Ruchika Roongta Nawal

Comparison of physical and mechanical properties of mineral trioxide aggregate and Biodentine

BACKGROUND Mineral trioxide aggregate (MTA) fulfills many of the ideal properties of the root-end filling material. However, its low cohesive property often makes it difficult to handle. Biodentine, new calcium-silicate-based cement has been developed to improve some MTA drawbacks such as its difficult handling property and long-setting time. AIM The objective of this study was to compare at different times the microleakage of roots filled with Biodentine and white MTA (WMTA)-Angelus and to investigate their setting time, handling properties and compressive strength. MATERIALS AND METHODS Root canals of single-rooted teeth were instrumented, filled with either Biodentine or WMTA-Angelus (n=15 each) with two positive and two negative control roots and stored at 37°C. Sealing was assessed at 4, 24 h, 1, 2, 4, 8, and 12 weeks by a fluid filtration method. The initial setting time, handling properties, and compressive strength of the test groups were investigated by a vicat needle, questionnaire of operational hand feel, and universal instron machine, respectively. RESULTS Significant differences in microleakage were found between two groups at 4-h and 24 h (P<0.05) and no difference at 1, 2, 4, 8, and 12 weeks. No significant difference was seen in the setting time of MTA-Angelus and Biodentine, though latter was found to have better handling consistency. Compressive strength of Biodentine was significantly higher than MTA-Angelus. CONCLUSIONS The results suggest that the new calcium-silicate-based endodontic cement provides improvement in sealing ability as well as clinical manageability of dental filling materials.

Current perspectives of bio-ceramic technology in endodontics: calcium enriched mixture cement - review of its composition, properties and applications

Advancements in bio-ceramic technology has revolutionised endodontic material science by enhancing the treatment outcome for patients. This class of dental materials conciliates excellent biocompatibility with high osseoconductivity that render them ideal for endodontic care. Few recently introduced bio-ceramic materials have shown considerable clinical success over their early generations in terms of good handling characteristics. Calcium enriched mixture (CEM) cement, Endosequence sealer, and root repair materials, Biodentine and BioAggregate are the new classes of bio-ceramic materials. The aim of this literature review is to present investigations regarding properties and applications of CEM cement in endodontics. A review of the existing literature was performed by using electronic and hand searching methods for CEM cement from January 2006 to December 2013. CEM cement has a different chemical composition from that of mineral trioxide aggregate (MTA) but has similar clinical applications. It combines the biocompatibility of MTA with more efficient characteristics, such as significantly shorter setting time, good handling characteristics, no staining of tooth and effective seal against bacterial leakage.

A comparative evaluation of 3 root canal filling systems

OBJECTIVE This in vitro study was conducted to evaluate and compare the microbial leakage of a new obturation system: Guttaflow with resin-based Resilon cones and Epiphany sealer, keeping gutta-percha with AH plus sealer as the standard. STUDY DESIGN The microbial leakage was tested using Enterococcus faecalis ATCC 29,212 as the bacterial marker in the microbial leakage test. These results were supplemented with scanning electron microscopy (SEM). RESULTS AND CONCLUSION The microbial leakage test indicated good sealing abilities for Resilon and Guttaflow, with the latter resisting microbial leakage for a longer period. AH plus with gutta-percha showed poor sealing ability. Results of the scanning electron microscopy correlated with the microbial leakage test. This study indicates that newer obturation systems like Guttaflow and Resilon cones with Epiphany provide better seal against microbial leakage than the standard obturation material, gutta-percha used with AH plus sealer.

A survey of attitude and opinions of endodontic residents towards regenerative endodontics.

Aim: The objective of this survey was to study the level of awareness, current state of knowledge and opinions towards regenerative endodontic treatments amongst the endodontic residents of India. Settings and Design: Questionnaire based survey was designed. Materials and Methods: After approval from the organizing committee of 26th Federation of Operative Dentistry of India and 19th Indian Endodontic Society National conference 2011, 200 copies of the questionnaire were circulated amongst the endodontic residents in conservative dentistry and endodontics at various colleges across the country about regenerative endodontic procedures. The survey included profile of the respondents and consisted of 23 questions about their knowledge, attitude and opinions regarding use of these procedures as part of future dental treatment. Results: The survey showed that half the participants (50.6%) had received continued education in stem cells and/or regenerative dental treatments. The majority of participants were of the opinion (86.6%) that regenerative therapy should be incorporated into dentistry, and most of them (88%) were willing to acquire training in learning this new treatment strategy. The results indicated that half of the participants (52.6%) were already using some type of regenerative therapy in their clinical practice; however, with a majority of these limited to use of membranes, scaffolds or bioactive materials. Conclusions: These results reflect that endodontic residents are optimistic about the use of regenerative endodontic procedures; however, a need for more research and training was felt.

Radix Entomolaris in Mandibular First Molars in Indian Population: A Review and Case Reports

Purpose. The aim of this paper is to present cases of mandibular first molars with an additional distolingual root and their management using appropriate instruments and techniques. Basic Procedures and Main Findings. Mandibular molars can sometimes present a variation called radix entomolaris, wherein the tooth has an extra root attached to its lingual aspect. This additional root may complicate the endodontic management of the tooth if it is misdiagnosed or maltreated. This paper reviews the prevalence of such cases in Indian population and reports the management of 6 such teeth. Principal Conclusions. (1) It is crucial to be familiar with variations in tooth/canal anatomy and characteristic features since such knowledge can aid location and negotiation of canals, as well as their subsequent management. (2) Accurate diagnosis and careful application of clinical endodontic skill can favorably alter the prognosis of mandibular molars with this root morphology.

Evaluation of Biocompatibility and Osteogenic Potential of Tricalcium Silicate–based Cements Using Human Bone Marrow–derived Mesenchymal Stem Cells

Introduction: The success of endodontic regeneration lies in the appropriate combination of stem cells and bioactive materials. Several novel dental materials are available on the market in this regard. Hence, the current study aimed to evaluate the proliferation, differentiation, and osteogenic potential of human bone marrow–derived mesenchymal stem cells (hBMSCs) onto biomaterials like ProRoot MTA (MTA; Dentsply Tulsa Dental, Tulsa, OK), Biodentine (BD; Septodont, Saint Maur de Fosses, France), and EndoSequence Root Repair Material (ERRM; Brasseler USA, Savannah, GA). Methods: Dental cements were formulated into discs and assessed for their biocompatibility. hBMSCs were used to study biocompatitibility and the proliferative and osteogenic potential of these dental cements. A live dead assay was performed using confocal microscopy to study the biocompatibility, proliferation, and cell attachment property of the cements. An 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide assay was also performed on days 1, 3, 5, and 7 to study growth kinetics. The osteogenic potential of these cements was studied by inducing hBMSCs over them using osteogenic differentiation medium (assessed by alkaline phosphatase assay). Results: ERRM and MTA have shown the best biocompatibility among the tricalcium silicate materials used with no significant difference between them. Both have shown significantly higher osteogenic bioactivity than BD. All 3 tricalcium silicate cements support good adherence of hBMSCs. Conclusions: All of the dental cements used in this study are biocompatible with the potential to induce proliferation and osteogenic differentiation of hBMSCs. Therefore, the newly introduced ERRM can be the material of choice in various endodontic applications.

Management of iatrogenic root perforation with pulp canal obliteration

Iatrogenic root perforations, which may have serious implications, occur in approximately 2-12% of endodontically treated teeth. Successful management of root perforations is dependent on early diagnosis of the defect, location of the perforation, choice of treatment, materials used, host response, and the experience of the practitioner. This report presents the successful management of an iatrogenic perforation in a tooth with radiographic evidence of pulp canal obliteration.

Effect of acid etching on the micro-shear bond strength of resin composite–calcium silicate interface evaluated over different time intervals of bond aging

Introduction: With the introduction of calcium silicate materials, pulp capping procedure has been simplified due to their therapeutic pulp capping capabilities and ability to be used as a provisional bulk restorative material simultaneously. The quality of the adhesive bond between these cements and composite is of clinical significance with regard to the longevity of the final laminate restoration. Thus, this study aims to compare the in vitro microtensile bond strengths of resin composite to different calcium silicate cements versus glass ionomer cement (GIC). Materials and Methodology: Resin composite was bonded to standardized disks of Biodentine, mineral trioxide aggregate (MTA), and GIC. The samples were divided into the following three groups, and each group was further divided into two subgroups based on the aging time (1 and 2 weeks) of the samples: (1) Group 1 – phosphoric acid etching on Biodentine. (2) Group 2 – phosphoric acid etching on MTA. (3) Group 3 – phosphoric acid etching on GIC. After bond aging, the microtensile bond strength was analyzed using the Instron universal testing machine. Results: There was no significant difference in micro-SBS between 1- and 4-week bond aging of MTA and Biodentine group, while a significant decrease is seen in the GIC group. Conclusion: Calcium silicate cements are weak in the early setting phase. Thus, placing the overlying composite is best delayed for at least 2 weeks to allow adequate maturation of the material.

Evaluation of retention and fracture resistance of different fiber reinforced posts: An in vitro study

Aim: The aim of this study was to evaluate retention & fracture resistance of different fibre posts. Methodology: 90 extracted human permanent maxillary central incisors were used in this study. For retention evaluation, after obturation, post space preparation was done in all root canals and posts were cemented under three groups. Later, the posts were grasped & pulled out from the roots with the help of a three-jaw chuck at a cross-head speed of 5mm/min. Force required to dislodge each post was recorded in Newtons. To evaluate the fracture behavior of posts, artificial root canals were drilled into aluminium blocks and posts were cemented. Load required to fracture each post was recorded in Newtons. Results: The results of the present study show the mean retention values for Fibrekleer Parallel post were significantly greater than those for Synca Double tapered post & Bioloren Tapered post. The mean retention values of the Double tapered post & the tapered post were not statistically different. The Synca Double tapered post had the highest mean load to fracture, and this value was significantly higher than those of FibreKleer Parallel & Bioloren Tapered post. The mean fracture resistance values of Parallel & tapered post were not statistically different Conclusions: This study showed parallel posts to have better retention than tapered and double tapered posts. Regarding the fracture resistance, double tapered posts were found to be better than parallel and tapered posts.

Saving the 2nd Molar from the 3rd Is it Really the Guilt of the Tilt

INTRODUCTION Clinicians often relate the distal caries in second molars to angulated third molars, which if left undetected can lead to gross decay that may further require removal of the tooth. Due to this fact, many third molars are advised for prophylactic removal to prevent decay in the second molar. But this approach would only be justified when the incidence of decay/loss of second molar due to third molar are reasonably high. We sought to determine incidence of caries experience and also sequel extraction in second molars associated with the third molars. AIM The study was conducted to answer the basic question that whether the incidence of caries and subsequent extraction of second molar due to angulated third molars is high enough to justify the prophylactic removal of third molar or not. MATERIALS AND METHODS This study was conducted on radiographic records of 1187 patients. The effect of tilted third molar on the second molar was measured in relation with three parameters namely level & position of third molar with respect to second molar and the distribution among arches. RESULTS The results indicated that out of total number of teeth examined only 5.4% of maxillary and 9.6% of mandibular second molars were affected by tilted third molars. Further, only 2.2% of mandibular and 2.9% of maxillary second molars were indicated for extraction. The data was statistically insignificant. CONCLUSION It was concluded that distal caries in second molars is not very common. It may be present in some cases of third molar impactions and prophylactic removal of these impacted teeth may not be considered appropriate.