Biometric analysis of furcation area of molar teeth and its relationship with instrumentation.

The anatomy of furcation favours the bacterial retention and makes periodontal debridement as well as oral hygiene procedures difficult. Teeth that have lost attachment to a level of the furcation are said to have a furcal invasion or furcation involved.Involvement of furcation in a multi-rooted tooth poses a very different type of clinical situation in terms of establishment of diagnosis, determination of prognosis and of course planning the treatment modality.The present study was carried out on 200 selected extracted human first and second permanent molar teeth based on a predefined criteria. Teeth with prosthetic crowns, fused or fractured roots, those not fully developed, grossly carious or heavily restored at the cementoenamel junction (CEJ) were excluded from the study. The morphology of the root trunk was recorded by measuring various dimensions of the root trunk,including furcal angle and root trunk volume was calculated by using a custom made special apparatus. The furcation areas were debrided with different types of curettes in the market in order to see how best the instrument could be maneuvered in the furcation area. The data so obtained was statistically analysed using SPSS version 22. The highest root trunk volume and the longest root trunk length were found to be in the maxillary second molar. 48.60% furcations didn't allow instrument engagementof furcation area with standard area specific curettes. The proposal of inclusion of root trunk length (mm) is suggested in addition to classification of FI to have assess prognosis and appropriate treatment for of the involved tooth.

Identification of prevalence of musculoskeletal disorders and various risk factors in dentists.

Purpose: The awkward and repetitive movements lead to tissue straining, potentially leading to painful musculoskeletal disorders (MSDs). MSDs in dentists result in work inefficiency and a reduction in work hours. A survey was conducted to assess the prevalence of MSDs amongst the dental population of interest. Methods: Customized individual detail questionnaires, Standard Nordic Musculoskeletal questionnaires, and Level of Pain estimation using the Likert Scale were used to deduce the various responsible risk factors for the occurrence of MSDs in dentists. Inferential statistical analysis was done to identify the prevalence and severity of the MSDs. The Chi-Square test (95 % confidence interval) was used to identify and compare the association of risk factors involved in MSDs with the occurrence of the Effect of MSDs, the presence of MSDs, and the severity of the MSDs. Results: The results of the study deduced that the dentists followed the sedentary work practices. The dentists experienced maximum discomfort in the neck region, which was accompanied by the discomfort experienced in the lower back, hands and wrists, making the upper extremity being more susceptible to the MSDs. Gender risk factors the, the prevalence of MSDs in the dentist's upper back, and the severity of pain in the upper back region showed a significant association level. Conclusion: The wrist posture, the prevalence of MSDs and the severity of pain in the dentists' neck, shoulder and upper back showed a significant association level.

Role of Chitosan Hydrogels in Clinical Dentistry.

Biopolymers are organic polymers that can be treated into intricate designs with porous characteristics that mimic essential biologic components. Due to their superior biosafety, biodegradability, biocompatibility, etc., they have been utilized immensely in biomedical engineering, regeneration, and drug delivery. To obtain the greatest number of results, a literature search was undertaken in scientific search engines utilizing keywords. Chitosan is used in a variety of medical sectors, with the goal of emphasizing its applications and benefits in the clinical dental industry. Chitosan can be dissolved in liquid form and combined with other substances to create a variety of products, including fibers, hydrogels, membranes, microspheres, resins, sponges, pastes, tablets, and micro granules. Chitosan has been studied in a variety of dental applications. Chitosan is used in the prevention of caries and wear, in pulpotomy to accelerate osteogenesis in guided tissue regeneration due to its hemostatic property, and primarily to benefit from its antimicrobial activity by adding it to materials, such as glass ionomer cement, calcium hydroxide, and adhesive systems. With its antibacterial activity and biocompatibility, chitosan is leading the pack as a promising ingredient in the production of dental materials. The current review provides an update on the background, fundamentals, and wide range of uses of chitosan and its gels in dental science.

Static and dynamic validation of kinect for ergonomic postural analysis using electro-goniometers as a gold standard:A preliminary study.

BACKGROUND: Evaluation of the working postures and development of new techniques are paramount in reducing the awkward postures and occurrence of musculoskeletal disorders (MSDs). The Kinect sensor, a portable and cost-effective device, appears to be a promising alternative to study work postures. OBJECTIVE: The current study aimed to evaluate the validity of Kinect against the gold-standard instrument (electro-goniometers) for body joint angle measurements. METHODS: A unique software application was developed to measure the critical body joint angles for postural evaluation by using the Kinect's skeletal tracking feature. The body joint angle data of ten volunteers were measured simultaneously by both Kinect and electro-goniometers. The validation analysis was conducted in both static and dynamic domains of application. RESULTS: Minimal variation was observed between the two techniques, and the Kinect correlated well for upper-arm joint angles of 45∘, 60∘ and 90∘; lower-arm joint angles of 30∘, 45∘, 60∘, and 90∘; straight neck position, neck joint angle at maximum possible flexion; straight trunk position, trunk bend angle at full flexion. In dynamic analysis, four out of five ICC values were > 0.75 except for the upper arm. Discrepancies in the results indicated the disapproval of Kinect for only wrist measurements. CONCLUSION: The results of the static and dynamic studies gave a sufficient basis to consider the Kinect tool as an alternative to contemporary posture-based ergonomic evaluation methods.

Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up: A case report and review of literature.

BACKGROUND: The presence of dens invaginatus (DI) complicates treatment of any tooth, from diagnosis to access cavity and biomechanical preparation and obturation. Reports of successful non-surgical management of DI type IIIB in maxillary lateral incisor are rare. Here, we report such a case, with three root canals and a long follow-up. CASE SUMMARY: A 13-year-old female patient presented with mild pain in the maxillary right lateral incisor (#7) for 10-15 d. On examination, the tooth was slightly rotated, with slight tenderness on percussion and grade I mobility but with no caries, pockets or restorations and non-vital pulp (via vitality tests). Radiographic examination revealed unusual configuration of the tooth's root canals, with an enamel-lined invagination extending to the apex, suggesting the possibility of DI Oehler's type IIIB and a periapical radiolucency. Widening the access cavity lingually revealed one distinct buccal orifice and two distinct palatal orifices; under higher magnification of a dental operating microscope (DOM), the mesio-palatal and disto-palatal orifices were observed as connected by a C-shaped groove. The root canals were prepared with hand K-files following a step-back technique, and obturated using a combination technique of lateral condensation and vertical compaction. At the 6-year follow-up, the patient was asymptomatic, and the periapical radiography displayed significant healing around the apical end of the root. CONCLUSION: Proper knowledge of unusual root canal anatomy is required in treating DI. Conventional methods of root canal treatment can successfully resolve such complex cases, facilitated by DOM and cone-beam computed tomography.

Assessing the Compliance of Dental Clinicians towards Regulatory Infection Control Guidelines Using a Newly Developed Survey Tool: A Pilot Cross-Sectional Study in India.

Adherence to the dental practice regulatory guidelines instituted during the COVID-19 pandemic is essential to minimize the transmission of SARS-CoV-2 strains. Given the lack of a valid and reliable survey tool to assess the adherence to dental practice guidelines, this study aims to develop, validate, and test a survey tool on a pilot sample of dental clinicians practicing in India. A survey tool was developed/validated through a sequential phasic approach: Phase I- developing survey using conceptual and literature framework; Phase II: ascertaining its validity and reliability; Phase III: pilot testing; and Phase IV: assessing construct validity by exploratory factor analysis (EFA) on the responses collected in Spring 2021. The EFA was achieved using a traditional unweighted least squares extraction method through a varimax rotation with Kaiser normalization. A six-factor solution with 18 items (with the global reliability of 86%) related to screening, regular infection prevention measures, infection control inside the dental operatory, disinfection of the dental unit, disposal, and other COVID-19-specific preventive measures were extracted. Our sample had higher compliance with regard to providing alcohol-based hand scrubs, providing protective gear to attendees, collecting travel/medical history, and screening patients for COVID-19 symptoms. In contrast, less compliance was observed regarding the use of paperless forms of practice and rubber dams in the operatory. The use of a validated survey tool ensures the collection of reliable and valid data, which can serve as baseline data to measure the uptake and effectiveness of dental practice regulatory guidelines in a clinical setting and community dental health clinics.

Comparative Evaluation of Gingival Crevicular Fluid Interleukin-17, 18 and 21 in Different Stages of Periodontal Health and Disease.

Background and Objectives: The elicitation of a host's immune−inflammatory responses to overcome oral bacterial biofilm challenges is mediated by numerous cytokines. We explored the role of three such cytokines, viz. interleukin (IL)-17, 18 and 21, by measuring their levels in the gingival crevicular fluid (GCF) of Indian individuals with healthy gingiva, chronic gingivitis, or chronic periodontitis. Materials and Method: Ninety systemically healthy individuals were enrolled in the study on the basis of predefined criteria and were categorized into three groups of 30 participants each. Groups A, B and C were composed of a control group with healthy gingiva, subjects with chronic gingivitis and subjects with chronic periodontitis, respectively. The periodontal disease status was assessed on the basis of a subject's gingival index, probing pocket depth, clinical attachment loss and radiographic evidence of bone loss. After the complete history-taking and identification of gingival sulcus/pocket depth areas for GCF collection, a sample was collected from each subject in all groups for an estimation of the cytokine levels using ELISA. Statistical analysis was performed using SPSS v 21.0. Intergroup comparisons were conducted using a post hoc Tukey's test. A value of p < 0.05 was considered to be statistically significant. Results: The mean IL-17, 18 and 21 concentrations in pg/mL was the greatest for Group C (99.67 ± 18.85, 144.61 ± 20.83 and 69.67 ± 12.46, respectively), followed by Group B (19.27 ± 2.78, 22.27 ± 2.43 and 22.74 ± 1.43, respectively) and finally by Group A (healthy control; 11.56 ± 0.99, 17.94 ± 1.24 and 12.83 ± 1.21 respectively). A statistically significant difference in the mean concentrations of two interleukins (IL-17 and IL-18) was observed between Groups A and C and also between Groups B and C. A statistically significant difference in the mean concentrations of IL-21 was observed between Groups B and C. Conclusions: Within the limitations of the present study, the findings revealed that the GCF levels of IL-17, IL-18 and IL-21 rose and correlated well with the severity of the disease. Thus, these cytokines present in GCF have the potential to be considered as biomarkers for periodontal tissue destruction. IL-21 in particular appears to be a promising biomarker for differentiating between gingivitis and periodontitis.

Knowledge, perception, and acceptance toward the booster dose of COVID-19 vaccine among patients visiting dental clinics in Aseer region of KSA.

Scientists have emerged with innovative research on non-human primates showing that the booster dose of the COVID-19 vaccine increases neutralizing antibody levels against all variants. The current cross-sectional survey was designed to evaluate the knowledge, perception, and acceptance of the booster dose of the COVID-19 vaccine among the patients visiting the various dental clinics in Aseer region, Kingdom of Saudi Arabia. A total of 609 dental patients were selected from various dental clinics by a simple random probability sampling method. The questionnaire was designed in multiple languages and categorized as demographic information, knowledge, perception, and acceptance of participants to a booster dose. An anonymous, self-administered, closed-ended online, and paper-based questionnaire was used to assess the above parameters. In the current survey, the majority of the participants were Saudis (80.8%) with an age mean of 37.7 ± 8.7 years. About 68.6% (418 out of 609) of participants had poor knowledge about the booster dose. Significant differences in the levels of knowledge were found in relation to gender, area of residency, education, nationality, and occupation. The distribution of level of perception of booster dose differs significantly among participants of different marital statuses and nationalities. Hesitation to booster was reported more in the rural than in the urban population. Despite a low level of knowledge, a higher level of good perception and acceptance of booster doses were reported among the studied population.

Literature Review of Omicron: A Grim Reality Amidst COVID-19.

Coronavirus disease 2019 (COVID-19) first emerged in Wuhan city in December 2019, and became a grave global concern due to its highly infectious nature. The Severe Acute Respiratory Coronavirus-2, with its predecessors (i.e., MERS-CoV and SARS-CoV) belong to the family of Coronaviridae. Reportedly, COVID-19 has infected 344,710,576 people around the globe and killed nearly 5,598,511 persons in the short span of two years. On November 24, 2021, B.1.1.529 strain, later named Omicron, was classified as a Variant of Concern (VOC). SARS-CoV-2 has continuously undergone a series of unprecedented mutations and evolved to exhibit varying characteristics. These mutations have largely occurred in the spike (S) protein (site for antibody binding), which attribute high infectivity and transmissibility characteristics to the Omicron strain. Although many studies have attempted to understand this new challenge in the COVID-19 strains race, there is still a lot to be demystified. Therefore, the purpose of this review was to summarize the structural or virologic characteristics, burden, and epidemiology of the Omicron variant and its potential to evade the immune response.

Synergistic Effect of Plant Extracts on Endodontic Pathogens Isolated from Teeth with Root Canal Treatment Failure: An In Vitro Study.

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the synergistic antimicrobial activity of extracts obtained from Salvadora persica (Miswak), Commiphora molmol (myrrh) and Azadirachta indica (neem) in combination with commercially available antimicrobial agents: penicillin, tetracycline, ofloxacin and fluconazole on endodontic pathogens such as Enterococcus faecalis, Streptococcus mitis,Actinomyces naeslundii and Candida albicans. MATERIALS AND METHODS: Microbiological samples from the root canals of the teeth undergoing retreatment were taken using sterile paper points kept at full length in the canal for 30 s. The disc diffusion method was used to check the susceptibility of microbes to the plant extracts and antimicrobials by measuring the diameter of the inhibition zones. Against the microbes, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC)/minimum fungicidal concentration (MFC) of the plant extracts were assessed. The fractional inhibitory concentration index (FICI) was used to estimate the synergistic effect of plant extracts combined with antimicrobials against the resistant endodontic microbes. RESULTS: The findings clearly indicate the effectiveness of all the three plant extracts, Commiphora molmol, Azadirachta indica, Salvadora persica, against all the experimental pathogenic microorganisms except for the ineffectiveness of Azadirachta indica, Salvadora persica against Candidaalbicans. Maximum antimicrobial activity was displayed by Azadirachta indica against Enterococcusfaecalis (MIC = 0.09 ± 1.2 mg/mL, MBC = 0.78 ± 1.25 mg/mL) and the minimum antimicrobial activity was displayed by Commiphora molmol against Actinomyces naeslundii (MIC = 12.5 ± 3.25 mg/mL, MBC = 100 ± 3.75 mg/mL). The best synergy was displayed by Commiphora molmol with fluconazole against Candidaalbicans (FICI = 0.45). CONCLUSIONS: The current study delineates the variable antimicrobial activity of plant extracts against the experimental endodontic pathogenic microorganisms. Plant extracts in conjunction with various antimicrobials can be valuable aids in combating relatively resistant endodontic microorganisms that have been the cause of worry in recent years, leading to failure even in treatment procedures following all required protocols.

Relation between Apical Seal and Apical Preparation Diameter: An In Vitro Study.

BACKGROUND: The current recommendations for the apical preparation diameter, one of the most important mechanical imperatives in the apical third preparation, are to preserve the apical foramen in its original position along with its narrowest diameter to avoid any complication such as tearing, zipping, or transport of the foramen. The aim of our study was to see the correlation between apical seal and apical preparation diameter. MATERIALS AND METHODS: In total, 90 extracted maxillary incisors were randomly allocated into three groups of 30 teeth each according to the apical preparation size: Group 1: finishing file F1 corresponding to size 20 reached the working length, Group 2: prepared up to size 30 corresponding to finishing file F3, and Group 3: prepared up to size 50 corresponding to finishing file F5. After the filling of the root canals, the teeth were isolated and immersed in a dye solution, then cut longitudinally, photographed, and the dye penetration were calculated using a computer software. RESULTS: Comparison of the three different apical preparation sizes showed no statistically significant differences regarding the apical microleakage. CONCLUSION: The most important value of the dye penetration was observed in the group with the largest apical diameter.

Multidisciplinary Approach for the Management of Mandibular Canines with Rare Configuration.

It is very rare (2%-6% cases) for a mandibular canine to have two root canals and the incidence of finding two roots with two root canals in a mandibular canine that too bilaterally is almost negligible. This case report discusses the presence and multidisciplinary management of such rarest configuration in both mandibular canines of a female patient. This case shows the importance of recognition of anatomical variations in successful accomplishment of root canal treatment.

Evaluation of Knowledge and Preparedness Among Indian Dentists During the Current COVID-19 Pandemic: A Cross-Sectional Study.

PURPOSE: The current scenario of the COVID-19 pandemic has forced dentists to prepare themselves by updating their knowledge and receive training to face the present and after effects of COVID-19. The present survey was thus conducted to assess the knowledge, risk perception, attitude, and preparedness of the dentists in India about COVID-19. MATERIALS AND METHODS: A cross-sectional online survey was carried out among registered dentists in India. A self-administered, anonymous, questionnaire comprising of 25 close-ended questions was circulated to gather the relevant information. A total of 765 dentists submitted a response, out of which 646 complete responses were included in the statistical analysis. Pearson's Chi-square test was used for inter-group statistical comparison. RESULTS: The majority (80.8%) of the dentists had a fair knowledge about the characteristics of COVID-19. Nearly 60.7% and 49.7% of the dentists had taken infection control training and special training for COVID-19, respectively. Nearly 50% of the dentists had the perception that COVID-19 is very dangerous. Only 41.8% of the dentists were willing to provide emergency services to patients. Most of the dentists had an opinion that there is a need to enhance personal protective measures. During the survey, it was found that varied technological advances are offered to dentists to ensure good clinical practice. They also concurred that there was a need to standardize the tools and measures available to carry out dental practices. CONCLUSION: In the present study, Indian dentists have presented satisfactory knowledge with adequate preparedness as the majority of them had a fair level of knowledge with significantly higher knowledge among female respondents and those with post-graduation studies. Dentists should make judicious utilization of all the precautionary measures to safely practice dentistry. As we are going through an evolutionary phase where new advances are expected to evolve, dentists will definitely emerge successfully out from the crisis of the COVID-19 pandemic.

Effect of Fluoride Concentration in Drinking Water on Dental Fluorosis in Southwest Saudi Arabia.

This study was intended to evaluate the fluoride concentration in drinking water and its effect on dental fluorosis in Southwest Saudi Arabia. Water samples were gathered rom wells, filtration plants and commercial brands (bottled water) in distinct urban and rural areas of Asir region of the Kingdom of Saudi Arabia (KSA). Overall, 63 water samples were collected from 12 locations and 9 brands of bottled water. ExStik® FL700Fluoridemeter was used in the analysis of water samples for fluoride levels. The total number of screened patients for dental fluorosis, aged between 9 and 50 years, was 1150; among them, 609 were males and 541 were females. Dean's index criteria were used to examine the patients for dental fluorosis. The results revealed that fluoride levels varied between 0.03 and 3.8 ppm. People who drank well water displayed increased fluoride levels (>0.81 ppm). The prevalence of dental fluorosis was established to be 20.43% among the total number of examined patients. The findings of this study show very mild to moderate dental fluorosis prevail among the patients who consume well water in the Asir region.

Assessment of Shear Bond Strength and Marginal Sealing Ability of Pit and Fissure Sealants: An in vitro Study.

AIM: The aim of the present study was to compare the shear bond strength and marginal sealing ability of self-adhering flow-able composite and conventional fissure sealant. MATERIALS AND METHODS: The samples consisted of 30 healthy premolar teeth which were extracted due to orthodontic reasons and randomly divided into two groups of 15, i.e., group I (Fissurit F) and group II (Dyad Flow). Shear bond strength and marginal sealing ability of both the groups were evaluated in Statistical Package for the Social Sciences (SPSS) version 16. RESULTS: The mean shear bond strength of Dyad Flow (group II) was found to be 1.4 ± 0.87 MPa and in Fissurit F (group I), it was 1.3 ± 1.4 MPa. Differences between the groups were statistically significant. In group II, 53.3% of specimens demonstrated score 0; 33.3% showed score 1; and 13.3% showed score 2. In group I, scores 0 and 1 showed 33.3% of dye penetration respectively. Scores 2 and 3 demonstrated 26.6 and 6.6% of dye penetration respectively. But there was no significant difference between both the sealant groups. CONCLUSION: The present study concluded that self-adhering flowable composite was found to have better shear bond strength and marginal sealing ability than conventional fissure sealant. CLINICAL SIGNIFICANCE: Self-adhering flowable composite can be effectively used in pediatric patients in whom isolation is difficult and exclusion of bonding agent leads to decrease in time consumption.

Management of A Rare Case of Communicating Internal-External Inflammatory Resorption.

The present case describes the successful management of a rare case of communicating internal-external resorption in which both internal and external resorption seem to develop independent of each other. The case report highlights the importance of correct diagnosis and need of revision of classification system of resorptive defects.