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   Table of Contents - Current issue
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January-June 2019
Volume 31 | Issue 1
Page Nos. 1-132

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EDITORIAL  

Endodontology: The Road Ahead p. 1
V Gopikrishna, Nandini Suresh, Usha Carounanidy, Sathya Narayanan, Ajay Logani, Vasudev Ballal, Jojo Kottoor, Saumya Parashar
DOI:10.4103/0970-7212.260628  
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ORIGINAL ARTICLES Top

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 p. 2
Sumita A Bhagwat, Anacleta Heredia, Leena V Padhye
DOI:10.4103/endo.endo_1_18  
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.
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In silico evaluation of the efficacies of two different medicaments against Enterococcus faecalis p. 9
IB Geeta, AS Anjum Husna, S Sachin Sha, Ameen M Muhammed, J Moses
DOI:10.4103/endo.endo_88_18  
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.
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The effectiveness of calcium hydroxide paste mixed with 2% chlorhexidine solution against Candida albicans-infected human roots: An ex vivo study p. 13
Fahd Alsalleeh, Amani Almohaimeed, Anfal Almoqbel, Ziyad Allahem
DOI:10.4103/endo.endo_127_18  
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.
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Effectiveness of three chemical solutions on gutta-percha cones by rapid sterilization technique: A scanning electron microscope study p. 17
S Anitha Rao, Muppala Nikhitha Chowdary, CS Soonu, T Muralidhar
DOI:10.4103/endo.endo_54_18  
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.
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Evaluation of a new means of pulpal diagnosis through a prospective study of 133 cases p. 21
Walid Lejri, Nabiha Douki, Ines Kallel
DOI:10.4103/endo.endo_47_18  
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.
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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 p. 25
Mohd Sibghatullah Khatib, Swapna V Devarasanahalli, Ranjini M Aswathanarayana, Paramarshi Das, Roopa R Nadig
DOI:10.4103/endo.endo_49_18  
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.
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Comparative pH and calcium ion release in newer calcium silicate-based root canal sealers p. 29
Shekhar Shashank, Shikha Jaiswal, Vineeta Nikhil, Sachin Gupta, Preeti Mishra, Shalya Raj
DOI:10.4103/endo.endo_53_18  
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.
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Clinical efficacy of hydrochloric acid and phosphoric acid in microabrasion technique for the treatment of different severities of dental fluorosis: An in vivo comparison p. 34
Dipanshu Kumar, Aparna Singh, Chitrita Gupta Mukherjee, Asib Ahmed, Arpanna Singh, Mukesh Kumar Hasija, Siddharth Anand
DOI:10.4103/endo.endo_142_18  
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.
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Comparative evaluation of apical dye penetration of hydrophilic and hydrophobic obturation system: A stereomicroscopic study p. 40
Asit Vats, Umme Farva, Ajay Paliwal, Kshiti Bharadawaj, Harpreet Singh Chhabbra, Arohan Singh
DOI:10.4103/endo.endo_67_18  
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.
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Volumetric analysis of hand and rotary root canal instrumentation using different obturation techniques: An in vitro spiral computed tomography study p. 45
Jatinderpal Singh, Anurag Aggarwal, Navjot Singh Mann, Ashu Jhamb
DOI:10.4103/endo.endo_15_18  
Aim: The aim of this study is to volumetrically analyze the root canal volume after instrumentation with hand and rotary files and to evaluate and compare the volume percentage of root canals obturated (POV) with gutta-percha (GP), with various techniques using spiral computed tomography (SCT). Materials and Methods: Sixty sound, noncarious, single-rooted extracted human teeth were sectioned at the cementoenamel junction. The specimens were divided into five groups based on the type of canal instrumentation and obturation technique used. Specimens were prepared with Hand Files and ProTaper Next and HyFlex CM rotary Files. The volume of root canal space was measured using SCT, and root canals were obturated (cold lateral condensation, cold flowable “GuttaFlow 2,” and single cone). A second SCT scan was performed to determine the POV of GP at coronal, middle, and apical third. The data were subjected to statistical analysis using one-way ANOVA and Tukey's post hoc multiple comparison tests. Results: There was a highly significant difference in percentage of obturated volume between the groups at coronal, middle, and apical third, and also, there was a highly significant difference in the total percentage of obturated volume of canal between the groups. Conclusion: No obturation technique produced void-free root canal fillings and the greatest POV was obtained with lateral condensation followed by single cone and least with cold flowable obturation technique. Lateral condensation and single-cone technique showed 100% POV in the apical third region and GuttaFlow 2 had the maximum voids.
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Comparative evaluation of removal of gutta-percha from root canals with laser using different solvents: An in vitro study p. 51
Mona Devi, Pardeep Mahajan, Shikha Baghi Bhandari, Prashant Monga, Nitika Bajaj, Fatinderjeet Singh
DOI:10.4103/endo.endo_31_18  
Aim: The aim of this study is to evaluate the gutta-percha removal from root canals with diode laser using chloroform and Endosolv E solvents. Materials and Methods: Thirty freshly extracted permanent human maxillary central incisors with single and straight root canals were selected for the study. Teeth were biomechanically prepared and then obturated. Teeth were then stored in 100% humidity at 37°C for 7 days. Then teeth were randomly divided into three groups based on retreatment method used: Group 1-Only diode laser; Group 2-Diode laser along with chloroform as solvent; Group 3-Diode laser along with Endosolv E (Tetrachloroethylene) as solvent. After completion of retreatment, roots were sectioned longitudinally and viewed under stereomicroscope at 10x magnification. The area of the remaining filling material in each half was measured using Image tool for Windows v. 3.00 software. Data were analyzed by using analysis of variance test followed by post hoc test. Results: The results showed that all the laser groups left some filling material inside the root canal. However, the specimens retreated with diode laser along with chloroform (Group 2) left less filling material inside the root canals as compared to other groups. Conclusion: The present study revealed that the diode laser with solvents (Chloroform and Endosolv E) were significantly more effective than only diode laser group in removing gutta-percha during retreatment of the root canal system. Out of these, Group 2 (diode laser along with chloroform as solvent) was more effective than other groups.
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A comparative evaluation of the push-out bond strength of a resin-based sealer (AH Plus™) when two different intermediate irrigants are used, with and without a root canal brush: In vitro study p. 57
Ishan Ahmed, Shalini Devindernath Aggarwal, Anita Sanap, Vinay Rai, Swapnil Khadtare, Poorva Kurtarkar
DOI:10.4103/endo.endo_7_18  
Aims: The aim of this study was to evaluate and compare the push-out bond strength (POBS) of a resin-based sealer (AH Plus™) when 95% isopropyl alcohol (IA) or 10% citric acid (CA) was used as an intermediate irrigant, with and without a Canal Brush™. Settings and Design: In vitro laboratory study. Subjects and Methods: After due processing, thirty human teeth were split into three main groups. As per the grouping, either 95% IA or 10% CA was used as intermediate irrigants. The control group used no intermediate irrigant. Each of these three groups was further split into two subgroups, each containing five samples. All the samples were subjected to cleaning and shaping with ProTaper rotary files (PTUN) up to size F2 using NaOCl and saline as the irrigants. The canals were then irrigated with 5.25% NaOCl during instrumentation and then were rinsed with an intermediate irrigant (either 95% IA or 10% CA) as per the specifications of that particular group. All the samples were then irrigated with Chlorhexidine Gluconate (CHX) as the final irrigant and one subgroup from each main group was further cleansed with a canal brush. The discs were then subjected to assess the POBS using the universal testing machine. Statistical Analysis Used: Statistical analysis was done using Tukey-Kramer's multiple comparison test, Student's unpaired t-test, and one-way ANOVA test. Results: The combined usage of CA with Canal Brush™ gave the highest (statistically significant) POBS value. The worst performers were the two subgroups in which no intermediate irrigant was used. The usage of IA and CA as intermediate irrigants did not lead to statistically significant results when no canal brush was used. Conclusions: Within the limitations of this study, it was concluded that the use of CA and IA with canal brush significantly increased the POBS of the resin-based sealer.
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Effect of continuous soft chelating irrigation protocol on removal of smear layer p. 63
Vibha Hegde, Pranav Thakkar
DOI:10.4103/endo.endo_58_18  
Aim: The purpose of this study was to compare the efficacy of continuous soft chelating irrigation protocol with conventional irrigation protocol. Methodology: sixty extracted single-rooted human teeth were randomly divided into 5 groups (n =12) and instrumented using Protaper Universal nickel-titanium rotary instruments. In conventional irrigation group each canal was subsequently irrigated with 5.25% NaOCl followed with 17%EDTA (Group A), SmearClear (Group B) or SmearOFF (Group C). After that, all the specimens were subjected to irrigation with 5.25% NaOCl. In continous soft chelating irrigation group The irrigation while instrumentation and after instrumention was done with Chloroquick Low (9% hebp + 3% NaOCl) (Group D) and Chloroquick High (18% hebp + 5.25% NaOCl) (Group E). teeth were then processed for scanning electron microscopy (SEM), and the removal of the smear layer was examined in the coronal, middle, and apical thirds. Result: The efficacy of various agents for smear layer removal was assessed by comparison of groups using Kruskal Wallis ANOVA and Mann- Whitney U test. The results showed that there were no significant differences in Conventional irrigation protocol groups and continuous irrigation protocol group at coronal and middle thirds of root canals but at apical third Chloroquick High was able to remove more smear layer statistically when compared to all the groups (p_0.029). Conclusion: this in-vitro study both the protocols conventional as well as continuous soft chelating irrigation protocols were able to remove smear layer at coronal and middle third of the root canals but at apical third only continues soft chelating irrigation protocol performed with Chloroquick High shows better removal of smear layer.
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Apical microleakage in root canal-treated teeth containing broken hand files obturated with two different obturating materials: An in vitro study p. 68
Shailendra Mashalkar, Gladson Selvakumar, Pawan Diwanji, Shreeshail Indi, Jyoti Warad
DOI:10.4103/endo.endo_77_18  
Introduction: Separated instruments in root canals complicate routine endodontic treatment. This study aimed to compare apical microleakage in root canals containing separated hand stainless steel K-files obturated with gutta-percha and Portland cement. Materials and Methods: In this in vitro, experimental study, forty single-rooted freshly extracted teeth were decoronated and then the roots were randomly divided into four groups (n = 40). The biomechanical preparation was done according to the step-back technique. The K-file of 25 size was intentionally broken in apical third and obturation was done with gutta-percha and AH Plus sealer using lateral compaction technique and with Portland cement. Apical microleakage was measured using dye penetration method; teeth were immersed in Indian ink for 48 h. The roots were rinsed and sectioned by a cutting saw. The sections were evaluated under a stereomicroscope under ×50 magnification by two observers. Data were analyzed using ANOVA test. Results: Root canals filled with Portland cement have shown lowest microleakage when compared to laterally compacted gutta-percha according to dye penetration depth. Statistical results with ANOVA have showed a significant difference in microleakage among the four groups (P < 0.001, significant). Conclusion: The results of this study have shown that apical microleakage is less in instrument-separated teeth obturated with Portland cement than in instrument-separated teeth obturated with gutta-percha.
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Efficacy of smear layer removal by two Ayurvedic herbal irrigants, using continuous vs. syringe and needle irrigation p. 72
Suparna Ganguly Saha, Rajeshwar Singh, Anuj Bhardwaj, Prashansa Vijaywargiya, Jayesh Billore, Divya Saxena
DOI:10.4103/endo.endo_28_18  
Introduction: A successful root canal therapy is largely dependent on thorough chemo-mechanical debridement of the root canal space. However, mechanical preparation inadvertently forms an amorphous layer, known as the “smear layer.” Traditionally used irrigants have a deleterious effect over root dentin and thus herbal alternatives can be a better option for smear layer removal with no action on root dentin. Aim: The purpose of the study was to compare the in vitro effectiveness of two potential herbal irrigants: 6% German chamomile extract (GCE) and 6% Morinda citrifolia juice (MCJ), in removal of smear layer. Materials and Methods: Eighty single-rooted human teeth were allocated into two equal groups: one to be instrumented with the self-adjusting file (SAF), while the other with WaveOne (WO). Four subgroups in each group were irrigated with 6% GCE, 6% MCJ, 17% ethylenediaminetetraacetic acid (EDTA) (positive control), and NS (negative control). Scanning electron microscopy (SEM) was used to evaluate the presence of smear layer. Statistical Analysis: As data for smear layer were categorical, Chi-square test was applied for data analysis. P < 0.05 was considered statistically significant. Results: The most effective smear layer removal in the coronal part was observed with SAF-EDTA and SAF-GCE, followed by WO-EDTA. In the middle part, SAF-GCE was equivalent to that of SAF-EDTA, followed by WO-EDTA and WO-GCE. In the apical third, the most efficient smear layer removal was observed with SAF-EDTA, followed by some removal of smear layer by WO-EDTA and SAF-GCE. GCE was as effective as EDTA in removal of smear layer in the coronal and mid-root regions, when used with continuous irrigation.
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Comparative evaluation of apical extrusion of intracanal bacteria using four single-file NiTi instruments: An in vitro study p. 78
A Sheerin Sarthaj, V Rajesh Gopal, A Arvind Kumar, Benin Paulaian, Lal Krishnan Raveendran, CS DeviPrasad
DOI:10.4103/endo.endo_30_18  
Introduction: A major objective in root canal treatment is to clean the root canal system. During the process, dentine chips, pulp tissue fragments, necrotic tissue, microorganisms, and intracanal irrigants may be extruded through the apical foramen. This in vitro study was conducted to evaluate the apical extrusion of Enterococcus faecalis with One Shape, F360, WaveOne, and Reciproc endodontic single-file systems. Materials and Methods: Seventy-five human single-rooted mandibular premolar teeth were selected. Endodontic access cavities were prepared. Pulp chamber was accessed, and a pure culture of E. faecalis was used to infect the root canals. Vials with rubber stoppers were selected as the test apparatus. Then, the samples were broadly divided into four main groups with a sample size of 15 teeth. Fifteen previously infected teeth were used as controls. All the root canals were instrumented with the size 25 instruments. A total volume of 2 ml of saline was used for each root canal as irrigant. After 24 h, colonies of bacteria were counted using classical bacterial counting technique as colony-forming units. Statistical Analysis: Data were analyzed statistically using Statistical Package for the Social Sciences, version – 21 (IBM Corp., NY) Software for Windows. Data were expressed in its mean and standard deviation. Results: The results indicated that all the four single-file systems tested caused a measurable apical extrusion of debris. Statistically, significant difference was observed between One Shape, F360, WaveOne, and Reciproc in terms of E. faecalis extrusion, P < 0.05. The highest mean value was with One Shape rotary single-file system and the lowest mean value was with WaveOne reciprocating single-file systems. Conclusion: Within the limitations of the present study, it can be concluded that the reciprocating single-file systems extruded less amount of E. faecalis than compared to rotary single-file systems.
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Push-out bond strength of four different Post systems: An in vitro study p. 84
Sanjeev Srivastava, Summaiyya Zaman Khan, Harpreet Chhabra, Sandeep Dubey, Arohan Singh, Kshiti Bhardwaj
DOI:10.4103/endo.endo_70_18  
Introduction: Endodontically treated teeth in most cases are left with the extensive loss of coronal tooth structure; hence, the salvaging of such teeth requires the use of an “intracanal retainer” such as post. The long-term success of any restorative or prosthetic rehabilitation of endodontically treated teeth depends on the quality of the restoration, clinical adaptation, and on the health of the supporting tissues. Materials and Methods: A total of 60 maxillary central incisors teeth were endodontically treated and Post space was prepared. The obturated teeth were randomly divided into four groups as follows: custom-made cast metal post, biological post, everstick post, and biological post. The consecutive posts were luted in each sample and sections were made. Push-out test was performed. The values were noted at bond failure and were subjected to statistical analysis. Results: Custom-made cast metal post showed the highest bond strength followed by prefabricated and everstick post. The least push-out bond strength was shown by prefabricated fiber post. Conclusions: The push-out values differed significantly according to posts systems used custom-made cast metal post showed the highest and prefabricated fiber post the least.
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Assessment of shaping ability of rotary and reciprocating file systems using cone-beam computed tomography in mandibular molars: An in vitro study p. 89
Anju Abraham, Anika Mittal, Sarita Singh, Aditi Dhaundiyal, Bidya Yendrembam, Shilpa Kumari
DOI:10.4103/endo.endo_74_18  
Aim: The purpose of this study was to compare the canal transportation, centering ability, canal curvature, dentin removal, the volume of the curved root canals, and time taken during and after instrumentation with Wave One, Reciproc, F360, and One shape (OS) by using cone-beam computed tomography (CBCT). Materials and Methods: According to the file systems used for canal preparation, eighty mesiobuccal canals of mandibular molars were distributed into four groups (20 samples each): OS (Group 1), F360 (Group 2), Wave One (Group 3), and reciproc (Group 4). According to the manufacturer's instructions, all groups were prepared until size 25 taper. Canals were scanned using CS three-dimensional CBCT scanner (Carestream) before and after preparation at 2 mm, 5 mm, and 8 mm from the apex. The data collected were evaluated using SPSS software with ANOVA and post hoc for a significant difference. Results: Significant difference was found between the entire group at 2 mm and 5 mm (P = 0.021) and at 8 mm (P = 0.037), where F360 showed the least canal transportation. The mean values for centering ability were not found significant at 2 mm and 5 mm. OS proved to remain more centered than the other groups. Curved canals were instrumented better with minor canal straightening by using Reciproc. The dentin was removed more by using Wave One, whereas least dentin was removed by F360. During pre- and post-instrumentation scans the change in volume of the root canal were not found statistically significant. Wave One showed the maximum increase in the volume of the canal after instrumentation. For the preparation of the canal, the time taken was less with reciproc as compared to other groups. Conclusion: Therefore, according to the study single-file rotary instrument like F360 used in the continuous rotation is suitable instrument for the root canal preparation followed by Reciproc, OS, and Wave One.
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Dimensional correlation between morphology and root canal anatomy in mesiobuccal root of permanent maxillary first molar: An ex vivo study p. 98
Archana Chaudhary Prasad, Sachin Gupta, Vineeta Nikhil, Shikha Jaiswal, Shalya Raj, Rohit Arora
DOI:10.4103/endo.endo_76_18  
Aim: The aim of the present study was to establish a correlation between morphology and root canal anatomy of mesiobuccal (MB) root of the permanent maxillary first molar using cone-beam computed tomography (CBCT) and stereomicroscope. Methodology: Access cavities were prepared on sixty permanent maxillary first molars. Efforts were made to locate MB second (MB2) canals without magnification and with magnification using methylene blue dye and ultrasonic troughing. The number of teeth possessing MB2 canal with both methods was recorded. Thereafter, the MB root was resected and observed under CBCT. The MB root was then sectioned at different levels and observed under stereomicroscope. Both the methods were used to assess the number of canals and root forms which were classified as long oval, oval, and round. The data thus obtained were then subjected to statistical analysis using ANOVA and Z-test. Results: Clinical techniques such as magnification, dyes, and troughing were found to be more efficient in the detection of MB2 canals as compared to unaided techniques. As observed with CBCT and stereomicroscope, the incidence of MB2 canal was significantly more in coronal as compared to middle and apical, and a statistical correlation between root form and number of canals was observed. Conclusion: Majority of the MB roots were long oval and oval in axial section and the incidence of finding MB2 in long oval and oval root forms was found to be greater as compared to round root form, although it is not necessary that all long oval or oval roots shall have two or more canals.
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In vitro comparison of the force required to fracture roots vertically following the use of two instrument retrieval systems p. 104
Asit Vats, Ashutosh Pratap Singh, Ajay Paliwal, Kshiti Bhardwaj, Sanjeev Srivastava, Harpreet Singh Chhabra
DOI:10.4103/endo.endo_8_18  
Objective: The objective of this study was to compare the force required to fracture the roots in a vertical direction following the use of two instrument retrieval systems. Introduction: A vertical root fracture is a longitudinal fracture of the root, extending throughout the dentin from the root canal to the periodontium. The fracture strength of teeth after the application of two systems used for instrument retrieval, i.e. ultrasonic (P5 Booster Company Irrisafe, Satelec ACTEON, North America) and instrument removal system (iRS Switzerland) was compared. Materials and Methods: Freshly extracted 60 maxillary central incisor teeth with straight roots and single canal were collected. The anatomical crowns of all the teeth were sectioned. The samples were cleaned and shaped with the crown down technique using Pro-Taper (DENTSPLY, Maillefer, USA) rotary instruments up to a size F2. The fracture of rotary file was deliberately induced by the pressure that was applied during rotary motion of F3 file. The samples were then randomly divided into three groups each having 20 teeth, i.e., Groups A, B, and C. Retrieval of separated file was performed in Groups B and C by means of Ultrasonic and Instrument retrieval system, respectively, while no retrieval of separated file was done in Group A. Each sample was then subjected to load by Instron testing machine until the sample got fractured. That load at the time of fracture of each sample was recorded. The data collected from all the samples were then subjected to statistical analysis using ANOVA and Tukey's HSD. Results: The results showed statistically significant difference among all the groups. The group in which no retrieval system was employed showed the best fracture resistance. The group in which ultrasonic removal system was used showed better fracture resistance as compared to the group in which iRS was used. The fracture resistance of Group A, Group B, and Group C ranged from 265.23–289.66, 114.67–135.66, and 70.56–97.56, respectively, with mean (± standard error) 277.60 ± 1.94, 124.65 ± 1.53, and 84.98 ± 1.76, respectively, and median 276.54, 123.95, and 85.78, respectively. Conclusion: According to the results of the present study, the difference between the force required to fracture roots vertically after removal of a fracture instrument with the ultrasonic and instrument removal system was statistically significant.
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In vitro evaluation of bond strength of sealers after using various irrigants and Erbium-Yttrium-Aluminum-Garnet laser irradiation on radicular dentin surface: A SEM study p. 110
Navdeep Kaur, Shikha Bhandari, Pardeep Mahajan, Prashant Monga, Sonam Mahajan, Nitika Bajaj
DOI:10.4103/endo.endo_9_18  
Aim: The aim of this in vitro study was to evaluate and compare the push-out bond strength of Adseal and mineral trioxide aggregate (MTA) Fillapex sealer after using various irrigants and Erbium-Yttrium-Aluminum-Garnet (Er:YAG) laser irradiation on radicular dentin surface. Materials and Methods: A total of 80 freshly extracted human permanent maxillary anterior teeth were sectioned transversally below the cemento-enamel junction. The remaining root portion was sectioned to get 4-mm thick dentin disc from coronal end of the root, with straight handpiece, and diamond disc. Root canal of specimens was prepared with bur to create space for sealer placement. Specimens were divided into eight groups of 10 samples each, as per irrigants and sealer used. In Group 1, 3, 5, and 7 specimens irrigated with distilled water, NaOCl, Ethylenediaminetetraacetic acid (EDTA), and Er:YAG laser, respectively, and obturated with Adseal sealer. In Group 2, 4, 6, and 8 irrigated with distilled water, NaOCl, EDTA, and Er:YAG laser, respectively, and obturated with MTA Fillapex sealer. After sealer setting, the force used to remove the sealer was evaluated using universal testing machine. Recorded force used to calculate the push-out bond strength in Megapascals and scanning electron microscopy examination was done for specimens. Results: Adseal sealer had significantly higher bond strength than MTA Fillapex sealer, irrespective of irrigant used. The highest bond strength was seen in specimens irrigated with EDTA and obturated with Adseal sealer and least in specimens irrigated with distilled water and obturated with MTA Fillapex sealer. Conclusion: Adseal sealer had significantly higher bond strength than the MTA Fillapex sealer. EDTA irrigation showed better smear layer removal, followed by Er:YAG laser irradiation, then NaOCl, least by distilled water.
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CASE REPORTS Top

Fractured tooth reattachment: A series of two case reports p. 117
Gourav Thapak, Ashtha Arya, Anshul Arora
DOI:10.4103/endo.endo_140_18  
Trauma to the anterior teeth is relatively a common occurrence. There are several treatment modalities for such condition, one of which is the reattachment of fractured fragment itself. Reattachment of fractured fragment provides immediate treatment with better esthetics, restoration of function, and is a faster and less complicated procedure. Reattachment of tooth fragment should be the first choice and is a viable alternative to conventional approaches because of simplicity, natural esthetics, and conservation of tooth structure. Patient cooperation and understanding of the limitations of the treatment is of utmost importance for good prognosis. The manuscript presents two case reports describing the management of a complicated fracture of maxillary anterior teeth treated endodontically, followed by reattachment of the same fragment. Reattachment of fractured tooth fragment offers a viable restorative alternative, immediately restores tooth function and esthetics with the use of a very conservative and cost-effective approach.
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Retrieval of separated instrument from the root canal using ultrasonics: Report of three cases p. 121
Ashtha Arya, Anshul Arora, Gourav Thapak
DOI:10.4103/endo.endo_25_18  
One of the most frequent mishaps during root canal procedure is the separation of an endodontic instrument during biomechanical preparation. It prevents proper debridement of the canal apical to the fragment and compromises the success of the treatment. Development in techniques and armamentarium has led to successful retrieval of separated instrument from the root canal. Adequate knowledge, good clinical skill, and experience enable good management of instrument fractured in the root canal. In this report, we present three cases with separated instruments in the root canal which were successfully retrieved with the use of ultrasonics under magnification.
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Invasive cervical resorption: An endodontic challenge managed by intentional replantation p. 125
Madhu Ahra, Tasneem Abuwala, Girish Parmar
DOI:10.4103/endo.endo_64_18  
Invasive cervical resorption (ICR) is an aggressive form of tooth resorption that is not well understood. Accurate diagnosis and early management are prerequisites for long-term retention of the tooth. Treatment procedure includes eliminating the resorptive tissue followed by restoring the defect with a suitable biocompatible material. This case report is on successful management of an ICR lesion; inaccessible to the conventional procedure; by root canal treatment and intentional replantation (IR) of the tooth for complete debridement and sealing of resorptive site with biodentine. At 18-month recall, the tooth was clinically sound with no radiographic evidence of inflammatory or replacement root resorption. Thus, IR should be considered as a viable treatment option.
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Maxillary second molar with single root and single canal: A case series p. 129
Parul Bansal, Preeti Mishra, Vineeta Nikhil, Shalya Raj, Apoorva Jain
DOI:10.4103/endo.endo_87_18  
Maxillary second molars are generally considered to have three roots and three or four canals. In the literature, various cases of maxillary second molars have been reported with more number of roots and root canals, but only very few cases have been reported with less number of roots and root canals. This article reports about the diagnosis and endodontic management of maxillary second molars with single root and single canal, as failure to identify such configuration may lead to poor prognosis due to excessive removal of the dentin in search of canals.
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