longitudinal sectioning to measure the surface area covered with the remaining intracanal medicament .In the current study, volume analysis was done with CBCT as it provides accurate results than surface area measurement. Advantages of the CBCT technique are a lower radiation dose, a shorter time and no loss of tooth specimen. 25 Nandani et al., 11 Ballalet al. 26 and Wiseman et al. 27 used computed tomography.
Sjogren et al (1991) 55 clinically evaluated the antibacterial effect of calcium hydroxide as a short term intracanal dressing by applying the medicament for 10 minutes or 7 days in root canals of teeth with periapical lesions. Sterile saline solution was introduced into the canal by means of a syringe. The fluid in the canal was absorbed with charcoaled paper points and transferred to a tube with 5 ml of anaerobic peptone yeast extract glucose (PYG) broth. The results showed that the 7- day dressing was effective in eliminating bacteria which survived biomechanical instrumentation of the canal, while the 10 minute application was ineffective.
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medication the choice for the intracanal dressing of infected root canals. It is bactericidal and neutralizes the remaining tissue debris in the root canal system (Bhandari, 2014). The use of calcium hydroxide as an intracanal medicament is very well documented. However its efficacy in clinical practice is controversial (Hargreaves, 2014). Bystrom et al showed that 34 out of 35 canals were bacteria free after 4 weeks of medication period with calcium hydroxide. The study conducted by Sjogren et al. (1991), also demonstrated that a 7 day dressing with Calcium hydroxide reduced all bacteria in root canal. However Kvist el al. (2004), reported that residual bacteria were detected in 29% of one visit teeth and 36% of two visit teeth treated with calcium hydroxide, with no statistically significant difference in both the groups. Nowdays interest has been developed in the effectiveness of CHX gel alone or its mixture with calcium hydroxide. Chlorhexidine (CHX) is a synthetic cationic bisguanide used in endodontics as an irrigant and intracanal dressing. It has an immediate antimicrobial effect, a wide spectrum of action, substantivity, and relatively less toxicity, but it cannot dissolve organic debris which might interfere with the sealing of the root filling (Carbajal Mejía, 2014). Ercan et al reported that 2% CHX gel was significantly more effective when compared with mixture of CHX gel and calcium hydroxide or calcium hydroxide alone against E.faecalis. Kandaswamy Eswar evaluated the antimicrobial efficacy using real-time polymerase chain reaction. This study also showed that chlorhexidine is more effective against E.faecalis compared to calcium hydroxide. However some studies states that altering the vehicle increases the antimicrobial effect of calcium hydroxide against E.faecalis when compared with chlorhexidine (Vaghela, 2011). The quest for better intra canal antimicrobial protocols must be continued to ensure complete eradication of bacteria from canal prior to obturation. Results of the different studies are inconsistent, because various techniques have been used to asses antimicrobial efficacy such as zone of inhibition, colony forming units, optical densities and polymerase chain reaction technique. This systematic review can clarify conflicting research data and current state of information regarding specific issues about intracanal medicament. So here in this systematic review we are comparing antibacterial efficacy of calcium hydroxide and chlorhexidine against E.faecalis when used as an intracanal medicament.
Periapical disease is the result of bacteria, their product, and the host response to them. Early histological stud- ies of diseased periapical tissue have not been able to demonstrate viable bacteria in the lesions studied (). More recent reports indicate that many of these lesions are indeed infected before and after endodontic treat- ment. In Wayman studied cases of periapical lesion (). He cut these lesions in half and examined one half histological and cultured the other half. In only of cases could he demonstrate bacteria histologi- cally. However, when the other half lesion was cultured of cases were positive. He found isolates, of which were strict anaerobes, were facultative anaerobes and only were aerobes. Iwu showed that or of periapical granulomas were positive for bacteria when they were cultured. Barkhodar and De- souza () also found bacteria in granulomas and cystis. For many clinicians calcium hydroxide is the most com- monly used intracanal medicament, although the eﬀ ec- tiveness of many other intracanal antimicrobials, such as metronidazole antibacterial gel (), ledermix with tetracycline (), clindamycin-impregnated ﬁ ber (), an- tibiotic mixtures of ciproﬂ oxacin, metronidazole, mino- cycline (), has been proven eﬀ ective. Calcium hydrox- ide as an intracanal medicament has many advantages (,), but latest evidence demonstrated that enterococci and fungi, commonly found in cases of endodontic failure are highly resistant to calcium hydroxide ().
Endodontic access preparation under rubber dam isolation was done; there was drainage of white straw- colored fluid from tooth #7. The root canal space of tooth #7 was negotiated and the working length was measured. The apical foramen was gauged using hand K files, and the apical width was found to be equivalent to a size 40 K file. The apical zone was prepared to a size 80 K file. In this case, due to the presence of open apex, the constriction was not widened and an apical stop was prepared. Copious irrigation with 20 mL of 2.5% sodium hypochlorite was performed and the canal was dried. After disinfection of the canal, calcium hydroxide was given as intracanal medicament and recalled after 7 days. Inter-appointment medication of triple antibiotic paste was applied. Doxycycline, Metronidazole, and Ciprofloxacin were grounded and mixed with distilled water to make a paste thick in consistency. 4 This antibiotic
Endodontic infections occur as a result of microbial mixtures containing bacteria represented by Enterococcus faecalis  and fungi which are especially represented by Candida Albicans . Anaerobic bacteria with their endotoxins on their cell walls also predominant in this microbial diversity and can be detected especially gram negative . It is well established that the complete removal of bacteria from the root canal sys- tem is difficult even with the new endodontic techniques. Combining procedures to eliminate bacterial infection may be accepted. These including mechanical root canal debridement by proper shaping, irrigation by chemical agents such as sodium hypoch- lorite (NaOCl) or hydrogen peroxide (H 2 O 2 ) in addition to the intracanal medicament
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40 single rooted mandibular premolars were divided into 2 groups of 20 teeth each namely Group 1: Intact roots and Group 2: Simulated resorbed roots. All teeth were decoronated at CEJ followed by root canal preparation using Protaper Universal rotary instruments and copiously irrigated with 3% NaOCl and 17% EDTA and final rinse was done with saline. The canals were completely dried using paper points and intracanal dressing was done with RC Cal. The access cavity was closed with IRM and sealed with varnish. All the specimens were then suspended in a 10ml of deionized water and incubated at 37 o C. A digital pH meter was used to measure the pH on the 3 rd ,7 th ,14 th ,21 st and 28 th day after placement of calcium hydroxide intracanal medicament.
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Calcium Hydroxide was introduced in endodontics as a direct pulp- capping agent and is highly recommended and widely accepted as an inter-appointment intracanal endodontic dressing. It demonstrates a pronounced antibacterial activity against most of the bacterial species identified in endodontic infections. It can be mixed with a variety of vehicles such as distilled water, saline solution, propylene glycol and glycerine. Most of the substances used as vehicles do not have significant antimicrobial activity. However, due to the relative inefficiency of CH in the elimination of both facultative anaerobes and yeasts, it has been combined with other medicaments such as 2% CHX gel, Iodoform, Camphorated Paramonochlorophenol (CPMC), to obtain a wide spectrum antimicrobial action . The merits of CH have also been disputed, not only concerning its efficacy as an antimicrobial agent, but also because of possible apical leakage of the obturated canal system after its use . Incomplete removal of CH medicaments from root canal surface, prevents the sealer from penetrating into the dentinal tubules, interferes with the normal setting reaction resulting in potential reduction of sealer adaptation, thus, affecting the seal of obturating material leading to microleakage and subsequent treatment failure . Hence, while placing an intracanal medicament it is important to consider its effect on leakage of the root canal system .
Although CSC has been used in different dental proce- dures as mentioned previously, it has not been used as intra- canal medicament due to its setting reaction. To use CSC as a potential intracanal medicament for endodontic therapy, the setting reaction of the cement must be retarded or inhibited and antibacterial activity needs to be enhanced. Some investigators had replaced its mixing liquid with an antibacterial agent to enhance its antimicrobial properties. It should be noted that chlorhexidine has been used as endodontic irrigant and intra- canal medicament during root canal treatment. 23 It has an antibacterial effect against E. faecalis which affects the endo- dontic success. 24 However, chlorhexidine does not act as a physical barrier against microbial recolonization and is inef- fective in detoxifying bacterial endotoxins. Furthermore, it is not radiopaque if it is used as an intracanal medicament. 25 It is well established that the combination of 2% chlorhexidine liquid with MTA powder improves the antibacterial effect of
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10 37°C. 2ml of the sterile brain heart infusion broth from each tube was replaced by 2ml of the prepared mixed bacterial suspension and then the test tubes were closed and incubated at 37°C for14 days. They were grouped as Group 1-calcium hydroxide paste, Group 2- chlorhexidine gel, Group 3 -corticosteroid antibiotic paste and Group 4-sterile physiologic saline (control group). Orifices of the canals were sealed with dental modelling wax and placed in humid sterile gauze in closed sterile Petri dishes. All the specimens were incubated for 7 days at 37°C. After the completion of the incubation period the wax seal and intra canal medicaments were removed. Microbial suspension was placed on the three media specific for the growth of the tested microorganisms. The growing colonies were counted and recorded as colony forming units. They concluded that chlorhexidine was the best medicament used to eliminate the three different tested organisms at the two experimental sites, root canal lumen and radicular dentin. Streptococcus mutans was the most sensitive microorganism to calcium hydroxide, chlorhexidine and triple antibiotic paste. Candida albicans was the most resistant microorganism. Enterococcus faecalis was more susceptible to chlorhexidine than the other medications. 18
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The principal aim of endodontic treatment is to prevent or eliminate microbial contamination of the root canal system, and the main reason for the majority of treatment failures is persistence of infections within these spaces. Although mechanical instrumentation and use of irrigation solutions with strong antimicrobial properties eliminate the majority of intracanal microorganisms, it has been demonstrated that it is not possible to completely eliminate them. On the other hand, some microorganisms are resistant to antimicrobial agents used within the root canal. E. faecalis is a gram-positive facultative anaerobic microorganism, which has been isolated from teeth with failed endodontic treatment E. faecalis can survive even in obturated canals without support from other microorganisms or with very small amounts of nutrients.
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Intracanal posts can be fabricated of different materials such as composite resin, metal, biological materials [1,5], reinforced fiber, fiberglass , orthodontic wires and omega- shaped stainless steel wires ; of the aforementioned materials, composite posts are more commonly used for primary teeth . Most studies on the bond strength of dentin adhesives have reported lower bond strength to primary compared to permanent teeth . Different properties of primary and permanent dentin may explain the difference in bond strength values [9,10]. On the other hand, it has been shown that application of the same etching time of permanent dentin for primary dentin decreases resin bond strength to primary dentin . Scanning electron microscopic analyses revealed that application of similar etching time for primary and permanent dentin resulted in deeper demineralization of primary dentin by 25- 30% compared to permanent dentin [9,11]. Resin monomers cannot penetrate into the depth of demineralized area. Consequently, an area composed of denuded collagen fibrils remains, which would be the weakest zone at the adhesive-dentin interface .
challenging. Several factors affect the retention of fiber posts in root canals, such as the type of the tooth, root canal treatment, intracanal post surface preparation, bonding agent and cement, and method of application of the cement . Despite the advantages, some failures have been witnessed after the use of fiber posts, such as root fracture, core fracture, and debonding . Complete debonding is the most favorable mode of failure . Partial debonding at the coronal section of the root would cause leakage and secondary caries. Partial debonding, especially at the apical area, interferes with stress distribution along the root, and may increase the risk of root fracture . It has been reported that cementation of posts with adhesive systems increases the retention of the post, and decreases debonding and microleakage at the dentin-fiber post interface [12,13]. Separate etch adhesives and self-adhesives are among the most commonly used adhesives for this purpose. In separate etch adhesive system, acid and bonding agent are used separately. In self-adhesive systems, acid and bonding agent are used simultaneously without rinsing. Thus, the latter system is simpler, and less technique-sensitive . Moreover, the risks of over-drying or excess moisture, and their adverse effects on the bond strength are eliminated due to decreased steps of the bonding procedure . Dentists should choose the type of cement and post based on clinical indication, required bond strength, predictability, and long-term success, instead of simplicity, or to avoid technique missteps which would compromise the restoration. Thus, this study sought to compare the effects of self-adhesive and separate etch adhesive dual cure resin cements on the bond strength of quartz fiber post to dentin at different parts of the root.
The radicular syndrome caused by lumbar disc herniation compressing neurologic elements is a clear indication for surgical decompression. In the last decades, as a minimally invasive surgical technique, the posterior lateral transforam- inal endoscopic surgery has been developed to perform discectomy for neurologic decompression under direct view and local anesthesia including YESS (Yeung Endoscopy Spine Surgery) [1–5] and TESS (Transforaminal Endo- scopic Spine Surgery) [6–11]. There was a high percentage of patient satisfaction and a low rate of complications in YESS or TESS for lumbar disc herniation [1–11]. Com- pared with traditional lumbar discectomy, YESS and TESS have certain advantages: (1) no need for general anesthesia, (2) less cases of iatrogenic neurologic damage, (3) no retrac- tion on the intracanal nerve elements, (4) significantly less infections, (5) only minimal disturbance of ligamentum flavum or intracanal capsular structures, therefore, less scar formation, (6) no interference of scar tissue to reach the recurrent herniated tissue in cases of previous dorsal- discectomy, and (7) shorter hospital stay, earlier func- tional recovery, earlier return to work, and higher cost- effectiveness [1–11]. Although nearly all kinds of disc herniations are accessible for TESS of outside disc-inside technique directly into the spinal canal [2, 3], complexity of C-arm guided orientation, difficulty to find the optimal trajectory for target, and more steps of surgical manipula- tion leaded to much exposure of X-ray, long duration of operation, and steep learning curve.
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The aim of pulpotomy is to preserve the radicular pulp, avoiding pain and swelling, and ultimately retain the tooth until natural exfoliation, thus preserving arch integrity. Formocresol has long been the gold standard medicament used for this procedure since its introduction by Sweet in 1932. Several authors have proven its success compared to other agents over the past 70 years. 5 However, studies have
Some recent surveys have assessed the discoloration potential of substances used during root canal treatment, including root canal irrigants, intracanal drugs, and endodontic filling materials . Vivacqua-Gomes et al  noted dark brown deposits when NaOCl was mixed with CHX gel as a canal irrigant. The same discoloration was reported after the use of NaOCl with CHX solution . Other studies have shown that interactions between CHX and EDTA irrigants result in the formation of white to pink deposits [14,15]. To achieve an aesthetic smile, discoloration is more important for many people than the normal alignment of the teeth within the arch. The aesthetic aspect of the teeth is of great significance for the general population and dental practitioners . Internal bleaching is usually suggested for the teeth discolored following endodontic therapy .
Thus we assumed that pharmaceutical technology involved in the preparation of dosage forms might have ensured that the active principle of the Ayurvedic preparations have adequate aqueous solubility in kwatha, hima, phant, or lipid soluble in sneha kalpa through amalgamation of one or more processes depending upon nature of medicament. The objective of this review is to explore the traditional technology used to explore the bioavailability of poorly water soluble active components with contemporary scientific knowledge and understanding.
Self-medication was found to be practised in almost one of every two households. The pattern was found to be similar to many other studies. The usage of antibiotics as self-medicament and decreased awareness regarding the side effects of self-medicaments were the worrisome factors. More studies have to be conducted in the area regarding the awareness of responsible self-medication, the barriers and facilitators for practising responsible self- medication in the area studied.
Colony Counting and Turbidity Testing (Optical Density at 600nm) were chosen to evaluate the antibacterial efficacy of intracanal medicaments as they would signify the quantity of live residual bacteria present in the root canals. Microbial root culturing is commonly used to assess the effectiveness of endodontic treatment measures. In a study by Gomes et al. 1995, evaluated themoleculartechnique and culture technique and concluded that molecular techniques cannot differentiate between viable and dead cultures. On the other hand, using culture techniques a minimum concentration of microorganism is necessary for their isolation, and hence for their recognition in the clinical situation.
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Furthermore, initially, only the microorganisms at the tubule orifice may be exposed to hydroxyl ions than the ones lining dentinal tubules. In an in- vitro study conducted by Perez et al, theyobserved that the depth of penetration of in the dentinal tubules was 479 um for streptococcus. For Enterococcus feacalis and Streptococcus sanguis, it was 300-400um deep after 2-3 weeks and Pseudomonas aeurigunosa infected the dentin as early as in 3 days as observed in the study conducted byOrstavik and Haapasal. At these distances, calcium hydroxide is ineffective even after seven days, and it has been observed that these microorganisms can survive even in high pH. Within the lateral canals and the reticulated network of the pulp tissue, bacteria may also be enclosed. Bacterial regrowth in the canal has been observed, with or without inter- appointment medicament including calcium hydroxide, in cases which was done in prolonged time using multiple appointments. 11, 24, 25