Worldwide, casecontrol studies have revealed that the treatment outcomes of root canal therapy (RCT) are generally favorable; however, the overall epidemiological success rate of RCT in the general population is relatively low. On the other hand, vitality of dental pulp is a key factor in the long-term prognosis of permanent teeth; in recent years, vital pulp therapy (VPT) has received significant consideration as it has been revealed that the inflamed pulp has the potential to heal. In this review article, the current best evidence with regard to VPT using calcium-enriched mixture (CEM) cement in human permanent/primary teeth is discussed. A strategy based on a search using keywords for CEM cement as well as VPT was applied.

Introduction: The success of root canal therapy depends on the locations of all the canals, thourough debridement and proper sealing. At times the clinicians are challenged with variations in morphology of root canal. This review article attempts to list out all the variations of permanent mandibular first molar published so for in the literature. Materials and Methods: An exhaustive search was undertaken using PUBMED database to identify published literature from 1900 to 2010 relating to the root canal morphology of permanent first molar by using key words. The selected artcles were obtained and reviewed. Results: Total ninty seven articles were selected out of which 50 were original article and forty seven were case reports. The incidence of third canal in mesial root was 0.95% to 15%. The incidence of three rooted mandibular first molar was 3% to 33%. Only ninety cases reported with c-shape canal configuration. Incidence of Taurodintism without congenital disorder was very rare. Conclusion: The root canal treatment requires proper knowlegde of variations in root canal morphology in order to recognise, disinfect and seal all portal of exit. This can be accomplished with proper diagnosis using newer modes, modification in access preparation, use of operating microscope, enhanced methods of disinfecting and sealing of all canals.

Aim: To evaluate and compare composite bond strength to carbamide peroxide bleached enamel following the application of 10% and 25% sodium ascorbate and alpha-tocopherol solutions. Materials and Methods: Sixty premolars were divided into six groups. Groups I and VI served as unbleached and bleached controls respectively. Groups II, III, IV and V served as the experimental groups and were subjected to 10% carbamide peroxide bleaching followed by 10 min application of 10% and 25% sodium ascorbate and 10% and 25% alpha-tocopherol solutions, respectively. Following composite bonding, shear bond strength was determined and the results were analyzed using ANOVA and Tukey highest significant difference test. Results: Only Group IV showed significantly lower bond strength when compared to Group I (unbleached control). When compared to Group VI (bleached control), except Group IV, groups II, III and V showed significantly higher bond strength. However, there was no statistically significant difference between the experimental groups corresponding to 10% and 25% and similar concentrations of sodium ascorbate and alpha-tocopherol solutions. Conclusion: Following 10% carbamide peroxide bleaching, except 10% alpha tocopherol, 10 min application of 10% and 25% sodium ascorbate and 25% alpha-tocopherol solutions significantly improves the shear bond strength of composite resin to enamel.

Introduction: Remineralization as a treatment procedure has received much attention from clinicians. The objective of this in vitro study was to find out the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), and tricalcium phosphate fluoride (TCP-F) in remineralizing enamel surface on which artificial caries lesion had been created. The changes were analyzed using DIAGNOdent^® (KaVo) and scanning electron microscope (SEM). Materials and Methods: A total of 52 premolars and 24 molars were selected and classified into four groups of 13 premolars and 6 molars in each: I (CPP-ACP), II (CPP-ACPF), III (TCP-F), and IV (artificial saliva). All the samples were assessed using DIAGNOdent at the baseline and after demineralization and remineralization. Ten samples were randomly selected from each group baseline after demineralization and after remineralization for surface evaluation using SEM. Results: Statistical analysis showed that all the experimental groups had a significantly higher amount of remineralization except for group IV. Conclusion: All the three experimental groups showed a statistically significant amount of remineralization. However, because of the added benefit of fluoride (NaF 0.2%), CPP-ACPF (Tooth Mousse-Plus^® ) and TCP-F showed marginally more amount of remineralization than did CPP-ACP (Tooth Mousse^® ). Remineralization efficacy was TCP-F > CPP-ACPF > CPP-ACP.

Aim: To evaluate the sound levels generated in dental clinics of conservative dentistry and endodontics. Material and Methods: A decibel-meter with digital readout was used to measure sound levels at different time intervals at the chairside and at the center of the clinic. Minimum and maximum readings during a 3 min interval were recorded. Results: In the post-graduate (PG) clinic, there was significant difference in noise levels between the chairside (66-81 dB[A]) and the center of the clinic (66-67 dB[A]) at certain times. In the under graduate (UG) clinic, noise levels with suction and either high/slow speed handpieces (67-80 dB[A]) were significantly higher than the center of clinic. Suction alone in the UG clinic (63-75 dB[A]) was significantly quieter than in the PG clinic (69-79 dB[A]). Conclusions: (1) Mean sound levels in the working clinics ranged from 63.0 dB[A] to 81.5 dB[A]. These are within the recommended range for dental equipment. (2) With suction and either low/high speed handpiece combination, the PG clinic was significantly noisier than the UG clinic at several time periods.

Aim: This study investigated the effect of one hemostatic agent on the shear bond strength of self-etch and etch-and-rinse adhesive systems. Materials and Methods: Sixty extracted third molars were selected. After preparing a flat surface of superficial dentin, they were randomly divided into six groups. Adhesives were Tetric N-Bond, AdheSE, and AdheSE One F. Before applying adhesives, surfaces were contaminated with ViscoStat for 60 s in three groups and rinsed. Then composite were attached to surfaces and light cured. After thermocycling, the bond strength was calculated and failure modes were determined by stereomicroscope. The data were analyzed by t-test and one-way ANOVA with P < 0.05 as the level of significance. Results: ViscoStat had significantly decreased the shear bond strength of AdheSE (P < 0.0001) to dentin. Modes of failures in all groups were mainly adhesive. Conclusion: Contamination had an adverse effect on the shear bond strength of AdheSE and reduced it.

Aim: To investigate pulp chamber penetration of different concentration of hydrogen peroxide. Materials and Methods: Fifty extracted human maxillary central incisor teeth were taken and grouped into five ( n = 10). All teeth were cut approximately 3 mm apical to the cemento-enamel junction. Pulp was removed and the pulp chamber filled with acetate buffer. Buccal crown surfaces of teeth in the experimental groups were subjected to whitening strip and paint on whitener gel. Control group teeth were exposed to distilled water. The acetate buffer solution in each tooth was then transferred to a glass test tube after 30 min. Leuco-crystal violet dye and enzyme horse radish peroxidase were added. The optical density of resultant blue color in the tubes was measured by UV-visible spectrophotometer. The values were converted into microgram equivalents of hydrogen peroxide. Results: The results were evaluated statistically using nonparametric Mann-Whitney U test. Whitening strip showed the lowest pulpal peroxide penetration whereas paint on whitener gel showed highest pulpal peroxide penetration. Conclusion: This study demonstrate that peroxide is readily penetrate into the pulp chamber of teeth.

Objectives: To evaluate the shear bond strength of composite resin to deep dentin, bonded using a self-etch adhesive, after treatment with two collagen cross-linkers at varying time intervals. Materials and Methods: Thirty extracted human incisors were sectioned longitudinally into equal mesial and distal halves ( n = 60). The proximal deep dentin was exposed and the specimens were divided based on the surface treatment of dentin prior to bonding as follows: Group I ( n = 12, control): No prior dentin surface treatment; group II ( n = 24): Dentin surface pretreated with 10% sodium ascorbate; and group III ( n = 24): Dentin surface pretreated with 6.5% proanthocyanidin. Groups II and III were further divided into two subgroups based on the pre-treatment time of five and 10 min. Shear bond strength of the specimens was tested using universal testing machine and the data were statistically analyzed. Results: Significantly higher shear bond strength to deep dentin was observed in teeth treated with 10% sodium ascorbate and 6.5% proanthocyanidin compared to control group. No significant difference was observed between 5 min and 10 min pre-treatment times. Conclusion: Dentin surface pre-treatment with both 10% sodium ascorbate and 6.5% proanthocyanidin resulted in significant improvement in bond strength of self-etch adhesive to deep dentin.

Purpose: To evaluate the fracture strength of endodontically treated teeth with reduced coronal structure reinforced with glass-fiber posts and cast posts and core (nickel-chromium alloy) with different thickness. Materials and Methods: Forty maxillary central incisors were sectioned at 1 mm of the cementoenamel junction and endodontically treated. The teeth were divided into four groups ( n = 10) and restored with cast post and core and glass-fiber posts with diameters of 1.5 mm and 1.1 mm. The fracture strength was evaluated using a Universal Testing Machine (Instron 1144) at 45° of angulation. The results were submitted to analysis of variance two-way and Tukey's test ( P < 0.05). The failure mode was also evaluated. Results: Cast post and core were statistically superior to the glass-fiber posts with the self-post diameter ( P = 0.001). When the self-post material was considered, no significant difference was observed between the two post-diameters ( P = 0.749). The glass-fiber post-groups presented more fractures in the cervical third than the cast post and core groups. Conclusion: Teeth restored with cast post and cores present higher fracture strength than those reinforced with glass-fiber posts. An increased post-thickness does not increase the fracture strength. Glass-fiber posts lead to less severe fractures.

Aim and Objectives: This in vitro study was designed to comparatively evaluate the antimicrobial efficacy of Curcuma longa (turmeric - T ₁ -10%, T ₂ -20%); Tachyspermum ammi (ajwain - A ₁ -10%, A ₂ -20%); chlorhexidine (CHX) gluconate gel (hexigel - 1%); and calcium hydroxide (10%) as intracanal medicaments against Enterococcus faecalis. Materials and Methods: Agar plates were prepared using brain-heart infusion (BHI) agar. Cultures of E. faecalis were grown in BHI broth at 37°C. Well diffusion method was used to derive results. Plates were inoculated for 72 h at 37°C and microbial zones of inhibition were recorded. Statistical analysis was performed with repeated measures analysis of variance. Results: C. longa (T ₂ -20%) and CHX gluconate gel (hexigel - CHX-1%) showed larger zones of microbial inhibition than C. longa (T ₁ -10%) that were statistically significant (P < 0.05) and were highly significant when compared to T. ammi (ajwain - A ₁ and A ₂ ) and calcium hydroxide. Conclusion: C. longa can be used as intracanal medicament in endodontic failure cases.

Objectives: This study evaluated the effect of ionizing radiations on resin-dentin interface in terms of marginal adaptation and micro-tensile bond strength under thermocycling and mechanical loading. Materials and Methods: Forty extracted human mandibular third molars were divided into four groups. GR I: No Irradiation and Class II MO cavities were prepared that were restored with composite restorations; GR II: Teeth were irradiated and restored; GR III: Teeth were restored and irradiated; GR IV: Teeth were restored during irradiation dosage fractions. All samples were thermal and mechanical loaded with 5000 cycles, 5 ± 2-55 ± 2°C, dwell time 30 s and 150,000 cycles at 60N. Resin-dentin slabs were trimmed into dumbbell-shaped slabs and microtensile bond strength was measured. The bond strength data was analyzed by one-way analysis of variance test. Results and Conclusions: Irradiation before tooth preparation deteriorated the microtensile bond strength.

Background: Dental caries remains the most common dental disease facing mankind. Prevention of initiation and interruption in progression of early lesions are the desirable modes of caries management. There is a scope for agents, which may be used to enhance anti - caries activity. This need has redirected research to develop novel preventive agents that can act as an adjunct to fluoride or independent of it. Casein Phosphopeptide - Amorphous Calcium Phosphate (CPP-ACP) is one such agent that has been proposed to have anti cariogenic properties. Aim: The purpose of this in vitro study was to evaluate the effect of paste containing CPP-ACP, MI Paste, on enamel remineralization. Materials and Methods: This study consisted of 30 samples embedded in orthodontic resin with either the buccal or lingual surface exposed. The samples were assigned to either a CPP-ACP containing paste; Fluoridated toothpaste; or a control group. The groups were then subjected to cycling in a demineralizing solution and a remineralizing solution. Groups II and III received prior application of MI paste and Fluoridated toothpaste respectively followed by cycling in a demineralizing solution and a remineralizing solution. Following 14 days of cycling, the samples were sectioned and examined using confocal microscopy. The lesion depth, were evaluated. Statistical Analysis: Image Proplus software was used to analyze the images. The values were statistically evaluated using one - way ANOVA and Scheffe's Test. Results and Conclusion: Within the limitations of the study it was concluded that enamel surfaces treated with the CPP-ACP paste exhibited the least lesion depths followed by the enamel surfaces treated with the fluoridated tooth paste and control group respectively.

Objectives: The present comparative analysis aimed at evaluating the mechanical behavior of various restorative materials in abfraction lesion in the presence and absence of occlusal restoration. Materials and Methods: A three-dimensional finite-element analysis was performed. Six experimental models of mandibular first premolar were generated and divided into two groups (groups A and B) of three each. All the groups had cervical abfraction lesion restored with materials and in addition group A had class I occlusal restoration. A load of 90 N, 200 N, and 400 N were applied at 45° loading angle on the buccal inclines of buccal cusp and Von Mises stresses was chosen for analysis. Results: In all the models, the values of stress recorded at the cervical margin of the restorations were at their maxima. Irrespective of the occlusal restoration, all the materials performed well at 90 N and 200 N. At 400 N, only low-shrink composite showed stresses lesser than its tensile strength indicating its success even at higher load. Conclusion: Irrespective of occlusal restoration, restorative materials with low modulus of elasticity are successful in abfraction lesions at moderate tensile stresses; whereas materials with higher modulus of elasticity and mechanical properties can support higher loads and resist wear. Significance: The model allows comparison of different restorative materials for restoration of abfraction lesions in the presence and absence of occlusal restoration. The model can be used to validate more sophisticated computational models as well as to conduct various optimization studies.

Introduction: The inferior alveolar nerve block (IAN) is the most frequently used mandibular injection technique for achieving local anesthesia in endodontics. Supplemental injections are essential to overcome failure of IAN block in patients with irreversible pulpitis. Aim: To evaluate the anesthetic efficacy of X-tip intraosseous injection (2% lidocaine with 1:80,000 epinephrine) in patients with irreversible pulpitis in mandibular posterior teeth when conventional IAN block failed. Materials and Methods: Thirty emergency patients diagnosed with irreversible pulpitis in a mandibular posterior tooth received an IAN block and experienced moderate to severe pain on endodontic access or initial instrumentation. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:80,000 epinephrine. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analogue scale ratings < 54 mm) on endodontic access or initial instrumentation. Results: Ninety-three percent of X-tip injections were successful and 7% were unsuccessful. Discomfort rating for X-tip perforation: 96.66% patients reported none or mild pain, whereas 3.34% reported moderate to severe pain. For discomfort rating during solution deposition, 74.99% patients reported none or mild pain and 24.92% reported moderate to severe pain. Ninety-six percent of the patients had subjective/objective increase in heart rate. Conclusions: Supplemental X-tip intraosseous injection using 2% lignocaine with 1:80,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.

Context: Sodium hypochlorite is the most commonly used irrigant but it has disadvantage like high cytotoxicity. So there is a need to find an alternative to 5.25% Sodium hypochlorite against microorganism Enterococcus faecalis and Candida albicans. Literature has shown that these 5 extracts namely Terminalia chebula, Myristica frangrans, Aloe barbadensis, Curcuma longa and Azadaricta indica has good properties which can be used as a potential endodontic irrigant. Aims: To evaluate the antimicrobial efficacy of various herbal extracts namely Curcuma longa (CL), Azadiracta indica (AI), Aloe barbadensis (AV), Myristica fragrans (MF) and Terminalia chebula (TC) as endodontic irrigant against Enterococcus faecalis and Candida albicans using real-time quantitative polymerase chain reaction (qPCR). Materials and Methods: Eighty-four teeth were extracted and suspended with Enterococcus faecalis and Candida albicans. A preliminary study was first performed to determine the minimum inhibitory concentration of extracts. The irrigating groups were divided into five herbal groups and 2 control groups. After irrigating the teeth the remaining microbial load was determined using qPCR. Statistical Analysis Used: Statistical analysis was performed using Oneway Anova/Kruskal-Wallis test with post-hoc Tukey's HSD and was statistically significant ( P < 0.05). Results: It was shown that Neem was highly efficient to 5.25% NaOCl in reducing Enterococcus faecalis and Candida albicans within the root canals when compared with other extracts. Conclusions: Neem leaf extract has a significant antimicrobial efficacy against Enterococcus faecalis and Candida albicans compared to 5.25% sodium hypochlorite.

Background: The purpose of this prospective, randomized, double-blind, placebo-controlled study was to compare the effect of the administration of preoperative ibuprofen, ketorolac, combination of etodolac with paracetamol and combination of aceclofenac with paracetamol versus placebo for the potential increased effectiveness of the inferior alveolar nerve block [IANB] anesthesia. Materials and Methods: A total of 100 endodontic emergency patients in moderate to severe pain diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, either a drug or placebo 30 minutes before the administration of a conventional IANB. Cold testing was done before administration of anesthesia to determine level of pain using Heft-Parker Visual Analogue Scale (VAS) score. Success was defined as no pain or pain (VAS) on access or initial instrumentation. Results: Overall success was 54% for all the groups. Success was highest (70%) for the ketorolac group, 55% for both ibuprofen group and combination of aceclofenac with paracetamol group, 50% for combination of etodolac with paracetamol group, and 40% for the placebo group. Conclusions: Under the conditions of this study, the use of preoperative medication did improve the anesthetic efficacy of IANB for the treatment of teeth diagnosed with irreversible pulpitis but not significantly.

Several techniques have been proposed for clinical crown lengthening procedures. Crown lengthening in esthetic zone can be classified in two basic types: Restorative and non-restorative cases after the crown lengthening is executed. Atraumatic surgical extrusion using a specially designed instrument called periotome was performed in four cases on isolated teeth in esthetic zone. The technique presented is an alternative approach to periodontal surgical procedures consisting orthodontic extrusion and osseous recontouring. It does not result in functional or esthetic deformities especially in the anterior esthetic zone.

External tooth resorption usually follows trauma to the periodontal ligament. It can be classified into five categories based on its clinical and histological manifestations. Calcium hydroxide has long been used as an intracanal medicament to slow down the resorption process due to its alkaline pH. A combination of both external and internal resorptions can also occur on the same tooth, making the management more complex. Five case reports of external resorption have been presented in this article along with pertinent review of literature. Successful management was possible in two cases, while extractions had to be advised in 3 cases due to advanced nature of the lesions.