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INTRODUCTION: This randomized double-blinded trial aimed to compare the anesthetic success of inferior alveolar nerve blocks (IANBs) with 2% lidocaine in mandibular molars with symptomatic irreversible pulpitis (SIP) after oral premedication of prednisolone, dexamethasone, and ketorolac with placebo. METHODS: One hundred eighty-four patients diagnosed with SIP in mandibular molars randomly received prednisolone, dexamethasone, ketorolac, or placebo (n = 46 each) 60 minutes before the administration of an IANB. The access cavity preparation was initiated after successfully confirming lip numbness and two consecutive negative responses to electric pulp testing. The success of the anesthesia was clinically confirmed when pain was absent during the endodontic access or instrumentation. A one-way analysis of variance test was used to compare quantitative variables among the groups, and chi-square tests were used for comparing categorical variables. Binary logistic regression was performed to analyze the relationship of age, preoperative pain, and preoperative medications. RESULTS: When premedicated with oral dexamethasone, ketorolac, prednisolone, and placebo, the success rate of IANB was determined to be 60.86 %, 65.21 %, 56.52 %, and 21.73 %, respectively. Compared to the placebo, the success rate of IANB was significantly increased when patients were premedicated with prednisolone, dexamethasone, or ketorolac. However, there were no statistically significant differences among prednisolone, dexamethasone, and ketorolac. One individual in the ketorolac group reported gastritis, whereas no adverse effects were reported in the dexamethasone or prednisolone groups. CONCLUSIONS: Preoperative use of oral ketorolac, dexamethasone, or prednisolone may increase the anesthetic efficacy of IANB in mandibular molars with SIP.

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Coronal fractures of the anterior teeth give an agonizing experience for a young individual due to the physical disfigurement, and the psychological impact that is imposed on them. One of the options for managing complicated/uncomplicated crown fractures when the tooth fragment is available, and there is no or minimal violation of the biological width is the rebonding of the fractured segment. This treatment approach is promising, providing good and long-lasting esthetics as it helps in maintaining the tooth's original anatomic form, hue, and surface texture. This article describes three case reports of successful reattachment of fractured tooth fragments. Following the root canal treatment procedures, prefabricated posts were cemented as intraradicular splint to reattach the fractured segments.

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Taro (Colocasia esculenta L. Schott, Araceae), an ancient root and tuber crop, is highly polygenic, polyphyletic, and polygeographic in nature, which leads to its rapid genetic erosion. To prevent the perceived loss of taro diversity, species discrimination and genetic conservation of promising taro genotypes need special attention. Reports on genetic discrimination of taro at its center of origin are still untapped. We performed DNA barcoding of twenty promising genotypes of taro indigenous to the northeastern hill region of India, deploying two chloroplast-plastid genes, matK and rbcL, and the ribosomal nuclear gene ITS2. The secondary structure of ITS2 was determined and molecular phylogeny was performed to assess genetic discrimination among the taro genotypes. The matK and rbcL genes were highly efficient (>90%) in amplification and sequencing. However, the ITS2 barcode region achieved significant discrimination among the tested taro genotypes. All the taro genotypes displayed most similar sequences at the conserved matK and rbcL loci. However, distinct sequence lengths were observed in the ITS2 barcode region, revealing accurate discriminations among the genotypes. Multiple barcode markers are unrelated to one another and change independently, providing different estimations of heritable traits and genetic lineages; thus, they are advantageous over a single locus in genetic discrimination studies. A dynamic programming algorithm that used base-pairing interactions within a single nucleic acid polymer or between two polymers transformed the secondary structures into the symbol code data to predict seven different minimum free energy secondary structures. Our analysis strengthens the potential of the ITS2 gene as a potent DNA barcode candidate in the prediction of a valuable secondary structure that would help in genetic discrimination between the genotypes while augmenting future breeding strategies in taro.

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Introduction: This in-vitro study comprises Antimicrobial and Confocal Microscopic analysis of the efficacy of Triple Antibiotic and Toluidine Blue (TBO) loaded chitosan nanoparticles (chnp) activated with photodynamic therapy (PDT) against Enterococcus faecalis (Ef). Methodology: 105 single-rooted extracted teeth were decoronated, cleaned and shaped, and incubated with Ef. The roots were randomly divided into three groups: Group I-Control, Group II-Triple Antibiotic Paste (TAP), Group III: Triple antibiotic-loaded chitosan nanoparticles (tachnp), and Group IV: Tachnp and TBO loaded chnp activated with PDT. Ten specimens from all the groups were subjected to antimicrobial analysis and five specimens were observed under the confocal microscope after 24 h and 7 days. Group IV was additionally analyzed after 24 h and 7 days of laser activation. Results: Group IV C showed the least colony-forming units followed by Group IVB, Group IIIB, Group IVA, and Group IIIA. Group II showed more colony-forming units. On intergroup comparison of mean colony count in control and experimental groups at 24 h and 7 days using one-way ANOVA F test was highly significant P < 0.001. The confocal microscopic images of IV C showed the increased intensity of fluorescent red indicating dead bacteria. Conclusion: Within the limitations of this study, TAP loaded chitosan nanoparticles activated with PDT showed a significant reduction in colony count.

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OBJECTIVES: This study aimed to assess the prevalence of dens invaginatus (DI) and its association with periapical lesions (PLs) in a Western Indian population by means of cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT volumes of 5201 subjects were evaluated. Associations among gender, tooth type, DI type (Oehler's classification), and presence of PL were investigated. PL was codified using Estrela's Cone Beam Computed Tomography Periapical Index (CBCTPAI). Chi-square tests and descriptive statistics were used at p = 0.05. RESULTS: Overall, 7048 CBCTs were assessed, containing 19,798 maxillary and mandibular anteriors, of which 77 maxillary teeth demonstrated DI (0.39% of all anteriors). Of all 5201 subjects, 57 had DI (1.1%). Bilateral DI was more common in females than in males (p = 0.046). DI type distribution was as follows: type I (22.1%), type II (61.03%), type IIIa (10.4%), and type IIIb (6.5%), which was significantly different (p < 0.001). Maxillary lateral incisors were the most associated with PL (p < 0.001). Type I was frequently associated with CBCTPAI scores 1 and 2 (absence of PL), whereas types II, IIIa, and IIIb were associated with CBCTPAI scores 3, 4, and 5 (presence of PL). CONCLUSIONS: A prevalence of 1.1% identifies DI as a common developmental tooth anomaly in a Western Indian subpopulation. The percentage of maxillary anteriors affected by DI and associated PLs should be considered before diagnosis and treatment planning. CLINICAL RELEVANCE: Knowledge about the prevalence of DI and its subtypes, and their association with/without periapical pathosis may aid clinicians in treatment planning and execution to improve patient outcomes.

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INTRODUCTION: This study aims to report a retrospective observation of the prevalence of apical periodontitis (AP) and quality of root canal treatment in cone-beam computed tomography (CBCT) scans among the Mid-West Indian population. MATERIALS AND METHODS: A total of 1229 CBCT scans were obtained across different CBCT centers in western India. After the exclusion criteria, those that were included were divided into broadly two groups - those that were filled and those that were unfilled. Various parameters were taken into account such as AP, length of the root canal filled, and coronal filling. RESULTS: There were a significantly higher percentage of nonfilled canals. Poor filling quality, inadequate coronal restoration, and also missed extra canal were significantly associated with AP. Both males and females showed higher presence of AP in the nonfilled teeth than filled ones (X2 - Chi square value M = 612.156, P < 0.00001, X2 F = 1032.9092, P < 0.00001). CONCLUSION: (1) The inadequacy of the filling of the root length was a contributory factor to the higher prevalence of AP among the study population. (2) The density of the filling and the quality of the coronal filling also significantly affected the successful outcome of the root canal treatment.

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AIM: To compare the vitality of Enterococcus faecalis within dentinal tubules after subjected to five root canal disinfection methods. MATERIALS AND METHODS: Dentin blocks (n = 60) were colonized with E. faecalis. After 4 weeks of incubation, the dentin blocks were divided into one control and five test groups (n = 10 each). The root canals of test groups were subjected to one of the disinfection methods, namely, normal saline (NS), sodium hypochlorite (NaOCl), chlorhexidine digluconate (CHX), neodymium-doped yttrium aluminum garnet (Nd: YAG) laser, and diode laser. The effect of disinfection methods was assessed by LIVE/DEAD BacLight stain under the confocal laser scanning microscopy to determine the "zone of dead bacteria" (ZDB). Mean values were calculated for ZDB and the difference between groups was established. RESULTS: Penetration of E. faecalis was seen to a depth of >1000 µm. Viable bacteria were detected with NS irrigation. NaOCl and CHX showed partial ZDB. When the root canals were disinfected with Nd: YAG and diode lasers, no viable bacteria were found. CONCLUSION: E. faecalis has the ability to colonize inside dentinal tubules to a depth of >1000 µm. In contrast to conventional irrigants, both Nd: YAG and diode lasers were effective in eliminating the vitality of E. faecalis. NS, NaOCl, and CHX showed viable bacteria remaining in dentinal tubules.

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Dens invaginatus, also known as dens in dente, is a rare anomaly affecting human dentition. The condition results in invagination of an amelodental structure within the pulp. This case report discusses the current management protocol of dens invaginatus using a minimally invasive and nonsurgical treatment option. As with most conditions, early diagnosis and preventive measures help minimize complications in dens invaginatus cases.

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AIM: To evaluate the effect of different irrigating solutions on postspace treatments on the push-out bond strength of glass fiber posts. MATERIALS AND METHODS: Thirty mandibular premolar roots were decoronated and endodontically treated. Postspaces were prepared and roots were divided into three groups: In group 1: 2.5% sodium hypochlorite irrigation (control), group 2: 17% ethylenediaminetetraacetic acid (EDTA) with hand activation, group 3: 17% EDTA irrigation with photon-induced photoacoustic streaming (PIPS) has been done to the postspaces. Scanning electron microscope (SEM) analysis has been made for two samples of each group. Fiber posts were then luted with resin cement. Each root was prepared for push-out test. Data have been statistically analyzed. RESULTS: SEM results showed clean postwalls with both group 2 and group 3, whereas group 1 showed adhesion of resin cement to intraradicular dentine. When all groups were compared, the bond strength values are higher with group 2 followed by group 3. CONCLUSION: Within the limitations of the study, clean postwalls and the highest bond strength values were obtained from 17% EDTA with hand activation and 17% EDTA with PIPS.

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Endodontic and periodontal microsurgery has surpassed the success rates for traditional endodontic and periodontal surgical procedures. Excellent healing results are being attributed to both the techniques, when employed, for isolated endodontic or periodontal defects. Combined endodontic-periodontal lesions have been referred to as a true challenge, requiring not only endodontic microsurgical management but also concurrent bone grafting and membrane barriers techniques. The prevention of epithelial downgrowth and regeneration of periodontal cementum, fiber, and bone seals the fate of these cases. Achieving primary closure with submergence of grafts has a positive effect on GTR outcome. New techniques of periodontal microsurgery, such as minimally invasive papilla preserving flaps with passive internal mattress suturing, have managed to obtain 90% primary flap closure over grafted sites. Root surface treatment and conditioning has also shown to be beneficial for GTR. Endodontic microsurgery for the combined lesion has not integrated these advances yet. These advances, along with a recently suggested treatment strategy, are ushering in the level next in management of the combined lesions. This article offers an overview of the combined lesion, the disease, its classification, treatment strategy, regenerative tools, microsurgical recommendations, and outcome studies.

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OBJECTIVES: Hypersensitivity is a common clinical multietiological problem. Many desensitizing treatments are there to overcome hypersensitivity. The aim of this study was to evaluate the effect of different dentin-desensitizing treatments on the tensile bond strength of composite restoration. MATERIALS AND METHODS: Twenty-four sound human molars were used. Enamel was wet abraded to expose flat dentin surfaces, polished with sandpaper. The specimens were then divided into three groups (n = 8) based on the type of dentin-desensitizing treatment given. The first group: G1 was the control group where no desensitizing agent was used. The second group: G2 was treated with desensitizing dentifrice containing a combination of potassium nitrate, triclosan, and sodium monoflorophosphate. The third group: G3 was treated with Er:YAG laser. Afterwards, the desensitized specimens were treated with one step self-etch adhesive according to manufacturer's instructions and composite microcylinders were packed. The specimens were then examined for tensile bond strength using universal tensile machine (KMI(TM) ). RESULTS: Statistical analysis of the data obtained revealed the mean values for the tensile bond strengths were 10.2613 MPa, 5.9400 MPa and 6.3575 MPa for groups 1, 2 and 3, respectively. These values were statistically significantly different between groups pretreated with laser or dentifrice as compared to control group. CONCLUSIONS: Dentifrice and Laser pre-treated dentin has lower tensile bond strength with resin composites as compared to dentin that is untreated.

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BACKGROUND: Microbial contamination of the pulp space is one of the major factors associated with endodontic failure. Thus, in addition to a three dimentional apical filling a coronal seal for root canal fillings has been recommended. AIM: The present study was conducted to evaluate and compare the intra-orifice sealing ability of three experimental materials after obturation of the root canal system. MATERIALS AND METHODS: Fourty single rooted mandibular premolars were decoronated, cleaned, shaped and obturated. Gutta-percha was removed to the depth of 3.5 mm from the orifice with a heated plugger. Ten specimens each were sealed with Light Cure Glass Ionomer Cement (LCGIC), Flowable Composite (Tetric N-Flow), and Light Cure Glass Ionomer Cement with Flowable Composite in Sandwich Technique along with a positive control respectively and roots submerged in Rhodamine-B dye in vacuum for one week. Specimens were longitudinally sectioned and leakage measured using a 10X stereomicroscope and graded for depth of leakage. RESULTS: According to the results of the present study LC GIC + Tetric N Flow demonstrated significantly better seal (P < 0.01) than LC GIC. However there was no statistically significant difference in leakage (P > 0.01) between Tetric N-Flow and LCGIC+Tetric N-Flow groups. CONCLUSION: In the current study LCGIC+Tetric N-Flow was found to be superior over other experimental materials as intra-orifice barriers.

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Salivary secretory immunoglobulin A (sIgA) is postulated to protect against dental caries. Dental hygiene and health are usually poor in rheumatoid arthritis (RA) due to several factors. We hypothesized higher salivary sIgA in caries-free subjects and a higher extent of caries in RA. A protocol-driven cross-sectional pilot study was carried out to determine salivary sIgA in 48 patients with RA and 102 non-RA, healthy case controls. Standard of care in clinical and dental assessments were done by experts. A decay, missing teeth, filled teeth (DMFT) index was used to classify caries. Whole unstimulated saliva was collected to assay sIgA using a commercial ELISA kit. Dental caries was diagnosed in 67% and 86% of the RA and healthy subjects, respectively. Eight percent of RA patients had visited a dental surgeon. Though they tend to be higher in caries-free status, there were no statistically significant differences (p > 0.05) between RA and non-RA subjects with respect to salivary sIgA and extent of caries. The salivary sIgA levels for both RA and healthy case control subjects in this ethnic Indian (Asian) study were much higher than that reported in literature and need further validation. Rheumatologists ought to educate patients on dental matters.

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Light polymerizable tooth colored restorative materials are most widely preferred for advantages such as esthetics, improved physical properties and operator's control over the working time. Since the introduction of these light polymerizable restorative materials, there has been a concern about the depth of appropriate cure throughout the restoration. Photopolymerization of the composite is of fundamental importance because adequate polymerization is a crucial factor for optimization of the physical and mechanical properties and clinical results of the composite material. Inadequate polymerization results in greater deterioration at the margins of the restoration, decreased bond strength between the tooth and the restoration, greater cytotoxicity, and reduced hardness. Therefore, the dentist must use a light curing unit that delivers adequate and sufficient energy to optimize composite polymerization. Varying light intensity affects the degree of conversion of monomer to polymer and depth of cure.

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This report describes a step-by-step sequence for preparation for a posterior partial veneered restoration for a space closure using a Maryland bridge-design veneered with a heat-cured composite resin. The modality provides sound posterior occlusal function, combined with a psychological satisfaction to the patient of regaining a missing tooth. The preparation takes into account the design for resin-bonded prostheses. This article presents the preparation and build-up method for a metal reinforced posterior partial veneered restoration through a conservative palatal approach for a highly aesthetic result.

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Air abrasion dentistry has evolved over a period of time from a new concept of an alternative means of cavity preparation to an essential means of providing a truly conservative preparation for preservation of a maximal sound tooth structure. The development of bonded restorations in combination with air abrasion dentistry provides a truly minimal intervention dentistry. This article reviews the development of air abrasion, its clinical uses, and the essential accessories required for its use.

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This articles describes a technique for placement of a matrix barrier prior to use of mineral trioxide aggregate (MTA) as an artificial root-end barrier. The technique also demonstrates the use of a delivery system utilizing large-bore needles for the predictable and precise placement of the barrier materials at the apex of the tooth.

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AIM: The purpose of this study is to examine the intensity of light curing units and factors affecting it in dental offices. MATERIALS AND METHODS: The output intensity of 200 light curing units in dental offices across Maharashtra were examined. The collection of related information (thenumber of months of use of curing unit, the approximate number of times used in a day, and presence or absence of composite build-ups) and measurement of the intensity was performed by two operators. L.E.D Radiometer (Kerr) was used for measuring the output intensity. The average output intensity was divided into three categories (<200 mW/cm(2), 200-400 mW/ cm(2)and >400 mW/cm(2)). RESULTS: Among the 200 curing units examined, 81 were LED units and 119 were QTH units. Only 10% LED machines and 2% QTH curing units had good intensities (>400 mW/cm( 2)). CONCLUSION: Most of the examined curing lights had low output intensity ranging from 200 to 400 mW/cm(2), and most of the curing units had composite build-ups on them.