Outcome Of Root Canal Treatment Research Articles

Prevalence of mesiobuccal 2 canal in first maxillary molar: A retrospective radiographic study

Finding two mesiobuccal root canals named MB1and MB2 in maxillary first molar is not uncommon. Mesio-buccal-2 (MB2) canal orifice located palatally to the mesio buccall orifice and buccally as well as mesially to palatal orifices. A complete understanding of MB2 root canal morphology can contribute to the successful outcome of root canal treatment. This study conducted on CBCT scans with age ranged from 15 to 60 years which was further divide into group I (15-30 years), group II (30-45 years) and group III (45-60 years). Unilateral as well as bilateral prevalence of MB2 canal in maxillary first molar in both the genders and prevalence of MB2 canal in maxillary first molar in accordance with age were determined. Results showed overall prevalence of MB2 canal in maxillary first molar was 60.7%. In age wise distribution, group II showed greater prevalence than group I and group III showed least prevalence than others. The results were statistically significant between age groups. There was no statistical significance obtained between gender and quadrant wise. Conventional diagnostic aids such as radiographs play an important role in assessment of complex root canal morphologies. These modalities, however, do not provide detailed information of the complexity as a result of their inherent limitations. Shifting from 2D radiographic techniques to 3D radiographic techniques provides better visualization and location of these small and difficult structures.

Influence of apical patency on root canal treatment outcome: a contemporary overview

Influence of apical patency on root canal treatment outcome: a contemporary overview

Radix entomolaris – A case report

Mandibular molars can have an additional root located lingually (the radix entomolaris) or buccally (the radix paramolaris). If present, an awareness and understanding of this unusual root and its root canal morphology can contribute to the successful outcome of root canal treatment. This paper describes case report of mandibular first molar with three roots (one mesial and two distal) and four canals (two in mesial and two in distal root). These case reports show an anatomic variation of internal morphology of the tooth and points out the importance of searching for additional canals. Keywords: Anatomical variations, Endodontic treatment, Mandibular molars, Radix entomolaris, Radix paramolaris.

Doxycycline-functionalized polymeric nanoparticles inhibit Enterococcus faecalis biofilm formation on dentine.

To evaluate in a laboratory setting the antimicrobial properties and the potential to inhibit biofilm formation of novel remineralizing polymeric nanoparticles (NPs) when applied to dentine surfaces and to ascertain the effect of the functionalization of these NPs with zinc, calcium or doxycycline. The antimicrobial activity and inhibition of biofilm formation of polymeric NPs were analysed on human dentine blocks that were infected with Enterococcus faecalis before or after application of NPs. LIVE/DEAD ® testing under Confocal Laser Scanning Microscopy and bacterial culturing were employed to analyse biofilm biovolume and bacterial viability. Field Emission Scanning Electron Microscopy was also employed to assess biofilm morphology. One-way anova with Welch's correction and post hoc comparison by the Games-Howell test were performed for comparisons between groups. The un-functionalized NPs displayed the greatest antimicrobial activity against E.faecalis biofilms as they provided the lowest biovolume (3865.7±2926.97µm3 ; P<0.001) and the highest dead/injured cells percentage (79.93±18.40%; P<0.001), followed by Dox-NPs (biovolume: 19,041.55±17,638.23µm3 , dead/injured cells: 45.53±26.50%; P<0.001). Doxycycline-loaded NPs had the largest values of inhibition of biofilm formation with the lowest biofilm biovolume (8517.65±7055.81µm3 ; P<0.001) and a high dead/injured bacterial percentage (68.68±12.50%; P<0.001). Un-functionalized NPs did not reduce biomass growth (P>0.05), but attained the largest percentage of compromised cells (93±8.23%; P<0.001), being able to disrupt biofilm formation. It also produced occlusion of dentinal tubules, potentially interfering with bacterial tubule penetration. A new generation of bioactive nano-fillers (doxycycline-functionalized polymeric NPs) had antibacterial activity and occluded dentinal tubules. Incorporating these NPs into endodontic sealers may have the potential to enhance the outcome of root canal treatment.

Smoking and Radiolucent Periapical Lesions in Root Filled Teeth: Systematic Review and Meta-Analysis.

Aim: This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT). Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279. Results: Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth—4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07–1.26; p = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias. Conclusions: Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT.

Endodontic management of maxillary permanent molar C-shaped morphology

Aim: Report on the successful endodontic management of 4 permanent maxillary molars with a C-shape configuration of the root canal system. Summary: Even though C-shaped anatomies are more commonly described in the mandibular molars, its occurrence in permanent maxillary molars has also been reported. Complexity of the root canal system may pose a difficulty in achieving proper chemo-mechanical debridement, and consequently jeopardize the success of endodontic therapy. Additional dedicated armamentarium can help the clinician recognize, assess, plan and better manage such complex configurations. Key learning points Although of rare prevalence, clinicians must be aware and recognize the possible existence of a C-shaped root canal configuration in both first and second permanent maxillary molars. This anatomy can be attributed to an embryologic alteration that leads to the non-division of roots during the root formation stage of tooth formation. Further studies on the prevalence of the C-shaped configuration in permanent maxillary molars may contribute to a better understanding and, consequently, proper management of this morphology. Specific tools, such as the dental operating microscope and specific ultrasonic tips, as well as additional means of enhancing chemical debridement, are essential for the correct management of these intricate anatomies and appear to positively impact outcome of root canal treatment.

Evaluation of Conventional Root Canal Treatment for Healing of Periapical Pathosis of Nonvital Teeth

Background: Root canal Therapy is one of the procedures for the management of nonvital tooth with periapical lesion. The principle of this therapy is the complete sterilization of the total pulp canal space thereby healing of the periradicular lesion.&#x0D; Objectives: This experimental study assessed the clinical and radiological outcome of root canal treatment for nonsurgical management of nonvital teeth with periapical lesion.&#x0D; Materials and Methods: A total number of 40 infected teeth with periapical lesion were treated by conventional root canal treatment. Irritants from the root canal system was removed by mechanical instrumentation( Crown down Technique), chemical irrigation with NaOCL and by using Calcium Hydroxide as intracanal medicaments and fluid tight obturation both apically and coronally resulting repairs of inflamed periradicular tissues. The protocol for follow up examination will be 3, 6 and 12 months post operatively. At the time of follow up examination a standard follow up chart will be maintained.&#x0D; Results: Among 40 cases 32 cases could be treated as acceptable as their responses were good both clinically and radiologically and 5 patients came back with some complications among them 3 cases were uncertain and 2 cases were unacceptable.&#x0D; Conclusion: It was concluded that conventional root canal treatment reduced clinical signs and symptoms successfully in teeth with periapical lesion and radiologically.&#x0D; TAJ 2020; 33(1): 25-30

Assessment of outcome of root canal treatment performed on an incomplete fracture non vital permanent first molar

Tooth infraction is usually of three types 1) confined to enamel (craze lines) and usually do not require treatment 2) related to cuspal fracture that typically do not involve pulp 3) more centrally located that do involve the pulp. Vertical root fracture (VRF) are longitudinal fracture that originate in root of teeth in contrast to tooth infraction that originate in the crown. VRF occurs usually in endodontically treated teeth. This case report represent tooth infraction originating in the tooth crown on the distal marginal ridge and propagating into the pulp chamber and DEJ(dentino enamel junction). Root canal treatment was performed and in a 7 month follow up period, there was a remarkable improvement in the supporting periodontal structures with bone deposition/remodelling in the crestal and furcation area/region and patient was quite satisfied with the treatment outcome.

Cigarette Smoking and Root Filled Teeth Extraction: Systematic Review and Meta-Analysis.

Aim: The aim of this systematic review and meta-analysis was to investigate the possible association between smoking habits and the occurrence of root-filled teeth (RFT) extraction. Material and Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was in adult patients who had RFT, does the absence or presence of smoking habits affect the prevalence of extracted RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, and PRISMA protocol was used to evaluate and present the results. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279. Results: After search strategy, 571 articles were recovered, seven were selected for full-text analysis, and two reported data on inclusion criteria, including 516 RFT, 351 in non-smokers, and 165 in smoker subjects. The meta-analysis provided an odds ratio indicating significant association between smoking and the prevalence of extracted RFT (OR = 3.43, 95% CI = 1.17–10.05, p = 0.02, I² = 64%). The certainty of the literature assessment was low per GRADE. Both studies were considered as moderate risk of bias. Conclusions: Tobacco smoking should be considered a negative prognostic factor for the outcome of root canal treatment, although the quality of the evidence is low. RFT of smoking patients are three times more likely to be extracted. Continuing to smoke after endodontic treatment may increase the risk of treatment failure. However, the overall strength of evidence is low. This must be considered a limitation of the present study and the conclusion should be valued with caution.

Current status on minimal access cavity preparations: a critical analysis and a proposal for a universal nomenclature.

In the last decade, several access cavity designs involveing minimal removal of tooth tissue have been described for gaining entry to pulp chambers during root canal treatment. The premise behind this concept assumes that maximum preservation of as much of the pulp chamber roof as possible during access preparation would maintain the fracture resistance of teeth following root canal treatment. However, the smaller the access cavity, the more difficult it may be to visualize and debride the pulp chamber as well as locate, shape, clean and fill the canals. At the same time, a small access cavity may increase the risk of iatrogenic complications as a result of poor visibility, which may have an impact on treatment outcome. This study aimed to critically analyse the literature on minimal access cavity preparations, propose new nomenclature based on self-explanatory abbreviations and highlight the areas in which more research is required. The search was conducted without restrictions using specifics terms and descriptors in four databases. A complementary screening of the references within the selected studies, as well as a manual search in the highest impact journals in endodontics, namely International Endodontic Journal and Journal of Endodontics, was also performed. The initial search retrieved 1831 publications. The titles and abstracts of these papers were reviewed, and the full text of 94 studies was assessed. Finally, a total of 28 studies were identified as evaluating the influence of minimally invasive access cavity designs on the fracture resistance of teeth and on the different stages of root canal treatment (orifice location, canal shaping, canal cleaning, canal filling and retreatment). Overall, the studies had major methodological drawbacks and reported inadequate and/or inconclusive results on the utility of minimally invasive access preparations. Furthermore, they offered limited scientific evidence to support the use of minimally invasive access cavities to improve the outcome of root canal treatment and retreatment; they also provided little evidence that they preserved the fracture resistance of root filled teeth to a greater extent than traditional access cavity preparations. It was concluded that at present, there is a lack of supporting evidence for the introduction of minimally invasive access cavity preparation into routine clinical practice and/or training of undergraduate and postgraduate students.

Disinfection and outcome of root canal treatment using single-file or multifile systems and Ca(OH)2 medication.

This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.

Diabetes mellitus and the healing of periapical lesions in root filled teeth: a systematic review and meta-analysis.

Diabetes mellitus (DM) may affect the healing and survival of root filled teeth with periapical lesions. To systematically analyse the available clinical literature to evaluate the association between DM and the prevalence of radiolucent periapical lesions in root filled teeth. The review question was 'Is there a difference between the root canal treatment healing outcome (in terms of presence or absence of radiolucent periapical lesions) in diabetic and non-diabetic patients?'. A systematic review of cross-sectional studies and prospective clinical trials was conducted according to the PRISMA checklist. The review involved a search of the electronic databases of PubMed, Scopus and EBSCO host. The research protocol was previously registered in the International Prospective Register of Ongoing Systematic Reviews (CRD42019130954) and included defined inclusion/exclusion criteria. The included studies were related to the root canal treatment outcome in diabetic patients in terms of periapical radiolucent lesions associated with root filled teeth. The selected studies were critically analysed by two evaluators using the Joanna Briggs Institute Critical Appraisal tool. The pooled odds ratio (OR) was recognized as the primary outcome variable and measure of the effect for the occurrence of periapical lesions associated with root filled teeth of control and diabetic patients. The random-effects Mantel-Haenszel method was used, at a 95% confidence interval, to calculate the pooled OR. A funnel plot was created to evaluate possible sources of heterogeneity. Ten studies published between 1989 and March 2019 were selected after thorough analysis and exclusion according to the strict criteria. Seven cross-sectional studies, 1 longitudinal and 2 prospective clinical studies were included. The pooled OR was calculated by comparing 773 diabetic subjects and 1133 control subjects. The pooled OR for the observational studies and clinical studies were 1.42 and 6.36, respectively. This value signified a high prevalence of periapical lesions in root filled teeth in diabetic subjects. There are limited prospective clinical trials on this topic. The majority of the included studies are observational. The data suggest a strong connection between the presence of periapical radiolucency on root filled teeth amongst diabetics as determined by the pooled OR.

Cone-beam Computed Tomographic and Micro–computed Tomographic Evaluations of the Root Apexes of Teeth with Posttreatment Apical Periodontitis

IntroductionThis study evaluated the association of different variables that may influence the outcome of root canal treatment through cone-beam computed tomographic (CBCT) and micro–computed tomography (micro-CT) assessments of root apexes obtained by endodontic microsurgery of teeth with posttreatment apical periodontitis (AP), the agreement between CBCT and micro-CT findings, and the association of these variables with symptoms or lesion size. MethodsClinical and CBCT records and root apexes obtained by endodontic microsurgery from 11 cases of symptomatic AP and 22 cases of asymptomatic AP were available. Apical root specimens were further scanned using micro-CT imaging. CBCT parameters included periapical radiolucency size, apical extent/density of root canal filling, and occurrence of procedural errors. Micro-CT images evaluated the same parameters plus the presence of filling material in lateral canals and ramifications, the volume of the filled/nonfilled apical root canal, and the percentage of the nonfilled canal space. The agreement between CBCT/micro-CT observations was evaluated. ResultsMandibular teeth, a lesion size <5 mm, a nonfilled volume <0.04 mm3, and the decreased percentage of the nonfilled canal volume were significantly associated with symptomatic AP. Maxillary teeth and inadequate apical filling density were significantly associated with larger lesions. Agreement between CBCT/micro-CT scores varied from fair (procedural errors) to satisfactory (extent/density of filling). ConclusionsTooth location, lesion size, the nonfilled apical canal volume, and the percentage of the nonfilled apical canal volume were associated with symptomatic AP. In addition, lesion size was significantly associated with tooth location and apical root canal filling density. CBCT imaging may not provide a reliable evaluation of procedural errors associated with posttreatment disease.

Rapid Chairside Microbial Detection Predicts Endodontic Treatment Outcome.

Background. The aim of this longitudinal, one-year cohort study was to explore the hypothesis that fluorescence sampling of the root canal space prior to obturation could predict the outcome of root canal treatment (RCT). Methods. Sixty-five teeth underwent primary RCT and were followed up clinically and radiographically. The outcome was determined radiographically with periapical radiographs (PR) and cone beam computed tomography (CBCT) scans. Results. Success at 12 months was predictable based on the fluorescence score. When the fluorescence score (defined as the percentage of signal over total signal including background) was lower than 67, there was a 4.5 times (Odds ratio (OR) = 0.028; 95% confidence interval (CI): 0.003, 0.291, p = 0.001) greater chance of success (90% overall). When the readings were above this threshold, the success rate was 20%. Conclusion. A chairside sampling method is able to predict the outcome of RCT, through the use of paper point sampling and fluorescence staining. This has reduced the prevalence of persistent infections by guiding the optimum time for obturation. ClinicalTrials.gov trial NCT03660163.

Outcome of Root Canal Treatments Provided by Endodontic Postgraduate Students. A Retrospective Study.

The aim of this study was to assess the preoperative, intraoperative, and postoperative factors that influenced complete periapical healing in teeth that underwent primary root canal treatment (RCT), in patients treated by postgraduate students in endodontics. Factors were retrieved and compared with the periapical status during the follow-up visit. Healing was considered as the absence of clinical and radiological symptoms. Variables significantly associated by the chi-squared test were included in a logistic regression model (LRM). Preoperative factors associated with healing were: American Society of Anesthesiology (ASA) status (p = 0.01); the absence of preoperative pain (p = 0.04); positive response to pulp tests; when the RCT cause was caries, pain, abscess, or sinus tract; probing depth <4 mm; the absence of mobility; absence or <4 mm periapical lesion (p < 0.01). In the LRM, the factors included were: absence or <4 mm periapical lesion; probing depths <4 mm; RCT caused by caries, pain, abscess, or sinus tract; the tooth was not a bridge abutment. Postoperative factors were: teeth with direct restoration; teeth that did not act as a support for a fixed prosthetic restoration; the favorable condition of the coronal restoration (p < 0.01). In the LRM, only the status of the coronal restoration was included. Preoperative conditions and the adequate fit of the coronal restoration influenced the outcome of RCT.

Diabetes Mellitus May Negatively Influence the Outcome of Conventional Nonsurgical Root Canal Treatment

Association between diabetes and the outcome of root canal treatment in adults: an umbrella review. Nagendrababu V, Segura-Egea JJ, Fouad AF, Pulikkotil SJ, Dummer PMH. Int Endod J 2020;53(4):455-66. Authors declared that no funding was received to support the study. Umbrella review (ie, overarching systematic review of systematic reviews).

Radiographic outcome of root canal treatment in general dental practice: tooth type and quality of root filling as prognostic factors

Objective This study evaluated the radiographic outcome of root canal treatments (RCTs) performed by general dental practitioners (GDPs) with focus on tooth type and quality of root filling. Materials and methods The target population included all patients receiving root filling by GDPs in City of Helsinki in 2010–2011. Equal numbers of each tooth type (anteriors, premolars, molars) by jaw were included, resulting in 426 teeth. Pre- and post-operative periapical radiographs were assessed to evaluate periapical status and quality of root filling. Statistical evaluation utilized Chi-squared tests, Cohen’s kappa and logistic regression modelling. Results The overall success rate of RCT was 67.4%, being 76.8%, 69.7% and 55.6% (p < .001) for anteriors, premolars and molars, respectively. The quality of root fillings varied by tooth type (p < .001); optimal fillings were least frequent (43%) in molars. In multifactorial analysis, RCTs were more likely to succeed in non-molars (OR = 1.8), in teeth with optimal root fillings (OR = 3.6) and in teeth without apical periodontitis (OR = 3.2). Conclusion The quality of root fillings and radiographic outcome of RCTs varied considerably according to tooth type; success was least likely in molars. Improvement is needed in quality of RCTs by GDPs.

A prospective study on the effect of coronal tooth structure loss on the 4‐year clinical survival of root canal retreated teeth and retrospective validation of the Dental Practicality Index

First, to examine the impact of the residual volume of coronal tooth structure in posterior teeth measured with an intra-oral scanner on the 4-year clinical survival of root canal retreated teeth. Secondly, to assess retrospectively the effectiveness of the Dental Practicality Index (DPI) in predicting the survival of root canal retreated teeth. A total of 156 posterior root canal treated teeth (140 patients) had baseline periapical radiographs (PA) and cone-beam computed tomography (CBCT) scans taken prior to root canal retreatment. These teeth were followed up with a clinical examination at 1, 2, 3 and 4years (T12, T24, T36 and T48) with periapical radiographs and CBCT images taken at T12, and PA taken at T24, T36 and T48 where appropriate. Root canal retreated teeth were dichotomized into 'survived' versus 'extracted'. Fisher's exact test was used to determine the association between the volume of remaining coronal tooth structure and the 4-year tooth survival. The Dental Practicality Index for each tooth was established using the preoperative clinical and radiographical data. Fisher's exact test was used to establish a relationship between categorical variables, the total score of DPI vs tooth outcome. The percentage of extractions associated with teeth with <29.5% remaining coronal tooth structure was 3 times higher (12.5%) compared to that of teeth with a residual tooth structure >29.5% (3.5%), but with no significant difference (P=0.073). There was a significant correlation between the outcome of root canal retreatments at 1year, assessed by both PA and CBCT, and the 4-year survival (Fisher's exact test, P=0.007 and P=0.001, respectively). Teeth with DPI scores≥6 were more likely to be extracted than teeth with DPI score<6 (18.8% vs. 3.9%) (Fisher's exact test, P=0.045). Teeth with <30% of remaining tooth structure were associated with a survival rate above 80% and teeth with more than 30% of residual tooth structure survived in more than 94% of the cases. The radiographic outcome of root canal treatment can also help to predict tooth survival with teeth having an unfavourable outcome at 1year more likely to be extracted within 4years of completion of treatment. The DPI score can potentially be used to identify teeth with failed root canal treatment, which are likely to be extracted following retreatment and cuspal coverage.

Endodontic “trends”: what does science have to say about them?

The Endodontic world is often flooded with new products and protocols, generally with a strong commercial appeal, ensuring improvements in the outcomes of root canal treatment. These new techniques have often been labeled as being less invasive or more biology-reliant and have been indicated to replace scientifically and clinically supported therapies. The most recent and widely discussed examples in the endodontic scenario are the minimally invasive treatments (especially minimally invasive endodontic access cavities), the so-called “natural” disinfection therapies such as ozone therapy, and new “biological miraculous” root canal sealers.

Use of natural substitutes as an intracanal medicament in the endodontics-An update for in vivo studies

The success of root canal treatment depends on the elimination of bacteria by chemo-mechanical instrumentation and use of various irrigants to remove or dissolve organic and inorganic debris.The intracanal medicament also has an important role in the outcome of root canal treatment. With the rise in bacterial resistance to antibiotics, there is considerable interest in the development of other classes of antimicrobials for the control of infection. Use of Herbal intracanal medicament has been shown promising results when used under in vitro conditions, but very limited clinical trials reported due to the ethical concern. Hence, this review highlights the current guidelines (laid by the drugs and cosmetics act as per the Gazette of India) regarding the use of herbal medicaments for the clinical trials in Endodontics.