Evaluation of the Antimicrobial Efficacy of Alexidine as an Endodontic Irrigant against Enterococcus faecalis by Time-kill Assay – An In vitro Study Shobana Krishnakumar, Mitthra Suresh, M. Madhana Madhubala, Anil Kumar Ramachandran, Vijay Venkatesh Kondas, Venkatesh Alagarsamy Journal of Interdisciplinary Dentistry, 2026 Aim: The aim of this study was to assess the time-dependent antimicrobial efficacy of three endodontic irrigants 1% chlorhexidine (CHX), 1% alexidine (ALX), and 5% sodium hypochlorite (NaOCl) against Enterococcus faecalis , a common pathogen in persistent root canal infections. Materials and Methods: The microdilution method was used to calculate the minimum inhibitory concentration (MIC) for the experimental irrigants against E. faecalis . For the time-kill assay (TKA), concentrations were set at double the MIC to ensure effective antimicrobial activity. Standardized inoculum of E. faecalis was exposed to the experimental irrigants (1% CHX, 1% ALX, and 5% NaOCl) and control (bacterial suspensions without any irrigant served as the control) group, and bacterial viability was assessed at 30, 60, 90, and 180 s using serial dilutions to measure log reductions in colony forming unit (CFU) counts. Results: The results of the TKA showed the lowest mean CFU for ALX (2.1 ± 3.28), followed by CHX (7.09 ± 0.030), NaOCl (7.13 ± 0.02), and the control (7.21 ± 0.135). The difference was statistically significant ( P < 0.0001). Conclusion: Hence, the authors conclude that ALX showed the highest antimicrobial activity and could serve as a valuable alternative to conventional irrigants, particularly in cases where rapid and effective bacterial eradication is crucial for successful treatment outcomes.
DENTO-GINGIVAL SMILE ANALYSIS ON YOUNG ADULTS OF SOUTH CHENNAI: A CROSS-SECTIONAL STUDY G S V Nivashini, Janani Balachandran, Mitthra Suresh, Alagarsamy Venkatesh, Pooraninagalakshmi J, Jinu Koshy Bulletin of Stomatology and Maxillofacial Surgery, 2025 Aim: This study aims to assess and analyse dento-gingival parameters in young adults residing in South Chennai. This study aims to assess and analyse dento-gingival parameters in young adults residing in South Chennai. Materials and Methods: A cross-sectional study was carried out among 100 participants (61Females & 39 males) between 18 and 23 years, within South Chennai region. The dento-gingival parameters such as smile line, buccal corridors, midline shift, and parallelism were determined by evaluating the participants photographs through Adobe Photoshop. The data analysis was done using Spearman’s correlation test and chi-square test for nonparametric data. Results: Buccal corridors were not present in 52% of the young adult population. 48% of young adults found to have non-parallel smile. A high smile line was observed in 23% of the participants. Dental midline shift was found in around 30% of young adults. There was a statistically significant difference in the parallelism of the lower lip line and the incisal curve incisal curve as well as in the upper lip line position in both the genders (P < 0.05). Conclusion: Understanding the dento-gingival unit as a whole and its association with the oral environment can help guide the clinicians in establishing an aesthetically pleasing treatment outcome.
The impact of maleic acid, carbohydrate-derived fulvic acid, and ethylenediaminetetraacetic acid on the flexural strength and modulus of elasticity of human radicular dentin: an in vitro study Loganathan Saatwika, Venkatachalam Prakash, Suresh Mitthra, Rajasekar Parthasarathy, Alagarsamy Venkatesh, Krishnamurthy Madhuram, Pachaiyappan Mukundan European Oral Research, 2025 Purpose: This study aimed to evaluate the impact of ethylenediamine tetra-acetic acid (EDTA), carbohydrate-derived fulvic acid (CHD-FA), and maleic acid (MA) on the flexural strength (FS) and modulus of elasticity (ME) of human radicular dentin. Materials and methods: Fifteen freshly extracted human mandibular premolars with single roots and single canals were selected. The teeth were decoronated 2 mm below the cementoenamel junction (CEJ), and the roots were sectioned into buccal and lingual halves. Each half was used to prepare two standardized plano-parallel dentin bars (7 mm in length × 1 mm in width × 1 mm in height). The samples were then divided into four groups and immersed in their respective irrigating solutions for 5 minutes: saline (control), maleic acid, CHD-FA, and EDTA. Subsequently, FS and ME were evaluated using a three-point bending test. Results: Both EDTA and maleic acid reduced the FS and ME of radicular dentin. However, the study demonstrated that higher mean values for FS and ME were recorded in the CHD-FA and saline (control) groups compared to the EDTA and maleic acid groups. Conclusion: CHD-FA is recommended as an endodontic irrigant, as it does not compromise the mechanical properties of radicular dentin, specifically FS and ME.
Factors Influencing the Success of Endodontic Retreatment: Insights from a Retrospective Study Shan Sainudeen, Priya Rani, Divya Batra, Bhargavi D. Vedula, Vidya A. Vaybase, Suresh Mitthra, Mohammed Mustafa Journal of Pharmacy and Bioallied Sciences, 2024 Objective: The purpose of this retrospective study was to assess the variables affecting endodontic retreatment technique success. Methods: A 5-year period of 500 patient records from a dental clinic were examined. Pre-operative factors, procedure specifics, post-operative results, and demographic information were all documented. The study employed statistical analysis to determine the important factors that influence retreatment success. Findings: The average age of the study group was 45.2 years, and 56% of the participants were female. Sixty-four percent of patients had multiple root canals, and the most frequent initial diagnosis (60%) was apical periodontitis. The results of the surgery varied: 50% of patients had full healing, 30% had partial healing, and 20% had no improvement at all. Significant indicators of retreatment success were found to include age, initial diagnosis, and root canal morphology (P < 0.05). Conclusion: The effectiveness of endodontic retreatment operations is mostly influenced by age, apical periodontitis, and root canal morphology. Optimizing treatment results requires individualized treatment techniques based on each patient’s unique features. Clinicians can benefit greatly from these findings in terms of increasing endodontic retreatment success rates and enhancing patient care.
A Study on Materials Used and Longevity of Implant-Supported Prostheses Sonali Perti, Rashi Singh, Kishan K. Choithani, Sareen Duseja, Suresh Mitthra, Harisha Dewan, Rahul Tiwari Journal of Pharmacy and Bioallied Sciences, 2024 Objective: This retrospective research was directed to investigate the longevity and maintenance requirements of implant-supported prostheses in subjects treated at a tertiary care center. Methods: Patient records of individuals who received implant-supported prostheses between January 2018 and December 2020 were retrospectively analyzed. Demographic information, implant type, prosthetic design, and follow-up data were collected. The primary outcomes assessed were prosthetic survival rates and the incidence of complications requiring maintenance interventions. Statistical analysis was performed to identify associations between demographic and clinical variables and the observed outcomes. Results: The research included 150 subjects with an average follow-up duration of 3 years. The overall survival rate of implant-supported prostheses was 90%, with 20% requiring maintenance interventions. Common complications included peri-implantitis (10%), prosthetic fracture (6%), and screw loosening (4%). Significant associations were found between smoking status and peri-implantitis (P < 0.05) and between prosthetic design and prosthetic fracture (P < 0.01). Conclusion: Implant-supported prostheses demonstrated a high overall longevity rate, with a subset of subjects requiring maintenance interventions due to complications. Peri-implantitis, prosthetic fracture, and screw loosening were the most prevalent complications, emphasizing the importance of tailored patient care and risk stratification.
Comparative Assessment of Pain during Infiltration by a Two-stage Infiltration Technique: A Double-blind Clinical Trial Paul V Abbott, Arunajatesan Subbiya, Nagarajan Geethapriya, Suresh Mitthra, Venkatachalam Prakash Journal of Contemporary Dental Practice, 2022 AIM The aim of this study was to assess and compare the pain during infiltration by a modified two-stage local anesthetic infiltration technique under topical anesthesia (TA). MATERIALS AND METHODS In this cross-over double-blind study, 30 volunteers participated, where two groups were given single-stage infiltration and the other two had two-stage infiltrations. Depending upon the infiltration technique (one- or two-stage) and the use of TA, the patients were randomly divided into four groups. Local anesthesia (LA) was administered by infiltration into the mucobuccal fold of the maxillary central incisor, and the pain perceived during the infiltration in each group was recorded. The volunteers were recalled after 24 hours to assess the tenderness at the injection site. The volunteers were recalled 2 weeks after infiltration for the subsequent groups to assess the pain for this cross-over study. RESULTS A statistically significant difference was observed in the pain perceived when TA was used and when the infiltration was done in two stages. Regarding the pain at the site of injection after 24 hours, no significant difference was observed among the volunteers. CONCLUSION Topical anesthesia was effective in reducing the pain of injection when compared to placebo. The pain of injection is further reduced with a two-stage infiltration technique after TA application. CLINICAL SIGNIFICANCE Topical anesthesia can be used routinely before infiltration, and LA infiltration injections are less painful if administered in two stages.
Evaluation of the Antibacterial Efficacy of Daptomycin, Gentamicin, and Calcium Hydroxide—Antibiotic Combinations on Enterococcus faecalis Dentinal Biofilm: An In Vitro Study Arunajatesan Subbiya, Suresh Mitthra, Kesavaram Padmavathy, Krishnan Mahalakshmi, Alagarsamy Venkatesh, Kotishwaran Gayathri Journal of Contemporary Dental Practice, 2021 AIM To evaluate the antibacterial efficacy of calcium hydroxide (CH) with antibiotic combinations: daptomycin and gentamicin against Enterococcus faecalis (E. faecalis) dentinal biofilm. MATERIALS AND METHODS Sixty freshly extracted single-rooted mandibular premolars were inoculated with E. faecalis(ATCC 29212) (n = 30) (group A) and clinical isolates (n = 30) (group B) for 3 weeks to form a biofilm. The tooth samples of groups A and B were randomly divided into three subgroups of 10 each, groups 1A and 1B (CH), groups 2A and 2B (CH+G), groups 3A and 3B (CH+D), depending on the medicaments to be placed for one week. The difference between initial and final CFU was calculated and statistically analyzed. RESULTS Among the clinical isolates, CH-antibiotic combinations were more effective than CH alone, which was statistically significant (p = 0.006). CONCLUSION The dentinal biofilm of clinical isolates of E. faecalis strains exhibited more reduction in bacterial colonies with CH in combination with antibiotics (D and G). CLINICAL SIGNIFICANCE Daptomycin and gentamicin when used as an intra-canal medicament in combination with CH are effective in eliminating E. faecalis. Keywords: Calcium hydroxide, Daptomycin, Dentinal biofilm, E. faecalis, Gentamicin.
Endodontic management of maxillary first molar with seven root canals diagnosed using cone-beam computed tomography: A case report Ravindranath Megha, Venkatachalam Prakash World Journal of Dentistry, 2021 Ab s t r Ac t Aim and objective: To present the endodontic treatment of maxillary right first molar with three roots and seven root canals diagnosed with cone-beam computed tomographic imaging and its successful management. Background: The anatomic complexities and variations of maxillary first molar reported vastly in the literature are constant challenges for successful endodontic therapy. Detection of all the root canals and their disinfection is important for proper healing and long-term survival of the tooth. CBCT imaging is being used extensively over the past two decades for the diagnosis of teeth with multiple root canals. The use of CBCT and various diagnostic tools for the successful management of a maxillary first molar with multiple root canals is discussed herein. Case description: This case report represents an unusual morphology of three roots and seven root canals in the maxillary first molar. A rare configuration of two mesiobuccal, two distobuccal, and three palatal root canals is reported. The diagnosis was done using multiple angulated radiographs and CBCT imaging. Nonsurgical endodontic treatment was performed followed by a full-coverage porcelain crown. Conclusion: Clinicians should always be mindful of various possible aberrations in the canal morphology of maxillary molars. This necessitates the use of various diagnostic tools like CBCT and dental operating microscope (DOM). The use of these aids led to successful diagnosis and treatment in the present case, thereby avoiding possible endodontic failure. Clinical significance: This case report along with the literature discusses and highlights the fact that maxillary first molars have the highest incidence of additional root canals. It also signifies the importance of CBCT and DOM as essential diagnostic tools in detecting the additional canals.
Dental health and pregnancy – an overview Narasimhan Manasa Suresh Mitthra Balasubramaniam Anuradha Indian Journal of Forensic Medicine and Toxicology, 2020 Pregnancy is a physiological state with significant changes in a woman’s body. Pregnant women are moreprone to gingival diseases due high levels of fluctuating pregnancy hormones.The aim of this article is tobring to light the changes in oral cavity during pregnancy, the consequences of not treating them and thecurrent recommendations for dental management of pregnant patients in different trimesters.
Re-attachment of tooth fragment―a case report Parthasarathy Rajasekar, Suresh Mitthra, Venkatachalam Prakash, Arunajetasan Subbiya Indian Journal of Public Health Research and Development, 2019
Occupational hazards in dentistry―a review Alagarsamy Venkatesh, Balasubramanian Anuradha, Suresh Mitthra, T. Sanjana Indian Journal of Public Health Research and Development, 2019
Diagnosis of vertical root fracture: A review Alagarsamy Venkatesh, Arunajatesan Subbiya, Suresh Mitthra, Venkatachalam Prakash Indian Journal of Public Health Research and Development, 2019
Buffered local anesthesia in dentistry―A review Joseph Changankary Pia, Suresh Mitthra, Balasubramanian Anuradha, Arunajetasan Subbiya Indian Journal of Public Health Research and Development, 2019
Avulsion –histological perspectives and storage media-a review Suresh Mitthra, Nivedita Lukram, Venkatachalam Prakash, New Begin Selvakumar Gold Pearlin Mary, Jagadeesh Shuruthi, Arunajatesan Subbiya Indian Journal of Public Health Research and Development, 2019
Bonding system for restorative materials - a review Mitthra Suresh, Teena Ans Abraham, Prakash Venkatachalam, Alagarsamy Venkatesh, Dhakinamoorthy Malarvizhi, Paramasivam Vivekanandhan Indian Journal of Public Health Research and Development, 2019
Gemination or fusion?: A case report ALAGARSAMY VENKATESH, SURESH MITTHRA, VENKATACHALAM PRAKASH, T. SRINIVASA PRASAD Biomedical and Pharmacology Journal, 2016
Pantoprazole - does it enhance the antibacterial efficacy of calcium hydroxide against Enterococcus Faecalis? International Journal of Pharma and Bio Sciences, 2015
The role of nanoparticles and nanodevices in nanomedicine Research Journal of Pharmaceutical Biological and Chemical Sciences, 2014
