Department Of Endodontics Research Articles

Evaluation of the Fracture Resistance Offered by Three Different Intraorifice Barriers on Obturated Teeth: An In-vitro Study

Introduction: The mere placement of a restoration after obturation carries the risk of the presence of voids between them. These voids reduce overall strength and allow for leakage. The placement of Intraorifice Barriers (IOB) between the restoration and the obturated material has been known to have several advantages, including the prevention of microleakage, enhancement of strength, and improvement in Fracture Resistance (FR). Aim: To evaluate if, Smart Dentin Replacement (SDR) flow plus, Resin Modified Glass Ionomer Cement (RMGIC), and Biodentine increase the FR of Endodontically Treated Teeth (ETT) as IOB. Additionally, the study aimed to compare the FR between roots sealed using Endosequence and AH Plus sealers. Materials and Methods: This in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India over a period of four weeks, from October 2020 to November 2020. The study sample consisted of 160 mandibular premolar roots instrumented using ProTaper gold rotary files. These roots were obturated with Gutta Percha (GP) and divided into two groups based on the sealer used (Group I=Endosequence; Group II=AH Plus). Each group was further divided into four subgroups, including a control group, with each subgroup receiving an IOB. FR was tested using a universal testing machine, and the forces were statistically analysed using Two-way Analysis of Variance (ANOVA), One-way ANOVA, and posthoc Bonferroni tests. Results: SDR offered the greatest FR values of 583.08 N and 612.13 N in groups I and II, respectively. Roots sealed with AH Plus showed greater FR than those sealed with Endosequence. In both groups, the differences between IOB and the control group in terms of FR were found to be highly significant (p<0.001). Conclusion: SDR showed the greatest FR when compared with RMGIC and BD as IOB in ETT. Teeth restored with SDR and sealed with AH Plus offered the greatest FR.

Evaluation of Intracanal Smear Layer Removal after Passive Microvolume Irrigation with Sodium Hypochlorite and Rotary NickelTitanium Instruments: An In-vitro Study

Introduction: Passive Microvolume Irrigation (PMI) with Sodium Hypochlorite (NaOCl) has been proposed as a new method for root canal disinfection. It is based on the concept that irregular surface characteristics of endodontic instruments can carry NaOCl into the canal space with controlled fluid volume, without applying any pressure. Aim: To compare and evaluate the efficacy of 3% and 5% NaOCl PMI, Saline PMI, and 3% NaOCl Standard Irrigation (SI) in removing the Smear Layer (SL) from the root canal walls at the cervical, middle, and apical thirds of single-rooted teeth. Materials and Methods: This study was conducted in the Department of Conservative Dentistry and Endodontics at Vishnu Dental College, Andhra Pradesh, India. The study was conducted in February 2018. Forty maxillary central incisors with a single canal, extracted within three months of the study, were collected. The teeth were divided into four groups (n=10) based on the irrigation method: Group-1 (3.0% NaOCl SI), Group-2 (3.0% NaOCl PMI), Group-3 (5.0% NaOCl PMI), and Group-4 (Saline PMI). All samples were instrumented upto F4 size with Protaper rotary files, and a final rinse of 17% Ethylenediaminetetraacetic Acid (EDTA) was used. SL removal was evaluated using Scanning Electron Microscope (SEM). The data were analysed using Statistical Package for Social Sciences (SPSS) 21.0. Statistical tests used were Kruskal Wallis and Mann-Whitney-U tests. A p-value of <0.05 was considered statistically significant for all comparisons. Results: There was no significant difference (p>0.05) in SL removal between 3.0% NaOCl SI, 3.0% NaOCl PMI, and 5.0% NaOCl PMI in the middle and apical thirds of the root canals. However, 5.0% NaOCl PMI showed significantly higher efficiency in SL removal at the cervical third compared to the other groups (p<0.05). Conclusion: Passive microvolume irrigation with 3% and 5% NaOCl showed comparable efficacy to 3% hypochlorite SI in the middle and apical thirds of the root canal.

Comparison of Two Different Continuous Wave Compaction Gutta-percha Obturation Techniques for Filling Oval-shaped Root Canals: An In-vitro Study

Introduction: The quality of Gutta-percha (GP) filling techniques depends on canal dimensions and anatomy. Thermoplasticised GP obturation techniques need to be modified in accordance to the root canal space anatomy. Aim: To evaluate the efficacy of continuous wave and modified continuous-wave compaction GP techniques in obturating ovoid canals. Materials and Methods: The present in-vitro study was carried out in the Department of Conservative Dentistry and Endodontics in MGMDCH, Navi Mumbai, Maharashtra, India, from October 2019 to December 2019 on 45 single rooted human teeth were selected and mounted in Eppendorf tubes. The canals were cleaned and shaped using the Protaper Next rotary system. The specimens were divided into three groups based on the obturation technique: Group 1-Lateral Compaction (LC), Group 2-Continuous Wave Compaction (CWC), and Group 3-modified continuous-wave compaction. After obturation, the specimens were radiographed in labial and distal views. Subsequently, the specimens were removed from the Eppendorf tubes, and the extrusion of filling materials was assessed. The radiographic images were analysed using image analysis software, and the void area was measured. The obtained data was tabulated and statistically analysed using the Kruskal-Wallis test, followed by Post-hoc Dunn’s test. Results: The warm compaction techniques showed denser obturations compared to LC and were statistically significant (p<0.0001) by the Kruskal-Wallis test in the distal view. Post-Hoc analysis using Dunn’s test for the density of obturation in the distal view showed a statistically significant difference between Group 1 compared to Group 2 (p=0.000002*) and Group 3 (p=0.000204*). Extrusion in Group 3 was comparable to Group 1, while the highest extrusion was observed in Group 2. Conclusion: The modified continuous warm compaction technique showed dense and homogenous obturation comparable to the continuous wave technique and outperformed the LC technique. Additionally, the modified continuous warm compaction technique exhibited less extrusion compared to the continuous warm compaction technique.

Comparative Cone Beam Computed Tomographic Evaluation of Conventional and Conservative Endodontic Access Cavity Designs on Pericervical Dentin Thickness and Fracture Resistance of Teeth: An In-vitro Study

Introduction: The concept of ‘extension for prevention’ accelerates treatment processes but eliminates precious dentin at the pericervical area, resulting in biomechanically weakened tooth structure after endodontic treatment. Pericervical Dentin (PCD) is a new paradigm for endodontic success supports the idea that the amount of residual tooth structure is closely associated with long-term retention of the tooth and resistance to fracturing. Aim: To determine the impact of two endodontic access cavity designs and biomechanical preparation on the pericervical dentin thickness using 3D Cone Beam Computed Tomographic (CBCT) visualisation technique and fracture resistance of the maxillary anterior teeth under compressive load using universal testing machine. Materials and Methods: The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Karnavati School of Dentistry, Gandhinagar, Gujarat, India, from October 2020 to March 2021. Study was carried out on the 30 single rooted freshly extracted maxillary central incisors and were randomly divided into two groups of conventional and conservative access preparation groups (n=15). Group 1 was conventional group, samples were accessed using endo access bur #1. Group 2 was conservative group, samples were accessed using CK micro-endodontic bur under a dental operating microscope. Cleaning and shaping was done using 17% Ethylenediamine Tetraacetic Acid (EDTA) as lubricant and 4% Hyflex CM rotary file system. The CBCT scans were taken preoperatively, following access cavity preparation and postobturation to evaluate the amount of pericervical dentin loss in mesial, lingual, facial and distal surfaces of the teeth at the levels of 1 mm to 4 mm above and below Cementoenamel Junction (CEJ). The samples were then loaded to fracture in the Universal Testing Machine, and the data were analysed using Independent sample t-test using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: In comparison to the group 2, group 1 led to an increase in substantial tooth structure loss in the pericervical region. Among all surfaces, pericervical dentin loss was more pronounced on the lingual surface in the group 1 than in the group 2 (p-value <0.001). Higher fracture resistance was observed in group 2 (1136.75 N) compared to group 1 (687.22 N) under compressive load (p-value <0.001). Conclusion: Incisal cavity design is a less invasive method of accessing maxillary central incisors that preserves pericervical dentin. Under compressive load, pericervical dentin conservation provided greater fracture resistance in the conservative group than in the conventional group.

Preference for Postendodontic Restoration for Fractured Anterior Teeth: A Questionnairebased Cross-sectional Study among Dentists in Maharashtra, India

Introduction: One of the common dilemmas faced by today’s clinicians is the management of structurally and aesthetically compromised endodontically treated teeth due to various treatment options available. There is no one factor which is the sole determinant for treatment planning. And there are various parameters contributing to the long-term success of a postendodontic restoration, especially in a fractured anterior tooth. Aim: This study is aimed to investigate the preference for postendodontic restoration for fractured anterior teeth with respect to the tooth structure and aesthetics. Materials and Methods: This cross-sectional study was conducted in the Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India, from August 2021 to December 2021 among 150 clinicians in Maharashtra. A validated questionnaire containing 17 close-ended questions was given to the participants which ascertained their treatment choices, the importance of preserving the tooth structure, aesthetics and the consideration given to the physical properties while choosing the material and planning the treatment. Data obtained from the survey were statistically analysed by the Chi-square test. Results: The mean age of the participants was 30.25±9.08 years. Among the 150 participants, postgraduates were 60 (40%) followed by general dentists 38 (25.3%), endodontists 36 (24%) and other specialists 16 (10.7%). Out of total, 82 (54.7%) preferred composites when more than 50% of the tooth structure remained. Crowns increased the longevity of the tooth according to 50 (83.3%) postgraduates. Among them, 28 (77.8%) endodontists opted for IPS Emax crowns over zirconia veneer for better aesthetics, 71 (47.3%) preferred glass fibre posts and 113 (75.3%) preferred ideal ferrule for better fracture resistance. Reattachment of the fragment was also a preferred option in all groups. Conclusion: A 77.8% of the endodontists preferred IPS Emax crowns while 71.1% of the general dentists preferred zirconia veneers. Good awareness was seen among endodontists regarding method, patient preferences and aesthetics, very good awareness in materials and excellent awareness in treatment choices. More awareness is needed among general dentists, postgraduates, and other specialists in terms of treatment methods.

Comparative Evaluation of Antibacterial Efficacy of Two Bioceramic Root Canal Sealers Incorporated with Novel Silica Doped TiO2 Nanoparticles: An In-vitro Study

Introduction: The success of Root Canal Treatment (RCT), depends on the complete elimination of microorganisms in combination with complete root canal system closure. Complete elimination of bacteria cannot be done by cleaning and shaping alone from lateral canals, isthmuses, and apical deltas. Thus, root canal sealers with ideal physical, biological, and improved antimicrobial characteristics are thus, necessary to avoid reinfections. Aim: To evaluate the antibacterial efficacy of two Bioceramic (Bio-C) modified root canal sealers, using Silica Doped Titanium Dioxide Nanoparticles (SiTiO2 ), a unique, extremely effective antibacterial agent on root canal dentin infected with Enterococcus faecalis (E. faecalis). Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics in collaboration with the Department of Microbiology at Sree Sai Dental College and Research Institute, Andhra Pradesh, India. The study was done in August 2022. The antibacterial efficacy of the two Bio-C sealers was evaluated by counting Colony Forming Units (CFU) and the percentage of live bacteria by a confocal laser scanning microscope. A total of 60 middle thirds of single-rooted teeth incubated with E.faecalis were chosen. Gutta-percha (GP) was used to fill the canals along with sealers in all six groups (group I-VI), namely Mineral Trioxide Aggregate based (MTA Fillapex); MTA Fillapex+SiTiO2 NPs (1% wt); MTA Fillapex +2% wt SiTiO2 NPs; Bio-C; Bio-C+ 1% wt SiTiO2 NPs; Bio-C+ 2% wt SiTiO2 NPs respectively, and incubated for seven days, each tooth was divided into two halves longitudinally. Microbiological analysis was conducted on one half, and microscopic analysis on the other half. The six groups were compared using a one-way Analysis of Variance (ANOVA) and intergroup comparison with Tukey’s post-hoc tests. Results: The addition of SiTiO2 NPs to Bio-C and MTA Fillapex significantly reduced the bacteria, compared to an unmodified sealer (p-value<0.001). MTA Fillapex with SiTiO2 NPs showed higher bacterial viability compared with Bio-C with SiTiO2 NPs. Conclusion: Loading endodontic sealers with SiTiO2 NPs has a material-dependent impact on the antibacterial properties, that could lower the frequency of secondary infections.

Awareness of artificial intelligence among dental students – A questionnaire survey

Artificial Intelligence (AI) is evolving in all fields, including medicine and dentistry. It is mostly used in diagnosis, patient management, and minor surgery. A survey was carried out by the Department of Conservative Dentistry and Endodontics, VMSDC Salem, to assess the awareness levels about ArtificialIntelligence among dental students. A validated questionnaire was circulated among 323 dental students. The results were collected and analyzed using SPSS Windows version 25. The response from the participants was positive, with the majority of them stating that AI is the future of dentistry and should be included in the curriculum. It was concluded that the participants had limited knowledge about Artificial Intelligence and its scope. However, when implemented in the academic syllabus, it would allow dental students to explore this new arena.

Impact of Root Canal Taper on Fracture Resistance of Endodontically Treated Teeth Prepared by Hero Shaper and RaCe File Systems: An In-vitro Study

Introduction: Tooth fracture is one of the most undesirable phenomena in Endodontically Treated Teeth (ETT) and usually leads to tooth extraction. Basically, removal of any hard tissue from the canal walls raises the chance of root fracture. Aim: To evaluate the impact of root canal taper on fracture resistance of ETT prepared by two different file systems (Hero Shaper and RaCe file systems). Materials and Methods: This in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli and Praj Metallurgical Laboratory Pune, Maharashtra, India, frome February 2021 to November 2021. The study included 44 freshly extracted mandibular premolar teeth were randomly divided into four groups. Group 1a had Hero Shaper 4%, group 1b had 6% Hero Shaper, group 2a had RaCe 4% and group 2b had RaCe 6% file system. After cleaning and shaping the root canals, obturation was completed using cold lateral compaction and root canals were embedded in standardised autopolymerising acrylic resin blocks, subjected to a vertical load in universal testing machine to cause vertical root fracture. The forces required to induce fractures were measured in Newtons. Data was analysed by using independent t-test and two-way Analysis of Variance (ANOVA) test for intergroup comparison. A p-value≤0.05 was considered as statistically significant. Results: Among instrumented groups, group 1a (Hero Shaper 4%) showed higher fracture resistance of 372.5 Newtons and group 2b (RaCe 6%) showed lowest fracture resistance of 314.56 Newtons as compared to other groups. Statistically significant difference (p-value=0.026) was seen in the mean fracture resistance among the group 1a and 1b, and group 2a and 2b. At pair wise comparison there was statistically significant difference in group 1a and group 2a (p-value=0.016). Conclusion: Amongst the instrumented groups, Hero Shaper file system showed the higher fracture resistance, than RaCe file system. Marked reduction in fracture resistance of ETT was seen with the use of greater taper instruments.

PRESENCE OF EXTRA CANAL IN PERMANENT MANDIBULAR FIRST MOLAR

Background: The success of root canal therapy depends on proper knowledge of root canal system, presence of extra canals, complete debridement and three-dimensional obturation of the entire root canal system. Previous studies have reported three to five canals in mandibular first molars. There might be chance of missing the canal that may lead to root canal failure, because of the variability in the number of root canals. The objective of this study was to determine the percentage of extra canal in the permanent mandibular first molar in patients undergoing root canal treatment. Methods: This cross-sectional study was conducted in the Department of Conservative Dentistry and Endodontics of Peoples Dental College and Hospital over a period of ten months from 6th September 2021 to 31st July 2022 after receiving ethical clearance from Institutional review Committee (IRC) Peoples dental college on 5th September 2021 (ref no1/ch no 5,2078/2079). About 350 mandibular first molar was selected by convenient sampling. After access preparation, all canal orifices were located and data were recorded. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 with frequency table. Results: Out of 350 patients, the percentage of three canals, four canals and five canals were respectively 273(78%), 76(21.7%) and 1(0.3%). Conclusions: The finding of this study supports the presence of extra canals in mandibular first molar. Thus, the clinicians require more diagnostic approaches, access modifications, and skills to locate, clean and shape the entire root canal system.

EFFECT OF OCCLUSAL REDUCTION ON POSTOPERATIVE PAIN IN MULTIPLE VISIT ROOT CANAL TREATMENT

The study aimed to assess occlusal reduction's effect on postoperative pain in multiple-visit root canal treatment. This randomized control trial was conducted at the Operative Dentistry & Endodontics Department, Baqai Dental College Karachi, from January 2021 to January 2022. A total of 110 patients fulfilling the inclusion criteria were included in the study. The patient was divided into two groups, Group A, occlusal reduction (OR) and Group B, no occlusal reduction (NOR). In group A, all occlusal contacts on the functional and non-functional cuspsand the marginal ridges were reduced by 1 mm by a diamond bur in a high-speed handpiece and confirmed with articulating paper. No occlusal reduction was performed in group B patients. Patients were recalled after 24 hours and 7 days, and their pain level was recorded on VAS; at the same appointment, the root canal was completed, and the tooth was restored permanently. Pain level on the 7th day was taken as the study's primary endpoint. The meanage of patients was 37.41±10.635, with a minimum age of 19 and a maximum of 59 years old. Female patients were 56% and 44%, male. There were two study groups' OR 50% and NOR 50%. The tooth type included were 40% anterior and 60% posterior. Group A patients had reduced pain levels after 24 hours, with a significant difference of P=0.014 compared to group B patients. After 7 days of treatment, no significant difference was found in postoperative pain between both groups with P=0.533. Thus, it can be concluded from the study that the occlusive reduction may not be effective in reducing pain at the 7th postoperative days of multiple visit root canal treatment. Although a significant difference in pain levels was identified after 24 hours of therapy, patients in the occlusion reduction group reported less discomfort than those in the control group.

Radiographic Evaluation of Errors during the Root Canal Treatment by 5th and 6th Year Undergraduate Students of Islamic Azad University of Isfahan (Khorasgan) from 2015 to 2018

Introduction: Quality of root canal treatment is considered as an important prognostic factor for endodontic therapy success. The aim of this study is to evaluate radiographic errors during the root canal treatment by 5th and 6th year undergraduate students of Islamic Azad university of Isfahan (Khorasgan) from 2015 to 2018.
 Materials & Methods: In this study records of 860 cases of endodontic treatment of patients referred to the General Endodontics Department and the Comprehensive Treatment Department of Isfahan Azad University (Khorasgan) during 2015-2018 including 1903 root canals that had received root canal treatment were examined. Periapical radiography was used to evaluate errors during access cavity preparation, canal preparation, and canal filling by two endodontic specialists and it was recorded in pre-prepared forms. In the access cavity preparation: furcation perforation, low access cavity expansion, high access cavity expansion were evaluated. During the canal preparation phase, errors such as missing of canal, ledge, transport, perforation types and broken instruments were investigated. Length and density of root filing were the criteria evaluated at the canal filling stage. The analysis was performed at both descriptive and inferential levels. Statistical analysis was performed by Chi-Square test and exact Fisher's test.
 Results: Frequency of acceptable root canal treatment (without errors) was 37.5%. Lower first molars showed the highest error rate (40.7%). Furcation perforation was reported with 9.4% highest error of access cavity preparation. The highest error rate was reported transport (7.8%) in the preparation phase. Inadequate density (gap) of 36.9% and under filling of 31.1% had the highest error in filling stage.
 Conclusion: According to the results of this study, it can be stated that general endodontics department needs careful planning to increase the quality of root canal treatments performed by students.

Cemento-osseous dysplasia in need of careful examination : a case report

Cemento-osseous dysplasia (COD) is a fibro-osseous lesion of the maxilla and mandible, originating from a periodontal ligament. It resembles a periapical lesion such as a periapical abscess or a cyst in its early stage. Usually, the affected tooth is vital and without symptoms. A healthy 35-year-old female was referred to the endodontic department for evaluation and endodontic treatment of an amalgam restored mandibular first molar with an apical radiolucency. Since the tooth was sensitive to a cold stimulus, chronic apical periodontitis was suspicious at first sight. But after clinical and radiographic evaluations, multiple periapical COD involving vital teeth of the mandible was diagnosed. No specific treatment of COD was scheduled except for renewing the pre-existing restoration. The present case is a confusing case since COD was associated with an asymptomatic tooth. Knowledge of the clinical features related to pulp vitality tests and cone-beam computed tomography (CBCT) helps determine the differential diagnosis between COD and a periapical lesion.

Nepali Translation and Validation of Dental Satisfaction Questionnaire

Introduction: Patient satisfaction is regarded as an important outcome of health care that contributes to better patient compliance and consequently offers improved clinical outcomes Dental school clinics must regulate both the clinical and academic classes in balance without hampering the needs of both the patient and students.
 Objectives: To develop a reliable and valid Nepali version of Dental Satisfaction Questionnaire (DSQ-N).
 Methodology: The English version of the dental satisfaction questionnaire (DSQ) was translated into Nepali following a standard translation process. Content validity followed by pre-testing were evaluated to obtain the final version of DSQ-N. Two hundred patients attending the Department of Conservative Dentistry and Endodontics completed the DSQ-N in the waiting room, at their convenience. Internal consistency of the questionnaire was determined by Cronbach's alpha and Principal component analysis was used to determine the construct of the scale.
 Result: Content Validity Index of the scale was 0.9 (S-CVI/ Avg) and alpha (Cronbach's) coefficient for the overall construct of DSQ was ≈0.83. Principal Component Analysis confirmed the internal structure of the scale and four components emerged from it.
 Conclusion: The translated nepali version of DSQ is a reliable and valid tool to determine patients’ satisfaction of dental care services based on the excellent content validation result together with robust internal reliability.

A 5-year retrospective study of computer aided design and computer aided manufacturing ceramic endocrowns in endodontically treated posterior teeth

Objective: To evaluate the clinical outcomes of computer aided design and computer aided manufacturing (CAD/CAM) ceramic endocrowns in endodontically treated posterior teeth after five years by a retrospective study. Methods: Patients who received CAD/CAM ceramic endocrowns after endodontically treatment in Department of Endodontics, School of Stomatology, The Fourth Military Medical University between January 2016 and June 2017 were invited for this clinical study. Clinical performance was evaluated in the aspect of color match, anatomic form,marginal adaptation, restoration integrity and secondary caries. Survival rate of the restorations was calculated by the use of Kaplan-Meier method. Log-rank test was applied as well for the sake of analyzing the effect of tooth position, sex and materials to the survival rate of the restorations. Results: Seventy-four patients, 25 men and 49 women with age of (38.8±10.2) years, participated in this study for a total of 101 CAD/CAM ceramic endocrowns after observation period of (62.8±12.0) months. There were 8 failed cases among 101 restorations, 5 were loss of retention, 2 were ceramic fracture and 1 was secondary caries respectively. In particular, 93% (89/96) restorations got score A on anatomic form and 95% (91/96) restorations got score A on marginal adaptation, while 38% (36/96) restorations showed the good color match compared with the abutment teeth. The estimated cumulative survival rate of CAD/CAM ceramic endocrowns in endodontically treated posterior teeth after 5 years was 93.0% (95%CI: 87.9%-98.1%). The single-factor Log-rank analysis demonstrated that there was no statistically significant difference in the survival rate of CAD/CAM ceramic endocrowns among men and women, premolars and molars, position in the dental arch, or different materials (χ²<0.01, P=0.957; χ²=0.64, P=0.422; χ²=0.69, P=0.407; χ²=0.88, P=0.349). Conclusions: Based on this clinical study, the clinical performance of CAD/CAM ceramic endocrowns in endodontically treated posterior teeth after five years is reliable, which could be a general option to restore nonvital teeth.

The Need of Endodontic Therapy among Patients Attending Tertiary Care Center in Central Nepal

Background Dental caries is considered as the most prevalent oral disease in Nepalese population that frequently needs endodontic therapy or root canal treatment (RCT). Pulp infection is one of the most common sequels of dental caries which when left untreated leads to pulpal necrosis and peri-radicular diseases. Patients usually reports to the dental hospital after there is pain, sensitivity, swelling or fracture of the tooth structure which usually impedes their normal routine of daily life. RCT is one of the efficacious therapeutic procedures that can save the teeth retaining its aesthetics and function.&#x0D; Objective To determine the need of RCT among patients attending Tertiary Care Hospital.&#x0D; Method A cross-sectional epidemiological study was conducted in the Department of Conservative Dentistry and Endodontics over the period of one year from April 2019 to April 2020. Ethical approval was taken from the Institutional Review Committee Kathmandu University School of Medical Sciences. In total, 7566 records of the patients that needed endodontic therapy and other treatments were collected and the need of endodontic therapy versus other treatments were assessed. The data obtained were analyzed using the SPSS version 20. The association between various patient-related variables were calculated by chi square test and mean, standard deviation, frequency and percentage were calculated using descriptive statistics. P value was set at &lt; 0.05 for statistical significance.&#x0D; Result Among the total study population, (n=7566), the mean age was 34.97±14.34 years among which 4387 (58%) were females and 3179 (42%) were males. The type of treatment required by the study participants were significantly associated with age and sex (p &lt; 0.001) and p &lt; 0.001, respectively).&#x0D; Conclusion The findings of this study concluded that there was an increased need for endodontic therapy among patients visiting the department compared to other treatments. There was a significant association between gender and age showing females and elderly patients in greater need for endodontic therapy.

Comparison of Clinical-related Characteristics of Endodontic Patients Before and During the COVID-19 Pandemic

Objective: To compare patient-related and clinical-related characteristics of endodontic patients, before and during the COVID-19 pandemic.&#x0D; &#x0D; Methods: The study population comprised 506 patients (teeth: n=674) aged 13–81 years who attended undergraduate dental clinics in the Endodontics Department of the Faculty of Dentistry at Biruni University for endodontic treatment. Patient-related and clinical-related data were compared at two time intervals: before the first COVID-19 case was reported in Turkey and after the first COVID-19 case was reported in Turkey&#x0D; &#x0D; Results: There were no significant differences in terms of age and sex of the patients attending the clinics before versus during the pandemic. The incidence of reported pain before the pandemic was significantly lower than that reported during the pandemic (p=0.041). Periapical health before the pandemic was significantly better than that during the pandemic (p

Preoperative factors analysis on root development after regenerative endodontic procedures: a retrospective study

BackgroundRegenerative endodontic procedures (REPs) have achieved clinical success on the immature permanent teeth with pulp necrosis, and can promote root development. However, preoperative factors and their effects on root development of REPs have not been definitely concluded. The aim of this study was to investigate the preoperative factors that may influence the root development of REPs.MethodsA total of 116 teeth in 110 patients treated with REPs in the Paediatric Dentistry Department and Endodontics Department from 2013 to 2017 were included in this study. Preoperative factors including aetiology, age, diagnosis and initial root morphology were collected retrospectively, and the associations between these factors and root development after REPs were analysed by Fisher's exact test and multivariate logistic regression model.ResultsThe overall rate of root development after REPs was 89.7%. The dens evaginatus group showed a higher rate (98.8%) in root development than the trauma group (67.6%) (P < 0.01). There was no significant difference among the different age groups (7–13 years old) or among different diagnoses groups (P > 0.05). And it showed in the trauma group that the teeth with apical foramen sizes larger than 3 mm significantly promoted root development than those smaller than 3 mm (P < 0.01). Multivariate logistic regression indicated that aetiology was significantly correlated with root development of REPs (OR: 0.07, 95% CI 0.007, 0.627, P < 0.05).ConclusionsThe REPs promoted more root developments in the dens evaginatus group than the trauma group, indicating that aetiology may be correlated with the root development of REPs.

Assessment of Oral Mucosal and Periodontal Manifestations in COVID-19 Positive Patients: A Cross Sectional Study

Background: Since 2021, there have been steadily increasing numbers of SARS-CoV-2 or novel coronavirus infection that causes COVID-19 disease. Some oral manifestations have been observed in patients with coronavirus during 2021(SARS- COV-2). Methods: This study was a Cross sectional study which was conducted at the department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh. This study conducts within 12 months. The sample size for this study was 100. Result: Age range of the patient was 21 to 69 years. The mean age of the patients was 54.7±12.5 years. Maximum 70.0% patients belong to age more than 50 years followed by 14.0% patients were in 41-50 years. 69.0% patients were male and 31.0% were female. Male: female ratio was 2:2:1. Male patients were predominant. 57.0% patients had acute oral ulcer, 36% patients had chronic ulcer and 7% recurrent oral ulcer. 64.0% patients had recurrent intra-oral petechiae, 20.0% patients had acute intra-oral petechiae and 16% patients had chronic intra-oral petechiae. 54.0% patients had chronic intra-oral vesicle/bullae followed by 41.0% patients had acute intra oral vesicle/bullae and 5% recurrent intra-oral vesicle/bullae. 94% patients had dryness of mouth. 97% patients had tongue whitish patches. Conclusion: We concluded that oral health status could have a potential impact on the severity of COVID-19 illness.

Impact of laser disinfection and passive ultrasonic irrigation on postoperative pain in single visit root canal therapy

Introduction: Postoperative endodontic pain is common. 3 to 58% of patients had post-op pain. Canal microbes are tough to eliminate. No irrigant meets all the perfect irrigant characteristics. Methods: In Kanpur, India, 46 participants were enrolled in this randomised clinical trial from January to June 2022. Department of Conservative Dentistry and Endodontics conducted the study. Local anaesthetic (1:2,000 lignocaine with adrenaline) was followed by rubber dam isolation and access cavity preparation. Teeth were cleaned and shaped. Patients were divided into two groups using a coin flip. Group A employed a 2 W 810 nm diode laser for laser disinfection. In Group B, sodium hypochlorite (NaOCl) was ultrasonically agitated. After a final treatment with saline, composite resin was used for obturation and post-endodontic restoration. A blinded assessor rated post-endodontic treatment after 6 hours, 24 hours, 48 hours, and 7 days. SPSS 20.0 was used to gather and analyse the data after utilising Pearson's Chi-square test with 5% significance. Results: 25 men and 19 women among 44 patients. 10 patients were 40-60, 28 were 30-40, and 12 were 18-29. No statistically significant difference was seen between PUI and laser disinfection in single visit root canal therapy (p=0.086).

Use and effectiveness of the Failure Modes and Effects Analysis (FMEA) for identification of potential errors and failures in the process of root canal treatment

Background and Aim: Root canal treatment (RCT) has high technical sensitivity, and many human procedural errors can compromise the success of treatment and well-being of patients. The failure modes and effects analysis (FMEA) is a risk assessment and management tool that ensures the safety of patient care by a systematic approach to failures. This study aimed to identify the potential errors and failures in the process of RCT using the FMEA.Materials and Methods: This descriptive study evaluated the failure modes and their effects qualitatively and quantitatively using the FMEA methodology. For this purpose, a FMEA team was first established and the steps of RCT were described in a flowchart. Next, the potential errors and failures in each step were identified, and each failure mode was scored from 1 to 10, based on the severity of impact, likelihood of occurrence, and likelihood of detection. The three scores were multiplied to obtain the risk priority number (RPN). Corrective measures and preventive strategies were suggested for high-risk failure modes (RPN≥250).Results: The FMEA identified 19 steps and 48 potential failures in the process of RCT. The maximum RPN in the process of RCT was assigned to file fracture in the root canal (RPN=324), apical extrusion of irrigating solution (RPN=320), and inappropriate or no rubber dam isolation (RPN=315).Conclusion: The FMEA has high efficacy for detection and prioritization of improvable points in a complex dental procedure in a busy department such as the endodontics department.