Introduction: Pain of endodontic origin has been a major concern to the patients and the clinicians for many years. Post-operative pain is associated with inflammation in the periradicular tissues caused by irritants egressing from root canal during treatment. It has been suggested that calcium hydroxide intra-canal medicament has pain-preventive properties because of its anti-microbial or tissue altering effects. Some dispute this and reasoned that calcium hydroxide may initiate or increase pain by inducing or increasing inflammation. Objective: To evaluate the effectiveness of calcium hydroxide in reducing the post-treatment pain when used as an intra-canal medicament Materials and Methods: The following databases were searched: PubMed CENTRAL (until July 2013), MEDLINE, and Cochrane Database of Systematic Reviews. Bibliographies of clinical studies and reviews identified in the electronic search were analyzed for studies published outside the electronically searched journals. The primary outcome measure was to evaluate the post-treatment pain reduction when calcium hydroxide is used as an intra-canal medicament in patients undergoing root canal therapy. Results: The reviews found some clinical evidence that calcium hydroxide is not very effective in reducing post-treatment pain when it is used alone, but its effectiveness can be increased when used in combination with other medicaments like chlorhexidine and camphorated monochlorophenol (CMCP). Conclusion: Even though calcium hydroxide is one of the most widely used intra-canal medicament due to its anti-microbial properties, there is no clear evidence of its effect on the post-treatment pain after the chemo-mechanical root canal preparation.

Aim: To evaluate and compare the effect of antibacterial intracanal medicaments on inter-appointment flare-up in diabetic patients. Materials and Methods: Fifty diabetic patients requiring root canal treatment were assigned into groups I, II, and III. In group I, no intracanal medicament was placed. In groups II and III, calcium hydroxide and triple antibiotic pastes were placed as intracanal medicaments, respectively. Patients were instructed to record their pain on days 1, 2, 3, 7, and 14. Inter-appointment flare-up was evaluated using verbal rating scale (VRS). Results: Overall incidence of inter-appointment flare-up among diabetic patients was found to be 16%. In group I, 50% of the patients and in group II, 15% of the patients developed inter-appointment flare-up. However, no patients in group III developed inter-appointment flare-up. The comparison of these results was found to be statistically significant (P = 0.002; χ² = 12.426). However, with respect to intergroup comparison, only the difference between groups I and III was found to be statistically significant (P = 0.002; χ² = 12.00). Conclusions: Calcium hydroxide and triple antibiotic paste are effective for managing inter-appointment flare-ups in diabetic patients. Triple antibiotic paste is more effective than calcium hydroxide in preventing the occurrence of flare-up in diabetic patients.

Aims: To evaluate the filling of simulated lateral canals with gutta-percha or Resilon when using thermomechanical compaction. Setting and Design: Forty-five human single-rooted teeth were subjected to tooth decalcification and clearing. Materials and Methods: After root canal preparation, artificial lateral canals were made at 2, 5, and 8 mm from the working length (WL), corresponding to the apical, middle, and cervical thirds, respectively. The specimens were divided (n = 15) according to the filling material: Dentsply gutta-percha (GD), Odous gutta-percha (GO), and Resilon cones (RE). Root canals were obturated by thermomechanical compaction using a #45 compactor and no sealer. Lateral canals were analyzed by digital radiography and digital images after tooth decalcification and clearing using the Image Tool software. Statistical Analysis Used: Data were subjected to the Kruskal-Wallis and Dunn tests at 5% significance. Results: In the coronal third, RE and GO presented more filling ability than GD (P < 0.05). In the middle and apical thirds, RE presented the best results. Conclusions: Resilon demonstrated filling ability as material for root canal obturation by using thermomechanical compaction.

Introduction: The aim of this study was to make a comparison between microleakage of conventionally restored class V cavities using bur and acid etchant and, the ones prepared and conditioned by Er:YAG laser. Materials and Methods: 30 recently extracted intact caries and filling free human permanent molars were used for this study. Then, Cold cure acrylic resin was used to seal the apices. The samples were randomly assigned to 5 groups of six each. Class V cavities were prepared one on buccal and one on lingual surface of each sample. Group 1: cavity preparation by diamond bur and turbine + acid etch, Group 2: cavity preparation by Er:YAG laser + acid etch, Group 3: cavity preparation by Er:YAG laser + Laser etching, Group 4: cavity preparation by diamond bur and turbine + laser etching, Group 5: cavity preparation by Er:YAG laser with no conditioning procedure. The cavities restored with restorative composite resin. Samples were then immersed in 2% methylene blue solution for 24 hours. The data were then analyzed using Wilcoxon signed ranks test and Kruskal-Wallis statistical tests. Results: The Kruskal Wallis test showed a significant difference (P < 0.05) between enamel and cementum margin microleakage, while the higher microleakage was related to the cementum margin of restorations. Conclusion: There was no significant difference in evaluating microleakeage degree of cavities prepared by Er:YAG laser and diamond bur.

Aim: This study evaluated the effect of 10% ascorbic acid on the bond strength between fiber post and composite resin core after applying 24% hydrogen peroxide. Materials and Methods: Twenty-four hydrogen peroxide-treated fiber posts were divided into 4 groups (n = 6). Group 1 was the control group with no treatment. In groups 2-4, post surfaces were treated with 10% v ascorbic acid solution for 10, 30 and 60 minutes, respectively. Cores were built up using flowable composite resin. Two sticks were prepared from each specimen. Microtensile bond strength test was performed for each stick. Failure modes of sticks were evaluated under a stereomicroscope (×20). Surface morphologies of two fractured sticks from each group were assessed by SEM. Statistical analysis: Data were analyzed using one-way ANOVA and Tukey HSD tests (α = 0.05). Results: The highest microtensile bond strength was observed in Group 4 (20.55 ± 2.09) and the lowest in Group 1 (10.10 ± 0.55). There were significant differences in microtensile bond strength between all the groups (P < 0.05). Conclusion: It is concluded that ascorbic acid application increased the microtensile bond strength between the hydrogen peroxide treated fiber post and composite resin core. The increase is dependent on the duration of exposure to the antioxidant.

Aim: To compare the diagnostic accuracy of conventional periapical radiography and cone beam computed tomography (CBCT) in detecting vertical root fracture (VRF) in tooth with metallic post (MP). Materials and Methods: Twenty endodontically-treated teeth received MPs, artificial fractures were created in 10 teeth, and they were all examined with tomography and radiography. The sample consisted of periapical radiography with post and without post, and tomography with post and without post; each group with five fractured and five non-fractured teeth. The images were evaluated by three dental/maxillofacial radiologists and statistical validations were carried out using receiver operating characteristic (ROC) analysis. Results: Sensitivity and specificity of the area under the ROC (Az) of tomography with post (Az = 0.953) and without post (Az = 0.956) were significantly higher than those of periapical radiography with post (Az = 0.753) and without post (Az = 0.778). Conclusion: CBCT was more accurate than conventional periapical radiography in detecting VRF.

Introduction: Compressive and tensile stresses of core materials are important properties because cores usually replace a large bulk of tooth structure and must resist multidirectional masticatory forces for many years. Material and Methods: The present study was undertaken to find out the best core build up material with respect to their physical properties among resin-based composites. Individual compressive, tensile, and flexural strength of fiber-reinforced dual cure resin core build up material, silorane-based composite resin, and dual curing composite for core build up with silver amalgam core was used as control were evaluated and compared using universal testing machine. Data were statistical analysed using Kruskal-Wallis test to determine whether statistically significant differences (P < 0.05) existed among core materials. Both dual cure composite materials with nanofillers were found superior to amalgam core. The silorane-based material showed the highest flexural strength, but other mechanical properties were inferior to dual cure composite materials with nanofillers.

Background: Microbial contamination of the pulp space is one of the major factors associated with endodontic failure. Thus, in addition to a three dimentional apical filling a coronal seal for root canal fillings has been recommended. Aim: The present study was conducted to evaluate and compare the intra-orifice sealing ability of three experimental materials after obturation of the root canal system. Materials and Methods: Fourty single rooted mandibular premolars were decoronated, cleaned, shaped and obturated. Gutta-percha was removed to the depth of 3.5 mm from the orifice with a heated plugger. Ten specimens each were sealed with Light Cure Glass Ionomer Cement (LCGIC), Flowable Composite (Tetric N-Flow), and Light Cure Glass Ionomer Cement with Flowable Composite in Sandwich Technique along with a positive control respectively and roots submerged in Rhodamine-B dye in vacuum for one week. Specimens were longitudinally sectioned and leakage measured using a 10X stereomicroscope and graded for depth of leakage. Results: According to the results of the present study LC GIC + Tetric N Flow demonstrated significantly better seal (P < 0.01) than LC GIC. However there was no statistically significant difference in leakage (P > 0.01) between Tetric N-Flow and LCGIC+Tetric N-Flow groups. Conclusion: In the current study LCGIC+Tetric N-Flow was found to be superior over other experimental materials as intra-orifice barriers.

Aims: The study was aimed to acquire better understanding of C-shaped canal systems in mandibular second molar teeth through a clinical approach using sophisticated techniques such as surgical operating microscope and cone beam computed tomography (CBCT). Materials and Methods: A total of 42 extracted mandibular second molar teeth with fused roots and longitudinal grooves were collected randomly from native Indian population. Pulp chamber floors of all specimens were examined under surgical operating microscope and classified into four types (Min's method). Subsequently, samples were subjected to CBCT scan after insertion of K-files size #10 or 15 into each canal orifice and evaluated using the cross-sectional and 3-dimensional images in consultation with dental radiologist so as to obtain more accurate results. Minimum distance between the external root surface on the groove and initial file placed in the canal was also measured at different levels and statistically analyzed. Results: Out of 42 teeth, maximum number of samples (15) belonged to Type-II category. A total of 100 files were inserted in 86 orifices of various types of specimens. Evaluation of the CBCT scan images of the teeth revealed that a total of 21 canals were missing completely or partially at different levels. The mean values for the minimum thickness were highest at coronal followed by middle and apical third levels in all the categories. Lowest values were obtained for teeth with Type-III category at all three levels. Conclusions: The present study revealed anatomical variations of C-shaped canal system in mandibular second molars. The prognosis of such complex canal anatomies can be improved by simultaneous employment of modern techniques such as surgical operating microscope and CBCT.

Aim: The purpose was to compare the effect of 0.2% sodium fluoride mouthwash and casein phosphopeptide-amorphous calcium phosphate paste on prevention of dentin erosion. Materials and Methods: Buccal surfaces of 36 sound premolar teeth were ground flat and polished with abrasive discs. Half the polished surfaces were covered with tape to maintain a reference surface. Samples were randomly allocated into three groups. Group A was pretreated with tooth mousse (TM) 4 times a day for 5 days. Group B was pretreated with 0.2% sodium fluoride mouthwash 4 times a day for 5 days. Group C was considered as the control group with no pretreatment. In the next step, the samples were exposed to Coca-Cola 4 times a day for 3 days. After each erosive cycle, the samples were rinsed with deionized water and stored in artificial saliva. The surface loss was determined using profilometry. Results: The erosion in both Groups A and B was less than the control group. The surface loss in mouthwash group was significantly lower than in the control group. Erosion in TM group was more than the mouthwash group and less than the control group. Conclusion: Sodium fluoride mouthwash is more effective for prevention of dentin erosion.

Aims: The aim of this in vitro study was to evaluate the cyclic fatigue resistance of three single-use nickel-titanium (NiTi) instruments. Materials and Methods: Forty files each of OneShape (OS), Reciproc R25 (R25), WaveOne Primary (WO) file, and ProTaper (PT) F2 (as control) were tested in four curved artificial canals with different angles and radii of curvature. The number of cycles to fracture (NCF) was determined and the data were compared for differences by using two-way analysis of variance (P < 0.05). Results: In general, all single-use instruments were more resistant than traditional rotary instrument used as control. R25 showed the highest cyclic fatigue resistance. One Shape and WO files showed similar cyclic fatigue resistance values, higher than PT F2. Conclusions: Within the limitations of this study, it can be concluded that R25 was the most fatigue resistant. OS rotary instruments seem to have good mechanical resistance, similar to NiTi files developed for reciprocating motion.

Introduction: To evaluate the effect of two different post space diameters and related resin cement film thicknesses on the bond strength of a polyfiber post. Materials and Methods: A total of 48 premolars were randomly divided into two according to the post space diameter: 1.1 mm and 1.5 mm. Then each group was divided into three sub-groups according to luting cement used: RelyX U100, Panavia F2.0/ED primer, Clearfil SA cement. Spirapost was then luted into the canal using luting cements. Two slices were obtained from each root specimen. Push-out tests were performed. Data was analyzed with Kruskal-Wallis and Connover post-hoc and Mann-Whitney U-test (P < 0.05). Results: Push-out bond strength was found to vary significantly according to type of adhesive system and post space diameter size (P < 0.05). The self-adhesive resin cement RelyX U100 had significantly higher bond strengths compared with the other adhesive system (P < 0.05). The self-etch adhesive system (Panavia F2.0) showed significantly lower bond strengths compared with the other systems (P < 0.05). There was a significant interaction between the luting systems and post space diameter (P < 0.05). Conclusion: The increases in post space diameter significantly reduced the bond strength of Spirapost to root dentine for both groups.

Aims: To investigate the effects of five beverages (apple cider, orange juice, Coca-Cola, coffee, and beer) on microhardness and surface characteristic changes of nanohybrid resin composite and giomer. Materials and Methods: Ninety-three specimens of each resin composite and giomer were prepared. Before immersion, baseline data of Vicker's microhardness was recorded and surface characteristics were examined using scanning electron microscopy (SEM). Five groups of discs (n = 18) were alternately immersed in 25 mL of each beverage for 5 s and in 25 mL of artificial saliva for 5 s for 10 cycles. Specimens were then stored in artificial saliva for 24 h. This process was repeated for 28 days. After immersion, specimens were evaluated and data were analyzed by two-way repeated analysis of variance (ANOVA), Tukey's honestly significant difference (HSD), and a t-test (α = 0.05). Results: Microhardness of all groups significantly decreased after being immersed in the tested beverages (P < 0.05). SEM photomicrographs presented surface degradation of all groups. Conclusions: The effect of these beverages on the surface of both restorative materials also depended upon the exposure time and chemical composition of the restorative materials and beverages.

Aim: The aim of this ex vivo study was to compare the antibacterial activity of total-etch and self-etch adhesive systems against Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus through disk diffusion method. Materials and Methods: The antibacterial effects of Single Bond (SB) and Adper Prompt (AP) and aqueous solution of chlorhexidine 0.2% (positive control) were tested against standard strain of S. mutans, L. acidophilus, and A. viscosus using the disk diffusion method. The diameters of inhibition zones were measured in millimeters. Data was analyzed using Kruskal-Wallis test. Mann-Whitney U test was used for pairwise comparison. Result: Of all the materials tested, AP showed the maximum inhibitory action against S. mutans and L. acidophilus. Aqueous solution of chlorhexidine 0.2% showed the maximum inhibitory action against A. viscosus. Very minimal antibacterial effect was noted for SB. Conclusion: The antibacterial effects observed for the tested different dentin bonding systems may be related to the acidic nature of the materials.

Aim: The purpose of this in vitro study was to determine whether the addition of 2% chlorhexidine gluconate or 10% doxycycline would enhance the antimicrobial activity of Biodentine against Staphylococcus aureus (ATCC-25923), Enterococcus faecalis (ATCC-29212), Candida albicans (ATCC-90028), and Streptococcus mutans (MTCC-497). Materials and Methods: Three wells of 4 mm diameter and 4 mm depth on each plate were prepared on the agar medium with standardized suspensions of each microorganism. Biodentine powder mixed with 2% chlorhexidine (0.06 g) or 10% doxycycline (0.30 g) in its liquid or liquid alone was placed to fill each well. Plates were incubated at 37°C as required for microbial growth. A blinded, independent observer measured zones of inhibition. The data were analyzed using independent "t" test to compare the differences among the three cement preparations for different micro-organisms. Results: All Biodentine samples inhibited microbial growth. The highest mean diameters of zone of inhibition for all the micro-organisms were found around Biodentine/chlorhexidine (13.417) followed by Biodentine alone (12.236) and Biodentine/doxycycline (11.25). Conclusion: In conclusion, adding 2% chlorhexidine gluconate in liquid of Biodentine enhanced the antimicrobial activity of Biodentine against all the tested micro-organisms except Candida albicans, while addition of 10% doxycycline decreased the antimicrobial activity of Biodentine. The differences were significant statistically (P < 0.05).

Aim: The purpose of this study was to evaluate the antifungal action of various concentrations of white mineral trioxide aggregate (MTA) against seven different strains of Candida albicans using the tube dilution test. Materials and Methods: Fresh mix of MTA was prepared at concentrations of 100, 50, 25, and 12.5 mg/ml and added to a broth tube containing Sabouraud's liquid medium. A total of 1287 broth tubes were prepared and divided into experimental and control groups. Stock cultures of seven strains of C. albicans were obtained. Fresh inoculate of the microorganism was prepared by growing overnight cultures. Aliquots of the test C. albicans were taken and added to the test tubes. All tubes were incubated at 37°C for 1-, 24-, 72-, and 168-h time periods. At each time period, the presence of C. albicans colonies was assessed. Statistical analysis used: Differences among the groups were statistically analyzed using Kruskal-Wallis and Mann-Whitney U tests. Results: Results showed that one strain showed resistance even after 3 days at the lower MTA concentrations of 12.5 and 25 mg/ml. Growth reoccurred with three strains at MTA concentration of 12.5 mg/ml after 7 days. A significant difference was found between strain 3 and other strains at MTA concentrations of 12.5 and 25 mg/ml at the 3-days time period and between tubes containing 12.5 mg/ml and tubes containing higher concentrations of MTA at the 7-days time period. Conclusion: White MTA in concentrations of 100 and 50 mg/ml is effective in inhibiting the seven tested strains of C. albicans for periods up to 1 week.

Objectives: To evaluate the effect of the eugenol exposure time of an eugenol-based provisional restorative material on the shear bond strength of two-step and one-step self-etching adhesives to dentin, at three different time intervals of 24 h, 7 days, and 14 days. Materials and Methods: Forty extracted human posterior teeth were sectioned mesiodistally to obtain two halves and the resulting 80 halves were randomly assigned into four groups of 20 specimens each (Group-I, -II, -III, and -IV). Cavities of specified dimensions were prepared to expose dentin surface. In Group-I, temporarization was carried out with noneugenol cement (Orafil-G) for 24 h (control group). In Group-II, -III, and -IV, temporarization was carried out with eugenol cement (intermediate restorative material (IRM)) for 24 h, 7 days, and 14 days, respectively. Each group was further divided into two subgroups of 10 teeth each for two-step (Adper SE Plus) and one-step (Adper Easy One) self-etch adhesive systems, respectively. A plastic tube loaded with microhybrid composite resin (Filtek Z-350, 3M) was placed over the dentin surface and light cured. The specimens were subjected to shear stress in universal testing machine. Results: Group-II yielded low shear bond strength values compared with Group-III, -IV, and Group-I, which was statistically significant. Conclusions: The prior use of eugenol containing temporary restorative material reduced the bond strength of self-etch adhesive systems at 24-h period. No reduction in bond strength at 7 or 14 days exposure was observed with either two-step or one-step self-etch adhesive.

A symptomatic endodontically treated immature tooth with periapical pathology presents multiple challenges to the clinician. Owing to incomplete root formation, gutta percha removal has to be done carefully without further damaging the periapical tissue or pushing the obturating material beyond the apex. Nonsurgical approach toward treating such a tooth would necessitate the creation of an apical barrier followed by conventional root canal treatment. Current literature suggests one-step apexification with mineral trioxide aggregate (MTA), with an apical matrix as the treatment of choice. A new calcium silicate-based cement also called as dentine substitute by the manufacturers with good handling properties has been introduced recently by the trade name Biodentine™ (Septodont, St. Maurdes Fossιs, France). This case report presents management of a secondary endodontic case with an open apex treated with the concept of 'lesion sterilization and tissue repair (LSTR)' using triantibiotic paste and Biodentine™ for apical barrier formation. A 12-month follow up with cone beam-computed topography (CBCT) exhibited progressive involution of periapical radiolucency with indications of good healing of the periapical tissues and absence of clinical symptoms.

Anatomical variations in root canal morphology are an enigma and it is this variability, which is often a complicating factor in a successful root canal treatment. To achieve success in endodontic therapy it is imperative that all the canals are located, cleaned and shaped and obturated three dimensionally. Maxillary first premolar having three separate roots has an incidence of 0.5-6%. Even rarer are reported clinical case reports of maxillary second premolar with three separate roots and three canals. This case report describes the endodontic management of maxillary second premolar with two palatal roots and one buccal root having three root canals

Geminated teeth are consequences of developmental anomalies leading to joined elements, due to incomplete attempt of one tooth germ to divide into two. This case report describes successful endodontic treatment of an unaesthetic geminated permanent maxillary lateral incisor tooth and its esthetic rehabilitation using all ceramic crowns. Newer imaging technique like cone beam computed tomography was taken for the better understanding of the complicated root canal morphology.

The introduction of the dental operating microscope was a turning point in the history of dentistry. It triggered a rapid transition from the conventional world of macro-dentistry to the precise, detailed world of micro-dentistry. However, working at these higher-power magnifications brings the clinician into the realm where even slight hand movements are disruptive. Physiologic hand tremor is a problem resulting in difficulty in mouth mirror placement. Hence, in this paper, a new instrument was designed to overcome the drawback of hand tremors during microscopic endodontics.