Background: The main aim of restorative dentistry is to restore and preserve dental health with the use of appropriate restorative modalities to protect the pulp and restore its function. This study compared the effect of different surface treatments of mineral trioxide aggregate (MTA) on the bond strength of composite resin to MTA. Materials and Methods: Forty cylindrical acrylic blocks with a hole were prepared and filled by ProRoot MTA. The samples were assigned to four groups: Group 1 – no surface treatment; Group 2 – phosphoric acid etching; Group 3 – sandblasting; and Group 4 – hydrofluoric acid (HF) etching, rinsing, and silane application. OptiBond Solo Plus adhesive was utilized in all the groups. Then, composite resin cylinders were bonded to sample surfaces. The samples were thermocycled and tested for microshear bond strength using a universal testing machine at a crosshead speed of 1 mm/min. Data were analyzed with Kruskal–Wallis and Mann–Whitney tests. Scanning electron microscopy images were prepared for each study group after surface treatments. Results: Means and standard deviations of bond strength values in study groups 1–4 were 14.83 ± 7.76, 21.85 ±7.99, 6.48 ± 3.89, and 26.01 ± 11.09 Mpa, respectively. Conclusions: Within the limitations of this study, phosphoric acid etching or HF etching plus silanization was preferred to surface treatment of MTA before composite resin bonding.

Introduction: The aim of this study is to compare the effectiveness of reciprocating and continuous rotary nickel-titanium instruments during retreatment performed through two different access outlines. Methodology: A total of 48 freshly extracted mandibular first and second premolars with single root and canal were selected. Initial root canal treatment was completed through a contracted endodontic cavity (CEC) design. Canals were instrumented with F2 ProTaper instrument, obturated with warm lateral condensation of gutta-percha with AH Plus sealer, and allowed to set for 30 days at 37°C and 100% humidity. For retreatment, specimens were divided into two groups (n = 24) on the basis of access outline, CEC or traditional endodontic cavity. Retreatment was initiated using ProTaper Retreatment instruments (D1–D3). Specimens were further divided (n = 12) and reinstrumented up to Neoniti 25/0.08 or WaveOne 25/0.08. Irrigation was performed using 3% sodium hypochlorite and 17% ethylene diamine tetraacetic acid. Retreatment time was recorded. Teeth were sectioned and photographed, and the percentage of remaining obturation material was measured. Results: Data were collected, and statistical analysis was performed using one-way analysis of variance and Tukey honestly significant difference multiple post hoc procedures (P < 0.05). Conclusion: None of the systems completely removed the root filling material from root canals. However, ProTaper/Neoniti instruments removed more GP when compared to Protaper/WaveOne instruments with both the access outlines. Both the instruments with traditional access outline required less time for removal of obturating material when compared to CEC.

Context: Medicinal plants have reportedly fewer side effects, compared to antifungal agents. Aims: This study was designed to compare the anti-Candida activity of two medicinal plants with two routine antifungal agents, used in the clinics, on Candida species isolated from the oral cavity of the liver transplant patients. Subjects and Methods: Anti-Candida activities of ethanol extracts of Lawsonia inermis leaf and Ziziphus spina christi unripe and ripe fruit (collected from south of Iran) versus nystatin and fluconazole were evaluated using CLSI M27-A3 standard method. Results: The minimum inhibitory concentration (MIC) 90 values for L. inermis, Ziziphus spina christi ripe, and unripe fruits in Candida albicans were 0.1 μg/mL, 25 μg/mL, and 0.1 μg/mL, and in Candida glabrata were 0.05 μg/mL, 25 μg/mL, and 0.05 μg/mL, respectively. The MIC90 value for nystatin in both species was 0.035 μg/mL, but MIC90 value for fluconazole in C. albicans was 0.5 μg/mL and in C. glabrata was 2 μg/mL. Conclusion: Unripe fruits of Ziziphus spina christi and L. inermis were found more effective than fluconazole on Candida species. Ziziphus spina christi unripe fruit and L. inermis leaf have potential anti-Candida activity and can be considered as a new mouthwash agent to prevent and treat Candida infections. Further studies regarding pharmacokinetics and toxicities of these extracts are needed for their use in humans.

Aim: The aim of this study is to evaluate the marginal sealing ability of self-adhesive flowable composite resin when used as a liner in Class II composite restoration with and without aging. Materials and Methods: A total of 120 standardized Class II tooth preparations with gingival margins 1 mm coronal and apical to cementenamel junction (CEJ) were prepared on 60 extracted permanent mandibular molars and were randomly divided into eight equal Groups: Group 1: cavities coronal to CEJ and restored with Dyad flow liner + Herculite ultra, Group 2: same as Group 1 but cavities margins apical to CEJ, Group 5: cavities coronal to CEJ and restored with only Herculite ultra, and Group 6: same as Group 5 but cavities apical to CEJ. Groups 3,4,7,8 were similar to Groups 1,2,5,6, respectively, but were aged for 6 months. After thermocycling, microleakage testing was done using 0.5% basic fuchsin dye. Result: At cervical level, Group 5 exhibited statistically lower (P = 0.006) microleakage than Group 6, and Group 1 showed lesser microleakage than Group 5 (P = 0.162). Group 2 exhibited significantly less microleakage than Group 6 (P = 0.002). Increased microleakage was observed in aging Groups; however, the difference with nonaging Groups was not statistically significant (P > 0.005). Conclusion: Margins of the cavity in cementum can be better sealed by placing self-adhesive liner and is not affected by aging.

Context: It is necessary to have a proper bond between pulp-capping agent and composite materials to maintain effective coronal seal. Aims: This study aims to compare the shear bond strength of a composite resin with two different adhesive systems and a resin-modified glass ionomer (RMGI) to calcium-enriched mixture (CEM). Methods: In this study, 30 acrylic blocks (with a central hole 4 mm diameter and 2 mm height) were prepared and filled with CEM. The blocks were divided into three groups: single bond2 (SB) with Filtek Z250, single bond universal (SBU) with Filtek Z250, and RMGI. The restorative materials were placed on the CEM, and shear bond strength was measured. Data were analyzed using one-way ANOVA and games Howell tests. P < 0.05 was considered statistically significant. Result: Bond strength of both composite groups to CEM showed significantly higher values than RMGI-CEM group (both P < 0.001). The type of the adhesive system( total etch or universal) had no significant effect on the bond strength of composite to CEM (P > 0.05). All the failures in composite groups were as cohesive in CEM and in RMGI group was as adhesive. Conclusions: Shear bond strength of composite resin to CEM cement was higher than RMGI irrespective of the type of the adhesive system. The universal bonding system is recommended for bonding of composite to CEM for ease of use.

Background: Sealers play an important role in the success of root canal treatment. The efficacy of root canal sealer is enhanced by its tubular penetration and adaptation properties. Aim: The aim of this study is to evaluate the interfacial adaptation and penetration depth of Bioroot RCS and MTA Plus sealers to root dentin. Materials and Methods: A total of 60 single-rooted mandibular premolar teeth were prepared using Pro Taper rotary Ni-Ti files and were randomly divided into three groups (n = 20 each) according to the type of sealer used for obturation. After obturation with lateral condensation, half of the samples in each group (n = 10 each) were sectioned transversely for measuring tubular depth penetration under confocal laser scanning microscopy. Longitudinal sections were obtained for remaining half samples to evaluate the adaptation of sealer using scanning electron microscope. Data were analyzed using two-way ANOVA and Tukey post hoc tests. Statistical Analysis Used: Data were analyzed using two-way ANOVA and Tukey post hoc tests. Results: AH Plus sealer has shown significantly higher depth of penetration and minimum gaps than bioceramic sealers (P < 0.05) MTA Plus sealer exhibited significantly more interfacial gaps and less penetration depth than Bioroot RCS (P < 0.05). Conclusions: At all root regions, AH plus sealer exhibited minimum gaps and more tubular penetration whereas MTA Plus sealer exhibited more gaps and less penetration.

Aim: The aim of the study was to evaluate the effect of staining solutions, remineralizing agent, and antioxidant on color stability of tooth during and after bleaching. Materials and Methods: Ninety human central incisors were bleached using 35% hydrogen peroxide (Pola office) and allocated to three groups (n = 30). Group I stained with cola-based soft drinks, Group II stained with pomegranate juice, and Group III stained with turmeric. The groups were then divided into three subgroups (n = 10): subgroup A – control (artificial saliva), subgroup B – remineralizing agent (Vantej), and subgroup C - antioxidant (grape seed extract [GSE]). Specimens were bleached according to the manufacturer's recommendations. Color variation measurement was performed using a photoreflectance spectrophotometer before bleaching, during each bleaching session (2-times/week), and after (7 and 15 days) the cessation of bleaching. Artificial saliva was used as the storage medium for the specimens except when measurements were to be recorded. The results were then subjected to statistical analysis. Results: Freshly bleached teeth exposed to Vantej and GSE and significantly lowered the stain absorption. Conclusion: Among the experimental agents, Vantej performed statistically better at all time intervals.

Aim: The aim of this study was compare the capacity of different irrigation protocols for debris removal from artificial grooves and assess the effectiveness of Easy Clean used in different kinematics by means of micro-CT. Methodology: Fifty acrylic prototyped maxillary incisors were instrumented and included in a muffle. The specimens were longitudinally sectioned, and a longitudinal groove was made on the inner surface of the root canal in one of hemisections, and the dentin debris was inserted into the grooves. The specimens were divided into five groups (n = 10): G1: Conventional with open-ended needle; G2: Conventional with double side-vented needle; G3: Easy Clean in reciprocating movement; G4: Easy clean in continuous rotation (ECCR); and G5: Passive ultrasonic irrigation (PUI). All specimens were scanned using microcomputed tomography before and after the irrigation technique and calculated the volume (mm³) of dentin debris. The paired t-test and post hoc Tukey test were the statistical tests used, with significance set at 5%. Results: There were no significant difference (P > 0.05) between PUI and ECCR. ECCR was significantly (P < 0.05) more effective than the groups of conventional irrigation techniques. Conclusions: PUI and ECCR favored the removal of a larger volume of dentin debris from the groove.

Aim: The aim of this study is to evaluate and compare the coronal discoloration induced by two Triple antibiotic paste (TAP 1 and 2), when used with varying depths of 2 and 4 mm of temporary sealing materials at the end of 0, 3, and 6 weeks. Objectives: (1) To evaluate coronal discoloration induced by TAP-1 when the depth of the temporary restorative material is 2 mm below cementoenamel junction at the end of 0, 3, and 6 weeks. Materials and Methods: Forty extracted permanent maxillary central and lateral incisors or single-rooted tooth were collected and chosen for the study. They were then divided into two groups and each group was then subdivided into two subgroups. Results: Both the triple antibiotic paste showed discoloration but it reduced with increase in thickness of temporary cement. Conclusion: TAP 1 and TAP 2 both showed an increase in discoloration, greater discoloration was seen with TAP, containing minocycline. There was a steady change in the discoloration from 0 to 6^th week. In both the groups, TAP 1 and TAP 2, there was a reduction in discoloration with increase thickness of the temporary restorative material.

Aim: The aim of this scanning electron microscope study was to compare the efficacy of two techniques (EndoVac and EndoActivator) and two irrigating solutions (5.25% NaOCl in combination with 17% ethylenediaminetetraacetic acid vs. Savlon™) for removal of calcium hydroxide (CH) from the root canal walls. Settings and Design: The study was carried out in the specialty of conservative dentistry and endodontics. Materials and Methods: Forty single-canal human teeth were used. The specimens were de-coronated to obtain a standardized root length of 15 mm using a diamond disk. The canals were instrumented till F3 ProTaper and CH intracanal medicament placed in the root canal. One week later, teeth were randomly divided into one control group and six experimental groups according to different irrigation protocols with different techniques. Statistical Analysis: Kruskal–Wallis test was conducted to analyze the effect of different treatment measures with respect to three regions of tooth. Results: The results indicated that there was no statistically significant difference between the two irrigation solutions and two techniques. Conclusion: To achieve the best adaptation of filling material after root canal treatment, it is crucial to remove intracanal medication from the root canal walls. However, none of the irrigation regimens and different techniques were able to completely remove the CH from the root canal wall.

Context: Sodium hypochlorite (NaOCl) is the most widely used endodontic irrigant. Although it fulfills most of the requisites of an ideal irrigant, it has certain drawbacks, chiefly severe soft-tissue damage. Allium sativum (garlic extract) is a proven antimicrobial agent that has the ability to dissolve inorganic tissue with minimal toxicity. However, its ability to remove smear layer (SL) is not known. Conventional hand-held syringe irrigation is ineffective in removing canal debris. The use of newer irrigation systems is limited owing to their high cost. Modified evacuation system (MES) may prove to be an effective yet economical alternative. Aims: This study aims to evaluate the SL removing capacity of garlic extract as an alternative to 5% NaOCl and the use of modified evacuation system for removal of irrigant along with debris from root canals. Settings and Design: Sixty-eight single-rooted mandibular premolars were divided into 8 Groups: Two control Groups A and B (4 samples each) and six experimental Groups C to H (10 samples each). Garlic extract was prepared at a concentration of 64 mg/ml. MES was set up using 21-gauge flat-end needle fixed onto chair side high-volume evacuation system. Subjects and Methods: Control groups were irrigated with normal saline, Groups C and D with 5% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA), Groups E and F with garlic extract and 17% EDTA and Groups G and H with plain garlic extract. MES was used in Groups B, D, F, and H. Scanning electron microscope analysis was done to view SL at coronal, middle, and apical thirds. Statistical Analysis Used: Chi-square test. Results: Groups A and B showed least scores. At coronal and middle thirds, Group D shows better results, followed by Groups F and H. Apically, Group F showed better results. Groups C and H, and E and G showed similar results. All groups with MES showed better results. Conclusions: A. sativum has an SL removal capacity. MES is effective in debris removal.

Introduction: The aim of this study was to investigate the microhardness and microstructural features of newer tricalcium silicate materials: TheraCal LC, mineral trioxide aggregate (MTA), biodentine (BD), and Endosequence Root Repair Material (ERRM) putty, after exposure to acidic environments in comparison with distilled water. Materials and Methods: A total of 80 extracted single-rooted premolars were collected. All the selected specimens were sectioned vertically, and cavities were prepared on the root surface. Specimens were divided into four groups of 20 each, i.e., Group 1: (n = 15) MTA (ProRoot, Dentsply Tulsa Dental, Tulsa, OK, USA), Group 2: (n = 15) BD (Septodont, France), Group 3: (n = 15) ERRM putty (Brasseler, USA), and Group 4: (n = 15) TheraCal LC (Bisco Inc Schaumburg). Materials were placed into prepared cavities. About 10 specimens per each group were exposed to butyric acid buffered at a pH level of 5.5 for 7 days at 37c, and 10 specimens from each group were exposed to distilled water serving as a control group. The surface microhardness was measured after exposure to either acid or distilled water. Scanning electron microscope was used to observe the internal microstructure morphology. Two-way analysis of variance was applied to evaluate the Knoop microhardness value (KHN). Results: Results showed that the microhardness values of the materials were significantly higher in the neutral environment of butyric acid at pH 7.4 when compared to those in the acidic condition of pH 5.4 for all groups (P < 0.001). TheraCal LC had higher microhardness values than BD, MTA, ERRM putty at 5.5 pH levels (P < 0.001). Conclusion: The microhardness values of TheraCal LC, BD, ERRM Putty, and MTA were reduced in an acidic environment, which resulted in these materials having more porous and less crystalline microstructures. TheraCal LC seems the most suitable material for application to an area of inflammation where a low pH value may exist.

Aim: The aim of this study is to evaluate the effect of different intracanal medicaments used during endodontic treatment on periodontal attachment level in concurrent endodontic-periodontal lesions without communication. Materials and Methods: Seventy-five teeth with combined endodontic-periodontal lesions were randomly assigned to 3 groups: Test Group I (calcium hydroxide [Ca(OH)₂]), Test Group II (2% chlorhexidine + Ca(OH)₂), and control group (no intracanal medicament). Root canal treatment (RCT) was performed using standard methodology. Teeth of test groups were medicated with respective medicaments for 10 days before obturation. Scaling and root planning was done 1 month after completion of RCT in all the groups. Clinical measurements, including probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded at baseline, 1, 3, and 6 months. Radiographic parameters, including periapical index (PAI) score and alveolar bone level, were measured at baseline and 6 months. Statistical Analysis: Data were analyzed using Friedman test, Kruskal–Wallis, and Wilcoxon signed-rank test. Results: Significant improvement in PD, CAL, %BOP, and PAI score (P < 0.05) was found in all the three groups from baseline to 6 months. However, there was no significant intergroup difference. No significant difference was observed from baseline to 6 months in marginal bone level within the three groups. Conclusion: Endodontic treatment before periodontal therapy results in attachment gain. Intracanal medicaments may not affect the healing of concurrent endodontic-periodontal lesions without communication.

Introduction: This study was aimed to evaluate the efficacy of 17% ethylenediaminetetraacetate (EDTA), 7% maleic acid and 0.7% fumaric acid in smear layer removal from the root canal walls. Materials and Methods: Forty single-rooted mandibular premolars were collected and prepared till F3 rotary ProTaper file with 1 ml of 3% of sodium hypochlorite after each instrument change. Samples were randomly divided into 4 groups according to the final irrigating solution: 17% EDTA, 7% maleic acid, 0.7% fumaric acid, and 0.9% saline. The samples were prepared for scanning electron microscope analysis to observe smear layer removal at coronal, middle, and apical third level of root canal system. Results: At coronal third level, fumaric acid was equally efficient in smear layer removal when compared to maleic acid and EDTA without any significant difference between them. At the middle third, fumaric acid showed significantly better results than maleic acid followed by EDTA. At the apical third, both fumaric acid and maleic acid were equally effective without any significant difference between them but both showed significantly better results than EDTA. Conclusion: Fumaric acid can be tried as a new irrigating agent for smear layer removal in root canal system.

Objective: This study was carried out to examine the effect of the application of different disinfecting agents on the shear bond strength (SBS) of an etch-and-rinse system. Materials and Methods: A total of 120 dentin surfaces of human molars were taken. Sixty samples were taken for immediate (testing was done after 24 h) and delayed (testing was done after 6 months) each. Further, they were divided into three subgroups (n = 20) according to the disinfectant used: Group I: control (no disinfectant); Group II: chlorhexidine based; and Group III: Aloe barbadensis miller (Aloe vera) based. Dentine bonding agent was applied, and resin composite build-ups were done for SBS testing. Samples were examined under scanning electron microscope for observing the gap formation for dentin-restoration interface. SBS results were statistically analyzed. Results: The results of the study showed that both chlorhexidine and aloe vera had improved bond strength as compared to the control group both for immediate and delayed SBSs. Conclusion: Thus, aloe vera can be used as an alternative to chlorhexidine for cavity disinfection.

Aim: The study evaluated the effectiveness of three intermediate endodontic irrigating solutions in eliminating the residual sodium hypochlorite (NaOCl), thus preventing the formation of the orange-brown precipitate when 2% chlorhexidine (CHX) is used as the final irrigant. Materials and Methods: A total of 40 extracted human maxillary anterior teeth were selected, disinfected, and decoronated to obtain a standardized length of 10 mm. The teeth were prepared with Protaper universal rotary files until size F4 using 2.5% NaOCl as an irrigant during instrumentation. The teeth were then randomly divided into four groups of 10 samples each based on the irrigating solutions used during final wash sequence as follows: Group A - (2.5% NaOCl and 2% CHX), Group B - (2.5% NaOCl followed by 70% Isopropyl Alcohol and 2% CHX), Group C - (2.5% NaOCl followed by 6.25% sodium metabisulfite and 2% CHX), and Group D - (2.5% NaOCl followed by 3.86% sodium Thiosulfate and 2% CHX). The roots were sectioned longitudinally and the canal surface was evaluated under dental operating microscope (×16) for the presence of orange-brown precipitate. The results were tabulated as per scoring criteria and statistically analyzed. Statistical Analysis Used: One-way ANOVA test and post hoc Tukey's test. Results: The lowest mean score was observed in Group C, followed by Group D and Group B, respectively. In comparison, there was a statistically significant (P < 0.001) difference in results between Group C and the other experimental groups. However, there was no statistically significant difference between Group B and Group D. Conclusion: Sodium metabisulfite was found to be very effective in preventing the formation of orange-brown precipitate.

Context: Remineralizing agents have been recommended to restore the integrity of bleached enamel. Aims: The aim of this study was to evaluate the effect of fluoride at high concentration (5000 ppm) applied to bleached enamel. Materials and Methods: A total of 30 specimens obtained from newly extracted third molars were divided into two groups (n = 15) as follows: control group and fluoride group. Specimens of both groups received bleaching treatment with 35% hydrogen peroxide, were then submitted to the Vickers hardness number/colorimetric test (VHN/CT) (n = 5) and Ra (n = 10) tests, and stored in artificial saliva. After bleaching, fluoride group received the application of a fluoride-based dentifrice, during 5 min. VHN, RS, and CT analysis of both groups were performed before and after treatments. For VHN, five indentations per specimen were performed, using a microdurometer. Ra analysis was performed with a rugosimeter. The color was analyzed through the CIE L* a* b* system, respectively, using a colorimeter. Statistical Analysis: For intergroup statistical analysis, ANOVA with Tukey's posttest was used. All tests were calculated at a significance level of 5%. Results: There was statistically significant difference (P < 0.01) between the analyzed groups, on VHN, Ra, and CT evaluations. Conclusions: The use of fluoride-based dentifrice at 5000 ppm was effective in minimizing the deleterious effects on bleached enamel.

Aim: The aim of this in vitro study was to compare the efficacy of irrigation with the negative pressure and the traditional positive pressure in eradicating Enterococcus faecalis from the root canal. Materials and Methods: A total of 40 extracted mandibular premolars were sterilized and divided into four groups with 10 samples each. Then, they were prepared to apical size #35 (Group 1, 3) and 45 (Group 2, 4) and inoculated with E. faecalis for 7 days and then irrigated with 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. The positive pressure irrigation was performed in Group 1 and Group 2 while the negative pressure irrigation (NPI) using the Endovac in Group 3 and Group 4. Samples taken after the root canal irrigation procedures were cultured and the colony-forming units were counted. Data were statistically analyzed using the Fisher's exact test. Results: Results were statistically significant when comparing apical negative-pressure irrigation size 45 (Group 4) to positive-pressure irrigation size 35 (Group 1). Conclusion: The results of this in vitro study showed that the apical NPI method (Endovac) was more effective in removing E. faecalis from the root canal at the larger apical preparation size.

Background: The present ex vivo study explores the role of Indian medicaments in endodontic irrigation in an attempt to search for a safe alternative to sodium hypochlorite (NaOCL). Aim: To evaluate the efficacy of commercial preparations of Morinda citrifolia juice (MCJ) and Triphala juice against Enterococcus faecalis and Candida albicans. Materials and Methods: The study was conducted on 84 permanent extracted human teeth. After decoronation and biomechanical preparation, inoculated (with E. faecalis and C. albicans) root sections were divided randomly into four experimental (MCJ, Triphala juice, 1% NaOCl, and 2% chlorhexidine [CHX]) and two control groups (preservative control and distilled water). Colony-forming units (CFUs) obtained for each group were counted at baseline (S₀) and after irrigation at 1 and 3 days (S₁and S₂, respectively). Mean of Log CFU at S₀, S₁, and S₂was compared for each irrigant using Friedman's two-way ANOVA. Results: There was a significant decrease in microbial counts of both microbes in all groups at S₁, but only CHX could demonstrate further decrease in the microbial counts of both microorganisms at S_2. Conclusion: The overall antimicrobial effects of different irrigants were maximum for CHX, whereas MCJ and Triphala juice also showed significant reductions. The herbal irrigants hold the promise of becoming efficient irrigants and warrant further research.

Context: Molar incisor hypomineralization (MIH) is a commonly occurring esthetic setback among patients. Depending on the graveness of the lesion, esthetics of MIH can be improved by treatments such as enamel microabrasion, bleaching, composite resin bonding, and the combination of some or all of these techniques. Aim: The aim of this study is to evaluate the esthetic results of resin infiltration treatment on incisors with Grade I molar incisor MIH. Materials and Methods: A total of 22incisor lesions with MIH were infiltrated with resin. Photographs were captured before infiltration, just after infiltration, and 6 months after infiltration. The photographic evaluation was done by the CIE L*a*b* scoring method. The means of each parameter such as ΔL and ΔE were calculated. Statistical Analysis: ANOVA in conjunction with Turkey's post hoc test was used to evaluate the means. Results: The total color change observed was equal just after treatment and 6 months after treatment, with no statistically significant difference (P = 0.87) between these two time points. The mean of difference in total color change (ΔE₃) of white tooth discoloration was 13.2 SD 6.8, showing an overall color change. Conclusion: Infiltration can conceal the white opaque appearance of Grade I MIH lesions, and also reduction in lesion whiteness is seen with time.

The use of digital tools offers a new perspective to daily clinical activities. The digital information serves as a starting point for a wax-up and intraoral mock-up, which is widely reported in literature as an objective and efficient communication tool among dentist, patient, and technician. This case report of a maxillary anterior rehabilitation demonstrates esthetic planning with the digital smile design (DSD) system and a direct mock-up technique. After preoperative photographs were obtained, digital planning was created using DSD. However, due to differences in virtual simulation, a direct mock-up with composite resin was performed. Porcelain laminate veneers using feldspathic ceramics were used to restore the anterior teeth. Many times, the DSD simulation is not enough for the patient to understand and observe the changes that will be performed on the anterior teeth. This combination of techniques can offer predictability to results as well increasing the patient expectation satisfaction.