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Aim: Lack of unanimity in decision-making regarding the management of deep caries and exposed pulp has been highlighted by several questionnaire-based studies from various geographic regions. There is no research available in the Indian setting. The aim of the present study was to evaluate the perspectives of the Indian Endodontic Society and Indian Association of Conservative Dentistry and Endodontics members using an online questionnaire. Methods: An online structured questionnaire of 17 questions was mailed to 200 members based on the periapical radiographs of two cases (18 and 55 years of age) highlighting deep carious lesions and normal periapex in a mandibular molar. Each case had three hypothetical scenarios based on pulpal symptoms, i.e., asymptomatic pulp, reversible, and irreversible pulpitis, respectively. Results: A response rate of 65.5% (n = 131) was achieved. Nonselective caries removal was chosen by 40% and 36% of the participants in young patients with asymptomatic pulp and reversible pulpitis. On pulpal exposure, direct pulp capping was chosen by a majority of the members (66% and 54%, respectively) in a young patient. For irreversible pulpitis, pulpectomy was favored by 70%. In an older patient, less vital pulp therapy and more pulpectomy were preferred. The symptoms and patient age significantly altered treatment decisions, as determined by Chi-square and Fisher's exact tests (P < 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp.

Aim: This study aimed to assess the shape, size, symmetry, and location of mental foramen (MF) in relation to mandibular dental and skeletal landmarks using cone-beam computed tomography (CBCT). Methods: This retrospective observational study was performed on 135 CBCT images of 74 males (mean age 36.16 ± 13.49 years) and 61 females (mean age 37.13 ± 13.53 years). Two independent observers performed the morphometric measurements of MF using CBCT images using Invivo software. Independent t-test and Mann–Whitney test were employed to evaluate the gender differences. A comparison of categorical data was performed using Chi-square test. Intraclass correlation coefficient and Kappa statistics were used to assess interobserver reliability. Results: The most common horizontal and vertical location of MF was the long axis of the second premolars (52.2%) and below the bicuspid root apices (70%), respectively. The most common shape was round (56.6%). Significant gender differences were observed for the MF size (mean width 0.35 mm larger in males), the distance of MF to lower border of mandible (16.10 ± 1.77 mm in males and 14.81 ± 1.48 mm in females), and MF to pogonion (28 ± 2.13 mm in males and 26.62 ± 1.98 mm in females). The horizontal and vertical locations were bilaterally symmetrical in 67.4% and 79.26% of subjects, respectively. Conclusion: Right and left sides of the mandible require separate evaluations since there are differences in the location of the MF on each side. Gender differences were observed in location of MF in the relation to skeletal landmarks. Nevertheless, skeletal landmarks are reliable for locating the MF.

This position statement on Vital Pulp Therapy (VPT) procedures, endorsed by the Indian Endodontic Society (IES), aims to provide a comprehensive perspective on the management of deep caries and exposed pulp within the realm of endodontic practice. VPT serves as the cornerstone of modern endodontics, particularly with advancements in biomaterials and regenerative methods. Its primary goal is to preserve the vitality of the dental pulp while simultaneously promoting the overall health of the tooth and periapical structures. In the diverse and dynamic landscape of Indian dentistry, the IES recognizes the need for a position statement tailored to the unique needs and challenges encountered by dental practitioners in India. This position statement presents evidence-based recommendations on VPT, considering not only international perspectives from reputed international organizations, but also the distinct factors influencing dental care in India. Drawing upon the collective expertise of the expert committee, this statement addresses key aspects of VPT, including patient selection, accurate diagnosis, effective treatment techniques, and follow-up protocols. While conventional endodontic therapy remains important, IES emphasizes the significance of VPT in well-selected cases. The statement also addresses areas of potential conflict, identifies avenues for future research, and presents the current status based on the best available scientific evidence. By providing a comprehensive overview of VPT, this position statement aims to serve as a valuable guide for dental practitioners, educators, and researchers, fostering optimal patient care and advancing the field of endodontics in India through evidence-based practice and continuous learning.

Introduction: Evidence-based endodontics improves patient care by combining clinical competence, research, and patient values. This review critically assessed scientific studies at an Indian national endodontic conference. Materials and Methods: Scientific research papers presented at the 30th National Endodontic Conference of the Indian Endodontic Society 2022 were categorized according to the area of interest and the level of evidence. Cuzick's test for trend was utilized to compare the level of evidence of the abstracts at the National Endodontic Conference (n = 396) and those published from the 20th European Society of Endodontology Biennial Congress 2022 (n = 91). Results: Endodontics (n = 265, 64.6%) was the most examined domain, followed by diagnosis (n = 49, 12.4%), restorative dentistry (n = 46, 11.6%), and miscellaneous (n = 45; 11.6%). Root canal disinfection (n = 64, 16.1%) was the most prevalent subcategory, followed by endodontic instruments and apparatus (n = 40, 10.1%) and restorations (n = 36, 9%). Laboratory and animal (nonhuman) studies dominated the national conference abstracts (n = 219, 55.3%), followed by level VI (n = 108; 27.2%), level III (n = 40; 10.1%), and level II (n = 23, 5.9%). There was no significant difference between the national and international conference levels of evidence (P = 0.318). Discussion: National and international conferences lack laboratory-to-clinical translation. Researchers must do high-quality, relevant, nonredundant evidence-based research. Conclusion: New studies should use evidence-based research to efficiently address valid research questions and provide predictable and high-quality patient treatment.

Stevens-Johnson syndrome (SJS) is a rare medical condition with severe mucocutaneous reaction due to infection or adverse drug reaction. The present case reports the impact of chloroquine-induced SJS on the tooth root development. A 20-year-old Indian male reported to conservative dentistry and endodontics speciality clinic with the chief complaint of food lodgement and sensitivity in maxillary and mandibular posterior teeth. He had a past medical history of severe cutaneous reaction after taking Tab. Lariago (chloroquine) for treatment of malarial fever at the age of 8 years. The acute inflammatory immune response was managed by hospitalization and administration of steroids and anti-inflammatory drugs. Clinical examination revealed dry mucosa, carious teeth with adequate oral hygiene. Panoramic X-ray showed multiple teeth with short roots. A detailed cone beam computed tomographic scan (CBCT) demonstrated a healthy bone trabecular pattern with the absence of any periapical radiolucency. Short, blunt roots with immature apex were seen in many teeth. Based upon the measurement of root to the crown ratio on the CBCT scan and correlating the development status of teeth with the medical history, a diagnosis of short root anomaly (SRA) after chloroquine-induced SJS was made. This is the first report to describe the three-dimensional features of teeth with SRA in a patient with SJS. Diagnostic, restorative, and endodontic implications of SJS are highlighted.

Background: Despite the high prevalence of traumatic dental injuries (TDIs), parents generally lack awareness about dental trauma emergency management. This preliminary study's goal was to assess parents'/guardians' awareness of the treatment of tooth fractures/avulsion. Materials and Methods: A preformed questionnaire in e-format was sent to parents of school-going children. Kolmogorov–Smirnov test and Shapiro–Wilks's test were employed to test the normality of data. In addition, a Chi-square test was performed for quantitative variables. P ≤ 0.05 was considered statistically significant. Results: A response rate of 82.1% was achieved. Approximately 19.6% of parents reported dental injuries, with the majority (51.9%) occurring at home. In avulsion, 54.8% of parents believed that reinserting the tooth back into the socket was possible. For tooth fractures, 36.2% of parents believed that the fractured tooth could be glued. Tap water was preferred as a storage medium (43.3%). An insignificant association was observed with regard to storage media (P > 0.05). Conclusion: Inadequate understanding of the treatment of TDI by the primary caregiver leads to ineffective interventions at the scene of the accident and a poor prognosis for otherwise treatable cases.

Background: Pulpotomy is a vital pulp therapy performed in carious pulp exposures in teeth in which the inflamed coronal pulp is removed and medicament is placed to conserve the vital root pulps. Recently, simvastatin which is a cholesterol-lowering drug has been found to be associated with the pulp regenerative potential. Aim: The aim of this parallel two-arm randomized control trial was to evaluate and compare the clinical and radiographic efficacy of diode laser (DL) and simvastatin gel (SG) in pulpotomy of carious primary molars. Methods: Hundred primary molars (in 98 children, 65 males, 33 females with age 4–8 years) requiring pulpotomy were randomized into the DL or SG group. Pulpotomy was performed as per the standardized protocol; thereafter, all teeth were restored with resin modified glass ionomer cement followed by stainless steel crowns. Follow-up evaluations were done at 3 and 12 months using clinical and radiographic criteria. Statistical analysis was done using Chi-square test at a significance level of 0.05. Results: At 12 months, out of 92 teeth available for clinical and radiographic evaluation by blinded evaluators, DL group showed clinical and radiographic success rates of 76.1% and 52.1%, while SG group showed 80.4% and 65.2% success rates, respectively. There was no statistically significant difference between the efficacy of two techniques clinically (P = 0.49) or radiographically (P = 0.30). Conclusions: Both SG and DL had similar efficacy for primary tooth pulpotomy, clinically and radiographically after 12 months. Considering its ease of application and low-cost, SG can be recommended as a potential pulpotomy medicament in primary molars.

Background: Dentinal microcracks formed during apical resection may lead to increased susceptibility to root fracture and improper sealing of apical preparation that may negatively influence the outcome of endodontic microsurgery. Aims: This study was performed to analyze the root-end surface for dentinal microcracks using a scanning electron microscope (SEM) after resection with high-speed bur and trephine drill. Materials and Methods: Thirty extracted single-rooted maxillary premolar teeth were selected and randomly distributed into two groups (n = 15). Working length was established using a #15 K-type file. Canals were prepared with a rotary Ni-Ti system to size 30/0.06 using endomotor, irrigated with 3% sodium hypochlorite, dried with paper points, and obturated with gutta-percha cones using a single-cone technique. All samples were mounted on preformed molds and poured using a mixture of sawdust and gypsum. In Group A; tungsten carbide bur was used to perform a freehand apicoectomy. In Group B; a trephine drill was used with a three-dimensional guide to perform 3 mm of root resection. Apicoectomy was performed in both groups under a dental operating microscope. Resected root ends were inspected for microcracks using SEM. The Shapiro-Wilk and Mann-Whitney U-test were used for statistical analysis. Results: Microcracks were observed in all samples in both study groups. Trephine drill produced more microcracks on the resected root surface compared to the use of high-speed tungsten carbide bur with a statistically significant difference (P < 0.05). Conclusions: The trephine drill used during targeted endodontic microsurgery produced more microcracks on the resected root dentine surface compared to the high-speed tungsten carbide bur used during freehand apicoectomy. [ABSTRACT FROM AUTHOR]

Context: Coronavirus disease 2019 (COVID-19) is declared as a global pandemic by the WHO. Due to lack of proper vaccine, social distancing and restriction of movement in the form of“lockdown” have been implemented to curb the spread. This has crippled dental care in the country. Aims: The aim of this article is to highlight the management of endodontic emergencies during the COVID-19 lockdown phase. Settings and Design: Retrospective analysis of patient's data at a tertiary care center Materials and Methods: The data of 247 patients referred to the specialty clinic between March 23 and May 31, 2020, were retrospectively analyzed. COVID-19 risk assessment was performed for all the patients. Based on the diagnosis, the cases were classified as emergency, urgent, or nonemergency. The endodontic intervention was performed for all the emergency cases. Minimally invasive dentistry and pharmacotherapy were provided for urgent and nonemergency cases. Results: One hundred and seventeen patients presented with true endodontic emergencies (symptomatic irreversible pulpitis with or without apical periodontitis [80%], pulp necrosis and acute apical abscess [18%] or traumatic dental injury [2%]). About 82% of the emergency cases were managed by nonsurgical endodontic therapy, and vital pulp therapy was performed in 15.4% of the cases. Conclusions: Management of most of the endodontic emergencies required the use of aerosol-generating procedures. Irreversible pulpitis was the most common cause for the patients seeking emergency endodontic treatment.

AIM. The aim of this study was to train dentists on the different oral hygiene measures to be followed by COVID-19 patients via Webinar and Information Education Communication (IEC) Materials and compare the effectiveness of both. METHODOLOGY. A total of 100 dental professionals were included by non-probability convenience sampling. Webinar and IEC Materials on oral hygiene measures, oral symptoms, and management strategies during COVID-19 were created and training was conducted for all dental professionals who registered themselves. An online version of the self-administered questionnaire (English) was created on the official Edantseva website and circulated to all the registered participants to obtain the pre and post-training data. RESULTS. Out of the total 80 participants in the Webinar group, 47 were females and 33 were males. Comparing the mean total scores obtained by the participants in the webinar and IEC groups in the pre and post-test showed that there is a significant difference in the scores obtained by the participants in the two groups in the pre and post-test (p<0.01). CONCLUSION. Educating dentists via IEC Materials was effective in improving their knowledge regarding oral health management during the COVID-19 pandemic. IEC materials being handy and referable at any time was found to be more effective. [ABSTRACT FROM AUTHOR]

Background: Oral hygiene maintenance is crucial for prevention of various oral diseases. Oral hygiene practices across the country vary largely and people in peri-urban and rural areas use traditional methods of oral hygiene like powders, bark, oil and salt etc. Their effect on oral soft and hard tissues need to be studied to understand their beneficial and/ or harmful effects on maintenance of oral hygiene and prevention or causation of oral diseases. Objectives: This study aimed to assess the plaque-cleaning efficacy, gingival bleeding, recession and tooth wear with different traditional oral hygiene methods as compared to use of toothpaste-toothbrush, the most accepted method of oral hygiene practice. Study Design: Hospital based cross sectional analytical study. Results: Total 1062 traditional oral hygiene method users were compared with same number of toothpaste-brush users. The maximum number in the former group used tooth powder (76%) as compared to other indigenous methods, such as use of bark of trees etc and out of tooth powder users; almost 75% reported using red toothpowder. The plaque scores and gingival bleeding & recession were found to be more in traditional oral hygiene method users. The toothwear was also more severe among the toothpowder users. Conclusions: Traditional methods were found to be inferior in plaque control as was documented by increased bleeding and gingival recession. Its effect on hard tissues of teeth was very damaging with higher tooth wear scores on all surfaces.

Endodontic therapy entails maneuvers in a complex anatomy. Intraoral periapical (IOPA) X-rays aid in providing information regarding the root canal system and periapical area. It offers clinicians with a high-resolution, low radiation, cost-effective imaging modality, and continues to be the method of choice for endodontic imaging. However, it has an inherent limitation of being a two-dimensional (2D) representation of a three-dimensional (3D) object. This can sometimes lead to misinterpretation, especially in cases where there is a diagnostic dilemma. Cone beam computed tomography (CBCT) has been specifically developed for the maxillofacial imaging. It has been extensively used for imaging during pre-, intra-, and post-endodontic therapy. It provides additional information when the sign/symptoms and the 2D radiographic picture do not collaborate. This paper highlights three interesting cases in which IOPA X-rays failed to divulge accurate information. CBCT aided the clinician to arrive at a correct diagnosis and treatment planning, thereby protecting the patient from further unnecessary iatrogenic complications.

Aim: This study aimed to assess the shape, size, symmetry, and location of mental foramen (MF) in relation to mandibular dental and skeletal landmarks using cone-beam computed tomography (CBCT). Methods: This retrospective observational study was performed on 135 CBCT images of 74 males (mean age 36.16 ± 13.49 years) and 61 females (mean age 37.13 ± 13.53 years). Two independent observers performed the morphometric measurements of MF using CBCT images using Invivo software. Independent t-test and Mann–Whitney test were employed to evaluate the gender differences. A comparison of categorical data was performed using Chi-square test. Intraclass correlation coefficient and Kappa statistics were used to assess interobserver reliability. Results: The most common horizontal and vertical location of MF was the long axis of the second premolars (52.2%) and below the bicuspid root apices (70%), respectively. The most common shape was round (56.6%). Significant gender differences were observed for the MF size (mean width 0.35 mm larger in males), the distance of MF to lower border of mandible (16.10 ± 1.77 mm in males and 14.81 ± 1.48 mm in females), and MF to pogonion (28 ± 2.13 mm in males and 26.62 ± 1.98 mm in females). The horizontal and vertical locations were bilaterally symmetrical in 67.4% and 79.26% of subjects, respectively. Conclusion: Right and left sides of the mandible require separate evaluations since there are differences in the location of the MF on each side. Gender differences were observed in location of MF in the relation to skeletal landmarks. Nevertheless, skeletal landmarks are reliable for locating the MF. [ABSTRACT FROM AUTHOR]

Introduction: Evidence-based endodontics improves patient care by combining clinical competence, research, and patient values. This review critically assessed scientific studies at an Indian national endodontic conference. Materials and Methods: Scientific research papers presented at the 30th National Endodontic Conference of the Indian Endodontic Society 2022 were categorized according to the area of interest and the level of evidence. Cuzick's test for trend was utilized to compare the level of evidence of the abstracts at the National Endodontic Conference (n = 396) and those published from the 20th European Society of Endodontology Biennial Congress 2022 (n = 91). Results: Endodontics (n = 265, 64.6%) was the most examined domain, followed by diagnosis (n = 49, 12.4%), restorative dentistry (n = 46, 11.6%), and miscellaneous (n = 45; 11.6%). Root canal disinfection (n = 64, 16.1%) was the most prevalent subcategory, followed by endodontic instruments and apparatus (n = 40, 10.1%) and restorations (n = 36, 9%). Laboratory and animal (nonhuman) studies dominated the national conference abstracts (n = 219, 55.3%), followed by level VI (n = 108; 27.2%), level III (n = 40; 10.1%), and level II (n = 23, 5.9%). There was no significant difference between the national and international conference levels of evidence (P = 0.318). Discussion: National and international conferences lack laboratory-to-clinical translation. Researchers must do high-quality, relevant, nonredundant evidence-based research. Conclusion: New studies should use evidence-based research to efficiently address valid research questions and provide predictable and high-quality patient treatment. [ABSTRACT FROM AUTHOR]

Context: In India, teeth cleaning with tooth powder is common in rural and semi-urban areas. These dentifrices may contain low-quality abrasives, which may have a deleterious effect on dental hard tissues. Aims: This study aims to evaluate the tooth substance loss caused by different dentifrices and to correlate it with chemical composition, size, and shape of abrasives used. Settings and Design: An indigenously made automated machine was used for brushing the specimens. Materials and Methods: Sixty-four freshly extracted premolars were allocated to eight groups (n = 8). Colgate toothpaste was used as the control group. Each specimen was brushed in a vertical motion for 2½ h at 200 strokes/min with a constant applied load of 200 g corresponding to 6-month brushing. The difference in weight (pre- and post-brushing) was determined by an analytical weighing machine. Chemical analysis was done to determine the presence of iron oxide by Inductively Coupled Plasma Mass Spectrometry method. Shape and size of the abrasive particles was evaluated under scanning electron microscopy (SEM). Statistical Analysis Used: One-way analysis of variance and Paired t-test were used to analyze the data. Results: Tooth substance loss was maximum in the group brushed with red tooth powder, which was shown to contain the highest amount of iron oxide and also exhibited large, irregularly shaped abrasive particles under SEM. Conclusions: Tooth substance loss was documented to be correlated with chemical composition (iron oxide) and the size and shape of abrasive particles used in dentifrices.

Objective: The objective of this study was to determine the most suitable material for indirect pulp treatment (IPT) clinically and to determine the thickness (in mm) and type of tissue in terms of radiodensity (in Hounsfield units [HU]) formed after pulp capping using cone-beam computed tomography (CBCT) scan. Materials and Methods: A longitudinal interventional single-blind randomized clinical trial was conducted on 94 children (7–12 years) with a deep carious lesion in one or more primary second molar and permanent first molar without the history of spontaneous pain indicated for indirect pulp capping (IPC) procedure. About 109 teeth were treated using three materials, namely, calcium hydroxide (setting type), glass ionomer cement (Type VII), and mineral trioxide aggregate randomly. The teeth were followed up at an interval of 8 weeks, 6 months, and 1 year for success of IPT as per the American Academy of Pediatric Dentistry clinical criteria. For determining the thickness and type of dentin tissue formed, a CBCT scan was done immediately postoperative and another scan at an interval of 6 months. The scans were compared to evaluate the average thickness of the dentin bridge formed. Results and Conclusions: Success rate for IPC was 96.85%. A significant difference was obtained in the average thickness of reparative dentin at immediate postoperative and 6-month postoperative values in all three groups suggesting distinct barrier formation. Similar significant findings were obtained in radiodensity of barrier formed (in HU). All three materials were found to be equally suitable as IPC agents suggesting mineral gain.

Recently, an innovative, nonsurgical regenerative endodontic treatment protocol “SealBio” was introduced to manage mature nonvital permanent teeth with periapical lesions. This paper explains the management of an unusual case of dens evaginatus and an attached supernumerary tooth/an odontome associated with two distinct radiolucencies in a mandibular premolar with “SealBio” technique and discusses the various hypotheses on the pathogenesis of unusual malformation and associated pericervical cyst-like radiolucency in the involved tooth.

Aims and Objectives: The study aims at determining pulp response of two high fluoride releasing materials silver diamine fluoride (SDF) and Type VII glass ionomer cement (GIC) when used as indirect pulp treatment (IPT) materials. Materials and Methods: Deep Class V cavities were made on four first premolars indicated for extraction for orthodontic reasons. SDF, Type VII GIC, and calcium hydroxide base are given in three premolars, and one is kept control. Premolars were extracted 6 weeks after the procedure and subjected to histopathological examination to determine the pulp response. The results were analyzed using Chi-square test. Results: No inflammatory changes were observed in any of the groups. Significantly more number of specimens in SDF and Type VII GIC groups showed tertiary dentin deposition (TDD) when compared to control group. No significant difference was seen in TDD when intergroup comparison was made. Odontoblasts were seen as short cuboidal cells with dense basophilic nucleus in SDF and Type VII GIC group. Conclusion: The study demonstrated TDD inducing ability of SDF and Type VII GIC and also established the biocompatibility when used as IPT materials.