MBRU Theses & Dissertations

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Assessment of The Quality Of Endodontic Retreatment On A Postgraduate Endodontic Clinic In Hbmcdm (2008-2015)
(2017-08) Alharmoodi, Reem
INTRODUCTION The main objective of endodontic therapy is to prevent or cure apical periodontitis by shaping and cleaning the endodontic pulp space and provide three dimensional obturation. However, shaping and cleaning the entire canal system can be a challenge particularly in retreatment cases which are generally considered high difficulty endodontic cases. AIM The aim of this study is to assess endodontic retreatment outcomes in terms of quality of obturation, causes of endodontic failure and healing on a postgraduate clinic. MATERIALS AND METHODS A total number of 223 radiographs of patients who had received endodontic retreatment during the period (2008-2015) at Hamdan Bin Mohammed College of Dental Medicine- Mohammed Bin Rashid University were selected (For the period between 2008 to 2012 the Institute was called Boston University). Unreadable radiographs due to technical errors and superimposed anatomical structures, third molars, cases treated by faculty and incomplete treatments were all excluded. From the original sample of 223, in total 24 iii radiographs were discarded. The final sample thus consisted of 199 root canal fillings of 140 patients treated by the endodontic residents. All radiographs were individually evaluated for the density of the root filling and the distance between the end of the root canal filling and radiographic apex based on a six-point scoring system. Subsequently, teeth were reviewed and follow up periapical radiographs were exposed. The outcome of healing was assessed using the Periapical Index (PAI) scoring system. RESULTS The results of the study revealed that 78.9% of the endodontic retreatments were homogeneity and length acceptable. The corresponding figure was only 13.1% before endodontic treatment and was statistically significant. Conversely, homogeneity and length unacceptable before endodontic retreatment was 47.2% reducing to a mere 2.5% after retreatment. The results were statistically significant (P<0.001). CONCLUSION There was a significant improvement in outcome after endodontic retreatment on the postgraduate endodontic clinic. The success rate of endodontic retreatment was over 70% which is in line with the endodontic literature. Radiographic follow up confirmed some 60% improvement in healing rate following endodontic retreatment.
Association between type II diabetes and apical periodontitis: a critical review and before/after study on the outcome of endodontic treatment in an emirati adult population
(2020) AlMutawa, Alaa Tariq
The work presented here consists of two distinct parts. Part 1: A Critical Review of the literature Background: Diabetes has been found to be associated with increased risk of infections, impaired immune response and delayed wound healing. Studies have found that these complications contribute to an increased prevalence of periapical lesions and decreased endodontic success. Aim: To critically review the literature with regards to the association between apical periodontitis and diabetes. Materials and Methods: An extensive search was carried out using MEDLINE (ovid), Embase, Pubmed, The Cochrane Central Register Search of controlled trials, and Cochrane Reviews to identify suitable human-based studies. These studies included adult participants, a diabatic and a control group, and used a radiographic assessment of periapical radiolucency. Results: The critical review included 11 studies conducted between 1989 to April 2019. From these studies, 4 studies found a significantly higher prevalence of apical periodontitis in diabatic patients compared to non-diabatic patients before endodontic treatment while 7 studies found significantly higher prevalence of apical periodontitis after endodontic treatment in diabatic than non-diabatic cases. Conclusion: An association was found between diabetes and apical periodontitis before and after Endodontic treatment. Part 2: Association between Type II Diabetes and Apical Periodontitis before and after Endodontic Treatment in an Adult Population in the United Arab Emirates Background: Diabetes Mellitus is one of the most common systemic disorders. Diabetes Mellitus results in hyperglycemia which can affect the healing of the dental pulp. Clinical studies have shown a higher prevalence of periapical lesions in uncontrolled diabetes although the exact relationship is not clearly understood. Aim: To determine the association between Type II diabetes and apical periodontitis (AP) before and after Endodontic treatment in an adult population in the United Arab Emirates. The null hypothesis that Type II diabetes has no effect on the size of AP lesions was tested. Materials and methods: A sample of 50 patients with Type II diabetes were selected from a database in a specialist Endodontic unit who had received endodontic treatment on one tooth. These were matched in terms of age and gender with a non-diabetic control group who received Endodontic treatment on the same tooth. For each group, the size of the AP lesion was recorded using the Periapical Index (PAI) scoring system preoperatively and 1 to 4 years post endodontic treatment. The 50 diabetic patients were made up of 27 controlled and 23 uncontrolled (HbA1c value of 8% or higher) diabetics. Results: The mean PAI score for the uncontrolled diabetic group (n=23) prior to endodontic treatment was 3.3 compared to 2.3 for the matched non-diabetic control group. The Wilcoxon sign rank test revealed that this was statistically significant (p=0.002) indicating that uncontrolled Type II diabetes influences the size of the AP lesion. These figures were reduced to a mean PAI score of 1.9 in the uncontrolled diabetic group and 1.5 in the healthy control group in the post endodontic treatment periapical radiographs. The corresponding mean PAI value prior to endodontic treatment were 2.4 and 2.7 in the controlled diabetic patients and their matching control group respectively. The differences were not statistically significant (p=0.13). For the sample as a whole (n=50), the mean PAI value for both diabetic and non-diabetic groups reduced to 1.7 and 1.6 respectively post Endodontic periapical radiographs. The Wilcoxon sign rank test revealed a statistically significant improvement in healing in both these groups (p<0.001). PAI scores, prior to Endodontic treatment, were significantly higher in the uncontrolled diabetic group compared to the controlled diabetic group. In all cases the Endodontic treatment significantly reduced the size of the AP lesions.
Attitude and Use of Rubber Dam During Endodontic Procedures in the United Arab Emirates
(2017-08) Alnuaimi, Hind
Introduction: Rubber dam is an essential adjunct in endodontic treatment that was introduced as early as 1864. It prevents swallowing of medicament, instruments and irrigating solutions, debris and retracts soft tissue. Although it makes a significant difference to endodontic treatment success, surprisingly it is not used routinely by many General Dental Practitioners. Aim: To evaluate the attitude and the use of rubber dam during endodontic procedures by final year undergraduate dental students and General Dental Practitioners, in the United Arab Emirates. Materials and Methods A questionnaire, consisting of 16 questions, was designed and distributed among the target population of 100 final year undergraduate dental students of Ajman University. The same questionnaire was also disseminated among 90 General Dental Practitioners. As well as the use of rubber dam, the survey also focused on other related factors such as latex allergy. The data gleaned from the questionnaires were analysed and presented in tables or bar charts. Statistical tests were also applied to check for significant differences (p< 0.05). Results: The completed returned questionnaires 90 (90%) by undergraduate dental students and 89(99%) by General Dental Practitioners were tabulated and analysed to establish trends. It was found that rubber dam was used routinely by 91.1 % of the undergraduate dental students. This figure, however, dropped dramatically to 46% with General Dental Practitioners. One of the main reasons cited by General Dental Practitioners for not using rubber dam was that of patients’ preference. For endodontic treatment of posterior teeth, 95.5% of the undergraduate dental students used rubber dam compared with only 24.7% of the General Dental Practitioners and this was statistically significant (P < 0.05) . The study also revealed that only 70% of dental students intended to use rubber dam for endodontic procedures in practice after graduation. Conclusions: The use of rubber dam on posterior teeth was 95.5% among the undergraduate dental students compared with 24.7% with General Dental Practitioners. The corresponding figures for anterior teeth was 50% and 20.2% for undergraduate dental students and General Dental Practitioners, respectively. For General Dental Practitioners, it was found that the use of rubber dam decreased with increasing postgraduate experience.
Attitude of Ajman University Dental Undergraduate Students and Residents to Vital and Non-Vital Bleaching
(2017) Alzaabi, Aaesha
The management of tooth discoloration has become a challenge, especially as people are keeping their teeth for longer. Discoloration can affect both primary and secondary teeth alike. The causes of tooth discoloration are multifactorial with different parts of the tooth taking up different stains. Bleaching can improve the whiteness of teeth significantly and at the same time is considered to be a conservative aesthetic procedure. To evaluate the attitude of undergraduate dental students to vital and non-vital bleaching. Additionally, to review and identify the best evidence papers for single tooth bleaching. Objectives of the study was to evaluate the attitude of undergraduate dental students to vital and non-vital bleaching. Additionally, to review and identify the best evidence papers for single tooth bleaching. Materials and methods used for this study is in two parts. For the first part of the work, a 12-point questionnaire was designed and distributed among the target population of final year dental students and residents at Ajman University. As well as confidence in providing vital and non-vital bleaching, the survey also focused on a number of other issues such as opinion on delivery of bleaching by non-dental professionals and the teaching received on bleaching. The data gleaned from the questionnaire were analysed and presented in the form of tables and bar charts. Statistical tests were also applied to check for significant differences (P<0.05). The second part of the study was a comprehensive literature review to identify the best method for single tooth bleaching (intra-coronal bleaching). The results of the review were successfully applied to two single tooth bleaching cases. Results found that the completed returned questionnaires 201(100%) were analysed and the data tabulated. It was found that undergraduate dental students were more confident at providing vital than non-vital bleaching and this was statistically significant (P<0.000001). Eighty-four percent of the students agreed that vital bleaching was safe compared with 80% for non-vital bleaching. On the other hand, only 5% agreed that it was safe for beauty salons to provide bleaching. This finding was also statistically significant (P<0.00001). A literature search on intra-coronal bleaching yielded 78,588 papers. Two of these papers were deemed best evidence papers and they were clinical trials. Both papers compared the efficacy of different intra-coronal bleaching techniques. The bleaching protocols obtained from the papers was applied successfully to treating two complex cases of single tooth bleaching cases. It is concluded that undergraduate dental students were more confident in carrying out vital than non-vital bleaching. The great majority do not agree with the concept of beauty salons providing bleaching. Carbamide peroxide and sodium perborate can provide similar aesthetic results as hydrogen peroxide if applied correctly.
The Current Trends and usage of Nickel-Titanium Engine-driven Endodontic Instruments: A multicenter Survey
(2022) Aljabilan, Ahmad H A E KH
Background: Due to their properties, Nickle-titanium (NiTi) alloys are used in manufacturing of endodontic instruments, especially rotaries. The first rotary 0.02 taper NiTi was designed by Dr. John MacSpadden and came to the market in 1992. Over the years, NiTi engine-driven instruments (NiTi-EIs) have evolved, and many changes are done to it from the first generation until the fifth generation. Heat-treated metal, different types of motion (rotation, reciprocating and adoptive), and different tapering with different rake angles. Aim: This questionnaire-based study aimed to assess the extent of adoption, usage, and improvement associated with NiTi-EIs and techniques in endodontists and postgraduate endodontic residents in Kuwait and the United Arab Emirates (UAE), and it was an anonymous survey. Materials and Methods: A cross-sectional survey of 75 endodontists from Kuwait and the UAE was conducted. Statistical analysis was carried out using Chi-square, t-test, ANOVA, and Pearson’s correlation test. Questions related to the knowledge and practice of NiTi instruments usage and modalities were tabled and cross-tabulated against demographic variables. Statistical significance was set as p <0.05. Results: The 97% of Kuwait’s participants are using NiTi-EIs in more than 90% of their cases, while in UAE, the percentage was 73%, with a significant difference (p=0.006). In Kuwait,60.6% of the participants preferred NaOCl as a lubricant, while 16.2% in UAE did the same, with a significant difference (p<0.001). Reciprocating motion is the predominant motion of 18.2% of Kuwait’s participants, while no participant from UAE used it predominantly with a significant difference (p=0.006). Dentsply Sirona was the most popular manufacturer in both regions and was chosen by 97.1% of all participants; among their products, ProTaper Universal Gold file was the most popular file in UAE with a significant difference (p<0.001), and ProTaper Next file was the most popular file in Kuwait with as significant difference (p=0.003). From FKG manufacturer iRace file was most popular in UAE than in Kuwait, with a significant difference (p=0.048). Coltene (p=0.004) and VDW® (p=0.002) were familiar in Kuwait more than in UAE. Conclusion: Within the limitations of the investigation, it can be stated that NiTi-EIs are widely used in the dental practice of both regions. Better education and lower costs, on the other hand, may enhance their use. Overall, endodontists demonstrated a high understanding of NiTi-EIs usage characteristics, which was reflected in usage modalities.
Effect of Silver Diamine Fluoride (SDF) Solution on the Stem Cells from Human Exfoliated Deciduous Teeth (SHEDs)
(2022) Monjazebi, Yasmine
Background: SDF is a solution containing silver, fluoride, and ammonia. Clinically, it is used to arrest the progression of carious lesions in primary teeth. Recent studies have shown that SDF has indirect effect on pulp tissues by triggering reparative/reactionary dentine formation, similar to pulp capping agents. Such effect could be attributed to mobilization of growth factors from dentine that was subjected to SDF. However, this assumed mechanism of action has not been investigated. Moreover, the effect of SDF on a cellular level has not been studied extensively yet. Aim: This in-vitro study aimed to investigate the effect of SDF on SHEDs at the cellular level, in addition to the ability of SDF to mobilize growth factors from dentine. Materials and Methods: SDF was diluted into concentrations of 3.8%, 0.38%, 0.038% and 0.0038% by (mesenchymal stem cell) MSC media. SHEDs were seeded and grown over 7 days with MSC media and MSC media supplemented with 38% SDF, along with the diluted concentrations. Cell cytotoxicity and proliferation of SDF were performed in triplicates using CyQuant assay. The CyQuant assay was validated using 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyl-2H-tetrazolium bromide (MTT) assay on SDF concentrations that showed the least ii cytotoxicity. Cell differentiation assay was used to investigate the differentiation ability of SHEDs exposed to non-cytotoxic SDF concentration. The ability of SHEDs to release transforming growth factor beta 1 (TGF β-1) from dentine was also investigated using enzyme-linked immunoassay (ELISA). Groups tested were 38% SDF, 10% Citric acid and phosphate-buffered saline (PBS) that were incubated on dentine discs for 3 days at 37°C. Results: CyQuant assay revealed that 38%, 3.8% and 0.38% SDF were cytotoxic. Highest cell proliferation rate was detected with 0.0038% SDF. MTT assay confirmed that 0.38% SDF was cytotoxic, while 0.0038% SDF showed no cytotoxicity. Osteogenic differentiation assay revealed no inhibition of differentiation in SHEDs treated with 0.0038% SDF. Highest TGF β1 release was detected in 10% citric acid, followed by 38% SDF and PBS. Conclusion: Cell viability and proliferation assay revealed that clinical concentration of SDF (38%) was cytotoxic on SHEDs. 0.0038% SDF promoted cell proliferation and osteogenic differentiation. ELISA experiment showed that dentine exposed to 38% SDF released TGF β1, indicating that SDF could promote reactionary dentinogenesis.
Effect of usage and autoclaving on the cyclic fatigue resistance of heat-treated nickel-titanium instrument
(2021) Alshehhi, Aisha Abdalla Ali
Background: Nickel-titanium (NiTi) instruments are often reused in endodontic treatment for economic reasons. Thus, cleaning, disinfection, and sterilization of these endodontic instruments are essential. Several studies have shown that additional heat treatment during the sterilization of NiTi instruments affects their physical properties. Some researchers concluded that sterilization has a detrimental impact on the physical properties of NiTi files. However, others found that sterilization for up to 10 cycles does not increase the risk of NiTi failure. Aim: To evaluate the effect of usage and sterilization on the cyclic fatigue resistance of a heat-treated NiTi instrument (ProTaper Gold). Materials and Methods: Thirty ProTaper Gold NiTi F2 files (length 25 mm) were used in this study. The files were assigned to three groups: Group I, new files (control group); Group II, files that underwent autoclave sterilization at 134 °C for 30 mins; and Group III, files that were prepared in a standardized J-shaped endo block followed by autoclave sterilization. Each NiTi file was rotated in an artificial curved metal block using a custom-made device in a repetitive up and down motion in a dynamic mode until fracture occur. The duration taken for the fracture to occur was recorded and translated into a number of cycles to failure (NCF). A digital micro-caliper was used to measure the length of the broken fragment. Following the cyclic fatigue test, all fractured fragments were examined under a scanning electron microscope to determine the topographic characteristics of the damaged surfaces. The data was analyzed using SPSS. The NCF was compared across the three groups using ANOVA, and fragment length using the Kruskal-Wallis test. A p-value of 0.05, was considered significant in all experiments. Results: There was no statistically significant difference in the number of cycles to failure (NCF) among the three classes (P = 0.292.). Scanning electron microscopy revealed the typical features of cyclic fatigue failure of each fracture surface. Conclusion: Under the limitations of this analysis, the findings provide precursory evidence that single canal file use and a single autoclave sterilization cycle do not affect the cyclic fatigue resistance of heat-treated nickel-titanium endodontic instrument (ProTaper Gold).
The effect of varying concentrations of hydrogen peroxide on bovine enamel and dentine
(2021) Alnaqbi, Nouf Khalfan
Background: Bleaching has become a popular treatment option for aesthetic management of discolored teeth. Bleaching is a conservative approach in aesthetic dentistry compared to other invasive restorative treatment modalities such as indirect veneers and crowns. While bleaching is successful and effective, several studies have documented structural changes such as increased roughness, decreased microhardness, and decreased enamel strength, as well as a decrease in mineral content (calcium, phosphate, and fluoride) and the emergence of clinical symptoms such as dentin hypersensitivity and gingival irritation. Aim: The aim of this study was to investigate the effects of varying concentrations of hydrogen peroxide (HP) on bovine enamel and dentine in term of calcium, magnesium, and phosphorous ion release. Materials and Methods: Bovine enamel and dentine discs were sectioned, prepared and treated with different concentrations of carbamide peroxide (CP) including 10%, 15%, and 20% CP, and 35% HP. Negative control group was saline solution, and the positive control group was vinegar (N=5). All solution samples were analyzed for ion release using a calcium, magnesium and phosphate meter. Results: Treatment with 35% HP resulted in statistically significant increase in the amount of calcium and magnesium ions released from both enamel and dentin samples (p <0.05 ). Treatment with CP 10-20% caused statistically significant increase in the amount of magnesium and phosphate ions released from enamel and dentin samples (p <0.05). Conclusions: From the results of this study, it can be concluded that tooth whitening with CP (10-20%) and high concentrations of HP (35%) can have detrimental effects on the structure of both enamel and dentin by increasing the dissolution of their mineral components.
Evaluation of root and canal morphology of mandibular permanent anterior teeth in Emirati subpopulation: A cone-beam computed tomography study
(2021) Albannay, Bader
Background: Failure in mandibular permanent anterior teeth is almost due to missed second canal. Advanced techniques such as using a dental operating microscope and cone-beam computed tomography (CBCT), one important tool is knowing the prevalence of the second canal in mandibular permanent anterior teeth in different populations. There were no studies have been conducted to examine the root canal morphology in mandibular permanent anterior teeth in the Emirati population. Aim: To examine the root and canal morphology of mandibular anterior teeth an determine the prevalence of the second canal in the Emirati population using CBCT. Materials & Methods: A total of 176 CBCT scans were randomly selected and obtained from Health Point Dental Center, Abu Dhabi. These scans were reviewed, and the canal configurations iii were categorized according to Vertucci’s classification. Results: A total of 176 scans were evaluated. All of the examined mandibular central and lateral incisors had one root. Only 1.5% of the examined mandibular canines had two roots. Almost 43.5% and 37.5% of the examined central and lateral incisors had a second canal, respectively. Whereas only 6.5% of the examined canines had two canals. Generally, Type I Vertucci canal configuration was the most common in all examined teeth (70.5%), followed by Type III (28%), type V (1%) while Type II was the least common configuration (0.5%). Regarding age groups, there was a statistically significant difference in the frequencies of left central incisor canal types between the groups (p40 years for the mandibular anterior. Regarding gender, it was highly symmetrical between male and female. In the analysis of bilateral symmetry of the types of Vertucci classification in the mandible anterior teeth, type I Vertucci classification had the highest incidence of bilateral symmetry canines (90%), lateral incisors (66%), and central incisors (48%), followed by Type III canines (10%) lateral incisors (30%) and central incisors (34%), while Type V had the least incidence of symmetry. Conclusions: This study shows a high prevalence of the second canal in mandibular anterior teeth in the Emirati population. More attention should be given to detect the additional canals and the use of CBCT might be recommended as an effective diagnostic tool to identify this canalConclusions: This study shows a high prevalence of the second canal in mandibular anterior teeth in the Emirati population. More attention should be given to detect the additional canals and the use of CBCT might be recommended as an effective diagnostic tool to identify this canal.
Evaluation of the mental foramen and the mandibular canal course in emirati population: a cone-beam computed tomography study
(2021) Alazemi, Abdulaziz
Background: The mandibular canal (MC) is an important bony structure presents in the mandible that contains a bundle of nerves and vessels including the inferior alveolar nerve (IAN) and the mandibular division of the trigeminal nerve (V3). During surgical or non-surgical dental treatment physical damage can occur to the contents of the inferior alveolar canal. Therefore, a comprehensive knowledge of the anatomy of the MC, its variants and relation to other anatomical structures is essential in the prevention and management of any damages to the IAN during surgical and non-surgical endodontic therapies involving mandibular teeth. It has been recommended to use CBCT to locate the MC course and relation to mandibular teeth prior to endodontic surgical procedures. Furthermore, due to its availability and its conservative nature, CBCT have been used as a tool to study the morphological characteristics of the MC, its course and its intra-bony location of different ethnic groups. Aim: The aim of this study was to Describe the morphological characteristics of the MC, its intra-bony location, and relation to the apices of mandibular posterior teeth in an Emirati subpopulation, using CBCT. Material and methods: This was a retrospective study designed to analyze the cone-beam computed tomography scans of Emirati patients who were treated at Healthpoint Dental Center (Mubadala, Abu Dhabi), United Arab Emirates, between 2017- 2018. 3700 CBCT scans were taken during that period as part of a treatment plan and 154 scans were selected for this study according to inclusion/exclusion criteria. Every patient treated at HDC signs a consent form which allows for research use of available patient data. All CBCT scans were acquired using Orthophos SL (Dentsply Sirona, USA) using a standard imaging protocol (CBCT at HDC are taken by same technician, using same CBCT machine with same parameters; 85 Kv, 7 mAs, with exposure time of 5 seconds and voxel size of 0.15 mm). The data were extracted and anonymized to remove all patient identifiers. The principal investigator (author) evaluated all scans on diagnostic quality monitors. Results: 154 CBCT scans were examined. Examining the selected patients’ scans details showed that 72 patients (46.8%) were female, while 82 patients (53.2%) were male. Selected patients’ age ranged from 16 to 71 years; more specifically, 26% were younger than or aged 30, 28.5% were between 31 and 40 years and 45.5% were older than 40 years. Overall, the mean distance of the mental foramen (MF) in relation to the line between the mandibular premolars was distal by 0.83mm ± 1.84. The mean distances of the root apices with the superior border of the MC in relation to the second premolar, mesial and distal roots of the first molar and mesial and distal roots of the second molar were 4.02mm ± 2.02, 4.54mm ± 1.96, 4.07mm ± 2.08, 2.58mm ± 1.79 and 2.06mm ± 1.83 respectively. The mean distances between the buccal aspect of the mandible with the MC in relation to the second premolar, mesial and distal roots of the first molar and mesial and distal iii roots of the second molar were 3.59mm ± 1.03, 4.52mm ± 1.13, 5.05mm ± 1.21, 5.11mm ± 1.27 and 4.83mm ± 1.36 respectively. The mean distances between the lingual aspect of the mandible with the MC in relation to the second premolar, mesial and distal roots of the first molar and mesial and distal roots of the second molar were 2.79mm ± 1.03, 1.92mm ± 0.8, 1.68mm ± 0.68, 1.77mm ± 0.69 and 1.73mm ± 0.74 respectively. The mean distances between the inferior border of the mandible with the MC in relation to the second premolar, mesial and distal roots of the first molar and mesial and distal roots of the second molar were 6.6mm ± 1.61, 5.52mm ± 1.41, 5.16mm ± 1.24, 5.11mm ± 1.36 and 5.46mm ± 1.51 respectively. Statistical analysis showed that for the MF location there is no significant deference found between males and females (males -0.3mm ± 2.2 and females -0.5mm ± 2.4) (P=0.635). however, the distances between root apices of mandibular teeth to the MC was significantly higher in males compared to females. Interestingly, all mean distances were higher in males compared to females except for the distance between the lingual aspect of the mandible and the IAC in relation to the mesial root of the second molar where females had greater distance compared to males (males 1.4mm ± 0.7 females 1.9mm ± 0.7) (P < 0.001). The statistical analysis showed that there is a negative relationship between age and the location of the MF in relation with the premolars (P<0.001). On the other hand, distances between the root apices and the IAC have a significant positive relationship with age. Conclusion: The most common location of the mental foramen is distal to the contact area between the mandibular first and second premolars (0.83mm ± 1.84), and this distance have a negative relationship with age. The distal root of the mandibular second molar is the closest root to the mandibular canal (2.06mm ± iv 1.83). The distance between the root apices of the mandibular teeth and the mandibular canal has a positive relationship with age and gender, as young female patients have smaller distance than older male patients. The common course of the canal being more lingual and inferior posteriorly and becoming more buccal and superior towards the mental foramen.
Evaluation of the root and canal morphology of maxillary and mandibular premolars in an Emirati subpopulation using cone beam computed tomographic data: A retrospective study
(2021) Almehrzi, Hanadi Rashed
Background: Missed canal anatomy is one of the most common cause of endodontic therapy failure. Numerous studies have reported that maxillary and mandibular premolars have a complex internal canal configuration, which can vary according to race and geographic origin. Therefore, a thorough knowledge and understanding of the root and canal morphology is crucial, to ensure successful outcome of root canal treatment. Aim: To describe the root and canal morphology of Maxillary and Mandibular first and second premolars in Emirati subpopulation by analyzing the 3-dimentional data from Cone-beam Computed Tomographic (CBCT) images. Materials and Methods: This is a retrospective study, in which 360 CBCT scans of patients treated at Healthpoint Dental center (Mubadala, Abu Dhabi), United Arab Emirates, between 2017-2018, were obtained and analyzed. The institutional review board approval was obtained to collect and analyze the CBCT scans for the purpose of this study. All CBCT scans at HDC were acquired using Orthophos SL (Dentsply Sirona, USA) by the same technician using the following imaging protocol; 85 Kv, 7 mAs, with exposure time of 5 seconds and voxel size of 0.15 mm. Two evaluators reviewed and recorded the findings twice with an intersession of 30 days. They recorded the number and shape of roots and categorize the canal morphology based on Vertucci classification (VC). Results: Most of maxillary first premolars had 1 root (52.1%), while only 0.9% had 3 roots. Type I VC was the most common canal configuration (53.8%). The majority of maxillary second premolars had 1 root (91%). Type I was the most canal configuration (47.4%), followed by Type III (32.4%). Most of mandibular first and second premolars had 1 root (77.3% and 97%, respectively) and Type I was the most common canal configuration (70.4% and 94.9%, respectively). C-shape canals were markedly noticed in mandibular first premolars with prevalence of 22.7%. Conclusion: This is the first study to investigate the root and canal morphology of maxillary and mandibular premolars in an Emirati subpopulation using CBCT. Our data showed great variations in the root and canal morphology of maxillary and mandibular premolars in Emirati populations. The prevalence of C-shaped canal in mandibular premolars in Emirati population is considered relatively high (22.7%) in comparison to other populations.
Fracture Resistance and Bending Stiffness of Heat Treated (oneflare)and Non-Heat Treated (oneflare) Nickel titanium Rotary Instruments with Same Geometric Features
(2017-08) Ataya, Maamoun
Background: The main objective of this study was to compare the cyclic fatigue resistance, torsional resistance and bending stiffness in commercially available heat treated NiTi rotary instruments (OneFlare-H) and non-heat treated NiTi instruments (OneFlare-O) of similar geometric features, customized for the present study. Methods: Ninety OneFlare were analyzed with torsional resistance, cyclic fatigue resistance and bending stiffness tests. The torsional resistance evaluated at 3 mm from the file tip by plotting the torsional load changes until fracture by rotational loading of 2 rpm. The cyclic fatigue resistance was compared by measuring the number of cycles to failure. The bending stiffness was measured in accordance with the American National Standard/American Dental Association Specification No. 28 and ISO Specification 3630-1. Many fractured fragments have been observed under a scanning electron microscope (SEM). Data analyzed: nonparametric Mann-Whitney U-test and parametric t-test were used. Result: No significant difference in torsional resistance was found between two groups of files when compared in terms of ultimate strength, fracture angle and toughness. Heat treated Oneflare showed superior resistance to cyclic fatigue compared to non-heated Oneflare files. The examination of fracture’s surfaces from Cyclic Fatigue test with SEM showed topographic differences between the two groups of files. Heat treated Oneflare showed lower Bending stiffness than conventional Oneflare-O. Conclusion: The Oneflare-H instruments using T-wire heat treatment technology showed improved mechanical properties in cyclic fatigue resistance and bending stiffness without any effect on torsional resistance.
Impact of Cone Beam Computed Tomography on Treatment Planning in Endodontics
(2017-01) Mohamad, Badriya
Introduction The use of Cone Beam Computed Tomography (CBCT) is rapidly increasing in all areas of dentistry, as it provides valuable 3D information of the area under investigation in a matter of minutes. However, the radiation dosage is higher than that of conventional radiographic images. It is advisable that CBCT should be used only in cases where clinically indicated. Aim The aim of our study was to evaluate the impact of limited volume CBCT upon treatment planning as part of endodontic management of posterior teeth. Materials and Methods Thirty five patients were selected from primary care referrals to a specialist endodontic unit in a leading UK dental hospital. For each patient, a dental and medical history, an intraoral image, parallax periapical radiographs and CBCT data set were taken . Four observers, General Dental Practitioners (GDPs) were selected to examine the data. Additionally, the author of this work also independently examined all the cases in her capacity as a third year Endodontic resident. A questionnaire was designed for the observers. The information for all the 35 patients was examined by the observers on two separate dates about 3 months apart. On one date, all the information was given to them but, on the other the CBCT images were withheld. This study dealt with only three questions relating to treatment planning. Results The availability of CBCT images changed the final treatment plan for extraction, endodontic treatment, and endodontic re-treatment in a minority of cases (15% to 35%). Three out of the fours GDPs found the availability of CBCT more helpful in reaching a final treatment plan. This was, however, statistically significant with only one of the GDPs (p<0.05).The fifth observer (the third year Endodontic resident) also found CBCT helpful in reaching a final treatment plan which was statistically significant (p<0.05). Conclusion The main conclusion that follows from this work is that CBCT images are vital for certain complex endodontic treatments and should not be used routinely for all endodontic cases. The study also highlighted the need for training on the interpretation of CBCT images by dentists who use such images in their workplace.
The influence of preparation size on efficacy of EDTA for smear layer removal in the apical part of root canal: an in vitro SEM study
(2019) AlMutawa, Reem
Background: Success of RCT relies on proper chemomechanical preparation, effective disinfection of root canal system and its three-dimensional obturation. During canal preparation a smear layer cover is produced. Adequate removal of this smear layer using EDTA is essential for the success of infected root canal treatment. Several parameters, including apical size preparation, affects the smear layer removal ability. Aim: To study the role of the size of apical root canal preparation on removal of smear layer after irrigation with EDTA solution on extracted human teeth. Materials and Methods: Forty-two extracted mandibular molars were included in the study. Radiographic examination with two views, mesio-distal and bucco-lingual, were taken for examination of distal canal. Teeth were selected according to specific inclusion criteria. They were divided into three groups; each contains fourteen samples. Working length was set at minor apical foramen, 1mm from major apical foramen visible under dental operating microscope. Protaper universal system was used for distal canal preparation with the Master Apical File as follows: Group A finishing at F2 (#25/0.08), Group B finishing at F4 (#40/0.06) and Group C finishing at F5 (#50/0.06). Full irrigation protocol was followed with 2ml of sodium hypochlorite in a concentration 5.25%, used between each file and 3ml after completion of canal preparation with activation 20 seconds for 3 cycles using Endo activator. 2ml EDTA solution in a concentration 17% was used for 1 minute with activation using Endo Activator. A 30-guage side vented needle was used for irrigation and set 1mm from minor apical foramen. Final irrigation was done with 5ml saline. Specimens were decoronated and distal root was sectioned bucco-lingually into two halves. The half which showed better apical configuration was selected and immersed in alcohol (70%) for 20 minutes for dehydration. The specimens were further sputter-coated with carbon (C) under vacuum and examined in a Scanning Electron Microscope. The SEM analysis was done at the General Department of Forensic Science and Criminology at the Dubai Police Head Quarter. SEM images were taken at three levels of the apical end, at 2mm, 4mm and 6mm. Total of 6 images fro each specimen. Images were randomly arranged for smear layer evaluation. The evaluation was performed by two blinded observers (endodontists) and reevaluation was done at a second session with 30 days interval. Images evaluation was done on the basis of a 4-grade score system as has been proposed by Hulsmann et al. 1997. Results: Clear root canal walls were found throughout the apical half of the roots in only 11.9%, 19 % and 54.7% of the samples in groups A, B and C, respectively. In comparison between groups, Group C showed to have significantly better scores (p=0.000) than other groups with 81% of the samples had less than 50% of the dentinal walls free of smear layer/debris, while it was only 45.2% and 35.7% of the samples in group B and A respectively. In comparison between levels, at level of 2mm, group C had significantly better results in estimating 0-50% presence of smear layer/debris in the scanned dentinal walls areas (p=0.041). At level of 4mm, also group C showed significantly better results in estimating 0-50% presence of smear layer/debris in the analyzed dentinal walls areas (p=0.002) and in estimating 0-15% of the presence of smear layer analysis (p=0.004). At level of 6mm, significantly better scores in estimating 0-15% of the presence of smear layer/debris in the scanned dentinal walls areas was found in group C (p=0.023). Conclusion: Significant differences between the groups of teeth with different size of apical enlargement were found when various measurement criteria were performed. The present iii results clearly indicate that the ability of irrigation to remove smear layer/debris from the instrumented straight root canals at their apical part is enhanced with increasing the size of apical preparation with the Protaper rotary system.
Investigation of static versus dynamic cyclic fatigue resistance in NiTi endodontic instruments with different alloy treatments
(2022) Abdulkareem, Tareq Ahmad
Background: Endodontic rotary instruments can be used in a variety of canal conditions; fatigue fracture is a risk. This study looked at the cyclic fatigue resistance of two batches of nickel–titanium (NiTi) dental rotary files with same geometry and different heat treatments operating in clinically simulated root canal. Aim: To compare the deference in the cyclic fatigue resistance between heat treated and nonheat treated NiTi rotary instruments in static and dynamic modes. Materials and Methods: Cyclic fatigue tests were performed on PTU and PTG instruments with a curvature of 35° and a radius of 6 mm in static and dynamic mode at body temperature (EndoC: DMJ mechanism, Busan, Korea). The number of cycles to fracture (NCF) was rerecorded. A scanning electron microscope was used to examine the fracture surfaces of all fragments. Results: Depending on the motions performed, the cyclic fatigue resistance of the PTU and PTG varies (static or dynamic). When PTU and PTG were compared, they showed statistically significant differences in cycle fatigue resistance. PTG had higher cyclic fatigue fracture resistance on both modes tasted, but dynamic mode of testing of testing was associated with a high NCF in both files tested. The transverse and longitudinal sections of SEM micrograph of the specimens were examined after cyclic fatigue testing for PTG files and PTU files. The micro crack initiation regions, overload quick fracture areas, and microcrack areas in both were identified. PTG was discovered to have a lower concentration of microcracks.
Optimizing a 3d endodontic stent for adhesive fiber post removal: in vitro experimental study
(2022) Fard, Fatemeh
Background: The aim of this study is to optimize the variables involved in the design and fabrication of 3D stent for fiber post removal to enhance it accuracy, efficacy and safety. Material and methods: 3D stents were designed with 3D Slicer and Rhino software utilizing NextDent™ Model 2.0 or NextDent™ Surgical Guide (SG) materials. Four experiments were performed to determine the effect of 3D software and fabrication materials on hole size accuracy, hole shape characterization, enlargement margin, and wire deviation/deflection. Results: 3D stents printed with NextDent™ Surgical guide (SG) fabrication material have larger hole sizes than the origin pre-determined size by +0.04-0.07 mm, while those made with NextDent™ Model 2.0 are smaller by -0.03–0.00 mm, regardless of the software used to design the stent. NextDent™ Model 2.0 has more staircase effects than NextDent™ SG. The required enlargement margin to allow a stainless steel round wire to fit into a matched predetermined hole is +0.05-0.1mm. The deviation distance in 3D stents designed by 3D Slicer and printed by NextDent™ Model 2.0 decreased with stent thickness from 4mm to 8 or 12mm, regardless of hole size. Conclusion: No matter the software or material used to design and print stents, the actual hole size is always different than the pre-determined hole. Always enlarge the hole radius by 0.5- 1.0mm to allow a wire (or bur) to fit. Increasing stent height from 4mm to 8 or 12mm reduces wire deviation.
The Relationship Between Endodontic Case Complexity and Treatment Outcomes
(2017-08) Fezai, Hessa
Introduction: The primary goal of endodontic therapy is to prevent or heal apical periodontitis. Dental pulp has a complex internal anatomy, a thorough knowledge of both root and root canal morphology is, therefore, a fundamental prerequisite to help ensure optimal outcomes of root canal treatment. Aim: The aim of this work is to correlate between endodontic case complexities and treatment quality outcomes. Materials and Methods: A total number of 349 radiographs of patients who had received endodontic treatment during the period (2012-2015) at Hamdan Bin Mohammed College of Dental MedicineMohammed Bin Rashid University were selected. Unreadable radiographs due to technical errors, superimposed anatomical structures, and incomplete treatments were all excluded. From the original sample of 349, in total 51 radiographs were discarded. The final sample thus consisted of 298 root canal fillings of 211 patients treated by the endodontic residents. iii All radiographs were individually evaluated following the American Association of Endodontic Case Difficulty Assessment Form. Base on this, the technical quality of the root filling which depends on two main parameters density of the root filling and the distance between the end of the root filling and radiographic apex was evaluated for each individual case. Results: The sample evaluated consisted of 53% of high, 35% of moderate and 12% of minimal difficulty cases. Adequate homogeneity of root canal fillings were found in 93% of the cases. This compared with 90% of cases with adequate length of root fillings. Thus 84% (0.93x0.90=0.84) of the cases were considered to have good quality endodontic work. There were statistically significant differences between the length of root canal filling and level of difficulty (p=0.016) but, no statistically significant difference between homogeneity of root canal filling and case difficulty (p=0.794). Conclusion: The referral pattern (53% high and 35% moderate difficulty) indicates that Hamdan Bin Mohammed College of Dental Medicine is considered a secondary/tertiary referral centre. A high percentage (84%) of the cases treated were proved to be adequate in terms of length and homogeneity. There were statistically significant differences between length of root canal filling and case difficulty but, not between homogeneity and case difficulty.
A Systematic Review of Sensibility Testing And Assessment of Trauma Cases In Permanent Anterior Teeth Presented At Hbmcdm From January 2008 to December 2016
(2017-08) Shablan, Sara
The work presented here consists of two distinct parts. Part I: A systematic review of sensibility testing Introduction: The assessment of pulp vitality during pain response is traditionally performed using an electric, hot, or cold pulp tester. However, these methods have the capability to assess only the vitality of the sensory supply or the blood supply of the dental pulp and they are viewed as better measurement approaches of true health than sensibility. Since such conventional tests may be unreliable for post-traumatic dental conditions, it is imperative to clinically evaluate such teeth using alternative approaches of pulp vitality such as laser doppler flowmetry and pulse oximetry. Aims and Objectives: To systematically review the literature concerned with sensibility and vitality pulp testing involved in the diagnostic approaches for traumatic injuries of permanent anterior teeth. Materials and Methods: We conducted our search according to PRISMA reporting system. We selected English articles only without date limitation using the following scientific databases: Medline (PubMeD), EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews. The data from all included studies were extracted independently using thorough reading and observation. The search consisted of using specific search terms as well as a manual hand searching using either the iii reference lists in the included articles or using “google scholar” search. The following studies were excluded during our search: 1) Animal studies 2) studies concerned with primary teeth 3) studies concerned with the assessment of diagnostic approaches of permanent anterior teeth after trauma in their predecessors 4) studies investigating assessment of pulp condition following trauma concurrent with any oral pathological condition which may impact the pulp. Results: The range of the selected articles was between 1936-2016. Initially, we found a total of 739 articles through searching in the aforementioned databases. After duplicate removal and screening for eligible studies, we narrowed the articles to 30 in this review. Conclusions: The diseased pulp after trauma might undergo unfavorable complications such as inflammatory root resorption. Therefore, a careful follow-up of such teeth is required at periodic intervals up to six months after trauma as the nerves may regain their function later. Despite the lack of response of traumatized teeth to sensibility neurological testing, in what is known as “pulp shock”, during the first few weeks after trauma, several studies have proved pulp vitality by showing the signs of pulpal blood flow using laser doppler flowmetry and pulse oximetry. As a result, the accurate treatment plans can be decided immediately as per reported by the pulp vitality assessment tests without waiting for the positive response yielded by the conventional tests. The follow-up process of the traumatized anterior teeth should be associated with accurate interpretations depending on several evidences from various results of clinical examination and the assistive diagnostic techniques. Part II: Assessment of trauma cases in permanent anterior teeth presented at HBMCDM from January 2008 to December 2016 Introduction: The assessment of Traumatic Dental Injuries (TDIs) in young and adult patients is important as it gives an opportunity to track the possible trauma reasons in each group as well as identify its consequences and complications. However, the lack of reporting of TDIs as a result of behavioral cultural diversities among different communities may relatively hinder obtaining accurate and significant results in the retrospective evaluations. Aims and Objectives: A retrospective study was conducted in Hamadan Bin Mohammed College of Dental Medicine between January 2008 and December 2016 in United Arab Emirates using the documentation of 64 patients with 114 traumatized teeth. Materials and Methods: Hamadan Bin Mohammed College of Dental Medicine patient data base was used. The data were collected from patient notes via the application of certain treatment codes. Radiographs were also assessed and all the extracted information was recorded in excel spread sheets. Statistical tests were applied to check for significant differences (P< 0.05). Results: It was found that the most frequently traumatized teeth were detected in tooth 21 (f= 41, 36%), tooth 11 (f= 35, 30.7%) and tooth 12 (f= 12, 10.5%). TDIs were significantly associated with patient gender (p< 0.001). Of the males, only 4 patients (7.8%) experienced uncomplicated TDIs, while the remaining male patients (n=47, 92.2%) had complicated TDIs. The most frequent TDI cases were recorded in patients aged more than 18 years (64 cases, 56.1%), followed by patients with age range 12-17 years (26 cases, 22.8%) while the prevalence of TDIs within the age range 7-11 years was 24 recorded cases (21.1%). There was a significant relationship between type of v TDIs, whether being complicated or uncomplicated, and the associated periapical pathologies (p< 0.001). Of the total population (n=114), periapical pathologies occurred in 53 affected teeth, while there were 61 teeth presented without pathologies. The incidence of periapical pathology was less prominent in the uncomplicated dental injuries (n=3) while more reported with complicated injuries (n=50). There was a significant relationship between the type of treatment provided and the associated periapical pathological conditions (p < 0.001) Conclusions 1. Traumatic dental injuries occurred almost in equal proportion amongst males and females with a slight tendency toward females. 2. Complicated injuries were more prominent in males than female patients. 3. The most frequent traumatic dental injuries were reported in patients aged more than 18 years old.

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