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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 34 | Issue 1
Page Nos. 1-68

Online since Friday, March 25, 2022

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EDITORIAL  

Endodontology: Change of Guard p. 1
V Gopikrishna
DOI:10.4103/endo.endo_229_21  
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REVIEW ARTICLE Top

Assessment of actual pulp status using pulp sensibility tests and pulp vascularity tests: A systematic review Highly accessed article p. 2
Krishnamachari Janani, Kavalipurapu Venkata Teja, Jerry Jose
DOI:10.4103/endo.endo_56_21  
Pulp vitality plays an important role in endodontic diagnosis as it has an integral role in primary care. In routine practice, the clinicians rely on pulp sensibility tests. Unfortunately, the major drawback with pulp sensibility tests is that these tests rely on the patient's response to pain and it is subjective in nature. Therefore, the actual status of pulp can be assessed by the vascular response of the tooth. The aim of the systematic review is to evaluate the diagnostic accuracy of pulp sensibility test and pulp vascularity test in identifying the actual status of pulp. The databases of PubMed, Medline, Cochrane Database of Systematic Review, Science Direct, and SCOPUS were searched up to January 2021. Only clinical studies assessing the status of pulp with pulp sensibility test and pulp vascularity test were recruited in this systematic review. The studies considered were based on the data extraction and analysis of the studies for the quality and publication bias. The data collection form was customized. The primary outcome measure was assessing the status of pulp sensibility test and pulp vascularity test. Only clinical study articles were recruited for the systematic review. The search identified 120 articles, out of which 13 duplicate articles and 107 articles were screened. Sixty-seven articles were excluded during the initial screening. Forty full-text articles were retrieved to assess for eligibility. Twenty articles were excluded as it did not fulfil the criteria of the research question. Finally, 20 articles were included for the systematic review. From this systematic review, it can be concluded that pulse oximeter and laser Doppler flowmetry accurately assessed the actual pulp status when compared to pulp sensibility test.
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ORIGINAL ARTICLES Top

Sealing ability of mineral trioxide aggregate, Biodentine, and EndoSequence RRM putty used as retrograde restorative material: An in vitro bacterial leakage model study p. 16
Jesmy K Antony, Liza George, Josey Mathew, Aleesha Joy
DOI:10.4103/endo.endo_176_21  
Aim: the present study aimed to evaluate and compare the bacterial sealing ability of ProrootMTA, Biodentine and EndoSequenceRRM putty as retrograde filling material using E-faecalis leakage model over a period of 6weeks. Materials and Method: Forty single rooted human premolar teeth were collected, disinfected and decoronated to a standardized of 16mm. Cleaning and shaping was done up to 40#K-file apical preparation and step back method. The roots were sectioned 3 mm from the apex. Root end cavities were prepared using ultrasonic tips (Woodpecker EMS EndoScaler TipE3D) and restored using the three different materials. Specimens were divided in to four groups with a sample size of n =10. Group 1–ProRootMTA, Group2– Biodentine, Group3– EndoSequenceRRM putty, Group 4-Control without any filling. Specimens were then mounted on the E-faecalis (ATCCstrain29212) bacterial leakage models. The bacterial leakage was assessed by measuring the optical density of the broth at every 7th day for a 6 weeks period. Results: In the baseline reading there was significant difference between all the groups. In the 2nd week, Group1 has got significantly higher values than Group 3 and not with Group 2. In the 3rd, 4th, 5th and 6th weeks, Group1 show significantly higher turbidity values than Group 2 and 3. No significant difference between Group2 and 3. Conclusion: Within limitations of this study it was concluded that, both ESRRMputty and Biodentine have got comparable sealing properties. ProrootMTA has got higher microleakage than others in the 3rd, 4th, 5th and 6th week. The microleakage for ProrootMTA, Biodentine and ESRRM putty was increasing up to the third week following which it is static.
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Comparative evaluation of mineral trioxide aggregate, endoseal, and biodentine in furcation perforation repair: A bacterial leakage study p. 22
Udita Khare Baralay, Srinidhi Surya Raghavendra
DOI:10.4103/endo.endo_199_21  
Objectives: The aim of this study is a comparative evaluation of the sealing ability of mineral trioxide aggregate (MTA) Angelus, pozzolan-based Endoseal MTA, and Biodentine when used as sealing materials for furcation perforation. This was done with a bacterial leakage model. Materials and Method: Sixty-four permanent mandibular molars were selected and horizontally sectioned at middle third of the root. Cavities of 2 mm depth were prepared at the root ends. Access cavities were prepared, and the canal orifices and the root end cavities were restored with light cured resin. Perforations of diameter 1.6 mm were created in the center of the pulpal floor using a round bur in a low-speed handpiece. The teeth were randomly assigned to three experimental groups (n = 20). The perforation sites in Groups 1, 2, and 3 were repaired with MTA Angelus, EndoSeal MTA, and Biodentine, respectively. The teeth were inserted individually in an Eppendorf vial which was then placed in a McCartney's bottle containing nutrient broth. The reservoirs were filled with 0.5 ml of Enterococcus faecalis. The system was incubated at 37°C and checked for appearance of turbidity in the nutrient broth for 30 days, and these findings were noted. Level of significance was fixed at P = 0.05, and statistical analysis was done with Chi-square analysis using IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA). Results: In the time interval of 30 days, all the materials showed contamination to varying degrees (MTA Angelus 8/20 samples, Endoseal MTA 10/20 samples, and Biodentine 7/20 samples). There was no significant difference between the three groups (P > 0.05). Conclusions: MTA Angelus, Endoseal MTA, and Biodentine showed contamination in a 30-day incubation period when used as furcation perforation seal materials.
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Comparative evaluation of the efficacy of diode laser, EndoActivator, passive ultrasonic irrigant, and manual irrigation activation systems in debridement of root canal isthmus: An in vitro study p. 27
Arun Kurian Varghese, SV Satish, Basavana Gowda, Roshan Uthappa, Ashwini M Patil
DOI:10.4103/endo.endo_173_21  
Objective: This study aimed to compare the efficacy of diode laser, EndoActivator, passive ultrasonic irrigation (PUI), and manual dynamic activation (MDA) in the debridement of root canal isthmus using a stereomicroscope. Materials and Methods: A total of 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 ProTaper rotary system up to F2. The samples were randomly divided into five groups (n = 13) used in the study. Group 1: Diode laser (n = 13): samples were irrigated using a diode laser having a wavelength of 980 nm. Group 2: EndoActivator (n = 13): the samples were irrigated using EndoActivator sonic device. Group 3: PUI (n = 13): samples were irrigated using an ultrasonic device. Group 4: MDA (n = 13): samples were irrigated manually by placing a master gutta-percha cone of F2 size. Group 5: Conventional needle irrigation (n = 13): no activation of irrigant. Following irrigant activation, the mesial roots were sectioned 4 mm from the apex and the isthmus cleanliness was observed under a stereomicroscope at ×20. Statistical analysis was done using ANOVA and post hoc Tukey's test. Results: EndoActivator showed the least amount of debris when compared to diode laser, passive ultrasonic irrigant, and MDA. MDA showed more amount of debris at the isthmus level. Conclusion: EndoActivator showed the least amount of debris at the isthmus level of mandibular molars when compared to diode laser, passive ultrasonic irrigant, and MDA.
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Histologic evaluation of dentin bridge formation by pachymic acid and biodentine in human tooth culture model p. 32
Manish Kumar Khazane, Sekar Mahalaxmi, Sampath Vidhya
DOI:10.4103/endo.endo_174_21  
Aim: Pachymic acid (PA) has been shown to induce reparative dentinogenesis at the cellular level. The aim of the present study was to histologically evaluate reparative dentin (RD) formation by Biodentine (BIO) and PA when used as pulp capping agents in entire human tooth culture models under in vitro conditions. Materials and Methods: Forty human maxillary and mandibular premolar or third molar teeth with immature root apices were included in the study. The specimens were randomly allocated to two groups (n = 20) based on the pulp capping material used. In a tooth culture model set up, pulp (approximately 1 mm2) was intentionally exposed and capped respectively with BIO (Group I) or PA (Group II). The capping material was overlaid with a 2 mm thick layer of light cure glass ionomer cement, followed by resin composite restoration. The samples were cultured in a 5% CO2 incubator at 37°C for 45 days, with the culture media being replenished every day. At the end of the incubation period, the samples from both the groups were removed from the model and taken up for histological analysis. Results: PA formed significantly less uniform and less thicker dentin bridge compared to BIO. A mild inflammatory response was seen in PA treated samples. A more uniform odontoblast layer was seen in samples treated with BIO. Conclusion: Though PA has the potential to initiate RD formation, BIO proved to be a superior pulp capping material.
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Pulp chamber floor anatomy of the maxillary first and second molars in an Indian population: A descriptive cross-sectional study using a new classification p. 38
Ajinkya M Pawar, Shishir H Singh
DOI:10.4103/endo.endo_147_21  
Aim: The purpose of the present descriptive study was to evaluate and depict the form of the coronal pulp chamber floor in the permanent maxillary first (pMFM) and second (pMSM) molars in an Indian population. Subjects and Methods: Five hundred freshly extracted pMFM (n = 250) and pMSM (n = 250) were acquired from a pool of freshly extracted teeth unrelated to the current study. The crowns were flattened occlusally till the pulpal anatomy was seen and were photographed using a stereomicroscope at ×4.5 magnification. The number of orifices, shapes of the orifices, incidence of mesiobuccal 2 (MB-2), incidence of discobuccal 2 (DB-2), incidence of palatal 2 (P-2), shape of the access cavity, incidence and shape of isthmus, location of extra orifice, and the shape of the pulp chamber floor according to the Pawar and Singh classification© (K, Y, I, and others) were observed. Statistical Analysis: The level of significance for descriptive and frequency statistics was determined at 5%, with 95% confidence intervals. Results: Three root canal orifices occurred predominantly in 50.4% pMFM and 69.2% pMSM. The root canal orifices in the MB and distobuccal roots were round, whereas palatal orifices were oval. The access cavities were triangular in 51.6% pMFM, 51.2% pMSM, rhomboid shaped in 34.8% pMFM, 20.4% pMSM, and others in 13.6% pMFM and 28.4% pMSM. The extra orifices in pMFM were in MB in 20.8%, distobuccal in 14%, and palatal in 8% roots. For the pMSM, extra orifices were in MB (7.2%), distobuccal (6.4%), and palatal (2.4%) roots. The K, Y, I, and other classification were seen in 18.4%, 55.2%, 12.8%, and 13.6%, respectively, for pMFM and in 3.6%, 61.6%, 23.6%, and 11.6%, respectively, for pMSM. Conclusion: Our study investigated and described the various anatomical patterns of the coronal pulp chamber floor in maxillary molars. The classification applied to the patterns of the pulp chamber floor architecture can help clinicians determine the total number of canals as well as their unique orifice position and better communication.
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Comparison of sealing ability of mineral trioxide aggregate, biodentine with and without bioactive glass as furcation repair materials: An ultraviolet spectrophotometric analysis p. 45
Shaik Afreen Kamal, Roopadevi Garlapati, Nagesh Bolla, Sayesh Vemuri, Bandaru Pydiahnaidu, Yandra Lakshmi Suvarna
DOI:10.4103/endo.endo_116_20  
Aim: The aim of this study was to evaluate the sealing ability of mineral trioxide aggregate (MTA), Biodentine with and without Bioactive glass (BG) as furcation repair materials by ultraviolet (UV) spectrophotometric analysis. Materials and Methods: Forty extracted human maxillary molars (n = 40) were selected and decoronated 3 mm above the cementoenamel junction and 3 mm below it and a defect in furcation was created. The samples were then divided into 4 groups of 10 (n = 10) each, Group I: MTA, Group II: Biodentine, Group III: BG + Biodentine and Group IV: BG + MTA and the defect was treated with respective furcation repair material. All the samples were then immersed in 2% methylene blue solution for 24 h and later stored in 65% nitric acid solution. The solution obtained was subjected to centrifuge at 3500 rpm for 5 min. From this solution, 100 μl of the supernatant was collected, analyzed in UV spectrophotometer at 550 nm with nitric acid as the blank and readings were recorded as absorbance units. Results: All four groups exhibited a significant difference in dye absorbance values (P < 0.01). Group I, i.e., MTA showed the least dye absorbance values when compared with the other three groups. Data were analyzed using one-way analysis of variance and post hoc Tukey tests. The level of statistical significance was set at P < 0.05. Conclusion: Within the limitations of the study, it can be concluded that MTA had superior sealing ability than Biodentine, whereas BG + Biodentine showed better sealing ability when compared with BG + MTA.
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Prevalence of middle mesial canal in the Indian subpopulation of Greater Noida and the related variations in the canal anatomy of mandibular molars using cone-beam computed tomography p. 50
Sana Iqbal, Rohit Kochhar, Manju Kumari
DOI:10.4103/endo.endo_108_21  
Aim: Missed canals are one of the imperative reasons for failure of endodontic treatment of molars. This study aimed to determine the 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 the presence or absence of MMC. Materials and Methods: Previous cone-beam computed tomography (CBCT) scans of mandibular molars from patients were included. The following data were 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 analyzed using the 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 the left side (24.3%) than on the 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 intraorifice distance was inversely related with the presence of MMC. Binary logistic regression was used to determine the possible association between predictor (independent variable) the MB-ML orifice distance and the occurrence of the outcome variable, which was the presence of an MM canal. Conclusion: MMC is a common finding in the population of Greater Noida. Along with the use of CBCT, careful exploration of the pulpal floor between canal orifices is crucial to prevent missing the MMC.
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Comparative evaluation of shaping ability of sequential rotary, single rotary, and single reciprocating file systems in simulated curved canals using cone-beam computed tomography: An in vitro study p. 55
P Senthamil Selvan, RV Aparajitha, A Shafie Ahamed, S Bhavani, G Rajaraman
DOI:10.4103/endo.endo_87_21  
Aim: The purpose of the study was to evaluate and compare canal transportation (CT) and centering ability (CA) between sequential rotary, single rotary, and single reciprocating file systems using cone-beam computed tomography (CBCT) in simulated curved canals. Materials and Methods: Thirty curved root canals simulated in clear resin blocks were divided randomly into three groups – Group I – ProTaper Gold–PTG (Sequential continuous rotation), Group II – One Curve-OC (Single-file continuous rotation), and Group III – WaveOne GOLD-WOGs (Single-file reciprocating motion) Ten samples of each group were positioned in a custom-made dental stone holder and subjected to CBCT scanning with 5 samples at a time at 3 mm, 5 mm, and 7 mm from the apical end before and after instrumentation. The canals were subjected to instrumentation using the files according to the group allotted. The files were used as recommended by the manufacturer and subjected to CBCT scanning. The values of CT and CA were obtained using the formula given by Gambill et al., and statistical analysis was performed. Results: The results showed that within the groups, all groups showed higher mean values of CT and lower CA in apical level followed by middle and coronal level, respectively, and between the groups, the least CT and highest CA exhibited in WOG followed by OC and PTG, respectively. Conclusion: The least CT and highest CA exhibited in WOG (Single-file reciprocation system) followed by OC (Single-file continuous rotation) and PTG (Sequential file system with continuous rotation), respectively.
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Evaluation of antimicrobial action and push-out bond strength and compressive strength using mineral trioxide aggregate and triple antibiotic medicament combination as root-end filling material: A novel in vitro study p. 61
Rahul S Halkai, Raeesunisa Begum, Kiran R Halkai, Kiran Ghatole, Ashwini Hambire, Amaan Ahmed
DOI:10.4103/endo.endo_172_21  
Aim: The study aims to evaluate the antimicrobial properties and push-out bond and compressive strength of mineral trioxide aggregate (MTA) mixed with different ratios of triple antibiotic paste (TAP) against Enterococcus faecalis. Methodology: Antimicrobial effect was evaluated using agar well diffusion method. Materials were divided into three groups. Group 1: MTA, Group 2: MTA + TAP (2:1 ratio), and Group 3: MTA + TAP (1:1 ratio) zone of inhibition were determined after 24 h of incubation at 37°C. To evaluate push-out bond strength, 30 extracted teeth were decoronated to a length of 13 mm, followed by root canal treatment, the root resected at 3 mm from the apex, and root-end cavity was prepared and filled. Cylindrical specimens (n = 10 per group) of size 3 mm × 6 mm were prepared of MTA, MTA plus triple antibiotic 2:1 and 1:1 ratio and tested for compressive strength using Instron Universal testing machine. All the data were statistically analysed using Krusal–Wallis test (P < 0.05). Results: MTA + TAP (1:1 ratio) exhibited highest antimicrobial activity than MTA + TAP (2:1 ratio) and MTA alone. The push-out bond and compressive strength of Group 1 (MTA alone) was better compared to two groups containing MTA in combination with TAP; however, no statistical significant difference was found between the three groups. Conclusion: Combination of TAP with MTA increases the antimicrobial activity against E. faecalis without compromising much of the compressive and push-out bond strength, hence can be advocated for root-end filling.
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CASE REPORT Top

Immune periapical granuloma with Mott cells: Endodontic significance and need for identification p. 66
Uma Vasant Datar, Aarti Mahendra Mahajan, Vishakha Chaudhari, Rahul B Patil
DOI:10.4103/endo.endo_163_21  
Periapical granulomas (PGs) respond well to endodontic treatment. In case of refractory response to the treatment apicectomy and finally, extraction is the treatment of choice. Herein, we present a case of endodontically failed PG with an excessive amount of Mott cells (MCs). MCs are plasma cells with spherical aggregates in their cytoplasm. The extensive accumulation of MCs in a periapical lesion is hitherto underreported and might elucidate the cause of refractory treatment outcomes of certain periapical lesions. The lesion was diagnosed with immune PG with multiple MCs. To the best of our literature search, there have been only two similar reports till date. Additional case reports and long-term follow-up are necessary to understand the nature and significance of such lesions. This article aspires to further the awareness regarding such unique presentation to aid appropriate diagnosis and also highlights the importance of subjecting apicectomy specimen to histopathological examination.
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