Manuel S Thomas

Evaluation and comparison of bond strength to 10% carbamide peroxide bleached enamel following the application of 10% and 25% sodium ascorbate and alpha-tocopherol solutions: An in vitro study.

Aim: To evaluate and compare composite bond strength to carbamide peroxide bleached enamel following the application of 10% and 25% sodium ascorbate and alpha-tocopherol solutions. Materials and Methods: Sixty premolars were divided into six groups. Groups I and VI served as unbleached and bleached controls respectively. Groups II, III, IV and V served as the experimental groups and were subjected to 10% carbamide peroxide bleaching followed by 10 min application of 10% and 25% sodium ascorbate and 10% and 25% alpha-tocopherol solutions, respectively. Following composite bonding, shear bond strength was determined and the results were analyzed using ANOVA and Tukey highest significant difference test. Results: Only Group IV showed significantly lower bond strength when compared to Group I (unbleached control). When compared to Group VI (bleached control), except Group IV, groups II, III and V showed significantly higher bond strength. However, there was no statistically significant difference between the experimental groups corresponding to 10% and 25% and similar concentrations of sodium ascorbate and alpha-tocopherol solutions. Conclusion: Following 10% carbamide peroxide bleaching, except 10% alpha tocopherol, 10 min application of 10% and 25% sodium ascorbate and 25% alpha-tocopherol solutions significantly improves the shear bond strength of composite resin to enamel.

Effect of calcium hydroxide and triple antibiotic paste as intracanal medicaments on the incidence of inter-appointment flare-up in diabetic patients: An in vivo study

Aim: To evaluate and compare the effect of antibacterial intracanal medicaments on inter-appointment flare-up in diabetic patients. Materials and Methods: Fifty diabetic patients requiring root canal treatment were assigned into groups I, II, and III. In group I, no intracanal medicament was placed. In groups II and III, calcium hydroxide and triple antibiotic pastes were placed as intracanal medicaments, respectively. Patients were instructed to record their pain on days 1, 2, 3, 7, and 14. Inter-appointment flare-up was evaluated using verbal rating scale (VRS). Results: Overall incidence of inter-appointment flare-up among diabetic patients was found to be 16%. In group I, 50% of the patients and in group II, 15% of the patients developed inter-appointment flare-up. However, no patients in group III developed inter-appointment flare-up. The comparison of these results was found to be statistically significant (P = 0.002; χ2 = 12.426). However, with respect to intergroup comparison, only the difference between groups I and III was found to be statistically significant (P = 0.002; χ2 = 12.00). Conclusions: Calcium hydroxide and triple antibiotic paste are effective for managing inter-appointment flare-ups in diabetic patients. Triple antibiotic paste is more effective than calcium hydroxide in preventing the occurrence of flare-up in diabetic patients.

Crown discoloration due to the use of triple antibiotic paste as an endodontic intra-canal medicament

The use of triple antibiotic paste (TAP) (mixture of ciprofloxacin, metronidazole and minocycline) as an intra-canal medicament have shown very encouraging results particularly in non-vital immature teeth associated with periradicular lesions. Hence, before opting for a surgical approach, a non-surgical approach can be thought of with extended use of TAP as intra-canal medicament, especially in patients who are phobic to invasive procedures. On the flip side, the use of TAP has few side-effects, of which one is the discoloration it can cause due to the presence of minocycline in the mix. The purpose of this article is to presents a case of coronal discoloration due to the use of TAP as an endodontic intra-canal medicament.

Resurrecting an unsalvageable lower incisor with a mono-block approach

Contemporary techniques, as well as the availability of bioactive and adhesive materials in endodontics, have helped revivifying teeth that were deemed hopeless. These newer materials and techniques would enable the clinician: (a) to predictably stop microbial activity (b) to achieve a total corono-apical fluid tight seal and (c) to strengthen mutilated teeth by obtaining intra-radicular reinforcement through mono-block effect. This case report demonstrates the successful treatment of a mutilated anterior tooth with the use of bioactive and adhesive materials to obtain a total seal and mono-block effect. This article also shows the use of a simple method in the placement of root filling cement into the root canal.

Patient record and communication in interdisciplinary dentistry

Well-maintained records and good communication are essentials tools in modern dentistry. The right components of a dental record and appropriate communication skills by far provide a step forward in quality dental treatment. This article discusses the importance of both, good records and communication skills, in interdisciplinary dentistry and provides an overview of the components involved.

Effect of storage temperature and heating on the concentration of available chlorine and pH of 2.5% sodium hypochlorite

Aim: This study investigates the amount of available chlorine and pH of sodium hypochlorite after dilution and the influence of storage temperature, heating, and aging. Materials and Methods: A 5.25% sodium hypochlorite solution was diluted to 2.5%, and free available chlorine (FAC) and pH were measured. This was labeled as the control group. The diluted solution was divided into four groups. The first and second groups were stored at 4°C and room temperature, respectively, and FAC and pH were measured at room temperature at intervals of 30 min, 1, 3, and 6 h. The third and fourth groups were stored at 4°C and room temperature, respectively. Samples were collected at intervals of 30 min, 1, 3, and 6 h after heating to 60°C–70°C, and FAC and pH were measured. An iodometric titration method was used for FAC estimation. pH was measured using a digital pH meter. Data obtained were statistically analyzed. Results: All groups showed depletion in FAC and decrease in pH over time. Available chlorine was utmost in Group III and least in Group II. No statistically significant difference in pH was recorded. Conclusions: Sodium hypochlorite at room temperature should be used within 3 h of dilution. Its shelf life can be enhanced by storing at 4°C. Heating the solution to 60°C–70°C before irrigation is more efficacious.

Dens evaginatus as a possible cause for pulpal complications

This letter is in reference to an article that I read in the recent issue of your journal by Wang et al. Although the crux of their case report was conservative treatment of immature teeth with apical periodontitis through a revascularization procedure, my letter focuses on a different issue common to both cases presented in this article. In both cases, the reason for apical periodontitis was clearly not dental caries as evidenced by clinical and radiographic images shown in the article. In Case 1, the diagnosis was acute apical abscess in a lower premolar where endodontic treatment was initiated. The most probable reason for initiating the treatment on the caries-free premolar could be because of a pin-point pulp exposure resulting from a worn accessory cusp. However, in Case 2, the authors mentioned attrition of the central cusp in the lower premolar as a probable cause for the periapical lesion. Therefore, the supplementary central cusp, also referred to as dens evaginatus, needs to be considered as a potential cause for endodontic pathosis. Dens evaginatus is mostly observed in people of Asian descent, with an incidence ranging from 0.5% to 4.3%. These anomalies are commonly seen on premolars, and are typically bilateral in occurrence. As per the study by Oehlers et al, 70% of the tubercle contained pulpal content. Therefore, attrition or fracture of these abnormal tubercles on the occlusal surface soon after eruption can subsequently cause pulpal inflammation and infection. It is of utmost importance for the clinician to identify and manage this developmental aberration as soon as the tooth is erupted into the oral cavity in order to avoid any pulpal complications. Various options to prophylactically prevent pulpal complications, especially in patients with immature teeth, include: (1) placement of composite reinforcements around the evagination to prevent its fracture or removal of the tubercle, followed by preventive resin restoration when pulp is not exposed; or (2) pulp capping/partial pulpotomy

Importance of anatomic mock-up for predictable esthetic smile design with ceramic veneers

Ceramic veneers are considered as an esthetic treatment option for anterior teeth with unusual positions or appearance, as they conserve tooth structure and offer predictable results when planned adequately. Anatomic wax mock-up is an important tool during the phase of treatment planning. It allows the dentist to effectively communicate with the patient regarding the final esthetic result. Esthetic preevaluative temporaries prepared from the anatomic wax mock-up will allow the clinician and the patient to assess the form and contour future restorations to be placed; and its effects on the lip posture, smile line, and function. The mock-up can also help in the fabrication of an index to aid in the conservation of the tooth structure, while veneer tooth preparation and also assist in temporization. The purpose of this case report is to highlight the importance anatomic mock-up for predictable esthetic smile design with ceramic veneers. Clinical Relevance to Interdisciplinary Dentistry The dental and gingival component of the smile can be manipulated to create a beautiful smile. A multidisciplinary role between restorative dentist, periodontist, and orthodontist is often required when designing a smile for a patient. Anatomic mock-up is an important tool for effective communication between the dentists from various fields, between the dentist and the ceramist, as well as between the dentist and the patient when altering the patients smile.