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   2019| July-December  | Volume 31 | Issue 2  
    Online since January 9, 2020

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Antibacterial activity of chitosan and its combination with other irrigants on Enterococcus faecalis: An in vitro study
Nagarjuna Kondreddi, Bhuvan Shome Venigalla, Thakur Veerandar Singh, Shekar Kamishetty, Smitha Reddy, Ravichandra Cherukupalli
July-December 2019, 31(2):133-137
Objective: The aim of the in vitro study was to compare the antibacterial efficacy of sodium hypochlorite (NaOCl), chlorhexidine (CHX), chitosan and their combinations in vitro. Materials and Methods: A total of 60 extracted single-rooted teeth were selected and used for the study. After the access cavity preparation and working length determination, the apical foramina of the samples were sealed with epoxy resin to prevent bacterial leakage, and the teeth were mounted in stone blocks. Biomechanical preparation was done using crown-down technique up to master apical file size of #50. Enterococcus faecalis (ATCC 29212) was used to contaminate the root canals. After incubation, samples were divided into six groups according to the solutions used for irrigation, that is, CHX, NaOCl, chitosan, alternating solution of chitosan and hypochlorite, alternating solution of chitosan and CHX, and saline. Antibacterial efficacy was assessed by obtaining the samples from root canal before and after the irrigation using paper points, culturing them on blood agar plates, and measuring the number of colony-forming units (CFUs) formed. Results: All the statistical analysis was done using SPSS version 16. P<0.05 was considered statistically significant. Comparison of mean values before and after the irrigation was done using the paired t-test. Comparison of percentage reduction among the groups was done using ANOVA with post hoc Games–Howell test. A statistically significant difference was found in the number of CFU between experimental groups compared to the control group and also among five experimental groups (P > 0.001). Maximum antibacterial activity was seen when chitosan was used alternatively with CHX and NaOCl. Independently, hypochlorite showed maximum antibacterial activity followed by CHX and chitosan which showed almost similar antibacterial activity. Conclusion: According to this study, there is synergistic antibacterial activity when chitosan is used alternatively with 2% CHX or 5% NaOCl.
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Fracture resistance of teeth undergoing postendodontic bleaching: Comparison of four treatment modalities – An in vitro study
Abe Antony, Rajesh Pillai, NO Varghese, U-Nu Sujathan, A Afzal, Sheila George
July-December 2019, 31(2):150-157
Aims: The aims of the study were: (1) to evaluate the fracture resistance of endodontically treated teeth restored with microhybrid composite following combination bleaching and (2) to assess the antioxidizing effect of 10% sodium ascorbate hydrogel. Settings and Design: This was a randomized control trial in a tertiary care setting. Subjects and Methods: Endodontic treatment was performed on 40 freshly extracted human mandibular premolars. Following removal of gutta-percha 2 mm apical to cementoenamel junction and application of resin-modified glass ionomer as cervical barrier, all teeth were embedded in acrylic resin using cylindrical molds. Specimens were divided into five groups: Group 1 (n = 8): Specimens subjected to inside and outside bleaching using 10% hydrogen peroxide followed by composite restoration. Group 2 (n = 8): Specimens subjected to inside-outside bleaching with 10% hydrogen peroxide and sodium perborate followed by composite restoration; Group 3 (n = 8): Specimens subjected to conditioning with 10% sodium ascorbate after inside-outside bleaching using 10% hydrogen peroxide followed by composite restoration; Group 4 (n = 8): Specimens subjected to conditioning with 10% sodium ascorbate after inside-outside bleaching with 10% hydrogen peroxide and sodium perborate followed by composite restoration; and Group 5 (negative control) (n = 8): After endodontic treatment specimens were restored with composite. Finally, all the specimens were subjected to fracture resistance test using Universal Testing Machine. Statistical Analysis Used: ANOVA test followed by post hoc comparison of groups taken together by Tukey's analysis was performed. Results: Statistically significant difference in fracture resistance was present between Group 5 and Group 1 and also between Group 5 and Group 2. Unpaired t-test showed statistically significant difference between Group 1 and Group 3 and also between Group 2 and Group 4. Conclusion: The use of 10% sodium ascorbate antioxidant gel was effective in compensating for the decreased fracture resistance following combination bleaching.
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Open apex solutions: One-step apexification, salvaging necrosed teeth with open apex
Sunandan Mittal Kumar, Tarun Kumar, Vanita Keshav, Sunny Arora, Ashima Singla
July-December 2019, 31(2):173-178
Open apices are a constant challenge to an endodontist. The one-step apexification technique in which an apical barrier is placed to achieve an adequate apical stop has become a popular procedure nowadays. This case series describes eight clinical cases with immature necrosed pulp which were subjected to one-step apexification procedure using different materials and techniques. The materials used varied from mineral trioxide aggregate (MTA) with hydroxyapatite (matrix), biodentine with hydroxyapatite (matrix), MTA alone, tailor-made gutta-percha with platelet-rich fibrin (matrix), and gutta-percha alone. All the cases were successful regarding the resolution of symptoms and periapical healing concluding that one-step apexification has successfully replaced the traditional methods of apexification. No matter what barrier is used or matrix is placed or not, healing takes place if the procedure is followed carefully using recommended protocols.
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Cone-beam computed tomography analysis of canal transportation and centering ratio of fifth-generation nickel-titanium rotary file systems in curved root canals
Marsrat Ibrahim Kapadwala, Geeta Asthana, Girish J Parmar
July-December 2019, 31(2):138-143
Aim: The aim of this study is to compare canal transportation and centering ratio using of Protaper Next (PTN) (Dentsply Maillefer, Ballaigues, Switzerland) and Revo-S (RS) (MicroMega, Besancon Cedex, France) compared to Protaper Universal (PTU) (Dentsply Maillefer, Ballaigues, Switzerland) nickel-titanium rotary file systems in curved root canals using cone-beam computed tomography. Materials and Methods: Ninety maxillary mesiobuccal first molar uncalcified canals with mature apex, curvature of 20°–45° (the Estrela method) and minimum 20-mm length were selected. The samples were randomly divided into three groups of 30 teeth each, respectively, Group I PTU, Group II PTN, and Group III RS Rotary systems and Instrumented according to the manufacturers' instructions. Pre- and post-instrumentation cone-beam tomographic scan was performed in same position to calculate canal transportation and centering ability at 2 mm, 5 mm, and 8 mm from the root apex. Statistical analysis was performed with ANOVA and Post-hoc Tukey test. Results: PTU had maximum mean canal transportation and minimum mean centering ratio at all levels, whereas PTN showed minimum mean canal transportation and maximum mean centering ratio. The results were statistically significant. Conclusions: In terms of canal transportation and centering ratio in the middle and coronal third of the root, PTN and RS performed better than PTU. However, in apical third, PTN performed best among all other groups.
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Determination of effective concentration of chitosan gel as an intracanal lubricant on smear layer removal: A scanning electron microscope study
Thati Jyotsnanjali, MA Ranjini, GR Krishna Kumar, SN Joshi, Gis George, Roopa R Nadig
July-December 2019, 31(2):144-149
Objective: The purpose of this study was to determine the effective concentration of indigenously prepared chitosan gel for smear layer removal. Materials and Methodology: Thirty single-rooted premolars were decoronated to a standard length enlarged along with irrigation of 2 mL 3% NaOCl on each change of instrument. Specimens were then divided into three equal groups. In the first group, 0.1% chitosan gel was used as a lubricating agent and final rinsing was done with 2 ml saline. Similarly, in other two groups, 0.2% and 0.3% chitosan gel was used as a lubricating agent and finally rinsed with saline. Samples were longitudinally sectioned subjected to scanning electron microscope evaluation for smear score. Results were analyzed statistically by Kruskal–Wallis test and Mann–Whitney Post hoc analysis. Results: No significant difference between 0.1%, 0.2%, and 0.3% chitosan gel on smear layer removal in the coronal third and in middle and apical third, and there was no significant difference between 0.2% and 0.3% chitosan gels on smear layer removal. Conclusion: All the experimental gel concentrations of chitosan as lubricant showed smear layer removal at all the thirds of the root canal. Smear layer removal was better in the coronal and middle third than in apical third with all the gel concentrations of chitosan. No significant difference in smear layer removal between 0.2%and 0.3% chitosan gel at all the thirds of the canal. Considering the smear layer removal efficacy at minimal concentration, 0.2% chitosan gel can be effective.
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Comparative evaluation of the shaping ability of rotary systems of varying metallurgy in curved canals and its analysis using cone-beam computed tomography: An in vitro study
Shreya Bansal, Sonali Taneja, Manju Kumari, Manu Dhillon
July-December 2019, 31(2):158-162
Background: This study compared the shaping ability of four nickel-titanium rotary file systems of varying metallurgy along curved canals. Aim: The aim of the present study is to compare the shaping ability of rotary systems of varying metallurgy in curved canals and its analysis using cone-beam computed tomography (CBCT). Materials and Methods: Forty mesiobuccal canals of mandibular first molars with an angle of curvature ranging from 20° to 40° were divided according to the instrument used in canal preparation into four groups of 10 samples each: Hyflex CM (Group I), Vortex Blue (Group II), Flexicon (Group III), and K3XF (Group IV). All samples were instrumented according to the manufacturer's guidelines and prepared to size 30, 0.06-taper master apical file. Canals were scanned and evaluated using an NNT CBCT unit before and after preparation at different levels from the apex. The data were subjected to statistical analysis. Statistical Analysis: The intergroup comparison in terms of canal transportation and the time taken for canal preparation was done by the one-way analysis of variance (ANOVA) test with Bonferroni post hoc test. The intragroup comparison in terms of canal transportation was done by the repeated measures ANOVA test with the post hoc Bonferroni test. For the canal-centering ability, the Kruskal–Wallis test with Mann–Whitney U-test was used for the intergroup comparison and the intragroup comparison was done by Friedman's test with Wilcoxon signed-rank test. Results: Hyflex CM and Vortex Blue files showed significantly least canal transportation and highest canal-centering ability values as compared to Flexicon and K3XF file systems. Conclusion: The metallurgy and file design of Hyflex CM and Vortex Blue file systems resulted in superior shaping ability, with the instruments remaining more centered in the canal than Flexicon and K3XF.
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Endodontic management of radix entomolaris in a mandibular third molar
Tushar Kohli, Alpa Gupta, Arundeep Singh Kawatra, Dax Abraham
July-December 2019, 31(2):179-182
A wide array of anatomical variations present to dentists from time to time. The mandibular third molars are not far away in this context. Many a time, extraction remains the choice of treatment because of their most posterior location and unpredictable anatomy. In terms of anatomy, an extra distolingual root (radix entomolaris) poses a serious challenge, and it is very rare as well. Hence, the identification and management of radix entomolaris is an essential goal for the successful root canal treatment. The aim of this article is to present article the successful endodontic management of a mandibular third molar with three roots and four root canals.
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A comparative evaluation of fracture resistance of endodontically treated teeth obturated with four different methods of obturation: An in vitro study
Khushboo Goyal, Shrija Paradkar, Suparna Ganguly Saha, Anuj Bhardwaj, Prashansa Vijaywargiya, SV Sai Prasad
July-December 2019, 31(2):168-172
Objective: The objective is to compare the vertical fracture resistance of teeth obturated with four different obturating techniques using universal testing machine (UTM). Materials and Methods: One hundred single-rooted mandibular premolars were instrumented with ProTaper Universal rotary files up to size F3. Samples were obturated using four different methods of obturation (Lateral compaction, continuous wave condensation (CWC), GuttaFlow 2, and GuttaCore). UTM was used for the evaluation of fracture resistance. Data were analyzed by one-way ANOVA and student t- test. Results: The highest tolerated mean load, in the decreasing order, was observed with GuttaCore (346.3 ± 45.0), GuttaFlow 2 (211.0 ± 29.8), lateral compaction (169.8 ± 23.6), and continuous-wave condensation obturation (167.6 ± 19.3). Conclusion: The GuttaCore system showed superior fracture resistance when compared to GuttaFlow 2, continuous-wave condensation and lateral compaction obturation method.
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Evaluation of canal transportation after root canal instrumentation a comparative in vitro study with cone-beam computed tomography
Aditi Jain, Asmita Singh Gupta
July-December 2019, 31(2):163-167
Aim: Reciproc and WaveOne (WO) system was used to evaluate the canal centering ability and apical transportation by cone-beam computed tomography. Materials and Methods: Forty extracted human single-rooted mandibular premolars were used in the present study. Preinstrumentation scans of all teeth were taken; canal curvatures were calculated; and the samples were randomly divided into two groups with 20 samples in each group, where Group 1-Reciproc system and Group 2-WO reciprocation system. Postinstrumentation scans were performed using DICOM software and the two scans were compared to determine centering ability and canal transportation at 3, 6, and 9 mm from the root apex. Results: Using Student's unpaired t-test results were as follows, for centering ability Group 1 showed nonstatistically significant difference at 3 mm and 9 mm, whereas a statistically significant difference (P < 0.05) at 6 mm was obtained. For canal transportation, Group 1 showed a statistically significant difference (P < 0.05) at 3 mm and 6 mm, and nonsignificant difference was obtained at 9 mm, but for Group 2, nonstatistically significant difference (P > 0.05) was obtained at 3 mm, 6 mm, and 9 mm. Conclusion: WO single reciprocation file has better centering ability, maintains original canal curvature, and causes lesser canal transportation as compared to reciproc.
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Reviewers, 2019

July-December 2019, 31(2):183-183
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