Detecting Vertical Root Fractures Using Modified Methylene Blue Dye: A Preliminary In Vitro Study.

Diagnostically, vertical root fractures (VRFs) can be a frustrating experience for the dentist. Misdiagnosis could result in significant time and effort losses involved in erroneously intervening endodontically and/or periodontally. Certainly, diagnosing VRFs is often very difficult, and diagnoses based on speculations have led to the extraction of many salvageable teeth. This study was conducted in the radiology unit of College of Dentistry, Prince Sattam bin Abdulaziz University, between December 2021 and June 2022 to evaluate the ability to detect VRFs following the use of a novel radio-opaque dye using periapical radiographs (PARs) and cone-beam computed tomography (CBCT). After carefully inducing VRFs on extracted, single-rooted, virgin premolars (n = 26), they were assigned to control (n = 2) and experimental groups (n = 24). The fracture site of the tooth in the control group received methylene blue dye, whereas the experimental group received a novel dye. Two differently angled PARs were obtained for all the teeth, followed by a CBCT image. Three blinded investigators participated in scoring a Likert scale form with a set of questions. Inter-/intra-examiner reliability showed excellent consistency using Cronbach's alpha test. The Z-test revealed CBCT and PAR to be equally adept at detecting VRFs, with the mean values showing no statistically significant differences. The extent of the VRFs and dye penetration were significantly better when angled radiographs and axial view CBCT were evaluated. Within the limitations of this study, the dye tested showed promising initial results as an aid in radiographically detecting VRFs. The use of such minimally invasive methods is critically needed for diagnosing and managing VRFs. However, further testing should be performed prior to its clinical use.

Salvadora persica's Biological Properties and Applications in Different Dental Specialties: A Narrative Review.

Salvadora persica is a tree that belongs to the salvadorecea family. It is also known as Miswak, which is a popular natural toothbrush that was used centuries ago in oral hygiene by Muslims in all parts of the world, especially in the Middle East. Numerous researchers highlighted the biological activity of this plant in medicine, dentistry, and pharmacology. The purpose of this article is to narratively review the biological properties of Salvadora persica. In addition, it expresses variant applications of this herb in different dental specialties. Materials and Methods. The search of the literature was based on PubMed, MEDLINE, and Google Scholar using keywords: Salvadora persica, S. persica, Miswak, Dentistry, and Dental. All relevant articles were reviewed to check if they would fit within the scope of this review, and then, the information was extracted. Results. Multiple biological effects of S. persica have been reported including antibacterial, antiviral, antifungal, antibiofilm, antioxidant, and even antiulcer effects. Dental effects were discussed and presented. Conclusion. The wide biological range of Salvadora persica's effects is promising for dental and nondental fields and allows for an expanded clinical application that has otherwise not been discussed in the literature.

Anatomy of the accessory mental foramen in a Saudi subpopulation: A multicenter CBCT study.

AIM: The aim of this is to evaluate the prevalence and location of the accessory mental foramen (AMF) in a Saudi population using cone-beam computed tomography (CBCT). METHODOLOGY: CBCT data were retrieved from two dental facilities at two universities located in two different cities and filtered over a period of four years. The scans were aligned when the AMF was noticed, and then the size of both the AMF and mental foramen (MF), its location, and the distance from the AMF to the MF were recorded. The AMF measurements were compared between males and females and between the two sides of the mandible. RESULTS: In total, 603 CBCT scans were investigated. The percentage of scans with an AMF was 9.95% (n = 60), and AMFs were almost equally distributed on both sides. Only four cases (0.66%) of a second AMF were detected among the scans. The MFs on both sides were significantly larger in males than in females (P > 0.05), but they showed no differences in the sizes of the AMFs. The AMFs were most commonly located inferior and posterior to the MF. The distance between the MF and AMF ranged from 2.32 to 5 mm. CONCLUSIONS: The prevalence of the AMF in this Saudi population was 9.95%, and it was significantly more prevalent in males than in females. Its proximity to the MF makes it clinically important to conduct proper detailed planning prior to performing any procedure that might risk the vital structures.

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.

Clinical dental students' knowledge regarding proper dental settings for treating patient during COVID-19: A cross-sectional study.

OBJECTIVES: To investigate the clinical dental students' knowledge on the proper dental setting during COVID-19. METHODS: Using multicenter cross-sectional study, a 10-items questionnaire was distributed in April 2020 among senior dental students from two dental schools. It comprised three main domains: demographic questions, questions investigating student's access to the proper recommendations of dental settings during COVID-19 and the specific recommendations questions. RESULTS: The questionnaire was sent to 654 clinical dental students and the total number of respondents were 267 representing a response rate of 40.83%. The overall knowledge mean was low (1±0.92). Gender was not a statistically significant factor affecting the knowledge score (P > 0.05). Most of the participants never visited the Saudi Center for Disease Prevention and Control (Saudi CDC) website and received no guidance or advice regarding proper dental practices during COVID-19. A statistically significant relationship was observed between the mean knowledge score and access to knowledge variables (P < 0.05). CONCLUSION: It was noted that clinical dental students have low knowledge on the proper dental settings during COVID-19 pandemic that was recommended by the Saudi CDC guidelines and they must be equipped with adequate knowledge from reliable sources to overcome their insufficiencies such as a well-structured and dynamic curriculum.

Biodentine or Mineral Trioxide Aggregate as Direct Pulp Capping Material in Mature Permanent Teeth with Carious Exposure? A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the success rate of direct pulp capping (DPC) with Biodentine in mature permanent teeth with carious vital pulp exposure compared to that of DPC with mineral trioxide aggregate (MTA) by means of a systematic review and meta-analysis. DATA SOURCES: The two authors searched independently the literature published through July 31, 2020, in five electronic databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science Core Collection, the Wiley Online Library, and the SCOPUS database). STUDY SELECTION: The research protocol was previously registered in the PROSPERO database (CRD42020192511). Clinical studies that met the inclusion criteria were chosen and independently screened by the authors. DATA EXTRACTION: A custom-designed spreadsheet was used to extract the data. The quality of each study was evaluated by means of the revised Cochrane risk of bias (ROB) tool or the ROB of nonrandomized studies of interventions tool. DATA SYNTHESIS: Three randomized controlled trials and one retrospective study met the inclusion criteria. Only one study had a high risk of bias. The included studies reported data on a total of 95 participants with an age range of 8-51 years. No significant difference was observed in the overall treatment outcome when comparing Biodentine with MTA (Risk ratio=1.00, 95% confidence interval [0.93-1.07], p=1.00). CONCLUSIONS: Biodentine had comparable clinical and radiographic success to that of MTA when used as a DPC agent in mature permanent teeth with carious vital pulp exposure. Additional high-quality studies are needed.

Root canal morphology of maxillary second molars in a Saudi sub-population: A cone beam computed tomography study.

INTRODUCTION: Root morphology and canal anatomy of maxillary molars shows several complexities and variations. Knowledge of these is essential for successful endodontic treatment. This study aimed to investigate the morphology of the maxillary second molars in a Saudi Arabian sub-population in relation to gender, age, and nationality, as well as to analyze the anatomical symmetry between the left and right side in each individual. METHODOLOGY: 420 digitized cone-beam computed tomography (CBCT) scans were collected, of which 351 scans met the inclusion criteria. Number of roots and canals at three different levels of the root in each case was counted at all available sides and compared on the basis of the study variables. Statistical significance was set at P ≤ 0.05. RESULTS: Most of the patients (n = 323, 92%) had three roots, while two roots (n = 23, 6.6%), four roots (n = 4, 1.1%), and one root (n = 1, 0.3%) were less frequently observed. A significant correlation between female patients and the presence of two canals, while male patients showed a higher correlation with the presence of four canals at all levels. There also was a correlation between Saudi participants and the presence of four canals at all levels. No significant correlation in symmetry between the left and right side root canal anatomy was found. There was an inverse relation between the number of canals and age. CONCLUSION: Considering the limitations in this study, it appears that the Saudi population is more likely to have three- and two-rooted maxillary second molars, with males and females showing greater tendencies to having three and two roots, respectively.

A Rare Case of Single-Rooted Mandibular Second Molar with Single Canal.

The root canal anatomy of mandibular second molar teeth is known to be highly variable. Whilst the most frequently seen configuration is two mesial canals and one distal canal, other variations such as four canals, two canals, and C-shaped canal system do also exist. This case report describes the diagnosis and management of unusual root canal configuration of a mandibular second molar, with one canal in a single conical root, using the contemporary advancements in endodontics. Following clinical and radiographic examinations of the case, a diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis of tooth #47 was established, and root canal treatment followed by composite buildup and crown were planned. Clinicians should be aware of the different anatomic variants each tooth may exhibit. Furthermore, clinicians need to possess the proper knowledge and skills that allow them to utilize the diagnostic and therapeutic tools available at their disposal in order to optimize the quality of care provided to their patients.

Prevalence of three-rooted mandibular permanent first and second molars in the Saudi population.

INTRODUCTION: This study aims to explore the frequency and factors affecting the prevalence of an extra root in the lower first and second permanent molars in the Saudi population. METHODS: Images of 379 Saudi patients who underwent CBCT for routine dental treatment were assessed. The CBCT images were evaluated on a 34-inch LED screen in a dark room and assessed by two examiners to count the prevalence of an additional root in the lower molars. Laterality and the gender factors were used to analyze that prevalence. Percentages represent categorical variables; Fisher's exact test and Chi square test were also used for the categorical variables. RESULTS: In the lower first molars, the prevalence of extra root in female patients was 5.7%, 3% in male patients and the overall prevalence was 3.05%; in lower second molars, the prevalence was 1.81% in female patients and 3.04% in male patients with an overall prevalence of 1.48%. A statistically significant difference was fond in the existence of an additional root with regard to laterality, to be more common on the right compared to the left side for both mandibular molars. The extra root prevalence was statistically significant in female patients at the first molar compared to male patients (p < 0.05). CONCLUSION: The overall of extra roots prevalence in the lower first and second molars in the Saudi population are 3.05% and 1.48%, respectively. Consideration and identification of this variation is essential to ensure successful endodontic treatment.

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.

Impact of orthodontic treatment on the integrity of endodontically treated teeth.

AIM: The purpose of this study was to evaluate the periapical status of endodontically treated teeth and the integrity of endodontic treatment before and after orthodontic treatment. MATERIALS AND METHODS: This retrospective study was conducted by evaluating 128 teeth with root canal treatment (RCT). The teeth were obtained from 72 patients (23 males, 49 females) who had undergone fixed orthodontic treatment. Panoramic radiographs were taken and were evaluated before the start and after the completion of orthodontic treatment. Apical periodontitis (AP) was evaluated by the periapical index (PAI) and the probability index (PRI) of periapical bone destruction. Other variables related to the quality of root canal fillings were included, such as RCT quality index, length, and homogeneity, and coronal restoration. RESULTS: According to the PRI, the proportion of teeth with periapical bone destruction was significantly higher after orthodontic treatment. Overall, there was no significant change in the PAI scores after orthodontic treatment. However, the quality of the endodontic treatment moderated the change in the PAI score, as well as the change in the PRI. There was no significant increase in PAI and PRI scores after orthodontic treatment for adequately treated teeth. However, the risk for periapical lesions and bone destruction after orthodontic treatment was significantly increased for teeth receiving inadequate endodontic treatment compared with those receiving adequate endodontic treatment. CONCLUSION: Increased PAI and PRI after orthodontic treatment correlated with the quality of endodontic treatment.

Five-Year Recall after Treatment of External Cervical Resorption.

The management of external cervical resorption can be challenging. This study described a two-step procedure for the treatment of external cervical resorption. It involved nonsurgical root canal treatment and a dental amalgam core buildup, followed by a surgical approach to restore the root structure using resin-modified glass ionomer (Geristore®). The patient was recalled for a period of five years, and the overall outcome was successful.