Restorative Dentistry

Aim To investigate the attitudes of general dental practitioners (GDPs) and endodontists in the UK towards management of fractured endodontic instruments.Methodology A questionnaire was sent to 330 systemically selected GDPs and all endodontists working in the UK (170). It was accompanied by a covering letter explaining the aims of the study and indicating that all the information given would remain confidential. Those who did not respond to the first mailing were sent another two mailings. Data were analysed using chi-square test at P ≤ 0.05.Results The overall response rate was 75%. Only 18.5% of respondents reported that they would retrieve instruments located in the apical third of root canals with a significantly higher proportion of endodontists (25.9%) compared with that of GDPs (14%) doing so. A significantly higher proportion of endodontists (98.5%) used ultrasonics for removal of fractured instruments compared with GDPs (75.8%). The most common complication of fractured instrument retrieval was thought to be excessive removal of dentine (67%). The majority of respondents (88.5%) reported that they would leave the unsuccessfully removed file in situ and obturate the root canal.Conclusion Both endodontists and GDPs were aware of the limitations of root canal anatomy when removal of fractured instruments was considered. Excessive removal of dentine, the most common complication associated with the removal process, suggests the need for more conservative techniques. Both endodontists and GDPs demonstrated a conservative approach when management of fractured instruments failed. Further studies regarding attitudes of GDPs and endodontists towards some specific aspects of fractured instruments management are required.

This in vitro study aimed to investigate the effect of ultrasonic removal of endodontic fractured files on tooth structure. Fifty-three canine roots were cleaned and weighed. They were scanned by a microcomputed tomography scanner producing two-dimensional images that were reconstructed into two-dimensional slices, and, finally, the canal volume was measured. In a control group, canals were prepared to F5-size Pro-Taper (Dentsply Ltd, Surrey, UK). In three experimental groups, F5-fractured files were ultrasonically removed from three root canal locations: coronal, middle, and apical. All roots were reweighed and rescanned. Reconstruction and analysis were performed to remeasure the canal volume. The differences in root mass (weight) and canal volume between before and after treatment were calculated. The highest change increase in canal volume was found when fractured files were removed from the apical part followed by middle and coronal. A positive correlation existed between canal volume and root mass changes. Microcomputed tomography scanning can reliably determine changes in canal volume resulting from fractured-file removal. (J Endod 2009;35: 125-128)

Objectives Assess calcium silicate cement (Biodentine™) vs. glass ionomer cement (Fuji IX™, control) as indirect pulp capping (IPC) materials in patients with reversible pulpitis after a 2-year follow-up. Evaluate the integrity of the overlying resin composite restorations using modified USPHS criteria and FDI criteria. Investigate the sensitivity of the modified USPHS criteria compared to the FDI criteria in the assessment of the restorations. Materials and methods Seventy-two restorations (36 Biodentine™, 36 Fuji IX™) were placed randomly in 53 patients. Periapical radiographs were taken at pre-treatment (T0), 12-month (T12), and 24-month (T24) review. Restorations were assessed using the modified USPHS and FDI criteria at T12 and T24. Results At 24 months, 15 teeth had failed to maintain vitality (6 Biodentine™, 9 Fuji IX™). Clinical success rate of IPC for both materials was 72% and is related to the intensity of reversible pulpitis symptoms. No difference was found between T12 and T24 in the periapical (PA) radiographs and in the integrity of the resin composite restorations overlying Biodentine™ compared to Fuji IX™. There was no difference in the efficacy of the USPHS criteria compared to the FDI criteria in the assessment of the resin composite restorations. Conclusions Biodentine™ and Fuji IX™ were clinically effective when used as IPC materials in teeth with reversible pulpitis at T24. Resin composite restorations overlying both materials performed well at T24. Using the USPHS or FDI criteria is equally efficient at T24; however, longer term follow-up is needed to establish whether there are sensitivity differences between these assessment criteria. Clinical significance Teeth with deep carious lesions approaching the pulp and with signs of reversible pulpitis can be treated successfully by indirect pulp capping using either Biodentine™ or Fuji IX™. Using the USPHS or FDI criteria to assess restorations is equally effective at 2 years. Trial registration NCT02201641 Keywords Indirect pulp capping. Reversible pulpitis. Periapical radiographs. Calcium silicate cements. Glass ionomer cements. USPHS. FDI criteria. MI dentistry. Carisolv gel. Selective caries removal

AIM AND OBJECTIVE To assess microtensile bond strength (μTBS) of two types of luting cement to monolithic zirconia and dentin following various surface modifications and aging. MATERIALS AND METHODS Monolithic zirconia blocks were divided into four main groups. Group N: no surface modification; Group SB: sandblasted using 50 μm Al2O3 particles. Group GH: glazed with a thin film of low-fusing porcelain glaze and etched with 10% hydrofluoric acid for 60 seconds. Group CJ: sandblasted with CoJet sand. Surface-treated ceramic blocks were bonded to dentin using either self-adhesive cement or resin-modified glass ionomer cement and submitted to 3 or 150 days of water storage protocol with aging. The specimens were subjected to tensile force until de-bonding. Surface roughness (Ra, μm) was assessed after surface treatment. Analysis of variance (ANOVA) tests followed by Tukey's tests were used to analyze the data (α = 0.05). RESULTS Surface modification using selective infiltration etch...

Objectives. To compare in-vitro micro-shear bond strengths (SBS) of resin composite to calcium silicate cement (Biodentine TM) vs. glass ionomer cement vs. resin modified glass ionomer cement (RM-GIC) using an adhesive in self-etch (SE)/total etch (TE) mode after aging three substrates and bond and characterizing their failure modes. Methods. Resin composite was SE/TE bonded to 920 standardized disks of Biodentine TM , GIC & RM-GIC. Dividing samples into two groups, the first underwent early (t = 0 min, 5 min, 20 min, 24 h) or delayed (t = 2 wk, 1 month, 3 months, 6 months) substrate aging before bonding and SBS (t = 24 h) testing. In the second, adhesive was applied after either early (t = 5 min) or delayed (t = 2 wk) substrate aging and then tested after bond aging (t = 2 wk, 1 month, 3 months, 6 months). The failure modes were identified using stereomicroscope. SEM images of selected samples were analyzed. Results. No significant differences were observed between (SE)/(TE) bonding modes (P = 0.42). With substrate aging, a significant reduction in SBS occurred between early and delayed time intervals for Biodentine TM (P = 0.001), but none for the GIC/RM-GIC (P = 0.465, P = 0.512 respectively). With bond aging, there was no significant difference between time intervals for all groups, except at 6 months for the GIC (P < 0.05). Modes of failure were primarily cohesive within all the substrates (68.82%) followed by adhesive failure at the resin-substrate interface (21.71%). Significance. Biodentine TM is a weak restorative material in its early setting phase. Placing the overlying resin composite as part of the laminate/layered definitive restoration is best delayed for >2 wk to allow sufficient intrinsic maturation to withstand contraction forces from the resin composite. A total-etch or self-etch adhesive may be used.

The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success ra...

Aim: This large-scale study explores oral hygiene practices (OHPs) of primary school children in the region of Madinah as reported by their parents and evaluates different contributing factors on OHPs. Materials and Methods: This is a cross-sectional study in which questionnaires were distributed through the Ministry of Education’s online education platform Madrasati to parents of primary school children in the region of Madinah. Various sociodemographic factors related to OHPs were calculated. Factors related to good OHP were given one mark with the maximum score of 8 marks. The multivariate analysis of variance (Manova) test was used to explore the effect of socio-economic status on scores of OHP and age of onset of tooth brushing. Results: There were a total of 2690 respondents, mostly, mothers (72.2%), Saudi nationals (84.4%), parents of children enrolled in public schools (92.8%), and those living in Al Madinah city (89.9%). OHP scores ranged between 0 and 8 with an average of ...

The following case report demonstrates how a multidisciplinary team approach can be utilized successfully for the minimally invasive esthetic treatment of congenitally missing maxillary lateral incisors through space closure and canine re‐anatomization.

Objectives: This research aims to investigate clinically and radiographically the dentine-pulp response to a calcium silicate cement (Biodentine™) compared to a glass ionomer cement (Fuji IX™ GIC) control material following indirect pulp capping in patients with signs of reversible pulpitis and to assess the integrity of the overlying resin composite restoration (N'Durance®) using USPHS and FDI criteria. This research also aims to evaluate the interface between Biodentine™ and the resin composite restoration using micro-shear mechanical testing and to investigate the possibility of reducing the radiation dose of cone beam computed tomography (CBCT) while maintaining an optimised image. Materials and methods: The randomised controlled clinical trial involved recruiting patients with signs of reversible pulpitis from Kings College Dental Institute at Guys Hospital. A CBCT and periapical radiograph (PA) were taken at baseline followed by minimally invasive (MI) treatment of the carious lesion. The definitive veneering composite restoration was placed one month later. The patients were followed up longitudinally at 6 and 12 months. Another CBCT and PA radiograph were taken at 12 months. The in-vitro study involves micro-shear testing of the bond strengths of resin composite to Biodentine™ vs. glass ionomer cement vs. resin modified glass ionomer cement using an adhesive in self-etch (SE) / total etch (TE) mode after aging the 3 substrates and the bond. Failure modes were characterised and SEM images were analysed. Reducing the CBCT radiation dose was attempted by comparing CBCT scans taken at 360° vs.180° rotation while maintaining accurate linear measurements. Accuracy of measurement was judged against the corresponding measurements taken from the porcine jaw specimens used as a reference standard. Results: 72 restorations (36 Biodentine™, 36 Fuji IX™) were placed randomly in 53 patients. Clinical success rates for Biodentine™ and Fuji IX™ GIC when used as indirect pulp capping agents were equal (83.3%). CBCT was significantly more effective in detecting periapical radiolucencies compared to

One of the current trends in dental education is to empower dental students on a global platform using advanced technology. Haptic virtual reality simulation (HVRS) is a relatively new technology in the field of teaching and learning operative dentistry. This study aims to assess the impact of haptic virtual reality simulation (HVRS) on dental students’ psychomotor skills acquisition in preclinical operative dentistry. Class I cavity preparations (CP) were performed at baseline by 21 novice dental students on plastic teeth. Duration of CP was recorded and cavity features were evaluated and scored. Then, students were exposed to HVRS training on CP. Another Class I CP was performed by each student on plastic teeth after HVRS training, then evaluated, and the duration was recorded. There was a statistically significant decrease in CP performance time after HVRS training (p &lt; 0.001) and an increase in the mean total marks of CP after HVRS training (p &lt; 0.001). The change in the s...

It has been nearly two years since the pandemic caused by the novel coronavirus disease (COVID-19) has affected the world. Several innovations and discoveries related to COVID-19 are surfacing every day and new problems associated with the COVID-19 virus are also coming to light. A similar situation is with the emergence of deep invasive fungal infections associated with severe acute respiratory syndrome 2 (SARS-CoV-2). Recent literature reported the cases of pulmonary and rhino-cerebral fungal infections appearing in patients previously infected by COVID-19. Histopathological analysis of these cases has shown that most of such infections are diagnosed as mucormycosis or aspergillosis. Rhino-orbital-cerebral mucormycosis usually affects the maxillary sinus with involvement of maxillary teeth, orbits, and ethmoidal sinuses. Diabetes mellitus is an independent risk factor for both COVID-19 as well as mucormycosis. At this point, there is scanty data on the subject and most of the publ...

Background: Dental caries is one of the most prevalent chronic childhood diseases affecting many people worldwide. Many people do not recognize the early signs of dental caries or its causes, which is crucial for the prevention and early intervention of the disease and consequently less-invasive and cheaper treatment options. Objective: This study aimed to evaluate the perspectives of parents about the meaning, causes, and early signs of dental caries, the association of tooth discoloration with decay, and the effect of different socio-demographic variables on the knowledge of patients regarding caries. Methods: Questionnaires were distributed to parents of primary school children in the region of Madinah, Saudi Arabia. Meaning of dental caries, early signs, causes of tooth discoloration related to decay, and the effect of different socio-demographic variables were calculated. Multiple linear regression analysis was carried out to identify significant predictor variables associated ...

Background: Dental caries is one of the most prevalent chronic childhood diseases affecting many people worldwide. Many people do not recognize the early signs of dental caries or its causes, which is crucial for the prevention and early intervention of the disease and consequently less-invasive and cheaper treatment options. Objective: This study aimed to evaluate the perspectives of parents about the meaning, causes, and early signs of dental caries, the association of tooth discoloration with decay, and the effect of different socio-demographic variables on the knowledge of patients regarding caries. Methods: Questionnaires were distributed to parents of primary school children in the region of Madinah, Saudi Arabia. Meaning of dental caries, early signs, causes of tooth discoloration related to decay, and the effect of different socio-demographic variables were calculated. Multiple linear regression analysis was carried out to identify significant predictor variables associated ...

Currently, the dental education system in Saudi Arabia is gender segregated. It is important to find out whether teaching methods must be altered to improve the learning experience for both genders throughout their years of study. This study aims to investigate the preferred learning styles for males and females studying dentistry at Taibah University, Madinah, Saudi Arabia and the effect of academic level on the learning style preference. Materials and Methods: A cross-sectional survey composed of the visual, aural, read/write, kinesthetic (VARK) questionnaire was distributed to 228 undergraduate dental students at Taibah University through emails during September/October 2020. Student learning styles were presented using descriptive statistics. Learning preferences between genders and academic years were compared using independent proportional t-test and Chi-square test. Results: A total of 168 dental students completed the questionnaire. Both genders displayed a higher percentage of a unimodal learning preference (60% males, 50% females) with 41% of males preferring the kinesthetic learning style, followed by the aural (26%) then the visual (20%), and lastly read/write learning style (12.6%). Female students preferred the kinesthetic learning style (42%), followed by the visual (27%) then the aural (20%), and lastly read/write learning style (11%). All students throughout the 6 academic years preferred the unimodal learning approach with the kinesthetic style favored. The quadmodal was preferred mostly by interns. Conclusion: Both male and female students studying dentistry at Taibah University had a unimodal learning preference. Quadmodal learning was popular among interns. Both genders preferred the kinesthetic learning style, followed by the aural for males and visual for females. Teaching methods must be tailored to suit the learning style of each gender to promote motivation and thriving for a successful outcome.

Currently, the dental education system in Saudi Arabia is gender segregated. It is important to find out whether teaching methods must be altered to improve the learning experience for both genders throughout their years of study. This study aims to investigate the preferred learning styles for males and females studying dentistry at Taibah University, Madinah, Saudi Arabia and the effect of academic level on the learning style preference. Materials and Methods: A cross-sectional survey composed of the visual, aural, read/write, kinesthetic (VARK) questionnaire was distributed to 228 undergraduate dental students at Taibah University through emails during September/October 2020. Student learning styles were presented using descriptive statistics. Learning preferences between genders and academic years were compared using independent proportional t-test and Chi-square test. Results: A total of 168 dental students completed the questionnaire. Both genders displayed a higher percentage of a unimodal learning preference (60% males, 50% females) with 41% of males preferring the kinesthetic learning style, followed by the aural (26%) then the visual (20%), and lastly read/write learning style (12.6%). Female students preferred the kinesthetic learning style (42%), followed by the visual (27%) then the aural (20%), and lastly read/write learning style (11%). All students throughout the 6 academic years preferred the unimodal learning approach with the kinesthetic style favored. The quadmodal was preferred mostly by interns. Conclusion: Both male and female students studying dentistry at Taibah University had a unimodal learning preference. Quadmodal learning was popular among interns. Both genders preferred the kinesthetic learning style, followed by the aural for males and visual for females. Teaching methods must be tailored to suit the learning style of each gender to promote motivation and thriving for a successful outcome.

The objectives of this study were to investigate the pH of common beverages and to evaluate the effects of common acidic beverages on the surface hardness and weight loss of human tooth specimens. A total of 106 beverages were conveniently purchased from supermarkets in Karachi, Pakistan. Prior to evaluation, beverages were refrigerated or stored at room temperature in accordance with the manufacturers’ recommendations. Beverages were categorized into six groups: ‘Sports and Energy drinks’, ‘Water’, ‘Fruit Juices and Drinks’, ‘Sodas’, ‘Milk and Flavored Milk’ and ‘Teas and Coffee’. Using a pH meter, the pH of each beverage was measured in triplicate at room temperature. In addition, the influence of five highly acidic beverages on the weight loss and surface hardness of human tooth specimens was evaluated using gravimetric analysis and the Vickers hardness tester, respectively. ‘Sports and Energy drinks’, ‘Fruits Juices and Drinks’ and ‘Sodas’ were the most acidic beverage categorie...