Sodium hypochlorite (NaOCl) is one of the most commonly used irrigant because of its several advantages. However, it is highly cytotoxic and can lead to severe tissue damage. NaOCl accident occurs when it is extruded beyond root confines into periapical or periradicular tissues. It is an irrigant mishap which can be life threatening and/or cause residual or long term or permanent consequences with malpractice and medico-legal implications. There are many factors which can influence the occurrence and progress of NaOCl accident. These factors can be broadly categorized as patient (host)-, tooth-, operator-, and NaOCl-related factors. They can be further categorized as predisposing and extent factors. It is vital for a clinician to thoroughly understand and identify various influencing factors to prevent NaOCl accident with its associated consequences including any potential medico-legal issues. The purpose of this article is to provide a narrative review on various factors which predispose to the occurrence of NaOCl accident and influence its extent and/or outcome.

Aim: The aim of the present study was to compare the incidence of postoperative pain in single sitting root canal treatment after using two reciprocating and two continuous rotating file systems. Methodology: One hundred and four permanent mandibular canine and first premolar teeth were selected for the study and were divided into two groups 1 and 2 comprising 52 teeth each. Group 1 was treated using reciprocating file systems and was subdivided into two subgroups A and B using WaveOne Gold (WOG) and Reciproc Blue (RB), respectively. Group 2 was treated using continuous rotating file systems and was divided into two subgroups A and B using One Curve (OC) and Vortex Blue (VB), respectively. Treatments were performed in a single sitting. After the visit, the patients were given a prescription for ibuprofen 400 mg to be taken every 6 h if they experience pain. Participants were asked to rate the intensity of the postoperative pain on a visual analog scale according to four classes (no pain, mild pain, moderate pain, and severe pain) after 24 h, 48 h, 72 h, and 7 days. Patients were also asked to record the number of prescribed analgesic medication tablets taken at these time points. Results: There was a statistically significant difference (P = 0.00) among the reciprocating file systems and continuous file systems regarding the incidence of postoperative pain after 24, 48, and 72 h which signifies that pain incidence and duration is less with respect to reciprocation instrumentation as compared to continuous instrumentation. Conclusion: The use of Reciproc instrumentation system (WOG and RB) showed significantly less intensity and duration of posttreatment pain compared to the single-file rotary system (OC and VB) in patients with symptomatic irreversible pulpitis with apical periodontitis.

Background: Decision-making regarding whether cuspal coverage is required or not for the restoration of root canal-treated posterior teeth is still a matter of challenge for the dentist. Methodology: Four models of endodontically treated mandibular molars with mesio-occlusal (MO) cavity were designed and simulated with direct composite resin restorations. Group 1A – cavity width <½ the intercuspal distance restored without cuspal coverage, Group 1B – same as Group 1A but with cuspal coverage, Group 2A – MO cavity width >½ but <2/3^rd the intercuspal distance restored without cuspal coverage, and Group 2B – same as Group 2A but with cuspal coverage. The models received occlusal load to simulate a mastication load. Static finite element analysis (FEA) was adopted for predicting the stress distribution generated in the restored tooth by the loading condition. Results: FEA of the models have shown that the variations in stress values were significant in bulk-fill material compared to enamel and other structures. Comparing the maximum and minimum principal stress values in the overall region demonstrated that 2A was safer, whereas 2B was found to be the worst case. Conclusions: The results indicate that restoration of endodontically treated mandibular molar with loss of one marginal ridge with composite resin without cuspal coverage revealed minimal internal stress values and showed the best performance overall.

Background: Rotary nickel-titanium files have become the most commonly used engine-powered endodontic instruments due to their improvement in fatigue resistance and flexibility. The autoclaving is the most commonly used method for sterilization. However, the risk of instrument fracture, mainly due to cyclic fatigue during rotation within a curved canal, is still a matter of critical concern. Aims: This study aimed to measure and compares the cyclic fatigue resistance of EdgeFile X7, 2Shape, and F-One files in a single curved simulated canal before and after autoclave sterilization. Materials and Methods: Twenty-four files each of EdgeFile X7, 2Shape, and F-One files were used in this study. They were grouped as group A: EdgeFile X7, group B: 2Shape, and group C: F-One files. Then, each group was subdivided into two, sterilized and nonsterilized, subgroups. The files were tested using a custom-made artificial canal. The number of cycles to fracture (NCF) was calculated. Statistical Analysis Used: One-way analysis of variance, post hoc Tukey's test, and independent t-test were used. Results: In nonsterilized instruments, the NCF of the EdgeFile X7 group was significantly higher than that in the other groups (P < 0.05). In sterilized instruments, there was a nonsignificant difference in NCF between EdgeFile X7 and F-One files (P > 0.05). The NCF of 2Shape was significantly lower than other files (P ≤ 0.05) in sterilized and nonsterilized groups. The autoclaving significantly decreased (P ≤ 0.05) the cyclic fatigue resistance of the tested files. Conclusions: EdgeFile X7 was the most fatigue resistant. Autoclaving reduced the cyclic fatigue resistance of the tested files.

Introduction: The study aimed to determine the apical debris extrusion and microbial elimination from infected root canals after using different irrigant activation methods. Materials and Methods: Forty freshly extracted human mandibular premolars were selected and randomly assigned to four groups (n = 10). The teeth were mechanically prepared, sterilized, and inoculated with Enterococcus faecalis for 1 week. Irrigation was done with 3% sodium hypochlorite following conventional syringe irrigation–Group 1, manual dynamic agitation (MDA)–Group 2, passive ultrasonic irrigation (PUI)-UltraX –Group 3, and sonic irrigation (SI)-EndoActivator -Group 4, and the extruded debris were collected using Myers and Montgomery model. The microbial samples were taken from the canals using sterile paper points, cultured and recorded as colonies. The amount of extruded debris was measured by subtracting the final weight of the Eppendorf tube with debris from the initial weight of the tube. Results: I. Group 3 showed the least apical debris extrusion (P < 0.05), followed by Groups 2 and 1 and the highest with Group 4. II. Group 3 showed the least colony-forming units (CFUs)/ml, followed by Group 4, and finally, Group 2 showed lesser mean CFUs/ml compared to Group 1 (P < 0.05). Conclusion: All the irrigation activation methods were associated with apical debris extrusion, with the PUI system extruding the least amount of debris compared to the other groups. Irrigation activation techniques were beneficial in reducing the microbial load from the infected canals with the PUI system showing a complete elimination of the microbes, followed by SI and MDA.

Aims and Objectives: The objective of this study was to compare surface roughness of a nano-spherical resin composite using four different multi-step polishing disc systems at five different speeds. Materials and Methods: In total, 154 discs samples were prepared using a supra-nano spherical resin composite. The samples were divided into negative and positive control groups and the following four finishing and polishing disc systems: Sof-Lex, Bisco Finishing Discs, OptiDisc, and Super-Snap. Each polishing disc system was applied at five different speeds (2000, 5000, 10,000, 15,000, and 20,000 revolutions per minute [RPM]) (n = 7). The surface roughness of samples was measured using a profilometer. One sample from each group was evaluated by scanning electron microscopy and atomic force microscopy. Two-way analysis of variance was used to evaluate the average roughness (Ra) data from the profilometric experiments using statistical software (GraphPad Prism4-GraphPad Software; La Jolla, CA, USA). The mean values were compared using the Bonferroni test (P = 0.05). Results: The mean roughness ranged from 0.07 μm to 0.41 μm. The smoothest surfaces were obtained with OptiDisc at 20,000 RPM and Super-Snap at 20,000 RPM. The Bisco Finishing Discs group at 2,000 RPM showed the highest surface roughness values. For all polishing systems, the roughness at 20,000 RPM was lower than that at other speeds. Conclusion: Within the limitations of the present in vitro study, it can be concluded that the polishing performance was in the following order: Super-Snap > OptiDisc > Sof-Lex > Bisco Finishing Discs. In addition, the surface roughness decreased as the polishing speed increased.

Background: This study aimed to evaluate the pH and calcium ions (Ca²⁺) release from two tricalcium silicate-based sealers (Sealer Plus BC and Bio-C Pulpecto) through roots of primary teeth. Methods: Forty root canals of primary incisors were prepared and distributed into four groups according to the filling material: G_PlusBC (Sealer Plus BC); G_BioC (Bio-C Pulpecto); G_Ultra (Ultracal); and G_C (no filled). pH measurement was performed with a digital pH meter, and the Ca² + release was measured in an atomic absorption spectrophotometer at baseline, 24 h and 1, 2, 3, and 4 weeks later. The data were analyzed using two-way ANOVA and Tukey's post hoc tests. Results: The results did not reveal significant differences between the groups in terms of pH in 24 h, 1-, and 2-weeks' periods. After 4 weeks, there was a significant difference, with the highest mean pH values in G_Ultra, followed, respectively, by G_PlusBC and G_BioC. Regarding the Ca² + release, the G_Ultra showed greatest mean values at all evaluated times, and the other groups showed no difference between them. Conclusion: Both sealers were able to promote the elevation of the pH and Ca² + release through roots of primary teeth, which brings favorable properties for their use as a filling material.

Context: Nano-calcium hydroxide (NCH) has been proven to have several advantages over normal calcium hydroxide, supporting in its possible use as an intracanal medicament. Aim: The aim is to evaluate and compare calcium ion release and pH change using NCH with different vehicles as intracanal medicament. Subjects and Methods: Sixty freshly extracted premolars were decoronated at the cementoenamel junction level and the length was standardized. Canals were enlarged to F3 size using protaper rotary system. The samples were divided into three groups (n = 20), namely NCH + distilled water (Group 1), NCH + propylene glycol (Group 2), and NCH + chitosan (CT) (Group 3). Each sample was suspended in 6 ml of distilled water using silicone putty with only the apical third of the roots immersed. The pH and calcium ions were assessed at 24 h, 7 days, 15 days, and 30 days using a pH meter and ultraviolet spectrophotometer, respectively. Statistical Analysis: Comparison of mean calcium release and pH change was made using Kruskal–Wallis ANOVA with post-hoc Dunn's test. The level of significance was set at 5%. Results: A significant difference was seen in the calcium ion release and pH change among the three groups at 24 h, 7 days, 15 days, and 30 days. Conclusions: NCH mixed with propylene glycol showed alkaline pH and adequate release of calcium ions till 30 days. NCH mixed with CT exhibited a high pH at the end of 30 days. Both combinations proved their efficacy as intracanal medicaments.

Aim: The aim of this study was to assess color changes in teeth and two different composite resins under the influence of chlorhexidine (CHX) with and without anti-discoloration system (ADS). Materials and Methods: A total of 20 extracted human premolar teeth for periodontal and orthodontic purposes were selected for the study. Further, a total of 40 composite specimens comprising 20 each nanoceramic and nanohybrid composite disks of size 10-mm diameter and 0.5-mm thickness were prepared on a customized model for standardization using the composite filling instrument. The specimens were cured with light-curing unit for 20 s and polished with a composite polishing kit. Two mouthrinses comprising CHX and CHX with ADS were used. Baseline color values of natural tooth and two composite resins were recorded using an ultraviolet spectrophotometer. After baseline spectrophotometric measurements, all the samples were subjected to the mouthrinses. The postimmersion color values of the samples were then recorded, respectively, using the same spectrophotometer. Statistical Analysis Used: The statistical analysis was done using paired t-test. Results: Reflectance values showed a statistically significant difference between CHX and CHX with ADS among nanoceramic and nanohybrid composite samples. There was no statistically significant difference in reflectance values among natural teeth samples with either CHX or CHX with ADS. Conclusion: Within the limitations of the current study, CHX with ADS may aid in avoiding stains caused due to use of CHX mouthwash, thereby making it more acceptable for patients.

Background: The adhesive bonding ability of composite resins makes it unnecessary to remove tooth structure for retention, prevention, and convenience. However, postoperative sensitivity after placing composite restoration has been a significant problem experienced by clinicians. Aim: The present randomized controlled trial was conducted to assess the role of dentin remineralization in the reduction of postoperative sensitivity after composite placement. Materials and Methods: Eighty participants with occlusal carious teeth were randomly allocated to one of the four study groups, each having 20 participants, and are as follows: Group A with test group, Group A with control group, Group B with test group, and Group B with control group. Postoperative sensitivity was assessed using the Visual Analog Scale (VAS) and the United States Public Health Service (USPHS) criteria at different time intervals such as baseline, 1 week, 1 month, and 3 months. Data were analyzed using the Kruskal–Wallis ANOVA test, Mann–Whitney U-test, and Wilcoxon matched-pair test. Results: All 80 participants were analyzed at the baseline, 1 week, 1 month, and the end of 3 months for the postoperative sensitivity using the VAS score and USPHS criteria. One restoration in Group A with control group reported mild sensitivity at the end of 1 week and one restoration in Group B with control group reported severe sensitivity at the end of 3 months, necessitating its replacement followed by root canal treatment. No relationship was reported between postoperative sensitivity and tooth type. There was no statistically significant difference in postoperative sensitivity in any of the treatment modalities. Conclusion: Class I restoration using self-etch or selective-etch as well as with or without zinc-carbonate hydroxyapatite is a viable and predictable solution for the reduction of postoperative sensitivity if all the aspects of restorative techniques are considered precisely.

Context: Sectional matrices and contact rings are valuable aids to establish proximal contact tightness in Class II composite restorations. Aims: This study aims to evaluate the proximal contact area in Class II composite restorations using three matrix systems based on morphological analysis, mesiodistal (M-D) diameter and contact tightness. Subjects and Methods: A standardized DO cavity was prepared in 30 plastic molar teeth. They were randomly divided into three groups (n = 10) and restored using Tetric N-Ceram composite material and three matrix systems – Saddle matrix, Palodent system, and Palodent Plus system. The quality of proximal contacts was assessed by measuring the maximum M-D diameter of the restored teeth using a digital caliper; the tightness of the proximal contact area using Unifloss and a standardized metal blade (30 μm). Qualitative assessment of contact morphology was done by visual means while quantitative assessment of contour was done using Medit scanner superimposing method and ExoCAD software. Statistical Analysis Used: One-way ANOVA test was used to compare the mean M-D diameter (in mm) in the occlusal third, middle third, and the proximal contact area between the three groups. Chi-square test was used to compare the proximal contact area tightness using the passage of Unifloss. The buccolingual and occluso-gingival morphology was also compared among the three groups. The level of significance (P value) was set at P < 0.05. Results: For the occlusal and middle third, significantly larger diameters were achieved with the Palodent Plus system than with the Saddle matrix. More flat contours were seen in the case of the Saddle matrix than in the case of the Palodent system while the Palodent Plus system exhibited a minimal depth of concavity as determined by three-dimensional imaging of the contact morphology. Conclusions: Palodent Plus and Palodent matrix systems established superior contacts and contours than the Saddle matrix.

Aim: The aim of this study was to compare the cytotoxic effect of calcium silicate-based Bio-C, CeraSeal, and mineral trioxide aggregate (MTA)-based (MTA-Fillapex) sealers to a widely used resin-based sealer (AH Plus) using 3-(4, 5 dimethythiazol-2yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and microscopic examination. Materials and Methods: A total of (n = 36) samples divided into four groups with three sealer samples per time period of 0 h, 24 h, and 7 days after mixing were extracted in cell culture medium using Dulbecco's Modified Eagle's Medium. The cytotoxicity of these sealers was evaluated using an MTT assay on L929 mouse fibroblasts, and changes in the cell morphology were observed under an inverted phase-contrast microscope (×20). The values obtained were analyzed statistically using one-way ANOVA, Tukey's post hoc, and Bonferroni's test. Results: Bio-C and CeraSeal showed a reduction in cytotoxicity from severe at 0 h to no cytotoxicity at 24 h and 7 day time period. AH Plus showed severe cytotoxicity at all time periods. MTA-Fillapex showed severe cytotoxicity at 0 h which decreased to moderate at 24 h and 7 days. The differences between groups were statistically significant (P < 0.05). Conclusions: The sealers with resin constituents (AH Plus and MTA-Fillapex) showed severe-to-moderate cytotoxicity at different time periods, whereas calcium silicate-based sealers (Bio-C and CeraSeal) were relatively biocompatible as their cytotoxicity decreased significantly from severe initially to noncytotoxic with time.

Aim: The present in vitro experimental study was undertaken to evaluate and compare the antimicrobial activity of triple antibiotic paste (TAP), diclofenac, and proton-pump inhibitor (PPI) against the microorganism Enterococcus faecalis. Materials and Methods: Three medicaments were selected for the study, TAP, diclofenac, and PPI. The experimental groups for the test were as follows: Part 1 – Group 1: TAP, Group 2: diclofenac, and Group 3: PPI; Part 2 – Group 1: TAP + PPI and Group 2: diclofenac + PPI. An agar well diffusion test was used to determine the efficacy of the experimental medicaments against E. faecalis (ATCC 29212). The diameter of inhibition zones was measured in millimeters using an inhibition zone measuring scale and the results were recorded. Statistical Analysis: The statistical analysis was done using an analysis of variance and an unpaired t-test. P value was set at < 0.05. Results: There was a significant difference in the diameter of growth inhibition zones, with the greatest diameter noted for TAP + PPI followed by diclofenac sodium (DS) + PPI, TAP, DS, and PPI. Conclusions: The antimicrobial effectiveness of TAP + PPI was found to be superior to all other medicaments (DS + PPI, TAP, DS, and PPI).

Aim: To compare the microleakage of Filtek bulk fill posterior and Beautifil II LS composites in Class II cavities using stereomicroscope. Materials and Methods: A total of 34 extracted teeth were randomly divided into two groups. Teeth were prepared and mounted on a plaster block. In each tooth, Class II cavities were prepared, following which the cavities were etched and bonded. In Group I, 17 teeth were restored with Filtek bulk fill posterior composite in bulk fill technique and in Group II, 17 teeth were restored with Beautifil II LS following manufacture's instructions. The samples were then thermocycled and then the tooth were immersed in 1% methylene blue for 24 h and were divided into two halves mesiodistally using a diamond disc at low speed. Then, all the sections were observed under a stereomicroscope at ×10 magnification. Results: Mann–Whitney U-test displayed a statistically significant higher mean rank among Filtek bulk fill group (mean rank = 23.09) when compared to Beautifil II LS composite group (mean rank = 11.91). Conclusion: The study concluded that in Class II restorations, Beautifil II LS showed significantly less microleakage than Filtek bulk fill posterior.

Background: Incomplete monomer infiltration into the etched dentin causes postoperative sensitivity (POS) with total-etch adhesives. Increasing the temperature of the air to dry the adhesive has shown to improve its infiltration into the dentin. Aims: The aim of this research is to evaluate the effectiveness of dry air temperatures of 15°C ± 5°C and 50°C ± 5°C on the POS, depth of penetration, and bond strength of an ethanol/water-based etch-and-rinse (ER) adhesive under in vivo and in vitro conditions. Methods: Forty-four premolars from 11 patients scheduled for orthodontic extraction were allocated into cold air (Group 1) and warm air (Group 2) groups using a split-mouth design. A 2 mm × 2 mm × 2 mm cavity was prepared on the middle third of the buccal surface of the teeth, acid etched, and two coats of an ethanol/water-based adhesive resin mixed with 0.1% rhodamine B was applied for 10 s. A dental air gun customized to deliver warm and cold air was used to dry the adhesive prior to its light polymerization. The cavities were restored with resin composite incrementally. POS was assessed using visual analog scale at 24 and 72 h using cold test. The teeth were atraumatically extracted and analyzed for depth of adhesive penetration using confocal laser scanning microscope (n = 11) and push-out bond strength (n = 11). Statistical Analysis Used: The data were analyzed using sample t-test and Wilcoxon signed-rank test (P < 0.05). Results: A significantly lower POS and greater adhesive penetration into the dentin was observed in the warm air group compared to cold air (P < 0.05). No significant difference could be elicited between the push-out bond strength of both the groups (P > 0.05). Conclusions: Warm air alleviated POS and improved the penetration of an ethanol/water-based ER adhesive into the dentin.

Context: The effect of chemical disinfection on gutta-percha (GP) has to be closely studied whether it affects surface topography and thereby causes leakage and reinfection of canals. Aims: The purpose of the study is to assess the surface topography of GP cones after disinfecting with a novel disinfecting material, graphene oxide (GO), and compare the same with other disinfecting materials, including sodium hypochlorite (NaOCl) and silver nanoparticles (AgNps). Settings and Design: After determining the power (0.84) of the study, 48 GP cones were taken and categorized into four different groups based on disinfecting agents. Materials and Methods: Forty-eight GP cones (ISO size 30 6% taper, DIADENT) were taken and are randomly selected and grouped as follows according to the disinfecting agents: Group 1 – control (untreated GP points, n = 12), Group 2 – NaOCl (n = 12), Group 3 – AgNPs (n = 12), and Group 4 – GO (n = 12), respectively. After treating with the above disinfecting materials, the surface topography of samples was evaluated using atomic force microscopy. The data were analyzed statistically using one-way ANOVA and post hoc (Tukey's honestly significant difference) tests. Statistical Analysis Used: IBM SPSS (version 21.0) software was used. The tests performed were one-way ANOVA and post hoc. Statistically, significance was set at a P ≤ 0.05. Results: The root means square values and surface roughness values were lesser for the GO group and AgNPs when compared with the NaOCl group, which were statistically significant. Conclusions: Within the limitations of the study, this study had shown lesser surface topography deterioration of GP cones when treated with GO and AgNPs, whereas more deterioration was observed with NaOCl.

Background: Rotary and ultrasonic instruments are not appreciable in the complete removal of Biodentine from root canals. Therefore, organic solvents can be used as an adjunct for its retrieval. Aim: The aim of this study was to compare the efficacy of 10% citric acid, 2% acetic acid, and 20% tartaric acid on the microhardness of Biodentine and radicular dentin. Materials and Methods: Forty single-rooted extracted teeth were decoronated at the cementoenamel junction and root canals were prepared with peeso reamers. Two-millimeter sections were obtained and restored with Biodentine. All samples were subjected to Vicker's microhardness test to record the microhardness of Biodentine and radicular dentin. Samples were randomly divided into four experimental groups and treated with (n = 20) – distilled water, 10% citric acid, 2% acetic acid, and 20% tartaric acid groups for 10 min, after which specimens were again subjected to the same microhardness test. Statistical Analysis: The data were subjected to Kruskal–Wallis ANOVA test, followed by Wilcoxon signed-rank test with a level of significance set at P ≤ 0.05. Results: 10% citric acid followed by 2% acetic acid exhibited the lowest mean microhardness values after immersing in respective solutions, whereas 20% tartaric acid exhibited the highest mean microhardness values on Biodentine and radicular dentin. Conclusion: 10% citric acid can be used for retrieving Biodentine from root canals for a limited time without adversely affecting the physical and chemical composition of radicular dentin.

Context: Mandibular impacted third molars are the most frequently impacted teeth in humans and can predispose the adjacent second molar to an array of detrimental effects such as caries, periodontitis, and cervical resorption thus the aim of this study was to determine the same. Subjects and Methods: A retrospective observational cross-sectional study involving patients with orthopantomography presenting with impacted lower third molar. The type, depth, and level of impaction, the extent of caries, periodontal changes, and the presence of cervical resorption were assessed. Statistical Analysis Used: Data were analyzed using SPSS version 21.0. with Chi-square. Results: Mesioangular impaction was most commonly noted. The pattern of impaction had a direct influence in the formation of carious lesions, cervical resorption, and periodontal ligament (PDL) changes. Conclusions: Noting the pattern of third molar impaction helps the clinician to forecast problems that may occur on adjacent teeth and initiate necessary prophylactic treatment.

Aim: This study evaluated the effect of three collagen cross-linking agents – proanthocyanidins (grape seed extract [GSE] and green tea extract [GTE]) and glutaraldehyde [GA] on microshear bond strength (μSBS) of caries-affected dentin (CAD)-resin complex. Materials and Methods: Freshly extracted 96 teeth with caries up to the middle third of dentin were sectioned through the deepest part of the occlusal fissure, perpendicular to the long axis of the crown. Caries was excavated with large round bur until firm dentin was obtained, confirmed by visual inspection and tactile examination. Flat occlusal dentin surfaces were treated as follows: Group-1 – 6.5% GSE (n = 30), Group-2 – 2% GTE (n = 30), Group-3 – 5% Glutaraldehyde (n = 30), Group-4 – control group (no agents) (n = 6). Each group was further divided into Subgroup A - Etch-N-Rinse 15s, Subgroup B - Etch-N-Rinse 45s, and Subgroup C - Self-etch. Two increments of 1.5-mm thick composite (Tetric-N-Ceram – Ivoclar Vivadent) with a 1-mm diameter were built-up. Each sample was subjected to μSBS test in Universal Testing Machine. Student's t-test was done for intragroup comparison and one-way ANOVA for intergroup comparison. Results: Statistically significant difference was present in mean μSBS, with Group 1B showing the best results and Group 4C, the least. Conclusions: Thus, the application of these collagen cross-linkers, to CAD, increases μSBS and promises a new approach to improve dentin bond strength.

Dental trauma results in various complications and poses an enigma to the practitioner. Calcific metamorphosis is one of the sequelae of trauma. A female patient of 35 years visited the specialty clinic of endodontics for the management of a discolored tooth. Clinically, discolored 21 was observed with no pain on palpation and percussion. The pulp sensibility test revealed a negative response. Radiographic examination revealed pulp canal obliteration with an apical radiolucency of Peri Apical Index (PAI 4). The tooth was diagnosed as necrotic pulp with asymptomatic apical periodontitis. Attempt to negotiate the canal under a Dental Operating Microscope (LABOMED, Los Angeles, CA, USA) and ultrasonics (Satelec, Acteon, France) was futile. Cone-beam computed tomography image revealed a patent canal in the apical third. Using real-time guided endodontics with a dynamic navigation system (Navident, ClaroNav, Toronto, ON, Canada), the protocol of plan, trace, and place was followed, and successful canal negotiation was achieved. After radiographic confirmation, root canal treatment was completed.