Impact of self-assessment on dental student's performance in pre-clinical conservative dentistry course.

BACKGROUND: Self-assessment (SA) is an interactive course that endorses the accomplishment of learning objectives through learners' identification of insufficiencies in their didactic knowledge and pre-clinical skills. This study was planned to determine whether there is any improvement in the faculty assessment (FA) score following the implementation of SA in the Pre-clinical Conservative Dentistry Course. METHODS: Fifty-four first-semester dental students were given an introductory lecture followed by a demonstration for Class I Cavity Preparation in typhodont mandibular first molar. At the end of the demonstration, the Scoring Rubric (SR) was explained point-wise in the prepared cavities. During the next session, all students performed Class I cavity preparation and they were given an assessment sheet to enter their scores (SA1). All teeth were evaluated by the Grading Faculties in a blinded manner (FA1). Each participant was explained the difference in their respective SA1 from FA1 and their queries were resolved individually. During the next sessions, Students and Grading Faculties followed the same protocol and scores were recorded as SA2, FA2, SA3 and FA3. RESULTS: The mean score of SA1 was significantly higher than that of FA1 (p < 0.001). However, no significant difference was obtained between SA and FA in the second (p = 0.352) and third (p = 0.434) assessments. In contrast with first assessment, mean marks obtained in FA were higher compared to SA in both second and third assessments. There was a statistically significant improvement in mean marks obtained by the students over time (p < 0.001). CONCLUSION: SA endorsed student-faculty communication and enhanced student's poise and technical skills in operative pre-clinical dentistry.

Root canal morphology of South Asian Indian mandibular first, second, and third molar: A dye penetration and clearing study.

CONTEXT: Studying in detail the root canal morphology specific to the Indian mandibular molars will help discern whether the root canal anatomy patterns resemble those reported internationally or are different from it. AIM: The aim is to study the root canal anatomy of Indian permanent mandibular first, second, and third molar teeth using a tooth clearing technique. METHODS: The root canals of a total of 300 extracted Indian mandibular molars consisting of 100 first, second, and third molars each were accessed and injected with India ink, after which they were subjected to the clearing technique. STATISTICAL ANALYSIS: Data was analyzed using descriptive statistics for the computation of percentages using SPSS version 21. RESULTS: Of the hundred first molars, 90% of teeth were two rooted with three canals, 79% had two apical foramina. 70% mesial roots of the three-rooted type showed Type I, whereas 100% distal roots and distolingual roots showed Type I Vertucci's anatomy. About 70% mesial roots of two roots showed Type II and 90% distal canals showed Type I configuration. Among the second molars, five (5%) were single-rooted, ninety-one (91%) teeth were two rooted and four (4%) had three roots. Among the mandibular third molars, fifteen (15%) teeth had one root, sixty-three (63%) teeth had two roots, eighteen (18%) teeth had three roots, and four (4%) teeth had four roots. CONCLUSIONS: The root canal anatomic features of mandibular molars showed differences in the frequency of particular anatomic types as compared to mandibular molars from other racial backgrounds. Further comparative studies on inter-racial anatomic characteristics from various geographic locations would be beneficial.

Resistance to fracture of teeth instrumented using novel EndoStar E5 rotary versus ProTaper NEXT and WaveOne file systems.

AIM: The current study compared the fracture resistance of samples instrumented by two rotary files and a reciprocating file, obturated with gutta-percha and AH Plus. MATERIALS AND METHODS: A total of 60 freshly extracted mandibular premolar teeth with single roots and single canals were acquired and decoronated at or below the cementoenamel junction. The samples were randomly divided into four groups (n = 15). Group 1 control (noninstrumented/obturated), and for Groups 2-4 root canal instrumentation was done by EndoStar E5 (EE5), ProTaper NEXT (PTN), and WaveOne, respectively. Following instrumentation, the samples were obturated using gutta-percha cones and AH Plus sealer using lateral compaction. A week later, vertical load was applied to the specimen's canal in each group until fracture. The loads required for fracture were recorded and statistically analyzed. RESULTS: The mean loads required to fracture (Newton; N) for the four groups were; 388.54 (±29.93), 310.35 (±26.05), 328.40 (±20.67), and 278.54 (±34.16). The loads exhibited highly significant difference (P < 0.0001; analysis variance). The following Tukey's post hoc test confirmed, both samples in Groups 2 and 3 required similar loads for fracture (P > 0.05) and significantly higher than Group 4 (P < 0.01). CONCLUSION: The samples instrumented by EE5 and PTN exhibit similar fracture resistance.

Effect of glide path preparation on apical extrusion of debris in root canals instrumented with three single-file systems: An ex vivo comparative study.

AIM: The aim of this study was to test the effect of new protocol of glide path preparation by 20/0.04 rotary file on apical extrusion of debris when instrumenting fine curved mesial canals in mandibular molars with Self-adjusting File (SAF) and compare it to a glide path prepared by 20/0.02 hand K-file and rotary OneShape (OS) and reciprocating WaveOne (WO) file instrumentation. MATERIALS AND METHODS: Sixty mandibular molars with curved mesial roots were selected and randomly divided into three groups (n = 20) for instrumentation. In two groups, glide path was prepared using 20/0.02 K-file for instrumentation by OS (size 25/0.06 taper) and WO (size 25/0.08 taper) files; in the remaining group, 20/0.04 rotary file was used for glide path preparation and instrumented by SAF (1.5 mm). The debris extruded during instrumentation was collected in preweighed Eppendorf tubes and stored in an incubator at 70°C for 5 days. Tubes containing the dry extruded debris were then weighed. One-way analysis of variance (ANOVA) was applied to the weights obtained, followed by Tukey's post hoc test for multiple comparison. RESULTS: The mean debris (g) extruded apically was 0.000651 ± 0.000291, 0.000823 ± 0.000319, and 0.000473 ± 0.000238 for Group 1 (20/0.02 + OS), Group 2 (20/0.02 + WO), and Group 3 (20/0.04 + SAF), respectively. The groups exhibited a significant difference (P < 0.01; ANOVA). Group 3 resulted in least debris extrusion compared to Groups 1 and 2 (P < 0.01; Tukey's post hoc test). CONCLUSION: Glide path prepared to size 20/0.04 and SAF 1.5 mm instrumentation produce less debris in curved mesial canals of mandibular molars, compared to glide path established by 20/0.02 and instrumentation by OS and WO files.

Permanent Maxillary Central Incisor with Dilacerated Crown and Root and C-Shaped Root Canal.

Dilaceration is a rare disturbance in traumatised permanent teeth, which constitutes about 3% of the injuries to developing teeth. It usually occurs as a result of trauma to the deciduous predecessors and results in non axial displacement of the already formed hard tissue portion of the developing crown. Endodontic treatment of such teeth presents a challenge to clinicians, and careful management is required to successfully address the root canal anatomy and other possible variations. The C-shaped canal configuration is most frequently seen in mandibular second molars, but this variation may also occur in mandibular first molars, mandibular third molars, maxillary molars, mandibular first premolars, and even in maxillary lateral incisors, with rare reports of such variations occurring in the maxillary central incisors. Diagnosis, endodontic access cavity preparation, root canal preparation and filling might be complicated by the presence of dilacerations and C-shaped canals. This paper is an attempt to provide details of an unusual case of crown and root dilacerations and a C-shaped canal in the maxillary central incisor, successfully managed by using Self-Adjusting File (SAF) system.

Root canal morphology and variations in mandibular second molar teeth of an Indian population: an in vivo cone-beam computed tomography analysis.

OBJECTIVES: This study aims to investigate the root canal morphology of permanent mandibular second molars of an Indian population in vivo using cone-beam computed tomography (CBCT) images. METHODS: CBCT images (n = 983; males = 489, females = 494) of untreated, completely developed permanent mandibular second molar teeth were examined. CBCT scans were acquired as part of diagnosis and treatment planning for treatments unrelated to the present study. The number of roots and root canals were recorded. Canal configuration was classified based on Vertucci's and Fan's classifications. RESULTS: The most common configuration was two-root (79.35%) and three-root canals (53.50%). The incidence of three-rooted molars was 7.53%, whereas 13.12% of the studied teeth studied have fused roots with C-shaped canals. The predominant canal morphology in the mesial roots was Vertucci's type IV (45.17%), followed by type II (32.55%), type I (7.23%), type V (1.02%), and type III (0.91%). The distal root in contrast showed type I (61.14%) as the predominant canal configuration, followed by type II (18.21%) and type IV (7.53%). The incidence of three-rooted molars was higher in males (n = 55; 5.59%) than in females (n = 19; 1.94%) (p < 0.01). The canals in the extra roots exhibited type I (100%) root canal morphology. In teeth with C-shaped root canal (13.12%), the variations in the coronal, middle, and apical third ranged from C1 to C4. CONCLUSIONS: Root canal systems of the mesial roots of mandibular second molars of the study population demonstrated a high degree of variability. While three roots were rare, there was a sexual predisposition. Fused roots with C-shaped canals were rare and demonstrated significant variations from the coronal to apical third. CLINICAL RELEVANCE: Root canal morphology can demonstrate variations based on race and sex of patients. Clinicians must always consider the possible variations to ensure successful endodontic treatment.

Apical extrusion of debris by supplementary files used for retreatment: An ex vivo comparative study.

AIM: This study evaluated whether using supplementary files for removing root canal filling residues after ProTaper Universal Retreatment files (RFs) increased the debris extrusion apically. MATERIALS AND METHODS: Eighty mandibular premolars with single root and canal were instrumented with ProTaper Universal rotary system (SX-F3) and obturated. The samples were divided randomly into four groups (n = 20). Group 1 served as a control; only ProTaper Universal RFs D1-D3 were used, and the extruded debris was weighed. Groups 2, 3, and 4 were the experimental groups, receiving a twofold retreatment protocol: Removal of the bulk, followed by the use of supplementary files. The bulk was removed by RFs, followed by the use of ProTaper NEXT (PTN), WaveOne (WO), and Self-Adjusting File (SAF) for removal of the remaining root filling residues. Debris extruded apically were weighed and compared to the control group. Statistical analysis was performed using one-way analysis of variance (ANOVA) and post hoc Tukey's test. RESULTS: All the three experimental groups presented significant difference (P < .01). The post hoc Tukey's test confirmed that Group 4 (SAF) exhibited significantly less (P < .01) debris extrusion between the three groups tested. CONCLUSION: SAF results in less extrusion of debris when used as supplementary file to remove root-filling residues, compared to WO and PTN.

Assessment of the fracture resistance of teeth instrumented using 2 rotary and 2 reciprocating files versus the Self-Adjusting File (SAF): An ex vivo comparative study on mandibular premolars.

AIM: Current ex vivo study compared fracture resistance of teeth instrumented using 5 endodontic files, filled with Gutta-percha and AH Plus. MATERIALS AND METHODS: Sixty freshly extracted, single-rooted mandibular premolars were acquired and decoronated to obtain 15 mm segments. These samples were randomly divided into six groups (n = 10). Group 1 served as the control containing untreated samples (without instrumentation or filling). In Groups 2-6, samples were instrumented using rotary (Universal ProTaper and Revo-S), reciprocating (WaveOne and RECIPROC(®)), and self-adjusting file (SAF), respectively. Following instrumentation, the samples were filled by lateral compaction with Gutta-percha and AH Plus. A week later, after the sealer was completely set, a vertical load was applied to the specimen's canal in each group until fracture. The loads required for fracture were recorded, and statistical analysis was performed. RESULTS: The mean fracture load differed significantly among the groups (P < 0.01; one-way ANOVA). Tukey's post-hoc tests revealed that the fracture resistance was similar in the control and SAF groups (P > 0.05) and was significantly higher than that of the 2 rotary and reciprocating groups (P < 0.01). CONCLUSION: The samples instrumented by the SAF exhibited a better fracture resistance.

The efficacy of the Self-Adjusting File versus WaveOne in removal of root filling residue that remains in oval canals after the use of ProTaper retreatment files: A cone-beam computed tomography study.

AIM: The current ex vivo study compared the efficacy of removing root fillings using ProTaper retreatment files followed by either WaveOne reciprocating file or the Self-Adjusting File (SAF). MATERIALS AND METHODS: Forty maxillary canines with single oval root canal were selected and sectioned to obtain 18-mm root segments. The root canals were instrumented with WaveOne primary files, followed by obturation using warm lateral compaction, and the sealer was allowed to fully set. The teeth were then divided into two equal groups (N = 20). Initial removal of the bulk of root filling material was performed with ProTaper retreatment files, followed by either WaveOne files (Group 1) or SAF (Group 2). Endosolv R was used as a gutta-percha softener. Preoperative and postoperative high-resolution cone-beam computed tomography (CBCT) was used to measure the volume of the root filling residue that was left after the procedure. Statistical analysis was performed using t-test. RESULTS: The mean volume of root filling residue in Group 1 was 9.4 (±0.5) mm(3), whereas in Group 2 the residue volume was 2.6 (±0.4) mm(3), (P < 0.001; t-test). CONCLUSIONS: When SAF was used after ProTaper retreatment files, significantly less root filling residue was left in the canals compared to when WaveOne was used.

The self-adjusting file instrumentation results in less debris extrusion apically when compared to WaveOne and ProTaper NEXT.

AIM: The present ex vivo study aimed to evaluate the debris extrusion after instrumenting the root canals by three different files systems. MATERIALS AND METHODS: Sixty extracted human mandibular premolars with single canals were selected and randomly divided into three groups (n = 20) for instrumentation with three different files. Group 1: WaveOne (primary) single reciprocating file (WO; Dentsply Maillefer, Ballaigues, Switzerland) (25/08), Group 2: Self-adjusting file (SAF; ReDent-Nova, Ra'anana, Israel) (1.5 mm), and Group 3: ProTaper NEXT X1 and X2 (PTN; Dentsply Tulsa Dental, Tulsa, OK) (25/06). Debris extruding by instrumentation were collected into pre-weighed Eppendorf tubes. These tubes were then stored in an incubator at 70°C for 5 days. The tubes were then weighed to obtain the final weight, with the extruded debris. Statistical analysis for the debris extruded apically was performed using one-way analysis of variance and post hoc Tukey's test. RESULTS: The statistical analysis showed a significant difference between all the three groups tested (P < 0.01). The following post hoc Tukey's test confirmed that Group 2 (SAF) exhibited significantly least (P < 0.01) debris extrusion between the three groups tested. CONCLUSIONS: The SAF resulted in significantly less extrusion of debris when compared to reciprocating WO and rotary PTN.

Root canal morphology of South Asian Indian maxillary molar teeth.

OBJECTIVE: The objective was to study the root canal morphology of South Asian Indian Maxillary molars using a tooth clearing technique. MATERIALS AND METHODS: Hundred teeth each comprising of first, second, and third molars collected from different dental schools and clinics in India were subjected to standard dye penetration, decalcification and clearing procedure before being studied. RESULTS: The first molar mesiobuccal roots exhibited 69% Type I, 24% Type II, 4% Type IV, 2% Type V, and 1% exhibited a Vertuccis Type VIII canal anatomy. In the group with three separate roots the second molar mesiobuccal roots in exhibited 80.6% Type I, 15.3% Type II, 2.7% Type IV, and 1.4% Type V canal anatomy while the third molars mesiobuccal roots exhibited 57.4% Type I, 32% Type II, 2.1% Type III, 8.5% Type IV, 1% had a Type V canal anatomy in the similar group. CONCLUSION: A varied root canal anatomy was seen in the mesiobuccal root canal of the maxillary molars.

Meant to make a difference, the clinical experience of minimally invasive endodontics with the self-adjusting file system in India.

The vital steps in any endodontic treatment are thorough mechanical shaping and chemical cleaning followed by obtaining a fluid tight impervious seal by an inert obturating material. For the past two decades, introduction and use of rotary nickel-titanium (Ni-Ti) files have changed our concepts of endodontic treatment from conventional to contemporary. They have reported good success rates, but still have many drawbacks. The Self-Adjusting File (SAF) introduces a new era in endodontics by performing the vital steps of shaping and cleaning simultaneously. The SAF is a hollow file in design that adapts itself three-dimensionally to the root canal and is a single file system, made up of Ni-Ti lattice. The case series presented in the paper report the clinical experience, while treating primary endodontic cases with the SAF system in India.

Root canal morphology of South asian Indian mandibular premolar teeth.

INTRODUCTION: The purpose of this study was to study the root canal morphology of South Asian Indian mandibular premolars using a tooth clearing technique. METHODS: Two hundred mandibular premolar teeth were collected from different dental schools and clinics in India. After pulp tissue removal and root canal staining with Indian ink, the specimens were decalcified with 5% nitric acid, dehydrated in ethyl alcohol, and subsequently cleared in methyl salicylate. RESULTS: Of the 200 mandibular premolars, 100 were first premolars and 100 were second premolars. Of the first premolars, 94% had a single root, whereas 6% were 2 rooted. Seventy-six percent had a single canal, 22% had 2 canals, and 2% had 3 canals. Eighty-two percent had a single apical foramen, 16% had 2 foramens, and 2% teeth had 3 apical foramens. Eighty percent of teeth had type I, 6% had type II, 10% had type IV, 2% had type V, and 2% teeth had type IX root canal anatomy. Of the 100 second premolars, 92% had a single root, whereas 8% teeth were 2 rooted and fused. Fifty-eight percent of teeth had a single canal, and 42% had two canals. Eighty-eight percent had a single apical foramen, and 12% had 2 foramens. Sixty-six percent had type I, 30% had type II, and 4% had type V root canal anatomy. CONCLUSIONS: A high prevalence of 2 canals was noted in the first and second premolars. Also, 20% of first premolars and 34% of second premolars had a root canal anatomy other than type I.

Comparative evaluation of root canal disinfection by conventional method and laser: an in vivo study.

OBJECTIVE: The aim of this study was to comparatively evaluate in vivo the disinfecting ability of conventional method and lasers in root canals. MATERIALS AND METHODS: Study criteria included 60 single rooted teeth, which were indicated for root canal therapy followed to dental caries and trauma with intact crowns. Such selected patients were randomly divided into 2 groups, namely, Group A (30 teeth) and Group B (30 teeth). All clinical procedures were carried out under strict aseptic precautions. The teeth in Group A were subjected to biomechanical preparation followed by the treatment with the help of diode laser containing the gallium aluminum and arsenic, which emitted 980 nm wavelengths. The teeth in Group B were treated with routine method of biomechanical preparation along with irrigation using sodium hypochlorite and hydrogen peroxide. The microbiological samples were taken immediately after the access preparation and after the completion of the root canal disinfection and were sent for microbiological analysis. RESULTS: The teeth in Group A showed presence of common strains of bacteria ranging from Streptococci, Staphylococci, Klebsiella, and Pseudomonas. Reduction in the growth of microorganisms was found for all types of microorganisms. Only 8 samples exhibited the growth after treatment with laser. Results of Group B also showed the presence of common strains of anaerobic and aerobic bacteria as shown in earlier studies, predominantly Staphylococcus, Streptococci, and Pseudomonas. Statistical analysis showed non-significant P values for the microorganisms; however, only 3 samples showed the growth after treatment with conventional technique using sodium hypochlorite and hydrogen peroxide. CONCLUSION: Conventional method by using sodium hypochlorite and hydrogen peroxide as irrigating solutions is highly effective in disinfecting the root canal. Lasers when used can also reduce the bacterial load of the infected root canal.

Histological evaluation to study the effects of dental amalgam and composite restoration on human dental pulp: an in vivo study.

OBJECTIVE: To study and compare the effects of dental amalgam and composite restorations on human dental pulp. MATERIALS AND METHODS: One hundred sound premolars scheduled for orthodontic extraction were divided equally into two groups: group A, teeth restored with silver amalgam, and group B, teeth restored with composite resin. Each group was equally subdivided into two subgroups [extracted after 24 h (A-1 and B-1) or 7 days (A-2 and B-2)], and the histological changes in the pulp related to the two different materials at the two different intervals were studied. RESULTS: It was found that after 24 h, the inflammatory response of the pulp in teeth restored with amalgam and composite was similar (p = 1.00). However, after 7 days, the severity of the inflammatory response of the pulp in teeth restored with amalgam was less compared to that in teeth restored with composite (p = 0.045). CONCLUSION: This study confirmed that amalgam continues to be the mechanically as well as biologically more competent restorative material. Composite could be a promising restorative material to satisfy esthetic needs for a considerable period of time. However, its biological acceptance is still in doubt.