Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Calcutta National Medical College & Hospital , Kolkata




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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : ZC18 - ZC22 Full Version

Effect of Calcium Hydroxide (CH), Triple Antibiotic Paste (TAP), Nano-sized CH and Nano-sized TAP as Intracanal Medicament on the Push-out Bond Strength of Biodentine: An In-vitro Study


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51958.16086
Gangavarapu Eswar Kowsik , Roopadevi Garlapati , Nagesh Bolla ,Sayesh Vemuri , Chukka Ram Sunil , Keerthi Priya Nandipati

1. Postgraduate Student, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 2. Reader, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 3. Professor, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 4. Professor, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 5. Professor, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 6. Postgraduate Student, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India.

Correspondence Address :
Dr. Gangavarapu Eswar Kowsik,
Postgraduate Student, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India.
E-mail: gekowsik@gmail.com

Abstract

Introduction: Root perforations are one of the common procedural errors faced in endodontic procedures. The ideal root repair material must be capable of bonding to the dentin. Calcium Hydroxide (CH) and Triple Antibiotic Paste (TAP) are mostly used for root canal disinfection.

Aim: To evaluate the effect of calcium hydroxide, triple antibiotic paste, nano-sized calcium hydroxide and nano-sized triple antibiotic paste as intracanal medicament on the push-out bond strength of biodentine.

Materials and Methods: The present in-vitro study was conducted in Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur for a period of 1 month (March 2020). A total of fifty maxillary central incisors (n=50) were decoronated, instrumented with ProTaper rotary NiTi instrument followed by peesoreamers up to number 3, and were divided into five groups (n=10). Group I: CH, Group II: Nano CH, Group III: TAP, Group IV: Nano TAP and Group V: Control group. The respective medicaments were mixed with propylene glycol and placed to the working length. After one week, medicaments were removed using Passive Ultrasonic Irrigation (PUI). Later, samples were sectioned into slices of 2 mm thickness using hard tissue microtome, and biodentine root repair material was placed into lumen of the slices. All the samples were stored for one week at 37°C, then subjected to push-out bond strength test. Data were analysed using one-way ANOVA, Tuckey, Dunnets Post-hoc test (p-value <0.05)

Results: The highest push-out bond strength values were observed in the group IV (p-value <0.001) and least in the control group. Biodentine showed significantly higher resistance to displacement among the group II (p-value=0.431) and group IV (p-value=0.074) when compared with their conventional medicaments.

Conclusion: Nano Triple Antibiotic Paste and Nano Calcium Hydroxide enhanced the push-out bond strength values of biodentine when compared to their conventional intracanal medicaments.

Keywords

Calcium silicate cement, Endodontic procedure, Nanoparticles, Passive ultrasonic irrigation

The primary rationale behind intracanal medicament is to kill the bacteria inside the root canal and to avert reinfection. Chemomechanical preparation cannot eliminate the bacteria residing deep in the dentinal tubules (Bystrom A and Sundqvist G) (1). If the root canal is not appropriately dressed with antiseptic medicaments between the visits, the residual bacteria may increase in the same number as it was in the starting stage of the endodontic treatment. Thus the use of effective intracanal medication for disinfection of root canal is necessitated (2).

Nanotechnology provides the advantage of reducing the size of the particles as well as increasing the efficacy of materials with their specific physicochemical characteristics, such as ultrasmall sizes, increased surface area/mass ratio, bactericidal, increased chemical reactivity and bioavailability (3),(4). Nanoparticle size is <100 nm and can reach the complex anatomy of the root canal system. The use of nanoparticulate intracanal medicaments are proven as an effective way to eliminate resistant bacterial strains (4).

Several intracanal medicaments are used to disinfect the root canal during the inter appointment period. Calcium hydroxide is widely used in clinical procedures due to its high alkalinity, better antimicrobial properties, ability to denature the bacterial lipopolysaccharide and tissue dissolving property (Siqueira Jr JF and Lopes HP) (5). However, it is ineffective in the elimination of Enterococcus fecalis, the most important bacteria in persistent infections and candidiasis infection. It also has disadvantages like prolonged treatment, alteration in the hardness, and demineralisation of dentine. Nano Calcium Hydroxide (NCH) particles are reported for higher levels of antimicrobial activity in comparison with conventional CH and deeper penetration into the dentinal tubules (6),(7).

The TAP is a mixture of ciprofloxacin, metronidazole, and minocycline. Initially, its use was recommended by Sato I et al., the proportions of the three antibiotics were recommended in a ratio of 1:1:1 by Hoshino E et al., 3:3:1 (Takushige T et al.,) and a 3 Mix MP paste using propylene glycol and macrogol as a vehicle in the ration 7:1; however, the ideal guideline to which to adhere remains a controversy (8),(9),(10). Triple Antibiotic Paste (TAP) also has some of the demerits, like causing tooth discolouration due to the presence of minocycline (11),(12). Karczewski A et al., reported the synthesis of clindamycin modified triple antibiotic nanofibres. In this study, the preparation of nano TAP was done by particle reduction using a ball miller (13).

Endodontic treatment can be complicated and challenging. Some of the iatrogenic errors complicate the outcome of endodontic treatment. Of those mishaps, one of the most commonly encountered procedural errors is a perforation of the root, which affects the prognosis of the tooth. Ideally, root perforations should immediately be repaired with a biocompatible material to seal the communication with the periradicular tissues. An ideal perforation repair material should provide an adequate seal, be biocompatible, not affected by blood contamination, not be extruded during condensation, able to resist masticatory forces under function, bactericidal, induce bone formation and healing, radio-opaque, induce mineralisation, cementogenesis and easily manipulated for placement (14),(15).

Calcium hydroxide, glass ionomer cement, Mineral Trioxide Aggregate (MTA), Hydroxyapatite, etc., are commonly used to manage perforation defects. Among these calcium silicate cements like MTA and Biodentine are emerging in contemporary practice because of their biomimetic properties and ability to withstand moist conditions. Biodentine (Septodont, Saint Maur des Fosses, France) has several advantages over MTA because of better handling properties, increased strength and hardness close to that of natural dentine, smaller particle size, increased micromechanical retention, ability to complete single appointment procedure (16),(17),(18),(19).

Interim medicaments should be removed entirely from the root canals to maintain the sealing efficacy of root canal sealers and filling materials. The literature to date suggests that no method was able to remove the intracanal medicament placed in the root canals completely. The frequency of the ultrasonic device is in the range of 20-40 kHz. It has advanced fluid dynamics by the formation of cavitation and acoustic microstreaming that can remove the debris even from the complex anatomy of the root canal system (Goodman A et al.,) (20).

To date, many studies have been attempted to evaluate the effect of different intracanal medicaments on the bonding ability of calcium silicate-based cements (21),(22),(23). None of them were based on the effect of nanoparticle ranged intracanal medicaments. The purpose of this study was to evaluate the effect of conventional TAP, CH, and their nano modified intracanal medicaments, i.e., nano TAP, NCH on the push-out bond strength of biodentine root repair material.

Material and Methods

This in-vitro study was conducted in March 2020 for a period of one month in the Department of Conservative Dentistry and Endodontics at Sibar Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh, India. The study protocol was approved by the Institutional Ethical Committee (IEC) (Pr.228/IEC/SIBAR/2020).

Inclusion criteria: Maxillary central incisors that were freshly extracted for periodontal reasons also with complete root formation and single canal with <10° curvature, no visible caries, fracture, cracks, resorption, calcifications. The degree of curvature was calculated using the methodology described by Schneider SW (24). Canal morphology was assessed by buccolingual and mesiodistal radiographs.

Exclusion criteria: Open apex tooth, teeth having more than one canal and >10° curvature, teeth that were having fracture, crack lines, resorptive defects and calcification.

Preparation of nano medicaments: Nano medicaments are prepared mechanically by particle size reduction attained through a ball miller (top-down approach) similar to Zhang W et al., (25). The average particle size of nano modified intracanal medicaments were analysed using the dynamic laser scattering method as done by Che L et al., in Zetasizer nano Ver.7.12 (Malvern Instrument Co., Southborough, UK) equipped with a He-Ne laser of wavelength 632.8 nm (26).

Specimen Preparation

Fifty maxillary central incisors (n=50) that were under inclusion criteria were selected and disinfected in 0.1% thymol solution for 24 hours and stored in saline until use. All the samples were decoronated upto cementoenamel junction using a diamond disc and the apical patencies was checked with a 10 k file (Mani.Inc., Tochigi, Japan). The working lengths were confirmed with radiographs. Root canals of all samples were prepared to the working length by using Protaper (Dentsply Maillefer, Ballaigues, Switzerland) NiTi rotary system to a size F3 using 17% Ethylenediaminetetraacetic acid (EDTA) (Desmear, Anabond Stedman Pharma Research Ltd, India). The canals were irrigated with 2 mL of 3% Sodium hypochlorite (NaOCl) (Prime Dental Products Pvt., Ltd.,) after each instrumentation. The samples were then prepared with peesoreamer (Mani, Inc. Ltd Japan) upto a size of number 3 to attain a standardised internal diameter of 1.3 mm. Final irrigation was done with 3% of NaOCl, followed by 17% EDTA to remove the smear layer. The samples were finally irrigated with 2 mL of saline to avoid harmful effects of NaOCl and EDTA and dried with paper points. The samples (n=50) were divided into five groups, as follows:

Group I: Calcium Hydroxide paste (CH) (n=10)

Group II: Nano Calcium Hydroxide paste (NCH) (n=10)

Group III: Triple Antibiotic Paste (n=10)

Group IV: Nano Triple Antibiotic Paste (n=10)

Group V: Control group (n=10)

The respective medicaments in Groups I-IV will be mixed with propylene glycol and placed to working length using a lentulospiral (Dentsply, Konstanz, Germany). No medicament was placed in the control group. The coronal orifices were sealed with a cotton pellet and temporary filling material (Cavit; 3M ESPE, Seefeld, Germany), and the samples were stored for one week in an incubator at 37oC and 100% relative humidity. After one week, the medicaments from group I-IV were removed from the root canals using Passive Ultrasonic Irrigation (PUI). A 15 U file was used, which was kept 2 mm short of working length and agitated for 30 seconds duration at a power setting of 6. Distilled water was used as an irrigant in PUI followed by 5 mL of NaOCl irrigation and a final flush of 5 mL of distilled water. The samples were sectioned perpendicular to the long axis to obtain 2 mm slices from the middle third of the root from each sample using hard tissue microtome (Isomet; Beuhler Ltd., NY, USA) so that from each group a total of 10 slices were taken from 10 samples.

The biodentine root repair material was mixed according to the manufacturer’s instructions, i.e., liquid from a single-dose container was emptied into a powder-containing capsule and mixed for 30 seconds at 4,000-4,200 rpm. It was incrementally placed into canal spaces of dentine slices being placed on a glass slab and condensed with a hand plugger. Excess material was removed from the surface of samples with a plastic instrument. The specimens were stored in an incubator at 37oC in 100% relative humidity for one week.

Push-Out Test

After one week, the samples were subjected to push-out bond strength analysis using Instron AutoGraph AG15 universal testing machine (Shimadzu, Japan) (Table/Fig 1). Samples were placed on a custom made metal slab with a central hole. It was aligned with the centre of the test sample, which allowed the stainless steel stylus of the machine to pass freely once the bond between the test material and tooth was broken. The plunger was placed such that it had only minimin clearance with the sample to ensure contact with test material only. A stainless steel needle with 1 mm diameter was used to apply the compressive load with downward pressure on the surface of test material at a speed of 1 mm/min. The maximum force at the time of dislodgement was recorded in Newtons. The push-out bond strength was calculated in MPa by using the formula

Push-out Bond strength (MPa)=debonding force (N)/surface area (2p×r×h) in mm2, where ‘p’ is the constant (3.14), ‘r’ is the root canal radius, and ‘h’ is the thickness of the root dentine slice in millimetres (27).

Statistical Analysis

Data were entered in MS-Excel and analysed in Statistical Package for the Social Sciences (SPSS) version 21.0. Shapiro Wilk test was applied to find normality. Descriptive statistics were represented by Mean with Standard Deviation (SD). A 95% confidence intervals were calculated. One-way ANOVA, Tuckey, Dunnets post-hoc test were applied to find significance. p-value <0.05 was considered statistically significant.

Results

(Table/Fig 2) represents the mean values and standard deviation of push-out bond strength (MPa) of all groups. The mean highest push-out bond strength values were observed in group IV i.e., 12.33 MPa (p-value <0.001) and least in the group V i.e., 3.32 MPa. Biodentine showed significantly higher resistance to displacement among the group II (p-value=0.431) and group IV (p-value=0.074) when compared with their conventional medicaments (Table/Fig 3).

Discussion

Root repair materials should adhere well to root canal dentine and offer significant resistance during the function in the oral cavity. There are various bond strength tests like tensile, shear, push-out bond strength to study the adhesive property of root repair materials to the dentine. In the present study, the push-out bond strength test was used, as it is a reliable, efficient, and practical method (27),(28),(29).

Chou K et al.,and Berkhoff JA et al., reported that removing intracanal medicaments entirely is a challenge because of their penetration and binding to root canal dentine (30),(31). Calt S and Serper A reported that the residual intracanal medicament affects the penetration of obturating material into the root canal dentine (32). Margelos J et al., confirmed the interaction of residual intracanal medicaments with zinc oxide based sealers affecting the quality of the sealer and Ozturk TY et al., reported formation of more voids during the marginal adaptation of biodentine with root canal wall (33),(34).

In the present study, PUI with distilled water, NaOCl as irrigants using stainless steel 15 U file keeping 2 mm short of working length was performed to remove the intracanal medicaments. This method enables better acoustic streaming of the irrigants producing micro cavitation bubbles within the root canals (Van der Sluis LW et al.,)(35). The effect of intracanal medicaments on the bond strength of root repair materials are critical because they affect the penetration ability of calcium silicate-based cements into the root canal dentine and formation of tag like structures and mineral infiltration zone by hindering calcium silicon ion exchange with the dentine (16).

In this study, the push-out bond strength values of Biodentine were higher in the nano TAP (group IV), followed by TAP (group III) when compared to other groups. Nano medicament groups showed significantly higher bond strength values when compared to their conventional counterparts. The results of the present study were in accordance with Tulumbaci F et al.,who reported that the binding of residual minocycline to the calcium via chelation might have increased the push-out bond strength values of TAP (36). On the contrary, Shaheen NA et al., found that intracanal medicaments have no significant effect on the bond strength values of biodentine. TAP causes excessive demineralisation of the dentinal surface, which might be the reason for the significant difference in the TAP group causing better penetration of the biodentine in our study (37). The residues of intracanal medicaments shown to decrease the micromechanical interlocking properties of these cements. In the present study, the least mean pushout bond strength in the control group (saline) might be due to the interaction of residual NaOCl with the biodentine affecting the adhesion of calcium silicate based biodentine (38). Pereira AC et al., found no significant effect of intracanal medicament on bond strength of biodentine when compared with chlorhexidine, TAP, distilled water and control groups (39). However, they detected small amounts of phosphorous ions in the triple antibiotic group at their interface. The higher bond strength of biodentine was due to the small particle size and high flowability of biodentine, which might have improved the penetration of the material into the dentinal tubules, increasing bond strength when compared to MTA group in their study. The powder of biodentine is composed of tricalcium silicate, calcium carbonate, zirconium oxide and the liquid part contains water and calcium chloride as a setting accelerator and a hydrosoluble polymer as water reducing agent, which improves the physical and handling properties of this material (40).

In the present study, the NCH (group II) had shown better push-out bond strength values when compared with the CH (group I); however, these were inferior when compared to group III and IV. Propylene glycol was used as a vehicle in the present study, which might have negatively affected the carbonation reaction of CH with the environment, study by Cruz EV et al., (41). The results of the present study are in accordance with Guiotti FA et al., who reported that CH remnants reduces the bond strengths of calcium silicate-based cements (42). Yassen GH et al., reported that disruption of dentinal collagen occurs due to the high alkaline pH of CH (43). This affects the bond between hydroxyapatite and collagen fibrils of dentine, which in turn decreases the push-out bond strength of biodentine. It might be the possible reason for the lesser push-out bond strength values of CH when compared to nano and conventional TAP. The study done by Nagas E et al., reported a higher bond strength of biodentine with CH group when compared with TAP (23). It was due to the smaller particle size of biodentine and better penetration ability.

The possible reason for better push-out bond strength values of nano modified medicaments in the present study when compared with the conventional groups might be due to the size of nano medicaments less than 100 nm. Nano medicaments might be easily dislodged on the ultrasonic activation leading to better bonding with the exposed dentinal tubules in the root canal wall. So lesser remnants cause better exposure of dentinal surface, enhancing the tag like structures of biodentine which might have increased resistance to dislodgement study by Aggarwal V et al., (15).

The difference in bond strengths of biodentine might also be due to experimenting maxillary incisors, usage of the viscous vehicle for the medicaments, and experimental design, affecting the bond strength values of biodentine when compared with previous studies by Alsubait S et al., Nagas E et al., Tulumbaci F et al., (21),(23),(36).

Limitation(s)

Although it is not always possible to generalise the results of in-vitro studies in the clinical scenarios. In the present study, the authors have considered the application of ultrasonics in comparing the effect of residual intracanal medicaments on push-out bond strength of biodentine. Further studies are necessary to substantiate the findings of this research and also the removal efficacy of ultrasonic agitation on nano-sized intracanal medicaments and highlight their importance in endodontic treatment.

Conclusion

Within the limitations of the present study it can be concluded that nano-sized medicaments can be efficiently used as intracanal medicaments as alternative to conventional medicaments because of improvement in the push-out bond strength values of biodentine. CH, NCH, TAP and nano TAP have enhanced the push-out bond strength values of biodentine. Nano TAP had shown highest mean pushout bond strength values when compared to other groups. NCH and nano TAP had significantly improved the push-out bond strength values when compared to CH and nano TAP respectively.

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DOI and Others

DOI: 10.7860/JCDR/2022/51958.16086

Date of Submission: Aug 16, 2021
Date of Peer Review: Nov 22, 2021
Date of Acceptance: Dec 21, 2021
Date of Publishing: Mar 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 19, 2021
• Manual Googling: Nov 24, 2021
• iThenticate Software: Dec 28, 2021 (4%)

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