Aim: The present study aimed to compare the remaining dentin thickness (RDT) and fracture resistance of conventional and conservative access and biomechanical preparation in molars using cone-beam computed tomography (CBCT). Methodology: A total of 60 freshly extracted human molars were selected and were randomly divided into two groups of conventional and conservative access preparation group (n = 30). Samples were subjected to pre-CBCT scan at the pericervical region for the measurement of total dentin thickness. For the conventional group, samples were accessed and biomechanical preparation was done using K3 XF file. For conservative group, samples were accessed using CK microendodontic burs using a dental operating microscope and biomechanical preparation was done using self-adjusting file. After obturation and postobturation with nanohybrid composite restoration, samples of both groups were subjected to post-CBCT scan at pericervical region for the measurement of RDT. The samples were then loaded to fracture in the Instron Universal Testing Machine, and the data were analyzed using paired sample t-test and independent sample t-test. Results: The mean RDT was less in conventional group than conservative group. Pericervical dentin was preserved more in conservative group. The statistical difference among both the experimental group was highly significant (<0.001). The mean load at fracture was less in conventional group than conservative group (<0.001). Conclusion: Coronal dentin was conserved in molars when accessed through conservative than through conventional. The dentin conservation afforded an increased resistance to fracture in conservative group which is doubled the fracture resistance in conventional group.

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Aim: This study aims to investigate the adhesive performance of three different universal adhesives to repair aged composite restorations, with or without the application of silane. Materials and Methods: A hundred and twenty resin composite samples were prepared, aged and randomly divided into 6 main Groups (single bond universal [SBU], All-Bond Universal [ABU], Futurabond U, Clearfil Tri-S Bond, Single Bond 2, and Clearfil SE Bond) and 2 subgroups (with or without silane). A microhybrid composite resin was placed on the aged composite surfaces and light cured. After a micro-shear bonding test, the fracture surfaces were examined under the scanning electron microscopy. Statistical analysis was performed using two-way ANOVA and Tukey's post hoc tests. Results: Among all the universal adhesives, SBU showed the highest bond strength values compared to the other two universal adhesives when used with and without silane (P > 0.05). Between ABU and Futurabond U, no significant difference was observed with silane (P > 0.05) and without silane (P > 0.05). Among conventional adhesives, there was no statistically significant difference (P > 0.05) both with and without silane. Conclusion: Within the limitations of this study, while SBU can be safely used with and without the application of silane, Futurabond U cannot be used without silane.

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Background: Minimally invasive dentistry (MID) encompasses early caries diagnosis through caries risk assessment (CRA), early detection of incipient carious lesion including primary and secondary prevention based on scientific evidence that remineralization of demineralized enamel and dentin is possible if detected early. Although the dental curriculum focuses on the advantages of MID in tooth preservation, this science is not usually translated into practice. Aim: This study aimed to evaluate the knowledge, attitude, and skills of dental practitioners of Puducherry regarding the concepts of MID. Subjects and Methods: Data were collected through an online survey questionnaire based on awareness and practice of MID. Statistical evaluation was done on SPSS by Chi-square test. Results: A total of 126 dentists responded of which only 55% were trained in MID during their undergraduate and internship period, mainly through lectures (49.6%). Nearly 81% agreed that CRA should be conducted for all patients. Almost 42.7% had heard about International Caries Detection and Assessment System, but only 25.9% used a blunt explorer for caries detection. About 13.7% use magnification (loupes/microscope), but majority (84.7%) use radiographs. More than 70% were unaware of newer methods of caries detection. Statistically significant differences were found (P < 0.05) regarding qualification and experience about the effectiveness of Atraumatic Restorative Treatment and sandwich technique for treatment of caries in permanent teeth and high caries-risk children. Conclusion: Although there is knowledge about advantages of MID among dentists of Puducherry, it does not benefit patients, as many practitioners still follow the traditional principles of total caries removal.

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Introduction: The aim of this study was to understand the mechanism by which iatrogenic root dentin removal influences radicular stress distribution and subsequently affects the resistance to vertical root fractures (VRF) in endodontically treated teeth. Materials and Methods: The experiments were conducted in two phases. Phase 1: freshly extracted premolar teeth maintained in phosphate-buffered saline were instrumented to simulate three different degrees of dentin removal, designated as low, medium, and extreme groups. Micro-Ct analyzes were performed to quantitatively determine: (a) the amount of dentin removed, (b) the remaining dentin volume, and (c) the moment of inertia of root dentin. The specimens were then subjected to thermomechanical cycling and continuous loading to determine (a) the mechanical load to fracture and (b) dentin microcracking (fractography) using scanning electron microscopy. Phase 2: Finite element analysis was used to evaluate the influence of dentin removal on the stress distribution pattern in root dentin. The data obtained were analyzed using one-way ANOVA and Tukey's post hoc test (P < 0.05). Results: Phase 1: A significantly greater volume of dentin was removed from teeth in extreme group when compared to low group (P < 0.01). The mechanical analysis showed that the load to fracture was significantly lower in teeth from extreme group (P < 0.05). A linear relationship was observed between the moment of inertia and load to fracture in all experimental groups (R² = 0.52). Fractography showed that most microcracks were initiated from the root canal walls in extreme group. Phase 2: The numerical analysis showed that the radicular stress distribution increased apically and buccolingually with greater degree of root canal dentin removal. Conclusions: The combined experimental/numerical analyses highlighted the influence of remaining root dentin volume on the radicular bending resistance, stress distribution pattern, and subsequent propensity to VRF.

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Aim and Objective: To evaluate the in vitro effect of red wine on color stability of three different esthetic restorative materials such as nanohybrid composites, conventional restorative glass ionomer cement (GIC), and feldspathic porcelain. Materials and Methods: The color stability of test materials was determined using a spectrophotometer. A total of 30 specimens were prepared (10 from each) from each material on a round metal mold (11 mm diameter and 2 mm deep). The specimens were stored in distilled water at 37°C for 24 h for rehydration. Baseline color of all groups was recorded. Specimens of each material were divided into 2 groups of 5 specimens each (n = 5). Two groups include red wine and distilled water as a control. Specimens were then immersed in 25 ml of red wine for 20 min at room temperature everyday for 28 days. Specimens were kept in distilled water for the remaining part of days. After the completion of immersion sequence, the specimens were rinsed with distilled water and blotted dry. Postimmersion color of all specimens was then recorded. Data were analyzed by two-way ANOVA and post hoc Tukey's test. Results: The color stability is significantly higher in porcelain than composite and conventional GIC. Conclusion: Within the limitations of this study, it was concluded that the porcelain shows less discoloration than composite and conventional restorative GIC.

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Aim: The aim of this study is to compare the incidence of postoperative pain using the ProTaper Next (PTN), WaveOne Gold (WOG), and Self-Adjusting File (SAF) systems. Materials and Methods: Two hundred and fourteen patients with irreversible pulpitis were selected for single-visit endodontics. The teeth were blindly assigned to three groups based on the instrumentation system used: Group A (PTN), Group B (WOG), and Group C (SAF). Participants were asked to note the incidence of the pre- and postoperative pain on a visual analog scale at different time intervals. Paired t-test and one-way ANOVA were used along with post hoc Tukey's test. Results: The greatest mean pain in Group A (PTN) and Group B (WOG) was found to be maximum in the first 24 h with a significant reduction in pain at the subsequent observation time points of 48 h, 72 h, and 7 days. Group C (SAF) showed minimum pain followed by Group B followed by Group A which showed comparatively higher pain scores even at the end of 7 days. Conclusions: In single-visit endodontics, SAF system may prove to be a better system compared with PTN and WOG as it produces minimal postoperative pain, thus improving the overall acceptance of endodontic treatment.

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Objectives: The aim of this study is to investigate the influence of the composite material and surface treatment to the bond strength when repairing an aged composite surface with new composite. Materials and Methods: One hundred and sixty resin blocks of methacrylate composite and silorane composite prepared and aged in artificial saliva for 6 months. Specimens treated either with a diamond bur (DB) or air abrasion (AA), conditioned with orthophosphoric acid (OA) or sodium hypochloride (SH) and repaired with methacrylate or silorane composite using the corresponding adhesive system. Repaired composites underwent thermocycling fatigue (×5000), and bond strength was measured at shear. Results: Methacrylate achieved the highest bond strengths as repair material, in all combinations (26.54-55.56 MPa). Silorane only reached 8.12 MPa when repairing silorane treated with DB and OA. For all other treatment combinations repairing with silorane led to pretest failures. The most susceptible to repair composites/surface treatment combination is when repairing methacrylate treated with AA and SH and methacrylate composite (55.56 MPa). Conclusions: Silorane composites are not suitable to be used when repairing an old composite restoration. The repair material is the most critical factor, while aged surface treatment has only a minor influence to the shear bond strength.

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Aims and Objectives: The aim of this in vivo study was to evaluate the antibacterial efficacy of a diode LASER on the infected root canal system. Methodology: A total of forty patients with infected root canals were selected. The root canals were prepared mechanically, and irrigation was done with 3% sodium hypochlorite (NaOCl). Microbiological samples were collected before LASER treatment with the help of the master apical file (MAF) to full working length for subsequent microbiological examination. The procedure was followed by laser treatment with an EZLASE diode LASER (940 nm), at different output powers. Following irradiation, samples were collected for microbiological examination. The samples were transferred to an agar plate and incubated for 48 h at 37°C. The colonies formed were then counted, and the total number of bacteria per ml before and after LASER application was assessed. Colony-forming unit (CFU/ml) was counted for Enterococcus faecalis and other bacterial flora from pretreatment and posttreatment samples that were then analyzed using the Kruskal–Wallis test and Mann–Whitney U-test. Results: The highest power of laser used (1.95 W) had resulted in maximum reduction of bacterial flora and E. faecalis counts. Conclusions: Combination therapy consisting of irrigation using NaOCl and LASER irradiation, especially at high output power was an effective treatment option for a reduction in E. faecalis as well as other bacterial flora from the root canal system.

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Endodontic treatments have as their objective the appropriate sealing of the space caused by the root canal, providing a complete seal of the canal in all dimensions, creating an airtight seal against fluids. Thus, endodontic cements must possess physical properties such as solubility and long-term dimensional stability. An electronic search in the main endodontic magazines using appropriate keywords to identify studies that investigated the porosity of endodontic materials using micro-computed tomography. Of the 125 studies researched, 16 fulfilled the criteria for inclusion. Four studies analyzed the porosity of endodontic cements specifically. Twelve studies investigated and compared different techniques of root canal obturation and the repercussions from the lowering of porosity in the interior of the endodontic cement. The presence of porosity inside the endodontic cement is a constant in the treatments of root canals, even now when there is a great variety of endodontic cements.

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Objectives: The objective of this study was to assess the effect of the operator's degree of clinical experience on the residual caries diagnosis through visual inspection and tactile sensation. Materials and Methods: The participants were asked about the years of their clinical practice, any further training concerning cariology, their familiarity with the minimal invasive philosophy, and the techniques that they use to remove dental caries and detect when to stop the removal of carious tissues. In addition, an in vitro diagnostic test was conducted. Carious teeth were excavated to a level selected in random. Teeth were examined by each participant individually. Initial examination was performed by visual inspection. Subsequently, a dental explorer was used concerning the potential need for further removal of dental tissues. A sample of 380 dentists and dental school students were selected for the purposes of this study. Results: Dental students presented statistically significant better sensitivity, than dentists from both age groups, during both visual inspection and tactile sensation of residual caries. Participants' ability to diagnose residual caries during cavity preparation was independent of their years of experience. Conclusions: During the removal of carious lesions, with the goal of limiting the sacrifice of healthy structures and the leftover of residual caries, clinicians should combine a selective removal technique and the attentive visual inspection, with at least one further diagnostic method, aside from the dental explorer. Tactile examination of residual caries solely with the dental explorer must be used with attention.

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Introduction: Pain of endodontic origin is of concern to both the patient and the clinician. Expectation of a painful experience can increase the patient's anxiety levels, making treatment more difficult. Management of endodontic pain is one of the challenging aspects in endodontics. Objective: To evaluate whether the intraligamentary mode of administration of diclogfenac sodium is effective in abating endodontic pain during interappointment visits. Aim: The purpose of this clinical trial is to evaluate the analgesic efficacy of diclofenac sodium administered through oral and intraligamentary routes in reducing postendodontic pain. Materials and Methods: Thirty patients were randomly allocated into three groups. Group A – placebo (Vitamin B12), Group B – diclofenac sodium (intraligamentary), and Group C – diclofenac sodium tablets. The tablets were given 30 min before the start of the procedure, while the intraligamentary injection was administered before commencing the endodontic procedure. The visual analog scale was used to evaluate the pain score at baseline and 6, 12, 24, and 48 h postoperatively. Results: Prophylactic intraligamentary injection of diclofenac sodium was found to be highly effective in reducing postendodontic pain than the oral route of administration. Conclusion: In patients with low pain threshold, intraligamentary route of administration is effective in controlling pain of endodontic origin postoperatively.

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The purpose of this study was to systematically evaluate the dentin bond strength of etch-and-rinse and self-etch adhesives to primary teeth. In this study, PubMed, ISI (all databases), Scopus, and Cochrane Database were searched according to the selected keywords up to May 11, 2016. The full texts of published articles that appeared to meet the primary criteria for inclusion in this study were obtained. Due to the variation in the methods used, the studies were divided into 2 groups: Group 1 – studies that evaluated the micro-tensile bond strengths (MTBSs) of two-step etch-and-rinse adhesives and two-step self-etch adhesives and Group 2 – studies that evaluated the MTBSs of two-step etch-and-rinse adhesives and one-step self-etch adhesives. The initial search yielded 1447 publications. After a methodological assessment, 8 publications were selected. The results of this study showed that the MTBS of the etch-and-rinse adhesives and the two-step self-etch adhesives were similar (P = 0.34), and both were significantly higher than that of the one-step self-etch adhesive (P = 0.001). This meta-analysis showed that the application of two-step self-etch adhesives performs well when used for primary dentin and can be used to save time in pediatric dentistry.

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Aim: The aim of this study was to investigate the adhesive performance of three different universal adhesives to repair aged amalgam by composite resins with or without Alloy Primer. Materials and Methods: Sixty amalgam samples were prepared, aged, and randomly divided into 12 main groups according to adhesive procedures used. Composite buildups were placed on amalgam surfaces. After micro-shear bonding test, the fracture surfaces were examined under the scanning electron microscopy statistical analysis was performed using two-way analysis of variance and Tukey's post hoc tests. Results: Without use of Alloy Primer, all of the universal adhesives provided similar bond strength values with conventional adhesives (P > 0.05); however, an Alloy Primer significantly increased the bond strength values of universal adhesives (P < 0.05). No significant difference in bond strength values was noted for conventional adhesives with or without Alloy Primer (P > 0.05) except for Clearfil SE Bond (P < 0.05). Conclusions: Within the limitations of this study, it can be concluded; using Alloy Primer before universal adhesives increased the bond strength significantly.

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Clinicians proceed the canal exploration according to the literature so far reported. At times, there are apparent variations in the teeth. These discrepancies should be thoroughly surveyed and piled up to date. One such rare complexity of canal morphology was discussed in the present case. A 48-year-old female patient referred to the endodontic clinic for full-mouth rehabilitation. On intraoral hard-tissue examination, decay was noted in multiple teeth which were confirmed by an orthopantomogram and endodontic treatment plan was suggested. The patient was prepared for the access opening of right mandibular first premolar (tooth #44) before which endodontic treatment of first and second quadrants was completed. The cone-beam computed tomography (CBCT) images revealed that tooth # 44 had two separate roots and four distinct root canals (mesiobuccal, mesiolingual, distobuccal, and distolingual). Root canal treatment was completed in two visits. Postoperative CBCT was advised to confirm the obturation of all the canals.

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Aim: The aim of this in vitro study was to evaluate and compare the microleakage of mineral trioxide aggregate (MTA) and Geristore root-end filling materials in different environments. Materials and Methods: After removing the anatomical crowns of ninety extracted human maxillary central incisors, their root canals were instrumented and obturated. The apical 3 mm of each root was resected, and a standardized root-end cavity was prepared using an ultrasonic tip. The roots were alienated into three equal subgroups for each material and the root-end filling was performed in different environments namely dry, saliva contaminated, and blood contaminated. Samples were immersed in 0.2% Rhodamine B dye for 48 h. Roots were sectioned longitudinally and examined under a fluorescent microscope to measure the linear dye penetration. The results were statistically analyzed using analysis of variance and Tukey's honestly significant difference post hoc test. Results: The Geristore dry group illustrated the lowest linear leakage, while the MTA saliva-contaminated group illustrated the highest leakage. In dry environment, linear dye penetration of both MTA and Geristore groups did not show any significant difference. However, statistically significant difference was observed between MTA and Geristore groups in blood- and saliva-contaminated environments. Conclusion: Geristore showed better results in saliva- and blood-contaminated environments; hence, Geristore may be used as an alternative to MTA for root-end filling.

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Aim: The aim of this study was to compare the wear resistance of cast gold with condensable bulk fill and a fiber reinforced bulk-fill composite. Materials and Methods: The 5 mm × 4 mm stainless steel molds were prepared for wear resistance. Forty-five samples were divided into three groups (n = 15). The samples were restored as follows: Group I: cast gold alloy (d. SIGN 98; Ivoclar Vivadent), Group II: fiber reinforced composite (Ever X Posterio; r GC Corp.), and Group III: condensable bulk-fill composite (Tetric N Ceram; Ivoclar Vivadent). A pin on disc wear tester was used to measure the wear resistance. Data were analyzed using one-way analysis of variance. Results: Higher statistically significant values were seen for the cast gold restorations than the other two bulk-fill composites. Conclusion: It is desirable for any restorative material to yield wear behavior. D. SIGN 98 (Type IV cast gold alloy) was the most wear resistant material tested, whereas Tetric N Ceram (condensable bulk-fill composite) was the least wear resistant.

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Context: Enterococcus faecalis is the most common bacteria found in infected root canals. Aim: The purpose of this study was to evaluate the effect of the mono instrument (wave-one^®) on the reduction of E. faecalis in root canals. Materials and Methods: Thirty-two human monoroot teeth were used. After sterilization by autoclave, the teeth were infected by E. faecalis and incubated for 24 h. Each tooth underwent sampling before and after the root canal shaping. After serial dilution, samples were incubated, and colony-forming units were counted. Results: The mono instrument technique reduced infection by E. faecalis in root canals of 30 teeth. The mean bacterial load (log₁₀) was 3.98 before treatment and 1.20 after treatment. The paired t-test showed a significant mean difference (log₁₀) of the bacterial load before and after treatment (P < 0.0001). Conclusion: This study found that the mono instrument (Wave One^®) significantly decreases bacterial load in root canals. However, the instrument alone is not enough to eradicate infections; thus, the use of a complementary antimicrobial is required.

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Objective: This study aimed to evaluate the dentin bond strength and degree of polymerization of bulk-fill and methacrylate-based flowable composites. Materials and Methods: Dentin bond strength of composites was evaluated using the microtensile bond strength (μTBS) test. Five different composites were applied on flat dentin surfaces with self-etch and etch-and-rinse adhesives. Twenty microspecimens with a 1 mm² cross-sectional area were prepared for each group (n = 20). The μTBS test was then applied. To measure the degree of polymerization of composites, eight cylindrical blocks were prepared (n = 8) from each composite. The surface microhardness of each composite was measured on the bottom and top surfaces, and a hardness ratio (HR) was calculated. Data were analyzed using one-way ANOVA and the Tukey's honestly significant difference test (α = 0.05). Results: According to the μTBS test results, the SDR Etch-and-Rinse group exhibited the highest dentin bonding strength and the Aelita self-etch group exhibited the lowest (P < 0.05). HR measurement showed that all composite groups had a sufficient degree of polymerization at a 2-mm thickness, while only the SDR and Xtra-Base groups had sufficient polymerization at a 4-mm thickness. Conclusions: Bulk-fill composite demonstrates an even higher degree of polymerization of methacrylate-based flowable composite when applied in a 4-mm thickness.

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Aim: The aim of this study was to compare the bacterial reduction achieved with reciprocating instruments such as Reciproc^® R25 (VDW GMBH, Munich, Germany) and Reciproc^® R25 combined with rotary file Mtwo 40.04 (VDW GMBH) during root canal preparation. Materials and Methods: Fifty mesiobuccal root canals of maxillary molars were contaminated with Enterococcus faecalis broth culture and then an initial bacterial sample was collected from the root canal with paper cones and plated on brain–heart infusion agar. The root canals were divided into four groups as follows: Reciproc^® R25 (n = 20) and Reciproc^® R25 combined with Mtwo 40.04 instrument (n = 20). The negative controls consisted of five uncontaminated root canals and the positive control consisted of five contaminated roots that were not subjected to any decontamination procedure. Irrigation was performed using sodium chloride. After instrumentation, samples were collected with paper cones and the rate of bacterial reduction was calculated. Microbiological testing (colony-forming units [CFUs]) was performed to quantify the decontamination obtained by the proposed protocols. Statistical analysis was performed by paired t-test and analysis of variance test. Results: Both techniques significantly reduced the number of bacteria in the root canal (P < 0.05), with no significant difference among them (P > 0.05). Conclusion: The addition of the instrument Mtwo 40.04 after the root preparation with the instrument R25 does not improve its decontamination capability.

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Objectives: To evaluate the effect of 2% lignocaine containing 1:80,000 adrenaline on the microleakage and ultrastructure of resin tooth interface using an acetone based total etch adhesive (Prime and Bond NT) and an ethanol water based self etch adhesive system (Xeno III). Materials and method: Class V cavities were prepared on buccal surfaces of 72 maxillary first premolars scheduled for orthodontic extraction. In 36 premolars procedure was performed under local anaesthesia (LA) and in other 36 teeth without LA. Restorations were done with hybrid composite Spectrum TPH using either Prime and Bond NT or Xeno III bonding agents. Results: Administration of 2% lignocaine with 1:80,000 adrenaline significantly reduced microleakage and improved quality of hybrid layer and tubular penetration in Prime and Bond NT specimens; but no significant effect was observed in Xeno III specimens. Conclusion: Under clinical conditions, administration of LA reduced microleakage and improved quality of hybrid layer and tubular penetration in total etch adhesive systems.

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