Endodontics

The smear layer in endodontic: To keep or remove – an updated overview Ruaa A Alamoudi Saudi Endodontic Journal 2019 9(2):71-81 During mechanical preparation, the use of hand or rotary instruments results in the production of considerable amount of smear layer. The smear layer consists of two parts: a superficial layer that covers the dentinal wall and a smear plug which occludes that dentinal tubules. Researchers had reached to different conclusions on the importance of removing or maintaining this layer. Removing the smear layer allows for more cleaning and disinfecting root canal walls and better adaptation of root canal filling materials. However, the presence of smear layer can act as a seal to the dentinal tubules and minimize the ability of bacteria and its toxins from penetrating the dentinal tubules. The ability to remove smear layer depends primarily on chemomechanical preparation. There are three main methods to remove smear layer: chemically, mechanically (ultrasonically), laser, or combinations. No one single irrigant has the ability to kill microorganisms, dissolve organic tissues, and demineralize smear layer. Thus, alternating between organic and inorganic solvents and the use of different methods and techniques have been recommended. Indeed, there is little relevance attributed to the influence of smear layer on the clinical treatment outcomes. Moreover, there is critical lack of clinical studies to determine the role of smear layer since all previous studies were carried out on laboratory based. Further experimental model with a longitudinal observational characteristic should be applied.

Parents' awareness and attitude toward urgent management of avulsed permanent tooth in AL-Baha city M Sarhan Alzahrani, Fatmah Ali Almaqboul Saudi Endodontic Journal 2019 9(2):82-87 Objective: This study was conducted to evaluate the parents' awareness and attitude toward emergency management of avulsed tooth in AL-Baha city. Materials and Methods: Eleven-item questionnaire form was designed and sent randomly to parents with different demographic characteristics in Al-Baha city. A total of 263 questionnaires were collected. Data were statistically analyzed using SPSS program. Results: The majority of the respondents (n = 227; 86.3%) were females. The result revealed insufficient awareness among parents regarding the emergency management of tooth avulsion. One hundred fifty-two (58%) of the respondents think that replantation of an avulsed tooth is impossible where 76% (n = 202) of the parents were not aware of the transportation medium for the avulsed tooth. The demographic characteristics showed a nonsignificant impact on the awareness and attitude toward emergency management of the avulsed tooth in this study (P < 0.05). Conclusion: This study showed an insufficient awareness regarding tooth avulsion among Saudi subpopulation.

Root canal treatment with postcore restoration versus implant restoration: Clinical and radiographic outcome and quality of life after treatment Abed Al-Hadi Hamasha, Ashraf Fareed Nbhan Saudi Endodontic Journal 2019 9(2):88-95 Introduction: The study intended to support the decision-making process regarding whether to save a compromised tooth by endodontic treatment with a subsequent postcore and crown or to extract such a tooth in favor of implant replacement. Therefore, the aim of this study is to explore differences between the two modalities of treatments in terms of clinical and radiographic outcomes and quality of life. Materials and Methods: A randomly selected 126 patients with 150 root canal treatment (RCT) teeth compared with 150 single-tooth implants in 129 patients was conducted at Jordan University of Science and Technology in Jordan. Participants were clinically and radiographically examined after 1 year of treatment. Administered questionnaires were filled on patient interview consisting of patient's characteristics and oral health impact profile (OHIP) instrument. Data analysis included descriptive statistics, bivariate analysis using Mann–Whitney tests and Chi-square tests. Results: Treatment outcomes for RCT and implant groups were as follows, respectively: success (75.3% and 56.7%), satisfactory survival (8.7% and 24.7%), compromised survival (4% and 10%), and failure (12% and 8.7%). Improvement of the subject's OHIP items reveals a notable improvement (67%–100%) following RCT (mean improvement = 96.32) and implant (mean improvement = 89.04) treatment. Conclusion: RCT and implant achieved equivalent proportion of cases having a good prognosis. However, implant restoration was associated with more postoperative complications. Both treatments achieved a predictable improvement in patient's OHIP.

Malondialdehyde expressions on pulp odontoblast cells after application of 2-hydroxyethyl methacrylate mixed with water, ethanol, and acetone solvents Adioro Soetojo, KH Ekhtiyanto Cahyadi, Edhie Arif Prasetyo Saudi Endodontic Journal 2019 9(2):96-100 Background: 2-hydroxyethyl methacrylate (HEMA) is a resin-based methacrylate material most widely used as an adhesive within dentistry. In order to reduce the level of HEMA toxicity, some ingredients such as water, ethanol, and acetone are used as solvent agents because they are readily available and inexpensive. However, significant concerns persist with regard to their biocompatibility. Purpose: The aim of this study was to compare and evaluate the biocompatibility of HEMA, HEMA with water solvent, HEMA with ethanol solvent, and HEMA with acetone solvent by measuring the oxidative stress parameters of malondialdehyde (MDA). Materials and Methods: Twenty-seven Wistar rats were equally divided into three groups. Three dental resin-based adhesive systems were subsequently applied to the dentin surface of their teeth. MDA assessment was conducted based on the levels of MDA expressions observable under microscope 24 h after initiation of the treatment. Results: There was a significant difference in MDA expression in the pulp odontoblast cells between Group 1 and Group 2 with a P = 0.000. Similarly, there was a significant difference in MDA expression in the pulp odontoblast cells between Group 1 and Group 3 with a = 0.000. Yet, there was no significant difference in MDA expression in the pulp odontoblast cells between Group 2 and Group 3 with a P = 0.082. Conclusion: HEMA with water solvent showed the least MDA expression compared to HEMA with ethanol and water solvent, therefore, HEMA with water solvent has the most suitable biocompatibility.

Impact of educational background on knowledge, attitude, and practice of root canal treatment among male university and high school students of Sakaka Province Ravi Jothish, Mohammad Khursheed Alam, Fayyaz Alam Saudi Endodontic Journal 2019 9(2):101-108 Aim: To determine the knowledge, attitude, and practice of root canal treatment (RCT) among male university and high school students of Sakaka province and to compare and analyze the impact of educational status on the three parameters mentioned earlier. Materials and Methods: A self-administered questionnaire prepared in Arabic and English was circulated among 600 male participants who consented to participate in the survey. Participants were divided into two groups – Group 1 (University) and Group 2 (high school) students. Pearson Chi-square test was used to analyze the data. Results: Data sheets were received from 500 participants only. Most of the participants, irrespective of the group, visit dentists only on the appearance of pain (84% and 82.8%, respectively). Substantial number of participants had a history of RCT (24.7% and 42.2%, respectively); 8.7 and 17% from respective groups reported that they were uncomfortable during the past RCT. However, majority of the participants (64.7% from either group) mentioned that they would opt for RCT in the future despite the slightly negative experience of the past. Conclusion: Young adults are reasonably well informed about RCT. Exposure to alternative sources like social media seems to be the reason behind this. Hence, internet platforms should be used to further popularize RCT among the youth.

Effect of chelating agents on the microhardness of Biodentine Nidambur Vasudev Ballal, Preeti Mishra, Sheetal Rao, Sree Teja Upadhyay Saudi Endodontic Journal 2019 9(2):109-112 Introduction: The objective of this study was to evaluate the effect of SmearOFF, 7% maleic acid (MA) and 17% ethylenediaminetetraacetic acid (EDTA), on the surface microhardness of Biodentine (BD). Materials and Methods: Forty BD cylindrical-shaped specimens were prepared using a split mold and were divided randomly into four groups (n = 10) based on the type of irrigant used for 1 min. In Group I, the specimens were treated with 17% EDTA, in Group II with 7% MA, in Group III with SmearOFF solution, and in Group IV with 5 mL distilled water. In all these groups, the irrigants were taken in a beaker and the samples were immersed with a magnetic stirrer placed to ensure complete wetting of the specimens. All the samples were then washed with distilled water and air-dried. The surface microhardness of the specimens was measured using Knoop hardness tester. Data were analyzed statistically using Kruskal–Wallis and Mann–Whitney U-test. The significant level was preset to P = 0.05. Results: MA significantly compromised the microhardness of BD followed by EDTA, SmearOFF, and distilled water which was statistically significant (P < 0.001). On comparison between 17% EDTA and SmearOFF, 17% EDTA reduced microhardness to maximum (P < 0.05). Conclusion: In conclusion, the present study demonstrated that microhardness of BD cement was generally affected by chelating agents.

Cone-beam computed tomographic evaluation of root canal morphology of mandibular canines in a Saudi subpopulation Yousef Al-Dahman, Abdullah Alqedairi, Hussam Alfawaz, Faisal Alnassar, Asma Al-Jebaly Saudi Endodontic Journal 2019 9(2):113-118 Introduction: The aim of the study was to investigate the root canal morphology of mandibular canines in a Saudi subpopulation using cone-beam computed tomography (CBCT). Materials and Methods: This retrospective cross-sectional study assessed CBCT images of 707 patients. A total of 454 mandibular canine teeth were evaluated. The number of roots and canal configuration was identified based on Vertucci's classification. The Fisher's exact test was used alongside the Chi-square test to analyze the association between gender and number of roots, as well as gender and root canal configuration. Results: Most patients had one root, 99.8%, while double-rooted mandibular canines were observed in 0.2%. Moreover, Type I, II, III, and IV canal configurations were observed in mandibular canines with Type I being the most prevalent canal configuration (95.4%). Fisher's exact and Chi-square tests showed no significant association between gender and number of roots (P = 0.463), while the presence of two canals was more frequent in men than in women with a statistically significant difference (P = 0.006). Conclusion: Single rooted with Type I canal configuration was the most prevalent in mandibular canines in the Saudi subpopulation. However, incidence of more than one root canal with different canal configurations was also detected.

Comparative evaluation of efficiency of single-file rotary and reciprocating systems in instrumenting severely curved mesial root canals of extracted mandibular first molars: A morphometric study using cone-beam computed tomography Deepthi Santhosh, A Devadathan, Josey Mathew, Manuja Nair, Baby James Saudi Endodontic Journal 2019 9(2):119-125 Aims and Objectives: The nickel–titanium multifile system is a viable tool in shaping severely curved canals as it reduces instrumentation errors. To eliminate the drawbacks with multifile systems, single-file systems were introduced. In this in vitro study, two single-file systems, One Shape and WaveOne, which work in a rotating and reciprocating motion, respectively, were compared with multifile systems for their efficiency in shaping severely curved mesial canals of extracted mandibular first molars, using cone-beam computed tomography (CBCT). Methodology: Fifty-two intact mesial roots of mandibular first molars with severely curved canals were selected using CBCT and divided into four groups of 13 samples each. Samples in Groups I, II, III, and IV, were instrumented using One Shape, WaveOne, ProTaper, and H and K-files, respectively. All the specimens were prepared up to working length to size 25 file using the manufacturer recommended technique along with standardized irrigation protocol. Pre- and postinstrumentation CBCT images were assessed at 8 mm, 5 mm, and 3 mm from apex to compare the changes in canal transportation (CT), canal centering (CC), and remaining dentin thickness. Results: All the groups showed CT with the statistically significant difference between the groups (P < 0.05). Except for ProTaper group at 5 mm (P < 0.05) none of the file systems showed CC. Except for Group I, a significant reduction in dentin thickness was noticed in Group II, III, and IV (P < 0.05). Conclusion: Among the two single-file systems compared, One Shape file in rotating motion prepared canals with fewer changes in canal anatomy than WaveOne file in the reciprocating motion.

Assessment of dental interns' knowledge toward managing endodontic emergency: A Survey of three dental schools in Jeddah city Ruaa A Alamoudi Saudi Endodontic Journal 2019 9(2):126-133 Introduction: Endodontic emergencies are about one-third of the total dental emergency cases. Treatment modalities of endodontic emergencies have shown a great controversy. Therefore, for dentists it is vital to have enough knowledge and information about the suitable treatment protocols to manage these situations properly. The primary goal of this study aimed to determine the knowledge of dental interns regarding the management of endodontic emergencies. Materials and Methods: This cross-sectional survey compromised of 20 closed-ended questions that was distributed among dental interns in three Dental schools; King Abdul-Aziz University, Ibn Sina National College, Batterjee Medical College; in academic year 2017–2018. Questionnaire divided into two parts. The first part assessed dental interns' background and training experience. The second part assessed their knowledge toward managing different endodontic emergencies which composed of 12 conditions of pulp/periapical emergencies, and thirteen modalities of treatment. Results: About 24.7% of dental interns answered correctly all endodontic emergency conditions according to the standard protocols. The correlation test showed that significant correlation between the correct answers and students who had high score of 6th year accumulative grade, 6th year endodontic grade, students who attended meeting or conferences related to endodontic emergency, and those who had exposed to any endodontic emergency during their clinical training (P > 0.001). Moreover, there is a significant difference between the knowledge of the three dental schools. King Abdul-Aziz University showed the higher percentage to answer correctly (39.6%) compared to 11.9% Ibn Sina National College and 15.4% Batterjee Medical College. Conclusions: This study showed that dental interns' knowledge and awareness were almost similar to previous studies except in few aspects. This emphasizes the importance of refreshing courses for dental interns to improve their competency in managing different endodontic emergencies.

Use of cone-beam computed tomography as a diagnostic aid in nonsurgical endodontic management of furcation perforations: Two case reports Paras Mull Gehlot, Bastin Cherian, Mysore Krishnaswamy Manjunath Saudi Endodontic Journal 2019 9(2):134-139 Iatrogenic furcation perforation is undesirable communication between the pulpal floor and the periodontium. This study reports nonsurgical endodontic management of iatrogenic furcation perforation in mandibular molars in two cases. Cone-beam computed tomography (CBCT) was used as an advanced diagnostic aid to accurately determine the location and extent of the perforation. The perforation was sealed with mineral trioxide aggregate, and the teeth were treated endodontically. Since the pulpal floor was weakened due to perforations, attempt was made to reinforce the coronal tooth structure using composite resin. Full crowns were placed as a definitive restoration. Two-year postoperative follow-up showed the absence of pain or swelling clinically, and radiographic examination revealed complete healing of furcation lesion. The use of CBCT in this report was a valuable diagnostic aid, which helped in better treatment planning and improved treatment outcome for the patient.