size of 360 teeth were analyzed. The distance from the buccal bone surface to root apex and 3 mm above the root apex in the sagittal view was reconstructed using the Romexis software version 3.2.1. Results: Distances from the buccal cortical bone surface to the apices of the root and 3 mm from the apex of the root were greater at the mandibular canine region than the central and lateral incisor (P < 0.001). The buccal bone was significantly thicker corresponding to the apices of the teeth compared to the region 3 mm from the apex (P < 0.001) The mean distance value from the cortical buccal bone surface to the lateral incisor apex (4.03 mm) was significant more among females (P = 0.006). Furthermore, the measured distance at the root apex and 3 mm above the of the root apex of the mandibular anterior roots were significantly more in patients below the age of 40 years (P < 0.05). Conclusion: The distance from the buccal bone's surface to the apex and 3 mm from the apex in the mandibular anterior region is significantly affected by the tooth type and patients' age. CBCT is a reliable tool for presurgical evaluation for both these parameters during endodontic surgeries and implant placement.
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A comparative evaluation of retrievability of three different obturating systems using protaper universal rotary retreatment files: An in vitro cone-beam computed tomography analysis p. 96
Shrija Paradkar, Khushboo Goyal, Suparna Ganguly Saha, Anuj Bhardwaj, Mainak Kanti Saha, Amit Singh Nirwan
DOI:10.4103/endo.endo_152_20  
Aim: The aim of this in-vitro study was to comparatively evaluate the ease of retreatment in canals, obturated through GuttaFlow 2, GuttaCore, and conventional Lateral compaction technique using ProTaper Universal Retreatment (PTUR) Files. Materials and Methods: Sixty single-rooted mandibular premolars were selected and the canals were instrumented with ProTaper Universal rotary files up to size #F3. Samples were randomly divided into three experimental groups of 20 teeth each and obturated using three different obturating systems (GROUP I-Lateral compaction technique, GROUP II-GuttaFlow 2, GROUP III-GuttaCore). All the groups underwent cone-beam computed tomography (CBCT) analysis following which retrieval of the previous root canal filling was done using the PTUR files. Post retreatment CBCT images were used to assess the amount of remaining obturating material at varying depths (3 mm, 6 mm, and 12 mm) for all three groups. Statistical analysis was performed using repeated measures analysis of variance and ANOVA. Results: Irrespective of the obturating system used, filling material could not be removed completely from the root canal walls. Significantly more amount of obturating material was observed in the apical third than the middle third and coronal third of the root canal space (P < 0.05). When comparing the groups, the maximum percentage of remaining obturating material was seen in Group III (GuttaCore) followed by Group I (lateral compaction), with the least being observed in Group II (GuttaFlow2). Conclusion: The GuttaCore technique utilizing carrier-based gutta-percha had the maximum amount of remaining obturating material after retreatment when compared to the GuttaFlow2 and Lateral Compaction techniques.
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Antimicrobial efficacy of commercially available ozonated olive oil and sodium hypochlorite with and without ultrasonic activation in primary endodontic infections: A randomized clinical trial p. 102
Rakesh Mittal, Monika Tandan, Garima Kaushik
DOI:10.4103/endo.endo_57_21  
Aim: This study compared the antimicrobial efficacy of commercially available ozonated olive oil and sodium hypochlorite (NaOCl) with and without ultrasonic activation in primary endodontic infections. Materials and Methods: Fifty-six patients fulfilling the inclusion criteria were selected and randomly assigned to four groups (n = 14) according to the irrigant and irrigation technique employed during biomechanical preparation. Group 1: NaOCl, Group 2: NaOCl with passive ultrasonic irrigation (PUI), Group 3-Ozonated olive oil, and Group 4-Ozonated olive oil with PUI. Bacteriological samples were taken from the canals before (S1) and after (S2) preparation using sterile paper points. Microbiological samples (S1, S2) were incubated and plated on Brain Heart Infusion agar. Colonies were counted after 24 h using the classic bacterial counting method. Collected data were statistically analyzed. Results: Statistically significant reduction (P < 0.05) of bacterial counts was found from S1 to S2 in all four experimental groups. The mean percentage reduction of bacterial counts of Group 1 and Group 3 was found to be lower than that of Group 2 and Group 4. The highest mean percentage bacterial reduction was seen in Group 2 (P < 0.05). Conclusion: PUI significantly enhanced the antimicrobial activity of the experimental groups and ozonated olive oil can be used as an adjunctive irrigant in primary endodontic infections. The antibacterial activity of ozonated olive oil with PUI was found to be comparable with that of NaOCl with PUI.
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Antimicrobial efficacy of photosensitized nanoparticles, diode laser, conventional, and sonic irrigation systems against enterococcus faecalis in root canals – An in vitro study p. 108
Ananya Sharma, Rohit Kochhar, Manju Kumari
DOI:10.4103/endo.endo_38_21  
Aim: This study aims to evaluate and compare the antimicrobial effect of Photosensitized Nanoparticles, Diode Laser (DL), and Conventional and Sonic Irrigation Systems against Enterococcus faecalis in root canals – An in vitro Study. Materials and Methods: The root canals of 104 extracted human single-rooted teeth were prepared, and E. faecalis was incubated in the root canals for 1 week. The teeth were randomly divided into four experimental groups and one control group (n = 20): No treatment was done, sodium hypochloride (NaOCl) group (n = 20): Canals irrigated with5 ml of 2.5% NaOCl for 60 s, NaOCl and Endoactivator group (n = 20): Canals irrigated with 5 ml of 2.5% NaOCl for 60 s followed by activation of NaOCl with Endoactivator for 30 s, NaOCl and 910 nm DL group (n = 20): (1 W 5 times for 5 s) canals irrigation with5 ml of 2.5% NaOCl for 60 s followed by Photodynamic Therapy (PDT) with 910 nm DL, silver nanoparticles (AgNPs)/Indocyanine green (ICG)/DL group (n = 20): DL modified PDT with 5 min of irrigation with 5 mL AgNPs (100 ppm)/ICG/910 nm DL (200 mW, 30 s). A reduction in colony count was assessed by counting colony-forming units by Digital Colony Counter. Results: Significant reductions were noted in E. faecalis colony counts in all groups (P < 0.05). The greatest reduction in colony count (99.93%) was noted in the NaOCl and DL group followed by NaOCl and Endoactivator group; however, the differences in this respect between the AN/ICG/DL group and NaOCl group were not significant (P > 0.05). Conclusions: NaOCl and 910 nm DL were more successful in reducing the number of E. faecalis colony counts followed by NaOCl and Endoactivator group but it can also be concluded that PDT with ICG, an 910 nm DL, and AgNPs has the potential to be used as an adjunct for disinfection of the root canal system.
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Biomechanical stress analysis of ceramic and indirect hybrid composite endocrowns: A three-dimensional finite element analysis p. 115
Beji Vijayakumar Joshna, Manigandan Kuzhanchinathan, Lakshmi Balaji
DOI:10.4103/endo.endo_156_21  
Aim: The purpose of this study was to compare equivalent stresses in mandibular first molar restored with endocrowns made of ceramic and indirect composites using three-dimensional (3D)-finite element analysis (FEA). Materials and Methods: Two 3D finite element models of mandibular first molar were designed. One model of intact tooth without any restoration was uses as a control. Another mandibular molar model with endocrown as postendodontic restoration was generated where the tooth was simulated with extensive coronal loss and divided into five groups with different materials such as lithium disilicate, zirconia, feldspathic, resin nanoceramic, and polymer infiltrated ceramic network (PICN). An axial loading force of 300 N at five diverse contacts areas was applied on the occlusal surface. Stress distribution at various regions of tooth, concentrating mainly on root dentin and alveolar bone, was measured using the Von Mises stress criteria by FEA software. Results: The lowest stress concentration in root dentin was seen in the cervical root region of resin nanoceramic endocrown group followed by PICN endocrown, feldspathic ceramic endocrown, intact tooth, zirconia endocrown, and lithium disilicate endocrown. In alveolar bone, the result showed that the lowest stress value was seen in resin nanoceramic endocrown, followed by PICN endocrown, zirconia endocrown, feldspathic endocrown, intact tooth, and lithium disilicate endocrown. Conclusion: Endocrown materials with the modulus of elasticity similar to that of dentin showed better stress distribution than the materials with high modulus of elasticity.
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Cone-beam computed tomography assessment of root canal transportation and evaluation of canal centering using Protaper Gold, XP Endoshaper, and Edgefile X7 p. 121
Tushar Kanti Majumdar, Minakshi Chowdhury, Sayantan Mukherjee, Paromita Mazumdar
DOI:10.4103/endo.endo_146_21  
Aim: This study aims to access and evaluate canal transportation and canal centering ability of Protaper Gold (PTG), XP EndoShaper (XPS) and EdgeFile X7 using cone-beam computed tomography (CBCT). Materials and Methods: Sixty freshly extracted single-rooted premolars with mature apex and a canal curvature of 10°–20° were chosen and arbitrarily divided into three experimental groups (n = 20). After decoronation, the teeth measuring 16 mm were included in the study for standardization. According to the manufacturer's instructions, canals were shaped with PTG in Group 1, XPS in Group 2 and EdgeFile X7 in Group 3. For the evaluation of the root canal transportation at 2 mm, 4 mm, and 6 mm from the apex, canals were scanned before and after instrumentation using CBCT scanner. Independent t-tests and one-way ANOVA were used to analyze data and significance level was set at P < 0.05. Results: XPS showed significantly lower canal transportation than PTG system. Moreover, the centering ability of the XPS significantly higher than EdgeFile X7 and PTG at all root levels (P < 0.05). Conclusion: The XPS and EdgeFile X7 rotary file system showed the lowest transportation in both mesiodistal and buccolingual directions and also the highest centering ability. The PTG file showed the highest transportation and lowest centering ability.
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Evaluation of shear bond strength of e-mineral trioxide aggregate and biodentine with glass ionomer cement: An in vitro study p. 127
Hemalatha Hiremath, Aishwarya Singh Solanki, Shivangi Trivedi, Devansh Verma
DOI:10.4103/endo.endo_17_22  
Aim: The aim of this study was to evaluate the shear bond strength of glass ionomer cement (GIC) with e-mineral trioxide aggregate (MTA) and Biodentine when placed immediately and after initial set. Materials and Methodology: Forty acrylic blocks with 2-mm height and 5-mm diameter central holes were prepared and randomly divided into two equal groups (n = 20). Group A (n = 20) and Group B (n = 20) were filled with E-MTA and Biodentine, respectively. These groups (n = 20) were further divided into two subgroups each; subgroup A1 (n = 10) and A2 (n = 10) were the placement of GIC immediately over freshly mixed e-MTA and after initial set e-MTA, respectively, subgroup B1 (n = 10) and B2 (n = 10) were the placement of GIC immediately over freshly mixed Biodentine and after initial set Biodentine, respectively. All the samples were later subjected to UTM for shear bond strength test. Results: The highest shear bond strength was recorded with subgroup B1 were the placement of GIC immediately over freshly mixed Biodentine, i. e., (18.72 MPa) and lowest with subgroup A2 placement of GIC after initial set MTA (5.96MPa). The shear bond strength of GIC condensed over freshly mixed e-MTA (subgroup A1) shows higher mean value then after initial set MTA (subgroup A2); however, SBS was highest in the placement of GIC immediately over freshly mixed Biodentine (subgroup B1). Conclusion: Within the limitation of this in vitro study, it can be concluded that freshly mixed Biodentine can be restored immediately with GIC.
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CASE REPORTS Top

Guided endodontics: Management of calcified tooth with a large periapical lesion using cone beam computed tomography and three-dimensional printed guide: A case report p. 131
Anciya Mohamed Nazar, Liza George, Josey Mathew
DOI:10.4103/endo.endo_84_21  
The aim of this case report is to depict novel guided endodontic approach for the management of calcified tooth with a large periapical lesion using cone beam computed tomography (CBCT) and three-dimensional (3D) printed guide. The patient presented with swelling on the upper left front tooth region. Intraoral periapical radiograph revealed periapical radiolucency associated with upper left lateral incisor. Due to pulp canal calcification, location of the root canal was judged to be difficult and associated with a high risk of perforation. A CBCT and an intraoral surface scan were performed and matched using software for virtual planning of guided endodontics. After planning the position of the drill for root canal location, a virtual template was designed and 3D printed which was then used for guided endodontic access.
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Management of an anomalous maxillary lateral incisor fused with a supernumerary tooth and a coronal dens invaginatus p. 137
Lalit Kumar Likhyani, Monika Choudhary, Suneet Khandelwal, Yohan Chacko
DOI:10.4103/endo.endo_197_21  
An abnormal union of two or more tooth germs in the development process results in fusion of teeth. Such clinical situations present a diagnostic dilemma and a challenge in treatment planning. This article reports the endodontic and esthetic management of an atypical permanent maxillary lateral incisor fused with a supernumerary tooth and a coronal dens invaginatus. A 22-year-old female reported an abnormally large and discolored permanent maxillary left lateral incisor (#22). Cone-beam computed tomographic evaluation revealed a complex, labiolingually thin ribbon-shaped canal system in the central portion interconnected with two other canals along with a coronal dens invaginatus. A 2-year follow-up demonstrated satisfactory clinical and radiographic outcomes after the endodontic therapy and a veneer placement on the concerned tooth.
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