Displaying publications 1 - 20 of 68 in total

  1. Pulikkotil SJ, Jayaraman J, Nagendrababu V
    Eur Arch Paediatr Dent, 2019 Oct;20(5):383-391.
    PMID: 30887462 DOI: 10.1007/s40368-019-00432-w
    AIM: To systematically evaluate the reporting quality of the abstract of systematic reviews and meta-analyses in paediatric dentistry journals.

    MATERIALS AND METHODS: Systematic reviews with meta-analyses in paediatric dentistry were searched in PubMed and Scopus databases from inception to December 2017. Selection of studies by title and abstract screening followed by full-text assessment was independently done by two reviewers. The quality of abstracts was assessed by PRISMA-Abstract checklist comprising of 12 items; one each for title and objective, three items for methods, three items for results, two items for discussion and two items for others. PRISMA-A median scores were calculated and compared with the article characteristics. Statistical significance was set at p 

  2. Ganesh A, Nagendrababu V, John A, Deivanayagam K
    J Clin Diagn Res, 2015 Nov;9(11):ZC61-5.
    PMID: 26675655 DOI: 10.7860/JCDR/2015/14602.6829
    Enterococcus faecalis is one of the most commonly occurring organisms retrieved from root canal treated teeth that show refractory apical periodontitis. Though it is well known that the ability of E. faecalis to form a matrix-encased biofilm contributes to its pathogenicity, the role of extracellular dextran and DNA in biofilm formation and its effect on the susceptibility of the biofilm to chlorhexidine remains poorly understood. It was hypothesized that the addition of an Extracellular Polymeric Substance (EPS) degrading enzyme along with a detergent to chlorhexidine may increase the susceptibility of the E. faecalis biofilm.
  3. Nagendrababu V, Duncan HF, Dummer PMH
    Int Endod J, 2020 Apr;53(4):437-439.
    PMID: 32170984 DOI: 10.1111/iej.13272
  4. Ordinola-Zapata R, Peters OA, Nagendrababu V, Azevedo B, Dummer PMH, Neelakantan P
    Int Endod J, 2020 Jan;53(1):36-52.
    PMID: 31454086 DOI: 10.1111/iej.13210
    AIM: To report the most common terminology used in titles of scientific papers published in the International Endodontic Journal (IEJ) and Journal of Endodontics (JOE) between 1980 and 2019 and to identify the most-cited papers in these journals.

    METHODOLOGY: The Web of Science database was searched to retrieve all the manuscripts published in the IEJ and JOE between 1980 and 2019. The articles were analysed using the VOS viewer software and the terms within the titles extracted. The top-10 terms were categorized according to the number of occurrences and the decade of publication. Maps were created using the text data for each decade of publication. Classic papers were identified when the number of citations was >400. During the same period of time, highly cited studies were identified including the authors, institutions and countries associated with these papers.

    RESULTS: Terms such as canal, molar and periapical lesion were the most commonly used in titles between 1980 and 1999. The terms instruments, expression, case report and cell were the most often terms used between 2000 and 2019. During the last 10 years, an increase in the number of reviews and papers on cone beam computed tomography occurred. The organizations with the largest number of citations in each decade were University of São Paulo, University College London, Loma Linda University and United States Army. The country with the largest number of citations and greatest number of top 10 and top 100 manuscripts was the United States. A paper had to be associated with more than 167 citations to be included in the top-100 most-cited list; at least 14 papers met the criteria to be categorized as a citation classic (>400 citations).

    CONCLUSION: While many diverse areas of endodontics have been explored in the last 40 years within the IEJ and JOE, only a relatively few topics are highly cited and can be considered as classics.

  5. Ooi HY, Tee WY, Davamani F, Nagendrababu V
    J Conserv Dent, 2019 8 2;22(3):241-244.
    PMID: 31367106 DOI: 10.4103/JCD.JCD_521_18
    Introduction: The aim of this study is to compare the antimicrobial activity of pediocin with chlorhexidine (CHX) and calcium hydroxide (Ca(OH)2) against Enterococcus faecalis and Staphylococcus epidermidis biofilms.

    Materials and Methods: The prepared root canals of 80 teeth were contaminated with E. faecalis (n = 40) and S. epidermidis (n = 40) for 21 days to create biofilms. The samples in each group were allocated randomly into the following four subgroups (n = 10) according to the decontamination protocol: Group 1: 1% Pediocin, Group 2: 2% CHX, Group 3: Ca(OH)2, and Group 4: saline (negative control). At 5 days, the antimicrobial efficacy of the medicaments against E. faecalis and S. epidermidis was assessed by collecting dentin shavings from the canal walls created using Gates Glidden drill sizes 4 and 5, corresponding to a depth into the root canal walls of 200 μm and 400 μm, respectively. The total number of colony-forming units (CFUs) was counted. The Wilcoxon signed-rank test was used to compare the difference in CFUs between the two depths (P > 0.05).

    Results: There was no bacterial growth in samples treated with pediocin, CHX, or Ca(OH)2 at either depth.

    Conclusion: In this laboratory experimental model, pediocin exhibited the same antimicrobial properties against E. faecalis and S. epidermidis as CHX and Ca(OH)2.

  6. Nagendrababu V, Pulikkotil SJ, Suresh A, Veettil SK, Bhatia S, Setzer FC
    Int Endod J, 2019 Jun;52(6):779-789.
    PMID: 30638269 DOI: 10.1111/iej.13072
    The management of pain during root canal treatment is important. The aim of this systematic review and network meta-analysis was to identify the anaesthetic solution that would provide the best pulpal anaesthesia for inferior alveolar nerve blocks (IANB) treating mandibular teeth with irreversible pulpitis. Two electronic databases (PubMed and Scopus) were searched to identify studies up to October 2018. Randomized clinical trials comparing at least two anaesthetic solutions (lidocaine (lignocaine), articaine, bupivacaine, prilocaine or mepivacaine) used for IANB for treatment of irreversible pulpitis were included. The revised Cochrane risk of bias tool for randomized trials was used to assess the quality of the included studies. Pairwise meta-analysis, network meta-analysis using a random-effects model, and SUCRA ranking were performed. The network meta-analysis estimated the probability of each treatment performing best. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. In total, 11 studies (n = 750) were included in the meta-analysis. The network meta-analysis revealed that only mepivacaine significantly increased the success rate of IANB compared to lidocaine (RR, 1.42 [95% CI 1.04-1.95]). However, no significant differences in the success rate of IANB were observed between mepivacaine and other anaesthetic agents (articaine and bupivacaine). Of all anaesthetic agents, mepivacaine (SUCRA = 0.81) ranked first in increasing the success rate of IANB, followed by prilocaine (SUCRA = 0.62), articaine (SUCRA = 0.54), bupivacaine (SUCRA = 0.41) and lidocaine (SUCRA = 0.13). The overall quality of evidence was very low to moderate. In conclusion, based on the evidence from the randomized clinical trials included in this review, mepivacaine with epinephrine demonstrated the highest probability of providing effective pulpal anaesthesia using IANB for teeth with irreversible pulpitis compared to prilocaine, articaine, bupivacaine and lidocaine. Further, high-quality clinical trials are needed to support the conclusion of this review.
  7. Jakovljevic A, Duncan HF, Nagendrababu V, Jacimovic J, Milasin J, Dummer PMH
    Int Endod J, 2020 Oct;53(10):1374-1386.
    PMID: 32648971 DOI: 10.1111/iej.13364
    BACKGROUND: The existence of an association between cardiovascular diseases (CVDs) and apical periodontitis (AP) remains unclear because results obtained from previous clinical studies and reviews are inconsistent or inconclusive.

    OBJECTIVE: To conduct an umbrella review to determine whether there is an association between CVDs and the prevalence of AP in adults.

    METHODS: The protocol of the review was registered in the PROSPERO database (CRD42020185753). The literature search was conducted using the following electronic databases: Clarivate Analytics' Web of Science Scopus, PubMed and Cochrane Database of Systematic Reviews, from inception to May, 2020, with no language restrictions. Systematic reviews with or without meta-analysis that evaluated the association between CVDs and AP were included. Other types of studies, including narrative reviews, were excluded. Two reviewers independently performed a literature search, data extraction and quality assessment of included studies. Any disagreements or doubts were resolved by a third reviewer. The quality of the reviews was assessed using the AMSTAR 2 tool (A measurement tool to assess systematic reviews), with 16 items. A final categorization of the systematic reviews classified each as of 'high', 'moderate', 'low' or 'critically low' quality.

    RESULTS: Four systematic reviews were included in the current review. Three reviews were graded by AMSTAR 2 as 'moderate' quality, whereas one review was graded as 'critically low' quality.

    DISCUSSION: Only one systematic review included a meta-analysis. Substantial heterogeneity amongst the primary studies included within each systematic review was notable in preventing a pooled analysis.

    CONCLUSIONS: From the limited 'moderate' to 'critically low' quality evidence available, the current umbrella review concluded that a weak association exists between CVDs and AP. In the future, well-designed, longitudinal clinical studies with long-term follow-up are required.

  8. Plotino G, Abella Sans F, Duggal MS, Grande NM, Krastl G, Nagendrababu V, et al.
    Int Endod J, 2020 Dec;53(12):1636-1652.
    PMID: 32869292 DOI: 10.1111/iej.13396
    Surgical extrusion is defined as the procedure in which the remaining tooth structure is repositioned at a more coronal/supragingival position in the same socket in which the tooth was located originally. Intentional replantation is defined as the deliberate extraction of a tooth and after evaluation of root surfaces, endodontic manipulation and repair, placement of the tooth back into its original position. Tooth autotransplantation is defined as the transplantation of an unerupted or erupted tooth in the same individual, from one site to another extraction site or a new surgically prepared socket. The advent of titanium implant rehabilitation has reduced the use of these treatments in day-by-day clinical practice; however, the re-emerging trend to conserve and preserve natural sound tissues has led to a rediscovery of these treatments. All three distinct surgical methods are closely related, as they act to treat teeth that cannot be predictably treated using other more conventional procedures in endodontics, periodontics and restorative dentistry. Furthermore, these procedures share the same treatment approach and include the atraumatic extraction of a tooth, visual inspection of the tooth/root and its subsequent replantation. The clinical procedures for surgical extrusion, intentional replantation and tooth autotransplantation treatment have undergone several changes in recent years, and currently, there are no clear clinical treatment protocols/guidelines available. The clinician should be aware of the outcome of these treatments. Hence, the aim of this narrative review is to provide the background, clinical procedures and outcomes of surgical extrusion, intentional replantation and tooth autotransplantation.
  9. Nagendrababu V, Duncan HF, Pulikkotil SJ, Dummer PMH
    Int Endod J, 2021 Mar;54(3):354-365.
    PMID: 33089501 DOI: 10.1111/iej.13434
    Randomized clinical trials are positioned at the highest level of primary clinical evidence, as they are designed to be unbiased with a reduced risk of systematic error. The Consolidated Standards of Reporting Trials (CONSORT) statement was first developed in 1996 to improve the reporting quality of randomized clinical trials with updates being published subsequently. Recently, the Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE) 2020 guidelines were developed exclusively for the field of Endodontics to address the suboptimal quality of randomized clinical trials submitted to Endodontic journals, which result in many being rejected. A principal flaw in submissions is the fact that many authors are unclear on the keys terms that should be used when developing manuscripts for publication. Clearly, authors should be aware of the most common terms used when conducting and reporting randomized clinical trials. Hence, the aim of the current paper is to present a comprehensive glossary of the terminology used in randomized clinical trials in order to assist authors when designing, executing and writing-up randomized clinical trials.
  10. Suresh N, Nagendrababu V, Koteeswaran V, Haritha JS, Swetha SD, Varghese A, et al.
    Int Endod J, 2021 Feb;54(2):198-209.
    PMID: 32976660 DOI: 10.1111/iej.13416
    AIM: This randomized, double-blinded, clinical trial evaluated the effect of oral premedication of piroxicam, prednisolone, dexamethasone or placebo on postoperative pain after single-visit root canal treatment in teeth with symptomatic irreversible pulpitis and symptomatic apical periodontitis.

    METHODOLOGY: The trial is reported according to the Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE) 2020 guidelines. The protocol was registered at the clinical trial registry (India) (CTRI/2019/06/019818). In total, 160 patients, assigned to four groups, received orally either 20 mg piroxicam, 20 mg prednisolone, 4 mg dexamethasone or a placebo 60 min before root canal treatment. Patients recorded their postoperative pain intensity at 6, 12, 24, 48 and 72 h using a 10-cm visual analogue scale. Intergroup comparison was performed using Kruskal-Wallis tests with post hoc analysis using Dunns test. Incidence of pain was analysed using chi-square tests. A P value  0.05). One patient in the piroxicam group reported gastritis, whereas no adverse effects were recorded in other groups.

    CONCLUSION: Preoperative oral administration of a single dose of 4 mg dexamethasone, 20 mg piroxicam or 20 mg prednisolone reduced the incidence and severity of postoperative pain following single-visit root canal treatment compared to a placebo in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis up to 24 h. The odds of postoperative pain at 24 h for patients premedicated with 4 mg dexamethasone or 20 mg piroxicam or 20 mg prednisolone were 5.3 times, 3.4 times and 2.5 times less compared to the placebo, respectively.

  11. Bhatia S, Nagendrababu V, Peters OA, Fawzy A, Daood U
    Sci Rep, 2021 04 27;11(1):9027.
    PMID: 33907252 DOI: 10.1038/s41598-021-88570-4
    To evaluate structural profiles and mechanical behaviour of WaveOne Gold (WOG), Twisted File Adaptive (TFA) and XP-endo shaper (XPS) instruments after root canal preparation. Standardized in vitro shaping was performed in presence of 5.25% sodium hypochlorite. File morphology was analyzed using scanning electron microscopy; X-ray diffraction analysis was performed before and after use along with Raman spectroscopy. Nanoindentation was carried out to characterize surface topography. Ni2+ release was measured at 1, 3, 5 and 7 days. X-ray photoelectron spectroscopy (XPS) analysis was done before and after use. After allocating scan line shifts like in WOG, mechanical deformation was shown using first order polynomials. XPS file system showed minimal grooves on surface. SEM of WOG instrument showed scraping surface defects. Hardness varied from 8.11 ± 0.99 GPa in TFA system to 6.7 ± 1.27 GPa and 4.06 ± 4.1 GPa in XPS and WOG. Ni2+ concentration from WOG was 171.2 μg/L. Raman peak at 540-545 cm-1 is attributed to Cr2O3. High resolution of Ti 2p spectrum show distinctive peaks with binding energies dominating in WOG, XPS and TFA file system. XRD exhibited NiTi phases with diffraction peaks. WOG files showed more surface deterioration and less passive layer formation as compared to TFA and XPS systems.
  12. Jayaraman J, Nagendrababu V, Pulikkotil SJ, Innes NP
    Int J Paediatr Dent, 2018 Nov;28(6):548-560.
    PMID: 30070003 DOI: 10.1111/ipd.12414
    OBJECTIVE: To systematically assess the methodological quality of Systematic Reviews (SRs) and Meta-Analyses (MA) published in Paediatric Dentistry journals and to analyse the relationship between the authors, journals, country, review topic, and the year of publication to the methodological quality of SRs and MA.

    DESIGN: Paediatric Dentistry journals ranked in the top five of the h5 index of Google Scholar Metrics were selected. SRs with MA were searched independently by two reviewers using PubMed and Scopus databases until December 2017. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool. Statistical significance was set at P 

  13. Decurcio DA, Lim E, Chaves GS, Nagendrababu V, Estrela C, Rossi-Fedele G
    Int Endod J, 2019 Aug;52(8):1153-1161.
    PMID: 30883828 DOI: 10.1111/iej.13116
    AIM: To compare the educational outcomes using artificial teeth versus extracted teeth for pre-clinical endodontic training.

    DATA SOURCES: Literature searches of PubMed, Scopus, Cochrane Library, Trip Database, Web of Science and Open Grey databases were conducted from their inception until November 2018 with no language restriction. Hand searching of most likely relevant journals was performed. The review followed the PRISMA guidelines.

    STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Studies that compared pre-clinical endodontic training using extracted teeth and artificial teeth were included.

    STUDY APPRAISAL AND SYNTHESIS METHODS: The quality of included studies was appraised by Joanna Briggs Institute Critical Appraisal tools. The findings were tabulated and summarized according to their outcomes with distinct narrative syntheses.

    RESULTS: Five studies were included. The component studies included 359 operators in total, mainly consisting of undergraduate students (97%, n = 349) and 10 endodontists (3%). Forty-seven per cent (n = 170) operated on artificial teeth only, whilst 19% (n = 67) worked primarily on extracted teeth, with the final treatment outcome being evaluated by independent observers using objective criteria. Operators in two studies (34%, n = 122) used both artificial teeth and ET and compared their experiences in surveys. Regarding technical outcomes, no significant differences between training with artificial teeth and extracted teeth were found, but the performance tended to be better in artificial teeth than extracted teeth. Operators trained solely on artificial teeth appeared to be adequately educated for subsequent root canal treatment (RCT) in the clinical setting.

    LIMITATIONS: Due to the scarcity of research on the topic overall, and the methodological variation between the studies, it was not possible to perform a quantitative analysis (meta-analysis).

    CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Based on the available evidence, the use of artificial teeth for pre-clinical endodontic training achieved similar educational outcomes compared to extracted teeth. However, the experiences reported by the operators diverged. Further studies assessing other artificial teeth available in the market testing other RCT procedures are necessary.

  14. Decurcio DA, Lim E, Nagendrababu V, Estrela C, Rossi-Fedele G
    Aust Endod J, 2020 Apr;46(1):47-51.
    PMID: 31267618 DOI: 10.1111/aej.12355
    This study aimed to determine the difficulty level of extracted teeth treated by undergraduate students for pre-clinical endodontic training. Two independent observers assessed a consecutive sample of 1000 periapical radiographs of extracted teeth used in endodontic pre-clinical training. Chi-square test was used to evaluate the adjustment of the distribution, and inter- and intra-examiner agreement were calculated. Minimal, moderate and high difficulty teeth represented 23.1%, 52.1% and 24.8%, respectively. The presence of curvature was the most common grading factor, with 'moderate curvature' reported in 28.7%, and 'extreme curvature' reported in 15.6% of the sample. A difference in the distribution of frequencies was found, favouring the moderate category (P 
  15. Duncan HF, Nagendrababu V, Bjørndal L, Kvist T, Dummer PMH
    Int Endod J, 2020 Jun;53(6):731-732.
    PMID: 32396666 DOI: 10.1111/iej.13297
  16. Naicker D, Zilm P, Nagendrababu V, Rossi-Fedele G
    Eur Endod J, 2020 12;5(3):242-247.
    PMID: 33353919 DOI: 10.14744/eej.2020.70883
    OBJECTIVE: To assess the effect of osmotic stress on various bacteria in a planktonic milieu and the effect of exposure to sodium hypochlorite (NaOCl) on the microbial cells previously subjected to osmotic stress.

    METHODS: Enterococcus faecalis, Streptococcus sanguinis, Fusobacterium nucleatum, Porphyromonas gingivalis and Prevotella intermedia were suspended as follows: Iso-osmotic group 0.9% NaCl; Hypo-osmotic group "ultrapure water"; Hyper-osmotic group 9% NaCl solution for 120 hours before exposure to 0.0001% NaOCl for 10 minutes. Quantitative analyses of viable cells were performed at 0 and 120 hours and after exposure to NaOCl to obtain colony forming units (CFU/mL). A linear mixed-effects model was used to find the association between mean CFU/mL (logarithmic transformation) and the interaction of solution Group and Time (P<0.001).

    RESULTS: F. nucleatum, P. gingivalis and P. intermedia did not survive after 24 hours in any of the solutions and were excluded from further testing. For S. sanguinis there were significant differences at each time interval, when holding solution group constant. After 120 hours, the Hyper-osmotic group presented with the highest CFU/mL and was significantly different to the Iso-osmotic group (P<0.001). For E. Faecalis, there was a significant difference for each pairwise comparison of time (P<0.001) in mean CFU/mL between 0 hours and 120 hours for the Iso-osmotic and Hyper-osmotic groups. At 120 hours, no significant differences were found between the three groups. Significant differences were also found between 0 hours and Post-NaOCl administration, and between 120 hours and Post-NaOCl administration for all three groups (P<0.001). Exposure to NaOCl after hypo-osmotic stress was associated with significantly less CFU/mL for S. sanguinis compared to hyperosmosis and iso-osmosis (P<0.001) and for E. Faecalis only compared to hyperosmosis (P<0.001).

    CONCLUSION: S. sanguinis and E. faecalis were able to withstand osmotic stress for 120 hours. Hypo-osmotic stress before contact with NaOCl was associated with lower viable bacterial numbers, when compared to the other media for the above species. Hyper-osmotic stress was associated with higher viable bacterial numbers after NaOCl exposure for E. faecalis.

  17. Pulikkotil SJ, Nagendrababu V, Veettil SK, Jinatongthai P, Setzer FC
    Int Endod J, 2018 Sep;51(9):989-1004.
    PMID: 29480930 DOI: 10.1111/iej.12912
    This systematic review (SR; PROSPERO database: CRD42017075160) and network meta-analysis (NMA) identified the most effective oral premedication for anaesthetic success of inferior alveolar nerve blocks (IANB) in cases of irreversible pulpitis. Medline and Ebscohost databases were searched up until 10/2017. Randomized controlled trials (RCT) studying the effect of oral premedication, alone or in combination, on the success of IANB for cases of irreversible pulpitis, compared to placebo or other oral premedications, were included. Quality of the included studies was appraised by the revised Cochrane risk of bias tool for randomized trials. Pairwise analysis, NMA and quality of evidence assessment using GRADE criteria were performed. Nineteen studies (n = 1654 participants) were included. NMA demonstrated that compared to placebo, dexamethasone was most effective in increasing anaesthetic success (RR, 2.92 [95% CI 1.74,4.91]; SUCRA = 0.96), followed by NSAIDs (RR, 1.92 [95% CI 1.63,2.27], SUCRA = 0.738) and Tramadol (RR, 2.03 [95% CI 1.18,3.49], SUCRA = 0.737). Premedication with acetaminophen added to NSAIDs demonstrated similar efficacy as NSAIDs alone (RR, 1.06 [95% CI 0.79,1.43]). Sensitivity analyses proved the superiority of dexamethasone or NSAIDs over any other premedications. Subgroup analyses of specific dosages in comparison with placebo demonstrated that dexamethasone 0.5 mg was most effective, followed by ketorolac 10 mg, piroxicam 20 mg, ibuprofen 400 mg + acetaminophen 500 mg and Tramadol 50 mg. Ibuprofen 400 mg, 600 mg and 800 mg had a significantly improved IANB success, while Ibuprofen 300 mg had no effect. Oral premedication with dexamethasone, NSAIDs or Tramadol significantly increased anaesthetic success. More trials are needed to evaluate the premedication effects of dexamethasone or Tramadol for improved anaesthetic success of IANB when treating irreversible pulpitis.
  18. Nagendrababu V, Jayaraman J, Suresh A, Kalyanasundaram S, Neelakantan P
    Clin Oral Investig, 2018 Mar;22(2):655-670.
    PMID: 29372445 DOI: 10.1007/s00784-018-2345-x
    OBJECTIVES: Reduction of microbial load from the root canal systems is a pre-requisite for healing of lesions of endodontic origin. Such microbial reduction is influenced by the method of irrigant delivery and activation. The aim of this systematic review was to compare the effect of ultrasonically activated irrigation (UAI) with other irrigation techniques on the reduction of microorganisms during root canal disinfection.

    MATERIALS AND METHODS: The research question was created based on the PICO strategy. Two reviewers independently performed a comprehensive literature search in electronic databases. Following application of inclusion and exclusion criteria to the selected articles, a systematic data extraction sheet was constructed. The selected articles were assessed using methodological quality scoring protocol. The risk of bias in selected studies was critically assessed by two reviewers.

    RESULTS: A total of 15 articles were included for the systematic review. The included studies were heterogeneous in study design; hence, meta-analysis was not performed. The overall risk of bias for the selected studies was moderate. Overall, UAI showed superior reduction of microbial counts, resulting in better disinfection compared to other irrigation systems chosen for comparison in this review.

    CONCLUSION: The use of UAI can bring about superior microbial reduction within the root canal system compared to other irrigant activation techniques.

    CLINICAL RELEVANCE: Activation of irrigants with ultrasonic brings about significant bacterial reduction from the root canal systems compared to other methods of irrigant activation and conventional syringe irrigation. This might help in improving the outcome of root canal treatment.

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