Journal of Conservative Dentistry最新文献

Sodium hypochlorite (NaOCl) is one of the most commonly used irrigant because of its several advantages. However, it is highly cytotoxic and can lead to severe tissue damage. NaOCl accident occurs when it is extruded beyond root confines into periapical or periradicular tissues. It is an irrigant mishap which can be life threatening and/or cause residual or long term or permanent consequences with malpractice and medico-legal implications. There are many factors which can influence the occurrence and progress of NaOCl accident. These factors can be broadly categorized as patient (host)-, tooth-, operator-, and NaOCl-related factors. They can be further categorized as predisposing and extent factors. It is vital for a clinician to thoroughly understand and identify various influencing factors to prevent NaOCl accident with its associated consequences including any potential medico-legal issues. The purpose of this article is to provide a narrative review on various factors which predispose to the occurrence of NaOCl accident and influence its extent and/or outcome.

Aim: The aim of this study was to assess color changes in teeth and two different composite resins under the influence of chlorhexidine (CHX) with and without anti-discoloration system (ADS).

Materials and methods: A total of 20 extracted human premolar teeth for periodontal and orthodontic purposes were selected for the study. Further, a total of 40 composite specimens comprising 20 each nanoceramic and nanohybrid composite disks of size 10-mm diameter and 0.5-mm thickness were prepared on a customized model for standardization using the composite filling instrument. The specimens were cured with light-curing unit for 20 s and polished with a composite polishing kit. Two mouthrinses comprising CHX and CHX with ADS were used. Baseline color values of natural tooth and two composite resins were recorded using an ultraviolet spectrophotometer. After baseline spectrophotometric measurements, all the samples were subjected to the mouthrinses. The postimmersion color values of the samples were then recorded, respectively, using the same spectrophotometer.

Statistical analysis used: The statistical analysis was done using paired t-test.

Results: Reflectance values showed a statistically significant difference between CHX and CHX with ADS among nanoceramic and nanohybrid composite samples. There was no statistically significant difference in reflectance values among natural teeth samples with either CHX or CHX with ADS.

Conclusion: Within the limitations of the current study, CHX with ADS may aid in avoiding stains caused due to use of CHX mouthwash, thereby making it more acceptable for patients.

Context: Mandibular impacted third molars are the most frequently impacted teeth in humans and can predispose the adjacent second molar to an array of detrimental effects such as caries, periodontitis, and cervical resorption thus the aim of this study was to determine the same.

Subjects and methods: A retrospective observational cross-sectional study involving patients with orthopantomography presenting with impacted lower third molar. The type, depth, and level of impaction, the extent of caries, periodontal changes, and the presence of cervical resorption were assessed.

Statistical analysis used: Data were analyzed using SPSS version 21.0. with Chi-square.

Results: Mesioangular impaction was most commonly noted. The pattern of impaction had a direct influence in the formation of carious lesions, cervical resorption, and periodontal ligament (PDL) changes.

Conclusions: Noting the pattern of third molar impaction helps the clinician to forecast problems that may occur on adjacent teeth and initiate necessary prophylactic treatment.

Dental trauma results in various complications and poses an enigma to the practitioner. Calcific metamorphosis is one of the sequelae of trauma. A female patient of 35 years visited the specialty clinic of endodontics for the management of a discolored tooth. Clinically, discolored 21 was observed with no pain on palpation and percussion. The pulp sensibility test revealed a negative response. Radiographic examination revealed pulp canal obliteration with an apical radiolucency of Peri Apical Index (PAI 4). The tooth was diagnosed as necrotic pulp with asymptomatic apical periodontitis. Attempt to negotiate the canal under a Dental Operating Microscope (LABOMED, Los Angeles, CA, USA) and ultrasonics (Satelec, Acteon, France) was futile. Cone-beam computed tomography image revealed a patent canal in the apical third. Using real-time guided endodontics with a dynamic navigation system (Navident, ClaroNav, Toronto, ON, Canada), the protocol of plan, trace, and place was followed, and successful canal negotiation was achieved. After radiographic confirmation, root canal treatment was completed.

Background: Rotary and ultrasonic instruments are not appreciable in the complete removal of Biodentine from root canals. Therefore, organic solvents can be used as an adjunct for its retrieval.

Aim: The aim of this study was to compare the efficacy of 10% citric acid, 2% acetic acid, and 20% tartaric acid on the microhardness of Biodentine and radicular dentin.

Materials and methods: Forty single-rooted extracted teeth were decoronated at the cementoenamel junction and root canals were prepared with peeso reamers. Two-millimeter sections were obtained and restored with Biodentine. All samples were subjected to Vicker's microhardness test to record the microhardness of Biodentine and radicular dentin. Samples were randomly divided into four experimental groups and treated with (n = 20) - distilled water, 10% citric acid, 2% acetic acid, and 20% tartaric acid groups for 10 min, after which specimens were again subjected to the same microhardness test.

Statistical analysis: The data were subjected to Kruskal-Wallis ANOVA test, followed by Wilcoxon signed-rank test with a level of significance set at P ≤ 0.05.

Results: 10% citric acid followed by 2% acetic acid exhibited the lowest mean microhardness values after immersing in respective solutions, whereas 20% tartaric acid exhibited the highest mean microhardness values on Biodentine and radicular dentin.

Conclusion: 10% citric acid can be used for retrieving Biodentine from root canals for a limited time without adversely affecting the physical and chemical composition of radicular dentin.

Aim: The present in vitro experimental study was undertaken to evaluate and compare the antimicrobial activity of triple antibiotic paste (TAP), diclofenac, and proton-pump inhibitor (PPI) against the microorganism Enterococcus faecalis.

Materials and methods: Three medicaments were selected for the study, TAP, diclofenac, and PPI. The experimental groups for the test were as follows: Part 1 - Group 1: TAP, Group 2: diclofenac, and Group 3: PPI; Part 2 - Group 1: TAP + PPI and Group 2: diclofenac + PPI. An agar well diffusion test was used to determine the efficacy of the experimental medicaments against E. faecalis (ATCC 29212). The diameter of inhibition zones was measured in millimeters using an inhibition zone measuring scale and the results were recorded.

Statistical analysis: The statistical analysis was done using an analysis of variance and an unpaired t-test. P value was set at < 0.05.

Results: There was a significant difference in the diameter of growth inhibition zones, with the greatest diameter noted for TAP + PPI followed by diclofenac sodium (DS) + PPI, TAP, DS, and PPI.

Conclusions: The antimicrobial effectiveness of TAP + PPI was found to be superior to all other medicaments (DS + PPI, TAP, DS, and PPI).

Context: The effect of chemical disinfection on gutta-percha (GP) has to be closely studied whether it affects surface topography and thereby causes leakage and reinfection of canals.

Aims: The purpose of the study is to assess the surface topography of GP cones after disinfecting with a novel disinfecting material, graphene oxide (GO), and compare the same with other disinfecting materials, including sodium hypochlorite (NaOCl) and silver nanoparticles (AgNps).

Settings and design: After determining the power (0.84) of the study, 48 GP cones were taken and categorized into four different groups based on disinfecting agents.

Materials and methods: Forty-eight GP cones (ISO size 30 6% taper, DIADENT) were taken and are randomly selected and grouped as follows according to the disinfecting agents: Group 1 - control (untreated GP points, n = 12), Group 2 - NaOCl (n = 12), Group 3 - AgNPs (n = 12), and Group 4 - GO (n = 12), respectively. After treating with the above disinfecting materials, the surface topography of samples was evaluated using atomic force microscopy. The data were analyzed statistically using one-way ANOVA and post hoc (Tukey's honestly significant difference) tests.

Statistical analysis used: IBM SPSS (version 21.0) software was used. The tests performed were one-way ANOVA and post hoc. Statistically, significance was set at a P ≤ 0.05.

Results: The root means square values and surface roughness values were lesser for the GO group and AgNPs when compared with the NaOCl group, which were statistically significant.

Conclusions: Within the limitations of the study, this study had shown lesser surface topography deterioration of GP cones when treated with GO and AgNPs, whereas more deterioration was observed with NaOCl.

Background: The adhesive bonding ability of composite resins makes it unnecessary to remove tooth structure for retention, prevention, and convenience. However, postoperative sensitivity after placing composite restoration has been a significant problem experienced by clinicians.

Aim: The present randomized controlled trial was conducted to assess the role of dentin remineralization in the reduction of postoperative sensitivity after composite placement.

Materials and methods: Eighty participants with occlusal carious teeth were randomly allocated to one of the four study groups, each having 20 participants, and are as follows: Group A with test group, Group A with control group, Group B with test group, and Group B with control group. Postoperative sensitivity was assessed using the Visual Analog Scale (VAS) and the United States Public Health Service (USPHS) criteria at different time intervals such as baseline, 1 week, 1 month, and 3 months. Data were analyzed using the Kruskal-Wallis ANOVA test, Mann-Whitney U-test, and Wilcoxon matched-pair test.

Results: All 80 participants were analyzed at the baseline, 1 week, 1 month, and the end of 3 months for the postoperative sensitivity using the VAS score and USPHS criteria. One restoration in Group A with control group reported mild sensitivity at the end of 1 week and one restoration in Group B with control group reported severe sensitivity at the end of 3 months, necessitating its replacement followed by root canal treatment. No relationship was reported between postoperative sensitivity and tooth type. There was no statistically significant difference in postoperative sensitivity in any of the treatment modalities.

Conclusion: Class I restoration using self-etch or selective-etch as well as with or without zinc-carbonate hydroxyapatite is a viable and predictable solution for the reduction of postoperative sensitivity if all the aspects of restorative techniques are considered precisely.

Context: Sectional matrices and contact rings are valuable aids to establish proximal contact tightness in Class II composite restorations.

Aims: This study aims to evaluate the proximal contact area in Class II composite restorations using three matrix systems based on morphological analysis, mesiodistal (M-D) diameter and contact tightness.

Subjects and methods: A standardized DO cavity was prepared in 30 plastic molar teeth. They were randomly divided into three groups (n = 10) and restored using Tetric N-Ceram composite material and three matrix systems - Saddle matrix, Palodent system, and Palodent Plus system. The quality of proximal contacts was assessed by measuring the maximum M-D diameter of the restored teeth using a digital caliper; the tightness of the proximal contact area using Unifloss and a standardized metal blade (30 μm). Qualitative assessment of contact morphology was done by visual means while quantitative assessment of contour was done using Medit scanner superimposing method and ExoCAD software.

Statistical analysis used: One-way ANOVA test was used to compare the mean M-D diameter (in mm) in the occlusal third, middle third, and the proximal contact area between the three groups. Chi-square test was used to compare the proximal contact area tightness using the passage of Unifloss. The buccolingual and occluso-gingival morphology was also compared among the three groups. The level of significance (P value) was set at P < 0.05.

Results: For the occlusal and middle third, significantly larger diameters were achieved with the Palodent Plus system than with the Saddle matrix. More flat contours were seen in the case of the Saddle matrix than in the case of the Palodent system while the Palodent Plus system exhibited a minimal depth of concavity as determined by three-dimensional imaging of the contact morphology.

Conclusions: Palodent Plus and Palodent matrix systems established superior contacts and contours than the Saddle matrix.

Introduction: The study aimed to determine the apical debris extrusion and microbial elimination from infected root canals after using different irrigant activation methods.

Materials and methods: Forty freshly extracted human mandibular premolars were selected and randomly assigned to four groups (n = 10). The teeth were mechanically prepared, sterilized, and inoculated with Enterococcus faecalis for 1 week. Irrigation was done with 3% sodium hypochlorite following conventional syringe irrigation-Group 1, manual dynamic agitation (MDA)-Group 2, passive ultrasonic irrigation (PUI)-UltraX -Group 3, and sonic irrigation (SI)-EndoActivator -Group 4, and the extruded debris were collected using Myers and Montgomery model. The microbial samples were taken from the canals using sterile paper points, cultured and recorded as colonies. The amount of extruded debris was measured by subtracting the final weight of the Eppendorf tube with debris from the initial weight of the tube.

Results: I. Group 3 showed the least apical debris extrusion (P < 0.05), followed by Groups 2 and 1 and the highest with Group 4. II. Group 3 showed the least colony-forming units (CFUs)/ml, followed by Group 4, and finally, Group 2 showed lesser mean CFUs/ml compared to Group 1 (P < 0.05).

Conclusion: All the irrigation activation methods were associated with apical debris extrusion, with the PUI system extruding the least amount of debris compared to the other groups. Irrigation activation techniques were beneficial in reducing the microbial load from the infected canals with the PUI system showing a complete elimination of the microbes, followed by SI and MDA.