COVID-19 Severity in Patients With Apical Periodontitis: A Case Control Study.

OBJECTIVES: Apical periodontitis (AP) has been associated with systemic inflammatory biomarkers that have also been associated with COVID-19 severity. This study was designed to test the hypothesis that the presence of apical periodontitis could be associated with increased risk of COVID-19 complications. METHODS: A case control study (N = 949) was performed using the medical and dental records of patients diagnosed with COVID-19 in the State of Qatar between March 2020 and February 2021. Cases comprised COVID-19 patients (n = 63) who experienced complications (death, intensive care unit admissions, mechanical ventilation), and controls were COVID-19 patients (n = 886) who recovered without such complications. The presence of periapical apical periodontitis was assessed on the radiographic records taken prior to COVID-19 infection. Associations between apical periodontitis and COVID 19 complications were analysed using logistic regression models adjusted for demographic and medical factors. Blood biomarkers were assessed in both groups and compared using the Kruskal-Wallis test. RESULTS: COVID-19 complications were found to be associated with the presence of apical periodontitis (adjusted odds ratio = 2.72; 95% CI, 1.30-5.68; P = .008). Blood analyses revealed that COVID-19 patients with apical periodontitis had higher levels of white blood cells and haemoglobin A1c than the patients without apical periodontitis. CONCLUSIONS: The presence of apical periodontitis could be associated with increased risk of COVID-19 complications.

The Potential Association Between Inflammatory Bowel Diseases and Apical Periodontitis: A Systematic Review and Meta-Analysis.

Recent literature has suggested a potential association between inflammatory bowel diseases (IBD) and apical periodontitis (AP). The present systematic review and meta-analysis sought to analyse and appraise the available evidence regarding the reported association. Following 2020 PRISMA guidelines, a comprehensive search of multiple online databases (PubMed, Scopus, Web of Science, and Google Scholar) was conducted for all relevant studies published from the date of inception until 27 April 2023 using various relevant keywords. All observational studies that assessed the association between IBD and AP in humans were eligible for inclusion. The quality of the selected studies was carried out independently by two reviewers, and meta-analysis was performed using Comprehensive Meta-Analysis Version 2.2.064. Six studies (five case-control studies and one cohort study) were included. A total of 657 patients (277 with IBD) were included in 5 case-control studies, and 48,223 subjects (35,740 with AP) were included in the cohort study, where 188 developed IBD on follow-up. The pooled data from the five case-control studies revealed that IBD was significantly associated with a higher risk of AP (OR=1.71, 95% CI: 1.21-2.42; I2=10.337%, fixed-effect, p=0.002). The qualitative analysis also showed that most of the included studies found a higher mean number of teeth with AP in IBD groups than the healthy controls. Newcastle-Ottawa Scale (NOS)-based quality appraisal results demonstrated that five studies were of high quality, and one was of moderate quality. The results suggest a potential association between IBD and AP. Large-scale and prospective studies are required to further confirm and elucidate the nature of such an association.

Leveling the curve of Spee using different sized archwires: a randomized clinical trial of blood flow changes.

OBJECTIVES: To compare blood flow (BF) changes of teeth subjected to orthodontic forces during curve of Spee (COS) leveling using different archwires (AW). MATERIAL AND METHODS: Thirty subjects with COS > 5 mm were randomly assigned (1:1:1) into three groups based on the AW used: group 1: 0.017 × 0.025-inch stainless-steel (SS)AW, group 2: 0.019 × 0.025-inch SSAW, and group 3: 0.021 × 0.025-inch ß-titanium (TMA)AW. In the 3 groups, a 5 mm-depth reverse COS was placed in the AWs. A laser Doppler flowmeter was used to measure BF at different time intervals (T0-T4). RESULTS: In the 3 AWs group, BF of all measured teeth was reduced 20 min after force application. Afterwards, the BF values started to increase until the baseline values were almost restored within 1 week. Differences in BF changes between the extrusion and intrusion subgroups were observed within groups 1 and 3 during the first 20 min of force application (P < 0.05). Similar BF changes were recorded using the 3 different AWs. BF changes were associated with tooth type and the amount of COS depth change. CONCLUSIONS: During CoS leveling, similar BF changes were recorded using the 3 different AWs. Tooth type and the amount of COS depth change were associated with BF changes within the first 20 min of force application. Greater BF reduction was found in premolars compared to incisors during the first 20 min of AW placement. CLINICAL RELEVANCE: It is important to select a type of applied forces that minimally affect the BF. Intrusive forces appeared to have lower negative effects on the BF of teeth during COS leveling. TRIAL REGISTRATION: ClinicalTrial.gov (# NCT04549948).

The influence of horizontal glass fiber posts on fracture strength and fracture pattern of endodontically treated teeth: A systematic review and meta-analysis of in vitro studies.

PURPOSE: This systematic review and meta-analysis aimed to summarize available evidence regarding the effect of horizontal glass fiber posts (HGFPs) on fracture strength and fracture pattern of endodontically treated teeth (ETT) compared to controls without HGFP. The review protocol was registered on the OSF registries. METHODS: Literature searches were conducted in MEDLINE/PubMed, Scopus, Web of Science, Embase, Google Scholar, and ProQuest for all relevant studies published up to February 2022. All in vitro studies that assessed the influence of HGFPs on fracture strength and fracture pattern of ETT whether mesio-occluso-distal or mesio-occlusal or DO cavities were considered eligible. Review Manager (RevMan) was used for the meta-analysis. Subgroup and funnel plot analyses were also performed. Quality assessment was conducted by two independent reviewers. RESULTS: A total of 12 articles met the inclusion criteria, and 10 studies underwent quantitative evaluation. The pooled effect showed that fracture resistance of molar teeth restored with HGFP was significantly higher than teeth without HGFP (standardized mean difference [SMD]: 1.61, 95% confidence interval [CI]: 0.14, 3.09, p = 0.03), whereas marginally significant for premolars (SMD: 1.36, 95% CI: -0.00, 2.73, p = 0.05). Regarding fracture patterns, the presence of an HGFP significantly increased the occurrence of restorable fracture patterns for premolars (odds ratios [OR]: 4.15, 95% CI: 1.60, 10.82, p = 0.004) compared to controls, whereas the difference was not significant for molars (OR: 1.09, 95% CI: 0.43, 2.77, p = 0.85). Moderate risk of bias was identified in 9/12 studies; one study showed a high risk of bias and two studies showed a low risk of bias. CONCLUSIONS: Within the limitations of this study, there is evidence from in vitro studies that the use of HGFP increases the fracture resistance of the ETT when compared to teeth without HGFP and also reduces the occurrence of non-restorable fractures for premolars. However, well-conducted in vitro and prospective clinical studies are warranted to validate this finding.

Development of professional identity among dental students - A qualitative study.

PURPOSE: The study explored dental students' perception of their professional identity (PI) development at a newly established dental college with a problem-based learning (PBL) curriculum. METHODS: Qualitative methods based on focus groups were used for data collection. The conceptual framework of the study was informed by a subject-centered sociocultural approach to PI development. Purposive sampling was used to collect data from five focus groups of undergraduate dental students to gain a deeper understanding of their PI development in a PBL environment. RESULTS: Out of a total of 38 dental students in years 2 and 3, 34 students (89.47%) participated in the focus groups. A theory-driven thematic analysis was used to dissect the views and experiences of the participants to explore factors contributing to PI development in the early years of the program. At an individual level, PBL was seen to be appropriate for PI development. However, some participants placed more emphasis on practical training in operative dental skills. Relational sources especially role modeling by the PBL facilitators and faculty staff were identified as a key factor to nurture PI development. Mixed views were observed on the value of PBL to enhance team-working skills. The participants also identified challenges of PBL and provided recommendations on further improvements to enhance the learning experiences of the students. CONCLUSIONS: This study provided useful insights into a PBL curriculum at a newly established dental institution. The findings underscore the value of PBL in developing PI and also highlight the challenges of implementing PBL in a socio-cultural context and pedagogical implications for further program improvement.

Development of self-regulation amongst dental students in problem-based learning curricula: A qualitative study.

AIMS: To explore the value of problem-based learning in the development of self-regulation amongst undergraduate dental students. MATERIALS AND METHODS: A qualitative approach using focus groups was used to explore the perceptions and experiences of the participants regarding the role of problem-based learning (PBL) in promoting self-regulation in undergraduate dental education. The study was carried out at a newly established dental institution in Qatar. Purposive sampling technique was used to recruit the participants. Invitations to potential participants were sent by e-mail through appropriate professional channels. All focus groups were transcribed verbatim, and data were imported into NVivo 12 and analysed thematically. RESULTS: A total of five focus groups were conducted with 37 participants which included 27 females and seven males from two different cohorts. Participants expressed their views on a range of issues related to the self-regulation in problem-based learning and also provided recommendations to enhance the learning experiences of students. PBL was perceived to be an appropriate and effective strategy to support student autonomy in construction of knowledge and developing problem-solving and interpersonal skills. However, the workload of the students can impact adversely on their motivation and time management skills. CONCLUSIONS: This study provides useful insights into the concept of self-regulation in problem-based learning environments as perceived by the stakeholders at a newly established dental institution. The findings of this study may offer clarity on how problem-based learning can be best utilised to promote self-regulation in undergraduate dental education.

Oral-Health-Related Self-Efficacy among the Elderly Population in Riyadh, Saudi Arabia.

Oral health self-efficacy is a fundamental determinant of behavioral changes among elderly patients. Objective: To assess the oral self-efficacy among the Saudi population aged 65 years old and above in Riyadh, Saudi Arabia. Methodology: This was a cross-sectional survey conducted on elderly individuals in Riyadh. An Arabic version of the Geriatric Self-Efficacy Scale for Oral Health (GSEOH) was administered to all participants. The dependent variables included oral function, oral hygiene habits, and dental visits. For the statistical analysis, two independent sample t-tests and a one-way ANOVA test were used. Significance was judged at a p-value less than 0.05. Results: Of 400 participants recruited, 53% were males. About 58% had retained teeth, and 72% had visited a dentist in the past 12 months. Overall, 31.6%, 34.64%, 22.65%, and 11.14% of the participants rated their oral health as good, fairly good, rather poor, and poor, respectively. Age (p < 0.001), educational level (p < 0.001), and working status (p < 0.001) were significantly associated with GSEOH scores. Other sociodemographic characteristics were not found to affect the GSEOH scores. Conclusions: The overall self-efficacy of oral health among Saudi elderly individuals is fairly good. Age, educational level, and occupational status are the main determinants of oral health self-efficacy scores.

Xerostomia, Salivary Flow, and Oral Health Status Among Saudi Diabetic Patients: A Comparative Cross-Sectional Study.

PURPOSE: Diabetes mellitus (DM) is associated with numerous oral complications, including frequent oral infections, periodontal diseases, hyposalivation, and xerostomia. The present study aimed to investigate salivary flow rate, xerostomia, and oral health status among a group of Saudi diabetic patients as compared to healthy controls. PATIENTS AND METHODS: This comparative cross-sectional study involved 50 diabetic patients (aged between 15 and 70 years) and 53 age- and gender-matched healthy controls. Data collection was carried out using a structured questionnaire and clinical examination of oral health status, which included salivary flow rates, saliva pH, tooth loss, plaque accumulation, and gingival health. Independent t-tests, one-way analysis of variance (ANOVA), and chi-square tests were performed to compare between groups. RESULTS: The results revealed a statistically significant lower salivary flow (0.33 ± 0.16 vs 0.59 ± 0.54; p = 0.002) and lower saliva pH (6.36 ± 0.49 vs 6.58 ± 0.39; p = 0.014) in diabetic patients than in the control group. A higher proportion of diabetic subjects (60%) self-reported having xerostomia compared to controls (52%), but the findings were statistically non-significant. Additionally, the results revealed slightly poorer oral health and greater tooth loss among DM patients, although the results did not attain a significant difference (P > 0.05). CONCLUSION: The findings of the present study demonstrate poor oral health and a high prevalence of xerostomia among Saudi diabetic patients. Oral health education should therefore be promoted in this group of patients.

Ethical Aspects concerning Instrument Separation and Perforations during Endodontic Treatment: A Cross-Sectional Study.

AIM: During endodontic treatment, dentists may face various unwanted procedural accidents, at any stage of the treatment that might compromise endodontic treatment outcome and bring obstacles to dentists as well. This study aimed to address and analyze several ethical concerns relating to the behavioural conduct of dentists towards endodontic instrument separation as well as perforation of the crown and/or root during root canal treatment in Riyadh, Saudi Arabia. METHOD: Hundred and eleven questionnaires were distributed among dentists working in Riyadh in university clinics and government and private sectors. Data were collected, reviewed, and statistically analyzed by Fisher's exact and chi-square tests at a 5% significance level, using SPSS software. RESULTS: 54.5% of the respondents have encountered instrument separation. 53.2% stated that they would inform the patient about the instrument separation. 43.6% of the respondents had experienced perforation during root canal treatment, and 54.9% reported that they would inform the patient of the accident. CONCLUSION: Within the limitation of this survey, we concluded that most of the dental professionals did not hesitate to adhere to the correct ethical conduct, and they would inform the patient if an incident occurred.

Case Report: An association of the gubernacular canal, supernumerary tooth and odontoma with an impacted canine on cone-beam computed tomography.

This report describes a clinical case of asymptomatic compound odontoma in the anterior left side of the maxilla associated with an impacted canine and supernumerary tooth with a gubernacular canal of a 47- year-old female with no relevant medical history. Cone-beam computed tomography (CBCT) was performed for precise three-dimensional localization of each structure and assessment of their spatial relationship with the associated structures before surgery. The treatment protocol involved surgical enucleation of the odontoma and open extraction of both impacted and supernumerary teeth. The patient had uneventful healing and proceeded with the prosthodontic treatment plan. The dentist should be aware of the probability of a close relationship between the development of odontoma and presence of the gubernacular tract, which could be used as a future radiographic diagnostic criterion of an odontoma. Also, we recommend that more studies be performed in this field to deeply analyze the imaging characteristics of GT and its spatial association with various pathological lesions in the future.

Shaping Ability of Superelastic and Controlled Memory Nickel-Titanium File Systems: An In Vitro Study.

Improvements in the thermomechanical processing procedures of NiTi wires have led to the development of new NiTi instruments that compose mainly of martensite crystals, making the wire stable at clinical condition. This study aimed at comparing the shaping ability of two rotary nickel-titanium systems manufactured from different NiTi wires. Twenty simulated root canals each with a curvature of 35° in resin blocks were divided into two groups of 10 canals each. Canals in the first group were prepared with superelastic F360 instruments (Gebr. Brasseler, Germany) while canals in the second group were prepared using controlled memory HyFlex®CM™ instruments (Coltène Whaledent, Switzerland). Images were taken before canal preparation and after the use of each instrument. The assessment of the canal shapes was accomplished with a computer image analysis program. Data were statistically analyzed using SPSS program. Within the limitation of this in vitro study, HyFlex®CM™ instruments remained better centered in the apical third of the canals. In most canal segments, no significant differences were observed between either system in the amount of material removed. Both systems were comparable to each other in regards to their ability to enlarge root canal in the same way without procedural errors.

Comparison of the shaping ability of GT® Series X, Twisted Files and AlphaKite rotary nickel-titanium systems in simulated canals.

BACKGROUND: Efforts to improve the performance of rotary NiTi instruments by enhancing the properties of NiTi alloy, or their manufacturing processes rather than changes in instrument geometries have been reported. The aim of this study was to compare in-vitro the shaping ability of three different rotary nickel-titanium instruments produced by different manufacturing methods. METHODS: Thirty simulated root canals with a curvature of 35˚ in resin blocks were prepared with three different rotary NiTi systems: AK- AlphaKite (Gebr. Brasseler, Germany), GTX- GT® Series X (Dentsply, Germany) and TF- Twisted Files (SybronEndo, USA).The canals were prepared according to the manufacturers' instructions. Pre- and post-instrumentation images were recorded and assessment of canal curvature modifications was carried out with an image analysis program (GSA, Germany).The preparation time and incidence of procedural errors were recorded. Instruments were evaluated under a microscope with 15 × magnifications (Carl Zeiss OPMI Pro Ergo, Germany) for signs of deformation. The Data were statistically analyzed using SPSS (Wilcoxon and Mann-Whitney U-tests, at a confidence interval of 95%). RESULTS: Less canal transportation was produced by TF apically, although the difference among the groups was not statistically significant. GTX removed the greatest amount of resin from the middle and coronal parts of the canal and the difference among the groups was statistically significant (p < 0.05). The shortest preparation time was registered with TF (444 s) and the longest with GTX (714 s), the difference among the groups was statistically significant (p < 0.05). During the preparation of the canals no instrument fractured. Eleven instruments of TF and one of AK were deformed. CONCLUSION: Under the conditions of this study, all rotary NiTi instruments maintained the working length and prepared a well-shaped root canal. The least canal transportation was produced by AK. GTX displayed the greatest cutting efficiency. TF prepared the canals faster than the other two systems.