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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 32 | Issue 2
Page Nos. 55-110

Online since Thursday, June 18, 2020

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REVIEW ARTICLE  

Endodontic and dental practice during COVID-19 pandemic: Position statement from the Indian Endodontic Society, Indian Dental Association, and International Federation of Endodontic Associations Highly accessed article p. 55
Jogikalmat Krithikadatta, Ruchika Roongta Nawal, Kurinji Amalavathy, William McLean, Velayutham Gopikrishna
DOI:10.4103/endo.endo_61_20  
The emergence of COVID-19 pandemic poses an immense global health challenge. As dental care providers, we are faced with significant responsibilities both to the dental team and our patients to limit exposure to the virus. Due to the nature of our work, the team are at a high risk of contracting the virus and potentially transmitting the virus. One of the prime modes of containing this pandemic is in enforcing effective social distancing. However, as dental care providers, we face the twin challenge of protecting ourselves and our patients from community transmission and at the same time ensuring patients continue to have access to urgent/emergency dental care. This position statement is for the benefit of endodontists and dentists and provides an objective method of streamlining their dental practices based on need and evidence-based disease containment protocols.
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ORIGINAL ARTICLES Top

Centering ability of three different mechanized files while instrumenting oval canals p. 67
Ajinkya Mansing Pawar
DOI:10.4103/endo.endo_77_19  
Purpose: The present study evaluated the centering ability of rotary ProTaper NEXT (PTN; Dentsply Tulsa Dental, Tulsa, OK), reciprocating WaveOne (WO; Dentsply Maillefer, Ballaigues, Switzerland) and vibratory Self-Adjusting File (SAF; ReDent Nova, Ràanana, Israel) when used for instrumenting mandibular premolars with oval canals. Materials and Methods: Ninety oval canals (confirmed using radiovisography, buccolingual dimensions were × 2.5 the mesiodistal canal dimensions) were acquired, preinstrumentation cone-beam computed tomography (CBCT) was taken, and divided into three groups (n = 30) for root canal instrumentation: group 1 – PTN; Group 2 – WO; and Group 3 – SAF. The samples were then subjected to postinstrumentation CBCT. The pre- and postinstrumentation scans were compared at 3 mm, 6 mm, and 9 mm from the apex to obtain the centering ability ratio of the three files. The data collected were analyzed using the one-way analysis of variance test and Duncan's multiple comparison tests. Results: The ratio obtained at 6 mm and 9 mm from the apex did not differ for the mesiodistal dimensions (P > 0.05), but a significant difference was observed when the buccolingual dimensions were considered (P < 0.001). The PTN and WO instrumentation were associated with a very high ratio for buccolingual dimensions. However, SAF instrumentation resulted in well-centered preparation for both the dimensions at 6 mm and 9 mm (P < 0.001). At 3 mm from the apex, the files did not differ in canal preparation (P > 0.05). Conclusion: The SAF instrumentation results in centered preparation when used for instrumenting nonround root canals.
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Retrospective analysis of the occurrence and distribution of radix entomolaris in mandibular first molars: A hospital-based study p. 72
K Naveen Kumar, L Krishna Prasada, S Karthika Raj
DOI:10.4103/endo.endo_66_19  
Aim: This study aimed to evaluate clinically the prevalence of radix entomolaris (RE) in mandibular first molars in Dakshina Kannada population. Materials and Methodology: Proper clinical records and soft copies of radiographs of patients who had reported to the department of conservative dentistry and endodontics in a private dental college and hospital in Dakshina Kannada to seek root canal treatment from January 2015 to July 2019 were collected for the study. The occurrence and distribution of RE revealed by periapical radiographs and clinical case records were analyzed, and the comparison of the occurrence between males and females, and between the right and left sides, was done. Statistical analysis was done using the Chi-square test and binary logistic regression test with a statistically significant level set at P ≤ 0.05. Results: Among 1093 treated mandibular first molars, 52 teeth were RE. There was a significant difference in the prevalence of RE between males and females, but there was no significant difference between right and left sides' occurrence. Conclusions: Clinicians must be familiar with RE and its variations to reduce endodontic failures caused by missing canal.
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Dentinal element incorporation, interfacial adaptation, and pH change induced by bioceramic sealer, mineral trioxide aggregate-based sealer, and epoxy resin-based sealer – An in vitro, scanning electron microscopy electron probe X-ray microanalysis study p. 76
Vibha R Hegde, Nikita J Arora
DOI:10.4103/endo.endo_131_18  
Aim: Comparative evaluation of Dentinal Element Incorporation, Interfacial Adaptation, and pH change induced by Bio-ceramic Sealer, mineral trioxide aggregate (MTA)-based sealer, and Epoxy Resin-based sealer. Materials and Methods: Freshly extracted eighty mandibular premolar teeth were divided into four groups (n = 20) based on the sealer used for obturation, i.e., AH Plus (Group I), Endoseal MTA (Group II), EndoSequence BC Sealer (Group III), or Unfilled, unimmersed (Group IV), which served as the control. Specimens of Group I, II, and III were immersed in calcium and magnesium-free phosphate-buffered saline for 7 days. Specimens were sectioned longitudinally, and the ultrastructure of the dentine material interface and the elemental incorporation in the interfacial layer was analyzed using a wavelength dispersive scanning electron microscope-X-ray spectroscopy electron probe microanalyzer (SEM). The interfacial adaptation was measured using SEM. pH was calculated using pH meter. Statistical Analysis: Data were statistically analyzed using one-way ANOVA and Duncan's multiple range tests. Results: At the interface, both bio-ceramic materials formed a tag-like structure rich in calcium and silicon deposits, which were significantly higher in EndoSequence and Endoseal MTA, respectively. Endosequence BC sealer showed fewer interfacial gaps and the highest pH change as compared to the other groups. Conclusions: Bio-ceramic sealers showed better interfacial adaptation, element incorporation in the interfacial layer, and increased alkalinity of pH, leading to a superior marginal seal as compared to AH Plus and the control group.
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Influence of working length determined by three different apex locators on the apical extrusion of debris following the instrumentation with rotary Ni–Ti instrumentation system p. 81
Awantika Chand, Pragya Kumar, Sonali Taneja
DOI:10.4103/endo.endo_60_19  
Aim: This study aimed to comparatively evaluate the influence of working length (WL) determined by three different electronic apex locators (EALs) on the apical extrusion of debris following the instrumentation with a rotary NiTi instrumentation system. Methodology: Forty extracted human maxillary or mandibular premolar teeth with single root and canal were selected. Standardized access cavities were prepared, and the samples were divided into four groups according to the method used to determine the WL: Group I (n = 10) – actual working length (AL), Group II (n = 10) – Root ZX mini, Group III (n = 10) – CanalPro™, and Group IV (n = 10) – Propex Pixi™. Each specimen was held in a test apparatus to evaluate the apical extrusion of debris during instrumentation. Instrumentation of all the specimens was done using ProTaper Next till the size X3. The apically extruded debris was collected and calculated by subtracting the initial weight of the tube from the weight of the tube containing dried debris. The apically extruded debris weight score was calculated and tabulated and was subjected to statistical analysis using one-way ANOVA and post hoc Tukey test. Results: Group II and Group III exhibited similar results and exhibited significantly less apical extrusion of debris compared to Groups I and IV. Conclusion: WL determined by EAL (Root ZX mini and CanalPro) showed lesser apical extrusion of debris than AL determination.
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Antibiofilm efficacy of root-end filling materials against Enterococcus faecalis - An in vitro study p. 86
Geeta Hiremath, Madhu Singh, Bhushan Kulkarni, Rajeev Potdar, Balaram Naik
DOI:10.4103/endo.endo_13_20  
Aim of the Study: This study aims to evaluate the antibiofilm activity of root end materials against Enterococcus faecalis. Materials and Methods: Mineral trioxide aggregate (MTA), MTA plus and Biodentine were conjugated with chitosan gel and tested against the 3-day biofilm of E. faecalis. The incubated plates were stained using crystal violet stain and the optical density of adherent stained biofilm was read at 590 nm using ELISA auto reader. Results: There was a mean clinical reduction in the biofilms of the conjugates as compared to their individual counter parts. There was a statistically significant difference seen between the groups (MTA Plus – Chitosan Conjugate) and (MTA – Chitosan Conjugate) with P = 0.0495. Conclusion: The conjugates did perform better in inhibiting the biofilm activity of E. faecalis. Although all conjugates formed were not statistically significant.
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Comparison of diode laser with maleic acid and ethylenediaminetetraacetic acid on smear layer removal from root canals: A scanning electron microscope study p. 91
Shahnaz Nabi, Riyaz Farooq
DOI:10.4103/endo.endo_125_18  
Aim: The aim of the study was to evaluate the effect of diode laser with maleic acid andethylenediaminetetraacetic acid (EDTA) on smear layer removal from root canals. Materials and Methods: A total of 160 mandibular premolars were decoronated to the working length of 12 mm and prepared with ProTaper gold rotary files up to size F3. Group 1 canals were irrigated with 1 ml of 17% EDTA, followed by 3 ml of 3% sodium hypochlorite (NaOCl). Group 2 canals were initially irrigated with 0.8 ml of 17% EDTA, the remaining 0.2 ml was used to fill the root canals, and diode laser application was done. Group 3 canals were irrigated with 1 ml of 7% maleic acid, followed by 3 ml of 3% NaOCl. Group 4 canals were irrigated with 0.8 ml of maleic acid and remaining 0.2 ml was used to fill canal (total 1 ml) and activated by diode laser, followed by 3 ml of 3% NaOCl. Scanning electron microscope examination of the canals was done for the remaining smear layer at the coronal middle and apical third levels. Results: Maleic acid with and without diode laser had the least smear layer scores. Conclusion: Diode laser with maleic acid performed significantly better than EDTA.
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Comparative evaluation of flow rate of four different endodontic sealers: An in vitro study p. 96
Avoy Kumar Dash, Abhilasha Dash, Jandel Singh Thakur, Shanin Farista, Hemant Asrani, Shikha Rathi
DOI:10.4103/endo.endo_33_19  
Aim: The purpose of this study was to compare the flow abilities of four different root canal sealers namely, AH Plus, mineral trioxide aggregate (MTA) Fillapex, Sealapex, and Adseal. Materials and Methods: According to the method proposed by International Organization for Standardization (ISO) specification 6876/2012 (root canal sealing materials), a volume of 0.05 ml of the cement was taken and mixed according to the manufacturer's recommendation and placed on a glass plate. At 180 ± 5 s after mixing, the second glass plate of 20 g was placed on top of the sealer, followed by the weight of mass 100 g to make a total mass on the plate of 120 ± 2 g. After 10 min from the start of mixing, the weight was removed and the diameter of the compressed disc of sealer was measured. The mean of five such values for each sealer was taken as the flow of the material. Results: The flow obtained for the sealers are as follows: 21.84 mm for Adseal, 20.01 mm for AH Plus, 22.43 mm for MTA Fillapex, and 19.84 mm for Sealapex. The results were expressed as arithmetic means, and the statistical analysis was then performed for the mean values using ANOVA and Tukey's tests using SPSS 16.0 and a value of <0.05 was considered significant. Conclusion: All the sealers tested conform to ISO specification that requires that a sealer should have a diameter of not < 20 mm. The MTA Fillapex achieved the greatest flow being statistically significant in comparison to other tested sealers (= 0.002), while Sealapex showed the least flow among all.
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Evaluation of various kinematics in WaveOne Gold reciprocating file system: An in vitro study p. 100
Sheerin A Sarthaj, Priya Johnson, Anoop Samuel, Eazhil , Vijay Kannan
DOI:10.4103/endo.endo_18_19  
Aim: To evaluate the various kinematic effects of WaveOne Gold reciprocating file system such as 150°° counterclockwise (CCW)–30°° clockwise (CW), 270°° CCW–30°° CW, 360°° CCW–30°° CW, and continuous rotation and the influence of reciprocating and continuous rotary motions of the same file system on the apical extrusion of debris. Materials and Methods: Sixty mandibular premolars were selected. Instrumentation of the canals was done using WaveOne Gold single-file reciprocating systems and grouped into four groups as follows: Group I – 150°° CCW–30°° CW; Group II – 270°° CCW–30°° CW; Group III – 360°° CCW–30°° CW; and Group IV – continuous rotation. The debris extruded through the apical foramen was collected, dried, and weighed, and the raw data thus obtained were subjected to statistical analysis using one-way analysis of variance and least significant difference post hoc tests (P = 0.05). Results: The mean value for the difference of debris extrusion for the four groups was as follows: Group I: 0.0023 ± 0.002 g, Group II: 0.0071 ± 0.0049 g, Group III: 0.0029 ± 0.002 g, and Group IV: 0.0019 ± 0.002 g. The mean value depicted that the manufacturer recommended reciprocation kinematics (Group I) and the continuous rotation (Group IV) extruded less debris than compared to the other two. The intergroup comparison showed that there were significant differences between Group II and III but no significant differences between Group I and IV. Conclusions: Debris extrusion is inevitable. However, the manufacturer prescribed kinematics 150°° CCW–30°° CW and 270°° CCW–30°° CW extruded less debris than compared with the other two groups.
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CASE REPORTS Top

Replantation of avulsed permanent tooth with incomplete rhizogenesis p. 104
Gabriel Bittencourt Damin, Josué Martos, Leticia Kirst Post, Cristina Braga Xavier
DOI:10.4103/endo.endo_63_19  
Dental avulsion is one of the most frequent injuries in permanent teeth and higher complexity in terms of treatment and prognosis. The International Association of Dental Traumatology divides this trauma into several categories and guides the conduct according to each category. The aim of the present study is to report a case of dental reimplantation of the upper central incisor in a patient with incomplete rhizogenesis. An 8-year-old male patient sought care after undergoing avulsion of upper left central incisor and left superior deciduous lateral incisor teeth and subluxation of the upper right central incisor tooth. The upper left central incisor tooth was maintained in dry medium and reimplanted in < 60 min after avulsion. The flexible restraint from the upper right canine deciduous to upper left canine deciduous remained for approximately 21 days. The clinical-radiographic follow-up was periodic and after 34 months posttrauma was observed crown integrity, root growth continuity, calcification of the canal of upper left central incisor, absence of radiographic image compatible with periapical lesion, and negative response to the pulp vitality test in the upper left central incisor tooth. We conclude from the exposed clinical case that, even with predictable sequelae, such as calcification of the root canal space and dental reimplantation is the procedure of choice in cases of dental avulsion.
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A maxillary second molar with an unusually positioned root and canal systems p. 108
Thakur Veerandar Singh, Naresh Gaddala, Kitu Sheoran,
DOI:10.4103/endo.endo_79_19  
Variations in the root canal anatomy can occur in any tooth, if not identified and treated accordingly; they may lead to endodontic treatment failure. A typical maxillary second molar usually has three separate roots with one canal in each. The present case report elucidates the successful endodontic treatment of a rare and unusual root canal anatomy of maxillary left second molar using cone-beam computed tomography as a diagnostic aid.
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