Attitude, perception and barriers of dental professionals towards artificial intelligence.

Aim: To know attitudes, perceptions and barriers towards the use of Artificial Intelligence (AI) in dentistry in India among undergraduate and postgraduate students. Methodology: A questionnaire-based cross-sectional study was conducted among participants pursuing graduation and postgraduation. The questionnaire consisted of 23 close-ended and 2 open-ended questions divided into various sections of attitude, perception and barriers. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24.0. Result: Out of 937 responses, 55.2% responded that they get information about AI from social media platforms. 51.3% of respondents have basic knowledge about the use of AI in dentistry. 59.6% agreed that AI can be used as a "definitive diagnostic tool" in the diagnosis of diseases. 66.5% agreed that AI can be used for radiographic diagnosis of tooth caries. 71.3% stated that AI can be used as a "treatment planning tool" in dentistry. 55.7% stated that AI should be part of undergraduate dental training. Conclusion: This study concluded that both dental students are aware of the concept of AI. Participants were positive when asked if AI can increase the efficiency of diagnosis, prognosis and treatment planning procedures as well as in managing patient data. Both participants believed that the barriers to the introduction of AI in dentistry are a lack of technical resources and a lack of training personnel in college.

Effect of amniotic membrane and platelet-rich fibrin membrane on bone healing post endodontic surgery: An ultrasonographic, randomized controlled study.

The use of membrane barriers and bone grafting materials in endodontic surgery promotes healing by regeneration rather than repair by scar tissue. Due to its valuable regenerative and therapeutic properties, the human amniotic membrane can support ideal periapical rehabilitation and promote better healing after surgery. The current trial aimed to evaluate the amniotic membrane's healing potential and compare it with platelet-rich fibrin using color doppler sonography. The current study is a randomized, double-blinded, parallel-group, single-center study. Thirty-four systematically healthy individuals requiring endodontic surgery who fulfilled all inclusion and exclusion criteria were selected and randomly placed in two groups. Surgical curettage of the bony lesion was performed and filled with hydroxyapatite graft. Amniotic membrane (Group 1) and platelet-rich fibrin (Group 2) were placed over the bony crypt, and the flap was sutured back. The lesion's surface area and vascularity were the parameters assessed with ultrasound and color doppler. and observations: The groups found a significant difference in mean vascularity at 1 month and mean vascularity change from baseline to 1 month (p < 0.05). Mean surface area had no statistically significant difference between the groups. However, in terms of the percentage change in surface area, a significant difference was found from baseline to 6 months (p < 0.05). Amniotic membrane was a significantly better promoter of angiogenesis than platelet-rich fibrin in the current trial. The osteogenic potential of both materials was similar. However, the clinical application, availability, and cost-effectiveness of amniotic membrane support it as a promising therapeutic alternative in clinical translation. Further large-scale trials and histologic studies are warranted.

Comparative evaluation of remineralizing effect of fluoride and nonfluoride agents on artificially induced caries using different advanced imaging techniques.

Aim: The aim of the study is to evaluate and compare the in-vitro remineralization efficacy of remineralizing agents, i.e., fluoride-free toothpaste, fluoride toothpaste, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), CPP-amorphous calcium fluoride phosphate (CPP ACFP), and silver diamine fluoride (SDF) paste on dentine over time. Methodology: Seventy-five extracted human permanent molars were selected. The buccal section of these samples was shaped into a slab. Artificial caries was induced by dipping the samples into the demineralizing solution (pH 4.5) for 21 days. They were then divided into five groups (n = 15). Each experimental group underwent one of the following treatments: Group 1 - Fluoride-free toothpaste (negative control), Group 2 - Fluoride toothpaste (positive control), Group 3 - CPP-ACP, Group 4 - CPP-Amorphous Calcium fluoride Phosphate and Group 5 - SDF. Postremineralizing treatment, Scanning electron microscope, Energy dispersive X-ray and Quantitative light induced fluorescence imaging were carried out to analyze the remineralizing efficacy. The data obtained was then subjected to statistical analysis using ANOVA and Paired t-tests. Results: It was seen that SDF showed highest remineralization efficacy followed by CPP-amorphous calcium fluoride phosphate, CPP-ACP, fluoride toothpaste and fluoride-free toothpaste. The difference in mean value among the groups was statistically significant (P < 0.001). Conclusion: SDF showed the highest remineralizing potential in scanning electron microscopy and energy dispersive X-ray, followed by CPP-ACFP, CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste. Quantitative light fluorescence analysis showed more fluorescence changes in the CPP-ACFP followed by CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste.

Human amniotic membrane as therapeutic agent in pulpotomy of permanent molars.

A 22-year-old woman reported with a cariously exposed mandibular molar. Pulpotomy was planned rather than routine root canal treatment, which was otherwise indicated. Amniotic membrane (AM) that has been extensively researched in different fields of medicine was used as the pulpotomy agent. After gaining coronal access to the root orifices, bleeding was arrested and activated AM was placed over the root stumps. Glass ionomer cement(GIC) was placed over the membrane and temporary restoration was done. One week later, permanent restoration with composite resin was done. The patient's symptoms resolved, and the tooth started responding normally to vitality tests at subsequent follow-ups. The present case report is an attempt to use human AM as a natural pulpotomy agent for treating irreversible pulpitis in permanent teeth. Understanding of innumerable beneficial properties of the AM and its application in preserving vitality of permanent teeth is the main learning objective.

A randomized controlled trial of endodontic treatment using ultrasonic irrigation and laser activated irrigation to evaluate healing in chronic apical periodontitis.

BACKGROUND: Aim of this trial was to evaluate the combined clinical and radiographic success rate of endodontic treatment using passive ultrasonic irrigation (PUI) and laser activated irrigation (LAI) as compared to conventional syringe irrigation. MATERIAL AND METHODS: Permanent incisors and single rooted premolars were assessed for eligibility and 69 patients were randomly divided into three treatment groups (n=23) by allocation concealment method and irrigation was performed in accordance with the allocated group. Teeth were evaluated clinically and radiographically with CBCT after 6 months and 12 months of the treatment. RESULTS: A significant difference was observed in the radiographic healing rates among three groups (χ2=12.29, p=0.05). On comparing the final outcome among the three groups (n=19), it was found that 2 (10.5%) cases of group I(Conventional Syringe irrigation), 7 (36.8%) cases of group II (Passive ultrasonic irrigation) and 8 (42.1%) cases of group III(Laser activated irrigation) were healed while under healing category 13 (68.4%) cases of group I, 12 (63.2%) cases of group II and 11 (57.9%) of group III were observed whereas 4 (21.1%) cases were categorised as diseased in group I only. CONCLUSIONS: LAI and PUI can increase the predictability of the endodontic treatment success in cases of chronic apical periodontitis. Key words:Cone-beam computed tomography, CBCT-PAI, Irrigation, LASER, Radiographic healing, Root canal treatment, Ultrasonic.

"Effect of local application of simvastatin in bone regeneration of peri-apical defects-a clinico-radiographic study.

OBJECTIVE: The present study evaluates and compares the effectiveness of Simvastatin (SIM), Hydroxyapatite (HA), and platelet-rich fibrin (PRF) in bone regeneration of periapical defects. MATERIAL& METHOD: Thirty-nine patients were selected and randomized into three groups, Group 1: HA (n = 13), Group 2: PRF (n = 13), Group 3: SIM (n = 13). After completion of RCT and apicoectomy, the grafts were placed locally in the defect and sutured. RESULTS: At the end of twelve months, postoperative symptoms and radiographic analysis assessed the outcome of the treatment. CONCLUSION: Intragroup analysis of CBCT- Periapical Index (PAI) scores at 6th and 12th month revealed a significant change in the SIM group (p = 0.018 and 0.001 respectively), compared to PRF (p = 0.026 and 0.001 respectively) and HA (p = 0.053 and 0.039 respectively). Intergroup analysis of change in the level of CBCT-PAI score was highly significant (p = 0.003).SIM caused a more considerable change in the level of CBCT-PAI score compared to other groups, thereby indicating a faster rate of bone regeneration.

A comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis.

AIM: This study aimed for a comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis. METHODS: Thirty single-rooted teeth were taken. Access preparation was done. Biomechanical preparation was done using Protaper universal file till F3. Teeth were decoronated to a standardized root length of 14 mm, and the apical end from outside was sealed using paraffin wax. Teeth were autoclaved under standard conditions and after autoclaving, Phosphate-buffered saline solution was introduced into the roots and was incubated for 24 h to check for the disinfection of roots. Once the disinfection of roots was achieved, the wild strain of E. faecalis, i.e., ATC 29212 strain, was introduced into the teeth and allowed to incubate for 24 h. Following bacterial colonization inside the roots, antimicrobials were introduced and efficacy was checked. The data obtained were subjected to statistical analysis using paired t-test for significance. RESULTS: Significant difference was observed between all the test groups. However, chlorhexidine gel showed the best value of mean difference, indicating it as the best antibacterial medicament. CONCLUSION: Within the limitations of this study, it can be concluded that chlorhexidine gel showed better antimicrobial properties against E. faecalis than other medicaments.

An ex vivo evaluation of effect of dentin pretreatment with various agents for varying time intervals on the shear bond strength of resin.

BACKGROUND: This article highlights the contribution of collagen structure/stability to the bond strength. We hypothesize that induction of cross-linking in dentin collagen fibrils improves dentin collagen stability and thus bond strength with composite also improves. AIMS: The aim of the study was to evaluate the effect of collagen cross-linking agents on the shear bond strength of composite resins. SUBJECTS AND METHODS: One hundred human permanent teeth were randomly divided into three groups: Group I (n = 20) - no dentin pretreatment done, Group II - dentin pretreatment with 10% sodium ascorbate for 5 min (IIa) and 10 min (IIb), and Group III - dentin pretreatment with 6.5% proanthocyanidin (PA) for 5 min (IIIa) and 10 min (IIIb). A composite resin was bonded on prepared surfaces and cured. Thermocycling was done, and shear bond strength of the prepared samples was tested using a universal testing machine. RESULTS: Values of Group I (control) were lowest whereas that of Group II (sodium ascorbate) were highest. The following order of shear bond strength was observed: IIb > IIa > IIIb ~ IIIa > I. Results for sodium ascorbate were found to be time dependent, whereas for PA, differences were nonsignificant. CONCLUSIONS: Treatment of dentinal surfaces with collagen cross-linking agent increases the shear bond strengths.

Comparative evaluation of antibacterial effect of nanoparticles and lasers against Endodontic Microbiota: An in vitro study.

BACKGROUND: Present study was conducted with the aim of evaluating antimicrobial efficacy of silver (AgNP) and gold nanoparticles (AuNP) with and without Nd: YAG laser (L) irradiation against experimentally inoculated Enterococcus faecalis in infected human root dentin. MATERIAL AND METHODS: 120 extracted single rooted human teeth were prepared and inoculated with E. faecalis for 24 hrs. The teeth were then randomly divided into 4 experimental group: AgNPs group: irrigation for 3minutes with 50 µl of 100 ppm, the AuNPs group: irrigation with 50 µl of 100 ppm, the AgNPs & Nd: YAG lasers group: irrigation with 50 µl of 100 ppm + irradiation with 1.5W laser for 60 seconds, the AuNPs & Nd: YAG lasers group: irrigation with 50 µl of 100 ppm + irradiation with 1.5W laser for 60 seconds. One control group consisting of 2% CHX irrigation for 3 minutes was also there (n = 20). The specimens were collected from the canal before and after irrigation, and colony forming units were observed. RESULTS: Significant difference was found among all the groups in comparison to the control group (p<0.05). The greatest reduction in CFU's was observed with combination of AgNPs & Nd: YAG lasers group. CONCLUSIONS: AgNPs in combination with Nd: YAG laser irradiation has the potential to be used as root canal disinfectant. Key words:Antibacterial efficacy, gold, silver, nanoparticles, lasers, solid-state.

A Comparative Evaluation of Smear Layer Removal Using Apical Negative Pressure (EndoVac), Sonic Irrigation (EndoActivator) and Er:YAG laser -An In vitro SEM Study.

BACKGROUND: This study aimed to compare the smear layer removing efficacy of the EndoActivator, EndoVac and Er:YAG laser in extracted mandibular premolars, at the apical, middle and coronal third of root canal, through scanning electron microscopy. MATERIAL AND METHODS: 40 extracted mandibular premolars were decoronated to a standardized length of 12 mm. Specimens were shaped to ProTaper F4 size and irrigated with 5.25% sodium hypochlorite at 370C between instrumentation. Teeth were divided into four groups (n=10), one control (needle irrigation) and three experimental, according to the irrigant activation technique used i.e. sonic irrigation (EndoActivator), apical negative pressure (EndoVac) or laser (Er:YAG). The final irrigants used were 10ml,17% ethylenediaminetetraacetic acid (EDTA) and 10ml, 5.25% sodium hypochlorite. Root canals were then split longitudinally and observed under a scanning electron microscope. The presence of smear layer at the apical, middle and coronal third of root canal was evaluated. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Intraexaminer and interexaminer reliability were determined by Kappa test. RESULTS: The EndoVac system was significantly more effective in removing debris from the apical third than all other groups. EndoActivator performed better than laser at the apical third. All three experimental groups (EndoVac, EndoActivator, and laser) were better than needle irrigation at the middle and apical third. At the coronal third, no significant difference was seen between the four groups. CONCLUSIONS: None of the activation systems completely removes the smear layer from the dentine walls; nevertheless, EndoVac is significantly better in removing debris from the apical third of canal. Key words:EndoVac, EndoActivator, Er:YAG laser, smear layer, scanning electron microscopy.

Comparative evaluation of antimicrobial efficacy of triple antibiotic paste, calcium hydroxide, and a proton pump inhibitor against resistant root canal pathogens.

OBJECTIVE: The objective of this study is to compare the antimicrobial efficacy of triple antibiotic paste (TAP) and a proton pump inhibitor (PPI) (omeprazole) in combination with calcium hydroxide (CH) against Enterococcus faecalis and Candida albicans. MATERIALS AND METHODS: E. faecalis and C. albicans were subcultured and inoculated at 37° overnight and were treated with different dilutions of TAP, 25 µg/ml (Group 1), CH (Group 2, control), CH 16 mg/ml + omeprazole 2 mg/ml (Group 3a) (CH 16 mg/ml + omeprazole 4 mg)/ml (Group 3b) for 24, 48, and 72 h in sterile uncoated 96-well microtiter plates. Minimum concentration at which the medicaments produced least optical density was determined using ELISA reader (ELx 808 BioTek Inc., USA) device set at optical density of 630 nm. Results were analyzed statistically by one-way analysis of variance followed by Tukey's multiple comparison tests. The significance level was set at 0.05. RESULTS: Mean concentration (irrespective of time) for TAP at which mean minimum optical density was recorded at 1.25 µg/ml (1:20 dilution) and 25 µg/ml (0 dilution) against E. faecalis and C. albicans, respectively. Least optical density for CH plus PPI group was obtained 1.6 µg/ml (1:10 dilution) and 16 µg/ml (0 dilution) for E. faecalis and C. albicans, respectively. However, CH alone showed a weaker antimicrobial action against either of the strains even at full concentration. CONCLUSIONS: PPI enhanced the antibacterial efficacy of CH against E. faecalis and C. albicans. However, TAP showed the best antibacterial property followed by CH plus PPIs against both the selected strains.

Nasopalatine duct cyst mimicking an endodontic periapical lesion: a case report.

Lesions of nonendodontic origin, such as nasopalatine or globulomaxillary cysts, may mimic periapical radiolucencies associated with pulpal pathosis, and incorrect diagnosis may lead to unnecessary endodontic treatment. Horizontal root fractures most commonly affect the maxillary central and lateral incisors. Prognosis depends largely on the level of fracture; fractures in the apical third have the best prognosis, and those in the cervical third have the worst. This case report discusses surgical and restorative management of a patient who had a nasopalatine cyst that had been misdiagnosed and treated as an endodontic lesion of the maxillary right central incisor as well as a midroot horizontal fracture of the adjacent lateral incisor.

Efficacy of LA Axxess burs, Gates Glidden drills and Protaper Sx in obtaining straight line access in mesiobuccal roots of mandibular first molars: A cone-beam computed tomography assessment.

OBJECTIVE: This study aims at cone-beam computed tomography (CBCT) evaluation of the ability of Gates Glidden (GG) drills, Protaper Sx, and LA Axxess burs to produce a straight line access (SLA) in mesiobuccal canals of mandibular first molars. METHODOLOGY: Forty-five freshly extracted mandibular teeth with a canal curvature of 10-20° were taken for the study and divided into three groups according to the instruments used for cervical preflaring: Group I (LA Axxess burs), Group II (GG drills), and Group III (Protaper Sx). Pre- and post-instrumentation CBCT images were evaluated for comparing the ability of GG drills, Protaper Sx and LA Axxess burs to produce an SLA in mesiobuccal canals of mandibular first molars. RESULTS: There was no significant change (P = 0.06) in the angle in the preSLA images of LA Axxess Group I (12.37 ± 1.01), GG Group II (13.39 ± 1.74), and Protaper Sx Group III (13.90 ± 1.74). The mean decrease in the angle from preSLA to postSLA was significant for all the three groups (P = 0.0001). However, the mean change was highest in Group I (4.25 ± 1.14), followed by Group II (3.28 ± 1.22) and Group III (2.89 ± 1.53). CONCLUSION: LA Axxess burs were the most effective in reducing the coronal curvature and produced a straighter access to apical third compared to GG Drills and Protaper Sx.

Accidental aspiration/ingestion of foreign bodies in dentistry: A clinical and legal perspective.

The potential of foreign body aspiration or ingestion is a worldwide health problem in dentistry. The general dental practitioners should be extremely attentive in handling of minor instruments during any intervention related to the oral cavity, especially in the supine or semi-recumbent position of the patient. Aspiration cases are usually more critical and less common than ingestion. We report a case of iatrogenic aspiration of an endodontic broach, which gets disclosed during the recording of past dental history of the patient. The patient was asymptomatic during that time. A quick posterior-anterior chest radiograph was taken which revealed the presence of broach in the lower lobe of the left lung. The patient was immediately referred to the pulmonary medicine department where the fiberoptic bronchoscope retrieval was planned, and the same was carried out successfully under local anesthesia. Although such accidents have rare occurrence, the associated risks and morbidity are too high to be overlooked, especially from the viewpoint of special care, resources, and the associated financial cost required for their management. Moreover, practitioners are also liable for malpractice litigation given the fact that such cases are avoidable. This article also discusses relevant review literature, risk factors, symptoms, and management of such iatrogenic accidents along with drawing attention to the significance of preventive measures and their role in avoiding meritorious legal and ethical issues.

A comparative evaluation of different irrigation activation systems on smear layer removal from root canal: An in-vitro scanning electron microscope study.

AIM: The aim of the following study is to compare the evaluation of different irrigation activation system-F-File, CanalBrush (CB) and EndoActivator (EA) in removing smear layer from root canal. MATERIALS AND METHODS: Root canals of eighty single rooted decoronated premolar teeth were instrumented using crown-down technique and then equally divided into four groups on basis of irrigation activation methods used: Without irrigation - control group, irrigation with F-File, CB, EA into Group I, II, III respectively. Samples were then longitudinally sectioned and examined under scanning electron microscope by three qualified observers using score from 1 to 4. Data was analyzed using Statistical Package for Social Sciences (SPSS), version 15.0 (SPSS Inc., Chicago IL) at significance level of P ≤ 0.05. RESULTS: Minimum mean score was observed in Group II at coronal, apical locations. Group III had minimum score at middle third. Groups difference in score were found to be significant statistically for all three locations as well as for overall assessment (P < 0.001). CONCLUSION: CB remove smear layer more efficiently from the root canal than F-File and EA in coronal and apical region.

Clinical negligence or endodontic mishaps: A surgeons dilemma.

Complications may occur during and after endodontic treatment, which may be due to negligence of the operator. The surgical treatment of a case presenting pain and persistent pus discharge and swelling due to the extrusion of the root canal filling to the base of the nasal floor between left maxillary lateral and canine teeth is presented in this report. First, carelessness was during root canal treatment that was over obturated and second time during extraction in which overextended gutta-percha remained in the bone, caused the complications like pain, persistent pus discharge, and headache. Clinicians should be aware of the fact that endodontic instruments and filling materials (solid or liquid) can be extended in such a degree that can lead to neurological or sinus complications.

Use of ultrasound, color Doppler imaging and radiography to monitor periapical healing after endodontic surgery.

This study evaluated the effectiveness of ultrasound, color Doppler imaging and conventional radiography in monitoring the post-surgical healing of periapical lesions of endodontic origin. Fifteen patients who underwent periapical surgery for endodontic pathology were randomly selected. In all patients, periapical lesions were evaluated preoperatively using ultrasound, color Doppler imaging and conventional radiography, to analyze characteristics such as size, shape and dimensions. On radiographic evaluation, dimensions were measured in the superoinferior and mesiodistal direction using image-analysis software. Ultrasound evaluation was used to measure the changes in shape and dimensions on the anteroposterior, superoinferior, and mesiodistal planes. Color Doppler imaging was used to detect the blood-flow velocity. Postoperative healing was monitored in all patients at 1 week and 6 months by using ultrasound and color Doppler imaging, together with conventional radiography. The findings were then analyzed to evaluate the effectiveness of the 3 imaging techniques. At 6 months, ultrasound and color Doppler imaging were significantly better than conventional radiography in detecting changes in the healing of hard tissue at the surgical site (P < 0.004). This study demonstrates that ultrasound and color Doppler imaging have the potential to supplement conventional radiography in monitoring the post-surgical healing of periapical lesions of endodontic origin.

Endodontic emergencies: Your medication may be the cause.

An endodontic clinician may face unwanted situations during root canal treatment. We present here an unusual case of soft tissue and gingival necrosis of the oral cavity following the use of formocresol((R)) during endodontic treatment.