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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 33 | Issue 2
Page Nos. 55-118

Online since Friday, June 11, 2021

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REVIEW ARTICLE  

How to write systematic review and meta-analysis Highly accessed article p. 55
Vivek Aggarwal, Mamta Singla, Alpa Gupta, Namrata Mehta, Umesh Kumar
DOI:10.4103/endo.endo_86_21  
There has been a paradigm shift in the treatment options available to an endodontist. A lot of clinical, as well as laboratory studies, have been published over the last few decades. Often a clinician faces a problem in deciding a treatment plan for a particular clinical problem. Systematic reviews (SRs) and meta-analysis (MA) can help to find reliable data for a specific research question. In simple words, the SR and MA are research on all existing literature on a specific research question. The purpose of this article is to provide a step-by-step procedure for conducting SRs and MA.
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ORIGINAL ARTICLES Top

Evaluation of surface roughness and push-out bond strength of glass fiber post with and without surface pretreatments: A scanning electron microscopy study p. 62
Rathna Piriyanga Subramani, Rajasekaran Meenakshisundaram, Anilkumar Ramachandran, Karumaran Chellaswamy Savarimalai
DOI:10.4103/endo.endo_115_20  
Objective: The aim is to evaluate and compare the surface roughness and push-out bond strength of glass fiber post with and without surface pretreatments using scanning electron microscopy. Materials and Method: A total of 40 extracted human maxillary central incisors selected were decoronated at 15 mm coronally from the root apex. The teeth were subjected to root canal treatment and the postspace preparation was done with Peeso reamers size 1, 2, and 3, leaving a minimum 4 mm apical seal and created a standard postspace of 10 mm. Forty glass fiber posts (Easy Post, Dentsply) were divided into four groups based on surface treatment of the post with 10 in each. Group I: Without Pretreatment (Control Group) (10 Nos), Group II: 9.6% hydrofluoric acid (10 Nos), Group III: Sandblasting with 110 μm aluminum oxide particles (10 Nos), and Group IV: erbium: yttrium-aluminum-garnet (Er: YAG) Laser (10 Nos). The surface roughness analysis with and without pretreatment was performed under Scanning Electron Microscope and measured in Mountains map premium 7.4 software. The posts were luted with Self-adhesive resin cement (RelyX U200) and light cured for 40s. Push-out bond strength was evaluated using the universal testing machine; the values were recorded, tabulated, and statistically analyzed. Results: The push-out bond strength of the post is significantly increased when the postsurface is treated with 9.6% hydrofluoric acid at all three levels. Conclusions: Acid etching of post with 9.6% hydrofluoric acid increased push-out bond strength significantly without changing the structural integrity of the post whereas Er:YAG can be used as alternative to sandblasting.
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Evaluation of microcrack formation after root-end preparation with two different types of ultrasonic retrotips and conventional bur: A stereomicroscopic study p. 69
Dilshad Kersi Mandviwala, Vineet Suresh Agrawal, Sonali Vinod Kapoor
DOI:10.4103/endo.endo_42_21  
Introduction: The aim of this in vitro study is to evaluate and compare the root-end cavities for the presence of microcracks after cavity preparation using two different ultrasonic (US) retrotips and conventional bur. Materials and Method: Thirty single-rooted teeth were instrumented and obturated. Three millimeters of apices were resected. Retrograde Class I cavities 3 mm deep were prepared on resected surfaces of ten teeth with diamond-coated US retrotip (Group 1), ten teeth with zirconium-nitride-coated US retrotip (Group 2), and ten teeth with conventional bur (Group 3). The root-end surfaces were examined under a stereomicroscope and the resected root surfaces were evaluated for the presence of microcracks on microphotographs. Results: Statistically significant difference was detected between diamond-coated and zirconium-nitride-coated US retrotips and also significant difference was detected when the same were compared with conventional bur for the presence of microcracks. Conclusion: Within the limitations of the study, it can be concluded that both zirconium-nitride- and diamond-coated retrotips produce more dentinal crack formation compared to conventional bur, but none of them produce a complete crack. Moreover, the diamond-coated retrotips produce less debris formation and minimal dentinal crack compared to zirconium-nitride-coated retrotips.
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A comparative evaluation of canal transportation, centering ability, and volumetric increase in the curved canals using thermally treated three nickel-titanium rotary files: A cone-beam computed tomography study p. 75
Meenu G Singla, Hemanshi Kumar, Neha Singh
DOI:10.4103/endo.endo_1_21  
Aims: The aim of this study was to evaluate and compare canal transportation (CT), centering ability (CA), and volumetric changes in the curved canals prepared using Hyflex Electrical Discharge Machining (HEDM), ProTaper Gold (PG), and NeoEndo Flex rotary file systems through cone-beam computed tomography (CBCT). Materials and Method: Sixty mesiobuccal canals of maxillary molars were selected. Pre- and postinstrumentation CBCT scans were taken in the same position. CT and CA were calculated at 1 mm, 4 mm, and 7 mm from the apex; change in volume for the whole canal was measured and analyzed statistically. Results: The results showed that mean CT of HEDM and NeoEndo was less than PG at all levels, with significant differences at 4 mm and 7 mm. Regarding CA, no significant differences were found among the file systems. PG showed maximum volumetric increase with no statistically significant differences between the groups. Conclusion: All the experimental file systems respected the canal anatomy, although in the middle third, PG showed significantly more CT than HEDM and NeoEndo, whereas in the coronal third, PG showed significantly greater CT than NeoEndo. Regarding CA, no significant differences were found among the file systems. PG showed maximum volume of dentin removal.
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Penetration depth of sodium hypochlorite into dentinal tubules influenced by different agitation systems p. 81
Keyur M Karad, Swapnil J Kolhe, Meenal N Gulve, Gayatri B Aher, Priyanka S Kolhe
DOI:10.4103/endo.endo_39_21  
Objectives: To compare the effect of different agitation systems on the penetration depth of sodium hypochlorite into dentinal tubules: An in vitro study. Background: Studies have found the presence of bacteria in dentinal tubule up to 200 μ. Passive irrigation using NaOCl may not adequately eliminate these bacteria. Hence, it is mandatory to use agitation systems during irrigation and disinfection of root canal. Materials and Method: Eighty extracted teeth with single canals were used. Standardized access cavity preparation and working length determination were done using visual method. All canals were instrumented till #30, 6%. All samples were immersed in crystal violet dye. The samples were randomly divided into four groups depending on the type of agitation system used (n = 20): Group A: manual dynamic agitation (MDA), Group B: EndoActivator (EA), Group C: EndoUltra (EU), and Group D: EndoVac (EV). Each agitation system was used with 5 ml of 5.25% NaOCl, and each tooth was sectioned into two halves. These sections were analyzed under a stereomicroscope, and NaOCl penetration depth was measured at coronal, middle, and apical third levels. Statistical Analysis Used: Statistical analysis was performed using one-way ANOVA and Tukey's post hoc test. Results: At all levels of examination, EU significantly showed a maximum penetration depth of NaOCl throughout the length of root canal, followed by EA, MDA, and EV. Conclusion: Ultrasonic agitation using EU is the most effective method to disinfect the dentinal tubules throughout the length of root canal than EA and MDA. EV showed the least penetration depth of sodium hypochlorite.
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Evaluation of calcium hydroxide incorporated with niobium pentoxide as a direct pulp capping agent – A preliminary ex vivo tooth culture model analysis p. 86
Selvakumar Kritika, Sekar Mahalaxmi
DOI:10.4103/endo.endo_22_21  
Aims: To assess the effect of addition of niobium pentoxide (NP) to calcium hydroxide (CH) when used as a pulp capping agent. The aim was to evaluate the material characteristics and hydration potential of CH incorporated with NP at 15 days in vitro followed by the evaluation of dentin bridge formation in an ex vivo tooth culture model. Materials and Method: Two groups, CH (Dycal) and NPCH (5wt% NP added to Dycal prior to mixing) were mixed and the set cement was evaluated under scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS) and X-ray diffraction (XRD). NPCH was also used for direct pulp capping in two freshly extracted human mandibular third molars for dentin bridge evaluation. The teeth were incubated in Dulbecco modified eagle's medium for 15 days, following which the teeth were sectioned and analyzed for hard tissue formation under SEM. Results: SEM analysis of the modified material revealed interlacing network with stronger attachment of the agglomerated CH particles and reactionary by-products formed due to the interaction of CH and NP. EDS analysis showed presence of calcium and oxygen; with Group 2 showing additional presence of niobium and phosphate. XRD showed higher intensity peaks with NPCH than CH. The tooth culture model showed distinct hard tissue formation. Conclusion: Within the limitations of this preliminary study, it can be concluded that the incorporation of NP into CH is a viable alternative to CH for direct pulp capping procedures.
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Sealer penetration in the dentinal tubules: A confocal laser scanning microscopy study p. 92
Sanjana Khullar, Anurag Aggarwal, Harleen Chhina, Tamanpreet Kaur, Mehak Sharma, Deepak Bala
DOI:10.4103/endo.endo_24_21  
Context: The penetration of sealer into dentinal tubules is considered to be a desirable feature as sealers prevent the colonization of residual bacteria into the dentinal tubules because of their antibacterial properties. Aims: This study aims to compare the depth of penetration of ADSEAL, Sealapex, and BioRoot RCS into the dentinal tubules in the apical area using confocal laser scanning microscope (CLSM). Settings and Design: Quality improvement projects. Materials and Method: After decoronating 120 extracted single rooted teeth, preparation was done using ProTaper universal rotary files until F3. Then, the samples were divided into four groups (n = 40) and obturated by the following endodontic sealers: Group A-ADSEAL, Group B-Sealapex and Group C-BioRoot RCS along with F3 gutta-percha cone. Before root canal filling, the sealers were mixed with 0.1% Rhodamine B dye. All the samples were sectioned at 3 mm and 5 mm from apex and visualized under CLSM. Statistical Analysis Used: Data were analyzed using two-way ANOVA and Tukey post hoc tests. Results: BioRoot RCS has shown significantly higher depth of penetration than resin based sealer and calcium hydroxide based sealer (α < 0.05). Conclusion: At all root regions, BioRoot RCS exhibited more tubular penetration whereas ADSEAL exhibited less penetration.
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Comparative antimicrobial efficacy of oregano oil, chlorhexidine, and sodium hypochlorite against Enterococcus faecalis: An in vitro study p. 97
Kavalipurapu Venkata Teja, Krishnamachari Janani, Vasundhara Apoorva Kaligotla, Krishnamachari Harini
DOI:10.4103/endo.endo_124_20  
Objective: The purpose of this study was to evaluate the comparative antibacterial efficacy of 0.2% oregano oil, 2% chlorhexidine (CHX), and 3% sodium hypochlorite (NaOCl) in disinfection of dentin tubules contaminated with Enterococcus faecalis. Materials and Method: One hundred and twenty human extracted anterior teeth were infected with E. faecalis for 21 days. They were assigned into three groups (n = 40) – Group 1: 3% NaOCl, Group 2: 2% CHX, and Group 3: 0.2% oregano oil. Disinfection protocol was followed using 31-gauge side-vented needle. After chemomechanical preparation, the apical 5 mm of the roots was removed frozen in liquid nitrogen and pulverized to expose E. faecalis in dentinal tubules. The number of colony-forming units of E. faecalis per mg dentin was determined. The data were analyzed statistically. Results: Zone of inhibition of oregano oil was found to be 15 mm, and the values were significant in Group III (P < 0.05) as compared to the other groups assessed. Conclusion: Within the study's limitation, 0.2% oregano oil showed better disinfection property against E. faecalis among tested irrigants. Therefore, it can be used as an effective alternative root canal irrigant.
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A comparison of different hand and rotary endodontic glide path files for buckling resistance: An in vitro study p. 102
Ruchika Gupta, Pramod Mohite, Suvarna Patil, Nandita Bansal
DOI:10.4103/endo.endo_126_20  
Introduction: The purpose of the present study was to compare the buckling resistance between the hand files and rotary files and compare the buckling resistance between pathfinding files made out of different alloys. Materials and Method: The test instruments were divided into two major groups based on the mode of use, hand instruments and rotary instruments. These groups were further divided into six subgroups. Six subgroups of endodontic files containing three samples were tested for buckling resistance by applying load in axial direction using a universal testing machine. The maximum load required to generate a lateral elastic displacement of 1 mm was recorded for each instrument. Data were analyzed using two-way analysis of variance and Newman–Keuls multiple post hoc tests using software SPSS version 19. P value was considered < 0.05. Results: The results indicated that the buckling resistance decreased in the following order: Hand C Plus file > Rotary One G file > Hand C pilot files > Rotary ProGlider file > Hand PathFinder Carbon Steel > Rotary HyFlex Electric Discharge Machining (EDM) file. Conclusion: The stainless steel instruments (C + and C-Pilot) were more resistant to buckling than carbon steel (Pathfinder CS) and nickel-titanium instruments (ProGlider and HyFlex EDM). Buckling resistance may influence instrument's performance during the negotiation of constricted canals, and the C Plus in hand file group showed significantly better results than the other instruments tested. Metallurgy and modulus of elasticity of the instruments play a significant role in buckling resistance as One G file in rotary file group showed highest buckling resistance (conventional austenite nickel-titanium) than ProGlider (M-wire NiTi) and HyFlex (EDM + Controlled Memory).
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CASE REPORTS Top

Hypersensitivity reaction to orange oil gutta-percha solvent in dental office p. 107
Sameer Makkar, Uzma Mushtaq, Tamanpreet Kaur, Mehak Sharma, Farheen Mushtaq, Divyangana Thakur
DOI:10.4103/endo.endo_121_20  
Root canal treatment is often required when primary endodontic treatment has failed. In order to remove the root canal filling material, chemical solvents are used to solubilize the gutta-percha. Despite many advantages, these solvents can lead to mishaps when not used cautiously. The purpose of this article is to present a case report of angioedema caused due to periapical seepage of orange oil and also highlighting the preventive measures and management of such accidents in dental office.
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Computer-aided design-CAM-guided endodontic microsurgical localization and retrieval of two separated instruments from the periapical area of a mandibular second molar p. 112
Akshayraj Langaliya, Ekta Chaudhari, Axita Patel, Jinali Shah
DOI:10.4103/endo.endo_60_20  
Three-dimensional (3D) imaging devices used for the visualization of anatomic structures not only allow for a more accurate diagnosis but also facilitate precise planning of surgical treatments, such as in guided surgery for instrument retrieval using templates. The innovative template-based treatment methods could also play a crucial role in future modern surgical endodontic treatments, enabling exact preplanning and precision-guided surgical interventions, and resulting in greater accuracy and success rates. We present here a case of a patient with a periapical lesion below a right mandibular second molar, with a fractured file segment extruding beyond the apex in the distal canal, and another instrument half-way extruded from the mesial canal, with radiolucencies evident at the mesial and distal root apices. The patient was treated by employing a 3D-guided microsurgical approach. First, 3D optical scans were imported into a guided surgery program. Periapical lesions and extruded fractured instruments were marked within the software. The osteotomy size, apical resection level, and bevel angle were defined pretreatment. This case introduces a novel-guided microsurgical endodontic technique, incorporating recommended guidelines of modern surgical endodontic treatment with the aid of 3D-printed surgical templates, by which minimally invasive surgical treatment was ensured with preservation of tooth, bone, and surrounding anatomical structures.
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BOOK REVIEW Top

Grossman's endodontic practice - 14th edition p. 118
A Parameswaran
DOI:10.4103/0970-7212.318141  
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