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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Introduction: To promote the remineralization by ionic exchange mechanism instead of invasive techniques many remineralizing agents can be used. Objective: To evaluate the remineralization effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSLs) and its inhibitory effect on Streptococcus mutans colonization. Materials and Methods: The study group consisted of 60 subjects exhibiting at least 1-WSL. Subjects were randomly divided into 2 groups: A test group using CPP-ACP cream (GC-Tooth Mousse, Leuven, Belgium) and a control group using only fluoride containing toothpaste for a period of 3-month. Baseline WSLs were scored using DIAGNOdent device (KaVo Germany) and the saliva samples were collected to measure S. mutans counts. After the 3-month period the WSLs were again recorded and the saliva collection was repeated. Result: DIAGNOdent measurements were increased by time (P = 0.002) in the control group and no statistically significant difference (P = 0.217) was found in the test group by the 3-month period. In both groups, the mutans counts were decreased in the 3-month experimental period. Conclusion: These clinical and laboratory results suggested that CPP-ACP containing cream had a slight remineralization effect on the WSL in the 3-month evaluation period however, longer observation is recommended to confirm whether the greater change in WSLs is maintained.

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Aim: The aim of this study was to evaluate the remineralizing potential of three different remineralizing agents (GC tooth Mousse, Clinpro tooth crθme and SHY-NM) on demineralized tooth surfaces using micro CT and microhardness. Materials and Methods: Forty five freshly extracted mandibular premolars were collected and enamel specimens were prepared. The samples were assigned to three groups with fifteen specimens in each group. The specimens were then demineralized using McInne's demineralizing solution in two cycles. After that, remineralization was carried out in two cycles for 30 days using Casein phosphopeptide - Amorphous calcium phosphate (CPP - ACP), 0.21% sodium fluoride - Tricalcium phosphate (f-TCP) and Calcium Sodium Phosphosilicate (CSP) containing tooth pastes for groups I, II, III respectively. The specimens were evaluated for Linear attenuation co-efficient using micro CT (Scanco ^TM ) and Vicker's Micro Hardness (Schimadzu ^TM ) testing at different time periods. The results were tabulated and statistically analysed. Results: It was observed that all the three remineralizing agents used in the study significantly increased the Linear Attenuation Co-efficient and Vicker's hardness number values of the enamel specimens following 15 days and 30 days application. Conclusion: CPP - ACP showed the better remineralizing potential than the other two agents and there was no statistical significant difference between f-TCP and CSP groups.

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Aim: The aim of this study was to assess the antibacterial efficacy of three different herbal irrigants against Enterococcus faecalis. Materials and Methods: Single rooted teeth were extracted due to orthodontic and periodontal reasons. The teeth were then inoculated with E. faecalis. The teeth were randomly divided into three experimental groups and two control groups of six samples each. Group 1 specimens were treated with 5.2% sodium hypochlorite (NaOCL) for 30 min followed by 5 mmol/L Ethylenediaminetetraacetic acid (EDTA) for 5 min and saline as final irrigant. Group 2 specimens were treated with and 5.2% NaOCl for 30 min as final irrigant. Group 3 were treated with Morinda citrifolia (MC) for 30 min as final irrigant. Group 4 were treated with Azadiracta indica (AI) as final irrigant. Group 5 were treated with green tea (GT) for 30 min as final irrigant. The dentin specimens were carefully spread onto a microscope slide and stained with BacLight and examined in a confocal laser scanning microscope set to monitor fluorescein isothiocyanate and propidium iodide. A total of nine fields were examined for each treatment and the bacteria presented were counted. Statistical Analysis: Using the one-way ANOVA with multiple comparison, significantly less bacteria were found adhering to the samples treated with Neem followed by NaOCL, GT, MC, Saline. Results: AI treatment produced the maximum reduction in adherence of E. faecalis to dentin (9.30%) followed by NaOCl (12.50%), GT (27.30%), MC (44.20%) and saline (86.70%). Conclusion: Neem is effective in preventing adhesion of E. faecalis to dentin.

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Background: Sealers are used to attain an impervious seal between the core material and root canal walls. Aim: To compare the depth and percentage of sealer penetration with three different placement techniques using confocal laser scanning microscopy as the evaluative tool. Materials and Methods: Root canals of 30 single-rooted teeth were prepared to a size of F3 and AH plus sealer with Rhodamine B was applied with Ultlrasonic file (Gr-1), lentulospiral (Gr-2), and Endoactivator (Gr-3). Canals were obturated with gutta-percha. The roots were sectioned at the 3 and 6-mm levels from the apical foramen and were examined on a confocal microscope. Results: A statistical significant differences among Gr-1, Gr-2, and Gr-3 were found at the 3 and 6-mm level (P < 0.05; ANOVA-Tukey tests) for the depth and percentage of sealer penetration except for Gr-1 and Gr-2 at 3-mm level. Gr-1 showed maximum mean depth of penetration (810 μm) and maximum mean percentage of sealer penetration (64.5) while Gr-3 showed minimum mean depth of penetration (112.7 μm) and minimum mean percentage of sealer penetration (26.7). Conclusion: Depth and percentage of penetration of sealer is influenced by the type of placement technique and by the root canal level with penetration decreasing apically.

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Objective: Early detection of smooth surface lesions is important for appropriate management and monitoring of dental caries. The purpose of this in vitro study was to evaluate the efficacy of laser fluorescence to detect demineralization and remineralization of smooth enamel surfaces. Materials and Methods: In this in vitro study, 132 enamel blocks of semi-impacted human third molars were obtained; artificial caries lesions were induced and they were submitted to the pH-cycling process to create remineralization. Superficial microhardness (SMH) and laser fluorescence (LF) analysis were performed at baseline, after demineralization, and remineralization processes. The data were analyzed by Statistical Package for Social Sciences (SPSS)-16 using analysis of variance (ANOVA), Paired samples t-test, and Pearson's correlation test. Results: There was a significant difference between SMH values at baseline, after demineralization and after remineralization. Also, a statistically significant difference was observed between LF values in these three stages. The LF values increased after demineralization and then decreased after remineralization, and the SMH values decreased after demineralization and increased after remineralization. There was an inverse relationship between SMH and LF only at baseline and after demineralization, but not after remineralization. Conclusion: The results showed that LF is an appropriate method for detection of demineralization in an in vitro condition in smooth enamel lesions, but it was not so efficient in the detection of remineralization.

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Aim: This in vitro study compared the coronal discoloration effect of three endodontic sealers at short-time intervals. Materials and Methods: The crowns of 50 extracted premolars were cut and their pulp chambers were cleaned and randomly divided into five groups ( n = 10). The following materials were placed into the pulp chambers: Group I: AH Plus, group II: Apexit Plus, group III: Sultan, group IV: Amalgam, and group V: Distilled water. The color of the crowns was measured using Shadepilot ^TM spectrophotometer (DeguDent, Hanau, Germany) prior and after the placement of experimental materials within pulp chambers. Color changes (ΔE values) and shades were recorded in 3, 10, and 17 days. A Kruskal-Wallis and Mann-Whitney tests were used to assess significant differences between the sealers. Wilcoxon test was used to compare color changes at different periods within each group. Results: All sealers showed significant discoloration effect that increased over the time. At the end of the observation period, Apexit Plus showed the lowest coronal discoloration effect (ΔE = 6.38 ± 0.55). Conclusions: All sealers used in the current study may cause a progressive coronal discoloration effect over 10-17 days. Apexit Plus sealer showed the lowest coronal discoloration effect.

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Background: Surgical endodontic therapy comprises of exposure of the involved root apex, resection of the apical end of the root, preparation of a class I cavity, and insertion of a root end filling material. Mineral trioxide aggregate (MTA) is now the gold standard among all root end filling materials. MTA is however difficult to handle, expensive and has a very slow setting reaction. Aim: (1) To compare the sealing ability of MTA, polymethylmethacrylate (PMMA) bone cement and CHITRA Calcium phosphate cement (CPC) when used as root end filling material using Rhodamine B dye evaluated under a confocal laser scanning microscope. (2) To compare the seal of root ends prepared using an ultrasonic retroprep tip and an Er: YAG laser using three different root end filling materials. Statistical Analysis: Statistical analysis was performed using a one-way ANOVA and a two-way ANOVA, independent samples t-test and Scheffe's post hoc test using SPSS Version 16 for Windows. Results: All the three materials, namely MTA, PMMA BONE CEMENT and CHITRA CPC, showed microleakage. Comparison of microleakage showed maximum peak value of 0.86 mm for MTA, 0.24 mm for PMMA bone cement and 1.37 mm for CHITRA CPC. The amount of dye penetration was found to be lesser in root ends prepared using Er: YAG laser when compared with ultrasonics, but the difference was found to be not statistically significant. Conclusion: PMMA bone cement is a better material as root end filling material to prevent apical microleakage. MTA still continues to be a gold standard root end filling material showing minimum microleakage. Er: YAG laser is a better alternative to ultrasonics for root end preparations.

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Context: During biomechanical preparation, a smear layer is formed which occludes the openings of dentinal tubules and disfavors the penetration of irrigants. Hence, such layers should be removed. It becomes more challenging when we approach the apical third of the root canal. Aim: The aim was to compare the efficacy of different irrigants including ethylenediaminetetraacetic acid (EDTA), EDTA along with ultrasonication, citric acid, and mixture of tetracycline isomer, an acid, and a detergent (MTAD) as final irrigants where sodium hypochlorite (NaOCl) was used in each experimental group during root canal preparation with special emphasis on the apical third. Settings and Design: Forty-five human upper anterior teeth were selected and divided into one control group (group 1) and four experimental groups (group 2 to group 5), each containing nine teeth. All the four experimental groups were irrigated with 5.25% NaOCl solution during preparation, whereas test irrigants (5 mL) as the final solution used in each experimental group were 17% EDTA, 17% EDTA along with ultrasonication, 25% citric acid, and MTAD, respectively. The samples were prepared and observed under a scanning electron microscope (SEM). The photomicrographs were recorded and evaluated with a scoring system. Statistical Analysis Used: Data were analyzed using Kruskal-Wallis test and Dunn's test ( P = 0.05). Results: None of the combined irrigants was found completely effective. All the test irrigants including MTAD worked well in the middle and cervical third, whereas MTAD showed excellent results in the apical third as compared to the other groups.

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Aim: The objective of this survey was to study the level of awareness, current state of knowledge and opinions towards regenerative endodontic treatments amongst the endodontic residents of India. Settings and Design: Questionnaire based survey was designed. Materials and Methods: After approval from the organizing committee of 26 ^th Federation of Operative Dentistry of India and 19 ^th Indian Endodontic Society National conference 2011, 200 copies of the questionnaire were circulated amongst the endodontic residents in conservative dentistry and endodontics at various colleges across the country about regenerative endodontic procedures. The survey included profile of the respondents and consisted of 23 questions about their knowledge, attitude and opinions regarding use of these procedures as part of future dental treatment. Results: The survey showed that half the participants (50.6%) had received continued education in stem cells and/or regenerative dental treatments. The majority of participants were of the opinion (86.6%) that regenerative therapy should be incorporated into dentistry, and most of them (88%) were willing to acquire training in learning this new treatment strategy. The results indicated that half of the participants (52.6%) were already using some type of regenerative therapy in their clinical practice; however, with a majority of these limited to use of membranes, scaffolds or bioactive materials. Conclusions: These results reflect that endodontic residents are optimistic about the use of regenerative endodontic procedures; however, a need for more research and training was felt.

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This case report demonstrates the benefits of utilizing Cone Beam Computed tomography (CBCT) in the assessment and mineral trioxide aggregate (MTA) in the management of perforating internal resorption in a 54-year-old woman. The advent of CBCT has enhanced the clinician's ability to make a confirmatory diagnosis and determining the treatment plan before undertaking the actual treatment. Thorough cleaning and shaping of the root canal space and the resorptive defect was achieved by mechanical instrumentation, irrigation, and interim calcium hydroxide dressing. Following this obturation of the canal below, the resorptive defect was done with gutta percha using lateral and warm vertical condensation. The resorptive defect was filled with mineral trioxide aggregate. Follow-up intraoral periapical radiographs and CBCT scans at 6 months showed adequate repair of the resorption and periapical rarefaction and the tooth remained asymptomatic.

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Aim: The purpose of this study was to evaluate the comparative antibacterial efficacy of Biopure MTAD, Metapex, Metronidazole, and Aztreonam against two obligate anerobic bacteria. Materials and Methods: Antimicrobial efficacy of selected medicaments against two obligate anaerobic bacteria Bacteroides fragilis and Propionibacterium acnes was done by Agar disc-diffusion method. Pre-sterilized Whatman paper discs, 6 mm in diameter and soaked with the test solution, were prepared and placed onto the previously seeded agar Petri plates. Each plate was incubated in anaerobic jar for anerobic environment at 37°C for 48 hours. A zone of inhibition was recorded for each plate and the results were analysed statistically. Saline and ethanol used as control group in this study. Results: Biopure MTAD, Metapex and Metronidazole were effective against all the selected microorganisms. Aztreonam was effective against Bacteroides fragilis. Saline and ethanol used as control were ineffective. Conclusions: Metronidazole showed the superior antibacterial property amongst the tested medicaments.

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Aims: The aim of this in vitro study was to evaluate comparatively the effects of multiple autoclaving on surface topography and cyclic fatigue of three different rotary nickel-titanium (Ni-Ti) instruments. Materials and Methods: Twenty-one files each of Twisted Files (TF), Revo-S, and RaCe were used in this study. They were grouped as group 1-TF, group 2-Revo-S, and group 3-RaCe. All the files were autoclaved and subjected for scanning electron microscopic analysis and cyclic fatigue analysis. Results: Data were subjected to statistical analysis using one way analysis of variance (ANOVA) and post hoc Tukey's Kramer multiple comparison test. TF exhibited the highest cyclic fatigue resistance followed by Revo-S and RaCe. Scanning electron photomicrographs showed no obvious surface changes in the files after three autoclaving cycles. Conclusions: Within the limitation of this study, it can be concluded that Twisted Files was the most fatigue resistant compared to Revo-S and RaCe, and multiple autoclaving cycles did not have any significant alterations in the cyclic fatigue resistance of rotary Ni-Ti files.

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Objective: Home bleaching agents may not be safe for composite resins. The purpose of this study was to evaluate the effects of 10 and 20% Opalescence ^® PF home bleaching agents on the surface roughness and hardness of universal nanocomposite (Filtek Z350), anterior nanocomposite (KeLFiL), and nanohybrid composite (TPH 3). Materials and Methods: Fifty-four composite resin samples with 18 samples for each type of composite resin were prepared using acrylic molds (4 × 2 mm). Each type of composite resin was further divided into three groups [n = 6 controls were placed in distilled water for 14 days and the other two groups of n = 6 were bleached with 10 and 20% carbamide peroxide (CP), respectively for 14 days]. Surface hardness of the composite resin was tested with a Vickers hardness tester, whereas surface roughness was tested with atomic force microscopy (AFM). Results: There were significant changes in the surface hardness of KeLFiL and TPH 3. However, all the tested materials showed no significant changes in the surface roughness. Conclusion: After 14 days of home bleaching treatment, there was no adverse effect on the surface roughness of all three composite resins, although the surface hardness for KeLFiL and TPH 3 were significantly reduced.

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Aim: This aim of this study was to evaluate the number of bacteria extruded apically during root canal preparation using Four Rotary instrumentation techniques. Materials and Methods: A total of 50 extracted mandibular premolars were selected, access cavities prepared and inserted in to rubber stoppers of 10 mL glass vial. Root canals were contaminated with a suspension of Enterococcus faecalis (E. faecalis) American Type Culture Collection (ATCC) 29212 and incubated for 24 h at 37°C. Debris extruded from the apical foramen during instrumentation was collected into vials. The numbers of Colony-forming units were determined for each sample. Statistical Analysis: The data obtained were analyzed using the one-way ANOVA followed by post-hoc tukey's test with a P = 0.05 as the level for statistical significance. Results: Results suggested a statistically significant difference in the number of colony forming units between four experimental rotary Nickel-Titanium instrumentation groups ( P < 0.001). Conclusion: Although, extrusion of bacteria was found in all the experimental groups. There was less bacterial extrusion in K3 Group while more bacterial extrusion was seen in Mtwo Group.

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Aim: To evaluate the effect of three polishing protocols that could be implemented at recall on the surface roughness of two direct esthetic restorative materials. Materials and Methods: Specimens (n = 40) measuring 8 mm (length) × 5 mm (width) × 4 mm (height) were fabricated in an acrylic mold using two light-cured resin-based materials (microfilled composite and microhybrid composite). After photopolymerization, all specimens were finished and polished with one of three polishing protocols (Enhance, One Gloss, and Sof-Lex polishing systems). The average surface roughness of each treated specimen was determined using 3D optical profilometer. Next all specimens were brushed 60,000 times with nylon bristles at 7200 rpm using crosshead brushing device with equal parts of toothpaste and water used as abrasive medium. The surface roughness of each specimen was measured after brushing followed by repolishing with one of three polishing protocols, and then, the final surface roughness values were determined. Results: The data were analyzed using one-way and two-factor analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD). Significant difference (P < 0.05) in surface roughness was observed. Simulated brushing following initial polishing procedure significantly roughened the surface of restorative material (P < 0.05). Conclusion: Polishing protocols can be used to restore a smooth surface on esthetic restorative materials following simulated tooth brushing.

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Objective: The objective of this study was to evaluate the antibacterial effect of two hybrid restoratives, namely resin modified glass ionomer cement (GC Fuji II™ LC, GC Corporation, Tokyo, Japan) and giomer (Beautifil-II, Shofu Inc., Kyoto, Japan) against Streptococcus mutans [Microbial Type Culture Collection (MTCC), 890]. Materials and Methods: The antibacterial effect was evaluated using an agar diffusion test. The prepared wells in petri dishes were completely filled with chlorhexidine (positive control group), resin modified glass ionomer cement and giomer respectively. Prepared bacterial suspension was poured over the petri dish and was spread evenly using the plate spreader. The culture plates were placed in the incubator for 24 h at 37°C. The antibacterial activity was evaluated after 24 h, 48 h, and 7 days for each group in triplicates. Results and Conclusion: The results of the antibacterial effect of the tested materials were collected, statistically analyzed using the ANOVA test to determine the difference between the mean diameters of the inhibition zone produced. The mean zone of bacterial inhibition was found to be more with the giomer specimens at all time periods. However, this inhibitory activity showed a gradual decrease over a period of 7 days and the maximum inhibition was evident after 24 h with both the test materials.

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Objective: To evaluate the effect of 2% chlorhexidine (CHX) and 30% proanthocyanidin (PA) application on the immediate and long-term bond strength of simplified etch-and-rinse adhesives to dentin. Materials and Methods: One hundred twenty extracted human molar teeth were ground to expose the flat dentin surface. The teeth were equally divided into six groups according to the adhesives used, either Tetric N Bond or Solobond M and pretreatments given either none, CHX, or PA. Composite cylinder was bonded to each specimen using the respective adhesive technique. Half the samples from each group (n = 10) were then tested immediately. The remaining samples were tested after 6 month storage in distilled water. Results: The mean bond strength of samples was not significantly different upon immediate testing being in the range of 8.4(±0.7) MPa. The bond strength fell dramatically in the control specimens after 6 month storage to around 4.7(±0.33) MPa, while the bond strength was maintained in the samples treated with both CHX and PA. Conclusion: Thirty percent PA was comparable to 2% CHX with respect to preservation of the resin dentin bond over 6 months.

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Aim: To evaluate physical properties and cytotoxicity of pure gypsum-based (pure-GYP) and experimental gypsum-based biomaterials mixed with polyacrylic acid (Gyp-PA). The results were compared with calcium hydroxide (CH) and glass ionomer cement (GIC) for application as base/liner materials. Materials and Methods: Vicat's needle was used to measure the setting time and solubility (%) was determined by percentage of weight loss of the materials following immersion in distilled water. For cytotoxicity test, eluates of different concentrations of materials were obtained and pipetted onto L-929 mouse fibroblast cultures and incubated for 3 days. Cellular viability was assessed using Dimethylthiazol diphenyltetrazolium bromide test to determine the cytotoxicity level. Statistical significance was determined by one-way analysis of variance followed by post hoc test ( P < 0.05). Results: Setting time was significantly higher for pure-GYP and Gyp-PA; solubility test showed a similar tendency (pure-Gyp > Gyp-PA > CH = GIC). The pure-Gyp was found as the least cytotoxic materials at different concentrations. At 100 mg/mL dilutions of materials in growth medium highest cytotoxicity was observed with CH group. Conclusion: Cytotoxic effect was not observed with pure-Gyp; application of this novel biomaterial on deeper dentin/an exposed pulp and possibility of gradual replacement of this biodegradable material by dentin like structure would be highly promising.

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Anatomic variations in maxillary molars are frequent. These deviations are also one of the major cause for endodontic treatment failure owing to inadequate cleaning, shaping and sealing of root canal system. Diagnosis of such aberrations using newer imaging techniques like cone beam computed tomography is firmly advocated. The present paper highlights the root canal treatment of a rare case of type I canal morphology diagnosed with an aid of cone beam computed tomographic technique.

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Aim and Objective: To compare and evaluate the micro tensile bond strength of different solvent based one step and two step adhesive systems to dentin. Materials and Methods: Sixty recently extracted human mandibular premolars were subjected for the study and divided into 4 groups of fifteen each. The adhesive materials Single Bond, Prime and Bond XP, Clearfil S3 Bond and G-Bond were applied to flat dentin surfaces according to the manufacturer's instructions. After resin composite build up, teeth were sectioned to obtain beams with an approximate cross sectional area of 2 mm ² and stressed to failure. Data were analysed statistically by ANOVA and student Neuman Keuls multiple comparison tests. Results: The study demonstrated that Single Bond has better bond strength to dentin compared to the other adhesive systems. Conclusion: Ethanol and water based two-step adhesive Single Bond exhibited significantly higher microtensile bond strength values to dentin among all the adhesive systems tested.

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