Nasopalatine duct cyst mimicking an endodontic periapical lesion: a case report.

Lesions of nonendodontic origin, such as nasopalatine or globulomaxillary cysts, may mimic periapical radiolucencies associated with pulpal pathosis, and incorrect diagnosis may lead to unnecessary endodontic treatment. Horizontal root fractures most commonly affect the maxillary central and lateral incisors. Prognosis depends largely on the level of fracture; fractures in the apical third have the best prognosis, and those in the cervical third have the worst. This case report discusses surgical and restorative management of a patient who had a nasopalatine cyst that had been misdiagnosed and treated as an endodontic lesion of the maxillary right central incisor as well as a midroot horizontal fracture of the adjacent lateral incisor.

Proposal for clinical classification of multifactorial noncarious cervical lesions.

Noncarious cervical lesions often present with overlapping symptoms and have a multifactorial etiology. The dimensions of the lesion axially (depth) and occlusogingivally (width), along with the orientation of the walls of the lesion to each other (angle), are the 3 factors that can be quantified to classify the lesion and assess its progress over time. This article analyzes these factors and proposes a simple classification system based upon the clinical appearance of the lesion in order to derive simple, therapeutic, treatment-based classifications.

Apert syndrome: craniofacial challenges and clinical implications.

Apert syndrome is a rare acro-cephalo-syndactyly syndrome characterised by craniosynostosis, severe syndactyly of hands and feet, and dysmorphic facial features. It demonstrates autosomal dominant inheritance assigned to mutations in the fibroblast growth factor receptor gene, as a result of which signals are not received to produce necessary fibrous material necessary for normal cranial sutures. Deformities are generally cosmetic but can affect various functions such as hearing, visual abnormalities, swallowing, writing, etc, so a multidisciplinary approach is needed for their management.Presently described is a case of a male in his late adolescence who was medically diagnosed with Apert syndrome at birth. Physical appearance and dental examination of the patient included acrocephaly, prominent forehead, ocular hypertelorism, proptosis, short and broad nose, pseudo-prognathism, dental crowding and ectopia, maxillary hypoplasia, low hairline, webbed neck, pectus excavatum and severe bilateral syndactyly of hands and feet.

Contextual barriers in effective interpersonal communication with patients: A qualitative analysis.

Purpose: Competence building in interpersonal communication (IPC) between undergraduate students and patients requires deep understanding of the factors influencing their interaction. These factors, contextual to our clinical setup were explored from multisource perspectives to understand the perceived barriers in IPC. Method: Qualitative hermeneutic phenomenological analysis was done for patient's semi-structured interviews (n = 16); interns (n = 15) and faculty (n = 14) unstructured focus group discussions. Three independent authors transcribed the data, derived codes and themes individually, and then collated and reflected on them to draw conclusions. Different collection methods, multisource perspectives, and multilevel analysis provided for triangulation and validation of the study results. Results: This study's multisource feedback identified seven inter-dependent barriers to interpersonal communication between students and patients. They were time constraints, lack of trust and respect, cultural diversity, loco-regional linguistic differences, lack of empathy, illiteracy, and financial constraints. Conclusions: The study concluded by identifying the unique set of barriers preventing interpersonal communication in our clinical microsystem. Addressing these contextual factors by preparing training modules and workshops would prepare undergraduate students for patient-centered care and partnership.

Undergraduate students' perception of the Indian dental curriculum: A focus-group based, multi-centric questionnaire survey.

Aim: the present study was designed to take a student's perception regarding the current dental education curriculum. Methodology: A structured, pre-validated questionnaire made on Google Forms was shared amongst participants pursuing undergraduate dental program in a DCI recognized dental college via e-mail, Facebook or WhatsApp. The questionnaire consisted of questions about the admission procedure (5questions), curriculum design (12 questions) teaching methods (5 questions) and assessment (5 questions) methods. The respondents were divided into 2 focus groups; Pre-clinical: BDS first & second year students and Clinical: BDS third & fourth year students. Results: The questionnaire was circulated amongst a total of 510 potential candidates, out of which 403 responded (response rate 79%). 48.4% (195/403) were from government dental colleges and 51.6% (206/403) were from private dental colleges. Preclinical group had 89 students (1st year = 27, 2nd year = 62) and clinical group 344 students (3rd year = 138, 4th year = 176). Students of both focus groups responded similarly to many questions relating to curriculum (need of syllabus revision, p = 0.912; horizontal/vertical integration, p = 0.076; and early clinical exposure p = 0.843), teaching methods (need of mixed teaching methods) and assessment methods (methods which are not based on quota-chasing p = 0.588). Statistically significant difference was seen to "whether the students are able to retain or relate to the basic sciences subjects taught in first & second year" (p < 0.0001). Conclusion: Students expressed a need for a horizontal & vertical integration of topics, frequent syllabus revision, Early Clinical Exposure, a mixed teaching method, and better assessment methods.

The Efficacy of Dental Caries Telediagnosis Using Smartphone: A Diagnostic Study in Geriatric Patients.

Background and aim The major barrier to oral health care for geriatrics is access to dental care. Teledentistry is the field of dentistry that uses telecommunication with digital imaging for the exchange of valid information for diagnosis, treatment, and continuing dental education, enabling some means of approach to oral health care. This study aimed to assess the accuracy of diagnosing dental caries in the older age group by examining intraoral photographs taken by smartphone camera compared with standard clinical dental examination. Methods and material A calibrated dentist examined 18 patients aged 60-75 for six variables: sound tooth, decayed tooth, filled tooth with and without caries, missing tooth, and the presence of prosthesis. Intraoral photographs of each patient were taken using a smartphone. The photographs were then sent to six different examiners through WhatsApp. The accuracy of the diagnosis was measured by applying Cohen's kappa, sensitivity, and specificity. Fleiss' kappa was used to measure the agreement index using the software R (R Foundation for Statistical Computing, Vienna, Austria) version 4.2.1. Results The overall agreement between the tele-examiners and the control was measured, with the kappa scores ranging from 0.897 to 0.921, and the mean kappa score was 0.909. There was high specificity and sensitivity in the value observed. The agreement index, measured through Fleiss' kappa for six teeth conditions, reported the perfect agreement (0.867) among six examiners. Conclusions Under the limitations of the study, teledentistry using a mobile phone has acceptable accuracy for diagnosing caries in the older age group compared to a standard clinical dental examination.

Management of a dentigerous cyst in a medically compromised geriatric patient: a case report.

BACKGROUND: Because of the increasing number of older persons seeking dental care, the growing trend towards a longer dental appointment and increased administration of drugs in dentistry, the possibility of occurrence of medical emergencies in dental offices has shown an upward trend. OBJECTIVE: This case report discusses enucleation of a central dentigerous cyst in a 72-year old male on long-term low dose aspirin therapy. MATERIAL AND METHODS: Surgical removal of impacted tooth with total enucleation of cystic lesion was performed in the dental chair under 2% lidocaine with 1:200,000 adrenaline, 3 days after aspirin cessation. After complete debridement of the surgical site, the wound was sutured and a gauge saturated with 10% tranexamic acid was placed on surgical site for 30 minutes. RESULT: No post-operative complications or bleeding was seen on subsequent appointment and healing was normal. CONCLUSION: A geriatric and medically compromised patient demands special care and attention; and the decision to cease aspirin before surgery or not is of critical importance.

Effect of amniotic membrane and platelet-rich fibrin membrane on bone healing post endodontic surgery: An ultrasonographic, randomized controlled study.

The use of membrane barriers and bone grafting materials in endodontic surgery promotes healing by regeneration rather than repair by scar tissue. Due to its valuable regenerative and therapeutic properties, the human amniotic membrane can support ideal periapical rehabilitation and promote better healing after surgery. The current trial aimed to evaluate the amniotic membrane's healing potential and compare it with platelet-rich fibrin using color doppler sonography. The current study is a randomized, double-blinded, parallel-group, single-center study. Thirty-four systematically healthy individuals requiring endodontic surgery who fulfilled all inclusion and exclusion criteria were selected and randomly placed in two groups. Surgical curettage of the bony lesion was performed and filled with hydroxyapatite graft. Amniotic membrane (Group 1) and platelet-rich fibrin (Group 2) were placed over the bony crypt, and the flap was sutured back. The lesion's surface area and vascularity were the parameters assessed with ultrasound and color doppler. and observations: The groups found a significant difference in mean vascularity at 1 month and mean vascularity change from baseline to 1 month (p < 0.05). Mean surface area had no statistically significant difference between the groups. However, in terms of the percentage change in surface area, a significant difference was found from baseline to 6 months (p < 0.05). Amniotic membrane was a significantly better promoter of angiogenesis than platelet-rich fibrin in the current trial. The osteogenic potential of both materials was similar. However, the clinical application, availability, and cost-effectiveness of amniotic membrane support it as a promising therapeutic alternative in clinical translation. Further large-scale trials and histologic studies are warranted.

Mucogingival surgery: where we stand today.

Mucogingival problems are developmental and acquired aberrations in the morphology, position, and/or the amount of gingiva surrounding teeth. According to an academic report by American Academy of Periodontology, mucogingival therapy should be advocated for gingival augmentation and to create adequate vestibular depth in areas with insufficient attached gingiva. This paper provides an overview on mucogingival surgical procedures from its inception to the current time.

Knowledge of COVID-19 and its implications in dental treatment, and practices of personal protective equipment among dentists: A survey-based assessment.

BACKGROUND: Oral health-care providers are always at a risk of transmitting or acquiring airborne, saliva-borne, or blood-borne infections due to their proximity to the patient's mouth, contact with saliva, and handling of sharp instruments. the aim this study was to evaluate the knowledge of the dentists regarding COVID-19, methods to prevent its transmission, and implications of COVID-19 in dental treatment. MATERIALS AND METHODS: It was a cross-sectional online survey. There were 35 questions in total, divided into sections of knowledge of COVID-19, practices of personal protective equipment (PPE), and knowledge of implications of COVID-19 in dental treatment. Both convenience sampling and snowball sampling were used, so that maximal participation could be ensured. The results were analyzed using descriptive statistics and making comparisons among various groups. The data were summarized as proportions and percentages (%). All the associations were tested using the Chi-square test, ANOVA, and Pearson's correlation coefficient. Statistical analyses were performed using SPSS version 19.0. RESULTS: 26.8% of respondents had a high knowledge, 61.5% had good knowledge, 10.1% had low knowledge, and 6 (1.5%) had nil knowledge about COVID-19. No significant association was found between qualification and knowledge level among the respondents (P = 0.053). Both graduates and postgraduates had low knowledge regarding effective PPE components (P = 0.053), donning (P = 0.888), and doffing (P = 0.745). Only 52.9% of postgraduates and 43.7% graduates answered correctly about the sequence of donning, and 47.9% of postgraduates and 46.1% of graduates had knowledge regarding correct doffing sequence of PPE. Furthermore, knowledge was low regarding the implications of COVID-19 in dental treatment. CONCLUSION: Although the dentists were found to have high/good knowledge scores regarding COVID-19, there was a lack of knowledge regarding hand hygiene, proper use of PPE, and implications of COVID-19 in dental treatment. Thus, they need to be trained and sensitized regarding the same.

Human amniotic membrane as therapeutic agent in pulpotomy of permanent molars.

A 22-year-old woman reported with a cariously exposed mandibular molar. Pulpotomy was planned rather than routine root canal treatment, which was otherwise indicated. Amniotic membrane (AM) that has been extensively researched in different fields of medicine was used as the pulpotomy agent. After gaining coronal access to the root orifices, bleeding was arrested and activated AM was placed over the root stumps. Glass ionomer cement(GIC) was placed over the membrane and temporary restoration was done. One week later, permanent restoration with composite resin was done. The patient's symptoms resolved, and the tooth started responding normally to vitality tests at subsequent follow-ups. The present case report is an attempt to use human AM as a natural pulpotomy agent for treating irreversible pulpitis in permanent teeth. Understanding of innumerable beneficial properties of the AM and its application in preserving vitality of permanent teeth is the main learning objective.

Comparative evaluation of sealing ability of gutta percha and resilon as root canal filling materials- a systematic review.

This systematic review aims to comparatively evaluate the sealing ability gutta-percha and resilon as root canal filling materials. A Medline search was conducted to identify in-vitro studies published between October 01, 2004 and October 01, 2019, conducted on human extracted teeth, published in English and testing the sealing ability of gutta-percha and resilon as root canal filling materials using fluid filtration method. The search identified fifty-five published articles. After a thorough screening, five articles meeting the selection, and validity assessment criteria were critically appraised. The results indicated that during the initial time-period, resilon/epiphany sealer has better sealing ability than gutta-percha. However, over a period of time the resilon system demonstrated increased fluid flow. Gutta-percha with AH plus sealer showed the best long term sealing ability.

"Effect of local application of simvastatin in bone regeneration of peri-apical defects-a clinico-radiographic study.

OBJECTIVE: The present study evaluates and compares the effectiveness of Simvastatin (SIM), Hydroxyapatite (HA), and platelet-rich fibrin (PRF) in bone regeneration of periapical defects. MATERIAL& METHOD: Thirty-nine patients were selected and randomized into three groups, Group 1: HA (n = 13), Group 2: PRF (n = 13), Group 3: SIM (n = 13). After completion of RCT and apicoectomy, the grafts were placed locally in the defect and sutured. RESULTS: At the end of twelve months, postoperative symptoms and radiographic analysis assessed the outcome of the treatment. CONCLUSION: Intragroup analysis of CBCT- Periapical Index (PAI) scores at 6th and 12th month revealed a significant change in the SIM group (p = 0.018 and 0.001 respectively), compared to PRF (p = 0.026 and 0.001 respectively) and HA (p = 0.053 and 0.039 respectively). Intergroup analysis of change in the level of CBCT-PAI score was highly significant (p = 0.003).SIM caused a more considerable change in the level of CBCT-PAI score compared to other groups, thereby indicating a faster rate of bone regeneration.

Lesions of endodontic origin: An emerging risk factor for coronary heart diseases.

A high inflammatory state, such as atherosclerosis, is a major underlying cause of coronary heart diseases (CHDs). Inflammatory mediators are known to lead to endothelial dysfunction and play a key role in initiation, progression, and rupture of atherothrombotic plaque. Chronic inflammatory dental infections such as periodontitis and lesions of endodontic origin or chronic apical periodontitis (CAP) may provide an environment conducive for such events. Atherosclerosis has shown to share a common spectrum of inflammatory markers with apical periodontitis. The possible correlation between CHD and CAP is emerging at microbiological, clinical, inflammatory, and molecular levels. This less recognized fact should be discussed more among the dental and medical fraternity so that more awareness and positive approach toward oral health can be created among patients and health-care providers.

Use of mineral trioxide aggregate for retreatment of a tooth with large periapical lesion, wide-open apices and vertical root fracture.

Chronic periapical lesions in necrotic teeth with open apex are difficult to manage. The situation becomes more complex if the tooth has a fracture line. This case report describes the management of a traumatised tooth that had already undergone unsuccessful endodontic treatment with a large periapical lesion and open apex along with a fracture line in the root. An attempt was made to save the tooth by using mineral trioxide aggregate (MTA) cement for orthograde filling, retrograde filling and also for sealing of the fracture line. Moreover, the bone defect was filled with autogenous bone harvested from the external oblique ridge. MTA, a bioactive tricalcium silicate cement, has been used in treating complex endodontic cases as it shows promising potential by inducing the biological mechanisms necessary for repair of involved teeth. A 1-year follow-up showed progressive healing as evident by radiographs and lack of any clinical signs and symptoms.

An ex vivo evaluation of effect of dentin pretreatment with various agents for varying time intervals on the shear bond strength of resin.

BACKGROUND: This article highlights the contribution of collagen structure/stability to the bond strength. We hypothesize that induction of cross-linking in dentin collagen fibrils improves dentin collagen stability and thus bond strength with composite also improves. AIMS: The aim of the study was to evaluate the effect of collagen cross-linking agents on the shear bond strength of composite resins. SUBJECTS AND METHODS: One hundred human permanent teeth were randomly divided into three groups: Group I (n = 20) - no dentin pretreatment done, Group II - dentin pretreatment with 10% sodium ascorbate for 5 min (IIa) and 10 min (IIb), and Group III - dentin pretreatment with 6.5% proanthocyanidin (PA) for 5 min (IIIa) and 10 min (IIIb). A composite resin was bonded on prepared surfaces and cured. Thermocycling was done, and shear bond strength of the prepared samples was tested using a universal testing machine. RESULTS: Values of Group I (control) were lowest whereas that of Group II (sodium ascorbate) were highest. The following order of shear bond strength was observed: IIb > IIa > IIIb ~ IIIa > I. Results for sodium ascorbate were found to be time dependent, whereas for PA, differences were nonsignificant. CONCLUSIONS: Treatment of dentinal surfaces with collagen cross-linking agent increases the shear bond strengths.

A comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis.

AIM: This study aimed for a comparative evaluation of the antimicrobial efficacy of calcium hydroxide, chlorhexidine gel, and a curcumin-based formulation against Enterococcus faecalis. METHODS: Thirty single-rooted teeth were taken. Access preparation was done. Biomechanical preparation was done using Protaper universal file till F3. Teeth were decoronated to a standardized root length of 14 mm, and the apical end from outside was sealed using paraffin wax. Teeth were autoclaved under standard conditions and after autoclaving, Phosphate-buffered saline solution was introduced into the roots and was incubated for 24 h to check for the disinfection of roots. Once the disinfection of roots was achieved, the wild strain of E. faecalis, i.e., ATC 29212 strain, was introduced into the teeth and allowed to incubate for 24 h. Following bacterial colonization inside the roots, antimicrobials were introduced and efficacy was checked. The data obtained were subjected to statistical analysis using paired t-test for significance. RESULTS: Significant difference was observed between all the test groups. However, chlorhexidine gel showed the best value of mean difference, indicating it as the best antibacterial medicament. CONCLUSION: Within the limitations of this study, it can be concluded that chlorhexidine gel showed better antimicrobial properties against E. faecalis than other medicaments.

A Comparative Evaluation of Smear Layer Removal Using Apical Negative Pressure (EndoVac), Sonic Irrigation (EndoActivator) and Er:YAG laser -An In vitro SEM Study.

BACKGROUND: This study aimed to compare the smear layer removing efficacy of the EndoActivator, EndoVac and Er:YAG laser in extracted mandibular premolars, at the apical, middle and coronal third of root canal, through scanning electron microscopy. MATERIAL AND METHODS: 40 extracted mandibular premolars were decoronated to a standardized length of 12 mm. Specimens were shaped to ProTaper F4 size and irrigated with 5.25% sodium hypochlorite at 370C between instrumentation. Teeth were divided into four groups (n=10), one control (needle irrigation) and three experimental, according to the irrigant activation technique used i.e. sonic irrigation (EndoActivator), apical negative pressure (EndoVac) or laser (Er:YAG). The final irrigants used were 10ml,17% ethylenediaminetetraacetic acid (EDTA) and 10ml, 5.25% sodium hypochlorite. Root canals were then split longitudinally and observed under a scanning electron microscope. The presence of smear layer at the apical, middle and coronal third of root canal was evaluated. Scores were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Intraexaminer and interexaminer reliability were determined by Kappa test. RESULTS: The EndoVac system was significantly more effective in removing debris from the apical third than all other groups. EndoActivator performed better than laser at the apical third. All three experimental groups (EndoVac, EndoActivator, and laser) were better than needle irrigation at the middle and apical third. At the coronal third, no significant difference was seen between the four groups. CONCLUSIONS: None of the activation systems completely removes the smear layer from the dentine walls; nevertheless, EndoVac is significantly better in removing debris from the apical third of canal. Key words:EndoVac, EndoActivator, Er:YAG laser, smear layer, scanning electron microscopy.

Comparative evaluation of antimicrobial efficacy of triple antibiotic paste, calcium hydroxide, and a proton pump inhibitor against resistant root canal pathogens.

OBJECTIVE: The objective of this study is to compare the antimicrobial efficacy of triple antibiotic paste (TAP) and a proton pump inhibitor (PPI) (omeprazole) in combination with calcium hydroxide (CH) against Enterococcus faecalis and Candida albicans. MATERIALS AND METHODS: E. faecalis and C. albicans were subcultured and inoculated at 37° overnight and were treated with different dilutions of TAP, 25 µg/ml (Group 1), CH (Group 2, control), CH 16 mg/ml + omeprazole 2 mg/ml (Group 3a) (CH 16 mg/ml + omeprazole 4 mg)/ml (Group 3b) for 24, 48, and 72 h in sterile uncoated 96-well microtiter plates. Minimum concentration at which the medicaments produced least optical density was determined using ELISA reader (ELx 808 BioTek Inc., USA) device set at optical density of 630 nm. Results were analyzed statistically by one-way analysis of variance followed by Tukey's multiple comparison tests. The significance level was set at 0.05. RESULTS: Mean concentration (irrespective of time) for TAP at which mean minimum optical density was recorded at 1.25 µg/ml (1:20 dilution) and 25 µg/ml (0 dilution) against E. faecalis and C. albicans, respectively. Least optical density for CH plus PPI group was obtained 1.6 µg/ml (1:10 dilution) and 16 µg/ml (0 dilution) for E. faecalis and C. albicans, respectively. However, CH alone showed a weaker antimicrobial action against either of the strains even at full concentration. CONCLUSIONS: PPI enhanced the antibacterial efficacy of CH against E. faecalis and C. albicans. However, TAP showed the best antibacterial property followed by CH plus PPIs against both the selected strains.

Measurement of pH and calcium ions release from different calcium hydroxide pastes at different intervals of time: Atomic spectrophotometric analysis.

AIM: To evaluate the effect of different vehicles on pH and release of calcium ions from calcium hydroxide (CH) paste from apical third of root canals. METHODS: 40 single rooted extracted human mandibular premolars were instrumented with RevoS files (MicroMega) up to ISO size 40. The teeth were divided into 4 groups on the basis of vehicle as follows: Group I - calcium hydroxide mixed with 2% chlorhexidine; Group II - calcium hydroxide mixed with propylene glycol; Group III - calcium hydroxide mixed with glycerine; and Control - calcium hydroxide mixed with double distilled water. Each group had two subgroups (n = 5) on the basis of the calcium hydroxide delivery. Subgroup A - calcium hydroxide paste placed with spiral filler (Lentulospiral) subgroup B - calcium hydroxide paste placed with flat wire filler (Paste Inject). pH and calcium ion release was evaluated at 24 h, 48 h, 7th day, 15th day and 30th day using a pH meter and atomic absorption spectrophotometer respectively. RESULTS: The calcium release from various groups was highest for CH+glycerine (Group III) followed by CH+chlorhexidine (Group I), CH+propylene glycol (Group II) and CH+double distilled water (control). At all the intervals the differences in calcium ion release among the groups were statistically significant (p < 0.05), except on day 7. Delivery technique did not have a significant effect on calcium ion release. Highest pH values were recorded from CH+glycerine group at day 30 for both the delivery systems, however rise in pH from day 1 to day 30 were non-significant in all groups with both delivery systems. CONCLUSION: Demonstrable changes in calcium ion release occurred from the calcium hydroxide mixed with various vehicles and CH+glycerine group showed the maximum calcium ion release at all intervals and highest pH day 30.