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Background: Sealers with antimicrobial properties play an important role in endodontic therapy success especially against Enterococcus faecalis infection found in failed root canal therapy. Addition of antibiotic agents to endodontic sealers may show significant increase in their antibacterial properties both against anaerobic and aerobic microbes. The purpose of the present study was to evaluate antimicrobial efficacy of Kerr pulp canal sealer (EWT) in combination with 10% amoxicillin against E. faecalis and post-root canal treatment viability of Enterococcus faecalis on the first and seventh day. Methods: A total of 60 extracted human mandibular premolar teeth were decoronated after initial decontamination with 1% NaOCl. Root length standardized to 12 mm. Canal instrumentation was done using ProTaper Universal file system till size F2 using 5.25% NaOCl. It was then infected with a pure strain of E. faecalis for a period of four days. Obturation was done using plain sealer, (n=30) and sealer-antibiotic combination, (n=30). Half of the teeth were sectioned at 24 hours (S, SA) and other half were sectioned seven days after obturation (S7, SA7). All samples were stained with SYTO9 and propidium iodide for imaging under Confocal Laser Scanning microscope. Statistical analysis was performed with the statistical software SPSS v. 17.0 (SPSS for Windows; SPSS Inc, Chicago, IL). Data was analysed using One Way ANOVA and post hoc Tukey test to determine statistical significance with p value < 0.01 considered significant. Results: Statistically significant differences were observed in green to red ratio between group S (9.561976) and S7 (0.435418) (p < 0.01). There was no difference found between SA (mean of green to red ratio, (0.70431) and SA7 (mean of green to red ratio, 0.85184). Conclusions: Antibiotics added to the sealer effectively eradicated of E. faecalis 24 hours post-obturation. However, after seven days, plain sealer was as effective as sealer-antibiotic combination.

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Aim: This study aimed at comparative evaluation of the efficacy of tooth bleaching using different concentrations of carbamide peroxide (CP) with and without diode laser at 980 nm for 2.5 and 5 min time duration. Materials and Methods: Hundred intact human incisors were selected. Teeth were artificially stained using black tea solution. Samples were randomly allocated into four groups: Group I: distilled water, Group II: 15%, 20%, and 35% CP without laser, Group III: 15%, 20%, and 35% CP using diode laser for 2.5 min, and Group IV: 15%, 20%, and 35% CP using diode laser for 5 min. Color measurements were made using spectrophotometer. Data were statistically analyzed by ANOVA, repeated measures of ANOVA, and Tukey post hoc test. Results: 35% concentration of CP gave similar mean shade (ΔE) value at T2, as 15% CP at T3. At T3, 15% concentration of CP using diode laser for 2.5 min gave similar mean shade (ΔE) value, as 35% concentration of CP using diode laser for 2.5 min. Conclusion: 35% CP causes change in chroma and whitens the tooth at a faster rate with a significantly more lightening effect. Bleaching twice weekly produces a similar effect when using high or low concentrations of CP. Laser-assisted bleaching decreases the time of whitening process.

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A thorough knowledge of variable and complex tooth morphology, detailed exploration of the internal anatomy and underlying pathology, proper interpretation of radiographic images, conservative access to explore all the canals, thorough debridement and disinfection of canal system, three-dimensional seal by obturation, and good coronal seal by final restoration are essential steps in the management for a successful endodontic treatment outcome. Clinical management of rare case with extra canals in the lower anterior teeth and premolars had to undergo root canal therapy has been described. Referring to the hard-tissue repository of the human dental internal morphology, carefully interpreting multiangled radiography/cone-beam computed tomography, using tools such as magnifying loupes with illumination and ultrasonics, thermoplasticized gutta-percha system to obturate, are very helpful to the clinician can achieve this goal. This article describes and illustrates the management of a rare case with Vertucci's Type VIII canal anatomy in lower anterior teeth and premolars.

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Background: Carnosic acid is an herbal derivative with potent antioxidant, anti-inflammatory, antimicrobial, and anticancer properties. Aim: Comparative evaluation of the antimicrobial potential of carnosic acid, calcium hydroxide, and triple antibiotic paste as intracanal medicaments against Enterococcus faecalis. Settings and Design: Department of Conservative Dentistry and Microbiology, an in vitro study. Materials and Methods: Fifty-two extracted single-rooted human teeth were decoronated and chemomechanical preparation was performed. The specimens were secured in the center of screw-capped vials and autoclaved. A strain of E. faecalis was inoculated into the canals and grown for 72 h. The teeth were divided into: Group I-Ca(OH)2, Group II- triple antibiotic paste (TAP), Group III-Carnosic acid, and Group IV-Negative control. The medicaments were applied in the canal and left for 14 days. The specimens were sectioned transversely at three levels to create dentinal discs and observed under the confocal laser scanning microscopic (CLSM). Images were analyzed, and quantification of bacteria was done using the Image J software. Statistical Analysis: Mean percentage of live/dead bacteria was analyzed using One-way ANOVA and Post hoc Tukey test. Results: Mean percentages of live and dead bacteria were seen under CLSM in Group I, Group II, and Group III were (4.44 ± 2.87, 4.56 ± 2.93, 1.61 ± 1.90), and (4.59 ± 3.04, 4.25 ± 2.98, 1.70 ± 1.99), respectively, with least mean percentages for live and dead bacteria in carnosic acid (Group III). Conclusion: Carnosic acid showed better antimicrobial efficacy against E. faecalis than TAP and Ca(OH)2 by showing a low percentage of both live and dead bacteria.

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INTRODUCTION: The presence of pulpal fluid can influence dentin bonding. This study aimed to evaluate the shear bond strength of universal dental adhesives under simulated intrapulpal pressure. MATERIALS AND METHODS: Forty intact maxillary premolars were distributed into four groups (Group 1 - 3M ESPE Adper Single Bond 2 total etch adhesive, Group 2 - 3M ESPE Single Bond Universal, Group 3 - Prime and Bond universal adhesive, and Group 4 - Ivoclar Tetric N Bond Universal). Adhesive restorative procedures were carried under intrapulpal pressure simulation following which it was subjected to a shear load of 0.5 mm/min. Fracture mode analysis was performed using a stereomicroscope. The data obtained were subjected to ANOVA and Tukey post hoc test with a P < 0.05. RESULTS: Highest bond strength was exhibited by Group 3 (7.01 ± 2.02 MPa) and least by Group 1 (5.36 ± 3.03 MPa). However, there were no statistical differences among the groups. Group 1 and 2 showed mostly cohesive failure, whereas Group 3 and 4 showed mixed failure. CONCLUSION: The results demonstrated that the experimental universal adhesive agents exhibited comparative shear bond strength when subjected to pulpal pressure. Pulpal pressure has a significant effect on bond strength.

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Background: The predictability of direct pulp capping (DPC) depends on the quality of the dentin bridge formation and the inflammatory response to the capping material. Various materials are available with variable success. Aim: The aim of this study is to evaluate histologically the effectiveness of calcium hydroxide, mineral aggregate, and dentin bonding agent when used as DPC in mechanically exposed adult pulp tissue. Materials and Methods: Pulpal exposures were made in 45 intact human premolars, scheduled for extraction for orthodontic purposes. Teeth were capped with hard setting calcium hydroxide (Dycal), mineral trioxide aggregate (ProRoot MTA), and dentin bonding agent (adper Single Bond). The final restoration was done with posterior composites using resin-modified glass-ionomer cement as a base. Pulps of teeth were evaluated histologically at the 15th and 45th day for inflammatory cell response and dentin bridge formation according to the criteria described by Cox et al. The statistical analysis of data was done using Chi-square test and P ≤ 0.05 was considered statsiticlly significant. Results: MTA as DPC agent showed milder inflammatory response compared to Dycal and Single Bond. The quality of bridge formation by MTA was similar to Dycal, which took the least time. Adper Single Bond Plus and Dycal showed a significantly higher degree of pulpal inflammation. Among all materials used, Adper Single Bond Plus took the longest time for both the resolution of pulpal inflammation and improvement of the quality of bridge formation. Conclusion: Based on the result, it can be concluded that Dycal and MTA produce similar types of dentin bridge formation when used a DPC agent. Adper Single Bond has the potential to be used as DPC agents, but it takes a longer time for the resolution of inflammation and dentin bridge formation.

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BACKGROUND: Dentin hypersensitivity is primarily caused due to patent or exposed dentinal tubules. Nonfluoridated-desensitizing agents deposit hydroxycarbonate apatite (HCA), within the dentinal tubules, thereby relieving hypersensitivity. Fluoride-containing bioactive glass-based agents form fluorapatite which is less soluble when compared to hydroxyapatite and HCA. MATERIALS AND METHODS: In this in vitro study forty dentin specimens obtained from extracted human premolars were divided randomly into four groups (n = 10): Group 1 - fluoridated bioactive glass (FBaG); Group 2 - bioactive glass (BaG); Group 3 - arginine calcium carbonate; Group 4 - saline. 37.5% phosphoric acid was used to ensure patent dentinal tubules. Test agents from each group were applied using a rubber cup. Half the treated samples were then subjected to 6% citric acid treatment. The degree of occlusion was evaluated using the scanning electron microscope, and the microscopic images were scored before and after the citric acid challenge by two blinded endodontists. Statistical analysis was performed using SPSS, one-way ANOVA, and post hoc Tukey test (P = 0.05). RESULTS: Group 1 demonstrated better tubule occlusion in comparison with Group 2 and a statistically significant difference when compared to Group 3 (P = 0.001). Following acid challenge, Group 2 showed significantly more occluded tubules when compared with Group 3 (P = 0.001) and comparable difference with Group 1. CONCLUSION: All desensitizing agents showed satisfactory dentinal tubule occlusion. While fluoridated bioactive glass demonstrated better occlusion immediately after application, Bioactive glass showed better resistance to acid treatment.

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BACKGROUND: Pulp capping should always be considered as the primary treatment of choice for teeth without irreversible pulpitis in lesions approaching dental pulp. The predictability of vital pulp therapy has improved with the introduction of newer bioceramic materials. AIM: The purpose of this randomized controlled trial was to compare the outcomes of mineral trioxide aggregate (MTA) (Angelus, Londrina, Brazil) and a pozzolan-based cement (ENDOCEM-Zr® [Maruchi, Wonju, Korea]) as an indirect pulp capping (IPC) material. MATERIALS AND METHODS: IPC was performed in forty patients who were randomly divided into ENDOCEM-Zr® and MTA groups. The outcome was assessed using clinical and radiographic tests at different time intervals. The prognostic factors on the outcome of IPC were also evaluated. RESULTS AND CONCLUSIONS: The success rate of ENDOCEM-Zr® and MTA groups was 94.7% and 89.4%, respectively. The results were not statistically significant. Binary logical regression showed that the age of the patient and the status of the pulp before treatment were deciding variables for the outcome of the study. Therefore, it was concluded from the study that the evaluated pozzolan-based cement could be used as an alternative to MTA because of its faster setting time and lower discoloration potential. In addition, pulp capping should be performed with caution in individuals above 40 years and in teeth with reversible pulpitis.

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BACKGROUND: The utilization of restorative dental care is very scarce in rural India. Association between level of education and health of a person has been well-documented in many countries and time periods with a range of potential factors shaping the connection between both. OBJECTIVES: This cross-sectional survey was conducted to evaluate an association between the level of education (educational qualification) and utilization of restorative dental care among rural women associated with self-help groups. MATERIALS AND METHODS: A semi-structured questionnaire was administrated to 660 rural women associated with self-help group by trained research assistants. The 604 completed questionnaires were received and reviewed. The education levels were divided into three groups: Group 1 - illiterates (17.2%), Group 2 - school educated (69.4%), and Group 3 - college educated (13.4%). Chi-square test was applied to evaluate the utilization of dental services by rural women, and logistic regression was applied to evaluate the influence of their educational qualifications on utilization. RESULTS: A total of 604 properly filled questionnaires out of 660 (91.51% response rate) were included in the analysis. Only 56.9% of the sampled rural women indicated that they have visited dentists earlier. The maximum number of individuals who have never visited the dentist belonged to illiterate group (55.7%), and the association was statistically significant (0.004) when compared with educated individuals. CONCLUSION: The results of this study concluded that the level of education has a significant influence on the utilization of dental care.

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INTRODUCTION: Intracanal medicaments have traditionally been used in endodontics to disinfect root canals between appointments. Calcium hydroxide is widely used as an intracanal medicament for disinfection and to promote periapical healing. It is stable for long periods, harmless to the body, and bactericidal in a limited area. The efficacy of calcium hydroxide as a disinfectant is dependent on the availability of the hydroxyl ions in the solution that depends on the vehicle in which the calcium hydroxide is carried. In general, three types of vehicles are used: Aqueous, viscous or oily. Some in vitro studies have shown that the type of vehicle has a direct relationship with the concentration and the velocity of ionic liberation as well as with the antibacterial action when the paste is carried into a contaminated area. AIM OF THE STUDY: To evaluate the calcium ion release and measure the change in pH of the environment that occurred when calcium hydroxide was combined with different vehicles (distilled water, propylene glycol, calcium hydroxide containing gutta-percha points and chitosan) over different time periods. MATERIALS AND METHODS: Forty single rooted mandibular first premolar teeth were decoronated for this study. Working length was established and the root canals were enlarged and irrigation accomplished with 2 ml of NaOCl solution after every file. The teeth were then randomly divided into four groups. The canals were then packed with different preparations of calcium hydroxide using the following vehicles-distilled water, propylene glycol, gutta-percha points and chitosan. Calcium ion release in different groups was analyzed using an ultraviolet spectrophotometer at 220 nm. The change in pH of was determined using a pH meter. Results were statistically evaluated using one-way ANOVA test. RESULT: For calcium ion release, Group 2 showed cumulative drug release of 81.97% at the end of 15 days, whereas Group 1, 3 and 4 showed a release of 99.53, 17.98, 74.93% respectively with a significant difference among all groups. Group 1 reached the highest Ca(2+) level (39.79%) at the end of 1 day but showed almost complete release of calcium hydroxide at the end of 15 days. Group 3 showed least calcium ion release (17.98%) at 15 days. Group 4 showed a sustained release of Ca(+2) ions from 74% at 15 days to 95% at the end of 30 days. After the 1(st) h; Group 1 showed the highest pH level (11.8). However, pH reduced to 7.8 at the end of 30 days in this group. Group 2 showed the highest pH value (10.35), followed by Group 4 (10.32) after 30 days. CONCLUSION: Chitosan can be used as a promising vehicle for calcium hydroxide to maintain an alkaline pH and to allow sustained release of calcium ions in the root canal system.

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The absence of a natural apical constriction in a nonvital young permanent tooth makes endodontic treatment a challenge. There is a need to induce or create an apical barrier against, which the obturating material can be condensed. Traditionally, calcium hydroxide is the material of choice to induce apexification. Due to certain drawbacks such as prolonged treatment duration and unpredictable apical barrier formation, it is being replaced by materials, which have a more predictable outcome like mineral trioxide aggregate (MTA). One-step apexification with MTA reduces the treatment time when compared with traditional calcium hydroxide apexification, which requires an average time of 12-19 months. In one-step apexification using MTA, the technical problem encountered is controlling the overfill or underfill of MTA. The use of a matrix material helps to overcome this shortcoming. Platelet rich fibrin (PRF) is an immune platelet concentrate, which can be used as a matrix, it also promotes wound healing and repair. This case report presents a case of one step apexification using MTA as an apical barrier and autologous PRF as an internal matrix.

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Periodontal attachment loss in the maxillary anterior region can often lead to esthetic and functional clinical problems. Lifelong motivation is essential to the supportive therapy for these patients, and the maintenance of good esthetics, combined with conducive to maintaining long term dental and professional health. This paper aims to demonstrate an innovative treatment option for dealing with aesthetic challenges posed by a number of patients who have undergone initial cause related therapy for aggressive periodontitis.