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Introduction: Contamination of composite restoration during incremental placement leads to decrease in the incremental bond strength. Adhesive application on freshly contaminated resin surface increases the bond strength but is a complex and time-consuming procedure. Recently composite systems combining etchant, bonding agent and flowable composite into a single component have been introduced to simplify bonding and save time. In this study incremental layer shear bond strength is utilised to assess bond stability at resin-resin interface after salivary contamination. Aim: To evaluate shear bond strength of incremental layer of self-etch self-adhesive novel flowable composite after salivary contamination. Materials and Methods: The present in-vitro experimental study included 55 acrylic resin cylinders (2x2.5 cm) with square shaped cavity (5x5 mm, thickness 2 mm) restored with DMGTM Constic flowable composite that were randomly divided into five groups with eleven specimens per group. Group I: No salivary contamination, Group II: Salivary contamination followed by air drying, Group III: Salivary contamination followed by rinsing and air drying. Group II and III were subdivided into subgroup a: application and brushing of 0.5 mm of Constic followed by light curing and filling of rest of mold by Constic, subgroup b: direct application of 2 mm of Constic. Shear bond strength between increments of composite was determined by universal testing machine. Data were analysed using One-way ANOVA test and Independent t-test. Level of significance was kept at 5%. Results: Incremental shear bond strength (MPa) was highest for group I (12.09±1.99) followed by group IIIa (10.21±3.49), group IIa (10.08±3.21), group IIb (7.59±2.31) and lowest for group IIIb (7.35±3.06). Conclusion: Active application of self-etch self-adhesive flowable composite successfully restores the incremental shear bond strength after salivary contamination. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to evaluate and compare the fracture resistance of four different core build-up materials on endodontically treated teeth. Materials and Methods: In this in vitro study, sample size estimation was done using G*power software (version 3.1.9.2), an effect size of 0.66 was obtained at 95% confidence interval. 48 Teeth samples were decoronated 2mm above the Cementoenamel junction. Root canal treatment done, followed by preparation of post space and fiberglass posts of 10mm length was cemented with resin cement into the root canal and 4mm above the prepared tooth. All the samples were randomly divided into 4 groups of 12 samples for four different core build up materials. All teeth were restored with a Nickel chromium crown of standard dimensions and cemented with glass ionomer cement. Fracture resistance measured by applying the load at an angle of 135° to the long axis of the tooth at a crosshead speed of 0.05mm/min until failure. Analysis was performed using KRUSKAL-WALLIS to compare mean values and standard deviation of fracture resistance, followed by post – hoc MANN WHITNEY test for assessing the significant difference of fracture resistance between the four groups. Results: Resistance to fracture was greater in Luxacore Z group followed by Vitremer, Denfil and Filtek. However, no statistically significant differences in the fracture resistance were observed among the groups. Conclusion: The results indicate that Luxacore Z core build-up material exhibits superior fracture resistance. Resin modified glass ionomer cement had fracture resistance comparable to Luxacore. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate the push‑out bonding strength of class II cavities of maxillary molars restored with different concentrations of chitosan nanoparticles (CSN) incorporated in universal composite resin and eighth‑generation dentin bonding agent (DBA). Materials and Methods: Seventy extracted human maxillary first molar teeth were cleaned and mounted in acrylic mold up to 2 mm below cementoenamel junction and mesio‑occlusal Class II cavities with standard measurements were prepared. CSN 2% and 0.25% powder were added to the DBA and composite resin. The samples then arbitrarily divided into three groups for restoration: Group 1: composite restoration without CSN (control group) (n = 10), Group 2: 2% CSN (n = 30), and Group 3: 0.25% CSN (n = 30). Groups 2 and 3 were further subdivided into three subgroups (n = 10 each) subgroup A. CSN incorporated in composite resin. B. CSN incorporated in DBA and C. CSN incorporated in composite and DBA. After restoration, push‑out bond strength was evaluated in each sample using a universal testing machine, and data collected were statistically analyzed by one‑way analysis of variance and Post hoc Tukey tests (P ≤ 0.05). Results: Subgroup 3A (0.25% CSN + composite) has shown an increase in bond strength among all experimental groups with no significant difference between group 1 (control group). Conclusion: CSN 0.25% incorporated in composite or DBA exhibits no harmful effect on the bond strength of class II restorations. Hence, it can be used to improve the antibacterial action and longevity of composite resin. [ABSTRACT FROM AUTHOR]

Introduction: Gingival recession (GR) is a condition in which the gingival border is apical to the cementoenamel junction and the root is exposed to the oral environment. Tobacco use is one of the most important risk factors for the development of destructive types of periodontal disease, as well as a risk factor for GR. Aim: The aim of the present cross-sectional study was to assess the prevalence of gingival recession among patients visiting a university dental hospital setting who are using different forms of tobacco. Materials & Method: This study was conducted during the period of November 2019 to April 2020 in Saveetha Dental College and Hospitals in Chennai among patients with gingival recession who are under the usage of various forms of tobacco. The data were sorted and tabulated in Microsoft Excel and then entered in IBM SPSS software version 23 for descriptive statistics. Results And Discussion: According to the results there is a decline in tobacco users with increase in age, drastically so after the age of 50. Figure 3 shows us that there is a maximum prevalence of GR of 19.60% among the age group 40-50 years and also shows the gradual increase in the prevalence of GR with age in accordance with the number of participants belonging to each age group. There may be a higher chance of prevalence of GR among those who use both the forms of tobacco, i.e smokable and chewable than just a single form of useage. Conclusion: From this retrospective study we conclude that gingival recession is evident in patients who use various forms of tobacco with a prevalence rate of 68.40 %. Highest prevalence of gingival recession among the age groups is 19.60% of age group 40-50 years who majorly smoked and used chewable forms of tobacco. [ABSTRACT FROM AUTHOR]

Objectives. The percentage of failure of endodontically treated maxillary molars is relatively high; one main reason is that the second mesiobuccal canal (MB2) is missing. Some techniques have been proposed for detection of the MB2. This study was aimed at assessing the diagnostic accuracy and agreement of the dental microscope and cone-beam computed tomography (CBCT) in comparison with microcomputed tomography (micro-CT) for detection of the MB2 of maxillary first molars in vitro. Materials and Methods. This in vitro, experimental study evaluated 71 permanent maxillary first molars that were stored in 100% humidity at room temperature. The teeth were mounted in 9 silicone dental arches to the level of their cementoenamel junction (8 teeth in each arch). The blocks underwent CBCT in a XG3D scanner. Access cavity was then prepared, and the teeth were inspected by a surgical microscope for negotiation of the MB2. Also, micro-CT images were obtained from the teeth to serve as the gold standard. CBCT and micro-CT images were observed by two examiners twice with a 2-week interval. Results. The frequency of the MB2 detected by dental microscope was significantly lower than micro-CT (P < 0.001) and CBCT (P = 0.008); no significant difference existed between micro-CT and CBCT in this respect. The sensitivity, specificity, positive predictive value, and negative predictive value of CBCT for detection of MB2 were 92.6%, 100%, 100%, and 81%, respectively. Conclusion. CBCT is superior to the dental microscope for detection of the MB2 of maxillary first molars and can be used for this purpose in the clinical setting with adequate accuracy. [ABSTRACT FROM AUTHOR]

Introduction: Extrusion of periapical debris is one of the common problem encountered during root canal treatment. As the endodontic instruments differ in terms of design and use, apical extrusion of debris may vary. Aim: To determine the quantity of debris extruded apically during various hand and rotary assisted instrumentation in extracted primary single rooted teeth. Materials And Methods: This in-vitro study was conducted in Department of Paediatric and Preventive Dentistry at Kannur Dental College, Anjarakandy, Kannur, Kerala, India, from December 2020 to May 2021. Four file systems were compared i.e, two hand files (Kedo SH and Protaper hand) and two rotary files (Kedo SG blue and Pro AF baby gold) among 60 therapeutically extracted single rooted primary teeth. The tooth was inserted into Eppendorf tube till cementoenamel junction, access opening was done, pulp extirpated, working length determined with 10 size k-file. After instrumentation, the tooth was washed with 10 mL of distilled water for debris collection. Tube was incubated at 70°c for drying and weighed to measure the collected debris. Data collected was analysed statistically using Independent t-test, One-way Analysis of Variance (ANOVA) and Least Significant Difference (LSD) Posthoc test for multiple comparison to compare between the groups were done. Level of statistical significance was set at p-value<0.05. Results: There was significant difference in the amount of debris collected between the hand file and rotary files (p-value<0.001), between Kedo SG blue and Pro AF baby gold (p-value<0.001), and Kedo SH hand file and Protaper hand file (p-value<0.05). Conclusion: Rotary files shows lesser amount of debris extrusion than the hand files. Comparing the four file system Kedo SG Blue file shows least periapical debris extrusion, the second least is Pro AF Baby Gold (rotary), then Kedo SH hand file and last Protaper hand file. [ABSTRACT FROM AUTHOR]

To analyze the anatomical limitations and characteristics of maxillary and mandibular retromolar regions affecting molar distalization using cone-beam computed tomography (CBCT). A total of 120 qualifying patients were classified into equal groups of skeletal Class II and Class III and stratified by vertical growth pattern, age, sex, and third molar presence. The available distance along the axis of distalization and cortical bone thickness (CBT) were measured in the maxillary and mandibular retromolar regions of Class II and Class III patients, respectively. One-way analysis of variance was used to examine the effects of the factors on the measured data. The minimum available distance of the Class II maxilla was observed at a level 3 mm from the cementoenamel junction (CEJ), while that of the Class III mandible was at a level 9 mm from the CEJ. The average available distance at the limit level was 4.06 ± 1.93 mm in the Class II maxilla, and the average corresponding CBT was 1.00 mm. The average available distance at the limit level in the Class III mandible was 2.80 ± 1.96 mm, and the corresponding CBT was 2.24 mm. In both skeletal Class II and Class III patients, hyperdivergent groups had the least available distance for molar distalization. The limit for available distance in the Class II maxilla is closer to the coronal level, while that of the Class III mandible is closer to the apical level. A hyperdivergent growth pattern in a patient is indicative of less potential for molar distalization. Axial slices of CBCT images provide valuable evaluation for molar distalization regarding limit levels. [ABSTRACT FROM AUTHOR]

In this study, an integrated deep learning framework was developed for classifying the periodontitis stages of each individual tooth using dental panoramic radiographs. Based on actual patient panoramic radiographs data, the bone loss by periodontitis and cementoenamel junction boundaries were detected, while the tooth number and tooth length were identified using data from AIHub, an open database platform. The two factors were integrated to classify and to evaluate the periodontitis staging on dental panoramic radiography. Periodontitis is classified into four stages based on the criteria of the radiographic bone level, as suggested at the relevant international conference in 2017. For the integrated deep learning framework developed in this study, the classification performance was evaluated by comparing the results of dental specialists, which indicated that the integrated framework had an accuracy of 0.929, with a recall and precision of 0.807 and 0.724, respectively, in average across all four stages. The novel framework was thus shown to exhibit a relatively high level of performance, and the findings in this study are expected to assist dental specialists with detecting the periodontitis stage and subsequent effective treatment. A systematic application will be developed in the future, to provide ancillary data for diagnosis and basic data for the treatment and prevention of periodontal disease. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical performance of two flowable composites based on methacrylate and one based on ormocer in treating non-carious cervical lesions (NCCLs) after 48-month evaluation in a split-mouth double-blind clinical study design., Methods: A total of 183 restorations were performed on NCCLs using a universal adhesive system (Futurabond U, Voco GmbH) with selective enamel etching on 27 participants: two participants received twelve restorations each, three received nine restorations each, and 22 participants received six restorations each. Three different flowable composites were employed (n = 61): a low-viscosity methacrylate-based composite (GrandioSO Flow, LVM), a high-viscosity methacrylate-based composite (GrandioSO Heavy Flow, HVM), and an ormocer-based flowable composite (Admira Fusion Flow, ORM). All restorations were evaluated using FDI and USPHS criteria after 48 months. Statistical analysis was conducted using Kaplan-Meier Survival analysis and Kruskal-Wallis analysis of variance rank (α = 0.05)., Results: After 48 months, 17 restorations were lost: LVM 6, HVM 9, ORM 2. The retention rates (95 % confidence interval) were 89.4 % for LVM, 80.4 % for HVM, and 95.6 % for ORM, with a significant difference between HVM vs. LVM and HVM vs. ORM (p < 0.05). Minor defects were observed in 30 restorations for marginal staining criteria (LVM 12, HVM 10, ORM 8) and in 71 restorations for marginal adaptation criteria (LVM 24, HVM 20, ORM 27) without significant difference between groups (p > 0.05). No restorations showed postoperative sensitivity or recurrence of caries., Significance: The increased viscosity of flowable composites could reduce the clinical longevity in NCCLs after 48 months. Ormocer-based and low-viscosity methacrylate-based flowable composites showed a successful clinical performance in NCCLs after 48 months., (Copyright © 2024 Elsevier Inc. All rights reserved.)

To evaluate the effect of smear layer deproteinization using hypochlorous acid (HOCl) with/without metal chlorides (SrCl 2 and ZnCl 2) on the microtensile bond strength (µTBS) of two simplified adhesives to dentin. Human dentin surfaces with a standardized smear layer were pretreated using a 105 ppm HOCl solution with/without SrCl 2 (0.05 M, 0.1 M, 0.2 M, 0.4 M) or ZnCl 2 (0.05 M, 0.1 M, 0.2 M) for 5 s, 15 s, or 30 s. After the deproteinizing solution was washed out with water for 5 s, 15 s, or 30 s, pretreated surfaces were bonded with one-step self-etch adhesive Bond Force II or universal adhesive Clearfil Universal Bond Quick, and µTBS was measured after 24 h. Additionally, the deproteinizing effects of HOCl solutions with/without the metal chlorides were compared by measuring changes in the amide:phosphate ratio using attenuated total reflection Fourier transform infrared spectroscopy. Statistical analysis was performed using multifactor ANOVA, Tukey's post hoc tests and t-tests (p < 0.05). Pretreatment with pure HOCl for 15 s and 30 s significantly decreased the amide:phosphate ratio (p < 0.05), indicating effective deproteinization, but the µTBS of both adhesives increased significantly only if HOCl was washed out for 30 s (p < 0.05). Increasing the concentrations of metal chlorides enabled shortening of the wash-out time down to 5 s while maintaining the improved µTBS (p < 0.05). The deproteinizing effect of HOCl was not significantly altered by the addition of metal chlorides (p > 0.05). The effectiveness of smear layer deproteinization using HOCl can be improved by the addition of metal chlorides, as their increasing concentration allowed to shorten the wash-out time from 30 s down to 5 s • Hypochlorous acid (HOCl) was effective in deproteinizing the dentin smear layer. • HOCl pretreatment followed by 30 s wash-out time improved bond strength to dentin. • Metal chlorides (SrCl 2 and ZnCl 2) did not alter the deproteinizing ability of HOCl. • HOCl with metal chlorides improved bond strength to dentin at shorter wash-out time. • Metal chlorides were particularly effective at higher concentration (0.4 M SrCl 2). [ABSTRACT FROM AUTHOR]

Periodontitis is a common oral disease mainly caused by bacterial infection and inflammation of the gingiva. In the prevention or treatment of periodontitis, anti-bacterial agents are used to inhibit pathogen growth, despite increasing levels of bacterial resistance. Sapindus mukorossi Gaertn (SM) seed oil has proven anti-bacterial and anti-inflammation properties. However, the possibility of using this plant to prevent or treat periodontitis has not been reported previously. The aim of this study was to evaluate the effects of SM oil on experimental periodontitis in rats by using micro-CT and microbiota analysis. The distance between cementoenamel junction (CEJ) and alveolar bone crest (ABC) on the sagittal micro-CT slide showed that total bone loss (TBL) was significantly lower in CEJ-ABC distances between SM oil and SM oil-free groups on Day 14. Histology data also showed less alveolar bone resorption, a result consistent result with micro-CT imaging. The microbiota analyzed at phylum and class levels were compared between the SM oil and SM oil-free groups on Day 7 and Day 14. At the phylum level, Proteobacteria, Firmicutes, Bacteroidetes, and Actinobacteria were the dominant bacterium. Firmicutes in box plot analysis was significantly less in the SM oil group than in the SM oil-free group on Day 7. At the class level, Bacteroidia, Gammaproteobacteria, Bacilli, Clostridia, and Erysipelotrichia were the dominant bacteria. The bacteria composition proportion of Bacilli, Clostridiay, and Erysipelotrichia could be seen in the SM oil group significantly less than in t SM oil-free group on Day 7. Overall, the present results show that topical application of SM oil can reduce bone resorption and change bacteria composition in the ligature-induced periodontitis model. According to these results, it is reasonable to suggest SM oil as a potential material for preventing oral disease. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the radiographic reliability in the diagnosis of furcation involvement in first molars. A total of 52 subjects were included in the current study. Personal history regarding smoking was recorded and a periodontal examination was performed. Pocket depth (PD), clinical attachment level (CAL), gingival recession, and furcation involvement in all first molars were assessed for each patient. Periodontal staging and grading were evaluated using the new classification of periodontal disease. Class II and Class III furcation classification were more frequently observed in radiographs than the Class I furcation; however, no significant differences were observed. Radiographic observation of the furcation was seen more when PD and CAL were >5 mm in all molars. The presence of gingival recession and its relation to the radiographic assessment did not reveal any statistically significant association (p > 0.05) except for tooth #16. The trend of visibility of furcation radiographically was more as the grade of staging was increased. Moreover, the presence of smoking habits and visibility of furcation radiographically did not have any statistical significance. Smoking may not be a factor in the furcation involvement. There is a direct relationship between the staging and grading of the periodontitis and furcation involvement. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study is to assess the effect of open apex on working length (WL) determination with aid of cone-beam computed tomography (CBCT) and electronic apex locators (EALs). Methods. Thirty-two extracted human mandibular premolars were selected, and apical 5 mm was removed. Root canals were prepared from the apical to the coronal direction of the canal using peeso reamers up to size 5 (retrograde) to simulate open apex. The samples were analyzed by CBCT, and WL was established (CWL) by a radiologist. An endodontist prepared the access cavities, and visual working length (VWL) was recorded. The samples were embedded in a freshly mixed alginate mould up to cementoenamel junction. Each root canal length was measured with two different EALs—Root ZX mini and i Root. The measurements were repeated 3 times by using a digital caliper, and the mean was recorded by the endodontist who was blinded to the results of the CWL. The recorded data was statistically analyzed using the SPSS software. Results. The results of this study showed statistically significant difference between VWL and i Root, CWL and i Root, and Root ZX mini and i Root (p < 0.05). Amongst EALs, a superior accuracy was noted for Root ZX mini than as compared to i Root. However, no statistically significant difference was seen between Root ZX mini and CWL (p > 0.05). Conclusion. The present study showed that CWL is as accurate and reliable as VWL which is the gold standard. Amongst EALs, Root ZX mini performed more accurately than i Root. Preexisting CBCT scans should be used as an advantage in determining WL. [ABSTRACT FROM AUTHOR]

Objectives. Variations between the material compositions and the presence of a smear layer on the dentin surface may influence the bond strength of the material, thus this study evaluated the push-out bond strength of different calcium silicate materials to root dentin in the presence or absence of smear layer. Materials and Methods. The palatal canal of sixty maxillary first premolars were prepared and divided into three groups according to the materials to be used: ProRoot WMTA, Biodentine, and TotalFill FS. Each group was then divided into two subgroups; with and without a smear layer. Roots were sectioned into three slices and filled with the tested materials. Push-out bond strength of materials was measured by universal machine. Results. Bond strength of Biodentine was significantly higher than the MTA and TotalFill FS in the presence or absence of smear layer. Overall, removing the smear layer reduced the bond strength of the three materials. The reduction was significant for MTA and TotalFill FS but not for Biodentine. Conclusions. Biodentine demonstrated the highest bond strength to radicular dentin followed by MTA, and then TotalFill FS. Overall, removal of the smear layer from dentin surface reduced the bond strength of the calcium silicate root repair materials. [ABSTRACT FROM AUTHOR]

10-Methacryloyloxydecyl dihydrogen phosphate (MDP) has been regarded as the most effective dentin-bonding monomer for more than 20 years. Although the dentin-bonding promoting effect of MDP has been well demonstrated, the mechanisms by which it benefits the stably of collagen within the adhesive–dentin hybrid layer are not currently fully understood. The objective of this study was to investigate the roles of MDP and its calcium salt in preserving the adhesive–dentin hybrid layer. MDP-conditioned collagen was investigated by Fourier-transform infrared spectroscopy, Ultraviolet–visible spectroscopy, and molecular docking. The structural changes to the dentin surface upon acid-etching and MDP-conditioning were observed by SEM. X-ray diffraction and nuclear magnetic resonance were used to investigate the chemical interactions between MDP and HAp. The collagen-protecting effects of MDP and its Ca salt were investigated using in-situ zymography, rhMMP-9 colorimetric assay, hydroxyproline assay, and molecular docking. MDP forms a stable collagen-phosphate complex through hydrogen bonding with the collagen in dentin. Furthermore, it generates MDP-Ca salts that are deposited on the dentin collagen scaffold, protecting it from degradation. Moreover, both free MDP and the MDP-Ca salt inhibit matrix metallopeptidase and exogenous proteases, with the inhibitory effect of the calcium salt being significantly stronger than that of the free form. MDP-based adhesives preserve the collagen within the hybrid layer by simultaneously improving collagen's resistance to exogenous enzymes and inhibiting MMP activity, both of which contribute to the longevity of dentin–resin bonding. [Display omitted] • MDP-Ca salt is deposited on the dentin collagen scaffold to protect the collagen. • Both free MDP and the formed MDP-Ca salt inhibit MMP-9 directly. • MDP and MDP-Ca salt improve collagen resistance against exogenous proteases. • MDP exhibits a hydrophobic effect and stable binding to type-I collagen. [ABSTRACT FROM AUTHOR]

Background: Periodontitis causes attachment and alveolar bone loss; hence, this study aimed to determine the prevalence, frequency, and pattern of bone loss at first molar–incisor areas using Cone Beam Computed Tomography (CBCT) images. Methods: A retrospective, cross-sectional analysis was conducted of 250 randomly selected CBCT images of clearly defined full arches of patients aged from 18 to 70 years who were divided into six age groups and into male and female groups. Four sites around each tooth were scanned at several accesses for bone loss detection. Distance beyond 2 mm apical to the cementoenamel junction to the level of the remaining bone was considered to indicate bone loss. The Shapiro–Wilk test was used to test the normality of the data, and statistical tests were applied for data analysis at the 0.05 p-value level. Results: The rate and amount of bone loss within the examined sample were relatively high. The examined images generally revealed a higher rate of bone loss on proximal than on labial/buccal and lingual/palatal surfaces of the first upper and lower molars. The highest amount of bone loss among all the teeth scanned in this study was seen on the mesial and distal bone of mandibular incisors, 4.36 mm and 4.31 mm, respectively, exceeding that in the labial and lingual bone, 3.23 mm and 1.89 mm, respectively, and it was highly horizontal rather than vertical in pattern. Conclusions: Based on 250 randomly selected CBCT images of clearly defined, full upper and lower arches scanned for this study, it was concluded that the rate and amount of horizontal bone loss were less than vertical bone loss and was focused mainly in the interproximal areas of the first molars. However, the highest recorded amount of bone loss was at the proximal and labial aspects of the mandibular incisors. Furthermore, younger age groups displayed significantly higher rates and amounts of bone loss than older groups, with a slight predilection for males. [ABSTRACT FROM AUTHOR]

A palatogingival groove (PGG) is a developmental deformity that may cause a severe periodontal breakdown or combined endodontic and periodontal defect. In the present case, a 24-year-old patient reported a complaint of pain in the upper left front tooth region for 3 months. Clinical and radiological examination revealed a PGG in the permanent maxillary left lateral incisor. Cone-beam computed tomography showed multiple shallow grooves on the root surface and a deep palatal groove extending to the apex. Interdisciplinary management comprising endodontic therapy and intentional replantation was formulated. After endodontic procedure, tooth #22 was gently extracted. The shallow grooves were removed by odontoplasty. A Class II cavity was made in the deep palatal groove and was connected with the root-end preparation. The cavity was sealed with biodentin up to the cementoenamel junction and the coronal portion was sealed with light-cured glass-ionomer cement. The tooth was replanted in socket and splinted for 7 days. Follow-up visits revealed the functional status of tooth and complete bony healing. Tooth discoloration was successfully managed with intracoronal bleaching with sodium perborate. A 12-month radiographic follow-up revealed no evidence of root resorption or ankylosis. [ABSTRACT FROM AUTHOR]

Background: The depletion of bond strength after the bleaching procedure has resulted in the usage of several antioxidants to get rid of discharging oxygen from residual peroxides before any adhesive restorations. Aim: The in vitro study aimed to compare and evaluate the shear bond strength of composite after application of three over-the-counter natural antioxidants on bleached enamel. Materials and Methods: Thirty-six extracted human anterior teeth were decoronated at the level of cementoenamel junction and implanted into self-cure acrylic resin exposing the labial surface alone. The embedded specimens were categorized into six groups of six teeth each, and the groups were as follows: Group I: unbleached + composite bonding, Group II: bleaching + delayed composite bonding, Groups III, IV, and V: bleaching + antioxidants - olive oil/Vitamin E oil/propolis + immediate composite bonding, and Group VI: bleaching + immediate composite bonding. The shear bond strength analysis was performed with the help of the universal testing machine, and the values obtained were statistically analyzed using IBM SPSS for Windows, v. 21.0. Results: The results obtained from the study reveal that all the three experimental groups showed an increase in the shear bond strength in comparison to Group VI (positive control) and the difference in the bond strength between the experimental groups and positive control is also statistically significant. Conclusion: Within the limitations of this study, although the bond strength of composite resin after application of the three natural over-the-counter antioxidants falls very closely, the usage of oil-based antioxidants had been found to perform less effectively in improving the shear bond strength. [ABSTRACT FROM AUTHOR]

Aim: The study aims to compare and evaluate the fracture resistance of endodontically treated bicuspids instrumented with Hand Files, TruNatomy (TRN), ProTaper Next (PTN), ProTaper Gold (PTG), and WaveOne (WO). Materials and Methods: In total, 45 extracted single-rooted human premolar teeth were selected and sectioned at or below the cementoenamel junction to obtain roots 15 mm long. The samples were divided into four experimental groups and one control group (n = 9): instrumentation with nickel-titanium (NiTi) Hand Files (control group), instrumentation with TRN files, instrumentation with PTN files, instrumentation with PTG files, and instrumentation with WO files. The samples were obturated by lateral compaction technique using gutta-percha points and AH Plus sealer. A vertical load was applied to the tooth using the universal testing machine (Tecsol-TSI-BDS-2Kn-Sr No. 170710) for the fracture resistance test. Statistical analysis was performed. Results: The study reported that teeth instrumented with NiTi hand files exhibited the highest fracture resistance when compared to all the rotary and reciprocating file systems. Among rotary and reciprocating instruments, root prepared with TRN files showed the most significant resistance to fracture compared with PTN, PTG, and WO files. Conclusion: Within the limitations of this study, it can be concluded that minimally invasive instrumentation of the system preserves more pericervical dentin, which may increase the resistance to fracture. Results of this study and other studies support the use of minimally tapered instruments to improve the fracture resistance of endodontically treated teeth. [ABSTRACT FROM AUTHOR]

Context: The efficiency of the luting system to adhere with tooth and restoration is an important determinant factor in the success of indirect restoration. Aims: The aim of this study is to evaluate and compare the sealing ability of a new resin cement which was undergoing trial with other three luting cements. Settings and Design: In vitro study. Subjects and Methods: Forty extracted intact human premolars were selected and standardized class 5 preparations for inlays were done at cementoenamel junction of buccal surfaces and direct composite inlay was fabricated. The samples were randomly grouped into 4: Group I luted with Rely X ARC resin cement, Group II with DCRC-10, a new indigenously developed resin cement, Group III with FujiCEM, and Group IV with zinc phosphate. After 24 h storage, samples were thermocycled and immersed in basic fuchsine dye. The longitudinal sections were assessed under a stereomicroscope for microleakage using graded criteria. Statistical Analysis Used: To analyze leakage scores among four groups and between enamel and dentin/cementum margins, Kruskal-Wallis nonparametric test and the Mann-Whitney test at P < 0.05 were used. Results: The dye penetration at cementum/dentin margins showed a statistically significant difference among four groups (P < 0.001). Adhesive luting cements produced lesser leakage scores at both margins than those cemented with zinc phosphate. Conclusions: The indigenously developed resin cement (DCRC-10, Group II) is comparable to that of Group I (RelyX ARC) in terms of its luting efficiency. [ABSTRACT FROM AUTHOR]

Aim: The aim of the current study was to evaluate the radicular dentin defect during retreatment employed diverse NiTi hand and rotary retreatment file systems. Materials and Methods: Eighty mandibular premolars with a single root and root canal that were recently extracted were gathered and stored. The premolars were subject to decoronation at cementoenamel junction (CEJ) beneath irrigation with water to attain a uniform radicular length of 16 mm. Gutta-percha cones were covered with sealer and introduced into the root canal up to the working length. Eighty teeth were allocated at random into four groups with each group consisting of 20 samples. Group I: Control, Group II: EdgeFile XR retreatment rotary files, Group III: ProTaper Universal retreatment files, and Group IV: MTwo retreatment files. Under constant water cooling, the roots were cut flat with a diamond disc at apical third (3 mm), middle third (6 mm), and cervical third (9 mm) points. Stereomicroscope was employed to visualize the sections below × 20 magnification. Results: A statistically significant difference was noted among the groups with respect to the formation of radicular dentinal defects at 3 mm (P < 0.01) and 6 mm (P < 0.001), while the sections at 9 mm did not exhibit any statistically significant difference (P > 0.598). Conclusion: Despite the limitations in this study, it was concluded that all the evaluated file systems efficiently eliminated root canal filling during the retreatment. In addition, it was noted that the EdgeFile XR group exhibited fewer root dentin defects in comparison with the MTwo and ProTaper Universal group of files. [ABSTRACT FROM AUTHOR]

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Background: Despite constant advances in science, obscurity remains in the efficient removal of pulp stones to aid in successful root canal treatment. In this context, chemical means of dissolving pulp stones were explored. Aim: The aim of this study is to evaluate and to compare the efficacy of decalcifying agents on the dissolution of pulp stones. Materials and Methods: The study was divided into two groups for pulp stone analysis (21 samples) and dentin analysis (54 samples). Twenty-one pulp stones from patients aged 18–70 who underwent root canal treatment were collected and divided into three subgroups (n = 7) randomly. They were subjected to chemical treatment in a labeled glass container with 5 ml of the respective chemical agents, such as 17% ethylenediaminetetraacetic acid solution (positive control), no treatment (negative control), and newly developed Physiological Simulated Decalcifying Agent (PSDA). At the end of the study period (24 h), the samples were removed, rinsed with deionized water, and subjected to physical analysis, scanning electron microscopy (SEM), and Energy –dispersive X-ray spectroscopy (EDS) analysis. Under dentin analysis, 54 maxillary premolars scheduled for orthodontic extraction without caries or extensive restorations were selected, following which 2-mm thick transverse dentinal sections at the cementoenamel junction level were obtained and randomly divided into two groups for SEM (n = 21) and microhardness analysis (n = 33). The samples were subjected to respective chemical treatment groups similar to pulp stones for 24 h and analyzed using SEM, EDS, and microhardness analysis. Results: Postchemical treatment with the newly developed decalcifying solution, the pulp stones showed the absence of nodular crystallites and surface softening under SEM and a decrease in the calcium level under EDS analysis. Concerning the microhardness of dentin, no significant changes could be observed. Conclusion: The newly explored PSDA was found to be efficacious in the decalcification of pulp stones at a clinically relevant time of 24 h, without significantly affecting the structural integrity and the hardness values of dentin. [ABSTRACT FROM AUTHOR]

Aims: The goal of this study was to analyze the bacterial microleakage following two methods (heat vs. rotary) of postspace preparation after two-time intervals (immediate vs. 1 week later). Setting and Design: In vitro-comparative study. Materials and Methods: Eighty-two single-rooted teeth were decoronated at the cementoenamel junction. Root canals were prepared using rotary files. After root canal obturation, specimens were randomly allocated to 4 experimental groups based on the method of postspace preparation (heat or peeso reamer) and time interval (immediate or 1 week later) (n = 18). Group 1: Peeso reamer-immediate, Group 2: Heat-immediate, Group 3: Peeso reamer-1 week later, Group 4: Heat-1 week later. 10 specimens were considered as positive and negative controls (n = 5 each). Custom-made dual-chamber devices were used to appraise the bacterial microleakage for 60 days. Statistical Analysis Used: Data were analyzed with Chi-Square and Log-Rank tests and Cox regression. Results: All through the experimental period, there was no significant difference (P = 0.41) between the studied groups. Groups 2 and 4 had the highest microleakage and the lowest survival rate (55.56% ± 11.71%). Group 1 showed the lowest microleakage and the highest survival rate (77.8% ± 9.80%). Conclusions: The applied techniques for postspace preparation and the time intervals (neither independently nor simultaneously) showed no significant difference in the field of bacterial leakage. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the influence of the sonic device on the clinical performance of one‐step self‐etch adhesive systems in non‐carious cervical lesions (NCCLs) after 18 months. Materials and methods: Forty patients participated in this study. Eighty restorations were assigned to two groups (n = 40): Sonic application and Manual application. After the adhesive application (iBond Self‐Etch, Kulzer, Hanau, Germany), NCCLs were restored using composite resin (Charisma, Kulzer, Hanau, Germany). The restorations were evaluated at baseline and after 18 months both according to the Word Dental Federation (FDI) and the United States Public Health Service (USPHS) criteria. Friedman repeated measures analysis of variance by rank and Wilcoxon test for significance in each pair were applied (α = 0.05). Results: After 18 months, 38 patients were evaluated. Twenty‐three restorations were lost (19 for manual vs. 4 for sonic application). The retention rates (95% confidence interval) were 50% (CI 34.8%–65.1%) for manual application and 84.2% (CI 69.6%–92.6%) for sonic application (p < 0.05). Twelve restorations showed marginal staining (nine for manual vs. three for sonic application; FDI, p < 0.05) and nine some marginal discrepancy (seven for manual vs. two for sonic application; FDI, p < 0.05). No restorations showed postoperative sensitivity and caries recurrence at the time. Conclusion: The sonic application increases the retention rate of iBond Self‐Etch after 18 months of clinical evaluation in NCCLs. Clinical relevance: The application of a simplified self‐etch adhesive (iBond Self‐Etch) associated to a sonic device seems to be an alternative to improve the clinical behavior in NCCLs. [ABSTRACT FROM AUTHOR]

Some evidence suggests that teeth treated with endodontic surgery and considered to have healed over the short term are seen to relapse when evaluated again after 3 or more years. However, long-term evidence is limited. This study compares healing after endodontic microsurgery over long-term (5–9 years) vs middle-term (1–4 years) follow-up and assesses the influence of different healing predictors over time. A retrospective study was made, comparing the endodontic microsurgery healing rates after 1–4 vs 5–9 years of follow-up. Healing was assessed based on clinical and radiographic parameters. Simple binary logistic regression models were used to analyze the influence of patient age and gender, the type of tooth, previous radiographic lesion size, apical extent of previous root canal filling, the presence of a post, type of restoration, and interproximal bone level upon the endodontic microsurgery healing rate. A sensitivity analysis was used excluding cases of vertical root fracture. Two calibrated observers independently evaluated the periapical radiographs. A total of 332 patients (60% women and 40% men) were included in the study. Of the 332 analyzed teeth, 198 were subjected to middle-term follow-up (1–4 years), with a healing rate of 86.9%, while 134 were subjected to long-term follow-up (5–9 years), with a healing rate of 67.2%. There were no statistically significant differences in terms of gender, age, type of tooth, size of the lesion, apical extent of previous root canal filling, presence of a post, or type of restoration. The regression models identified 2 statistically significant associations: cohort and interproximal bone level (P <.05). A success rate of 86.9% was recorded after 1-4 years of follow-up, vs 67.2% after 5–9 years. Excluding cases of vertical root fractures, in the shortest follow-up cohort (1–4 years), the healing rate was 92.5%, vs 82.6% in the cohort with longer follow-up (5–9 years). The prognosis was influenced by the crestal bone level in relation to the cementoenamel junction of the tooth, being significantly poorer when probing depth was >3 mm mesial or distal to the treated tooth. [ABSTRACT FROM AUTHOR]

Introduction: Introduction: The present study aimed to evaluate the coronal discoloration of human teeth induced by using a new Endoseal MTA compared to an AH Plus Sealer. Methods: A total of 40 premolars extracted for orthodontic reasons were used in the present study. Then, the teeth were incised in the coronal third of the root 3 mm below the cementoenamel junction. Samples were randomly allocated to two experimental groups (group 1: AH Plus sealer, group 2: Endoseal MTA) and 6 teeth as the negative control group. The color evaluation was determined at four different times: before placing sealers (T0), 1 month (T1), 3 months (T2), and 6 months (T3) after that with an intraoral spectrophotometer. Data were analyzed using Multivariate Test and Hotelling's Trace. A P-value <0.05 was considered statistically significant. Results: The Endoseal group showed discoloration after 1 and 3 months of the placement of sealer as AH Plus sealer. Also, discoloration of the AH Plus group was higher than that of the Endoseal group after 3 months; however, it was not significant (P0.05). Furthermore, discoloration of the Endoseal group was significantly higher than that of the AH Plus group after 6 months (P<0.05). Discoloration tended to decrease until 6 months in both groups. Conclusion: The Endoseal group indicated discoloration which is comparable to AH Plus in 1 and 3 months; however, discoloration in the AH Plus group decreased compared to the Endoeseal MTA group after 6 months. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate marginal bone loss over a 10-year period in individuals and in tooth groups in relation to age and level of marginal bone.Materials and Methods: In 1997, 616 randomly selected individuals (mean age: 42 years, range: 21-63 years) underwent a full-mouth radiographic survey. In 2008, the survey was repeated in 362 of the same individuals (182 women and 180 men). The marginal bone level of each tooth was measured in mm from the cementoenamel junction to the marginal bone. These measurements were used to calculate marginal bone loss during the 10-year period for individuals and tooth groups in relation to age and to baseline marginal bone level, calculated as the average between measurements in 1997 and 2008 to circumvent regression towards the mean.Results: The average annual marginal bone loss was 0.09 mm (SD ± 0.04 mm) during the 10-year study period. The association between marginal bone loss and baseline marginal bone level was more pronounced in the youngest age group, compared to the other age groups. Molars displayed the most severe bone loss during the study period.Conclusion: Marginal bone loss over a 10-year period is associated with age and baseline marginal bone level. Younger individuals with a reduced marginal bone level were at higher risk for further bone loss. Molars lose marginal bone more rapidly than other tooth groups. [ABSTRACT FROM AUTHOR]

Circulating blood is a readily available scaffold when enough bleeding cannot be induced from periapical tissues during regenerative endodontic treatments (RETs). The aim of this investigation was to compare the radiographic outcome (ie, linear and 3-dimensional volumetric) of RET using periapical blood or circulating blood as scaffolds in sheep immature mandibular incisors. Thirty-two immature sheep mandibular central incisors were randomly assigned to the following groups (n = 8): the positive control groups, the pulps were removed without any treatment; the periapical blood group, RET was performed using periapical blood as the scaffold; the circulating blood group, RET was performed using circulating blood as the scaffold; and the negative control group, intact teeth without any treatment. After 8 months, micro–computed tomographic images of mandibular blocks were taken to assess the following: root length, root thickness at the midroot and cementoenamel junction levels, and the incidence of apical closure. Root structures were segmented, and root volumes were calculated and analyzed statistically. RET using periapical blood and circulating blood resulted in increases in root length and root wall thickness at the midroot and cementoenamel junction levels, the incidence of apical closure, and root volume (P <.05). There were no significant differences between the RET groups and the negative control group regarding linear measurements (ie, root length, root thickness, and apical closure) (P >.05). The root volumes of the 2 RET groups were similar (P >.05) and were less than those observed in the negative control group (P <.05). There were no significant radiographic differences between the RET groups using periapical blood and circulating blood as scaffolds. RET resulted in less root volume compared with normal root development. [ABSTRACT FROM AUTHOR]

Objective: This in vitro study aimed to evaluate the fracture resistance of endodontically treated premolar teeth restored with flowable short fibre-reinforced resin composite (FSFRRC) at varying depths within the root canals. Methods: Fifty freshly extracted human single-rooted premolars were divided into 5 Groups (n=10), Group I (IN) intact teeth, Group II (P) restored coronally with resin composite only, Group III, IV and V (FSFRRC2, FSFRRC4, FSFRRC6) based on post space preparation to the respective depths of 2, 4 and 6 mm. Root canal treatment was performed for all the samples of Group II, III, IV, V and the teeth were decoronated 2 mm above cementoenamel junction. Following decoronation, post space preparation was done to the depths of 2, 4, and 6 mm (Group III, IV, V). Teeth were restored with FSFRRC (Groups III-V) intra-radicularly and coronally sealed using resin composite. All the teeth were subjected to fracture strength test using Universal testing machine, and mode of failure was analysed. Kruskal-Wallis test followed by Dunn Post-hoc test was conducted for statistical analysis. Statistical significance was set at P<0.05. Results: All FSFRRC groups showed higher fracture resistance than teeth restored only with resin composite. FSFRRC4 and FSFRRC6 showed significantly (P<0.05) higher fracture resistance than intact teeth and other experimental groups. Conclusion: Intra-radicular placement of FSFRRC increased the fractured resistance significantly and may serve as a promising alternative to conventional post systems to rehabilitate endodontically treated teeth. [ABSTRACT FROM AUTHOR]

The purpose of this case report is to demonstrate direct access to obliterated root canals and root canal treatment with the aid of guided endodontics (GE) created with a three-dimensional (3D) printer using 3D imaging techniques. A female patient presented to our clinic with the complaint of percussion sensitivity in the left upper second premolar. According to the clinical and radiographic examination of the tooth, root canal obliteration was detected, extending 2 mm below the cementoenamel junction of the tooth. The root canals were localized using cone beam computed tomography (CBCT). The endodontic guide was prepared by transferring the images obtained with the intraoral scanner and the CBCT data to a 3D printer with a special computer program. Root canals were accessed with the help of this guide using endodontic bur. Root canal treatment of the patient was completed with routine endodontic procedures. After the treatment with the aid of GE, it was observed that the patient's symptoms disappeared and the tooth was in function. In the treatment of teeth with obliterated root canals, many complications can be prevented by providing a safe endodontic intervention with the aid of GE obtained with 3D printers. [ABSTRACT FROM AUTHOR]

The reported prevalence of periodontitis in children and adolescents varies considerably between populations globally. This cross‐sectional study compares clinical and microbiological findings on 83 Somali immigrants and 96 non‐Somali children aged 10–17 years old living in Trollhättan, Sweden. The clinical examination included registration of bleeding on probing, plaque, and calculus on incisors and first molars. The distance between cemento‐enamel junction and bone level was measured on bitewing radiographs. Pooled microbiological samples (1 μL) were taken from the mesial surface of 16, 11, 31, 36, and analyzed by culture and real‐time polymerase chain reaction for seven periodontal associated bacterial species. The Somali participants had poorer oral hygiene and more bleeding, plaque, and calculus. Ten of the Somali but none of the non‐Somali participants showed periodontal breakdown (radiographical bone loss > 3 mm), corresponding to a prevalence of 12% (95% CI: 5.9, 21.0%). The presence of A. actinomycetemcomitans was almost exclusively associated with Somali participants. Further, the JP2 clone was found in five Somalis (including two periodontitis cases) confirming the association of this clone with African populations. The Somali group showed significantly higher frequencies and numbers of Porphyromonas gingivalis and Treponema denticola, implying a mature and adult type of subgingival microbiota. [ABSTRACT FROM AUTHOR]

Background: Evaluate the use of collagen matrix (CM) as adjunctive to coronally advanced flap (CAF versus CAF + CM) to treat gingival recession (GR) associated with non-carious cervical lesion-combined defects (CDs).Methods: Sixty-two patients presenting 62 CDs (RT1 GR and non-carious cervical lesion (NCCLs) were randomly allocated to either CAF group (n = 31): partial restoration of the NCCL and CAF; or to CAF + CM group (n = 31): partial restoration of the NCCL and CAF associated with CM. Clinical, esthetic, patient-centered outcomes, and restorative parameters were assessed.Results: After 12 months, CD coverage were 55.2% for CAF and 54.4% for CAF + CM (P = 0.8). Recession reduction were 1.9 ± 0.8 mm for CAF and 2.0 ± 0.7 mm for CAF + CM (P = 0.6). CAF+CM resulted in higher increase in keratinized tissue (KT) width (CAF: 0.3 ± 0.7 mm; CAF + CM: 0.9 ± 0.8 mm; P = 0.004) and KT thickness gain (CAF: 0.1 ± 0.3 mm; CAF + CM: 0.7 ± 0.2 mm; P = 0.001). Both treatments presented low postoperative pain and resulted in esthetics improvements. In addition, no restoration was lost, 27.4% showed a reduction of the superficial polishing, and 8% showed marginal staining, but still clinically acceptable.Conclusion: Partial resin composite restoration (with the apical limit up to 1 mm of the estimated CEJ) and CAF alone or combined with CM are suitable for treating CDs. The use of CM provided additional benefits in terms of KT width and thickness gain. (NCT03341598). [ABSTRACT FROM AUTHOR]

Objective: To quantitatively study the effect of the labial inclination of the mandibular central incisors on the surrounding cortical and cancellous-bone morphology among patients with low-angle, skeletal class III malocclusion, by using cone-beam computed-tomography (CBCT) imaging. Materials and methods: The CBCT images of 60 patients with low-angle, skeletal class III malocclusion were divided into lingual-inclination, upright, and labial-inclination groups. The height of the alveolar bone and the thickness and area of the cortical, cancellous, and total alveolar bone were measured separately on each side of the mandibular central incisors. Results: The thickness of the labial cortical bone from 6 mm below the cementoenamel junction (CEJ) to the root apex; the thickness of the labial cancellous bone at the root apex; the total thickness of the alveolar bone at the root apex; the area of labial cortical bone; the total area of labial alveolar bone; and the height of the labial alveolar bone were highest in the labial-inclination group (all P<0.05). All these variables were positively correlated with the labial inclination of the mandibular central incisors (all P<0.05). There were no statistical differences between the groups for any of the measurements on the lingual side of the teeth (P>0.05). Conclusion: The morphology of the alveolar bone on the labial but not the lingual side of the mandibular central incisors was statistically significantly correlated with the labial inclination of those teeth in patients with low-angle, skeletal class III malocclusion. [ABSTRACT FROM AUTHOR]