Aim: To evaluate the effect of application a new-generation bulk-fill flowable composite resin as an intermediate material between composite resin and dental substrates on micro-leakage in Class V composite restorations. Materials and Methods: A total of 144 Class V cavities were prepared in 72 human molars. Specimens were then randomly distributed among three groups according to adhesive system applied (Group 1: Clearfil SE Bond; Group 2: Adper Easy One; Group 3: Adhesive 200T), and each group was divided into three subgroups according to liner material used (Group A: No liner-control group; Group B: Aelite Flo LV, low viscosity microhybrid composite; Group C: Smart dentin replacement). All cavities were restored using resin composite (Aelite LS, low shrinkage posterior composite). Specimens were stained with 0.5% basic fuchsin and evaluated dye penetration. Results: There was no significant difference in dye penetration was found between the control and the experimental groups. Conclusions: Micro-leakage is not affected by the application of either conventional or new-generation flowable composite resin as an intermediate material between composite resin and dental substrates.

Aim: To compare the efficacy of garlic extract with 2% chlorhexidine (CHX) and calcium hydroxide Ca(OH) ₂ in disinfection of dentinal tubules contaminated with Enterococcus faecalis by using real-time polymerase chain reaction (PCR). Materials and Methods: Agar diffusion test was done to evaluate the minimum inhibitory concentration of garlic extract against E. faecalis. Forty human extracted mandibular premolar teeth were selected for this study, access cavity was prepared and cleaning and shaping was done. Middle third of the root was cut using a rotary diamond disc. The teeth specimens were inoculated with E. faecalis for 21 days. Specimens were divided into four groups---Group 1: 2% CHX, Group 2: Garlic extract, Group 3: Ca(OH) ₂ , and Group 4: Saline (negative control). The intracanal medicaments were packed inside the tooth specimens and incubated for 5 days. The dentinal chips were collected at 400 μm depth using a Gates-Glidden drill, following which DNA isolation was done. The specimens were analyzed using real-time PCR. The results were then statistically analyzed using one-way analysis of variance, followed by post hoc Tukey's honestly significant difference (HSD) multiple comparison of means. Results: Threshold cycle (Ct) values of 2% CHX was found to be 32.4, garlic extract to be 27.5, and Ca(OH) ₂ to be 25.6. Conclusion: A total of 2% CHX showed the maximum efficacy against E. faecalis, followed by garlic extract and Ca(OH) ₂ .

Aim: Organic acids have the potential to decrease the strength of mineral trioxide aggregate (MTA) during retreatment. However, this might cause alterations in dentin composition and structure. The aim of this study was to assess the efficacy of chemicals on surface microhardness of white MTA (WMTA) and dentin. Materials and Methods: White MTA-Angelus^® was mixed and packed into tooth molds. Six experimental groups (n = 15) were formed and exposed to 2% carbonic acid, 2% chlorhexidine gluconate, 5.25% sodium hypochlorite, 10% citric acid, 20% tartaric acid, and normal saline for 10 min and 20 min intervals on 1 and 21 days of setting, respectively. Vickers microhardness of WMTA and dentin for each specimen was measured before and after exposure. Data were subjected to repeated-analysis of variance (ANOVA) and post-hoc tests. Results: Carbonic acid was effective in significantly reducing the surface hardness of WMTA on both 1 and 21 days; followed by citric and tartaric acid (P < 0.05). Two percent chlorhexidine gluconate and NaOCl were effective on 1-day set WMTA. All chemicals, except 2% chlorhexidine, decreased microhardness of dentin significantly (P < 0.05) at 20 min interval. Conclusion: Cautious use of these chemicals not exceeding 10 min is mandatory to prevent significant alterations in mechanical properties of tooth during MTA retrieval.

Introduction: Dental caries is one of the most prevalent infectious diseases affecting the human dentition. Fluorides are effective anti-carious agents and have been widely used for caries prevention in the form of systemic and topical fluorides. Neutral sodium fluoride (NaF) is commonly used as a topical fluoride agent. A special category of topical fluorides are organic fluorides in the form of amine fluorides (AmF). Researchers have reported that AmF is superior to inorganic fluorides in improving the caries resistance of enamel due to the significant anti-enzyme effect of the organic fragment. Aim: The aim of the present study was to compare the enamel surface micro hardness after topical application of NaF and AmF solutions. Materials and Methods: Twenty fresh samples of sound human enamel were treated with demineralizing solution for 72 h and divided into Group A (treated with NaF) and Group B (treated with AmF) solutions for 3 min twice daily for 7 days. In between treatment, the samples were stored in artificial saliva. The enamel surface hardness was measured with Vickers hardness test at baseline, post-demineralization and post-treatment with two different fluoride solutions (NaF and AmF) and a comparative analysis was made. Results: The increase in mean micro hardness of human enamel after treatment with AmF application was found to be statistically significant (P < 0.01) when compared to the mean micro hardness after treatment with NaF. Conclusion: Fluoride enhances the remineralization process by accelerating the growth of enamel crystals that have been demineralized. It can be concluded from the present study that AmF compounds result in a marked increase in enamel micro hardness when compared to NaF.

Background: Ceramic fracture in metal ceramic restorations are serious and pose an aesthetic and functional dilemma both for the patients and the dentist. This has created a demand for the development of practical repair options which do not necessitate the removal and remake of entire restorations. Aim: To evaluate and compare the effect of four different surface treatments on shear bond strength of metal ceramic specimens with three commercially available porcelain repair systems. Materials and Methods: Specimens were fabricated with a base-metal ceramic alloy and divided into three groups, to evaluate three porcelain repair systems. Each group was divided into four subgroups based on surface treatment (A) sandblasting, (B) sandblasting followed by etching with 9% HF (Hydrofluoric acid) on surrounding ceramic, (C) Use of a diamond bur on exposed metal followed by etching with 37% H ₃ PO ₄ and (D) Control groups (D ₁ , D ₂ , D ₃ for three groups of porcelain repair system which was not subjected to further treatment after finishing with 240 grit silicon carbide paper grinding. Shear bond strength of each group of specimens based on surface treatment were evaluated with a universal testing machine after storing in distilled water for 7 days. One way ANOVA and Tukey-HSD procedure were used to compare the mean values between and among the groups. Results: The mean shear bond strength of group III (10.402 ± 1.055) were significantly higher than group I (8.647 ± 0.990) and group II (8.099 ± 0.600) for all surface treatments. However the mean values of shear bond strength of sub-group A were significantly higher than sub-group C and D but were not significantly higher than sub-group B. Conclusion: The results of this study suggest that in fractured metal ceramic restorations the exposed metal surface treated with sandblasting or sandblasting and etching the surrounding ceramic surface with HF can increase the shear bond strength of the repaired metal ceramic area. Porcelain repair systems which contain hybrid composites and 4-META as primer had increased bond strength.

Aim: The purpose of this study was to compare the in vitro micro-leakage resistance of adhesive resin materials to long-used zinc oxide-eugenol and epoxy resin sealers. Materials and Methods: Seven materials, five test (Real Seal, Real Seal XT, Panavia F 2.0, Infinity Syringeable, GCEM) and two controls (Tubliseal, AH Plus), were evaluated for micro-leakage resistance in a bovine incisor root model, with 12 roots per material. Teeth were root canal treated, stored in water, artificially aged by thermal-cycling, stained with silver nitrate, sectioned to yield eight measurement points per tooth (four coronal and four apical), giving 672 measurement points. Stain penetration was measured using digital positioners and a toolmakers microscope; then analyzed using descriptive statistics, two-way analysis of variance and multiple comparisons testing ( P < 0.05). Results: All modern adhesive resinous materials leaked significantly less than long-used zinc oxide-eugenol and epoxy resin sealers ( P < 0.05). Mean leakage values and their associated (standard deviations) in mm were: Infinity Syringeable 2.5 (1.5), Real Seal XT 3.2 (1.4), Real Seal 3.4 (1.6), Panavia F 2.0 3.8 (2.7), GCEM 4.2 (1.8), Tubli-seal 5.4 (2.8), AH Plus 6.3 (2.3). Overall, more leakage occurred apically than coronally ( P < 0.0001). Many materials exhibited dimensional instability: Marked contraction, expansion, or lack of cohesion. Conclusion: A variety of adhesive resinous materials, endodontic sealers and crown cements, reduced micro-leakage in comparison to long and widely used zinc oxide- eugenol and epoxy sealers.

Objective: Analysis of shaping ability of four different rotary endodontic instruments using spiral computed tomography (CT). Materials and Methods: Eighty freshly extracted human mandibular first molars were used in the present study. Samples were randomly divided into four experimental groups with twenty samples in each group. Images of mesiobuccal canal of each sample were obtained pre- and post-operatively using spiral CT. All samples were prepared using their respective endodontic file systems (group I - ProTaper, group II - K3, group III - RaCe, and group IV - Mtwo). Image analyses were done using image analysis software for evaluation of canal transportation and centering ability. Data was then statistically analyzed using analysis of variance. Results: There was no statistically significance in transportation in their intergroup difference at any of the three locations (coronal, middle, and apical third). In centering ability there was no statistically significance in the coronal and middle third of the intergroup. However, there was a statistically significance of (P = 0.044) at the apical third between all the groups. Conclusion: Canals prepared with ProTaper had more canal transportation at all the three levels of root canal (coronal, middle, and apical third). Canals prepared with Mtwo were well centered at coronal and middle third whereas with RaCe canals were centered only at the apical third. All instruments showed some degree of canal aberrations in terms of shaping ability.

Background: Among the advice on prevent cross-infection was included usage of mechanical barriers on tips of photoactivation units. However, questions about the use of protective barriers placed on the light-curing unit's tips and the possibility of interference with the ability of guaranteeing an effective polymerization of composite resins need to be clarified. Aims: The aim of this study was to evaluate the effect of cross infection control barriers used on the light-curing device tips on the cure depth of composite resin. Materials and Methods: Power density measurements from the light-cure unit were recorded with a radiometer on ten separate occasions with different types and placement modes of each barrier (low-density polyethylene and polyvinyl chloride (PVC) film - smooth and folds) and no-barrier (control). Cure depth of TPH™ Spectrum™ resin, A2-A4, was evaluated by the scraping test. Statistical Analysis: The data were analyzed using Student's t-test or ANOVA one-way with Tukey's test (α =0.05). Results: Same type of barrier and different shades (A2, A4) of composite exhibited significant difference in the cure depth among all groups (P < 0.05). Both low-density polyethylene and PVC film folded barriers produced a significant reduction in the light intensity (P < 0.05). Conclusions: Regarding the resin shade, there was a significant reduction in the cure depth of A4 composite resin (dark shade) but this reduction is not enough to cause any adverse effect on the material's clinical performance. Therefore, disposable barriers can be recommended for use over the end of the light guide.

Aims: The aim of this clinical study was to evaluate the clinical accuracy of two electronic apex locators (EALs). Materials and Methods: A total of 120 patients with 283 roots were randomized into three groups including, traditional radiographic method, EAL (Root ZX mini), and apex locating endodontic motor (VDW Gold) for working length (WL) determination. Root canals were instrumented to a size ProTaper F3 nickel titanium file. The obturation quality of matched tapered master cone (ProTaper F3) was determined for the accuracy of WL. Statistical Analysis Used: Descriptive statistics were expressed as numbers and percentages. Pearson Chi-square test was used to determine for differences between groups. P < 0.05 was considered statistically significant for all tests. Results: There was no statistically significant difference between the three tested groups ( P = 0.894). Conclusions: The success of both apex locators was similar to the radiographic WL determination technique.

Aim: To compare the polymerization efficacy of micro-hybrid and nanocomposites cured with Quartz-tungsten halogen (QTH) and light emitting diode (LED) light curing units (LCUs). The effectiveness of pulse cure mode in LED LCU was also investigated. Materials and Methods: Both micro-hybrid and nanocomposite specimens were cured using four different curing protocols giving a total of eight experimental groups. Ten cylindrical specimens were prepared for each group, and light cured for 40 s on the top surface, thus giving a total of eighty specimens. Vicker hardness measurements were carried out on the top and bottom surfaces after 24 h and hardness ratio was calculated. Results: For both micro-hybrid and nanocomposites, highest mean VHN was observed for the group cured with QTH LCU, and the lowest was observed for the group cured with second LED LCU in standard mode but the difference was significant only in case of nanocomposite. Conclusion: Curing nanocomposites with QTH LCU results in better micro hardness. Pulse cure mode does not effectively increase polymerization efficacy than the standard mode of curing.

Aim: To evaluate and compare the push-out bond strengths of three obturation materials; Gutta-percha/AH Plus, Resilon/Epiphany self-etch (SE) and EndoREZ obturation system to intraradicular dentin. Materials and Methods: Sixty single-canal anterior teeth were prepared and assigned to experimental groups (n = 20), designated as Group I: Gutta-percha/AH Plus, Group II: Resilon/Epiphany SE and Group III: EndoREZ sealer/EndoREZ points.After obturation, each tooth was prepared for push-out assessment with root slices of 2 mm thickness using universal testing machine. Statistical Analysis: Two way analysis of variance and Scheffe's test. Results: Gutta-percha/AH Plus root fillings showed significantly highest bond strength. Also, root segment location did not have a significant influence on bond strength. Conclusion: The adhesiveness quality to root dentin promoted by newer methacrylate resin-based obturation systems like Resilon/Epihany SE and EndoREZ is compromised even when teeth with simple anatomic features were obturated under well-monitored laboratory conditions.

Background: Attempts to improve bond strength of self-etch adhesives can enhance the durability of composite restorations. Aims: The aim of the present study was to evaluate the effect of collagen and smear layer removal with sodium hypochlorite solution (NaOCl) and EDTA on micro-tensile bond strength (μTBS) of self-etch adhesives to dentin. Settings and Design: It was an in-vitro study. Materials and Methods: Seventy-two teeth were divided into eight groups and their crowns were ground perpendicular to their long axis to expose dentin. The teeth were polished with silicon-carbide papers. The groups were treated as follows: No conditioning, 0.5-M EDTA conditioning, 2.5% NaOCl conditioning, NaOCl + EDTA conditioning. The surfaces were rinsed and blot-dried. Clearfil S3 and I-Bond were applied according to manufacturers' instructions and restored with Z100 composite. After 500 cycles of thermo-cycling between 5±C and 55±C, the samples were sectioned and tested for μTBS. Statistical Analysis: Data were analyzed by two-way ANOVA and Tukey-HSD test. Results: The highest μTBS was recorded with Clearfil S3 + NaOCl + EDTA, and the lowest was recorded with I-Bond without conditioning. μTBS in EDTA-and EDTA + NaOCl-treated groups was significantly higher than the control and NaOCl-conditioned groups. Conclusions: Application of EDTA or EDTA + NaOCl before one-step self-etch adhesives increased μTBS.

Context: Sealing ability of furcation repair material. Aims: To evaluate the sealing ability of bioactive bone cement, mineral trioxide aggregate (MTA) and Super Ethoxybenzoic Acid (EBA) as furcation repair materials in mandibular molars using a dye extraction leakage model. Settings and Design: In vitro, dye extraction study. Materials and Methods: Forty mandibular molars were randomly divided according to the material used to repair perforation: Group I-MTA, Group II-bioactive bone cement, Group III-Super EBA, Group IV-Control (furcation left unrepaired). All samples were subject to ortho grade and retrograde methylene blue dye challenge followed by dye extraction with 65% nitric acid. Samples were then analyzed using Ultra violet (UV) Visible Spectrophotometer. Statistical Analysis Used: One way analysis of variance (ANOVA), Tukey-Kramer Multiple Comparisons Test. Results: MTA and bioactive bone cement showed almost similar and lower absorbance values in comparison to Super EBA. Conclusions: Bioactive bone cement provi ded an excellent seal for furcal perforation repair and at the same time it provided comfortable handling properties, which could overcome the potential disadvantages as faced with MTA.

Background: Elimination of water entrapment in hybrid layer during bonding procedure would increase bonding durability. Aims: This study evaluated the effect of oxalate desensitizer (OX) pretreatment on bond strength of three one-bottle adhesives to ethylene-diamine tetra acetic acid (EDTA)-conditioned dentin under dry bonding. Materials and Methods: Three adhesive systems, One-Step Plus (OS), Optibond Solo Plus (OP) and Adper Single Bond (SB) were bonded on dentin surfaces under four bonding conditions: (1) Wet-bonding on acid-etched dentin, (2) wet bonding on EDTA-conditioned dentin, (3) dry bonding on EDTA-conditioned dentin, (4) dry bonding associated with OX on the EDTA-conditioned dentin. After storage and thermo cycling, shear bond strength test was performed. Data were analyzed using two-way analysis of variance and Tukey tests. Results: Wet bonding with EDTA or acid etching showed similar bond strength for test adhesives. Dry bonding with EDTA significantly decreased the bond strength of OS, but it had no effect on the bonding of OP and SB. OX application in the forth bonding condition, in comparison with the third condition, had a negative effect on the bond strength of OP, but not influence on OS and SB. Conclusions: The use of an OX on EDTA-conditioned dentin compromised the bonding efficacy of OS and OP under dry bonding but compatible for SB.

Aims: The aim of the present study was to evaluate solubility of white mineral trioxide aggregate (WMTA) in an acidic environment. Materials and Methods: Twenty-four metal rings were prepared, filled with WMTA and randomly divided into two groups. The samples in groups 1 and 2 were set in synthetic tissue fluid with pH values of 7.4 and 4.4, respectively and then were transferred to beakers containing synthetic tissue fluid with pH values of 7.7 and 4.4. Solubility of WMTA samples were calculated at the 9 experimental intervals. Data was analyzed with two-factor ANOVA and Bonferroni test ( P < 0.03). Results: The total solubility of WMTA in groups 1 and 2 were −9.1796 ± 1.9158% and −1.1192 ± 2.6236%, ( P = 0.028) with weight changes of 9.1574 ± 2.1432% and 7.3276 ± 1.5823%, respectively ( P = 0.002). Statistical analysis revealed significant differences between the two groups. Conclusions: It was concluded that solubility of WMTA increases in acidic environments and additional therapeutic precautions should be taken to decrease inflammation in endodontic treatment.

Periapical inflammatory lesion is the local response of bone around the apex of tooth that develops after the necrosis of the pulp tissue or extensive periodontal disease. The final outcome of the nature of wound healing after endodontic surgery can be repair or regeneration depending on the nature of the wound; the availability of progenitor cells; signaling molecules; and micro-environmental cues such as adhesion molecules, extracellular matrix, and associated non-collagenous protein molecules. The purpose of this case report is to add knowledge to the existing literature about the combined use of graft material [platelet rich fibrin (PRF) and hydroxyapatite (HA)] and barrier membrane in the treatment of large periapical lesion. A periapical endodontic surgery was performed on a 45 year old male patient with a swelling in the upper front teeth region and a large bony defect radiologically. The surgical defect was filled with a combination of PRF and HA bone graft crystals. The defect was covered by PRF membrane and sutured. Clinical examination revealed uneventful wound healing. Radiologically the HA crystals have been completely replaced by new bone at the end of 2 years. On the basis of the results obtained in our case report, we hypothesize that the use of PRF in conjunction with HA crystals might have accelerated the resorption of the graft crystals and would have induced the rapid rate of bone formation.

Intrusive luxation is one of the most severe types of dental trauma. The risk of development of inflammatory or replacement root resorption is high if not timely managed. Endodontic intervention is required soon after the occurrence of trauma, in an attempt to prevent or delay inflammatory root resorption. This case report emphasized timely referral for endodontic management of intruded tooth to prevent inflammatory root resorption.

Clinicians frequently encounter hypodontia in their practice. It can be associated with any syndrome or more commonly it is asyndromic. This asyndromic form is commonly familial and can be followed in heredity of the patient. The patient referred in this report presented with a rare anomaly of hypodontia with altered morphology where the patient had all the teeth single rooted and single canalled. Studies have indicated several genes that affect the tooth morphology and number. A genetic correlation of hypodontia with altered permanent teeth morphology may be explored further in studies.

Aberrations in the root canal system can pose a considerable challenge to the endodontist during root canal treatment. These anatomical variations are more commonly seen in maxillary molars and mandibular teeth, but only a few cases have been reported with alteration in the internal canal anatomy of maxillary canine. The present report describes the diagnosis of bilateral occurrence of two root canals in maxillary canines with single root and the endodontic management of the right maxillary canine with the aid of spiral computed tomography (CT). The CT images revealed the presence of Vertucci's type-III canal configuration in the right maxillary canine. The same canal pattern was found in the contra-lateral canine, which was absolutely healthy; and also all the mandibular anterior teeth and first premolars showed bifid canal pattern.