Spatial Abilities and Endodontic Access Cavity Preparation: Implications for Dental Education.

INTRODUCTION: Access cavity preparation is a crucial step in root canal treatment but is one of the most complex procedures in the curriculum to learn, with students often reporting spatial orientation difficulties during drilling. The present study aimed to evaluate the influence of spatial abilities on the preparation of endodontic access cavities among third-year dental students. MATERIALS AND METHODS: Students from Lyon dental faculty participated voluntarily. The mental rotation test (MRT) evaluated spatial ability. Students prepared access cavities on 3D-printed mandibular molars, subsequently scanned and assessed against eight evaluation points, including morphology, canal access, floor preservation and convergence angle. Principal component analysis (PCA) assessed dataset variations. RESULTS: A total of 43 volunteers participated. PCA revealed two principal components accounting for 80.8% of variations: the first PC primarily consisted of MRT score (64.3%) and morphology (14.1%); the second comprised operative time (46.1%) and morphology (18.0%). There were significant differences in morphology based on MRT scores, but no correlation was found between other parameters. DISCUSSION: Lower MRT scores were associated with larger cavity preparations, raising questions about potential curriculum adaptations to enhance spatial reasoning. The operative time was not correlated with higher MRT scores but did contribute to variations in cavity morphology. CONCLUSION: Spatial abilities have a substantial impact on the quality of endodontic access cavity preparations; further studies should evaluate if the incorporation of 3D atlas exercises could be beneficial.

Assessment of guide fitting using an intra-oral scanner: An in vitro study.

OBJECTIVES: The aim of this study was to evaluate the capacity of an intra-oral scanner (IOS) to assess the position of an endodontic guide in vitro. METHODS: Fourteen extracted human teeth were placed into a maxillary model and scanned using computed tomography and a reference laboratory scanner. An ideal endodontic guide was then created and modified by adding defects of different thicknesses to simulate incorrect positions: 50 µm, 150 µm, 400 µm, and 1000 µm. For each thickness, guides were printed three times and each guide was scanned by three experimented operators using a Trios 4 IOS (3Shape, Copenhagen, Denmark). The 36 scans were compared using a best-fit alignment to the master model without defect to define the accuracy of the method and the positioning error. RESULTS: The IOS presented a mean trueness of 1.28 µm (SD= 12.70) and a mean precision of 11.52 µm (SD= 62.17). Considering all sizes of defect, the mean measured position of the endodontic guide was highly correlated (R>0.99) with the expected position. Compared to the ideal guide, there was a mean linear deviation of 46.11 µm (SD= 23.21) and a mean angular deviation of 5.9° (SD= 1.2); this deviation was not influenced by the operator. CONCLUSION: The present study found that an IOS had good performance to detect a positioning error of the endodontic guide in vitro. CLINICAL SIGNIFICANCE: This new application of IOS has a promising potential in clinical practice to assist practitioners during the fitting of guides.

Experimental borosilicate bioactive glasses: Pulp cells cytocompatibility and mechanical characterization.

AIM: To assess in vitro the effect of two novel phase separated borosilicate glasses (PSBS) in the system SiO2 -B2 O3 -K2 O-CaO-Al2 O3 on dental pulp cells; and to compare their bioactivity and mechanical properties to a conventional fluoroaluminosilicate glass ionomer cement namely FUJI IX. METHODOLOGY: The cytocompatibility assessment of the two novel borosilicate glasses, one without alumina (PSBS8) and one containing alumina (PSBS16), was performed on cultured primary human pulp cells. Alamar blue assay was used to assess cell metabolic activity and cell morphology was evaluated by confocal imaging. The bioactivity in Stimulated Body Fluid was also evaluated after 1 and 3 weeks of immersion using SEM-EDX analysis. Vickers microhardness and flexural strength were assessed after incorporating the glass particles into a commercial glass ionomer cement (GIC) liquid containing both polyacrylic and polybasic carboxylic acid. RESULTS: The data revealed that the two borosilicate glasses enhanced cell viability ratios at all-time points in both direct and indirect contact assays. After 3 days of contact, PSBS8 without alumina showed higher viability rate (152%) compared to the PSBS16 containing alumina (145%) and the conventional glass ionomer particles (117%). EDX analysis confirmed an initial Ca/P ratio of 2.1 for 45S5K and 2.08 for PSBS8 without alumina after 3 weeks of immersion. The cement prepared using PSBS8 showed significantly higher Vickers hardness values (p = .001) than that prepared using PSBS16 (46.6 vs. 36.7 MPa). After 24 h of maturation, PSBS8 (without alumina) exhibited a flexural strength of 12.9 MPa compared to a value of 16.4 MPa for the commercial control. PSBS8 without alumina had a higher strength than PSBS16 with alumina, after 1 and 7 days of maturation (p = .001). CONCLUSIONS: The present in vitro results demonstrated that the borosilicate bioactive glass without alumina enhanced pulp cell viability, spreading and acellular bioactivity better than the conventional GIC and the experimental borosilicate glass containing alumina.

Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions.

BACKGROUND: During interventions for deep caries lesions without severe symptoms, preserving pulpal vitality is important to ensure treatment success, improve organ prognosis, and decrease cost-effectiveness. Current pre-operative radiographs allow visual estimation but not accurate measurement of lesion depth. PURPOSE: Investigate the ability of ratio 'remaining/total dentin thickness' (RDT/TDT, as determined on pre-operative radiographs) to predict pulp exposure during excavation. METHODS: This retrospective study (January 2018-June 2020) analyzed data on 360 patients. Four independent raters examined standard pre-operative radiographs and their contrasted versions. Lines put at the dentino-enamel junction, the floor of the carious lesion, and the pulp chamber wall allowed deriving RDT/TDT. Inter-rater agreements and concordance were assessed. A logistic regression accounting for measurement errors provided odds ratios that estimated the ability of the RDT/TDT to predict pulp exposure. RESULTS: The median RDT/TDT ratio ranges were 16.8-26.5% on standard and 16.2-24.6% on contrasted radiographs. Inter-rater agreements on RDT/TDT were rather poor and inter-rater reliability was low and similar in standard and contrasted radiographs: the concordance correlation coefficients (95% CIs) were estimated at 0.46 (0.40; 0.51) and 0.46 (0.40; 0.52), respectively. The risk of pulp exposure increased by 2.5 times [odds ratio (95% CI) 2.57 (2.06; 3.20)] per 10-point decrease of the ratio on standard radiographs vs. 4.15 (3.15; 5.46) on contrasted radiographs. CONCLUSION: RDT/TDT ratio is potentially helpful in predicting pulp exposure. However, the measurement errors on RDT and TDT being non-negligible and the interrater agreements poor, there is still place for advances through development of an automated process that will improve reliability and reproducibility of pulp exposure risk assessment. CLINICAL TRIAL: Trial registration number. ClinicalTrials.gov NCT04607395, October 29, 2020.

[What are the cephalometric features of "good" and "bad" guys in cartoons?] / Quelles sont les caractéristiques céphalométriques des « bons ¼ et des « mauvais ¼ dans les dessins animés ?

OBJECTIVE: The objective of the study was to search for links between specific facial features and the psychology of the "good" and "bad" guys in cartoons. MATERIAL AND METHOD: We made 60 cephalometric tracings and compared the characters' profiles using statistical tests. RESULTS: The "bad guy" profile is closer to the normal profile of real humans than that of the "good guys". Profiles perceived as "good" in cartoons appear to be stereotyped. Thus, any profile not matching the "norm" can be interpreted as being unpleasant and consequently associated with the features of the "bad guys". The standard "bad guy" profile has a longer more prominent nose, a jutting chin (a bigger soft-tissue angle) and a higher upper third of the face than the lower third (the opposite of the standard profile of the "good guys"). DISCUSSION: These standardized portraits reflect and influence the (subconscious) prejudices of both young and less young movie-goers (not to mention the cartoonists) regarding their fellow humans.

One-step partial or complete caries removal and bonding with antibacterial or traditional self-etch adhesives: study protocol for a randomized controlled trial.

BACKGROUND: Current concepts in conservative dentistry advocate minimally invasive dentistry and pulp vitality preservation. Moreover, complete removal of carious dentin in deep carious lesions often leads to pulp exposure and root canal treatment, despite the absence of irreversible pulp inflammation. For years, partial caries removal has been performed on primary teeth, but little evidence supports its effectiveness for permanent teeth. Furthermore, the recent development of new antibacterial adhesive systems could be interesting in the treatment of such lesions. The objectives of this study are to compare the effectiveness of partial versus complete carious dentin removal in deep lesions (primary objective) and the use of an antibacterial versus a traditional two-step self-etch adhesive system (main secondary objective). METHODS/DESIGN: The DEep CAries Treatment (DECAT) study protocol is a multicenter, randomized, controlled superiority trial comparing partial versus complete caries removal followed by adhesive restoration. The minimum sample size required is 464 patients. Two successive randomizations will be performed (allocation ratio 1:1): the first for the type of excavation (partial versus complete) and the second (if no root canal treatment is required) for the type of adhesive (antibacterial versus traditional). For the two objectives, the outcome is the success of the treatment after 1 year, measured according to a composite outcome of five FDI criteria: material fracture and retention, marginal adaptation, radiographic examination (including apical pathologies), postoperative sensitivity and tooth vitality, and carious lesion recurrence. DISCUSSION: The study will investigate the interest of a conservative approach for the management of deep carious lesions in terms of dentin excavation and bioactive adhesive systems. The results may help practitioners achieve the most efficient restorative procedure to maintain pulp vitality and increase the restoration longevity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02286388 . Registered in November 2014.

Comparison of mechanical properties of a new fiber reinforced composite and bulk filling composites.

OBJECTIVES: The aim of this study was to evaluate the mechanical and physical properties of a newly developed fiber reinforced dental composite. MATERIALS AND METHODS: Fiber reinforced composite EverX Posterior (EXP, GC EUROPE), and other commercially available bulk fill composites, including Filtek Bulk Fill (FB, 3M ESPE), SonicFill (SF, Kerr Corp.), SureFil (SDR, Dentsply), Venus Bulk Fill (VB, HerausKultzer), Tetric evoceram bulk fill (TECB, Ivoclar Vivadent), and Xtra Base (XB, Voco) were characterized. Composite samples light-cured with a LED device were evaluated in terms of flexural strength, flexural modulus (ISO 4049, n = 6), fracture toughness (n = 6), and Vickers hardness (0, 2, and 4 mm in depth at 24 hr, n = 5). The EXP samples and the fracture surface were observed under a scanning electron microscopy. Data were statistically analyzed using one-way ANOVA and unpaired t-test. RESULTS: EXP, FB, and VB had significantly higher fracture toughness value compared to all the other bulk composite types. SF, EXP, and XB were not statistically different, and had significantly higher flexural strength values compared to other tested composite materials. EXP had the highest flexural modulus, VB had the lowest values. Vickers hardness values revealed SF, EXP, TECB, and XB were not statistically different, and had significantly higher values compared to other tested composite materials. SEM observations show well dispersed fibers working as a reinforcing phase. CONCLUSIONS: The addition of fibers to methacrylate-based matrix results in composites with either comparable or superior mechanical properties compared to the other bulk fill materials tested.

Tensile Bond Strengths of Two Adhesives on Irradiated and Nonirradiated Human Dentin.

The aim of this study was to assess the effect of radiotherapy on bond efficiency of two different adhesive systems using tensile bond strength test. Twenty extracted teeth after radiotherapy and twenty nonirradiated extracted teeth were used. The irradiation was applied in vivo to a minimal dose of 50 Gy. The specimens of each group were randomly assigned to two subgroups to test two different adhesive systems. A three-step/etch-and-rinse adhesive system (Optibond FL) and a two-steps/self-etch adhesive system (Optibond XTR) were used. Composite buildups were performed with a nanohybrid composite (Herculite XTR). All specimens were submitted to thermocycling ageing (10000 cycles). The specimens were sectioned in 1 mm(2) sticks. Microtensile bond strength tests were measured. Nonparametric statistical analyses were performed due to nonnormality of data. Optibond XTR on irradiated and nonirradiated teeth did not show any significant differences. However, Optibond FL bond strength was more effective on nonirradiated teeth than on irradiated teeth. Within the limitations of an in vitro study, it can be concluded that radiotherapy had a significant detrimental effect on bond strength to human dentin. However, it seems that adhesive choice could be adapted to the substrata. According to the present study, the two-steps/self-etch (Optibond XTR) adhesive system tested could be more effective on irradiated dentin compared to three-steps/etch-and-rinse adhesive system (Optibond FL).

Initial sliding wear kinetics of two types of glass ionomer cement: a tribological study.

The aim of this work was to characterize the initial wear kinetics of two different types of glass ionomer cement used in dentistry (the conventional glass ionomer cement and the resin-modified glass ionomer cement) under sliding friction after 28-day storing in distilled water or Ringer's solution. Sliding friction was applied through a pin-on-disk tribometer, in sphere-on-plane contact conditions, under 5 N normal load and 120 rotations per minute. The test lasted 7500 cycles and replicas were performed at 2500, 5000 and 7500 cycles. A profilometer was used to evaluate the wear volume. Data were analysed using Student's t-test at a significant level of 5%. There is no statistical significant difference between the results obtained for a given material with the maturation media (P > 0.05). However, for a given maturation medium, there are significant statistical differences between the data obtained for the two materials at each measurement (P < 0.0001). The wear rates of both materials decrease continuously during the running-in period between 0 and 2500 cycles. After 2500 cycles, the wear rate becomes constant and equal for both materials. The resin matrix contained in the resin-modified glass ionomer cement weakens the tribological behaviour of this material.

Conservative approach of a symptomatic carious immature permanent tooth using a tricalcium silicate cement (Biodentine): a case report.

The restorative management of deep carious lesions and the preservation of pulp vitality of immature teeth present real challenges for dental practitioners. New tricalcium silicate cements are of interest in the treatment of such cases. This case describes the immediate management and the follow-up of an extensive carious lesion on an immature second right mandibular premolar. Following anesthesia and rubber dam isolation, the carious lesion was removed and a partial pulpotomy was performed. After obtaining hemostasis, the exposed pulp was covered with a tricalcium silicate cement (Biodentine, Septodont) and a glass ionomer cement (Fuji IX extra, GC Corp.) restoration was placed over the tricalcium silicate cement. A review appointment was arranged after seven days, where the tooth was asymptomatic with the patient reporting no pain during the intervening period. At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests. Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation. This case report demonstrates a fast tissue response both at the pulpal and root dentin level. The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

Impedance methodology: A new way to characterize the setting reaction of dental cements.

OBJECTIVES: Impedance spectroscopy is a non-destructive, quantitative method, commonly used nowadays for industrial research on cement and concrete. The aim of this study is to investigate the interest of impedance spectroscopy in the characterization of setting process of dental cements. METHODS: Two types of dental cements are used in this experiment: a new Calcium Silicate cement Biodentine™ (Septodont, Saint Maur-des Fossés, France) and a glass ionomer cement resin modified or not (Fuji II(®) LC Improved Capsules and Fuji IX(®) GP Fast set Capsules, GC Corp., Tokyo, Japan). The conductivity of the dental cements was determined by impedance spectroscopy measurements carried out on dental cement samples immersed in a 0.1M potassium chloride solution (KCl) in a "like-permeation" cell connected to a potentiostat and a Frequency Response Analyzer. The temperature of the solution is 37°C. From the moment of mixing of powder and liquid, the experiments lasted 2 weeks. RESULTS: The results obtained for each material are relevant of the setting process. For GIC, impedance values are stabilized after 5 days while at least 14 days are necessary for the calcium silicate based cement. SIGNIFICANCE: In accordance with the literature regarding studies of cements and concrete, impedance spectroscopy can characterize ion mobility, porosity and hardening process of dental hydrogel materials.