Introduction: Enterococcus faecalis is the most common bacterial species in persistent root canal infections. Sodium hypochlorite (NaOCl) has shown antibacterial activity against E. faecalis at room temperature. It has been proven that heating enhances the properties of NaOCl. Thus, the aim of the present study is to compare the effectiveness of intracanal and extracanal heated NaOCl against E. faecalis. Methodology: The specimens were decoronated up to cementoenamel junction and prepared up to size F3 and were inoculated with E. faecalis. Then, teeth were divided into four groups and irrigation was performed. Group A - 5% NaOCl (Prime Dental Products Pvt. Ltd., India) at room temperature, Group B - 5% NaOCl (Prime Dental Products Pvt. Ltd., India) heated extracanal at 600C in a water bath, Group C - 5% NaOCl (Prime Dental Products Pvt. Ltd., India) intracanal heated using 980 Nm diode laser, and Group D - 5% NaOCl (Prime Dental Products Pvt. Ltd., India) intracanal heated using Elements System-B. The antimicrobial efficacy was tested by collecting transfer fluid and counting the colony forming units of viable E. faecalis on agar plates. Results: Following the disinfection protocol significant reduction in E. faecalis count was seen in the groups irrigated using intracanal heated and extracanal heated NaOCl with that of NaOCl used at room temperature with a significant value of P ≤ 0.001*. Conclusion: Within the limitations of the present study, it can be concluded that intracanal heating using Elements System-B Heat Source and Diode Laser has better antimicrobial efficacy as compared to that of NaOCl extracanal heated and at room temperature.

Aim: To compare the vertical root fractures (VRFs) resistance of teeth instrumented with ProTaper Universal, ProTaper Next, HyFlex CM and HERO Shaper nickel titanium (NiTi) rotary systems and obturated with compatible gutta-percha cones using the single-cone technique. Materials and Methods: The present study was performed in 72 extracted mandibular premolars. After removing the coronal parts of the teeth and determining working length, the roots were mounted in Eppendorf tubes. The samples were divided into five experimental groups, and one control group (n = 12). In Group 1, teeth were instrumented by hand K files; Group 2 ProTaper Universal (PTU); Group 3 HERO Shaper (HS); Group 4 HyFlex CM (HCM); Group 5 ProTaper Next (PTN); and Group 6 (Controls): the root canals were not shaped or filled. After the preparations were completed, roots were obturated with gutta percha. All the mounted samples were subjected to fracture resistance testing. Statistical Analysis: One-way ANOVA test and post hoc Tukey's test at a significance level of P < 0.05. Results: Fracture resistance of hand K file did not differ significantly from, HERO Shaper, HCM, and PTN NiTi rotary files (P = 0.929; P = 0.996; P = 1.000, respectively). PTU showed significantly less fracture resistance than hand K file (0.044). Among all NiTi rotary files, PTN depicted the highest fracture resistance, whereas PTU showed the least fracture resistance with statistically significant difference (P = 0.048). However, PTN did not differ significantly from HERO Shaper and HCM regarding fracture resistance. Conclusion: All rotary files showed similar fracture resistance values to Hand K file group except ProTaper Universal, which demonstrated significantly lower fracture resistance.

Aim: Maxillary sinusitis of odontogenic origin accounts for approximately 10%–12% of maxillary sinusitis cases. The primary objective of the present study was to analyze the vertical relationship between the maxillary posterior roots and the adjacent maxillary sinus floor (MSF) in the Indian population using cone-beam computed tomography. The secondary objective was to correlate the data with age and gender. Materials and Methods: The shortest distance between 452 maxillary posterior teeth and the adjacent border of MSF was measured. The data were divided into three groups. Group IS included maxillary posterior teeth roots protruding into the sinus, Group CO included root apices contacting the MSF, and Group OS included root apices not contacting the MSF. The data obtained were correlated with age and gender. Results: The vertical distance of the root apices of second premolars from the MSF was significantly lesser compared to the root apices of first premolars (P < 0.05). The difference between the vertical distance of buccal roots and palatal roots (PRs) of first molar from the MSF was significantly more (P < 0.05). Majority of the roots of posterior teeth were located below the MSF border (Type OS). Type IS was most frequently seen for PRs of maxillary first molars (29.12%). The frequency of Type IS decreased with increasing age. The distance between the posterior root apices and the adjacent border of the MSF was found to be more in males compared to females. Conclusion: The PRs of maxillary first molars were found to be closest to the MSF. Variation in the vertical relationship was found by age and gender.

Aims: The aim of this study is to evaluate the influence of access cavity designs on the fracture resistance and root canal filling efficacy of simulated young permanent molars. Methodology: A total of seventy human unerupted impacted mandibular third molar teeth were collected. Ten were allocated as control; the remaining were designated as experimental, which were divided into three groups (20 each) based on access cavity design. All the samples were exposed to cone-beam computed tomography (CBCT) scanner before the access cavity preparation. Group I-The control group. Group IIa-traditional endodontic cavity (TEC), Group IIb-conservative endodontic cavity (CEC), Group IIc-ninja endodontic cavity (NEC). Endodontic access cavities were prepared and exposed to CBCT. Pre- and post-treatment percentage volumes of lost pericervical dentin were evaluated. Then the root canals were filled with calcium hydroxide and subjected to CBCT imaging for the evaluation of root canal filling efficacy. Evaluation of fracture resistance was carried out using a universal testing machine. Results: On observation, the volume of lost pericervical dentin was (14.8%) in TEC, (8.3%) in CEC and (6.8%) in NEC. There was no statistically significant difference (P > 0.05) between all the groups on root canal filling efficacy and the number of voids. Fracture resistance of the NEC and control group (P > 0.05) was greater compared to CEC and TEC. Conclusion: NEC is the accepted method that had better fracture resistance, with a minimum number of voids in the coronal and middle third of the root and had adequate apical seal compared to conservative and TECs.

Aim: The aim of the study was to evaluate the marginal adaptation of two epoxy resin-based sealers to dentin. Materials and Methods: Forty freshly extracted human single-rooted mandibular premolar teeth with completely formed apices were selected. Teeth were decoronated, and root canals were instrumented. The specimens were divided equally into two groups: (1) Group 1 (n = 20) – Teeth obturated with gutta percha and Perma Evolution. (2) Group 2 (n = 20) – Teeth obturated with gutta percha and AH Plus sealer. Later, samples were vertically sectioned using diamond disk, and marginal adaptation of sealers was evaluated at coronal, middle, and apical halves using scanning electron microscopy, and marginal gap values were recorded. Results: Both the sealers produced a marginal gap to a certain extent. Perma Evolution exhibited an average marginal gap of 6.02 ± 4.81, followed by AH-Plus with 6.56 ± 4.73. Conclusion: As the marginal gaps between dentin sealers were seen to be minimum in Perma Evolution, we conclude that Perma Evolution is better adapted to root canal dentin than AH-Plus sealer.

Background: Postendodontic pain (PEP) is defined as pain of any degree that occurs after initiation of root canal treatment (RCT). The development of postoperative pain is usually due to acute inflammatory response in the periradicular tissues. Aim: The aim of the study was to evaluate and compare the influence of different laser modalities on PEP following a single-visit RCT. Materials and Methods: Thirty-six patients were divided into three Groups (36 = 12 × 3), Group 1, Control (Placebo); Group 2, Canal Disinfection; and Group 3, Periapical Biostimulation. A questionnaire was given at the end of the appointment to be filled at 6, 12, 24, and 48 hours using visual analog scale. Results: Group 2 (Canal Disinfection) showed minimum PEP with a mean pain score (0.08) at the end of 48 hours which was statistically significant (P < 0.0001). However, Group 2 (Canal Disinfection) in comparison with Group 3 (Periapical Biostimulation) was found to be statistically not significant (P = 1.00). Conclusion: Laser stimulation had a positive effect on PEP. Minimum PEP was seen in patients in which lasers were used for Canal Disinfection which was better than Periapical Biostimulation. However, it was found to be statistically not significant.

Introduction: During chemo-mechanical preparation, irrgants play a vital role for eradication of endodontic pathogens. Due to the shortcomings of the current irrgants used, a need has come to find out whether herbal irrigants has better cytological acceptance and whether there is a decrease in biomedical waste. With the growing trends of using herbal extracts and oils as an alternate to conventional irrigants as an antimicrobial agent, the main objective of this study was to test sesame oil itself and its combination with various agents for its antimicrobial efficacy on Enterococcus faecalis (EF). Aim: The antimicrobial efficacy of edible sesame oil and sesame oil mixture on EF using agar diffusion test. Materials and Methods: Forty-five extracted single teeth with single canal configuration were decoronated from each tooth at the cementoenamel junction and the orifices of canals were enlarged with Gates Glidden drill size number 4. EF colonies were adjusted to 1.5 × 10⁸ colony forming unit (CFU)/ml. Crystal violet staining and observation under stereomicroscope (BX-63 Olympus DIC) were performed to check the 100% purity of culture. The inoculated specimens were divided into three groups (n = 15). The three groups are as follows: Group A was irrigated with 5.25% sodium hypochlorite (NaOCl); Group B was irrigated with edible sesame oil; and under Group C was irrigated with prepared sesame oil mixture. After 3 weeks, following the use of F4, 2 ml experimental irrigant was left undisturbed for 60 s. A volume of 20 ml of the all three irrigants were used. Absorbent paper points of sizes similar to the last apical file size used, i.e., 40.06 (F4) were placed in the canals for 5 min and transported for microbial assessment. CFUs were checked after 24 h on blood agar plates. Statistical Analysis: The intergroup statistical comparisons were performed using one-way analysis of variance (ANOVA) with Tukey's post hoc test for multiple group comparisons (P < 0.05). The intragroup comparisons were performed using r ANOVA in each study group (P < 0.01). Results: The intergroup comparison of the mean CFUs of EF on blood agar plates was significantly higher in for edible sesame oil (13.30 ± 1.64) compared to NaOCl (9.40 ± 1.24) and sesame oil mixture (7.60 ± 1.43). Conclusion: The present study confirmed the in vitro antimicrobial efficacy of prepared sesame oil mixture compared to 5.25% NaOCl and edible sesame oil.

Intrusive luxation is a severe dental injury and may result in complicated healing sequelae. Management and prognosis of these injuries depend on the factors such as severity of intrusion, stage of root development, and time elapsed between injury and treatment intervention. The aim of this article is to report the management of severe intrusion injury in an adult patient with mature apices who had delayed seeking treatment by 7 days. Three-year follow-up of the patient has shown successful radiographic and clinical outcomes in spite of limiting prognostic factors. This article also reviews the literature regarding current treatment protocols and summarizes the management strategy employed in the present case in a decision/intervention flowchart.

Von Willebrand's disease (VWD) is a lifelong bleeding disorder in which the blood does not clot well. Mutations in the VWD gene cause VWD. The von Willebrand factor as a blood-clotting protein is provided by the VWF gene and is essential for the formation of blood clots. People with inherited bleeding disorders present a particular risk with regard to dental treatment. It is that these patients are treated safely and appropriately to avoid unnecessary risk of bleeding but also to minimize the use of clotting factor concentrate in situations where alternative methods of treatment can be effective. The aim of this case report is to provide information on how to handle a patient with a probably diagnosis of VWD with symptomatic irreversible pulpitis and symptomatic apical periodontitis of mandibular left second molar #37. The endodontic therapy was performed together with nonsurgical initial cause-related therapy. Even though the patient was on medication, the bleeding was obviously during the treatment. During follow-up period, the endodontic therapy was successfully. The strategy used in this case was effective in the management of coagulopathy and allowed emergency care to be carried out without complications.