The Assessment of C-shaped Canal Prevalence in Mandibular Second Molars Using Endodontic Microscopy and Cone Beam Computed Tomography: An In Vivo Investigation.

Background Understanding root canal anatomy variations, particularly C-shaped canals, is crucial for successful endodontic treatment. This study used clinical and radiographic methods to assess the prevalence and characteristics of C-shaped canals in mandibular second molars in Western Maharashtra. Materials and methods This prospective study was conducted in the western region of Maharashtra, India. The samples included patients requiring endodontic treatment for mandibular second molars. Clinical evaluation was conducted using a surgical endodontic microscope and cone beam computed tomography (CBCT) imaging. Inclusion and exclusion criteria ensured the selection of a focused and homogeneous sample. Data analysis included assessment of unilateral/bilateral occurrence, canal distribution, and cross-sectional characteristics. Results Out of 200 mandibular second molars, 7.5% exhibited C-shaped root canals, with no significant gender differences. Canal distribution varied across coronal, middle, and apical levels, with prevalent configurations being C1, C2, C3, and C4. No significant differences were observed in canal distribution based on root levels. No significant gender differences were found in the presence of grooves on the root surfaces. Conclusion This study provides valuable insights into the prevalence and characteristics of C-shaped canals in mandibular second molars in Western Maharashtra. Further research into histological and genetic aspects can enhance our understanding, leading to improved treatment strategies for complex root canal anatomy variations.

Comparative Evaluation of the Sealing Ability of Mineral Trioxide Aggregate (MTA)-Based, Resin-Based, and Zinc Oxide Eugenol Root Canal Sealers: An In Vitro Study.

Root canal therapy is a crucial procedure in endodontics that is done to achieve complete obliteration of the root canal space. The success of this therapy depends on achieving a proper seal, which is facilitated using root canal sealers. This study aimed to compare the apical sealing ability of three different root canal sealers: MTA Fillapex, AH Plus, and zinc oxide eugenol (ZOE), using the dye penetration method. Forty freshly extracted single-rooted human maxillary incisors were collected and prepared for the study. The root canals were instrumented using the ProTaper system, and the canals were then obturated using the lateral condensation technique with the respective sealers. After one week of storage, the samples were coated with nail varnish, immersed in a rhodamine B dye solution, and then sectioned longitudinally. The depth of dye penetration was measured, and the results were analyzed statistically. The results revealed significant differences in apical leakage among the three experimental groups. Group 2 (AH Plus) showed the minimum leakage with a mean of 0.13 mm, while Group 4 (no sealer) exhibited the maximum leakage with a mean of 4.49 mm. Group 3 (ZOE) showed an intermediate level of leakage with a mean of 2.37 mm. The statistical analysis confirmed the significant difference in mean leakage among the groups. The findings of this study indicate that AH Plus exhibited superior apical sealing ability compared to MTA Fillapex and ZOE. AH Plus is a resin-based sealer known for its dimensional stability. On the other hand, MTA Fillapex, a newly introduced sealer containing mineral trioxide aggregate, resin, and silica, showed promising sealing properties but had slightly higher leakage compared to AH Plus. ZOE, a traditional sealer, demonstrated relatively higher leakage than the other sealers. In conclusion, choosing a root canal sealer is crucial in achieving a successful endodontic treatment outcome. AH Plus demonstrated superior apical sealing ability among the three sealers tested. Further research and long-term clinical studies are warranted to validate these findings and assess the impact of sealer choice on treatment outcomes and post-endodontic healing.

Sensory Changes Related to Dental Implant Placement: A Scoping Review.

AIMS: To perform a scoping review of the literature to elucidate the occurrence of nerve damage related to dental implant placement and the factors causing the sensory changes. METHODS: An extensive electronic search was conducted using the Cochrane Library, Medline via Ovid, PubMed, Wiley Online, Science Direct, CINAHL, and the Google Scholar databases from the year 1950 to 2020. RESULTS: The search resulted in 1,067 articles, out of which 76 were selected for this review. The articles were categorized as literature review articles, retrospective studies, prospective studies, and case series/case reports. Altogether, 2,526 subjects were assessed retrospectively, with 5.27% transient and 1.39% persistent sensory changes, and a cohort of 2,750 subjects were followed prospectively, with 6.22% transient and 1.31% persistent sensory changes. A total of 336 subjects were enrolled in various case reports and case series, with 5.95% transient sensory changes and 84.52% persistent neurosensory changes. The articles included were not of high quality and have variations in their study designs and reporting procedures, with limited sensory change data to include in this study. CONCLUSION: After surgical placement of dental implants in 5,612 patients, the incidence of transient sensory changes was 5.63%, and the incidence of persistent sensory changes was 6.33%. Factors affecting the incidence were: mandibular location of the implant, with the inferior alveolar nerve as the most commonly affected nerve. The common symptoms reported were paresthesia and dysesthesia. Age and gender were among other factors, for which data were not available in all the articles.

Occipital Neuralgia and Its Management: An Overview.

BACKGROUND: Greater and lesser occipital neuralgias are primary neuralgias that are relatively uncommon, where the pain is felt in the distribution of these nerves. OBJECTIVE: This review paper was intended to describe the features and management of occipital neuralgia in the context of a challenging case. MATERIAL AND METHODS: We looked at succinct literature from the past 30 years. We compared the features of our challenging case given in the current literature. In addition, an overview of the current literature is provided. RESULTS: The case, although proved to be a diagnostic challenge, we were able to reach a conclusion and render the patient almost complete pain relief by conservative management modalities. It proved to be a rare presentation of occipital neuralgia with unusual pain distribution, and we are able to describe a literature-based explanation for this entity to be a diagnostic and management challenge. CONCLUSION: Primary headaches, i'n general, are a group of headache disorders that require exquisite diagnostic skills. The clinical history is a key factor when making an accurate diagnosis, and to establish an appropriate management plan.

Nummular Headache - a Case Report of a Rare Entity.

PURPOSE OF REVIEW: The purpose of this manuscript is to shed light on systematic work-up of a diagnostic challenge such as nummular headache (NH), and to summarize the relevant literature on NH. RECENT FINDINGS: The specific nature of the shape of the pain site is usually characteristic of NH. Multiple modalities of investigation including succinct imaging are necessary to successfully rule out other similar conditions. A 26-year-old female patient of Asian-Indian origin presented to the clinic with the chief complaint of chronic persistent left parietal headache for more than 10 years, which has been worsening over the past few days with no specific identifiable trigger. The diagnosis of nummular headache is challenging and confusing due to the rare occurrence and inadequate references in the literature. Appropriate imaging was done, which revealed no pathology that could explain the headache presentation. These findings are consistent with our diagnosis of nummular headache, and helped in the successful management of the case.

Aggregatibacter actinomycetemcomitans (Aa) Under the Radar: Myths and Misunderstandings of Aa and Its Role in Aggressive Periodontitis.

Aggregatibacter actinomycetemcomitans (Aa) is a low-abundance Gram-negative oral pathobiont that is highly associated with a silent but aggressive orphan disease that results in periodontitis and tooth loss in adolescents of African heritage. For the most part Aa conducts its business by utilizing strategies allowing it to conceal itself below the radar of the host mucosal immune defense system. A great deal of misinformation has been conveyed with respect to Aa biology in health and disease. The purpose of this review is to present misconceptions about Aa and the strategies that it uses to colonize, survive, and evade the host. In the process Aa manages to undermine host mucosal defenses and contribute to disease initiation. This review will present clinical observational, molecular, and interventional studies that illustrate genetic, phenotypic, and biogeographical tactics that have been recently clarified and demonstrate how Aa survives and suppresses host mucosal defenses to take part in disease pathogenesis. At one point in time Aa was considered to be the causative agent of Localized Aggressive Periodontitis. Currently, it is most accurate to look at Aa as a community activist and necessary partner of a pathogenic consortium that suppresses the initial host response so as to encourage overgrowth of its partners. The data for Aa's activist role stems from molecular genetic studies complemented by experimental animal investigations that demonstrate how Aa establishes a habitat (housing), nutritional sustenance in that habitat (food), and biogeographical mobilization and/or relocation from its initial habitat (transportation). In this manner Aa can transfer to a protected but vulnerable domain (pocket or sulcus) where its community activism is most useful. Aa's "strategy" includes obtaining housing, food, and transportation at no cost to its partners challenging the economic theory that "there ain't no such thing as a free lunch." This "strategy" illustrates how co-evolution can promote Aa's survival, on one hand, and overgrowth of community members, on the other, which can result in local host dysbiosis and susceptibility to infection.

The Effect of Nonstrenuous Aerobic Exercise in Patients with Chronic Masticatory Myalgia.

AIMS: To evaluate the effect of nonstrenuous aerobic exercise on chronic masticatory myalgia (CMM) patients and healthy controls (HC) by means of mechanical temporal summation (TS) and response to mechanical stimulation (RMS) performed on the dominant forearm. METHODS: A total of 30 patients diagnosed with CMM and 30 pain-free HCs were first evaluated for maximum number of steps (MNS) on a stepper machine for 1 minute. Additionally, they completed the Generalized Anxiety Disorder (GAD-7), Graded Chronic Pain Scale (GCPS), and Jaw Functional Limitation Scale (JFL) questionnaires. On the second visit, RMS, mechanical TS, exercise-induced hypoalgesia (EIH), blood pressure, pulse pressure, and heart rate were assessed prior to and immediately, 5, 15, and 30 minutes following 5 minutes of stepper exercise at 50% MNS. RESULTS: Compared to HCs, CMM patients demonstrated increased mechanical TS and less efficient EIH. Mechanical TS scores were reduced in both groups; however, the HC reduction was more robust and persistent. CMM patients demonstrated a delayed reduction in RMS following exercise in contrast to an immediate reduction in HCs. GAD-7, GCPS, and JFL scores for CMM patients were higher than for HCs and were associated with baseline pain intensity but not with EIH or TS. CONCLUSION: These findings suggest that, compared to HC, CMM patients' pain modulation is both suppressed and has a different effect duration and timing pattern. Further research should explore the mechanisms and clinical relevance of the delayed hypoalgesia and the inhibitory effect on TS induced by nonstrenuous aerobic exercise in CMM patients.

Classification and diagnosis of aggressive periodontitis.

OBJECTIVE: Since the initial description of aggressive periodontitis (AgP) in the early 1900s, classification of this disease has been in flux. The goal of this manuscript is to review the existing literature and to revisit definitions and diagnostic criteria for AgP. STUDY ANALYSIS: An extensive literature search was performed that included databases from PubMed, Medline, Cochrane, Scopus and Web of Science. Of 4930 articles reviewed, 4737 were eliminated. Criteria for elimination included; age > 30 years old, abstracts, review articles, absence of controls, fewer than; a) 200 subjects for genetic studies, and b) 20 subjects for other studies. Studies satisfying the entrance criteria were included in tables developed for AgP (localized and generalized), in areas related to epidemiology, microbial, host and genetic analyses. The highest rank was given to studies that were; a) case controlled or cohort, b) assessed at more than one time-point, c) assessed for more than one factor (microbial or host), and at multiple sites. RESULTS: Epidemiologic studies provided insight into ethnic and societal factors affecting AgP. DNA analysis of microbes showed some consistency but significant variability. Host factor analysis was less consistent. Many genetic studies were conducted but few had either sufficient power or looked at multiple genes in AgP. CONCLUSIONS: Conflicting data resulted for several reasons; 1) the classification was too broad, 2) the disease (AgP) was not studied from its inception, at differing time points (temporal), and at different locations (topographic). New technologic advances coupled with a more delimiting definition of disease will allow for genetic, host and microbial factor analyses in an unbiased manner. As such we predict that progress can be made in identifying a robust group of genetic, host, and microbial risk-markers associated with periodontal disease that can improve diagnostic capability in disease associated with juveniles, adolescents, and post-adolescent individuals.

Classification and diagnosis of aggressive periodontitis.

OBJECTIVE: Since the initial description of aggressive periodontitis (AgP) in the early 1900s, classification of this disease has been in flux. The goal of this manuscript is to review the existing literature and to revisit definitions and diagnostic criteria for AgP. STUDY ANALYSIS: An extensive literature search was performed that included databases from PubMed, Medline, Cochrane, Scopus and Web of Science. Of 4930 articles reviewed, 4737 were eliminated. Criteria for elimination included; age > 30 years old, abstracts, review articles, absence of controls, fewer than; a) 200 subjects for genetic studies, and b) 20 subjects for other studies. Studies satisfying the entrance criteria were included in tables developed for AgP (localized and generalized), in areas related to epidemiology, microbial, host and genetic analyses. The highest rank was given to studies that were; a) case controlled or cohort, b) assessed at more than one time-point, c) assessed for more than one factor (microbial or host), and at multiple sites. RESULTS: Epidemiologic studies provided insight into ethnic and societal factors affecting AgP. DNA analysis of microbes showed some consistency but significant variability. Host factor analysis was less consistent. Many genetic studies were conducted but few had either sufficient power or looked at multiple genes in AgP. CONCLUSIONS: Conflicting data resulted for several reasons; 1) the classification was too broad, 2) the disease (AgP) was not studied from its inception, at differing time points (temporal), and at different locations (topographic). New technologic advances coupled with a more delimiting definition of disease will allow for genetic, host and microbial factor analyses in an unbiased manner. As such we predict that progress can be made in identifying a robust group of genetic, host, and microbial risk-markers associated with periodontal disease that can improve diagnostic capability in disease associated with juveniles, adolescents, and post-adolescent individuals.