Resident selection, assessment, and management: Proceedings of the 2022 ADEA Advanced Dental Education Summit.

The fifth biennial Advanced Dental Education Summit was organized by the ADEA Council on Advanced Education Programs. With a focus on "Resident selection, assessment, and management," the summit aimed to discuss best practices for selecting, assessing, and managing advanced education residents. Expert presentations covered the resident's journey from interview to graduation, emphasizing strategies for supporting resident wellness, success, and evaluation. The summit provided recommendations, including the incorporation of psychosocial assessments in the selection process, early recognition of behavioral issues, clearly defining clinical competencies, and creating a culture of wellness through supportive policies and structures.

Altered Prevalence of Pulp Diagnoses in Diabetes Mellitus Patients: A Retrospective Study.

INTRODUCTION: Diabetes mellitus (DM) is a complex multisystemic disorder that affects an estimated 21 million Americans. No studies have evaluated the association of DM with the prevalence of each pulpal diagnosis. The objective of this study was to compare the prevalence of each pulp diagnosis including symptomatic irreversible pulpitis (SIP), asymptomatic irreversible pulpitis, reversible pulpitis, normal pulp, and pulp necrosis (PN) in DM patients against a nondiabetic control group. METHODS: A retrospective chart review was approved by Rutgers University Institutional Review Board. The prevalence of the diagnoses SIP, asymptomatic irreversible pulpitis, reversible pulpitis, normal pulp, and PN was calculated from AxiUm (Exan software, Las Vegas, NV) electronic health records at Rutgers School of Dental Medicine. The chi-square test was used to see the relationship between the 2 categoric variables. Second, binary logistic regression analyses were performed for each group. RESULTS: A total of 2979 teeth were diagnosed with a pulp condition between April 2013 and November 2018. The total tooth number of DM patients was 682, whereas the tooth number of nondiabetic patients was 2297. In the subgroup of patients younger than 40 years old, SIP was notably more prevalent in DM patients. In addition, the prevalence of PN in elderly DM patients (60-69 years old) was significantly higher than in the control group. CONCLUSIONS: The prevalence of SIP in DM patients was significantly higher compared with the control group (<40 years old), suggesting the possibility that DM could hypersensitize the subgroup of patients younger than 40 years old to pulpitis pain.

Genetic variation in catechol-O-methyltransferase is associated with individual differences in conditioned pain modulation in healthy subjects.

BACKGROUND: Genetic variation in the catechol-O-methyltransferase (COMT) gene is associated with sensitivity to both acute experimental pain and chronic pain conditions. Four single nucleotide polymorphisms (SNPs) have traditionally been used to infer three common haplotypes designated as low, average and high pain sensitivity and are reported to affect both COMT enzymatic activity and pain sensitivity. One mechanism that may partly explain individual differences in sensitivity to pain is conditioned pain modulation (CPM). We hypothesized that variation in CPM may have a genetic basis. METHODS: We evaluated CPM in 77 healthy pain-free Caucasian subjects by applying repeated mechanical stimuli to the dominant forearm using 26-g von Frey filament as the test stimulus with immersion of the non-dominant hand in hot water as the conditioning stimulus. We assayed COMT SNP genotypes by the TaqMan method using DNA extracted from saliva. RESULTS: SNP rs4680 (val158 met) was not associated with individual differences in CPM. However, CPM was associated with COMT low pain sensitivity haplotypes under an additive model (p = 0.004) and the effect was independent of gender. CONCLUSIONS: We show that, although four SNPs are used to infer COMT haplotypes, the low pain sensitivity haplotype is determined by SNP rs6269 (located in the 5' regulatory region of COMT), suggesting that inherited variation in gene expression may underlie individual differences in pain modulation. Analysis of 13 global populations revealed that the COMT low pain sensitivity haplotype varies in frequency from 13% to 44% and showed that two SNPs are sufficient to distinguish all COMT haplotypes in most populations.

Factors Associated with Incomplete Endodontic Care.

INTRODUCTION: Incomplete endodontic treatment has been associated with detrimental health outcomes. METHODS: This retrospective study reviewed charts of patients receiving endodontic care over a 1-year period at the Postgraduate Endodontic Clinic at Rutgers School of Dental Medicine, Newark, NJ, to assess whether factors such as receipt of palliative endodontic care and demographic factors were associated with completion, or noncompletion, of initial nonsurgical root canal therapy (RCT). RESULTS: A total of 1806 patient charts met the study inclusion criteria. With descriptive statistics and bivariate analysis, the variables of palliative care, Medicaid recipient, age group, and distance from the clinic were significantly associated with RCT completion (P < .05). In the binary logistic regression with all independent variables, palliative care and age group variables were the significant factors (P < .05). Patients who had no palliative care had 8.5 times the odds of completing RCT than patients who had received palliative care. The age group of 18-35 years had 0.59 times the odds of complete RCT than the age group <18 years. CONCLUSIONS: Incomplete nonsurgical endodontic treatment is highly associated with the receipt of prior palliative care. Further research is indicated to investigate additional factors that may influence patient completion of endodontic care and opportunities to improve public health care program design to obtain optimal patient-centered outcomes.

Effect of Diabetes on Rotary Instrumentation of Dentin.

INTRODUCTION: Diabetes mellitus (DM) may affect the physical and mechanical properties of dentin, which could potentially have an impact on root canal procedures. This study aimed to compare the amount of dentin removed by an endodontic rotary file, comparing dentin from diabetic patients with dentin from control patients under laboratory conditions. METHODS: The amount of dentin removed was tested using new F3 ProTaper (Dentsply Maillefer, Ballaigues, Switzerland) files applied against the surface of prepared dentin discs for 3 different groups: diabetic type 1 (D1), diabetic type 2 (D2), and nondiabetic (normal). The dentin removed was determined by measuring the depth of penetration of the file using a digital caliper and by measuring the weight loss. Data were analyzed using Kolmogorov-Smirnov, analysis of variance, post hoc Tukey, and Pearson correlation tests (P < .05). RESULTS: Significantly more dentin was removed, and the penetration of the F3 instrument was significantly higher (P < .05) in DM specimens. The statistical analysis revealed significant differences between the D1, D2, and normal groups (P < .05) for the weight loss of the specimen as well as the penetration depth at point B (P < .05). Both the weight loss and depth of penetration showed a very high positive correlation (P < .05). CONCLUSIONS: The dentin of patients suffering from both D1 and D2 exhibited an increased amount of dentin removed compared with the nondiabetic dentin specimens. This can be observed by the increased penetration of the rotary instruments into dentin. Under certain circumstances, this may impact instrumentation, increasing procedural accidents and leading to subsequent weakening of root canal-treated teeth in diabetic patients.

Dental Abscess to Septic Shock: A Case Report and Literature Review.

Sepsis is a leading cause of death in the United States, with a mortality rate in excess of 215,000 deaths per year. It may lead to septic shock, a complex pathophysiological process with microbial and host response events that progress to multisystem derangement. There is poor documentation of the relationship between dental infection and septic shock, with only a few case reports of septic shock secondary to dentoalveolar abscess. Presented is a case of sepsis/septic shock in a 23-year-old man with signs and symptoms of pulpal necrosis, acute apical abscess, and canine space infection that rapidly progressed to an altered mental state, hyperthermia, tachycardia, hypotension, acute respiratory failure, diarrhea, renal insufficiency, lactic acidosis, leukocytosis, and hyperglycemia. Once septic shock develops, the mortality rate is nearly 50%. Early antimicrobial intervention is associated with surviving severe sepsis, making it critical for dentists to understand local factors leading to the crisis and the signs and symptoms of the sepsis-septic shock continuum.

Chamberless Endodontic Access for Treatment of Calcified Anterior Central Incisors.

INTRODUCTION: Modern techniques for treating maxillary anterior central incisors with calcified canals emphasize maintaining coronal dentin with small crown access. Alternatively, traditional retrograde surgical procedures are focused on creating an apical seal predominately limited to the remaining resected apical one third of the root canal space. A treatment option for calcified anterior teeth, with avoidance of traditional orthograde access, is presented. Chamberless endodontic access (CEA) to the canal is chosen in this case, leveraging a previous surgical treatment and osseous defect to create straight line canal access. METHODS: A tooth presenting with a chronic apical abscess and an apparent previous apical surgery was instrumented and obturated using a CEA avoiding the traditional orthograde approach to the root canal system. Straight line approach was achieved retrograde and canal instrumentation was performed using ultrasonic activated U-files. Canal obturation was accomplished with warm vertical condensation technique followed by placement of an apical retroseal. RESULTS: A successful 52-month outcome demonstrated the viability of CEA facilitating retrograde instrumentation and obturation. CONCLUSIONS: Use of CEA simultaneously protected the clinical crown and provided a successful clinical outcome. A viable option for treatment of an anterior calcified canal and abscess due to dental trauma, CEA mitigates many of the risks associated with the treatment of calcified root anatomy.

Incidence of Middle Mesial Canals Based on Distance between Mesial Canal Orifices in Mandibular Molars: A Clinical and Cone-beam Computed Tomographic Analysis.

INTRODUCTION: This study evaluated the presence of midmesial canals (MMCs) in a random sample of mandibular molars and the relationship of the intracanal distance between mesiobuccal (MB) and mesiolingual (ML) canal orifices. METHODS: Fifty-one extracted mandibular molars were divided into samples of 3 to 4 teeth, mounted in plaster and boxing wax, and immersed in water before cone-beam computed tomographic (CBCT) imaging. Two endodontic residents completed the access openings. The teeth and the CBCT images were interpreted for the presence of MMCs and the mesial intracanal distance. CBCT software measured the distance between the buccal of the MB canal to the lingual of the ML canal at the pulpal floor to determine the average length between the canals. RESULTS: Seven distinct MMCs were seen both clinically (incidence of 13.725%) and on the CBCT images. Twenty-seven teeth (52.94%) had ambiguous broad isthmi between the MB and the ML orifices. MMCs were present at the furcation level but merged with the MB or ML canal toward the apex in 6 of 7 teeth (85.71%). The mean distance between the mesial canals in teeth with MMCs was 3.643 mm, and it was 3.818 mm for teeth without MMCs. According to independent sample t testing, the P value was >.05. CONCLUSIONS: The incidence of MMCs in mandibular molars appears consistent with the literature. However, there does not appear to be a statistically significant difference in the mesial intracanal distance in teeth with and without MMCs. Visualization of MMCs on CBCTs may be subjective. There does not appear to be a correlation between the presence of MMCs and an increased or decreased mesial intracanal distance.

Altered pain modulation in patients with persistent postendodontic pain.

Persistent pain may follow nerve injuries associated with invasive therapeutic interventions. About 3% to 7% of the patients remain with chronic pain after endodontic treatment, and these are described as suffering from painful posttraumatic trigeminal neuropathy (PTTN). Unfortunately, we are unable to identify which patients undergoing such procedures are at increased risk of developing PTTN. Recent findings suggest that impaired endogenous analgesia may be associated with the development of postsurgical chronic pain. We hypothesized that patients with PTTN display pronociceptive pain modulation, in line with other chronic pain disorders. Dynamic (conditioned pain modulation, temporal summation) and static (response to mechanical and cold stimulation) psychophysical tests were performed intraorally and in the forearm of 27 patients with PTTN and 27 sex- and age-matched controls. The dynamic sensory testing demonstrated less efficient conditioned pain modulation, suggesting reduced function of the inhibitory endogenous pain-modulatory system, in patients with PTTN, mainly in those suffering from the condition for more than a year. The static sensory testing of patients with PTTN demonstrated forearm hyperalgesia to mechanical stimulation mainly in patients suffering from the condition for less than a year and prolonged painful sensation after intraoral cold stimulus mainly in patients suffering from the condition for more than a year. These findings suggest that PTTN is associated more with the inhibitory rather than the facilitatory arm of pain modulation and that the central nervous system has a role in PTTN pathophysiology, possibly in a time-dependent fashion.

An evaluation of setting time of mineral trioxide aggregate and EndoSequence root repair material in the presence of human blood and minimal essential media.

INTRODUCTION: The purpose of this study was to compare the ability of MTA (Dentsply Maillefer, Tulsa, OK) and EndoSequence Root Repair Material (ESRRM; Brasseler USA, Savannah, GA) to set in the presence of human blood and minimal essential media. METHODS: A model was created using polymethyl methacrylate blocks each prepared with 10 standardized wells (2-mm diameter × 3-mm depth). Prepared ProRoot MTA (Dentsply Maillefer) and ESRRM were each placed in 6 separate blocks. The samples were distributed among the 4 different media (ie, blood, minimal essential media, blood and minimal essential media, and sterile saline as the control). Each block was submerged for 4, 5, 6, 8, 24, 36, and 48 hours in an incubator at 37°C with 100% humidity. RESULTS: The results revealed that regardless of the type of media exposure, neither of the materials set at 4 or 6 hours. ESRRM was not set at 48 hours, whereas all of the MTA samples were set at 36 hours. CONCLUSIONS: This outcome draws into question the proposed setting time given by each respective manufacturer. Furthermore, despite ESRRM being marketed as a direct competitor to MTA with superior handling properties, MTA consistently set at a faster rate under the conditions of this study.

Comparison of sealing ability of MTA and EndoSequence Bioceramic Root Repair Material: a bacterial leakage study.

OBJECTIVE: To compare the sealing ability of ProRoot mineral trioxide aggregate (MTA) to the sealing ability of EndoSequence Bioceramic Root Repair Material (ES-BCRR) putty using a bacterial leakage model. METHOD AND MATERIALS: Root canals of 60 single-rooted extracted teeth were enlarged to an apical diameter of 0.5 mm using EndoSequence files. The apical 3 mm of each root was sectioned at 90 degrees to the long axis of the root. An ultrasonic surgical tip was used to prepare a 3-mm deep root-end preparation in all teeth. Teeth were equally divided into four groups: Group 1, MTA; Group 2, ES-BCRR putty; Group 3, positive control, gutta-percha without sealer; Group 4, negative control, sealed with wax and nail varnish. Prepared teeth were kept moist for 48 hours to allow for initial setting of the materials. After ethylene oxide sterilization, the teeth were suspended in sterilized vials containing 3% phenol lactose broth and inoculated with Enterococcus faecalis through the occlusal access openings. The samples were observed daily for leakage to a maximum of 28 days. Chi-square and Fisher exact tests were used to compare the experimental groups and an alpha level of significance was set at P = .05. RESULTS: In the ES-BCRR group 93% of samples leaked, compared to only 20% of samples in the MTA group. There was a significant difference in leakage between the experimental groups (P < .0001). Also there were no significant differences between the negative control group and MTA group and between the positive control group and ES-BCRR group (P = 1.00). CONCLUSION: Samples in the ES-BCRR group leaked significantly more than samples in the MTA group.