Outcomes of nonsurgical endodontic treatment under general anesthesia in special health care needs: An observational study.

BACKGROUND AND AIM: The alarming rise in the number of people with special health care needs (SHCNs) necessitates a paradigm shift in how to approach their oral health needs. General anesthesia (GA) is a valuable technique for facilitating dental procedures in patients with SHCNs who may not be able to tolerate treatment without it. The aim was to assess nonsurgical endodontic treatment and outcomes in patients with SHCNs performed under GA. METHOD: Seventy-eight permanent teeth in 33 patients who received nonsurgical endodontic treatment under GA were included between 2018 and 2022 in SHCNs hospital clinics. The demographic data, types of SHCNs, pulpal and periapical diagnosis, type of treatment, and material used were analyzed. All patients were recalled for clinical and radiographic examinations. Pre-treatment and recall periapical radiographs were evaluated and scored using the Periapical Index (PAI). RESULTS: Autism and Attention deficit hyperactivity disorder were 39.4% of patients treated. Most treatments delivered were primary nonsurgical root canal treatment (95%). Warm vertical compaction of gutta-percha for obturation accounted for 88% of cases treated. Single cone obturation technique was used in 9 cases (12%) utilizing tricalcium silicate sealer. At the recall visits, 98.7% of teeth treated had survived. Twelve teeth have pre-treatment periapical lesions, and all healed except one. Female patients were found to have higher scores of PAI compared to male patients (23.7% vs 7.5%), yet insignificant. Only 10 patients with nonsurgical root canal treatment reported recurrent caries. CONCLUSION: This study demonstrates a high survival rate for nonsurgical endodontic treatment performed under GA in a cohort of patients with SHCNs. Interestingly, patients with social and communication disorders received the highest proportion of treatments under GA. These findings highlight the potential of GA-facilitated endodontics for this population. However, further research is warranted to explore additional methods for optimizing oral health outcomes in SHCNs.

Odontogenic Factors Associated with Maxillary Sinus Schneiderian Membrane Thickness and their Relationship to Chronic Sinonasal Symptoms: An Ambispective Cohort Study.

Odontogenic sinusitis is a common maxillary sinus disease. It develops due to the violation of the Schneiderian membrane due to pathological, iatrogenic, or traumatic causes from dental and dentoalveolar structures. The aim of this cohort study was to investigate local and systemic factors associated with Schneiderian mucosal thickening (MT) in patients referred for evaluation of apical periodontitis (AP) and examine their relationship with chronic sinonasal symptoms. Cone-beam computed tomography (CBCT) scans of 197 patients referred for evaluation of endodontic diseases were reviewed. Mucosal thickening in relation to the affected tooth was measured in the coronal section in millimeters at the maximum area perpendicular to the bone. Based on this measurement, the sinus floor was categorized for MT as present (>1 mm) or absent (<1 mm). The sociodemographic and clinical characteristics of the study participants were assessed and compared according to the presence or absence of MT. Furthermore, the relationship between odontogenic sinusitis and chronic sinonasal symptoms was assessed using a chronic sinusitis survey. Male patients had a higher MT than female patients. The presence of periapical lesions and inadequate endodontic treatment were significantly associated with MT. The multivariate logistic regression model showed that the presence of AP increased the odds of MT by approximately 2.5 times (p = 0.028), and nasal obstruction was significantly higher in patients diagnosed with mucosal thickness at different times of their follow-up period (p = 0.018). MT was 2.5 times more likely in the presence of apical periodontitis, and nasal obstruction was the most significant factor associated with the presence of MT.

Predicting no-shows for dental appointments.

Patient no-shows is a significant problem in healthcare, reaching up to 80% of booked appointments and costing billions of dollars. Predicting no-shows for individual patients empowers clinics to implement better mitigation strategies. Patients' no-show behavior varies across health clinics and the types of appointments, calling for fine-grained studies to uncover these variations in no-show patterns. This article focuses on dental appointments because they are notably longer than regular medical appointments due to the complexity of dental procedures. We leverage machine learning techniques to develop predictive models for dental no-shows, with the best model achieving an Area Under the Curve (AUC) of 0.718 and an F1 score of 66.5%. Additionally, we propose and evaluate a novel method to represent no-show history as a binary sequence of events, enabling the predictive models to learn the associated future no-show behavior with these patterns. We discuss the utility of no-show predictions to improve the scheduling of dental appointments, such as reallocating appointments and reducing their duration.

Exploring the Quality of Life for Saudi Patients Utilizing Dental Healthcare Services: A Systematic Review.

Over three billion people globally are affected by oral diseases. The Kingdom of Saudi Arabia (KSA) has declared a new vision for 2030, which includes an aim to improve the quality of healthcare in the Kingdom while maintaining the efficacy of spending. The Oral Health Impact Profile (OHIP) is a quality of life instrument that helps evaluate health status. This study aims to evaluate equity in accessing dental services and the integration of different types of dental services in the Kingdom of Saudi Arabia. A systematic review of the MEDLINE, ClinicalTrials.gov, and EBSCOhost Research Databases was conducted on August 1, 2021. To answer the research question, the SPIDER search tool that identified the sample, the phenomenon of interest, design, evaluation, and research type prior to conducting the review was adapted. Multiple steps were followed to identify the results. The first step was scanning and selecting the related titles. The second step involved reviewing the abstracts, and the third step involved scanning the full manuscript for all criteria to determine and validate the eligibility of the articles. Twenty-two articles remained in the final stage of the study. The first study applying the OHIP instrument in the KSA was in 2010, and the latest was in 2021. In terms of cities, nine cities accounted for research within eight administrative regions. Of the 4794 patients recruited within these reviewed articles, the highest number of patients reported was 1141 for fashion braces, while the minimum number of patients was 32 for conventional complete dentures. This study shows that the Arabic OHIP tool was successfully adapted by multiple dental studies in the KSA with various dental services and results were reported. The reviewed studies suggest that equity and integration of dental health services are well established in Saudi Arabia. Moreover, the major role of dental academic researchers has been identified.

The mid-mesial canal prevalence in mandibular molars of a Saudi population: A cone-beam computed tomography study.

INTRODUCTION: The aim was to assess the prevalence of Mid Mesial Canal (MMC) in the first and second mandibular molars in a Saudi subpopulation sample and assess its relation to side, gender, and age using Cone beam computed tomography (CBCT). METHODS: The CBCT scans at King Saud University Dental Hospital between 2016 and 2019 were reviewed and filtered. The MMC of the mandibular molars were assessed according to Pomeranz et al. classification which was: (1) independent; (2) fin; (3) confluent with the mesiobuccal canal; and (4) confluent with the mesiolingual canal. Three calibrated observers examined the MMC on all planes at both sides. Age and gender factors were used to analyze that prevalence. A chi-squared test was used and (P ≤ 0.05) was considered to be statistically significant. RESULTS: 395 patients, and 1377 teeth met the inclusion criteria. The total number of mid-mesial canals was 12 (0.9%): nine at the mandibular first molar (1.3%) and three in the mandibular second molar (0.4%). The most common type of mid-mesial canal was confluent (n = 10), of which 6 fused with the mesiobuccal canal and 4 fused with the mesiolingual canal. Two canals were of the fin type, and there was no instance of independent mid-mesial canal. There was no significant difference between all variables: tooth type, tooth side, patient gender, and patient age group (p > 0.05). CONCLUSION: In this study, the most common MMC configuration was the confluent type followed by the fin type and no independent type were found. The patient side, gender and age did not influence the prevalence of the MMC.

Analysis of mandibular premolar root position in relation to adjacent cortical plates and mental foramen using cone beam computed tomography in the Saudi population.

OBJECTIVES: To evaluate the horizontal and vertical location of the mental foramen (MF), as well as the relationship of lower premolars to buccal and lingual cortical plates using cone beam computed tomography (CBCT). Methods: Retrospective cross-sectional study conducted using CBCT scans that were obtained between early 2014 and late 2016 from King Saud University Dental hospital database in Riyadh, Kingdom of Saudi Arabia; 94 patients (53 males and 41 females) were included. Three examiners independently performed one-sided measurements for each patient. Data analyzed statistically and a p less than 0.05 was considered significant. Results: The mean distances from the outer boundary of the buccal cortex to the first and second premolars (R1) were 1.55 mm and 1.98 mm. The mean distances from the outer boundary of the lingual cortical plate to the first and second premolars (R2) were 4.06 mm and 4.73 mm. The respective mean total bone thicknesses, including the roots of the first and second premolars (R3), were 9.32 mm and 10.08 mm. The mean distance between the MF and the mandibular second premolar apex was 3.13 mm. Conclusion: Mandibular premolars are in close proximity to MF especially mandibular second premolar. Presurgical assessment is essential when surgical treatment is planned at this area.

An analysis of the first and second mandibular molar roots proximity to the inferior alveolar canal and cortical plates using cone beam computed tomography among the Saudi population.

OBJECTIVES: To evaluate the relationship of the first and second mandibular molar roots to the inferior alveolar canal (IAC) and cortical plates using cone beam computed tomography (CBCT) in the Saudi population. Methods: Scans of 60 patients were collected retrospectively from the dental hospital database in King Saud University, Riyadh, Kingdom of Saudi Arabia. Measurements of the right and left first and second mandibular molars for each dental root and the mandibular bone thickness were determined. The position of the IAC was estimated using axial, coronal, and sagittal views. Three examiners performed the measurements independently. RESULTS: The mean distance between the root apices of the mandibular molars and the IAC ranged from 1.68-4.79 mm, whereas the mean distance from the outer surface of the buccal cortical plate to the buccal root surface ranged from 2.33-6.72 mm. Similarly, the mean distance from the outer surface of the lingual cortical plate to the lingual root surface ranged from 2.62-4.80 mm. Finally, the mean distance from the outer surface of the lingual cortical plate to the outer surface of the buccal cortical plate was 11.93-13.19 mm. Conclusion: The measurements reported in this study may be of value to practitioners treating Saudi patients, as they need to be familiar with the distance of the mandibular first and second molars in relation to the IAC and surrounding cortical plates to accurately assess and plan endodontic surgeries, surgical extractions, and implant placements.

Direct and Indirect Effect of Chlorhexidine on Survival of Stem Cells from the Apical Papilla and Its Neutralization.

INTRODUCTION: Several irrigants have been used for disinfection in regenerative endodontic procedures including chlorhexidine (CHX). In this context, the antibacterial properties of disinfectants are mainly in focus of research even though they may have an undesirable impact on the fate of stem cells. In this study, we hypothesized that CHX has both a direct effect when applied to stem cells of the apical papilla (SCAPs) and an indirect effect when SCAPs are exposed to dentin previously conditioned with CHX. METHODS: Cell toxicity was evaluated in vitro using the CellTox green fluorescence assay (Promega, Madison, WI) and CellTiter-Glo (Promega) after SCAPs were exposed directly to a dynamic concentration range of CHX; apical papilla explant cultures were stained with ApopTag (Merck Millipore, Billerica, MA) after culture with CHX. Furthermore, standardized slabs from human dentin were treated with CHX and consecutively rinsed in EDTA, L-α-lecithin (Sigma-Aldrich, St Louis, MO), or L-α-lecithin followed by EDTA. After that, SCAPs were cultured on the slabs for 5 days, and cellular viability was determined (indirect effect). Data were treated nonparametrically and analyzed using the Krukal-Wallis test (P ≤ .05). RESULTS: Direct exposure of SCAPs to CHX highly affected cell viability at concentrations above 10-3%, whereas lower concentrations had no adverse effect. During the initial 60 minutes, concentrations of 10-2% CHX or higher resulted in early pronounced toxicity with a maximum effect within 15 minutes after exposure. Likewise, CHX-conditioned dentin slabs were detrimental to SCAP survival; however, the deleterious effects were completely reversed by neutralization with L-α-lecithin. CONCLUSIONS: Chlorhexidine is toxic to SCAPs when applied directly or indirectly via conditioned dentin. If applied for a short time and neutralized by L-α-lecithin, it can be a gentle and cell-preserving disinfectant before endodontic regeneration.

Effect of dentin conditioning with intracanal medicaments on survival of stem cells of apical papilla.

INTRODUCTION: Regenerative endodontics is a valuable treatment modality for immature teeth with pulpal necrosis. A common feature in regenerative cases is the use of intracanal medicaments. Although these medicaments are chosen because of their antibacterial properties, their enduring effect on dentin (conditioning) and the subsequent impact on stem cell survival has never been evaluated. In this study, we hypothesized that triple antibiotic paste (TAP), double antibiotic paste (DAP), or Ca(OH)2 has an indirect adverse effect on the survival of stem cells of apical papilla (SCAP) by dentin conditioning. METHODS: Human dentin disks were created with a standardized root canal diameter of 3.2 mm. The disks were then exposed to either TAP or DAP (at concentrations of 1 mg/mL or 1000 mg/mL), Ca(OH)2 (Ultracal), or Hank's balanced salt solution for 7 or 28 days. Next, the medicaments were removed with copious irrigation, followed by placement of SCAP in a Matrigel scaffold in the lumen of the disks. The bioengineered constructs were cultured for 7 days, followed by determination of cellular viability by using the CellTiter-Glo luminescence assay. Data were analyzed using 1-way analysis of variance with Bonferroni post hoc test. RESULTS: Exposure of dentin to TAP or DAP at 1000 mg/mL resulted in no viable SCAP, whereas the use of these medicaments at 1 mg/mL had no adverse effect on cell viability. In contrast, Ca(OH)2 treatment significantly increased SCAP survival and proliferation when compared with the control group. CONCLUSIONS: Dentin conditioning with TAP and DAP at commonly used clinical concentration (approximately 1000 mg/mL) alters dentin in such a way as to prevent SCAP survival. This lethal indirect effect of both TAP and DAP can be largely avoided if these medicaments are used at the 1 mg/mL concentration. Conversely, dentin conditioning with Ca(OH)2 promotes SCAP survival and proliferation.

Evaluation of cyclic flexural fatigue of M-wire nickel-titanium rotary instruments.

INTRODUCTION: This study was conducted to investigate cyclic flexural fatigue resistance of GT series X rotary files made from the newly developed M-wire nickel-titanium alloy compared with GT and Profile nickel-titanium files made from a conventional nickel-titanium alloy. METHODS: Fifteen files, size 30/0.04, of each type were used to evaluate the cyclic flexural fatigue resistance. A simple device was specifically constructed to measure the time each file type required to fail under cyclic flexural fatigue testing. RESULTS: The results of this experiment indicated that the GT series X files had superior cyclic flexural fatigue resistance than the other 2 file types made from a conventional nickel-titanium alloy (P = .004). On the other hand, the difference between the Profile and the GT files was not statistically significant. CONCLUSIONS: The findings of this study suggest that size 30/0.04 nickel-titanium rotary files made from the newly developed M-wire alloy have better cyclic flexural fatigue resistance than files of similar design and size made from the conventional nickel-titanium alloy.