The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.

Increasing the volume of 4% articaine with 1 : 100 000 epinephrine from 1.8 to 3.6 mL, given as supplementary buccal infiltrations after a failed primary IANB with 1.8 mL of 4% articaine with 1 : 100 000, did not improve the anaesthetic success rates in patients with symptomatic irreversible pulpitis.

Aim To assess the influence of root canal treatment on serum high‐sensitivity C‐reactive protein (hsCRP) levels in systemically healthy human adults. Methodology Fifteen individuals aged 20–40 years diagnosed with apical periodontitis [Periapical Index (PAI) score ≥3] who were otherwise healthy took part in this prospective interventional study. Patients with moderate to severe periodontitis, systemic diseases and traditional cardiac risk factors (hypertension, diabetes, dyslipidemia and smoking) were excluded. Root canal treatment was completed in two visits with an inter‐appointment calcium hydroxide intracanal medicament. After 6 months, healing of apical periodontitis was evaluated clinically and radiographically, and serum hsCRP levels were recorded. A paired sample T‐test was used to compare the mean hsCRP values between the pre‐ and post‐treatment groups. The Mann–Whitney U test was used to compare hsCRP values between patients with PAI scores of 3 and 4, and the Wilcoxon signed‐rank test was used to compare pre‐ and postoperative PAI scores. Results The mean preoperative baseline serum hsCRP level was 2.88 ± 1.06 mg L−1 which can be associated with a moderate risk for cardiovascular disease (CVD). Based on the preoperative hsCRP levels, eight of the 15 patients were categorized as high risk (hsCRP > 3 mg L−1) and the other seven as medium risk (hsCRP 1–3 mg L−1) for CVD. The mean preoperative hsCRP value of patients with a PAI score of 3 was 2.88 ± 1.19 mg L−1, and the mean preoperative hsCRP of patients with a PAI score of 4 was 2.87 ± 0.15 mg L−1, which was not significantly different (P = 0.942). Six months after root canal treatment, the mean PAI score had significantly reduced from 3.2 ± 0.42 to 1.4 ± 0.69 (P = 0.003). The PAI score had reduced to ≤2 in 87% of the patients, and the mean serum hsCRP levels had significantly reduced to 1.34 ± 0.52 mg L−1 (P < 0.001). Ten of the 15 patients had a reduction in their CVD risk status. Conclusions This study suggests that root canal treatment can reduce serum hsCRP levels in systemically healthy individuals with apical periodontitis.

Chronic apical periodontitis can drain through a sinus tract, which may be intra-oral or extra-oral, though an intra-oral drainage is more common. Though such cases can be treated in a single visit, there is no report on a single visit endodontic treatment for a chronic apical periodontitis with a draining sinus. This case report demonstrates that the apical periodontitis with a cutaneous sinus tract can be successfully treated endodontically as a single visit procedure, if the patient is in good systemic health.

Introduction:The Enterococcus faecalis biofilm in the root canal makes it difficult to be eradicated by the conventional irrigants with no toxicity to the tissues. Hence, plant products with least side effects are explored for their use as irrigants in the root canal therapy.Aim:To evaluate and compare the antibacterial efficacy of Mangifera indica L. kernel (mango kernel) and Ocimum sanctum L. leaves (tulsi) extracts with conventional irrigants (5% sodium hypochlorite (NaOCl) and 2% chlorhexidine) against E. faecalis dentinal biofilm.Materials and Methods:Agar diffusion and broth microdilution assay was performed with the herbal extracts and conventional irrigants (2% chlorhexidine and 5% NaOCl) against E. faecalis planktonic cells. The assay was extended onto 3 week E. faecalis dentinal biofilm.Results:Significant reduction of colony forming units (CFU)/mL was observed for the herbal groups and the antibacterial activity of the herbal groups was at par with 5% NaOCl.Conclusions:The antibacterial activity of these herbal extracts is found to be comparable with that of conventional irrigants both on the biofilm and planktonic counterparts.

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Successful root canal treatment depends on adequate cleaning, shaping, and filling of the root canal system. The presence of middle mesial (MM) root canal of mandibular molars has been reported by various authors. But incidence of four canals in mesial root of mandibular molar is very rare. The aim of this case report is to present and describe the identification and management of a mandibular first molar with four canals in the mesial root and single canal in the distal root.

Aim:The aim of this study was to evaluate the surface roughness of three composites with three different polishing systems.Materials and Methods:Composite specimens were made from the Teflon mold with a standardized cavity size (6 mm diameter and 3 mm height). Group I — Filtek Z350XT (Nano clusters), group II — T-Econom plus (Microhybrid), group III — G-aenial Flo (True Nano). The samples were cured for 30 s from both sides with the matrices in place. The 60 samples were divided into 3 groups (N = 20), which accounted for 40 surfaces, (n = 20 × 2 = 40) in each groups. Each group were subdivided into four subgroups based on the type polishing material, subgroup A — Control, subgroup B — Astrobrush, subgroup C — Astropol, and subgroup D — Soflex spiral wheel. The samples of all groups except group A (control) were finished and polished according to the manufacture's instruction.Results:After polishing, the roughness (Ra) of the resin composite of all the specimens were measured using a profilometer. Soflex spiral wheel (group D) significantly had the least roughness (Ra) value as compared to the other groups.Conclusion:Among the three resin composites tested, G-aenial Flo exhibited least Ra value due to its reduced filler size and its uniform distribution.