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This systematic review was designed to answer the following question: Does chitosan provide better smear layer removal and antimicrobial efficacy than other root canal irrigants? A literature search was done using electronic databases PubMed, Scopus, Web of Science, Cochrane Library, EBSCO host, Grey Literature Report, and Open Grey from inception to June 18, 2024. The reference lists of included articles were also hand-searched. Two reviewers independently assessed the studies' eligibility based on the inclusion and exclusion criteria and performed data extraction. Two reviewers independently evaluated the risk of bias in the selected studies. The search retrieved 2330 studies. After analysis, 36 studies fulfilled the eligibility criteria and were included, with 19 involving smear layer removal, 16 involving antibacterial efficacy, and 1 involving both. The overall risk of bias of the included studies was medium. Chitosan removed the smear layer more effectively than citric acid and acetic acid, similar to MTAD and Qmix, with conflicting results against EDTA. In addition, chitosan demonstrated comparable antibacterial efficacy to chlorhexidine, propolis, and photodynamic therapy but was less effective than sodium hypochlorite. Based on available evidence, it was found that chitosan provided better smear layer removal and antimicrobial efficacy than most root canal irrigants compared in this systematic review. There was substantial heterogeneity in the methodology of included studies. As a result, this review highly recommends further research using standardized methods to assess the effectiveness of chitosan as a root canal irrigant in in-vitro studies to validate its clinical use. [ABSTRACT FROM AUTHOR]

Aim: The aim was (1) to study the cytotoxicity of novel Bioactive Caries-detecting Dye solution (BCD) and its antimicrobial activity against Streptococcus mutans, Lactobacillus acidophilus, Actinomyces naeslundii, and Candida albicans and (2) comparative assessment of BCD and Carie-Care for efficient removal of caries (stereomicroscope) and dentin tubule occlusion (scanning electron microscope [SEM]). Materials and Methods: For BCD cytotoxic study (direct contact method), colorimetric MTT assay, and cell line study(L929 mouse fibroblast NCTC clone 929 strain L) was performed. Xenetix 350, chitosan, nanohydroxyapatite (nHA), BCD, and Carie-Care solutions were subjected to the antimicrobial activity through blood agar well diffusion method, and the minimum inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were determined. On 20 extracted human carious teeth a comparative pilot study was done for BCD (Group A, n = 10) and Carie-Care (Group B, n = 10), and evaluated visually and radiographically. After mechanical excavation of caries with a spoon excavator, teeth sectioned longitudinally and stereomicroscopically were evaluated (8x–40x) by two observers. The percentage of dentinal tubule occlusion was evaluated with SEM for both solutions. Statistical kappa analysis of agreement was 0.7–0.8 (P < 0.01). Mann–Whitney test ranks and Wilcoxon signed-rank test (P = 0.01) were applied. Results: Cytotoxicity test revealed BCD to be nontoxic and biocompatible. Antimicrobial tests (zone of inhibition) showed BCD > chitosan > chlorhexidine > Carie-Care > Xenetix 350 > nHA. MIC and MBC values suggested chlorhexidine > BCD > Carie-Care. Stereomicroscopic analysis showed effective mechanical removal of caries in BCD without residual dye in the dentinal tubules as compared to Carie-Care. Dentinal tubule occlusion (SEM analysis) was 80%–85% for BCD and 10% for Carie-Care. Conclusions: Profound synergistic effect for BCD was observed with advantage of radiographic assessment. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare the antifungal efficacy of three endodontic sealers (AH Plus, Apexit Plus, and MTA Fillapex) with and without the incorporation of chitosan nanoparticles against Candida albicans. Materials and Methods: The present study was carried out by the Kirby–Bauer method. C. albicans were cultured in Sabouraud Dextrose Agar plates. Filter papers (n = 10) were placed in the cultured Petri dishes and the sealers were mixed according to the manufacturer's instructions and placed on the top of the filter papers. Group division of sealers is as follows: Group I – AH Plus, Group II – Apexit Plus, and Group III – MTA Fillapex. Group IC, Group IIC, and Group IIIC were the addition of 2% chitosan nanoparticles with respective sealers. Plates were incubated for 18 h, and the zone of inhibition was measured with a measuring scale and values (in millimeter) were recorded. Statistical analysis was done by one-way analysis of variance followed by post hoc multiple pair-wise comparisons. Results: All the tested groups showed statistically significant difference (P < 0.05) from each other. Two percent chitosan-incorporated groups showed superior zone of inhibition compared to sealers used alone. Group IC (16.35 ± 0.71 mm) had the highest zone of inhibition followed by Group I (13.8 ± 0.86 mm). For the remaining groups, the zone of inhibition was in the following order: Group IIC > Group II > Group IIIC > Group III. Conclusion: AH Plus sealer mixed with 2% chitosan showed significantly higher antifungal property. Mixing of 2% chitosan with endodontic sealer provides an added advantage so that endodontic re-infections can be minimized and will be helpful in retreatment cases. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the intensity of pain after unintentional extrusion of resin-based and calcium hydroxide (Ca[OH]2)-based endodontic sealers as well as their influence on the periradicular tissues. Materials and Methods: A total of 120 single-rooted teeth exhibiting extrusion of sealer in the postoperative radiographs were included in the study. According to the sealers used, the teeth were divided into four groups (n=30): Group I - AH Plus®, Group II-Resino Seal, Group III-Sealapex™, and Group IV-Apexit® Plus. Postoperative pain was assessed at 0-6 h, 6-12 h, 12-24 h, and 24-48 h of obturation using Visual Analog Scale. Radiographs were taken at 3, 6, and ≥9 months to 1-year follow-up and compared with baseline radiographs to assess the dissolution of extruded sealers and healing of periradicular tissues. Statistical Analysis: ANOVA, Kruskal-Wallis, and Pearson's Chi-square test were used. Statistical significance level was set at P ≤ 0.05. Results: Postoperative pain intensity was higher in case of AH Plus® sealer followed by Sealapex™ up to 12 h of obturation and was statistically nonsignificant. Apexit® Plus at all time intervals showed statistically significant less pain intensity than AH Plus® and Sealapex™ but not from Resino Seal group. At 9-month follow-up, better healing of periradicular tissues was shown by AH Plus® (48.1%) followed by Apexit® Plus (44.4%) and Sealapex™ (41.2%) with statistically nonsignificant difference. Conclusion: In case of periapical extrusion, both resin-based and Ca(OH)2-based sealers caused postoperative pain. Both Ca(OH)2-and resin-based sealers did not influence the treatment outcome. [ABSTRACT FROM AUTHOR]

Introduction: During endodontic retreatment apical extrusion of debris in the form of filling materials, necrotic pulp tissues, microorganisms as well as irrigants may lead to post instrumentation pain, inflammation and impaired healing. Aim: The aim of the study was to compare the amount of debris extruded from the apex during retreatment procedures using ProTaper R (PTR; Dentsply Maillefer, Ballaigues, Switzerland) and Endostar RE Re endo rotary system (ERE; Poldent Co. Ltd., Warsaw, Poland) file systems. Materials and Methods: A total of 30 extracted mandibular premolars were prepared and obturated with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using warm vertical compaction technique. The teeth were randomly divided into two groups of 15 each for removal of root canal filling material with PTR and ERE files. The Apically Extruded Debris (AED) was collected in preweighed eppendorf tubes. Data were analysed statistically using independent sample t-test. Significance level was established at α=0.05 Results: No significant difference (p=0.701) was found among the groups regarding the amount of AED. AED was more for PTR files as compared to ERE files while PTR files cleaned the canal walls better as compared to ERE. Conclusion: Both retreatment file systems were associated with some degree of debris extrusion from the apex. Though statistically insignificant PTR files extruded more debris than ERE files. [ABSTRACT FROM AUTHOR]

Introduction: Dentin hypersensitivity (DH) is a sudden short sharp pain best explained by hydrodynamic theory. Several agents are available throughout the market that can treat DH either by blocking the nerves that helps in conducting pain or by blocking the open dentinal tubules. The aim of the present study was to compare the tubule occluding efficacy of four different desensitizing dentifrices under scanning electron microscope (SEM). Materials and Methods: Sixty-two dentin blocks measuring 5 mm x 5 mm x 3 mm were obtained from extracted human molar teeth and were randomly divided into five groups: Group 1-no treatment (control, n = 2); Group 2-Pepsodent Pro-sensitive relief and repair (n = 15); Group 3-Sensodyne repair and protect (n = 15); Group 4 -Remin Pro (n = 15); Group 5 - Test toothpaste containing 15% nano-hydroxyapatite (n-HA) crystals (n = 15). The specimens were brushed for 2 min/day for 14 days and stored in artificial saliva. After final brushing, specimens were gold sputtered and viewed under SEM at x2000 magnification. Results obtained were statistically analyzed using nonparametric Kruskal-Wallis test and least significant difference post hoc test. Results: All test groups showed significant increase in dentin tubule occlusion as compared to control group. The highest percentage of tubules occluded was shown by Group 4 and Group 5 which was significantly different from other groups (P ⩽0.05) and there was no significant difference in tubule occlusion among them. Conclusion: Newer desensitizing dentifrices containing 15% n-HA and Remin Pro can provide effective tubule occlusion and thereby reduce the pain and discomfort caused by DH. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to compare the difference in the output intensity of Light Emitting Diode (LED) light cure (LC) devices with and without a protective sleeve and its clinical significance. Materials and Methods: The output intensity of 152 LC units in dental offices across the state of Odisha were examined. The collection of related information included an average number of exposures per day and the charging status. LED Radiometer (SDI Ltd, VIC, AUS) was used for measuring output intensity. Results: Out of all the 152 LC devices examined, 137 were found to emit light intensity above minimum baseline values when used with a protective sleeve. The decrease in output intensity, when used with a protective sleeve was statistically significant (p<0.05). 78 LC devices with direct current supply, maintained better intensity than battery operated ones. 74 battery operated LC devices showed statistically significant differences (p<0.05) in intensity output based on the number of exposures/day. Devices that were being charged daily maintained significantly (p<0.05) better intensity output than those being charged once or twice a week. Conclusion: LED Light cure devices can be safely used along with a protective sleeve to improve cross infection control without affecting its output intensity. Battery operated LED devices must be charged at least 3 times/ week to prevent a significant decrease in output intensity. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of three different pastes containing 5% NovaMin, 8% arginine, and 15% hydroxyapatite nanoparticles (n-HA) respectively in the treatment of dentin hypersensitivity (DH). Materials and Methods: A 4 weeks study was conducted on 45 adult patients with cervical abrasions leading to hypersensitivity of two or more teeth anterior to molars. Patients were divided into three toothpaste groups. Group I: 5% NovaMin, Group II: 8% arginine, Group III: 15% n-HA. Sensitivity was assessed at baseline, immediately after application and after 1-week and 4 weeks. Tactile stimuli response using a visual analog scale and standard cold air blast using Schiff cold air sensitivity scale were used to compare the efficacies of toothpastes after a single application. Statistical Analysis: Two-way analysis of variance and post-hoc Tukey test were used and P ≤ 0.05 was considered statistically significant. Results: Visual analog scale analysis: Group III and Group II showed statistically significant reduction in DH at all-time intervals when compared with Group I. In SCA analysis there is no statistically significant difference between Group II and Group III immediately after application. Conclusion: Toothpaste containing 15% n-HA was found to be most effective in reduction of DH after a single application up to a period of 4 weeks followed by 8% arginine and 5% NovaMin toothpastes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this prospective, randomized, double-blind, placebo-controlled study was to compare the effect of the administration of preoperative ibuprofen, ketorolac, combination of etodolac with paracetamol and combination of aceclofenac with paracetamol versus placebo for the potential increased effectiveness of the inferior alveolar nerve block [IANB] anesthesia. Materials and Methods: A total of 100 endodontic emergency patients in moderate to severe pain diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, either a drug or placebo 30 minutes before the administration of a conventional IANB. Cold testing was done before administration of anesthesia to determine level of pain using Heft-Parker Visual Analogue Scale (VAS) score. Success was defined as no pain or pain (VAS) on access or initial instrumentation. Results: Overall success was 54% for all the groups. Success was highest (70%) for the ketorolac group, 55% for both ibuprofen group and combination of aceclofenac with paracetamol group, 50% for combination of etodolac with paracetamol group, and 40% for the placebo group. Conclusions: Under the conditions of this study, the use of preoperative medication did improve the anesthetic efficacy of IANB for the treatment of teeth diagnosed with irreversible pulpitis but not significantly. [ABSTRACT FROM AUTHOR]