The purpose of this systematic review was to evaluate clinical performance of flowable composite in carious and noncarious lesions. An electronic search was conducted using specific databases (PubMed, Embase, Cochrane Library, and LILACS) through March 2017. Clinical trials for restoration of carious and noncarious lesions were included with no date restrictions; follow-up was 6 months at least and dental restorations were evaluated using the United States Public Health Service criteria. The systematic search generated 908 papers, of which 35 papers were included for full-text review. Inclusion criteria were met by eight papers, six papers were for noncarious lesions and two papers were for restoration of carious lesions. The results of this review have shown no statistical or clinical difference between flowable and conventional composites for all tested outcomes in both carious and noncarious lesions. Both materials have shown clinically acceptable scores for all criteria, with no evidence of clinically unacceptable scores except in retention, with a retention rate of 83% in both materials after 36 months. Flowable composites had clinical efficacy after 3 years of service similar to that of conventional composite in both carious and noncarious lesions, these results are based on low quality of evidence. Based on the available literature and the best available evidence, flowable composites can be used in restoration of noncarious cervical lesions and minimally invasive occlusal cavities.

Polymerization shrinkage is one of the dental clinician's main entanglements when placing resin-based composite restorations. None of the method can assure a perfectly sealed restoration for adhesive restorative materials; clinicians must abode problems of polymerization shrinkage and its possible ill effects. The objective of this article is to review different incremental techniques that can ruin the polymerization shrinkage stress of direct composite restoration.

Objectives: The objective of the study is to incorporate the nanostructured silver vanadate (AgVO₃) decorated with silver nanoparticles at endodontic sealers AH Plus, Sealapex, Sealer 26, and Endofill, at concentrations of 2.5%, 5%, and 10%, and to evaluate physical-chemical properties. Materials and Methods: The study was to evaluate the radiopacity using digital radiography (n = 5), the tooth color change in 48 incisors (n = 3) for 7, 30, 90, and 180 days in a spectrophotometer, and the topographic distribution in a confocal laser (n = 5). The radiopacity was analyzed by Kruskal–Wallis test and the permutation (α = 0.05) and the color and topographical distribution by descriptive statistical analysis. Results: The AgVO₃ had no effect on the radiopacity of Endofill and Sealapex (P > 0.05) and at 2.5% concentrations increased the radiopacity of Sealer 26 and AH Plus (P < 0.05). The Endofill 10% showed less color change, and the major changes were the modified groups in 180 days. The AgVO₃ showed a circular topographic distribution in areas of the sealers. Conclusion: It was found that the addition of AgVO₃ did not affect the radiopacity of Endofill and Sealapex however, increased the radipacity of Sealer 26 and AH Plus. For modified groups, the greatest color change was promoted after 180 days, except for Endofill with 10%. Topographic distribution of nanomaterial affected the color change of theevaluated sealers.

Background: Even after rapid progress in contemporary dental practice, we encounter the failures due to endodontic, periodontal, or combined lesions. Complex anatomy of tooth and resistant microbes demands the development of new treatment strategies. Aim: The aim of this study is to biosynthesize silver nanoparticles (AgNPs) using fungi and determine the antibacterial efficacy against Porphyromonas gingivalis, Bacillus pumilus, and Enterococcus faecalis. Materials and Methods: Fungi isolated from healthy leaves of Withania somnifera were used to biosynthesize AgNPs. The biosynthesized AgNPs were characterized by different methods, and antibacterial efficacy was evaluated by agar well diffusion method measuring the zone of inhibition. Test microorganisms were divided as Group 1: B. pumilus 27142 (American Type Culture Collection [ATCC]), Group 2: E. faecalis 29212 (ATCC), and Group 3: P. gingivalis 33277 (ATCC). Agents used for antibacterial efficacy were grouped as: AgNPs: A (20 μl), B (40 μl), C (60 μl), D (80 μl), E (100 μl), F (0.2% chlorhexidine [CHX]), G (2% CHX), H (Ampicillin), and I (sterile distilled water). Results: Characterization studies showed the color change from colorless to reddish brown color; ultraviolet spectrum showed peak at 420 nm, transmission electron microscope revealed the particles spherical in shape and 10–20 nm size. Fourier transform infrared spectroscopy analysis revealed the presence of functional groups. Data collected for antibacterial efficacy were analyzed using one-way ANOVA and post hoc Tukey's multiple shows no significant difference among three groups (P < 0.0001). AgNPs were as effective as CHX and positive control ampicillin. No zones were seen for I (distilled water). Conclusion: Biosynthesized AgNPs showed efficient antibacterial efficacy. Therefore, it creates a new horizon in the management of endodontic, periodontal, and combined lesions.

Aim: Maintenance of primary dentition is imperative for the development of arch form, esthetics, function, mastication, and normal eruption of permanent teeth. Premature loss can cause various problems such as ectopic eruption, space loss for the successor permanent teeth, alterations in speech, and impairment of function. Hence, decayed primary teeth should not be extracted and treated whenever possible. Pulpectomy is generally recommended as a treatment of choice in such cases. The purpose of this study was to evaluate the clinical and radiographic success of pulpectomized primary teeth with chronic infection using a mixture of metronidazole, ciprofloxacin, and minocycline (3MIX)-MP as an intracanal medicament before the obturation. Methodology: Sixty primary teeth were selected, which were randomly divided into two groups (Group A and Group B) with thirty teeth in each group. In Group A, 3MIX-MP was used as intracanal medicament whereas in Group B, conventional pulpectomy was performed. Resolution of clinical signs and symptoms were evaluated within 2 weeks after the treatment and at recalled 3^rd, 6^th, and 12^th month intervals. The treated teeth were evaluated clinically and radiographically. Results: High success rate was observed in Group A samples both clinically and radiographically. Although the difference in clinical success was not statistically significant, the difference in radiographic success was statistically significant. Conclusion: All the primary teeth with chronic infection which were treated using 3MIX-MP, followed by the instrumentation and obturation provided excellent clinical and radiographic success when compared to conventional pulpectomy and noninstrumentational lesion sterilization tissue repair therapy.

Aim: The aim of this study is to compare the effects of conventional syringe, passive ultrasonic irrigation (PUI), and EndoIrrigator Plus on the amount of apically extruded debris. Materials and Methods: Thirty extracted human mandibular premolars were selected and randomly assigned to three groups (n = 10). The root canals were irrigated with conventional syringe, PUI, and EndoIrrigator Plus. Sodium hypochlorite was used as an irrigant, and debris was collected in a previously described experimental model (Myers and Montgomery 1991). It was then stored in an incubator at 37°C for 10 days to evaporate the irrigant before weighing the dry debris. The mean weight of debris was assessed, one-way analysis of variance was used for comparison of values, and post hoc Tukey's test was used between groups (P = 0.05). Results: The EndoIrrigator Plus group extruded significantly less debris than PUI and conventional syringe groups (P < 0.05). Furthermore, PUI group extruded significantly less debris than conventional syringe irrigation group (P < 0.05). Conclusions: 1. All the three irrigation systems were associated with apical extrusion of debris, 2. EndoIrrigator Plus system extruded significantly less debris than the PUI system and the conventional syringe irrigation system, 3. PUI system extruded significantly less debris than the conventional syringe irrigation system.

Aim: The aim of this study was to determine remineralizing potential of grape seed extract (GSE) compared to casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and calcium glycerophosphate (CaGP) through pH-cycling model and subsequent evaluation using polarized light microscope (PLM). Subjects and Methods: Twenty sound human teeth fragments of ten teeth were obtained from the cervical portion of the roots and were stored in demineralizing solution for 96 h at 37°C to induce artificial root carious lesion. The sections then were divided into four treatment groups including: 6.5% GSE, CPP-ACP, 0.5% CaGP, and control group (no treatment). The demineralized samples were then pH cycled through treatment solutions, acidic buffer, and neutral buffer for 8 days at six cycles per day. The samples were subsequently evaluated using PLM. Statistical Analysis Used: Data were analyzed using ANOVA and Scheffe post hoc comparison test (P < 0.001). Results: PLM data revealed a significantly thicker mineral precipitation band on the surface layer of the GSE-treated lesions compared to the other groups (P < 0.001). Conclusion: GSE positively affects the demineralization and/or remineralization processes of artificial root caries lesions.

Aim: The aim of this study is to evaluate the effectiveness of ultrasonic activation of photosensitizer (PS) drug Foscan in the elimination of endodontic pathogen from root canal system. Materials and Methods: The minimal bactericidal concentration of “Foscan” was determined using disc diffusion and broth dilution method. Forty-eight extracted single-rooted premolars with periapical pathology were used for the study. After access opening, the first microbial sample was taken. The teeth were then randomly divided into four groups: Group 1: Chemomechanical debridement (CMD), Group 2: CMD and passive ultrasonic irrigation (CMD + PUI), Group 3: CMD and antimicrobial photodynamic therapy (aPDT), and Group 4: CMD and aPDT with activation by ultrasonics. After antimicrobial protocols, the second microbiological sample was collected. The samples were analyzed by multiplex polymerase chain reaction for the effectiveness of four antimicrobial protocols on Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas gingivalis, and Treponema denticola. Statistical Analysis Used: Wilcoxon signed-rank test and Mann–Whitney U-test with the significant level P < 0.05, using IBM SPSS statistics 20 version software. Results: Foscan at concentration of 3.125 μg/ml was chosen for antimicrobial analysis. The prevalence of T. denticola, F. nucleatum, P. gingivalis, and P. intermedia was 79.17%, 70.84%, 70.83%, and 58.33%, respectively. Group 4 showed highest bacterial reduction of 99.51%, followed by Group 1 which showed bacterial reduction of 97.35%. Conclusions: Foscan can be used as an effective PS dye at low concentration with minimal tendency for tooth discoloration. Ultrasonic activation of PS dye facilitated better diffusion into dentinal tubules and biofilm obtaining greater bacterial reduction.

Aim and Objective: The aim of this study is to evaluate and compare the effect of one shape, Neolix rotary single-file systems and WaveOne, Reciproc reciprocating single-file systems on pericervical dentin (PCD) using cone-beam computed tomography (CBCT). Materials and Methods: A total of 40 freshly extracted mandibular premolars were collected and divided into two groups, namely, Group A – Rotary: A₁ – Neolix and A₂ – OneShape and Group B – Reciprocating: B₁ – WaveOne and B₂ – Reciproc. Preoperative scans of each were taken followed by conventional access cavity preparation and working length determination with 10-k file. Instrumentation of the canal was done according to the respective file system, and postinstrumentation CBCT scans of teeth were obtained. 90 μm thick slices were obtained 4 mm apical and coronal to the cementoenamel junction. The PCD thickness was calculated as the shortest distance from the canal outline to the closest adjacent root surface, which was measured in four surfaces, i.e., facial, lingual, mesial, and distal for all the groups in the two obtained scans. Results: There was no significant difference found between rotary single-file systems and reciprocating single-file systems in their effect on PCD, but in Group B₂, there was most significant loss of tooth structure in the mesial, lingual, and distal surface (P < 0.05). Conclusion: Reciproc single-file system removes more PCD as compared to other experimental groups, whereas Neolix single file system had the least effect on PCD.

Objective: The objective of the study was to compare and evaluate the clinical and radiographic outcome of single- versus multivisit endodontic treatment in teeth with periapical pathology at the end of 1, 3, and 6 months. Materials and Methods: Sixty single- and multi-rooted teeth indicated for root canal treatment with periapical pathology were included in the study. The teeth were assigned randomly into two groups Group I and Group II (n = 30 each), which were further subdivided into subgroup IA, subgroup IB and subgroup IIA, subgroup IIB (n = 15 each), respectively. Group I was medicated with ApexCal paste and obturated using the standardized protocol in second visit 7–10 days later, whereas Group II was obturated at the first visit. In subgroup IA and subgroup IIA, obturation was done using Apexit Plus sealer, whereas, in subgroup IB and subgroup IIB, AH Plus sealer was used. Patients were recalled at intervals of 1, 3, and 6 months to evaluate teeth for periapical healing. Results: Kruskal–Wallis and one-way ANOVA test showed no significant difference between Groups I and II, whereas Wilcoxon signed-rank test showed improvement in all the subgroups with highly significant P value (≤0.001). Conclusion: Single-visit root canal treatment can be considered as a viable option for treatment of teeth with periapical pathology.

Introduction: The aim of this study was to compare canal transportation of two single-file systems, WaveOne Gold and Neoniti, using cone-beam computed tomography (CBCT). Methodology: A total of 40 mesiobuccal canals of maxillary first molars with curvatures of 15°–30° were chosen and randomly divided into two experimental groups (n = 20). In both groups, glide path was established using ProGlider. In group 1, canals were shaped with WaveOne Gold and in group 2 with Neoniti A1, respectively. According to manufacturer's instructions, canal preparation was made. Canals were scanned before and after instrumentation using CBCT scanner to evaluate root canal transportation at 3, 5, and 7 mm from the apex. Data were statistically analyzed, and significance level was set at P < 0.05. Results: Mesiodistal and buccolingual transportation showed a statistically significant difference at 3 mm (P = 0.009) and 7 mm (P = 0.002), respectively, when instrumented with Neoniti than WaveOne Gold. Conclusion: WaveOne Gold single reciprocation file respected original canal anatomy better than Neoniti single continuous file

Aim: This ex vivo study compared the efficiency of different irrigations systems to remove calcium hydroxide from root canal walls, especially from the apical third by using scanning electron microscopy (SEM). Materials and Methods: Eighty-four single-rooted teeth were divided into 4 groups of 20 teeth each, according to different irrigation protocols using a 30-gauge slot-tipped needle, ultrasonic irrigation system, erbium-doped yttrium aluminum garnet laser (Er: YAG) laser, and EndoVac system. The rest 4 teeth were used as control groups (2 positive and 2 negative control groups). After coronal access, all teeth were instrumented by Protaper Next rotary files (Dentsply-Maillefer, Ballaigues, Switzerland) up to size X3, followed an irrigation protocol and filled with pure calcium hydroxide powder mixed with saline. Teeth were stored in an incubator for 7 days, and then, calcium hydroxide was removed using 3 techniques: Manually (Group 1), by ultrasonic irrigation (Group 2), by laser Er: YAG and x-pulse tip (Group 3), and by EndoVac system (Group 4). The teeth of control groups were instrumented as the experimental groups; no removal technique was applied in positive group, whereas in negative one, the root canals were left empty. Teeth were sectioned longitudinally and observed under SEM Results were statistically analyzed with the Kruskal–Wallis Test and Mann–Whitney Test. Results: The results showed a significant difference between laser and the other three groups in coronal and middle root third, but no statistic difference in apical third. Conclusion: Laser improved the removal of calcium hydroxide in comparison with conventional techniques.

Aim and Objectives: The aim of this study is to evaluate and compare the fracture resistance of root canals obturated with four different obturating systems in endodontically treated teeth. Materials and Methods: One hundred and twenty single-rooted teeth were selected and decoronated at cementoenamel junction. Instrumentation of teeth (except control group) was done with Mtwo rotary files up to size 25/0.06 using a step-back technique. All teeth were divided into four experimental groups (n = 25) and two control groups (n = 10). In Group I (negative control), teeth were neither instrumented nor obturated, in Group II (positive control), instrumentation was done, but no obturation was performed, in Group III, obturation was done with cold lateral compaction technique, in Group IV, obturation was done with cold free-flow compaction technique, in Group V, obturation was done with warm vertical compaction technique, and in Group VI, obturation was done with injection-molded thermoplasticized technique. All prepared teeth were embedded in an acrylic resin block, and their fracture strength was measured using Universal Testing Machine. Statistical data were analyzed using one-way analysis of variance and Tukey's honestly significant difference test. Results: Negative control Group I showed highest fracture resistance and positive control Group II had lowest fracture resistance. Among experimental groups, cold free-flow compaction technique with GuttaFlow2 (Group IV) showed higher fracture resistance as compared to the Group III, Group V, and Group VI. Conclusion: GuttaFlow2 has the potential to strengthen the endodontically treated roots to a level that is similar to that of intact teeth.

Aim: To compare and evaluate the cleaning ability of two reciprocating systems, that is, WaveOne (WO) and self-adjusting files (SAF) in terms of removal of smear layer using sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHX) at apical one-third of the root canal. Materials and Methods: Forty-three human maxillary anterior teeth were selected. The canal was instrumented manually up to a number 25 K-file size. WO and SAF were used to prepare the root canals. The following groups were studied: Group 1 using WO:-Group 1a = 5% NaOCl + 17% ethylenediaminetetraacetic acid (EDTA), Group 1b = 2% CHX + 17% EDTA, Group 2 using SAF:-Group 2a = 5% NaOCl + 17% EDTA, Group 2b = 2% CHX + 17% EDTA. All roots were split longitudinally and subjected to scanning electron microscopic. The presence of smear layer apical thirds was evaluated using a 5-score evaluation system. Chi-square tests were used for statistical analysis. Results: The results showed no significant difference in smear layer removal among both reciprocating system and among the irrigants. Group 2a exhibited the best results and was close to significant difference in score (P > 0.05). The NaOCl + EDTA solution used in Group 1a and Group 2a could effectively remove the smear layer in most of the specimens. However, SAF was more effective than WO in the apical third of the canal. Conclusion: The results obtained from the present study suggest that using the SAF system and continuous irrigation action with NaOCl and EDTA solution could overcome the difficulty of removing smear layer even in hard-to-reach regions of the root canal.

Introduction: The purpose of this in vitro study was to compare the incidence of dentinal defects during root canal preparation with hand files using different irrigants. Materials and Methods: A total of 120 extracted mandibular incisors were randomly divided into onecontrol group and five experimental groups (n = 20) depending on the irrigant used. Biomechanical preparation was not done in control group. Teeth in experimental groups were prepared with hand K-files to a master apical file #35 with 1-mm increments step-back up to #50. In Group 2, saline was used as an irrigant. In Groups 3, 4, 5, and 6, 3% sodium hypochlorite (NaOCL), SmearClear, 17% ethylenediaminetetraacetic acid (EDTA), and 2% chlorhexidine (CHX), respectively, were used as an irrigant. Specimens were sectioned perpendicular to the long axis at 3, 6, and 9 mm from the apex. Sections were observed under a digital stereomicroscope at 30× magnification. Two-tailed t-test was used for statistical analysis. Results: There was a statistically significant difference between the six groups. Group 5 (17% EDTA) had the highest number of dentinal defects, followed by Group 3 (3% NaOCl), Group 4 (SmearClear), and Group 6 (2% CHX). Conclusions: 17% EDTA causes more dentinal defects as compared to 3% NaOCl, SmearClear, 2% CHX, and saline.

Background: Remineralization of noncavitated enamel is dependent on the bioavailability of calcium, phosphate, and hydroxyl ions in saliva. However, it is enhanced by the presence of fluoride. This study compared the remineralizing potential of three different topical fluoride agents. Materials and Methods: Fifteen extracted premolars were selected for the study. The crown of each tooth was longitudinally sectioned buccolingually and mesiodistally using a diamond disc so as to obtain sixty specimens which were embedded in acrylic molds. The specimens were immersed in demineralizing solution for 3 days. The specimens were randomly assigned to four groups, namely Duraphat fluoride varnish, ReminPro paste, ClinPro Tooth Crème, and control group (no surface treatment). A pH cycling includes alternate demineralization and remineralization. Surface mean hardness (SMH) was recorded with 50 g load for 5 s using VHN machine at baseline, after demineralization and pH cycling. The four groups were compared for difference in SMH using one-way ANOVA followed by Tukey–Kramer test. All testing was done with alpha 0.05. Results: SMH recovery results for ClinPro, Duraphat, and ReminPro were 54.88%, 43.42%, and 26.86%, respectively. The difference in the percentage SMH recovery for ClinPro paste was better than Duraphat and ReminPro, and this difference was statistically significant (P < 0.05). Conclusions: ClinPro tooth Crème showed the best remineralization potential among the three materials tested followed by Duraphat and ReminPro.

Background: Endodontic instrumentation is liable to cause some postinstrumentation pain (PIP). Rotary endodontic instruments differ in their design, metallurgy, surface treatment, etc. Aim: This randomized clinical trial aimed to assess the incidence of PIP after root canal instrumentation with three different rotary endodontic systems which differ in their design, namely, ProTaper, Mtwo, and K3. Materials and Methods: A total of 150 patients between the ages of 25 and 50 were chosen for the study. Teeth with asymptomatic irreversible pulpitis due to carious exposure were selected. The patients received local anesthesia by inferior alveolar nerve block. After preparing the access cavity, root canal instrumentation was done with one of the three instruments (n = 50) and closed dressing was given. PIP was assessed every 12 h for 5 days, and tenderness to percussion was analyzed at the end of 1, 3, and 7 days. Statistical Analysis: Mann–Whitney U-test to determine significant differences at P < 0.01. Results: The PIP and tenderness were less in Mtwo group when compared to ProTaper and K3 groups up to 84 h and 72 h respectively and statistically significant (P < 0.05). There was no statistically significant difference between ProTaper and K3 both in PIP and tenderness. Conclusion: Rotary endodontic instrumentation causes some degree of PIP and tenderness to percussion. Among the instruments used, Mtwo causes less PIP and tenderness when compared to ProTaper and K3, and there was no difference between ProTaper and K3. Clinical Relevance: PIP is highly subjective and may vary among different subjects. The apical (3 mm) taper of ProTaper was 0.08 followed by a smaller taper, whereas, the other two files were of a constant 0.06 taper, which means there could have been a greater apical extrusion and therefore more PIP. Despite, the mean of the age was similar, there could have been a difference in the size of the canal and therefore a difference in apical extrusion and PIP.

Background: The aim of this study was to evaluate and compare relatively less explored fragment reattachment methods following traumatic injury. Materials and Methods: Eighty sound permanent maxillary incisors were selected and mounted in acrylic blocks. Teeth were sectioned using the diamond disc and randomly divided into 4 groups (n = 20), Group A, B, C, D. In Group A, after reattachment with composite, a 1 mm-depth circumferential chamfer was placed in the fracture line using a diamond disc bur and filled with composite. In Group B, two vertical grooves 1 mm deep, 1 mm wide, and 4 mm length were placed on the labial surface perpendicular to the fracture line and filled with two fiber-reinforced composite (FRC) posts and composite. In Group C, dentin is removed from the fragment and filled with composite. In Group D, the teeth were intact which served as control group. The force required to fracture the reattached teeth were recorded in Newton's using an onscreen calibration tool of the universal testing machine. Results: Teeth in Groups A, B, C required lesser force to fracture when compared with the teeth of the Group D. When compared to Group D, Group A showed a fracture resistance of 36%, Group B 62%, and Group C 32%. Conclusion: This study proves that reattachment by vertical grooves with FRC posts showed highest fracture resistance and it is the most preferred method. So far no attempt has been made to reattach fractured fragment using vertical grooves and reinforcing with FRC posts.

The aim of this study was to recognize the importance of canalis sinuosus in Endodontics. A 60-year-old male patient reported with the chief complaint of pain and swelling in upper front tooth region for 2 weeks with a history of trauma 21 years back. Clinical examination revealed fractured tooth 21 (maxillary left central incisor) with an associated sinus tract. Radiographic examination revealed diffuse periapical radiolucency in relation to tooth 21 and external resorptive defect in apical third of the root of tooth 11 (maxillary right central incisor). Cone-beam computed tomography advised to plan surgical treatment for the same disclosed the presence of an anatomic variation of canalis sinuosus. The location and course of this canal illuded as a resorptive defect, which is a very rare occurrence. This led to a change in diagnosis with relation to tooth 11 and treatment plan was formulated accordingly.