Root Canal Treatment Procedures Research Articles

The Effectiveness of Triton Used With XP-3D Adaptive Files and Active Irrigation on Smear Layer Removal During Root Canal Preparation: A Qualitative Scanning Electron Microscopy (SEM) Study.

Standard irrigating protocols during root canal treatment call for the use of sodium hypochlorite during chemo-mechanical preparation, followed by final irrigation with ethylenediaminetetraacetic acid (EDTA). This study determined the effectiveness of a new irrigant, Triton (Brasseler, USA), on smear layer removal during root canal treatment compared to that of 5.25% sodium hypochlorite and CanalPro EDTA 17% (Coltene). Twenty-one extracted anterior teeth were prepared for root canal treatment. The teeth were divided into three groups: five teeth were used as control with saline as the irrigant, eight teeth with sodium hypochlorite and 17% EDTA as irrigants, and eight teeth with Triton as the irrigant. Root canal preparation was done using the XP-3D shaper and finisher files (Brasseler, USA) for all teeth with respective irrigants. A single operator performed all root canal treatment procedures. The teeth were prepared for scanning electron microscopy (SEM), and analysis was performed by a second investigator. The smear layer removal was qualitatively assessed to determine the effectiveness of irrigants. Smear layer removal was most effective for teeth irrigated with 5.25% sodium hypochlorite, followed by 17% EDTA (Group B). Teeth irrigated with Triton (Group A) showed a similar appearance to the hypochlorite/EDTA group but with isolated instances of inter-tubular debris. Sodium hypochlorite use followed by a final rinse with EDTA remains the gold standard for the removal of the smear layer created during canal instrumentation.

Root Canal Treatment and Demand for Continuing Education among Thai Dental Practitioners

Background In recent times, there have been significant advancements in the techniques and materials used for root canal treatment. Nevertheless, there is a lack of study on the current methods used for root canal treatment among dentists in Thailand. Therefore, the primary purpose of this study was to investigate the current root canal treatment procedures and the demand for continuing education among Thai dental practitioners. Methods The survey, consisting of two sections and a total of 25 questions, was randomly distributed to 412 dentists in Thailand, both online and offline. Data on demographics, information on current root canal treatment protocols, and demand for continuing education, were collected. The association between demographic data and current root canal treatment protocols was analyzed using the chi-square test. The data gathered were analyzed using the JASP statistical software version 0.18. Results Three hundred and ninety-four questionnaires were completed. Sixty percent of the respondents (236) regularly performed root canal treatment. Most respondents treated one to five anterior teeth weekly. Seventy-six percent of the respondents did not use magnification. Fifty-eight percent of the respondents used an electronic apex locator in conjunction with a radiograph to determine the working length. Forty-four percent of the respondents used hand files for mechanical instrumentation. Sodium hypochlorite was the most used irrigant, while cold lateral compaction was the preferred obturation technique. The participants revealed the most interest in enrolling in two to three-day short seminar courses. Conclusion More Thai dental practitioners strictly followed the standard protocol compared to the previous survey. The short seminar courses were the most preferred program for continuous education.

Association between the irrigation-agitation techniques and Periapical Healing of large periapical lesions: a Randomized Controlled Trial

ObjectivesThe aim of this study was to evaluate the effects of manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), and laser-activated irrigation (shock wave-enhanced emission photoacoustic streaming (SWEEPS)) on the periapical healing of large periapical lesions following nonsurgical root canal treatment.Materials and methodsA total of fifty-six systemically healthy patients with a mandibular single-rooted tooth with periapical lesions of endodontic origin and a periapical index score of 3 or higher were included in the study. Before the treatment procedures, lesion volumes were determined volumetrically using cone–beam computed tomography (CBCT). Patients were randomized into treatment (MDA, PUI, SWEEPS) and control groups (n = 14). Root canal treatment and irrigation procedures were performed by a calibrated postgraduate operator and completed at one visit. For routine follow-up, clinical and radiographic evaluations were performed by a blinded evaluator using periapical (PA) radiographs according to Molven’s criteria at 3, 6, and 9 months. At 12 months, lesion volumes were quantified volumetrically using CBCT (ITK-SNAP). The data were statistically analyzed with the Wilcoxon test. The significance level was set at p < 0.05.ResultsIn all groups, the mean lesion volume after treatment was significantly smaller than the mean volume before treatment (p = 0.001). Among the 56 teeth, 11 teeth were ‘totally healed’, and 39 teeth were ‘reduced’ on PA radiographs. No ‘enlargement’ was detected in any group. On CBCT, the lesion volume decreased in the following order: LAI-SWEEPS (86.9%) > PUI (85.4%) > MDA (80.4%) > control (74.5%), with no statistically significant difference (p > 0.05).ConclusionsDespite the limitations of the present study, although a greater percentage of healing was observed in the LAI-SWEEPS and PUI groups, irrigation procedures had no statistically significant effect on the healing of periapical lesions with a single root canal at the 12-month follow-up. On the other hand, the outcome may change in multirooted teeth with curved and complex root canal systems.Clinical relevanceIn the short term and in single-canal teeth, advanced irrigation agitation methods such as laser and ultrasonic did not make a difference in healing other than manual irrigation agitation.

Comparative Analysis of Endodontic ISO Size 06, 08, and 10 Stainless Steel K-Files Used for Glide Path Procedures.

Small-sized stainless steel hand files are conventionally employed in root canal treatment procedures for canal scouting and for glide path establishment, owing to their superior flexibility and proficiency in navigating confined spaces. Given the diversity of brands available in the market, there exists potential variability in their physical characteristics, thereby influencing clinical performance. Consequently, this study aims to conduct a comparative analysis of the design, metallurgy, and mechanical characteristics among seven stainless steel hand file brands across ISO sizes 06, 08, and 10. A total of 315 new 25 mm length stainless steel hand files with apical sizes of 0.06, 0.08, and 0.10 from seven distinct brands were included in the study. A meticulous inspection of all instruments was undertaken to identify any structural deformations that might render them ineligible for the study. The design inspection involved the random selection of instruments from each group, which were examined under various microscopes, including a dental operating microscope, optical microscope, and scanning electron microscope. Furthermore, two instruments from each group underwent energy-dispersive X-ray spectroscopy analysis for elemental composition documentation. Mechanical tests were conducted to evaluate the instruments' resistance to lateral deformation (buckling) and their microhardness. Statistical analysis was executed using the nonparametric Mood's median test, with a predetermined significance level of 0.05. Regarding the instruments design, all files exhibited an active blade length ranging from 16 to 17 mm. However, variations were observed in the number of spirals, tip designs, and sizes, with the API K-File notably larger in sizes 0.06 and 0.08 compared to the other instruments. Despite uniform elements composition, differences in geometric features and mechanical properties were evident. Concerning buckling strength, the API K-File demonstrated superior performance across all tested sizes, while the Dentsply ReadySteel, SybronEndo, and Mani K-Files exhibited lower results (p < 0.05). In microhardness assessments, both the API and Oro K-Files displayed the lowest outcomes, with medians of 531 HVN and 532 HVN, respectively, whereas the SybronEndo K-File exhibited the highest microhardness (657 HVN). Despite similar metallurgical composition, the observed distinctions in geometric features and mechanical properties underscore the impact of the manufacturing process on the characteristics of glide path stainless steel endodontic files. These disparities may ultimately influence their clinical performance.

Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures.

This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures. This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures. Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up. Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups. CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.

Middle mesial canal - A mystery in mandibular first molar: Report of two cases

Endodontic therapy aims at disinfection of the root canal system. Efforts are made by root canal instrumentation and chemical disinfection to remove the infected pulp tissue and debris from the root canal space. However due to variations in canal anatomy, it is impossible to instrument all the parts of canal and that may lead to persistence or progression of infection. Thorough knowledge of tooth morphology is important to improve the success rate of endodontic treatment. Missed canals are considered to be an important factor for endodontic failure and about 4% cases treated by specialists also reported have shown to have missed canals. Hence use of all the available methods to detect the additional aberrant canals and disinfection of them during root canal treatment procedure is essential for favorable endodontic outcome.

Differences in Pain between Topical Gel and Chlor Ethyl in Paedodontic Patients before Infiltration Anesthesia

Abstract: Pain control during invasive and non-invasive dental procedures is very important since discomfort can cause patients to refuse treatment. Local anesthesia (LA) is required in any dental practice, including pedodontics, to reduce pain during dental procedures such as extractions, pulpotomy, root canal treatment, pulpectomy, abscess drainage, and minor oral surgical procedures. Application of flavoured topical anesthetic gel is most frequently used in pediatric dentistry. There are various types of topical anesthetics according to the medicinal ingredients in the forms of liquid, gel, and spray. This study aimed to find out the difference between the use of topical gel and chlorine ethyl in paedodontic patients before infiltration anesthesia at Paedodontics Department of rsgm Baiturrahmah. This was a descriptive and observational study with a cross sectional design. The topical anesthetics used were topical gel and chlorine ethyl; each for 10 patients. Data were obtained directly from student observations of the patient's face during topical anesthesia using the Visual analog Scale (VAS). The results showed that most patients were 9 years old (35.0%); female (65.0%). Most of the VAS results were found in the "like" criterion namely as many as eight respondents (40.0%); six of them were female (75%). Topical gel was the most topical anaesthetic type used with "like" criterion of VAS, as many as eight respondents (100%). In conclusion, most of the VAS results in the "like" criterion for topical gel indicating that topical gel is an effective anesthetic to reduce pain in pediatric patients. Keywords: pain; anxiety; topical gel; chlor ethyl; visual analogue scale

A microcomputed tomographic analysis of the morphological variabilities and incidence of extra canals in mandibular first molar teeth in an Egyptian subpopulation

A well-protected microbial habitat may be present in the root and canal morphology, which is varied and complicated. Before initiating effective root canal treatment, a detailed knowledge of the root and canal anatomical variances in each tooth is a must. This study aimed to investigate the root canal configuration, apical constriction anatomy, location of the apical foramen, dentine thickness, and prevalence of accessory canals in mandibular molar teeth in an Egyptian subpopulation using micro-computed tomography (microCT). A total of 96 mandibular first molars were scanned using microCT, and 3D reconstruction was performed using Mimics software. The root canal configurations of each of the mesial and distal root were classified with two different classification systems. The prevalence and dentin thickness around middle mesial and middle distal canals were investigated. The number, location and anatomy of major apical foramina and the apical constriction anatomy analysed. The number and location of accessory canals were identified. Our findings showed that two separate canals (15%) and one single canal (65%) were the most common configuration in the mesial and distal roots, respectively. More than half of the mesial roots had complex canal configurations and 51% had middle mesial canals. The single apical constriction anatomy was the most common for both canals followed by the parallel anatomy. Disto-lingual and distal locations of the apical foramen are the most common location for both roots. Mandibular molars in Egyptians show a wide range of variations in root canal anatomy with high prevalence of middle mesial canals. Clinicians should be aware of such anatomical variations for successful root canal treatment procedures. A specific access refinement protocol and appropriate shaping parameters should be designated for each case to fulfil the mechanical and biological objectives of root canal treatment without compromising the longevity of treated teeth.

The Application of Mixed Reality in Root Canal Treatment

The priority of modern dentistry is to keep patients’ teeth for as long as possible. Tooth extraction is a procedure performed as a last resort when conservative methods and endodontic surgery procedures have not brought the expected results. As a consequence, the number of patients in dental offices, who require first and repeated endodontic treatment, is increasing. Thus, the development of new technologies in the medical industry, including microscopy, computer tomography (CT), as well as diode and neodymium-YAG-erbium lasers, enables dentists to increase the percentage of successful treatments. Moreover, mixed reality (MR) is a very new technology, in which the 3D view can help plan or simulate various types of tasks before they will be carried out in real life. In dentistry, 3D holography can be applied to display CT data to plan endodontic treatment. The most important element in effective root canal treatment is the precise imaging of the root canal. The CT scans allow dentists to view the anatomy of the patient’s tooth with much higher precision and understanding than using 2D radiography (RTG-radiographic photo) pictures. Recently, the development of new 3D technologies allows dentists to obtain even more data from existing CT scans. In this paper, the CT scan data were applied to generate patient teeth in 3D and simulate the view of the root canal’s anatomy in MR devices, i.e., Microsoft HoloLens 2. Using DICOM RAW data from the CT exam, we generated a 3D model of the jaw with a tooth. In the next step, the crown of the tooth was removed in a similar way to how a dentist would do this using a dental handpiece. Furthermore, all root canals were cleaned of everything inside. This way we achieved empty tunnels, namely root canals. Finally, we added appropriate lighting, similar to the type of lighting that dentists use. The proposed approach enables to display of the root canals in the same way as during the endodontic procedure using a microscope. It allows for the visualization of the root canal and changing its direction, in which dimensional accuracy is crucial. It turns out that mixed reality can be considered a complementary method to the traditional approach, which reduces the amount of time for the root canal treatment procedure by up to 72.25%, depending on the complexity of the case, and increases its effectiveness. Thus, the mixed reality-based system can be considered an effective tool for planning dental treatment.

A comparative assessment of Conventional and Rough-Based Multi-Criteria methods for failure mode and effects analysis of Root canal treatment

This paper presents failure mode and effects analysis (FMEA) of a dentistry procedure i.e. root canal treatment (RCT) The aims of the present study are as follows: (i) to identify the potential failure modes (FMs) associated with RCT and (ii) to determine the ranks of the identified FMs to represent their degree of severity for the failure of the RCT procedure. Sixteen potential FMs of RCT are identified with the help of five members of the FMEA team. The FMs are evaluated with respect to three risk factors (RFs) i.e. severity (S), occurrence (O), and detection (D). Opinions regarding the importance of RFs on a scale of 1-9 and importance of each RF for each FM on a scale of 1-10 are gathered from FMEA team members. Subsequently, the obtained information is transformed into rough numbers in order to take care of the vagueness and inconsistency present in the human judgement. Further, weights of the RFs, in terms of rough numbers, are determined. Subsequently, four rough-based multi-criteria decision making (MCDM) methods i.e. rough weighted aggregated sum product assessment (R-WASPAS), rough additive ratio assessment (R-ARAS), rough TOPSIS (R-TOPSIS), and rough VIKOR (R-VIKOR) are used to rank the FMs. The final ranking of the FMs is derived using the grade average integrated ranking method. The results reveal that “Missed canal” and “Root canal under fillings” are the most and the least critical FMs, respectively. Further, the top 20%, the next 30%, and the last 50% FMs are categorized into highly, fairly, and the least critical groups. A few important suggestions are proposed to reduce the risks of the top 20% FMs. The results of the study may be useful for the professionals involved in the RCT and may help them in properly planning and successfully executing the RCT procedure.

Comparative evaluation of cleaning efficiency of single file NiTi rotary system during root canal treatment procedure - A scanning electron microscope study.

Optimal biomechanical preparation, thorough irrigation, proper disinfection, and finally, well-sealed obturation is a must to attain definitive success in root canal procedure. Proper preparation of the root canal is all the more imperative to establish a hermetic apical seal with adequately placed filling materials. The present study was conducted for comparing the Cleaning Efficiency of F360 system and the WaveOne Gold (WOG) system of rotary NiTi instrumentation for a root canal. One hundred freshly extracted noncarious mandibular canines were obtained. Access cavity of standard size was made followed by the establishment of working length. Afterward, random division of all the specimens was done into two study groups: group A: the group in which F360 system was used for instrumentation and group B: the group in which the WOG system was used for instrumentation. Irrigations of all the specimens of both the study groups were done followed by root canal shaping by the instrument system of their respective study groups. Scanning electron microscope (SEM) was used for assessment after specimens were cut buccolingually. Debris score and residual smear layer score were used for assessment. Among group A specimens, the mean smear layer score at the coronal third, middle third, and apical third was 1.76, 2.39, and 2.65, respectively. Among group B specimens, the mean smear layer score at the coronal third, middle third, and apical third was 1.34, 1.59, and 1.92, respectively. While analyzing statistically, it was seen that the mean smear layer score was significantly higher among specimens of group A in comparison to group B. While analyzing statistically, it was seen that the mean debris score was significantly higher among specimens of group A in comparison to group B. The cleaning effectiveness of WOG instruments was significantly enhanced in comparison to F360 equipment.

Prevalence of Separated Instruments in Routine Endodontic Practice and its Overall Impact on the Procedure: A Questionnaire Study

Background Fracture of endodontic instruments during routine root canal treatment and retreatment procedures has high prevalence. This unfortunate mishap requires certain expertise to diagnose and manage without any further complications.Objectives The objective of the present questionnaire study was to assess the knowledge of the clinician to diagnose an instrument separation during routine endodontic procedure and the steps carried out to manage this unfortunate mishap.Methods An online questionnaire comprising of 26 questions was circulated on social media groups to be filled by undergraduate postgraduate students practicing dental surgeons and specialists. All the responses were recorded and descriptive analysis of all the variables was done using frequency and proportion for categorical variables and Chi square test was used to compare the proportions. The level of significance was set at p lt0.05.Results The results showed that 75.8 of the participants could diagnose instrument separation. About 73.6 noticed instrument separation in the apical third of the root canals and 48.1 of the separated instruments were found in the mesial root of mandibular molars. Around 59.3 of the respondents opined that the separation was because of over usage of the instruments. 61.3 of them could bypass and complete obturation. Multiple visits were preferred for the management of separated instrument by 68.9 of the respondents.Conclusion Within the limitations of the study we conclude that most clinicians could diagnose the instrument separation and manage it by either removing or bypassing the instrument.

Effect on undergraduate student self-confidence in using 3D printed primary molars for root canal treatment simulation training.

The main purpose of this study was to assess the effect of a root canal treatment (RCT) practical simulation-based session using 3D printed primary molars on the self-confidence of fourth-year undergraduate dental students. Our study was also designed to explore student experiences with both manual and rotary RCT procedures and to investigate the association between the self-confidence in undertaking an RCT and the quality of the RCT. Student global self-confidence in undertaking an RCT on a healthy, cooperative child aged 4-5years was evaluated 2h before, 1month after, and 11months after the simulation training session. Once each instrumental procedure had been completed, the students were also asked to score the level of confidence (specific self-confidence) they felt regarding the use of RP and MP. After each training session, the quality of the RCT was radiographically evaluated by two trained, independent investigators. Overall, student global self-confidence in undertaking an RCT increased significantly immediately after the practical session and remained stable for the ensuing eleven months. The students declared a clear preference for RP and were more self-confident in undertaking an RCT after RP than after MP. The proportion of RCTs considered of good quality was the same for the manual (31.5%) and rotary (30.3%) procedures. Simulation training is a good way to train dental students who are confident in undertaking RCTs. However, confidence is not directly related to competence. Teachers should be encouraged to develop a comprehensive simulation training program, including feedback, debriefing, and repetitions.

Evaluation of the quality and reliability of internet information on fissure sealants using JAMA benchmark and HONcode seal

Background: This retrospective study aimed to investigate the distribution of root canal treatment (RCT) procedures performed on first permanent molars according to age, sex, mandible, maxilla, right jaw, and left jaw in a group of children.Methods: The records of RCT of a total of 6286 first permanent molar teeth of 5432 patients aged 8-16 years who visited the Department of Pediatric Dentistry, Faculty of Dentistry, Dicle University, Turkey from 2013 to 2018 were examined. Moreover, parameters such as age, gender, lower jaw, upper jaw, right jaw, and left jaw were evaluated. Frequency analysis and Pearson correlation test were used for statistical analysis and the level of significance was set at P<0.05.Results: The results of this study indicated that most of the boys (31.97%) received RCT of the lower left first molar tooth and most of the girls (34.21%) received RCT of the lower right first molar tooth. The tooth most receiving RCT was the mandibular right first permanent molar (33.09%). The tooth least receiving RCT was the maxillary right first permanent molar tooth (16.59%). In general, RCT was performed on the maxillary jaw less than on the mandibular.Conclusion: RCT of first permanent molars showed variability according to age and position of jaws. RCT was performed more on the mandibular jaw than on the maxillary. It was observed that the incidence of RCT generally increased with age.

COMPARATIVE EVALUATION OF ANAESTHETIC EFFICACY OF ARTICANE 4%, BUPIVACAINE 0.5% AND LIDOCAINE 2% FOR INFRAORBITAL NERVE BLOCK: A RANDOMIZED CLINICAL TRIAL

Aim:The aim of this clinical trial was compare of anaesthetic efficacy of articane 4%, bupivacaine 0.5% and lidocaine 2% for infraorbital nerve block. Materials And Methods: 75 patients were randomly assigned in to 3 groups where they were injected with eitherarticane 4%, bupivacaine 0.5% and lidocaine 2% and their anaesthetic efficacy was checked . Normality testing was done using the Shapiro-Wilk test. Data for EPT failed normality and hence, non-parametric tests were used for analysis. The EPT scores for pain threshold were compared between the three groups using Kruskal-Wallis test (non-parametric ANOVA) at pre-dosing, post-dosing, 1 hour, 2 hours and 3 hours. Post-hoc Mann-Whitney U test was used for pair-wise comparisons at all time periods. Results:As per the results obtained from the present study, the post-dosing results with electronic pulp tester was highest with Articaine followed by lignocaine and was least with bupivacaine. This showed that the Articaine had early onset amongst all three and bupivacaine showed late onset. Conclusion:This study shows that statistically significant difference was observed between lidocaine, Articaine and bupivacaine.Articaine has a faster onset and provides clinically effective anaesthesia in root canal treatment and other restorative procedures.

Microbiological analysis of sterile and nonsterile gloves before and during root canal treatment procedures

Objective: To evaluate the microbiological contamination of sterile (SG) and non-sterile (NSG) gloves before and during different stages of endodontic treatment. Methodology: Five brands (n = 10 per brand) of NSG (Supermax, UniGloves, Lemgruber, Nugard and Embramac) and four brands (n = 10 per brand) of SG (Sensitex, Sanro, Mucambo, Madeitex) were analyzed. Microbiological collections were performed at 3 different time-points: immediately after opening the packages (S1); after performing rubber dam placement (S2); and at the end of root canal treatment (S3). In the NSG group, to assess possible contamination by exposure to the clinical environment, samples were also collected within 24 hours (S4) and 7 days (S5) after opening the packages. After smearing the gloves with sterile swabs, the samples were immediately placed in test tubes containing specific BHI culture medium. These samples were incubated for 24 and 48h and the turbidity of the medium was evaluated. For turbid samples, bacterial identification was performed through culture and biochemical tests. Results: At S1, only the NSG UniGloves and Nugard brands showed contamination, while no contamination was observed in the SG. After S2 and S3 all brands showed contamination. In the NSG assessments, 24h after opening the packaging (S4) only the UniGloves brand showed no contamination, but this was not observed after 7 days (S5). The most observed species were Staphylococcus aureus, Staphylococcus ssp, Staphylococcus intermedius, Neisseria ssp, Escherichia coli and Pseudomonas aeroginosa. Conclusion: The NSG can be contaminated after opening the packaging and their exposure to the dental office environment can make it contaminated. SG are sterile but can also become contaminated during procedures. In the trans-operative period of root canal treatment, both NSG and SG can be contaminated by Gram-positive and Gram-negative bacteria.

Assessment of the Current Endodontic Practices among General Dental Practitioners in the Kingdom of Saudi Arabia.

A contemporary knowledge of root canal treatment (RCT) is a prerequisite for a successful outcome. Studies observed that General Dental Practitioners (GDPs) were not abreast of current endodontic knowledge due to a lack of continuing dental education, not following the treatment protocols that they had learned in their undergraduate program, and overlooking the evidence-based current endodontic practices. Therefore, this study was intended to assess the awareness, attitude, and clinical endodontic practices among General Dental Practitioners in Saudi Arabia. This cross-sectional questionnaire-based study was conducted among all 312 GDPs working in Saudi Arabia. The questionnaire consisted of socio-demographic details and 23 questions regarding current endodontic practices. The collected data was analyzed using the SPSS Version 21 (Chicago, IL, USA). The chi-square test was applied to explore the influence of gender, workplace, and the years of professional activity on the materials and techniques employed in the RCT procedure. The study results showed that of all respondents, 159 (51.0%) were males, 153 (49.0%) were females, and 286 (91.7%) were Saudi nationals. Most of the GDPs, i.e., 204 (65.4%) practiced in private hospitals or clinics whereas 108 (34.6%) practiced in Government hospitals. Root canal treatment on all teeth had been performed by 196 (62%) of the practitioners. Association of gender with demographic details and endodontic practices revealed a statistically significant difference between both genders with respect to region, nationality, type of RCT treated on the tooth, and the technique used to measure the working length (p < 0.05). Furthermore, years of professional experience and workplace significantly affect endodontic practices (p < 0.05). This study concluded that most of the general dental practitioners complied with quality standard guidelines showing a positive attitude toward endodontic practices. Furthermore, irrespective of gender, most of the steps in endodontic procedures revealed a significant association with years of professional experience and the workplace.

Evaluation of Microleakage Using Dye-penetration Method in Three Different Composite Resin Core Build-up Materials: An In Vitro Study

Aim of the current research is to establish and assess the microleakage in bulk-fill composite, nanohybrid ormocer-based resins, and nanofilled composite resin core build-up materials employing the dye-penetration technique. Sixty human mandibular first premolar teeth with a solitary root canal without dental caries were chosen for this research. Each specimen was subjected to decoronation of 2 mm from the cementoenamel junction (CEJ), following which the root canal treatment procedure was rendered complete. A space for the post was made for all the 60 samples. Following positioning of the post, specimens were allocated into one of the following three investigational groups (20 specimens in every group) on the basis of the core build-up materials used as group I: bulk-fill composites, group II: nanohybrid ormocer-based resins, and group III: nanofilled resin composites. Direct composite was used for core build-up and subjected to light-curing. Following this, the specimens were immersed in 1% methylene blue solution for 24 hours interval. Each section was evaluated for dye diffusion employing a stereomicroscope with software at a magnifying power of 40× and surface contact between dentin and base of the material was evaluated under scanning electron microscope. Nanohybrid ormocer-based composites exhibited the least microleakage at 1.12 ± 0.14, in pursuit by nanofilled composite resins at 1.79 ± 0.09, and finally the bulk-fill composites at 2.85 ± 0.11, amid the investigational groups studied. A statistically significant difference amid the three dissimilar cores buildup substances was found upon analysis of variance. Despite the study limitations, this research came to a conclusion that each of the three investigated core build-up substances exhibited microleakage. However, amid the three, nanohybrid ormocer-based composites depicted the lowest amount of microleakage in pursuit by the nanofilled resins and the bulk-fill composites. Core build-up is an important requirement as the remaining tooth substance following root canal treatment reduces and needs reinforcement with core build-up to sustain the tooth structure and provide resistance. A vital mandate for enduring efficiency of the restoration in the mouth is high-quality adhesive bond of these agents to cavity walls with diminished microleakage.

Comparison of postoperative pain after the use of different nickel titanium instrumentation systems: a randomized clinical trial.

Postoperative pain is a common complication in endodontics contributed by multiple etiological factors, which consist canal preparation instruments and kinematics. The aim of this randomized clinical trial compare the postoperative pain in terms of intensity and incidence after the use of different nickel titanium (NiTi) file systems. In this randomized clinical trial (NCT03791762), a total of 150 patients were root canal treated by 2 experienced endodontists according to a standardised protocol. The subjects were randomly assigned to 1 of the 3 groups according to preparation instrument used: ProTaper Next (Dentsply Sirona, Ballaigues, Switzerland), Reciproc Blue (VDW, Munich, Germany) and WaveOne Gold (Dentsply Sirona). Following preparation the teeth underwent standardized root canal treatment procedures in a single visit. The patients were contacted to gather information about the incidence of pain and intensity at 6th, 12th, 18th, 24th, 48th, and 72nd hours postoperatively. The data were analysed using chi-square, one-way analysis of variance and post hoc Tukey tests and logistic regression analysis with 5% significance threshold. No significant difference was found among preparation groups in relation to the intensity of postoperative pain. The incidence of postoperative pain was significantly linked with the preoperative pain presence with odds ratio values ranging between 2.06 and 4.08 irrespective of the preparation technique (P<0.05). The effects of reciprocating and the continuous rotary systems on the intensity and incidence of postoperative pain were found to be similar.

Endodontic consideration in geriatric patients

Advancements in health care services have enhanced life expectancy, thus maintaining healthy dentition is significant for overall health. Furthermore, the growing desire of elderly patients to maintain their teeth has led to an increased need for the performance of complex dental treatments in elderly patients. Root canal therapy is an essential phase of such treatments. Elderly patients may exhibit one or more systemic conditions that require special care, in addition to other changes that occur within the dentition and oral mucosa because of aging. This makes root canal treatment in elderly patients a great challenge. This article reviews to characterize pathologic and physiologic changes in elderly patients that can interfere with root canal treatment procedures, as well as attitudes of elderly patients toward such treatment, and to provide guidelines and clinical considerations for the management of root canal treatment in elderly patients.