Conservative Dentistry

From the Desk of the Editor … The new dawn - Hope in the pandemic Shishir Singh Journal of Conservative Dentistry 2020 23(4):319-319

Preferred Reporting Items for study Designs in Endodontology (PRIDE): Guiding authors to produce high.quality manuscripts Venkateshbabu Nagendrababu, Paul M H. Dummer Journal of Conservative Dentistry 2020 23(4):320-324 Implementing evidence-based dentistry involves a systematic process that includes collecting and analyzing evidence to address a clinical question. However, the inadequacy of many manuscripts and the incomplete and often misleading information they provide when published in healthcare journals are of major concern. The literature confirms that reporting guidelines improve the overall completeness and transparency of manuscripts in the field of oral health research. To improve the overall quality and clinical translation of studies in Endodontology, a new suite of guidelines under the umbrella of the Preferred Reporting Items for study Designs in Endodontology (PRIDE) project has been developed. Under the PRIDE project, five reporting guidelines focusing on specific study designs within the specialty either have or are in the process of being developed: (Case reports: Preferred Reporting Items for Case reports in Endodontics (PRICE); Randomized clinical trials: Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE); Laboratory studies: Preferred Reporting Items for Laboratory studies in Endodontology (PRILE); Animal studies: Preferred Reporting Items for Animal Studies in Endodontology (PRIASE) and Observational studies: Preferred Reporting items for OBservational studies in Endodontics (PROBE). For each guideline, the project leaders (VN, PD) formed a steering committee made up of experts from across the globe. Each steering committee developed an initial draft checklist containing a list of proposed items related to the specific study design to fit the specialty of Endodontology. In addition, a flowchart to graphically illustrate the process involved in the development of a manuscript was created to accompany each individual guideline. Each steering committee then formed a Delphi panel that included approximately 30 experts from across the globe who commented individually and anonymously upon the items to be included in each checklist and flowchart until a consensus was achieved. The draft checklists and flowcharts were then discussed during face-to-face or online meetings of approximately 20 experts to further debate and refine each guideline, which were then piloted by several authors while writing a manuscript. Eventually, each guideline (checklist and flowchart) will be published along with supporting material as well as being freely accessible on the PRIDE website (www.pride-endodonticguidelines.org). The PRIDE guidelines will help authors produce high-quality manuscripts in the discipline of Endodontology.

India's contribution to regenerative endodontics: A bibliometric analysis Arunakshi Krishnan, Aakriti Saini, Sidhartha Sharma, Vijay Kumar, Amrita Chawla, Ajay Logani Journal of Conservative Dentistry 2020 23(4):325-329 Regenerative endodontics (RE) is a dynamic field with widespread global impact. The aim of this bibliometric analysis is to highlight India's contribution in the field. Electronic search was performed in PubMed and Web of Science database till December 2019 using the search terms “Dental pulp regeneration,” “Pulp revascularisation,” “Revitalisation,” “Regenerative endodontic,” and their permutation. Articles of Indian authors with affiliation to Indian institutes were included. The following data were extracted: first author, institute and state of affiliation, year and journal of publication, study design, level of evidence (LOE), and number of citations. A total of 76 articles (case reports [n = 29, 38.15%], review [n = 25, 32.8%]) were published between 2008 and 2019. Majority (42.6%) were categorized as LOE 4. 7.4% articles were in LOE1 category. Eight percent articles had citations above 100 (highest cited-354 citations). The average yearly growth rate between 2011 and 2019 was 33.28% and highest number of publications was in the year 2015. The south zone had the maximum publications. At an institutional level, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, had the maximum publications. Journal of Conservative Dentistry published the highest number of articles. India contributed 7.6% of the global PubMed indexed publications and reported 22% of clinical trials. This analysis reveals increasing trend of research in RE in India. However, it highlights the need to generate articles with higher LOE by conducting quality multicenter trials and promote national and international collaborations.

Evaluation of remineralization potential and cytotoxicity of a novel strontium-doped nanohydroxyapatite paste: An in vitro study Ratheesh Rajendran, K Radhakrishnan Nair, Raghu Sandhya, P Mohammed Ashik, Rakhi Pattuvanmar Veedu, Shinu Saleem Journal of Conservative Dentistry 2020 23(4):330-336 Background: The focus of caries management has shifted to the early detection of caries and noninvasive methods of management of incipient lesions with novel remineralizing agents. Aim: The aim of this study is to evaluate and compare the remineralization potential of a novel laboratory synthesized strontium-doped nanohydroxyapatite (SrnHAp) paste to a commercially available regular dentifrice. Materials and Methods: Sixty enamel specimens (4 mm × 4 mm × 1 mm) were divided into two groups based on the type of dentifrice applied: Group I – regular toothpaste and Group II – SrnHAp paste. Calcium/phosphorous ratio of all sound specimens was evaluated using Scanning Electron Microscopy-Energy Dispersive X-ray analysis. Samples in both groups were subjected to demineralization, and the calcium/phosphorous ratio was analyzed. The samples were then subjected to remineralization using the specific agents in each group, and the mean calcium–phosphorus ratio was assessed. Cytotoxic evaluation of both pastes was done by direct microscopic observation and MTT assay. Statistical Analysis: Comparison of mean calcium and phosphorous values of sound enamel, demineralized, and remineralized specimen in Groups I and II was done using the one-way ANOVA and Tukeys post hoc test. Intergroup comparison after remineralization was done using the Student's t-test. Results and Conclusion: Group II showed higher remineralization potential than Group I and was statistically significant. Cytotoxicity of novel paste was less compared to the regular toothpaste. SrnHAp showed better remineralization than regular toothpaste and can be considered for enamel repair in incipient carious lesions.

Association of hormonal fingerprints and dental caries: A pilot study Akansha Rajawat, Chandrakanth Majeti, Uday Kumar Podugu, Mamta Kaushik, X Nagamaheshwari, Neha Mehra Journal of Conservative Dentistry 2020 23(4):337-340 Context: Dental caries remains the most widespread oral disease among all age groups. Hormonal fingerprints (second digit: fourth digit ratio or 2D:4D ratio) are biomarkers displaying sexual dimorphism and diverse human phenotypic traits. A person's genetic makeup may influence the occurrence of dental caries. Aim: The present study aimed to evaluate the influence of digit ratio on the incidence of dental caries. Settings and Design: Two hundred patients between 18 and 55 years, reporting for restorations or endodontic therapy, participated in the study. Subjects and Methods: Hormonal fingerprints (2D:4D ratio) were measured with the help of a digital vernier caliper. Caries incidence was recorded using the DMFT index. Statistical Analysis used: Data obtained were tabulated and statistically analyzed using Independent t-test and Chi-square test. Results: Males had a less mean 2D:4D ratio than females, which was statistically significant (p-value = 0.003). Chi-square test was applied, and there was a statistically significant correlation between high digit ratio and caries experience (p-value = 0.002). Females with a high digit ratio and males with a low digit ratio were in the moderate and low caries risk groups with a p-value of 0.029 and 0.001 in the respective risk groups. Conclusion: The present study displayed a correlation between hormonal fingerprints (2D:4D ratio) and dental caries. An indicator of caries risk will help prevent caries by implementing oral hygiene measures, which will reduce its incidence as the most occurring oral disease.

Influence of desensitizing agents in management of noncarious cervical lesion and bonded restorations: A preliminary 12-week report J Joyson Joe Asir, I Anand Sherwood, Bennett T Amaechi, M Vaanjay, S Swathipriyadarshini, P Ernest Prince Journal of Conservative Dentistry 2020 23(4):341-347 Objectives: The primary objective of this study was to investigate the effectiveness in reducing dentin hypersensitivity in noncarious cervical lesions (NCCLs) by home-based desensitizing toothpaste (TP), in-office Gluma desensitizer application, and resin-modified glass-ionomer cement (RMGIC) restoration. The secondary objective was to evaluate the long-term outcome of the? glass-ionomer cement restoration following the application of bioactive glass-containing desensitizer TP. Materials and Methods: A total of 73 patients or 151 teeth were included in the study and randomly allotted to one of the four different treatment groups. Pre- and postoperative symptom and air-blast/tactile sensitivity scores were recorded for statistical analysis. Postoperative sensitivity was analyzed at 1, 4, and 12 weeks after treatment. Nonparametric statistical tests were employed. Results: Kruskal–Wallis test noted a significant reduction in postoperative sensitivity at all time periods with the RMGIC group compared to other treatment options. Significantly higher patient dropout was observed in desensitizing TP regimen. Conclusions: This interim 12-week report on dentin hypersensitivity management of NCCLs concludes that resin-modified glass-ionomer restoration was able to achieve a significant instant reduction in sensitivity and patient satisfaction compared to other noninvasive at-home and in-office procedures. Clinical relevance: This interim 12-week report on dentin hypersensitivity management of noncarious cervical lesions concludes that resin-modified glass-ionomer restoration was able to achieve a significant reduction in sensitivity, and patient satisfaction was higher compared to other noninvasive at-home and in-office procedures.

Comparative analysis of platelet.rich fibrin, platelet-rich fibrin with hydroxyapatite and platelet-rich fibrin with alendronate in bone regeneration: A cone-beam computed tomography analysis Urvashi Ojha Tiwari, Ramesh Chandra, Supratim Tripathi, Jyoti Jain, Sanjay Jaiswal, Rahul Kumar Tiwari Journal of Conservative Dentistry 2020 23(4):348-353 Aim: This clinical study was designed to evaluate the volumetric healing of periapical (PA) bone defect after PA surgery, using platelet-rich fibrin (PRF), and its combination with hydroxyapatite and alendronate. Subjects and Methods: Twenty male patients of age between 25 and 35 years, having PA pathology (>5 mm on intraoral periapical radiograph (IOPA)) with intraoral sinus opening, were included in this study. Cone-beam computed tomography (CBCT) imaging of all patients was done. Root canal treatment with PA surgery was done. Patients were divided into four groups (5 in each group), on the basis of material placed in PA bone defect. After 1 year, CBCT imaging was done. Linear measurement of maximal dimensions in all three orthogonal planes was done in both pre- and post-CBCT image. These measurements were used to estimate the volume of the lesion healed after 1 year of surgery. Statistical Analysis: Analysis of variance and Post hoc Tukey's test were used for statistical analysis. Results: Change in volume were significantly different between Group 1 vs Group 3; Group 2 vs Group 3 and Group 3 vs Group 4. The Group Order for change in volume 1 year post surgery Group 3> Group 4 ≈Group 2> Group 1. Conclusions: PA bone healing after surgery is enhanced by placing combination of bone regenerative materials. PRF with hydroxyapatite provides best healing outcomes in comparison to PRF with alendronate or PRF alone.

Comparative evaluation of platelet-rich fibrin, platelet-rich fibrin + 50 wt% nanohydroxyapatite, platelet-rich fibrin + 50 wt% dentin chips on odontoblastic differentiation - An in vitro study-part 2 Kottuppallil Girija, Mahendran Kavitha Journal of Conservative Dentistry 2020 23(4):354-358 Aim: The purpose of this study was to investigate the effects of platelet-rich fibrin (PRF) modified with bioactive radiopacifiers–nanohydroxyapatite (nHA) and dentin chips (DC) on odontoblastic differentiation in human dental pulp cells (HDPCs). Subjects and Methods: PRF was modified with 50wt% of nHA (G bone-SHAG31, Surgiwear Company) and 50 wt% of DC. HDPSCs differentiation and mineralization by the groups ([Group A - Control (Dimethyl sulfoxide), Group B - PRF, Group C – PRF + nHA, Group D – PRF + DC]) were assessed. ELISA was done to quantify the interleukin (IL)-6 and IL-8 cytokine expression. The odontoblastic differentiation was determined by the expression of odontogenesis-related genes and the extent of mineralization using alizarin red S staining. Statistical Analysis Used: One-way ANOVA with post hoc Tukey-honestly significant difference tests were applied to assess the significance among various groups. Results: The level of inflammatory cytokines (IL-6 and IL-8) expression by Group D (PRF + 50 wt% DC) was higher compared to Group B (PRF) and Group C (PRF + 50 wt% DC). Group C (PRF + 50 wt% nHA) induced more mineralization nodules compared to other groups. The integrated density value for the DSPP and DMP-1 protein expression by Group C (PRF + 50 wt% nHA) and Group D (PRF + 50 wt% DC) was higher compared to Group B (PRF). Conclusions: The results suggest that the addition of bioactive radiopacifiers into PRF has a synergistic effect on the stimulation of odontoblastic differentiation of HDPCs, hence inducing mineralization.

Evaluation of vascular endothelial growth factor - A release from platelet-rich fibrin, platelet-rich fibrin matrix, and dental pulp at different time intervals Shruthi Nagaraja, Sylvia Mathew, Anil Abraham, Poornima Ramesh, Shashank Chandanala Journal of Conservative Dentistry 2020 23(4):359-363 Background: Lack of collateral blood supply and the low compliance environment of pulp makes its healing, a challenge. Vascular endothelial growth factor (VEGF) is a primary angiogenic growth factor. Knowledge of dose and time-dependent expression of VEGF from platelet concentrates, namely platelet-rich fibrin (PRF) and PRF matrix (PRFM), along with vital pulp can aid in developing strategies to improve the outcome of vital pulp therapy and regenerative procedures. Hence, the aim of this study was to compare VEGF kinetics of PRF, PRFM, and dental pulp. Materials and Methods: The PRF, PRFM, and vital dental pulp were placed in culture media for a week; the supernatant was collected from these samples at days 1, 4, and 7. VEGF-A expression was evaluated using ELISA and compared with the weight of the sample so as to quantify the release of VEGF-A per milligram of sample. Results: PRF exhibited maximum VEGF-A release on day 4 and was sustained till day 7. In contrast, PRFM and dental pulp showed no significant release of VEGF-A till day 7. However, on day 7, there was a rapid increase in VEGF-A expression from dental pulp that was comparable to PRF. On comparing the release of VEGF-A per milligram of tissue, pulp exhibited the maximum values. Conclusion: Among the platelet concentrates, differential expression of VEGF-A was superior in PRF. The use of PRF in partial pulpitis should be explored in order to restore pulp vascularity and hasten pulpal healing.

Cyclic fatigue, torsional failure, and flexural resistance of rotary and reciprocating instruments Carlos Henrique Ribeiro Camargo, Tatiane Sampaio Bittencourt, Amjad Abu Hasna, Renato Miotto Palo, Claudio Antonio Talge Carvalho, Marcia Carneiro Valera Journal of Conservative Dentistry 2020 23(4):364-369 Aim: The aim was to compare cyclic fatigue, torsional failure, and flexural resistance of NiTi endodontic files: Hyflex CM (HYF), Genius files (GEN), WaveOne Gold (WOG), and ProTaper Universal (PTU). Materials and Methods: Fifteen files of each brand were used in cyclic fatigue test and other fifteen files for flexural test and torsional failure test. To the cyclic fatigue test, used torque limit and revolutions per minute were set according to the respective manufacturer guidelines. The test was performed under deionized water at 36°C, and all files were tested in a 3 mm radius of curvature with an angle of curvature of 60°, time of the fracture was recorded. Torsional fatigue test was performed in the torsional machine (Instron MT, USA), recording the fractured time and torque data by the machine software. Flexural fatigue test was performed in 60° of curvature. All data were statistically analyzed by one-way analysis of variance, and Tukey test for multiple comparisons. Results: Cyclic fatigue (seconds)= HYF: 744.1 ± 231.9/GEN: 477.3 ± 220.5/WO: 278.4 ± 57.0/PTU: 152.4 ± 65.2; torsional failure (N × cm)= HYF: 6.85 ± 1.484/GEN: 6.55 ± 0.828/WOG: 5.73 ± 0.360/PTU: 4.43 ± 0.900; flexural resistance (N × mm)= HYF: 0.33 ± 0.294/GEN: 0.19 ± 0.136/WOG: 0.98 ± 0.216/PTU: 1.85 ± 0.276. Conclusion: HYF and GEN showed the best results for cyclic fatigue, torsional failure, and flexural resistance, followed by WOG and PTU.

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