Journal of Conservative Dentistry
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   Table of Contents - Current issue
Coverpage
March-April 2021
Volume 24 | Issue 2
Page Nos. 111-227

Online since Saturday, October 9, 2021

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EDITORIAL  

Blended learning Highly accessed article p. 111
Sekar Mahalaxmi
DOI:10.4103/jcd.jcd_473_21  
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REVIEW ARTICLES Top

Effect of surface treatment on the dislocation resistance of prefabricated esthetic fiber posts bonded with self-adhesive resin cement: A systematic review and meta-analysis Highly accessed article p. 113
Shweta Elizabeth Jacob, Sabah Mohd Zubair, Manuel Sebastian Thomas, Vinod Jathanna, Ramya Shenoy
DOI:10.4103/jcd.jcd_656_20  
Background: This systematic review aimed to determine the presence of any in vitro proof to validate the utilization of surface treatments to advance the bond strength of fiber posts to intraradicular dentin with self-adhesive resin cements. Methodology: Laboratory studies that assessed the push-out or pull-out bond strength of the prefabricated esthetic posts whose surface was treated with either chemical or physical treatment or a combination and bonded using self-adhesive resin cement within root canal model were included for this systematic review. The review began after obtaining the registration number from the International Prospective Register of Systematic Reviews (PROSPERO ID-CRD42020165009). Study reporting was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant articles were identified using a literature database search in Web of Science, Scopus, PubMed, and EBSCO. Besides this, handsearch was also done to ensure complete capture of the articles. Results: Fifteen articles were then selected and included in this study, out of which four were excluded for meta-analysis due to usage of the artificial substrate. It was shown that an additional step of surface treatment of esthetic fiber post did not result in significant improvement in dislocation resistance. Assessment of risk of bias categorized the available research into high risk and medium risk. The results showed heterogeneity. Conclusion: The use of additional steps such as chemical, mechanical, or a combination of post surface treatment does not have any added benefit. However, the results must be interpreted with caution due to methodological shortcomings.
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Premixed bioceramics: A novel pulp capping agent Highly accessed article p. 124
Nidhi Motwani, Anuja Ikhar, Pradnya Nikhade, Manoj Chandak, Saurabh Rathi, Meghna Dugar, Rutuja Rajnekar
DOI:10.4103/JCD.JCD_202_20  
The main aim of restorative dentistry is to protect the vitality of the Pulp tissue. The pin point carious expoure and iatrogenic errors warrant the need for various pulp capping procedures like Indirect Pulp Capping and Direct Pulp Capping. Pulp Capping is dressing of the dental pulp exposed due to mechanical procedure, carious lesion or traumatic injury to preserve its vitality and function. There has been constant evolution and research on materials used to cap the Pulp tissue. The different kind of chemical and biological materials has been used with varying degree of success. The prognosis based on the pulp capping material has dramatically improved with the introduction of bioactive cement. Though MTA and biodentine have shown a high success rate, their properties can be adversely affected with error in powder/liquid ratio and may present with difficulty in the handling characteristic. Premixed bioceramics have been introduced in the market and present with desirable properties as a pulp capping agent. Owing to good handling characteristics, biocompatibility, odontogenic property, and antibacterial action it is a potent pulp capping agent for clinical application. This review is aimed to discuss the introduction of premixed bioceramics, forms of premixed bioceramics available, and its physical, chemical, and biocompatible properties.
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ORIGINAL RESEARCH ARTICLES Top

The effect of natural reducing agents on push-out bond strength of AH plus and BioRoot RCS to sodium hypochlorite treated root dentin p. 130
S Mann Navjot, Jhamb Ashu, Kaur Kamalpreet, K Mann Navneet, Rana Manu, Batra Divya
DOI:10.4103/jcd.jcd_52_21  
Aims: To evaluate the effect of natural anticoagulants 6.5% proanthocyanidin (PA) and 25% bamboo salt on push-out bond strength (PBS) of AH Plus and BioRoot RCS to dentin. Subjects and Methods: 30 single-rooted extracted human teeth were collected. After establishing the working length samples were prepared up to size F3. 5 ml of 3% NaOCl was used as irrigant during instrumentation followed by rinse with 5 ml of 17% ethylenediaminetetraacetic acid. Samples were randomly divided into groups based on the final irrigation solution: Group I – AH plus sealer group, Ia – Saline group, Ib – PA group, Ic – Bamboo salt (BS) group. Group II – BioRoot RCS group, IIa – Saline group, IIb – PA group, IIc – BS group. After obturation, samples were embedded in self-cure acrylic resin and 2 mm thick root slices were made at coronal middle and apical 3rd. These slices were subjected to PBS testing followed by stereomicroscopic examination for checking the mode of failure. Statistical Analysis Used: Kruskal–Wallis and Dunn's post hoc test. Results: 3% NaOCl significantly decreased the bond strength of AH Plus as compared to BioRoot RCS to dentin (P < 0.05). Both PA and BS were capable of increasing the PBS of AH Plus and BioRoot RCS to NaOCl-treated dentin. Conclusions: Final irrigation with antioxidants such as PA and BS eliminates the risk of reduced bond strength of sealer to root canal walls, which ensues following the use of NaOCl as an irrigant.
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Effect of nonthermal atmospheric plasma on the shear bond strength of composite resin after using different tooth-whitening systems: An in vitro study p. 135
Bolla Nagesh, Kommineni Harika Chowdary, Praveen Kumar Gali, Tammineedi Sravanthi, Lakshmi Bhavani Potru, Aameena Banu Mayana
DOI:10.4103/JCD.JCD_612_20  
Aim: We aimed to evaluate the effect of nonthermal atmospheric plasma (NTAP) on the bond strength of composite resin after using different tooth-whitening systems. Methods: Eighty maxillary central incisors (n = 80) were divided into two groups based on the tooth-whitening procedure used – Group 1: bleaching (Pola Office, USA), Group 2: microabrasion (Opalustre, Australia). The samples were subdivided into four groups depending on the surface treatments – Group A: control (no surface treatment), Group B: plasma, Group C: antioxidant (sodium ascorbate), and Group D: buffering agent (sodium bicarbonate). After the surface treatments, the specimens were stored in artificial saliva for 24 h and composite resin was bonded to the labial surface of the teeth perpendicular to the long axis. The samples were then subjected to shear bond strength test under the universal testing machine. Statistical Analysis: The results received from shear bond strength analysis were subjected to statistical analysis using a two-way ANOVA test, independent t-test, and Tukey's multiple post hoc tests. The P value set was <0.05. Results: The highest mean bond strength value was seen in Group 2B (NTAP treatment after microabrasion) followed by Group 1B (NTAP treatment after bleaching). Mean shear bond strength values have suggested a statistically significant difference between all the other groups (P < 0.05) except between Groups 1A, 2A and 1D, 2D. Conclusions: Within the limitations of the current in vitro study, bleaching and microabrasion followed by surface treatment using NTAP showed the highest bond strength than other groups.
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Perspective and practice of root caries management: a multicountry study – Part I p. 141
Abubaker Qutieshat, Abdurahman Salem, Rayhana Aouididi, Juliana Delatorre Bronzato, Haider Al-Waeli, Mousa Abufadalah, Saleem Shaikh, Yassir Yassir, Ahmed Mhanni, Priyanka Vasantavada, Hatem Amer
DOI:10.4103/jcd.jcd_19_21  
Background: Every effort needs to be made to better understand the current state of practice and trends relating to root caries management which will be of benefit to dentists universally in the practice of dentistry. Aim: This article presents a multicountry questionnaire survey of the current state of practice in the management of root caries among dentists in nine different countries to get a wider range of opinions and perspectives. Methodology: A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among groups. Results: The results showed statistically significant differences among dentists in most questionnaire aspects. Bleeding is the greatest obstacle facing dentists when restoring root surface lesions. Reported survival rates reflect uncertainty about the material and/or approach of choice in the management of root surface caries. Conclusion: This questionnaire survey revealed the current status of management of root surface caries in clinical practice in various countries. Substantial attention is required to bridge the knowledge gap and address the current void of uncertainty as relates to root caries management by providing a common ground for communication between dentists from all around the globe. In all, this work found a degree of consensus at the international level on what appears to work well among the dental practices surveyed and identified several issues with existing approaches that need to be addressed in future studies.
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Comparative evaluation of antimicrobial and antifungal efficacy of bioactive root-end filling materials: An in vitro study p. 148
Gopika Viswanath, Mahima Tilakchand, Balaram D Naik, Anuradha S Kalabhavi, Raghavendra D Kulkarni
DOI:10.4103/JCD.JCD_548_19  
Context: Microorganisms are the main cause of failure of endodontic treatment. When retreatment fails periapical surgery followed by retrograde filling is done to seal the apex. A root-end filling material should have antimicrobial property as well as bioactive properties necessary for healing, repair, and regeneration of the apex. Aims: The aim of this study was to evaluate the antibacterial and antifungal efficacy of three bioactive root-end filling materials: mineral trioxide aggregate (MTA) Plus, Biodentine, Endosequence root repair material (ERRM) against Enterococcus faecalis and Candida albicans. Subjects and Methods: E. faecalis and C. albicans standard bacterial strains were used. 100 μl was taken from liquid cultures of E. faecalis and planted in Mueller-Hinton agar and the same amount of C. albicans was planted in Sabouraud dextrose agar by lawn culture. MTA Plus, Biodentine, and ERRM were aseptically filled into the opened pits. Following this, the media were kept in the drying oven at 37°C for 24, 48, and 72 h and the diameters of the inhibition zones were measured. Statistical Analysis Used: Statistical analysis was carried out by Kruskal–Wallis, Post hoc (Mann–Whitney), Friedman, and Post hoc (Wilcoxon-sign) test. Results: Among the three groups, the antimicrobial activity of Biodentine against E. faecalis was statistically higher than MTA Plus and ERRM (P < 0.05). Antifungal activity of MTA Plus against C. albicans was statistically higher than Biodentine and ERRM (P < 0.05). ERRM showed the smallest inhibition zone against E. faecalis and C. albicans among the three groups (P < 0.05). Conclusions: Biodentine exhibited the greatest antimicrobial activity and MTA Plus exhibited the greatest antifungal activity among the three groups. ERRM exhibited the least antibacterial and antifungal activity among the three groups.
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An innovative technique to safely perform active cleaning in teeth with open apices: CAB technique p. 153
Alfredo Iandolo, Alessandra Amato, Giuseppe Pantaleo, Alberto Dagna, Luca Ivaldi, Federica di Spirito, Dina Abdellatif
DOI:10.4103/jcd.jcd_42_21  
The current study aims to evaluate in vitro the extrusion of NaOCl, using an artificial root canal with an open apex, using different canal irrigation protocols. For this study, a transparent artificial root canal was used. The apex was shaped to be oversized and irregular in form. After root canal mechanical shaping, the artificial cylindrical chamber, which was made below the large apical foramen, was filled with fuchsine-stained bovine pulp tissue. Afterward, irrigation protocols were carried out and compared regarding their safety with regards to irrigant extrusion. Subsequently, the examiner created two groups, Group A: internal heating associated with ultrasonic activation and Group B: internal heating associated with ultrasonic activation, using the CAB technique. In both the groups, 5.25% sodium hypochlorite solution was used as the irrigant. Regarding assessing the presence or absence of the extrusion, photographs at ×20 were taken and analyzed. For the statistical analysis, a t-test for paired samples was used. Extrusion of irrigant beyond the apex was present only in Group A. The main objective of endodontic treatment is the removal of damaged tissues and bacteria. For this reason, active cleaning is crucial in all endodontic treatment cases. Internal heating followed with ultrasonic activation while using the CAB technique was an effective and safe technique to ensure no irrigant extrusion beyond the open apex.
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Comparing the pulp/tooth area ratio and dentin thickness of mandibular first molars in different age groups: A cone-beam computed tomography study p. 158
Mathukan Chaleefong, Sangsom Prapayasatok, Sakarat Nalampang, Phumisak Louwakul
DOI:10.4103/jcd.jcd_47_21  
Context: Mandibular first molar frequently requires endodontic treatment. Understanding age-related changes in pulp-dentin complex and root canal morphologies is essential for successful endodontic and restorative treatments. Aim: This study aimed to compare pulp/tooth area ratio (PTAR) and dentin thickness (DT) in mandibular first molars in different age groups through cone-beam computed tomography (CBCT) imaging. Subjects and Methods: One hundred CBCT images of mandibular first molar were divided into five groups; age 20–29, 30–39, 40–49, 50–59, and 60 years old and older. Axial images were used to determine PTAR at Level A (furcation), Level B (between Levels A and C), and Level C (half distance between the furcation and apex of the root). The minimum DT of the distal wall of mesiobuccal (MB) and mesiolingual (MLi) canal and mesial wall of distal canal at 2 and 3 mm under the furcation was measured. Statistical Analysis Used: Analysis of variance was used to determine differences among age groups. Results: PTAR was determined to reduce as age increases, showing a significant difference among the age groups at Levels A, B, and C of both roots (P < 0.05). The minimum DT was found to increase with age, demonstrating a significant difference among the age groups of MB and MLi canal at 2 and 3 mm (P < 0.05). No statistically significant difference was observed in the mesial DT of distal canal. Conclusions: The reduction of PTAR and the increasing DT were confirmed with advanced age.
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Perspective and practice of root caries management: A multicountry study – Part II: A deeper dive into risk factors p. 163
Abdurahman Salem, Rayhana Aouididi, Juliana Delatorre Bronzato, Haider Al-Waeli, Mousa Abufadalah, Saleem Shaikh, Yassir Yassir, Ahmed Mhanni, Priyanka Vasantavada, Hatem Amer, Abubaker Qutieshat
DOI:10.4103/jcd.jcd_20_21  
Background: The potential of an improved understanding to prevent and treat a complex oral condition such as root caries is important, given its correlation with multiple factors and the uncertainty surrounding the approach/material of choice. Deeper insights into risk factors may improve the quality of treatment and reduce the formation of root surface caries. Aim: The present work aims to gain knowledge about dentists' opinions and experiences on assessing the risk factor related to the development of root caries and to help identify any overlooked factors that may contribute to less efficacious clinical outcomes. Methodology: A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among the groups. Results: Dentists around the world ranked the oral hygiene status of patients as the most important factor in the development of root surface caries. Patients with poor oral hygiene, active periodontal disease, reduced salivary flow, and gingival recession are perceived to have a higher risk of developing new root surface caries. There is a greater focus on prevention in the UK and greater levels of untreated dental disease in other countries, especially those recovering from civil wars. Conclusion: This work identified some overlooked factors that may have contributed to the less efficacious clinical outcomes reported in the literature. It is hoped that this deep dive into risk factors coupled with the findings presented in Part I of this study will be used as a basis for a more comprehensive investigation into the management of patients with root surface caries.
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Evaluation of shear bond strength of various adhesives under Simulated intrapulpal pressure: An in vitro study p. 169
Sreelakshmi Pradeep, Neeta Shetty, Ravindra Kotian, Ramya Shenoy, Ishani Saluja
DOI:10.4103/jcd.jcd_84_21  
Introduction: The presence of pulpal fluid can influence dentin bonding. This study aimed to evaluate the shear bond strength of universal dental adhesives under simulated intrapulpal pressure. Materials and Methods: Forty intact maxillary premolars were distributed into four groups (Group 1 – 3M ESPE Adper Single Bond 2 total etch adhesive, Group 2 – 3M ESPE Single Bond Universal, Group 3 – Prime and Bond universal adhesive, and Group 4 – Ivoclar Tetric N Bond Universal). Adhesive restorative procedures were carried under intrapulpal pressure simulation following which it was subjected to a shear load of 0.5 mm/min. Fracture mode analysis was performed using a stereomicroscope. The data obtained were subjected to ANOVA and Tukey post hoc test with a P < 0.05. Results: Highest bond strength was exhibited by Group 3 (7.01 ± 2.02 MPa) and least by Group 1 (5.36 ± 3.03 MPa). However, there were no statistical differences among the groups. Group 1 and 2 showed mostly cohesive failure, whereas Group 3 and 4 showed mixed failure. Conclusion: The results demonstrated that the experimental universal adhesive agents exhibited comparative shear bond strength when subjected to pulpal pressure. Pulpal pressure has a significant effect on bond strength.
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Evaluation of apical leakage after immediate and delayed postspace preparation using different root canal sealers: An in vitro study p. 174
Nirmitee Narendra Gujarathi, Jyoti Mandlik, Sarita Singh, Shweta Chaubey
DOI:10.4103/jcd.jcd_79_21  
Background: Endodontically treated teeth with extensive loss of tooth structure lacks sufficient support for a permanent restoration. While restoring them with post and core it is important not to disrupt the apical seal. Aim: Evaluation of apical leakage after immediate and delayed postspace preparation using two root canal sealers. Materials and Methods: Sixty single-rooted teeth were decoronated and roots were biomechanically prepared and obturated with gutta-percha and 2 sealers: AH Plus (Group A, n = 30) and Sure-Seal root canal sealer (Group B, n = 30). Groups A and B were subdivided into A1, A2 and B1, B2. Postspace was prepared immediately for A1 and B1. For A2 and B2 post space was prepared after storage in physiologic saline for 1 week. The samples were kept in Rhodamine B dye for 72 h and then sectioned longitudinally to observe dye penetration along the root canal wall under Stereomicroscope. The dye penetration was measured linearly and the values were subjected for statistical analysis using one-way analysis of variance and t-test. Results: Statistically significant difference between Group A (1.00 mm) and B (2.71 mm) was observed (P < 0.001). However, the subgroups for immediate and delayed post space preparation did not show statistically significant difference (A1 = 0.947; A2 = 1.043; B1 = 2.306 and B2 = 3.120, P < 0.001). Conclusion: AH plus sealer showed lesser leakage compared to Sure-Seal Root canal sealer. The difference in leakage values was not statistically significant in delayed and immediate post space preparation groups, Time of postspace preparation has no influence on apical leakage.
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Hybrid layer formation and bond strength to dentin impregnated with endodontic sealer after cleaning protocols p. 179
Joissi Ferrari Zaniboni, Joao Felipe Besegato, Flavia Angelica Guiotti, Matheus Sousa Vitoria, Reinaldo Oliveira Lima, Milton Carlos Kuga
DOI:10.4103/jcd.jcd_14_21  
Aims: This study evaluated the hybrid layer formation and bond strength of two adhesive systems, Scotchbond Universal (U) or Adper Scotchbond Multi Purpose (M), after cleaning protocols using ethanol (E) or xylol (X), to dentin impregnated with an epoxy-resin based endodontic sealer. Settings and Design: The study design was an Experimental in vitro study. Methodology: One hundred bovine dentin specimens were randomly allocated into five groups (n = 10): Computed tomography (CT) (control): Only acid etching + M; E+U; X+U; E+M. After the specimen preparation, images were obtained using confocal laser scanning microscopy to evaluate the hybrid layer formation. For microshear bond strength test, the dentin specimens were included in polyvinyl chloride tubes and four resin composite cylinders were placed on the surface. The analysis was performed 24 h after storage. Statistical Analysis Used: For parametric and nonparametric data, analysis of variance followed by Tukey test and Kruskal–Wallis, followed by Dunn test were, respectively, used at a significance level of 5%. Results: Regarding hybrid layer formation, all experimental groups were similar to each other (P > 0.05). However, CT showed higher hybrid layer formation than other groups (P < 0.05), except in relation to X+M (P > 0.05). Bond strength was statistically similar among all groups (P > 0.05). Conclusions: Hybrid layer formation in dentin impregnated with epoxy resin-based sealer and submitted to different cleaning protocols was similar to the control group only for X+M. No differences were found among the experimental groups. Regarding the bond strength, no effect was observed for any group.
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A retrospective three-dimensional assessment of the prevalence of apical periodontitis and quality of root canal treatment in Mid-West Indian population p. 184
Asiya Mujawar, Vivek Hegde, S Srilatha
DOI:10.4103/jcd.jcd_44_21  
Introduction: This study aims to report a retrospective observation of the prevalence of apical periodontitis (AP) and quality of root canal treatment in cone-beam computed tomography (CBCT) scans among the Mid-West Indian population. Materials and Methods: A total of 1229 CBCT scans were obtained across different CBCT centers in western India. After the exclusion criteria, those that were included were divided into broadly two groups – those that were filled and those that were unfilled. Various parameters were taken into account such as AP, length of the root canal filled, and coronal filling. Results: There were a significantly higher percentage of nonfilled canals. Poor filling quality, inadequate coronal restoration, and also missed extra canal were significantly associated with AP. Both males and females showed higher presence of AP in the nonfilled teeth than filled ones (X2 - Chi square value M = 612.156, P < 0.00001, X2 F = 1032.9092, P < 0.00001). Conclusion: (1) The inadequacy of the filling of the root length was a contributory factor to the higher prevalence of AP among the study population. (2) The density of the filling and the quality of the coronal filling also significantly affected the successful outcome of the root canal treatment.
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Comparative evaluation of marginal and internal fit of endocrowns using lithium disilicate and polyetheretherketone computer-aided design - computer-aided manufacturing (CAD-CAM) materials: An in vitro study p. 190
Aamir Zahid Godil, Arshi Ilyas Kazi, Sanaa Akhlaq Wadwan, Kashif Yusuf Gandhi, Ramandeep J S. Dugal
DOI:10.4103/JCD.JCD_547_20  
Purpose: To evaluate the marginal and internal fit of endocrowns with different computer-aided design/ computer-aided manufacturing (CAD-CAM) materials by measuring them with a stereomicroscope (μm). Materials and Methods: A mandibular first molar typodont tooth was prepared to receive an endocrown. The preparation was scanned using an extra-oral scanner. Endocrowns (n = 20) were fabricated using lithium disilicate (IPS e. max CAD LT block; CEREC Ivoclar Vivadent, Liechtenstein) and polyetheretherketone (PEEK) (breCAM. BioHPP®; Bredent, UK) using CAD-CAM technique. Marginal gap was evaluated using a stereomicroscope at the midpoint of all four surfaces (mid buccal, mid lingual, mid mesial, mid distal). This was followed by sectioning of the endocrowns in a sagittal plane along with the prepared tooth to evaluate the internal fit at four different points (A, B, C, D) using a stereomicroscope. Statistical analysis was performed using one-way analysis of variance test. Results: Mean values of marginal gap of lithium disilicate and PEEK endocrowns are 56.6 ± 6.1 μm and 81.3 ± 10.1 μm, respectively. Mean value internal gaps of lithium disilicate and PEEK endocrowns are 158.2 ± 11.1 μm and 199.1 ± 13 μm, respectively. Results in the present study have shown that the marginal and internal fits of lithium disilicate endocrowns are superior to that of PEEK endocrowns. Conclusions: Based on the outcomes of this in vitro study, the marginal and internal fit of lithium disilicate endocrowns is better than PEEK endocrowns. The marginal gap clinically acceptable is <120 μm. The marginal gap values recorded in this study are within the acceptable range for both materials.
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Effect of root dentin conditioning using different chelating agents on pushout bond strength of MTA-fillapex and bioroot RCS: An in vitro study p. 195
Jesline Maria Jose, EM Manju Krishna, S Maneesh Ahamed, Robin Theruvil, Jain Mathew, Saira George
DOI:10.4103/JCD.JCD_574_20  
Context: The success of endodontic therapy depends on proper biomechanical preparation and obturation. Aim: To evaluate and compare the pushout bond strength (POBS) of MTA Fillapex (MF) and BioRoot RCS (BRCS) sealers in endodontically treated teeth with different irrigants-5.25% Sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA) and 0.2% Chitosan. Materials and Methods: 60 premolars were divided into three groups. Each group was then subdivided into A and B. The three groups were Group 1A: 17% EDTA + 5.25% NaOCl with MF sealer (n = 10); Group 1B: 17% EDTA + 5.25% NaOCl with BRCS sealer (n = 10); Group 2A: 0.2% Chitosan + 5.25% NaOCl with MF sealer (n = 10); Group 2B: 0.2% Chitosan + 5.25%NaOCl with BRCS sealer (n = 10); Group 3A: 5.25% NaOCl + MF sealer (n = 10); and Group 3B: 5.25% NaOCl + BRCS sealer (n = 10). After obturation, they were sectioned horizontally (1.5 mm thick). The POBS was studied using a universal testing machine (Autograph AG-1). The sample size was calculated using the statistical package G * Power (3.1.5). Results: It was found that the POBS of BRCS was higher when the root canal was irrigated with 0.2% Chitosan + 5.25% NaOCl. Thus, Group 2B showed significantly higher POBS than Group 2A. Conclusion: The irrigation regimen of Chitosan with NaOCl was found to have better debriding effect on the root canal. Of the two sealers, BRCS showed the higher bond strength values than MF.
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Comparison of the penetration depth of five root canal sealers: A confocal laser scanning microscopic study p. 199
Priyanka Mokashi, Jinal Shah, Padmini Chandrasekhar, Gaurav Prakash Kulkarni, Rajesh Podar, Shishir Singh
DOI:10.4103/JCD.JCD_364_19  
Background: Sealer penetration into dentinal tubules eliminates the pathways for bacterial leakage and entombs intratubular bacteria. Aim: The aim of this study was to evaluate and compare the depth of radicular dentinal tubule penetration of five root canal sealers using confocal laser scanning microscopy. Methods: Fifty freshly extracted single-rooted maxillary anterior teeth were used. After decoronation at the cementoenamel junction, they were prepared to ProTaper size F3. After irrigation with 5 mL smear clear, 5 mL 5% sodium hypochlorite and 5 mL distilled water alternatively, the samples were randomly divided into five groups (n = 10) and obturated by lateral compaction technique using the test sealers labeled by fluorescent rhodamine B dye (Mayor Diagnostics, Mumbai, India). Zinc oxide eugenol (ZOE) (Prime Dental Products), EndoREZ (Ultradent), Sealapex (SybronEndo), AH Plus (Dentsply Maillefer), and MTA-Fillapex (Angelus) formed the test groups. Teeth were then positioned in blocks of orthodontic resin. Three horizontal sections of 1-mm representing coronal middle and apical thirds were made and examined with Zeiss (laser scanning microscope [LSM] 780) confocal LSM. Images were analyzed using ZEN 2.1 software. Statistical Analysis: Data were recorded and subjected to statistical analysis using one-way ANOVA test. Results: Maximum penetration depth was demonstrated by AH Plus in the coronal and apical thirds, MTA-Fillapex in the middle thirds, while minimum penetration depth was seen in ZOE in the coronal and middle thirds and Sealapex in the apical thirds. None of the root canal sealers were able to penetrate the complete depth of radicular dentinal tubules. Conclusion: While AH Plus and MTA-Fillapex showed the highest penetration into radicular dentinal tubules, ZOE and Sealapex demonstrated the least penetration.
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Comparative evaluation of efficacy of two minimally invasive caries removal techniques on fracture resistance of the teeth restored with composite: An SEM study p. 204
Manjula Kittur, Sheetal Ghivari, Madhu Pujar
DOI:10.4103/JCD.JCD_481_20  
Aim: The aim of the study was to evaluate and compare the efficacy and fracture resistance of the teeth restored with composite using two minimally invasive caries removal techniques under a scanning electron microscope. Materials and Methodology: Forty-five freshly extracted human permanent molars with Class I and II dentinal caries were selected. Diamond bur group (15): The carious lesion was excavated using round diamond bur until hard dentine was detected. Polymer bur group (15): Carious lesion was removed using polymer burs in circular motions. V-cariesolve gel group (15): Carious lesion was covered with V-cariesolve gel for 30 s and was scraped using a spoon excavator. The time required for the caries removal by each group was recorded. The effectiveness of caries excavation was verified using caries indicator dye. The smear layer removal was assessed using a scanning electron microscope. The cavities were restored with composite resin and fracture resistance of teeth was evaluated. All the data were tabulated and analyzed using Kruskal–Wallis test for overall comparison followed by Mann–Whitney U-test for pairwise comparison. Results: The mean time taken for caries excavation by diamond bur group was less (86.13 s), retention of smear layer was less with diamond bur group, and the median score for staining of infected dentin was more (3) in V-cariesolve gel group. Fracture resistance was highest (1.53) with diamond bur group (P < 0.001). Conclusion: Caries removal efficacy and fracture resistance for diamond bur group were better compared to polymer bur group and v-cariesolve gel.
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Assessment of yogic relaxation techniques for its anxiolytic effects in patients requiring endodontic treatment: A prospective, randomized controlled study p. 209
Meenakshi R Verma, Rahul D Rao, Deepak Langade, Ashish K Jain, Ananya Guha, Malavika Mohan
DOI:10.4103/jcd.jcd_97_21  
Background: The aim of the study is to assess the anxiolytic effects of yogic relaxation technique (YRT) in patients requiring root canal treatment (RCT). Materials and Methods: In this prospective, randomized, placebo-controlled study, 30 patients undergoing RCT with baseline visual analog scale for anxiety (VAS-A) of score >4 were divided into Group 1: YRTs; Group 2: alprazolam (0.25 mg/0.5 mg), and Group 3: placebo. After 30 min of completion of YRT, endodontic treatment was performed. Reduction in anxiety was analyzed using state anxiety score (domain) of the state-trait anxiety inventory scale. Results: There was no significant difference in anxiety score 1 h before RCT between groups (P = 0.401). Ten minutes before (P < 0.0001) and after RCT (P < 0.0001), there was significant difference between groups (yogic relaxation vs. alprazolam [P < 0.0001]; yogic relaxation vs. placebo [P < 0.0001]). Ten minutes before RCT, yoga relaxation showed significant difference in anxiety score for pain versus alprazolam and placebo (P < 0.0001 for both). Ten minutes after RCT, the change from baseline in mean anxiety score for pain was significantly different with yogic relaxation (versus alprazolam [P = 0.043]; versus placebo [P = 0.002]). As per the global assessment of efficacy, the response was excellent in 9 (90%), 2 (20%), and 1 (10%) patients in yoga relaxation group, alprazolam group, and placebo group, respectively. Difference in response between three groups was significant (P < 0.0001). There was no significant difference in the global assessment of tolerability between three groups (P = 0.535). No adverse events were reported. Conclusion: Before RCT, YRT is an effective alternative to anxiolytic agents, alprazolam.
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Effect of dental acid etchant-mediated photodynamic therapy on bacterial reduction and microshear bond strength of composite to dentin – An in vitro study p. 214
Jaya Gupta, Sonali Taneja, Anshi Jain
DOI:10.4103/JCD.JCD_620_20  
Objective: The objective of this study was to assess the effect of dental acid etchant (DAE)-mediated photodynamic therapy on bacterial reduction and microshear bond strength of composite to dentin. Materials and Methods: Eighty permanent third molars after sample preparation were exposed to a cariogenic challenge with Streptococcus mutans. After incubation, specimens were randomly divided into four groups (n = 20): Group I – DAE, Group II – low-level laser (LLL), Group III – diode laser + methylene blue (MB + L), and Group IV – diode laser + DAE (DAE + L). Half of the specimens from each group were selected for bacterial reduction assessment and the other half for microshear bond strength. All the samples for assessment of bacterial reduction (before and after intervention) were seeded onto the surface of mitis-salivarius-bacitracin medium. After incubation, the viable bacterial count was determined in colony-forming unit/mL. For microshear bond strength assessment, samples were subjected to various treatment modalities and then bonding and debonding procedure was performed for blocks of composite and values were recorded. Results: Significant reductions in S. mutans were observed in all the groups – Group I (DAE) 68.50%, Group II (LLL) 55.90%, Group III (MB + L) 88.60%, and Group IV (DAE + L) 87% with comparable bacterial reduction between Group III (MB + L) and Group IV (DAE + L). Furthermore, a significant difference in bond strength values was seen in Group III (MB + L) 10.99 MPa and Group IV (DAE + L) 17.99 MPa whereas an insignificant difference was found between Group I (DAE) 20.74 MPa, Group II (LLL) 18.27 MPa, and Group IV (DAE + L). Conclusion: DAE caused a comparable reduction in bacterial count to MB-assisted PDT and also there was no adverse effect on bond strength values. PDT can be performed while acid etchant containing MB dye is being applied in the cavity, thus reducing operative time and enhancing cavity disinfection.
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CASE REPORTS Top

Nonsurgical management of cutaneous sinus tract of odontogenic origin: A report of two cases p. 219
G Keerthana, Jigyasa Duhan, Pankaj Sangwan, Ritika Yadav
DOI:10.4103/jcd.jcd_125_21  
Discharging facial lesions of dental etiology are almost always difficult to diagnose. Due to the lack of dental signs in most patients, these lesions are often misunderstood and overlooked. Such patients often seek cosmetic therapy and end up undergoing unnecessary treatments, if an odontogenic source is not established. To make an accurate diagnosis, a comprehensive medical and dental history, as well as knowledge of the various presentations of facial lesions, is of pivotal importance. The cases identified here were misdiagnosed at first, and they were treated with antibiotics and surgical procedures as a result. Root canal operations were performed after referral to a dental unit, and the sinus tract eventually healed. This emphasizes the significance of taking odontogenic sources into account when treating head and neck lesions.
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Management of cutaneous sinus tract of odontogenic origin: Eighteen months follow-up p. 223
Ines Kallel, Eya Moussaoui, Islem Kharret, Asma Saad, Nabiha Douki
DOI:10.4103/jcd.jcd_56_21  
An odontogenic cutaneous sinus tract is a pathologic canal that initiates in the oral cavity but opens externally at the cutaneous surface of the face or neck. It is frequently misdiagnosed, leading to inappropriate treatment. A 44-year-old female patient referred to us with a chronically draining lesion on his chin. The lesion previously was misdiagnosed by medical doctors and had undergone cryotherapy and surgery with a focus on the skin lesion and had received antibiotic therapy for a prolonged period of time. After clinical and radiologic examination the dental origin of the lesion was evident and proper endodontic treatment was performed followed by surgical treatment after the recurrence of pus discharge 2 weeks after the conventionnel root canal treatment. Five months later, after the treatment, the lesion showed an obvious healing. After 18 months, the patient was comfortable and a significant healing of the sinus tract was noted, the periapical radiograph shows clear regression of the periapical lesion and an improvement in bone trabeculation. The key to successful treatment of cutaneous sinus tract of dental origin must be appropriate communication between the dentist and the physician in order to achieve correct diagnosis and therapy in such cases.
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