Root canal therapy has been practiced ever since 1928 and the success rate has tremendously increased over the years owing to various advancements in the field. One main reason is the complete understanding of the microbiology involved in the endodontic pathology. This has helped us to modify the conventional treatment plans and effectively combat the microorganisms. Now, studies are aiming to explore the characteristics of the "most" resistant organism and the methods to eliminate them. This article gives an insight of the microbiology involved in endodontic pathology and discusses its role in our treatment procedure. Information from original reviews listed in PubMed, published from 1995 to 2010, has been mainly included in this review.

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In vitro studies form a pivotal role in dental research contribution to a substantial evidence base. The reporting standards of these studies are not uniform thus resulting in lacunae in evidence reported. The effort of this concept note is to propose a Checklist for Reporting in vitro Studies (CRIS guidelines) that would promote quality and transparency in reporting in vitro studies.

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In the last few decades, there have been tremendous advances in the mechanical properties and methods of fabrication of ceramic materials. While porcelain-based materials are still a major component of the market, there have been moves to replace metal ceramics systems with all ceramic systems. Advances in bonding techniques have increased the range and scope for use of ceramics in dentistry. In this brief review, we will discuss advances in ceramic materials and fabrication techniques. Examples of the microstructure property relationships for these ceramic materials will also be addressed.

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Aim: This in vitro study was conducted on enamel blocks of human premolars with the aim of evaluating the remineralization potential of fluoride and ACP-CPP and the combination of ACP-CPP and fluoride on early enamel lesions. Materials and Methods: Fifteen intact carious free human premolars were selected. The coronal part of each tooth was sectioned into four parts to make 4 enamel blocks. The baseline SMH (surface microhardness) was measured for all the enamel specimens using Vickers microhardness (VHN) testing machine. Artificial enamel carious lesions were created by inserting the specimens in demineralization solution for 3 consecutive days. The SMH of the demineralised specimens was evaluated. Then the four enamel sections of each tooth were subjected to various surface treatments , i.e. Group 1- Fluoride varnish, Group 2- ACP-CPP cream, Group 3- Fluoride + ACP-CPP & Group 4- Control (No surface treatment). A caries progression test (pH cycling) was carried out, which consisted of alternative demineralization (3hours) and remineralization with artificial saliva (21 hours) for five consecutive days. After pH cycling again SMH of each specimen was assessed to evaluate the remineralization potential of each surface treatment agent. Then, to asses the remineralization potential of various surface treatments at the subsurface level, each enamel specimen was longitudinally sectioned through the centre to expose the subsurface enamel area. Cross-sectional microhardness (CSMH) was evaluated to assess any subsurface remineralization Results: Statistical analysis using one-way ANOVA followed by multiple comparisons test was applied to detect significant differences at P ≤ 0.05 levels between various surface treatments at different phases. Conclusions: With in the limits, the present study concludes that; ACP-CPP cream is effective, but to a lesser extent than fluoride in remineralizing early enamel caries at surface level. Combination of fluoride and ACP-CPP does not provide any additive remineralization potential compared to fluoride alone. Fluoride, ACP-CPP and their combination are not effective in remineralizing the early enamel caries at the subsurface level.

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Aim: The aim is to review and discuss the strategies available for use of platelet rich fibrin as healing aid in dentistry. Background: Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after a certain time and that can serve as a resorbable membrane. Choukroun and his associates were amongst the pioneers for using PRF protocol in oral and maxillofacial surgery to improve bone healing in implant dentistry. Autologous PRF is considered to be a healing biomaterial, and presently, studies have shown its application in various disciplines of dentistry. Materials and Methods: By using specific keywords, electronic search of scientific papers was carried out on the entire PubMed database with custom range of 5 years. The electronic search yielded 302 papers; based on inclusion and exclusion criteria which were specifically predetermined, 72 papers were identified as suitable to the inclusion criteria and the remaining 230 papers were excluded. After adding three more selected papers through hand search, full text of all the articles retrieved and review was done. By pooling the extracted data from selected papers, the reviewed data was synthesized. Conclusion: Recently by showing good promising results with use of the PRF, it has proved to have a good prospect for its use as healing aid in various aspects of the dentistry.

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Background: Macro-bond strength tests resulted in cohesive failures and overestimation of bond strengths. To reduce the flaws, micro-bond strength tests were introduced. They are the most commonly used bond-strength tests. Objective: Thus the objective of this review is to critically review the reliability of micro-bond strength tests used to evaluate resin-tooth interface. Data Collection: Relevant articles published between January 1994 and July 2013 were collected from Pubmed database, Google scholar and hand searched journals of Conservative Dentistry, Endodontics and Dental materials. Data Synthesis: Variables that influence the test outcome are categorized into substrate related factors, factors related to specimen properties, specimen preparation and test methodology. Impact of these variables on the test outcome is critically analyzed. Conclusion: Micro-bond tests are more reliable than macro-bond tests. However, no standard format exists for reporting the bond strength tests which could lead to misinterpretation of the data and bonding abilities of adhesives.

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Adhesive systems are selected based on their bond strengths achieved while testing in laboratories. These bond strengths can predict the longevity of a restoration to some extent. There were several discrepancies in the reported bond strengths. To critically review the reliability of macro-bond strength tests used to evaluate resin-tooth interface. Relevant literature published between January 1983 and May 2013 was collected from PubMed database, Google scholar, and hand-searched journals of Conservative Dentistry, Endodontics and Dental materials. Variables that influence the test outcome are categorized into substrate-related factors, factors related to specimen properties, preparation of specimens, and test methodology. Impact of these variables on the test outcome is critically analyzed. There is lack of a standard format for reporting the bond strength tests, which could lead to misinterpretation of the data and bonding abilities of adhesives.

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Dentinal hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. It can affect patients of any age group and most commonly affects the canines and premolars of both the arches. This article concisely reviews the patho-physiology, mechanism and clinical management of the DH. Treatment of DH should start with an accurate diagnosis. Differential diagnosis should be made and all other probable causes should be excluded. An often neglected phase of clinical management of DH is the identification and treatment of the causative factors of DH. By removing the etiological factors, the condition can be even prevented from occurring or recurring. There are various treatment modalities available which can be used at home or may be professionally applied. The "at home" desensitizing agents include toothpastes, mouthwashes or chewing gums and they act by either occluding the dentinal tubules or blocking the neural transmission. This article also discusses the recent treatment options like bioglass, Portland cement, lasers and casein phosphopeptide.

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Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal. Of these three essential steps of root canal therapy, irrigation of the root canal is the most important determinant in the healing of the periapical tissues. The primary endodontic treatment goal must thus be to optimize root canal disinfection and to prevent reinfection. In this review of the literature, various irrigants and the interactions between irrigants are discussed. We performed a Medline search for English-language papers published untill July 2010. The keywords used were 'root canal irrigants' and 'endodontic irrigants.' The reference lists of each article were manually checked for additional articles of relevance.

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Context : Vital pulp therapy has been known as one of the treatment options to preserve pulp after being exposed by trauma or caries. Aim : To investigate human pulpal response to white and grey mineral trioxide aggregate (WMTA, GMTA) and Dycal (MTA) as pulp capping agents. Setting and Design : Human volunteers were participated in this randomized clinical trial. Materials and Methods : This study was conducted on 90 intact first and second premolars of human maxillary and mandibular teeth. The teeth were randomly assigned into three groups of 30 each. Under local anesthesia, teeth were exposed and capped either with GMTA, WMTA, or Dycal. After 30, 60, and 90 days 10 teeth of each group were extracted and prepared for histologic observation. Statistical Analysis : Histopathologic data were analyzed by χ², Kruskal Wallis and Mann Whitney tests. Results : the calcified bridge in teeth that were capped with GMTA was significantly thicker than Dycal at 30 and 60 days (P= 0.015 and P=0.002, respectively); whereas WMTA showed significantly thicker calcified bridge than Dycal at 90 days (P=0.02). In addition, GMTA specimens showed significantly less inflammation compared to Dycal samples at 90 days interval (P=0.019). No significant difference was found between GMTA and WMTA in terms of calcified bridge thickness and pulp inflammatory response to the capping materials (P>0.05). Conclusions : Based on the result of this study, both types of MTA can be suggested as the materials of choice for direct pulp capping procedure instead of Dycal as hard setting calcium hydroxide cement.

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Mineral trioxide aggregate (MTA) is composed of Portland cement, with 4:1 addition of bismuth oxide added so that the material can be detected on a radiograph. The cement is made up of calcium, silicon and aluminium. The main constituent phases are tricalcium and dicalcium silicate and tricalcium aluminate. There are two commercial forms of MTA, namely the grey and the white. The difference between the grey and the white materials is the presence of iron in the grey material, which makes up the phase tetracalcium alumino-ferrite. This phase is absent in white MTA. Hydration of MTA occurs in two stages. The initial reaction between tricalcium aluminate and water in the presence of calcium sulphate results in the production of ettringite. Tricalcium and dicalcium silicate react with water to produce calcium silicate hydrate and calcium hydroxide, which is leached out of the cement with time.

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A new emphasis on caries measurement and management is required for the dental community. The dental professionals need new approaches in caries detection, its assessment, and management. The future of research, practice, and education in Cariology requires the development of an integrated definition of dental caries, and uniform systems for measuring the caries process. Keeping this in view, the International Caries Detection and Assessment System (ICDAS) has presented a new paradigm for the measurement of dental caries, which was developed from the systematic reviews of literature on the clinical caries detection system and other sources. The ICDAS can serve as a basis and benchmark for clinical and epidemiological research and inform dental undergraduate and postgraduate teaching in Cariology. The ICDAS system was developed to bring forward the current understanding of the process of initiation and progression of dental caries to the fields of epidemiological and clinical research.

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An organized and systematic approach is required to evaluate, diagnose and resolve esthetic problems predictably. It is of prime importance that the final result is not dependent only on the looks alone. Our ultimate goal as clinicians is to achieve pleasing composition in the smile by creating an arrangement of various esthetic elements. This article reviews the various principles that govern the art of smile designing. The literature search was done using PubMed search and Medline. This article will provide a basic knowledge to the reader to bring out a functional stable smile.

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Regeneration of pulp-dentin complex in an infected necrotic tooth with an open apex is possible if the canal is effectively disinfected. The purpose of this case report is to add a regenerative endodontic case to the existing literature about using Platelet Rich Fibrin (PRF). A nine year old boy who accidently broke his immature maxillary central incisor tooth, developed pulpal necrosis with apical periodontitis. After the access cavity preparation, the canal was effectively irrigated with 20 ml of 5.25% sodium hypochlorite solution and 10ml of 0.2% chlorhexidine solution and dried with paper points. Triple antibiotic paste was placed inside the canal and left for 21 days. 12 ml of whole blood was drawn from the patient's right antecubital vein and centrifuged for 10 minutes to obtain the Choukroun's PRF. After the removal of the triple antibiotic paste, the PRF was placed into the canal till the level of cementoenamel junction and 3mm of grey MTA was placed directly over the PRF clot. The setting of MTA was confirmed 3 days later and the tooth was double sealed with GIC and Composite restoration.After 1 year the clinical examination revealed negative responses to percussion and palpation tests. The tooth responded positively to cold and electric pulp tests. Radiographic examination revealed continued thickening of the dentinal walls, root lengthening, regression of the periapical lesion and apical closure. On the basis of the results obtained in our case report we conclude that revitalization of necrotic infected immature tooth is possible under conditions of total canal disinfection and PRF is an ideal biomaterial for pulp-dentin complex regeneration.

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Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that “cures” or “stops” SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.

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Aim: The current in vitro study evaluated Vickers hardness (VK) and depth of cure (hardness ratio) of six resin composites, polymerized with a light-emitting diode (LED) curing unit by different polymerization modes: Standard 20 s, Standard 40 s, Soft-start 40 s. Materials and Methods: Six resin composites were selected for the present study: three microhybrid (Esthet.X HD, Amaris, Filtek Silorane), two nanohybrid (Grandio, Ceram.X mono) and one nanofilled (Filtek Supreme XT). The VK of the surface was determined with a microhardness tester using a Vickers diamond indenter and a 200 g load applied for 15 seconds. The mean VK and hardness ratio of the specimens were calculated using the formula: hardness ratio = VK of bottom surface / VK of top surface. Results: For all the materials tested and with all the polymerization modes, hardness ratio was higher than the minimum value indicated in literature in order to consider the bottom surface as adequately cured (0.80). Curing time did not affect hardness ratio values for Filtek Silorane, Grandio and Filtek Supreme XT. Conclusion: The effectiveness of cure at the top and bottom surface was not affected by Soft-start polymerization mode.

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Aim and Objectives: This in vitro study was designed to comparatively evaluate the antimicrobial efficacy of Curcuma longa (turmeric - T ₁ -10%, T ₂ -20%); Tachyspermum ammi (ajwain - A ₁ -10%, A ₂ -20%); chlorhexidine (CHX) gluconate gel (hexigel - 1%); and calcium hydroxide (10%) as intracanal medicaments against Enterococcus faecalis. Materials and Methods: Agar plates were prepared using brain-heart infusion (BHI) agar. Cultures of E. faecalis were grown in BHI broth at 37°C. Well diffusion method was used to derive results. Plates were inoculated for 72 h at 37°C and microbial zones of inhibition were recorded. Statistical analysis was performed with repeated measures analysis of variance. Results: C. longa (T ₂ -20%) and CHX gluconate gel (hexigel - CHX-1%) showed larger zones of microbial inhibition than C. longa (T ₁ -10%) that were statistically significant (P < 0.05) and were highly significant when compared to T. ammi (ajwain - A ₁ and A ₂ ) and calcium hydroxide. Conclusion: C. longa can be used as intracanal medicament in endodontic failure cases.

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Aims: The aim of this study was to evaluate and compare the remineralization potential of bioactive-Glass (BAG) (Novamin^; /Calcium-sodium-phosphosilicate) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) containing dentifrice. Materials and Methods: A total of 30 sound human premolars were decoronated, coated with nail varnish except for a 4 mm Χ 4 mm window on the buccal surface of crown and were randomly divided in two groups (n = 15). Group A - BAG dentifrice and Group B - CPP-ACP dentifrice. The baseline surface microhardness (SMH) was measured for all the specimens using the vickers microhardness testing machine. Artificial enamel carious lesions were created by inserting the specimens in de-mineralizing solution for 96 h. SMH of demineralized specimens was evaluated. 10 days of pH-cycling regimen was carried out. SMH of remineralized specimens was evaluated. Statistical Analysis: Data was analyzed using ANOVA and multiple comparisons within groups was done using Bonferroni method (post-hoc tests) to detect significant differences at P < 0.05 levels. Results: Group A showed significantly higher values (P < 0.05) when compared with the hardness values of Group B. Conclusions: Within the limits; the present study concluded that; both BAG and CPP-ACP are effective in remineralizing early enamel caries. Application of BAG more effectively remineralized the carious lesion when compared with CPP-ACP.

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Aim: The aim of this study was to evaluate the antimicrobial efficacy of Aloe vera and to determine its effectiveness in decontaminating gutta percha cones. Materials and Methods: A concentrated extract of Aloe vera was used to check for the antimicrobial efficacy using the agar well diffusion method. Presence of zones' of diffusion was identified against three common GP contaminants namely, E.coli, E.faecalis and Staph. aureus. New GP Cones, freshly taken out of the packet were then decontaminated for 1minute using Aloe vera gel and then placed in thioglycolate broth to check for the presence of turbidity. Results: The zones of inhibition on the agar plate were measured as 24mm,21mm and 24mm respectively. The broth remained clear even after 48 hours of incubation. Conclusion: We conclude that Aloe vera is indeed effective as a GP decontaminant and it holds a promising future as a medium for storage of GP cones.

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The success of restorative dentistry is determined on the basis of functional and esthetic results. To achieve esthetics, four basic determinants are required in sequence; viz., position, contour, texture and color. The knowledge of the concept of color is essential for achieving good esthetics. This review compiles the various aspects of color, its measurements and shade matching in dentistry.

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The aim of this case series was to determine the clinical and radiographic success rate of pulpotomy, with new endodontic cement (NEC), in human mature permanent molar teeth. Twelve molars with established irreversible pulpitis were selected from patients 14 - 62 years old. The selection criteria included carious pulp exposure with a positive history of lingering pain. After isolation, caries removal, and pulp exposure, pulpotomy with NEC was performed and a permanent restoration was immediately placed. At the first recall (+1 day) no patients reported postoperative pain. One wisdom tooth had been extracted after two months because of failure in coronal restoration. Eleven patients were available for the second recall, with a mean time of 15.8 months. Clinical and radiographic examination revealed that all teeth were functional and free of signs and symptoms. Histological examination of the extracted teeth revealed complete dentin bridge formation and a normal pulp. Although the results favored the use of NEC, more studies with larger samples and a longer recall period were suggested, to justify the use of this novel material for treatment of irreversible pulpitis in human permanent molar teeth.

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Objective: To evaluate the cervical marginal and internal adaptation of posterior bulk fill resin composites of different viscosities, before and after thermo-cycling (TMC). Materials and Methods: Eighty box-only class II cavities were prepared in 40 extracted human premolars with the distal proximal box beneath the enamel-cementum junction (CEJ). The teeth in the experimental groups were restored with bulk fill resin composite restorations (Gr. I- Sonic Fill, Gr. II- SDR, Gr. III- Tetric N Ceram Bulk Fill or a conventional composite designed for 2-mm increments (Gr. IV- Tetric N Flow along with Tetric N Ceram). Before and after thermal cycling, the gap-free marginal length was analyzed using SEM of epoxy resin replicas. After thermal cycling, specimens were cut longitudinally in order to investigate internal dentine adaptation by epoxy replicas under SEM (500 × magnification). Results: Statistical analysis was performed using the ANOVA and Tukey Post Hoc tests (P < 0.05). In enamel, high percentages of gap-free margins were initially identified for all the groups, which declined after thermal cycling. However, no significant differences were identified among any of the groups (P > 0.05). In dentine, bulk fill groups performed at par with the incremental placement; for both marginal and internal adaptation (P < 0.05), for all materials except Tetric N Ceram Bulk Fill. Conclusions: Viscosity of the bulk fill restorative material influenced the proportion of gap-free marginal interface and the internal adaptation in dentin.

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Various authors have demonstrated the regenerative process in immature, non vital teeth by revascularization induced maturogenesis. The aim of this case report is to compare calcium hydroxide apexification and pulp revascularization induced maturation procedures in the same patient, in two different teeth. The right maxillary central incisor in this individual was treated with conventional calcium hydroxide induced apexification procedure followed by guttaperchaobturation, and the left maxillary central incisor was treated by pulp revascularization induced maturation procedures. 24 months follow-up shows root elongation and apical closure in the tooth treated with revascularization induced maturation procedures. Revascularization induced maturogenesis, where indicated, can provide several advantages over conventional apexification procedures.

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Aesthetic dentistry continues to evolve through innovations in bonding agents, restorative materials, and conservative preparation techniques. The use of direct composite restoration in posterior teeth is limited to relatively small cavities due to polymerization stresses. Indirect composites offer an esthetic alternative to ceramics for posterior teeth. This review article focuses on the material aspect of the newer generation of composites. This review was based on a PubMed database search which we limited to peer-reviewed articles in English that were published between 1990 and 2010 in dental journals. The key words used were 'indirect resin composites,' composite inlays,' and 'fiber-reinforced composites.'

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While the regeneration of a lost tissue is known to mankind for several years, it is only in the recent past that research on regenerative medicine/dentistry has gained momentum and eluded the dramatic yet scientific advancements in the field of molecular biology. The growing understanding of biological concepts in the regeneration of oral/dental tissues coupled with experiments on stem cells is likely to result in a paradigm shift in the therapeutic armamentarium of dental and oral diseases culminating in an intense search for "biological solutions to biological problems." Stem cells have been successfully isolated from variety of human tissues including orofacial tissues. Initial evidence from pioneering studies has documented the likely breakthrough that stem cells offer for various life-threatening diseases that have so far defeated modern medical care. The evidence gathered so far has propelled many elegant studies exploring the role of stem cells and their manifold dental applications. This review takes you on a sojourn of the origin of stem cells, their properties, characteristics, current research, and their potential applications. It also focuses on the various challenges and barriers that we have to surmount before translating laboratory results to successful clinical applications heralding the dawn of regenerative dentistry.

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