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Aim: The aim of this study was to compare the anesthetic efficacy of 4% articaine and 2% lidocaine as supplementary buccal infiltration after failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Methods: MESH terms and specific keywords were used to search Scopus, EBSCOhost, Cochrane Library, and PubMed. Randomized clinical trials were among the included articles that compared the anesthetic efficacy of 4% articaine or 2% lignocaine as supplementary buccal infiltration following a failed IANB in patients with chronic irreversible pulpitis. Results: Five of the 871 studies that were reviewed were given full-text reading considerations, and three studies were subjected to qualitative analysis after meeting the inclusion and exclusion criteria. In 234 patients altogether, patients anesthetized with 4% articaine buccal infiltration had a success rate of 61%–83.3% in the 118 patients in the 4% articaine BI group and 116 patients in the 2% lidocaine BI group. Conclusion: Supplemental buccal infiltration with 4% articaine in permanent mandibular molars was associated with greater anesthetic efficacy than the 2% lignocaine in patients with symptomatic irreversible pulpitis after unsuccessful IANB.

Aim: The purpose of this study was to compare equivalent stresses in mandibular first molar restored with endocrowns made of ceramic and indirect composites using three-dimensional (3D)-finite element analysis (FEA). Materials and Methods: Two 3D finite element models of mandibular first molar were designed. One model of intact tooth without any restoration was uses as a control. Another mandibular molar model with endocrown as postendodontic restoration was generated where the tooth was simulated with extensive coronal loss and divided into five groups with different materials such as lithium disilicate, zirconia, feldspathic, resin nanoceramic, and polymer infiltrated ceramic network (PICN). An axial loading force of 300 N at five diverse contacts areas was applied on the occlusal surface. Stress distribution at various regions of tooth, concentrating mainly on root dentin and alveolar bone, was measured using the Von Mises stress criteria by FEA software. Results: The lowest stress concentration in root dentin was seen in the cervical root region of resin nanoceramic endocrown group followed by PICN endocrown, feldspathic ceramic endocrown, intact tooth, zirconia endocrown, and lithium disilicate endocrown. In alveolar bone, the result showed that the lowest stress value was seen in resin nanoceramic endocrown, followed by PICN endocrown, zirconia endocrown, feldspathic endocrown, intact tooth, and lithium disilicate endocrown. Conclusion: Endocrown materials with the modulus of elasticity similar to that of dentin showed better stress distribution than the materials with high modulus of elasticity.

Objective: This study aimed to compare the two nickel–titanium (NiTi) instruments on root dentin thickness using cone-beam computed tomography (CBCT) and ability to remove the smear layer using scanning electron microscope (SEM). Materials and Methods: The effect of two NiTi rotary instruments such as XP Endo shaper and ProTaper Gold (PTG) in retaining adequate dentin thickness and debridement (i.e., removal of smear layer) was evaluated in vitro using CBCT and SEM. After cleaning and shaping of the root canal with adequate irrigation, the effect of two NiTi instrument systems at 3 mm (apical), 6 mm (middle), and 9 mm (coronal) levels on buccal, lingual, mesial, and distal aspects in terms of amount of dentin removal and smear layer removal was evaluated. The data were analyzed using student's unpaired t-test with a significance of P ≤ 0.05. Results: Both NiTi instrument systems had no statistically significant difference in amount of dentin removal at all three levels and on all four aspects. In smear layer removal, PTG had significantly better efficacy compared to XP Endo shaper at the coronal third of root canal. Conclusion: Instrumentation with XP Endo Shaper and PTG showed a similar amount of dentin removal. PTG has a significant effect on smear layer removal compared to XP Endo Shaper only at the coronal third of root canal.

Introduction: A subgingivally extending proximal carious defect can be adequately restored with an adhesive indirect aesthetic restoration only when the proximal margins can be raised coronal to the Cementoenamel Junction (CEJ) using various Margin Elevation Materials (MEM). This approach is commonly referred to as the Proximal Box Elevation (PBE) technique. However, there is a lack of evidence in the literature regarding the quality of the marginal seal at the root dentine- MEM interface when using PBE technique. Aim: The purpose of this systematic review was to summarise the available evidence on the the quality of the marginal seal at the root dentine- MEM when using the PBE technique during the placement of adhesive indirect aesthetic restorations. Materials and Methods: Comprehensive electronic search was performed in PubMed Central, Cochrane Library and Google Scholar from their inception to January 2021 at the Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research (SRIHER) between May 2020 to January 2021. Full text articles published in english language which have performed an indirect restoration with and without PBE technique were included in the review. A total of 249 articles were screened initially in the review. The main keywords used were: “PBE”, “Cervical Margin Relocation (CMR)”, “Deep Margin Elevation (DME)” and “coronal margin relocation”. The review protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias assessment of the included studies was performed independently. Results: A total of 9 in-vitro studies were included in the present systematic review. Resin based composites of different viscosities seemed to perform adequately as MEM. It may be prudent to perform the margin elevation in multiple layers. Self etch adhesives had a better marginal seal than the total etch adhesives. Regarding the effect of indirect restoration on the marginal seal at the root dentine- MEM interface, there was no conclusive evidence. PBE may provide a congenial environment for predictable and efficient bonding of indirect adhesive aesthetic restorations. Conclusion: Based on the moderate quality of evidence from the included articles in this systematic review, it can be concluded that while performing a PBE technique, the quality of marginal seal at root dentine- MEM interface is satisfactory under in-vitro conditions.

As aging progresses, there is tooth destruction in the cervical portion of the tooth not possibly due to carious process. This may be attributed to either abrasion, erosion or abfraction or a combination. The etiology, extent, and clinical view of these lesions vary, and it is a challenge to the clinician to identify the cause and decide proper restorative materials and treatment plan for each type of lesion.

Objective: The purpose of this randomized clinical study was to investigate the influence of occlusal surface reduction on postendodontic pain. Methodology: Sixty patients were included with a diagnosis of acute irreversible pulpitis and acute apical periodontitis and divided randomly into two groups. In the intervention group, occlusal surfaces were reduced and left intact in the control group. Postoperative pain was evaluated at the 6th, 12th, 24th, and 48th h after the root canal instrumentation and 6th and 12th h following obturation using visual analog scale. Data were evaluated using the Chi-square test, t -test, Friedman test, Mann–Whitney U -test, and Wilcoxon rank test. Results: Postoperative pain levels in both groups were reduced significantly over the time period evaluated, however, between the two groups, there was no difference evident. Conclusion: Occlusal surface reduction did not influence the pain following root canal instrumentation and obturation. [ABSTRACT FROM AUTHOR]

Introduction: Maxillary molars may frequently require root canal therapy and can have complex anatomy. It is important to locate and treat the second mesiobuccal canal to significantly improve prognosis.Aim Of the Study: The purpose of this study was to evaluate direct vision, dental operating microscope (DOM), selective dentin removal under DOM, and cone beam computed tomography (CBCT) in clinical detection of second mesiobuccal root canal (MB2) in maxillary molars.Materials and Methods: A total of 122 maxillary first and second molars indicated for root canal treatment were included in our study. Following access cavity preparation, the presence of MB2 canal orifice was assessed in four stages. Stage I: with direct vision. Stage II: under DOM, Stage III: after selective dentin removal under DOM and Stage IV: teeth in which MB2 canal was not identified by Stage III were further investigated with CBCT. The number of canals identified during each stage was analyzed statistically.Results: Clinical detection of MB2 canal in our study was 90%, with 93% in maxillary first molar and 86% in maxillary second molar. 64% MB2 canals were located at Stage I (direct vision) which improved to 84% at Stage II (under DOM) and 90% at Stage III (selective dentin removal under DOM). CBCT investigation (Stage IV) further improved the identification of MB2 canal leading to overall prevalence of 93%.Conclusion: The results of our study demonstrated that MB2 canal can be clinically detected in up to 90% of maxillary molars by the use of DOM and selective dentin removal. CBCT investigation is indicated when MB2 canals are not clinically detected. [ABSTRACT FROM AUTHOR]

Background: Clinical research is important to evaluate the effect of desensitizing agents. Aims: This randomized clinical trial evaluated the immediate and 1 week desensitizing effect of two desensitizing agents Uno Topical Gel and Profluorid. Materials and Methods: Thirtyfive patients with teeth presenting with dentin hypersensitivity were included in this clinical trial. Each quadrant in a patient was randomly assigned to one of two groups: Uno Topical Gel or Profluorid Varnish. A VAS score was used to assess tooth sensitivity at baseline, immediately after application of desensitizer and after 1 week. Additionally, 30 dentin discs were prepared, divided into Group 1(Control Group), Group 2 (Profluorid Varnish) and Group 3 (Uno Topical Gel) and examined using scanning electron microscopy (SEM) after 1hour and 24 hours to evaluate tubule occlusion. Statistical Analysis: Clinical data were analysed using Friedman's test and Mann – Whitney U test. SEM data was analysed using Student's 2-sample t-test. Results: Uno group was significantly better to evaporative stimuli immediately (P=0.01) after application. After 1 week, Uno group was significantly better to tactile (P=0.000) and evaporative (P=0.000) stimuli than Profluorid. SEM images showed that 1 hour after application, Uno and Profluorid demonstrated more than 90% and 80% dentin tubule occlusion respectively. At 24 hours, Uno and Profluorid demonstrated more than 50% and 60% dentin tubule occlusion respectively. Conclusions: Uno Topical Gel was significantly better than Profluorid in reducing pain of dentin hypersensitivity due to tactile and evaporative stimuli after 1 week. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate and compare the apical constriction (AC) and apical canal morphology of maxillary first and second molars, using micro-computed tomography (micro-CT)., Materials and Methods: The anatomical features of 313 root canals from 41 maxillary first molars and 57 maxillary second molars of patients with known age and sex were evaluated using micro-CT, with a resolution of 26.7 µm. The factors evaluated were the presence or absence of AC, the morphotypes, bucco-lingual dimension, mesio-distal dimension, and the profile (shape) of AC and the apical root canal. The apical root canal dimensions, location of the apical foramen (AF), AC to AF distance, and presence of accessory canals in the apical 5 mm were also assessed. Descriptive and analytical statistics were used for data evaluation., Results: AC was present in all 313 root canals. Patients' age and sex did not significantly impact either AC or the apical canal dimensions. The most common AC morphotype detected was the traditional (single) constriction (52%), followed by the parallel (29%) morphotype. The mean AC dimensions in maxillary first molars were not significantly different from those in maxillary second molars. Sixty percent of AF were located within 0.5 mm from the anatomic apex., Conclusions: The most common morphotype of AC detected was the traditional constriction. Neither patients' age nor sex had a significant impact on the dimensions of the AC or the apical root canal. The majority of AF (60%) were located within 0.5 mm from the anatomic apex., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2022. The Korean Academy of Conservative Dentistry.)