Context: The identification of root canals plays an important role in successful endodontic diagnosis and treatment. An inappropriate identification of canal resulting in incomplete removal of pulp tissue from the root canals is the main reason for the failure of endodontic treatment in molars. Radiographic imaging is an essential investigative tool in successful endodontics. Cone beam computed tomography (CBCT) the imaging is relatively a new method to visualize the roots in all the three planes. Aims: This is a study to assess number of root canals in maxillary and mandibular first and second molars on both the right and left sides using CBCT imaging. Settings and Design: A total of 100 CBCT images, which were available as soft copies on the hard drive of the computer in the Department of Oral Medicine and Radiology were considered for the study. Subjects and Methods: The axial view sections of the maxillary and mandibular arch of 1 mm thickness were examined with a magnification of 250%. The Images were scrolled down from the cementoenamel junction till the apical foramen and the maximum number of canals in each root were recorded. Statistical Analysis Used: The collected data were tabulated (Microsoft Excel 2013) and analyzed by independent t-test using statistical analysis software SPSS. Results: Among the maxillary first molars, 72.5% had 4 canals with 76.5% of mesiobuccal root having 2 canals. 49% of maxillary second molar had 3 canals with 53.5% of mesiobuccal root having 1 canal. 67.5% of mandibular first molar had 3 canals with 96.5% of mesial root having 2 canals. Conclusions: According to this study, the variations in the number of canals were more with respect to maxillary first molars when compared to the other molars. CBCT can provide the clinician with supplemental information about the different root canal configurations for successful root canal treatment.

Significance of Study: Mineral trioxide aggregate (MTA) and Biodentine (calcium silicate-based materials) have great importance in dentistry. There is no study comparing the bond strength of Biodentine and MTA for composite, compomer, and compomer or resin-modified glass ionomer (RMGIC). Although many advantages of Biodentine over MTA; in this study, MTA has shown better shear bond strength (SBS) to restorative materials. Aim: Recently, a variety of calcium silicate-based materials are often used for pulp capping, perforation repair, and endodontic therapies. After those treatment procedures, teeth are commonly restored with composite resin, (RMGIC materials in pediatric dentistry. The aim of this study was to evaluate the SBS of composite resin (Filtek™ Z250; 3M ESPE, USA), compomer (Dyract XP; LD Caulk/Dentsply, USA), and resin-modified glass ionomer (Photac-Fil Quick Aplicap; 3M ESPE, USA) to white MTA and Biodentine. Materials and Methods: Ninety acrylic cylindrical blocks were prepared and divided into two groups (n = 45). The acrylic blocks were randomly allocated into 3 subgroups; Group-1A: MTA + composite (Filtek™ Z250), Group-1B: MTA + compomer (Dyract XP), Group-1C: MTA + RMGIC (Photac-Fil Quick Aplicap), Group-2A: Biodentine + composite, Group-2B: Biodentine + compomer, Group-2C: Biodentine + RMGIC. The specimens were mounted in Universal Testing Machine. A crosshead speed 1 mm/min was applied to each specimen using a knife-edge blade until the bond between the MTA/Biodentine and restorative material failed. Failure modes of each group were evaluated under polarized light microscope at ×40 magnification. Results: There was no statistically significant difference between MTA + Composite resin with MTA + Compomer; and MTA + RMGIC with Biodentine + RMGIC (P > 0.05). There were statistically significant differences between other groups (P < 0.05). Conclusions: The results of the present study displayed that although many advantages of Biodentine over MTA; MTA has shown better SBS to compomer and composite resin materials than Biodentine.

Aim: This study aimed to compare, through dentin microhardness and colorimetric analysis, the chelating effect of 0.2% chitosan solubilized in different acids. Materials and Methods: The second and third cuts of the cervical region of maxillary central incisors were divided into four quadrants, resulting in eight specimens, which were treated with 50 μL of solution for 5 min according to their group (n = 10): GI – 0.2% chitosan solubilized in 1% acetic acid; GII – 0.2% chitosan solubilized in 3.3% citric acid; GIII – 0.2% chitosan solubilized in 0.00145% hydrochloric acid; and GIV – 0.2% chitosan solubilized in 0.00112% nitric acid. A control was made from the chelating properties of the following acids: GV – 3.3% citric acid, GVI – 0.00145% hydrochloric acid, GVII – 0.00112% nitric acid, and GVIII – control (distilled water). Afterward, they were subjected to the Knoop microhardness tester with a load of 10 g for 15 s, resulting in three indentations of the root canal toward the cement. The measurements obtained were subjected to the one-way ANOVA test followed by Tukey's test (α =0.05). Subsequently dispensing the chitosan solutions, the same were subjected to colorimetric analysis. Results: Chitosan solubilized in acetic acid, followed by chitosan in citric acid, provided a greater reducing effect compared to the other groups. Similar results were observed in the colorimetric analysis. Conclusion: It was concluded that the chelating ability of the chitosan solution solubilized in acetic acid is higher than solubilization in citric, hydrochloric, and nitric acids.

Aim: To evaluate the effects of sodium hypochlorite (NaOCl), chlorhexidine (CHX), and two naturally derived reducing agents on the bond strength of epoxy resin-based sealer to root dentin. Materials and Methods: A total of 60 single-rooted human teeth were prepared using ProTaper (Dentsply Tulsa Dental Specialties, Johnson City, TN, USA) and an irrigation protocol including 5% NaOCl or 2% CHX gel, and ethylenediaminetetraacetic acid (EDTA), for smear layer removal. The following subgroups (n = 10) were also assessed according to the naturally derived reducing agent used: no agent (control group); grape seed extract (GSE); and green tea. Root canals were filled with gutta-percha and AH Plus (Dentsply DeTrey, Konstanz, Germany). Bond strength was measured using the push-out test, and statistical analyses were performed using ANOVA; failure patterns (modes) were classified as adhesive, cohesive, or mixed. The types of failure modes were evaluated using the Chi-squared test at α =0.05. Results: The irrigation protocols demonstrated similar bond strength values (P > 0.05). However, the Chi-squared test revealed significant differences in failure mode among the groups (P < 0.05). An increase in the incidence of adhesive failures was observed for the NaOCl and EDTA groups. The other groups demonstrated a prevalence of mixed and cohesive failures. Conclusion: The irrigation protocols and use of naturally derived reducing agents had no effect on the bond strength of the resin-based sealer to dentin; however, improvement was evident in the adhesion quality of AH Plus to NaOCl-treated root dentin, due to the prevalence of cohesive failure.

Aim of the Study: The aim of this study was to compare and evaluate the sealing ability of four root end filling materials mineral trioxide aggregate (MTA)-Plus, Biodentine, MTA (MTA Angelus) and glass ionomer cement (GIC) using fluid filtration method. Materials and Methods: Forty-four extracted, human single-rooted teeth were collected. The crown of each tooth was decoronated 2 mm above the cementoenamel junction. Canals were negotiated, instrumented, obturated using lateral compaction method. The access cavities were sealed with Cavit. Root end resection and apical root end cavity preparations of 4 mm were made in each specimen. The selected roots were then randomly divided into four groups (n = 11) and restored as follows. Group 1 – GIC, Group 2 – MTA (MTA Angelus), Group 3 – Biodentine, and Group 4 – MTA Plus. The apical microleakage of each specimen was assessed using fluid filtration method at 72 h, 1 month and 3 months. Microleakage in each specimen was recorded in mm (millimeter) and converted to μl/min/cm H₂O. Results: MTA Angelus showed least microleakage followed by Biodentine and MTA Plus. Least sealing ability was seen with GIC. There was statistically significant difference between all the materials at various time intervals. Conclusion: MTA Angelus showed superior sealing ability as a retrograde filling material followed by Biodentine and MTA Plus.

Context: Endodontic retreatment is performed in teeth with endodontic failures. The main goal of retreatment is cleaning and shaping of the root canal with removal of old root filling material. Hand instruments and rotary instruments are mainly used for removing this filling material. Aim of Study: To compare the relative efficacy of three rotary instrumentation systems for removal of gutta-percha from root canal during endodontic retreatment. Objective of Study: To find out which NiTi system is more efficacious in retreatment and to check out the efficacy of retreatment with and without use of solvent. Materials and Methods: Sixty freshly extracted, single-rooted human mandibular premolars were instrumented with K-files, and each root canal was filled with gutta-percha and AH Plus (Dentsply Detrey, Konstanz, Germany) sealer using lateral compaction. Specimens were then divided into three experimental groups with twenty specimens each. Groups were then subdivided into ten specimens each. Groups were then retreated either with or without solvent. The removal of gutta-percha was performed using ProTaper retreatment files, Mtwo retreatment files, and R-Endo files after 2 weeks. The amount of root canal filling material remnant in the coronal, middle, and apical thirds was measured using stereomicroscope and computer image analysis program. Statistical Analysis Used: Data were evaluated statistically using analysis of variance. Results: ProTaper group was found to have less remnant filling material as compared to the other groups in coronal and middle thirds, but a significant difference was observed between ProTaper and Mtwo and Mtwo and R-Endo in the nonsolvent groups (P < 0.05). Mtwo group demonstrated less amount of remaining filling material in the nonsolvent group. Conclusions: Both nickel–titanium systems and ProTaper and Mtwo retreatment file systems, were found to be effective in the removal of root canal filling material. However, complete removal of gutta-percha from root canals did not occur with any of the experimental groups.

Aim: The aim of this study is to evaluate and to compare the effect of different light-curing modes and different liners on cuspal deflection in premolar teeth restored with bulk filled or incrementally filled composite measured at different time intervals. Materials and Methods: The study was divided into two parts (Part 1-different curing modes, Part 2-different liner) each with sixty extracted human upper premolar teeth with standardized large mesio-occlusal-distal cavities prepared. Each part was divided into two groups according to the composite used (Group A-Filtek Z350 XT, Group B-Sonic fill). Each group was then divided into three subgroups according to the light-curing modes (soft-start, pulse, and continuous curing mode) and liner (Filtek Z350 XT Flowable, Vitremer) used. The cuspal deflection was then measured with a digital micrometer gauge and subjected to statistically analysis using analysis of variance and Tukey's post hoc test. Results: Sonic fill composite, resin-modified glass ionomer cement (RMGIC) liner and curing with soft-start/pulse curing mode had significantly lower cuspal deflection compared to Filtek Z350 XT, flowable liner, and continuous curing mode, respectively. Conclusion: Sonic fill composite, RMGIC liner under the restorations and composites cured with soft start/pulse curing mode resulted in reduced cuspal deflection.

Aim: This study was intended to evaluate the amount of apically extruded debris following root canal preparation with three different instrumentation systems. Materials and Methods: Sixty mandibular incisor teeth were selected and randomly divided into three groups (n = 20/group) according to the instrumentation system used: the ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), the Twisted File Adaptive (TFA; SybronEndo, Orange, CA, USA), and the WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland). All apically extruded debris was collected and dried in preweighed glass vials. The mean weight of the apically extruded debris was obtained using a microbalance. The time for root canal preparation was also recorded. The data were analyzed using a one-way analysis of variance. Results: The mean weights of apically extruded debris were 0.00035 ± 0.00014 g (PTN); 0.00023 ± 0.0001 g (TFA); and 0.00019 ± 0.0001 g (WOG) (P < 0.01). The mean preparation time value was 301,13 ± 62.14 s (PTN); 234.27 ± 34.88 s (TFA); and 239.8 ± 58.6 s (WOG) (P < 0.05). Conclusions: The PTN system extruded more debris than the TFA and WOG systems. The TFA and WOG systems were faster than the PTN system.

Background: Differential diagnosis of periapical cysts and granulomas is required as their treatment modalities are different. Aim: The aim of this study was to evaluate the efficacy of cone beam computed tomography (CBCT) in the differential diagnosis of periapical cysts from granulomas. Settings and Design: A single-centered observational study was carried out in the Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, using CBCT and dental operating microscope. Methods: Forty-five lesions were analyzed using CBCT scans. One evaluator analyzed each CBCT scan for the presence of the following six characteristic radiological features: cyst like-location, shape, periphery, internal structure, effect on the surrounding structures, and cortical plate perforation. Another independent evaluator analyzed the CBCT scans. This process was repeated after 6 months, and inter- and intrarater reliability of CBCT diagnoses was evaluated. Periapical surgeries were performed and tissue samples were obtained for histopathological analysis. To evaluate the efficacy, CBCT diagnoses were compared with histopathological diagnoses, and six receiver operating characteristic (ROC) curve analyses were conducted. Statistical Analysis Used: ROC curve, Cronbach's alpha (α) test, and Cohen Kappa (κ) test were used for statistical analysis. Results: Both inter- and intrarater reliability were excellent (α = 0.94, κ = 0.75 and 0.77, respectively). ROC curve with regard to ≥4 positive findings revealed the highest area under curve (0.66). Conclusion: CBCT is moderately accurate in the differential diagnosis of periapical cysts and granulomas.

Background: Numerous researches have been done on the permanent maxillary first molars for the presence of an extra canal, especially the mesiobuccal roots for the presence of MB2 canals. Cone beam computed tomography (CBCT) has been used recently in the detection of these canals. However, literature discussing the efficacy and reliability of CBCT in the detection of these canals is scanty. Aims: This study aims to evaluate the efficacy of CBCT as a preoperative diagnostic aid in locating the second mesiobuccal canal in maxillary first molars. Methods: Selected sixty extracted maxillary first molars were placed in the skull base, and CBCT scans were done for evaluating the presence of MB2 canals in the mesiobuccal root. Sectioning of the roots at 3, 5, and 7 mm from the tip was performed and further examined under the microscope for the presence of the MB2 canals. Evaluations were done by two evaluators independently. Results of evaluations were statistically analyzed. Statistical analysis used were standard normal deviation (Z value), interrater reliability (Chronbach's alpha-), P value and receiver operating curve(ROC). Results and Conclusions: Detection rates of MB2 using both the methods did not show any significant difference (P > 0.05). CBCT was found to be a reliable tool for the detection of MB2 canal in maxillary first molar teeth when compared to gold standard sectioning technique.

Aim: This study aims to evaluate the color change in human enamel bleached with three different concentrations of hydrogen peroxide, containing pineapple extract as an additive in two different timings, using reflectance spectrophotometer. Background: The study aimed to investigate the bleaching efficacy on natural teeth using natural enzymes. Materials and Methods: Baseline color values of 10 randomly selected artificially stained incisors were obtained. The specimens were divided into three groups of 20 teeth each: Group 1 – 30% hydrogen peroxide, Group II – 20% hydrogen peroxide, and Group III – 10% hydrogen peroxide. One half of the tooth was bleached with hydrogen peroxide, and other was bleached with hydrogen peroxide and pineapple extract for 20 min (Subgroup A) and 10 min (Subgroup B). Statistical Analysis: The results were statistically analyzed using student's t-test. Results: The mean ΔE values of Group IA (31.62 ± 0.9), Group IIA (29.85 ± 1.2), and Group IIIA (28.65 ± 1.2) showed statistically significant higher values when compared to the mean Δ E values of Group 1A (25.02 ± 1.2), Group IIA (22.86 ± 1.1), and Group IIIA (16.56 ± 1.1). Identical results were obtained in Subgroup B. Conclusion: The addition of pineapple extract to hydrogen peroxide resulted in effective bleaching.

Context: Human dentin powder (HD), bovine serum albumin (BSA) and endotoxin (LPS) may affect the antimicrobial activity of irrigating solutions. Aim: To evaluate the inhibitory effect of HD powder, BSA, and LPS on the antibacterial activity of 0.5%, 1%, 2.5%, and 5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) gel, BioPure mixture of tetracycline, citric acid, and detergent (MTAD), and QMix. Methods: The direct contact test against Enterococcus faecalis (ATCC 29212) for 2-min, 30-min and 6-h was used. Sterile pyrogen-free water was the negative control. After experimental periods, a neutralizing agent was used. Colony-forming units were determined by 10-fold serial dilutions and culture on agar plates. Data were analyzed by Kruskal–Wallis and Dunn's test (α = 5%). Results: In the absence of inhibitors, all irrigants eliminated E. faecalis. In contact with HD, all solutions eliminated E. faecalis within 2-min, with the exception of MTAD. In the presence of BSA, only 5% NaOCl killed E. faecalis within 2-min. LPS did not affect the antibacterial effect of any irrigant. At 30-min and at 6-h, all substances eliminated E. faecalis. Conclusions: In the presence of albumin, irrigants needed >2-min to eliminate E. faecalis, except for 5% NaOCl. The same was observed in the presence of dentin when E. faecalis was exposed to MTAD.

Background: A novel technique of sterilization of endodontic files is introduced in this article. Aims: Newly introduced sterilization unit, named “SteriFast” is compared with autoclave and glass bead sterilizer using biological indicator. Materials and Methods: Spore strips of Bacillus pumilus were cultured in nutrient broth. This cultured media was used to contaminate the experimental samples of endodontic files. These contaminated files were sterilized using three different techniques. The sterilized files were transferred into nutrient medium under aseptic condition. The results were observed after 24 h, 48 h, and 7 days. Results: The results showed that autoclave and new sterilization device (SteriFast) showed complete sterilization. The files sterilized using glass bead sterilizer showed bacterial growth (80%). Conclusions: Thus, it proves that autoclave and SteriFast are ideal techniques of sterilization of endodontic files. Glass bead sterilizer does not completely sterilize the files. The article also compares SteriFast and autoclave in other aspects such as its design, basic principle, advantages, and disadvantages. The article also describes features and design of SteriFast, used for all kind of small dental instruments.

Introduction: To evaluate the prevalence of C-shaped root canals in mandibular molars using cone beam computed tomography (CBCT) in a subpopulation of Central India. Materials and Methods: CBCT scans of patients from diagnostic imaging center were selected in accordance with the criteria given by Fan et al. (2004) for C-shaped canals. A total of 238 CBCT scans fulfilled the inclusion criteria and thereby divided into two groups: Group 1: Images showing C-shaped canal configuration in mandibular second molars. Group 2: Images showing C-shaped canal configuration in mandibular third molars. The frequency and distribution of canals and their configuration along with the position of lingual/buccal grooves in the images were evaluated, and the data was analyzed. Results: CBCT evaluation showed that 9.7% of second molars and 8% of third molars had C-shaped canals. A prominent buccal groove was seen in these teeth. The data showed a significant difference (P = 0.038) for the presence of such anatomy on the right side for mandibular third molars. Conclusion: The study showed a significant prevalence of C-shaped canal configuration in the subpopulation studied.

Introduction: To evaluate the incidence of microcrack formation canal preparation with two rotary nickel–titanium systems Mtwo and ProTaper Next along with the self-adjusting file system. Materials and Methods: One hundred and twenty mandibular premolar teeth were selected. Standardized access cavities were prepared and the canals were manually prepared up to size 20 after coronal preflaring. The teeth were divided into three experimental groups and one control group (n = 30). Group 1: The canals were prepared using Mtwo rotary files. Group 2: The canals were prepared with ProTaper Next files. Group 3: The canals were prepared with self-adjusting files. Group 4: The canals were unprepared and used as a control. The roots were sectioned horizontally 3, 6, and 9 mm from the apex and examined under a scanning electron microscope to check for the presence of microcracks. The Pearson's Chi-square test was applied. Results: The highest incidence of microcracks were associated with the ProTaper Next group, 80% (P = 0.00), followed by the Mtwo group, 70% (P = 0.000), and the least number of microcracks was noted in the self-adjusting file group, 10% (P = 0.068). No significant difference was found between the ProTaper Next and Mtwo groups (P = 0.368) while a significant difference was observed between the ProTaper Next and self-adjusting file groups (P = 0.000) as well as the Mtwo and self-adjusting file groups (P = 0.000). Conclusion: All nickel–titanium rotary instrument systems were associated with microcracks. However, the self-adjusting file system had significantly fewer microcracks when compared with the Mtwo and ProTaper Next.

Aim: Comparative evaluation of the fracture resistance of maxillary premolar teeth restored with two high-viscosity bulk-fill composites and incrementally placed composite. Materials and Methods: Seventy-five freshly extracted maxillary premolar teeth were selected. Fifteen specimens served as positive control (Group 1). Mesio-occluso-distal cavity preparation was prepared on the rest of the specimens. These specimens were further divided into four groups: unrestored teeth (Group 2), teeth restored with incrementally placed nanocomposite (Group 3), teeth restored with high-viscosity bulk-fill giomer (Group 4), and teeth restored with high-viscosity bulk-fill nanocomposite (Group 5). The specimens were then subjected to compressive axial load using Instron universal testing machine. Data were analyzed using data were analyzed using Statistical package for social sciences software (SPSS v 20.0, IBM Corp.). Results: The positive control group exhibited highest fracture resistance (1104.70 ± 122.2 N). There was no statistically significant difference seen in between the incrementally placed nanocomposite and high-viscosity nanocomposite (P > 0.05). The fracture resistance values displayed by the high-viscosity bulk-fill giomer were found to be statistically lower than the other two groups. Conclusion: High-viscosity bulk-fill nanocomposite may substitute incrementally placed nanocomposite with respect to fracture resistance.

Excessive tooth structure loss is a common iatrogenic error encountered during endodontic practice. Conservative treatment planning is essential to maintain the structural integrity in such teeth. This case report elucidates a novel approach in sculpting Biodentine as a dentin substitute followed by internal bleaching and restoration with fiber-reinforced composite.

Knowledge and understanding the anatomical configuration of individual tooth play a significant role in success of endodontic treatment, in addition to through debridement and obturation of the canals. The canal anatomy of maxillary second premolar has been studied extensively, and the presence of a significant variety of multirooted canals is relatively rare in it. A 27-year-old female reported with a chief complaint of pain in her upper right posterior region for 10 days. On intraoral hard tissue examination, ill-defined access preparation was seen in maxillary right second premolar with exposed pulp. An intraoral periapical radiograph reveals radiolucency involving the pulp space and varied morphology in the same tooth. The occurrence of three roots with four canals in the maxillary second premolar is rare and not documented in the literature so far. This case report describes the nonsurgical endodontic management of such varied anatomical configuration using cone beam computed tomography as an evaluating diagnostic tool.

Periapical lesions are the most common pathological conditions involving teeth which often require surgical intervention. To achieve optimal healing both clinically and radiographically, bone grafts and barrier membranes have been used to fill the periapical defect after degranulation of the lesion. Colostrum is one of the new materials, which has osteoinductive or regenerative potential. The present case reports describe the use of bovine colostrum in the treatment of periapical inflammatory lesion with a follow-up period of 12 months. These case reports suggest that colostrum can be used to fill the periapical defect after degranulation, which has a favorable outcome.