Post-endodontic pain in curved canals prepared with different rotary instrumentation techniques: A randomized controlled trial.

BACKGROUND: Curved root canals are associated with the highest number of procedural errors during endodontic instrumentation. Recently, numerous rotary instruments have been developed, with both manual and automated mechanisms, to facilitate endodontic treatment and manage the complications related to it. OBJECTIVES: The aim of the study was to assess post-endodontic pain after using the HyFlex® EDM OneFile (HEDM), WaveOne® Gold (WOG) and XP-endo® Shaper (XPS) systems in the preparation of curved canals in patients with asymptomatic irreversible pulpitis. MATERIAL AND METHODS: A total of 45 molars with curved canals and asymptomatic irreversible pulpitis were randomly divided into 3 equal groups based on the instrumentation used: HEDM (group A); WOG (group B); and XPS (group C). All teeth were prepared according to the manufacturers' instructions. Postendodontic pain was assessed using the visual analog scale (VAS) at 6, 12, 18, 24, 48, and 72 h after root canal instrumentation. The data was analyzed using the one-way analysis of variance (ANOVA) and the paired-samples t test with the Bonferroni correction, with a p-value of 0.05 set for statistical significance. RESULTS: The highest levels of post-endodontic pain were recorded at 6 h after treatment. Then, the values gradually decreased until the pain nearly vanished after 72 h. No statistically significant differences were observed in the VAS scores between groups A and B. At the same time, group C showed the lowest VAS scores at all follow-up time points. CONCLUSIONS: The use of the XPS system resulted in the lowest pain scores at all follow-ups. The HEDM and WOG groups showed no differences in the pain scores throughout the whole follow-up period.

Immediate dental implantation after indirect sinus elevation using osseodensification concept: a case report.

Implantation in the posterior maxilla is more challenging due to the insufficient bone height after maxillary sinus pneumatization and the low bone density. Osseodensification (OD) is considered a novel, less invasive, and more effective indirect sinus floor elevation technique. Case presentation: A 52-year-old male presented to the oral and maxillofacial surgery department with a main complaint of chewing difficulties in the right posterior area maxilla (teeth numbers: 26 and 27). A cone-beam computed tomography (CBCT) imaging showed that the residual bone height ranged between 1 and 4 mm and the width ranged between 9 and 12 mm in the area of teeth numbers 16 and 17. Intervention and outcome: The treatment plan was to extract the teeth (numbers: 16 and 17) and conduct internal sinus lifting and bone grafting using the OD burs with immediate implantation. Clinical discussion: OD is proposed as an alternative procedure to the direct (lateral window) sinus floor elevation procedure. The amount of vertical bone gain obtained by this technique in transcrestal sinus lifting can be the same as external sinus lifting in this case. Conclusion: OD can be considered a promising technique for direct sinus floor elevation, considering the amount of vertical bone gain obtained by this technique.

Evaluation of the pulp response following direct pulp capping with exogenous nitric oxide and Mineral Trioxide Aggregate (MTA) a histologic study.

Background: Recently, vital pulp therapy is widely used all over the world. It aims to maintain the viability and function of the injured dental pulp tissue. Direct pulp capping is recognized as one of the most common used techniques in this approach. Aim of the study: we aimed to compare the histopathological response of the dental pulp following direct pulp capping using two different capping materials; the exogenous nitric oxide (NOC-18) and Mineral Trioxide Aggregate (MTA) in dogs' teeth. Methods and materials: The pulp of thirty-two premolars and canines from four dogs (eight teeth per each dog) the pulp was exposed and treated with either exogenous nitric oxide (NOC-18) and MTA (four teeth in each group). The treated teeth were extracted and prepared for histologic evaluation after one month and three months, respectively. The histologic study evaluated the formation of dentine bridge, the degree of pulpitis, calcification of the coronal pulp tissue and odontoblasts layer activity. We have the ethical approval to achieve this research from the scientific committee in Faculty of Dentistry, Damascus University. Results: The results showed that the active statue of odontoblasts layer in NOC-18 group was significantly more than in MTA group after a month of recall (P: 0.003). No significant difference was found between MTA and NOC-18 categories in the formation of dentine bridge after 3 months (P: 1.000). Conclusion: Exogenous nitric oxide (NOC-18) maybe has a positive impact on formation of calcified bridge and efficacy of odontoblasts layer on directly capped dog's teeth. Exogenous NO donors might offer alternative to current pulp capping agents in Vital Pulp Therapy in endodontic.

Comparison of calcium sulfate and tricalcium phosphate in bone grafting after sinus lifting for dental implantation: A randomized controlled trial.

BACKGROUND: Maxillary sinus grafting is considered the most common surgical technique to secure a sufficient bone height for placing dental implants. It is carried out either by making a bony window in the lateral wall of the maxillary sinus (the external procedure) or through the alveolar entrance technique by using alveolar osteotomes (the internal procedure), depending on the quality and quantity of the remaining bone. OBJECTIVES: The aim of the present study was to compare radiologically the amount of bone gain (an increase in bone dimensions) and bone reduction (the loss of the graft volume) obtained by using tricalcium phosphate (TCP) and calcium sulfate (CS) grafts mixed with advanced platelet-rich fibrin (A-PRF). MATERIAL AND METHODS: Nine patients (18 maxillary sinuses) participated in this study, all of whom had bilateral edentulism involving the premolar/molar areas and a bone height of 0.5-5 mm between the sinus floor and the alveolar ridge. Two biomaterials were used in the sinus augmentation procedures. Each patient underwent a bilateral maxillary sinus lift with the use of different bone graft materials - with CS mixed with A-PRF used on one side, and TCP mixed with A-PRF on the other side. The grafting site was selected randomly. Afterward, bone gain and bone reduction were evaluated at the grafting site by using cone-beam computed tomography (CBCT). RESULTS: The mean bone gain on the side treated with TCP mixed with A-PRF was 7.532 ±1.150 mm, and on the side treated with CS mixed with A-PRF side it was 7.961 ±2.781 mm. The comparison of bone gain and bone reduction between the 2 groups showed no statistically significant differences at a 6-month follow-up. CONCLUSIONS: Using CS or TCP mixed with A-PRF was beneficial and safe in the two-stage maxillary sinus lifting procedure. A sufficient amount of bone was obtained for dental implantation.

Immunohistochemical study of insulin-like growth factor 1 in calcifying epithelial odontogenic tumor and ameloblastoma: experimental research.

Several studies have indicated that increased levels of insulin-like growth factor 1 (IGF-I) or altered levels of its binding proteins are associated with an increased risk of the most common cancers, including cancers of the colorectal, lung, breast and prostate. The aim of this study is to investigate the expression of IGF-1 in both calcifying epithelial odontogenic tumor (CEOT) and ameloblastoma. Materials and methods: The research sample consisted of 23 paraffin block from Oral Pathology Department, Faculty of Dentistry, Damascus University, including six biopsies of CEOT, two biopsies of the plexiform ameloblastoma and 14 biopsies of the follicular ameloblastoma. All specimen were prepared and immunostained with rabbit polyclonal antibody to IGF-1. Immunostaining was assessed according to German-semiquantitative scoring system, and then the results were aggregated and statistically analyzed using SPSS version 13.0 (Student's test for two independent samples, one-way analysis of variance, Kruskal-Wallis test and Mann-Whitney U-test), the significance level P value less than 0.05 was considered statistically significant. Results: All CEOT and ameloblastoma samples were positive for IGF-1 staining, except one sample of ameloblastoma, which was negative. The results showed that there were no statistically significant differences between CEOT and ameloblastoma in the values of IGF-1 expression (P=0.993) and IGF-1 expression rates (P=0.874) and in the frequency of IGF-1 expression (P=0.761) and IGF-1 staining intensity score (P=0.731). Conclusion: IGF-1 plays an important role in the growth of odontogenic tumors and there are no differences in IGF-1 expression between CEOT and ameloblastoma.

External sinus lifting using calcium sulphate as a bone grafting in an adult male patient: Case report.

Introduction: and importance: Nowadays, dental implant is considered as a revolutionary method in teeth replacement. Occasionally, missing bone is seen in the area of missing teeth. Oral surgeons need to rebuild this are before implantology, which could be supported by using bone grafts. The practitioners face a problem in the maxilla because of its anatomy and the presence of maxillary sinus. In some cases, and after losing the bone, maxillary sinus needs to be lift before the implant is placed. Calcium sulphate (CS) is one of the promising methods as one of the biocompatible bone grafts. Case presentation: A 30-year-old male patient was reported to the oral and maxillofacial surgery in Faculty of Dentistry, Damascus University. The main complaint was to replace missing teeth (teeth no: 26,27). The patient had no contraindication for surgery.Clinical Findings and Investigations: intra-oral examination revealed a good oral hygiene with no other diseases either in bone or in the oral mucosa. Cone-beam computed tomography systems (CBCT) scan was done to determine the thickness of the remaining bone and the treatment plan was discussed with the patient. Interventions and outcome: the treatment plan was to do external sinus lifting for the posterior left maxilla, using calcium sulphate as a graft and placing the implants after six months. Each procedure during surgical work was documented and monitored using CBCT. The follow-up and results were made by clinical measures as well CBCT to evaluate radiological bone-gain and bone reduction (two-year follow-up). Relevance and impact: the use of calcium sulphate has tremendous benefit as biocompatible bone grafts in sinus lifting in order to gain bone before dental implantation. It may increase the bone gain which will improve the surgical site of the implant.

Heterotopic gastrointestinal cyst in the mandible of a young adult: A rare case-report from Syria.

Heterotopic gastrointestinal cyst (HGC) is a rare entity in the head and neck region. The dorsal surface of tongue and the floor of the mouth is the most commonly affected sites and rarely affects bone. Histologic examination reveals a lesion resembling any part in the gastric tract; colonic, intestinal or gastric mucosa. We report a HGC presenting in a twenty-one-year-old Syrian female patient.