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Abstract Aim This research aimed to use an extra-oral 3D scanner for conducting volumetric analysis after caries excavation using caries-detecting dyes and chemomechanical caries removal agents in individuals with occlusal and proximal carious lesions. Methods Patients with occlusal (A1, A2, A3) and proximal carious lesions (B1, B2, B3) were treated with the conventional rotary technique, caries detecting dyes (CDD) and chemomechanical caries removal (CMCR) method on 90 teeth (n = 45 for each). Group A1, B1: Excavation was performed using diamond points. Group A2, B2: CDD (Sable Seek™ caries indicator, Ultradent) was applied and left for 10 s, and then the cavity was rinsed and dried. For caries removal, diamond points or excavators were used. Group A3 and B3: BRIX3000 papain gel was applied with a micro-brush for 20 s and was activated for 2 min, and then the carious tissue was removed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required and the verbal pain score (VPS) for pain were scored during excavation. Post-restoration evaluation was performed at 1, 3, and 6 months FDI (Federation Dentaire Internationale) criteria. Results Comparison of age, time and volume with study groups were made using Independent Sample’ t’ test and one-way analysis of variance (ANOVA) for two and more than two groups, respectively. Using Cohen’s Kappa Statistics, evaluators 1 and 2 agreed on caries removal status aesthetic, functional and biological properties at different follow-ups. The chi-square test revealed that the rotary groups [A1(2.5 ± 0.4 min) B1(4.0 ± 0.4 min)] had significantly less (p = 0.000) mean procedural time than CDD [A2(4.5 ± 0.4 min) B2(5.7 ± 0.4 min)] and CMCR [A3(5.4 ± 0.7 min) B3(6.2 ± 0.6 min)] groups. The CMCR group showed better patient acceptance and less pain during caries excavation than the rotary and CDD groups. CMCR group showed significantly less mean caries excavated volume(p = 0.000). Evaluation of restoration after 1-, 3-, and 6-month intervals was acceptable for all the groups. Conclusion Brix3000 helps effectively remove denatured teeth with less pain or sensitivity. The time required for caries removal was lowest in the rotary method and highest in the brix3000 group, while the volume of caries removed was the lowest for brix3000 and highest for the rotary group.

Clinicians always face a challenge in selecting the appropriate material for clinical use. Presently, the term bioactive is being used judiciously and unquestionably in the field of dental materials. The introduction of nanotechnology brought about a revolution in material science leading to the development of bioactive materials for caries prevention and management. This review comprehensively evaluates the use of bioactive materials for modification of the oral biome, prevention of dental caries, and the management of dental caries as restorative materials. Six online database (PubMed, Scopus, Science Direct, Embase, Web of Science, and Cochrane library) were systematically searched using broad keywords. Published articles were scrutinized, analyzed and the full-text articles were selected. Data reveals relatively limited application of tissue engineering and regeneration for enamel and dentin due to their limited ability to remodel. However, many steps are being taken in biomimetic approach for the modification of dentin. The path to overcoming any challenges will require active collaboration among clinicians, a material scientist and pulp biologist.

Objective: This study aimed to evaluate oral hygiene status, salivary fluoride concentration, and Streptococcus mutans and Lactobacillus levels in saliva of thalassemic, hemophilic and individuals without any other systemic disorders. Materials and Methods: A total 162 individuals (44 healthy individuals, 86 thalassemic and 32 hemophilic patients) were selected, and randomly (n=30 in each group), the patients were allocated to Group A: individuals without any systemic condition, Group B: thalassemic patients, and Group C: hemophilic patients. Detailed case history, DMFT/DMFS, and OHI-S index were recorded. An aliquot of 5 ml of saliva was collected from each patient to determine the salivary fluoride concentration and predominant microbial colony in saliva. The data were analyzed by chi-square test of independence and nonparametric Kruskal-Wallis H test. Results: The mean debris and calculus index among groups A, B, and C was 0.55 ± 0.43, 0.61 ± 0.46, 0.46 ± 0.47 and 0.33 ± 0.48, 0.18 ± 0.34, and 0.15 ± 0.34, respectively. The DMFT score for group A was high (1.93 ± 1.86, 1.67 ± 1.92) compared to groups B (0.40 ± 0.77, 0.67 ± 1.37) and C (0.47 ± 0.68, 0.30 ± 0.54). The fluoride concentrations among three groups (A, B, and C) were 0.06 ± 0.07, 0.12 ± 0.13, and 0.12 ± 0.13 ppm respectively. The number of colony-forming units was highest in the healthy individual>hemophilic>thalassemic and presence of predominant microorganisms showed insignificant association among the groups (p=0.323). Conclusion: Compared to healthy individuals, thalassemic and hemophilic patients had better oral hygiene.

Introduction: The nature and progression of acute and chronic carious lesion are extremely variable on different tooth surfaces. Early detection of dental caries is challenging for clinicians and involves careful visual and tactile examination. Caries detection dyes and chemomechanical caries removal solutions guide the clinicians in the removal of infected dentin. This study aims to prepare and analyze the physical, chemical, and thermal characterizations of novel bioactive caries detecting dye solution (BCD) and its effectiveness in caries removal from the tooth structure. Materials and Methods: BCD is a combination of contrast agent (iobitridol), chitosan (CS), nanohydroxyapatite (nHAP), and coloring agent. It is synthesized, lyophilized, and subjected to Fourier transformed infrared spectroscopy (FTIR), X-ray diffraction (XRD), and differential scanning calorimeter (DSC) analysis. Pilot study was conducted by applying BCD on two extracted carious teeth for evaluating caries removal efficiency under a microscope (10x). Scanning electron microscopy (SEM) image analysis was done to assess the percentage of dentinal tubules occlusion. Results: FTIR, XRD, and DSC analysis revealed that BCD has compatible interfacial bond between the components and is endothermic. Effective caries removal was seen under a microscope and SEM analysis revealed mean 77.66% of dentinal tubules occlusion. Conclusion: BCD is a stable solution without exothermic reaction, has caries identifying potential, and helps in caries removal. BCD is also bioactive in nature due to the presence of CS and nHAP as ingredients.

Background: The goal of materials should be early caries detection, removal of carious lesions, and reduction of dentin hypersensitivity. Thus, the study aims to determine the efficacy of a bioactive caries detecting dye (BCD) for the diagnosing and mechanical removal of occlusal and proximal dental caries. Methods: Patients with occlusal (A1, A2) and proximal carious lesions (B1, B2) were treated with the rotary technique and BCD solution on 120 teeth (n = 60 for each). Group 1: Excavation was performed using diamond points. Group 2: 0.5 mL of BCD solution was scrubbed for 20 sec and excavation was performed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required, VAS for pain, VAS for facial expression, and sound eye motor scoring were scored during excavation. Post-restoration evaluation was performed at 3, 6, and 12 months (FDI criteria). Results: The chi-square test revealed that the A1 (197.90 30.97 s) and B1 (273.06 69.95 s) had significantly less mean procedural time than the A2 (292.13 44.87 s) and B2 (411.86 88.34 s). BCD (A2, B2) group showed good patient acceptance, less pain during caries excavation VAS (p = 0.001, FACE (p = 0.001), and SEM (p < 0.001) analysis than the rotary group. There was a statistically insignificant difference between groups immediately (p = 0.235), (p = 0.475) and after 24 h (p = 0.561), (p = 0.688). Color score, hardness of excavated surface, and caries removal score for occlusal and proximal groups showed insignificant differences between the groups. BCD group showed significantly less mean caries excavated volume for the occlusal group (p = 0.003) as compared to the proximal group (p = 0.417) evaluated by 3D scanner. Evaluation of restoration after 3-, 6-, and 12 months intervals (Occlusal caries group (p = 0.247), (p = 0.330), and (0.489) and Proximal caries group (p = 0.299), (p = 0.594), and (0.494)) was acceptable for both the groups. Conclusion: BCD helps in identification of dental caries clinically, radiographically, and in effective removal of denatured teeth with less pain or sensitivity.

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]

Nanotechnology is emerging as an interdisciplinary field that is undergoing rapid development and has brought about enormous changes in medicine and dentistry. Nanomaterial-based design is able to mimic some of the mechanical and structural properties of native tissue and can promote biointegration. Nanotechnology has various applications in dentistry, including dentition renaturalization, therapy for dentin hypersensitivity, complete orthodontic realignment in a single visit, covalently bonding diamondized enamel, enhancing properties of root canal sealers, and continuous oral health maintenance using mechanical dentifrobots. A range of synthetic nanoparticles such as hydroxyapatite, bioglass, titanium, zirconia, and silver nanoparticles are proposed for dental restoration. This review focuses on the developments in the field of nanomaterials in dentistry in the form of tissue regeneration materials, implantable devices, nanocomposites, endodontic sealers etc. and issues of patient safety. [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]