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Ballal NV, Jalan P, Rai N, Al-Haj Husain N, Özcan M. Evaluation of New Alkasite Based Restorative Material for Restoring Non- Carious Cervical Lesions- Randomized Controlled Clinical Trial. Eur J Prosthodont Restor Dent 2023; 31:72-77. [PMID: 35659319 DOI: 10.1922/ejprd_2410ballal06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 11/11/2022]
Abstract
Two different restoration materials, an alkasite-based resin composite and a resinmodified glass ionomer cement were used to assess restoration of non-carious cervical dental lesions. This split mouth randomized controlled trial included 40 patients. After randomization both sides of the dental arch were restored with either an alkasite-based (Cention N, Ivoclar Vivadent) or a resin-modified glass ionomer cement (Voco GmbH) restoration. The placed fillings were evaluated by blinded additional operators 1, 6 months and 1 year after to the USPHS criteria (retention, marginal integrity and discoloration, anatomical form and secondary caries). Data were analyzed using Kendall's Coefficient of Concordance test and Chi-square tests using SPSS software (SPSS Inc., Version 20) (P=0.05). As for retention and anatomic form both materials performed similar after one month. However, the retention and anatomic form for alkasite based restorative Cention showed significantly better results after 6 months (p=0.013/p=0.003) and one year (p=0.026/p=0.008). The resin modified glass ionomer restoration showed higher discoloration after 6 months (p=0.025) and one year (p=0.018), while Cention performed better regarding marginal integrity at all time intervals. No secondary caries occurred. Alkasite based restorative materials displayed superior technical, mechanical and aesthetical performance in a follow-up period of one year and can therefore be recommended as an alternative to resin-modified glass ionomer cements.
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Affiliation(s)
- N V Ballal
- Manipal University, Tiger Circle Road, Madhav Nagar, Manipal, Karnataka 576104, India
| | - P Jalan
- Manipal University, Tiger Circle Road, Madhav Nagar, Manipal, Karnataka 576104, India
| | - N Rai
- Manipal University, Tiger Circle Road, Madhav Nagar, Manipal, Karnataka 576104, India
| | | | - M Özcan
- University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland
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Ballal NV, Duncan HF, Wiedemeier DB, Rai N, Jalan P, Bhat V, Belle VS, Zehnder M. MMP-9 Levels and NaOCl Lavage in Randomized Trial on Direct Pulp Capping. J Dent Res 2021; 101:414-419. [PMID: 34706567 PMCID: PMC8935528 DOI: 10.1177/00220345211046874] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Outcome expectations of direct pulp capping in carious teeth are obscured by a clinically unknown infiltration and breakdown of the dental pulp tissue. Histologic studies showed that this soft tissue breakdown is related to the innate immune system. We hypothesized 1) that a neutrophil biomarker could predict the outcome of direct pulp capping and 2) that using sodium hypochlorite (NaOCl) as a lavage solution to remove necrotized infected pulp tissue could improve it. In this randomized trial in mature posterior teeth causing no or mild discomfort with carious pulpal exposures, pulpal fluid was collected to assess neutrophil gelatinase (matrix metalloproteinase 9 [MMP-9]) per total protein (TP) levels as a predictive local biomarker. Subsequently, the dentin-pulp wound was randomly washed with a 2.5% NaOCl or a physiologic saline solution (1:1 allocation), capped with mineral trioxide aggregate, and the tooth was immediately restored with a resin-based composite restoration. Ninety-six patients were included, and 84 individuals could be followed up to treatment failure or clinically confirmed pulp survival after a minimum of 1 y. The entire data were fitted to a Cox proportional hazards model to assess the influence of the observational variables MMP-9/TP and discomfort with the randomized lavage treatment on pulp survival. The Kaplan-Meier pulp survival rates after 1 y were 55% for saline and 89% for NaOCl lavage. The inflammatory state of the pulp tissue as reflected by MMP-9/TP levels and NaOCl lavage had a highly significant (P < 0.001 and P = 0.004, respectively) impact on pulp survival, while mild preoperative discomfort did not. In conclusion, MMP-9/TP showed great promise as a predictive local biomarker, and NaOCl lavage considerably improved the survival time of cariously exposed and directly capped pulps.
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Affiliation(s)
- N V Ballal
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences-Manipal, Manipal Academy of Higher Education, Manipal, India
| | - H F Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - D B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - N Rai
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences-Manipal, Manipal Academy of Higher Education, Manipal, India
| | - P Jalan
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences-Manipal, Manipal Academy of Higher Education, Manipal, India
| | - V Bhat
- Department of Biochemistry, Kasturba Medical College-Manipal, Manipal Academy of Higher Education, Manipal, India
| | - V S Belle
- Department of Biochemistry, Kasturba Medical College-Manipal, Manipal Academy of Higher Education, Manipal, India
| | - M Zehnder
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
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Giardino L, Bidossi A, Del Fabbro M, Savadori P, Maddalone M, Ferrari L, Ballal NV, Das S, Rao BSS. Antimicrobial activity, toxicity and accumulated hard‐tissue debris (AHTD) removal efficacy of several chelating agents. Int Endod J 2020; 53:1093-1110. [DOI: 10.1111/iej.13314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/18/2022]
Affiliation(s)
- L. Giardino
- School of Dentistry University of Catanzaro Magna Graecia Catanzaro Italy
| | - A. Bidossi
- Laboratory of Clinical Chemistry and Microbiology IRCCS Orthopedic Institute Galeazzi Milano Italy
| | - M. Del Fabbro
- Department of Biomedical Surgical and Dental Sciences Università degli Studi di Milano Milano Italy
- IRCCS Orthopedic Institute Galeazzi Milano Italy
| | - P. Savadori
- IRCCS Orthopedic Institute Galeazzi Milano Italy
| | - M. Maddalone
- Department of Medicine and Surgery University of Milano‐Bicocca Monza Italy
| | - L. Ferrari
- Department of Medicine and Surgery University of Milano‐Bicocca Monza Italy
| | - N. V. Ballal
- Department of Conservative Dentistry and Endodontics Manipal College of Dental Sciences, Manipal Academy of Higher Education Manipal Karnataka India
| | - S. Das
- Department of Radiation Biology and Toxicology Manipal School of Life Sciences Manipal Academy of Higher Education Manipal Karnataka India
| | - B. S. S. Rao
- Department of Radiation Biology and Toxicology Manipal School of Life Sciences Manipal Academy of Higher Education Manipal Karnataka India
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Ballal NV, Gandhi P, Shenoy PA, Shenoy Belle V, Bhat V, Rechenberg D, Zehnder M. Safety assessment of an etidronate in a sodium hypochlorite solution: randomized double‐blind trial. Int Endod J 2019; 52:1274-1282. [DOI: 10.1111/iej.13129] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/12/2019] [Indexed: 11/28/2022]
Affiliation(s)
- N. V. Ballal
- Department of Conservative Dentistry and Endodontics Manipal College of Dental Sciences Manipal Academy of Higher Education Manipal Karnataka India
| | - P. Gandhi
- Department of Conservative Dentistry and Endodontics Manipal College of Dental Sciences Manipal Academy of Higher Education Manipal Karnataka India
| | - P. A. Shenoy
- Department of Microbiology Kasturba Medical College Manipal, Manipal Academy of Higher Education Manipal Karnataka India
| | - V. Shenoy Belle
- Department of Biochemistry Kasturba Medical College Manipal, Manipal Academy of Higher Education Manipal Karnataka India
| | - V. Bhat
- Department of Biochemistry Kasturba Medical College Manipal, Manipal Academy of Higher Education Manipal Karnataka India
| | - D.‐K. Rechenberg
- Department of Preventive Dentistry, Periodontology and Cariology University of Zürich Zürich Switzerland
| | - M. Zehnder
- Department of Preventive Dentistry, Periodontology and Cariology University of Zürich Zürich Switzerland
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Ballal NV, Das S, Rao BSS, Zehnder M, Mohn D. Chemical, cytotoxic and genotoxic analysis of etidronate in sodium hypochlorite solution. Int Endod J 2019; 52:1228-1234. [PMID: 30848496 DOI: 10.1111/iej.13110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
AIM To test whether the incorporation of a chelation powder, etidronate, marketed for root canal irrigation (Dual Rinse HEDP) into a sodium hypochlorite (NaOCl) solution induced additional cytotoxic and genotoxic effects not observed with NaOCl alone. METHODOLOGY Fresh and 24-h-old mixtures of 0.9 g of etidronate in 10 mL of 2.5% NaOCl were assessed for their basic chemical features including pH and the ability to chelate Ca2+ from hydroxylapatite. Pure NaOCl and phosphate-buffered saline (PBS) with/without etidronate served as control solutions. Cytotoxic and genotoxic effects of diluted solutions (1:10, 1:100, and 1:1000) were assessed on Chinese hamster lung fibroblast (V79) using the MTT, clonogenic and micronucleus assays, respectively. One-way ANOVA and Tukey's HSD test were applied with an alpha-type error of 5% (P < 0.05). RESULTS In mixtures of NaOCl and etidronate, the free available chlorine was lost completely after 24 h, and the pH dropped by more than 3 units. However, the ability of the etidronate to chelate Ca2+ was maintained. The fresh mixtures of NaOCl and etidronate were not more toxic than NaOCl alone (P > 0.05), whilst the 24-h-old mixtures were less toxic (P < 0.05) and statistically similar to pure etidronate. Etidronate per se showed little cytotoxicity and no genotoxicity at the tested dilutions. CONCLUSIONS The ability of the used etidronate, Dual Rinse HEDP, to chelate calcium is not affected by NaOCl. Cytotoxicity and genotoxicity of mixed solutions is dictated by the presence of free available chlorine therein.
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Affiliation(s)
- N V Ballal
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - S Das
- Department of Radiation Biology and Toxicology, School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B S S Rao
- Department of Radiation Biology and Toxicology, School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - M Zehnder
- Department of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - D Mohn
- Department of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
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Purayil TP, Ballal NV, Ginjupalli K. Comparative Evaluation of Surface Defects In Single File Rotary Systems Before and After Instrumentation In Curved Root Canals. Eur J Prosthodont Restor Dent 2018; 26:130-135. [PMID: 30152957 DOI: 10.1922/ejprd_01714purayil06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study aims to evaluate the surface defects and efficiency of two single file rotary systems with different surface treatments in curved root canal instrumentation. A total of 160 root canals were randomly divided into two groups and were subjected to root canal instrumentation with electropolished surface rotary file (Group 1) and with EDM surface treated rotary file (Group 2). All the files were then subjected to SEM analysis to evaluate the surface defects prior to the root canal instrumentation,after 5 uses and 8 uses inside the root canal. From the scanning electron microscopic images, the surface defects as observed were scored and were statistically analyzed. SEM analysis of both the single file systems revealed significantly varying surface defects. Rotary file with electropolishing appeared to be more resistant to deformation compared to the rotary file with EDM treatment after instrumentation of five canals. Hence it can be concluded that electropolished file can be safely instrumented for five times compared to EDM processed files in curved root canals.
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Ballal NV, Tweeny A, Baumgartner JC, Ginjupalli K, Saraswathin V. Effect of maleic acid and ethylenediaminetetraacetic acid on the shear bond strength of RealSeal SE sealer to root canal dentin. Eur J Prosthodont Restor Dent 2013; 21:152-156. [PMID: 24479211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Aim of this study was to evaluate the effect of 7% maleic acid and 17% ethylenediaminetetraacetic acid (EDTA) on the shear bond strength of RealSeal SE sealer to root canal dentin. Twenty incisors were split into coronal, middle and apical third and were treated in the following manner: Group 1: 5 ml of saline (1 minute). Group 2: 2.5% sodium hypochlorite (5 ml/min) followed by 79% maleic acid (5 ml/min). Group 3: 2.5% sodium hypochlorite (5 ml/min) followed by 17% EDTA (5 ml/min). Sealer was the placed on the root dentin and samples were subjected to bond strength measurement. There was no significant difference in bond strength between maleic acid and 17% EDTA in coronal & middle third. However, in apical third, 7% maleic acid showed higher bond strength. Least bond strength was observed with saline. Bond strength was maximum in apical third for both 7% maleic acid and 17% EDTA.
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Affiliation(s)
- N V Ballal
- Manipal College of Dental Sciences, Manipal University, Karnataka, India.
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Ballal NV, Kumar SR, Laxmikanth HK, Saraswathi MV. Comparative evaluation of different chelators in removal of calcium hydroxide preparations from root canals. Aust Dent J 2012; 57:344-8. [DOI: 10.1111/j.1834-7819.2012.01710.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ballal NV, Mala K, Bhat KS. Effect of maleic acid and ethylenediaminetetraacetic acid on the dissolution of human pulp tissue - an in vitro study. Int Endod J 2011; 44:353-6. [DOI: 10.1111/j.1365-2591.2010.01837.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ballal NV, Kundabala M, Bhat KS, Acharya S, Ballal M, Kumar R, Prakash PY. Susceptibility ofCandida albicansandEnterococcus faecalisto Chitosan, Chlorhexidine gluconate and their combinationin vitro. AUST ENDOD J 2009; 35:29-33. [DOI: 10.1111/j.1747-4477.2008.00126.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIM To describe the diagnosis and management of tooth 22 with a necrotic pulp and severe periodontal destruction associated with a deep palatogingival groove extending to the root apex. SUMMARY Palatogingival grooves are uncommon in maxillary lateral incisors, but when present may contribute to the pathogenesis of periodontal and endodontic lesions. In the present case, the prognosis was considered poor, as the patient presented with a deep probing defect, advanced bone loss and grade III mobility of tooth 22. Root canal treatment was performed, followed by periodontal surgery, during which the groove was conditioned and sealed with conventional glass-ionomer cement and the osseous defect filled with indigenously prepared hydroxyapatite. The 18 month post-operative follow up showed substantial resolution of the osseous defect with gain in attachment and decreased tooth mobility. KEY LEARNING POINTS Teeth with deep palatogingival grooves may be significantly compromised with severe periodontal and periapical bone loss. Following thorough evaluation, the careful application of endodontic and periodontal surgical procedures may restore satisfactory function.
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Affiliation(s)
- N V Ballal
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, Karnataka, India.
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