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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Current rotary file systems are effective tools. Nevertheless, they have two main shortcomings:

1. They are unable to effectively clean and shape oval canals and depend too much on the irrigant to do the cleaning, which is an unrealistic illusion
2. They may jeopardize the long-term survival of the tooth via unnecessary, excessive removal of sound dentin and creation of micro-cracks in the remaining root dentin.

The new Self-adjusting File (SAF) technology uses a hollow, compressible NiTi file, with no central metal core, through which a continuous flow of irrigant is provided throughout the procedure. The SAF technology allows for effective cleaning of all root canals including oval canals, thus allowing for the effective disinfection and obturation of all canal morphologies. This technology uses a new concept of cleaning and shaping in which a uniform layer of dentin is removed from around the entire perimeter of the root canal, thus avoiding unnecessary excessive removal of sound dentin. Furthermore, the mode of action used by this file system does not apply the machining of all root canals to a circular bore, as do all other rotary file systems, and does not cause micro-cracks in the remaining root dentin. The new SAF technology allows for a new concept in cleaning and shaping root canals: Minimally Invasive 3D Endodontics.

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Introduction: Persistent infections of human root canals play a fundamental role in the failure of endodontic treatment. The purpose of this study is to determine the chemical composition of Myrtus communis (M. communis) essential oil and to assess its antimicrobial activity against Enterococcus faecalis, Staphylococcus aureus and Candida albicans compared to that of sodium hypochlorite (NaOCl) and chlorhexidine (CHX). Materials and Methods: Gas chromatography-mass spectrometry (GC-MS) was used to determine the chemical composition of essential oil from M. communis leaves. A micro-dilution susceptibility assay and disk diffusion methods were utilized to evaluate the antimicrobial activity [minimum inhibitory concentration (MIC) and minimum lethal dose concentration] of the tested solutions against selected microorganisms. Results: GC-MS analyses revealed that M. communis contained 1, 8-Cineole (28.62%), α-Pinene (17.8%), Linalool (17.55%), and Geranylacetate (6.3%) as the major compounds and Geraniol (1.6%), α-Humulene (1.5%), eugenol (1.3%), isobutyl-isobutyrate (0.8%), and methyl chavicol (0.5%) as minor components. Chlorhexidine had the lowest MIC value among all medicaments tested. M. communis oil had less MIC values than NaOCl against both bacteria, but it had more MIC value against C. albicans. Conclusion: M. communis essential oil with the minimum inhibitory concentration in the range of 0.032-32 μg/mL was an effective antimicrobial agent against persistent endodontic microorganisms.

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Aim: Photoactivated disinfection has been used as an adjunct to conventional endodontic treatment. Its use in regenerative endodontics is not reported in literature. The aim of this case report was to describe a new proposal for pulp revascularization with disinfection of pulp canal space using a unique combination of a photosensitizer solution and low-power laser light. Materials and Methods: A 9-year-old boy came with the chief complaint of discolored upper central incisors (#8, #9). A diagnosis of pulp necrosis was made on the basis of clinical and radiographic findings. The canal was irrigated with 5.25% sodium hypochlorite solution and dried with paper points. Photodynamic therapy was used to disinfect the root canal and platelet-rich fibrin was used to revitalize the pulp. Three millimeters of gray mineral trioxide aggregate was placed directly over the platelet-rich plasma clot. Three days later, the tooth was double-sealed with permanent filling materials. Results: Clinical examination revealed no sensitivity to percussion or palpation tests. Radiograph revealed continued thickening of the dentinal walls, root lengthening, regression of the peri-apical lesion and apical closure. Both the roots showed complete apical closure at the 10-month follow-up. However, the teeth were not responsive to electric pulp test. Conclusion: This report of pulp revascularization shows that disinfection with photodynamic therapy combined with platelet-rich fibrin leads to satisfactory root development in necrotic immature teeth.

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Aim: To use Atomic Force Microscope and Energy Dispersive X-ray Spectroscopy to evaluate the effect of 5% NaOCl, 17% EDTA and triphala on ProTaper and iRaCe rotary Ni-Ti instruments. Methodology: A total of eight Ni-Ti rotary files, four files each of ProTaper - S2 (Dentsply) and iRaCe - R3 (FKG DENTAIRE) were used. Three out of four files each from ProTaper and iRaCe were immersed in 5% NaOCl, 17% EDTA and Triphala separately for five minutes. The Roughness average (Ra), Root Mean Square (RMS) and Mean Height of Roughness Profile Elements (Rc) of the scanned profiles were then recorded using AFM and the elemental composition was evaluated with EDS. Data were analyzed by Student's t test, One Way ANOVA and Duncan's Multiple Range Test. Results: Topographic irregularities at the nanometric scale were observed for all files. Files immersed in EDTA and NaOCl showed highly significant surface roughness than untreated files. Conclusion: Short-term contact with 17% EDTA and 5% NaOCl can cause significant surface deterioration of ProTaper and iRaCe rotary NiTi files. AFM proves to be a suitable method for evaluating the instrument surface.

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Aim: To evaluate the cytotoxicity of three root repair materials, mineral trioxide aggregate (MTA), Endosequence Root Repair Material and Biodentine in human periodontal ligament fibroblasts. Materials and Methods: Periodontal ligament fibroblasts were cultured from healthy premolar extracted for orthodontic purpose. Cells in the third passage were used in the study. The cultured fibroblast cells were placed in contact with root repair materials: (a) Biodentine, (b) MTA, (c) Endosequence, (d) control. The effects of these three materials on the viability of Periodontal ligament (PDL) fibroblasts were determined by trypan blue dye assay after 24 hours and 48-hour time period. Cell viability was determined using inverted phase contrast microscope. Statistical Analysis: Cell viability was compared for all the experimental groups with Wilcoxons matched pair test. Results: At the 24-hour examination period, all the materials showed increased cell viability. At 48-hour time period, there is slight decrease in cell viability. Mineral trioxide aggregate showed statistically significant increase in the cell viability when compared to other root repair materials. Conclusion: Mineral trioxide aggregate was shown to be less toxic to periodontal ligament fibroblasts than Endosequence Root Repair Material and Biodentine.

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Background: Several disinfection techniques have been recently introduced with the main objective of improving root canal disinfection in the inaccessible areas of the root canal system. This in vitro study was done to evaluate the antimicrobial effect and viability of Enterococcus faecalis biofilms using conventional irrigation, EndoActivator (Dentsply, Tulsa Dental, USA), diode laser irradiation and photon-initiated photoacoustic streaming (PIPS). Materials and Methods: Root canals of 130 single rooted mandibular premolars, standardized to a uniform length of 20 mm were instrumented until finishing file, F1 (Universal Protaper Rotary System, Dentsply, Tulsa Dental Specialties, USA). After smear layer removal and sterilization, five teeth were randomly selected to assure sterility before bacterial inoculation. The remaining 125 samples were contaminated with E. faecalis suspension, incubated for 21 days and divided into five groups (n = 25). In Group 1; untreated group (positive control), the root canals were not subjected to any disinfection procedure. Sampling was performed within the canals and the colony-forming unit count was evaluated for 20 samples. Five samples were selected to visualize the pattern of colonization at Level 1 (4 mm from the apex) and Level 2 (1 mm from the apex) by confocal laser scanning microscopy. Samples in Groups 2-5 namely conventional needle irrigation, EndoActivator, diode laser and PIPS were subjected to their respective disinfection procedures. Postdisinfection sample evaluation criteria was followed for all groups as same as that for Group 1. Results: Diode laser displayed the highest antibacterial efficacy and least viable bacteria than the other three disinfection techniques. Conclusion: Diode laser group showed better antibacterial efficacy and least viable bacteria when compared to conventional needle irrigation, PIPS and EndoActivator groups in minimally instrumented, experimentally infected root canals.

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Aim: This study determined the effectiveness of G-coat plus surface protective agent over petroleum jelly on the surface texture of conventional Glass ionomer restorative materials. Materials and Methods: Three chemically cured conventional glass ionomer restorative materials type II, type IX and ketac molar were evaluated in this study. Sixty specimens were made for each restorative material. They were divided into two groups of thirty specimens each. Of the sixty specimens, thirty were coated with G-coat plus (a nano-filler coating) and the rest with petroleum jelly. Thirty samples of both protective coating agents were randomly divided into six groups of five specimens and conditioned in citric acid solutions of differing pH (pH 2, 3, 4, 5, 6 & 7). Each specimen was kept in citric acid for three hours a day, and the rest of time stored in salivary substitute. This procedure was repeated for 8 days. After conditioning, the surface roughness (Ra, ΅m) of each specimen was measured using a surface profilometer (Taylor & Habson, UK). Data was analyzed using one-way analysis of variance (ANOVA) and Tukey's HSD test at a significance level of 0.05. Results: The surface textures of all the tested glass ionomer restorative materials protected with G-coat plus were not significantly affected by acids at low pH. The surface textures of all the tested glass ionomer restorative materials protected with petroleum jelly coating were significantly affected by acids at low pH. Conclusion: The effects of pH on the surface texture of glass ionomer restoratives are material dependent. Among all the materials tested the surface texture of Type II GIC (Group I) revealed marked deterioration when conditioned in solutions of low pH and was statistically significant. Hence, a protective coating either with G-coat plus or with light polymerized low viscosity unfilled resin adhesives is mandatory for all the glass ionomer restorations to increase the wear resistance of the restorative materials.

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Talon cusp is an uncommon dental anomaly showing morphologically well delineated, accessory cusp-like structure projecting from cingulum to the incisal edge of anterior teeth. This anomaly is rare in the mandibular dentition and rarer on the facial aspect. A case of this infrequent entity of mandibular facial talon cusp and its management is reported here.

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Aim: This study compared the amount of aqueous-based and oil-based calcium hydroxide [Ca(OH) ₂ ] remaining in the canal, after removal with two different chelators 17% EDTA and 0.2% Chitosan in combination with ultrasonic agitation. Materials and Methods: Cleaning and shaping of root canals of 28 mandibular premolar was done and canals were filled either with Metapex or Ca(OH) ₂ mixed with distilled water. Volumetric analysis was performed utilizing cone beam-computed tomography (CBCT) after 7 days of incubation. Ca(OH) ₂ was removed using either 17% EDTA or 0.2% Chitosan in combination with ultrasonic agitation. Volumetric analysis was repeated and percentage difference was calculated and statistically analysed using Kruskal-Wallis and Mann-Whitney U test. Results: Both the chelators failed to remove aqueous-based as well as oil-based Ca(OH) ₂ completely from the root canal. Aqueous-based Ca(OH) ₂ was easier to be removed than oil-based Ca(OH) ₂ . 0.2% Chitosan was significantly more effective for removal of oil-based Ca(OH) ₂ (P < 0.01) while both 17% EDTA and 0.2% Chitosan were equally effective in removing aqueous-based Ca(OH) ₂ . Conclusion: Combination of 0.2% Chitosan and ultrasonic agitation results in lower amount of Ca(OH) ₂ remnants than 17% EDTA irrespective of type of vehicle present in the mix.

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Objectives: Hypersensitivity is a common clinical multietiological problem. Many desensitizing treatments are there to overcome hypersensitivity. The aim of this study was to evaluate the effect of different dentin-desensitizing treatments on the tensile bond strength of composite restoration. Materials and Methods: Twenty-four sound human molars were used. Enamel was wet abraded to expose flat dentin surfaces, polished with sandpaper. The specimens were then divided into three groups (n = 8) based on the type of dentin-desensitizing treatment given. The first group: G1 was the control group where no desensitizing agent was used. The second group: G2 was treated with desensitizing dentifrice containing a combination of potassium nitrate, triclosan, and sodium monoflorophosphate. The third group: G3 was treated with Er:YAG laser. Afterwards, the desensitized specimens were treated with one step self-etch adhesive according to manufacturer's instructions and composite microcylinders were packed. The specimens were then examined for tensile bond strength using universal tensile machine (KMI ^TM ). Results: Statistical analysis of the data obtained revealed the mean values for the tensile bond strengths were 10.2613 MPa, 5.9400 MPa and 6.3575 MPa for groups 1, 2 and 3, respectively. These values were statistically significantly different between groups pretreated with laser or dentifrice as compared to control group. Conclusions: Dentifrice and Laser pre-treated dentin has lower tensile bond strength with resin composites as compared to dentin that is untreated.

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Background: The achievement of successful local anesthesia is a continual challenge in dentistry. Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection (the Stabident system and the X-tip system) have been proposed to be advantageous in cases where the conventional local anesthetic techniques have failed. Aim: A clinical study was undertaken using intraosseous injection system by name X-tip to evaluate its effectiveness in cases where inferior alveolar nerve block has failed to provide pulpal anesthesia. Materials and Methods: Sixty adult patients selected were to undergo endodontic treatment for a mandibular molar tooth. Inferior alveolar nerve block was given using 4% articaine with 1:100,000 epinephrine. Twenty-four patients (40%) had pain even after administration of IAN block; intraosseous injection was administered using 4% articaine containing 1:100,000 epinephrine, using the X-tip system. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analog scale ratings ≤ 54 mm) on endodontic access or initial instrumentation. Results: Intraosseous injection technique was successful in 21 out of 24 patients (87.5%), except three patients who had pain even after supplemental X-tip injection. Conclusion: Within the limits of this study, we can conclude that supplemental intraosseous injection using 4% articaine with 1:100,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.

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Aim: The aim of this in vitro study was to evaluate the effects of different ultrasonic surgical-tips and power-settings on micro-leakage of root-end filling material. Materials and Methods: The root canals were instrumented using rotary-files and were filled with tapered gutta-percha and root canal sealer using a single-cone technique. The apical 3 mm of each root was resected and the roots were divided into six experimental groups; negative and positive control groups. Root-end cavities were prepared with diamond-coated, zirconum-nitride-coated and stainless-steel ultrasonic retro-tips at half-power and high-power settings. The time required to prepare the root-end cavities for each group was recorded. Root-end cavities were filled with Super-EBA. Leakage values of all samples evaluated with glucose penetration method on 7, 14, 21 and 28 ^th days. The results were statistically analyzed with Kruskal-Wallis and Hollander-Wolfe tests. Results: The mean time required to prepare retro cavities using diamond-coated surgical tip at high-power setting was significantly less than other groups (P < 0.01). There were no statistically significant differences in the glucose penetration between the groups at first and second weeks (P > 0.01). Diamond-coated surgical tip showed the least leakage at high-power setting at 3 ^rd and 4 ^th weeks (P < 0.01). Conclusions: Under the conditions of this study, cavity preparation time was the shortest and the leakage of the root-end filling was the least when diamond-coated retro-tip used at high-power setting.

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Tooth fusion is a developmental anomaly characterized by the union between the dentin and/or enamel of at least two separately developing teeth. Fusion is a rare occurrence, with overall prevalence to be approximately 0.5% in deciduous teeth and 0.1% in permanent dentition. The significance of this particular case was that the unilateral fusion occurred in a permanent mandibular second molar with a paramolar and successful endodontic management was done. The rarity with which this entity appears, along with its complex characteristics, often makes it difficult to treat. In this case, a new advanced three-dimensional imaging Cone Beam Computed Tomography (CBCT) was used as an adjunctive diagnostic aid to differentiate between fusion occurred before or after root formation and help to reach the correct diagnosis.

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Complete cleaning and shaping is the key to successful endodontic treatment. A thorough understanding of the internal anatomy and morphology of the root canal system is an important consideration when performing cleaning and shaping procedures. Mandibular premolars are one of the most difficult teeth to treat endodontically because of aberrant root canal anatomy. This article describes case series of mandibular premolars with variations in root canal anatomy treated successfully by conventional endodontic treatment.

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Anatomic variations may be observed in the crown or in the roots of maxillary molars. In rare instances, crown and root morphology, both show variations. Occurrence of paramolar cusp on the occlusal surface as central cusp or on the buccal surface as parastyle has been frequently reported in maxillary molars. However, presence of paramolar cusp on the palatal surface has not been reported. 'Formation supradentalis' is a condition in which supernumerary cusp is associated with a supernumerary root in a molar. The occurrence of such concomitant corono-radicular morphology is multifactorial, that is primary polygenic with secondary environmental influences. This case reports the diagnosis and endodontic management of Formation-supradentalis that had six cusps and four roots in the maxillary first molar. The tooth exhibited a prominent paramolar palatal cusp and cusp of Carabelli along with a supernumerary palatal root. To the best of author's knowledge, this is the first documentation of endodontic management of Formation supradentalis.

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Context: Non-carious cervical lesions are usually associated with dentin hypersensitivity. The use of oxalic acid in restorations of these lesions could be beneficial in relieving pain. Aims: To evaluate the use of oxalic acid in restorations of non-carious cervical lesions. Settings and Design: A randomized clinical trial. Subjects and Methods: One operator placed 90 restorations in 20 volunteers of both sexes, with at least two lesions to be restored with the techniques: Control - Restoration with total-etch technique and Experimental - Restoration with pretreatment with oxalic acid followed by application of adhesive system. The restorative adhesive system used was XP Bond/Durafill. The restorations were directly assessed by two independent examiners using a modified United States Public Health Service (USPHS) method at baseline, 6 and 12 months, taking into account the following criteria: Retention (R), marginal integrity (MI), marginal discoloration (MD), postoperative sensitivity (S), caries (C), and anatomic form (AF). Statistical analysis used: The data were statistically analyzed using the Fisher exact and McNemar tests. The level of significance was set at 5%. Results: After 1 year, the results of restorations clinically satisfactory obtained for the control and experimental group respectively were: R (97% / 89%), MI (100% / 100%), MD (100% / 100%), S (100% / 100%), C (100% / 100%), and AF (100% / 100%). Conclusions: The use of oxalic acid as an agent of dentin pretreatment did not influence the clinical performance of restorations in non-carious cervical lesions after 1 year.

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Introduction: The aim of this study was to compare the shear bond strength of resin modified glass ionomer cement to conditioned and unconditioned mineral trioxide aggregate surface. Materials and Method: White Mineral Trioxide Aggregate (WMTA) and Resin Modified Glass Ionomer Cement (RMGIC) were used for the study. 60 WMTA specimens were prepared and stored in an incubator at 37° C and 100% humidity for 72 hrs. The specimens were then divided into two groups- half of the specimens were conditioned and remaining half were left unconditioned, subsequent to which RMGIC was placed over MTA. The specimens were then stored in an incubator for 24 hrs at 37° C and 100% humidity. The shear bond strength value of RMGIC to conditioned and unconditioned WMTA was measured and compared using unpaired 't  ' test. Results: The mean shear bond strength of value of RMGIC to conditioned and unconditioned WMTA was 6.59 MPa and 7.587 MPa respectively. Statistical analysis using unpaired t-test revealed that the difference between values of two groups was not statistically significant (P > 0.05). Conclusions: During clinical procedures like pulp capping and furcal repair, if RMGIC is placed as a base over MTA, then conditioning should be done to increase the bond strength between RMGIC and dentin and any inadvertent contact of conditioner with MTA will not significantly affect the shear bond strength value of RMGIC to MTA.

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Mesiodens is the commonly occurring supernumerary tooth seen between the maxillary central incisors which causes compromised aesthetics and malocclusion. Till date orthodontic therapy provides an excellent solution for the management of mesiodens. Recently, Restorative Space Management (RSM) has been used successfully to correct tooth shape, proportions and colour with minimal tooth preparations. This case report describes the successful management of an unaesthetic smile due to presence of a mesiodens in the midline primarily using aesthetic treatment only.

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Aims: This study evaluated the effect of ultrasonic scaling on surface roughness of four different tooth-colored class V restorations. Materials and Methods: Out of 100 human extracted teeth, 20 were randomly selected for each group, marked with the outline of class V cavity. Class V cavities were prepared on facial surface of teeth of all groups except control group. These cavities were then restored with GC 2, GC 9, GC 2 LC, and Filtek Z 250 XT. All the specimens were stored in artificial saliva at 37 ^o C for 1 month. Initial surface roughness values (Ra in μm) of restorations were evaluated with the surface roughness tester. Ultrasonic instrumentation was then carried out for 60 s on the restoration surface and final roughness values were evaluated. Data were analyzed with Paired t-test, One-way ANOVA, Tukey's test. Results: Mean Pre-instrumentation surface roughness was highest with GC 2, whereas it was least in case of Filtek Z 250 XT. Mean post-instrumentation surface roughness was highest with GC 2, whereas it is least in case of Filtek Z 250 XT. Conclusion: GC 2 LC showed highest and Filtek Z 250 XT showed least susceptibility to ultrasonic scaling.

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