Kundabala Mala

Comparison of the Efficacy of Maleic Acid and Ethylenediaminetetraacetic Acid in Smear Layer Removal from Instrumented Human Root Canal: A Scanning Electron Microscopic Study

INTRODUCTION The aim of this study was to assess, by scanning electron microscopic (SEM) analysis, the ability of 17% EDTA and 7% maleic acid in the removal of the smear layer from the human root canal system. METHODS Eighty single-rooted human anterior teeth were subjected to standardized root canal instrumentation (step-back technique) and were irrigated with 2.5% NaOCl after each instrument. Based on the final irrigating solution used, samples were divided randomly into three groups: (1) the EDTA group: 17% EDTA+ 2.5% NaOCl (n = 30), (2) the maleic acid group: 7% maleic acid + 2.5% NaOCl (n = 30), and (3) the control group: 0.9% saline (n = 20). After final irrigation, teeth were prepared for SEM analysis to evaluate the cleaning of the coronal, middle, and apical thirds of radicular dentin by determining the presence or absence of smear layer. The data was statistically analyzed using the Kruskall-Wallis test. RESULTS At the coronal and middle thirds, there was no significant difference between EDTA and maleic acid. Both were equally efficient in the removal of smear layer. In the apical third, maleic acid showed significantly better smear layer removing ability than EDTA. CONCLUSION Final irrigation with 7% maleic acid is more efficient than 17%EDTA in the removal of smear layer from the apical third of the root canal system, which is a crucial area for disinfection.

Evaluation of the Effect of Maleic Acid and Ethylenediaminetetraacetic Acid on the Microhardness and Surface Roughness of Human Root Canal Dentin

INTRODUCTION The aim of this in vitro study was to evaluate the effect of 7% maleic acid and 17% EDTA solutions on the microhardness and the surface roughness of human root canal dentin. METHODS Forty-five extracted human maxillary central incisors were sectioned longitudinally into a total of 90 segments, were embedded in auto polymerizing acrylic resin, and were grounded flat with silicon carbide abrasive papers. Based on the test solutions used, samples were divided randomly into three groups: (1) the EDTA group, 1 mL of 17% EDTA for 1 minute (n = 30), (2) the maleic acid group, 1 mL of 7% maleic acid for 1 minute (n = 30), and (3) the control group, 1 mL of 0.9% saline for 1 minute (n = 30). Every group was then divided into two subgroups of 15 specimens each. In group 1a, 2a, and 3a, specimens were used to determine the microhardness of the root canal dentine in the coronal, middle, and apical third using Vickers hardness tester. In groups 1b, 2b, and 3b, specimens were used for the determination of surface roughness of the root canal dentine using a roughness tester (Surtronic, Leicester, England). The data were statistically analyzed using the Kruskall Wallis and Mann Whitney U tests. RESULTS There was no significant difference between EDTA and maleic acid in the reduction of microhardness. The increase in roughness was significantly greater with maleic acid when compared with EDTA. CONCLUSION Maleic acid reduced the microhardness of root dentin similar to EDTA but increased the surface roughness significantly more than EDTA.

Regenerative endodontics as a tissue engineering approach: Past, current and future

With the reported startling statistics of high incidence of tooth decay and tooth loss, the current interest is focused on the development of alternate dental tissue replacement therapies. This has led to the application of dental tissue engineering as a clinically relevant method for the regeneration of dental tissues and generation of bioengineered whole tooth. Although, tissue engineering approach requires the three main key elements of stem cells, scaffold and morphogens, a conductive environment (fourth element) is equally important for successful engineering of any tissue and/or organ. The applications of this science has evolved continuously in dentistry, beginning from the application of Ca(OH)(2) in vital pulp therapy to the development of a fully functional bioengineered tooth (mice). Thus, with advances in basic research, recent reports and studies have shown successful application of tissue engineering in the field of dentistry. However, certain practical obstacles are yet to be overcome before dental tissue regeneration can be applied as evidence-based approach in clinics. The article highlights on the past achievements, current developments and future prospects of tissue engineering and regenerative therapy in the field of endodontics and bioengineered teeth (bioteeth).

Evaluation of decalcifying effect of maleic acid and EDTA on root canal dentin using energy dispersive spectrometer

OBJECTIVE The aim of this study was to evaluate mineral contents of root canal dentin after treatment with 7% maleic acid (MA) or 17% EDTA. STUDY DESIGN Thirty pieces of teeth were divided into 3 groups: 1) 17% EDTA; 2) 7% MA; and 3) saline. All specimens were treated for 0, 1, 5, 10, 15 minutes. Levels of calcium, phosphorus, magnesium, sodium, sulfur, and oxygen were measured using energy dispersive spectrometer. Data were analyzed using 1-way analysis of variance. Tukey honest significant difference and Bonferroni test were used for comparison between the groups and time periods. RESULTS MA reduced maximum amount of calcium and phosphorus at all time intervals, but was significant only up to 5 minutes (P < .001). Oxygen, sulfur, and magnesium were decreased more with saline and least with MA (P < .001). Sodium was decreased more with MA and least with EDTA (P < .001). CONCLUSIONS MA decalcifies the root dentin, with most calcium and phosphorus extracted during the first 5 minutes, compared with EDTA.

In vitro antimicrobial activity of maleic acid and ethylenediaminetetraacetic acid on endodontic pathogens

OBJECTIVE The aim of this study was to evaluate the antimicrobial efficacy of 7% maleic acid (MA) and 17% ethylenediaminetetraacetic acid (EDTA) in elimination of Enterococcus faecalis, Candida albicans, and Staphylococcus aureus at different time intervals. STUDY DESIGN Transfer culture of microbial strains were used for inoculum preparation and determination of time-kill assay. The viability counts of 7% MA and 17% EDTA suspensions were performed at 0, 2, 4, 6, 12, and 24 hours. Assay results were analyzed by determining number of strains that yielded log(10) CFU/mL of -1 compared with counts at 0 hours, for test medicaments at time intervals. Medicaments were considered to be microbicidal at a minimum inhibitory concentration that reduced original inoculum by >3 log(10) CFU/mL (99.9%) and microbiostatic if inoculum was reduced by <3 log(10) CFU/mL. Statistical analysis was performed using chi-square and Fisher exact tests as well as Friedman test for comparison of the time interval within the MA and EDTA groups. RESULTS At all time intervals, there was no significant difference between MA and EDTA for all of the organisms (P > .05). However, within the MA and EDTA groups at various time intervals, there were significant differences (P < .001). CONCLUSIONS Equivalent antimicrobial activity was observed by MA and EDTA against all of the organisms tested at various periods.

Endo‑perio lesion: A dilemma from 19 th until 21 st century

The interrelationship between endodontic and periodontal diseases has been a subject of speculation, confusion and controversy for many years. Pulpal and periodontal problems are responsible for more than 50% of tooth mortality today. An endo-perio lesion can have a varied pathogenesis which ranges from quite simple to relatively complex one. These lesions often present challenges to the clinician as far as diagnosis and prognosis of the involved teeth are concerned. It is very essential to make a correct diagnosis so that the appropriate treatment can be provided. To make a correct diagnosis the clinician should have a thorough understanding and scientific knowledge of these lesions and may need to perform restorative, endoontic or periodontal therapy, either singly or in combination to treat them. Therefore, this presentation will highlight the diagnostic, clinical guidelines and decision-making in the treatment of these lesions from an Endodontists point of view to achieve the best outcome. Clinical Relevance to Interdisciplinary Dentistry Perio-endo lesions are very complex in nature and can have a varied pathogenesis. Treatment decision-making and prognosis depend primarily on the diagnosis of the specific endodontic and/or periodontal diseases. To have the best prognosis, clinician should refer the case to various areas of specialization, to perform restorative, endodontic or periodontal therapy, either singly or in combination. Therefore, to achieve the best outcome for these lesions, a multi-disciplinary approach should be involved.

Sound levels in conservative dentistry and endodontics clinic

Aim: To evaluate the sound levels generated in dental clinics of conservative dentistry and endodontics. Material and Methods: A decibel-meter with digital readout was used to measure sound levels at different time intervals at the chairside and at the center of the clinic. Minimum and maximum readings during a 3 min interval were recorded. Results: In the post-graduate (PG) clinic, there was significant difference in noise levels between the chairside (66-81 dB[A]) and the center of the clinic (66-67 dB[A]) at certain times. In the under graduate (UG) clinic, noise levels with suction and either high/slow speed handpieces (67-80 dB[A]) were significantly higher than the center of clinic. Suction alone in the UG clinic (63-75 dB[A]) was significantly quieter than in the PG clinic (69-79 dB[A]). Conclusions: (1) Mean sound levels in the working clinics ranged from 63.0 dB[A] to 81.5 dB[A]. These are within the recommended range for dental equipment. (2) With suction and either low/high speed handpiece combination, the PG clinic was significantly noisier than the UG clinic at several time periods.

An in vitro comparative evaluation of physical properties of four different types of core materials

Introduction: Compressive and tensile stresses of core materials are important properties because cores usually replace a large bulk of tooth structure and must resist multidirectional masticatory forces for many years. Material and Methods: The present study was undertaken to find out the best core build up material with respect to their physical properties among resin-based composites. Individual compressive, tensile, and flexural strength of fiber-reinforced dual cure resin core build up material, silorane-based composite resin, and dual curing composite for core build up with silver amalgam core was used as control were evaluated and compared using universal testing machine. Data were statistical analysed using Kruskal-Wallis test to determine whether statistically significant differences (P < 0.05) existed among core materials. Both dual cure composite materials with nanofillers were found superior to amalgam core. The silorane-based material showed the highest flexural strength, but other mechanical properties were inferior to dual cure composite materials with nanofillers.

Evaluation of sealing ability of a root canal sealer with various antibiotic additives: An in vitro study

Introduction: One of the reasons for persistent endodontic infection is the retention of microorganism on root canal walls. Studies on endodontic prognosis have demonstrated that the addition of antibiotics to the root canal sealer is proven to be beneficial to prevent re-infection and impart antimicrobial property for a longer time. Aims and Objectives: The primary aim of this study is to determine and the secondary aim is to compare the sealing ability of Kerr Pulp Canal Sealer (extended working time) (PCS [EWT]) when used with or without various antibiotic additives viz.; amoxycillin, doxycycline and metronidazole using apical dye leakage method. Materials and Methods: An in vitro study was performed on extracted human teeth, obturated with sealer-antibiotic combinations and sealers alone. Rhodamine-B dye penetration was done for 10 days and the teeth were sectioned and viewed under light microscope; then linear dye penetration was measured and statistically analyzed. Results: Kerr PCS (EWT) showed mean apical leakage of 3.475 mm (P = 0.655, Z = 0.447), whereas PCS (EWT) combined with amoxycillin showed a mean apical leakage of 0.997 mm (P = 0.084, Z = 1.727) showing its clinical significance. PCS (EWT) + amoxycillin showed the best sealing ability with least apical leakage. Conclusion: Addition of antibiotics such as amoxycillin, doxycycline and metronidazole to Kerr PCS (EWT) sealer is recommended as it helps to improve the antibacterial property and the apical sealing ability. Clinical Relevance to Interdisciplinary Dentistry Bacteria and by-products in the dentinal tubules can cause reinfection of root canal treated teeth. The continuous release of antibacterial agent is desirable to prevent reinfection in root canal treated teeth. This original research hopes to prevent reinfection under the restorations of endodontically treated teeth by the action of additives in root canal sealers and by controlling the microleakage.

Association of level of education and utilization of restorative dental care among rural women in India: Cross-sectional study

Background: The utilization of restorative dental care is very scarce in rural India. Association between level of education and health of a person has been well-documented in many countries and time periods with a range of potential factors shaping the connection between both. Objectives: This cross-sectional survey was conducted to evaluate an association between the level of education (educational qualification) and utilization of restorative dental care among rural women associated with self-help groups. Materials and Methods: A semi-structured questionnaire was administrated to 660 rural women associated with self-help group by trained research assistants. The 604 completed questionnaires were received and reviewed. The education levels were divided into three groups: Group 1 - illiterates (17.2%), Group 2 - school educated (69.4%), and Group 3 - college educated (13.4%). Chi-square test was applied to evaluate the utilization of dental services by rural women, and logistic regression was applied to evaluate the influence of their educational qualifications on utilization. Results: A total of 604 properly filled questionnaires out of 660 (91.51% response rate) were included in the analysis. Only 56.9% of the sampled rural women indicated that they have visited dentists earlier. The maximum number of individuals who have never visited the dentist belonged to illiterate group (55.7%), and the association was statistically significant (0.004) when compared with educated individuals. Conclusion: The results of this study concluded that the level of education has a significant influence on the utilization of dental care.