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Background: Development of a standardized set of topic‐specific outcomes known as a Core Outcome Set (COS) is important to address issues of heterogeneity in reporting research findings in order to streamline evidence synthesis and clinical decision making. Aim: The aim of the current international consensus study is to identify "what" outcomes to include in the Core Outcome Set for Endodontic Treatments (COSET). Outcomes of various endodontic treatments (non‐surgical root canal treatment, surgical endodontics, vital pulp treatment and revitalization procedures) performed on permanent teeth were considered. Methods: A standard validated methodology for COS development and reporting was adopted. The process involved identification of existing outcomes through four published scoping reviews. This enabled creation of a list of outcomes to be prioritized via semi‐structured patient interviews, e‐Delphi process and a consensus meeting with a range of relevant global stakeholders. Outcomes were prioritized using a 1–9 Likert scale, with outcomes rated 7–9 considered critical, 4–6 are important and 1–3 are less important. Outcomes rated 7–9 by ≥70% and 1–3 by <15% of participants were considered to achieve consensus for inclusion in the COS. The outcomes that did not achieve consensus in the first round were considered for further prioritization in the second Delphi round and consensus meeting. Final decisions about the outcomes to include in COSET were made by voting during the consensus panel meeting using the Zoom Poll function. Results: A total of 95 participants including patients contributed to the COS development process. The consensus panel recommended, with strong consensus, eight outcomes shared across all treatment modalities for inclusion in COSET: pain; signs of infection (swelling, sinus tract); further intervention/exacerbation; tenderness to percussion/palpation; radiographic evidence of disease progression/healing; function; tooth survival; and patient satisfaction. Additional treatment specific outcomes were also recommended. Discussion: Many of the outcomes included in COSET are patient reported. All should be included in future outcomes studies. Conclusion: COSET identified outcomes that are important for patients and clinicians and validated these using a rigorous methodology. Further work is ongoing to determine "how" and "when" these outcomes should be measured. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the impact of different irrigation protocols on debris extrusion. Single-rooted teeth were distributed into groups based on the irrigation protocols (n = 40): 2.5% NaOCl (biomechanical preparation: 20 mL and final irrigation: 5 mL); 2.5% NaOCl (biomechanical preparation: 20 mL) + 17% EDTA (final irrigation: 2 mL) + 2.5% NaOCl (final irrigation: 3 mL); and a mixture of 5% NaOCl +18% HEDP (biomechanical preparation: 20 mL and final irrigation: 5 mL). The canals were prepared using a reciprocating instrument size 40/0.06. For final irrigation, the groups were reassigned based on the agitation methods (n = 10): (a) no agitation; (b) ultrasonic; (c) sonic; and (d) continuous rotation. The control group (n = 10) received saline solution without agitation. The amount of debris extruded was measured by weight and analysed using One-way ANOVA (α < 0.05). The subgroups treated with NaOCl + HEDP mixture showed a significantly higher amount of extruded debris (p < 0.05), while there was no difference among agitation methods in all groups (p > 0.05)., (© 2023 Australian Society of Endodontology Inc.)

Background: The main factors that affect the success of an endodontic infection are effective cleaning and shaping of the root canal system including complete disinfection by using chemical irrigating solutions and obturation with an endodontic sealer to provide a fluid-tight seal. Using rotary and hand instruments for shaping and cleaning the root canal along with irrigants produces a smear layer on the surface of root dentin affecting the penetration of the endodontic sealer into the dentinal tubules. This smear is difficult to remove with the use of only endodontic irrigants, hence, chelating agents were introduced in adjunct with irrigating solutions for irrigation protocol for effective removal of smear layer which effect the penetration of endodontic sealers into the dentinal tubules. Methods: 32 mandibular premolar teeth were used. The biomechanical preparation was done till Protaper F3 size. Irrigation was done with 2.5 mL sodium hypochlorite (NaOCl) solution after each instrumentation change for 1 min. Samples were then divided into 4 groups according to the irrigating solution used as the final rinse used with passive ultrasonic agitation. The groups were: Group I: 5 ml of saline, Group II: 5ml of 17% ethylenediaminetetraacetic acid, Group III: 5 ml of 10% citric acid, Group IV: 5 ml of 7% maleic acid each for one minute. All the canals were obturated with BioRoot tm RCS with gutta-percha using the ultrasonic condensation technique. For staining the samples for Confocal LASER microscopy, BioRoot tm RCS was mixed with Rhodamine B dye. Results: The maximum penetration of bio-ceramic sealer was observed in the coronal region. At the apical third, the maximum sealer penetration was seen with 7% maleic acid. Conclusions: Maximum sealer penetration was seen in the coronal section followed by the middle and apical section. Maximum sealer penetration was seen with 7 % maleic acid at the apical third., Competing Interests: No competing interests were disclosed., (Copyright: © 2022 Shekhar S et al.)

Background: There has been no unanimity concerning the ideal concentration of citric acid for safe use in clinical practice. This study evaluated the cytotoxicity and the antibacterial activity in infected dentinal tubules of 10% and 1% citric acid (CA) solutions., Methods: The cytotoxicity of CA solutions in DMEM (diluted 1/10, 1/100) was assessed in L-929 fibroblasts. A broth macrodilution method (MIC and MBC) was used to assess CA antibacterial concentration. The antimicrobial activity of CA solutions was also evaluated after their final rinse inside root canals in previously Enterococcus faecalis -contaminated dentinal tubules. Ten infected dentine samples were rinsed for 5 min with 5% NaOCl and subsequently with 1% citric acid for 3 min. Another 10 were rinsed with 5% NaOCl and 10% citric acid for 3 min; the remaining four specimens were utilized as positive controls. Two uncontaminated specimens were used as negative controls. After LIVE/DEAD BacLight staining, the samples were assessed using CLSM to analyze the percentage of residual live and dead cells., Results: Both undiluted and diluted CA solutions showed severe toxicity; no changes from normal morphology were displayed when diluted 1/100. The MIC and MBC of CA were 6.25 mg/mL and 12.50 mg/mL, respectively. CA solutions demonstrated significantly low levels of bacterial counts than the positive control group, reporting a value of 9.3% for the 10% solution versus the 1% solution (35.2%)., Conclusions: Despite its valuable antimicrobial properties, the cytotoxic effects of citric acid should be considered during endodontic treatment., Competing Interests: The authors declare no conflict of interest.

Introduction: dental procedures produce bio-aerosols that can carry the highly contagious COVID-19 virus. Hence, the entire dental care team has to follow the current COVID-19 related infection control protocols. The study aims to assess the knowledge, attitude, and practices associated with infection control methods during dental procedures among dental practitioners during the COVID-19 pandemic in India., Methods: the online questionnaire consisted of four sections namely, demographic details, eight questions on knowledge, four questions on attitude and eight questions on the practice of dentists during COVID-19 pandemic. One point was attributed for a correct response and zero point for an incorrect response. The study used descriptive statistics and binary logistic regression models in Jamovi 1.8.1 to establish relationships between knowledge, attitude, and practices among dental professionals and their demographic characteristics., Results: among 384 dentists, 294 (76.6%) were aware of the hand hygiene methods, 372 dentists (96.9%) were aware of the Personal Protective Equipment (PPE), 343 dentists (89.3%) recorded the body temperature of the patients. One hundred and thirty eight (138) dentists (35.9%) did not use rubber dam and 158 dentists (41.1%) were not aware of the four-handed dentistry. Among the study participants, 57.8% displayed adequate knowledge, 63.8% possessed good attitude and 93.5% followed good practices on COVID-19 appropriate infection control measures during dental procedures. The mean knowledge, attitude, and practice scores were found to be 6.61, 2.04, and 3.38 respectively. Based on multivariable binary logistic regression analysis, it is observed that males (aOR: 0.55, 95% CI 0.35-0.87; p=0.011) have a lower likelihood of having a good knowledge when compared with females after adjusting for the other independent variables in the model. Also, individuals with higher qualifications (aOR: 0.57, 95% CI 0.36-0.92; p=0.022) appear to have lower likelihood of having good knowledge on COVID-19 infection control methods during dental procedure., Conclusion: the study concludes that participants possess sound knowledge, attitude and practice on hand hygiene, PPE, patient triage and waiting area modifications at the workplace. However, poor response was noted on the use of rubber dam, remote telephonic screening and four-handed dentistry practice., Competing Interests: The authors declare no competing interests., (Copyright: Neetha Shenoy et al.)

To evaluate the antibacterial efficacy of HybenX, an endodontic irrigant against Enterococcus faecalis biofilm and determine its efficacy in removal of smear layer. Forty root canals were inoculated with E. faecalis for three weeks, divided into 4 groups and irrigated with: Group1: 5 ml 2.5% sodium hypochlorite; Group2: 5 ml 2% chlorhexidine gluconate; Group3: 5 ml HybenX; Group4: 5 ml distilled water (control). Dentin shavings were collected and plated on agar plates, followed by colony forming unit (CFU) determination. For smear layer removal examination, 30 single rooted teeth were instrumented and divided into 3 groups and treated with: GroupI: 5 ml of 17% EDTA; GroupII:5 ml of HybenX; and GroupIII: 5 ml of distilled water. Samples were then subjected to SEM examination. All irrigants showed a significant reduction in CFUs compared to the control group (P⟨ .001), but none compared to each other. Regarding smear layer removal in the apical third, EDTA removed smear layer more effectively than HybenX (P = .014). HybenX demonstrated good antimicrobial efficacy against E. faecalis biofilm and removed the smear layer effectively in coronal and middle third of the root canal system. HybenX can be considered as a promising irrigating agent in root canal treatment of infected teeth., (Copyright© 2021 Dennis Barber Ltd.)

This study evaluated different irrigation methods in smear layer removal from the root canal walls using maleic acid (MA). Maxillary anterior teeth (N=30, n=10 per group) were decoronated, canals were enlarged with Protaper (size F4) and allocated to three groups: EndoUltra: 2.5 ml of 7% MA was irrigated for 30 s, followed by EndoUltra activation for 30 s; EndoSafe: EndoSafe irrigation system was used for 1 minute using 5 ml of 7% MA; Side-vented needle: 30 gauge needle irrigation was performed for 1 min using 5 ml of 7% MA. After SEM analysis, the inter-examiner reliability was verified using Kendall's Co-efficient and data were analyzed using Pearson Chi-Square test. No statistical significant differences were found between the two examiners (p⟩0.05). In intra-group comparison, needle and EndoSafe irrigation demonstrated significantly better smear layer removal at middle third of the root canal system (p⟨0.05) when compared to apical third. In inter-group comparison, smear layer was minimally removed with needle irrigation. In the apical third, EndoUltra group removed smear layer more effectively. Endosafe needle irrigation in combination with 7% MA removed the smear layer in the root canal at best, while the EndoUltra performed the best at the apical third of the root., (Copyright© 2019 Dennis Barber Ltd.)

This study evaluated the effect of previous irrigation with chlorhexidine (CHX) on the bond strength of a calcium silicate-based material, Biodentine, when used for furcal repair. Furcal perforations were produced in 30 extracted mandibular molars. Teeth were divided into 3 groups according to the irrigant used: distilled water (DW), CHX followed by DW (CHX), and CHX followed by ethylenediaminetetraacetic acid (EDTA) and DW (CHX/EDTA). Biodentine was used to repair the perforations. A push-out bond strength test was performed after 7 days, and data were statistically analyzed using Kruskal-Wallis and Dunn tests (P < 0.05). The CHX/EDTA group showed significantly lower values than the DW and CHX groups (P < 0.05). The failure mode of the DW group was mainly mixed, while that of the CHX group was cohesive. The CHX/EDTA group exhibited adhesive and mixed failures. Irrigation with CHX prior to furcation repair did not result in a statistically significant difference, compared to the use of DW, in the push-out bond strength of Biodentine., Competing Interests: The authors report no conflicts of interest pertaining to any of the products or companies discussed in this article.

The analysis of molecular cues in dentinal fluid from an excavated cavity could improve diagnostics in the context of minimally invasive caries treatment. In the current clinical trial we assessed whether the dentinal fluid levels of MMP-9 (matrix metalloproteinase-9; neutrophil gelatinase) would increase with the progression of carious lesions. MMP-9 is associated with neutrophil-related tissue breakdown in the pulp. Absolute MMP-9 levels were contrasted against the levels of MMP-2, an enzyme related to normal tissue turnover. Dentinal fluid was collected below deep and shallow caries from molars and premolars within the same patients aged 18 years and older (n = 30, 1 tooth per group/patient). Experimental teeth were isolated under a rubber dam prior to excavation. Dentinal fluid was collected from the bottom of the cavity using a size 25 paper point. MMP levels were assessed using an enzyme-linked immunosorbent assay. Nonparametric methods were applied to test for differences between groups. Significantly more (p < 0.05, Wilcoxon test) MMP-9 was collected from the deep carious lesions than from the shallow counterparts. Pairwise comparison of MMP-9 values within patients revealed that there was more MMP-9 collected from deep lesions than from shallow counterparts in 27 of the 30 individuals under investigation (pairwise Wilcoxon test, p < 0.001). In contrast, no such difference existed for MMP-2. There was a high correlation between MMP-9 from deep and shallow lesions (Spearman's ρ = 0.72, p < 0.001), indicating that patients with more MMP-9 in the deep carious lesion also tended to have more MMP-9 in the shallow lesion., (© 2017 S. Karger AG, Basel.)

Introduction: Accurate determination of working length (WL) is a critical factor for endodontic success. This is commonly achieved using an apex locator which is influenced by the presence or absence of the apical constriction. Hence, this study was done to compare the accuracy of two generations of apex locators in teeth with simulated apical root resorption., Materials and Methods: Forty maxillary central incisors were selected and after access preparation, were embedded in an alginate mold. On achieving partial set, teeth were removed, and a 45° oblique cut was made at the apex. The teeth were replanted and stabilized in the mold, and WL was determined using two generations of apex locators (Raypex 5 and Apex NRG XFR). Actual length of teeth (control) was determined by visual method., Statistical Analysis: Results were subjected to statistical analysis using the paired t-test., Results: Raypex 5 and Apex NRG was accurate for only 33.75% and 23.75% of samples, respectively. However, with ±0.5 mm acceptance limit, they showed an average accuracy of 56.2% and 57.5%, respectively. There was no significant difference in the accuracy between the two apex locators., Conclusion: Neither of the two apex locators were 100% accurate in determining the WL.

Mucosal fenestrations are rarely encountered in clinical practice, and as such their management is not often reported. Their treatment might be further complicated due to a communication with the oral environment, making them more susceptible to accumulation of debris, plaque, and calculus, thereby reducing the probability of mucosal renewal. The aim of the present case report is to highlight one such rare clinical scenario and its apt and effective management. Surgical management of an uncommon presentation of concomitant gingival recession with an isolated mucosal fenestration in an atypical location, with an allograft matrix is presented here with 2 years' follow-up. A review of the literature reveals no previous application of AlloDerm graft for the management of a similar situation.

Fighting the controversies, amalgam, as a posterior restorative material has survived till date. The fate of amalgam restoration is determined by geometry of the cavity preparation and cavosurface angle is one integral part of the cavity, which decides the marginal characteristics of the restoration and health of the tooth. Low edge strength of amalgam highlights the importance of cavosurface angle. However, at the same time conservation of the tooth also should be considered. This article presents a self-designed instrument to evaluate and obtain a cavosurface angle close to 110°. The design of the instrument also helps in evaluating parameters, such as depth of the cavity, undercut angle, and allows finishing of the buccal or lingual walls.

Aim: The objective of the present study was to evaluate and compare the wetting behavior of three different root canal sealers on the root canal dentin surface treated with irrigants and their combination., Materials and Methods: Decoronation and apical third resections of 27 extracted single-rooted human mandibular premolars were done. The roots were then split longitudinally into two halves, and randomly assigned into three treatment groups (n=18). The root dentin surfaces in Group1, Group 2 and Group 3 were treated with 17% ethylene diamine tetra acetic acid (EDTA), 3% sodium hypochlorite (NaOCl) and combination of 17% EDTA and 3% NaOCl, respectively. Each group was subdivided into three subgroups of 6 specimens each, depending on the the sealer used, i.e. sub group A. zinc oxide (ZnOE), sub group B. AH plus, subgroup C. Guttaflow sealer, respectively. The contact angle was measured using First Ten Angstroms (FTA) 200 dynamic contact angle analyzer., Results: The contact angle values for AH Plus sealer were significantly lower when compared to the other two sealer groups., Conclusion: The wettability of AH Plus sealer on the root surface dentin was found to be better than Gutta-Flow and ZnOE sealer.

The purpose of this article is to report a rare case of orthodontically induced external root resorption of a maxillary left central incisor with a large periapical radiolucency; it was treated successfully with a conservative approach that included the use of calcium hydroxide. The tooth was nonvital and had grade III mobility. It was treated endodontically for 2 years with an interim filling of calcium hydroxide mixed with propylene glycol. After 2 years, the postoperative intraoral periapical radiograph showed good periapical healing with complete resolution of periapical radiolucency. There was a significant reduction in the mobility of the tooth, from grade III to grade I.