Objectives: To compare and evaluate the clinical symptoms and radiographic evidence of periapical healing after endodontic treatment of teeth with periapical pathology when completed in one-visit or two-visits with ApexCal paste at 3, 6, and 12 months. Materials and Methods: A total of 57 patients requiring root canal treatment on 64 single rooted teeth with periapical pathology preoperatively were included. The teeth were assigned randomly into two groups and treated according to standardized protocol. The teeth in group I (n = 34) were obturated at the first visit, while those in group II (n = 30) were medicated with ApexCal paste, and obturated in a second visit 7 days later. Patients were recalled at intervals of 3, 6, and 12 months to evaluate the treated teeth both clinically and radiographically for periapical healing. Results: Mann - Whitney U test showed no difference between groups I and II. Wilcoxon signed rank test showed significant decrease in mean periapical index (PAI) scores within both groups during 12 months evaluation. The level of significance used was P < 0.05. Conclusions: Both groups exhibited equally favorable healing at 12 months, with no statistically significant differences between groups I and II.

Aim: The aim of this study is to compare the corono-apical sealing ability of three single-cone obturation systems using a glucose leakage model. Materials and Methods: A total of 90 extracted maxillary single rooted teeth were selected and their crowns were cut. The root canal of each sample was instrumented using a rotary crown down technique and then divided into four experimental (n = 20 each) and two control groups (n = 5 each). Samples in the experimental groups were filled as follows: Group 1, cold lateral condensation using Gutta-percha/AH Plus; Group 2, single-cone Gutta-percha and AH Plus; Group 3, single-cone Gutta-percha/and GuttaFlow2; Group 4, single-cone Resilon/RealSeal SE after 7 days, the sealing ability of root canal fillings was tested at different time intervals using glucose leakage model. Glucose leakage values were measured using a spectrophotometer and statistically analyzed. Results: The four experimental groups presented significantly different glucose leakage values at all test periods (P < 0.05). At the end of the observation period, the cumulative glucose leakage values of Groups 3 and 4 were significantly lower than those of Groups 1 and 2 (P < 0.05). Conclusion: Gutta-percha/GuttaFlow2 or Resilon/RealSeal SE combinations provided the superior sealing ability over the lateral condensation technique.

Aim: The aim of this study was to compare the clinical and radiological outcome of mineral trioxide aggregate (MTA) or epoxy resin as a root canal sealer compared with zinc oxide eugenol sealer. Materials and Methods: 45 single rooted teeth with periapical index Score 2 or more were allotted to three groups with 15 teeth in each group. Root canal treatment was performed in two visits and obturated with Gutta-percha as obturating material and zinc oxide eugenol as sealer in Group 1, epoxy resin as sealer in Group 2 and MTA mixed with propylene glycol as sealer in Group 3. Visual analog scale, periapical index and VixWin digital Pro image analysis software were used for evaluation. The quantitative data was analyzed by t-test and analysis of variance. Ordinal data was analyzed by Wilcoxon's signed rank test, Mann-Whitney and Kruskall-Wallis test. Results: Results suggested that there exists no statistically significant difference in clinical or radiological outcome of root canal therapy with three different types of sealers used in this study. Conclusions: MTA could be used as a root canal sealer with equal effectiveness compared with epoxy resin and zinc oxide eugenol sealers. Further long-term studies should be carried out to prove the effectiveness.

Aims: To determine the in vitro shear bond strengths (SBS) of zirconia ceramic to resin composite after various primer treatments. Materials and Methods: Forty zirconia ceramic (Zeno, Wieland Dental) specimens (10 mm in diameter and 2 mm thick) were prepared, sandblasted with 50 μm alumina, and divided into four groups (n = 10). Three experimental groups were surface treated with three primers; CP (RelyX Ceramic Primer, 3M ESPE), AP (Alloy Primer, Kuraray Medical), and MP (Monobond Plus, Ivoclar Vivadent AG). One group was not treated and served as the control. All specimens were bonded to a resin composite (Filtek Supreme XT, 3M ESPE) cylinder with an adhesive system (Adper Scotchbond Multi-Purpose Plus Adhesive, 3M ESPE) and then stored in 100% humidity at 37°C for 24 h before SBS testing in a universal testing machine. Mean SBS (MPa) were analyzed with one-way analysis of variance (ANOVA) and the Tukey's Honestly Significant Difference (HSD) test (α = 0.05). Results: Group AP yielded the highest mean and standard deviation (SD) value of SBS (16.8 ± 2.5 MPa) and Group C presented the lowest mean and SD value (15.4 ± 1.6 MPa). The SBS did not differ significantly among the groups (P = 0.079). Conclusions: Within the limitations of this study, the SBS values between zirconia ceramic to resin composite using various primers and untreated surface were not significantly different.

Aim and Objectives: To comparatively evaluate the microleakage and microgap formation along the gingival margin in class II cavities restored with silorane resin composite and methacrylate resin composite with and without flowable resin liner. Materials and Methods: Sixty human mandibular premolars were distributed into three groups, each group containing 20 teeth (n = 20). Mesial (subgroup A) and distal (subgroup B) box cavities were prepared with gingival margin above and below cemento enamel junction (CEJ), respectively, in each tooth and restored as follows - Group I - Silorane resin composite with self-etch primer and bond (Filtek P90, 3M ESPE MN, USA). Group II - Methacrylate resin composite (Filtek P60, 3M ESPE MN, USA) and self-etch adhesive (Adper Easy one, 3M ESPE MN, USA). Group III - Methacrylate resin composite with self-etch adhesive and a flowable resin liner (Filtek Z350 XT, 3M ESPE MN, USA). The teeth were thermocycled and immersed in 50% silver nitrate solution before sectioning. The specimens were observed under scanning electron microscope for dye penetration and microgap formation. The data was subjected to statistical analysis using Kruskal-Wallis test and Mann-Whitney U test using SPSS version 18. Results: Subgroup A in all the three groups showed significantly less microleakage and microgap formation compared to subgroup B with P < 0.05. Intergroup comparison of subgroup A did not show statistically significant difference, whereas subgroup B showed statistically significant difference for microleakage between group I and group II (P = 0.003), group III and group II (P = 0.002). Conclusion: Silorane resin composite and methacrylate resin with liner showed significantly less microleakage in class II cavities along the gingival margin placed below CEJ compared to methacrylate resin without liner. All the study groups showed less microleakage and microgap formation along the gingival margin placed above CEJ.

Aim: The purpose of this in vitro study was to evaluate the cleaning efficacy of NaviTip, Max-i-Probe and Endovac in removal of debris from the root canal at 1.5 and 3.5 mm from the apex. Materials and Methods: Forty single-rooted teeth were divided into four groups according to the root canal irrigation system (EndoVac, NaviTip, Max-i-Probe, and control). Instrumentation was done using ProFile 0.06 taper series to MAF #40. Root canals were irrigated after each file size with 1 ml of 5% NaOCl. For final irrigation 5 ml of 5% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA) was used. Each group was irrigated with a different irrigation device. Four micron thick serial sections were prepared at 1.5 and 3.5 mm from the apical level and photographs were taken for the analysis. The influence of the irrigation system was evaluated using a one-way analysis of variance (ANOVA) test and unpaired t-test (P < 0.05). Results: Endovac showed significantly least amount of mean percentage debris followed by Max-i-probe and NaviTip at both levels (P < 0.05). In all the experimental groups, significantly less amount of mean percentage debris was seen at 3.5 mm level than at 1.5 mm level (P < 0.05). However, the difference was statistically insignificant in case of Endovac irrigation system group. Conclusions: Amongst all the experimental groups, Endovac removed significantly more debris followed by Max-i-probe and NaviTip at both levels.

Aim: To evaluate the influence of immediate and delayed post space preparation on sealing ability of Resilon-Epiphany and Gutta percha-AH plus. Materials and Methods: Eighty extracted permanent maxillary central and lateral incisors were decoronated. Roots canals were prepared and obturated. Samples were divided into four groups depending on the time of post space preparation and obturated material. Group I and II: Immediate and delayed post space preparation respectively with Gutta percha/AH plus as obturating material. Group III and IV: Immediate and delayed post space preparation with Resilon/Epiphany as the obturating material. The samples were kept in methylene blue dye ,sectioned and then measured under stereomicroscope and studied under SEM. Statistical Analysis: The data was subjected to statistical analysis using unpaired t-test. Results: There was significant difference found between immediate and delayed post space preparation in Resilon-Epiphany group (P = 0.0109) as well as in AH plus-GP group (<0.0001). Difference in the sealing ability of the two materials was seen in delayed group (P = 0.0202). No statistically significant result was found between the two obturating materials when post space was prepared immediately (P = 0.0875). Conclusion: Within the limitations of this study, there was significantly less leakage when post space is prepared immediately in both the groups. Resilon-Epiphany shows better results when post space is delayed amongst the two whereas in immediate post space preparation there is no significant difference.

Aims: The aim of this study is to evaluate the course of the inferior alveolar canal (IAC) including its frequently seen variations in relation to root apices and the cortices of the mandible at fixed pre-determined anatomic reference points using cone beam volumetric computed tomography (CBVCT). Material and Methods: This retrospective study utilized CBVCT images from 44 patients to obtain quantifiable data to localize the IAC. Measurements to the IAC were made from the buccal and lingual cortical plates (BCP/LCP), inferior border of the mandible and the root apices of the mandibular posterior teeth and canine. Descriptive analysis was used to map out the course of the IAC. Results: IACs were noted to course superiorly toward the root apices from the second molar to the first premolar and closer to the buccal cortical plate anteriorly. The canal was closest to the LCP at the level of the second molar. In 32.95% of the cases, the canal was seen at the level of the canine. Conclusions: This study indicates that caution needs to be exercised during endodontic surgical procedures in the mandible even at the level of the canine. CBVCT seems to provide an optimal, low-dose, 3D imaging modality to help address the complexities in canal configuration.

Aim: To evaluate the role of rotary root canal instrumentation followed by obturation with three different techniques and two different materials on the incidence of dentinal defects. Materials and Methods: One hundred and sixty mandibular premolars were divided into eight groups (n = 20). Group I was left untreated and served as control. The other seven groups were prepared with profile rotary instruments till #40.06 taper. After preparation, group II was left unfilled, groups III, IV, and V were obturated with Gutta-percha and AH Plus sealer using passive technique, lateral compaction and warm vertical compaction, respectively. Groups VI, VII, and VIII were obturated with Resilon and Realseal sealer using passive technique, lateral compaction, and warm vertical compaction, respectively. Roots were then sectioned at 3, 6, and 9 mm from the apex and inspected under a stereomicroscope (50Χ) for dentinal defects. Chi-square test was performed to compare the incidence of dentinal defects between the groups (P < 0.05). Results: The unprepared control group had no dentinal defects. The instrumentation group (group II) and the obturation group (groups III-VIII) showed significantly more defects than the uninstrumented control group (group I) (P < 0.001). There was no significant difference between the root canal obturating techniques (group III-VIII) when compared with the instrumentation group (group II). On inter group comparison among the obturation groups the number of defects after lateral compaction with Gutta-percha (group IV) was significantly larger than passive Gutta-percha obturation (group III) (P < 0.05). Conclusions: The results suggest that root canal instrumentation significantly influenced the incidence of dentinal defects or fracture. Dentinal defects were more significantly attributed to the role of root canal instrumentation rather than the type of obturation technique or material. Lateral compaction with Gutta-percha significantly produces more defects than passive Gutta-percha obturation.

Background: Intraoral degradation of resin restorative materials involves both mechanical and chemical factors. Thus, an in vitro study was conducted to compare the strength of nanocomposite to commonly used esthetic restorative materials in simulated in vivo conditions. Aim: The aim of this study was to determine the influence of dietary solvents on the strength of nanocomposite and other esthetic restorative materials. Materials and Methods: Three test groups (nanocomposite, compomer and glass ionomer cement) each containing 60 pre-conditioned samples, divided into four subgroups of 15 samples each and conditioned in different dietary solvents, were subjected to shear punch test in custom designed shear punch apparatus in Instron Universal Testing Machine. Statistical Analysis: Descriptive statistics, one way analysis of variance (ANOVA), paired t-test were implied. Results: One-way ANOVA revealed nanocomposite to bear most shear punch strength post-conditioning, as compared with the other two test materials. Conclusion: Nanocomposite yielded better strength than the other two test materials, indicating its universal application as a restorative material.

Introduction: Endodontic infections are polymicrobial in nature. Candida albicans is the most common fungus isolated from failed endodontic cases. The constant increase in antibiotic resistant strains and side-effects caused by synthetic drugs has prompted researchers to look for herbal alternatives such as propolis, Morinda citrifolia and Azadirachta indica (Neem) etc., since, the gold standard for irrigation, i.e., sodium hypochlorite has many disadvantages. Materials and Methods: Extracted human mandibular premolars were biomechanically prepared, vertically sectioned, placed in tissue culture wells exposing the root canal surface to C. albicans grown on Sabouraud Dextrose Agar to form a biofilm. At the end of 2 days, all groups were treated with test solutions and control for 10 min and evaluated for Candida growth and number of colony forming units. The readings were subjected to statistical analysis using analysis of variance and post hoc Tukey tests. Results: Sodium hypochlorite and propolis groups exhibited highest antimicrobial efficacy against C. albicans with no statistically significant difference. It was followed by the A. indica (Neem) group. M. citrifolia had limited antifungal action followed by the negative control group of saline. Conclusion: According to the results of this study, propolis can be used as an effective antifungal agent similar to that of sodium hypochlorite, although long-term in vivo studies are warranted.

Aims: to evaluate the influence of preheating the bonding agent (Scotchbond Multipurpose Adhesive/3M ESPE) and the light-activated resin cement (RelyX Venner/3M ESPE) on dentin microtensile bond strength. Materials and Methods: The exposed flat dentin surface of 40 human third molars were randomly distributed into four groups for cementation (SR Adoro/Ivoclar Vivadent) (n = 10): G1-bond and resin cement, both at room temperature (22°C), G2-bond preheated to 58°C and cement at room temperature (22°C), G3-bond at room temperature (22°C) and the cement preheated to 58°C, G4-bond preheated to 58°C and cement preheated to 58°C. Sticks of dentin/block set measuring approximately 1 mm ² were obtained and used for the microtensile bond strength test. All sticks had their failure mode classified. Statistical analysis used: Factorial analysis of variance was applied, 2 × 2 (bond × cement) (P < 0.05). Results: Preheating the bonding agent (P = 0.8411) or the cement (P = 0.7155), yielded no significant difference. The interaction bond × cement was not significant (P = 0.9389). Conclusions: Preheating the bond and/or the light-activated resin cement did not influence dentin bond strength or fracture failure mode.

Aims: The purpose of this study was to compare the sealing ability of Mineral Trioxide Aggregate (MTA) and Glass Ionomer Cement (GIC) when used over gutta-percha as intracanal sealing materials. The study also evaluated the sealing ability of Zinc oxide eugenol (ZOE) cement and Acroseal sealer. Materials and Methods: Teeth were obturated with gutta-percha using sealer ZOE (group A, C, D) and Acroseal (group B). The groups were further divided into 2 subgroups (15 premolars each) on the basis of intracanal sealing material used: GIC subgroups (A1, B1) and MTA in subgroups (A2, B2). The clearing technique was used in this study for leakage evaluation. Seventy mandibular premolars were prepared using step-back technique and divided into experimental groups A and B (30 premolars each) and the positive and negative control groups C and D (5 premolars each). Statistical analysis used: Coronal microleakage was determined under stereomicroscope using 15X magnification. Data was statistically analyzed using one-way ANOVA followed by Post-Hoc Multiple comparison (Bonferroni). Results: MTA group leaked significantly less than GIC group (P < 0.05). Acroseal exhibited better sealing ability than ZOE sealer. Teeth with no intracanal barrier showed almost complete leakage. Conclusions: MTA may be preferred over GIC as an intracanal barrier.

Aim: To compare the effect of 20% aqueous extract of Terminalia chebula and Emblica officinallis with chlorhexidine as an anticaries mouthwash - an in vivo study. Methodology: 20% aqueous extract of Terminalia chebula and Emblica officinalis were prepared. Forty five high caries risk patients were divided into group 1,2,3 [ n=15]and asked to rinse with 20% aqueous extract of Terminalia chebula and Emblica officinalis, 0.2% Chlorhexidine for 40 seconds respectively. Salivary samples were collected for pH, buffering capacity before and after rinsing at repeated intervals of 10, 30,60 and 90 minutes and except for microbial analysis for which it was collected before and 90 minutes after rinsing. The pH and the buffering capacity analysis was done using chairside kit and percentage of reduction of Streptococcus mutans and Lactobacillus were tabulated and statistically analyzed. Results: For salivary pH, Group 2 showed the highest peak value followed by group 1. For salivary buffering capacity,there was no significant difference between any of the groups. For microbial count, highest percentage of reduction was seen in group 2 followed by group 1 and 3. However group 3 was more efficient at 90 minutes followed by group 1 and group 2. Conclusion: The aqueous extract of Embilica officinalis extract and Terminalia chebula was more effective anticaries mouthwash but with less time of action than chlorhexidine.

Aim: The aim was to compare the micro-shear bond strength between composite and resin-modified glass-ionomer (RMGI) by different adhesive systems. Materials and Methods: A total of 16 discs of RMGI with a diameter of 15 mm and a thickness of 2 mm were randomly divided into four groups (n = 4). Four cylinders of composite resin (z250) were bonded to the RMGI discs with Single Bond, Clearfil SE Bond and Clearfil S3 Bond in Groups 1-3, respectively. The fourth group was the control. Samples were tested by a mechanical testing machine with a strain rate of 0.5 mm/min. Failure mode was assessed under a stereo-microscope. Results: The means of micro-shear bond strength values for Groups 1-4 were 14.45, 23.49, 16.23 and 5.46 MPa, respectively. Using a bonding agent significantly increased micro-shear bond strength (P = 0.0001). Conclusion: Micro-shear bond strength of RMGI to composite increased significantly with the use of adhesive resin. The bond strength of RMGI to composite resin could vary depending upon the type of adhesive system used.

Aim: The aim of the present study is to evaluate and to compare the accuracy of two electronic apex locators (EALs): DentaPort ZX and iPex, at a position 0.5 mm short of the apical foramen. Materials and Methods: Thirty single-rooted, mandibular premolar teeth were selected. Standard access cavities were prepared and the actual length (AL) was calculated. The samples were then embedded in alginate and the electronic measurements were determined and recorded. Results: The results obtained showed that in determining the root canal length with a tolerance level of ±0.5 mm, i.e., AL ± 0.5 mm, DentaPort ZX was accurate in 93.3% of the samples and iPex was accurate in 90% of the samples at a position 0.5 mm short of the apical foramen. Conclusion: A strong correlation was seen between the two electronic methods and AL and also in between the two EALs, showing the possibility of their use to measure the root canal length. No statistically significant difference was found between both the apex locators.

Aim: This in vitro study assessed the surface quality of three nanoparticle composites with four commercially available polishing systems. Materials and Methods: A total of 180 specimens (10 × 2 mm) were prepared in metal molds using three nanocomposites, Filtek Z-350 XT, Ceram-X Mono, and Tetric N-Ceram. Sixty specimens of each material were then randomly assigned to five study groups. Control specimens were left untreated and the remaining specimens were subjected to polishing with SpinBrite, CompoMaster, AstroPol, and SofLex polishing systems. Average roughness (Ra) and average ten-point roughness (Rz) were calculated using Perthometer, and the data were analyzed by two-way analysis of variance (ANOVA) and post-hoc Tukey's tests. Results: For all the materials, the roughest surfaces were observed for control specimens, with no statistically significant differences between the material groups. For Filtek Z-350 XT, the decrease in surface roughness after two-step polishing was insignificant. For Ceram-X, SpinBrite specimens showed similar degree of roughness as control specimens. For Tetric N-Ceram, no significant decrease in roughness was observed after one-step polishing. Two-way ANOVA (interaction of subgroups and groups) did not show a significant association with the outcome. Conclusions: For nanofilled composites (Filtek Z-350 XT), the surface roughness decreased with the increase in number of polishing steps, whereas one-step and multi-step polishing procedures produced similar quality of smoothness for nanohybrid composites (Ceram-X, Tetric N-Ceram). Ra and Rz values of surface roughness are a function of type of finishing/polishing only.

Aim: To determine the surface roughness of esthetic restorative materials after finishing and polishing. Materials and Methods: All 60 specimens were divided into four groups. Group I: Nanocomposite, Z 350 XT (3M ESPE, USA); Group II: Microhybrid composite, Z 250 (3M ESPE, USA); Group III: Compomer, Dyract XP (LD Caulk/Dentsply, USA); and Group IV: Resin modified glass ionomer cement (GIC), Fuji II LC (GC, Japan). Each group was again divided into three subgroups. Subgroup A: Sof-Lex (3M ESPE); Subgroup B: Super-Snap Rainbow finishing and polishing kit (Shofu INC, Japan); and Subgroup C: Control Mylar strip. Surface roughness was determined by Perthen Perthometer S6P profilometer. Result: Filtek Z350 XT showed minimum surface roughness followed by Filtek Z250, Dyract XT and Fuji II LC. Super-Snap exhibited less surface roughness than Sof-Lex polishing systems. Statistical Analysis: One-way analysis of variance (ANOVA) followed by multiple post hoc comparisons using least square difference method and unpaired t-test was used. Conclusion: Filtek Z350 XT with Mylar strip exhibited least surface roughness.

Loss of pulp vitality in an immature permanent tooth arrests root development. This leads to tooth with open apex and weak lateral dentinal walls. Management of such necrotic teeth with immature roots poses several treatment challenges. The documented study was performed to evaluate and compare apexogenesis induced by revascularization, with and without platelet rich plasma (PRP) in non-vital, immature anterior teeth. Three patients having bilateral, non-vital, immature maxillary central incisors with apical periodontitis were recruited after institutional ethical clearance. Subsequent to chemo-mechanical preparation, revascularization with and without PRP was randomly induced in either of the tooth. The cases were followed-up clinically and radiographically at 6 and 12 months. There was a marked difference in periapical healing, apical closure and dentinal wall thickening of teeth treated by revascularization with PRP.

Injury to anterior teeth is a common event. It requires a treatment approach that assures the complete biologic healing and functional restoration of the tooth or teeth involved. A cystic lesion, which is unable to heal nonsurgically, heals well with surgical intervention and use of mineral trioxide aggregate (MTA) as retrograde filling has been reported in literature. Another material with largely improved handling properties; Biodentine™ (Septodont, St. Maurdes Fossιs, France) was introduced in 2011. It is a calcium silicate based material and manufacturers claim that it can be used for crown and root dentin repair treatment, repair of perforations or resorptions, apexification, and root end fillings. This article presents a case report of surgical management of a large cystic lesion using Biodentine™ as retrograde filling material which has not been reported in literature so far. Eighteen months radiographic follow-up exhibited completely healed cystic lesion.

The presence of accessory roots is rare in the primary dentition. Complete knowledge and understanding of tooth anatomy is essential to carry out high quality dental treatment with excellent outcome. In addition, the persistent primary tooth and its missing permanent successor in the dental arch pose several hurdles in front of the clinician due to doubtful survival of primary tooth. In this paper, highlights the root canal treatment of a rarest four rooted retained primary maxillary second molar.

External root resorption (ERR) is a lytic process occurring in the cementum or cementum and dentin of the roots of teeth. Here we report a case of inflammatory ERR in a mandibular right molar in a 22-year-old male patient with history of incomplete root canal treatment with the same. Considering the biological properties of mineral trioxide aggregate cement, especially its alkalinity and sustained calcium hydroxide release, this material was used for the treatment of ERR, followed by permanent prosthesis. The clinical and radiographic follow-up for 24 months revealed that treated teeth were functional, the progression of the ERR had ceased, the resorptive area were replaced with newly formed bone and periapical radiolucencies was healed.

Gemination refers to an attempt by a single tooth bud to divide, with a resultant formation of either a large tooth with a bifid crown or two completely divided teeth throughout the crown and root. This report describes a rare case of bilateral gemination of permanent mandibular second premolar tooth giving rise to molarization of premolars. The mesiodistal width of these teeth is similar to mandibular molars, but the cervicoocclusal width is lesser than that of the molar tooth. This paper also discusses the potential orthodontic, periodontal, and endodontic complications of premolar molarization.