Aim: To systematically review articles on canal centering ability of endodontic rotary cutting Nickel-Titanium (Ni-Ti) instruments and subject results to meta-analysis. Materials and Methods: A comprehensive search was initiated on canal centering ability of different rotary cutting Ni-Ti files such as Protaper, Hero Shaper, K3, Mtwo, Race, Wave One by selecting articles published in peer reviewed journals during 1991-2013 using "Pub Med" database. Inclusion and exclusion criteria were established. A data was created by tabulating: Author name, publication year, sample size, number of experimental groups, methods to evaluate canal centering ability, instrument cross section, taper, tip design, rake angle, mean and standard deviation. The data generated was subjected to meta-analysis. Results: Maximum studies were found to be conducted on mesiobuccal canal of mandibular 1 ^st molar with curvature ranging from 15-60°. The difference in canal centering ability of different rotary cutting Ni-Ti instruments was not statistically significant. Conclusion: All endodontic rotary cutting Ni-Ti instruments are capable of producing centered preparations. Protaper depicted the best centering ability. Computed tomography is an effective method of evaluating canal centering ability.

Endodontic and periodontal microsurgery has surpassed the success rates for traditional endodontic and periodontal surgical procedures. Excellent healing results are being attributed to both the techniques, when employed, for isolated endodontic or periodontal defects. Combined endodontic-periodontal lesions have been referred to as a true challenge, requiring not only endodontic microsurgical management but also concurrent bone grafting and membrane barriers techniques. The prevention of epithelial downgrowth and regeneration of periodontal cementum, fiber, and bone seals the fate of these cases. Achieving primary closure with submergence of grafts has a positive effect on GTR outcome. New techniques of periodontal microsurgery, such as minimally invasive papilla preserving flaps with passive internal mattress suturing, have managed to obtain 90% primary flap closure over grafted sites. Root surface treatment and conditioning has also shown to be beneficial for GTR. Endodontic microsurgery for the combined lesion has not integrated these advances yet. These advances, along with a recently suggested treatment strategy, are ushering in the level next in management of the combined lesions. This article offers an overview of the combined lesion, the disease, its classification, treatment strategy, regenerative tools, microsurgical recommendations, and outcome studies.

Introduction: One of the aims of root canal treatment is to prevent or eliminate pain. Postoperative endodontic pain control continues to be a significant challenge. Aim: To compare and evaluate the effect of single oral dose of 100 mg of tapentadol, 400 mg of etodolac, or 10 mg of ketorolac as a pretreatment analgesic for the prevention and control of postoperative endodontic pain in patients with symptomatic irreversible pulpitis. The incidence of side effects was recorded as secondary outcome. Materials and Methods: Sixty emergency patients with moderate to severe pain, diagnosed with symptomatic irreversible pulpitis were randomly allocated (1:1:1) to any of the three groups; tapentadol, etodolac, or ketorolac. Medications were administered 30 min before beginning of the endodontic treatment. Patients recorded pain intensity on 10 cm visual analog scale (VAS) after treatment, for upto 24 h. Results: At 24 h, mean ±standard deviation (SD) of VAS scores (in cm) for tapentadol, etodolac, and ketorolac were 0.89 ± 0.83, 2.68 ± 2.29, and 0.42 ± 0.69, respectively. Kruskal-Wallis (K-W) test showed significant difference among the three groups (P = 0.001). Mann-Whitney test showed significantly lower VAS scores in tapentadol and ketorolac than etodolac group (P = 0.013 and 0.001, respectively). Conclusions: Single oral dose of 10 mg of ketorolac and 100mg of tapentadol as a pretreatment analgesic significantly reduced postoperative endodontic pain in patients with symptomatic irreversible pulpitis when compared to 400 mg of etodolac.

Introduction: Pain management remains the utmost important qualifying criteria in minimizing patient agony and establishing a strong dentist-patient rapport. Symptomatic irreversible pulpitis is a painful condition necessitating immediate attention and supplemental anesthetic techniques are often resorted to in addition to conventional inferior alveolar nerve block. Aim: The purpose of the study was to evaluate the anesthetic efficacy of X-tip intraosseous injection in patients with symptomatic irreversible pulpitis, in mandibular posterior teeth, using 4% Articaine with 1:100,000 adrenaline as local anesthetic, when the conventional inferior alveolar nerve block proved ineffective. Materials and Methods: X-tip system was used to administer 1.7 ml of 4% articaine with 1:100,000 adrenaline in 30 patients diagnosed with irreversible pulpitis of mandibular posterior teeth with moderate to severe pain on endodontic access after administration of an inferior alveolar nerve block. Results: The results of the study showed that 25 X-tip injections (83.33%) were successful and 5 X-tip injections (16.66%) were unsuccessful. Conclusion: When the inferior alveolar nerve block fails to provide adequate pulpal anesthesia, X-tip system using 4% articaine with 1:100,000 adrenaline was successful in achieving pulpal anesthesia in patients with irreversible pulpitis.

Aim: To investigate the role of bismuth oxide, a constituent of contemporary mineral trioxide aggregate (MTA) materials, and its response to various solutions that may contribute to the potential discoloration that occurs following MTA applications within the scope of endodontics. Setting and Design: Laboratory assessment of chemical reactions with white ProRoot^® MTA and white Portland cement (WPC). Materials and Methods: Set specimens and freshly mixed specimens of white ProRoot^® MTA and white ProRoot^® MTA powder, along with specimens of WPC were exposed to distilled water, phosphate buffered saline (PBS), 10% formalin, hydroxyethylmethacrylate (HEMA), sodium hypochlorite, sodium hydroxide (NaOH) base, and hydrochloric acid (HCl) acid. Specimens were visually inspected periodically for color changes. Results: All forms of ProRoot MTA showed discoloration when exposed to 10% formalin within 30 min, as opposed to WPC, and were completely blackened at 4 days. Bismuth oxide alone and with calcium oxide also turned black within 30 min after exposure to 10% formalin. No discoloration was seen when exposed to the other solutions. Conclusions: Exposing MTA in various forms to a variety of liquids has determined that bismuth oxidein combination with other chemical moieties is the prime cause of staining observed by clinicians.

Objectives: To investigate the effect of acidic solution on surface roughness and microleakage of tooth-colored restorative materials. Materials and Methods: A 160 box-shaped cavities were prepared on the buccal surfaces of 160 human molars, and assigned to four groups: Group A restored with Ketac™ Molar Easymix, Group B with Fuji II™ LC, Group C with Ketac™N100, and Group D with Filtek™ Z250, and subdivided into study and control groups (n = 20). Study groups were immersed in lemon juice (pH = 2.79) for 24 h, whilst controlgroups in deionized distilled water. All samples were immersed in 2% methylene blue dye, sectioned into two equal halves for surface roughness, and microleakage tests. Data were analyzed using Mann-Whitney and Kruskal-Wallis tests at P < 0.05. Results: There was a significant difference in surface roughness of Ketac™ Molar, Fuji II™LC, and Ketac™N100. No significant difference was found in microleakage of Ketac™ Molar and Fuji II™LC; however, there were significant differences in the gingival margin of Ketac™N100, and the occlusal margin of Filtek™Z250. Conclusions: All glass ionomer cements were eroded after exposure to the acidic drink. Filtek™ Z250 and Ketac™ Molar Easymix showed more microleakage. All materials showed more microleakage at the gingival margins.

Background: Chemomechanical caries removal system is part of the minimal invasive dentistry; the aim of the study was to compare the amount of bacteria after caries removal with chemomechanical system and conventional rotatory instruments and to test the Vickers microhardness and micro-RAMAN analysis of residual dentin after excavation. Materials and Methods: Molars were induced for demineralization, confirmed with DIAGNOdent; Streptococcus mutans were inoculated into the cavities and filled. Caries removal was performed with rotatory instruments and chemomechanical system; surviving bacteria were cultured for 24 and 48 hours at 37΀C. Vickers microhardness and micro-RAMAN analysis were tested after excavation. Data were analyzed with Wilcoxon, continuity correction, odds ratio, ANOVA post hoc Tukey test, and Spearman correlation. Results: Demineralization was significantly detectable at 240 hours of incubation; conventional rotatory instruments and chemomechanical caries removal were effective in 19.4%-22.6% and 25.8%-32.3%, respectively. Vickers microhardness of chemomechanical system was higher (P < 0.0001) than conventional rotatory instruments and comparable to healthy dentin. Micro-RAMAN analysis showed that healthy dentin is correlated to chemomechanical system (R ² = 0.683, P < 0.00001) and drilling with burs (R ² = 0.139, P < 0.00001). Conclusion: The chemomechanical system is effective for caries elimination, comparable to conventional rotatory instruments; the remaining Vickers microhardness and composition surface tissue are similar to healthy dentin.

Introduction: Irrigation plays an indispensable role in removal of tissue remnants and debris from the complicated root canal system. This study compared the human pulp tissue dissolution by different concentrations of chlorine dioxide, calcium hypochlorite and sodium hypochlorite. Materials and Methods: Pulp tissue was standardized to a weight of 9 mg for each sample. In all,60 samples obtained were divided into 6 groups according to the irrigating solution used- 2.5% sodium hypochlorite (NaOCl), 5.25% NaOCl, 5% calcium hypochlorite (Ca(OCl) ₂ ), 10% Ca(OCl) ₂ , 5%chlorine dioxide (ClO ₂ ) and 13% ClO ₂ . Pulp tissue was placed in each test tube carrying irrigants of measured volume (5ml) according to their specified subgroup time interval: 30 minutes (Subgroup A) and 60 minutes (Subgroup B). The solution from each sample test tube was filtered and was left for drying overnight. The residual weight was calculated by filtration method. Results: Mean tissue dissolution increases with increase in time period. Results showed 5.25% NaOCl to be most effective at both time intervals followed by 2.5% NaOCl at 60 minutes, 10%Ca(OCl) ₂ and 13% ClO ₂ at 60 minutes. Least amount of tissue dissolving ability was demonstrated by 5% Ca(OCl) ₂ and 5% ClO ₂ at 30 minutes. Distilled water showed no pulp tissue dissolution. Conclusion: Withinthe limitations of the study, NaOCl most efficiently dissolved the pulp tissue at both concentrations and at both time intervals. Mean tissue dissolution by Ca(OCl) ₂ and ClO ₂ gradually increased with time and with their increase in concentration.

Aim: To compare the changes in microhardness of root dentin caused by two novel irrigation regimens with conventional irrigation. Materials and Methods: Forty extracted human permanent incisor teeth were selected. Decoronated roots were separated longitudinally to get 80 specimens that were embedded in autopolymerizing acrylic resin and grounded flat with silicon carbide abrasive papers. Of these, 60 root segments without any cracks or defects were selected and divided into four groups according to the irrigation regimen used (n = 15). Group I: 5% sodium hypochlorite (NaOCl) + 17% ethylenediaminetetraacetic acid (EDTA) + 0.2% chlorhexidine digluconate (CHX) (conventional). Group II: 6% Morinda Citrifolia Juice + 17% EDTA (MCJ). Group III: 5% NaOCl + Q Mix 2 in 1 (QMix). Group IV: Distilled water (control). Irrigation regimens were performed for 5 minutes. Dentin microhardness was measured with a Vickers indenter under a 200-g load and a 20-s dwell time at the midroot level of root dentin. The data were analyzed using Kruskal Wallis test and Dunn's multiple comparison tests. Results: A significant difference was seen in the median values of the four groups. The control group showed the least reduction in microhardness when comparison with the other groups. Except for Group III (Q Mix), the other groups that were tested (MCJ and conventional regimens) showed statistically significant difference from the control group. Conclusion: Within the limitation of this study, it was concluded that NaOCl + Q Mix were least detrimental to root dentin microhardness when compared with MCJ and conventional irrigation regimens.

Aim: The aim of this study was to compare the micro hardness of a nanohybrid composite resin after brushing with two herbal and one non-herbal whitening toothpastes. Materials and Methods: We divided Eighty disk-shaped specimens of a nanohybrid composite (Tetric N Ceram, Ivoclar Vivadent, Asia) into 4 groups of 20 specimens each: Groups A, B, C, and D. Group A was control, Group B was brushed with Colgate total advanced whitening (Colgate-Palmolive (India) Limited), Group C with Salt and Lemon, Dabur (Dabur International Limited, Dubai, UAE), and Group D with HiOra Shine, Himalaya (The Himalaya Drug Company, India). The specimens were polished using medium, fine, and superfine discs (Sof-lex, 3M, ESPE, USA) and subsequently placed at 37°C in distilled water. They were brushed for 2 minutes twice daily with a soft motorized toothbrush (Colgate 360 sonic power battery-operated tooth brush, Colgate Palmolive, India) for 30 days. The samples were rinsed under running water to remove the toothpaste and stored in distilled water at 37°C until the readout was taken on the Vickers's hardness tester for microhardness. Results: The results revealed that the difference among the groups was statistically significant (P < 0.001). Tukey's test showed that reduction in microhardness for Group B was significantly higher than that for Group C and Group D (P < 0.001). Conclusion: Within the limitations of this study, non-herbal whitening toothpaste had a greater impact on the microhardness of nanohybrid resin composite than herbal whitening toothpastes.

Aim: The aim of this study was to investigate the correlation between endodontic clinical signs and symptoms and the presence of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia or their association by Multiplex polymerase chain reaction assay. Materials and Methods: Microbial samples were taken from 30 cases with necrotic pulp tissues in primary infections. DNA was extracted from the samples, which were analyzed for the presence of three endodontic pathogens by using species-specific primers. Results: P. gingivalis, T. denticola, T. forsythia, and Red Complex were present in 11, 17, 4, and 2 canals, respectively. Clinical and statistically significant relationships were found between T. forsythia and mobility and between T. denticola and swelling. (P < 0.05). Presence of other Red complex bacteria shows clinical association with presence of signs and symptoms but no statistically significant relationship. Conclusion: The high prevalence of P. gingivalis, T. denticola, and T. forsythia in the examined samples suggests that these bacteria are related to the etiology of symptomatic periradicular diseases.

Aim: The aim of the present study was to compare the canal transportation and centering ability of Rotary ProTaper, One Shape and Wave One systems using cone beam computed tomography (CBCT) in curved root canals to find better instrumentation technique for maintaining root canal geometry. Materials and Methods: Total 30 freshly extracted premolars having curved root canals with at least 10 degrees of curvature were divided into three groups of 10 teeth each. All teeth were scanned by CBCT to determine the root canal shape before instrumentation. In Group 1, the canals were prepared with Rotary ProTaper files, in Group 2 the canals were prepared with One Shape files and in Group 3 canals were prepared with Wave One files. After preparation, post-instrumentation scan was performed. Pre-instrumentation and post-instrumentation images were obtained at three levels, 3 mm apical, 3 mm coronal and 8 mm apical above the apical foramen were compared using CBCT software. Amount of transportation and centering ability were assessed. The three groups were statistically compared with analysis of variance and Tukey honestly significant. Results: All instruments maintained the original canal curvature with significant differences between the different files. Data suggested that Wave One files presented the best outcomes for both the variables evaluated. Wave One files caused lesser transportation and remained better centered in the canal than One Shape and Rotary ProTaper files. Conclusion: The canal preparation with Wave One files showed lesser transportation and better centering ability than One Shape and ProTaper.

Aim: The present study compares the marginal adaption of Mineral Trioxide Aggregate (MTA), Glass Ionomer Cement (GIC) and Intermediate Restorative Material (IRM) as root-end filling materials in extracted human teeth using Scanning Electron Microscope (SEM). Materials and Methods: Thirty single rooted human teeth were obturated with Gutta-percha after cleaning and shaping. Apical 3 mm of roots were resected and retrofilled with MTA, GIC and IRM. One millimeter transverse section of the retrofilled area was used to study the marginal adaptation of the restorative material with the dentin. Mounted specimens were examined using SEM at approximately 15 Kv and 10 ^-6 Torr under high vacuum condition. At 2000 X magnification, the gap size at the material-tooth interface was recorded at 2 points in microns. Statistical Analysis: One way ANOVA Analysis of the data was carried out with gap size as the dependent variable, and material as independent variable. Results: The lowest mean value of gap size was recorded in MTA group (0.722 ± 0.438 μm) and the largest mean gap in GIC group (1.778 ± 0.697 μm). Conclusion: MTA showed least gap size when compared to IRM and GIC suggesting a better marginal adaptation.

Aims and Objectives: The purpose of this study was to compare the efficacy of 5.25% sodium hypochlorite, 2% chlorehexidine and MTAD in disinfecting gutta-percha cones and to analyze the surface topography of gutta-percha cones after the rapid chemical disinfection procedure. Materials and Methods: Gutta-percha cones were immersed in suspensions of Enterococcus faecalis and Staphylococcus aureus separately. The cones were then immersed in 5.25% NaOCl, 2% CHX and MTAD for 30 seconds, 1 minute and 5 minutes separately. The disinfected cones were then incubated in thioglycollate media for 7 days. The thioglycolate media was sub-cultured and colony forming units were counted. For topographical examination of gutta-percha cones, the cones were immersed in respective solutions for one minute and allowed to air dry for 30 minutes after rinsing or without rinsing the cones with distilled water. The topography of the cones were then analyzed under SEM. Data was statistically analyzed using one way anova. Results: MTAD was found to be the most effective disinfecting solution. The topographical examination of GP cones found some deposits after the disinfection procedure in every group. These deposits were removed when the GP cones were rinsed with distilled water. Conclusions: MTAD possesses superior bactericidal activity when compared with NaOCl and CHX and a final rinse with distilled water is essential after the disinfection procedure.

Aim: To investigate the influence of cervical preflaring using different rotary instruments on apical file size determination. Materials and Methods: Extracted human molar teeth were randomly divided in to eight groups (N = 10): Control group (CG); LA Axxess group (LA); HyFLex group (HF); GatesGlidden group (GG); ProTaper group (PT); Race group(RC); FlexMaster group (FM); and K3 group (K3). Patency was maintained and working length was established under magnification. All instruments were used according to manufacturer's instructions. Steriomicroscopic images were taken to determine the discrepancies in diameters. ProPlus software (USA) was used to determine the diameter of the root canal. ANOVA test and Post Hoc Tests-Bonferroni Multiple Comparisons were used for statistical analysis. Results: Canals preflared with LA Axxess burs showed the best results. Control group that is, the canals with no cervical preflaring showed the maximum discrepancy between the initial apical file diameter and apical canal diameter. Conclusion: Cervical preflaring plays an important role in reducing the discrepancy between initial apical file diameter and apical canal diameter.

Objective: This in vitro study evaluated and compared the microleakage of three sealers; Endosequence bioceramic (BC) sealer, AH Plus and Epiphany. Materials and Methods: Study was done on 75 extracted human single rooted permanent teeth, which were decoronated and the root canals were instrumented. The specimens were randomly divided into three groups (n = 25) and obturated by continuous wave condensation technique. Group A: using Endosequence BC, Group B: using AH Plus sealer, Group C: using Resilon Epiphany system. Microleakage was evaluated using dye penetration method. Teeth were split longitudinally and then horizontally markings were made at 2, 4 and 6 mm from the apex. Dye penetration evaluation was done under stereomicroscope (30X magnification). Results: The dye penetration in Group B was more than in Group A and C in both vertical and horizontal directions, suggesting that newly introduced BC sealer and Epiphany sealer sealed the root canal better compared to AH Plus Sealer. Conclusion: Newer root canal sealers seal the root canal better but cannot totally eliminate leakage.

Objective: This study investigated whether the canal curvature has an influence on the accuracy of Electronic Apex Locator. Materials and Methods: Sixty mandibular posterior teeth were decoronated. A number (No.) 10 file was inserted into the mesiobuccal canal and radiographs were taken to determine the degree of curvature by Schneider's method. Samples were divided into three groups of mild (<20 ^o ), moderate (20-36°) and severe curvature (>36 ^o ). After enlarging the orifice, the actual canal length was determined by introducing a file until the tip emerged through the major foramen when observed under 20X magnification. The teeth were embedded in an alginate model and the Root ZX was used to determine the electronic length. The data was analyzed by Kruskal-Wallis test followed by Mann-Whitney test. Results: The difference in measurement of Actual and Electronic working length was statistically significant between group 1 and 2 (P < 0.05) as well as between group 1 and group 3 (P < 0.05) with group 1 showing the lowest difference. Conclusion: Considering ± 0.5 mm as tolerance limit for accuracy, the device was 95% accurate for the mild curvature group and 80% accurate for moderate and severe groups.

In traumatic dental injury, concomitant occurrence of avulsion and intrusive luxation is exceptional. This is because the vectors of forces responsible for both avulsive and intrusive injuries are in different directions. The present case report reviews the management of a rare combination of avulsion in right maxillary lateral incisor (tooth #12) and intrusive luxation in right maxillary central incisor (tooth #11) in a 22-year-old Asian male. Clinical and radiographic evaluation was done at 12-month follow-up. Various treatment modalities and complications associated with both avulsion and intrusion are also discussed in the paper.

Management of internal root resorption is a challenge to the endodontists. It may occur in cases with chronic pulpal inflammation, following caries or due to trauma in the form of an accidental blow. Most cases of internal root resorption are seen in anterior teeth, due to their susceptibility to trauma. However, it may be seen in posterior teeth, most likely because of carious involvement of the pulp. Early diagnosis, removal of the cause, proper treatment of the resorbed root is mandatory for successful treatment outcome. This paper is an attempt to summarize the knowledge on internal root resorption and present various cases, which were successfully managed with different treatment modalities.

Introduction: Palatoradicular groove is a developmental anomaly which is predominantly found in maxillary lateral incisors. It provides a susceptible alcove for the progression of localised periodontal inflammation which can further cause pulpal involvement. This case report describes the successful treatment of a large periodontic - endodontic lesion usingnon surgical endodontic therapy and biodentine for the sealing of the palatoradicular groove.