Exploring age and gender variations in root canal morphology of maxillary premolars in Saudi sub population: a cross-sectional CBCT study.

BACKGROUND: In complex teeth like maxillary premolars, endodontic treatment success depends on a complete comprehension of root canal anatomy. The research on mandibular premolars' root canal anatomy has been extensive and well-documented in existing literature. However, there appears to be a notable gap in available data concerning the root canal anatomy of maxillary premolars. This study aimed to explore the root canal morphology of maxillary premolars using cone-beam computed tomography (CBCT) imaging, considering age and gender variations. METHODS: From 500 patient CBCT scans, 787 maxillary premolar teeth were evaluated. The sample was divided by gender and age (10-20, 21-30, 31-40, 41-50, 51-60, and 61 years and older). Ahmed et al. classification system was used to record root canal morphology. RESULTS: The most frequent classifications for right maxillary 1st premolars were 2MPM1 B1 L1 (39.03%) and 1MPM1 (2.81%), while the most frequent classifications for right maxillary 2nd premolars were 2MPM1 B1 L1 (39.08%) and 1MPM1 (17.85%). Most of the premolars typically had two roots (left maxillary first premolars: 81.5%, left maxillary second premolars: 82.7%, right maxillary first premolars: 74.4%, right maxillary second premolars: 75.7%). Left and right maxillary 1st premolars for classes 1MPM1 and 1MPM1-2-1 showed significant gender differences. For classifications 1MPM1 and 1MPM1-2-1, age-related changes were seen in the left and right maxillary first premolars. CONCLUSION: This study provides novel insights into the root canal anatomy of maxillary premolars within the Saudi population, addressing a notable gap in the literature specific to this demographic. Through CBCT imaging and analysis of large sample sizes, the complex and diverse nature of root canal morphology in these teeth among Saudi individuals is elucidated. The findings underscore the importance of CBCT imaging in precise treatment planning and decision-making tailored to the Saudi population. Consideration of age and gender-related variations further enhances understanding and aids in personalized endodontic interventions within this demographic.

Efficacy of electronic apex locators in comparison with intraoral radiographs in working length determination- a systematic review and meta-analysis.

BACKGROUND: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL. OBJECTIVE: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects. METHODS: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1. RESULTS: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI .29 to .28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI .11 to .99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03-1.18, 573 participants; P value = 0.006). CONCLUSION: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods.

Systematic review fracture resistance of endodontically treated posterior teeth restored with fiber reinforced composites- a systematic review.

BACKGROUND: Large cavity designs and access cavities impair endodontically treated tooth fracture resistance. As the tooth's strength is known to reduce significantly after the root canal treatment, occlusal loading as a result of functions such as chewing, biting and certain parafunctional tendencies makes the endodontically treated tooth vulnerable to fracture. Hence, after endodontic treatment, it is vital to give adequate and appropriate restorative material to avoid tooth fractures. Accordingly, the choice of such restorative material should be dictated by the property of fracture resistance. OBJECTIVE: The goal of this study was to conduct a systematic review and critical analysis of available data from in vitro studies examining the fracture resistance of endodontically treated posterior teeth restored with fiber-reinforced composites. METHODOLOGY: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRIS-MA) Statement was used to guide the reporting of this systematic review A comprehensive literature search was performed using MEDLINE (via PubMed), Scopus, ScienceDirect, Google Scholar, and LILACS. A manual search of the reference lists of the articles was also performed. The databases provided a total of 796 studies from the electronic systematic search. The databases provided a total of 796 studies from the electronic systematic search. Two reviewers scrutinized the papers for eligibility based on inclusion/exclusion criteria and extracted data. The studies were assessed for their potential risk of bias. Based on modified JBI & CRIS (checklist for reporting in vitro studies) guidelines, along with the methodology and treatment objective, we have formulated 13 parameters specifically to assess the risk of bias. A total of 18 studies met the inclusion criteria and were included for qualitative analysis. Considering the high heterogeneity of the studies included, a meta-analysis could not be performed. RESULTS: The majority of the included studies had a moderate or high risk of bias. When compared to traditional hybrid composites, fiber-reinforced composites showed increased fracture resistance of endodontically treated teeth in the majority of investigations. On the other hand, limited evidence was found for the bulk fill composites. Moreover, moderate evidence was found for the fracture resistance of inlays and fiber posts with fiber-reinforced composites for core build-up in endodontically treated teeth. No evidence could be found comparing the fracture resistance of endo crowns and fiber-reinforced composites in endodontically treated teeth. CONCLUSION: According to the research, using fiber-reinforced composites instead of conventional hybrid composites improves the fracture resistance of endodontically treated teeth. However, there was a high risk of bias in the research considered. No judgments could be reached about the superiority of one material over another based-on comparisons between other core restorations.

Knowledge, Attitude and Practice towards the COVID-19 Pandemic: A Cross-Sectional Survey Study among the General Public in the Kingdom of Saudi Arabia.

Background: The novel coronavirus disease 2019 (COVID-19) is an infectious disease that has been spreading worldwide in an unprecedented manner. The knowledge, attitude and practices of the general population play a vital role in prevention of COVID-19. Objectives: The present study aimed to assess the COVID-19-related knowledge, attitudes and practices of the general public of Sakaka, Saudi Arabia, to identify which populations show low levels of knowledge, attitudes and practices towards COVID-19, making them highly likely to remain vulnerable during the pandemic. Methodology: For this study, a nineteen-item closed-ended questionnaire was hand delivered to the general public, including patients and other hospital attendees attending the Outpatient Department of the College of Dentistry, Jouf University, Saudi Arabia. The research questions focused on the demographic information, knowledge, attitude and practices related to COVID-19. Data analysis is presented through tables and descriptive methods. Results: A total of 722 participants took part in the survey questionnaire. The majority of the respondents belonged to the age group of 28-37 years (n = 320; 44.3%), with female participants (n = 419; 58.0%) outnumbering the male participants (n = 303; 42.0%). Most of the respondents had good knowledge, attitudes and practices towards COVID-19. Patients aged 28-37 years (p = 0.000) with a master's degree (p = 0.011) and government employees (p = 0.000) had significantly better knowledge than their counterparts. Significantly optimistic attitudes were noticed in participants aged 28-37 years (p = 0.000) with a master's degree (p = 0.000), the married (p = 0.047) and government employees (p = 0.000). Government employees (p = 0.014) had significantly better practices. Conclusions: Overall, the participants of this study had good COVID-19-related knowledge, attitudes and practices. These findings would be useful in motivating the general population to follow the precautionary measures that will aid in prevention of COVID-19. Furthermore, the findings may help policymakers identify the target populations, especially the less educated and older adults, for COVID-19 prevention and health education.

Biocompatibility and antioxidant activity of a novel carrageenan based injectable hydrogel scaffold incorporated with Cissus quadrangularis: an in vitro study.

BACKGROUND: Over the past years, polysaccharide-based scaffolds have emerged as the most promising material for tissue engineering. In the present study, carrageenan, an injectable scaffold has been used owing to its advantage and superior property. Cissus quadrangularis, a natural agent was incorporated into the carrageenan scaffold. Therefore, the present study aimed to assess the antioxidant activity and biocompatibility of this novel material. METHODS: The present in vitro study comprised of four study groups each constituting a sample of 15 with a total sample size of sixty (n = 60). The carrageenan hydrogel devoid of Cissus quadrangularis acted as the control group (Group-I). Based on the concentration of aqueous extract of Cissus quadrangularis (10% w/v, 20% w/v and 30% w/v) in carrageenan hydrogel, respective study groups namely II, III and IV were considered. Antioxidant activity was assessed using a 1,1-diphenyl-2-picrylhydrazyl radical scavenging assay, whereas the biocompatibility test was performed using a brine shrimp lethality assay. The microstructure and surface morphology of the hydrogel samples containing different concentrations of Cissus quadrangularis aqueous extract was investigated using SEM. One-way ANOVA with the post hoc tukey test was performed using SPSS software v22. RESULTS: A significant difference (P < 0.05) in the antioxidant activity was observed among the study groups. Group III reported the highest activity, whereas the control group showed the least antioxidant activity. Additionally, a significant (P < 0.01) drop in the antioxidant activity was observed in group IV when compared with group III. While assessing the biocompatibility, a significant (P < 0.001) dose-dependent increase in biocompatibility was observed with the increasing concentration of aqueous extract of Cissus quadrangularis. SEM analysis in group III showed even distribution throughout the hydrogel although the particles are close and densely arranged. Reduced antioxidant activity in group IV was probably due to clumping of the particles, thus reducing the active surface area. CONCLUSION: Keeping the limitations of in vitro study, it can be assumed that a carrageenan based injectable hydrogel scaffold incorporated with 20% w/v Cissus quadrangularis can provide a favourable micro-environment as it is biocompatible and possess better antioxidant property.

Caries Risk Assessment Using the Caries Management by Risk Assessment (CAMBRA) Protocol among the General Population of Sakaka, Saudi Arabia-A Cross-Sectional Study.

Background: Caries risk assessment is a useful tool in caries prevention and management. Using a tool such as CAMBRA, every individual can be assessed according to his or her disease indicators, risk factors, and protective factors for the current and future caries. Aim: This study aimed to assess caries risk among the general population of Sakaka, Saudi Arabia using the CAMBRA protocol. Methods: This cross-sectional study was conducted at university dental clinics using a questionnaire that was formulated using the CAMBRA caries risk assessment tool; afterwards, all 160 participants were intra-orally examined to assess oral hygiene status and presence of disease. Independent t-tests, ANOVAs, and chi-square tests were performed for analysis. Results: The majority of participants had one or more disease indicators, with white spots and visible cavities (71.3%), and the most commonly present risk factor was visible heavy plaque on teeth (82.5%). The use of fluoridated toothpaste (92.5%) was the most common protective factor. The majority of participants (85%) were in the 'High' category of Caries risk assessment. The prevalence of high caries risk was significantly higher among the rural participants compared to the urban (p <0.05), and significantly fewer of those with a primary school education level or lower were in the high dental caries risk group compared to the other educational categories (p <0.001). Conclusion: The caries risk among the general population of Sakaka, Saudi Arabia, is high, with significant variation among age groups, education levels, and geographical locations.