Background: Successful regeneration depends on four key elements of tissue engineering such as stem cells, growth factors, scaffold and sterile environment. Therefore, regenerative endodontic therapy requires higher degree of disinfection for successful outcomes. Aims and Objective: To evaluate the clinical and radiographic outcome using conventional and laser assisted disinfection in regenerative endodontics at 1, 3 and 6 months. Materials and Methods: 18 children with necrotic young permanent teeth were selected for the study. In Group A, in the first appointment AAE (American Association of Endodontics, Clinical Consideration for Regenerative Endodontic Procedure - 2016) disinfection protocol was employed. In Group B laser assisted disinfection (810 nm diode laser, 1 W, 20 ms Pulse length and 20 ms interval duration) was performed. Microbial samples were obtained before and after disinfection to check the level of disinfection. The cases were followed up at 1 month, 3 months and 6 months interval and evaluated for clinical outcome, periapical healing and apical response. Data were statistically analyzed with level of significance set 1% or 5% accordingly (P<0.01 or P<0.05) Results: On intragroup comparison there was significant reduction in bacterial count before and after disinfection with respect to laser assisted disinfection group. (P value = 0.007) There was no significant change in the clinical outcome score in laser group at 1,3- and 6-months interval. Periapical healing score showed statistically significant results in laser group when followed from 3 months to 6 months (P value = 0.04). Conclusion: Along with AAE 2016 protocol, use of laser assisted disinfection resulted in improved quality of disinfection and an expeditious clinical outcome and periapical healing in necrotic young permanent teeth. Keywords: Disinfection; laser; regenerative endodontics; sodium hypochlorite; tooth apex

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Aim: The aim of this study is to evaluate the effect of different bonding techniques ethanol wet bonding and dimethyl sulfoxide (DMSO) wet bonding and a novel collagen cross-linker Quercetin application on the durability of resin-dentin bond and observe the bonded interface under the scanning electron microscope (SEM). Materials and Methods: For shear bond strength testing, flat coronal dentin surfaces were prepared on 110 extracted human molars. Teeth were randomly divided into five experimental groups according to different surface pretreatments techniques. Group A was control group without any surface pretreatment. In Group B, ethanol wet bonding pretreatment was done before the application of adhesive. In Group C, DMSO wet bonding was done before the application of adhesive and in Groups D and E, Quercetin along with ethanol and Quercetin along with DMSO pretreatment, respectively, were done before adhesive application. Composite restorations were placed in all the samples. Twenty samples from each group were subjected to immediate and delayed (9 months) shear bond strength evaluation. In addition, two samples per group were subjected to the scanning electron microscopic analysis for the observation of resin-dentin interface. Statistical Analysis: Data collected were subjected to the statistical analysis using the one-way analysis of variance and post hoc Tukey's test at a significance level of P < 0.05. Results: Dentin pretreatment with all the techniques resulted in significantly higher resin-dentin bond strength after 9 months storage with DMSO group showing the highest bond strength values. Conclusion: It can be concluded that these biomodification techniques can improve the durability of the resin-dentin bond.

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Background: The success of direct pulp capping (DPC) depends on the preoperative assessment of pulpal status, intraoperative judgment after pulp exposure, and the biomaterials used to cap the pulp. Aim: The study aims to compare the clinical and radiographic responses of the pulp–dentin complex after DPC with TheraCal LC, Biodentine, and current gold standard mineral trioxide aggregate (MTA) Plus. Materials and Methods: Ninety vital permanent teeth with Class I deep carious lesions were randomly divided into three different groups. After the caries excavation, hemostasis was established using sodium hypochlorite at the site of pulp exposure on which the material was placed. Clinical and radiographic follow-ups were performed at 1-, 3-, and 6-month intervals. Results: Overall success rates of MTA Plus, Biodentine, and TheraCal LC were statistically insignificant. Conclusions: TheraCal LC and Biodentine showed similar success rates when compared to MTA Plus and can be used as an agent in DPC.

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Background: It is important to use instruments that cause minimal changes in the canal path for root canal preparation. There is inadequate literature comparing rotary and reciprocating systems and hand files. No study used three-dimensional printed models to compare rotary, reciprocating, and hand files. Aims: We aimed to assess the canal transportation and centering ability of WaveOne Gold, ProTaper Gold, and NiTi Flex K-file systems with and without glide path preparation. Material and Methods: Forty-nine resin models were randomly divided into Group I A – WaveOne Gold with WaveOne Gold Glider and Group I B – WaveOne Gold without glide path; Group II A – ProTaper Gold with ProGlider and Group II B – ProTaper Gold without glide path; and Group III A – NiTi Flex K-files with no. 10 stainless steel K-file and Group III B – NiTi Flex K-files without glide path. Pre- and postinstrumentation cross-sectional images at levels 3, 5, 7, 9, and 11 mm were compared. Results: WaveOne Gold caused the least canal transportation and improved centering ability (P < 0.05). NiTi Flex K-files transported the canal more than others in the apical levels (3, 5 mm). Glide path creation reduced canal transportation and improved canal-centering ability. Conclusions: WaveOne Gold system has better centering ability and lesser canal transportation than ProTaper Gold and NiTi Flex K-file. Glide path creation reduced canal transportation and improved canal-centering ability.

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Irrigating solutions are an essential adjunct in the root canal therapy for the complete disinfection of the root canal space. The recent trend focuses on the use of herbal extracts in endodontics owing to their advantages and minimal side effects. In view of this, we have proposed a classification system to classify herbal endodontic irrigants as currently, there is no standard classification available. This structured classification will give an overview of the diversity of herbal irrigants and also highlight the potential use of each of them. Thus, it will be easy to segregate the study and use the herbal endodontic irrigants according to the requirements. The proposed classification system shall prove to be highly beneficial to the students, researchers, and clinicians.

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Aim and Objectives: The aim of the study was to investigate the effect of two different collagen cross-linking agents proanthocyanidin (Grape seed extract [GSE] and 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide) on the surface topography of etched dentin and microtensile bond strength (μTBS) of resin dentin bond. Materials and Methods: Fifty-two sound human 3^rd molars were collected, and their occlusal surfaces were ground flat to expose dentin. Dentin surfaces were etched using phosphoric acid and then teeth were randomly divided into four groups, according to the dentin treatment: Group 1: wet bonding technique, Group 2: dry bonding technique, Group 3: 6.5% proanthocyanidin, and Group 4: 0.1M carbodiimide. Scanning electron microscope analysis was done for twenty specimens (n = 5 per group) at ×10,000 and ×30,000 magnification. Remaining 32 specimens were restored with TETRIC N-Bond adhesive systems and resin composite. After 24 h, teeth were sectioned to produce a cross-sectional surface area of 1.0 mm² and tested for μTBS. Statistical Analysis: Data were statistically analyzed using ANOVA and post hoc least significant difference test (P < 0.05). Conclusion: When acid-etched dentin is treated by 6.5% proanthocyanidin (GSE) and 0.1M carbodiimide, followed by application of adhesives, it results in increased μTBS due to cross-linking of collagen fibrils.

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Aim: The aim of the study was to evaluate and compare canal transportation (CT), centering ability (CA), and volumetric changes in severely curved canals prepared using ProTaper Gold (PTG), One Curve (OC), and Self-Adjusting File (SAF) systems via cone-beam computed tomography (CBCT). Materials and Methods: Sixty mesiobuccal canals of maxillary molars were selected. Pre- and postinstrumentation CBCT scans were taken in the same position. CT and CA were calculated at 1 mm, 4 mm, and 7 mm from the apex; change in volume for whole canal was measured and analyzed statistically. Results: SAF showed the least mean CT at all the levels with no statistically significant differences at 1 mm and 4 mm when compared to other groups while statistically significant differences were observed at 7 mm with PTG and OC. Regarding CA, SAF better maintained canal centricity than PTG and OC at all the levels assessed, though the differences were not statistically significant except at 7 mm where statistically significant difference was observed between SAF and OC. SAF removed less volume of dentin followed by PTG and the highest removal was shown by OC. Conclusion: SAF showed promising behavior with the least CT, most centered preparation, and minimal dentin removal.

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Background: Perforations in the furcation area are common procedural accidents that can impact the outcome of treatment. There are many bioactive materials available to repair these defects. Aim: The purpose of this study was to determine and compare the effect of 25% aluminum chloride solution, 20% ferric sulfate solution, and a 980-nm diode laser, when used for hemostasis, on the dislocation resistance of Biodentine placed to repair furcation perforation. Materials and Methods: This in vitro study was conducted on fifty extracted human permanent mandibular molars, with ten teeth in each group. The stimulated perforations were contaminated with blood, except for one group. The contaminated groups were either treated with aluminum chloride, ferric sulfate, diode laser, or none at all. All the perforations were restored with Biodentine and tested for push-out bond strength. Statistical Analysis Used: One-way analysis of variance and Tukey's HSD post hoc test were applied with a level of significance set at 0.05. Results: The dislocation resistance of Biodentine was found to be highest when aluminum chloride or diode laser was used for arresting bleeding. In contrast, the ferric sulfate group gave the lowest value for push-out bond strength (P < 0.05). Conclusions: According to the present study, the use of ferric sulfate as a hemostatic agent showed a negative effect on the bond strength of the calcium silicate cement to dentin. Furthermore, Biodentine performed better when diode laser and aluminum chloride were used for hemostasis.

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Aim: The aim of this study was to evaluate the efficacy of smear layer removal from the root canals using 2 ml of 5.25% sodium hypochlorite passive ultrasonic irrigation, EndoVac, and diode laser during endodontic therapy. Materials and Methods: Forty single-rooted human teeth were selected. Access cavity preparation was done. Working length was determined. Instrumentation was initiated with ISO hand files number 15 k file, followed by ProTaper rotary files size F3. Two milliliters of 5.25% NaOCl was used as an irrigant after every instrumentation, with a final flush of 17% EDTA, followed by a rinse with 3 ml of distilled water. Teeth samples were divided into four groups – Group I (n = 10) conventional irrigation with 5.25% NaOCl, 17% EDTA for 1 min, Group II (n = 10) instrumented and irrigated with ultrasonic activation for 1 min, Group III (n = 10) instrumented and irrigated with EndoVac for 1 min, Group IV (n = 10) (analyzed with irradiation of 2 W continuous wave of 910 nm diode laser). Teeth samples were then sectioned longitudinally. Scanning electron microscope examination of canals was done for evaluating smear layer at different levels. Statistical data analysis was done by one-way ANOVA test to evaluate the smear layer score at a significance level of P ≤ 0.05. Results: Group III and Group IV have a minimal amount of smear layer at the apical third when compared to Group I and Group II which was statistically significant with a P < 0.05. Conclusion: Diode laser and EndoVac performed better in removing the smear layer when compared with 2 ml of 5.25% sodium hypochlorite and ultrasonic irrigation.

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Background: Rubber dam plays essential role in dentistry and various modifications have been done to improve patients acceptance and to eliminate the discomfort caused due to clamps. Aim: Clinical evaluation of efficacy and postoperative outcome of metal clamps with customized cushions and standard metal clamps during rubber dam isolation procedures. Materials and Methods: After institutional ethical approval and informed consent total 64 patients were randomly assigned in two groups. Group A - rubber dam metal clamp with customized cushees (n = 32), Group B - rubber dam with standard metal clamp (n = 32). After selection of appropriate clamp for Group A, Customized cushions were prepared and restoration was performed. The evaluation was done using self-designed assessment criteria which included postoperative pain, rubber dam slippage, trauma to gingival and adjacent tissues and sealing ability of both the groups. Statistical Analysis Used: Chi-square value was calculated with SPSS software version 18.0. Results: There was statistically significant difference between postoperative pain, rubber dam slippage, trauma to gingival tissues (P < 0.001) with reduced postoperative pain. Conclusion: Cushions have played significant role in reducing postoperative pain, trauma to the gingival tissue and slippage of rubber dam clamp compared to standard metal clamps.

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Aim: To compare and evaluate the surface characteristics of different restorative materials used for restoration of cervical defects when subjected to periodontal prophylactic instrumentation techniques. Materials and Methodology: Sixty box-shaped cavities were prepared on the labial surface of decoronated permanent maxillary anterior teeth which were randomly divided into two groups (n = 30) based on the instrumentation technique Group I: Manual instrumentation using curettes and Group II: Ultrasonic instrumentation. The samples were further divided into three subgroups based on restorative material subgroups I V and II V-restored with Vitremer, subgroups I F and II F-restored with Filtek Z 250 XT and subgroups I D and II D-restored with Dyract flow, respectively. After finishing and polishing, the samples were subjected to surface profilometry analysis for determining the surface roughness values (Ra). Thereafter, the restored surfaces of all the samples in different subgroups were subjected to prophylactic instrumentation with Gracey's curettes (Group I) and ultrasonic scalers (Group II). Ra values were recorded again after prophylactic instrumentation and after polishing. The data thus obtained were subjected to the statistical analysis using the independent t-test and one-way ANOVA (p<0.05). Results: Ra values were significantly higher for both manual and ultrasonic prophylaxis compared to preprophylaxis and postpolishing in all the three restorative materials. Ultrasonic scaling produced significantly higher Ra for subgroup V as compared to subgroup F and subgroup D, whereas the difference between the materials was not significant for manual scaling. Conclusion: Manual prophylaxis resulted in significant reduction in surface roughness of all the three restorative materials while ultrasonic prophylaxis resulted in significant reduction for Vitremer only. Polishing after scaling significantly reduced the effect of both manual and ultrasonic prophylaxis on surface roughness.

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Aims: The aim of the study is to compare and evaluate the bonding ability of alkasite restorative material to TheraCal LC^™ (TLC), Biodentine^™ (BD), resin-modified glass ionomer cement (RMGIC) using an universal adhesive and characterizing their failure modes. Subjects and Methods: Ninety extracted intact human molars were divided into three groups of (n = 30) as Group I (TLC), Group II (RMGIC), and Group III (BD). Each group was subdivided into two based on application of universal adhesive. Cention N was bonded to each sample. Shear bond strength analysis was performed. The data were analyzed using SPSS version 22 software. Results: No significant difference was observed between Group I and Group II (P < 0.05) while Group III showed the least bond strength (P < 0.05). The modes of failure were predominantly cohesive in Groups I and III (TLC and BD) while RMGIC showed mixed and adhesive failures. Conclusions: The bond strength of Cention N to TLC and RMGIC was similar and significantly higher than that of BD following application of universal adhesive.

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