Pulpal necrosis in permanent teeth that have not completed their root development leads to teeth with a very short root, roots with very thin walls, and an inadequate crown-root ratio, which overshadows their survival prognosis. Currently, there are various therapies to treat immature permanent teeth with pulpal pathology such as the case of apexification. An electronic search was performed in the PubMed database (www.ncbi.nlm.nih.gov), Scopus (www.scopus.com), Cochrane (www.cochrane.org) to identify the clinical investigations related to evolution of the cases. The search of the literature of clinical studies on permanent teeth with open apex that present pulpar pathology and that need treatment, have been found 11 clinical studies of treatments with apexification. The apexification by calcium hydroxide has been applied for many years back to the present as a valid therapy to perform the treatment of apexification.

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Introduction: The aim of this study is to evaluate the surface of root canals dentine using scanning electron microscope (SEM) after instrumentation with rotary Nickel-Titanium systems and two different protocols of activation of sodium hypochlorite (NaOCl) (extracanal heating at 50°C and intracanal heating at 180°C), to assess the presence/absence of smear layer and also the presence/absence of open dentinal tubules along the walls at the coronal, middle, and apical third of each sample. Materials and Methods: Thirty-six single-rooted teeth were selected, divided into three groups and shaped with ProTaper Universal instruments following irrigation protocols with 5.25% NaOCl. At the end of the preparation, three different protocols of activation were used: nonheated NaOCl in Group A, extra-canal heated NaOCl at 50°C for Group B and intracanal heated NaOCl at 180°C for Group C. Specimens were cut longitudinally and analyzed by SEM at standard magnification of ×1000. The presence/absence of the smear layer as well as the presence/absence of open tubules at the coronal, middle, and apical third of each canal were estimated using a five-step scale for scores. Numeric data were analyzed using Kruskal–Wallis and Mann–Whitney U statistical tests and significance was predetermined at P < 0.05. Results: Kruskal–Wallis analysis of variance (ANOVA) for debris score showed significant differences among the Ni-Ti systems (P < 0.05). Mann–Whitney test confirmed that Group A presented significantly higher score values than other Ni-Ti systems. The same results were assessed considering the smear layer scores. ANOVA confirmed that the apical third of the canal maintained a higher quantity of debris and smear layer after preparation of all the samples. Discussion and Conclusions: Intra-canal heating of NaOCl at 180°C proved to be more effective in obtaining clean canal walls. On the other hand, extra-canal heating at 50°C of NaOCl left a higher quantity of debris and the smear layer was widely represented.

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Background: Biodentine is comparatively a new biomaterial claimed to have properties comparable to mineral trioxide aggregate (MTA). Biodentine and MTA are effectively used for direct pulp capping (DPC), and they are capable of regenerating relatively damaged pulp and formation of hard dentine bridge. Objectives: The aim of this systematic review was to test the null hypothesis of no difference between Biodentine and MTA as DPC materials for human permanent mature teeth, against the alternative hypothesis of a difference. Data Sources: Clinical trials were identified by electronic databases searches of Midline, CENTRAL Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scopus, Scientific Electronic Library Online, evidence-based endodontics literature, KoreaMed, and Google Scholar. The literature search was performed from January 2010 to February 2018. Hand searches were also performed for relevant abstracts, books, and reference lists. Titles and abstracts of studies identified using the above-described protocol were independently screened by two authors. Full texts of studies judged by title and abstracts to be relevant were independently evaluated by two authors for stated eligibility criteria. Study Eligibility Criteria: The eligibility criteria included randomized clinical trials (RCTs) and non-RCTs. Participants: Patients with permanent mature molars indicated for surgical extraction or molars that have symptomless exposure of vital pulp tissue by caries or trauma. In both cases, the molars were subjected to DPC. Interventions: The pulp exposures were directly treated by Biodentine or MTA. Study Appraisal: To assess article quality, two authors independently used the risk of bias in nonrandomized studies – of interventions. Methods: Qualitative metasynthesis was used to analyze data across qualitative studies. Results: The initial search identified 8725 unique references through the search process. No additional studies were identified through handsearching. After filtering, 915 references were recorded and screened. After the eligibility criteria were applied, seven unduplicated prospective and retrospective cohort studies were included in the qualitative metasynthesis. Limitations: Further RCTs with much larger sample size and proper methodology with longer observational time are still in need to adequately address the questions of the present systematic review. Conclusion and Implications of Key Findings: Within the limitations of this review, it may be concluded that Biodentine had a similar effect on dentin bridge formation likely to MTA. However, this conclusion is based on only very few well-conducted prospective and retrospective cohort studies. Systematic Review Registration Number: The review had been registered with PROSPERO (registration number CRD42018089302).

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Aims and Objectives: The aim of this study is to compare the esthetic improvement of white spot lesions (WSLs) treated by icon, sodium fluoride (NaF), and bioactive glass using VITA Easyshade^® spectrophotometer. Methodology: Ninety intact human maxillary central incisors were collected and artificial WSLs were created on facial surface having dimensions of 4 mm × 4 mm by immersing in demineralized solution for 4 days, baseline comparisons were performed by measuring the color of the WSLs compared to the adjacent sound enamel. All samples were divided into three groups of 30 each. Three groups were Group 1: Treated by NaF, Group 2: Treated by the bioactive glass, and Group 3: ICON^®-DMG America (Resin infiltration). After treatment, the specimens of all groups were stored in artificial saliva and reevaluated at 4 and 8 weeks after the beginning of the treatments with VITA Easyshade^® spectrophotometer. Results: Statistical analysis was performed with One-way analysis of variance. Post hoc analysis with the Tukey's honest significant difference test was used to compare the data between the groups. Among three groups, resin infiltration has significant color change (ΔE) of infiltrated lesions when compared to other treatment groups (P < 0.001) Conclusion: Within the limitations of this study, it can be concluded resin infiltration (ICON^®) can improve the esthetic characteristics of WSLs. Resin (ICON^®) is a better treatment option when compared to bioactive glass and NaF as concerned to esthetics.

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Aim: This study aimed to evaluate the intensity of pain after unintentional extrusion of resin-based and calcium hydroxide (Ca[OH]₂)-based endodontic sealers as well as their influence on the periradicular tissues. Materials and Methods: A total of 120 single-rooted teeth exhibiting extrusion of sealer in the postoperative radiographs were included in the study. According to the sealers used, the teeth were divided into four groups (n = 30): Group I – AH Plus^®, Group II – Resino Seal, Group III – Sealapex™, and Group IV – Apexit^® Plus. Postoperative pain was assessed at 0–6 h, 6–12 h, 12–24 h, and 24–48 h of obturation using Visual Analog Scale. Radiographs were taken at 3, 6, and ≥9 months to 1-year follow-up and compared with baseline radiographs to assess the dissolution of extruded sealers and healing of periradicular tissues. Statistical Analysis: ANOVA, Kruskal–Wallis, and Pearson's Chi-square test were used. Statistical significance level was set at P ≤ 0.05. Results: Postoperative pain intensity was higher in case of AH Plus^® sealer followed by Sealapex™ up to 12 h of obturation and was statistically nonsignificant. Apexit^® Plus at all time intervals showed statistically significant less pain intensity than AH Plus^® and Sealapex™ but not from Resino Seal group. At 9-month follow-up, better healing of periradicular tissues was shown by AH Plus^® (48.1%) followed by Apexit^® Plus (44.4%) and Sealapex™ (41.2%) with statistically nonsignificant difference. Conclusion: In case of periapical extrusion, both resin-based and Ca(OH)₂-based sealers caused postoperative pain. Both Ca(OH)₂- and resin-based sealers did not influence the treatment outcome.

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Background: The restoration of noncarious cervical lesions (NCCLs) often poses a challenge to the clinician. Various restorative materials are available in the market for the restoration of the same. Each material has various advantages and shortcomings. Aim: The aim of this study was to compare and to evaluate the clinical performance of capsulated resin-modified glass ionomer cement (RMGIC), flowable composite, and polyacid-modified composite resin (PMCR) in NCCLs. Materials and Methods: A total of 101 restorations were placed among healthy controls in this clinical trial. A total of 101 restorations were divided into three groups with n = minimum 32 per group (Group 1: 33 restorations, Group 2: 34 restorations, and Group 3: 34 restorations). The restorative materials used were capsulated RMGIC, flowable composite and PMCR. After the placement, the restorations were evaluated for the United States Public Health Services criteria for six parameters, namely retention, marginal adaptation, marginal discoloration, color stability, surface roughness, and sensitivity. The restorations were evaluated at baseline, 6 and 12 months. Statistical Analysis: Statistics was performed using SPSS 21.0 version. Chi-square test was done to compare the proportions between groups. Fisher's exact test was used to compare proportion change between time points. Results: There was no statistically significant difference seen among the three groups for retention, color stability, surface roughness, and hypersensitivity. RMGIC had shown superior characteristics in marginal adaptation and marginal discoloration compared to flowable composite and PMCR, and the difference was statistically significant. Conclusion: Within the limitations of this study, all the three restorative materials are clinically acceptable for the restoration of NCCLs. RMGIC is superior regarding marginal adaptation and esthetics for restoring NCCLs.

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Background: Self-adhering flowable composite (SAFC) minimized the time-consuming application procedures encountered with the traditional adhesive systems and restorative materials. Self-adhering composite combines the merits of both adhesive and restorative material technologies (8^th generation) in a single product, bringing new horizons, and ambitions to restorative procedures. Aim: The aim of this study was to evaluate the clinical performance of SAFC compared to conventional flowable composite in conservative Class I cavities. Materials and Methods: In a split-mouth design, after cavity preparation, 18 patients with conservative Class I cavities received randomly two pairs of restorations, either Vertise™ flow or Filtek™ Z350 XT Flowable combined with Scotchbond™ Universal Etchant and Single Bond Universal, all materials were applied according to the manufacturer's instructions. Restorations were evaluated at baseline and after 6 months by two calibrated assessors using the modified United States Public Health Service criteria measuring (retention, postoperative hypersensitivity, color match, marginal adaptation, and marginal discoloration). Statistical Analysis: Chi-square test was used to compare between flowable composite materials after different follow-up periods, Wilcoxon signed-rank test was used to explore changes over follow-up periods. A value of P ≤ 0.05 was considered statistically significant. Results: At baseline and 6 months, there was no statistically significant difference between both materials for all tested outcomes. Conclusions: SAFC has shown clinical performance similar to conventional flowable composite after 6 months of clinical service.

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Introduction: The purpose of this study was to compare the stress distributions in the teeth treated through minimally invasive access (MIA) designs to those of the teeth treated through traditional straight-line access and their relationship to the final restoration using three-dimensional finite element analysis (FEA). Materials and Methods: Four FEA models of an extracted mandibular first molar were constructed. An intact model served as the control, whereas the other three were prepared with either an MIA or traditional straight-line access. Simulated composite access fillings with or without a simulated gold crown were applied to the models, followed by application of an occlusal load of 100 N. Von Mises stresses in the teeth were then calculated and analyzed. Results: Stress values within the dentin for baseline, MIA with composite filling, MIA with composite filling and crown, and traditional access with composite filling and crown were 10.14 MPa, 6.98 MPa, 11.79 MPa, and 16.81 MPa, respectively. Higher stress values indicate that the tooth is more prone to fracture. Conclusions: A traditional endodontic access cavity may render a tooth more susceptible to fracture compared with an MIA design.

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Background: The biomimetic self-assembling peptide technology is a paradigm for dental hard tissue regeneration. Aim: To investigate the efficacy of biomimetic self-assembling peptide (P₁₁-4) on enamel remineralization compared to casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and fluoride-based delivery systems. Materials and Methods: Artificial enamel lesions were created on buccal surfaces of 40 extracted human molars. Specimens were randomly assigned to four groups (n = 10) according to the remineralizing agent used: G1 – control: artificial saliva, G2 – fluoride varnish, G3 – CPP-ACPF varnish, G4 – self-assembling peptide agent. All products were applied according to the manufacturer's instructions and the specimens were stored in daily renewed artificial saliva. Surface microhardness (SMH) was assessed at baseline, after demineralization, after 1 week and after 4 weeks storage. SMH values were analyzed using ANOVA and Tukey's post hoc test. Results: Self-assembling peptide showed the highest statistically significant mean SMH followed by fluoride and CPP-ACPF while the lowest mean SMH was found in artificial saliva. However, no statistically significant difference was found between fluoride and CPP-ACPF. Higher statistically significant mean SMH was found after 4 weeks compared to 1 week remineralization in all groups. Conclusions: Self-assembling peptide confers the highest remineralizing efficacy compared to fluoride and CPP-ACPF, showing a promising, noninvasive regeneration potential. Furthermore, extended period of time helped attain more benefits from the remineralizing regimens applied.

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Aim: The aim of this study was the assessment of the anatomical thickness of danger zone in the cervical third of mesial canals of mandibular molars. Materials and Methods: Fifty mandibular molars were selected and scanned with cone-beam computed tomography. Data were compared using a length tool provided by scanner software. The measured areas were the mesial and distal walls of the cervical third of the mesial roots, which correspond to the safety and danger zones, respectively. In addition, dentin thickness at the furcation was evaluated. Results: Dentin thicknesses of the safety zone were higher than in the danger zone in all teeth examined. The thinnest dentin of the safety zone was found at a point located 4 mm below the canal orifice, with a mean value of 1.03 mm; conversely, in the danger zone, the thinnest point was located 3 mm below the orifice, with a mean value of 0.81 mm. As for the distance from the pulp chamber floor to the furcation, the average value was 2.23 mm. Conclusion: These results show that mean thicknesses at the danger zone of mandibular molar mesial roots were <1.0 mm. These data reinforce the importance of understanding anatomy and the need for conservative preparations when assessing and instrumenting these root canals.

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Background: Apically extruded debris produced during root canal preparation can induce postoperative inflammation and subsequent failure of root canal treatment. Therefore, debris production must be reduced to improve the outcome of root canal treatment. Aim: This study aimed to provide a theoretical basis for the improvement of root canal treatment by comparing the difference in the amount of apically extruded debris produced during the root canal preparation of extracted human teeth with ProTaper Universal (PTU), ProTaper Next (PTN), and WaveOne (WO). Materials and Methods: On March 30, 2017, three researchers searched five electronic databases (PubMed/Medline, Cochrane, Science Direct Online, Embase, and Web of Science) with no time limitations. Only articles written in English were retrieved, and 150 articles were obtained. Then, the three researchers independently selected articles in accordance with previously established inclusion and exclusion criteria, and inconsistent results were discussed. Data were analyzed through meta-analysis for standardized mean difference (SMD). Results: Eight studies met the inclusion criteria and were subjected to qualitative analysis. Four articles showed that PTU produced higher amounts of apical debris than WO; two articles showed that PTU produced lower amounts of apical debris than WO; and three articles showed that PTN produced lower amounts of apical debris than WO. Moreover, one article demonstrated that PTU produced higher amounts of apical debris than PTN. A meta-analysis showed that PTU and WO did not produce significantly different amounts of apically extruded debris: SMD = −0.26, Z = 0.50 (P > 0.05). PTU produced lower amounts of apically extruded debris than WO: SMD = −4.98, Z = 2.79 (P < 0.05). However, results were significantly heterogeneous among all the included studies (I² = 97%). No significant difference was found between PTU and WO in the amounts of apically extruded debris: SMD = 0.47, Z = 1.06 (P > 0.05). Conclusion: Currently available evidence shows that PTN can produce lower amounts of apical debris than WO (P < 0.05). Moreover, the amounts of apically extruded debris produced by PTU and WO are not significantly different (P > 0.05). Nevertheless, given the limited number of studies reviewed, a definitive conclusion cannot be reached.

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Invasive cervical resorption of the tooth is a relatively rare and uncommon phenomenon where the etiology remains idiopathic and unclear, and if not treated may lead to ultimate loss of tooth structure. Advancements in digital imaging have made the clinician to diagnose the pathological changes with great precision. Proper diagnosis and management of this condition is key to the successful outcome. The aim of this article was to elaborate two case reports of invasive cervical root resorption with surgical management using biocompatible restorative material.

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Aim: The aim of this randomized, controlled, double-blinded, clinical study is to evaluate and compare the clinical effectiveness of low-level diode GaAlAs laser and glutaraldehyde-based topical desensitizing agent on cervical dentin hypersensitivity with the help of visual analog scale (VAS). Materials and Methods: Fifty teeth of patients aged between 20 and 50 years were included, and VAS was used to assess the dentin hypersensitivity. The teeth were randomly allocated to either Group 1 or 2 using flip coin technique. Group 1 received glutaraldehyde desensitizer and Group 2 received 905 nm low-level laser. The sensitivity scores were recorded, immediately, after1 week and 3 months after therapy. Data was analyzed using Mann-Whitney U test for intergroup comparison and Friedman's test for intragroup comparison. Results: There was a significant reduction in pain in both the groups at 3 months evaluation (P = 0.001).However, Group 2 showed a significant decrease in mean VAS scores when compared with Group 1 at both the one week and three month follow ups (P = 0.04, P = 0.03, respectively). Conclusion: Although topical desensitizer and Low Level Laser are both effective in reducing dentinal hypersensitivity, Low Level Lasers are comparatively more effective at the studied time intervals.

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Introduction: This study evaluated the effect of root canal preparation, obturation, and different techniques of retreatment on the percentage increase in the number of dentinal microcracks using microcomputed tomography (CT) analysis. Materials and Methods: Forty-five mandibular premolars after micro-CT scanning were prepared using Protaper universal files up to F4 and obturated. After the second micro-CT scanning again, the samples were randomly divided into three groups (n = 15) for retreatment procedure. In Group 1, retreatment was done with Protaper universal D1, D2, and D3 retreatment files followed by Protaper universal file till F4. In Group 2, retreatment was performed with R-Endo reciprocating motion, Re, R1, R2, R3, and Rs followed by Hero Shaper size #40. In Group 3, retreatment was performed with H-files and xylene till size #40. After gutta percha removal, the samples were again scanned for micro-CT for the evaluation of percentage increase in dentinal microcracks. Data were analyzed using “Kruskal–Wallis test ANOVA” and “student t-test” at 5% level of significance. Results: Few unprepared samples showed preexisting microcracks. There were statistically significant percentage increase dentinal cracks after root canal preparation and obturation as well as after retreatment procedure with statistically significant percentage increase in the number of dentinal microcracks between all three groups. Conclusion: Intraradicular procedures such as shaping and cleaning and obturation as well as the use of retreatment file lead to the induction and propagation of dentinal microcracks. In the present study, the maximum microcracks were produced with Protaper universal retreatment file system followed by R-Endo system. H-files produced minimum cracks during retreatment procedures.

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Introduction: Dental erosion is defined as the loss of tooth structure due to chemical process that does not involve bacteria. The management of such a condition calls for a comprehensive approach to identifying the cause and treating it. Aim: The aim of this study is to comparatively evaluate the role of grape seed extract (GSE) and cranberry extract (CE) in preventing dental erosion using optical emission spectrometry. Materials and Methods: Prepared enamel specimens were subjected to the erosive challenge using HCl for 10 s, followed by immersion in experimental natural groups and control fluoride group for 30 s and artificial saliva for 60 min. This cycle was repeated three times. The amounts of calcium and phosphorous present in the acid solution after 1^st, 2^nd, and 3^rd erosive challenges were determined for each group using induced coupled plasma-optical emission spectrometry. Results: The cumulative calcium and phosphorous release after the 1^st, 2^nd, and 3^rd erosive challenges were found to be the least in SnF2 group, followed by GSE group and then in CE group. Conclusion: The protective of GSE and CE was inferior to the gold standard control group of stannous fluoride role, against enamel erosion. GSE showed better remineralizing effect; however, there was no statistically significant difference between the two groups.

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Context: The internal anatomy of mandibular first molars has been studied in depth in different populations. However, limited information is present in differentiating a true middle mesial (MM) canal from an isthmus. Aims: The primary aim of this study was to identify the prevalence of a true MM canal and isthmus by retrospectively analyzing cone-beam computed tomography (CBCT) images in vivo. The secondary aim was to determine any correlation between related factors such as sex and age. Materials and Methods: CBCT images of 130 patients with the age group of 13–70 years were selected. Findings of MM canals and isthmus were recorded along with variables such as age and sex. Prevalence was compared using the Chi-square test (P < 0.05). Results: Out of 143 mandibular first molars, the prevalence of the MM canal was 18.2%. There was no statistically significant difference between sex and prevalence of the MM canal and isthmus. The prevalence of isthmi in the mesial roots was 78.4%. Their presence was significantly higher in the apical third area (37.1%) (P < 0.05). Both MM canal and isthmus were seen significantly higher in the age group of 31–50 years (P < 0.05). Conclusions: This study showed a high prevalence of MM canals (18.2%) and isthmus (78.4%). The prevalence of the MM canal and isthmi was significantly higher in the middle age groups. This knowledge may direct the clinicians in locating them leading to good endodontic prognosis.

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Introduction: Among the various causes of tooth discoloration after root canal treatment, percolation of sealer remnants into the dentinal tubules of the pulp chamber is the most common cause. Objectives: The aim of this study is to evaluate the efficacy of dentin bonding agent (DBA) in preventing coronal discoloration caused by four different root canal sealers- MTA Fillapex, Sealapex, Zical and Z. O. B seal at different time intervals by measuring chromatic alterations using digital images analysis method. Methodology: Ninety mandibular premolars were collected and sectioned at 1 mm below the cementoenamel junction. Standard access cavity preparations of dimensions (depth-3 mm, width-0.8 mm, and length-3 mm) were prepared with a No. 245 bur through the cervical access. Following the standard irrigation protocol, specimens were then randomly divided into nine groups (four groups without DBA [1–4] +4 groups with DBA [5–8] +1 negative control [9]). In Groups 1–4, four different root canal sealers (MTA Fillapex, Sealapex, Zical, and Z.O.B seal) were applied to the walls of the pulp chamber. For Groups 5–8, the samples were etched with 37% phosphoric acid and DBA application was done before the respective root canal sealer application. The cervical access in all specimens was sealed using glass ionomer cement. Digital photographs were taken under standard lighting and environmental conditions at different time intervals: preprocedural, postprocedural, and after 1, 2, 3, and 4 months. These images were analyzed using Adobe Photoshop CS6 from which laboratory values and subsequently Delta E values were obtained. Results: Statistical analysis performed using repeated measures ANOVA and post hoc Tukey's tests show that the groups with DBA application had significantly lower mean Delta E values (P < 0.05) compared to the groups without DBA application. Conclusion: DBAs applied to the dentinal walls of the pulp chamber before obturation can effectively reduce the sealer-induced coronal discoloration.

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Context: Noncarious cervical lesions may penetrate the pulp and require root canal treatment followed by crown placement. Such teeth may be susceptible to fracture, especially at the cervical area. Aims: To estimate which combination of restorative material and crown resulted in homogenous stress–strain distribution of endodontically treated abfracted mandibular premolar using three-dimensional finite element model (FEM). Settings and Design: A three-dimensional model of mandibular single-rooted premolar along with alveolar bone was created in finite element analysis (FEA) software preprocessor ANSYS rel 14.5 FEM software (ANSYS Inc., Houston, USA, 1994). Cervical lesion was created in the model with specific dimensions, 3 mm mesiodistally and 2 mm gingivoocclusally with enamel occlusal margin and dentin gingival margin. Materials and Methods: Tooth was simulated to be root canal treated and restored with different types of cements and crowns followed by placing a static load of 300 N at an angle of 135°. Analysis was run and stress distribution pattern was studied. Results: Cervical region of an endodontically treated tooth is subjected to stresses, irrespective of restorative material used. Porcelain fused to metal (PFM) crowns showed least strain values with different postendodontic, restorative materials. Conclusions: FEA is a predictable and reproducible model to predict stress–strain behavior. PFM crowns with different postendodontic restorative materials showed least strain values in the cervical area of abfracted, endodontically treated premolars.

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This case report deals with the successful endodontic treatment of double dens invaginatus in maxillary left central incisor. Dens invaginatus is a rare developmental anomaly that is challenging to diagnose and treat. A patient reported with unesthetic appearance and previously attempted endodontic treatment of tooth #21. Cone beam computed tomography revealed the presence of a complex invagination communicating with the periodontium. A combination of techniques enhanced the debridement of the complex invagination. Obturation was performed using warm vertical compaction. The patient was asymptomatic during the follow-up period of 12 months.

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Background: Longevity of composite restoration in the oral cavity is dependent on various factors. One such factor is exposure to various foods and beverages which could alter the properties of the material. Aim: The aim of this in vitro study was to evaluate the effect of most widely consumed alcoholic beverages on shear bond strength of composites to enamel. Material and Methods: A total of seventy human premolars were embedded in acrylic resin blocks. Labial enamel surfaces was flattened, etched, bonded, and restored with composite resin (Tetric N Ceram – Ivoclar Vivadent AG, Schaan, Liechtenstein). The specimens were randomly divided into four groups: Group I: beer; Group II: wine; Group III: whiskey, and Group IV: artificial saliva. Group I to Group III were again divided into moderate (Group IA, IIA, and IIIA) and heavy (Group IB, IIB, and IIIB) consumption subgroups. The specimens were soaked in their respective groups for 90 min daily in Group IA, IIA, and IIIA and for 30 min every alternate day in Group IB, IIB, and IIIB until 30 days. Universal testing machine was used to determine the shear bond strength of composite with enamel. Statistical Analysis Used: The values obtained were statistically analyzed using two-way analysis of variance followed by post hoc test with the significant level set at P < 0.05, using GraphPad prism software version 6.01. Results: Group IIB showed the highest reduction in shear bond strength, with a mean value of 6.6 ± 1.2 Mpa in comparison to control with a mean value of 21.8 ± 1.6 Mpa. Conclusion: As the content of alcohol and time of exposure increased along with a decrease in the pH of alcoholic beverages, shear bond strength between composite and enamel decreased.

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Context: Bleaching can affect the surface properties of resin composites. Aims: The aim of this study was to evaluate the effect of three regimens of carbamide peroxide (CP) on staining susceptibility of silorane and methacrylate-based resin composites. Methods: In this study, 80 composite disks were prepared from A2 shade of P90 and Z250 composite resins (40 each). Samples were divided into three test groups based on the CP concentration (10%, 16%, and 22%) and bleached for 14 days. Controls were kept in distilled water. Then, specimens were immersed in a tea solution for 14 consecutive days. A spectrophotometer was used to measure the specimen colors in CIE L*a*b system, initially and after staining. Data were analyzed using SPSS 16 software using two-way ANOVA, t-test, and Tukey honestly significant difference tests at α = 0.05. Results: The color susceptibility of Z250 samples were significantly affected in groups bleached with 22% CP compared to the controls (P = 0.001). The different concentrations of CP did not affect the staining susceptibility of the P90 samples (P > 0.05). Conclusions: Bleaching of the tested resin composites did not increase their susceptibility to extrinsic staining in vitro except for the Z250 samples bleached with 22% CP.

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Aim: The purpose of this study is to compare the porosity of two sealant cements, mineral trioxide aggregate (MTA) Fillapex^® and BioRoot^® root canal sealer (RCS). These samples were analyzed using microcomputed tomography. Materials and Methods: Sixteen samples were used in the study that were divided according to the composition of the materials used. MTA Fillapex^® (n = 8) and BioRoot^® RCS (n = 8) were the samples prepared according to the manufacturer's instructions. They were placed in silicone molds of 5 ± 0.1 mm in height and an internal diameter of 5 ± 0.1 mm; 24 h after its preparation, the samples were scanned through a microcomputed tomography, and the porosity results were analyzed statistically by independent t-tests. Results: It is evident that MTA Fillapex^® has better porosity properties than BioRoot^® RCS. The results of the study quantify a smaller number of pores per surface, a smaller volume in each pore per mm³, and a lower total porosity present in samples of MTA Fillapex^® unlike BioRoot^® RCS samples which is larger in both. Conclusions: The results obtained in computerized microtomography endodontic biomaterial samples concluded that MTA Fillapex^® has a lower porosity than BioRoot^® RCS.

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Background: Effective removal of smear layer ensures better penetration of irrigants ensuring root canal disinfection and has the potential of sealing dentinal tubules during obturation. Aim: The aim of this study is to evaluate the canal cleaning efficacy and calcium ion liberation with the use of demineralizing irrigants, namely, 17% ethylenediaminetetraacetic acid (EDTA), 7% maleic acid, and 10% citric acid with or without ultrasonic (US) activation. Materials and Methods: Crowns of 62 extracted maxillary central incisors were decoronated and root canals prepared. Based on the final irrigant teeth were divided into following groups (n = 10), namely, 10% citric acid, 7% maleic acid, 17% EDTA, and 10% citric acid with US activation, 7% maleic acid with US activation, and 17% EDTA with US activation. Irrigants were subjected to inductively coupled plasma–atomic emission spectroscopy followed by debris scoring and scanning electron microscope analysis. Statistical Analysis: One-way analysis of variance with the Bonferroni's correction for multiple testing was employed. Results: About 10% citric acid with US activation liberated the highest calcium ions and removed the maximum smear layer. Conclusions: Citric acid with US activation is a potentially effective irrigation regimen with sodium hypochlorite.

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Persistent apical periodontitis even after nonsurgical retreatment demands for a surgical approach. This requires a thorough diagnosis and planning to eliminate the pathology and induce healing. This is sometimes challenging when the pathology is present in close relationship to the vital structures. In such cases, modern, sophisticated technology such as three-dimensional (3D) printing can come very handy in patient education as well as for planning and mock-up preparation of the surgery. In this case, a nonhealing persistent apical periodontitis in relation to 16 was surgically treated. However, the pathology was in close association with the maxillary sinus hence fused deposition modeling-based 3D printed models were fabricated for patient education and to locate and determine the extent of the lesion. This was followed by the surgical enucleation of the lesion and apicectomy of mesiobuccal and distobuccal roots and mineral trioxide aggregate retro-filling and as the symptoms subsided after the follow-up full coverage metal crown was fabricated and cemented. This technology has opened a new horizon for the use of 3D printing in conjugation with endodontic principles for more predictable endodontic success.

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