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Abstract Background Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth’s strength is known to reduce significantly after the root canal treatment, occlusal loading as a result of functions such as chewing, biting and certain parafunctional tendencies makes the endodontically treated tooth vulnerable to fracture. Hence, after endodontic treatment, it is vital to give adequate and appropriate restorative material to avoid tooth fractures. Accordingly, the choice of such restorative material should be dictated by the property of fracture resistance. Objective The goal of this study was to conduct a systematic review and critical analysis of available data from in vitro studies examining the fracture resistance of endodontically treated posterior teeth restored with fiber-reinforced composites. Methodology The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRIS-MA) Statement was used to guide the reporting of this systematic review A comprehensive literature search was performed using MEDLINE (via PubMed), Scopus, ScienceDirect, Google Scholar, and LILACS. A manual search of the reference lists of the articles was also performed. The databases provided a total of 796 studies from the electronic systematic search. The databases provided a total of 796 studies from the electronic systematic search. Two reviewers scrutinized the papers for eligibility based on inclusion/exclusion criteria and extracted data. The studies were assessed for their potential risk of bias. Based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective, we have formulated 13 parameters specifically to assess the risk of bias. A total of 18 studies met the inclusion criteria and were included for qualitative analysis. Considering the high heterogeneity of the studies included, a meta-analysis could not be performed. Results The majority of the included studies had a moderate or high risk of bias. When compared to traditional hybrid composites, fiber-reinforced composites showed increased fracture resistance of endodontically treated teeth in the majority of investigations. On the other hand, limited evidence was found for the bulk fill composites. Moreover, moderate evidence was found for the fracture resistance of inlays and fiber posts with fiber-reinforced composites for core build-up in endodontically treated teeth. No evidence could be found comparing the fracture resistance of endo crowns and fiber-reinforced composites in endodontically treated teeth. Conclusion According to the research, using fiber-reinforced composites instead of conventional hybrid composites improves the fracture resistance of endodontically treated teeth. However, there was a high risk of bias in the research considered. No judgments could be reached about the superiority of one material over another based-on comparisons between other core restorations.

Abstract Background Pain is usually subjective and thus it is challenging to describe its characteristics such as nature, intensity, and origin. Non-invasive methods such as assessing salivary alpha-amylase (SAA) may aid the practitioner to evaluate the pain intensity. Hence, the current study aimed to correlate the levels of SAA with the pain intensity in patients presenting with varied endodontic pain levels. Methods Sixty patients who presented with varied intensities of endodontic pain were selected for the present study out of which seven patients were excluded/dropped, leaving a total sample of fifty-five patients for assessment. Mandibular molar with symptomatic irreversible pulpitis without periapical pathology were included in the study. A 5ml of un-stimulated was obtained from the patients, following which the local anesthesia was administered. Root canal treatment was then performed and the pain scores at pre-operative and post-operative were recorded. Additionally, salivary samples were collected after emergency endodontic treatment and sent for sialochemical analysis. IBM.SPSS statistics software 23.0 was employed to assess the obtained data. Results A statistically significant drop in the pain score (P

Abstract Background Over the past years, polysaccharide-based scaffolds have emerged as the most promising material for tissue engineering. In the present study, carrageenan, an injectable scaffold has been used owing to its advantage and superior property. Cissus quadrangularis, a natural agent was incorporated into the carrageenan scaffold. Therefore, the present study aimed to assess the antioxidant activity and biocompatibility of this novel material. Methods The present in vitro study comprised of four study groups each constituting a sample of 15 with a total sample size of sixty (n = 60). The carrageenan hydrogel devoid of Cissus quadrangularis acted as the control group (Group-I). Based on the concentration of aqueous extract of Cissus quadrangularis (10% w/v, 20% w/v and 30% w/v) in carrageenan hydrogel, respective study groups namely II, III and IV were considered. Antioxidant activity was assessed using a 1,1-diphenyl-2-picrylhydrazyl radical scavenging assay, whereas the biocompatibility test was performed using a brine shrimp lethality assay. The microstructure and surface morphology of the hydrogel samples containing different concentrations of Cissus quadrangularis aqueous extract was investigated using SEM. One-way ANOVA with the post hoc tukey test was performed using SPSS software v22. Results A significant difference (P

Background: Fluid dynamics is a majorly neglected aspect to be studied in root canal irrigation. The fundamental rule to understand mechanics is to observe patterns of flow during the process. Thus, this work is conducted to do a systemic assessment of the in-vitro and ex-vivo based studies to evaluate the effect of various parameters on the irrigant flow and apical pressure on using a manual syringe needle for root canal irrigation. Methods: The literature search was conducted through libraries such as PubMed (Medline), CINAHL, Embase, Scopus and other hand literature from Google Scholar, the British medical library etc. The systematic review was reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. As they include studies that were in-vitro and ex-vivo based, the risk of bias of the selected articles was assessed using a customized tool based on the previous literature and parameters evaluated in the studies included. Results: The literature search resulted in 101 items of which 19 records were included in this review. Results reported that multiple factors and parameters were assessed to evaluate the flow and apical pressures on using manual syringe needle irrigation. Conclusions: Present systematic review gives insights in-depth about the irrigation dynamics of manual syringe needle irrigation. Besides, it is inconclusive to compile a single factor or a single parameter contributing to the enhanced irrigant flow and least apical pressures.

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.

Objective: The purpose of this study was to evaluate the comparative antibacterial efficacy of 0.2% oregano oil, 2% chlorhexidine (CHX), and 3% sodium hypochlorite (NaOCl) in disinfection of dentin tubules contaminated with Enterococcus faecalis. Materials and Method: One hundred and twenty human extracted anterior teeth were infected with E. faecalis for 21 days. They were assigned into three groups (n = 40) – Group 1: 3% NaOCl, Group 2: 2% CHX, and Group 3: 0.2% oregano oil. Disinfection protocol was followed using 31-gauge side-vented needle. After chemomechanical preparation, the apical 5 mm of the roots was removed frozen in liquid nitrogen and pulverized to expose E. faecalis in dentinal tubules. The number of colony-forming units of E. faecalis per mg dentin was determined. The data were analyzed statistically. Results: Zone of inhibition of oregano oil was found to be 15 mm, and the values were significant in Group III (P < 0.05) as compared to the other groups assessed. Conclusion: Within the study's limitation, 0.2% oregano oil showed better disinfection property against E. faecalis among tested irrigants. Therefore, it can be used as an effective alternative root canal irrigant.

Background: The rationale of endodontic treatment is to eradicate the infection and prevent the microorganisms from infecting or re-infecting the root canal system (RCS). Gram-negative anaerobic rods, Gram-positive anaerobic cocci, Gram-positive anaerobic, and facultative rods are most commonly isolated from the RCS. Herbal compounds can be used as a promising alternative to conventional calcium hydroxide. The current study aimed to compare and evaluate the antimicrobial effect of four different intracanal medicaments against Enterococcus faecalis. Aim: The objective of the current study is to compare and evaluate the antimicrobial effect of a new herbal intracanal medicament compared with the other four agents against E. faecalis. Materials and Methods: A total of 100 single-rooted teeth were selected, root canal preparation was performed using a standardized protocol, inoculated E. faecalis, which were further divided into five groups each according to intracanal medicaments used. Group 1: Calcium Hydroxide-16 mg/ml of distilled water (n = 20), Group 2: Diclofenac–400 mg/ml of distilled water (n = 20), Group 3: Ibuprofen–400 mg/ml of distilled water (n = 20), Group 4: Omeprazole–2 mg/ml of distilled water (n = 20), and Group 5: Oregano essential oil–25 μg/ml of distilled water (n = 20). The antimicrobial assessment was performed on the 7th day, and dentine samples were collected to determine the number of colony-forming units. One-way analysis of variance and post hoc Tukey test was performed. Results: Group 1 (calcium hydroxide) showed a statistically significant reduction of E. faecalis (P < 0.05), followed by group 5 (Oregano essential oil extract). Conclusion: Calcium hydroxide showed a beneficial reduction of E. faecalis when compared to other tested agents.

Aim: This study aims to assess the diagnostic accuracy of new custom-made pulse oximeter sensor holder in assessment of actual pulp status with three pulp sensibility tests. Materials and Methods: Seventy-nine single canal teeth requiring endodontic therapy was included in the study. The tooth that was requiring root canal treatment was tested with heat test, cold test, electric pulp test, and pulse oximeter. Between each test, a time period of 2 min was allowed. The response from three pulp sensibility tests and the reading from pulse oximeter were recorded. Following which root canal treatment was performed. The result obtained from four pulp tests were correlated with the clinical finding after access cavity preparation. The data obtained was statistically assessed. Receiver operator characteristic (ROC) curve analysis was performed to assess the efficacy of the pulp tests. In the above statistical tools, the probability value. 05 is considered as significant level. Results: The overall diagnostic accuracy was found to be significantly higher with pulse oximeter when compared with other three pulp sensibility tests. The ROC curve demonstrates the results obtained from pulse oximeter was found to be more reliable than other pulp tests. Conclusion: Within the limitation of the study, diagnostic accuracy of pulse oximeter with custom made sensor holder was reliable and accurate in assessment of actual pulp status.

The success of endodontic treatment relies on both apical and coronal sealing. To achieve a good three-dimensional seal, the removal of the smear layer becomes mandatory. This study aims to assess the difference in debris accumulation and smear layer formation while using automated root canal irrigation and conventional syringe needle irrigation. Single-rooted human mandibular premolar teeth (n = 30) which were indicated for orthodontic extractions were selected. An endodontic access cavity was prepared, and a glide path was created. Based on the irrigation protocol decided upon for the study, the teeth were randomly allocated into three study groups, namely Group 1, where the manual syringe needle irrigation method was adopted; Group 2, in which automated root canal irrigation was undertaken; and Group 3, in which teeth remained un-instrumented as it was considered the Control group. The teeth were decoronated at the cement-enamel junction (CEJ) and were subjected for scanning electron microscopy (SEM) examination. Debris and smear layers were viewed in 1000× magnification and scored. A statistically significant (p < 0.05) lower mean debris and smear layer score (p < 0.05) was observed in both study groups when compared with the control group. However, no significant difference (p > 0.05) in the debris and smear layer was observed between the manual syringe needle irrigation and automated irrigation, although automated irrigation devices can be a potential alternative. The present study concluded that the efficacy of smear layer removal remained the same with both automated irrigation and manual syringe irrigation.

Introduction: Cone beam computed tomography (CBCT) is used as a diagnostic tool, which aids in deciding the treatment plan in various fields of dentistry. In endodontics, CBCT is a useful tool in diagnosing apical periodontitis, resorptions, perforation, root canal morphology, traumatic injuries, and voids. The objective of this study was to evaluate the knowledge attitude and practice in diagnosing and interpreting the endodontic treatment using CBCT among the endodontists. Materials and Methods: A cross-sectional questionnaire survey was conducted among endodontists. Overall, 97 participants were included in the survey and the questionnaire containing 15 closed-ended questions was administered to the participants. Descriptive statistics were used to analyze the data. Results: On analyzing the response to the questionnaire, it was found that out of 97 participants, 24 had professional experience of more than 10 years. About 57% of participants preferred using digital radiographic technique for diagnosis. Majority of them were aware that CBCT is used for identifying location, size, and extent of periapical lesions. About 46% of participants stated that in detecting voids, CBCT was thrice significant compared with periapical radiography. According to 31% of the endodontists, CBCT was not reliable to detect vertical root fracture. It was found that 63% of the endodontists said they have not undergone any training or workshop in CBCT. Conclusion: This research study revealed that adequate training and skills are required in interpreting CBCT in endodontic treatment procedure among endodontists.

The interest in the use of green-mediated synthesis of nanoparticles (NPs) is shown to have increased due to their biocompatibility and reduction of overall production costs. The current study aimed to evaluate a novel nanocomposite (NC) prepared by using a combination of zinc oxide, silver and chitosan with lemon extract as a cross-linking agent and assessed its antimicrobial effectiveness against Enterococcus faecalis (E. faecalis). The NPs and NC were prepared individually using a modification of previously established methods. Ananalys is of the physiochemical properties of the NC was conducted using ultraviolet-visible spectroscopy (UV-Vis) (Shimadzu Corporation, Kyoto, Japan). and transmission electron microscopy (TEM) imaging(HR-TEM; JEOL Ltd., Akishima-shi, Japan. The microbial reduction with this novel NC was evaluated by measuring the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) using a tube assay analytic technique. A time-kill assay analysis was conducted to evaluate the kinetic potential against E. faecalis at different time intervals. The novel NC showed a homogenous nanoparticle size under TEM imaging and under UV-Vis established an absorption range of 350–420 nm making it similar to its individual counterparts. The MIC and MIB were measured at 62.5 ± 20 mg/L (p < 0.05) and 250 ± 72 mg/L (p < 0.05), respectively. A time-kill assay analysis for the NC showed 5 h was required to eradicate E. faecalis. Based on the achieved results, it was seen that the novel NC using a combination of silver, zinc oxide and chitosan showed improved antimicrobial action against E. faecalis compared with its individual components under laboratory conditions. A complete eradication of 108 log units of E. faecalis at 250 mg/L occurred after a total of 5 h. These preliminary results establish the use of lemon extract-mediated silver, zinc and chitosan-based NC had an antibacterial effectiveness against E. faecalis similar to the individual counterparts used for its production under laboratory conditions.

Esthetics, improved colour stability and ease of contour have made photo-activated resin based restorative materials being widely used in routine dental clinical practice. Perhaps improper and inadequate polymerization of resin based composite material might lead to elution of monomer. Thus, the aim of the current study was to quantify the monomer elution from three resin composites. The intended analysis was made using high performance liquid chromatography (HPLC) at two different time periods. Three different materials that were investigated in the current study included Swiss Tech resin composite (Group A), Ceram X (Group B) and Beautifil Injectable composite (Group C). Ten cylindrical samples were fabricated in each study group. In 75% wt of ethanol, the samples were ingressed immediately and stored at room temperature. A 0.5 mL of the samples was assessed at pre-defined time intervals at 24 h and 7th day. Later, assessment of the samples was performed with HPLC and the data was analyzed using statistical test. Bisphenol A-glycidyl methacrylate (Bis-GMA), Triethylene glycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA) and Urethane dimethacrylate (UDMA) were quantified in the samples. When analyzing the release monomer, it was found that at the end of 24 h Bis-GMA was eluted more in the injectable resin composite whereas, TEGDMA was eluted from Swiss Tech and Ceram X resin composites. At the end of the 7th day it was evident that Bis-GMA was eluted maximum in all the three resin composites. Thus, monomer release was found to be evident among all three resin composites and it is of utmost important to be assessed in routine clinical practice.

The present systematic review aims to evaluate the efficiency of Physics forceps over the conventional forceps for the extraction of a tooth. The study began with targeted electronic searches of MEDLINE, PubMed, Cochrane, Science Direct and Google Scholar databases. All selected articles were reviewed by four independent reviewers for eligibility. The Cochrane Risk of Bias tool was used to analyze the studies for bias. Due to heterogeneity of the selected studies, a meta-analysis of the current systematic review was not possible. A total of five studies were considered for the final analysis. The risk of bias showed high risk for all five included articles. Various parameters, such as fracture of the root, dry socket, healing, pain, postoperative infection, crown fractures, buccal bone fractures, extraction time, gingival and marginal bone loss, gingival laceration, bleeding and healing were assessed. Based on the data available, there is an insufficient quality of evidence to conclude the superiority of the Physics forceps over conventional forceps.

The present study aimed to evaluate if commonly used endodontic irrigants such as 3% sodium hypochlorite (NaOCl, Prime Dental, Thane, India), 2% chlorhexidine (CHX, Sigma-Aldrich Co., St. Louis, MO, USA), and 17% ethylenediaminetetraacetic acid (EDTA, Meta-Biomed Co. Ltd., Cheongju-si, South Korea) influenced the setting time and metal composition of different base endodontic sealers on exposure. AH Plus (Dentsply De Trey GmbH, Konstanz, Germany), Sealapex (SybronEndo, Orange, CA, USA), mineral trioxide aggregate (MTA) Fillapex (Angelus Soluções Odontológicas, Londrina, Brazil), and Tubli-Seal (Kerr Dental, Orange, CA, USA) were selected as the different base representatives of endodontic sealers. These sealers were exposed to 3% NaOCl, 2% CHX, and 17% EDTA, and the individual setting time of the sealers was analyzed. The samples were analyzed for heavy metal elements such as chromium (Cr), nickel (Ni), cobalt (Co), cadmium (Cd), arsenic (As), mercury (Hg), lead (Pb), and beryllium (Be) by using inductively coupled plasma mass spectrometry (ICP-MS) analysis. For statistical analysis, one-way ANOVA and post hoc Tukey’s tests were used. All selected sealers showed variation in setting time post-exposure to different irrigants. MTA Fillapex had the shortest mean setting time (215.7 min, post-exposure at 187.3 min) (p < 0.05). Mean setting time was also affected for AH Plus (479.6 min, post-exposure at 423.9 min) (p < 0.05) and Tubli-Seal (514.7 min, post-exposure at 465.2 min) (p < 0.05). Sealapex showed the maximum reduction of setting time (864.8 min, post-exposure at 673.4 min) (p < 0.05). All tested sealers showed heavy metals (Cr, Ni, Co, Cd, As, Hg, and Pb) in their composition, and the quantities were influenced by interaction with different irrigants. The heavy metal Be was not seen in any of the samples. Sealapex showed the longest setting time in comparison to other test sealers. Heavy metals were most present in Sealapex, followed by AH Plus, Tubli-Seal, and MTA Fillapex. MTA Fillapex was seen to have the shortest setting time, and heavy metal composition was least affected on interaction with different commonly used endodontic irrigants. Further, this study provides significant insight into the influence of different endodontic irrigants on interaction with different base endodontic sealers, which has not been reported previously, and future studies should emphasize endodontic irrigant-sealer interactions and their possible effects in the long run.

Gram-negative, anaerobic bacterias are predominate in periapical infections. The bacterial lipopolysaccharide (LPS) initiates the process of inflammation and periapical bone resorption. Usage of various medicaments retards or inactivates the bacterial endotoxin (LPS). However, the results are not highly effective. In recent years, owing to antimicrobial resistance, the shift from conventional agents to herbal agents has been increased tremendously in research. Keeping this in mind, the present study was formulated to evaluate the efficacy of oregano essential oil in inhibiting bacterial LPS- induced osteoclastogenesis. Four different concentrations (0 ng/mL, 25 ng/mL, 50 ng/mL, and 100 ng/mL) of oregano essential oil extract were added into 96-well culture plate. Under light microscope, quantification of osteoclast cells was performed. One-way ANOVA with post-hoc Tukey test was carried out on SPSS v21. A significant reduction (p < 0.001) in the osteoclast was observed in the experimental groups compared to no oregano essential oil extract (control). A dose-dependent significant reduction (p < 0.001) in osteoclast formation was observed among the experimental groups, with lesser osteoclast seen in group IV with 100 ng/mL of oregano essential oil extract. Thus, it can be concluded that oregano essential oil extract can be utilized as a therapeutic agent that can target bacterial LPS-induced osteoclastogenesis. However, randomized controlled studies should be conducted to assess the potential use of this extract in the periapical bone resorption of endodontic origin.

Background: Advancement in treatment modalities has improved as a result of research. Individual’s critical thinking and analysis has enhanced. In the advent of incorporating their clinical trials into practice, it had greatly improved in treating patients and enhancing patients care. Aim: To compare the awareness, attitude and obstacles in the field of research among interns, postgraduate students and faculty members among Dental professionals. Materials and Method: An institutional based cross sectional questionnaire survey was conducted among interns, postgraduates and faculty members of the dental profession. A sample size of 261 was determined. Ethical clearance was obtained from Institutional Ethics Committee. Statistical Analysis: Descriptive statistics, chi-square test and student’s t-test were used to analyze the data. Results: On analyzing the questionnaire, 61.2%of study subjects were currently guiding and undertaking research projects. Majority of the subjects stated that doing research enhanced their critical thinking and knowledge. The most common obstacle stated for research was lack of time and lack of financial incentives. When assessing barriers to publishing an article, it was reported that lack of publication related knowledge was the most major obstacle in all groups. Majority of the post graduates and faculty members prefer to conduct recent advance based research; whereas interns prefer to do research based on innovative idea which was statistically significant. Conclusion: This research study revealed positive attitude toward research among dental professionals. [ABSTRACT FROM AUTHOR]