This study investigated the clinical longevity of direct anterior composite restorations. Clinical studies exploring survival of anterior light-cured composite restorations with minimum of 2 years of follow-up were screened and reasons related to failure of direct anterior composite restorations were noted. PubMed, LILIACS, ProQuest, CENTRAL, and MEDLINE databases were searched with no restriction on date. Articles obtainable in the English language solely were enclosed during this study. Furthermore, articles to which reviewers had access were solely enclosed in ProQuest. Reference lists of eligible studies were hand searched. Initially, four reviewers screened the titles/abstracts of 947 studies. Out of those studies, a total of 47 articles were selected for full text reading, from which 25 studies were selected for qualitative synthesis. The studies that were enclosed evaluated the clinical performance of composite class III and class IV restorations (11 studies), which were placed due to caries, fracture, or replaced old restorations, veneers and full coverage restorations placed for esthetic reasons (9 studies), restorations in worn teeth (4 studies) with one study including combination of three type of studies listed above. A total of 75,637 restorations were evaluated and annual failure rates were in the range of 0% to 27.11% with survival rates ranging from 28.6% to 100%. Class III restorations had lower failure rates than alternative restorations. Fracture was the main cause of failure of restorations. The factors related to failure of restoration were adhesive technique, type of composite resin used, replacement of restoration first placed, and time required to make up the restorations.

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Aim : The objective was to evaluate the retrievability of bioceramic sealers in comparison with epoxy resin-based sealers assessed using microcomputed tomography. Materials and Methods : Four reviewers independently conducted a systematic literature search in four electronic databases. The risk of bias was assessed using modified Joanna Briggs Institute Critical Appraisal tools for Quasi-Experimental Studies. Results : Ten articles were included in this review and all had a moderate risk of bias. The results across the included articles were inconsistent with some indicating easier/difficult removal of bioceramic sealers, while others indicate no difference. The studies varied in terms of the type of bioceramic sealer used, root canal anatomy, and retreatment techniques followed. Due to heterogeneity, only a qualitative analysis was performed and no meta-analysis was conducted. Conclusion : The quality of evidence is low and no definitive conclusion could be derived regarding the retrievability of bioceramic sealer/AH plus sealer from the root canals during retreatment procedures.

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Background : The dentinal tubular penetration depth and interfacial adaptation of sealer are important factors for successful root canal treatment. Aims : This study aims to assess and evaluate the sealer penetration depth and interfacial adaptation of AH Plus, Apexit Plus, and GuttaFlow Bioseal sealer to root dentin. Materials and Methods : After decoronating sixty extracted single-rooted premolar teeth, preparation was done using ProTaper Gold rotary files until F3. The samples were randomly divided into three groups (n = 20 each) consistent with the sort of sealer used for obturation. After obturation with lateral compaction technique, half of the samples (n = 10 each) were sectioned transversely for measuring tubular depth penetration under a confocal laser scanning microscope. Longitudinal sections were obtained for the rest half the samples to gauge the difference of sealer using the scanning electron microscope. Statistical Analysis Used : Data were analyzed using one-way analysis of variance and Tukey's post hoc tests. Results : GuttaFlow Bioseal has shown a significantly higher depth of sealer penetration and minimum interfacial adaptation than resin-based sealer and calcium hydroxide-based sealer (P < 0.05). Conclusion : At all root regions, the GuttaFlow Bioseal sealer exhibited more sealer penetration and minimum interfacial adaptation whereas the Apexit Plus sealer exhibited less sealer penetration and maximum interfacial adaptation.

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Background : Restoration of endodontically treated teeth is one of the most challenging part of operative dentistry. The introduction of fiber-reinforced composite has provided a considerable opportunity to modify material's behavior and to enhance the response of existing materials. Aim : The aim of the study is to comparatively evaluate the efficacy of fiber-reinforced composite resins and nanohybrid resin impregnated with glass fibers as postendodontic restoration in molars. Materials and Methods : Fifty patients with deep occlusal carious lesion requiring root canal treatment were selected and treated. For postendodontic restoration, it was divided into Group A (Interlig) and Group B (ever-X posterior) which were eventually restored according to the manufacturer's instructions. Patients were recalled for evaluation at 3-, 6-, 12-month interval. The restorations were evaluated according to modified United States Public Health Service Criteria. Statistical Analysis : Chi-square test was used for intergroup comparison. Results : A statistically significant difference was noted in terms of fracture of tooth and ever-X posteriors proved to be a superior material and no statistically significant difference observed for marginal discoloration, marginal integrity, fracture of core-build up and secondary caries at the evaluation period of 1 year. Conclusion : Ever-X posteriors performed better than Interlig group as postendodontic restoration after 1 year of evaluation.

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Background : The antibacterial activity of restorative material and the amount of fluoride released are interlinked. Hence, these are the two foremost properties to be studied. Aim : This study aimed to evaluate and compare the amount and pattern of fluoride release from Type IX GIC (GC HS posterior), nanoionomer (Ketac N100), and alkasite (Cention N), and the antibacterial activity against Streptococcus mutans at 24 and 48 h. Settings and Design : This in vitro study was carried out in laboratory settings with six samples of each group for fluoride release using an ion-chromatography (IC) machine and five samples of each group for antibacterial activity using agar plates. Materials and Methodology : Samples of each group, Group I – Type IX GIC, Group II – nanoionomer, and Group III –alkasite, were prepared, immersed in 2 ml of artificial saliva, and fluoride release recorded using IC after 1, 7, 14, and 28 days intervals. The antibacterial activity against S. mutans was evaluated by placing samples of each group in the agar plates and measuring the diameter of zones of inhibition after 24 and 48 h. Statistical Analysis : One-way ANOVA test to check to mean differences between the groups and Tukey's honestly significant difference post hoc test for multiple intergroup comparisons (P = 0.05). Results : The Type IX GIC showed the highest fluoride release after day1. However, nanoionomer showed the maximum fluoride release for the remaining days. The least amount of fluoride released was from the alkasite throughout the study. The antibacterial activity of nanoionomer was the highest, followed by Type IX GIC and alkasite at both 24 and 48 h. Conclusions : Nanoionomer showed the highest fluoride release and antibacterial activity.

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Introduction: The purpose of antimicrobial agents is to eliminate the microorganisms without causing toxicity to host cells. This study aimed to assess the cytotoxic effect of oregano essential oil on L929 fibroblast cells. Materials and Methods: L929 fibroblast cells were exposed to four different concentrations of oregano essential oil (25–200 μg/ml) and calcium hydroxide (1 mg/ml). Dose-response curve was evaluated using 3-(4,5 dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide assay. The toxicity of L929 fibroblast cells was determined by lactate dehydrogenase activity (LDH). The results were analyzed using one-way analysis of variance and turkey post hoc test. P <0.05 was considered statistically significant. Results: Oregano essential oil showed a higher percentage of cell viability than the calcium hydroxide group. At 50 μg/ml, fibroblast cells showed arbitrarily 80% of cell viability compared to calcium hydroxide. There was a statistically significant difference with P < 0.05 on evaluating the effect of oregano essential oil on cytotoxicity measurement by LDH release of L929 fibroblast cells. Conclusion: Within the limitation of the study, Oregano essential oil at 50 μg/ml reported to show reduced cytotoxicity compared to calcium hydroxide at 1 mg/ml. Therefore, perhaps after evaluating other properties, it might be considered an intracanal medicament.

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Background: Periapical granuloma, radicular cyst, and periapical abscess represent periapical changes of frequent occurrence. Addressing this diagnostic dilemma is a matter of great concern, as it aids in governing the treatment planning and predicting its outcome. Aim: To evaluate the comparative accuracy of ultrasonography (USG), intraoral periapical (IOPA) radiography, and cone-beam computed tomography (CBCT) in differentially diagnosing periapical lesions of endodontic origin. Methods: Thirty-five patients having periapical lesions associated with anterior teeth requiring endodontic therapy were included in the study. The lesions were analyzed using IOPA radiographs, CBCT scans, and USG with color Doppler (CD). Periapical surgery ensued and enucleated tissue samples were subjected to histopathological analysis. To evaluate the accuracy, diagnoses made by each of the three modalities were compared with the gold standard histopathological reports, and the diagnostic accuracy, sensitivity, and specificity of each were calculated. Statistical Analysis: Cohen kappa (κ) was used for interrater reliability, and Pearson's contingency coefficient (C) was used for correlating findings of USG with histopathology. Results: USG showed good concordance with histopathological findings (contingency coefficient: 0.664). It also showed a higher accuracy rate compared to IOPA radiography and CBCT in differentially diagnosing periapical lesions. Conclusion: USG with CD holds the potential to be used as a noninvasive adjunct in periapical diagnostics.

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Aims: The objective of this study was to evaluate the effect of two collagen crosslinking agents on shear bond strength of a nanocomposite using total-etch adhesive to deep dentin. Materials and Methods: Thirty maxillary central incisors were selected for the study and each tooth was divided into two equal halves with diamond disc (n = 60). Proximal surfaces were prepared to expose the deep dentin until the remaining dentin thickness was approximately 1 mm. The specimens were divided into three groups based upon the biomodification of dentin with collagen crosslinking agents. In Group I (n = 20), no collagen crosslinking agent was used before bonding system. In Group II, deep dentin biomodification was done with 6.5% proanthocyanidin (PA). In Group III, deep dentin biomodification was done with Riboflavin. Shear bond strength was evaluated using universal testing machine. Statistical Analysis Used: One-way analysis (ANNOVA). Pairwise comparison of groups was done with post hoc test. Results: Biomodification of deep dentin with PA showed the highest shear bond strength followed by riboflavin and control group. Conclusion: Biomodification of dentin surface with collagen cross-linking agents results in improvement of bond strength of total-etch adhesive to deep dentin.

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Aim: The aim of the study is to determine the effect of autoclaving on the cyclic fatigue resistance (CFR) in respect to three different rotary nickel-titanium (NiTi) systems. Methods: Three rotary NiTi files with different manufacturing process were selected and arranged into three groups. Group 1: Neolix Neoniti files (n = 15), Group 2: Edge Files (n = 15), Group 3: NeoendoFlex files (n = 15). Each group was then subdivided into three subgroups containing 5 samples each based on the number of cycles of autoclaving (0, 1, 5 cycles). The instruments were subjected to autoclave without usage. The files of size 25, taper 6%, and 25 mm length were taken. After the autoclaving cycles, the files were rotated in cyclic fatigue testing device with simulated canal curvature of 60° until file separation. Time taken for the instrument separation (in minutes) was multiplied by the number of rotations per minute to attain the mean number of cycles to failure for every file. The obtained results were subjected to statistical analysis using two-way ANOVA and Newman–Keuls multiple post hoc procedures. Results: Neolix Neoniti files exhibited the maximum CFR (98.80) than EdgeFiles (80.47) and Neoendo Flex files (41.80) (P = 0.0001). Reduction in CFR was observed with increase in the number of cycles of autoclaving (i.e., 0, 1, 5 cycles). Conclusion: Autoclaving has a negative influence on the CFR of the rotary NiTi files used. Neolix Neoniti files exhibited greater CFR than EdgeFiles and Neoendo Flex files.

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Background: Evaluation of the biomechanical response of tooth with perforation repair is important to attain predictable prognosis. It may remain altered even after perforation repair due to the loss of tooth structure. Aim: The aim of this study is to assess and compare the effect of pulpal floor perforation repair of different sites with biodentine, on the biomechanical response of mandibular molar through 3-dimensional (3D) finite element analysis (FEA). Materials and Methods: Five different 3D models were constructed based on the site of perforation on the pulpal floor using cone-beam computed tomographic images of an extracted mandibular molar. Perforation size was standardized and simulated to be repaired with calcium silicate-based cement. A force of 200 N was applied simulating normal occlusal loads. Static linear FEA was performed using the Ansys FEA software. Tensile stresses were evaluated (P_max). Statistical Analysis Used: The data were evaluated using the independent t-test (P = 0.05). Results: All the simulated models with perforation repair exhibited higher stress values than their equivalent sites in the control group. The P_max values of the repaired models were highest in central furcal perforation, followed by buccal furcal perforation. However, there was no statistically significant difference in the stress accumulation among the different repaired perforation sites. Conclusion: The site of the pulpal floor perforation affected the stress distribution and accumulation. Central and buccal furcal perforation repairs on the pulpal floor with calcium silicate-based cement in mandibular molar are likely to have an increased risk of fracture.

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During the esthetic evaluation of smile, the presence of diastemas, tooth color, size and shape, and the amount of gingival exposure are important factors to be considered. A 23-year-old female patient was referred to us with a dissatisfaction with her smile. After clinical examination revealed esthetic alterations as generalized tooth yellowish discoloration, a slight diastema in the upper anterior region, and a shortened appearance of maxillary dental crowns, providing a gingival smile. The proposed treatment consisted of an esthetic rehabilitation for resolution of gummy smile and closure of diastema in anterior teeth by the use of digital planning as a guide for the accomplishment of integrated procedures. The result obtained by the multidisciplinary treatment associating periodontal surgical procedure for esthetic crown lengthening with in-office bleaching and direct restorations with composite resin, by digital planning, provided evident harmonization between tooth color and shape and gingival contour, enabling more harmonious smile esthetics.

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Background: Proper hybrid layer formation lays the foundation of resin–dentin bonding. The resin infiltration in demineralized dentin collagen couples with the adhesive/resin composites in the mineralized dentin surface. However, the activation of enzymatic activity in the collagen matrix can degrade the hybrid layer. Over the time, it leads to reduced bond strength. Mainly, the enzymes involved are matrix metalloproteinases (MMPs) which are involved in degrading most of the extracellular matrix components. Aloe vera is an herb with an anti-inflammatory effect, but its role in human dentin as an enzyme inhibitor has not been verified yet. Aims: The purpose of the study was designed for evaluating the inhibitory action of Aloe vera on MMP in human dentin with and without dentin bonding agents. Materials and Methods: A total of 15 freshly extracted healthy human teeth were collected and stored at 4°C until use. The roots were separated. The enamel and remnant pulp tissue were removed, and collected teeth were pulverized with liquid nitrogen in the minimum volume of 50-mM phosphate buffer to obtain dentin powder extract. The dentin powder extract is the source of MMPs, and therefore, the extract was treated with A. vera solution and incubated to assess the enzyme inhibition by the plate assay method and zymographic analysis. Results: A. vera treated sample with and without dentin bonding agent showed inhibition of dentin MMP's activity by plate assay method and confirmed by zymogram analysis. Conclusions: A. vera has the potential for inhibiting the MMPs enzyme activity of human dentin collagen with and without dentin bonding agents.

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Context : The incidence of root fractures is about 1.2%–7% in permanent teeth and horizontal mid root fractures are most common in maxillary anteriors. Aims : This study aims to evaluate the stress distribution in a maxillary central incisor with mid root fracture after various management protocols using three-dimensional finite element (FE) analysis. Materials and Methods : Four three dimensional FE models were constructed: Model 1-Normal tooth, Model 2-tooth with horizontal mid root fracture, Model 3-tooth with horizontal mid root fracture, coronal fragment filled with Biodentine, and access cavity sealed with composite resin cement and apical fragment left untreated and Model 4-tooth with horizontal mid root fracture restored with intraradicular fiber post as a splint and access cavity sealed with composite resin cement. The properties of materials were assigned and a force of 100 N was applied at 45° angle to the longitudinal axis of the tooth onto the palatal surface incisal to the cingulum. Statistical Analysis : Von-Mises stress along the length of the root analyzed and compared. Results : The maximum stress distribution was observed at the palatal end of the coronal radicular fragment in both without treatment and with biodentine treatment. The stress distribution was concentrated more at the junction of the splinted area in the intraradicular fiber post splinted model. Conclusions : The model with intraradicular fiber post as a splint exhibited more stress concentration at the splinted area due to bending forces. These stresses may adversely affect the healing around the fracture site and affect the longevity.

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Background : Self- adhesive flowable composite (SAFC) has been introduced to eliminate etching and bonding procedures. However, they have shown increased microleakage and poor bonding ability when used as per the manufacturer's instructions. It is unclear if prerestorative techniques can improve the same. Aims : This study aimed to evaluate the effects of acid etching, bevel placement and air abrasion on the marginal sealing ability of SAFCs when used in Class V restorations. Materials and Methods : 56 human mandibular premolars were taken and standard Class V cavities were prepared on the buccal aspect. They were divided into 4 groups comprising of control and three restorative techniques. Group A: SAFC used alone formed the control group, Group B: Acid-etched using 37.5% phosphoric acid gel, Group C: 1 mm bevel placed on the occlusal margin, Group D: Subjected to air abrasion. Each group was further subdivided into two, with one half being restored with Dyad flow (Kerr) while the remaining with Constic (DMG). The samples were thermocycled and the dye extraction method was used to assess microleakage using ultraviolet spectrophotometer. Statistical Analysis: Microleakage values were subjected to analysis of variance and post hoc analysis. Results : Statistically significant differences in the absorbance values were seen between the two SAFCs. Results with P < 0.05 were considered statistically significant. For Dyad flow, there was a statistically significant difference between Groups B and D (P = 0.028), while for Constic, it was between Groups A and B (P = 0.031) and Groups B and D (P = 0.025). Conclusions: Among restorative techniques, air abrasion showed the least microleakage, while acid etching showed the highest values. Among the two SAFCs, Constic presented lower microleakage than Dyad Flow.

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Aim : This study evaluated the effect of four intracanal medications commonly used in regenerative endodontic procedures on the bond strength of four calcium silicate-based materials, in which two are powder-to-liquid products (MTA and MTA-HP) and the other are ready-to-use materials (EndoSequence Root Repair Material Fast Set Putty [ERRM] and Bioceramic Repair [BIO-C Repair]). Methods : Ten bovine central incisors were selected and 4 slices (1.0 ± 0.1 mm) were prepared from each root. Next, four 0.8-mm wide holes were drilled in each slice and specimens were filled with one of the following intracanal medications: triple antibiotic paste, double antibiotic paste, calcium hydroxide with distilled water, and calcium hydroxide with 2% chlorhexidine gel. After 21 days, holes were filled with one of the materials: MTA, MTA-HP, ERRM, or BIO-C Repair. After storage, push-out test and failure analysis were performed. Data were submitted to analysis of variance in a 4 × 4 factorial scheme. Tukey's test was used for multiple comparisons. Results : The use of different interappointment dressings did not influence the results (P > 0.05). ERRM and BIO-C Repair presented significantly higher values than MTA and MTA-HP (P < 0.0001). Specimens showed a 100% occurrence of adhesive failures. Conclusion : The use of different intracanal medications presented similar impact on bond strength of calcium silicate-based materials. Ready-to-use ERRM and BIO-C Repair materials presented the best push-out values to dentine, whereas powder-to-liquid MTA and MTA-HP cements showed the lowest results.

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Context: A wire composite splint (WCS) is most commonly used in clinical practice for the management of luxation dental injuries (LDIs). Wire thickness and adhesive point dimensions influence the rigidity of WCS. However, the influence of presplint tooth mobility on the rigidity of splint is not yet addressed. Aim: The aim of this study is to identify the optimal thickness of WCS that achieves physiologic mobility in teeth with varying degrees of loosening (DoL) in a simulated LDI model. Settings and Design: In vitro study. Materials and Methods: Three typodont models with resin teeth were used. Right central incisor (Tooth 11) was simulated as an injured tooth and adjacent right lateral and left central incisor teeth (12 and21) acted as uninjured teeth. Each typodont model was modified to reproduce DoL 1, 2, and 3 in tooth 11 and categorized as Groups I, II, and III, respectively. The simulated injured tooth 11 was splinted with adjacent teeth 12 and 21 using 0.3, 0.5, and 0.8 mm WCS. Postsplinting DoL was assessed with Periotest. Statistical Analysis Used: Two-way ANOVA and post hoc Tukey test were used for intragroup and intergroup comparisons of pre- and postsplinting Periotest values (PTVs). Friedman's two-way ANOVA and Kruskal–Wallis test were used for the intragroup and intergroup comparison of splint effect. Results: Irrespective of the thickness of WCS, the postsplint PTVs corresponding to DoL 0 for simulated injured right central incisor tooth (11) were not achieved in Groups II and III. In three study groups, there was no statistically significant difference in the splint effect produced by 0.3 mm versus 0.5 mm WCS or 0.5 mm versus 0.8 mm WCS for tooth 11. Conclusions: The postsplint DoL for a luxated tooth is affected by both the degree of presplint tooth mobility and the thickness of the wire.

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Background: Numerous cone beam computed tomography (CBCT) studies have been done to analyze the canal anatomy of maxillary molars. However, research on comparison of symmetry in contralateral molars in the Indian population is limited. Aim: The aim of this study is to identify and assess the variations in the internal anatomy based on Vertucci's classification and to compare the prevalence of additional canals in contralateral maxillary first molar (Mx 1 M) and maxillary second molar (Mx 2 M) using CBCT. Settings and Design: A total of 120 small and medium field of view CBCT images with Mx1M and Mx2M were collected and retrospectively evaluated. Materials and Methods: Coronal, sagittal, and axial views of CBCT scans were analyzed by scrolling the scans, adjusting the contrast and brightness, and magnifying the canal configuration, along with additional canals and symmetry were identified and recorded. Statistical Analysis: Data were analyzed using McNemar's test and Chi-square test. Results: Both Mx1M and Mx2M showed bilateral symmetry in the mesiobuccal root with Type I canal anatomy in 86.1% and 97.8%, respectively. The MB2 canal was evident in 34.1% of Mx1M and 8.4% of Mx2M. Conclusion: Variations such a single-rooted and two-rooted teeth in Mx2M with Type I Vertucci's canal anatomy were seen. The MB2 canal was the only additional canal found.

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This article describes an unusual location of the orifices and roots in a permanent mandibular second molar with symptomatic irreversible pulpitis and symptomatic apical periodontitis. During its micro-endodontic management, the cone-beam computed tomography evaluation revealed a rare variant of a three-rooted permanent mandibular second molar with four canals. The single buccal root had two canals with Vertucci's Type II pattern and a lingual root dividing into two with a single canal in each root, respectively. Interestingly, the concerned tooth had normal occlusal morphology and alignment in the arch. A follow-up of 9 months after the completion of endodontic therapy exhibited satisfactory clinical and radiographic findings.

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Context : Characteristics of dental pulp capping agents may influence its interaction with the pulpal cells and can impact the treatment outcome. Aims : This study aims to microscopically characterize various pulp capping agents following hydration. Settings and Design: Original research. Materials and Methods : Disk-shaped specimens of five calcium silicate-based materials, i.e., mineral trioxide aggregate (MTA) Angelus, Biodentine, TheraCal LC, ApaCal ART, and Endocem MTA were prepared. After final set, the materials were immersed in 10 mL of deionized water for 14 days at 37°C. The set materials were characterized by scanning electron microscopy (SEM), X-ray energy dispersive analysis (EDX), and X-ray diffraction (XRD) analysis along with pH analysis of the storage solution using pH meter. Results : On SEM analysis, all the materials showed crystalline deposition on the cement surface with Biodentine exhibiting the most dense and homogenous microstructure. Calcium-silicate-hydrate and calcium hydroxide (CH) were observed as dark-grey and light-grey matrix material, respectively. EDX analysis revealed a high concentration of calcium. The other major elements were oxygen and carbon. The surface calcium concentration in the tested specimens was as follows: Biodentine (42.59 wt.%) > MTA Angelus (38.51wt.%) > Endocem MTA (30.24wt.%) > TheraCal LC (27.51wt.%) > ApaCal ART (22.02wt.%). On XRD analysis, all the materials exhibited peaks for tricalcium silicate and CH, after 14 days of hydration. Conclusions : The higher surface calcium level in Biodentine and MTA Angelus may enhance reparative dentin formation. The surface calcium concentration of Endocem MTA and ApaCal ART was found to be lesser than that of MTA Angelus, but with the added advantage of fast-setting property. Hence, they are potential alternative materials for vital pulp therapy.

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