Manju Kumari

Use of triple antibiotic paste in the treatment of large periradicular lesions.

Microorganisms are the possible source of endodontic lesions. The polymicrobial infection makes the sterilization of the root canal difficult. The following case report describes the non-surgical endodontic treatment of teeth with a large periradicular lesion. First, an intracanal dressing of calcium hydroxide was given. Since the symptoms did not subside, the treatment protocol was changed. A triple antibiotic paste was used instead for 3 months. On follow up, teeth were clinically asymptomatic and radiographically showed healing of the periradicular lesion. The result of the case show that when most commonly-used medicaments fail in eliminating the symptoms, then a triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) can be used clinically in the treatment of teeth with large periradicular lesions.

Nonsurgical healing of large periradicular lesions using a triple antibiotic paste: A case series

The infection of the root canal system is considered to be a polymicrobial infection, consisting of both aerobic and anaerobic bacteria. Because of the complexity of the root canal infection, it is unlikely that any single antibiotic could result in effective sterilization of the canal. A combination of antibiotic drugs (metronidazole, ciprofloxacin, and minocycline) is used to eliminate target bacteria, which are possible sources of endodontic lesions. Three case reports describe the nonsurgical endodontic treatment of teeth with large periradicular lesions. A triple antibiotic paste was used for 3 months. After 3 months, teeth were asymptomatic and were obturated. The follow-up radiograph of all the three cases showed progressive healing of periradicular lesions. The results of these cases show that when most commonly used medicaments fail in eliminating the symptoms then a triple antibiotic paste can be used clinically in the treatment of teeth with large periradicular lesions.

Comparative evaluation of the efficacy of three different irrigation devices in removal of debris from root canal at two different levels: An in vitro study

Aim: The purpose of this in vitro study was to evaluate the cleaning efficacy of NaviTip, Max-i-Probe and Endovac in removal of debris from the root canal at 1.5 and 3.5 mm from the apex. Materials and Methods: Forty single-rooted teeth were divided into four groups according to the root canal irrigation system (EndoVac, NaviTip, Max-i-Probe, and control). Instrumentation was done using ProFile 0.06 taper series to MAF #40. Root canals were irrigated after each file size with 1 ml of 5% NaOCl. For final irrigation 5 ml of 5% NaOCl and 17% ethylenediaminetetraacetic acid (EDTA) was used. Each group was irrigated with a different irrigation device. Four micron thick serial sections were prepared at 1.5 and 3.5 mm from the apical level and photographs were taken for the analysis. The influence of the irrigation system was evaluated using a one-way analysis of variance (ANOVA) test and unpaired t-test (P < 0.05). Results: Endovac showed significantly least amount of mean percentage debris followed by Max-i-probe and NaviTip at both levels (P < 0.05). In all the experimental groups, significantly less amount of mean percentage debris was seen at 3.5 mm level than at 1.5 mm level (P < 0.05). However, the difference was statistically insignificant in case of Endovac irrigation system group. Conclusions: Amongst all the experimental groups, Endovac removed significantly more debris followed by Max-i-probe and NaviTip at both levels.

Effect of ceramic type, thickness, and time of irradiation on degree of polymerization of dual - cure resin cement

Aim : The aim of the study is to evaluate the effect of ceramic type, thickness, and time of irradiation on degree of polymerization of dual-cure resin cement. Materials and Methods: Dual-cure resin cement (SoloCem) was used to prepare disk-shaped samples (0.5 mm thick × 5 mm diameter). Study group samples (n = 5) were light-cured for 40, 60, and 80 s through all ceramic leucite-reinforced (Cergo Kiss), lithium disilicate-reinforced (IPS e.max), and monolithic zirconia-reinforced (Ziecon) of three thicknesses (2, 3, and 4 mm). Negative control group samples were cured through metal disks and positive control samples were cured without the presence of ceramic. The degree of conversion (DC) was evaluated by Fourier transform infrared spectrometer. The recorded data were subjected to one-way analysis of variance, followed by post hoc analysis (Tukey HSD). Results and Conclusion: Greatest light transmission and DC were seen through Cergo Kiss, followed by IPS e.max Press and Ziecon, with insignificant difference between the latter two. The attenuation of light irradiance increased with increasing thickness of ceramic disks, with statistically significant values between 3 and 4 mm. Increasing time of irradiation to cure dual-cure resin cement did not always result in greater degree of polymerization.

Evaluation of light transmission through different esthetic posts and its influence on the degree of polymerization of a dual cure resin cement.

Aim: To measure the light transmission through different esthetic posts and to evaluate the degree of polymerization of dual cure resin cement cured through these posts. Materials and Methods: The posts were divided into two experimental groups i.e. Group A (D.T. Light post); Group B (D.T. White post) and control i.e. Group C (metal post), each group having 10 samples. Posts of each group were illuminated with curing light and photographs were taken keeping the parameters standardized to evaluate the intensity of light transmission at different levels. The degree of polymerization of dual cure resin cement was evaluated using Fourier Transform Infrared spectroscopy. The data obtained was subjected to statistical analysis. Results: D.T. Light post showed highest light transmission and degree of polymerization. The light intensity decreased from cervical to apical for both esthetic post but the decrease from middle to apical third was insignificant for D.T. White post group. No light transmission was detected in metal post but the degree of polymerization decreased significantly from cervical to middle third. Conclusion: Cementation of fibre post with superior light transmitting ability using dual cured resin cement resulted in increased degree of polymerization.

Effect of QMix, peracetic acid and ethylenediaminetetraacetic acid on calcium loss and microhardness of root dentine

Objectives: The objective of this in vitro study was to assess the effect of different chelating agents on the calcium loss and its subsequent effect on the microhardness of the root dentin. Materials and Methods: Ten single rooted lower premolars were selected. The teeth were decoronated and thick transverse sections of 2 mm were obtained from the coronal third of the root. Each section was then divided into four quarters, each part constituting a sample specimen from the same tooth for each group. The treatment groups were: Group 1 (Control): 5% Sodium hypochlorite (NaOCl) for 5 min + distilled water for 5 min; Group 2: 5% NaOCl for 5 min + 17% ethylenediaminetetraacetic acid (EDTA) for 5 min; Group 3: 5% NaOCl for 5 min + 2.25% Peracetic acid (PAA) for 5 min and Group 4: 5% NaOCl for 5 min + QMix for 5 min respectively. The calcium loss of the samples was evaluated using the Atomic Absorption Spectrophotometer followed by determination of their microhardness using Vickers Hardness Tester. Data was analyzed using one-way ANOVA, Post hoc Tukey test and Pearson correlation. Results: The maximum calcium loss and minimum microhardness was observed in Group 3 followed by Group 2, Group 4 and Group 1. There was a statistically significant difference between all the groups except between Groups 2 and 4. Conclusions: Irrigation with NaOCl + 2.25% PAA caused the maximum calcium loss from root dentin and reduced microhardness. A negative correlation existed between the calcium loss and reduction in the microhardness of root dentin.

Effect of accelerants on the immediate and the delayed sealing ability of mineral trioxide aggregate when used as an apical plug: An in vitro study

Aim: To evaluate and compare the influence of various accelerators, 15% disodium hydrogen phosphate (Na2HPO4), 10% calcium chloride (CaCl2) and 23.1 wt% calcium lactate gluconate (CLG), on the immediate (after 72 h) and delayed (after 2 months) sealing ability of white ProRoot mineral trioxide aggregate (WMTA) when it is used as an apical plug. Materials and Methods: Eighty, single-rooted mandibular premolars were instrumented and standardized artificial open apices were created. The samples were then randomly assigned into four experimental groups and two control groups. WMTA was mixed with the respective accelerators and an apical plug of 4-mm thickness was fabricated. The remaining canal spaces were then backfilled. The samples were stored for the stipulated time periods and then immersed in 0.2% Rhodamine B solution for 72 h. Dye leakage was analyzed using a stereomicroscope. Results: Mean microleakage values of all experimental groups revealed that MTA + 23.1 wt% CLG showed the least leakage, followed by MTA + 15% Na2HPO4 and MTA + 10% CaCl2 with MTA + deionized water showing the maximum leakage at both the time intervals (P < 0.001). All the samples stored for a period of 2 months showed less leakage as compared with the samples stored for 72 h (P < 0.05). Conclusions: It was found that all three accelerators significantly accelerated the set of WMTA, of which 23.1 wt% CLG showed the best results, followed by 15% Na2HPO4 and 10% CaCl2. The sealing ability of all the experimental groups was significantly superior after 2 months as compared with that after 72 h.

Effect of internal matrices of hydroxyapatite and calcium sulfate on the sealing ability of mineral trioxide aggregate and light cured glass ionomer cement.

Objective: The present study was undertaken to evaluate the effect of hydroxyapatite (HA) and calcium sulfate (CS) on the sealing ability of mineral trioxide aggregate (MTA) and light cured glass ionomer cement (LC GIC) when used to repair furcation perforations. Materials and Methods: The study was conducted on 70 human molars. Sixty teeth with furcal perforations were randomly divided into six groups of 10 teeth each and repaired with MTA or LC GIC either alone or over an internal matrix, i.e., CS or HA. Access openings were filled with composite resin. Five teeth with unrepaired perforations were used as positive controls and five teeth without perforations were used as negative controls. The teeth were immersed in a solution of 2% methylene blue dye for 2 weeks. The samples were then sectioned and evaluated for linear dye leakage and analyzed statistically. Results: MTA showed the best sealing ability followed by LC GIC, MTA + CS, MTA + HA, LC GIC + CS and LC GIC + HA. Conclusion: Neither of the two internal matrices improved the sealing ability of the repair materials used.

Effect of saliva and blood contamination on the shear bond strength of fifth-, seventh-, and eighth-generation bonding agents: An in vitro study

Aim: To evaluate the bond strength of different adhesives after contamination with saliva and blood at various steps of application. Materials and Methods: Buccal surfaces of 180 human premolars were sliced to expose dentin. The specimens were randomly divided into six groups (n = 30), in which saliva and blood were used as contaminants in three groups each. The groups were further divided according to the generation (fifth – OptiBond Solo Plus Kerr, USA; seventh – OptiBond All-In-One Kerr, USA; eighth – Futurabond DC, Voco, Germany) of the adhesive used. Effect of contaminant application both before and after polymerization of the adhesive was evaluated. Composite cylinders were fabricated on exposed dentinal surfaces and were subjected to shear bond strength test. The results were subjected to one-way analysis of variance and t-test. Results: The eighth-generation adhesive showed the highest mean shear bond strength, followed by fifth- and seventh-generation adhesive. Salivary contamination resulted in greater decrease of bond strength when contaminated before polymerization. However, the results were vice versa when blood contamination was done, except in the case of fifth-generation adhesive. Blood contamination produced the lowest shear bond strength in all conditions. Conclusion: The eighth-generation adhesives showed the highest and blood contamination the lowest bond strength in all conditions.

An in vitro comparison of effect on fracture strength, pH and calcium ion diffusion from various biomimetic materials when used for repair of simulated root resorption defects

Aim: The aim of this study was to compare the effect on fracture strength, pH and calcium ion diffusion from mineral trioxide aggregate (MTA) Fillapex, iRoot SP, and Ultracal when used for repair of simulated root resorption defects. Materials and Methods: Three sets of 40 teeth each were used, and biomechanical preparation was done. Resorption cavity was made at 5 mm from the apex. Teeth were filled with different experimental materials. In control group, saline was used. Samples of fracture resistance were stored in an incubator for 3 months and then subjected to the universal testing machine. To evaluate the pH and calcium ion release were checked at 1 day and 1, 2, 3, and 4 weeks intervals. Data were recorded and statistical analysis done by one-way analysis of variance followed by post-hoc Tukey test. Results: Highest fracture resistance was seen in MTA Fillapex followed by iRoot SP, control, and then Ultracal group. Teeth filled with iRoot SP showed highest pH and calcium ion release followed by MTA Fillapex and Ultracal group. Conclusion: Bioceramic sealers showed high pH, calcium ion release, and good root reinforcement potential. Initial dressing of calcium hydroxide followed by obturation with Gutta-percha and bioceramic sealer may be considered as an alternative treatment modality for inflammatory resorption.