Endodontology

Endodontology: The Road Ahead V Gopikrishna, Nandini Suresh, Usha Carounanidy, Sathya Narayanan, Ajay Logani, Vasudev Ballal, Jojo Kottoor, Saumya Parashar Endodontology 2019 31(1):1-1

An in vivo double-blind randomized controlled study comparing the postoperative pain in single sitting root canal treatment under bupivacaine versus lignocaine used as a local anesthetic agent Sumita A Bhagwat, Anacleta Heredia, Leena V Padhye Endodontology 2019 31(1):2-8 Aim: This in vivo double-blind randomized control trial was carried out to evaluate the efficacy of a long-acting local anesthetic bupivacaine in preventing postoperative pain associated with single sitting endodontic treatment and to compare it with lignocaine when used as a local anesthetic agent. Methods: A total of fifty patients with symptomatic irreversible pulpitis were selected to be included in the study. The patients were randomly divided into two groups: Group A patients were given lignocaine as local anesthetic and Group B were given bupivacaine. The root canal procedures for the patients were carried out in single sittings under rubber dam using hand ProTaper™ system, 2.5% sodium hypochlorite as irrigant alternating with normal saline and obturation by lateral condensation technique. A questionnaire employing visual analog scale for pain assessment was given to the patient and instructions on how to fill the form were given. The patients were recalled after 2 days, and the pain was analyzed. The result was tabulated and statistically analyzed for incidence and degree of pain. Results: The mean overall postoperative pain for bupivacaine was lesser than that for lignocaine, and the difference was statistically significant. Conclusion: Based on our findings and in comparison with those of other studies, we reached the conclusion that it may be recommended that bupivacaine may replace lignocaine as the anesthetic of choice in the single visit endodontic protocol in order to reduce the incidence of postoperative pain often seen after single visit endodontic procedures.

In silico evaluation of the efficacies of two different medicaments against Enterococcus faecalis IB Geeta, AS Anjum Husna, S Sachin Sha, Ameen M Muhammed, J Moses Endodontology 2019 31(1):9-12 Aim: The aim of the study is to evaluate the efficacies of two different medicaments, such as ledermix and licorice pastes, against Enterococcus faecalis using in silico method. Methodology: Procurement of medicaments is from pharmaceutical shop. Culturing of E. faecalis is done under sterile conditions using brain–heart infusion broth. Bacterial growth check is done at 600 nm for further processing. Medicaments are mixed in double distilled for the analyses. After autoclaving at 121°C, the butylated hydroxyanisole is poured into Petri dishes to solidify. After solidification, wells are punched using sterile punchers. The punched plates are ultraviolet treated for 10 min before inoculating with the organism. About 100 mL of culture sample is inoculated and made a fine spread inside the Petri dish. The prepared medicaments are poured and incubated at 37°C for analysis. After incubation, the clear zone is measured mechanically for antimicrobial effect at the duration of 24 h and 3, 5, and 7 days for virulence factor. The growth of the bacteria is subjected to microscopic analysis. Molecular docking studies are to be carried out using in silico method to find out the action of medicaments against E. faecalis at the molecular level. Groups are Group I: ledermix paste and Group II: licorice paste + Ca(OH)2 at 1:1 ratio. Results: The zone of inhibition of licorice paste + Ca(OH)2 was higher at 24 and 48 h, whereas ledermix showed less significant zone of inhibition against E. faecalis. Conclusion: Combination of licorice + Ca(OH)2 completely inhibited the growth of E. faecalis. Licorice + Ca(OH)2 compounds show best results both in Microbial inhibition concentration (MIC) (6 ± 1 cm) and in docking mechanism (−7 K cal/mol). Comparatively, ledermix showed only (4 ± 1 cm) in Microbial inhibition concentration and only (−6.8 K cal/mol) in docking mechanism.

The effectiveness of calcium hydroxide paste mixed with 2% chlorhexidine solution against Candida albicans-infected human roots: An ex vivo study Fahd Alsalleeh, Amani Almohaimeed, Anfal Almoqbel, Ziyad Allahem Endodontology 2019 31(1):13-16 It is known that Candida albicans is involved in the etiology of persistent periradicular lesions. Aims: The aim of this study was to determine the antifungal activity of calcium hydroxide (Ca[OH]2), paste (Ultradent Products Inc., South Jordan, UT, USA) mixed with 2% chlorhexidine against C. albicans. Subjects and Methods: Fifty extracted human single-rooted teeth were selected. The teeth were standardized and instrumented with K3™ Nickel–Titanium rotary files (Kerr Dental). Teeth were then infected with C. albicans, except negative controls. After 7 days, teeth were randomly divided into the following groups according to intracanal medicament protocols (n = 10): Ca(OH)2 mixed with 2% chlorhexidine, Ca(OH)2 mixed with normal saline, Ca(OH)2 alone, or 2% chlorhexidine alone. Normal saline alone was used as positive controls. All teeth were incubated at 37°C and 100% humidity for a week. C. albicans growth was recorded. Pairwise comparison and Tukey's analysis of mean differences were conducted with the significance level set at the 0.05 level. Results: All samples of the positive controls, Ca(OH)2 alone and Ca(OH)2 mixed with the saline groups showed C. albicans growth (100%). Ca(OH)2 mixed with chlorhexidine showed 70% growth, whereas chlorhexidine alone group showed 60% growth. The negative controls had no growth. Conclusions: A mixture of Ca(OH)2 and 2% chlorhexidine had better antifungal activity against C. albicans in human-extracted teeth compared to that of Ca(OH)2 alone.

Effectiveness of three chemical solutions on gutta-percha cones by rapid sterilization technique: A scanning electron microscope study S Anitha Rao, Muppala Nikhitha Chowdary, CS Soonu, T Muralidhar Endodontology 2019 31(1):17-20 Objectives: It is prudent to produce most sterile root canal system and to maximize the most hermetical seal so gutta percha cones are used gutta-percha (GP) cones are used to obliterate the root canal space, prevention of contamination becomes a problem. Hence, the aim of this study was to identify the presence of surface topography, crystallization, and subsequent removal of sodium hypochlorite, glutaraldehyde, and aloe vera crystals on GP cones after rapid sterilization technique – this was a scanning electron microscope (SEM) study. Materials and Methods: GP points of size 80 and 2% taper were divided into four groups depending on the type of agents used for sterilization. Four groups were as follows: Group 1 – control group, Group 2 – aloe vera, Group 3 – glutaraldehyde, and Group 4 – NaOCL. About 10 GP points of each group were immersed for 2 min in different concentrations and observed under SEM to evaluate surface topography and presence of chloride crystals. Statistical analysis was carried out using Chi-square test, Kruskal–Wallis test and Mann–Whitney U-test to compare the results between the groups. All the data were expressed as mean ± standard deviation, and the difference of P < 0.05 or more was considered significant. Results: Aloe vera found to be an effective medium in decontaminating GP cones compared to glutaraldehyde and NaOCL (sodium hypochlorite). Conclusion: The use of sterile GP cones for the obliteration of root canals is of prime importance, and aloe vera group shows no changes in surface topography and the presence of chloride crystal formation compared to the control group. Hence, it is prudent to produce the most sterile root canal system, maximizing most hermetical seal possible.

Evaluation of a new means of pulpal diagnosis through a prospective study of 133 cases Walid Lejri, Nabiha Douki, Ines Kallel Endodontology 2019 31(1):21-24 Introduction: The most accurate method for evaluation of pulpal status is histological examination. Unfortunately, it is clinically inapplicable. The goal of our work is to focus on in situ observation, which is proven to be a historically reliable and clinically applicable means. Materials and Methods: This is a 22-month prospective cross-sectional epidemiological study of 133 cases. For each case, the initial pulpal diagnosis is confronted with the in situ observation. The initial pulpal diagnosis is either retained or corrected according to the in situ observation. Results: The Chi-squared test gave a value of P < 0.005; no correlation is observed between the initial pulpal diagnosis and the final diagnosis (After the in situ observation). Conclusion: Histologically, when the pulp is irritated, a vascular reaction is observed. This reaction will influence the color and the flow of pulp blood. This blood changes can be detected with the naked eye which led us to propose a classification of the different in situ observations to refine the initial pulp diagnosis.

Comparison of the sealing ability of Endocem mineral trioxide aggregate and Endoseal mineral trioxide aggregate as a furcal perforation repair material under the operating microscope: An in-vitro study Mohd Sibghatullah Khatib, Swapna V Devarasanahalli, Ranjini M Aswathanarayana, Paramarshi Das, Roopa R Nadig Endodontology 2019 31(1):25-28 Objective: The aim of this study was to compare the sealing ability of pozzolan-based mineral trioxide aggregate (MTA) (Endocem) cement and pozzolan-based MTA (Endoseal) when used to repair the furcal perforations in permanent molars using the stereomicroscope. Materials and Methods: The study sample comprised forty-three recently extracted permanent molars. These teeth were placed in a 5.25% sodium hypochlorite solution for 24 h and washed with tap water. Access cavities were made using a #5 round bur in high-speed handpiece. Perforations were made in the center of the floor of the pulpal chamber using a round bur. The teeth were randomly assigned into three experimental groups based on the material used to seal the perforation: Group 1 – control group, Group 2 – Endocem MTA group, and Group 3 – Endoseal MTA group. The packed materials were allowed to set for 24 h. The samples were sectioned longitudinally, and the extent of marginal adaptation was measured by stereomicroscope. Kruskal–Wallis test was used for statistical analysis using SPSS software. Results: The difference in the mean length of dye penetration between groups was statistically significant. The pair-wise comparison was done between the three groups using Mann–Whitney U-tests as post hoc analysis, which reveals the difference between Group 1 and Group 2 was statistically significant P < 0.04 and also between Group 2 and Group 3 P < 0.001. However, the mean difference between Group 1 and Group 3 was non significant P < 0.31. Conclusion: Endoseal MTA showed more microleakage than Endocem MTA. Therefore, within the limitations of this study, we suggest that Endocem has the potential to be used as a perforation repair material rather than Endoseal MTA.

Comparative pH and calcium ion release in newer calcium silicate-based root canal sealers Shekhar Shashank, Shikha Jaiswal, Vineeta Nikhil, Sachin Gupta, Preeti Mishra, Shalya Raj Endodontology 2019 31(1):29-33 Aims: The aim of this study is to compare and evaluate pH and calcium ion release in newer calcium silicate-based root canal sealers. Methodology: Polyethylene tubes were cut into 35 tubes of equal sizes; with each tube measuring 10 mm length × 1 mm diameter. The tubes were pre-weighted using digital weighing balance machine to allow a similar weight of each tube. The polyethylene tubes were divided into four groups according to the materials with which they were filled. Group 1 (n = 5) control group, Group 2 (n = 10) sealapex, Group 3 (n = 10) mineral trioxide aggregate (MTA) fillapex, and Group 4 (n = 10) White MTA. The tubes after being packed with the respective sealers were placed inside polypropylene flasks containing 10 ml of deionized water. The flask was closed and stored at a constant temperature of 37°C during all the evaluation period. At 24 h, 7 days and 1 month, pH and calcium ion released was measured using pH meter and atomic absorption spectrophotometer, respectively. Results: At 24 h, White MTA showed the highest pH (8.52) and highest calcium (Ca++) release (14.7). At 7 days and 28 days, MTA fillapex showed significantly higher pH (8.64; 8.7) and Ca++ release (10.30; 18.60) than the other two groups. Conclusion: Although at 24 h, the new calcium silicate-based root canal sealer, MTA fillapex showed the least Ca++ release but over longer time intervals, i.e., at 7 days and 28 days, MTA fillapex showed significantly higher pH and Ca++ release than both White MTA and sealapex.

Clinical efficacy of hydrochloric acid and phosphoric acid in microabrasion technique for the treatment of different severities of dental fluorosis: An in vivo comparison Dipanshu Kumar, Aparna Singh, Chitrita Gupta Mukherjee, Asib Ahmed, Arpanna Singh, Mukesh Kumar Hasija, Siddharth Anand Endodontology 2019 31(1):34-39 Aim: The aim of this study was to evaluate and to compare the clinical efficacy of two compounds (hydrochloric acid and phosphoric acid) in microabrasion in terms of degree of stain removal (DSR) and improvement of appearance for the different severities of dental fluorosis. The mean time and number of applications required by the two experimental compounds were also compared. Methodology: Children between the age group of 9–14 years with dental fluorosis to two or more fluorozed anterior permanent teeth were included in the study. The Dean's Fluorosis Index was used to classify each tooth, and they were randomly selected into mild (Group I), moderate (Group II), and severe (Group III) groups of fluorosis. Ten teeth from each of these groups were randomly allotted for undergoing microabrasion using 18% HCl with pumice and other 10 teeth using 37% phosphoric acid with pumice. Colored preoperative and postoperative photographs were taken for each patient and analyzed for improvement in appearance and DSR. Time and number of applications and parent–patient response with both the compounds were also recorded. The results were tabulated and statistically analyzed. Results: The results of the present study showed that a nonsignificant difference existed in DSR and improvement in appearance between the two compounds of microabrasion for all the three degrees of dental fluorosis. Significantly lesser time was taken by HCl in mild and moderate fluorosis. Significantly lesser number of applications was required with HCl for moderate fluorosis. Nonsignificant difference existed for parent-patient response with both the compounds for all the severities of dental fluorosis. Conclusion: 18% HCl with pumice and 37% phosphoric acid with pumice both can be used for microabrasion for all the severities of dental fluorosis. The time and number of applications using HCl were lesser; therefore, it should be preferred over H3PO4 for all the severities of fluorosis.

Comparative evaluation of apical dye penetration of hydrophilic and hydrophobic obturation system: A stereomicroscopic study Asit Vats, Umme Farva, Ajay Paliwal, Kshiti Bharadawaj, Harpreet Singh Chhabbra, Arohan Singh Endodontology 2019 31(1):40-44 Aim: The aim of this study is to evaluate the apical leakage of hydrophilic and hydrophobic obturation systems using a dye penetration method under stereomicroscope. Materials and Methods: Sixty freshly extracted human single-rooted mandibular incisors were decoronated and standardized to a working length of 16 mm. Root canal preparation was done with rotary ProTaper file system in all samples. The teeth were randomly divided into three groups (20 each) and obturation was done. Group A was obturated using gutta-percha (GP)/AH Plus (hydrophobic), Group B using Resilon/Epiphany system (hydrophilic), and Group C using SmartSeal system (hydrophilic). The linear apical dye leakage was measured using methylene blue dye under stereomicroscope. Statistical Analysis: Statistical analysis was performed using SPSS version 21.0. Kruskal–Wallis test (nonparametric ANOVA) was used for intergroup comparisons. Between-group comparisons were made using Mann–Whitney U-test was done. Results: All three groups showed dye leakage. Intergroup comparison exhibited statistically significant difference among the groups. GP with AH Plus showed a highest dye leakage value. Conclusion: The sealing to apical leakage shown by hydrophilic obturation systems was significantly better as compared to hydrophobic obturation systems, though none of the obturation systems were found out to be completely devoid of leakage.