Journal of Conservative Dentistry
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   Table of Contents - Current issue
Coverpage
March-April 2022
Volume 25 | Issue 2
Page Nos. 109-212

Online since Wednesday, May 4, 2022

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EDITORIAL  

Esthetic Dentistry – An Indian Perspective p. 109
Shishir Singh
DOI:10.4103/jcd.jcd_254_22  
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REVIEW ARTICLE Top

Recommended clinical practice guidelines of aesthetic dentistry for Indians: An expert consensus p. 110
Dibyendu Majumder, Mithra N Hegde, Shishir Singh, Ashu Gupta, Shashi Rashmi Acharya, P Karunakar, RS Mohan Kumar, B Mrinalini, Shazeena Qaiser, Urvashi Bhimjibhai Sodvadia, Honap Manjiri Nagesh
DOI:10.4103/jcd.jcd_32_22  
Objective: The research for analyzing the smile characteristics in the Indian population has been limited with contradictory outcomes. This consensus statement aims to critically review the literature and provide basic practice guidelines on dental aesthetics related to the Indian population. Clinical Considerations: 9 clinicians and 6 resource persons from dental colleges in India collaborated in this consensus statement which covered 6 topics along with 6 introductory and 6 conclusive remarks. The statement was developed through a colloquium conducted on topics; global aesthetics: different smile design proportions and guidelines, patient perspective towards aesthetic dentistry in India, a literature survey of aesthetic dentistry for the Indian population, macro and micro-aesthetics, multidisciplinary approach in aesthetic dentistry, inclusion of high-end technologies in Indian modern-day practice, followed by a panel discussion to devise and establish the practice guidelines of aesthetic dentistry in India. The Consensus Statement has been formulated according to AGREE Reporting checklist. Conclusion: The experts and panelists reached a Consensus on protocols to institute clinical practice guidelines of aesthetic dentistry for Indians. However, based on all available literature from India, further research is required to investigate many questions that have not been previously considered.
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ORIGINAL ARTICLES Top

Effect of fiber orientation and placement on fracture resistance of large class II mesio-occluso-distal cavities in maxillary premolars: An in vitro study p. 122
Vineet Suresh Agrawal, Arpit Shah, Sonali Kapoor
DOI:10.4103/jcd.jcd_384_21  
Background and Aim: To analyze the outcome of fiber placement and orientation over fracture resistance in wide Class II (Mesio-occluso-distal [MOD]) cavities prepared on maxillary premolars. Materials and Methods: After selection of 120 extracted human maxillary premolars, Class II (MOD) cavities were prepared maintaining uniform dimensions and samples were divided into six groups randomly (n = 20 each): Group I, G-aenial posterior; Group II, G-aenial posterior + Horizontal Ribbond placement on gingival and pulpal floor; Group III, G-aenial posterior + Horizontal Ribbond placement only on pulpal floor; Group IV, G-aenial posterior + vertical Ribbond placement on gingival and pulpal floor; Group V, G-aenial posterior + Ribbond chips; Group VI, Ever-X posterior. After restorations and completion of thermocycling process, universal testing machine measured the fracture resistance of all samples. Fracture modes were inspected under stereomicroscope. Analyzation of data was performed using one-way ANOVA and Tukey test at significance levels of P < 0.05. Results: Fiber placement significantly increased fracture resistance. The highest fracture resistance was shown by Group 2 (1288.8 N) followed by Group 3 (976 N), group 4 (942.3 N), Group 5 (876.3 N), and Group 6 (833 N). Group 1 (No Fiber group) showed the least fracture resistance of 588.41 N. Repairable fractures were seen highest with Group 2 (80%) followed by Group 6 (70%) and least in Group 1 (30%). Conclusions: Horizontal orientation of polyethylene fiber on both pulpal and gingival floor of MOD cavities gives the highest fracture resistance in maxillary premolars and repairable mode of fracture.
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Formulation and evaluation of oral disintegrating films using a natural ingredient against Streptococcus mutans p. 128
K Harini, Krishnamachari Janani, Kavalipurapu Venkata Teja, Chandra Mohan, M Sukumar
DOI:10.4103/jcd.jcd_143_21  
Background: Oral disintegrating films (ODFs) are one of the forms of drug delivery system with better patient compliance. The advantage is that it disintegrates quickly when placed on the tongue and has better bioavailability. Aim: The aim of this study is to develop an ODF using Vaccinium oxycoccos and Plectranthus amboinicus targeting Streptococcus mutans. Setting and Design: This in vitro study was conducted at an institutional laboratory Materials and Methods: The chemical composition of aqueous extracts of Vaccinium oxycoccos and Plectranthus amboinicus was examined using gas chromatography (GC)-mass spectrometry (MS). Extracts were added at its minimal inhibitory concentration (MIC) into the hydroxy propylmethyl cellulose (HPMC) polymer matrix solution to develop active ODF. The study concentrated on assessing the physical properties such as thickness of film, PH of the film, folding endurance, swelling test, disintegration, and dissolution test. Color analysis, Fourier transform infrared (FTIR), spectroscopy, and scanning electron microscope (SEM) were the mechanical properties of the film assessed. Statistical Analysis: Data were analyzed statistically, one-way analysis of variance followed by post hoc analysis for the assessment of MIC. Descriptive statistics were performed for the analysis of film properties. Results: MIC was 25 μg/ml for Vaccinium oxycoccos and 50 μg/ml for Plectranthus amboinicus. Three percentage HPMC with 1% citric acid and 1% aspartame was used to develop a polymer matrix. Films pH was between 6 and 7. FTIR and SEM analysis were done to confirm the attachment of active compound in a polymer matrix. Conclusion: Vaccinium oxycoccos and Plectranthus amboinicus showed good antibacterial activity, therefore could be a potent source to minimize the incidence of S. mutans
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A 1-year comparative evaluation of clinical performance of conventional direct composite restoration technique with a novel “custom shield” technique in class I compound lesions – A randomized clinical study p. 135
Nidhi Surendra Pisal, Nimisha Chinmay Shah, Namita N Gandhi, Ajay Singh Rao, Meetkumar S Dedania, Neha S Pisal
DOI:10.4103/jcd.jcd_309_21  
Aim: The aim of the study is to evaluate and compare the 1-year clinical performance of conventional direct composite restoration technique with a novel “custom shield” technique in class I compound lesions. Subjects and Methods: After ethical approval, 72 patients who signed the informed consent form participated in the study. They were divided into two groups – Group A: Conventional direct composite restoration (n = 36) and Group B: Composite restoration using custom shield technique (n = 36) by computer randomization. In Group A, composite restoration was performed by the incremental layering technique. In Group B, restoration was performed using a novel custom shield and occlusal stamp along with the incremental layering technique. Patients were evaluated using the modified USPHS criteria by blinded evaluators for 1 year. Statistical Analysis: Chi-square test and Friedman test using SPSS version 21.0. Results: A statistically significant difference was obtained for marginal adaptation (P = 0.024), retention (P = 0.23), surface texture, and anatomic form (P < 0.001), and time taken to perform the procedure for Group B was higher than Group A. Conclusion: Conventional composite restoration and custom shield technique can be successfully used in class I compound lesions with custom shield technique having a higher edge over the conventional technique.
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A Comparative Evaluation of fibrin density with Chitosan, Papain and 17% EDTA-Normal saline combination as irrigants in teeth with open apices: An ex vivo SEM study p. 140
Yadav Chakravarthy, Madhumidha Chellamuthu, Arun Senthamilselvan, Aarthi Ganapathy, Mallikarjunan D Yadhavakrishnan, M Assmee
DOI:10.4103/jcd.jcd_553_21  
Context: In regenerative endodontic techniques, a blood clot acts as a natural scaffold for revitalizing dental pulp tissue. Although 17% ethylene diamine tetra acetic acid (EDTA) releases growth factors from the dentin matrix and induces odontoblast differentiation, it has anticoagulant property. Aims: The aim of the study is to evaluate the ability of alternatives (0.2% chitosan and papain) in fibrin formation when used as root canal irrigants during regenerative endodontic procedures in teeth with open apices. Also investigated whether 0.2% chitosan and papain solutions can be used as alternatives to 17% EDTA-normal saline solution (EDTA-NSS) combination, as root canal irrigants during regenerative endodontic procedures in teeth with open apices. Subjects and Methods: Twenty-five human freshly extracted single-rooted mandibular premolars were taken. They were then divided into five groups and irrigated accordingly. Human donor blood samples were collected and placed in the specimens and fibrin density was evaluated using scanning electron microscopy. Comparison of fibers per 10 μm among 5 experimental groups at each level was performed using one-way analysis of variance test. Results: Results revealed that the specimens irrigated with EDTA-NSS followed by papain had an increased fibrin density when compared with chitosan. Conclusions: All the root canal irrigants that were used in this study as part of treatment protocol for open apex exhibited positive results.
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Comparative evaluation of push-out bond strength of bioceramic and epoxy sealers after using various final irrigants: An in vitro study p. 145
Chandrasekhar Veeramachaneni, Swathi Aravelli, Sreeja Dundigalla
DOI:10.4103/jcd.jcd_10_22  
Aim: The aim of the study is to compare the push-out bond strength of bioceramic and epoxy sealers after using various final irrigants. Materials and Methods: Hundred single-rooted teeth were divided into two groups (n = 50) according to the sealer used: Group A: Bio C (bioceramic sealer), Group B: Dia-Proseal (epoxy sealer). Each group was subdivided into five subgroups (n = 10) according to the final irrigation protocol: Group A1 and B1 – 5% glycolic acid (GA), Group A2 and B2 – 17% GA, Group A3 and B3 – 0.2% chitosan, Group A4 and B4 – 17% ethylenediaminetetraacetic acid, and Group A5 and B5 – 0.9% saline. Samples were obturated in combination with one of the mentioned sealers and were allowed to set for 1 week. Two horizontal slices were obtained from each sample and subjected to push-out test. Statistical Analysis: The data were statistically analyzed using two-way ANOVA and independent Student's t-test. Results: Both the sealers exhibited higher push-out bond strength after treatment with GA with no significant difference between 5% and 17% GA. Bio C sealer with GA as final irrigant showed higher bond strength than Dia-Proseal (P < 0.05). Conclusion: The push-out bond strength of the sealer was significantly affected by the final irrigation solution used. The highest push-out bond strength was seen with Bio C sealer after treatment with GA with no significant difference between 5% and 17% GA.
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Comparative evaluation of the effect of adhesive restorative composite resins on the reinforcement of peri-cervical dentin: An in vitro study p. 151
Indukuri Sai Lakshmi Durga, K Madhu Varma, Girija S Sajjan, R Kalyan Satish, Gadde Praveen
DOI:10.4103/jcd.jcd_487_21  
Background: Peri-cervical dentin (PCD) and its reinforcement play a crucial role in the fracture resistance of root canal-treated teeth. Aims: The aim of this study was to compare the fracture resistance of dual-cure, nano-hybrid, and short-fiber reinforced composite resins restored PCD with conventional hybrid composite (CHC) resin restored endodontically treated mandibular premolars. Settings and Design: Academic, in vitro study. Materials and Methods: The prepared mandibular premolar samples were randomly divided into five groups of 10 each. In Group 1, teeth were left intact. The remaining 40 teeth were endodontically treated and obturated as follows: In Group 2, teeth were obturated with gutta-percha till cementoenamel junction and restored with CHC. Teeth in Groups 3, 4, and 5 were obturated to a depth of 5 mm from the cervical line and restored with dual-cure, nano-hybrid, and short-fiber reinforced composite resins, respectively. Fracture resistance was tested using a universal testing machine. Statistical Analysis Used: One-way analysis of variance and post hoc Tukey's test. Results: Short-fiber reinforced composite resin showed a significantly higher mean fracture resistance value compared with other experimental groups. The mean fracture resistance values were obtained as Group 1 > Group 5 > Group 4 > Group 3 > Group 2. Conclusions: Reinforcement with short-fiber reinforced composite showed significantly higher fracture resistance compared with nano-hybrid and dual-cure composite resins.
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Comparative clinical evaluation of a self-adhering flowable composite with conventional flowable composite in Class I cavity: An in vivo study p. 156
Ashwini V Kalola, SU Sreejith, Shikha Kanodia, Abhishek Parmar, Jaiprathiksha V Iyer, Girish J Parmar
DOI:10.4103/jcd.jcd_456_21  
Context: The purpose of this study was to evaluate the efficiency of self-adhering flowable composite with that of a time-tested conventional flowable composite. Since the self-adhering composite reduces chair time and is convenient to use, its clinical behavior was monitored for a year. Aim: This study aimed to evaluate the clinical behavior of self-adhering flowable composite – Fusio Liquid Dentin – in small-sized Class I cavities and also to compare it with conventional flowable composite – Tetric N-Flow – bonded to the tooth structure with fifth-generation two-step-etch-and-rinse adhesive. Subjects and Methods: A total of 60 cavities were restored using flowable composite materials (30 cavities in each group) and evaluated at baseline, 1 month, 3 months, 6 months, and 1 year with modified United States Public Health Service criteria. The statistical analysis for the study was done using Fisher's exact test for intergroup comparison and Chi-square test for intragroup comparison. P < 0.05 was considered statistically significant. Results: Statistically no significant differences were observed in Fusio Liquid Dentin restorations during the recall visits. Statistically significant differences were found in color match evaluated for Tetric restorations during the recall visits. Conclusion: Based on the data acquired, the novel self-adhering composite material demonstrated good clinical behavior. As a result, at this point in the prospective clinical study, the use of Fusio Liquid Dentin to repair Class I cavities is acceptable.
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Comparative study of effects of home bleach and laser bleach using digital spectrophotometer: An in vitro study p. 161
Priyadarshini L Naik, Kusum Valli
DOI:10.4103/jcd.jcd_568_21  
Background: With the increasing demand for teeth whitening, we have seen a trend in emergence of newer bleaching products. Patients often come to dentists to find a solution in order to address the stains in the oral cavity. Thus, this study was performed to give quality esthetic treatment to patients. Aim: The aim of this study was to compare if laser bleaching or 3-day home bleaching is effective for paan-stained and tea-stained teeth. Materials and Methodology: Forty extracted teeth were randomly divided (n = 20 each) into Group 1 laser bleaching and Group 2 for home bleaching and further subdivided into Group 1a and 2a for tea stains and Group 1b and 2b for paan stains. The shade was evaluated with digital spectrophotometer. Pola Office + was applied on tooth and activated using the diode laser for Group 1. The bleaching was carried out with Zoom Nitewhite for Group 2. The second color measurement of the specimens was made. Statistical Test: ANOVA with Tukey's post hoc analysis was done. Results: 1. The test results demonstrated that there was no statistically significant difference in shade change on comparing Groups 1a and 2a (laser and home and tea stains). 2. The test results demonstrated that there was a statistically significant difference in shade change on comparing both the groups; Groups 1b and 2b (laser and home and paan stains) and Group 2b showed a lesser change in shade compared to Group 1b (P < 0.05). Conclusion: Laser bleaching was effective when compared to 3-day home bleach for paan-stained teeth, whereas for tea-stained teeth, both treatments showed similar results.
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Evaluation of the efficacy of diode laser in bleaching of the tooth at different time intervals using spectrophotometer: An in vitro study p. 166
Ishani Saluja, Neeta Shetty, Ramya Shenoy, Sandeep Nayak Pangal
DOI:10.4103/jcd.jcd_621_21  
Aim: This study aimed at comparative evaluation of the efficacy of tooth bleaching using different concentrations of carbamide peroxide (CP) with and without diode laser at 980 nm for 2.5 and 5 min time duration. Materials and Methods: Hundred intact human incisors were selected. Teeth were artificially stained using black tea solution. Samples were randomly allocated into four groups: Group I: distilled water, Group II: 15%, 20%, and 35% CP without laser, Group III: 15%, 20%, and 35% CP using diode laser for 2.5 min, and Group IV: 15%, 20%, and 35% CP using diode laser for 5 min. Color measurements were made using spectrophotometer. Data were statistically analyzed by ANOVA, repeated measures of ANOVA, and Tukey post hoc test. Results: 35% concentration of CP gave similar mean shade (ΔE) value at T2, as 15% CP at T3. At T3, 15% concentration of CP using diode laser for 2.5 min gave similar mean shade (ΔE) value, as 35% concentration of CP using diode laser for 2.5 min. Conclusion: 35% CP causes change in chroma and whitens the tooth at a faster rate with a significantly more lightening effect. Bleaching twice weekly produces a similar effect when using high or low concentrations of CP. Laser-assisted bleaching decreases the time of whitening process.
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A comparative study on mandibular premolar root canal morphology employing cone-beam computed tomography and microcomputed tomography imaging p. 173
Khor Choo Pang, Kacharaju Kranthi Raja, Phrabhakaran Nambiar
DOI:10.4103/jcd.jcd_606_21  
Aim: The present study was to investigate the root canal morphology of mandibular premolars in Malaysian population using cone-beam computed tomography (CBCT) and microcomputed tomography (micro-CT) scanned images. Materials and Methods: Sixty selected mandibular premolars were evaluated in vitro and the root canal morphologies of the samples were categorized based on Vertucci's classification. The position of apical foramen, presence, and location of lateral canal, as well as prevalence of apical delta, were also determined. Results: Invariably, Type I variety (Vertucci's classification) was the most frequent root canal morphology followed by Type V and Type III after micro-CT imaging. CBCT investigation also revealed Type I as the most numerous; however, the second most common configuration was Type III followed closely by others. There was a moderate agreement in Vertucci's classification of root canal configuration and also prevalence of apical delta (kappa: 0.516 and 0.550, respectively). However, only a fair agreement (kappa: 0.289) was observed between CBCT and micro-CT on the prevalence of lateral canal. Conclusion: CBCT should be cautiously used in determining root canal configuration as deficiencies were evident and revealed during micro-CT imaging.
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Reinforcing the cervical dentin with bonded materials to improve fracture resistance of endodontically treated roots p. 179
Sharvaree Ratnakar Deshpande, Sunanda Laxman Gaddalay, Yogesh Naresh Damade, Unmesh Deepak Khanvilkar, Akshay Satish Chaudhari, Vaishali Anala
DOI:10.4103/jcd.jcd_609_21  
Introduction: Endodontic procedure leads to the loss of tooth structure resulting in fractures. Intraorifice barriers of bonded restorative materials placed in the cervical third of tooth may help in increasing fracture resistance. Materials and Methods: Human mandibular premolars (n = 75) underwent decoronation to adjust working length at 14 mm and prepared up to F3. They were obturated using gutta-percha and resin sealer AH-Plus and randomly divided into five groups (n = 15), Group 1: Control obturated with gutta-percha only. Groups 2, 3, 4, and 5 had placement of intraorifice barriers after the removal of 3 mm coronal gutta-percha such that Group 2: RMGI, Group 3: Self-adhering flowable composite, Group 4: Bulkfill Flowable Composite, and Group 5: mineral trioxide aggregate (MTA). Mounting of specimens was done in acrylic resin to expose coronal 3 mm and tested using the universal testing machine. Results: Group 1 (control) showed least fracture strength among all groups. Among those with intraorifice barriers, Group 2 Resin-modified glass ionomer cement showed maximum fracture resistance followed by Group 4 (Bulkfill composite) and Group 5 (self-adhering flowable composite) and least by Group 5 (MTA). Conclusion: The type of intraorifice barrier had a significant impact on root fracture resistance.
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Toxicity of bioceramic and resinous endodontic sealers using an alternative animal model: Artemia salina p. 185
Cristiana Pereira Malta, Raquel Cristine Silva Barcelos, Hecson Jesser Segat, Marilise Escobar Burger, Carlos Alexandre Souza Bier, Renata Dornelles Morgental
DOI:10.4103/jcd.jcd_401_21  
Aims: The present study assessed the toxicity of a novel calcium silicate-based root canal sealer (Bio-C Sealer) in comparison to Endosequence BC Sealer and AH Plus through a lethality assay involving brine shrimp (Artemia salina). Methods: Brine shrimp cysts were incubated for 24 h for the hatching of the larvae, which were then exposed to different concentrations (2.5, 5, 10, 20, 40, 80, and 100 μg/mL) of the test endodontic sealers for 24 h, followed by the determination of the survival rate. Statistical Analysis Used: One-way repeated-measures ANOVA and the Newman–Keuls post hoc test were used to compare the different materials as well as different concentrations of the same material. Dunnett's test was used to compare the different concentrations and different sealers to the control. The lethal concentration of each endodontic sealer necessary to kill 50% of the brine shrimp larvae (LC50) was also determined. Results: The toxicity of Bio-C (10, 20, 40, 80, and 100 μg/mL) and Endosequence BC Sealer (20, 80, and 100 μg/mL) was lower than that of AH Plus. No significant difference was found between Bio-C and Endosequence BC Sealer or among the different intragroup concentrations of these sealers. In the AH Plus group, concentrations ≥5.0 μg/mL exhibited greater toxicity compared to the concentration of 2.5 μg/mL and the control. AH Plus had the lowest LC50 (59.95 μg/mL), whereas Bio-C and Endosequence BC Sealer had LC50 values >200 μg/mL. Conclusions: Bio-C Sealer proved to be less toxic than AH Plus and exhibited similar toxicity to that of Endosequence BC Sealer.
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Evaluation of titanium mesh and fibers in reinforcing endodontically treated molars: An in vitro study p. 189
Hemalatha Hiremath, Devansh Verma, Sheetal Khandelwal, Aishwarya Singh Solanki, Sonam Patidar
DOI:10.4103/jcd.jcd_601_21  
Aim/Objective: We aimed to evaluate the fracture resistance of titanium mesh and fibers that could aid as a substitute for crown coverage. Materials and Methodology: Forty extracted human mandibular molar teeth were selected for this study and were divided into four groups (n = 10). Access cavity preparation was done in all experimental teeth (Groups 2–4) maintaining 1.2–1.5 mm diameter of tooth structure around the circumference to mimic the structural loss of teeth due to the extent of dental caries. Group 1 consisted of intact teeth which were assigned as control. Group 2 was reinforced with titanium mesh. Group 3 was reinforced with glass fiber. Group 4 was reinforced with polyethylene fiber. The access cavities in all the experimental teeth were later filled with nanohybrid composite and were subjected to fracture resistance using a universal testing machine. Results: The results of the study were evaluated statistically using the Kruskal–Wallis test. There was no statistically significant difference among the experimental and control groups. Conclusion: Within the constraint of this in vitro study, an inference can be given that fiber-reinforced composite and titanium mesh could rule out the mandatory procedure of crown placement for endodontically treated molars.
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Dentinal defects after root canal preparation with rotary nickel-titanium files using different irrigants: An in vitro study p. 193
Ruchi Singla, Swaty Jhamb, Amandeep Kaur, Jagat Bhushan, Amandeep Singh Uppal
DOI:10.4103/jcd.jcd_563_21  
Aim: This in vitro study aims to detect the dentinal defects associated with different irrigants during biomechanical preparation using rotary nickel-titanium (Ni-Ti) files (Hyflex CM). Materials and Methods: For the study, 120 extracted mandibular incisors were taken. Depending on the irrigant used, teeth were divided into six groups (n = 20). In Group 1, teeth were not biomechanically prepared considered as, control group. In Group 2, Group 3, Group 4, Group 5, and Group 6, biomechanical preparation was with Hyflex CM rotary Ni-Ti files using saline, 3% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), SmearClear, and 2% chlorhexidine (CHX), respectively, as irrigant. IsoMet Saw was used to section samples at 3, 6, and 9 mm from the apex perpendicular to the long axis of tooth. Segments were seen at 30x magnification under a digital stereomicroscope. Statistical Analysis: Statistical analysis was done using two-tailed t-test. Results: Maximum number of dentinal defects was seen with 17% EDTA, followed by 3% NaOCl, SmearClear, and 2% CHX. Conclusions: Irrigation with 17% EDTA causes more dentinal defects as compared to irrigation with 3% NaOCl, SmearClear, and 2% CHX.
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CASE REPORTS Top

Endodontic Management of Mandibular anterior teeth and premolars with Vertucci's Type VIII canal morphology: A Rare Case p. 197
Rachit Jain, Kundabala Mala, Neeta Shetty, Nilesh Bhimani, Priyanka Madhav Kamath
DOI:10.4103/jcd.jcd_518_21  
A thorough knowledge of variable and complex tooth morphology, detailed exploration of the internal anatomy and underlying pathology, proper interpretation of radiographic images, conservative access to explore all the canals, thorough debridement and disinfection of canal system, three-dimensional seal by obturation, and good coronal seal by final restoration are essential steps in the management for a successful endodontic treatment outcome. Clinical management of rare case with extra canals in the lower anterior teeth and premolars had to undergo root canal therapy has been described. Referring to the hard-tissue repository of the human dental internal morphology, carefully interpreting multiangled radiography/cone-beam computed tomography, using tools such as magnifying loupes with illumination and ultrasonics, thermoplasticized gutta-percha system to obturate, are very helpful to the clinician can achieve this goal. This article describes and illustrates the management of a rare case with Vertucci's Type VIII canal anatomy in lower anterior teeth and premolars.
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Current trend of restoration of endodontically treated teeth with extensive subgingival caries: A case series p. 202
Meganathan Anand, Kittappa Karthikeyan, Mahalaxmi Sekar
DOI:10.4103/jcd.jcd_502_21  
Endodontically treated teeth (ETT) are structurally and esthetically compromised. Conventionally, after endodontic therapy, the tooth is restored with full-coverage crowns to improve their fracture resistance and ensure their long-term success rate. However, the tooth preparation required for these restorations can result in the significant loss of enamel and dentin. The periodontal health will be affected if the margin of prosthesis is extended subgingival. Restoring ETT using minimally invasive methods is an effective way to preserve the remaining tooth structure. This case series show cases restoration of four endodontically treated mandibular first molars with extensive subgingival caries restored with short fiber-reinforced composite resin (everX Posterior, GC Europe N.V. Interleuvenlaan, Leuven), with 2-year follow-up.
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Radicectomy of radix entomolaris: An alternative treatment approach for persistent periapical lesion assisted by cone-beam computed tomography and operating microscope p. 206
Prasanthi Gonapa, T Rambabu, Uday Kumar Podugu, Durgabhavani Gondi, Tejasree Rathod
DOI:10.4103/jcd.jcd_372_21  
Every clinician as well as patient would prefer to sustain their natural teeth in all situations. For a badly mutilated terminal abutment, molar treatment options are limited, but loss of posterior tooth can lead to several unwanted sequelae. A guiding principle should be to preserve what is present. If complete preservation is not possible, the most conservative treatment should follow in every clinical situation. Radisectomy is one such conservative surgical treatment approach that allows resection of one or more affected roots of tooth at the level of furcation and preserves the remaining roots and the complete crown structure, thereby maintaining the occlusal harmony. Hereby, we are presenting a case report on radicectomy of distobuccal root of a mandibular third molar with persistent periradicular pathosis, with the assistance of microscope and cone-beam computed tomography.
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LETTERS TO EDITOR Top

Mu-can: A bacterial-fungal symbiosis that reduces dental caries p. 211
Pradnya V Kakodkar, Mamatha G S Reddy
DOI:10.4103/jcd.jcd_29_22  
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