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Lodi E, Bello YD, Duarte KBDP, Montagner F, Cecchin D. Antimicrobial Efficacy and Dentin Collagen Damage Caused by Calcium Hypochlorite and Sodium Hypochlorite. Braz Dent J 2024; 35:e245771. [PMID: 38922251 PMCID: PMC11196027 DOI: 10.1590/0103-6440202405771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/27/2024] [Indexed: 06/27/2024] Open
Abstract
This study aimed to evaluate the antimicrobial activity of calcium hypochlorite (Ca (OCl)2) and sodium hypochlorite (NaOCl) using confocal laser scanning microscopy (CLSM) and dentin organic matrix alteration by picrosirius staining and light microscopy (LM). Samples of human extracted teeth were infected with Enterococcus faecalis by centrifugation of the bacterial suspension and were treated with Ca(OCl)2 or NaOCl at 0.5%, 2.5%, and 6% for 15, 30, and 60 seconds. CLSM and viability staining were used to quantitatively analyze the proportions of dead/live bacteria in the canal lumen and border of the root canal. The data were analyzed by ANOVA and Fisher test. For LM analysis, one hundred bovine teeth were randomly divided into 10 test groups (n=10): G1- Without treatment; G2- 17% EDTA; G3- 6% NaOCl; G4- 6% NaOCl + EDTA; G5- 0.5% Ca(OCl)2; G6- 0.5% Ca(OCl)2 + EDTA; G7- 2.5% Ca(OCl)2; G8- 2.5% Ca(OCl)2 + EDTA; G9- 6% Ca(OCl)2; G10- 6% Ca(OCl)2 + EDTA. The samples were fragmented and stained with Picrosirius. Data were analyzed by Kruskal-Wallis and Dunn (P<0.05). There was a strong correlation between the results of the canal lumen and the border of the root canal (r=0.962). Both hypochlorites at a concentration of 0.5% showed less microbial reduction compared to 2.5% and 6% (P<0.05). There was less antimicrobial activity at 15 seconds compared to 30 and 60 seconds (P<0.05). Ca(OCl)2 and NaOCl showed similar results at the same concentrations (P>0.05). In conclusion, Ca(OCl)2 caused fewer alterations to the dentin organic matrix at concentrations of 0.5% and 2.5%. Ca(OCl)2 presents antimicrobial activity similar to NaOCl, and collagen damage is concentration-dependent.
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Affiliation(s)
- Ediléia Lodi
- Universidade de Passo Fundo, Passo Fundo, RS, Brasil
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Steier L, Albino Souza M, Poli de Figueiredo JA. NaOCl alternative options. Br Dent J 2024; 236:859. [PMID: 38877233 DOI: 10.1038/s41415-024-7513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/15/2024] [Indexed: 06/16/2024]
Affiliation(s)
- L Steier
- University of Pennsylvania, School of Dental Medicine, Philadelphia, USA.
| | - M Albino Souza
- University of Passo Fundo, Dental School, Passo Fundo, Rio Grande do Sul, Brazil.
| | - J A Poli de Figueiredo
- Federal University of Rio Grande do Sul, Department of Morphological Sciences, Porto Alegre, Rio Grande do Sul, Brazil.
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Sesen Uslu Y, Arıcan Alpay B, Sesen P, Özyürek T. The Efficacy of Different Laser Applications on Dentin Sealing in Preventing Discoloration Induced by Mineral Trioxide Aggregate. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1015. [PMID: 38473488 DOI: 10.3390/ma17051015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
The aim of this in vitro study was to evaluate the effect of the pre-application of a dentin-bonding agent and the application of different lasers on the prevention of tooth discoloration caused by mineral trioxide aggregate (MTA) in the presence of blood. Sixty extracted human anterior teeth were selected, with root lengths standardized to 10 mm and root canals shaped using Gates-Glidden drills #3 to #5. The samples were divided into six groups (n = 10): Group 1 with no surface treatment and Groups 2 to 6 with Optibond universal adhesive and Neodymium yttrium aluminum garnet (Nd:YAG), Erbium yttrium aluminum garnet (Er:YAG), Erbium-chromium-yttrium-scandium-gallium-garnet (Er:Cr:YSGG), and diode laser applications, respectively. Root canals were filled with fresh human blood, and ProRoot MTA and a collagen barrier were then placed. Color changes were measured with a spectrophotometer at 0, 7, 30, 90, and 180 days post MTA placement. Color differences (∆E) were analyzed using a two-factor mixed-design ANOVA with the Sidak method (p = 0.05). All treatment groups exhibited discoloration above the acceptability threshold. Although all treatment approaches exhibited less color change compared to the control group (p < 0.05), there was no significant difference among them in terms of preventing color change (p > 0.05). It was determined that none of the methods could guarantee 100% prevention of discoloration caused by MTA-blood contact.
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Affiliation(s)
- Yesim Sesen Uslu
- Department of Restorative Dentistry, School of Dental Medicine, Bahçeşehir University, Istanbul 34349, Turkey
| | - Burçin Arıcan Alpay
- Department of Endodontics, School of Dental Medicine, Bahçeşehir University, Istanbul 34349, Turkey
| | - Pinar Sesen
- Department of Prosthodontics, Faculty of Dentistry, Istanbul Kent University, Istanbul 34433, Turkey
| | - Taha Özyürek
- Department of Endodontics, School of Dental Medicine, Bahçeşehir University, Istanbul 34349, Turkey
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Krishnan CS, Tompkins GR, Lyons KM, Cannon RD. Electrolysed oxidising water as a multi-purpose biocide in dental healthcare-A scoping review. Gerodontology 2023; 40:422-462. [PMID: 37694292 DOI: 10.1111/ger.12712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES The objective of this scoping review was to map evidence of electrolysed oxidising water (EOW) as a biocide for dental applications of relevance to older people and identify research gaps. BACKGROUND EOW is an emerging, "green," and cost-effective biocide. There are no reviews on the landscape of EOW research as either an antiseptic or disinfectant in dental healthcare or its suitability for the oral healthcare of older people. MATERIALS AND METHODS The review follows the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Database searches (Google Scholar, PubMed, Web of Science, Ovid, Scopus and Science Direct) were undertaken using MESH terms and Boolean operators with no date restrictions, to identify full-text, original reports published in English-language peer-reviewed journals. RESULTS The search yielded 114 papers that met the inclusion/exclusion criteria. Dental applications of EOW include its use as an endodontic irrigant (39%); mouth rinse/surgical irrigant (21%); disinfectant for dental unit water lines (19%) and dental biomaterials (17%); and for antimicrobial efficacy, effects on oral tissues and on dental material properties. Most studies (83%) evaluated a single EOW formulation (acidic, moderately acidic or neutral) that was either generated at 'point-of-use' (POU; 72%), bottled ('ready-to-use', RTU; 24%) or from unspecified (3%) sources. Six reports evaluated storage-related parameters and 25 evaluated clinical applications; 89 were in vitro studies and one investigated the cost-effectiveness of POU EOW. CONCLUSIONS Neutral-pH, EOW is effective as an antimicrobial agent without deleterious effects on oral tissues. However, research on the impact of storage conditions, anti-Candida biofilm efficacy and mechanism of action against yeasts, long-term effects on denture materials and cost-effectiveness is required to establish the suitability of EOW as a multipurpose biocide for dental healthcare, including infection-control requirements relating to older people.
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Affiliation(s)
- Chitra S Krishnan
- Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Geoffrey R Tompkins
- Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Karl M Lyons
- Department of Oral Rehabilitation, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Richard D Cannon
- Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Huang Y, Zhang Y, Liu Q, Zhu Z, Zhang Y, She Y, Zhang X, Liu Y. Evaluation of structural integrity effect on adhesion strength of root dentin with a multi-functional irrigation strategy. Clin Oral Investig 2022; 27:1465-1472. [PMID: 36348096 DOI: 10.1007/s00784-022-04765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate effects of a novel auxiliary irrigation strategy, proanthocyanidin (PA) + carboxymethyl chitosan/amorphous calcium phosphate (CMC/ACP) nanocomplexes, on maintaining the organic-inorganic structural integrity and hence optimizing the adhesion strength of root dentin. MATERIALS AND METHODS Dentin specimens (n = 150) were prepared and subjected to the classical irrigating strategy with or without PA and CMC/ACP. The ultrastructure and biomechanical behaviour of dentin were characterized by scanning electron microscopy and atomic force microscope, respectively. Forty single root-canal premolars were employed for push-out bond strength testing. Besides, the antibacterial effects against Enterococcus faecalis were evaluated with confocal laser scanning microscopy. Statistical differences were verified with one-way ANOVA and Tukey's post-tests. RESULTS The organic-inorganic structural integrity of root dentin was repaired with the synergetic use of PA and CMC/ACP. Correspondingly, the bond stability between the root canal wall and the AH-Plus sealer was significantly reinforced (P < 0.05). Meanwhile, the tissue biomechanical properties and antibacterial behaviour were enhanced compared to that of control group (P < 0.05). CONCLUSIONS The synergistic utilization of PA and CMC/ACP can preserve the structural integrity of root dentin, contributing to optimizing the sealing effects of root canal. Moreover, the novel irrigation strategy demonstrated a favourable antimicrobial activity. CLINICAL RELEVANCE The combination of PA and CMC/ACP can serve as a promising auxiliary irrigation strategy to optimize the outcomes of chemical preparation, enhance the sealing effects of root canal and hence improve the success rate of treatment.
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Affiliation(s)
- Ying Huang
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
- Department of Endodontics, Hainan Stomatology Center, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou, China
| | - Ye Zhang
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Qing Liu
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Zihui Zhu
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Yuchen Zhang
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Yichen She
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Xu Zhang
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China
- Institute of Stomatology, Tianjin Medical University, Tianjin, 300070, China
| | - Ying Liu
- School and Hospital of Stomatology, Tianjin Medical University, Tianjin, 300070, China.
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Cytotoxicity and Efficacy in Debris and Smear Layer Removal of HOCl-Based Irrigating Solution: An In Vitro Study. J Funct Biomater 2022; 13:jfb13030095. [PMID: 35893463 PMCID: PMC9326542 DOI: 10.3390/jfb13030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
Abstract
In the present study we evaluated the cytotoxicity of super-oxidized water on human gingival fibroblasts and its efficacy in debris and smear layer removal from root canal walls. Cultured gingival fibroblasts were exposed to super-oxidized water (Sterilox), which was diluted in Iscove’s modified Dulbecco’s medium (IMDM) at 30%, 40%, 50%, 60% and 70% concentrations. The control group was maintained in IMDM. The cell viability was evaluated by means of an MTT assay after incubation periods of 1 h, 2 h, 24 h and 48 h. Pathological cellular changes were also observed under fluorescence and phase contrast microscopes. The efficacy in debris and smear layer removal was evaluated in comparison to the conventional application of sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA). Forty maxillary premolars were randomly divided into two equal groups (n = 20) and shaped with ProTaper NEXT rotary instruments using Sterilox or NaOCl/EDTA for irrigation. Afterwards, roots were split longitudinally and examined under a scanning electron microscope. The results revealed that super-oxidized water and sterile distilled water have acceptable biological properties for endodontic applications at concentrations up to 50% (p > 0.05). Moreover, super-oxidized water is equally effective in debris and smear layer removal as compared to NaOCl/EDTA (p > 0.05).
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de Jesus LS, Volpato CAM, Bortoluzzi EA, da Silveira Teixeira C, Rossetto HL, de Carvalho Panzeri Pires-de-Souza F, da Fonseca Roberti Garcia L. Tooth discoloration induced by the different phases of a calcium aluminate cement: One-year assessment. J ESTHET RESTOR DENT 2021; 33:999-1009. [PMID: 33929073 DOI: 10.1111/jerd.12739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the discoloration of teeth treated with the different phases of calcium aluminate cement (CAC), in comparison with the conventional CAC and mineral trioxide aggregate (MTA). MATERIALS AND METHODS Fifty bovine incisors were prepared and filled. Two millimeters of the filling was removed to fabricate a cervical plug with the following cements (n=10): CA(CaO.Al2 O3 ); CA2 (CaO.2Al2 O3 ); C12 A7 (12CaO.7Al2 O3 ); CAC and MTA. The initial color measurement was performed and after 7, 15, 30, 45, 90, 180, and 365 days new color measurements were performed to determine the color (ΔE00 ), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and the whiteness index (WID ). RESULTS ΔE00 was significant for groups (p = 0.036) and periods (p < 0.05). The greater ΔE00 was observed after 365 days for CAC (12.8). C12 A7 (7.2) had the smallest ΔE00 . ΔL' and ΔC' were significant for groups and periods (p < 0.05). ΔH' was significant for periods (p < 0.05). After 365 days, significant reduction in lightness was observed for all groups. For CA, CA2 , CAC, and MTA groups, the WID values decreased over time (p < 0.05). CONCLUSIONS The tested cements changed the color behavior of the samples, resulting in greater teeth darkening over time. CLINICAL SIGNIFICANCE There is no long-term study assessing the discoloration induced by the different phases of CAC.
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Affiliation(s)
- Lucas Santos de Jesus
- Department of Dentistry, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Eduardo Antunes Bortoluzzi
- Department of Dentistry, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
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Gonzalez CS, Estevez R, Loroño G, García VDF, Caballero Montes JA, Rossi-Fedele G, Cisneros R. Etidronic acid and ethylenediaminetetraacetic acid associated with sodium hypochlorite have limited effect on the compressive fracture resistance of roots ex vivo. J Conserv Dent 2021; 23:484-488. [PMID: 33911358 PMCID: PMC8066680 DOI: 10.4103/jcd.jcd_527_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/20/2020] [Accepted: 12/06/2020] [Indexed: 12/04/2022] Open
Abstract
Aims: To assess the effect of etidronic acid (EA) mixed with sodium hypochlorite (NaOCl) and two ethylenediaminetetraacetic acid-containing preparations (EDTA and SmearClear) alternated with NaOCl, as a final rinse, on root fracture resistance to a compressive force. Materials and Methods: Seventy-two premolar roots were randomly allocated to the following groups according to the irrigant solutions. For the EA group, 9% EA + 2.5% NaOCl were used throughout the assays (n = 21). The remaining groups received 2.5% NaOCl during and immediately after chemo-mechanical instrumentation. Intermediately, the roots received 17% EDTA (n = 19), or SmearClear (n = 16), or no irrigation (control) (n = 16) plus a final rinse with 2.5% NaOCl. The specimens were subjected to a vertical compressive force loaded at a crosshead speed of 0.02 mm/s parallel to the long axis of the root until fracture occurred. The results were compared statistically using the one-way analysis of variance for intergroup comparisons. Results: The negative control presented with the highest values, whereas the SmearClear presented with the lowest values, though no significant differences were found when comparing the different groups (P = 0.82). Conclusions: The use of EA + NaOCl or two EDTA formulations in association with NaOCl does not affect the fracture resistance of previously chemo-mechanically prepared roots.
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Affiliation(s)
| | - Roberto Estevez
- Endodontic Unit, Engineering and Design, European University of Madrid, Madrid, Spain
| | - Gaizka Loroño
- Endodontic Unit, Engineering and Design, European University of Madrid, Madrid, Spain
| | | | | | - Giampiero Rossi-Fedele
- Endodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Rafael Cisneros
- Endodontic Unit, Engineering and Design, European University of Madrid, Madrid, Spain
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Ahn JH, Kim JW, Yoon YM, Lee NY, Lee SH, Jih MK. Time-Dependent Anti-Demineralization Effect of Silver Diamine Fluoride. CHILDREN-BASEL 2020; 7:children7120251. [PMID: 33255281 PMCID: PMC7760551 DOI: 10.3390/children7120251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022]
Abstract
This study compared the demineralization resistance of teeth treated with silver diamine fluoride (SDF) to that treated with fluoride varnish. A total of 105 healthy bovine incisors were divided into control, fluoride varnish, and SDF groups. The enamel surface density change was then measured by micro-computed tomography (micro-CT) at three depths. The demineralized zone volume was measured on 3D micro-CT images to evaluate the total demineralization rate. The enamel surface morphology was assessed by scanning electron microscope. The enamel density had continuously decreased while demineralization increased in the control and fluoride varnish groups. The enamel density had increased in the SDF group till the 7th day of demineralization treatment and decreased thereafter. However, the decrease in the SDF group was less severe than that in the other groups (p < 0.05). The demineralized enamel volume had increased through treatment and was the highest in the control group, followed by the fluoride varnish and SDF group. The enamel surface morphology was the roughest and most irregular in the control group, followed by the fluoride varnish group and SDF groups.
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Affiliation(s)
- Ji-Hye Ahn
- Department of Pediatric Dentistry, School of Dentistry, Chosun University, Gwangju 61452, Korea; (J.-H.A.); (J.-W.K.); (N.-Y.L.); (S.-H.L.)
| | - Ji-Woong Kim
- Department of Pediatric Dentistry, School of Dentistry, Chosun University, Gwangju 61452, Korea; (J.-H.A.); (J.-W.K.); (N.-Y.L.); (S.-H.L.)
| | | | - Nan-Young Lee
- Department of Pediatric Dentistry, School of Dentistry, Chosun University, Gwangju 61452, Korea; (J.-H.A.); (J.-W.K.); (N.-Y.L.); (S.-H.L.)
| | - Sang-Ho Lee
- Department of Pediatric Dentistry, School of Dentistry, Chosun University, Gwangju 61452, Korea; (J.-H.A.); (J.-W.K.); (N.-Y.L.); (S.-H.L.)
| | - Myeong-Kwan Jih
- Department of Pediatric Dentistry, School of Dentistry, Chosun University, Gwangju 61452, Korea; (J.-H.A.); (J.-W.K.); (N.-Y.L.); (S.-H.L.)
- Correspondence: ; Tel.: +82-62-220-3868; Fax: +82-62-225-8240
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Sayed M, Hiraishi N, Matin K, Abdou A, Burrow MF, Tagami J. Effect of silver-containing agents on the ultra-structural morphology of dentinal collagen. Dent Mater 2020; 36:936-944. [DOI: 10.1016/j.dental.2020.04.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/15/2020] [Accepted: 04/30/2020] [Indexed: 01/04/2023]
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Souza MA, Lago BLT, Pletsch A, Binotto A, Poletti A, Rodrigues FT, Ricci R, Bischoff KF, Dias CT, Palhano HS, Lago CTR, Farina AP, Cecchin D, Bervian J, de Figueiredo JAP. Association of calcium hypochlorite, reciprocating instrumentation and photodynamic therapy: Antimicrobial analysis and effects on root dentin structure. Photodiagnosis Photodyn Ther 2020; 29:101625. [DOI: 10.1016/j.pdpdt.2019.101625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/18/2019] [Accepted: 12/17/2019] [Indexed: 11/26/2022]
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Borges CC, Palma-Dibb RG, Rodrigues FCC, Plotegher F, Rossi-Fedele G, de Sousa-Neto MD, Souza-Gabriel AE. The Effect of Diode and Er,Cr:YSGG Lasers on the Bond Strength of Fiber Posts. Photobiomodul Photomed Laser Surg 2019; 38:66-74. [PMID: 31393231 DOI: 10.1089/photob.2019.4668] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Laser irradiation modifies the topography and composition of dentin surface aiming to increase the retention of bonded posts. Objective: To assess the effect of dentin irradiation with Er,Cr:YSGG or diode lasers on the bond strength of fiber posts using self-adhesive resin cement. Materials and methods: Sixty bovine root canals were root-canal treated, post spaces were prepared, and subsequently fiber posts were cemented. The samples were distributed according to the surface treatment: distilled water (control), Er,Cr:YSGG (1.5 W, 20 sec), or diode (1.5 W, 20 sec) lasers. Bond strengths were assessed by pull-out (n = 10) or push-out testing (n = 10). Pearson's correlation was calculated. Failure mode after testing and the depth of tags in the dentinal tubules were analyzed by confocal laser microscopy. Data were submitted to analysis of variance and Tukey's test. A p < 0.05 was considered significant. Results: In the push-out test, Er,Cr:YSGG laser had significantly different higher values (5.43 ± 0.10 MPa) compared to the control (4.79 ± 0.05 MPa). Diode laser values were not significantly different from the other groups (5.12 ± 0.27 MPa). In the pull-out test, there were no significant differences between Er,Cr:YSGG (6.86 ± 2.16 MPa) and diode (8.43 ± 1.77 MPa) lasers, and both had significant differences compared to the control (4.18 ± 1.29 MPa). No correlation was found. Adhesive failures were predominant in all groups, and no significant differences in tag penetration among the groups were found. Conclusions: The Er,Cr:YSGG laser increases the bond strength of resin cement and fiber post to dentin in both tests, compared to control group without laser treatment. Diode laser only enhanced bonding for pull-out test.
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Affiliation(s)
- Caroline Cristina Borges
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Regina Guenka Palma-Dibb
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Flávia Cássia Cabral Rodrigues
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Fernanda Plotegher
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Manoel Damião de Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Cardoso LR, Baldasso FER, Delai D, Montagner F, Kopper PMP. Effect of EDTA, sodium, and calcium hypochlorite on the inorganic component of root canal dentin: A SEM analysis. Microsc Res Tech 2018; 82:128-133. [PMID: 30582246 DOI: 10.1002/jemt.23151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 11/11/2022]
Abstract
This study evaluated the influence of canal irrigation protocols with 5.25% calcium hypochlorite [Ca(OCl)2 ], 5.25% sodium hypochlorite (NaOCl) and 17% EDTA solution on the inorganic component of root canal dentin. Sixty roots were randomly divided into six groups (n = 10): Saline solution (SS) (control); Saline solution (SSE) +17% EDTA; CH - 5.25% Ca(OCl)2 ; CHE - 5.25% Ca(OCl)2 + 17% EDTA; SH - 5.25% NaOCl; SHE - 5.25% NaOCl +17% EDTA. After canal irrigation, the specimens were longitudinally split and analyzed by scanning electron microscopy (SEM). Dentinal tubules were observed in transverse (middle and apical thirds) direction. The images were classified in scores, according to smear layer removal and peritubular dentin alteration, and data were analyzed by Kruskal-Wallis's test, followed by Dunn's test (α = 0.05). In the middle third, all groups with EDTA presented better removal of the smear layer with higher peritubular dentin alteration (p < .05). In the apical third, this happened only in SHE (p < .05). Ca(OCl)2 and NaOCl exhibit similar performance to remove smear layer and alteration of the inorganic component in the middle third. In the apical third, NaOCl associated with EDTA showed better performance in smear layer removal.
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Affiliation(s)
- Luana Roleto Cardoso
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, RS, Brazil
| | | | - Débora Delai
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, RS, Brazil
| | - Francisco Montagner
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul, UFRGS, Porto Alegre, RS, Brazil
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Uchinuma S, Shimada Y, Matin K, Hosaka K, Yoshiyama M, Sumi Y, Tagami J. Effects of UVB and UVC irradiation on cariogenic bacteria in vitro. Lasers Med Sci 2018; 34:981-989. [DOI: 10.1007/s10103-018-2685-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022]
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Sayed M, Matsui N, Hiraishi N, Inoue G, Nikaido T, Burrow MF, Tagami J. Evaluation of discoloration of sound/demineralized root dentin with silver diamine fluoride: In-vitro study. Dent Mater J 2018; 38:143-149. [PMID: 30381632 DOI: 10.4012/dmj.2018-008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective was to evaluate the effect of application of silver diamine fluoride (SDF) on discoloration of demineralized dentin over time. Dentin specimens were divided into four groups according to time of dentin demineralization. A 38% SDF solution was then applied to the dentin surfaces. Half of the specimens were placed in light-proof boxes while the remainder were exposed to light. Both groups were maintained at 37˚C. Color change was determined using a spectrophotometer at different time intervals. SEM/EDS analysis were also undertaken. The 13 h EDTA demineralized group showed the highest values for color change among different time intervals, with the control being the lowest. The light exposed groups showed more color change compared to the unexposed groups. We concluded that the degree of dentin demineralization leads to a significant increase of the rate of dentin color change after application of SDF.
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Affiliation(s)
- Mahmoud Sayed
- Cariology and Operative Dentistry, Oral Restitution Department, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Naoko Matsui
- Cariology and Operative Dentistry, Oral Restitution Department, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noriko Hiraishi
- Cariology and Operative Dentistry, Oral Restitution Department, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Go Inoue
- Cariology and Operative Dentistry, Oral Restitution Department, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Toru Nikaido
- Cariology and Operative Dentistry, Oral Restitution Department, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | | | - Junji Tagami
- Cariology and Operative Dentistry, Oral Restitution Department, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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Sayed M, Matsui N, Hiraishi N, Nikaido T, Burrow MF, Tagami J. Effect of Glutathione Bio-Molecule on Tooth Discoloration Associated with Silver Diammine Fluoride. Int J Mol Sci 2018; 19:ijms19051322. [PMID: 29710829 PMCID: PMC5983840 DOI: 10.3390/ijms19051322] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 11/24/2022] Open
Abstract
This study evaluated the effect of Glutathione (GSH) bio-molecule on the reduction of enamel and dentin discoloration after application of 38% silver diammine fluoride solution (SDF). One hundred and twenty bovine teeth specimens were used. The enamel and dentin specimens were divided into three groups: (1) SDF only (control); (2) SDF followed by application of a potassium iodide solution (KI); and (3) SDF mixed with 20% GSH. Half the specimens were exposed to light and the remainder kept in dark conditions (n = 10) Color changes were measured using a spectrophotometer at the following time intervals: before solution application (baseline) and immediately after application, then 3, 6, 24, 48, 72 h, and 7, 10 and 14 days. SEM/EDS analysis was performed on treated enamel and dentin. Statistical analysis was done using a repeated measures ANOVA test. The spectrophotometer results showed that the SDF group exhibited the greatest color changes under both light exposed and dark conditions, while SDF + GSH group was effective in decreasing the color changes in both light and dark conditions. The SDF + KI group showed an insignificant color changes over time. SEM/EDS analysis showed different patterns for the silver crystal formation in each group (SDF, SDF + GSH, and SDF + KI group). It was concluded GSH can effectively minimize color changes after application of SDF, especially on enamel and to a lesser extent on dentin.
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Affiliation(s)
- Mahmoud Sayed
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 113-8510 Tokyo, Japan.
| | - Naoko Matsui
- Cariology and Operative Dentistry, Oral Restitution Department, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8549 Tokyo, Japan.
| | - Noriko Hiraishi
- Research Fellow of Japan Society for the Promotion of Science, Tokyo Medical and Dental University, 113-8510 Tokyo, Japan.
| | - Toru Nikaido
- Cariology and Operative Dentistry, Oral Restitution Department, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8549 Tokyo, Japan.
| | - Michael F Burrow
- Faculty of Dentistry, University of Hong Kong, Hong Kong, China.
| | - Junji Tagami
- Cariology and Operative Dentistry, Oral Restitution Department, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, 113-8549 Tokyo, Japan.
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Xu K, Wang J, Wang K, Gen N, Li J. Micro-computed tomographic evaluation of the effect of the final apical size prepared by rotary nickel-titanium files on the removal efficacy of hard-tissue debris. J Int Med Res 2018; 46:2219-2229. [PMID: 29584511 PMCID: PMC6023043 DOI: 10.1177/0300060518757607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective This study was performed to compare the removal efficacy of hard-tissue debris in mandibular first molars prepared to various apical sizes. Methods The mesial root canals of 40 extracted mandibular first molars were prepared by rotary nickel-titanium files to an apical size of #25/0.04 (Group #2504), #30/0.04 (Group #3004), #35/0.04 (Group #3504), and #40/0.04 (Group #4004). Irrigation was performed with 5.25% NaOCl and 17% EDTA. Micro-computed tomography was used to scan the samples before and after root canal preparation. Remnant hard-tissue debris was identified, quantified, and visualized three-dimensionally using shape recognition and image superimposition analysis, and the debris was mapped to its location. Results After preparation, 11.67%±2.99% of the root canals contained hard-tissue debris in Group #2504, 8.00%±2.71% in Group #3004, 7.17%±2.88% in Group #3504, and 4.51%±1.61% in Group #4004. The amount of accumulated hard-tissue debris was significantly less in Group #4004 than in the other groups. However, there were no significant differences between Groups #3004 and #3504. Conclusions An increased final apical size resulted in significantly lower debris accumulation. However, no root canal in any group was completely free from hard-tissue debris, and debris was mostly found in the isthmus of the mesial root canals.
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Affiliation(s)
- Ke Xu
- Department of Endodontics, Stomatological Hospital Affiliated to Soochow University, Suzhou Stomatological Hospital, Suzhou, Jiangsu, China
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Juan Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Ke Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Nan Gen
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Jin Li
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
- Jin Li, Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, 136 Hanzhong Road, Nanjing 210029, China.
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Baldasso FER, Cardoso LR, Silva VDD, Morgental RD, Kopper PMP. Evaluation of the effect of four final irrigation protocols on root canal dentin components by polarized light microscopy and scanning electron microscopy. Microsc Res Tech 2017; 80:1337-1343. [DOI: 10.1002/jemt.22946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/28/2017] [Accepted: 09/04/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Flávia Emi Razera Baldasso
- Department of Conservative Dentistry, School of Dentistry; Federal University of Rio Grande do Sul (UFRGS), Av. Ramiro Barcelos; Porto Alegre/RS Brazil
| | - Luana Roleto Cardoso
- Department of Conservative Dentistry, School of Dentistry; Federal University of Rio Grande do Sul (UFRGS), Av. Ramiro Barcelos; Porto Alegre/RS Brazil
| | - Vinicius Duval da Silva
- Department of Pathology, School of Medicine; Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga; Porto Alegre Brazil
| | - Renata Dornelles Morgental
- Department of Stomatology, School of Dentistry; Federal University of Santa Maria (UFSM); Rua Marechal Floriano Peixoto Santa Maria Brazil
| | - Patrícia Maria Poli Kopper
- Department of Conservative Dentistry, School of Dentistry; Federal University of Rio Grande do Sul (UFRGS), Av. Ramiro Barcelos; Porto Alegre/RS Brazil
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Cecchin D, Soares Giaretta V, Granella Cadorin B, Albino Souza M, Vidal CDMP, Paula Farina A. Effect of synthetic and natural-derived novel endodontic irrigant solutions on mechanical properties of human dentin. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:141. [PMID: 28819809 DOI: 10.1007/s10856-017-5960-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/05/2017] [Indexed: 06/07/2023]
Abstract
This study aimed to evaluate the effects of different synthetic and natural-derived root canal irrigants (6% sodium hypochlorite [NaOCl], 6% calcium hypochlorite [Ca(OCl)2] and 6.5% grape seed extract [GSE]) on dentin mechanical properties (flexural strength, ultimate tensile strength [UTS] and fracture resistance). Rectangular-shaped beams and hourglass-shaped sections obtained from mid-coronal and root dentin were treated with 6% NaOCl, 6% Ca(OCl)2 or 6.5% GSE for 30 min. The irrigant solutions were replaced every 5 min. Then, the dentin specimens were rinsed with distilled water (DW) followed by incubation with 17% EDTA for 1 min, and thoroughly rinsed with DW again. Specimens from the control group were tested without prior irrigation. After treatment with the irrigants, dentin beams were used to assess the flexural strength (n = 10) while UTS was evaluated using the root dentin hourglass-shaped sections (n = 10). Similarly, roots with 1 mm of dentinal wall thickness were obtained from human teeth and treated with the same irrigant solutions (n = 10). A compressive loading was applied to the coronal surfaces of roots until fracture. The values of each mechanical test were statistically analyzed individually by one-way ANOVA followed by Tukey HSD test (P < 0.05). NaOCl significantly reduced the mechanical properties of dentin in all mechanical tests (P < 0.05) and no statistical difference was found among Ca(OCl)2, GSE and control group (P > 0.05). It can be concluded that Ca(OCl)2 and GSE may be alternative irrigant solutions, since they do not negatively affect the dentin mechanical properties.
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Affiliation(s)
- Doglas Cecchin
- Department of Restorative Dentistry, Dental School of Universidade de Passo Fundo, Passo Fundo, RS, Brazil.
| | - Vitória Soares Giaretta
- Department of Restorative Dentistry, Dental School of Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Bérove Granella Cadorin
- Department of Restorative Dentistry, Dental School of Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Matheus Albino Souza
- Department of Restorative Dentistry, Dental School of Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | | | - Ana Paula Farina
- Department of Restorative Dentistry, Dental School of Universidade de Passo Fundo, Passo Fundo, RS, Brazil
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Simezo AP, da Silveira Bueno CE, Cunha RS, Pelegrine RA, Rocha DGP, de Martin AS, Kato AS. Comparative Analysis of Dentinal Erosion after Passive Ultrasonic Irrigation versus Irrigation with Reciprocating Activation: An Environmental Scanning Electron Study. J Endod 2016; 43:141-146. [PMID: 27939728 DOI: 10.1016/j.joen.2016.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to assess ex vivo the erosive effects of passive ultrasonic irrigation versus irrigation with reciprocating activation on the dentinal surface of the root canal at 3 predetermined levels using environmental scanning electron microscopy. METHODS Ten roots of mandibular premolars were prepared using the ProTaper Universal system (Dentsply Maillefer, Ballaigues, Switzerland). The specimens were embedded in flasks cleaved longitudinally, and indentations were made 3.0, 6.0, and 9.0 mm from the apex. The specimens in the control group (n = 10) were cleaned in an ultrasonic bath containing 2.5% sodium hypochlorite and 17% EDTA and then dried. Then, environmental scanning electron microscopic images were obtained at magnification × 800. The specimens were then reassembled in their flasks, and the NaOCl and EDTA solutions were activated according to the conditions established for the experimental groups (ie, the passive ultrasonic irrigation group [n = 5] and the EasyClean (Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brazil) group, irrigation with reciprocating activation with the EasyClean instrument [n = 5]). The specimens of both experimental groups were analyzed in the same manner as in the control group. Analysis of the dentinal surface topography was conducted using the 3D Roughness Reconstruction program (Phenom-World BV, Eindhoven, the Netherlands) as a means for assessing erosion. The data were evaluated by means of the Kruskal-Wallis, Student-Newman-Keuls, and Mann-Whitney tests. RESULTS In the EasyClean group, the degree of dentinal erosion at 3.0 mm was significantly higher than at 9.0 mm. In the other comparisons, there was no statistically significant difference (P < .05). CONCLUSIONS The final irrigation techniques tested were equivalent in relation to the degree of erosion caused to the dentinal surface.
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Affiliation(s)
- Ana Paula Simezo
- Department of Endodontics, São Leopoldo Mandic Dental Research Center, Campinas, São Paulo, Brazil
| | | | | | - Rina Andrea Pelegrine
- Department of Endodontics, São Leopoldo Mandic Dental Research Center, Campinas, São Paulo, Brazil
| | | | | | - Augusto Shoji Kato
- Department of Endodontics, São Leopoldo Mandic Dental Research Center, Campinas, São Paulo, Brazil.
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Ramos JC, Palma PJ, Nascimento R, Caramelo F, Messias A, Vinagre A, Santos JM. 1-year In Vitro Evaluation of Tooth Discoloration Induced by 2 Calcium Silicate–based Cements. J Endod 2016; 42:1403-7. [DOI: 10.1016/j.joen.2016.06.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/03/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Gandhi B, Bollineni S, Janga RK, Saraswati D, Babu MR. Evaluating the Effect of CPP-ACP as a Final Irrigant in Improving the Micro-Hardness of Erosive Root Dentin and its Influence on the Bond Strength of Self Etch Resin Sealer - An In-vitro Study. J Clin Diagn Res 2016; 10:ZC53-6. [PMID: 27656564 DOI: 10.7860/jcdr/2016/20819.8272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smear layer removal from the root canal wall involves the use of 17% EDTA and 5.25% sodium hypochlorite, which thereby improves the adhesion of obturating materials to root dentin. But these chemical irrigants have shown to decrease micro hardness, increase roughness, cause erosion and reduce the root dentin fracture toughness. To combat these adverse effects, studies can be focussed on the remineralisation of the erosive root dentin and this novel idea has been utilized in the present study. AIM To evaluate the micro hardness of erosive root dentin when Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) was used as a final irrigant and its influence on resin sealer bonding tested by push-out bond strength method. MATERIALS AND METHODS Sixty extracted maxillary incisors were divided into three groups based on the final irrigation protocol. Group 1-normal saline, Group 2-17% EDTA (Ethylene Diamine Tetraacetic Acid) + 5.25% NaOCl (Sodium Hypochlorite), Group 3 - 17% EDTA + 5.25% NaOCl + CPP-ACP; each group was divided into two subgroups. Half the specimens of each group were evaluated for Vicker's micro hardness test after the treatment. In continuation with the above methodology the remaining specimens were tested for push-out bond strength after obturation of the specimens with self etch adhesive resin sealer and conventional 6% gutta percha cones. RESULTS Micro hardness was statistically analysed using Kruskal Wallis test and push-out bond strength was evaluated using Mann Whitney test and paired t-test. CPP-ACP treated group showed increased micro hardness (p<0.05). There was no statistically significant difference between the push-out bond strength values between group EDTA + NaOCl group and EDTA + NaOCl + CPP-ACP group. CONCLUSION Within the limitations of this study it can be concluded that, CPP-ACP improved the micro hardness of erosive root dentin and is not affecting its bond strength. Therefore, CPP-ACP may be used before bonding procedures for promoting remineralization of root dentin.
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Affiliation(s)
- Bhavana Gandhi
- Assistant Professor, Department of Conservative Dentistry and Endodontics, Drs. Sudha and Nageswara Rao Institute of Dental Sciences , Gannavaram, Andhra Pradesh, India
| | - Swetha Bollineni
- Assistant Professor, Department of Conservative Dentistry and Endodontics, Drs. Sudha and Nageswara Rao Institute of Dental Sciences , Gannavaram, Andhra Pradesh, India
| | - Ravi Kumar Janga
- Associate Professor, Department of Conservative Dentistry and Endodontics, Drs. Sudha and Nageswara Rao Institute of Dental Sciences , Gannavaram, Andhra Pradesh, India
| | - Disha Saraswati
- Professor, Department of Conservative Dentistry and Endodontics, Drs. Sudha and Nageswara Rao Institute of Dental Sciences , Gannavaram, Andhra Pradesh, India
| | - Mandava Ramesh Babu
- Professor, Department of Conservative Dentistry and Endodontics, Drs. Sudha and Nageswara Rao Institute of Dental Sciences , Gannavaram, Andhra Pradesh, India
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