Promila Verma

Endodontic emergencies: Your medication may be the cause

An endodontic clinician may face unwanted situations during root canal treatment. We present here an unusual case of soft tissue and gingival necrosis of the oral cavity following the use of formocresol® during endodontic treatment.

A comparative evaluation of different irrigation activation systems on smear layer removal from root canal: An in-vitro scanning electron microscope study

Aim: The aim of the following study is to compare the evaluation of different irrigation activation system-F-File, CanalBrush (CB) and EndoActivator (EA) in removing smear layer from root canal. Materials and Methods: Root canals of eighty single rooted decoronated premolar teeth were instrumented using crown-down technique and then equally divided into four groups on basis of irrigation activation methods used: Without irrigation - control group, irrigation with F-File, CB, EA into Group I, II, III respectively. Samples were then longitudinally sectioned and examined under scanning electron microscope by three qualified observers using score from 1 to 4. Data was analyzed using Statistical Package for Social Sciences (SPSS), version 15.0 (SPSS Inc., Chicago IL) at significance level of P ≤ 0.05. Results: Minimum mean score was observed in Group II at coronal, apical locations. Group III had minimum score at middle third. Groups difference in score were found to be significant statistically for all three locations as well as for overall assessment (P < 0.001). Conclusion: CB remove smear layer more efficiently from the root canal than F-File and EA in coronal and apical region.

Clinical negligence or endodontic mishaps: A surgeons dilemma

Complications may occur during and after endodontic treatment, which may be due to negligence of the operator. The surgical treatment of a case presenting pain and persistent pus discharge and swelling due to the extrusion of the root canal filling to the base of the nasal floor between left maxillary lateral and canine teeth is presented in this report. First, carelessness was during root canal treatment that was over obturated and second time during extraction in which overextended gutta-percha remained in the bone, caused the complications like pain, persistent pus discharge, and headache. Clinicians should be aware of the fact that endodontic instruments and filling materials (solid or liquid) can be extended in such a degree that can lead to neurological or sinus complications.

Comparative evaluation of antimicrobial efficacy of triple antibiotic paste, calcium hydroxide, and a proton pump inhibitor against resistant root canal pathogens

Objective: The objective of this study is to compare the antimicrobial efficacy of triple antibiotic paste (TAP) and a proton pump inhibitor (PPI) (omeprazole) in combination with calcium hydroxide (CH) against Enterococcus faecalis and Candida albicans. Materials and Methods: E. faecalis and C. albicans were subcultured and inoculated at 37° overnight and were treated with different dilutions of TAP, 25 μg/ml (Group 1), CH (Group 2, control), CH 16 mg/ml + omeprazole 2 mg/ml (Group 3a) (CH 16 mg/ml + omeprazole 4 mg)/ml (Group 3b) for 24, 48, and 72 h in sterile uncoated 96-well microtiter plates. Minimum concentration at which the medicaments produced least optical density was determined using ELISA reader (ELx 808 BioTek Inc., USA) device set at optical density of 630 nm. Results were analyzed statistically by one-way analysis of variance followed by Tukeys multiple comparison tests. The significance level was set at 0.05. Results: Mean concentration (irrespective of time) for TAP at which mean minimum optical density was recorded at 1.25 μg/ml (1:20 dilution) and 25 μg/ml (0 dilution) against E. faecalis and C. albicans, respectively. Least optical density for CH plus PPI group was obtained 1.6 μg/ml (1:10 dilution) and 16 μg/ml (0 dilution) for E. faecalis and C. albicans, respectively. However, CH alone showed a weaker antimicrobial action against either of the strains even at full concentration. Conclusions: PPI enhanced the antibacterial efficacy of CH against E. faecalis and C. albicans. However, TAP showed the best antibacterial property followed by CH plus PPIs against both the selected strains.

Surface finish of esthetic materials - an in-vitro SEM study

Proper finishing and polishing of tooth coloured restoration enhances the esthetics and longevity of restored teeth. Plaque retention, surface discoloration and esthetics of the restoration have been related to the smoothness of the restoration surfaces. This study was done to evaluate the amount of surface smoothness produced after the use of various finishing and polishing devices on restoration. The first article of this series of taro articles discusses the effect of various finishing devices on light cure composite (sure fit) while second article is on compomer and comparison of both the groups.

A comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis

Aim: This study aimed for a comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis. Methods: Thirty single-rooted teeth were taken. Access preparation was done. Biomechanical preparation was done using Protaper universal file till F3. Teeth were decoronated to a standardized root length of 14 mm, and the apical end from outside was sealed using paraffin wax. Teeth were autoclaved under standard conditions and after autoclaving, Phosphate-buffered saline solution was introduced into the roots and was incubated for 24 h to check for the disinfection of roots. Once the disinfection of roots was achieved, the wild strain of E. faecalis, i.e., ATC 29212 strain, was introduced into the teeth and allowed to incubate for 24 h. Following bacterial colonization inside the roots, antimicrobials were introduced and efficacy was checked. The data obtained were subjected to statistical analysis using paired t-test for significance. Results: Significant difference was observed between all the test groups. However, chlorhexidine gel showed the best value of mean difference, indicating it as the best antibacterial medicament. Conclusion: Within the limitations of this study, it can be concluded that chlorhexidine gel showed better antimicrobial properties against E. faecalis than other medicaments.

An ex vivo evaluation of effect of dentin pretreatment with various agents for varying time intervals on the shear bond strength of resin

Background: This article highlights the contribution of collagen structure/stability to the bond strength. We hypothesize that induction of cross-linking in dentin collagen fibrils improves dentin collagen stability and thus bond strength with composite also improves. Aims: The aim of the study was to evaluate the effect of collagen cross-linking agents on the shear bond strength of composite resins. Subjects and Methods: One hundred human permanent teeth were randomly divided into three groups: Group I (n = 20) – no dentin pretreatment done, Group II – dentin pretreatment with 10% sodium ascorbate for 5 min (IIa) and 10 min (IIb), and Group III – dentin pretreatment with 6.5% proanthocyanidin (PA) for 5 min (IIIa) and 10 min (IIIb). A composite resin was bonded on prepared surfaces and cured. Thermocycling was done, and shear bond strength of the prepared samples was tested using a universal testing machine. Results: Values of Group I (control) were lowest whereas that of Group II (sodium ascorbate) were highest. The following order of shear bond strength was observed: IIb > IIa > IIIb ~ IIIa > I. Results for sodium ascorbate were found to be time dependent, whereas for PA, differences were nonsignificant. Conclusions: Treatment of dentinal surfaces with collagen cross-linking agent increases the shear bond strengths.

Efficacy of LA Axxess burs, Gates Glidden drills and Protaper Sx in obtaining straight line access in mesiobuccal roots of mandibular first molars: A cone-beam computed tomography assessment.

Objective: This study aims at cone-beam computed tomography (CBCT) evaluation of the ability of Gates Glidden (GG) drills, Protaper Sx, and LA Axxess burs to produce a straight line access (SLA) in mesiobuccal canals of mandibular first molars. Methodology: Forty-five freshly extracted mandibular teeth with a canal curvature of 10-20° were taken for the study and divided into three groups according to the instruments used for cervical preflaring: Group I (LA Axxess burs), Group II (GG drills), and Group III (Protaper Sx). Pre- and post-instrumentation CBCT images were evaluated for comparing the ability of GG drills, Protaper Sx and LA Axxess burs to produce an SLA in mesiobuccal canals of mandibular first molars. Results: There was no significant change (P = 0.06) in the angle in the preSLA images of LA Axxess Group I (12.37 ± 1.01), GG Group II (13.39 ± 1.74), and Protaper Sx Group III (13.90 ± 1.74). The mean decrease in the angle from preSLA to postSLA was significant for all the three groups (P = 0.0001). However, the mean change was highest in Group I (4.25 ± 1.14), followed by Group II (3.28 ± 1.22) and Group III (2.89 ± 1.53). Conclusion: LA Axxess burs were the most effective in reducing the coronal curvature and produced a straighter access to apical third compared to GG Drills and Protaper Sx.

A comparative evaluation of different restorative technique using polyethylene fibre in reinforcing the root-filled teeth: An in vitro study"

Aim: The purpose of any restorative material is not only to restore the decayed of defective tooth and provide an effective seal between the restoration and the tooth, but also to strengthen it. Endodontic treatment removes the vital contents of the canal, leaving the tooth pulpless and resulting in teeth with calcified tissues that contain significantly less moisture than that of vital teeth. The restorative material should be as much as strong, which support the endodontically treated tooth against the occlusal forces. Thus, the present study was undertaken to evaluate different restorative technique using the polyethylene fiber in reinforcing the root-filled teeth. Materials and Methods: 50 freshly extracted maxillary premolar human teeth were taken. All teeth were divided into 2 groups, the control and experimental group), sub group I (had unrestored mesial occlusal distal [MOD] cavities), sub group II (where MOD cavities were filled with composite), sub group III (where polyethylene fiber placed occlusally on the composite restoration) and sub group IV (had polyethylene fiber inserted under the composite the restorations). The specimens were then placed into a universal testing machine. A vertical compressive force was applied at a crosshead speed of 0.5 mm/min and the force necessary to fracture. Results: Fracture resistance was significantly highest in sub group III as compared to sub group IV, sub group II and sub group I. Conclusion: This study concluded that use of polyethylene fiber inserted over or under the restoration significantly increased the fracture strength of the root canal treated teeth and when the fiber was placed on the occlusal surface of the restoration from a buccal to lingual direction significantly higher fracture resistance was observed.