Aim: The rate of healing of periapical lesion after the antibacterial dressing with triple antibiotic paste and calcium hydroxide was assessed. Materials and Methods: Case reports which used triple antibiotic paste and calcium hydroxide as the intracanal dressing was searched in PubMed, Google Scholar and Cochrane Oral Health's Trials Register up to August 2020, without language and period restriction. Two authors independently reviewed all identified titles and abstracts for eligibility. Tables were generated to summarize the included studies. Results: Sixteen (n = 16) articles met the eligibility criteria. Nonsurgical endodontic treatment was carried out in eleven cases with triple antibiotic paste and in nineteen cases calcium hydroxide was used. Results of the study after analyzing the case reports indicate that both triple antibiotic paste and calcium hydroxide are equally effective as intracanal medicament. In cases where calcium hydroxide failed to eliminate symptoms, triple antibiotic paste was found to be effective. Conclusion: As far as the effect on the healing of the periapical lesions is concerned, all the studies showed a high success rate. Available scientific data indicates nonsurgical treatment can be adopted as a routine measure to conservatively treat large periapical lesions of endodontic origin.

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Background: The root canal anatomy is a complex space, and using a single-cone obturation technique does not guarantee a complete filling. Aim: This research aimed to evaluate the actual temperature of the biosealer during the obturation phase inside the root canal using a new hot technique. In addition, this study evaluated the penetration depth of the biosealer inside dentinal tubules. Setting and Design: The current study was concluded on two ex vivo experiments; the former tested the temperature evaluation. The latter examined the penetration depth of the biosealer. Materials and Methods: In this study, 42 sec mandibular premolars were used, and two experiments were carried out. In the first experiment, two premolars were utilized, and two thermocouples of K-type for each tooth were used. During the second experiment, the penetration depth of the biosealer was examined, 40 teeth were selected. Root canals were prepared then divided into two obturation groups: A, gutta-percha, and biosealer with single-cone technique and B, gutta-percha, and biosealer with a newly proposed obturation method. Confocal laser scanning was used to assess the penetration of the sealer. Statistical Analysis Used: In the first experiment, the Bonferroni method was performed to compare the temperature data. The tests used in the second experiment were Shapiro–Wilk's test, Kruskal–Wallis, and Mann–Whitney tests. Results: The first experiment results showed that the heat does not reach the apical third using the new obturation method. In the second experiment, the results showed in Group B significantly higher biosealer penetration into the dentinal tubules as compared to Group A (P < 0.05). Conclusions: The highest level of penetration of the biosealer in the dentinal tubules was observed in the group of the new obturation method, and the last apical 3 mm remained at 37° using this novel hot modified technique providing no risk of chemical alteration of the biosealer.

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Background: The goal of root canal therapy depends on chemomechanical debridement and three-dimensional filling of the root canal system.^[1] Aim: The aim of this study is to assess the effect of NaOCl + Ethylenediaminetetraacetic acid (EDTA) and Twin Kleen as a final irrigating solution on the depth of penetration of AH Plus and Perma Evolution sealers into the dentinal tubules. Materials and Methods: Forty mandibular premolars were decoronated and instrumented up to size 30. Moreover, randomly assigned into two groups based on final rinse Group A (n = 20): 5.25% NaOCl + 17% EDTA. Group B (n = 20): Twin Kleen solution. Resin sealers were labeled with few grains of fluorescent rhodamine B dye and subdivided into two subgroups, Subgroup A1and B1 (n¹ = 10): AH Plus; Subgroup A2 and B2 (n² = 10): Perma Evolution and obturated. Confocal laser scanning microscopy was used to examine the sections taken 2, 5, and 8 mm from the apex. Images were exported to Image J software to determine the sealer penetration depth. Statistical Analysis: Independent t-test and one-way analysis of variance followed by Tukey's HSD post hoc test. Results: Maximum depth of sealer penetration was seen in Twin Kleen in all sections. Perma Evolution showed highest sealer penetration at the middle and apical third region of root canal for both groups. Conclusions: Final irrigation with Twin Kleen produced highest sealer penetration than with EDTA.

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Background : Short-term complications after root canal therapy (RCT) include mild pain or flare-up. Patients regard these complications as a benchmark for the assessment of clinician's abilities. In this context, the evidence for recommending either one- or two-visit RCT is not consistent. Aims : This study aims to compare the prevalence of postoperative pain and tenderness to percussion after single-visit (SV) versus two-visit RCT on the mandibular first molar. Materials and Methods : The study was registered with www.ctri.nic.in (CTRI/2019/05/019067). Seventy individuals requiring RCT on a mandibular first molar were selected and randomly ascribed to either single- (Group 1, n = 35) or two-visit RCT (Group 2, n = 35). Postoperative pain levels were assessed using heft parker visual analog scale. The treated teeth were appraised for tenderness to percussion after 1 week of obturation. Statistical Analysis : Thirty-four patients were evaluated in each group: One patient, each, dropped out from both the groups. The data analysis was done using Student's t-test and Chi-square test. Results and Conclusion : Pain score in multiple-visit (MV) was significantly higher than SV after 12- (P = 0.039) and 48 h (P = 0.043). Short-term postoperative pain was higher in MV than SV RCT of mandibular first molar teeth.

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Background : Irrigation dynamics vary in optimally shaped canals. Various factors combine to create a stress-induced environment leading to a dynamic irrigant flow. Aim : The aim of the study is to evaluate the irrigant flow and apical pressure using 30G open-ended needle in virtually created root canal model of single-rooted teeth. Materials and Methods : Sixty extracted single-rooted premolars were selected and prepared using a single rotary instrument Hyflex CM and grouped as – Group I: 30 size 0.6% taper (n = 15), Group II: 30 size 0.4% taper (n = 15), Group III: 25 size 0.6% taper (n = 15), and Group IV: 25 size 0.4% taper (n = 15). Postinstrumentation imaging was carried out using cone-beam computed tomography, and computer-aided design models were obtained. Subgrouping was done based on the nozzle position, and computational fluid dynamic analysis was carried out for the respective parameters assessed. Results : Statistical significance was elicited in all the groups at different nozzle positions analyzed (P < 0.05). A post hoc test revealed significance in the mean flow rate and flow velocity in Group I at low nozzle position (P < 0.05) as compared to others. Conclusions : 30 size 0.6% tapered preparations proved efficient irrigant flow and least apical pressures at all nozzle positions.

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The objective of the study was to review the literature on root anatomy and canal configuration in permanent mandibular second molar based on Vertucci classification. Online electronic databases such as PubMed-Medline, Embase, Scopus, and Cochrane Library were searched using appropriate keywords from the earliest available date till 10th February 2021 restriction on language. Additional sources such as Google Scholar, major journals, unpublished studies, conference proceedings, and cross-references were explored. Information curated for data extraction included methodology, population, sample size (number of teeth), number of root canals, and type of root canal configuration (RCC). Thirty-seven articles were selected with a total of 12,393 permanent mandibular second molar teeth. In the mesial root, Type IV canal configuration with 37.3% was more frequent, having two canals with 70.4%. In the distal roots, one canal was more prevalent with 77% occurrence, and Type I canal configuration was more frequent with 85.2%. Comprehensive knowledge of tooth anatomy and root canal morphology is crucial to root canal treatment. Therefore, an understanding of the canal configuration and anatomy is necessary for the dentist to enhance successful endodontic treatment. Our systematic review findings reveal a wide variety of possible canal configurations among permanent mandibular second molar, while the number of canals ranged from 1 to 5 in number. The evidence is intended to help dental practitioners to avoid mishaps such as perforation and missing canals and anticipation of potential complications during treatment.

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Aim : The study was designed to clinically evaluate biodentine and endosequence root repair material (ERRM) as direct pulp capping agent at 3 months, 6 months, and 12 months intervals. Materials and Methods : Sixty permanent posterior teeth with deep caries, without any signs of irreversible pulpitis were allotted into two experimental groups: Group I -Biodentine, Group II-ERRM. Follow-up evaluations were done. Every 24 h for 7 days, the pain was assessed using visual analog scale. Statistical Analysis: Paired t-test along with Pearson's Chi-square test was performed. Results : The success rate of clinical assessment at 12 months for biodentine group is 78.60% and ERRM Group is 64.70%. Conclusion : Biodentine group performed superior than ERRM group clinically at all-time interval and hence it can be successfully used to restore exposed vital tooth.

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Background : Success of all-ceramic restorations depends on their cementation process. Bonding crystalline materials like zirconia to an underlying substrate is challenging. Recently, universal adhesives have been developed. They claim to chemically bond to zirconia due to the presence of compounds like 10-methacryloyloxydecyl dihydrogen phosphate. But for majority of these adhesives, few studies demonstrating their effectiveness are available. Aims : This study aimed to assess the effect of two universal adhesives, One Coat 7 Universal and Tetric N-Bond Universal on shear bond strength at zirconia–resin junction. Materials and Methods : Thirty CAD-CAM milled zirconia cylinders (5 mm × 8 mm) were sandblasted and divided into three groups: Group A (control) received no treatment, while Groups B and C were primed by One Coat 7 Universal and Tetric N-Bond Universal, respectively. They were luted to composite surfaces by a dual-curing resin cement. After 24 h, a shear bond strength test was conducted and failure mode was analyzed. Statistical Analysis: One-way analysis of variance and post hoc Tukey's test were used for statistical analysis. Results : Both One Coat 7 Universal (24.43 ± 2.66 MPa) and Tetric N-Bond Universal (28.61 ± 3.11 MPa) had significantly higher strength than the control group (9.86 ± 2.00 MPa). Control group underwent 100% adhesive failures. Experimental groups had predominantly mixed/cohesive failures. Conclusion : Both universal adhesives increased the bond strength at resin–zirconia junction. Tetric N-Bond Universal exhibited the highest strength.

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Background: Bibliometric analysis is the quantitative analysis of measurable citation information of a journal. It unveils research topics, publishing trends, assess research impact, and productivity. Aims: The purpose of this study was to conduct a bibliometric analysis to identify and analyze the top 50 most cited articles published in the Journal of Conservative Dentistry (JCD). Methodology: Clarivate Analytics' Web of Science was used to search and identify the 50 most cited scientific papers of JCD. Each article was then cross-matched with Google Scholar and PubMed databases and the mean citation was derived. In addition, citation density for each article was derived to negate the age of publication factor. Statistical Analysis: Shapiro–Wilk test and Kolmogorov–Smirnov test were done to detect departures from normality. For testing and determining correlations among several variables, the Spearman rank test was performed. Results: The top 50 most-cited articles received a total of 6263 (Google Scholar), 323 (PubMed), and 2056 (Web of Science) citations. Major topics of interest in the top 50 most-cited articles were dental material science (n = 18) and carious and noncarious lesion management (n = 14). There was no significant association between mean citation count and time since publication (correlation coefficient = 0.273, P = 0.055). However, there was a significant negative association of citation density (correlation coefficient = −0.647, P < 0.01) with time since publication. Conclusions: Bibliometric analysis of top-cited articles gave valuable insights into journal's research history and progress of the journal concerning dissemination of scholarly work.

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Aim: This study aims to investigate the prevalence of palatogingival groove (PG) in anterior maxillary teeth in an Indian cohort using cone beam computed tomography (CBCT) scans. Study Design: Retrospective study. Materials and Methods: Analysis of 119 CBCT scans (64 males, 55 females, and mean age 31.6 ± 13.5 years) was performed. The data of 636 anterior maxillary teeth (220 canine, 212 lateral incisor, and 204 central incisor teeth) were studied for PG's presence. Demographic details of patients and characteristics of PG, i.e., location, extension, depth, and type were recorded. Results: Out of the 636 anterior maxillary teeth studied, PGs were detected in 12 (1.88%) teeth (3 [1.47%] central incisors, 9 [4.2%] lateral incisors, and 0 canines). All the teeth were categorized as having either type I (Seven teeth) or type II (Five teeth) radicular groove. Two of the 12 PGs were present in the mesial, six in the mid-palatal, and four were present in the distal portion of the palatal surface of the teeth. Conclusions: The prevalence of PG in maxillary incisors in this Indian cohort is 2.88%. Maxillary lateral incisors are the most affected teeth.

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Background: Reactive oxygen species (ROS) are formed when mixing calcium hydroxide (CH) with chlorhexidine (CHX). Aim: To analyze the antibacterial efficacy of aqueous (AGL) and ethanolic (EGL) extracts of Psidium guajava leaves against root canal bacteria such as Streptococcus mutans, Staphylococcus aureus, Lactobacillus acidophilus and Enterococcus faecalis, to evaluate the antioxidant potential of the extracts and its ability to counteract the ROS. Materials and Methods: Three different concentrations (10%, 25%, and 35%) of AGL and EGL were prepared. The antibacterial efficacy was analyzed using the Kirby-Bauer disc diffusion method. The different concentrations of both AGL and EGL were evaluated for their antioxidant property using ultraviolet spectrometer. Further, the ability of these extracts on neutralizing the ROS formation was analyzed using mass spectrometer. Results: CH and CHX mixture exhibited maximum antibacterial activity followed by the same mixture with 35% EGL. EGL showed greater antioxidant activity than AGL extract at all concentrations. Conclusions: The addition of natural antioxidants like guava leaves extract decreases ROS formed by CH and CHX mixture.

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Aim: This study evaluates Vickers microhardness and surface roughness in Biodentine cement (M1) and glass-ionomer cement Fuji IX (M2), both immersed in mouthwash. Materials and Methods: Fifty-four samples were randomly distributed in distilled water (S1), Listerine Cool Mint (S2), and Colgate Plax (S3). Each sample was put in a flask with mouthwash for 2 min, under vibration, twice a day for 21 days. Microhardness and surface roughness were assessed at 48 h (T0), 7 days (T1), 14 days (T2), and 21 days (T3). Results: For roughness: time (T), solution (S) and material (M), TxM, and SxM and for microhardness: M, TxS, TxM, and SxM were statistically significant. T3, M1, M1T3, and M1S1 presented the highest surface roughness. M2, M1T0, M1T1, M1T2, M1S1, and M1S2 presented higher microhardness. Conclusion: Biodentine showed higher surface roughness for T1, T2, and T3 and higher microhardness for T0, T1, and T2 against Fuji IX. Biodentine presented higher microhardness independently of solution.

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Anatomic variations in mesiobuccal root (MBR) of maxillary molars are common. This variation is found to be more common in maxillary first molars as compared to second molars. However, finding three independent mesiobuccal (MB) canals in the MBR of maxillary molars is clinically a rare entity. With the use of magnification, illumination, and cone-beam computed tomography, combined with the skill of the operator, there is an increased possibility of detecting such additional canals. The present case report describes the successful clinical management of a second molar in a 58-year-old female patient having three MBR canals (MB1, MB2, and MB3) with a Vertucci's Type VIII canal configuration and an almost obliterated pulp chamber. The canals were prepared using hand and rotary instruments, followed by obturation. Very few such cases have been documented clinically in the literature.

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Objectives: The objective of the study is to evaluate the effect of eugenol-based temporary on microtensile bond strength of self-adhering composite at 1 day and 7-day time intervals. Materials and Methods: Occlusal enamel of 24 human molars was removed. Zinc oxide eugenol (ZnOE) and noneugenol temporary cement (ZnONE) were placed on the dentin surfaces and left for different times (1 day, 7 days). After removal of temporary cement, teeth were randomly divided into eight subgroups: subgroup GE1S (n = 3): ZnOE cement + Self-adhering composite (SAC), subgroup GE1N (n = 3): ZnOE cement + adhesive system (one coat 7 universal) + nanohybrid composite, subgroup GE7S (n = 3): ZnOE cement + SAC, subgroup GE7N (n = 3): ZnOE cement + adhesive system + nanohybrid composite, subgroup GNE1S (n = 3): ZnONE cement + SAC, subgroup GNE1N (n = 3): ZnONE cement + adhesive system + nanohybrid composite, subgroup GNE7S (n = 3): ZnONE cement + SAC, subgroup GNE7N (n = 3): ZnONE cement + adhesive system + nanohybrid composite. Four sticks per tooth were obtained, resulting in 12 sticks per group with a cross-sectional area of 0.5 mm². The μTBS test was performed with a crosshead speed of 0.5 mm/min. Statistical Analysis: Kruskal–Wallis and Mann–Whitney U-test were used for analysis. Results: Highest and lowest mean value of microtensile bond strength was observed in GNE7N (12.75MPa) and GE1S (1.42MPa), respectively. Conclusion: The presence of eugenol at early stage, i.e. 1 day, has a negative influence on microtensile bond strength of SAC. At 7 days, the negative effect of eugenol on microtensile bond strength gets nullified. Thus, a waiting period of 1 week is sufficient to overcome negative influence of eugenol-based temporaries on polymerization of SAC.

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The maxillary anterior region is the most common site for the occurrence of radicular cyst in permanent dentition, because of a high frequency of trauma in this region. As radicular cyst is categorized as an inflammatory cyst, endodontic treatment of the tooth associated with the cyst becomes a part of the treatment regimen. Management of radicular cyst becomes challenging when it involves tooth with complex root morphology. This report presents the diagnosis and successful management of a dilacerated maxillary central incisor associated with a radicular cyst and external root resorption. Cone-beam computed tomography was used to view the extent of the cyst and understand the aberrant root canal morphology of the dilacerated tooth. Root canal therapy was followed by cyst enucleation, apicoectomy, and placement of platelet-rich fibrin. At 1-year recall, appreciable healing as evidenced by a decrease in the size of the radiolucency on the radiographic examination was seen.

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Aims : The aim of this study was to evaluate the biocompatibility of resinous root canal sealers: Sealer 26, AH plus, and SK Seal Root Canal Sealer in the subcutaneous tissue of rats. Subjects and Methods : Twenty-four Wistar rats received polyethylene tubes containing the sealers and empty tubes as control (n = 6). After 7, 15, 30, and 60 days, animals were killed and polyethylene tubes were removed with the surrounding tissues. The specimens were embedded in paraffin, processed for hematoxylin-eosin and immunohistochemistry assessed for fibronectin (FN) and tenascin (TN). Statistical Analysis Used : Data were tabulated and analyzed via Kruskal–Wallis and Dunn's test (P < 0.05). Results : All groups induced a moderate inflammatory reaction after 7 and 15 days (P > 0.05); after 30 days, a mild inflammatory infiltrate was observed in control groups, and moderate in sealers groups (P > 0.05); all groups showed mild inflammatory infiltrate at 60 days (P > 0.05). Overall, the fibrous capsule was considered thick only on the 7^th day and became thin over time. All groups had expression for FN and TN in all analyzed periods, with high immunolabeling in sealers groups when comparing with the control group (P < 0.05). Conclusion : All sealers demonstrated biocompatibility and induced FN and TN expression.

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Aim: To assess the knowledge, attitude, and practice of traumatic dental injury (TDI) management among school teachers of Chennai. Materials and Methods: Forty-seven schools were selected from various parts of Chennai for the cross-sectional survey by simple random sampling. Four hundred school teachers who participated were from 26 regular schools and 21 special schools. Questionnaire with 32 close-ended questions assessing knowledge, attitude, and practice of TDI management was devised, face validated by experts, and pilot tested. Link to the online survey questions was provided after obtaining the informed consent. Responses were analyzed using Microsoft Excel. Results: Twenty-two percent reported to have undergone first aid training and among them, 4% were trained on TDIs management. 27% had a false sense of knowledge and practice of TDIs management. 12% were confident in replanting an avulsed tooth by themselves. Ten percent were aware of using milk as a storage media. 86% were willing to learn about TDIs management. Conclusions: Within the limitations of the present study, it can be concluded that despite the lack of knowledge and practice regarding TDI management, school teachers of Chennai had a good attitude towards TDI education. Emergency management training is by itself a necessity in schools and it should be inclusive of TDI management.

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Background : Lack of bond stability between the composite resin and dentin remains one of the main reasons for having to replace esthetic restorations. Aim : This study aimed to evaluate the influence of chlorhexidine (CHX) on the bond strength of a total etching system to dentin tissue after degradation of the adhesive interface. Materials and Methods : One hundred and eighty fragments of human molars were divided into three groups (n = 15) according to the materials used during the acid-etching step: Group 1 (control), 37% phosphoric acid; Group 2, a combined solution of 37% phosphoric acid and 2% CHX; and Group 3, 37% phosphoric acid followed by 2% CHX. Following the restorative procedures, the groups were divided into four subgroups according to the number of thermal cycles (TC) and to the time of storage in water (SW), and then subjected to a shear strength test, until fracture: (A) 0 TC/24-h SW; (B) 500 TC/1-week SW; (C) 2,000 TC/1-month SW; and (D) 12,000 TC/6-month SW. Two-way analysis of variance and Duncan's complementary test were used to perform multiple comparisons. Results : After the 24-h and 1-week SW time periods, no statistically significant difference was found among the shear strength values of the control and the experimental groups: 5.48 ± 0.59 MPa, 5.44 ± 0.56 MPa, and 5.65 ± 0.94 MPa for G1, G2, and G3, respectively. However, the shear strength values decreased significantly in all the study groups after 1 month, namely 3.60 ± 0.41 MPa, 3.08 ± 0.65 MPa, and 3.49 ± 0.23 MPa for G1, G2, and G3, respectively. After 6 months, similar results were found for G1 and G3, namely 2.77 ± 0.58 MPa and 1.74 ± 0.52 MPa, respectively, whereas the 0.77 ± 0.26 MPa value found for G2 was significantly lower than those found for the G1 and G3 groups. No differences were found between the groups with respect to fracture-type frequencies. Conclusion : The use of CHX as an agent to rehydrate the dentin had a negative influence on bond strength.

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Background: Tooth preparation for fixed prosthodontic procedures often induces enough thermal or mechanical stresses on the pulp. The extent of pulpal injury and ability to repair depends on factors like amount of remaining dentin, extent of heat produced, and permeability of dentinal tubules. However, there is no infallible method to predict the pulpal response and so the treatment outcome. Aim: This survey tries to assess the knowledge and perception among dental practitioners on the need for prophylactic endodontic therapy in abutment teeth for fixed partial denture (FPD). Setting and Design: Questionnaire-based survey. Methodology: An observational study was then conducted among 303 dental practitioners in the state of Tamil Nadu and 250 participants responded. Statistical Analysis Used: Descriptive statistics and multiple linear regression analysis. Results and Conclusion: The survey further imparts light on the clinical outcomes that help minimize the incidence of biological failure underneath a FPD.

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Root canal system typically has a diverse canal configuration. One of the most difficult aspects of ensuring successful endodontic treatment is accurately identifying all canals found in a tooth. Diverse root canal configurations are not uncommon, even if the majority of maxillary incisors have a single root canal. One canal bifurcating into two at the apical third is exceptionally rare, with only two case reports previously reported. For the precise diagnosis of certain anatomical peculiarities, a thorough evaluation of preoperative diagnostic radiographs is highly required. As of periapical radiography, which is the most important diagnostic imaging for determining root canal anatomy, is limited by its two-dimensional nature, technological innovations such as cone beam computed tomography can be extremely beneficial. This paper emphasizes the significance of preoperative diagnostic imaging in the treatment planning of maxillary central incisors with unusual root canal morphology.

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