Canal disinfection using photo-chemically activated micro-bubble emulsion, Emblica officinalis, and Nd: YAP laser on smear layer and push-out bond strength of resin-based root canal sealer to the radicular dentin.

AIMS: Evaluation of the effects of the latest root canal disinfectants i.e., Micro-bubble emulsion (MBE), Neodymium-doped yttrium aluminum perovskite (Nd: YAP), Emblica officinalis (E. officinalis) on the removal of smear layer (SL) and push out bond strength (PBS) of resin-based root canal sealer to the radicular dentin. METHODS: The coronal portion of sixty single-rooted human mandibular premolar teeth was precisely sectioned at the cementoenamel junction. The canals were prepared to utilize ProTaper universal rotary files till F3. All the study specimens were divided into four groups based on the disinfection regime (n = 15) Group 1: 5.25% NaOCl, Group 2: MBE, Group 3: Nd: YAP laser and Group 4: E. officinalis extract. All the canals were then finally irrigated using 17% EDTA solution as a final disinfecting agent. SL removal assessment was performed on five samples from each group using a scanning electron microscope (SEM). Ten samples from each group were then filled with root canal filling material and the roots were sectioned. Push-out test and failure mode analysis were performed using the universal testing machine (UTM) and stereomicroscope respectively. The mean scores of PBS and SL removal were compared using a one-way analysis of variance (ANOVA) and Post Hoc Tukey's HSD test p = 0.05. RESULTS: Group-2 (MBE + EDTA) coronal section (1.50 ± 0.23) exhibited the most effective eradication of SL from the canal space. The apical third of Group-1 (NaOCl+EDTA) (2.68 ± 0.82) samples demonstrated the least effective removal of SL from the radicular canal. The maximum score of PBS of AH plus sealer to the canal dentin was exhibited by the coronal section of Group-2 (MBE + EDTA) (9.55 ± 0.45 MPa) samples. However, the apical third of Group-1 (NaOCl+ EDTA) specimens (5.16 ± 0.32 MPa) demonstrated the minimum EBS. CONCLUSION: MBE+ EDTA displayed better smear layer removal and bond integrity of AH plus sealer to the root canal dentin. Nd: YAP+ EDTA laser and E.officinalis displayed comparable outcomes to that of control NaOCl+ EDTA.

Pretreatment of Root Dentin Using Photon-Induced Photoacoustic Streaming, Photodynamic Therapy, and Riboflavin with EDTA as a Final Irrigant to Improve Bond Integrity of Glass Fiber Post.

Objective: To evaluate the outcome of post space disinfection using Er,Cr:YSGG laser (ECYL), riboflavin photosensitizer (RFP), and photon-induced photoacoustic streaming (PIPS) along with ethylene diamine tetra acetic acid (EDTA) as final irrigant on the bond values of glass fiber post (GFP) to the canal wall. Materials and methods: Forty human mandibular premolars were subjected to root canal treatment after decoronation till the cementoenamel junction. Post space was prepared using a Gates-Glidden drill leaving 4 mm of gutta perch at the apical third of the root section. Random allocation of samples was performed into four groups based on the post space disinfection (n = 10 each): Group 1: 1% RFP and 17% EDTA, group 2: 5.25% sodium hypochlorite (NaOCl) and 17% EDTA (control), group 3: PIPS and 17% EDTA, and group 4: ECYL and 17% EDTA. GFP was luted using Rely X Unicem. A universal testing machine and stereomicroscope were used to assess the push-out bond strength (PBS) and failure mode, respectively. Analysis of variance determined the PBS amid different experimental groups at three root levels. Multiple group comparison using means of tested groups was identified using post hoc Tukey. Results: The coronal third of group 2 (5.25% NaOCl +17% EDTA) demonstrated the highest PBS (8.83 ± 0.11 MPa). However, the lowest bond integrity (4.15 ± 0.52 MPa) was displayed in an apical third of group 1 (RFP +17% EDTA). The intergroup comparison revealed that 5.25% NaOCl +17% EDTA at all three levels demonstrated comparable outcomes of PBS with PIPS +17% EDTA and ECYL +17% EDTA specimens (p > 0.05). However, riboflavin +17% EDTA demonstrated the lowest bond strength (p < 0.05). Conclusions: Er,Cr: YSGG and PIPS in combination with 17% EDTA demonstrated comparable outcomes of bond score with those of conventional gold standard irrigation regime 5.25% NaOCl.

The effect of instructional methods on dental students' performance in a preclinical endodontic course: A comparative ambispective cohort study.

OBJECTIVE: The aim of this ambispective cohort study was to examine the effect of instructional methods on dental students' performance in a preclinical endodontic course. Two cohorts of undergraduate students were included. The pre-pandemic (retrospective) cohort, which had been taught via traditional instruction (live lecture and live demonstration), and the pandemic (prospective) cohort group, which had been taught via a blended learning approach (online/video recorded lecture and video demonstration, combined with practical training in the simulation laboratory). METHODS: A total of 263 dental students' competencies and written exam results were reviewed, with 137 students from the traditional and 126 from the blended learning groups. Students' performances in the competency practical and written exams for both groups were compared. Additionally, a post-course survey was designed to explore the students' perceptions of blended learning and was sent to the blended learning cohort. RESULTS: There was a statistically significant difference between both groups in students' weekly practical project scores. The average score for females was significantly higher than that of males. However, their practical competency exam scores were comparable. On the other hand, the written exam scores were significantly higher in the blended than in the traditional group, with females demonstrating significantly higher written exam scores compared to males (p < 0.001). CONCLUSION: Blended learning is an effective teaching method for preclinical endodontic courses. It could be more useful than traditional learning methods for the course's theoretical content. Additionally, the students preferred to continue learning using this model.

Exploring the Most Effective Apical Seal for Contemporary Bioceramic and Conventional Endodontic Sealers Using Three Obturation Techniques.

Background and Objective: Despite a plethora of studies conducted to date, researchers continue to investigate the best sealer and obturation technique combinations. The aim of this study is to compare the apical seal provided by two bioceramic sealers (Endoseal and Endosequence) with that provided by a calcium hydroxide sealer (Sealapex), and to evaluate the effect of different obturation techniques (cold lateral condensation, continuous wave compaction and single cone) on the apical seal under a stereomicroscope. Materials and Methods: A total of 110 single-rooted mandibular premolar teeth were decoronated, cleaned and shaped using the Endosequence filing system to tip size 30/0.04 taper. Canals were irrigated with 5.25% NaOCl and 17% EDTA. The samples were randomly divided into 11 groups (9 experimental and 2 control groups) according to the designated sealer and technique. Samples were stored in an incubator for 7 days at 37 °C under 100% humidity. Samples were coated with nail varnish except for apical 2 mm and vertically placed in 0.2% rhodamine B dye solution for 48 h. Samples were split longitudinally and viewed under a stereomicroscope at 40× magnification. Results: Insignificant results were obtained between obturation techniques (p = 0.499) whereas statistically significant results were attained based on the type of endodontic sealer (p < 0.001). The overall lowest mean apical microleakage and best sealing ability was demonstrated by Sealapex (2.59 ± 1.20 mm) and amongst techniques by continuous wave compaction (3.90 ± 2.51 mm). Conclusions: Endosequence produced the best apical seal with the continuous wave compaction technique, whereas Endoseal did so with the bioceramic-coated single-cone technique. For the Sealapex sealer, the most effective apical seal was observed using cold lateral condensation. The quality and effectiveness of apical seal differed with the type of endodontic sealer and obturation technique used, and vice versa.

Efficacy of curcumin-mediated photodynamic therapy for root canal therapy procedures: A systematic review.

BACKGROUND: This systematic review aimed to investigate the effectiveness of CUR-mediated PDT (Curcumin mediated PDT) as an adjunct to conventional chemo-mechanical debridement and/or standard PDT of the RC system with endodontic infections. METHODS: The focused research question was: "Whether the application Curcumin mediated PDT as an adjunct is more effective than the traditional chemo-mechanical debridement and/or standard PDT of the RC system alone for improving antibacterial and/or mechanical features among subjects undergoing RCT?". An electronic literature search was performed in Scopus, PubMed, and Web of Science. In vitro reports utilizing Curcumin mediated PDT as an adjunct to conventional chemo-mechanical debridement considering permanent dentition assessing the antibacterial and/or mechanical effect were included. RESULTS: Eighteen articles were included in the review, out of which 13 studies assessed the antibacterial activity, while 5 evaluated the mechanical properties. Most of the studies concluded that Curcumin mediated PDT had a significant antibacterial activity than the conventional chemo-mechanical debridement and/or standard PDT. Four of the five studies suggested that Curcumin mediated PDT had no impact on the push-out bond strength of root dentin. Furthermore, the significant heterogeneity in the data from the included studies did not permit the author to carry out a meta-analysis. CONCLUSION: There is potential for application of Curcumin mediated PDT as an adjunct to the conventional chemo-mechanical debridement and/or standard PDT in reducing the bacterial load, however, Curcumin mediated PDT has minimal effect on enhancing the pushout bond strength of fiber posts to radicular dentin. Moreover, clinical studies are required to provide a more conclusive opinion on the efficacy of Curcumin mediated PDT for RCT procedures.

Comparative Study Assessing the Canal Cleanliness Using Automated Device and Conventional Syringe Needle for Root Canal Irrigation-An Ex-Vivo Study.

The success of endodontic treatment relies on both apical and coronal sealing. To achieve a good three-dimensional seal, the removal of the smear layer becomes mandatory. This study aims to assess the difference in debris accumulation and smear layer formation while using automated root canal irrigation and conventional syringe needle irrigation. Single-rooted human mandibular premolar teeth (n = 30) which were indicated for orthodontic extractions were selected. An endodontic access cavity was prepared, and a glide path was created. Based on the irrigation protocol decided upon for the study, the teeth were randomly allocated into three study groups, namely Group 1, where the manual syringe needle irrigation method was adopted; Group 2, in which automated root canal irrigation was undertaken; and Group 3, in which teeth remained un-instrumented as it was considered the Control group. The teeth were decoronated at the cement-enamel junction (CEJ) and were subjected for scanning electron microscopy (SEM) examination. Debris and smear layers were viewed in 1000× magnification and scored. A statistically significant (p < 0.05) lower mean debris and smear layer score (p < 0.05) was observed in both study groups when compared with the control group. However, no significant difference (p > 0.05) in the debris and smear layer was observed between the manual syringe needle irrigation and automated irrigation, although automated irrigation devices can be a potential alternative. The present study concluded that the efficacy of smear layer removal remained the same with both automated irrigation and manual syringe irrigation.

Anatomical Evaluation of Root and Root Canal Morphology of Permanent Mandibular Dentition among the Saudi Arabian Population: A Systematic Review.

This study aimed to conduct a compendious review of root canal morphology of "permanent mandibular teeth in different regions of Saudi Arabia" to obtain a large sample representing the total population. A detailed search through the databases Web of Science, Scopus, and PubMed was conducted following the PRISMA guidelines. The data were analyzed based on the following inclusion criteria: original full-length original articles that reported the variables of interest "(number of roots, number of canals, Vertucci's classification system and C-shaped canals or mid-mesial canals)" of the mandibular teeth and conducted on Saudi subjects. The retrieved data were presented as frequencies and percentages. The results revealed that 56.6% of mandibular central incisors had one canal and Vertucci type I (56.6%), while 57.4% of the mandibular lateral incisors had one canal, with Vertucci types I and III most frequent. In mandibular canines, 91.8% had one canal and 8.2% had two canals. Most of the mandibular first premolars had one root (86.6%), while almost all mandibular second premolars (91.5%) had one canal, and 96.9% had Vertucci type I configuration. Among the mandibular first molars, three and four canals were prevalent in 58.7% and 40.6%, respectively. The majority of mesial roots had Vertucci type IV (60.6%), and most of distal roots had Vertucci type I (72.2%). Most of the mandibular second molars had three canals (87.3%) and showed Vertucci type IV (39.4%) canals for mesial roots and Vertucci type I (95.6%) for distal roots. The C-shaped canals were seen in 8% of first premolars and 9.8% of second molars. The middle mesial canal was found in 4.2% and 0.4% of first and second molars, respectively. This review could represent "the population of Saudi Arabia as the included samples were combined from different regions of the country." Some variations were noticed within the same group of teeth from different regions. However, the overall results of combined samples were comparable to the other international studies.

Gene and protein interaction network analysis in the epithelial-mesenchymal transition of Hertwig's Epithelial Root Sheath reveals periodontal regenerative drug targets - An in silico study.

Background and aim: Hertwig's Εpithelial Root Sheath (HΕRS) has a major function in the developing tooth roots. Earlier research revealed that it undergoes epithelial-mesenchymal transition, a vital process for the morphogenesis and complete development of the tooth and its surrounding periodontium. Few studies have demonstrated the role of HERS in cementogenesis through ΕMΤ. The background of this in-silico system biology approach is to find a hub protein and gene involved in the EMT of HERS that may uncover novel insights in periodontal regenerative drug targets. Materials and methods: The protein and gene list involved in epithelial-mesenchymal transition were obtained from literature sources. The protein interaction was constructed using STRING software and the protein interaction network was analyzed. Molecular docking simulation checks the binding energy and stability of protein-ligand complex. Results: Results revealed the hub gene to be DYRK1A(Hepcidin), and the ligand was identified as isoetharine. SΤRIΝG results showed a confidence cutoff of 0.9 in sensitivity analysis with a condensed protein interaction network. Overall, 98 nodes from 163 nodes of expected edges were found with an average node degree of 11.9. Docking results show binding energy of -4.70, and simulation results show an RMSD value of 5.6 Å at 50 ns. Conclusion: Isoetharine could be a potential drug for periodontal regeneration.

Extrusion bond strength of glass fiber post to radicular dentin after final irrigation using MTAD, EDTA, Pineapple peel extract, and Riboflavin.

INTRODUCTION: The present study aims to determine the effect of different post-space final irrigants ethylenediaminetetraacetic acid (EDTA), a mixture of Doxycycline citric acid and detergent (MTAD), Riboflavin (RF) and Pineapple peel extract (PPE) on the bond integrity of GFPs bonded to radicular dentin. MATERIALS AND METHODS: Crowns of forty human mandibular premolars teeth were sectioned up to cementoenamel junction CEJ. Root canal treatment was performed. Gates Glidden drills were used to retrieve gutta-percha from the canal. All the specimens were randomly divided into four groups based on the final irrigant used. Group 1 (NaOCl with EDTA), group 2 NaOCl+ MTAD, group 3 NaOCl+RF and group 4 NaOCl+PPE. Cementation of glass fiber posts (GFPs) was performed using self-etch dual-cure resin cement. Sectioning was performed using a slow-speed saw from the coronal, middle, and apical third under constant water irrigation. A universal testing machine was used to assess push-out bond strength (PBS) and failure mode was evaluated using a Stereomicroscope at 40x magnification. One-way analysis of variance (ANOVA) and Tukey multiple comparison tests were used for statistical analysis (p = 0.05). RESULTS: Group 4 (2.5% NaOCl+ PPE) displayed the highest PBS at all three root levels (Cervical: 11.22 ± 0.74 MPa, Middle: 8.99 ± 0.97 MPa, and Apical: 6.00 ± 0.88 MPa). However, Group 1 (2.5% NaOCl+17% EDTA) demonstrated the lowest EBS (Cervical: 9.25 ± 0.17 MPa, Middle: 7.01 ± 1.84 MPa, and Apical: 4.41 ± 0.17 MPa). Inter-group comparison displayed that PBS to be comparable between group 1 and group 3 (2.5% NaOCl+ Riboflavin) (Cervical: 9.74 ± 0.41 MPa, Middle: 7.44 ± 1.18 MPa, and Apical: 4.21 ± 0.05 MPa) (p > 0.05). Whereas, group 2 (1.3% NaOCl+ MTAD) (Cervical: 9.32 ± 1.36 MPa, Middle: 7.17 ± 1.75 MPa, and Apical: 4.85 ± 0.19 MPa) and group 4 demonstrated comparable values of PBS (p > 0.05). CONCLUSION: Pineapple peel extract and a mixture of Doxycycline citric acid and a detergent when used as a final irrigant demonstrated better bond integrity of GFPs to radicular dentin at all three levels coronal, middle and apical.

Analysis of occupational stress, burnout, and job satisfaction among dental practitioners.

BACKGROUND: Dental practitioners can be prone to stress because of the long working hours, high patient expectations, and work environment. OBJECTIVE: To investigate dimensions of occupational stress among dental practitioners leading to burnout and to model its causality with job satisfaction. METHODS: An analytical cross-sectional study was conducted for five months. A sample of 302 practicing dental practitioners was selected using the consecutive sample technique. This sample included dental practitioners working in clinical and non-clinical departments of public and private sector universities as well as those doing private general practice. A self-administered structured questionnaire based on the Work Stress Questionnaire was sent using Survey Monkey. Descriptive statistics were calculated. Spearman correlation was applied between stress scores and job satisfaction. A Chi-square test was applied to look into the association between stress levels and different categories. Univariate and multivariate analysis was performed. RESULT: The prevalence of overall occupational stress was high among dental practitioners (83.4%). Occupational stress was greatest in females (55.8%), dental practitioners in the private sector (55.7%), and general dental practitioners (GDPs) (47%). The overall prevalence of job satisfaction among dental professionals was 30%. Occupational stress was significantly associated with burnout and job dissatisfaction in dentistry. Stress levels and working hours were statistically and positively associated, whereas the association between stress levels and job satisfaction was inversely and significantly associated. CONCLUSION: The prevalence of occupational stress among dental practitioners was high and the level of job satisfaction was moderate. The model between these variables was well-fitted.

Effect of Different Intracanal Medicaments on the Viability and Survival of Dental Pulp Stem Cells.

BACKGROUND: Stem cells play an important role in the success of regenerative endodontic procedures. They are affected by the presence of medicaments that are used before the induction of bleeding or the creation of a scaffold for endodontic regeneration. This study examines the effects of different intracanal medicaments on the viability and survival of dental pulp stem cells at different doses and over different exposure times. METHODS: Dental pulp stem cells were cultured from healthy third molar teeth using the long-term explant culture method and characterized using flow cytometry and exposed to different concentrations of calcium hydroxide, doxycycline, potassium iodide, triamcinolone, and glutaraldehyde, each ranging from 0 (control) to 1000 µg/mL. Exposure times were 6, 24, and 48 h. Cell viability was measured using the MTT assay, and apoptosis was measured using the Annexin V-binding assay. RESULTS: All medicaments significantly reduced cell viability at different concentrations over different exposure times. Calcium hydroxide and triamcinolone favored cell viability at higher concentrations during all exposure times compared to other medicaments. The apoptosis assay showed a significant increase in cell death on exposure to doxycycline, potassium iodide, and glutaraldehyde. CONCLUSION: The intracanal medicaments examined in our study affected the viability of dental pulp stem cells in a time and dose-dependent manner. They also adversely affected the survival of dental pulp stem cells. Further studies are needed to better understand the effect of prolonged exposure to medicaments according to clinical protocols and their effect on the stemness of dental pulp stem cells.

Radicular canal disinfection using photodynamic therapy and sodium hypochlorite following three chelating agents' green tea extract, grape extract, and EDTA on the push-out bond strength of epoxy resin-based sealer.

AIM: To appraise the efficacy of photodynamic therapy (PDT) and conventional regime (NaOCl) following three chelating agents ethylene diamine tetraacetic acid (EDTA), Green tea extract (GTE), grape extract (GE) on pushout bond strength (PBS) of epoxy resin-based sealer with root dentin. MATERIAL AND METHODS: 60 single-rooted human teeth were prepped using a ProTaper system and cleansed using photodynamic therapy (PDT) and 5% NaOCl (n = 30 each). Samples in each group PDT and 5% NaOCl were further divided into 6 sub-group (n = 10) based on the chelating agents used: 17% EDTA, GTE, and GE. Gutta-percha and AH Plus were used to obturate the canals. The push-out test was used to determine bond strength, and ANOVA was used to conduct statistical analysis while failure patterns were classified as adhesive, cohesive, or mixed. The Chi-squared test was used to examine the different failure modes at a significance level of 0.05. RESULTS: NaOCl disinfection, when applied with naturally derived reducing agents (17% EDTA, GTE, and GE) demonstrated significantly higher PBS compared to PDT when used with chelating agents (17% EDTA, GTE, and GE) (p < 0.05). The most predominant failure mode was an adhesive failure when root dentin was disinfected with PDT while NaOCl treatment showed a high percentage of cohesive failure. CONCLUSION: Radicular canal disinfection with sodium hypochlorite following three chelating agents (Green tea extract, Grape extract, and Ethylene diamine tetraacetic acid) exhibited better push-out bond strength bonded to radicular dentin with epoxy resin-based sealer.

Radicular canal disinfection using photon-induced photoacoustic streaming and riboflavin photosensitizer to silver diamine fluoride and diode laser bonded to fiber post: An assessment of extrusion bond strength.

AIM: The present study aimed to estimate and compare the effectiveness of different innovative canal cleansing approaches photon induced photoacoustic streaming (PIPS) Riboflavin Photosensitizer (RF), Diode Laser, and silver diamine fluoride (SDF) on push out bond strength (PBS) of fiber post cemented to radicular dentin MATERIAL AND METHODS: Forty extracted premolars were disinfected and decoronated up to the cement-o-enamel junction. Canals of all specimens were cleaned and shaped utilizing a reciprocating system. Post space was created by employing peso-reamers and samples were randomized into four groups based on methods of disinfection (n = 10). Group 1 (PIPS), group 2 (Diode Laser), group 3 (RP), and group 4 (SDF) canal disinfection. Fiber posts were cemented via Self etch resin cement (SERC) in a radicular dentin post space area and root was segmented at three levels (coronal, middle and apical). PBS analysis was performed, and a stereomicroscope was used to assess the failure mode. The means and standard deviations of PBS among studied groups were measured using one-way analysis of variance (ANOVA) after exposure. The means of bonding strength were compared by Tukey multiple comparison tests (p > 0.05). RESULTS: RF had the highest PBS at all three root levels, coronal (8.31 ± 0.64 MPa), middle (8.13 ± 0.11 MPa) and apical (5.68 ± 0.54 MPa) while group 4 SDF samples showed lowest PBS at all root portions, coronal (6.14 ± 0.78 MPa), middle (5.18 ± 0.15 MPa) and apical (3.15 ± 0.19 MPa), respectively. Intergroup comparison unveiled comparable PBS at all three root levels for group 1 (PIPS) and group 3 RF (p > 0.05). Intragroup comparison displayed a significant decline in PBS values from coronal, middle to the apical direction in all studied groups CONCLUSION: Disinfection of radicular dentin with Riboflavin Photosensitizer and photon-induced photoacoustic streaming bonded to fiber post have the greatest PBS at all three levels cervical, middle and apical.

Risk analysis of factors in clinical anxiety among undergraduate and postgraduate students in dentistry.

BACKGROUND: When anxiety is persistent among dental students, the consequence could be poor academic performance, ill health, lack of empathy, and exhaustion. OBJECTIVE: This study aimed to determine the level of anxiety along with anxiety-provoking factors among clinical dental students. METHODS: This study included dental undergraduate and postgraduate clinical students from a public university. A modified version of the self-administered Moss and McManus questionnaire, which consisted of 50 items, was utilized to evaluate the levels of anxiety. The results were analyzed using SPSS® version 24. The significance level was set at p < 0.05. RESULTS: Within 180 participants, 140 (77.77%) were undergraduate students, while 40 (22.22%) were postgraduate dental students. Overall, the top clinical anxiety-provoking factor included failure to pass the final examination, whereas the least clinical anxiety-provoking element was communicating with the opposite gender. Significant differences existed among male and female participants in the seven anxiety-provoking factors among the participants namely dealing with elderly patients, fail to pass finals, arresting post-extraction bleeding, patients asking difficult questions, fear of accidental pulp exposure, dealing with a child or non-cooperative patient, and fear of taking an incorrect impression. Postgraduate students showed lower anxiety scores in various clinical tasks as compared to undergraduate students. CONCLUSIONS: Postgraduate dental students share largely the same perspectives with undergraduate dental students on the clinical anxiety-provoking situations with slight variations. Being the future healthcare providers, dental students must learn techniques to help them manage their dental anxiety and fear as well as deal with anxiety related to treating patients.

Influence of synthetic and natural photosensitizers activated by photodynamic therapy on extrusion bond strength of fiber post to radicular dentin.

OBJECTIVE: To assess the effect of different photosensitizers activated by low-level laser therapy on EBS of glass fiber post to radicular dentin. METHODS: This study was conducted at King Saud University from January 2021 to March 202. Fifty maxillary central incisors were sanitized and decoronated. NiTi was used for mechanical instrumentation of the canal. All canals were shaped, cleaned and obturated with gutta-percha. Post space was made using peso reamers. Four Division of groups were made according to photosensitizers used (n=10). Group-1: MBP at 100mg/l, Group-2: Phycocyanin at 100mg/l, Group-3: CP at 500mg/l, and Group-4 toluidine blue photosensitizer (TB). Lasers were used for activation of photosensitizers. In Group-5 samples were irrigated using sodium hypochlorite NaOCl +17% EDTA. Posts were cemented and teeth sectioned into apical, coronal and middle. For EBS all samples were subjected to a universal testing machine. Fracture patterns were analyzed using stereomicroscope. To compare EBS at different segments One-way analysis of variance (ANOVA) and Tukey multiple comparison tests (p=0.05) was performed. RESULTS: The maximum value of EBS was shown in Group-2 radicular canal treated with CP with 17% EDTA at all three levels cervical (8.61±1.32 MPa), middle (6.81±0.73 MPa), and apical (5.51±0.25 MPa). Similarly, the minimum value of EBS was displayed in Group-5 canal irrigated with 2.25% NaOCl +17% EDTA (control) coronal (6.10±1.77 MPa), middle (5.11±0.75MPa), and apical (3.60±0.94 MPa). Intragroup assessment disclosed a decrease in EBS from cervical one-third to apical one-third in all groups. CONCLUSION: P, CP, and TB along with EDTA have the potential to be used as canal disinfectant and favors the bonding of GFP to radicular dentin using self-etch adhesive resin.

Saving a Natural Tooth in the Implant Era: A Case Report on Noninvasive Surgical Root Amputation.

AIM: This report highlights the use of a seldom-used treatment modality to save a diseased multirooted tooth, as an alternative to extraction and implant. BACKGROUND: Root-resection therapy is a simple surgical procedure performed by an endodontist or periodontist to save a multirooted tooth with furcation involvement and/or defective root. CASE DESCRIPTION: A 64-year-old female patient reported a strip perforation in the distobuccal (DB) root of the maxillary left first molar. The tooth had previously undergone endodontic treatment and had a well-fitted crown. After presenting the patient with treatment options and prognosis, a treatment plan of root amputation to save the tooth was formulated. A full mucoperiosteal flap was reflected. The DB root was amputated and GIC was placed to cover the root. Sutures were placed and the patient was given postoperative instructions. A follow-up was carried out with clinical examination, and periapical radiographs were taken at 10 months, 2 years, and 5 years after the procedure. The tooth was intact and functioning; no signs or symptoms were reported. CONCLUSION: Root resection has a deserved place in the modern clinical management of endodontic lesions or injuries. Conventional conservative treatment plans can succeed with proper treatment planning, diagnosis, case selection, maintenance of oral hygiene, and meticulous follow-up. CLINICAL SIGNIFICANCE: This case emphasizes a viable treatment procedure to manage teeth with compromised radicular or restorative presentations. Root resection is a venerable treatment option that is often ignored in the era of implants even though it shows favorable prognosis and success rates.

Efficacy of Different Endodontic Irrigant Activation Techniques on Debris Removal from the Mesial Root Canal System of Mandibular Molars.

AIM AND OBJECTIVE: This study was conducted to compare debris removal from the mesial canal system with four different irrigation techniques: sonic activation with EDDY, passive ultrasonic irrigation (PUI), mechanical activation with the XP-endo Finisher (XPF), and manual dynamic irrigation (MDI) with gutta-percha. MATERIALS AND METHODS: Fifty-six extracted mandibular molars with isthmus in the apical 5 mm in mesial roots were sectioned horizontally at 3 mm and 5 mm from the apex. The sections were reassembled, and the mesial canals were prepared chemomecahanically. Specimens were allocated randomly into four groups according to the final irrigation technique. Standardized images of the coronal aspect of cross sections were obtained using a digital stereomicroscope before and after final irrigation protocols to calculate the percentage of debris elimination from the canal system after final irrigation. RESULTS: The use of EDDY, PUI, and XPF exhibited significant reductions in debris compared with MDI at 5 mm (p <0.00) and at 3 mm (p <0.00). Furthermore, no significant difference was noted among EDDY, PUI, and XPF. For intragroup analysis, no statistically significant difference in the percentage of debris elimination was noted between 3 mm and 5 mm in all four groups. CONCLUSION: All groups showed a reduction in debris after the final irrigation protocol. However, the use of EDDY, PUI, and XPF after cleaning and shaping yielded a significant reduction in debris compared with MDI. CLINICAL SIGNIFICANCE: The use of PUI, XPF, and EDDY as an adjunctive irrigation step presented similar results in improving canal cleanliness, which is hypothesized to affect the treatment outcome.

Complete Obturation-Cold Lateral Condensation vs. Thermoplastic Techniques: A Systematic Review of Micro-CT Studies.

To prevent re-infection and provide a hermetic seal of the root canal system, an endodontist must aim to produce a void-free obturation. This review aimed to compare the completeness of root canal obturation between the two most prevalent methods-cold lateral condensation and warm gutta-percha techniques-using micro-CT (PROSPERO reg no. 249815). MATERIALS AND METHODS: A search of Scopus, Embase, PubMed (Medline via PubMed), and Web of Science databases was done without any time restriction according to the PRISMA protocol. Articles that compared both techniques and were published in English were included. Data was extracted and the risk of bias was assessed using an adapted tool based on previous studies. RESULTS: A total of 141 studies were identified by the search. Following the screening and selection of articles, 9 studies were included for review. Data was extracted manually and tabulated. Most studies had a moderate risk of bias. None determined operator skill in both methods before comparison. The data extracted from the included studies suggests that both techniques produce voids in the obturation. The thermoplasticized gutta-percha techniques may result in fewer voids compared to cold lateral condensation. CONCLUSION: Considering the limitations of the included studies, it was concluded that neither technique could completely obturate the root canal. Thermoplasticized gutta-percha techniques showed better outcomes despite a possible learning bias in favor of cold lateral condensation. Establishing operator skills before comparison may help reduce this bias.

Prevalence of Missed Canals and Their Association with Apical Periodontitis in Posterior Endodontically Treated Teeth: A CBCT Study.

BACKGROUND: This study aimed to assess the prevalence of missed canals in endodontically treated teeth and their association with apical periodontitis in a Saudi Arabian population using CBCT. MATERIALS AND METHODS: A total of 208 CBCT radiographs were investigated. For each tooth, radiographs of axial, coronal, and sagittal segments were acquired to appraise the external as well as the internal structure of the root canal system and apical area. In root canal-treated teeth, unfilled canals appearing from the cementoenamel junction to the apex were defined as missed untreated canals; and a periapical lesion was considered when disruption of the lamina dura was detected, and the low-density area associated with the radiographic apex was at least twice the width of the periodontal ligament space. The data were presented as frequencies and percentages. The Z-test was used to analyze the differences in proportions with the significance level set at P value <0.05. RESULTS: The overall prevalence of missed canals among endodontically treated teeth was 18%. The prevalence of missed canals was higher in maxillary first molars with 40.6%. The overall prevalence of apical periodontitis among teeth with missed canals was 90%. It was 84.2% in the maxilla and 100% in the mandible. The second mesiobuccal canal in the maxillary first molars and mesiobuccal and distobuccal canals in mandibular teeth were the most missed canals. CONCLUSION: Apical periodontitis in root canal-treated teeth with missed canals was high (90%), with most identified missed canals in maxillary and mandibular first molars.

Ethnical Anatomical Differences in Mandibular First Permanent Molars between Indian and Saudi Arabian Subpopulations: A Retrospective Cross-sectional Study.

AIM AND OBJECTIVE: The variation in the anatomy of the root canal system has anthropological and demographic significances. The aim of this study was to compare the number of roots, root canals, and internal canal morphology of permanent mandibular first molars between Indian and Saudi Arabian populations. MATERIALS AND METHODS: A total of 523 (255 teeth of Indian sample and 268 teeth of Saudi Arabian sample) mandibular first molar (M1) were included for comparative analysis using cone-beam computed tomography images based on the inclusion criteria. The external and internal morphologies were assessed and compared by trained endodontist and the data was recorded. RESULTS: M1 with three roots were found in 3.9% of the Indian population and 6% of the Saudi population. Overall, high prevalence was observed in two roots (95.0%), three canals (70.4%), Vertucci type IV of the mesial root (56.0%), and Vertucci type I of the distal root (76.7%). Comparison between Indian and Saudi Arabian molars revealed significant differences in relation to the number of canals (p <0.001), Vertucci types of the mesial root (p = 0.008), and Vertucci types of the distal root (p <0.001). Differences between genders for the whole sample revealed significant differences in relation to Vertucci types of the distal root (p = 0.025) with a relatively high male prevalence of type I (54.4%) and type IV (57.1%). CONCLUSION: The predominant parameters of M1 were two roots, three canals, Vertucci type II and IV mesial root configuration, and type I distal root configuration irrespective of both populations. The root canal morphology of Indian and Saudi Arabian populations shares a common trait of Asian origin. CLINICAL SIGNIFICANCE: The likelihood of predicting the complex system of the root canal with marked preference to ethnic identity would be a clinical benefit for the dentist performing root canal treatment. How to cite this article: Mashyakhy M, Vinothkumar TS, Arthisri AS et al. Ethnical Anatomical Differences in Mandibular First Permanent Molars between Indian and Saudi Arabian Subpopulations: A Retrospective Cross-sectional Study. J Contemp Dent Pract 2021;22(5):484-490.