Utilizing a Novel AI Tool to Detect the Posterior Superior Alveolar Artery's Location's Impact on Maxillary Sinus Mucosal Thickening in the Presence of Periapical Lesions.

Periapical lesions have been implicated in sinus-related complications, but the precise influence of anatomical variations in the posterior superior alveolar artery (PSAA) on mucosal thickening remains an uncharted aspect. The new AI tool employed in this research utilizes advanced image processing algorithms to enhance image visualization. Background and Objectives: This study examines the accuracy of a new cone beam computed tomography (CBCT) software (eVol DXS, version 1.0.1.0) employing AI to detect the PSAA's location and the effect of that on maxillary sinus thickening in the presence of periapical lesions. Materials and Methods: This retrospective study included 120 CBCT cases with posterior maxillary periapical lesions and 120 without odontogenic infections. Teeth with proximity (<2 mm) to the sinus were excluded in both groups to eliminate the sinus floor's perforation effect. Both the PSAA locations and maxillary sinus thickening were classified and compared. Results: The mucosal thickening differs significantly (p < 0.001) between the study group and the control group. The study showed that an increased sinus thickness occurred when the PSAA was beneath the sinus membrane in the study group (62.5% compared to 8.6%; p < 0.001 *). The AI tool helped to achieve a 100% identification rate in determining the PSAA locations. Conclusions: AI algorithms for PSAA localization, which affects mucosal thickness in response to periapical lesions, yield excellent results.

Outcome of Regenerative Endodontic Procedures in Nonvital Immature Permanent Teeth Using 2 Intracanal Medications: A Prospective Randomized Clinical Study.

INTRODUCTION: This randomized clinical trial aimed to assess and compare the long-term clinical and radiographic outcomes of regenerative endodontic procedures (REPs) in treating nonvital immature permanent teeth using 2 intracanal medicaments. METHODS: Forty-five patients yielding a total of 50 anterior and posterior nonvital immature teeth were randomly divided into 2 groups. REPs using either nonsetting calcium hydroxide (Ca[OH]2) (n = 25) or modified triple antibiotic paste (TAP) (n = 25) as intracanal medicaments were performed. NeoMTA Plus (Avalon Biomed Inc) was applied for coronal sealing. Cases were followed up clinically and radiographically for 36 months. The survival rate, success rate, and clinical outcome measures were analyzed. Preoperative and recall radiographs were evaluated for dimensional changes in root length, dentin thickness, apical diameter, and periapical radiolucency. RESULTS: At the 36-month follow-up, the success and survival rates were 81.6% and 100%, respectively, in which 79.4% of cases showed complete resolution of periapical radiolucency with no significant difference between the nonsetting Ca(OH)2 and modified TAP groups (P > .050). The cumulative changes in root length, root dentin thickness, and apical diameter throughout the study period were observed in 47.9%, 77.1%, and 89.6% of cases, respectively, with no significant differences between groups (P ≥ .39). Intracanal calcifications were detected in 60% of cases with no significant difference between groups (P = .77). CONCLUSIONS: REPs, using either nonsetting Ca(OH)2 or modified TAP as the intracanal medicament, exhibited high success and survival rates over a follow-up period of 36 months with equally favorable clinical and radiographic outcome data.

Root and canal morphology of third molar teeth.

Restorative and prosthetic considerations usually necessitates endodontic treatment of third molars in order to retain them as a functional component of the dental arch. However, the anatomy of third molars has been described as unpredictable. To date, there has been little published work on root and canal morphology of third molars, with an adequate sample size. The aim of this study was to investigate root and canal morphology of third molars. Maxillary and mandibular third molars were gathered from dental surgeries within north Jordan. Following access cavity preparation, pulp tissue was removed and root canals stained. Teeth were subject to examination after rendering them clear by immersion in methyl salicylate, and the following features evaluated: (1) number of roots; (2) number and type of root canals; (3) number and position of lateral canals; and (4) presence of inter-canal communications. Out of the examined 592 maxillary third molars, 69.9% had three roots, 10.81% had one, 9.79% had two, 9.12% had four, and 0.34% had five roots. Most had three (52.36%) and four canals (28.2%) with less frequency of two (11.48%), one (5.91%) and five canals (2.03%). Of the 639 mandibular third molars, 89.76% had two roots, 7.35% had three, 2.5% had one, and 0.47% had four roots. Most had three (55.71%) and two canals (29.42%) with less frequency of four (13.61%), one (1.09%) and five canals (0.15%). The majority of maxillary third molars had 3 roots, while the majority of mandibular third molars had two. Overall, nearly half of the maxillary and mandibular third molars had three canals. New canal configurations, not previously described in the literature nor included in Vertucci's classifications, were identified in both maxillary and mandibular third molars.

Mandibular first premolar apical morphology: A stereomicroscopic study.

The aim of this study was to investigate the size, shape and position of the physiological foramen and the relationship between the age and gender to the location and size of the apical foramen of mandibular first premolars. One hundred and one extracted human mandibular first premolar teeth were examined; age and gender of the patients were recorded. Apices of teeth were examined stereomicroscopically for number, size and shape of apical foramina; frequency and deviation of accessory foramina from the apex and the relation with age and gender. Sixty-four of the premolars had one foramen and 23% had two. The distances from the foramina openings to the apices ranged from 0.07 to 2.18 mm. In younger range irregular shape was dominant (41%), whilst in older range, round shape was dominant (45%). The shape of the apical foramen changed with age and the distance from the foramen to the anatomical apex increased with age.

Outcomes of Vital Pulp Therapy Using Mineral Trioxide Aggregate or Biodentine: A Prospective Randomized Clinical Trial.

INTRODUCTION: Mineral trioxide aggregate (MTA) has been used in pulp capping of cariously exposed mature permanent teeth with promising results. The search for alternative materials that seal better and set faster than MTA and do not stain is ongoing. Biodentine (Septodont, St Maur-des-Fossés, France) exhibits these advantages but has not been tested yet for a prolonged duration in mature teeth. This study aimed to evaluate the clinical performance of Biodentine and white MTA (Angelus, Londrina, Brazil) in cariously exposed mature permanent teeth. METHODS: This was a prospective longitudinal randomized controlled study of 68 vital permanent teeth with deep caries. Patients were randomly allocated into 2 study arms: Biodentine and MTA. Teeth were assessed clinically and radiographically before the procedure. Caries were excavated under local anesthesia; hemostasis was achieved after pulp exposure using sodium hypochlorite and capped with Biodentine or MTA. Clinical and radiographic follow-ups were performed by a blinded calibrated evaluator after 6 months and 1, 2, and 3 years. RESULTS: There were no significant differences in the overall success rate between Biodentine and MTA; it was 93.3% (Biodentine = 93.1% and MTA = 93.5%) at 6 months. The overall success rate increased to 96.2% (Biodentine = 96.0% and MTA = 100%) at 1 year and to 100% at 2 years. At the 3-year follow-up, it decreased to 93.8% (Biodentine = 91.7% and MTA = 96.0%). CONCLUSIONS: Biodentine and MTA have favorable and comparable success rates when used as direct pulp capping or pulpotomy material in permanent mature teeth with carious exposure. The remaining tooth structure and durability of coronal restoration might affect significantly the long-term success of vital pulp therapy.

The Antifungal Effect of Propolis Endodontic Irrigant with Three Other Irrigation Solutions in Presence and Absence of Smear Layer: An In Vitro Study.

INTRODUCTION: The aim of this in vitro study was to compare the antifungal effect of propolis as an endodontic irrigant agent with a mixture of doxycycline, citric acid, and a detergent mixture (MTAD), 2% chlorhexidine (CHX) and 3% sodium hypochlorite (NaOCl) against Candida albicans in presence and absence of smear layer. METHODS AND MATERIALS: Extracted teeth with single canals (n=104) were prepared and randomly distributed into four experimental groups; 30% propolis, MTAD, 2% CHX and 3% NaOCl. Each group had two subgroups; with and without smear layer. The antifungal effectiveness was evaluated. The Kruskal-Wallis and Mann-Whitney tests were used to compare the overall effectiveness of different treatments at significance level of 0.05. RESULTS: Propolis, CHX and NaOCl had similar levels of effectiveness to each other against C. albicans, and these levels were not affected by the presence or absence of the smear layer. Each irrigant was significantly more effective than MTAD or saline solution. MTAD was less effective in the presence of the smear layer than in its absence. CONCLUSIONS: Propolis irrigation can produce root canals that are free of C. albicans, even in the presence of the smear layer.

Human periodontal fibroblasts viability stored in Custodiol® , coconut water, and propolis. An ex vivo study.

BACKGROUND/AIMS: Successful replantation of an avulsed tooth depends on the regeneration of periodontal ligament (PDL) attachment which is affected by the transport medium, dry time, and storage time. Various storage media have been studied but the search for the optimum storage medium is still needed to determine the ideal material and storage time to maintain PDL cells. The aim of this study was to determine the ability of Custodiol® , coconut water (CW) from different stages of maturity, and propolis as storage media for avulsed teeth by evaluating the viability of PDL cells for different time intervals. MATERIALS AND METHODS: PDL cultures were subjected to Cutodiol® , immature, half mature, and mature coconut water, and different concentrations of propolis in Dulbecco's Modified Eagles Medium (DMEM). Culture plates with the tested media were incubated for 1, 2, 6, 24, 48, 72, and 168 hour. PDL fibroblast cell viability was assessed by MTT assay. RESULTS: CW showed significantly higher viability of cells than other groups at 6 hour with half mature CW being superior. Propolis at 6.25 mg/mL in DMEM resulted in 138% viable PDL and it was able to preserve PDL cells for up to 168 hour. CONCLUSIONS: Half mature and mature CW are superior storage media if replantation of avulsed teeth is within 6 hour. Propolis in DMEM could be a potential storage media for prolonged storage intervals up to 48 hour.

Higher Maximal Occlusal Bite Force in Endodontically Treated Teeth Versus Vital Contralateral Counterparts.

INTRODUCTION: Decreased sensitivity to occlusal load could lead to a greater risk of damage to endodontically treated teeth. Therefore, this study aims to test whether root canal treatment reduces the sensitivity of the treated teeth to occlusal load. METHODS: This is a comparative cross-sectional study of 124 patients who received root canal treatment. Treated teeth were compared with vital teeth on the contralateral side. After interviews with participants, their maximal bite forces (MBFs) of their root canal-treated and contralateral untreated teeth were measured using a digital bite fork force transducer. Data were analyzed by comparing the mean MBF of root canal-treated and control teeth. RESULTS: The mean MBF (± standard deviation) was 226.6 N (±168.7) for root canal-treated teeth and 207.93 N (±158.08) for control teeth. Root canal-treated teeth had a significantly higher difference in the mean MBF than the control group (P < .0001) using the paired sample t test. A univariate analysis test showed that differences in the MBF were affected by molar relationship, overbite, and the quality of root filling. CONCLUSIONS: The difference in the MBF was significantly higher in root canal-treated teeth, which is consistent with the function of dental pulp as a highly sensitive sensor. Therefore, the reduction in the sensitivity of teeth to an applied load after pulp removal may increase the risk of overloading. This may, in turn, increase the frequency of tooth damage after root canal treatment.

Adhesion of Epiphany self-etch sealer to dentin treated with intracanal irrigating solutions.

INTRODUCTION: This in vitro study assessed the adhesion of Epiphany self-etch (SE) root canal sealer to dentin treated with different irrigation regimens. METHODS: Flat dentin surfaces were obtained from human third molar teeth; smear layer was created on each sample. Five groups of 10 samples each were conditioned with one of the following regimens: (1) deionized water for 10 minutes; (2) 5% sodium hypochlorite (NaOCl) for 10 minutes; (3) 5% NaOCl for 10 minutes and then 10% sodium ascorbate (Na-Ascr) for 10 minutes; (4) 5% NaOCl for 10 minutes and then 2% chlorhexidine (CHX) for 5 minutes; or (5) 5% NaOCl for 10 minutes and then 10% Na-Ascr for 10 minutes, followed by 2% CHX for 5 minutes. The conditioned dentin surfaces were dried with absorbent paper points. The Epiphany SE sealer was placed on each dentin surface with the use of hollow stainless steel tubes with specific diameter and height. The samples were stored in 100% humidity at 37°C for 7 days and then tested for shear bond strength in a universal testing machine. RESULTS: Shear bond strength data were analyzed by one-way analysis of variance and Tukey post hoc tests (P < .05). There were statistically significant differences among the groups. CONCLUSIONS: NaOCl decreased the bond strength of Epiphany SE sealer to dentin, whereas the use of Na-Ascr reversed this negative effect of NaOCl. CHX had neither negative nor positive influence on the bond strength.

Effect of Coconut Water Concentration on Survival of Bench-Dried Periodontal Ligament Cells.

Background : Coconut water is a biological and sterile liquid. It contains a variety of electrolytes, sugars and amino acids. The purpose of this study is to evaluate the effect of concentration and maturity of coconut water on its ability to preserve human PDL cell viability after exposure to dry time of up to 120 minutes using an in vitro cell culture model. Methods : PDL cells were obtained from sound permanent first molars which were cultured in Dulbecco's Modified Eagle's Medium (DMEM). Cultures were subjected to 0, 30, 60, 90 and 120 minutes dry periods then incubated with 100 and 50% young and mature coconut water for 45 minutes at room temperature (18-26°C). Untreated cells at 0 and 120 minutes, and cells incubated in DMEM served as controls. PDL cell viability was assessed by MTT assay. Statistical analysis of data was accomplished by using one-way analysis of variance complemented by Tukey test, and the level of significance was 5% (p < 0.05). Results : 100% mature coconut water (MCW) was better than 50% dilutions obtained from mature or young coconuts. However, no significant benefit to the cells was noticed from the addition of the soaking step prior to 30 minutes dry time. Conclusion : Avulsed teeth which are left dry for > 30 minutes may be benefited from soaking in 100% mature coconut water; further studies on simulated avulsion in animal models are needed to verify the above results.

Effectiveness of propolis and calcium hydroxide as a short-term intracanal medicament against Enterococcus faecalis: a laboratory study.

The aim of this study was to investigate the antimicrobial activity of propolis-based intracanal medicament against Enterococcus faecalis using infected dentine models, and to compare its antimicrobial efficacy with that of the non-setting calcium hydroxide paste when used as a short-term medication for 1 and 2 days. A total of 50 dentine discs of 7-mm length was obtained from extracted human teeth. Five dentine discs were kept sterile to serve as a negative control. The remaining 45 were contaminated with E. faecalis and divided into two groups (n = 20) in addition to five discs that served as a positive control. The discs were treated as follow: 20 discs were filled with propolis, while the other 20 discs were filled with non-setting calcium hydroxide. Microbiological sampling was performed utilising sterile paper point, headstrom file and disc immersion. Results showed that propolis was significantly more effective than non-setting calcium hydroxide against E. faecalis after short-term application, which made comparison from this prospect unlevelled. The most effective microbiological sampling technique was abrading the lumen with headstrom file. Propolis is very effective as intracanal medicament in rapidly eliminating E. faecalis ex vivo.

Root form and canal morphology of Jordanian maxillary first premolars.

This study was conducted to investigate root canal morphology of maxillary first premolars in a Jordanian population. Six hundred maxillary first premolars were collected, stained, and decalcified. Cleared teeth were examined and the following features were evaluated: (1) number of roots, (2) presence of furcation grooves, (3) location of apical foramina, (4) number and types of root canal, (5) number of lateral canals and isthmi, and (6) frequency of apical deltas. Of the six hundred maxillary first premolars 30.8% has one root, 63.2% has two, and 5.2% has bifid roots. Concerning root canal morphology, 79.7% had two canals with two separate apical foramina, whereas 3.3% of the teeth possessed type I canal systems. All two rooted maxillary first premolars showed furcation groove in the buccal roots. Maxillary first premolars are mainly two rooted and mostly have two canals. The presence of furcation groove should be kept in mind during both endodontic and prosthodontic procedures.

Caries-induced changes in the expression of pulpal neuropeptide Y.

Recent evidence suggests that the sympathetic nervous system may have a role in modulating neurogenic inflammation and bone remodelling. Neuropeptide Y (NPY) is a well-characterized neuropeptide transmitter in the peripheral sympathetic nervous system. NPY is known to be present in human dental pulp; however, quantitative data on NPY levels in pulpal health and disease in an adult population remain to be determined. The aims of the current study were to assess, quantitatively, NPY levels by radioimmunoassay and confirm the distribution of NPY fibres by immunocytochemistry in carious and non-carious adult human pulp tissue. Our results suggest changes in the levels and distribution of NPY in human dental pulp during the caries process, with significantly higher levels of NPY in carious compared with non-carious adult human teeth. Within the carious samples studied, our finding, that NPY levels were significantly elevated in mild/moderate caries, concurs with the hypothesis that NPY could have a modulatory role in pulpal inflammation and in reparative dentine formation.

The role of cathepsin C in Papillon-Lefèvre syndrome, prepubertal periodontitis, and aggressive periodontitis.

We have previously reported that loss-of-function mutations in the cathepsin C gene (CTSC) result in Papillon-Lefèvre syndrome, an autosomal recessive condition characterized by palmoplantar keratosis and early-onset, severe periodontitis. Others have also reported CTSC mutations in patients with severe prepubertal periodontitis, but without any skin manifestations. The possible role of CTSC variants in more common types of non-mendelian, early-onset, severe periodontitis ("aggressive periodontitis") has not been investigated. In this study, we have investigated the role of CTSC in all three conditions. We demonstrate that PLS is genetically homogeneous and the mutation spectrum that includes three novel mutations (c.386T>A/p.V129E, c.935A>G/p.Q312R, and c.1235A>G/p.Y412C) in 21 PLS families (including eight from our previous study) provides an insight into structure-function relationships of CTSC. Our data also suggest that a complete loss-of-function appears to be necessary for the manifestation of the phenotype, making it unlikely that weak CTSC mutations are a cause of aggressive periodontitis. This was confirmed by analyses of the CTSC activity in 30 subjects with aggressive periodontitis and age-sex matched controls, which demonstrated that there was no significant difference between these two groups (1,728.7 +/- SD 576.8 micro moles/mg/min vs. 1,678.7 +/- SD 527.2 micro moles/mg/min, respectively, p = 0.73). CTSC mutations were detected in only one of two families with prepubertal periodontitis; these did not form a separate functional class with respect to those observed in classical PLS. The affected individuals in the other prepubertal periodontitis family not only lacked CTSC mutations, but in addition did not share the haplotypes at the CTSC locus. These data suggest that prepubertal periodontitis is a genetically heterogeneous disease that, in some families, just represents a partially penetrant PLS.

Quantitative analysis of substance P, neurokinin A and calcitonin gene-related peptide in gingival crevicular fluid associated with painful human teeth.

The aim of this study was to investigate the presence of substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) in the gingival crevicular fluid of teeth diagnosed with pain of pulpal origin compared with clinically healthy teeth, and to detect any changes in the levels of these neuropeptides in gingival crevicular fluid after removal of the pulp from the painful teeth. Gingival crevicular fluid was collected at baseline from one interproximal site at a painful and a non-painful contralateral tooth from 54 adult patients. Sampling was repeated after 1 wk in a subset of 21 subjects. Samples were analysed for SP, NKA, and CGRP using radioimmunoassay. The mean levels of SP and NKA were significantly higher in gingival crevicular fluid from painful teeth compared with non-painful teeth. The level of SP in the GCF of painful teeth fell significantly 1 wk after pulpectomy. In contralateral teeth, there were no significant differences in the levels of SP and NKA after 1 wk. It is concluded that SP and NKA are present in significantly greater amounts in the GCF of painful teeth compared with healthy teeth.