Chitharanjan Shetty

Background: Restoration of structurally compromised endodontically treated teeth with extensive coronal destruction and subgingival margins remains a significant restorative challenge. Contemporary biomimetic restorative approaches emphasize preservation of the remaining tooth structure through adhesive reinforcement strategies that improve biomechanical performance while minimizing additional radicular dentin removal. Case presentation: This case report describes the biomimetic rehabilitation of a previously root canal–treated maxillary canine with severe coronal destruction and subgingival palatal and proximal margins. Following laser gingivectomy and margin exposure, complete caries excavation was performed using caries detector dye guidance, followed by immediate dentin sealing using Prime & Bond NT (Dentsply DeTrey GmbH, Konstanz, Germany). Deep margin elevation was carried out using the doughnut technique with SDR Flow + Flowable Composite (Dentsply Sirona, Charlotte, NC, USA). Conservative post-space preparation was subsequently performed, and a polyethylene fiber–reinforced post and composite core buildup were completed using dual-cure resin cement under adhesive protocol. Definitive rehabilitation was achieved using a monolithic zirconia crown fabricated from Cercon XT zirconia (Dentsply Sirona, Bensheim, Germany), conditioned according to the APC (air-particle abrasion, primer application, and composite resin cementation) protocol prior to adhesive cementation. Outcome: Clinical and radiographic follow-up at one month demonstrated satisfactory esthetic and functional rehabilitation with healthy periodontal response, satisfactory marginal adaptation, and absence of clinical symptoms. Conclusion: Within the limitations of a single case report and short-term follow-up, polyethylene fiber–reinforced post and core systems combined with adhesive biomimetic restorative protocols such as immediate dentin sealing and deep margin elevation may represent a conservative treatment option for rehabilitation of structurally compromised endodontically treated teeth with compromised ferrule and subgingival defects.

Background: The integration of endodontic services into preventive oral health care has become increasingly important as dental caries and pulpal pathologies remain major contributors to the global burden of oral disease. However, despite advances in preventive dentistry, gaps persist in the early identification and management of pulpal disease within primary care systems. Integrating endodontic services may enhance early diagnosis, timely intervention, and long‐term tooth preservation. Methods: A narrative review of published literature was conducted to examine current models, strategies, and evidence related to integrating endodontic care within preventive oral health frameworks. Key databases and professional organizational documents were reviewed to identify themes including service delivery models, workforce considerations, recent technological advances, barriers, and policy directions. Methodological rigor was enhanced using structured narrative review approaches and guided thematic synthesis. Results: Evidence indicates that integration enhances continuity of care, improves access to early pulp therapy, and reduces disease progression. Successful models include referral‐based coordination, colocation of care, and deployment of practitioners with enhanced endodontic skills. Technological developments such as digital diagnostics, artificial intelligence, and minimally invasive endodontic techniques further support integration. However, barriers such as fragmented health systems, limited workforce capacity, inconsistent funding, and inadequate training persist. Importantly, the current evidence base remains heterogeneous, with limited long‐term outcome data and variability in implementation across health systems. Policy frameworks and interprofessional collaboration are essential to overcoming these challenges. Conclusion: Integrating endodontic services into preventive oral health systems is feasible and beneficial, offering improved patient outcomes and stronger primary care delivery. Adoption of standardized referral pathways, workforce development, digital infrastructure, and supportive policies can facilitate broader implementation. Future research should prioritize cost‐effectiveness analyses, standardized outcome measures, and evaluation of long‐term clinical impact to support scalable integration models.

Introduction: Cold atmospheric pressure plasma (CAPP) has emerged as a promising nonthermal technology for antimicrobial disinfection and tissue modulation in dentistry. Its reactive oxygen and nitrogen species (RONS) facilitate the destruction of microorganisms, the disruption of biofilms, and the biomodulation of cells and tissues without causing thermal harm. The lack of translation into clinical practice despite the large number of in vitro investigations calls for a thorough synthesis of the available data. Objective: To systematically evaluate the efficacy and safety of CAPP across dental applications based on preclinical (in vitro and animal) and clinical studies. Materials and Methods: This review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420251154333) and adhered to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A comprehensive search was conducted in PubMed, MEDLINE, Scopus, Cochrane CENTRAL, and Web of Science. Inclusion criteria encompassed in vitro, ex vivo, animal, and human studies employing CAPP or plasma‐activated liquids (PALs) for dental applications. Outcomes included antimicrobial efficacy, remineralization, bond strength, wound healing, and safety. Results: Nineteen studies met the inclusion criteria. Consistent antibacterial, remineralizing, and bonding‐enhancing effects were shown in in vitro tests, along with significant increases in fibroblast proliferation and wound healing capability. Long‐term exposure safety and a decrease in alveolar bone loss, peri‐implant bacterial load, and periodontal inflammation were validated by in vivo investigations. No cytotoxic or carcinogenic effects were reported. Conclusions: Evidence from included studies, which were predominantly preclinical, suggests that CAPP demonstrates antimicrobial, bonding, remineralization, and regenerative potential with a favorable safety profile. However, clinical evidence is limited to a single short‐term randomized trial. Therefore, conclusions regarding routine clinical application remain preliminary, and further well‐designed clinical studies are required.

Aims: The aim of this study was to assess the smear layer removal efficacy of sodium hypochlorite (NaOCl) and ethylene diamine tetraacetic acid (EDTA), with and without the addition of poloxamer, in an in vitro model. Materials and Methods: In this in vitro study, 60 human premolars were randomly selected and decoronated to standardize the root length to 15 mm. The working length was set 1 mm short of the apex. The canals were instrumented to size F3 using the Protaper file system, with irrigation using NaOCl and saline between instrumentations. The samples were randomly divided into four groups based on the final irrigation protocol: Group 1 (n = 15) - 3% NaOCl with poloxamer, Group 2 (n = 15) - 17% EDTA with poloxamer, Group 3 (n = 15) - 3% NaOCl without poloxamer, and Group 4 (n = 15) - 17% EDTA without poloxamer. All samples were irrigated using an apical negative pressure system, and smear layer removal was analyzed using scanning electron microscopy (SEM). A five-graded scoring system was used to assess smear layer removal. Data were statistically analyzed using the Kruskal–Wallis test. Results: The group irrigated with EDTA and poloxamer showed the most effective smear layer removal, with a median score of 2 in both the middle and apical thirds of the canal. The NaOCl with poloxamer group showed a median score of 3, while the NaOCl-only group had a median score of 5, indicating less efficient removal of the smear layer. Conclusion: The study concluded that the addition of poloxamer to NaOCl and EDTA improved smear layer removal by lowering the surface tension of the irrigants. The combination of EDTA with poloxamer exhibited the best smear layer removal, followed by NaOCl with poloxamer. The NaOCl-only group showed the least effectiveness. This enhanced smear layer removal improves irrigant penetration, particularly for NaOCl, and may also enhance its antimicrobial efficacy. Furthermore, poloxamer’s surfactant properties suggest its potential as a drug delivery agent for intracanal medicaments. The results suggest that incorporating poloxamer into root canal irrigation protocols can significantly improve the efficacy of smear layer removal, leading to better irrigation outcomes and improved penetration of medicaments. This could enhance the overall success of endodontic treatments, particularly by improving antimicrobial activity and facilitating more effective drug delivery to the root canal system. Future research could explore the long-term clinical effects of using poloxamer-enhanced irrigants in various root canal systems, as well as investigate its potential as a carrier for additional intracanal medicaments. Further studies should also examine the impact of poloxamer on the mechanical properties of the root canal dentin and its compatibility with other commonly used irrigants.

Objective To evaluate the efficacy of various irrigants (5.25% sodium hypochlorite [NaOCl] followed by 17% ethylenediaminetetraacetic acid [EDTA] and 0.2% chitosan nanoparticle [NP]) and different irrigation techniques (conventional and EndoVac) for the removal of Metapex from the apical third of the root canal by scanning electron microscopy (SEM) analysis. Materials and Methods Forty extracted single-rooted human premolars were instrumented using a rotary ProTaper file system up to F3. The canals were dried and Metapex was placed inside the root canal. The access cavity was sealed with a cotton pellet and Cavit followed by the storage of specimens at 37°C at 100% humidity for 1 week. Cavit was removed and the samples were divided into: Group 1 (conventional irrigation using 5.25% NaOCl and 17% EDTA, n = 10), Group 2 (conventional irrigation using 0.2% chitosan NP, n = 10), Group 3 (EndoVac using 5.25% NaOCl and 17% EDTA, n = 10), and Group 4 (EndoVac using 0.2% chitosan NP, n = 10). After irrigant activation, the roots were divided in half, and the apical third of one-half of each tooth was subjected to SEM analysis. A five-graded scoring scale was used to evaluate dentinal wall cleanliness. Data were statistically analyzed using one-way analysis of variance. Results There were statistically significant differences in mean canal cleanliness scores observed between the four groups. Chitosan NPs showed lower mean canal cleanliness scores at the apical one-third of the root canal indicating better cleanliness when compared with the other irrigants and techniques. Conclusion None of the irrigation techniques was successful in entirely removing the calcium hydroxide intracanal medicament from the apical third.

Aim: To investigate the precipitate formed from the interaction between 2% lidocaine hydrochloride with adrenaline (LA) with 2.5% sodium hypochlorite (NaOCl) and 0.2% chitosan nanoparticles on root canal dentin, using scanning electron microscopy (SEM). Material and Methods: Sixty mandibular premolars were decoronated, and the root length standardised. The specimens were randomly distributed into the following groups: Group 1 (control): 2% LA mixed with sterile water without root canal instrumentation, Group 2: 2% LA with 2.5% NaOCl in water without root canal instrumentation, and Group 3: 2% LA with 0.2% chitosan nanoparticles in water without root canal instrumentation. Teeth specimens were split and subjected to SEM analysis at cervical, middle, and apical root thirds. On observing precipitate formation in Group 2, 10 premolars were decoronated and treated with 2% LA and 2.5% NaOCl and subjected to root canal instrumentation. Results: Group 1 and Group 3 showed patent dentinal tubules and no precipitate formation. Group 2 showed precipitate blocking dentinal tubules in all the three sections, and the precipitate could not be removed completely after cleaning and shaping. Conclusion: NaOCl forms an insoluble precipitate on interaction with local anaesthetic solution that cannot be removed after chemo-mechanical preparation. Chitosan nanoparticles do not form any such precipitate and show patent dentinal tubules. Hence, chitosan can be used as a flushing irrigant.

Dental index or indices are devices to find out the incidence, prevalence and severity of the disease, based on which preventive programs can be adopted. This current review article emphasizes and lists out the different indices that are used regularly in screening and treatment of various oral conditions. Few of the recent advances on dental indices have also been enumerated in the current article.

Aim and Objective To evaluate and compare the microleakage in class five cavities restored by a nano-hybrid and a nano-filled composite resin by dye penetration method. Method and Methodology Twenty premolar teeth were collected and standardized Class five cavities were prepared. The samples were divided into two groups, Group A and Group B. All the samples were then restored with the composite pertaining to that group (n=10). The samples were immersed in 2% methylene blue dye for 24 hours, post which they were sectioned vertically and the microleakage was assessed under the stereomicroscope. Results and Statistical Analysis The data for all the samples was obtained and subjected to statistical analysis. Conclusion Group B (Nano-filled composite resin) achieved superior results over the nano-hybrid composite resin group and exhibited lesser microleakage.

Perforations in the furcation region are one of the major complications leading to failure of endodontic treatment and causes significant impact on the long term prognosis of the tooth. It is estimated that furcation perforation is the second major cause of failure in endodontics. Biodentine is a calcium silicate-based bioactive material. It is a powder liquid system, powder composed of Tri-calcium silicate, Di-calcium silicate, Calcium carbonate and oxide, Iron oxide, Zirconium oxide. Liquid consist of Calcium chloride, Hydro soluble polymer. It is easy to handle owing to its ease of manipulation and a short setting time approximately 12 minutes, has high alkaline pH and is a biocompatible material makes it a favourable material for perforation repair, whereas cyanoacrylate has been shown to be an excellent tissue adhesive and hemostatic agent which is well tolerated by the tissues of the oral cavity, promotes healing of the tissues. Hence, this study would compare the microleakage of mineral trioxide aggregate and cyanoacrylate cement, in repairing furcal perforations using 2% methylene blue dye solution, conc. Nitric acid, ELISA plates for detecting the maximum dye leakage.