Background: Endodontic flare-up can occur in teeth undergoing root canal treatment. Intracanal medicaments are most commonly used in between appointments to eliminate microbial flora in the canal. However, extrusion of medicaments in the periapical region can cause an inflammatory reaction leading to postoperative pain. Aim: The aim of this study was to evaluate the prevalence of endodontic flare-up following intracanal medicament placement in permanent teeth undergoing endodontic treatment. Study Design: A comprehensive search was done in MEDLINE through PubMed, Cochrane, EBSCOhost, and Google Scholar from July 31, 1999 to July 31, 2019 to identify randomized trials involving the use of intracanal medicaments in teeth undergoing root canal treatment. Methods: The titles and abstracts of all retrieved articles were screened by two independent reviewers, and irrelevant studies were excluded. Full texts of the eligible studies were obtained and thoroughly assessed. Seventeen randomized control trials comprising 2665 subjects were included. Statistical Analysis: Narrative synthesis was provided for the findings obtained from the studies, mainly focusing on the intervention details. Heterogeneity of the previously mentioned characteristics was assessed using the Chi-square test and I² statistics. Results: Placement of intracanal medicament was not associated with the occurrence of pain. Conclusion: The present review suggests that intracanal medicament do not cause endodontic flare-up rather reduces inter-appointment pain during endodontic treatment.

Analgesic medications in dentistry are indicated for the relief of acute pain, postoperative pain, chronic pain as well as controlling adjunctive intraoperative pain. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has shown an effective reduction of postendodontic pain by action on the cyclooxygenase pathway. Another medication which is used recently is corticosteroid which enables the reduction of pain. They are hormones secreted from the adrenal gland and have strong anti-inflammatory actions. This review aims to compare the analgesic efficacy of NSAIDs and corticosteroids when administered through oral route for reducing postendodontic pain. The secondary objective was to assess the anesthetic effect of the nerve block when an oral premedication of NSAIDs or corticosteroids was administered. The databases of PubMed, ScienceDirect, LILACS, and Cochrane were searched for related topics from 1983 to April 2020. Bibliographies of clinical studies were identified in the electronic search. Clinical studies with postendodontic pain reduction using NSAIDs and corticosteroids were selected. Clinical studies that met all inclusion criteria were reviewed. Data extraction was performed independently by two reviewers. All individuals who administered single dose analgesic (NSAID or corticosteroid) before initiating root canal treatment were taken into inclusion criteria. All the relevant data were extracted from the selected studies were reviewed by two independent reviewers using a standardized data collection form, and in case of disagreement, a third reviewer was enquired to achieve a consensus. Risk of bias of the selected studies was done using Cochrane Risk of Bias Tool (version 1). Mean pain score levels at various time intervals showed an increased analgesic success rate for corticosteroids (32-1) in comparison to NSAIDs (32-21.4). Anesthetic effect of the nerve block administered was seen to be better when an oral premedication of corticosteroids (38.2%–80.8%) was given in comparison to NSAID (25.5%–73.1%). From the present study, it can be concluded that oral administration of corticosteroids provides a better analgesic efficacy when compared to NSAIDs as an oral premedication for postoperative pain reduction. It can also be concluded that corticosteroids when used as an oral premedication provide a better anesthetic effect of the nerve block administered when compared to NSAIDs given as an oral premedication. These findings could help the clinician determine which pretreatment analgesic would have a better effect in reduction of pain posttreatment as well as increasing the anesthetic efficacy of administered block. Systematic Review Registration Number: CRD42021235394.

Background: Carnosic acid is an herbal derivative with potent antioxidant, anti-inflammatory, antimicrobial, and anticancer properties. Aim: Comparative evaluation of the antimicrobial potential of carnosic acid, calcium hydroxide, and triple antibiotic paste as intracanal medicaments against Enterococcus faecalis. Settings and Design: Department of Conservative Dentistry and Microbiology, an in vitro study. Materials and Methods: Fifty-two extracted single-rooted human teeth were decoronated and chemomechanical preparation was performed. The specimens were secured in the center of screw-capped vials and autoclaved. A strain of E. faecalis was inoculated into the canals and grown for 72 h. The teeth were divided into: Group I-Ca(OH)₂, Group II- triple antibiotic paste (TAP), Group III-Carnosic acid, and Group IV-Negative control. The medicaments were applied in the canal and left for 14 days. The specimens were sectioned transversely at three levels to create dentinal discs and observed under the confocal laser scanning microscopic (CLSM). Images were analyzed, and quantification of bacteria was done using the Image J software. Statistical Analysis: Mean percentage of live/dead bacteria was analyzed using One-way ANOVA and Post hoc Tukey test. Results: Mean percentages of live and dead bacteria were seen under CLSM in Group I, Group II, and Group III were (4.44 ± 2.87, 4.56 ± 2.93, 1.61 ± 1.90), and (4.59 ± 3.04, 4.25 ± 2.98, 1.70 ± 1.99), respectively, with least mean percentages for live and dead bacteria in carnosic acid (Group III). Conclusion: Carnosic acid showed better antimicrobial efficacy against E. faecalis than TAP and Ca(OH)₂ by showing a low percentage of both live and dead bacteria.

Aim: The aim of the study is to evaluate and compare the in-vitro remineralization efficacy of remineralizing agents, i.e., fluoride-free toothpaste, fluoride toothpaste, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), CPP-amorphous calcium fluoride phosphate (CPP ACFP), and silver diamine fluoride (SDF) paste on dentine over time. Methodology: Seventy-five extracted human permanent molars were selected. The buccal section of these samples was shaped into a slab. Artificial caries was induced by dipping the samples into the demineralizing solution (pH 4.5) for 21 days. They were then divided into five groups (n = 15). Each experimental group underwent one of the following treatments: Group 1 – Fluoride-free toothpaste (negative control), Group 2 – Fluoride toothpaste (positive control), Group 3 – CPP-ACP, Group 4 – CPP-Amorphous Calcium fluoride Phosphate and Group 5 – SDF. Postremineralizing treatment, Scanning electron microscope, Energy dispersive X-ray and Quantitative light induced fluorescence imaging were carried out to analyze the remineralizing efficacy. The data obtained was then subjected to statistical analysis using ANOVA and Paired t-tests. Results: It was seen that SDF showed highest remineralization efficacy followed by CPP-amorphous calcium fluoride phosphate, CPP-ACP, fluoride toothpaste and fluoride-free toothpaste. The difference in mean value among the groups was statistically significant (P < 0.001). Conclusion: SDF showed the highest remineralizing potential in scanning electron microscopy and energy dispersive X-ray, followed by CPP-ACFP, CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste. Quantitative light fluorescence analysis showed more fluorescence changes in the CPP-ACFP followed by CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste.

Aim: The aim of the study is to compare and evaluate the remaining dentin thickness following biomechanical preparation of teeth using different rotary file systems. Materials and Methodology: Sixty noncarious mandibular premolar teeth were collected and decoronated at the level of cementoenamel junction with a diamond disc. All specimens were randomly divided into 5 experimental groups – ProTaper Next (Dentsply Mallifer), Mtwo (VDW, Antaeus, Munich, Germany), RaCe (FKG, La Chaux-de-Fonds, Switzerland), Hyflex electro-discharge machining (EDM) (Coltene-Whaledent, Allstetten, Switzerland), NeoNiTi (Neolix, France) and 1 control group of 10 teeth each. After mounting the samples on a modeling wax sheet, preoperative cone-beam computed tomography (CBCT) scans were taken. Biomechanical preparation of canals was done following the assigned protocol of manufacturers. Postoperative CBCT scans were taken and comparison was carried out with preoperative scans. Statistical Analysis Used: Difference among the groups was analyzed by post hoc Turkey and analysis of variance tests. A P < 0.05 was considered statistically significant for all tests. Results: A comparison of preinstrumentation and postinstrumentation CBCT images revealed ProTaper Next group to remove more dentin at 7 mm as opposed to other groups in mesiodistal direction. However, no statistical difference was evident between ProTaper Next, MTwo, Race, Hyflex EDM, NeoNiTi file systems at 3 mm, 5 mm, and 7 mm in buccolingual direction. A statistically nonsignificant difference was evident between MTwo, Race, Hyflex EDM, NeoNiTi file systems at 3 mm, 5 mm, and 7 mm in both mesiodistal and buccolingual direction. Conclusion: Race file system performed better and removed lesser dentin in both buccolingual and mesiodistal directions. More dentin was removed at the coronal in mesiodistal direction with the use of ProTaper Next, and significant difference was seen between Protaper Next group and other groups in the study.

Context: Enterococcus faecalis is the microorganism most frequently associated with failure of endodontic treatment. Chitosan is an irrigant in dentistry has the properties of biocompatibility, biodegradability, bioadhesion, and not toxic to human cells. Several studies have suggested the use of ultrasonics to enhancing the action of irrigants. Aims: The aim of the study was to investigate the bacterial growth and surface roughness of the root canal surface after irrigation and agitation with passive ultrasonic irrigant. Subjects and Methods: Experimental research with randomized block design obtained a sample size for each group of 9 samples with a total number of 27 teeth divided into three treatment groups. Statistical analysis used was one-way analysis of variance. Results: The irrigation material for nano-chitosan high molecular 0.2% with passive ultrasonic irrigation (PUI) activation was shown to cause lysis on surface of bacterial cell walls. There was no significant difference between the roughness values in all treatment groups. Conclusions: The irrigation of root canal treatment with 0.2% high molecular nano-chitosan with the addition of PUI activation had significant antibacterial activities against E. faecalis.

Background: Tooth whitening procedures such as bleaching and microabrasion alters the enamel surface and thus reduce the composites' bond strength. Hence, various surface treatments were introduced to overcome this problem. Aim: To assess the effect of nonthermal atmospheric plasma (NTAP), grape seed extract (GSE) and bromelain on the shear bond strength (SBS) of the composite after bleaching and microabrasion. Materials and Methods: Eighty extracted maxillary anterior teeth were distributed into two groups. Group 1: bleaching and Group 2: Microabrasion and further subdivided into four subgroups (n = 10) based on the form of surface treatment employed. Group A: no surface treatment, Group B: bromelain, Group C: GSE, Group D: NTAP. Composite resin was bonded to the labial surface and placed in artificial saliva for 24 h. SBS testing was done for all the samples. Statistical Analysis: Analysis was performed using two-way analysis of variance and post hoc Tukey's test with P < 0.05 considered statistically significant. Results: Group 1D revealed the highest bond strength (35.4 Mpa) and Group 1A showed the least bond strength values (15.7 Mpa). Among the bleaching groups, significant difference was observed between all the subgroups except Group 1A and 1B (P = 0.972). In microabrasion group, significant difference was observed between Group 2A and 2D (P = 0.0001), Group 2B and 2D (P = 0.0010), and Group 2C and 2D (P = 0.0001). Conclusions: Following bleaching, NTAP application and GSE significantly improved the SBS of composite resin. Application of NTAP to microabraded surfaces increased the bond strength of composite resin.

Aims: This study aimed to evaluate the effect of preheated nanoceramic resin-based composite (RBC) (Ceram-X-Mono) placed in Class I occlusal cavities over a period of 18 months. Settings and Design: This study involves split-mouth design, randomized controlled clinical trial (RCT) Materials and Methods: One operator restored 60 Class I occlusal cavities in 24 patients. Preheating of nanoceramic RBC to 60°C for 10 min was performed before insertion of the material into 30 prepared cavities, whereas 30 restorations in the nonpreheated group were placed according to the manufacturer's instructions. Two observers evaluated the restorations using Federation Dentaire Internationale (FDI) criteria at baseline, 6, 12, and 18 months. Statistical Analysis: Kappa index, Friedman and Wilcoxon matched pair test, and Krushal-Wallis and Mann-Whitney tests were used for statistical analysis. Results: 100% retention rates were seen in both the groups. In nonpreheated group, significant difference was observed for surface staining (P = 0.0001), color stability (P = 0.0277), anatomic form (P = 0.0431), and marginal adaptation (P = 0.0051), whereas in preheated group, significant increase in surface staining (P = 0.0051) was recorded. There was a statistically significant difference observed between the preheated and nonpreheated groups at different time periods for the tested clinical parameters. Conclusion: Within the limitations of this RCT of 18 months, preheated nanoceramic RBC restorations showed better clinical performance compared to nonpreheated group.

Background: Calcium silicate-based cements or bioceramics have revolutionized and simplified pulp-capping procedures due to its versatility and accessibility. Aim: This study aimed to assess the shear bond strength (SBS) of a bioceramic material to composite resin at two aging periods and with three universal adhesives. Materials and Methods: Forty-eight samples of Biodentine with a height of 2 mm and internal diameter of 4 mm were prepared. After 12 min of mixing, 24 samples were randomly selected and divided into four subgroups: Group I: Single Bond Universal, Group II: Palfique Universal Bond, Group III: G-Premio BOND, and Group IV: Control. Composite resin was restored over Biodentine after the application of universal adhesives using a cylindrical plastic mold of 2 mm height and 2 mm internal diameter. This process was repeated 24 h after mixing on the remaining 24 samples of Biodentine. The universal testing machine was used to measure the SBS of the fractured specimens, followed by stereomicroscopic evaluation. One-way ANOVA test and Bonferroni post hoc test were used to statistically analyze the data. Results: Highest SBS values were observed in Group III at 12 min and 24 h of the setting of Biodentine. Conclusions: Compared to the 12-min group, SBS was higher at 24 h. Group III exhibited higher bond strength than other subgroups.

Background: The aim of this in vitro study was to determine the accuracy in measuring the working length (WL) using Dentaport ZX, Rootor, and a newly introduced budget friendly electronic apex locator (EAL), E-Pex Pro in two commonly simulated clinical conditions (in the presence of irrigant and blood). Materials and Methodology: Eighty-eight single-rooted premolars were randomly assigned to two groups according to simulated clinical conditions: Group 1: Presence of irrigant (5% NaOCl) and Group 2: Presence of blood. WL was determined with all three EAL and was then compared with actual length (AL) of the tooth, which was measured using Vision Inspection System. The difference between the length measured by EAL and AL was tabulated and statistically analyzed using one-way analysis of variance (ANOVA) with post hoc Dunnett's test. All testing was done using two-sided tests at alpha 0.05 (95% confidence level). Thus, the criteria for rejecting the null hypothesis were “P < 0.05.” Results: Measurement using Dentaport ZX, Rootor, and E-Pex Pro had an accuracy of 99.79%, 99.69%, and 99.64%, respectively, in Group 1 and 99.95%, 99.7%, and 99.74%, respectively, in Group 2. ANOVA revealed that the mean error value is least for Dentaport ZX followed by Rootor and then E-Pex pro EAL. Conclusion: Dentaport ZX gave better results both in the presence of NaOCl and blood followed by Rootor and E-Pex Pro EALs.

Context: Considering the effectiveness and safety concerns of synthetic intracanal medicaments (ICM), alternative usage of herbal ingredients in the root canal treatment may prove to be beneficial. Hence, the naturally available potent proteolytic, anti-inflammatory, and antimicrobial pineapple extract Bromelain as an ICMs needs to be studied. Aim: The aim of this study is to evaluate and compare the antimicrobial efficacy of calcium hydroxide (CaOH) and triple antibiotic paste (TAP) with Bromelain against Enterococcus faecalis bacteria using the turbidity method. Materials and Methods: Forty-four freshly extracted single-rooted teeth were collected and 6 mm sections were prepared. These samples were infected with E. faecalis bacteria (ATCC 29212), randomly divided into four groups. Negative control, CaOH paste, TAP, and Bromelain paste. After the removal of medicament, the optical density (OD) of the dentinal shavings was measured using a spectrophotometer. Statistical Analysis: The Chi-square and Kruskal − Wallis ANOVA test were used. The confidence interval was set to 95% at 5% significance level. Results: TAP showed less OD than CaOH₂ paste which is statistically significant. (P = 0.0022). The OD reading of Bromelain paste was less than CaOH₂ with P = 0.007. The OD of Bromelain and TAP were statistically insignificant (P = 0.095), indicating their comparable antibacterial efficacy. Conclusions: The antimicrobial efficiency of Bromelain was found to be more effective than Ca (OH) ₂ paste and comparable to TAP against E. faecalis.

Background: Pulp capping should always be considered as the primary treatment of choice for teeth without irreversible pulpitis in lesions approaching dental pulp. The predictability of vital pulp therapy has improved with the introduction of newer bioceramic materials. Aim: The aim of this study was to evaluate the clinical success of Biodentine, calcium hydroxide (CH), and mineral trioxide aggregate (MTA) as pulp capping materials for indirect pulp capping in carious permanent teeth. Materials and Methods: Indirect pulp capping was done for 36 molars of 36 patients with deep caries lesions. They were randomly divided into three groups: Biodentine group (12 teeth), MTA group (12 teeth), and CH group (12 teeth). Patients were recalled at 1, 3, and 6 months to evaluate the clinical success of the treatment outcome. Statistical Analysis: All statistical analysis was performed using SPSS software version 21.0. Pearson's Chi-square test was used to compare the success and failure rates between Biodentine, MTA, and Ca(OH)₂ at three different time intervals (30, 90, and 180 days) and also the overall success and failure rates between Biodentine, MTA, and Ca(OH)₂ irrespective of the time intervals. P < 0.05 was considered statistically significant. Results: In a statistical trial/study, the pulp capping materials gave different success rates, 91.67% success in the Biodentine group, 83.33% success in the MTA group, and 58.33% success in the CH group. The results were not statistically significant. Conclusion: Indirect pulp capping with calcium silicate materials provided better results compared to that of calcium hydroxide.

Background: Whey protein supplements might be a potential risk factor for the restoration surface due to its pH and lactose content. Aim: The study aimed to evaluate the effect of whey protein beverages on the microhardness of four restorative composites with different microstructures (Filtek Z 350XT, Filtek Z 250XT, Filtek Bulk Fill (FBF), and Filtek P 60). Materials and Methodology: Forty disc-shaped samples from each material (in total 160) were prepared and wet polished. The samples of each group were randomly divided into four subgroups and subjected to four immersion media namely, whey protein Concentrate (WPC), whey protein Isolate (WPI), whey protein water (WPW), and distilled water (DW). The immersion protocol was performed twice for 10 min daily for 30 days followed by immersion in artificial saliva for another 10 min and stored in DW till the next cycle. The pre immersion and post immersion microhardness of all the samples were recorded with a Microhardness Tester FM-800. Data obtained were statistically analyzed using SPSS 25 software. Results and Conclusions: All composites exhibited decline in microhardness, except for FBF. P 60 composites which showed the highest decline in microhardness. WPC and WPI caused the greatest reduction in microhardness compared to WPW.

Background: Due to the large number of publications relating the occurrence of dental microcracks to endodontic procedures, this bibliometric study evaluated the scientific pattern and trends in literature and provided an overview of scientific production in this context. Aim: To analyze, quantify, and characterize the scientific production and trends of published articles evaluating dentinal microcracks formation after endodontic treatment procedures between 2010 and 2020 using bibliometric indicators. Materials and Methods: Published articles were found by the search in the Medline (PubMed) and Scopus database using the combination of the following keywords: Dentinal crack OR Dentinal Microcrack OR Crack formation OR Dentin Defect AND Endodontic treatment OR Root canal preparation OR Canal Preparation OR Root canal treatment OR endodontic procedures. The search was also conducted in the Journal of Endodontics and International Endodontic Journal. After inclusion and exclusion criteria application, data from all studies included were collected. Results: Among the 556 results after the search, 45 studies were included and analyzed in this bibliometry. No trend was observed in terms of the increasing number of articles over time. Most of them used an in vitro design, compared the effect of different endodontic techniques/systems for root canal instrumentation on dentinal microcracks formation, and were conducted in Turkey, Brazil, and India. Journal of Endodontics and International Endodontic Journal were the main journals with a higher number of articles published. Interestingly, studies conducted with some funding did not lead to higher citation numbers. Moreover, a relevant proportion of studies did not consider the inclusion of control groups, baseline evaluation, or statistical analysis. Micro-CT was the main technique used to evaluate microcrack presence. Conclusion: Microcrack formation after the use of different endodontic techniques/systems has been constantly evaluated in the literature. There is a pattern of methodologies used, which may explain the concentration of these studies in specific journals and countries.

Introduction: Bulk-fill composite restorations displayed substantial annual failure related to imperfect marginal adaptation. Although preheated composites improved, marginal adaptation demonstrated early loss of plasticity. A new technique of ultrasonics plasticization was used for fabricating restorations. Aim: The aim of this study was to assess the clinical behavior of bulk-fill composite resin restorations plasticized by preheating and ultrasonics. Methodology: Randomized split-mouth double-blinded clinical trial was designed. Bulk-fill composite resin (Tetric N-Ceram Bulk Fill Ivoclar Vivadent products, Delhi) was used to fill 56 cavities. In 28 restorations, composite resin was plasticized by preheating in composite warmer (Delta Co., India) and remaining were plasticized with modified ultrasonic–retreatment tip-RT No 2 (Cricdental, India). Clinical follow-up assessments were done at 6 and 12 months using Ryge's criteria. Mann–Whitney U-test was used for statistical analysis with P < 0.05 and effect size of 0.61. Results: Hundred percent clinical success with ultrasonic plasticized group and 95.2% success with preheated composite resin group were observed without statistical significance. Conclusion: The ultrasonics plasticization of composite resin demonstrated comparable results with that of preheated composite resin after 6- and 12-month recall. Use of vibration energy utilizing the thixotropic effect might have resulted in better clinical performance.

Background: With the increasing prevalence of erosive tooth wear affecting both adults and children; designing optimum protocols of management in a noninvasive manner is gaining precedence. Aim: Comparative evaluation of topically applied calcium phosphate-based agents casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and beta tricalcium phosphate (β-TCP) on the surface of eroded dentin. Materials and Methods: Dentin blocks from human third molars in four groups were subjected to the surface treatment: (G1) sound dentin (G2) demineralized dentin (G3) CPP-ACP (G4) β-TCP. All the samples except control (G1) were immersed in an acidic solution incubated at 37°C for 96 h. The samples in G3 and G4 were topically treated with CPP-ACP and β-TCP for 4 min twice daily for 14 days; followed by pH-cycling for 21 days. Surface hardness testing and surface morphology were observed using the scanning electron microscopy. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software with Kruskal-Wallis test and post hoc test. Results: Dentin treated with both CPP-ACP (37.25) and β-TCP (32.05) recorded significantly higher VHN than demineralized (G2-23.51) but lower compared to sound control (G1-57.06). Conclusion: The topical application of CPP-ACP and β-TCP agents shows definite potential in promoting the hardening of demineralized dentin surface.

A 21-year-old male patient reported with chief complaint of pain in the upper front teeth. Clinical examination revealed tooth fracture in teeth # 11, 21, and prior attempted endodontic treatment. The radiographic examination revealed periapical radiolucency in relation to upper central incisors with thinning of dentinal walls. The upper left central incisor had grossly diminished root canal dentin walls with immature apex, whereas the upper right central incisor had moderate loss of dentin from the root canal wall with an open apex. Hence, it was decided to extract the upper left central incisor, whereas apexification and root canal dentin wall reinforcement with Biodentine were carried out for the upper right central incisor. The patient was asymptomatic at 1-, 4-, and 6-month follow-up visits.

Maxillary premolar with an oval-shaped canal always poses a challenge while reconstruction using the post and core system. Fiber-post has many advantages over metallic-post and so fiber-post is becoming more popular and particularly widely used than metallic-post nowadays. Fiber-post has benefits of esthetic and strength, and its combination with flexible material, Ribbond has provided it with a high rise in the field of dentistry. The purpose of this case report was to show an innovative technique to place both glass fiber-post and Ribbond as a single assembly into the canal which gives a monoblock effect. This technique is feasible and may eradicate some of the problems associated with the cementation of ill-fitted fiber-post in an oval-shaped canal with widened canal space.

Retreatment of endodontically involved teeth may require the removal of obstruction from root canal space. Instrument fracture is an undesirable and stressful incident which can negatively affect the prognosis of the tooth. Any corrective step taken should be performed with utmost care to prevent extrusion of the fragment into periapex. This case report describes a rare occurrence of movement of a fractured instrument during inter-appointment period. A previously treated left mandibular first molar with a fractured instrument was taken up for retreatment. During the course of treatment, the fractured fragment which was previously located in the apical third of the distal canal was dislodged into the periapical region. However, it was found that fragment moved back inside the canal after the inter-appointment period. The same sequence of events repeated before the instrument could be retrieved. Hydrostatic and vascular pressure build due to periapical inflammation could be cited reasons for such a movement.