Antimicrobial efficacy of two commercially available herbal products with and without ultrasonic activation in primary endodontic infections: A randomized clinical trial

Background

Effective irrigation is crucial for successful endodontic treatment. Traditional irrigants like sodium hypochlorite (NaOCl) have been widely used, but there is a growing interest in exploring natural alternatives for their potential antimicrobial properties.

Objective

The study aims to compare the antimicrobial efficacy of Neem, Bitter Gourd, and NaOCl, with and without ultrasonic activation in managing primary endodontic infections.

Materials and Methods

Ninety patients were randomly assigned six groups (n = 15) Group 1: NaOCl, Group 2: NaOCl with passive ultrasonic irrigation (PUI), Group 3: Neem juice, Group 4: Neem juice with PUI, Group 5: Bitter gourd juice, and Group 6: Bitter gourd juice with PUI. Bacteriological samples were collected before (S1) and after (S2) shaping, plated on brain heart infusion agar, and colony counting was done after 24 h.

Statistical Analysis Used

Shapiro-Wilk test, one-way ANOVA, post hoc Tukey analysis, and paired t-test.

Results

All the groups demonstrated a significant reduction in bacterial count. Groups with PUI (2, 4, 6) demonstrated higher mean bacterial reduction than their counterparts without PUI (1, 3, 5).

Conclusion

Neem and Bitter gourd juices, particularly when used with PUI, demonstrated antimicrobial efficacy comparable to NaOCl with PUI.

The Successful Interdisciplinary Outcome of Blunderbuss Canal with an Open Apex Using MTA under Magnification: A Case Report

Aim and objective

The present case report aims to describe the nonsurgical management of an anterior tooth with a blunderbuss canal and an open apex using mineral trioxide aggregate (MTA) under magnification.

Background

When pulp is traumatized before root formation, it results in pulpal necrosis, due to which dentin and root formation are interrupted. As a result, the canal remains broad due to thin and fragile dentin walls leading to the open apex. Therefore, root canal treatment is a big challenge currently. In such cases, we prefer MTA apexification to form the hard tissue apical barrier, which is a foreseeable treatment and has been used as another advanced method than calcium hydroxide (CaOH2) apexification due to its superior properties.

Case description

A novel apexification technique was used by the Departments of Pediatric Dentistry and Conservative Dentistry and Endodontics for MTA placement in the central incisor with respect to 11 of a 9-year-old female patient. MTA was used to form an apical barrier using the micro-apical placement (MAP) system under a dental operating microscope (DOM). Following MTA hard set confirmation, obturation with bioceramic sealer and gutta percha with warm vertical condensation was done, followed by post-endodontic composite restoration.

Conclusion

This case describes the nonsurgical management of an open apex using MTA, MAP system, magnification, and bioceramics, which aided in the management of this endodontic enigma.

How to cite this article

Bhasin P, Saraf BG, Chauhan S, et al. The Successful Interdisciplinary Outcome of Blunderbuss Canal with an Open Apex Using MTA under Magnification: A Case Report. Int J Clin Pediatr Dent 2024;17(1):97-101.

Root Canal Cleaning after Different Irrigation Techniques: An Ex Vivo Analysis

Background and Objectives: The endodontic space is a complex area on both micro and macro levels; therefore, traditional irrigation techniques may not guarantee a complete cleaning of such a complicated tridimensional system. The presented ex vivo study aimed to evaluate root canal cleanliness, obtained through an equal volume of traditionally applied sodium hypochlorite (NaOCl), compared to ultrasonically activated NaOCl and ultrasonically activated NaOCl that had undergone intracanal heating NaOCl. Materials and Methods: A total of 60 freshly extracted human mandibular premolars underwent root sample length standardization (18 mm), root canal preparation and, based on the irrigation method employed, were randomly and equally assigned to three study groups, composed of root samples treated with ultrasonically activated NaOCl, ultrasonically activated NaOCl that had undergone intracanal heating and traditionally applied NaOCl. The root specimens were subsequently fixated with 4% buffered formalin solution and decalcified in Morse liquid. A total often 6-micron-thick serial cross-sections were obtained, dyed using hematoxylin and eosin and examined through an optical microscope at 40×, 100×, and 200×. Results: Ultrasonically activated NaOCl that had undergone intracanal heating showed a significantly smaller amount of debris compared to ultrasonically activated and traditionally applied NaOCl groups (p value < 0.05). Conclusions: Root canal cleanliness saw significant enhancements by ultrasonically activated NaOCl that had undergone intracanal heating.

Assessment of C-Reactive Protein Level in Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma Patient

Background:

Potentially malignant disorders are highly prevalent in India. In this study, we assessed C-reactive protein (CRP) levels in patients with oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC).

Methodology:

Sixty-four patients (OSMF and OSCC) were undertaken and were classified into 3 groups, OSMF patients (Group I, 34), OSCC (Group II, 30), and healthy controls (Group III, 26). Immunoturbidimetry method was used for the estimation of CRP levels.

Results:

Maximum cases in Group I was seen in the age group 40–60 years (males-10, females-3), Group II in the age group 40–60 years (males-11, females-5) and Group III (males-5, females-6). The mean CRP level in Group I was 6.12 ± 4.5 mg/l, in Group II was 28.4 ± 21.5 mg/l, and in Group III was 3.15 ± 2.19 mg/l. The difference was significant (P < 0.05).

Conclusion:

Authors found that OSMF and oral cancer patients had increased CRP levels as compared to healthy subjects.

An In Vitro Evaluation of Antimicrobial Effects of Three Different Root Canal Irrigating Solutions against Enterococcus faecalis and Streptococcus mutans

AIM

The present study was conducted to evaluate and compare antimicrobial effect of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) and N-Acetylcysteine (NAC) irrigating solutions against Enterococcus faecalis (E. faecalis) and Streptococcus mutans (S.mutans).

MATERIALS AND METHODS

The present study was conducted on 40 freshly extracted noncarious permanent mandibular incisors teeth of both genders (males-12, females-14). In all teeth, root canal preparation was done up to size 40 K-file. Roots were sterilized and microbial suspension of mixed culture of the tested microorganisms was inoculated into canals and incubated for 48 h. Teeth were divided into four groups, group I (5.25% sodium hypochlorite), group II (2% chlorhexidine), group III (200 mg/mL N-Acetylcysteine NAC) and group IV (sterile distilled water). The antimicrobial effect in each group was compared.

RESULTS

Statistical evaluation was completed using statistical software Statistical Package for the Social Sciences (SPSS). Planktonic S. mutans bacterial count was lowest in group III followed by group I, group II and group IV.E. faecalis count was 6.14 ± 0.12 in group I, 5.76 ± 0.44 in group II, 3.88 ± 0.08 in group III and 11.98 ± 1.04 in group IV. The difference was significant (p < 0.05). The proportion of dead cell found to be 0.04± 0.01, 0.72 ± 0.06, 0.01 ± 0.06 and 1.02 ± 0.11 in groups I, II, III and IV respectively. The difference was significant (p < 0.05).

CONCLUSION

NAC proved to be effective against E. faecalis and S. mutans. This solution can be considered alternative in root canal infections in addition with CHX and NaOCl.

CLINICAL SIGNIFICANCE

Effectiveness of three different irrigating solutions was compared and NAC found to be more efficient in decreasing bacterial count. Hence, NAC can be precisely used in irrigating root canals to achieve optimal clinical outcomes particularly regarding reoccurrences of infections. Furthermore, NAC could be proved as a promising innovation in future endodontic methodologies.

Comparative efficacy of placental membrane and Healiguide™ in treatment of gingival recession using guided tissue regeneration

Background

Guided tissue regeneration-based root coverage has emerged as a promising treatment modality in the treatment of gingival recession. A variety of nonresorbable and bioresorbable membranes have been successfully used. Among resorbable membranes, collagen has been extensively studied. Recently, a third generation barrier membrane derived from placenta has been introduced for periodontal regeneration.

Aim

The objective of the present study is to clinically compare the efficacy of placental membrane (Amnion) and collagen membrane (Healiguide) for the treatment of gingival recession.

Materials and Methods

Twelve patients having isolated bilateral gingival recession defects were included in the study and were divided into two groups randomly. Group I were treated by coronally positioned flap and amnion membrane and Group II were treated by coronally positioned flap and collagen membrane (Healiguide)™. Clinical parameters, including dental plaque index (PI), gingival index (GI), gingival recession depth, probing pocket depth, clinical attachment level, and gingival biotype, were recorded before surgery at baseline and then reevaluated at 3 and 6 months postoperatively.

Statistical Analysis

Nonparametric test, i.e., Wilcoxon Signed-Ranks Test was used in the present study. Significance was reported at 95% confidence level.

Results

The results of the present study revealed statistically no significant difference (P > 0.05) in dental PI improved, GI and probing pocket depth in both groups. Significant reduction in gingival recession defects and gain in clinical attachment level was observed in both the groups. Intergroup comparison of gingival recession defects and clinical attachment level yielded nonsignificant differences. However, a statistically significant increase (P < 0.05) in gingival tissue thickness was observed in Group II as compared to Group I.

Conclusion

Both membranes are equally efficacious in the treatment of gingival recession. More gingival tissue thickness (gingival biotype) enhancement was observed in sites treated with collagen membrane.

Relative bradycardia in patients with traumatic hypotension

BACKGROUND

Tachycardia is considered a physiologic response to traumatic hypotension. The inability of the heart to respond to shock with tachycardia has been described as paradoxical bradycardia or relative bradycardia. The incidence and clinical significance of this condition in major trauma is not known. The objective of this study was to examine the incidence and prognostic significance of tachycardia and relative bradycardia in patients with traumatic hypotension. Relative bradycardia is defined as a systolic pressure < or = 90 mm Hg and a pulse rate < or = 90 beats per minute.

METHODS

This is a retrospective study conducted at a large Level I academic trauma center during a 4-year period. Seventeen demographic and injury severity factors were analyzed for their possible role in tachycardic or bradycardic response in hypotensive patients. Incidence and mortality were derived for each subpopulation. Bivariate analysis of the association of incidence and mortality with each risk factor was performed. Factors with p values < 0.2 were included in stepwise logistic regression analyses that identified significant risk factors and derived adjusted relative mortality risks between tachycardic and bradycardic hypotensive patients.

RESULTS

Excluding transfers and patients dead on arrival, 10,833 major trauma patients were seen during the study period. Seven hundred fifty patients (6.9%) had systolic blood pressure < or = 90 mm Hg; 533 patients had tachycardia (overall incidence of 4.9%, or 71.1% of hypotensive patients), and 217 patients had bradycardia (overall incidence of 2.0%, or 28.9% of hypotensive patients). The overall crude mortality was 29.2% among tachycardia patients and 21.7% among bradycardia patients (crude relative risk = 1.34; 95% confidence interval = 1.00-1.81; p = 0.047). The adjusted relative mortality risk between the two groups was 1.23 (95% confidence interval = 0.84-1.73; p = 0.284). Multivariate analysis showed that patients with relative bradycardia in the subgroups with Injury Severity Scores > or = 16, chest Abbreviated Injury Scale scores > or = 3, or abdominal Abbreviated Injury Scale scores > or = 3 had significantly better survival than patients with similar injuries presenting with tachycardia.

CONCLUSION

Relative bradycardia in hypotensive trauma patients is a common hemodynamic finding. Mortality among tachycardic patients was more predictable than among bradycardic patients using commonly used demographic and injury indicators. The presence of relative bradycardia in some subgroups of patients with severe injuries seems to be associated with better prognosis than the presence of tachycardia.

Chronic verapamil treatment attenuates the negative inotropic effect of ethanol in diabetic rat myocardium

It is well established that cardiomyopathy is a consistent feature of diabetic myocardium and that alcohol consumption increases the risk of cardiovascular disease among diabetic subjects. The objective of this investigation was to determine whether acute or chronic verapamil treatment attenuates the negative inotropic effect of ethanol (EtOH) in the diabetic rat heart. Wistar rats were made diabetic with streptozotocin (55 mg/kg, iv). Left-ventricular papillary muscles, from normal and diabetic (8 weeks) rats, were superfused with Tyrode's solution at 30 degrees C while driven at 0.5 Hz. A subgroup of diabetic and normal animals received daily injections of verapamil (8 mg/kg, ip; 8 weeks), whereas muscles from untreated animals were exposed to verapamil (2 microM) in vitro. Peak tension developed (PTD), time to peak tension (TPT), time to 90% relaxation (RT90), and the maximum velocities of tension development (+VT) and decay (-VT) were determined in the absence and presence of clinically relevant concentrations of EtOH (80-240 mg/dL, i.e., 17.4-52.1 mM). Ethanol at 80 mg/dL reduced PTD, +VT, and -VT only in preparations from diabetic animals. Higher concentrations of EtOH (120-240 mg/dL) decreased PTD, TPT, +VT, and -VT. The negative inotropic effect of EtOH (240 mg/dL) was attenuated only in diabetic myocardium chronically treated with verapamil, whereas acute verapamil treatment potentiated the negative inotropic effect of EtOH in both normal and diabetic myocardium. Thus, chronic verapamil therapy diminishes the negative inotropic effect of EtOH in diabetic myocardium and acute verapamil treatment exaggerates it.(ABSTRACT TRUNCATED AT 250 WORDS)

Respiratory symptoms and pulmonary function in farmers

A questionnaire was given to 1,824 farmers and 556 control subjects in Saskatchewan to assess respiratory health and pulmonary function tests. With data corrected for age and smoking, farmers were found to have increased prevalences of the respiratory symptoms of phlegm, wheeze, shortness of breath, and the condition of chronic bronchitis. In addition, farmers had significantly lower values for the pulmonary function test variables forced vital capacity (FVC), forced expired volume in one second (FEV1) and maximum midexpiratory flow rate. However, the FEV1/FVC ratio was slightly but significantly greater in farmers than in control subjects. These findings suggest an increase in respiratory symptoms in farmers compared with rural control subjects who are not farmers and a decrease in lung volume and expired flow rates. The slightly high FEV1/FVC ratio may indicate a mixed obstructive and restrictive picture.