Rajiv Gandhi University of Health Sciences s45

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1. NAME OF THE CANDIDATE DR.RAVI GUPTA AND ADDRESS POST GRADUATE STUDENT DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS VOKKALIGARA SANGHA DENTAL COLLEGE AND HOSPITAL , KR ROAD, V.V PURAM BANGALORE

2. NAME OF THE INSTITUTION VOKKALIGARA SANGHA DENTAL COLLEGE & HOSPITAL, BANGALORE. 3. COURSE OF STUDY AND MASTER OF DENTAL SURGERY- SUBJECT CONSERVATIVE DENTISTRY AND ENDODONTICS

4. DATE OF ADMISSION TO JUNE 2013 COURSE

5. TITLE OF THE TOPIC “CORONAL DISCOLORATION INDUCED BY THREE DIFFERENT ENDODONTIC SEALERS:AN INVITRO SPECTROPHOTOMETRIC ANALYSIS” 6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR THE STUDY:

Crown discoloration after endodontic treatment is considered a common esthetic problem for the patient and dentist, particularly for anterior teeth.1 The main causes of intrinsic crown discoloration related to endodontic treatment are: Disintegration of necrotic pulp tissue, hemorrhage into the pulp chamber, and endodontic medicaments and filling materials.2 A major etiological factor for the occurrence of local intrinsic staining, especially in the cervical and middle third of the crown, is the presence of root canal filling materials in contact with the coronal dentin of the pulp chamber.3In the long-term, core materials and sealers interact with dentin. Any change to the optical and chromatic properties of the dentinal structure is likely to cause an alteration in the outward appearance of the crown caused by its light transmitting and reflecting properties. Despite the improvement of physicochemical, biomechanical and biological properties of endodontic sealers, the appearance of coronal discoloration is still evident in daily practice. Recently, Mineral Trioxide Aggregate (MTA) Fillapex® was introduced as a new generation MTA-based sealer. Roekoseal is silicone based sealer .Sealapex is calcium hydroxide based sealer. The need of this study is to evaluate the coronal discoloration in human tooth crowns induced by MTA Fillapex and Roekoseal and Sealapex root canal sealer.

6.2 REVIEW OF LITERATURE:

In this study crowns of 50 extracted premolars were cut and their pulp chambers were cleaned and randomly divided into five groups . The following materials were placed into the pulp chambers: Group I: AH Plus, group II: Apexit Plus, group III: Sultan, group IV: Amalgam, and group V: Distilled water. The color of the crowns was measured using Shadepilot spectrophotometer prior and after the placement of experimental materials within pulp chambers. The result showed that all sealers cause significant discoloration that increases over a period of time .Least discoloration was shown by Apexit plus . It was concluded that all sealers used in the study cause a progressive coronal discoloration effect over 10-17 days.1

In this study fifty intact human extracted maxillary central incisors were employed. Access cavities were prepared in all samples and root canals were instrumented; coronal orifices were then sealed using self-cure glass ionomer. The teeth were divided into two experimental groups (n=20) according to utilized sealer in pulp chambers including AH26 and Dorifill (ZOE). The remaining 10 teeth served as negative and positive controls (n=5). The access cavities were sealed with self-cure glass ionomer. Teeth were kept in incubator for four month. Preliminary digital images of the teeth were taken and then compared with those related to 4-month follow-up. The images were assessed using Photoshop software. Result showed that the teeth which were filled with AH26 sealer showed significantly greater discoloration than those filled with ZOE sealer (Dorifill) (P<0.05). It was concluded that AH26 sealer causes greater discoloration of the crown compared to ZOE sealer. Despite the other disadvantage of AH26 sealer, it seems that Dorifill is more esthetically considerate.2 In this study coronal discoloration produced by four different sealers (Sealapex, Roth’s 801, AH 26 and Kerr Pulp Canal Sealer) was evaluated. Two control groups were included, in which one was filled with blood and the other was left empty. After 1, 3, 9 and 12 months, standardized pictures were taken of the teeth using a digital imaging system .The result showed that coronal discoloration was significantly more for AH26 and Kerr Pulp .3 This study evaluated the validity and reliability of the visual assessment of tooth color using a commercial shade guide. Ninety-two individuals were randomly selected from subjects enrolled in a randomized controlled trial comparing two formulations of carbamide peroxide. Initially, each individual had the color of his or her six maxillary anterior teeth (n=552) determined by one examiner using a digital spectrophotometer (Vita Easyshade). Then, a visual assessment was made by two calibrated examiners using a shade guide (Vitapan Classical). The results of this study showed that the visual assessment of tooth color using the Vitapan Classical shade guide is a valid method for distinguishing between light and dark tooth colors.4

In this study total of 90 plastic discs were casted to obtain metal dies for three different newer ceramic applications each on thirty samples. The color and surface roughness of these samples were measured using stereomicroscope and surface roughness tester following which they were kept in different test solutions for different durations and revaluated for color changes and surface roughness in the similar manner.The result showed that among all the five test solutions, Coffee showed the maximum staining of the ceramic whereas maximum surface roughness was shown by Orange Juice.5

6.3 OBJECTIVES OF STUDY:

AIM OF THE STUDY:

The aim of this study was to assess the degree of staining of crowns of teeth by using three endodontic sealers using a spectrophotometric method of color analysis.

OBJECTIVES OF THE STUDY:

1) To assess coronal discoloration due to endodontic sealers. 2) To compare discoloration effect of different endodontic sealers.

7. Materials and Methods:

7.1 Source of data:

Study duration : 1 year Study design : In vitro Sampling : Purposive sampling Sample size : 75 sample

7.2 Method of collection of data: 75 extracted mandibular premolars from the department of Oral surgery, V. S Dental College and Hospital will be selected for this study.

7.3 INCLUSION CRITERIA:

Mandibular Premolar extracted for orthodontic purpose.

7.4 EXCLUSION CRITERIA:

Teeth which are extracted due to decay or fractures. Teeth with restorations. Discolored teeth.

7.5 Statistical tests:

A Kruskal-Wallis and Mann-Whitney tests will be used to assess significant differences between the sealers. Wilcoxon test and Repeated Measures of Anova will be used to compare color changes at different periods within each group.

7. 6 Study material:

1. Fillapex - MTA based sealer (Angelus) 2. Roekoseal - Silicone based sealer(Coltene) 3. Sealapex - Calcium hydroxide based sealer (Kerr) 4. Airotar and contra angled handpiece 5. Endo access bur 6. Spectophotometer 7. Probe and magnifying glass 8. Pumice paste and rubber cup 9. Protaper files. 10. Incubator

7.7 Study Method: All the teeth are cleaned using a rubber cup and pumice to remove surface debris and stains. 75teeth are included in the experiment. The teeth are assigned to the three experimental group i.e. Group 1: MTA Fillapex, Group 2: Roekoseal , Group 3: Sealapex and the two control groups. Forty five teeth are used as experimental teeth, which will be obturated with GP and respective sealant (15 teeth per group). The remaining 30 teeth are used as the control teeth with 15 teeth as positive controls and 15 teeth as negative controls. The 15 positive control teeth are filled with an amalgam filling material in the access opening and sealed with composite.

The 15 negative control teeth are only instrumented and sealed with a composite . Composite will be used to fill the access cavities of the positive and negative control teeth . A coronal access cavity will be prepared in all the teeth using a Endo access bur ( Dentsply- Maillefer Instruments, Switzerland) in a airotar handpiece. The root canal are then prepared using protaper hand files according to manufacture instruction. Thorough irrigation with 2.5% sodium hypochlorite followed by 17% EDTA is used throughout the preparation procedure according to the standard irrigation protocol . The canals are then dried with paper points and cotton pellets. This will be followed by obturation using the tested sealer and GP (Dentsply-Maillefer, Switzerland). The coronal access will be sealed with composite resin filling material .Teeth are then stored partially submerged in sterile water in individually marked vials in an incubator at 37°C . After obturation, and at subsequent intervals (2, 4, 6, and 8 weeks), the teeth will be evaluated for their color co-ordinates utilizing the spectrophotometer.

Tooth color measurements:

Tooth color can be measured in several ways including visual assessment and by using instruments such as colorimeters and spectrophotometers. Spectrophotometers are considered as the reference instruments in the field of color science and have been used successfully in dentistry for tooth color measurements. 4 Spectrophotometer is used to measure the color quantitatively and qualitatively. The spectrophotometer is calibrated according to the manufacturer’s instructions before taking each reading and then carefully placed at right angle to buccal surface of the crown. A custom-made index is fabricated for each tooth using silicone impression putty. The index is constructed by moulding the impression putty around the 2mm aperture of the spectrophotometer when the probe was in the desired place on the tooth. The indices acted as a guide for the probe to ensure that it captured the CIE L*a*b* reading from exactly the same position every time the measurements were recorded. The resulting shades will be taken directly from the digital screen of computer attached to spectrophotometer device and CIE L*a*b* readings are taken. Pretreatment color shades and readings of the entire buccal surfaces will be taken and considered as baseline data to which the subsequent readings at 2,4,6,8 weeks will be compared. The color difference (E) at each time interval are calculated according to the following formula: E[(L*) 2(a*) 2(b*) 2]½ Where  L is the difference in lightness calculated from differences in the L* readings between two periods. This can be calculated for any period between baseline and at 2,4,6,8 weeks .a and b refer to the difference in chroma and are also obtained in the same manner as for L. 5

7.8 Does the study require any investigation or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

7.9 Has ethical clearance been obtained from your institution for this study?

Not required. 8. List of References:

1. Mohamed Abdel Aziz El Sayed, Hosameldein Etemadi . Coronal discoloration effect of three endodontic sealers: An in vitro spectrophotometric analysis. Journal of conservative dentistry 2013;16:347-351

2. Maryam Zare Jahromi . Comparing coronal discoloration due to AH-26 and ZOE sealers. Iran Endod J. 2011 Autumn; 6(4): 146–149

3. Parsons JR, Walton RE, Ricks-Williamson L. In vitro longitudinal assessment of coronal discoloration from endodontic sealers. J Endod 2001;27:699-702

4. SS Meireles , FF Demarco , IS Santos ,SC Dumith A Della Bona . Validation and Reliability of Visual Assessment with a Shade Guide for Tooth-Color Classification. Operative Dentistry, 2008, 33-2,121-126

5. Chandni Jain, Akshay Bhargava, Sharad Gupta, Rishi Rath, Abhishek Nagpal,Prince Kumar . Spectrophotometric evaluation of the color changes of different feldspathic porcelains after exposure to commonly consumed beverages .European journal of dentistry 2013;7: 172-80

9. SIGNATURE OF CANDIDATE

10. REMARKS OF THE GUIDE Discoloration of endodontically treated tooth is a common problem faced in routine clinical practice.Hence this study is required to understand discoloration potential of three different endodontic sealers.

11. NAME AND DESIGNATION OF:

11.1 GUIDE DR. R. ANITHA KUMARI Professor, Dept. of Conservative Dentistry & Endodontics, V.S Dental college and Hospital, Bangalore.

11.2 SIGNATURE

11.3 CO-GUIDE ( if any )

11.4 SIGNATURE

DR. USHA H.L 11.5 HEAD OF DEPARTMENT V.S Dental college and Hospital, Bangalore. 11.6 SIGNATURE

12. 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.2 SIGNATURE OF THE CHAIRMAN AND PRINCIPAL