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   Table of Contents - Current issue
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October-December 2020
Volume 32 | Issue 4
Page Nos. 167-238

Online since Monday, January 18, 2021

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REVIEW ARTICLE  

Calcium sulfate applications in dentistry: A literature review Highly accessed article p. 167
Yousof H Sinjab, Khaled H Sinjab, Claudia Navarrete-Bedoya, James L Gutmann
DOI:10.4103/endo.endo_156_20  
Calcium sulfate (CS) is a ubiquitous compound that has been incorporated in several medical and dental procedures. This can be attributed to its many advantageous characteristics, including being resorbable as well as its biocompatibility. Primarily, it was used to help treat a variety of osseous defects by acting as a bone substitute. Due to its unique properties, other therapeutic applications have been identified. Whilst the outcomes of these applications are varied, they have shown to be beneficial within the disciplines of endodontics, periodontics and oral & maxillofacial surgery. The aim of this review is to thoroughly discuss CS including its characteristics, chemical and physical properties, and known relative indications in dentistry. Clinical studies reporting the outcomes of CS for particular treatment modalities are further analyzed and discussed.
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ORIGINAL ARTICLES Top

Comparative evaluation of different instrumentation techniques on post endodontic pain in single visit root canal treatment: A randomized controlled trial Highly accessed article p. 175
Anchal Aggarwal, Ruchika Dewan
DOI:10.4103/endo.endo_11_20  
Background: Postendodontic pain (PEP) is defined as pain of any degree that occurs after the initiation of randomized controlled trial. The development of postoperative pain is usually due to acute inflammatory response in the periradicular tissues. Aim: The aim of the study was to evaluate and compare the influence of different instrumentation techniques on PEP following a single-visit root canal treatment. Materials and Methods: Ninety-nine patients were divided into three groups (99 = 33 × 3): Group 1, Control (ProTaper Universal Hand); Group 2, Rotary (ProTaper Universal Rotary); and Group 3, Reciprocating (WaveOne Gold). A Visual Analog Scale questionnaire was given at the end of the appointment to be filled at 6, 12, 24, and 48 h. Results: Group 2 (Rotary technique) (ProTaper Universal Hand) showed minimum PEP with a mean pain score of 2.0 at the end of 48 h, which was statistically significant (P < 0.0001). Conclusion: Different instrumentation techniques/systems used for biomechanical preparation had an effect on PEP. Minimum PEP was reported by patients in Group 2 (ProTaper Universal Rotary) when compared with those in Group 3 (WaveOne Gold) and Group 1 (ProTaper Universal Hand).
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A comparative evaluation of apical extrusion of debris during endodontic instrumentation with continuous rotation and reciprocating motion: An in vitro study p. 181
Shrija Paradkar, Suparna G Saha, Anuj Bhardwaj, Mainak Kanti Saha, Khushboo Goyal, Ruchi Verma
DOI:10.4103/endo.endo_88_19  
Aim: The aim is to compare the apical extrusion of debris during endodontic instrumentation with continuous rotation and reciprocating motion. Materials and Methods: Sixty extracted single-rooted mandibular premolar human teeth were randomly assigned to four groups of 15 teeth each. The canals were then instrumented with the following instrument systems: ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), 2Shape (TS; MicroMega, Besancon, France), Reciproc Blue (RB; VDW, Munich, Germany) and WaveOne Gold (WOG; Dentsply Sirona, Ballaigues, Switzerland). Apically extruded debris during instrumentation was collected into pre-weighed Eppendorf tubes. The Eppendorf tubes were then stored in an incubator at 70°C for 5 days. The weight of the dry extruded debris was established by subtracting the pre-instrumentation weight from postinstrumentation weight of the Eppendorf tubes. The data were analyzed using one-way analysis of variance and Tukey's Post hoc tests. Results: Among the instruments tested in the present study, the least amount of extrusion of debris was seen with TS rotary file system (Group IA) followed by RB (Group IIA) and WOG (Group IIB) (P < 0.05), the results, however, were not found to be statistically significant between them. The maximum amount of debris extrusion was observed with PTN (Group IB) with a statistically significant difference when compared to TS, RB, and WOG file system (P > 0.05). Conclusion: All instruments were associated with apical extrusion of debris with TS rotary file system associated minimum extrusion and PTN, resulting in maximum extrusion of debris.
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Comparison of Five different methods of Working length determination: An ex vivo study p. 187
Palani Selvi Kamaraj, Hemalatha Parandhaman, Vidhya Raguganesh
DOI:10.4103/endo.endo_30_20  
Aim: The aim of the study was to determine the accuracy and reliability of working length determination using tactile sensation method, digital radiographic method, and electronic apex locator (EAL) in lower premolars in vivo and to compare the lengths so measured to the working length measured with cone-beam computed tomography (CBCT) and the actual working length (AWL) with magnifying loupe, ex vivo. Materials and Methods: Thirty mandibular premolars scheduled for orthodontic extraction were selected. Under local anesthesia, access cavities were prepared and the working lengths were determined by two operators after blinding, using the tactile sensation method, digital radiographic method (radiovisiography [RVG]), and EAL, and tabulated. The teeth were then extracted and subjected to CBCT to determine the working length (CBCTWL). The AWL of the teeth was measured with a K-file that was inserted into the root canal until the file tip is visible at the apical foramen which was confirmed using a magnifying loupe (×8). The values were then statistically analyzed. Statistical Analysis: The SPSS version 20 software (IBM Corp., Armonk, NY, USA) was used to perform statistical analyses, and the confidence interval was determined at P < 0.05. Kappa test was used for the determination of the intra-observer agreement for each method. The comparison of the means of the groups was assessed using repeated measures ANOVA with Greenhouse–Geisser correction and post hoc Bonferroni test. Results: There is a significant difference between the methods in determining the working length. Based on the correlation values on reliability, CBCT method has a more positive correlation with AWL measured using magnifying loupe, followed by EAL, RVG, and tactile sensation. Conclusion: Hence, we conclude that the use of EAL technique is clinically effective for measuring the working length which correlates more positively with the CBCTWL and AWL. Diagnostic CBCT scan can be used as a reliable method for determining the working length.
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Elastic analysis of Gutta percha cones in 50 μg/ml and 80 μg/ml concentration of silver nanoparticles and 5.25% sodium hypochlorite by atomic force microscope: In vitro study p. 193
Priyesh Mishra, Sanjeev Tyagi, Divya Tripathi
DOI:10.4103/endo.endo_62_20  
Introduction: Gutta percha (GP) should be sterilized and chemical sterilization is the most reliable method, but the surface topographical alteration is observed on GP; hence in this study, comparison and evaluation of the changes in modulus of elasticity of GP cones after disinfecting it with 5.25% sodium hypochlorite (NaOCl) and 50 μg/ml and 80 μg/ml concentration of silver nanoparticles (AgNPs) for three different durations were performed. Materials and Methods: Ninety GP cones (Dentsply) were taken from the same batch and were randomly selected for the study. GP points were cut 3 mm from their tip and affix to a glass base with a rapid-setting cyanoacrylate glue. Then, the samples were divided into three treatment groups: Group 1, Group 2, and Group 3 comparison between 50 μg/ml and 80 μg/ml AgNPs and 5.25% NaOCl in 1, 5, and 10 min. Untreated GP points were used as control. The samples were positioned in the atomic force microscope (AFM). The AFM analyses were performed on 12 different regions located between 1 and 2 mm from the specimen's tip. One-way ANOVA was used for the statistical analysis. Results: Group 1 – root mean square (RMS) value of 50 μg/ml in 1 min is 8.2, in 80 μg/ml is 8.0, and 5.25% is 6.4; Group II – RMS value of 50 μg/ml in 5 min is 7.94, 80 μg/ml is 7.11, and 5.25% is 5.34; Group III – RMS value of 50 μg/ml in 10 min is 6.38, 80 μg/ml is 6.24, and 5.25% is 4.82; and Group IV – untreated GP cones showed RMS value of 8.3. A statistically significant difference was found among groups. Conclusion: NaOCl despite of being the ideal material for GP sterilization showed some flaws when it comes to surface topographical and physical changes. Changes are, A – NaOCl solution at 5.25% would increase the modulus of elasticity and left a numerous pitting on the surface of GP cones and B –where as AgNPs solution at 50 and 80 μg/ml did not significantly affect mechanical properties and surface texture of GP even after 10 min of disinfection exposure. Therefore, AgNPs can be seen as a safe disinfectant.
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Evaluation of canal transportation and centering ability in mesiobuccal canals of maxillary molars using two Ni-Ti file systems: An ex-vivo micro-computed tomographic study p. 198
Anuradha Vijay Sawardeker, Aseem Prakash Tikku, Ramesh Bharti, Rhythm Bains
DOI:10.4103/endo.endo_41_20  
Aim: This study aims to evaluate and compare the canal transportation and centering ability of two nickel–titanium file systems, ProTaper Next and WaveOne Gold, in comparison with ProTaper Universal in mesiobuccal canals of maxillary molars using micro-computed tomography. Materials and Methods: Seventy-five permanent maxillary first and second molars having mesiobuccal canals with curvatures between 20° and 30° were selected and subjected to pre-operative micro-computed tomographic scans. They were then divided into three groups (n = 25) based on the file system to be tested: Group 1-ProTaper universal (control), Group 2: ProTaper Next, and Group 3-WaveOne Gold. Access cavities were prepared, following which each specimen was instrumented using the specific file system. Post-instrumentation micro-computed tomographic scans were then carried out for each specimen. Pre- and post-instrumentation measurements of mesiobuccal canals were performed using the ImageJ 1.8.0 software. Canal transportation and centering ratio were calculated at three cross-section levels that corresponded to 3-mm, 6-mm, and 9-mm distance from the apical end of the root. The data obtained were then subjected to statistical analysis using ANOVA and Tukey's post-hoc tests. Results: It was seen that WaveOne Gold caused the least overall canal transportation and exhibited the highest centering ability, followed by ProTaper Next and ProTaper Universal, though the difference was not significant. Furthermore, there was no significant difference between the canal transportation and centering ability of ProTaper Universal, ProTaper Next, and WaveOne Gold at all three levels. Conclusion: None of the systems evaluated exhibited perfect centering ability and zero canal transportation. All file systems caused root canal transportation and minor changes in the root canal anatomy.
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Effect of final irrigant on depth of tubular penetration of resin-based root canal sealer and bioactive sealers using confocal laser scanning microscope p. 204
Shruti Singh Kanwar, Sonali Taneja, Pragya Kumar, Chetna Dudeja
DOI:10.4103/endo.endo_49_20  
Background: Deep dentin tubular penetration of the sealer provides a three dimensional sealing of root canal space Aim: To evaluate the effect of final irrigant on depth of tubular penetration of resin based root canal sealer and bioactive sealers using Confocal Laser Scanning Microscope (CLSM) Materials and Method: Ninety- six freshly extracted human mandibular first premolar teeth were decoronated at 15 mm from the apex. Cleaning and shaping procedure was accomplished using Hyflex CM rotary files till F3. The sample were divided into three groups(n=32) according to final irrgant used : Group A (17 % EDTA), Group B (QMix 2 in 1), Group C (Distilled water). The final irrigation in each respective group was performed with EndoVac system. The samples were further subdivided into 4 subgroups (n=8) according to the type of sealer used for obturation with 6% guttapercha cones - Subgroup I (AH Plus), Subgroup II (Gutta Flow Bioseal), Subgroup III ( Endosequence BC ), Subgroup IV (EndoSeal MTA). Two mm horizontal sections were obtained at 2 mm (apical sections), 5 mm (middle sections) and 7 mm (coronal sections) from the root apex using CLSM to evaluate the maximum depth and percentage of sealer penetration into the dentinal tubules by using Kruskal-Wallis test for overall analysis and a series of Mann-Whitney U tests for pairwise comparison. Result: Endosequence BC showed maximum depth of penetration and penetrated percentage perimeter, while Gutta Flow Bioseal showed least values. Q Mix 2 in 1 showed better penetration values than EDTA and distilled water. Conclusion: Irrigants, nature of sealer and level of root canal affected sealer penetratio.
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Comparative evaluation and efficacy of ethylenediaminetetracetic acid, carbonated water, and chloroquick as final irrigant in smear layer removal using scanning electron microscope p. 209
Vipul Srivastava, Nazia Ali, Ayush Razdan Singh, Raju Chauhan
DOI:10.4103/endo.endo_69_20  
Aim: The purpose of this study was to evaluate and compare the efficacy of EDTA, carbonated water, and chloroquick in smear layer removal at apical, middle, and coronal third of the root canal. Materials and Methods: Eighty freshly extracted human mandibular premolars were used for the study The teeth were decoronated to obtain standardized working length of 14 mm. All samples were instrumented with ProTaper gold till apical size #F3 with 3% NaOCl irrigation between each file. The samples were randomly divided into four groups (n = 20) on the basis of final irrigant used: Group I: 17% ethylenediaminetetracetic acid (EDTA), Group II: carbonated water, Group III: chloroquick solution, and Group IV: normal saline (negative control). The samples were then split into longitudinal sections and observed under scanning electron microscope (SEM) at apical, middle, and coronal levels for the amount of smear layer present. Statistical Analysis: Data were analyzed statistically using Kruskal–Wallis analysis of variance followed by the Mann–Whitney U-test and Chi-square test. The level of significance was set at 0.05. Results: The present study showed that all the three experimental irrigants removed the smear layer equally at the middle and coronal third. At the apical third, Group III (Chloroquick solution) showed the least smear layer score (2.20 ± 0.41) followed by Group I (17% EDTA) (2.35 ± 0.49) and then Group II (Carbonated water) (2.45 ± 0.51). The P value was found to be < 0.001. Conclusion: Chloroquick is more effective in smear layer removal in apical third followed by 17% EDTA and then carbonated water when used as final irrigant. No statistically significant result was found in smear layer removal among the three groups at coronal and middle third of the root canal.
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Effect of different chelating agents on bovine tissue dissolving capacity of sodium hypochlorite p. 216
Nishant Vyavahare, SR Srinidhi, Niranjan Desai, Ajit Hindlekar, Omkar Balsaraf, Pallavi Surwade
DOI:10.4103/endo.endo_47_20  
Background: The success of endodontic therapy depends on thorough cleaning of the canal system. This is done by the use of various irrigants together with mechanical cleaning. The most popular irrigant used is sodium hypochlorite (NaOCl) in different concentrations. It has an added advantage in that it is a tissue dissolvent. To improve the removal of the smear layer in the canal, NaOCl is used with chelating agents such as ethylenediaminetetraacetic acid (EDTA), etidronic acid, or chitosan. The aim of this study was to evaluate the effect of different chelating agents when used with NaOCl on tissue dissolving capability. Materials and Methods: Cleaned bovine tissue was cut into equal pieces of 4 mm × 4 mm × 2 mm and divided into 60 samples having a weight of 70 ± 3 mg. Irrigant solutions were divided into four groups. Group 1: 3% NaOCl, Gp 2: 3%NaOCl + 17% EDTA, Group 3: 3% NaOCl + 18% Etidronic acid, and Group 4: 3% NaOCl + 0.2% chitosan in acetic acid. Samples were taken into test tubes and kept in 10 ml solution of each group for 10 min. Later, samples were taken out from solution and washed with distilled water, blotted dry, and weighed again for change of weight. The difference between the initial and final weights was used to calculate the weight loss. Results: There was a significant difference between the sample weight before and after treatment for all the groups. NaOCl (Group 1) showed best percentage difference of weight loss, followed by NaOCl + Etidronic acid (P < 0.05), then NaOCl + EDTA (P < 0.05) and least with NaOCl + Chitosan (P < 0.05). Conclusion: Etidronic acid has shown better dissolution capacity as compared to EDTA and chitosan group when used with NaOCl.
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Effect of three different rotary file systems on dentinal crack formation – A stereomicroscopic analysis p. 220
Elkanti Soujanya, Neha Verma, Mamta Kaushik, X Nagamaheshwari, Neha Mehra, Lokam Karthik Prasad
DOI:10.4103/endo.endo_96_20  
Background: This study is aimed to analyze and compare the formation of dentinal cracks after root canal preparation with three different rotary file systems using a stereomicroscope. Materials and Methods: Forty extracted human mandibular premolars were selected and divided into three experimental groups and a control group of 10 each. The root canals were prepared in the experimental groups. Group I: ProTaper Gold files (PTG), Group II: Neo Endo flex files, and Group III: Waldent Wal flex files. No preparation was done in the control group (Group IV). The roots were sectioned at 3, 6, and 9 mm from the apex, and the surfaces were examined under a stereomicroscope. The data were analyzed using the Chi-square test. Results: There were no cracks in the control group. Neo Endo flex showed maximum cracks at 3 mm level, which was statistically significant compared to other groups (P < 0.05). There was no statistically significant difference among experimental groups at 6 mm and 9 mm levels (P > 0.05). Conclusion: All the rotary files that were tested produced dentinal cracks. Neo Endo flex files group was associated with more number of cracks than PTG and Waldent Wal flex files group. The apical section of samples showed significantly higher defects compared to the middle and coronal sections.
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Management of endodontic emergencies at a tertiary care hospital during the lockdown phase of the COVID-19 pandemic p. 225
Sidhartha Sharma, Ajay Logani, Amrita Chawla, Vijay Kumar, Sarita Gill
DOI:10.4103/endo.endo_79_20  
Context: Coronavirus disease 2019 (COVID-19) is declared as a global pandemic by the WHO. Due to lack of proper vaccine, social distancing and restriction of movement in the form of“lockdown” have been implemented to curb the spread. This has crippled dental care in the country. Aims: The aim of this article is to highlight the management of endodontic emergencies during the COVID-19 lockdown phase. Settings and Design: Retrospective analysis of patient's data at a tertiary care center Materials and Methods: The data of 247 patients referred to the specialty clinic between March 23 and May 31, 2020, were retrospectively analyzed. COVID-19 risk assessment was performed for all the patients. Based on the diagnosis, the cases were classified as emergency, urgent, or nonemergency. The endodontic intervention was performed for all the emergency cases. Minimally invasive dentistry and pharmacotherapy were provided for urgent and nonemergency cases. Results: One hundred and seventeen patients presented with true endodontic emergencies (symptomatic irreversible pulpitis with or without apical periodontitis [80%], pulp necrosis and acute apical abscess [18%] or traumatic dental injury [2%]). About 82% of the emergency cases were managed by nonsurgical endodontic therapy, and vital pulp therapy was performed in 15.4% of the cases. Conclusions: Management of most of the endodontic emergencies required the use of aerosol-generating procedures. Irreversible pulpitis was the most common cause for the patients seeking emergency endodontic treatment.
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Effect of diode laser irradiation and 10% citric acid conditioning on the sealing ability of mineral trioxide aggregate as a retrograde filling material p. 231
Shailendra Mashalkar, Syed Mubeen Mohiuddin Hussaini, Pavan Diwanji, Shreeshail Indi, Ashwini Hambire
DOI:10.4103/endo.endo_58_20  
Aim: The aim was to evaluate the effect of diode laser irradiation and 5% citric acid conditioning on microleakage of mineral trioxide aggregate (MTA) when used as root-end filling material. Materials and Methods: Forty-five human anterior teeth were decoronated and subjected to root canal instrumentation. Three millimeters of apical root portion was resected, and root-end cavities were prepared using ultrasonic tips. The teeth were then randomly divided into three groups (n = 15), In Group 1 – root-end cavity was prepared and treated with citric acid followed by MTA application; in Group 2 – root-end cavity was prepared and treated with diode laser followed by MTA application; and in Group 3 – root-end cavity was prepared and treated with citric acid and laser application followed by MTA application. The specimens were then subjected to glucose leakage analysis at 48 h, 7 days, and 14 days. One-way ANOVA test was used for raw data and Chi-square test for consolidated data to test the significance of difference between the variables. SPSS software version 20 was used for analyzing the data. Results: Group 1 showed significantly more leakage than Group 2 and Group 3 at all time intervals, whereas Group 3 showed the least microleakage at 48 h, 7 days, and 14 days. Conclusion: MTA had a better sealing ability when root-end cavities were conditioned with 5% citric acid followed by diode laser irradiation.
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CONFERENCE REPORT Top

Online 12th IFEA World Endodontic Conference report p. 234

DOI:10.4103/0970-7212.307325  
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