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   Table of Contents - Current issue
Oct-Dec 2022
Volume 34 | Issue 4
Page Nos. 221-309

Online since Wednesday, December 28, 2022

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Authorship ethics - An enigma! Highly accessed article p. 221
Nandini Suresh
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Effect of calcium hydroxide on fracture resistance and microhardness of dentin in human teeth: A systematic review Highly accessed article p. 223
Simar Sethi, Alpa Gupta, Ansy Hanna Kurian, Dax Abraham, Parul Chauhan, Kritika Aneja, Sucheta Jala, Arundeep Singh
Aim: Calcium hydroxide to date is a widely used intracanal medicament during endodontic treatment. Long duration of exposure of dentin to calcium hydroxide may influence the fracture resistance and microhardness of dentin thereby affecting the tooth. The aim of this review was to identify and systematically analyze the effect of calcium hydroxide on fracture resistance and microhardness of dentin in human teeth. Methods: A PubMed and Scopus search was performed using keywords 'fracture resistance' and 'microhardness' along with Medical Subject Heading (MeSH) terms 'Calcium hydroxide' and 'dentin' and 'tooth' till 12th March 2022. 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. Only articles written in English language were included in this systematic review. The review was conducted according to the PRISMA checklist. Results: Ten in-vitro studies that fulfilled the inclusion criteria were included in this review. The findings of majority of studies showed that an exposure duration of more than one month to calcium hydroxide decreased the fracture resistance and microhardness of dentin thereby affecting the strength of the tooth. Further, one 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 increased duration of exposure of dentin to calcium hydroxide negatively affects the fracture resistance and microhardness, thereby weakening the tooth.
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The effect of cinnamon and ginger essential oils against Enterococcus faecalis biofilm: An in vitro feasibility study Highly accessed article p. 229
Carla Yvonne Falcon, Sally Abdelkarim, Paul A Falcon, Craig S Hirschberg, Carla Cugini
Aim: Enterococcus faecalis has gained attention in the endodontic literature as it is frequently isolated from root canals in cases of failed treatments. Current medicaments are unlikely to predictably achieve a bacteria-free root canal system, which can lead to these failures. Phytotherapeutic substances are attractive medicaments as they are generally safe and well tolerated. This study evaluated the antimicrobial potential of two phytotherapeutic agents, cinnamon and ginger oils, against in vitro preformed biofilms of an oral strain of E. faecalis. Methods: A biofilm of E. faecalis was grown in 96-well plate under anaerobic conditions to simulate root canal conditions during reinfection. The biofilms were treated with 1% cinnamon oil in brain–heart infusion (BHI) media or saline, which were compared to the widely used medicament, calcium hydroxide, under the same conditions. A 2,3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-([phenylamino] carbonyl)-2H-tetrazolium hydroxide assay was employed for measuring cell viability. All tests were performed with a minimum of five technical replicates and in biological triplicate. A single biological trial was also conducted using 1% ginger oil following the same protocol. Data were analyzed using Kruskal–Wallis and Student's t-tests. Results: Cinnamon oil demonstrated antimicrobial activity in the eradication of E. faecalis biofilm. A statistically significant difference was detected between 1% cinnamon oil and 0.1% calcium hydroxide (P < 0.05). Ginger oil also displayed a reduction of the biofilm. Both oils showed a significant difference between BHI and saline conditions (P < 0.05), in which the biofilm reduction was maximized in saline. Conclusion: Cinnamon oil may provide a potential adjunctive therapy in treating endodontic infections associated with E. faecalis.
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Comparative evaluation of efficacy of XP Endo Finisher, sonic, and ultrasonic irrigation in removal of calcium hydroxide and subsequent adaptation of gutta percha in simulated internal resorption cavity - An in vitro study p. 236
Sonali Taneja, Pragya Kumar, Akriti Dheer
Aim: The study aims to comparatively evaluate various irrigating techniques in removing calcium hydroxide (CH, aqueous/silicon oil based) from simulated internal resorptive cavity and subsequent adaptability of thermoplasticized gutta percha (GP) to root canal walls. Methods: One hundred and sixty extracted human mandibular second premolars with single root were chemomechanically prepared to a size F3 (size 30, 6% taper). Standardized internal root resorption cavities were prepared, and samples were randomly divided into two main groups (n = 80) according to type of CH medicament used: Group I - silicon oil based (Metapex) and Group II - aqueous based (RC Cal) and four subgroups (n = 20) according to the technique used for removal of CH: Subgroup A - passive ultrasonic irrigation, Subgroup B - XP Endo Finisher (XP), Subgroup C - sonic irrigation, Subgroup D - conventional syringe irrigation. Half of the samples were evaluated for the quantity of remaining CH and the remaining half were evaluated for the adaptability of thermoplasticized GP under a stereomicroscope. The statistical analysis of the obtained scores was done using a nonparametric test, Kruskal–Wallis test, followed by Mann–Whitney U-test. Results: XP showed maximum removal of CH and adaptation of GP in both the groups. Adaptability of GP to the dentinal wall was better in Group II than in Group I. Conclusions: Complete removal of CH (both formulations) was not possible with either of the experimental irrigation techniques from simulated internal root resorptive defects.
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Evaluation of irrigant flow in the root canal isthmus region using a computational fluid dynamics model p. 242
Anchu Rachel Thomas, Dhanasekaran Sihivahanan, Ranjith Kumar Sivarajan
Aim: The aim of this study was to evaluate the irrigation dynamics of irrigant delivery systems and irrigating solutions in the root canal isthmus region of a mandibular premolar using computational fluid dynamics (CFD). Methods: A CFD model of the mandibular premolar with the root canal isthmus was created using scanned microcomputed tomography images. Using this CFD model, the irrigant flow in the root canal isthmus region was visualized. The irrigation dynamics of three irrigant delivery systems – Group 1: syringe irrigation (open-ended), Group 2: EndoVac irrigation system, and Group 3: modified EndoVac system were studied and compared to assess the efficiency. Following which, the wall shear stress, streamline of irrigant in the isthmus region, and irrigant velocity were evaluated. Results: Group 1 (open-ended needle) presented with the highest wall shear stress as compared to other groups, restricted to the apical third. All groups exhibited maximum velocity at the region of irrigant exit followed by a gradual decline in the isthmus and coronal region. It was observed that only Group III (Modified EndoVac) displayed a flow of irrigant in the isthmus region. Conclusions: The modified EndoVac system was efficient in delivering the irrigating solutions to the isthmus region.
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Auto irrigate - The continuous irrigant delivery and intracanal aspiration system p. 248
Ridyumna Garain, Veena S Pai, GR Krishnakumar, M Bharathi, B Vedavathi, Jibin Karim
Aims: To compare the delivery of irrigant to the apical third of the root canals using an ingeniously designed continuous irrigation and intracanal aspiration system to standard irrigation techniques. Methods: Sixty-six freshly extracted single-rooted mandibular second premolars of similar dimensions with a single straight canal, confirmed radiographically, were selected and divided into three groups (n = 22) based on irrigation techniques employed: (i) manual dynamic activation, (ii) passive ultrasonic activation, and (iii) the system designed by the authors. Standard oval-shaped access cavities were prepared and the working length was determined radiographically. Instrumentation with ProTaper F2 rotary files was followed by irrigation with 2.5% NaOCl and saline using a 2.5 ml syringe and needle for Groups 1 and 2, and the irrigant delivery system for Group 3. A prefinal rinse with EDTA and a final rinse with saline was also carried out. Apical delivery of irrigant was evaluated by flooding the root canals with 1% toluidine blue dye for 30 seconds. The specimens were decoronated and split vertically and labiolingually and visualized under a stereomicroscope (×5 magnification) and photographed. The images were analyzed using ImageJ software to measure the unstained apical region. One-way ANOVA with Tukey's post hoc test was used to statistically analyze 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). Conclusions: The proposed simple root canal irrigating device can be made with materials readily available. Comparing the same to standard techniques showed better irrigant delivery 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 practice.
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Antibacterial efficacy of sodium hypochlorite versus apple cider vinegar against Enterococcus faecalis in contracted endodontic cavity: An in vitro study p. 254
Kaur Supreet, Karkala Venkappa Kishan, Nimisha Chinmay Shah
Aim: The aim of this study is to evaluate and compare the antibacterial efficacy of 3% sodium hypochlorite with 5% apple cider vinegar using passive ultrasonic irrigation (PUI) against Enterococcus faecalis in contracted endodontic access cavity on mandibular molars. Methods: Contracted access cavity was prepared in 30 extracted human permanent mandibular molar teeth. The root canals were incubated with strain of E. faecalis MTCC 9845 (Strain designation – HBL/BAC– 002/08–09) using 15 K-type manual file for 3 weeks. At this point, the S1 sample was collected using 15 paper points. The extracted teeth were randomly divided into two groups: sodium hypochlorite group and apple cider vinegar group. After mechanical instrumentation up to 25/04 rotary files HyFlex CM (Coltene Whaledent, Altstätten, Switzerland) and use of respective irrigants (3% sodium hypochlorite and 5% apple cider vinegar) using PUI, S2 sample was collected using 25 size paper point. The cultivated samples were incubated at 37°C for 24 h, and the number of bacterial colonies was counted as colony-forming units (CFUs)/mL. Data obtained from S1 and S2 were tabulated and subjected to Wilcoxon signed-ranks test and Mann–Whitney test. Results: There was a significant reduction in microbial count in both groups (P < 0.05) when preoperative CFUs were compared with postoperative. There was slightly higher reduction in the apple cider vinegar group in S2 sample, as compared to the sodium hypochlorite group, but it was not statistically significant (P > 0.05). Conclusion: Antimicrobial activity of 5% apple cider vinegar is similar to 3% sodium hypochlorite.
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Efficacy of various proton-pump inhibitors and calcium hydroxide as intracanal medicaments against Enterococcus Faecalis: An in vitro study p. 259
Tejas Koparkar, Sai Kalyan, Lalitagauri Mandke, Mansi Vandekar
Aim: The purpose of this study was to compare the efficacy of four proton-pump inhibitors (PPIs) (pantoprazole, omeprazole, lansoprazole, and rabeprazole) when combined with calcium hydroxide and used as intracanal medicaments against Enterococcus faecalis. Methods: A total of 550 microliters of E. faecalis strain was inoculated into two mixtures 6.25 μg/ml and 25 μg/ml containing calcium hydroxide (concentration 16 mg/ml) and PPIs (concentration 1 mg/ml). The efficacy was evaluated by comparing the optical density of the mixtures at 630 nm with two time parameters of 18 h and 24 h. Results: At 18 h, O6 (calcium hydroxide and omeprazole 6.25 μg/ml) showed the maximum percentage inhibition of E. faecalis strain and R25 (calcium hydroxide and rabeprazole 25 μg/ml) showed the least inhibition. At 24-h time interval, O6 showed the maximum inhibition, while R6 (calcium hydroxide and rabeprazole 6.25 μg/ml) showed the least inhibition of E. faecalis strain. Conclusion: The use of PPIs with calcium hydroxide did show promising results and the combination could be used successfully as an intracanal medicament.
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Biomechanical properties of mandibular first molar with truss and conventional access cavities: A finite element analysis p. 265
Harika Lakshmisetty, Ramya Raghu, Ashish Shetty, Subhashini Rajasekhara, Sumit Sharma, G Bharath
Aim: The aim of this study was to compare the biomechanical strength properties of the mandibular first molar with truss and conventional endodontic access cavities using the finite element method. Methods: Two finite element analysis (FEA) models of a mandibular first molar were designed and constructed with truss endodontic cavity (TREC) and Conventional endodontic cavity (CEC). Each model was subjected to three different force loads directed at the occlusal surface. The stress distribution patterns and the maximum von Mises (VM) stresses were calculated and compared. FEM software ANSYS was used for evaluation. Results: The peak VM stress on both models was at the site of the force load. The occlusal stresses were spread in an approximate actinomorphic pattern from where the force was loaded, 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 cavity size increased and became concentrated in the area between the filling materials and the dentin. Conclusion: Under all loading conditions, the TREC model showed low-stress concentration compared to the CEC model. With enlargement of the access cavity, the stress on the pericervical dentin increased significantly.
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Periapical lesions in patients with primary Sjögren syndrome: A cross-sectional retrospective study of medical charts platform p. 270
Ilan Rotstein, Joseph Katz
Aim: The aim of this study was to assess the prevalence of acute periapical lesions in patients with pSS. Methods: Integrated data of hospital patients was used. Data from the corresponding diagnosis codes for pSS and acute periapical abscess was retrieved by searching the appropriate query in the database. The patient population analyzed was mixed, presenting with different disease conditions including periapical abscesses without sinus. The different diagnoses were coded using the international coding systems ICD 10. Diagnosis was made by calibrated dentists in a hospital setting based on clinical examination and imaging data. Patients with ICD 10 diagnosis code of acute periapical abscess were recorded and the prevalence of acute periapical abscesses in patients with primary Sjögren syndrome were compared to the prevalence in the total hospital patient population. The odds ratio (OR) for the prevalence of acute periapical abscesses and its association with pSS were calculated with a 95% confidence interval and the statistical difference between the groups was assessed. Results: The odds ratio (OR) for the prevalence of acute apical abscesses and its association with pSS were calculated and analyzed statistically. The prevalence of periapical abscesses in patients with pSS was 1.87% as compared to 0.58% in the general patient population of the hospital. The OR was 3.11 and the difference was statistically significant (p<0.0001). Conclusions: Under the conditions of this study, it appears that the prevalence of acute periapical abscesses is significantly higher in patients with pSS.
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Assessment of heat transfer to periodontal tissues and stress distribution in a tooth with simulated internal resorption cavities at different root levels using two thermoplasticized obturation systems – A finite element analysis study p. 275
Vibha Rahul Hegde, Pritisha Bharat Jain, Pooja Sunil Bhagat
Aim: This study aimed to evaluate the heat transfer to periodontal tissues and stress distribution within simulated roots with internal root resorption cavities at three different levels using two thermoplasticized obturation systems using finite element analysis. Methods: Maxillary central incisors with single canals were chosen for the construction of the simulation and geometric models. Cone beam computed tomography scan of a skull was used to model the periodontal ligament and alveolar bone. Construction of the simulating model and geometric model and conversion to finite element model was conducted with three-dimensional tetrahedral elements at three different levels. These three models were duplicated for stress distribution and heat transfer analysis during the down packing and backfilling procedure to periodontal tissues. A simulation of root canal preparation and obturation procedures was conducted using ANSYS 19.2 software, and static structural, steady-state thermal, and transient analysis were carried out. Results: The total average stress was the highest when the resorption cavity was in the middle third (1.72 Mpa) for the calamus dual obturation system. The total average temperature observed was the highest when the resorption cavity was in the middle third (37.4°C) for the elements free obturation system and in the apical third (53.73°C) for the calamus dual obturation system. Conclusion: It was observed that between the two systems, elements free obturation system led to lower heat transfer and heat flux during the down packing procedure in comparison to the calamus dual obturation system, and the remaining dentin thickness was directly proportional to the amount of heat transferred to the surrounding tissues.
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Synthesis and characterization of nisin-incorporated alpha-tricalcium phosphate for pulp capping – An in vitro study p. 282
Veni Ashok Baskaran, Manavalan Madhana Madhubala, Thangam Menon, Shankar Narayanan Gopal, SM Venkatesan
Aim: The present study aimed to synthesize and characterize Nisin incorporated Alpha Tricalcium Phosphate (NTCP) and to evaluate nisin release from NTCP when used as a pulp capping agent. Methods: Alpha TCP(aTCP) powder was synthesized by the wet chemical method. Nisin was incorporated into this prepared aTCP at various ratios and grouped as follows: Group 1 - 1% wt%; Group 2 -2.5wt%; Group 3-5%wt%; Group 4- 7.5%wt%; Group 5 -10%wt% ; Group 6 -Nisin 100 mg; All these samples were characterized using Fourier Transmission Infrared Spectroscopy(FTIR) and Differential Scanning Calorimetry (DSC). For evaluation of nisin release from NTCP using HPLC, around fifteen freshly extracted non-carious human third molars were collected and mounted in gypsum blocks. A standard box-type class-I cavity (4.5x 4.5 mm) was prepared with the pulpal floor ending at deep dentin, The experimental materials were mixed with propylene glycol to prepare it as pulp capping material in paste form. Subsequently pulpal floor of all the cavities were lined with the respective materials. The entire samples were kept to set for 30 minutes in ambient temperature and subsequently immersed in water and stored in an incubator at 37oC. After 14 days of immersion, dentin lying directly below the sample was cut and powdered using mortar and pestle. The powdered dentin was then subjected to HPLC analysis. The peak time of nisin release from experimental groups was recorded. Results: FTIR results revealed Group 5 with highly appreciable corresponding bends of amine N-H, C-H stretching and phosphate peaks at 1100 and 554 close to Control TCP samples. DSC analysis showed that TCP did not change from 30oC to 80oC and sample 1, 2, 3,and 4, did not show any denaturation point. Sample 5 showed denaturation point slightly above the denaturation temperature of nisin. On HPLC analysis, samples 4 and 5 showed higher peaks of nisin release and traces of nisin release from all the groups. Conclusion: Within the limitations of this study, it can be concluded that NTCP can be synthesized successfully without any influence on the properties of each other material. 10% NTCP provides higher release into dentinal tubules when used as a pulp capping agent.
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An in vitro evaluation of canal transportation and centering ability of ProTaper Universal, Hyflex EDM, and WaveOne gold using microcomputed tomography p. 288
Ashwin Ravichandran, Veni Ashok Baskaran, Shankar Narayanan Gopal, Venkatesan S Motilal, Meenakshisundram Rajasekaran, Anil Kumar Ramachandran
Aim: The study was to determine and compare the values of canal transportation and centering ability of ProTaper Universal (PTU), Hyflex EDM (HEDM), and WaveOne GOLD (WOG) using microcomputed tomography (Micro-CT). Methods: Sixty mandibular molar mesiobuccal canals were randomly allocated into three groups, each with 20 samples: PTU (group one), HEDM (group two), and WOG (group three). Micro-CT was used to scan samples before and after instrumentation. Three-dimensional scans of root cross-sections at 3 mm, 6 mm, and 9 mm from the apex were obtained to measure canal transportation and centering ability. For statistical analysis, SPSS software was utilized. P = 0.05 was used as the significance level. Results: When compared all three systems, PTU files had the highest transportation and were less centered. HEDM and WOG showed no significant difference (P > 0.05). Conclusion: Curved roots canals were shaped without any significant canal transportation by Hyflex EDM and WOG when compared with PTU files.
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A simplified and cost-effective targeted endodontic guide for calcified canal negotiation and surgical management p. 293
MR Pradeepa, B Rahul, CT Valliappan, I Anand Sherwood, James L Gutmann, Rathna Piriyanga Subramani, A Andamuthu Sivakumar
Management of pulp canal obliteration and apicoectomy procedures with an endodontic guide is presented in multiple cases. This case report series highlights a cost-effective guide construction approach using an open-source cone-beam computed tomography software, ITK-snap. A simple soft template was used as a guide for successful access of calcified canals and osteotomy preparation with reduction of unwarranted adjacent tissue damage.
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Revascularization of an immature necrotic permanent mandibular second premolar with dens evaginatus: A case report with 3 years' follow-up p. 300
Kwa Zheng Kang, Raghavendra Penukonda, Harshada Pattar, Afaf Al-Haddad
Dentists face a challenge when treating necrotic immature teeth with periapical pathology because apexification techniques leave the tooth vulnerable to fracture. After all, the roots are not matured, and the canal walls are thin. Pulp revascularization is a regenerative endodontic procedure that emerged as a viable treatment for apical closure, continued root development, and dentinal wall thickening with successful clinical and radiographical outcomes. In this case report, an 11-year-old boy complained of pain and associated swelling in the lower left posterior teeth region, diagnosed as pulp necrosis with acute apical abscess of an immature tooth with dens evaginatus (DE). After periapical radiographs, drainage was done through the access cavity, and a regenerative endodontic procedure was performed with the final restoration of composite resin. This report emphasizes the successful management of an immature necrotic permanent mandibular second premolar with DE using a revascularization procedure.
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A multidisciplinary approach toward the replacement of missing maxillary anterior teeth using impacted mesiodens as abutment via “reverse endodontic treatment” p. 306
Sunandan Mittal, Vivek Aggarwal, Sudhir Munjal, Tarun Kumar, Vanita Keshav, Anmolpreet Kaur, Arshpreet Kaur
The case report presents the rehabilitation of a missing maxillary anterior tooth. The case was complicated by the presence of an inverted, impacted mesiodens, which led to the impaction of the permanent maxillary central incisor. The apical area of the mesiodens was surgically exposed, and the endodontic treatment was carried out via the root apex in an apicocoronal direction. The case was restored with an angulated post–core crown. This case highlights an unusual placement of mesiodens and its challenging endodontic rehabilitation.
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