Conservative Dentistry & Endodontics Research Papers (original) (raw)

The objective of implementing newer techniques in dentistry is to overcome the shortcomings of traditional ones. Dentistry, being a dynamic field, is always on the lookout for innovative techniques, and embracing newer technology has indeed improved patient care in many ways. Lasersare being used as an adjunct or alternative tool to conventional dental procedures. Many dental disciplines such as oral surgery, oral medicine, periodontics, paediatric dentistry, implantology, and operative dentistry have benefitted from the use of laser technology. Lasers have become an invaluable tool in many procedures, including caries removal, caries decontamination, caries prevention, cavity preparation, soft tissue surgeries, root canal decontamination, analgesic and anti-inflammatory effects, to name a few. Laser treatment in dentistry can be quicker and more efficient. Other benefits would include markedly less pain, lack of bleeding, minimal need of anaesthesia and reduced postoperative discomfort. Also, patients may be able to resume
their daily activities shortly after the treatment is rendered, owing to faster healing. However, the caveat would be that adequate training is a mandatory prerequisite before handling patients with these powerful instruments.

Background and objectives: The successful surgical treatment of oral cancer depends upon the stage of disease at diagnosis and adequate resection of tumor. Residual disease after surgery is responsible for early recurrence and poor prognosis. Complete removal of lesion with adequate safe margins is therefore of paramount importance. A variety of aids are used to ensure the complete removal of lesion. The present study was aimed to determine the diagnostic accuracy of Lugol’s iodine staining in detection of safe margins of oral squamous cell carcinoma, taking histopathology as gold standard. Patients and methods: This study was conducted in the Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore. Data was collected from 50 patients using non-probability sampling technique. After informed consent, appropriate pre-operative preparation was done. Diagnosed cases of oral squamous cell carcinoma were included in the study. All patients were treated under general anesthesia...

- by Dr. Salima Naveed Manji and +2
- •
- Medical Education, Medical Ethics, Operative Dentistry, Conservative Dentistry & Endodontics

Objective: This review was performed to answer the controversial clinical situation of post endodontic restoration of severely mutilated teeth with a high degree of evidence. The review helps evaluate the type of post (custom made cast post) that demonstrates superior clinical performance in endodontically treated teeth. Data Sources: Electronic databases (MEDLINE, CENTRAL, SCIENCE DIRECT, GOOGLE SCHOLAR AND LILAC) were screened upto April 2021. Only randomised controlled trials with at least a follow up of one year were included in this review.

Background: The long term management of miniplate fixation osteosynthesis remains debatable and controversial with few authors advocating routine removal of the miniplates after 3-6 months of placement, while others recommend retention of the miniplates unless their removal is clinically indicated.
Objective: The aim was to study the incidence, indications, time gap, role of metallic composition and site of removal of miniplates in operated cases of maxillofacial region over a one-year period. Materials and Methods: Patients undergoing removal of miniplates over a one year period were studied and evaluated regarding the number of miniplates removed, time gap present between fixation and removal of miniplates, indications for removal, metallic composition of miniplates removed, sites of removal and complications. Correlations between indications
for miniplate removal based upon time gap, metallic composition, age of patients undergoing plate removal and number of miniplates present were determined using Chi-square test. Correlation between metallic composition of miniplate and time gap was also determined using Chi-square test
Results: The miniplates were removed in 31 patients (26 males and 5 females). Most common indication for removal was infection (45%). Forty-five percent of the patients underwent miniplate removal within 1 year of placement. The correlation between indications for miniplate removal and time gap was found to be statistically significant (P = 0.04).
Conclusion: Most of the hardware removal is performed subsequent to complications associated with hardware and local factors . There is no significant association between the composition of the hardware and pate removal . However there is a significant association between the time gap and indication for plate.Miniplate removal should be performed when hardware is causing various complications and physical symptoms. Infection, miniplate exposure, pain, palpability or any other morbidity that appears after bony union should be treated by miniplate removal.

Introduction: The success of endodontic treatment is complete obturation of the root canal system up to the cementodentinal junction. Obturation of the root canal is usually done with gutta-percha along with a root canal sealer. Sealers are used as binding agents, and they lubricant and aid in sealing of gutta-percha. The hermetic sealing of the root canal by means of a three dimensional obturation of the pulp space constitutes the key factor for successful endodontic therapy.
Aim and objective: The aim of the present study was to evaluate and compare the apical sealing ability of three root canal sealers using dye penetration method.

Marfan syndrome (MFS) is a type of connective tissue disorder caused by a mutation of the fibrillin gene and increased TGF-β in tissues. This disorder leads to connective tissue fragility, with such clinical manifestations as slender fingers, long limbs, abnormal cardiac valves, and aortic aneurysm development. We present here a case of Class II maxillary protrusion in a 13-year-old male with MFS. The patient underwent orthodontic treatment, including extractions of the upper and lower bicuspids. The treatment achieved a good Class I occlusion with normal overjet and overbite. On the other hand, we found extraordinary craniofacial skeleton development during the post-adolescent period and untreatable marginal gingivitis despite complete plaque control, which might be resulted from connective tissue fragility.

The study aimed to highlight the relationship between forensic science and endodontics by illustrating CBCT records can be used as legal evidence for forensic analysis and evaluate the effect of elevated temperature on the endodontically treated teeth. Methods: The present study was conducted on 40 extracted permanent mandibular premolars, which were divided into two groups based on predetermined incineration temperature: Group I-400°C & Group II-800°C subjected for 15 minutes holding time in a digital burnout furnace. The root canal treatment was performed for both the groups and a Pre-incineration CBCT scan was taken for both the groups as an ante-mortem data. Following heating analysis, root canal treated teeth were examined using a stereomicroscope at 20x resolution to evaluate the morphological changes. The post-incineration CBCT scan was taken as the post-mortem record for each group. Both ante-mortem records and post-mortem records were compared for the forensic analysis. Results: The endodontically treated teeth display a series of macroscopic and stereo-microscopic changes for each temperature scale. The CBCT records identify the thermal stress-induced 3D alterations in the gutta-percha filled teeth. Conclusion: Knowledge of changes in human dentition and traces of the endodontically treated teeth can help forensic experts for the identification of the fire victims.

Dental anatomy plays a crucial role in human body as it helps in survival. The after-treatment protocol in the root canal treatment (RCT) for improper functioning of the anatomy is major challenge for dentists. RCT deals with repairing and saving the tooth that is badly decayed or becomes infected. The RCT, if analyzed mechanically; various factors govern efficacy of the treatment out of which incomplete filling and sealing of 3D root canal space with suitable biomaterial against bacterial growth is major parameter. Today, thanks to modern technologies satisfactory results are obtained, but the cost of treatment is substantially increased which is unaffordable. Thus, a survey was carried by visiting doctors practicing for more than 25 years in conservative dentistry to recent students admitted to dental surgery in various colleges to understand tools/aids used during RCT with hypothesis of developing low cost obturation device for augmenting the dental device feasibility. The success rate of obturation device is high over hand pluggers; but the cost parameter limits the usage of same. The survey also coveys that complete sealing is also not possible with hand pluggers as well as existing available aids, and thus there is a need to develop a low cost obturation device using dual energy (low operating frequency and heat) source for increasing efficacy of treatment. To test feasibility of the collected data, it's being analyzed through p-test (p>0.05) for selected parameters and correlation was found to be statistically significant.

- by SWANAND PACHPORE and +1
- •
- Biomedical Engineering, Conservative Dentistry & Endodontics

ABSTRACT : The root canal system is an arborizational, anastomotic, byzanthine, labyrinthine complexity, morphologically comparable to a mosaic. While primary canals exist, the tributaries, accessory branches and lumina of dentinal tubules harbour extensive tissue and microflora which if left untreated remains vector for persistent and refractory pathology. Therefore root canal shaping and cleaning is of utmost importance in the success of root canal treatment. Number of systems are available for effective shaping accounting from hand files to nickel titanium rotary files to the new single file concept “WAVE ONE” KEYWORDS : Wave One, Reciprocating Motion, Nickel Titanium, Reverse Balanced Force Technique, vCJD
| Dr VINEET VINAYAK| Dr VINEET VINAYAK|dr VINEET vinayak

- by sheetal kubasad
- •
- Microbiology, Dentistry, Bacteriology, Public Health Dentistry

Introduction: Dentin hypersensitivity is a very common clinical condition of the teeth, associated with the exposure of the dentin to external environment of the mouth. There is still no promising solution for dentin hypersensitivity due to little knowledge about its etiology and predisposing factors. The purpose of this study was to compare the efficacy of gallium-aluminum-arsenide diode laser (GaAlAs) and dentin bonding agent in the treatment of dentin hypersensitivity. Materials and Method: Sixty permanent teeth with diagnosis of dentin hypersensitivity were selected from patients reporting the department. The selected teeth were divided into two groups: In group I, teeth were treated with 980 nm GaAlAs laser for 1 min at 30mW and in group II, teeth were treated with dentin bonding agent. Sensitivity was assessed by evaporative stimulus, measured with the criteria proposed by Uchida at baseline and after treatment; immediately, at 15 and at 30 days. Results: The mean dentin hypersensitivity in both the laser and dentin bonding agent group was 1.9 ± 0.76.After 30 days, the degree of dentin hypersensitivity in Laser treated group (0.90 ± 0.80) was significantly lower than that of Dentin Bonding Agent group (1.40 ± 1.07)(p< 0.05), thereby showing greater clinical efficacy of diode Laser over Dentin Bonding Agent for the treatment of dentin hypersensitivity. Conclusion: The dentin bonding agent had less desensitizing efficacy compared with GaAlAs laser. However, the desensitizing effect of the dentin bonding agent still could be considered an effective therapy for treating dentin hypersensitivity.

Bichectomy, or Bichat fat pad removal, is a surgical procedure
indicated when there is excess volume on the middle third of the
face (bellow the cheekbones / zygoma) giving it a chubby or round
look. The ideal candidates are men and women who wish to achieve
a slimmer face appearance in this area, and it is also recommended
for patients with chronic cheek biting. Extra-oral photographs are
part of the preoperative clinical assessment and will be compared
with photographs taken postoperative (immediately after the
procedure, after 15 days, 45 days and the final evaluation after 4
months), when the facial contour and volume reduction will be
monitored.

Introduction and Aim: Flipped classrooms learning refers to teaching and learning activities where students watch a lecture
video outside the class and have hands-on activities in the class. There is growing concern among medical and dental educators
that conventional modes of teaching neither create interest in students nor imparts a life-long respect for learning. The aim
of this study was to

Aim To evaluate the influence of the location and design of endodontic access cavities on root canal shaping and filling ability, pulp chamber cleaning and fracture resistance of extracted human mandibular incisors.
Methodology After pre-selection using periapical radiographs, forty extracted intact human mandibular incisors were scanned in a micro-computed tomographic device. The teeth were matched based on similar anatomical features of the canals and assigned to four
experimental groups (n=10) according to the endodontic access cavity and root canal preparation protocol: traditional/TRUShape (T/TRU);
traditional/MTwo (T/MT); minimally invasive/TRUShape (MI/TRU); and minimally invasive/MTwo (MI/MT). The samples were scanned after root canal instrumentation and filling procedures. The parameters evaluated were: volume and area of the root canal, non-instrumented canal areas, canal transportation and centering ratio, accumulated hard tissue debris, voids in root canal fillings and root canal filling materials remnants in the pulp chamber. After root canal filling and cavity restoration procedures, the samples were submitted to the fracture resistance test. Data were statistically analysed using Shapiro–
Wilk, one-way ANOVA and Bonferroni tests with a significance level of 5% (α=0.05).
Results There was no difference regarding all parameters evaluated before and after root canal preparation (volume and area of the root canal, non-instrumented canal areas, canal transportation and centering ratio, and accumulated hard tissue debris) among the groups (P>0.05). MI/TRU and MI/MT groups were associated with significantly more voids in root canal fillings when compared to the T/TRU and T/MT
groups (P<0.05). Percentage of root canal filling material remnants in the pulp chamber after cleaning procedures and mean fracture resistance values were not ssignificantly different among the four
experimental groups (P>0.05).
Conclusions The location and design of the endodontic access cavity did not impact on the root canal preparation and resistance to fracture of extracted mandibular incisors, regardless of the instrument used.
Minimally invasive access cavities were associated with significantly more voids in root canal fillings.

Background: A disproportionately higher number of individuals who succumb to the adverse effects of tobacco use reside in low and middle-income countries and this disparity is expected to widen further over the next several decades.
Materials And Methods: A cross-sectional study was conducted in arts & science colleges in Chennai District. The study was conducted among 492 arts and students in Chennai district. Convenient sampling methodology was followed and the google form link was shared among the students in arts and science colleges. Responses were collected and the results were tabulated. Descriptive statistics was used to describe the frequency distribution of the responses.
Results: Among 492 students, 86 (17.5%) reported to use tobacco. Majority of them that is 60 (70%) used cigarettes. Among the tobacco users, 53 (61.6%) tried to quit tobacco. Nearly half of the study participants, 288 (58.5%) reported that smoking should not to be allowed in university campus. Among 492 study participants, only 208 (42.2%) were aware that tobacco use leads to cancer.
Conclusion: Prevalence of tobacco use among the study participants was low. The knowledge related to ill effects of tobacco has to be improved.

Tobacco use is one among the harmful habit that kills its consumers. Tobacco is a risk factor for various conditions and is associated with various cancers. Tobacco addiction is attributed to nicotine present in the tobacco products. Smoking not only harms the smokers but also the persons who doesn’t smoke by means of second-hand smoke. Though various measures been initiated and implemented to curb the tobacco use, yet the complete success is not achieved. Coordinated effort by government agencies, community organisations, professional organisations at the national and international level are required for achieving the goal of tobacco control.

Objectives: To investigate the effects of acidic beverages regarding brushing on surface roughness and erosion of bulk-fill restorative materials.
Methods: Sixty-seven specimens of each bulk-fill resin composite and giomer were prepared. Baseline data of surface roughness and erosion were recorded using a profilometer and surface characteristics were examined using scanning electron microscopy (SEM). Three groups of discs (n = 22) were alternately immersed in 300 mL of each beverage for 5 s and in 300 mL of artificial saliva for 5 s for 10 cycles. After immersion, specimens were divided into two subgroups, the brushing group with automatic toothbrush for 2 s with a force of 2 N and the non-brushing group. This process was repeated every 8 hours. Surface roughness and erosion was recorded again on day 7, 14, 21, and 28, and surface characteristics were examined on day 28. The specimens were
evaluated and data were analyzed by repeated analysis of variance (ANOVA), Tukey’s honestly significant difference and t-test (α= 0.05).
Results: Coca-cola caused significantly greater roughness and erosion than other groups (P < 0.05). Giomer had significantly greater roughness and erosion than the bulk-fill resin composite (P < 0.05). Brushing groups caused a rougher surface than nonbrushing groups (P < 0.05).
Conclusions: The effects of coca-cola and orange juice on the surface roughness and erosion of bulk fill restorative materials depended on the physical and chemical composition of the restorative materials, pH of the beverages and brushing.

Background: Laser photobiomodulation can be a useful adjunctive method in tissue engineering in enhancement of proliferation
and differentiation of mesenchymal stem cells. Buccal fat pad-derived stem cells (BFPSCs)has been introduced as a promising
source for craniofacial bone tissue engineering. Current study aimed to evaluate the effects of near infra-red photobiomodulation
on (BFPSCs)behavior.
Conclusion: According to the results of this study a pulsed mode of irradiations showed better viability results. Although the 3J/
cm2 0.3W, Pulsed irradiation showed significantly better results for viability and proliferation, however no statistically significant
effect was observed in osteogenic differentiation.

Objective: This study focuses on investigating the influence of the interproximal contact area and width on periodontal parameters. Materials and Methods: A total of 30 periodontitis subjects were involved in the study, and 661 teeth were selected for analysis. Periodontal parameters such as plaque score, gingiva score, clinical probing depth and radiographic bone level were recorded for each tooth. Upper and lower impressions were taken for construction of study models which were used for the measurement of interproximal contact area and width. simple linear regression (SLR) and multiple linear regressions (MLR) analysis were used to evaluate the relationship between periodontal parameters and interproximal dimension. Results: The SLR analyses consistently showed that the interproximal contact area and width were both significantly related with plaque score, gingiva score and bone level, and MLR analyses confirmed that both the interproximal contact area and width were significant predictors for each plaque score, gingiva score and bone level model. Conclusion: Within the limitation of the study, we can conclude that the interproximal contact area and width have a significant relationship with the presence of dental biofilm, gingival bleeding and bone level in the subjects susceptible to periodontal disease.

The survival of the tooth after endodontic treatment is extremely important for the overall success and improvement of quality of life of the patient. This depends on the choice of the post-endodontic restoration. In the past, post-endodontics, it was advised to crown all teeth with full coverage restorations. Over the years, minimally invasive dentistry has become more popular among restorative dentists. Evidence has made clinicians and researchers realize that full coverage restorations are not advisable and that tremendous amounts of healthy tooth structure may be lost in the process. Recently, many more minimally invasive options are available to restore endodontically treated teeth. They include, partial coverage restorations, inlays, onlays,
overlays, and even simple resin composite cores. Although this minimal approach is quite tempting, some teeth do require more coverage. There are numerous factors that must be studied before a choice of post-endodontic restoration is made including, the type of tooth, the occlusal load on the tooth, number of missing teeth, the amount of remaining healthy tooth structure, position of the tooth, etc. Apart from this, newer materials have been introduced by manufacturers like zirconias,
lithium disilicate, leucite ceramics, etc. that provide better properties to the restorations The clinical decision making process might become quite confusing due to these reasons. A proper guideline is thus required, which includes all the parameters that need to be assessed before making a choice of post-endodontic restoration. Hence, this paper aims at reviewing the various options available today for post-endodontic restorations as well as formulating clinical practice guidelines to aid clinicians in making the correct choice of restoration of endodontically treated teeth.

The core of endodontic instrumentation lies in the cleaning,
shaping and canal preparation. It is contemplated as an important step as it removes the vital and necrotic pulp which contains
the microflora that can cause failure of the endodontic treatment
[1, 2]. Furthermore, the debris that contains the chips of dentin,
other organic and inorganic content block the canals for proper
flow of sealer leading to a poor obturation. Several studies have
been conducted and regardthat the debris should be completely
removed for a successful endodontic treatment. For this purpose,
the canals are thoroughly instrumented with both hand and rotary
instruments in an effort to remove the debris totally.

Periodontal dressings were first introduced by Dr. A.W Ward in 1923. Since then, they have been used as surgical dressings in periodontal surgical wounds. Protecting the wound from mechanical trauma and stability of the surgical site during the healing process are important advantages of periodontal dressing application after surgery [7, 15, 16]. It also provides good adaptation to underlying gingival and bone tissue, prevents post-operative haemorrhage or infection and decreases tooth hypersensitivity in the first hours after surgery. The periodontal dressing is known to protect the clot from forces applied during speaking or chewing [17, 18].

Aim To investigate the attitudes of general dental practitioners (GDPs) and endodontists in the UK towards management of fractured endodontic instruments.Methodology A questionnaire was sent to 330 systemically selected GDPs and all endodontists working in the UK (170). It was accompanied by a covering letter explaining the aims of the study and indicating that all the information given would remain confidential. Those who did not respond to the first mailing were sent another two mailings. Data were analysed using chi-square test at P ≤ 0.05.Results The overall response rate was 75%. Only 18.5% of respondents reported that they would retrieve instruments located in the apical third of root canals with a significantly higher proportion of endodontists (25.9%) compared with that of GDPs (14%) doing so. A significantly higher proportion of endodontists (98.5%) used ultrasonics for removal of fractured instruments compared with GDPs (75.8%). The most common complication of fractured instrument retrieval was thought to be excessive removal of dentine (67%). The majority of respondents (88.5%) reported that they would leave the unsuccessfully removed file in situ and obturate the root canal.Conclusion Both endodontists and GDPs were aware of the limitations of root canal anatomy when removal of fractured instruments was considered. Excessive removal of dentine, the most common complication associated with the removal process, suggests the need for more conservative techniques. Both endodontists and GDPs demonstrated a conservative approach when management of fractured instruments failed. Further studies regarding attitudes of GDPs and endodontists towards some specific aspects of fractured instruments management are required.

- by Ahmad Madarati
- •
- Dentistry, Restorative Dentistry And Endodontics, Microscopy, Microsurgery

Aim: Dental Erosion is clinically defined as the progressive and irreversible loss of dental hard tissue caused by a chemical process of acid dissolution that does not involve bacteria. Dental Erosion can have intrinsic or extrinsic causes. There is growing evidence of considerable increase in consumption of erosive drinks. This aim of this study was to assess the knowledge among the general public towards the awareness of the association between diet and dental erosion. Materials and Methods: The present study is a cross sectional, descriptive questionnaire study conducted among the general public in Tamilnadu, India. A descriptive questionnaire survey was conducted among 325 participants regarding dental erosion and its association with diet from August to October,2019. Data were analysed by using Statistical Package for Social Sciences (SPSS) including Mean, Standard Deviation and Chi-Square Test.(p value<0.05). Results: Lack of awareness of the association between diet and dental erosion was found among the General Public. Since the p-value is significant there is a correlation between most of the groups and variables in this study. The Chi-square test results showed that there was significant impact in most of the variables of this study. Conclusion: This cross-sectional descriptive study shows a majority of the general public are associated with the consumption of potentially erosive drinks. They do not have adequate knowledge about dental erosion and its associated diet factors. Hence, establishing awareness among the general public regarding dental erosion and its association with diet is mandatory.

Background: Dry socket is the most common complication following tooth extraction. However, it is a painful and annoying condition for the patient, and up to the present time the causes of this condition have not been precisely determined, and the proposed treatments aim to relieve symptoms, until the socket heals itself. Aim: The main objective of this study is to compare the efficacy of Alo evera extract and Alvogyl in pain relief associated with dry socket. Materials and Methods: 40 patients (ranged from 29 to 60 years), who had dry socket after tooth extraction in the molar region, were included in the study. They were divided equally and randomly into two groups: group A (Aloe vera) and group B (Alvogyl). Pain values were recorded in the two groups after 2, and 7 days. Results: After 2, and 7 days Aloe vera showed a statistically significant difference in relieving pain compared to Alvogyl (pvalue < 0.05). Conclusion: The use of Aloevera extract shows promising results in terms of pain relief in patients with dry socket.

Introduction To evaluate the cyclic fatigue resistance of 3 replica-like rotary instruments compared to their original brand systems using continuous rotation and optimum torque reverse (OTR) kinematics. Methods New F1 rotary instruments (n=20 per group) from ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland) and ProTaper Gold (Dentsply Maillefer) original brand systems were compared to 3 replica-like instruments (U-File, Dentmark, Ludhiana, India; Super Files, Shenzhen Flydent Medical, Shenzhen, China; and Super Files Blue, Shenzhen Flydent Medical) regarding cyclic fatigue resistance. In each group, the selected instruments were randomly distributed into two subgroups (n=10), according to the kinematic. In the rotary group (ROT), the instruments were activated with a continuous clockwise rotation (300 rpm, 1.5 N.cm), while in the OTR group, the asymmetric oscillatory motion was performed setting the OTR function at 300 rpm and adjusting the torque limit at minimum level, using the TriAuto ZX2 motor (J. Morita, Kyoto, Japan). The time to fracture was recorded and statistically compared according to the kinematics (ROT x OTR) and the instrument type (replica-like x original brand) using the independent sample t-test (α=0.05). Additionally, the metal alloy characterization of each system was performed by differential scanning calorimetry (DSC) and energy-dispersive X-ray spectroscopy (EDS). Results Statistical analysis revealed significantly higher time to fracture for all rotary systems tested in the OTR motion compared to continuous rotation (P < .05), with a mean percentage increase ranging from 52.1% (ProTaper Gold) to 156.7% (U-File). The replica-like instruments showed a significantly higher time to fracture when compared to the respective original brand instruments in either ROT or OTR motions (P < .05). Replicas presented austenitic temperatures above the ones displayed by the original brands, and an almost equiatomic ratio between nickel and titanium elements. Conclusions OTR motion significantly improved the fatigue resistance of both original and replica-like systems. The replicas showed higher cyclic fatigue resistance than original brand instruments and higher transition temperatures to austenitic phase.

Aim: To assess the interfacial adaptation (gap-containing areas) of two root canal
sealers (EndoSequence BC Sealer and AH Plus) to a conventional gutta-percha
(GP) cone (GP-sealer interface) in oval-shaped canals filled using the single cone
technique.
Methodology: Sixteen teeth with oval-shaped canals were selected, scanned in a micro-computed tomographic device, and pair-matched according to the volume, aspect ratio and configuration of root canals. Root canals were then sequentially prepared with WaveOne Gold Primary and Large instruments, followed by filling with WaveOne Large GP points associated with either the premixed calcium-silicate EndoSequence BC Sealer or the epoxy resin-based AH Plus sealer (n = 8 per group) using the single cone technique. After 7 days stored in phosphate-buffered
saline solution at 37°C, the specimens were rescanned and the reconstructed images segmented in order to differentiate the filling materials (sealer and GP cone) to the dentine. A total of 453 cross-sectional slices were assessed and categorized according to the presence or absence of gaps at the GP-sealer interface. Mann-Whitney U-test verified the differences between groups and were considered significant at alpha = 5%.
Results: Gaps were non-homogenously distributed in two-dimensional axial cross-section images and none of the specimens showed completely gap-free areas along
the entire GP-sealer interface. Root canals filled with EndoSequence BC Sealer and
AH Plus displayed 171 (37.75%) and 136 (30.02%) slices with gaps in the GP-sealer
interface and these frequencies were statistically significant (p = .000).
Conclusions: Although none of the specimens had a gap-free area along the entire
GP-sealer interface, oval canals filled with AH Plus showed less gaps than the ones
filled with EndoSequence BC Sealer.

To evaluate the incidence of dentinal microcracks formation after root canal shaping procedures with HyFlex EDM and Vortex Blue rotary systems comparing with that of hand instrumentation using micro-computed tomography. Mandibular first molar teeth (n=60) having 50 to 200mesial root curvature were scanned using high resolution micro-CT imaging before root canal preparation to identify the presence of dentinal defects. Post-instrumentation cross-sectional images were taken and increased number and type of root defects were assessed and recorded. The data was statistically analysed by using chi-square test and McNemar's test at a significance level of 5%. HyFlex EDM has shown greater increase in post instrumentation dentinal defects. Both rotary systems exhibited increased dentinal defects formation at coronal, middle regions which is statistically significant (P=0.042) when compared to apical region. HyFlex EDM has shown greater increase in post instrumentation dentinal defects f...

- by Alejandro Peña López
- •
- Materials Science, Dentistry, Titanium, Medicine

The aim of this study was to evaluate the styloid process and its anatomical variations on the orthopantomographs (OPG) of patients who do not have symptoms of Eagle’s syndrome. The styloid process arises from the temporal bone. The normal length of the styloid ranges between 20 to 30 mm. Any elongations beyond the normal range is considered as an elongated styloid process. Three muscles originate from the styloid process, the styloglossus, stylohyoid, and stylopharyngeus. This study was carried in a random sample of 100 patients (50 males and 50 females), who were divided into two age groups, 10-40 years of age and 41-70 years of age. The orthopantomographs used for the assessment of the styloid process was obtained by reviewing the case sheets of the patients visiting the hospital. The data was collected and tabulated in the excel sheets, and was transferred to the SPSS software for statistical analysis. From the present study, it was evident that the normal type of styloid process was observed on both sides.(right side- 40% and left side 38%). The most common type of calcification of styloid processes found in the right and left sides were the partially calcified type. (Right-48% and left-57%). Partially calcified type of styloid process was commonly observed in both age groups. (10-40 years :30%, 41-70 years:18% on the right side and 10-40 years:32%, 41-70 years: 25%).

Martins JNR, Silva EJNL, Marques D, Belladonna F, Simões-Carvalho M, Camacho E, Braz Fernandes FM, Versiani MA. Comparison of design, metallurgy, mechanical performance and shaping ability of replica-like and counterfeit instruments of the ProTaper Next system. International Endodontic Journal. Aim To compare the ProTaper Next (PTN) system with a replica-like and a counterfeit system regarding design, metallurgy, mechanical performance and shaping ability. Methodology Replica-like (X-File) and counterfeit (PTN-CF) instruments were compared to the PTN system regarding design (microscopy), phase transformation temperatures (differential scanning calorimetry), nickel-titanium ratio (energy-dispersive X-ray spec-troscopy), cyclic fatigue, torsional resistance, bending strength, and untouched canal areas in extracted mandibular molars (micro-CT). ANOVA, post hoc Tukey's and Kruskal-Wallis tests were used according to normality assessment (Shapiro-Wilk test) with the significance level set at 5%. Results Overall similarities in design and nickel-titanium (Ni/Ti) ratio were observed amongst instruments with the X-File having a smoother surface finish. PTN and PTN-CF had mixed austenite plus R-phase (R-phase start approximately at 45°C and near 30°C, respectively), whilst X-File instruments were austenitic (R-phase started at approximately at 17°C) at room temperature (20°C). PTN-CF had the greatest inconsistency in the phase transformation temperatures. Time to fracture of PTN-CF X2 and X3 was significantly shorter than PTN and X-File instruments (P < 0.05), whilst no difference was noted in maximum torque to fracture amongst the tested systems (P > 0.05). X-Files and PTN-CF had a stress-induced phase change during bending load. Mean unprepared surface areas of root canals were 25.8% (PTN), 31.1% (X-File) and 32.5% (PTN-CF) with no significant difference amongst groups (P > 0.05). Conclusion Similarities amongst the systems were noted in the Ni/Ti ratio and maximum torque to fracture , whilst differences were observed in the design, phase transformation temperatures and mechanical behaviour. The ProTaper Next counterfeit instruments could be considered as the less secure system considering its low-cyclic fatigue resistance. Apart from these differences, the unprepared canal surface areas, obtained with the tested systems, were similar.

- by Duarte Marques and +2
- •
- Dentistry, Conservative Dentistry & Endodontics, Rotary Endodontics

Introduction: Vocal polyps and nodules are benign lesions of vocal cords. These lesions have significant influence on quality of life of patients. Mainly these lesions present as hoarse-ness of voice with vocal demand and abuse as significant precipitating factor. Objective of the study was to analyze clinical and demographic profile and VHI-10 of patients with vocal cord polyps and nodules. Material and Methods: A total of 50 patients with clinical diagnosis of vocal polyp or nodule were studied. All cases were analyzed clinically. History, laryngeal examination (Indirect laryngoscope and fibro-optic laryngoscopy) and patient self reporting questionnaire (VHI-10) was taken from every patient. Results: Total 50 cases with Male: Female ratio of 1.5:1 were analyzed. Age of patients ranged from 14 to 65 years and majority of patients with vocal polyps and nodules presented in 4 th decade. Voice demanding profession was presented in 46% of cases. Apart from voice demanding profession, other form of voice abuse, smoking and laryngopharyngeal reflux disease were other predisposing factors in 54%, 30% and 34% of patients respectively. Vocal polyps and nodules were roughly in equal ratio 26:24. Over all mean (+ SD) of VHI-10 was 11.16+6.68. In male, it was 10.2+5.91 and in female, it was 12.60+7.63. Conclusion: Vocal polyps and nodules are benign lesions of vocal cords with male predominance and voice demand/abuse acts as significant precipitating factor and have a significant impact on patients quality of life.

The interrelationship between endodontic and periodontal disease has been a subject of confusion and controversy for many years. Pulpal and periodontal problems are responsible for more than 50% of tooth mortality rate. The aim of the study was to evaluate the prevalence of endo-perio lesions among patients in an institution. This retrospective study included patients who were diagnosed with endo perio lesion from June 2019 to March 2020 in a private institution. Variables such as age, gender and the site of endo perio lesion were retrieved from the patient’s records. Data was tabulated and was statistically subjected to IBM SPSS version 23 and results were obtained. Descriptive and inferential statistics were done. In our study, out of 150 patients, 17.3% of the patients had endo perio lesion. There were 12.7% males and 4.7% females. On analysing the age and the prevalence of endo perio lesion, the higher prevalence was seen among 31-40 years age groups (5.3%). Also, there was statistically significant association between age and the endo perio lesion while there was no statistically significant association
between gender and the endo perio lesion. The present study showed that 17.3% of the study population had endo perio lesion. Also, prevalence of endo perio lesion was higher among males (12.7%) and among the age group of 31-40 years (5.3%).

Multi disciplinary approach was followed in treatment of endoperio lesion in a mandibular molar with furcal involvement and apical lesion. The patient presented with pain and mobility in the right mandibular first molar. There was grade I mobility and periapical lesion along with furcal involvement in relation to 46. A probing depth of 7mm was elicited in relation to buccal aspect of 46. The endodontic management of 46 was done using sonic activation of irrigant along with calcium hydroxide
intracanal medicament. Periodontal flap surgery along with placement of bone graft and Platelet rich fibrin was done to facilitate healing kinetics of periapical healing as well as periodontal regeneration. The patient was recalled after 1,3,6 months and at one year follow up, complete healing of the furcal defect was seen in 46.

The presence of bacteria in teeth with apical periodontitis is a well established fact. The success of endodontic treatment depends on minimising the microbial load and preventing it from getting recolonised with in the canal system. The disinfection protocol depends on the ample usage of irrigants and intracanal medicaments. Intracanal medicaments tend to eliminate bacteria in the inter-appointment phases.
Hence, it is imperative for clinicians to understand the factors that affect the action of an intracanal medicament and factors that help in choosing the right one depending on the case. The current review was performed to check for various intracanal medicaments available and their effect.

The study aims to to evaluate the association between age wise distribution of patients reported with posterior crossbite in Angle’s
class I, II, III malocclusion and to assess the percentage distribution of various treatment modalities in posterior crossbite in class I, class II and class III malocclusion in adolescents and young adults. A sample comprising 30 subjects with posterior cross bite undergoing treatment were selected. Within the limits of this study, the percentage distribution of treatment options was determined. The hyrax appliance remains the appliance of choice in 21.43% of patients in the age group of 10 to 14 years, 18.18 % of patients in the age group 15 to 19 years and bone borne anchorage being chosen for only 9.09 % of patients in the age group 15 to 19 years and 20% of patients in the age group of 20 to 24 years with the help of MARPE (miniscrew assisted rapid palatal expansion) appliance.

A medical emergency can be stated as an acute injury or illness that poses an immediate risk to a person's life or long-term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies such as cardiovascular (heart), respiratory, and gastrointestinal cannot be dealt with by the victim themselves.2 Dependent on the severity of the emergency, and the quality of any treatment given, it may require the involvement of multiple levels of care, from first aiders to Emergency Medical Technicians and emergency physicians.
Life threating emergencies can and do occur in the practice of dentistry. They can happen to anyone whether a patient, a doctor, a member of the office staff, or a person who is merely accompanying patient. Although the occurrence of life-threatening emergencies in dental office is infrequent, many factors can increase the likelihood of such incidents. These include (1) the increasing number of older persons seeking dental care, (2) the therapeutic advances in the medical professions, (3) the growing trend toward longer dental appointments, and (4) the increasing use and administration of drugs in dentistry.
Keywords: Emergency kit, ADA guidelines and ABC.

Early childhood caries remains a significant problem challenging our diagnostic, preventive, and restorative skills. Often, caries in very young children involves the maxillary anterior teeth and the primary molars while the mandibular anterior teeth are generally not involved. Carious involvement of the maxillary incisors not only potentially compromises the integrity of the dentition, but can create an undesirable esthetic appearance. This paper will highlight on the aesthetic crowns available in paediatric dentistry.

Objective: An analogue and digital workflow for the fabrication of a diagnostic 3D printed polymer template and its duplication for long-term injected composite resin interim restorations is described, because of the lack of scientific evidence in 3-dimensional (3D) printing applied to dentistry in terms of printer technology, printer parameters, postpolymerization processes, and material characteristics. In addition, in the case of 3D printed temporary resins, they cannot be relined successfully and its mechanical properties in the mouth have not been tested yet. Conclusions: The main benefits of this approach relate to the improvement of clinical and laboratory procedures, as conventional waxing is eliminated, conventional master casts are not needed and the process is entirely automatized, improving the workflow, with minimal intervention of the laboratory technician. Clinical Significance: The additive manufactured diagnostic template represents the materializa-tion of the digital diagnostic waxing and provides a powerful tool to visualize the digital diagnostic waxing in the patient's mouth and face. Furthermore, the diagnostic 3D printed template can be used for multiple applications including interim restorations, radiographical, or surgical guide fabrication. The duplication technique described provides a predictable workflow to obtain long-term injected resin composite restorations from an additive manufactured esthetic diagnostic template, improving the laboratory and chairside procedures.

- by Marta Revilla-León
- •
- Dentistry, Prosthodontics, 3D printing, Additive Manufacturing

Nanoparticles and nano-composites are major advanced materials used in many medical and dental applications. In this present investigation, we have prepared silymarin, chitosan and hydroxyapatite based nanocomposite using magnetic stirring. The prepared nanocomposite characterized using UV-vis spectroscopic analysis. The free radical scavenging activity of prepared nanocomposites was tested using DPPH assay. The results are statically analyzed and the antioxidant results are good for nanocomposite materials. Based on the results the prepred nanocomposites may used in various dental applications.

Introduction: Candida albicans remains the most common
species causing human infections but recent epidemiological
data reveal shift from C. albicans to non albicans Candida
species. The conventional methods of identification are time
consuming and difficult to perform. The present study was
done to evaluate the performance of conventional identification
method (phenotypic and biochemical) and commercially
available chromogenic Candida speciation media (Hicrome
Candida differential agar) for the identification of medically
important Candida species in a routine clinical microbiology
laboratory.
Material and Methods: A total of 115 Candida isolates from
various clinical specimens received in the Department of Microbiology
were taken up for the study over a period of one
year i.e. from January 2014 to December 2014. The Candida
isolates were speciated by using conventional methods and
were compared against chromogenic agar medium (Hicrome
Candida differential agar).The conventional methods used
for speciation of yeast isolates were germ tube test, colony
morphology on corn meal agar, sugar fermentation and sugar
assimilation test
Results: The isolation of non albicans Candida (59.1%) predominated
over Candida albicans (40.9%). Non albicans
Candida species isolated were C. tropicalis (40%) followed
by C. guilliermondii (10.43%), C. krusei (4.34%), C. glabrata
(2.60%), C. kefyr and C. parapsilosis (0.87%) each.
Conclusion: The accurate species identification of Candida is
important for the treatment, as not all species respond to the
same treatment and also because of the problem of anti-fungal
resistance. Hicrome Candida differential agar is a convenient
and rapid method of identification of Candida species even in
resource limited poor settings.
Keyword: Candida albicans, Non albicans Candida species,
Hicrome Candida differential agar and Conventional method

The advent of CBCT has made it possible to visualize the
dentition, the maxillofacial skeleton and the relationship of
anatomic structures in 3D. CBCT represents a valuable resource in
dental practice because it allows the establishment of a precise
treatment plan by means of diagnostic imaging. In cases of
increased difficulty or intra operative complications, root
resorptions, perforations and root fracture it is prudent to consider
the use of CBCT with its diagnostic value and limited radiation
exposure. Analyzing the morphology of the root canals in human
dentition conclude that the 3D image provided by CBCT is a great
advancement as an auxiliary method to establish the endodontic
diagnosis.

The nose-lip-chin relationships are very important in determination of facial aesthetics [1]. The nasolabial angle defines the angular inclination of the columella as it meets the upper lip. The angle is formed between the intersection of a line tangent to the upper lip and sub nasal and a line tangent to the sub nasal and the most anterior point of the columella. This angle should measure 95 to 110 degrees in women and 90 to 95 degrees in men [2]. The mentolabial angle is the anterior angle formed by the intersection of a tangent to the lower lip) sublabiale to labraleinferius) and a tangent to the upperpart of the soft tissue chin pad (sublabiale to soft tissue pogonion).

- by Luca Martinelli
- •
- Dentistry, Dental Implants, Odontologia, Conservative Dentistry & Endodontics

Key words : Demineralization and remineralization begins with historical prespective on caries. Caries were identified as a major public health problem in 1940s. Demineralization is a process of removal of minerals from dental enamel. Remineralization on the other side is the process of restoring minerals to hydroxyapatite lattice. The battle to keep teeth strong and healthy is dependent upon ratio between demineralizaton and remineralization. In this scientific era new advances have changed our idea from "cure" to "prevention". Remineralization can mainly be achieved by mineral or ionic technology .Ionic technology mainly includes fluorides. Fluorides works primarily via topical mechanism which includes ,inhibition of demineralization at crystal surface, enhancement of remineralzation at crystal surface, and at high concentration inhibition of bacterial enzymes. This article deals with various aspects of fluorides in management of De/ Remineralization.

Pigmentation of gingiva has a major impact on esthetics and also creates psychological negativity. Although a wide range of depigmentation techniques are available to manage this condition, there is a scarcity of literature that guides clinicians to choose the
most appropriate technique. Hence, the aim of this review is to evaluate the available depigmentation treatment modalities with their pros and cons. Cryosurgery followed by lasers has been reported to be the superior techniques with better esthetic results and low rate of recurrence. However, further randomized controlled longitudinal studies are warranted to elaborate the efficiency and effectiveness of available techniques.