Conservative Dentistry Journal

Two-rooted maxillary central incisor incidental finding in CBCT

2025-11-19T12:00:17+07:00

Background: Understanding the intricacies of the root canal system and its anatomical/morphological diversities is vital for achieving optimal results in root canal treatments. The effectiveness of endodontic therapy is a function of a comprehensive understanding of tooth anatomy and its potential alterations. Purpose: This case presents the importance of 3D radiography for endodontic diagnostic and treatment planning. The availability of 3D radiography has significantly enhanced endodontics’ diagnostic and curing planning aspects. Case: A female patient was referred for radiographic evaluation of her remaining teeth and edentulous area for implant placement. Case Management: Evaluation was conducted by cone-beam computed tomography using Paxi3D with field of view (FOV) 9*12,200 micrometer resolution. A maxillary central incisor with two distinct roots and root canals was identified and discovered by a 3D radiography. Discussion: Given the infrequent occurrence of two-rooted maxillary central incisors, conducting a thorough radiological and clinical inspection before starting endodontic treatment is of great necessity.

Impact of dental anxiety on quality of life in patients undergoing endodontic and restorative care

2025-11-19T15:08:54+07:00

Background: Dental anxiety is a common psychological condition that affects individuals undergoing conservative dental procedures such as root canal therapy and restorative treatments. It influences not only a patient’s decision to seek care but also their perception of treatment outcomes and overall quality of life related to oral health. Purpose: This literature review aims to evaluate the relationship between dental anxiety and oral health, particularly its impact on the quality of life of patients undergoing endodontic and restorative dental treatments. Reviews: Dental anxiety is closely associated with increased pain perception, reduced cooperation, and decreased trust in dental professionals. Patients with high anxiety often experience greater discomfort and dissatisfaction, reflected in difficulties eating, speaking, and socializing. Studies consistently show that anxiety can impair treatment experiences and outcomes, while proper management leads to improved oral health and well-being. Effective strategies such as clear communication, empathetic interaction, and adequate pre-treatment preparation are proven to reduce fear and enhance patient satisfaction.Conclusion: Dental anxiety has a significant effect on many aspects of a patient's well-being before, during, and after conservative dental procedures. By adopting a caring and personalized approach, dental professionals can help alleviate anxiety and support improved treatment experiences and outcomes.

The inhibitory activity of Avicennia marina leaf extract on Enterococcus faecalis as a root canal irrigation material

2025-11-20T14:54:12+07:00

Background: Enterococcus faecalis is considered the most common cause of root canal failure and persistent infection. The standard irrigation solution is 5.25% NaOCl which has drawbacks, such as causing inflammation in the periapical area. New antibacterial agents from natural materials with similar antibacterial properties to chemicals have been developed. Avicennia marina contains flavonoids, saponins, tannins, and avicequinone, which can inhibit bacterial metabolism. Objective: to determine the effect of Avicennia marina leaf extract with various concentrations on the antibacterial inhibitory power of Enterococcus faecalis as a root canal irrigation material. Materials and Methods: The samples were divided into six groups: K+ (5.25% NaOCl), K- (distilled water), P1 (7.5%), P2 (12.5%), P3 (17.5%), and P4 (22.5%). The leaves of Avicennia marina were extracted using ethanol maceration with a rotary evaporator to obtain a concentrated extract, which was then diluted with distilled water to the desired concentrations. The antibacterial effect was tested using the disk diffusion method by applying 0.01 ml of each test sample to sterile paper disks with a sterile micropipette. Results: Inhibition zones were observed as follows: K+ (21.67 mm), P1 (0 mm), P2 (10.50 mm), P3 (13.50 mm), and P4 (14.50 mm). Mann Whitney tests showed significant differences (p < 0.05) between K+ and P1, P2, P3 and P4, as well as between P3 and P4. Conclusion: Avicennia marina leaf extract had antibacterial effects against Enterococcus faecalis at concentrations of 12.5%, 17.5%, and 22.5%.

Effect of kombucha butterfly pea (Clitoria ternatea) solution on Enterococcus faecalis biofilm

2025-11-20T15:19:41+07:00

Background: Enterococcus faecalis is a facultative anaerobic bacterium that is often found in the root canals of teeth with pulp necrosis and is often the cause of endodontic treatment failure. On the other hand, the fermented beverage kombucha is made using a fermentation process by bacteria and yeast, known as SCOBY (Symbiotic Culture of Bacterial and Yeast). The fermentation process in kombucha causes a decrease in the pH of the medium, where the bacteria in the SCOBY convert sugar into ethanol and acetic acid. The butterfly pea flower (Clitoria ternatea) has single petals of purple, blue, pink, or white color and is proven to have antibacterial as well as antibiofilm properties. Purpose: To determine the effect of kombucha butterfly pea (Clitoria ternatea) solution on Enterococcus faecalis biofilm. Methods: Kombucha butterfly pea with concentrations of 100%, 50%, 25%, 12.5%, 6.25%, 3.125%, and 1.56%, as well as NaOCl 2,5% was given Enterococcus faecalis biofilm. To determine biofilm formation, test tubes were washed, adherent cells were stained with 0.1% crystal violet, and light absorbance was measured with a spectrophotometer at a wavelength of 540nm. Results: The percentage of inhibitory power of kombucha butterfly pea against E. faecalis biofilm decreased gradually from concentrations of 100%, 50%, 25%, 12.5%, 6.25%, 3.125%, and 1.56%. The highest percentage of inhibition was in kombucha with butterfly pea with a concentration of 100% which is equivalent to 2,5% NaOCl as an antibiotic for root canal irigation. Conclusion: Kombucha of butterfly pea flower (Clitoria ternatea) can reduce the decrease in Enterococcus faecalis biofilm formation with a concentration of 12.5% designated as MBIC50 and a concentration of 100% designated as MBEC90.

Ethical and legal dimensions of informed consent in aesthetic conservative dentistry: a review under Indonesia’s health law

2025-11-20T15:38:48+07:00

Background: Aesthetic treatments in conservative dentistry, such as tooth whitening, veneers, and composite restorations, have become increasingly popular as more patients seek to enhance their appearance. Unlike therapeutic procedures, these treatments are often elective and based on personal preferences, which brings forward important ethical and legal questions. One of the key aspects is how dentists ensure that patients truly understand the benefits, risks, and alternatives before making a decision. Purpose: This review aims to examine the ethical and legal dimensions of informed consent in aesthetic conservative dentistry, with particular reference to Indonesia's Law No. 17/2023 concerning Health. It explores how dental professionals are expected to balance patients' aesthetic desires with ethical responsibilities and legal duties. Reviews: The discussion covers core ethical principles, including autonomy, beneficence, nonmaleficence, and justice as the foundation of a meaningful consent process. It also examines the latest national regulation, which outlines patient rights and dentist responsibilities, particularly Law No. 17/2023 concerning Health. Since aesthetic procedures are not always medically necessary, they require extra care in communication and documentation to ensure proper patient care and treatment. Conclusion: Informed consent in aesthetic dental care should not be treated as a formality. It is a vital ethical practice that ensures patients feel respected and well-informed. For dentists, especially those involved in aesthetic procedures, it is important to apply both ethical reflection and legal awareness in every step of patient care. Following Law No. 17/2023 concerning Health, maintaining open and honest communication fosters trust and supports safe, responsible treatment.

Characterization of a novel calcium phosphate cement–calcium sulfate hemihydrate–acemannan for vital pulp therapy

2025-11-21T16:07:45+07:00

Background: Dental caries remains as one of the most prevalent oral diseases worldwide, especially in developing nations like Indonesia. Untreated caries may lead to pulp involvement, prompting vital pulp therapy (VPT) to protect pulp vitality. The success of VPT is dependent on the biological and physical properties of the capping materials. Traditional pulp capping materials, such calcium hydroxide Ca(OH)₂ and mineral trioxide aggregate (MTA), show bio-activity but are limited by issues of solubility, manipulation, and bio-compatibility. Consequently, calcium phosphate cement (CPC) and calcium sulfate hemihydrate (CSH) with acemannan (Ace) have been explored as potential alternatives. Purpose: This research aimed to evaluate the potential of a mixture containing CPC-CSH-Ace as a bio-active material for vital pulp therapy. Methods: CPC–CSH–Ace was formulated by combining 70 wt% CPC and 30 wt% CSH with acemannan concentrations of 3 wt%, 5 wt%, and 10 wt%. Calcium hydroxide (Dycal, Dentsply) and MTA (Bio MTA+, Cerkamed) were used as controls. Particle size was measured using a Particle Size Analyzer (Horiba SZ-100), surface morphology and calcium ratio were tested with SEM–EDS, and crystal structure was determined using XRD (Rigaku Miniflex). Data were examined utilizing one-way ANOVA and subsequent post-hoc testing (p < 0.05). Results: CPC–CSH–Ace exhibited smaller particle sizes, smoother surfaces, higher Ca/P ratios, and more defined hydroxyapatite peaks than Ca(OH)₂ and MTA. Conclusion The combination of CPC–CSH-Ace showed significant chemical and physical characteristics and has promise as a new bio-active material for vital pulp therapy.

Single visit endodontic treatment and zirconia crown restoration for functional and esthetic rehabilitation

2025-12-02T11:34:09+07:00

Background: Endodontic treatment followed by full-coverage restoration represents the standard of care for structurally compromised posterior teeth. The integration of contemporary endodontic techniques with high-strength esthetic materials, such as zirconia crowns, facilitates comprehensive functional and esthetic rehabilitation in a single treatment sequence, particularly for younger patients with high esthetic expectations. Purpose: To present a successful case of single-visit endodontic treatment followed by fiber post placement and zirconia crown restoration on a mandibular molar in a young female, resulting in favorable functional and esthetic outcomes. Case: A 20-year-old female presented with persistent spontaneous pain in the lower left posterior region for one week, following two years of untreated dental caries. Initial management was conducted at a primary health center with pain control. Clinical and radiographic examination revealed a deep Class II caries lesion with pulp exposure on tooth 36 and a positive percussion response, indicative of irreversible pulpitis. Case Management: Tooth 36 underwent single-visit root canal therapy using a crown-down pressureless technique and single-cone obturation. This was followed by fiber post placement for coronal reinforcement and definitive restoration with a zirconia crown. At the one-week follow-up after crown cementation, the tooth exhibited excellent functional performance, stable periapical healing, intact crown margins, and high patient satisfaction with the esthetic result. Conclusion: This case demonstrates the clinical efficiency and long-term esthetic advantages of combining single-visit endodontic therapy with zirconia crown restoration in young adult patients.

Effectiveness of micro and nano sized propolis with calcium hydroxide combination in inhibiting the formation of Lactobacillus acidophilus biofilm

2025-12-02T11:59:13+07:00

Background: Lactobacillus acidophilus is involved in secondary caries that can accelerate demineralization of the tooth surface. Bacteria forms biofilm as part of a defense mechanism. One of the caries treatments is direct pulp capping with calcium hydroxide (Ca(OH)₂) as the gold standard. Due to its high pH, calcium hydroxide can induce necrosis of pulp tissue when it comes into direct contact. Propolis is a natural material produced by honey bees. Propolis has many benefits including antibacterial effects. Nanoparticles are microscopic particles measuring 1-100 nm, reducing particle size can increase the rate of dissolution and absorption. Purpose: This study aims to prove the difference in the biofilm inhibitory ability of a micro and nano-sized combination of propolis and Ca(OH)2 against L. acidophilus biofilms. Methods: This study used true experimental laboratories research with treatment groups that included a control, combination of micro-sized propolis and Ca(OH)2 and combination of nano-sized propolis and Ca(OH)2. Results: The results showed that there was a significant difference between the micro and nano-sized combination of propolis and Ca(OH)2 in inhibiting biofilm growth, with the combination of nano-sized propolis and Ca(OH)2 showing higher effectiveness compared to the micro-sized one. The combination of nano-sized propolis and Ca(OH)2 produced an inhibition value of 84.35%, while the micro-sized one produced an inhibition value of 77.18%. Conclusion: The combination of nano-sized propolis and Ca(OH)2 had a greater biofilm inhibition compared to the combination of micro-sized propolis and Ca(OH)2.

Management of ledge and overprepared access cavity in mandibular second molar

2025-12-02T12:18:40+07:00

Background: Endodontic success depends on precise execution. Iatrogenic complications such as ledge formation and excessive access cavity preparation can obstruct canal negotiation, impair disinfection, weaken tooth structure, and increase treatment failure. Purpose: This case report describes the management of a ledge and an overprepared access cavity in a mandibular second molar. Case: A 33-year-old female was referred with tooth 37 restored using a subgingival temporary filling. Radiographs revealed mesial radiolucency, an excessively extended access cavity, and a ledge in the mesial root canal. Case Management: Treatment was performed under rubber dam isolation. Temporary restoration and caries were removed, followed by artificial wall construction with resin composite. Pre-curved K-files (#10, #15) were used to bypass the ledge and establish a glide path and determine the working length. Rotary glide path instruments and heat-treated NiTi files were used to shape up to size #25/.04, with irrigation using 5.25% NaOCl and 17% EDTA. After intracanal calcium hydroxide medication, obturation was completed using bioceramic sealer, warm vertical compaction in the mesial root, and a single-cone technique in the distal root. A flowable bulk-fill composite was placed as the intracanal barrier, and final restoration was completed with packable composite. Conclusion: Ledges obstruct instrumentation and disinfection, requiring flexible pre-curved files and careful negotiation to re-establish canal patency. Excessive access cavity preparation compromises peri-cervical dentin, increasing susceptibility to structural failure. Bulk-fill flowable composite offers good marginal adaptation and may improve restoration durability. Thorough planning, controlled instrumentation, and appropriate restorative materials are essential to manage such complications effectively.

An aesthetic rehabilitation of fractured anterior maxillary teeth with multiple diastema

2025-12-02T12:34:17+07:00

Background: Aesthetic issues on anterior maxillary teeth often require comprehensive treatment due to both functional and psychological impacts. This case report highlights the clinical approach and management for anterior maxillary teeth with crown fracture and multiple diastemas through restorative aesthetic procedures. Purpose: To describe a clinical approach and restorative aesthetic management for a 37 year-old female patient with a crown fracture and multiple diastemas on the anterior maxillary teeth, aiming to restore aesthetics and function through a carefully planned dental treatment. Case(s): A 37 year-old female patient presented to RSGMP UNAIR with a chief complaint of fractured upper anterior teeth and a history of intermittent pain. The patient also reported concern about the spacing between her upper front teeth. The clinical examination revealed involvement of teeth 13, 12, 11, 21, 22, and 23. The patient had no previous dental treatment and no systemic health issues. Case Management: A detailed clinical and radiographic examination was performed, followed by a comprehensive treatment strategy targeting tooth elements 13, 12, 11, 21, 22, and 23. The management focused on restoring tooth structure, closing the diastema, and improving smile aesthetics. Conclusion: Aesthetic and functional rehabilitation of the anterior maxillary teeth was planned and carried out through an integrative restorative approach. The case emphasizes the importance of proper diagnosis dan treatment planning in managing complex aesthetic cases.