Department Of Endodontics Research Articles

Influence of operator's experience on the quality and success rate of root canal treatment with new nickel-titanium instruments

Objective: To analyze the influence of operator's experience on the quality and success rate of root canal treatment with new nickel-titanium instruments, providing support for improving the success rate of root canal treatment with new nickel-titanium instruments in clinic. Methods: Cases of root canal treatment and non-surgical root canal retreatment with 6-12 months recall performed by residents (resident group) with experience of 1-3 years and endodontic specialists (specialist group) with experience of 5-7 years were collected from the electronic medical system of the Department of Endodontics, School of Stomatology, Capital Medical University, from September 2020 to August 2021. All cases were prepared by engine-driven glide path files and controlled memory nickel-titanium finishing files. Chi-square test and logistic regression were used to analyze the differences and influencing factors of complications, filling quality and success rate of root canal treatment between the two groups. Results: A total of 277 cases performed by 24 residents and 3 specialists were included, 169 in the resident group and 108 in the specialist group. The clinical incidence of flare-ups was significantly higher in the resident group [3.6% (6/169)] than in the specialist group [0(0/108)] (P=0.048). There were no significant differences in ledges, root canal transportations, perforations, or instrument separations between the two groups (P>0.05). The prevalence of satisfactory fillings was 62.7% (106/169) in the resident group, which was significantly lower than that in the specialist group [86.1% (93/108)] (P<0.05). The success rate of root canal treatment was 91.7% (155/169) and 94.4% (102/108) in the resident group and the specialist group, respectively, with no significant differences (χ2=0.73,P=0.392). Multivariate analysis showed that the success rate of root canal treatment was related to complications and quality of root fillings (P<0.05). Conclusions: Higher success rate of root canal treatment could be achieved by residents and endodontic specialists with engine-driven glide path files and controlled memory nickel-titanium files.

Reasons for Patients Preferring Extraction over Root Canal Treatment in a Tertiary Care Hospital

Introduction: Dental caries is a major global oral health issue, potentially progressing to irreversible pulpitis and causing substantial discomfort. Although advancements in materials, instruments and knowledge have improved the success rates of root canal procedures, some patients opt for tooth extraction instead of root canal treatment. This choice can result in tooth loss, necessitating costly prosthetic replacements. Objective: The objective of this study was to determine the reasons for patients choosing extraction over root canal treatment. Methods: A descriptive cross-sectional study was conducted among 205 patients visiting the Department of Conservative Dentistry and Endodontics at Kathmandu Medical College for the treatment of irreversible pulpitis, who ultimately opted for extraction. A structured questionnaire was utilized, and responses were recorded and analyzed using the Statistical Package for the Social Sciences. Mean, standard deviation, frequency and percentage were calculated depending upon the nature of data. Results: The study found that the primary reason for patients not undergoing root canal treatment (RCT) was the high cost of RCT and crown, accounting for 42.9% (88 patients), followed by the need for more appointments with pain, at 31.2% (64 patients). Conclusions: This study revealed the cost of RCT and crown to be the major factor for patients opting out from RCT. The study provides valuable insights into the psychology of patients regarding RCT, highlighting reasons for its rejection. Such understanding assists dentists and specialists in tailoring treatment plans that align with patient preferences and needs.

Patient’s Perceptions and Experiences about the Root Canal Treatment: A Survey among Patients Visiting Nobel Medical College

Introduction: One major drawback of root canal therapy (RCT) is that most people don't know enough about it. To effectively address the issue, it is imperative to comprehend and identify the elements that impede or discourage patients from undergoing Root Canal Treatment. A survey of the literature reveals a dearth of information regarding patients' understanding and acceptability of root canal treatment (RCT) in the Nepali community. Objective: The objective of the study was to determine how well-informed patients were about root canal treatment at Nobel Medical College and Teaching Hospital in Biratnagar. A wide-ranging patient viewpoint on the matter was sought by means of a patient survey. Methods: This survey was conducted with the help of prestructured questionnaire consisting of 15 questions, distributed to random 250 patients coming to the outpatient department of Conservative dentistry and Endodontics at Nobel Medical College and Teaching Hospital. The completed questionnaires were then analyzed to assess patients’ experiences, concerns, and perceptions about RCT. Results: There is a lack of awareness among patients regarding RCT. Conclusion: The people need to be made more aware of the importance of maintaining a healthy dentition and the consequences that follow if this isn't done. If patients were fully informed about endodontic procedures, more might consider having them.

Root Canal Morphology of Premolars in Population of Hyderabad, Pakistan: A Cone Beam Computerised Tomographic Analysis.

To investigate the mean tooth length and root canal configuration of human maxillary and mandibular premolars in the population of Hyderabad, Pakistan, using Cone Beam Computed Tomography (CBCT). Observational study. Place and Duration of the Study: Department of Operative Dentistry and Endodontics, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan, from December 2022 to March 2023. Using retrospective analysis of CBCT scans, tooth length, the number of roots, and root canal configuration of 536 mandibular and maxillary premolars were assessed in the subpopulation of Pakistan. The data were analysed employing descriptive statistics, Chi-square tests, and One-Way ANOVA to determine the association between various factors and root canal morphology. Vertucci Type 1 (one canal) was the most common configuration in maxillary premolars, with frequencies ranging from 46.3 to 52.2%. The mean length of all 8 premolars ranged from 20.56 mm to 21.58 mm. C-shaped canal configurations were observed in a small percentage of maxillary and mandibular premolars, with C1 being the most common. No significant association was found between gender and canal configuration or tooth length, and in tooth lengths among different canal configurations. Vertucci Type 1 was the most common configuration in maxillary premolars, followed by Vertucci Type 4. Single-rooted premolars were more prevalent, while two-root configurations were less common. C-shaped canal configurations were observed in a small percentage of premolars, with higher frequency in mandibular premolars. Cone beam computed tomography, Dental anatomy, Endodontics, Premolars, Root canal morphology.

EFFECT OF INTRACANAL CRYOTHERAPY ON THE POST ENDODONTIC PAIN IN TEETH WITH SYMPTOMATIC APICAL PERIODONTITIS

Objectives: To compare the effect of cryotherapy, room temperature saline and no saline as final root canal irrigants on post-endodontic pain in patients with symptomatic apical periodontitis.Materials and Methods: An observational study was done at the Endodontics Department of Rehman College of Dentistry, Peshawar from August 2023 to January 2024. Ninety patients were selected via purposive sampling technique and underwent root canal treatment. After root canal preparation, patients were equally divided into three groups using the lottery method: Cryotherapy group, room temperature saline group and no saline group. Pain on percussion was recorded pre-operatively and 24hours post-operatively for every patient using the visual analogue scale. Wilcoxon Signed ranks test was used to assess the signifi cant difference between mean pre-endodontic and post-endodontic pain levels. Post hoc analysis was used to compare the significant difference (p value&lt;0.05) between each group. Results: At 24 hour post-operatively, the mean post-endodontic pain scores on visual analogue scale were 2.50± 1.253 for cryotherapy group, 2.70±2.261 for room temperature saline group and 3.63±1.938 for no saline group. The result shows that the post-endodontic pain reduces signifi cantly in all the three groups(p&lt;0.05). However, cryotherapy as the final irrigant was found to be significantly more eff ective in reducing the post-endodontic pain than no saline as the final irrigant (p value 0.029). No significant difference was found in between the cryotherapy group and the room temperature saline groups (p value 0.964).Conclusion: Cryotherapy as the final root canal irrigant is the most effective method of reducing post-endodontic pain as compared to when no saline was used as the final irrigant. Room temperature saline is also as useful as cryotherapy in reducing post-endodontic pain. The findings of the study will be helpful for the dentists to minimize post-endodontic pain.

Effectiveness of mechanical vs. chemomechanical methods in removing intracanal calcium hydroxide medication: a randomised trial.

To compare the mechanical and chemomechanical methods for removing calcium hydroxide medication from the root canal system. The triple-blind, randomised clinical trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, from December 16, 2022, to June 15, 2023, and comprised patients having necrotic teeth and chronic apical pathosis. They were randomised into groups A and B. On the initial visit, after access opening and chemomechanical preparation, calcium hydroxide paste was placed as an intracanal medication in both groups. the patients were recalled after two weeks. In Group A, calcium hydroxide was removed from the canals using a rotary master apical file, while in Group B, an endoactivator was used to sonically agitate the endodontic irrigant. Verification of placement was done by using a periapical radiograph. Data was analysed using SPSS 26. Of the 98 individuals assessed initially, 60(61.22%) were included; 34(57%) females and 26(43%) males with age ranging from 19 to 57 years. There were 27(45%) incisors, 22(36.7%) premolars and 11(18.3%) canines. There were 30(50%) patients in each of the 2 groups. The intergroup difference was not statistically significant (p=0.43). Tooth arch did not significantly correlate with the removal method (p=0.79). Both methods were found to be equally effective in removing water-based calcium hydroxide medication from the endodontic system. NCT05744661.

Postoperative sensitivity of composites using novel Bacillus subtilis nanofortified adhesives: a triple-blind study

Nanotechnologyis the art and science of dealing with nanoscale particles. This has transformed contemporary dental practices through myriad contributions to biomaterial science. Titanium dioxide nanoparticles procured from Bacillus subtilis, an eco-friendly and biogenic source, can significantly magnify the physiochemical attributes of dental materials. However, postoperative sensitivity is a major drawback of composite restorations. The incorporation of these nanoparticles into dental adhesives can greatly benefit clinical dentistry by resolving this issue. This trial aimed to evaluate the effectiveness of a novel titanium dioxide nanofortified adhesive on the postoperative sensitivity of composite restorations.MethodsThis triple-blind, parallel-group randomized controlled trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Islamabad, from May 15, 2023, to November 25, 2023. Participants (n = 60) with Class I and II primary carious lesions with a minimum cavity depth of 3–5 mm were randomly assigned to two groups (n = 30). After obtaining informed consent, the restorative procedure was accomplished using a minimally invasive approach and etch-and-rinse adhesive strategy. In group A, a nanofortified adhesive was used for composite restoration, whereas in group B, an adhesive without nanoparticles was used. Postoperative sensitivity was evaluated using the Visual Analog Scale (VAS) score at follow-up periods: of one day, one week, two weeks and one month. A Chi-square test was used to compare postoperative sensitivity between the two groups. The level of significance was set at p < 0.05.ResultsA noteworthy association was observed between sensitivity and the group variable at all four evaluation periods: after one day (p = 0.002), 1 week (p = 0.002), 2 weeks (p = 0.007) and one month. In conclusion, participants who underwent restorative intervention using titanium dioxide nanoreinforced adhesives reported a notable reduction in sensitivity at all time intervals. Hence, the occurrence and severity of postoperative sensitivity are significantly reduced using Bacillus subtilis-procured nanofortified adhesives as compared to conventional adhesives without nanoparticles.Trial registrationThis trial was retrospectively registered at ClinicalTrials.gov (ID: NCT06242184) on 03/02/2024. All procedures involving human participants were performed in conformance with this protocol.

Comparing efficacies of various papain-based enzyme agents and 2.4% sodium hypochlorite gel in chemomechanical caries removal: a randomized controlled trial

ObjectiveThis study aimed to evaluate and compare the efficacies of Papacarie Duo gel, Brix 3000, Selecti-Solve gel, 2.4% sodium hypochlorite gel, and conventional rotary-mechanical method in caries removal and to evaluate the patient comfort.MethodsIt was a single-blinded, randomized, parallel-group, active-controlled trial with five arms. It was conducted at the Department of Restorative Dentistry and Endodontics, Damascus University. Seventy-five specimens were randomly allocated into five groups: chemomechanical caries removal (CMCR) using Selecti-Solve gel (G1), BRIX3000 (G2), Papacarie DUO gel (G3), or 2.4% sodium hypochlorite gel (G4), and caries excavation using conventional rotary-mechanical method (G5) (control group). The trial considered healthy patients aged 18–40. Permanent molars with class I carious lesions extending to the middle third of dentin with no pulpal and/or periodontal pathology were included. The efficacy of caries removal was considered the primary outcome measure, and the secondary outcome measures were treatment time, volumetric measurement of the cavity, and pain assessment.ResultsThe majority (73.30%) of cases from BRIX3000 and conventional rotary-mechanical method groups showed complete caries removal (p = 0.982). The mean time of caries removal was the highest (17.45 ± 4.42) in the 2.4% sodium hypochlorite gel group (p < 0.05), and the lowest (6.33 ± 1.69) was in the conventional rotary-mechanical method group (p < 0.05). The mean cavity volume was the highest (18.97 ± 9.76) in the Papacarie DUO gel group, and the lowest (14.87 ± 4.76) was in the 2.4% sodium hypochlorite gel group (p = 0.506). The conventional rotary-mechanical group exhibited the highest mean score (5.40 ± 1.72) of pain (p < 0.05). However, the mean score (2.67 ± 1.11) of pain reported reduced in the BRIX3000 group.ConclusionsCMCR agents could be a potential substitute for conventional rotary instrumentation methods, taking into account the long working time.

Clinical Efficacy of a Novel Titania Nanoparticle-Reinforced Bonding Agent in Reducing Post-Restorative Sensitivity: A randomized clinical trial.

To evaluate the clinical efficacy of novel titania-nanoparticle reinforced bonding agent on post-restorative sensitivity in patients. This triple-blinded, randomized clinical trial included participants (n = 60) having Class- I and II cavitations with a minimum cavity depth of 3mm at Department of Operative Dentistry & Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad from January 5, 2023, to June 20, 2023. They were randomly assigned into two groups A and B (n = 30). After informed consent, restorative intervention was accomplished using an etch-and-rinse adhesive strategy. In Group-A, titania-nanoparticle-incorporated bonding agent was used for composite restoration, while in Group-B, bonding agent without nanoparticles was used. The primary outcome was assessed using Visual Analogue Scale mean score. Participants were instructed to rate their sensitivity status at follow-ups: 24 hours, one week, and one month. Mann-Whitney U test was employed to compare sensitivity between the two groups. According to results of this trial, a significant difference was observed between two groups after 24 hours (p = 0.004) and one week (p = 0.002). However, no discernible difference was observed after one month (p = 0.643). Post-restorative sensitivity in patients with composite restorations was reduced using titania-reinforced bonding agents as compared to bonding agents without nanoparticles. This shows that inclusion of titania nanoparticles into adhesive dentistry could be beneficial in resolving post-restorative sensitivity occurring with composite restorations.

A survey on the application of online and offline blended teaching in microendodontics

Objective: To evaluate the effect of online and offline blended teaching in microendodontics, attempting to promote the widespread application of blended teaching mode in Operative Dentistry and Endodontics. Methods: A questionnaire survey was carried out among 865 trainees who attended the blended teaching in microendodontics combined the online theory curriculum and offline practice training from April 6 to 28 in 2022, organized by Department of Operative Dentistry and Endodontics, Hospital of Stomatotogy, Sun Yat-sen University. The content of questionnaire included trainees' basic information as well as their perspectives and expectations on the teaching mode. Data was analyzed by SPSS 24.0 and Chi-square test was used for enumeration data. Results: A total of 855 trainees participated in the valid survey with the effective recall rate of 98.8% (855/865), 50.3% (430/855) of which were young people in 18-30 years old. Their working period ranged from 0.5 to 40 years. Physicians and physician assistants occupied 40.9% (350/855) and 32.9% (281/855), respectively. And the intermediate and senior titles accounted for 26.2% (224/855). The proportion of trainees who had used and never used dental operative microscope (DOM) were 70.5% (603/855) and 29.5% (252/855), respectively. The blended teaching in microendodontics was universally approved by the trainees, which showed more superiority in the improvement of learning efficiency and interest, comprehension of knowledge as well as practical ability, etc., compared to the traditional offline teaching. For the current stomatology education, trainees were inclined to choose the blended teaching mode combining online theory curriculum and offline practice training, whereas 41.3% (353/855) and 39.6% (339/855) of trainees agreed that the teaching effectiveness was likely influenced by the condition and frequency of the offline training, respectively. Besides, significant differences were detected in the question about the factors affecting the blended teaching effectiveness of microendodontics between the trainees who had used and not used DOM (χ²=13.37, P=0.004). Conclusions: The application of online and offline blended teaching in microendodontics was affirmed to have some advantages, and it should be considered that the discrepancy in the level of expertise among trainees probably influenced the teaching effectiveness, which may promote the quality and effect of teaching, the spread and sharing of microendodontics, and provide experience and reference for the practice teaching of Operative Dentistry and Endodontics.

Assessment of anxiety in patient’s undergone surgical extraction and root canal treatment – A comparative study

: To quantitate and compare the anxiety level associated with patients who have undergone surgical extraction of teeth and root canal treatment.: This study was conducted on 100 patients who reported to the Department of Oral and Maxillofacial Surgery (50) requiring surgical extraction of teeth and Department of Conservative Dentistry and Endodontics (50) requiring root canal treatment. Patients were randomly enrolled for the study and were given a questionnaire after the completion treatment (extraction and root canal treatment). The anxiety levels were evaluated based on the scores of the Corah's Dental Anxiety Scale. : The results of the present study showed that the dental anxiety was higher among subjects who have undergone surgical extraction of teeth when compared to the patients undergone root canal treatment. : In conclusion, maxillofacial surgeons should consider that patients initially visit dental office for treatment of surgical extraction of teeth with severe anxiety which could be due to conditioning or learned responses which these patients might have experienced or first visit. Thus a prior awareness of the patient's predisposition to dental anxiety may be of value, enabling to take appropriate measures pre-operatively. Thus our aim is to give anxiety free dental treatment to the patients and better postoperative recovery.

Autotransplanted premolars for substituting traumatic maxillary central incisors in a Class II growing patient

A 10-year-old young Hispanic male patient was referred to the Endodontics Department with the chief complaint of color change of maxillary central incisors. The parents reported trauma one year before and as a result root canal treatment; maxillary central incisors extractions were necessary due to poor prognosis, so he was referred to the Orthodontics Department to evaluate if the patient could be the candidate for orthodontic treatment, as he showed severe crowding. The patient had no medical conditions, and the pretreatment records showed a Class II skeletal relation and vertical pattern. Dental findings were mixed dentition, an Angle Class II molar relationship, moderate upper and lower anterior crowding, 4 mm of overbite, and 7 mm of overjet. The patient underwent autotransplantation of maxillary second premolars into the place of maxillary central incisors that needed to be extracted as stated by the endodontist (premolar extractions were needed to solve the orthodontic problems). The suggested position for the autotransplant teeth was not accomplished by the surgeon, so orthodontic forces were applied to the autotransplant teeth to the ideal position. At the end of orthodontic treatment, the autotransplanted teeth were restored by the prosthodontist. Therefore, the facial balance improved, and the final occlusal relationships were good. COVID-19 global lockdown was a challenging obstacle to overcome during treatment. This case report intends to highlight the potential benefits of tooth autotransplantation and to increase awareness of this treatment protocol.

FREQUENCY OF SECOND MESIOBUCCAL CANAL IN PERMANENT MAXILLARY SECOND MOLARS AT A TERTIARY CARE CENTRE OF NEPAL

Background: The success of endodontic treatment relies on the precise identification of root canals followed by cleaning, shaping, and obturating the canals. Mesiobuccal root of maxillary second molar teeth present wide variations with regard to the number and type of root canals. The complexity of the root canal varies widely in different ethnic groups. The study aimed to determine the prevalence of second mesiobuccal canal (MB2 canal) in maxillary second molar. Methods: A descriptive cross-sectional study was conducted at Department of Conservative Dentistry and Endodontics, Universal College of Medical Sciences, Bhairahawa. A total of 100 permanent maxillary second molar undergoing endodontic treatments were studied. After access cavity preparation ultrasonic tips and magnification loupes were used to open the subpulpal groove in a direction from first mesiobuccal (MB1) canal towards the palatal canal to locate the second mesiobuccal (MB2) canal. Radiovisiography (RVG) was taken to confirm the presence of MB2 canals. Results: MB2 canals were detected in 52 teeth out of 100 teeth that were studied. It was found that the younger adult (18-35 years) tends to have a higher proportion of MB2 canals (65.6%) as compared to the middle-aged elderly (36-55years) in whom it could be identified only 33.4% of the time. Conclusions: Based on this study, it can be concluded that the prevalence of MB2 canal in mesiobuccal root of the permanent maxillary second molar is high.

To Evaluate Different Endodontic Instrumentation Systems Regarding Post-Operative Pain After Endodontic Therapy: A Clinical Study.

Despite substantial breakthroughs in instrumentation systems and pharmaceutical interventions, pain following endodontic therapy remains a serious concern. The effect of the type of endodontic instrumentation system in post-operative pain after endodontic therapy has been a matter of debate. To evaluate different endodontic instrumentation systems, namely Reciproc (GmbH, Munich), OneShape® (MicroMega, France), Protaper Gold (Dentsply Sirona, USA), and Hyflex® EDM (Coltène/Whaledent Inc., USA) file systems, regarding post-operative pain after endodontic therapy Methods and materials: The endodontic department treated healthy patients aged 20 to 50 years who were experiencing symptoms of irreparable pulpitis in one or more maxillary molars or mandibular molars. Five hundred was the determined size of the sample. The study participants were divided into five categories, each comprising 100 participants. These categories were: Category 1: Reciproc instrumentation system. Category 2: OneShape® instrumentation system. Category 3: ProtaperGold instrumentation system. Category 4: HyFlex® EDM instrumentation system. Category 5: Control (stainless steel K-files). Following endodontic therapy, these scores were recorded at 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours using the VAS scale. The visual analog scale (VAS) score (mean±SD) in the control group was 0.73± 0.40 (<0.001). The VAS score in the Reciproc group was 0.43± 0.05 (<0.001). The VAS score in the OneShape® group was 0.36±0.09 (<0.001). The VAS score in the Protaper Gold group was 0.41 ±0.08 (<0.001). The VAS score in the HyFlex® EDM group was 0.55 ±0.02 (<0.001). The VAS score in all instrumentation techniques at 72 hours follow-up was lesser in comparison to a control group with meaningful statistical significance (<0.001). However, the post-operative pain among the Reciproc, OneShape®, Protaper Gold, and HyFlex® EDM instrumentation systems was not different clinically when compared among themselves. However, VAS values were greater in OneShape® and HyFlex® EDM compared to Reciproc and Protaper Gold, showing increased post-operative pain in OneShape and HyFlex® EDM compared to Reciproc and Protaper Gold. It was also observed that there was a decline in the VAS score in all instrumentation systems as the follow-up period increased from 6 hours to 72 hours, with maximum post-operative pain at 6 hours of follow-up and minimum post-operative pain at 72 hours of follow-up. However, the decline was lesser in OneShape® and HyFlex® EDM in comparison to Reciproc and Protaper Gold, with increased post-operative pain in OneShape® and HyFlex® EDM in comparison to Reciproc and Protaper Gold. Post-operative pain at all follow-ups of endodontic procedures was less in Reciproc, OneShape®, Protaper Gold, and HyFlex® EDM than in the control group. VAS scores were higher in the OneShape® and HyFlex® EDM groups compared to the Reciproc and Protaper Gold groups, indicating increased post-operative pain with OneShape® and HyFlex® EDM instruments in comparison to Reciproc and Protaper Gold.

Challenges faced by final year dental students and house officers while performing endodontic treatment.

Objective: To identify the challenges faced by final year dental students and house officers while performing endodontic treatment. Study Design: Cross sectional study. Setting: Multicenter study. Setting: Involving Dental Colleges of Twin Cities Dental Hospitals of Islamabad and Rawalpindi including Islamabad Dental Hospital, Islamic International Dental Hospital, Pakistan Institute of Medical Sciences, Armed Forces Institute of Dentistry, Rawal Institute of Health Sciences and Margalla Institute of Health Sciences. Period: June 2023 to December 2023. Material &amp; Methods: This cross sectional descriptive study was conducted on 263 participants. The inclusion criteria was final year dental students and house officers who had completed their mandatory rotation in endodontics department and performed root canal treatment with conventional methods. A structured questionnaire consisting of five sections containing patient management, access opening, working length determination, cleaning and shaping procedure and obturation was constructed. Google forms were sent to the participants after sample size was calculated with WHO calculator. Data was analyzed through Google forms. Results: The current study shows that majority of the participants faced difficulties in the patient management and obturation procedure. The overall most common difficulty encountered was rubber dam application (44.1%) followed by accessory GP bending during obturation (42%), apex locator use (39.4%), and canal orifice location (39.8%). Conclusion: The students and house officers are facing multiple difficulties in performing root canal treatment independently. Therefore there is a need to focus more on the training of students and house officers in their endodontic department rotation.

Clinical outcome of direct pulp capping by using mineral trioxide aggregate and calcium hydroxide in the mature permanent teeth during the carious tissue removal.

Objective: To compare the clinical outcome in between the mineral trioxide aggregate (MTA) and calcium hydroxide (CaOH) during the direct pulp capping in mature permanent teeth. Study Design: Comparative Cross Sectional. Setting: Department of Operative Dentistry and Endodontics, Institute of Dentistry, Liaquat University of Medical &amp; Health Sciences Jamshoro / Hyderabad. Period: January 2022 to December 2022. Material &amp; Methods: We included all patients who had vital pulp, reversible pulpitis, mature teeth with closed apex, and were between the ages of 18 and 35, regardless of gender. Two groups of patients with equal numbers were formed. Those in groups A and B. Patients in Group A received MTA treatment, whereas those in Group B received CaOH treatment. Patients in both groups were encouraged to follow up to check on the discomfort and sensitivity of the tooth after 24 hours, a week, three months and six months. Data were gathered using a research proforma. Results: The mean age of the patients was 27.13+4.59 years in CaOH group and 27.43+4.40 years in MTA group. Pre- operatively the most of the patients had moderate to severe pain in both groups as 40.0% and 46.7% in CaOH group and 20.0% and 80.0% in MTA group respectively. Severity of the post-operative pain was less in MTA group while findings were statistically insignificant (p-0.143). On the pain assessment after 3 months, only 13.3% cases had mild pain in CaOH group, while no any case found with pain in MTA group (p-0.038). Post operative pain on 7th month was almost decreased complete in both groups. Test validity was positive in all of the cases till 6th months follow-up, which indicted that no nay cases had developed narcosis after treatment in both groups. Furthermore, in this study, there was no any cases found with radiological abnormalities during follow- up of 24 hours to 6 month post-operatively in both groups. Conclusion: After direct pulp capping in adult permanent teeth, both mineral trioxide aggregate and calcium hydroxide were demonstrated to be effective. However, MTA seems to be more effective than calcium hydroxide in preserving long-term pulp vitality.

Effect of Occlusal Reduction on Alleviating Pain in Symptomatic Apical Periodontitis

OBJECTIVE: To evaluate pain relief in response to occlusal reduction in teeth with symptomatic apical periodontitis METHODOLOGY:A randomized controlled trial was done at department of Operative Dentistry and Endodontics, PIMS Hospital, Islamabad, Pakistan 27th May 2019 to 30th May 2020 on 166 patients suffering from irreversible pulpitis with symptomatic apical periodontitis were included in the study. After consent, Visual Analogue Scale (VAS) was used to document preoperative pain levels. Pulpectomy was done and patients were randomly divided into Group A (without occlusal reduction) and Group B (with 1-1.5mm occlusal reduction). Mean pain scores of Group A and Group B were compared at 24hrs, 72 hours and seventh day using T-test RESULTS: There was a significant difference in mean pain score (p=0.0001) post-pulpectomy between the teeth with and without occlusal reduction. CONCLUSION: The teeth that underwent occlusal reduction after pulpectomy showed lower mean pain levels compared to the non-reduction group. KEYWORDS: Occlusal reduction, apical periodontitis, irreversible pulpitis, pulpectomy, root canal therapy

Assessment of Distortion of Radiovisiographical Tooth Length Compared to Actual Tooth Length: In-vivo and In-vitro Study

Background: Determination of appropriate or exact working length measurement with radiovisiography (RVG) during root canal treatment (RCT) is an essential for the long-term success. As, there are several controversies with the distortion of RVG image in assessing the working tooth length (WTL) during RCT compared to actual tooth length (ATL). So, this study was aimed to assess the frequency of distortion of radiovisiographical tooth length (RTL) compared to actual tooth length (ATL). Methods: An analytical (in-vivo and in-vitro) study was conducted at Department of Conservative Dentistry and Endodontics, BSMMU. The patient indicated for extraction purpose of orthodontic treatment was considered as the study population. Human premolar teeth (n=20) were selected as study sample by purposive sampling technique which met the inclusion and exclusion criteria. The RTL measurements were carried out with RVG images before and after tooth extraction (in-vivo and in-vitro setting). Then the ATL measurements of extracted tooth samples were carried out with both Inch Architectural Scale Ruler and Endodontic Ruler individually three concordant times. Statistical analysis: The data was analyzed using T test and presented in frequency and percentages with tables. Results: For 95% of study samples, the differences from actual and radiovisiographical tooth length were &lt;0.5 mm. Total 19 tooth samples (out of 20) showed acceptable level of coincidence except one sample showed non-acceptable level of coincidence. There was no sample revealed exact level of coincidence. There was a significant difference between the distortion category; yes (95%)/ no (5%) (P 0.001). The radiovisiological tooth lengths among all samples were same in both in-vivo and in-vitro setting. Study results also revealed the average distortion of RTL to ATL was 2.61±0.97 mm when RVG was done without using RVG sensor positioner. Conclusion: RVG tooth length images exhibited no distortion with the exact anatomical tooth lengths when the RTL was carried out with RVG sensor positioner. It’s recommended that to overcome the RVG image distortion, the RTL measurement ought to be carried out with RVG sensor positioner allowing RVG sensor/film parallel to long axis of tooth; RVG beam position perpendicular (900) to long axis of tooth.

Influence of operator’s experience on complications of root canal treatment using contemporary techniques: a retrospective study

BackgroundEndodontic treatment has benefited from the development of new techniques and equipment. Few clinical studies have been published on the complications associated with root canal preparations performed by doctors with different working experiences using contemporary techniques. This study aimed to analyze the complications of endodontic treatment performed by residents and endodontic specialists in a teaching stomatology hospital using contemporary techniques.MethodsCases of root canal treatment (RCT) and non-surgical root canal retreatment (ReRCT) performed by residents with 1–3 years of experience and endodontic specialists with 5–7 years of experience were collected from the electronic medical system of the Department of Endodontics, Beijing Stomatology Hospital, from September 1, 2020 to August 31, 2021. The cases were examined in terms of patient age, sex, type of tooth, diagnosis, treatment modality (RCT or ReRCT), number of appointments, whether an operating microscope was used, presence of ledges, canal transportation, perforations, missed canals, separated instruments, flare-ups and clinical incidence of second mesiobuccal (MB2) root canal in the maxillary molars.ResultsIn total, 859 teeth from 820 patients were included in the analysis. The overall incidence of complications in the resident group was significantly higher than that in the specialist group. More ledges and flare-ups were observed in the resident group (p < 0.05). The clinical incidence of MB2 was significantly higher in the specialist group (p < 0.05). There were no significant differences in root canal transportation, perforation, or instrument separation between the two groups (p < 0.05). Multivariate analysis showed that the incidence of root canal preparation complications was related to operator experience, tooth type and treatment modality.ConclusionsTechnical advancements could reduce the effect of working experience on RCT complications between residents and endodontic specialists in a teaching stomatology hospital.

Potential role of salivary vitamin D antimicrobial peptide LL-37 and interleukins in severity of dental caries: an exvivo study

IntroductionVitamin D performs various functions as a hormone by promoting calcium absorption but plays a major role in innate immunity,cell differentiation, cell maturation through its genomic effects via vitamin D receptor. The immune response also plays a major role in tooth surface and supporting structure destruction and playing a major factor in high caries formation. The inflammatory cytokines are released has proinflammatory cytokines and stimulate cells in disease process. Therefore, in the present study we have evaluated the association of salivary vitamin D, LL-37, interleukins 6 and 17A in various levels of severity of dental caries.MethodEthical approval was obtained (NU/CEC/2020/0339), 377 individuals reporting to department of conservative dentistry and endodontics, AB Shetty memorial institute of dental sciences were included based on inclusion criteria. The individuals were further divided into caries free(N = 105) and caries active(N = 272) based on their caries prevalence. The salivary were collected and evaluated for vitamin D, LL-37,IL-17A and IL-6.Results were statistically analysed with SPSS vs 22 (IBM Corp, USA). Normally distributed data were expressed as mean ± SD. Skewed data were expressed as median and interquartile range. To compare (mean) outcome measures between the two groups unpaired independent t-test was applied and for values in median IQR, Mann Whitney U test was used. All statistical analysis for P value were two-sided and significance was set to P ≤ 0.05.ResultsThe study showed that, the salivary vitamin D statistically decreased with increasing severity of caries which showed that vitamin D plays an important role in prevention of caries. Antimicrobial peptide LL-37 was higher in caries free group but was not statistically significant, salivary IL-6 level was higher in caries active group but intergroup comparison did not show significant difference. Salivary IL-17A did not show statistically significant between caries active and caries free group.ConclusionThe salivary levels of vitamin D may play a vital role in prevalence of dental caries and its severity which can be a underlying cause in presence of other etiological factors.