Background: Extrusion of infected debris into the periapical tissue has been cited as the major cause of postoperative pain, regardless of instrumentation technique. Aim: Comprehensively review two different kinematics of instrumentation (reciprocating and rotary) and association to the postoperative pain after endodontic treatment. Methods: Two investigators performed a systematic review with meta-analysis. MEDLINE/PubMed, Cochrane Library, and Scopus supplied relevant data from studies published until February 2018 to answer the PICO question. Primary outcome was overall postoperative pain, and the secondary outcomes were nature of the pain (mild, moderate, and severe) at 12, 24, and 48 h. Results: Ten randomized clinical trials fulfilled eligibility criteria, and five of them were submitted in the meta-analysis. Primary outcome indicated that reciprocating system results in less postoperative pain compared to rotary system (P < 0.05). As a secondary outcome, there was no statistical difference for mild, moderate, and severe pain after 12 and 24 h using reciprocating or rotary systems (P > 0.05). However, the reciprocation system showed less severe pain after 48 h (P < 0.05). Conclusion: Rotary motion had a negative impact on postoperative pain after endodontic treatment. Furthermore, after 48 h, more patients presented severe pain under rotary motion. More randomized clinical studies would be helpful.

Context: Postoperative pain control after endodontic treatment is important to maintain patient comfort. Aim: The aim of this prospective clinical study was to evaluate the postoperative symptomatology of endodontic treatments performed in a single session, with or without photodynamic therapy (PDT), using Reciproc #40 file in necrotic unirradicular anterior teeth. Materials and Methods: In a prospective clinical study, 40 teeth indicated for endodontic treatment were treated by a single endodontist according to a preestablished protocol. The teeth were randomly divided into two groups (n = 20): control group (CG) and laser group (LG). After 24 h, 72 h, and 1 week of endodontic treatment, patients' pain symptomatology was evaluated through a Visual Analog Scale (VAS) ranging from 0 to 10, in which 0 corresponds to no pain and 10 indicates extreme pain. In both workgroups, similar protocols were used for instrumentation with the Reciproc system (R40), irrigation with 2.5% sodium hypochlorite, and filling by the gutta-percha plastification technique, in which the CG did not use PDT, and the LG used PDT after the instrumentation sequence. After the visit, the patients were given a prescription for ibuprofen 400 mg to be taken every 6 h if they experienced pain. Results: The results of the study, analyzing the VAS, did not show any difference in pain symptoms between the groups at 24 h, 72 h, and 1 week (P > 0.05). Conclusions: It was concluded that there was no statistical difference between the groups.

Aim: The aim of the study was to evaluate and compare the vertical marginal discrepancy of computer-aided design (CAD)/computer-aided manufacturing (CAM) and pressable lithium disilicate onlays. Materials and Methods: A maxillary first premolar typodont tooth was prepared to receive lithium disilicate onlay. Mesio-occluso-distal cavity was prepared with palatal cusp reduction and collar preparation. In the proximal box, gingival seat was placed 1 mm coronal to the cementoenamel junction and mesiodistal width of the seat was kept to 1 mm. Thirty stone models were prepared from thirty rubber base impressions and divided into two groups, based on the technique of fabrication of onlays: (1) Group CL (CAD/CAM lithium disilicate) and (2) Group PL (Pressable lithium disilicate). Fifteen onlays per each group were fabricated by following the manufacturer instructions. Marginal fit of all the samples were analyzed by using stereomicroscope with Image Analysis software.Statistical analysis was done by t-test. Results: Statistical significant difference was found between both the groups. The lowest marginal discrepancy (41.46 μm) was measured for Group CL (CAD/CAM lithium disilicate) specimens, and the highest (55.95 μm) discrepancy was observed on the Group PL (Pressable lithium disilicate) specimens. Conclusion: Although there was a statistically significant difference between the two groups, marginal gap of both the groups were in clinically acceptable levels.

Aim: The aim of this study is to evaluate the pushout bond strength of two bioceramic materials, two component calcium trisilicate material (biodentine), and premixed calcium trisilicate putty (Endosequence root repair material-fast set putty). Subjects and Methods: 20 maxillary incisors were used in the study. Apical sections of 3mm were obtained and retro cavities to a depth of 3mm were prepared using a straight fissure bur. Another transverse section was made 4-mm coronal to the previous section. The specimens were placed into acrylic resin rings and separated into two groups and their cavities filled with the materials. The pushout test was carried out using a universal testing machine at a cross head speed of 0.5 mm/min, and the specimens were examined in a stereomicroscope at to evaluate the modes of failure. Statistical Analysis: The pushout bond strength values were analyzed using the unpaired t-test, and the modes of failure were compared using Fisher's exact test. Results: The pushout bond strength was seen to be significantly higher (P < 0.001) for the two-component calcium trisilicate material (11.596 ± 3.309). Cohesive failure patterns were observed in both the test groups. Conclusion: Two component calcium trisilicate material demonstrated higher bond strength values to apical dentine.

Introduction: Chlorhexidine (CHX) interacts with sodium hypochlorite (NaOCl) and herbal irrigants such as neem and tulsi to form precipitate which contains para-chloroaniline (PCA). No studies till date have reported about metal elements present in this combination as well as in irrigants. Aim: The aim of this study was to evaluate the precipitate formed on combination of different irrigants, weigh the amount of precipitate formed, and to analyze 35 different metal elements in each irrigant, precipitate formed as well as in PCA. Materials and Methods: Seven irrigants, namely 2% CHX gluconate, 3% NaOCl, 17% ethylenediaminetetraacetic acid (EDTA), 5% neem, 5% tulsi, 5% Aloe vera, and 5% garlic were taken in different test tubes. Group (1–6): 1 ml of CHX is mixed with 1 ml of 3% NaOCl/17% EDTA/5% neem/5% tulsi/5% A. vera/5% garlic. Group (7–11): 1 ml of 3% NaOCl is mixed with 1 ml of 17% EDTA/5% neem/5% tulsi/5% A. vera/5% garlic. Group (12–15): 1 ml of 17% EDTA is mixed with 1 ml of 5% neem/5% tulsi/5% A. vera/5% garlic. Group (16–18): 1 ml of 5% neem is mixed with 1 ml of 5% tulsi/5% A. vera/5% garlic. Group (19 and 20): 1 ml of 5% tulsi is mixed with 5% A. vera/5% garlic. Group 21 includes 1 ml of 5% A. vera and 5% garlic. Each group is observed for any precipitate formation, and precipitate formed was weighed. Samples such as 2% CHX gluconate, 3% NaOCl, 17% EDTA, 5% neem, 5% tulsi, 5% A. vera, PCA, and precipitate formed in each group were analyzed for 35 different metal elements using inductively coupled plasma mass spectrometry (ICP-MS). Statistical Analysis: One-way ANOVA and Post hoc Tukey's test for the precipitate formed. Results: Precipitate formation was seen in CHX + NaOCl (reddish-brown), CHX + EDTA (white), CHX + neem (light green), CHX + A. vera (green), CHX + tulsi (dark green), CHX + garlic (beige). ICP-MS analysis showed the presence of International Agency for Research on Cancer Group 1 carcinogens in NaOCl, CHX, EDTA, and PCA. Conclusion: Carcinogenic metals are undetected in herbal irrigants which is found to be risk free alternatives in near future.

Aim: The aim of the study is to quantify the amount of debris extrusion after instrumentation with single-file rotary and reciprocating systems used either with conventional irrigation (CI) or passive ultrasonic irrigation (PUI) systems. Methodology: Sixty extracted human mandibular incisors were randomly assigned to two groups (n = 30); rotary single-file system, One Shape (OS-Group 1) and reciprocating single-file system, WaveOne (WO-Group 2) instruments. The two groups were further subdivided into two subgroups (n = 15); (A) PUI and (B) CI. The apically extruded debris was collected in preweighed glass vials as per the Myers and Montgomery method. After drying, the mean weight of debris was assessed with a microbalance and statistically analyzed using analysis of variance and Student's t-test. Results: The reciprocating file system produced significantly more debris compared to the rotary file system using either of the irrigation systems (P = 0.04). CI produced significantly more (P = 0.02) debris extrusion compared to PUI irrespective of the file system used. Conclusion: Under the conditions of this study, both systems caused apical debris extrusion. Rotary single-file system produced less debris extrusion compared to reciprocating single-file system. Use of PUI may be advocated as an alternative to CI, as it causes lesser apical debris extrusion.

Context: Anxiety and fear of pain are the two major deterrents for which patients avoid dental treatment. Local anesthetic, which forms the foundation for the delivery of pain-free endodontic treatment, does not serve the purpose in anxious patients and requires augmentation with other pharmacological agents. Aims: The aim of this study is to observe the effectiveness of nitrous oxide in alleviating patient anxiety and pain during endodontic treatment of a vital tooth. Settings and Design: The present in vivo study was conducted on sixty healthy patients from the Outpatient Department of Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India. Subjects and Methods: Sixty anxious patients having irreversible pulpitis in their lower molar were selected and divided into two groups, namely control group and intervention group, with thirty patients placed in each group. In control group, access opening and pulp extirpation was done under local anesthesia only, whereas in intervention group, access opening and pulp extirpation was done under local anesthesia and nitrous oxide sedation. The anxiety levels of patients, before and after the treatment, were measured using the Modified Dental Anxiety Scale. Pain felt by the patients during administration of local anesthesia and during access opening was measured using the Visual Analog Scale. Statistical Analysis Used: The data were analyzed using ANOVA and paired t-test, and graphical analysis of the data was done. Results: Significant reduction in anxiety and pain levels of patients during endodontic access opening including significant reduction in pain during administration of local anesthesia was observed under nitrous oxide sedation. Conclusions: Conscious sedation with nitrous oxide is a useful technique to add to the armamentarium used in the treatment of teeth with symptomatic irreversible pulpitis.

Background: Root-end preparation during surgical endodontics may produce dentinal microcrack formation and/or propagation, leading to vertical root fractures. Aim: This study aimed to evaluate and compare the microcrack formation and propagation during ultrasonic root-end cavity preparation, with diamond- and zirconium nitride-coated tips using micro-computed tomography (CT). Methodology: Twenty-eight extracted, mature, free-of-defect, mandibular premolars were decoronated and micro-CT scanned for the presence of preexisting microcracks. Samples were prepared till F4, were obturated, and were re-scanned to determine an increase in the number of microcracks. After 3 mm of root-end resection, the samples were randomly divided for ultrasonic root-end preparation into Group 1 (n = 12): preparation was done with ProUltra Surg tip, Group 2 (n = 12): preparation was done with KiS tip, and Group 3 (n = 4): no preparation was done. The samples were rescanned, and data collected were analyzed using ANOVA and Student's t-test. The level of significance was set at 5%. Results: Preexisting microcracks were observed in few samples. The mean percentage number increase of microcracks after root-end preparation in ProUltra Surg group was 1.25 and in KiS group, it was 0.5. The difference in mean percentage increase for the number of microcracks after root-end cavity preparation using ProUltra Surg tip and KiS tip was 0.75. However, this difference was not statistically significant (P = 0.34). Conclusion: Both diamond- and zirconium nitride-coated ultrasonic tips resulted in more number of dentinal crack formation and propagation when preexisting cracks were present.

Objectives: The study was aimed at evaluating the antimicrobial efficacy of 20% Punica granatum, 0.2% chlorhexidine (CHX) gluconate, and 2.5% sodium hypochlorite used alone or in combinations against Enterococcus faecalis. Materials and Methods: Aqueous extract of pomegranate peel was prepared in the Pharmacology Departmental Laboratory. A total of 240 wells were prepared (40 for each group) with 5 wells per with a diameter of 6 mm and depth of 4 mm at equidistant from each other. Using a pipette, each well was filled with 50 μl of the test irrigant solution. CHX (0.2%), 2.5% sodium hypochlorite, and aqueous extract of pomegranate peel and their combinations were tested as root canal irrigants against a standard strain of E. faecalis (ATCC 29212) on sheep blood agar plate by calculating the zones of inhibition. The mean diameter of zones was calculated and tabulated. Data were analyzed using one-way analysis of variance and Tukey's post hoc test. Descriptive statistics was obtained using SPSS software (version 11.5) with P established at < 0.05. Results: Combination of Punica granatum with sodium hypochlorite and CHX showed maximum mean zones of inhibition with mean of 23.9 and 25.7 mm, respectively, and showed significantly better results than all other groups either irrigants used alone or in combinations. Conclusions: Punica granatum and CHX was proved to be a very good combination among experimental groups against E. faecalis, and sodium hypochlorite was least effective against E. Faecalis.

Introduction: Resin-based composites (RBCs), as restorative dental materials, have given a new dimension to conservative and esthetic dentistry. The objective of the present study is to evaluate and compare the depth of cure of RBC's for posterior use: Sculptable bulk-fill composite – Tetric N-Ceram bulk fill (TNCBF), Flowable bulk-fill composites-TetricEvoflow bulk fill (TEFBF), Surefil SDR bulk fill (SDRBF), Dual cure bulk fill-Fill-Up (FDCBF) with conventional RBC-Esthet-X flow (EXF) and Filtex Z250 (FZ). Materials and Methods: A standardized polyacrylic mold was bulk filled with each of the six composites and light-cured for 20 s, followed by 24 h storage in water. The surface hardness was measured on the top and the bottom by recording Vickers hardness number by Vickers hardness indenter. Results: The mean bottom surface hardness value (HV) of SDR and TEFBF exceeded 80% of the top surface HV (HV-80%). Low viscosity bulk-fill composites (SDR and Tetric Evoflow) were properly cured in 4-mm increments. The TNCBF, high-viscosity composite, and Fill-Up, dual-cure bulk fill were not sufficiently cured in 4-mm increments. Conclusion: With increase in incremental thickness, HV decreased for the conventional resin composite but generally remained constant for the bulk-fill resin composites.

Aims: The aim of this study is to determine the mean failure load for each postsystem and the relationship between post lengths with the mean failure loads. Materials and Methods: Ninety single-rooted decoronated mandibular premolar teeth were endodontically treated and randomly assigned to three groups with respect to their post length (2/3^rd and ½ of the root length). The first two groups were randomly divided into four subgroups, restored with the following postsystem: polyethylene-woven fiber posts, glass fiber tape, prefabricated carbon, and glass fiber posts. A composite core with no post served as control. All posts were cemented using dual-cure resin cement, and the same was used for core buildup. The standard cores were formed in each group. All the specimens were tested in a universal testing machine, and the load was calculated. Results: One-way analysis of variance (ANOVA) showed that prefabricated glass fiber post had significantly highest fracture resistance when compared to other prefabricated and custom fiber-reinforced composite posts. Two-way ANOVA demonstrated no significant difference among the post lengths. Conclusion: The results of this study showed that glass fiber posts showed higher fracture load, but post length did not significantly increase the fracture resistance of endodontically treated teeth.

Background: The endodontic spacers are placed between the endodontic appointments or after completion of the endodontic therapy, and until the placement of a definitive restoration. Aims: The aim of this study was to evaluate the sealing ability of polytetrafluoroethylene (PTFE) access spacer against microbial leakage and to compare it with that of a cotton pellet. Materials and Methods: Fifty-two extracted human single-rooted premolars were divided into two experimental groups (n = 20) according to the endodontic spacer; cotton pellet or PTFE tape, and two control groups (n = 6). Following standardized access cavity, cleaning, and shaping procedures, the access cavities received a standardized thickness of the spacer material followed by a Cavit restoration in all the teeth except for the positive controls, which were left empty. Negative controls had the root surfaces completely sealed with nail polish. A dual-chamber microbial leakage model was used with Enterococcus faecalis as the test strain. At days 7 and 30, samples of the lower chambers' solution were obtained and subjected to the quantitative real-time polymerase chain reaction (qPCR) analysis to quantify bacterial levels. Furthermore, broth turbidity in the lower chambers was recorded weekly. The Mann–Whitney U test and Wilcoxon test were used to compare E. faecalis counts between and within groups, respectively. Results: At days 7 and 14, the experimental groups leaked similarly as determined by broth turbidity. However, at days 21 and 30, a significantly higher number of cotton pellet samples exhibited microbial leakage. Analysis by qPCR revealed higher levels of E. faecalis counts in cotton pellet samples compared with PTFE samples. This difference was statistically significant at day 7, but not at day 30. Conclusions: PTFE spacer showed improved sealing ability compared with the commonly used cotton pellet and may serve as an alternative endodontic access cavity spacer.

Aim: The purpose of this study was to evaluate the effect of 17% ethylenediaminetetraacetic acid (EDTA) and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate (MTA). Materials and Methods: Midroot dentin of single-rooted human canine teeth were sectioned into 2-mm-thick slices horizontally (n = 60). The canal space of each dentin slice was enlarged with a 1.3-mm-diameter diamond bur. The samples were divided into two groups (n = 30) based on the type of perforation repair material placed, i.e., Biodentine and ProRoot MTA. The samples were wrapped in wet gauge for 10 min, and based on the type of chelating agent used for removal of smear layer, each group is further divided into three subgroups (n = 10), to be immersed into saline (control), 17% EDTA and 0.2% chitosan for 30 min, and a wet cotton pellet was placed over each test material. After 48 h of incubation, the dislodgement resistance of the samples was measured using a universal testing machine. Statistical Analysis: Data were analyzed using one-way analysis of variance and post hoc Tukey tests. The level of statistical significance was set at 0.05. Results: Biodentine showed significantly higher pushout bond strength than ProRoot MTA. Biodentine and ProRoot MTA lost strength when exposed to 0.2% chitosan. Conclusion: Biodentine showed considerable performance as a perforation repair material than ProRoot MTA even after being exposed to various endodontic chelating agents.

Background: Root-end resection followed by retrofilling is one of the prime requisites to avoid apical microleakage. Aim: It comparatively evaluated the microleakage after root-end resection by erbium, chromium:yttrium, scandium, gallium, and garnet laser and carbide bur with or without placement of mineral trioxide aggregate (MTA). Materials and Methods: In this study, 60 maxillary central incisors were decoronated and biomechanically prepared. Out of 60 samples, 48 were included in the experimental group while the rest 12 were in the control group. The samples in the experimental group were obturated, whereas the samples in the control group were not obturated. The experimental group samples were divided into two: one group resected with the laser and the other half resected with carbide bur. These groups were further subdivided into two – one group retrofilled with MTA and the other half without MTA. The control group had both laser- and carbide bur-resected samples with positive and negative controls. All the samples were dyed, decalcified, and cleared. Digital photograph of each sample was taken, and the area of dye penetration was measured with the help of ImageJ software. Statistical Analysis: Analysis of variance and Tukey's test were done. Results: The highest microleakage was seen in carbide without MTA and the least was seen with laser with MTA. Conclusion: Laser-resected MTA-retrofilled samples showed minimum leakage.

Context: The use of mineral trioxide aggregate (MTA) and Biodentine as a root-end filling materials used in the root-end cavities prepared by laser or ultrasonic technique is a current topic in the branch of dentistry and push-out bond strength is used to measure the adhesiveness provided by the root-end filling materials. Aim: The aim of this study is to evaluate the push-out bond strength of MTA and Biodentine in root-end cavities prepared by erbium:yttrium-aluminium-garne (Er:YAG) laser and ultrasonic retrotip. Materials and Methods: A total of 40 extracted maxillary central incisors and canines were selected. Chemomechanical preparation and obturation were done. Root-end resections were performed followed by the root-end cavity preparation and root-end filling. Specimens were divided into four groups. Root-end cavities prepared by Er:YAG laser and filled with MTA, root-end cavities prepared by Er:YAG laser and filled with Biodentine, root-end cavities prepared by ultrasonic retrotip and filled with MTA and root-end cavities prepared by ultrasonic retrotip and filled with Biodentine, respectively. The apical end was again sectioned perpendicular to the long axis. The push-out bond strength was evaluated using a universal testing machine. Statistical Analysis Used: The data were analyzed using the analysis of variance and post hoc Tukey test. Results: Difference between push-out bond strength of root-end filling materials to root-end cavity walls prepared by laser and ultrasonic retrotips was statistically nonsignificant. Push-out bond strength of MTA and Biodentine did not differ significantly. Conclusion: Difference between push-out bond strength of MTA and Biodentine to root-end cavity walls prepared by Er:YAG Laser or ultrasonic retrotip were statistically nonsignificant.

This clinical report describes the enamel microabrasion technique for removing maxillary and mandibular hard fluorotic enamel stains followed by home-monitored home dental bleaching. The removal of fluorotic enamel stains utilized macroabrasion with a water-cooled, fine-tapered 3195 FF diamond bur followed microabrasion with the application of Prema Compound (Premier Dental Products Co, Norristown, PA, USA). Home-monitored dental bleaching was performed 14 days after enamel microabrasion using a 10% carbamide peroxide gel for 2 h/day. The wearing time of the acetate tray/dental bleaching was quantified by a microsensor from TheraMon microelectronic system (Sales Agency Gschladt, Hargelsberg, Austria) that was completely embedded in the acetate trays. The teeth were bleached effectively during 23 days. The mean wearing time of the acetate trays/dental bleaching product was 1.54 h/day, for the upper and lower arches. The patient reported satisfaction with the treatment. The association of enamel microabrasion and home dental bleaching was an excellent clinical treatment for teeth affected with enamel fluorosis.