Comparative Analysis of Coronal Sealing Materials in Endodontics: Exploring Non-Eugenol Zinc Oxide-Based versus Glass-Ionomer Cement Systems.

The proper closure of the access cavity between appointments during endodontic treatment is paramount and relies on temporary fillings. This systematic review evaluates the effectiveness of zinc oxide-based materials and glass-ionomer cement (GIC) as temporary coronal sealers after root canal treatment in extracted human teeth. Three databases were searched to identify randomized clinical trials that examined the sealing properties of various temporary sealing materials using dyes or stains as indicators. A total of seven in vitro studies that fulfilled the eligibility criteria were critically analyzed. These indicated significant variations in the relative sealing ability of the coronal breach of endodontically treated teeth, either by zinc oxide or GIC-based materials. While GIC-based material (e.g., Fuji IX and Fuji II) exhibited superior sealing of single-rooted teeth, zinc oxide-based material (e.g., Cavit, Coltosol, Caviton) also showed promising attributes. Resin-modified GIC formulations displayed enhanced physical properties, yet challenges related to adhesive failure and shrinkage during polymerization were observed. Zinc oxide-based materials have demonstrated superior coronal sealing effectiveness over certain GIC in controlled settings. Their premixed nature ensures consistent application and hygroscopic properties improve cavity sealing. However, the focus on dye penetration tests for microleakage in vitro may not fully represent the risk of bacterial infiltration. Thus, in vivo studies are crucial for validating these findings in clinical contexts.

An Audit of the Technical Quality and Iatrogenic Errors of Root Canal Treatment by Undergraduate Dental Students at the University of Sharjah.

OBJECTIVES: The aim of this study was to determine the technical quality of root canal fillings and the presence of iatrogenic errors in the cases treated by undergraduate dental students using radiographic images. MATERIALS AND METHODS: This study included 480 root-filled teeth, which were evaluated using intraoral periapical radiographic images. The technical quality of obturation was assessed by observing the length, density, and taperness of the root filling. Ledges, apical transportation, fractured instruments, zipping, and root perforation were recorded as iatrogenic errors. Teeth were classified as acceptable if the technical parameters were adequate and there were no iatrogenic errors. STATISTICAL ANALYSIS: Data were statistically analyzed using Pearson's chi-squared test. RESULTS: The quality of root filling was acceptable in 183 of the 480 teeth. The rate of acceptable quality was higher for the teeth treated by 4th-year students (41.9%) than for those treated by 5th-year students (27.4%; p = 0.004). Length and taperness were adequate in more of the patients treated by the 4th-year students (p<0.05). There was a significant difference in the incidence of ledge formation and apical transportation in relation to the student's level (p<0.05). CONCLUSIONS: The technical quality of root fillings performed without iatrogenic errors by undergraduate dental students was declared acceptable in 38.1% of the assessed teeth. There was a noticeable difference in the quality of root canal treatment between the 4th- and 5th-year students. CLINICAL RELEVANCE: The findings demonstrate that periodic assessment of the technical quality of root filling performed by undergraduate dental students provides feedback on curriculum standards.

Comparison of clinical outcomes of non-surgical adjunctive use of the 980-nm diode laser to conventional periodontal flap procedure-a randomised controlled split-mouth clinical trial.

Lasers have been found to be effective as an adjunctive in periodontal therapy. The objective of the study was to compare the outcomes of non-surgical adjunctive use of 980-nm diode laser to that of conventional flap surgery in terms of clinical outcome measures and radiographic osseous defect depths. This study was designed as a double-blinded split-mouth randomised controlled clinical trial. A total of fifteen patients (30 quadrants) with generalised periodontitis stage III grade B were randomly assigned test group (diode laser) and control group (conventional flap surgery). Both test and control groups had 15 quadrants each. At 3 months, the probing pocket depth (PPD) was 3.46 ± 0.19 mm (test) and 4.20 ± 0.20 mm (control), with a statistically significant difference between the groups (p = 0.01). Similarly, at 6 months re-evaluation, PPD was 1.46 ± 0.12 mm (test) and 2.33 ± 0.13 mm (control) with a highly significant statistical difference (p = 0.001). Plaque index showed a difference between both test and control groups at baseline, 3 months and 6 months (p = 0.001) while gingival index, modified sulcular bleeding index and radiographic osseous defect depth showed a difference at 3 months and 6 months (p = 0.001). Within the study's limitations, 980-nm diode laser can result in significant improvements in the clinical and radiographic parameters and is very well tolerated by the subjects.

Morphological and Chemical Analysis of Different Types of Calcium Silicate-Based Cements.

Objectives: Particle size and shape can influence the properties of materials. However, to improve the physicochemical and biological properties of mineral trioxide aggregate (MTA), silicate-based hydraulic cements were introduced. This study aimed to evaluate and compare the major constituents and crystalline structures along with the surface morphology of different types of calcium silicate-based cement (CSC). Materials and Methods: Six different types of CSC (white Portland cement, white ProRoot MTA, white MTA Angelus, Biodentine, and Endosequence, both putty and paste) were used in this study. Five samples of each material were analyzed in both uncured and cured cement using scanning electron microscopy/energy-dispersive X-ray (SEM/EDX), X-ray diffraction (XRD), and Fourier transform-infrared spectroscopy (FTIR). Results: SEM analysis showed that the surfaces of all materials consisted of particle sizes ranging from 0.194 µm to approximately 51.82 µm. The basic elements found in both uncured and cured cement of all tested materials using EDX were carbon, calcium, silicon, and oxygen. A difference was observed in the presence or absence of magnesium, aluminum, bismuth, zirconium, and tantalum. XRD showed that all tested materials were composed mainly of tricalcium silicate and dicalcium silicate, which are the main components of Portland cement. FTIR analysis showed aromatic rings, phosphine PH, alkyl halides, and alcohol O-H groups in all tested materials but at different wavenumbers. Conclusions: The different types of CSCs tested in this study were primarily modified types of Portland cement with the addition of radiopacifiers. ProRoot MTA and MTA Angelus contained bismuth oxide, Biodentine contains zirconium oxide, whereas Endosequence root repair materials (both putty and paste) contained zirconium oxide and tantalum oxide. Endosequence root repair materials showed smaller particle sizes than the other groups. White PC had the most irregular and large particle sizes. CSC had a smaller particle size, except for MTA Angelus. Clinical Relevance. The composition of CSC has a direct influence on the properties of these cements, which may affect the clinical outcome of the treatment.

Comparative Evaluation of Accuracy of Different Apex Locators: Propex IQ, Raypex 6, Root ZX, and Apex ID with CBCT and Periapical Radiograph-In Vitro Study.

OBJECTIVES: This study aimed to validate the accuracy of working length (WL) measurements obtained with the newly introduced Propex IQ apex locator and to compare it with the latest generations of other electronic apex locators, CBCT, and conventional periapical radiographs by using the actual WL measurements obtained by using an endodontics microscope as a reference. MATERIALS AND METHODS: Thirty-five extracted single-rooted human mandibular first premolars with curvatures from 10° to 20° were selected according to the inclusion and exclusion criteria and cut at the cementoenamel junction to achieve a standard reference point for WL determination. The actual WL was obtained by inserting a size-15 k-file in the root canal until the tip of the file was visible under an endodontic microscope. The definitive WL was measured using Propex IQ (Dentsply Sirona), Raypex 6 (VDW Dental), Root ZX (Morita), and Apex ID (Kerr Dental). In addition, radiographic WL was obtained using periapical radiographs and CBCT. One-way ANOVA was used for comparisons of the WL values, with a p value < 0.05. The percentage of success of each method for determination of the definitive WL was assessed using cross-tabulation and chi-square tests. RESULTS: CBCT radiographs and Propex IQ apex locator yielded the most accurate WL measurements in comparison with the actual WL measurements (p < 0.05). Raypex 6, Root ZX, and Apex ID yielded more accurate WL measurements than conventional periapical radiographs (p < 0.05). Periapical radiographs yielded the least accurate WL measurements in comparison with the actual WL values (p < 0.05). CONCLUSIONS: Within the limitations of this study, the Propex IQ apex locator showed higher accuracy than Raypex 6, Root ZX, and Apex ID for WL determination in the root canal. Nevertheless, CBCT radiographs yielded the maximum accuracy for WL measurements.

Application of a Cone-Beam Computed Tomography-Based Index for Evaluating Surgical Sites Prior to Sinus Lift Procedures-A Pilot Study.

OBJECTIVES: Radiography-based indices can help surgeons perform detailed examinations of the surgical site and predict the surgical difficulty of cases. We aimed to develop and validate a novel CBCT-based index that can predict the surgical difficulty of sinus-augmentation procedures. MATERIALS AND METHODS: In the first stage, five experienced dental specialists performed a review of the literature and closed group discussions and designed the novel index. In the next stage, the index was validated. CBCT scans of 30 patients scheduled for sinus-augmentation procedures were evaluated and assigned presurgical CBCT evaluation scores (PSCESs) by five examiners. Subsequently, one oral surgeon performed sinus augmentation using the lateral antrostomy technique and assigned surgical difficulty scores (SDSs) to each of the 30 cases along with 2 observers. The PSCESs and SDSs were statistically analysed to determine the interrater reliability and validity of the index. RESULTS: The interrater agreement of the PSCES among the five presurgical evaluators was 0.85. The PSCES of the five evaluators had highly significant correlation (P < 0.001, r = 0.68 to 0.76) with the SDS. Regression analysis revealed that for every unit increase in the PSCES, there is 0.46 to 0.57 increase in the SDS value. CONCLUSION: The results of this pilot study revealed that a novel CBCT-based index can be used as a reliable tool for predicting the surgical difficulty of sinus-augmentation procedures. However, the novel index needs to be tested on a larger sample of patients and evaluators for a more concrete validity and reliability.

Cone Beam Computed Tomography Analysis of Root and Root Canal Morphology of First Permanent Lower Molars in a Middle East Subpopulation.

AIM: The aim of this study was to investigate variations in the number of roots and root canals in first permanent lower molars (FPLMs) using cone beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 640 CBCT images were analyzed using SIDEXIS XG software version 2.62 (Sirona Dental Systems, Bensheim, Germany). The entire root anatomy of FPLMs was investigated in three dimensions and the number of roots, root canals, and the number of canals per root were recorded. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software, version 24, (IBM Corporation, USA) to determine the relationship between root anatomy and gender, age, or tooth location (right or left side). RESULTS: The majority of FPLMs had two roots (96%), whereas the remaining 32 FPLMs (4%) had three roots. Almost two-thirds of the sample (62.7%) had three root canals, whereas only three cases (0.4%) of the FPLMs had six canals. When comparing bilateral differences in the distribution of root canals, it was determined that a quarter of FPLMs (24.1%) had an unequal number of canals. Moreover, there were differences in the number of additional canals between the mesial and distal roots with 17.5% of the former having three canals as compared with only 0.5% of the distal root. Interestingly, not more than one canal was observed in all additional root cases. No significant differences were observed in the number of canals between males and females or between right and left sides of the examined FPLMs (P > 0.05). CONCLUSION: Dental clinicians should be aware of the presence of an additional root in 4% of FPLMs, and about a quarter of the cases (27%) had an extra middle mesial canal in the mesial root, which was found to be more prevalent in middle age groups.

Gypsum-Based Material for Dental Pulp Capping: Effect of Chitosan and BMP-2 on Physical, Mechanical, and Cellular Properties.

Effective pulp capping material must be biocompatible and have the ability to induce dentin bridge formation as well as having suitable physical and mechanical properties; however, many current materials do not satisfy the clinical requirements. This study aimed to assess the physical and mechanical properties of gypsum-based chitosan material (Gp-CT) and to evaluate its effects on cellular properties of stem cells from human exfoliated deciduous teeth (SHED). The experimental material was prepared with different concentrations of chitosan (CT) with or without BMP-2. Then, setting time, compressive strength, and pH were determined. In addition, cell viability, alkaline phosphatase (ALP) activity, and cell attachment were assessed. The setting time, compressive strength, and pH obtained were 4.1-6.6 min, 2.63-5.83 MPa, and 6.5-5.7, respectively. The cell viability to gypsum (Gp) with different CT concentrations was similar to that of the control on day 1 but statistically different from that of Gp alone on day 3. The ALP activity of SHED was significantly higher (p < 0.05) in CT- and BMP-2-containing materials than those in the control and Dycal at days 3 and 14. The scanning electron microscopy (SEM) image revealed that flattened cells were distributed across and adhered to the material surface. In conclusion, Gp-CT material shows promise as a potential material for direct pulp capping.

Cone-beam computed tomography analysis on root and canal morphology of mandibular first permanent molar among multiracial population in East Coast Malaysian population.

OBJECTIVE: The aim of this study is to investigate the variations in the number of root and canal in the mandibular first permanent molars (MFPMs) teeth in East Coast Malaysian population using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT images which show MFPMs recorded in HUSM Dental Clinic between January 2015 and June 2016 was obtained and analyzed for their number of roots and canals. A total of 208 CBCT images of MFPMs were collected; 118 patients had unilateral molars and 90 patients had bilateral molars. The following observations were made: (1) root number; (2) number of canals per root; and (3) comparisons of number of roots and canals according to gender, ethnicity, and position. RESULTS: The majority of cases of bilateral MFPM had the same number of roots (95.6%, 95% confidence interval [CI]: 89.01%, 98.78%) on both the right and left side and only 4 cases (4.4%, 95% CI: 1.22%, 10.99%) had 3 roots on the right and 2 roots on the left sides. The majority of cases had the same number of canals on both sides (66.7%, 95% CI: 55.95, 76.26%) and 33.3% (95% CI: 23.74%, 44.05%) with unequal number of canals. The occurrence of the number of canals was not independent of the sides of the arch (P < 0.001) and there was statistically significantly greater proportion of cases who had greater number of canals on the right side than the left (P = 0.03). The prevalence of right single-rooted MFPM was very small at 0.3% (n = 1) in a Malay male (95% CI: 0.00, 1.83) and the most prevalent was two roots first molar (88.4%). The number of roots was not associated with sex or ethnic group (P > 0.05). The MFPM with a single root was found to have only one mesial canal. For two rooted MFPM, the most prevalent occurrence was two canals at the mesial and one canal at the distal roots (59%); followed by single canals in each mesial and distal (21%) and double canals per root (18%). Three roots MFPM have either single or double canals in the mesial root and double canals in the distal root. CONCLUSIONS: The majority of population in the East Coast region of Malaysia has two roots and three root canals in their MFPMs. There was no difference in the number of roots between gender and ethnic and canals between ethnic.

A Review of Supernumerary Teeth in the Premolar Region.

Supernumerary teeth in the premolar region, unlike other supernumeraries, occur more often in the mandible where they are generally of the supplemental type. Occasionally, they are conical or smaller than normal, particularly in the upper premolar regions. They might occur singly or in multiples, be erupted or impacted, but the majority have been found to be unerupted and asymptomatic. The prevalence of supernumerary teeth in the premolar region has been demonstrated to be between 0.01 and 1 percent depending on the population studied. Interestingly, populations from the East or Africa are known to be the most affected. Various theories have been suggested to explain the etiology of supernumerary teeth in general including both genetic and environmental factors. Furthermore, it has been suggested that supernumerary premolar teeth belong to a third (postpermanent) series, developing from extensions of the dental lamina. Several consequences can result from the presence of supernumerary premolars, especially in the mandible, such as cyst formation, transposition, and other clinical scenarios.