Introduction: Effective management of endodontic pain represents a continuing challenge. Many of the dental professionals are facing significant problems associated with postendodontic pain. Hence, the postendodontic pain has to be prevented at its primary stage without waiting for its occurrence. This trial was carried out to evaluate the use of a preoperative, single oral dose of diclofenac sodium for the prevention and control of postendodontic pain. Materials and Methods: Fifty patients were randomly assigned to two groups, placebo and diclofenac sodium (100 mg). The medications were administered 30 min before the start of standard endodontic treatment. Postoperative pain was assessed after 6, 12, and 24 h by using a visual analog scale. Results: Postendodontic pain showed a statistically significant difference between both groups at 6 and 12 h (P < 0.05) and there was no significant difference at 24 h. Conclusion: Postendodontic pain was substantially reduced by preoperative administration of single oral dose of diclofenac sodium. It is thus possible to conclude that these favorable results might help to prevent postendodontic pain, especially in patients with a low pain threshold.

Aim: This study aimed to systematically review the literature for the effect of digluconate chlorhexidine (CHX) on bond strength between dental adhesive systems and dentin of composite restorations. Materials and Methods: The electronic databases that were searched to identify manuscripts for inclusion were Medline via PubMed and Google search engine. The search strategies were computer search of the database and review of reference lists of the related articles. Search words/terms were as follows: (digluconate chlorhexidine*) AND (dentin* OR adhesive system* OR bond strength*). Results: Bond strength reduction after CHX treatments varied among the studies, ranging 0-84.9%. In most of the studies, pretreatment CHX exhibited lower bond strength reduction than the control experimental groups. Researchers who previously investigated the effect of CHX on the bond strength of dental adhesive systems on dentin have reported contrary results, which may be attributed to different experimental methods, different designs of the experiments, and different materials investigated. Conclusions: Further investigations, in particular clinical studies, would be necessary to clarify the effect of CHX on the longevity of dentin bonds.

Aim: The purpose of this study was to evaluate the antibacterial efficacies of 2% chlorhexidine (CHX), N-acetyl cysteine (NAC) and assess their synergistic or antagonist action as intracanal medicament. Materials and Methods: Agar diffusion test was performed with 2% CHX, NAC, and their combination against E. faecalis planktonic cells. The diameters of the zones of bacterial inhibition were measured and recorded for each solution. The assay was further extended to 2 weeks old E. faecalis dentinal biofilm. Sixteen freshly extracted teeth were vertically sectioned into two halves resulting in a total of 32 samples. The samples were inoculated with bacterial suspension and incubated at 37°C for 2 weeks for biofilm formation. The samples were then divided into four experimental groups with 8 samples in each group. The samples were gently washed in saline and placed in culture wells containing the test solutions, i.e., 2% CHX, NAC, a combination of 2% CHX and NAC in 1:1 ratio, and a control group containing saline. The biofilm formed on the root canal surface were removed with a sterile scalpel and inoculated on blood agar plates to check for the formation of E. faecalis colonies. Statistical Analysis: For agar diffusion test, data were analyzed statistically using one-way analysis of variance and then by post-hoc Scheffe's test to compare the antimicrobial efficacy between the groups. Statistical analysis was not done for the cultures obtained from the biofilm as there was no growth in all the three test groups except the control group, i.e., saline. Results: In agar diffusion test, among the three groups tested, 2% CHX and NAC showed almost equal zones of inhibition whereas maximum inhibition was shown by a combination of NAC and 2% CHX suggesting a synergistic action. The results obtained were highly significant (P < 0.001) for the combination of medicament when compared to individual test group. In culture analysis, which was done for the biofilm, no growth was observed in all the three test groups. The results obtained were biologically significant but statistically insignificant. Conclusion: NAC has almost equal antimicrobial property as 2% CHX whereas their combination showed a synergistic action.

Objective: The aim of this study was to evaluate the microtensile bond strength (μTBS) of different flowable composite resins placed in different configuration factors (C-factors) into Class I cavities. Materials and Methods: Fifty freshly extracted human molars were divided into 10 groups. Five different composite resins; a universal flowable composite (AeliteFlo, BISCO), two highly filled flowable composites (GrandioSO Flow, VOCO; GrandioSO Heavy Flow, VOCO), a bulk-fill flowable composite (smart dentin replacement [SDR], Dentsply), and a conventional paste-like composite (Filtek Supreme XT, 3M ESPE) were placed into Class I cavities (4 mm deep) with 1 mm or 2 mm layers. Restored teeth were sectioned vertically with a slow-speed diamond saw (Isomet 1000, Buehler) and four micro-specimens (1 mm × 1 mm) were obtained from each tooth (n = 20). Specimens were subjected to μTBS test. Data were recorded and statistically analyzed with two-way analysis of variance and Tukey's post-hoc test. Fractured surfaces were examined using a scanning electron microscope. Results: The μTBS in SDR-1 mm were higher than other groups, where Filtek Supreme XT-2 mm and GrandioSO Flow-2 mm were lower. No significant differences were found between C-factors for any composite resin (P > 0.05). Conclusion: Bulk-fill flowable composite provided more satisfactory μTBS than others. Different C-factors did not affect mean μTBS of the materials tested.

Aim: The aim of this study was to investigate the influence of cleaning methods to remove zinc oxide-eugenol-based root canal sealer (Endomethasone) on the bond strength of the self-etching adhesive to dentin. Materials and Methods: Twenty crowns of bovine incisors were cut to expose the pulp chamber. A zinc oxide- and eugenol-based sealer was placed for 10 min in contact with the pulp chamber dentin. Specimens were divided into four groups according to the cleaning method of dentin used: G1, no root canal sealer (control); G2, 0.9% sodium chlorite (NaCl); G3, ethanol; and G4, followed by diamond drill. After cleaning, the teeth were restored with composite resin and Clearfil SE Bond. All specimens were sectioned to produce rectangular sticks and dentin/resin interface was submitted to microtensile bond testing. The mean bond strengths were analyzed using ANOVA/Tukey (α = 0.05). Results: G3 and G4 showed bond strengths similar to the G1 (P > 0.05). A significant decrease in the bond strength in the G2 was observed (P < 0.05). G1, G3, and G4, the predominant failure mode was the mixed type. The prevalence of adhesive failure mode was verified in the G2. Conclusion: The cleaning methods affected the bond strength of the self-etching adhesive to dentin differently.

Aim: The purpose of this study was to evaluate the effectiveness of three desensitizing agents on dentinal tubule obliteration and their durability in use on the dentinal tubules. Materials and Methods: Sixty specimens were obtained from 30 extracted sound human maxillary first premolars. Each tooth was mesiodistally sectioned to obtain 30 buccal and 30 lingual surfaces, and enamel was removed in order to simulate hypersensitive dentin. Specimens were divided into four groups with 15 specimens each. Group 1 samples were immersed in artificial saliva, Group 2 samples were coated with Vivasens, Group 3 samples were coated with VOCO Admira Protect, and Group 4 samples were coated with Neo Active Apatite suspension. These specimens were examined under scanning electron microscope (SEM) to find out the occluding ability of the respective products. The specimens were brushed to find out their durability for 1 week and 1 month and were examined under SEM. Statistical Analysis: The results were statistically analyzed by analysis of variance (ANOVA) and Tukey's test. Results: Group 1 differed significantly from the Vivasens, Admira, and Neo Active Apatite groups at 5% level of significance (P < 0.05). The Vivasens group differed significantly from the Admira and Neo Active Apatite groups at 5% level of significance (P < 0.05). Conclusion: The Ormocer-based Admira Protect showed the best results.

Objective: The study aimed to investigate the influence of different polishing systems on the surface roughness of nano-hybrid composite resins. Background: Different shapes of polishing systems are available according to the site of work. To minimize variability, a new system with single shape is developed that can be utilized in both anterior as well as posterior teeth. Materials and Methods: Seventy composite discs were fabricated using Teflon well (10 mm × 3 mm). Two main group of nano-hybrid composite Group I - Filtek Z350 and Group II - Tetric N-Ceram were used (n = 35 for each group). Both groups were further divided into four subgroups. Subgroup a - OneGloss (n = 10), Subgroup b - PoGo (n = 10), Subgroup c - Sof-Lex spiral (n = 10), Subgroup d - Mylar strip (control, n = 5). Samples were polished according to the manufacturer's recommendations. Surface roughness test was performed using contact profilometer. The obtained data were analyzed using the one-way analysis of variance test. Result: Tetric N-Ceram produced smoother surfaces than Filtek Z350 (P < 0.05). Mylar strip and "PoGo" created equally smooth surfaces, while significantly rougher surfaces were obtained after applications of "Sof-Lex spiral" and "OneGloss" (P < 0.05). Conclusion: Polishing ability of Tetric N-Ceram is better than Filtek Z350 XT. "PoGo" seems to be a better polishing system than "OneGloss" and "Sof-Lex Spiral."

Context: The fluoride release of sealants in vitro shows a marked decrease. Giomers are distinguishable from manufactured resin-based sealants and contain prereacted glass-ionomer particles (PRG). Aims: To compare the amounts of fluoride released from the main pit and fissure of a resin-based sealant with that from a Giomer and to assess the abilities of the sealant and the Giomer to recharge when exposed to regular use of fluoride rinse. Materials and Methods: The readings for the fluoride concentration were carried out for 60 days using a fluoride ion-specific electrode. After this period, the samples were recharged using a fluoride mouth rinse. The amount of fluoride released after this recharge was determined for 5 days. The data were analyzed using Student's t- and analysis of variance tests. Results: In general, all materials presented higher fluoride release in the first 24 h; G1 and G4 showed a higher fluoride release in this period. On the other hand, G3 and G1 presented the most constant fluoride release until the 8 ^th day, wherein all the sealants considerably decreased in the amount of fluoride released. Conclusion: G1 and G3 released higher concentrations of fluoride, although no significant differences were found. Giomers recharged in the first 24 h after polymerization presented an improved and sustained fluoride release.

Aim: The aim of the study was to investigate the effects of different interface materials and curing units on color changes in a resin cement material. Materials and Methods: Three interface materials and different curing systems, quartz-tungsten-halogen and polywave and monowave light-emitting diode (LED) light curing units, were studied at two-time intervals. Polystyrene strip was used as a control group. All measurements were made on a white background for standard color measurement. According to the CIE L*a*b* color space, the baseline color values of each specimen were measured. Differences between the measurements were calculated as ΔE, ΔL, Δa, and Δb. Data were analyzed using analysis of variance (ANOVA) and Duncan's tests (α = 0.05) with SPSS 20.0 software (SPSS Inc., Chicago, IL, USA). ANOVA revealed significance for interface materials and curing units and time for ΔE (P < 0.05). Results: Interaction between polymerizing units, material and time was not significant (P > 0.05). Monowave LED exhibited significantly higher color changes than the other units ([P < 0.05] [ΔE 2.94 ± 0.44]). QTH promoted composite specimens significantly less color change ([P < 0.05] [ΔE 0.87 ± 0.41]). Conclusion: This study concluded that color of resin cement used in the adhesion of indirect restorations was affected by curing device light and indirect restoration material type.

Aims: This study aimed to investigate the effects of red and white wine on the surface roughness and erosion of nanohybrid and nanofilled resin composites. Materials and Methods: Sixty specimens of each resin-based composite (RBC) were prepared. Before immersion, baseline data roughness values were recorded using a profilometer. Three groups of discs (n = 20) were then alternately immersed in red wine, white wine, and deionized water (as a control) for 25 min and artificial saliva for 5 min over four cycles. The specimens were then stored in artificial saliva for 22 h. This process was repeated for 5 days following immersion in artificial saliva for 2 days. Subsequently, the process was repeated. After immersion, the specimens were evaluated and data were analyzed by two-way repeated analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) (α = 0.05). Results: Red wine caused significantly greater roughness and erosion than did white wine and deionized water (P < 0.05). Nanohybrid resin composites were significantly rougher than nanofilled resin composites (P < 0.05). Conclusion: The effects of red and white wine on the surface roughness and erosion of resin composite restorative materials depended upon the physical and chemical composition of the restorative materials and the types of wine.

Introduction: Resin based composites are widely used aesthetic restorative materials in clinical restorative dentistry. The filler size and the percentage of fillers affects smooth surface, clinical durability, aesthetics, better optical properties, compatibility with natural enamel tissue, surface gloss, and preventing the discoloration of the restoration. The finishing and polishing of tooth-coloured restorations are necessary clinical steps for better aesthetics and longevity of restored teeth. Aim: In this study nano composites were chosen, because these contain nano particles which provide better overall composites features, including the quality of polished surface. The aim of this study was to evaluate the surface roughness of different newer posterior composites. Material and Method: Five commercially available posterior restorative composite were tested in this study. All the specimens were polished with shofu multi step polishing system. After polishing the samples were all analyzed by atomic force microscopy which is used to study surface topography and surface morphology of materials. Results: The values of surface roughness of each specimen were statistically analyzed using Kruskal Wallis ANOVA, and Pair wise comparisons by Mann-Whitney U test setting the statistical significance at p ≤ 0.05. Conclusion: Tetric Evo Ceram, Z350 exhibited less surface roughness compared to Ever X, Clearfil Majesty and Sure fil SDR. There was no statistical difference between groups regarding surface rough ness between groups.

Background: Remaining dentin wall thickness may influence the fracture resistance of tooth. Aims: To investigate the effect of various coronal dentin wall widths on the fracture strength of root canal treated teeth. Materials and Methods: Fifty recently extracted single canal mandibular premolars were used for the study. Ten unrestored teeth were used as control (Group 1); remaining teeth were root canal treated and divided into four groups (n = 10). The Groups 2a, 2b and 3a, 3b were having 2.5 mm, 1.5 mm remaining dentin with and without post, respectively. The samples fracture resistance was tested under the universal testing machine. The data were analyzed with one-way ANOVA and post-hoc Tukey test for comparative evaluation. Results: The mean fracture strength observed in Group 1 was (29.75 Mpa) followed by Group 2a (28.97 Mpa), Group 2b (27.70 Mpa), Group 3a (23.39 Mpa), and Group 3b (16.38 Mpa). There was no statistically significant difference between control and Groups 2a and 2b with P > 0.05. The post contributed significantly for fracture resistance in Group 3a. Conclusion: The endodontic post is not required in root canal treated teeth >2.5 mm coronal dentin wall width while the post is essential for a tooth with <1.5 mm dentin wall width to improve fracture resistance.

Background/Aim: To compare apically extruded debris using ProTaper Universal (PTU), ProTaper Next (PTN), WaveOne (WO), Twisted File (TF), M-Two (MT), and Revo-S (RS) after determining the working length (WL) with root ZX. Materials and Methods: Seventy-two teeth were selected. The WL determination was performed with root ZX. The teeth were divided into six experimental groups, randomly. In groups, root canals were prepared with PTU to size F4/0.06, with PTN to size X4/0.06, with WO to size 40/0.08, with TF to size 40/0.04, with MT to size 40/0.06, and with RS to size AS40/0.06. After preparations were completed, final irrigation was performed with 2 mL distilled water, and a total of 10 mL of distilled water was used in each tooth. Tubes were stored in an incubator at 68°C for 5 days to evaporate the distilled water before weighing the dry debris. Data were analyzed by the Mann-Whitney U-test. Results: The RS group led to the highest amount of extruded debris, however, WO led to the least amount of extruded debris. There was no statistically difference among the groups (P > 0.05). Conclusions: The authors conclude that the results obtained might depend on the apex locator used to determine the WL.

Aim: The current ex vivo study compared the efficacy of removing root fillings using ProTaper retreatment files followed by either WaveOne reciprocating file or the Self-Adjusting File (SAF). Materials and Methods: Forty maxillary canines with single oval root canal were selected and sectioned to obtain 18-mm root segments. The root canals were instrumented with WaveOne primary files, followed by obturation using warm lateral compaction, and the sealer was allowed to fully set. The teeth were then divided into two equal groups (N = 20). Initial removal of the bulk of root filling material was performed with ProTaper retreatment files, followed by either WaveOne files (Group 1) or SAF (Group 2). Endosolv R was used as a gutta-percha softener. Preoperative and postoperative high-resolution cone-beam computed tomography (CBCT) was used to measure the volume of the root filling residue that was left after the procedure. Statistical analysis was performed using t-test. Results: The mean volume of root filling residue in Group 1 was 9.4 (±0.5) mm ³ , whereas in Group 2 the residue volume was 2.6 (±0.4) mm ³ , (P < 0.001; t-test). Conclusions: When SAF was used after ProTaper retreatment files, significantly less root filling residue was left in the canals compared to when WaveOne was used.

Aim: To compare newer bulk-fill composites with an incrementally filled composite for adaptability and subsequent gap formation at the pulpal floor. Materials and Methods: Class I cavities were prepared in 60 intact molars, with a shallow depression in the center of the pulpal floor. The samples were divided into four groups (n = 15), according to the material used; smart dentine replacement (SDR), SonicFill, Ever X Flow and Z350 XT, restored to a depth of 4 mm. Following thermocycling, samples were sectioned buccolingually and examined under a stereomicroscope. Seven samples from each group were coated with nail varnish except for approximately 1 mm around the tooth restoration junction. These samples were examined under stereomicroscope after staining with 2% buffered methylene blue dye. The remaining samples were examined under a scanning electron microscope for gap formation. The data were statistically analyzed using one-way ANOVA and post-hoc Bonferroni test. Results: SDR showed the significantly best adaptability as compared to both SonicFill and Ever X Flow (comparable). However, significantly least adaptive capacity was seen in the incrementally filled group (Z350 XT). Conclusion: Bulk-fill composites performed better than incremental composites, demonstrating better adaptability and less gap formation at the pulpal floor.

Aim: To evaluate the effect of different irrigating solutions on postspace treatments on the push-out bond strength of glass fiber posts. Materials and Methods: Thirty mandibular premolar roots were decoronated and endodontically treated. Postspaces were prepared and roots were divided into three groups: In group 1: 2.5% sodium hypochlorite irrigation (control), group 2: 17% ethylenediaminetetraacetic acid (EDTA) with hand activation, group 3: 17% EDTA irrigation with photon-induced photoacoustic streaming (PIPS) has been done to the postspaces. Scanning electron microscope (SEM) analysis has been made for two samples of each group. Fiber posts were then luted with resin cement. Each root was prepared for push-out test. Data have been statistically analyzed. Results: SEM results showed clean postwalls with both group 2 and group 3, whereas group 1 showed adhesion of resin cement to intraradicular dentine. When all groups were compared, the bond strength values are higher with group 2 followed by group 3. Conclusion: Within the limitations of the study, clean postwalls and the highest bond strength values were obtained from 17% EDTA with hand activation and 17% EDTA with PIPS.

Aim: The aim of this in vitro study is to compare the smear layer removal efficacy of different irrigating solutions at the apical third of the root canal. Materials and Methods: Forty human single-rooted mandibular premolar teeth were taken and decoronated to standardize the canal length to 14 mm. They were prepared by ProTaper rotary system to an apical preparation of file size F3. Prepared teeth were randomly divided into four groups (n = 10); saline (Group 1; negative control), ethylenediaminetetraacetic acid (Group 2), BioPure MTAD (Group 3), and QMix 2 in 1 (Group 4). After final irrigation with tested irrigants, the teeth were split into two halves longitudinally and observed under a scanning electron microscope (SEM) for the removal of smear layer. The SEM images were then analyzed for the amount of smear layer present using a three score system. Statistical Analysis: Data are analyzed using the Kruskal-Wallis test and Mann-Whitney U-test. Results: Intergroup comparison of groups showed statistically significant difference in the smear layer removal efficacy of irrigants tested. QMix 2 in 1 is most effective in removal of smear layer when compared to other tested irrigants. Conclusion: QMix 2 in 1 is the most effective final irrigating solution for smear layer removal.

Aim: This study aims to investigate the effects of finishing and polishing procedures on four novel resin composites using three-dimensional optical profilometer. Materials and Methods: Four composites classified according to their filler size, were selected: Filtek^™ Z350 XT/Nanofill (3M™ ESPE™), Esthet-X HD/Hybrid (Dentsply Caulk), Te Econom/Microfill (Ivoclar Vivadent ^® ), Tetric EvoCeram ^® /Nanohybrid (Ivoclar Vivadent ^® ). Composite specimens were made in Plexiglass mold and polished with Soflex (3M ESPE), Enhance + Pogo (Dentsply Caulk). Both the systems were used according to the manufacturers' instructions, and the polished surfaces were assessed with an optical profilometer. Statistical Analysis Used: Kruskal-Wallis test and further pairwise comparison were performed by Mann-Whitney test. Results: The smoothest surfaces for all the resin composites tested were obtained from the Mylar strip; statistically significant differences were observed among them (P = 0.001). The order of composites was ranked from the lowest to highest surface roughness; Filtek Z350 XT < Te Econom < Tetric EvoCeram < Esthet XHD. Pairwise multiple comparison with Mann-Whitney test showed Filtek Z350 to have the smoothest surface and the least with Teric EvoCeram. Among the polishing systems, Soflex showed the smoothest surface and was significantly different from Pogo (P = 0.046). Conclusions: The effectiveness of the polishing systems seems to be dependent on the material used, treatment modality and also on the filler particle size.

Context: Irrigation of root canals with chlorhexidine (CHX) and ethanol is common practice to prevent root canal infection during postplacement. However, pretreatment with these solvents may interfere with the bond strength of posts. Aims: This study aimed to evaluate if root dentin pretreatment using CHX and/or ethanol influences the push-out bond strength of fiber-reinforced composite resin (FRCR) posts. Materials and Methods: Fifty space posts prepared in endodontically treated extracted human canine roots were randomly divided into five groups (n = 10) according to the dentin pretreatment: Distilled water (W); 1% CHX diacetate solution (1C); CHX diacetate + 99% ethanol (1CE); 99% ethanol (E); and 2% CHX digluconate solution (2C). After pretreatment, the adhesive system (Peak Universal Bond; Ultradent, South Jordan, UT, USA) was applied in the root dentin and the FRCR was cemented with resin cement. Then, horizontal slices of 2 mm were obtained from each root third and the push-out bond strength was assessed. Statistical analysis was done using analysis of variance (ANOVA) and Tukey's tests (P = 0.05). Results: At all thirds, 1CE and E groups presented similar push-out bond strength values (P > 0.05), which were higher than the other groups (P < 0.05). W, 1C, and 2C groups were similar (P > 0.05). Conclusion: The root dentin pretreatment with ethanol, alone or mixed with CHX diacetate increased the bond strength of FRCR luted with resin cement.

Introduction: This study compared the antifungal effect of Zataria multiflora essential oil (EO) with that of sodium hypochlorite (NaOCl) as an irrigant for root canals infected with Candida albicans. Materials and Methods: Sixty mandibular premolars were infected with C. albicans suspension. After 72 h of incubation, the samples were divided into four groups. Teeth in Group 1 were irrigated with minimum fungicidal concentration (MFC) of Z. multiflora EO, in Group 2 with twice the MFC of Z. multiflora, in Group 3 with MFC of NaOCl, and in Group 4 with distilled water (DW). Pre- and post-operative samples were cultured, and fungal colony count of each specimen was obtained. Data were analyzed using Kruskal-Wallis and Mann-Whitney tests (P < 0.05). Results: NaOCl at MFC and Z. multiflora EO at twice the MFC showed the highest antifungal efficacy, with no significant difference (P > 0.05). However, antifungal efficacies of these irrigants were significantly different from those of Z. multiflora EO at MFC and DW (P < 0.05). Conclusion: Our results showed that Z. multiflora EO at twice the MFC had the same antifungal efficacy as NaOCl at MFC.

We report a case where 2% chlorhexidine (CHX) gluconate was mistaken for an anesthetic solution and infiltrated into the buccal vestibule during routine root canal treatment. Accidentally, 2% CHX gluconate solution was injected in the right upper buccal vestibule (16) of a 23-year-old male during routine root canal treatment. The patient experienced pain and a burning sensation over the injected area shortly after injection. Swelling with mild extraoral redness over the right cheek area was observed clinically. The patient was immediately administered dexamethasone intramuscularly, and was prescribed antibiotics, analgesics, and antihistamines. The patient complained of a loss of sensation over the right cheek by the 15 ^th day. The swelling reduced gradually over a period of 15 days. Reversal of sensation was attained after 35 days.