Assessment of sealing efficacy, radiopacity, and surface topography of a bioinspired polymer for perforation repair.

Background: Root perforation repair presents a significant challenge in dentistry due to inherent limitations of existing materials. This study explored the potential of a novel polydopamine-based composite as a root repair material by evaluating its sealing efficacy, radiopacity, and surface topography. Methods: Confocal microscopy assessed sealing ability, comparing the polydopamine-based composite to the gold standard, mineral trioxide aggregate (MTA). Radiopacity was evaluated using the aluminium step wedge technique conforming to ISO standards. Surface roughness analysis utilized atomic force microscopy (AFM), while field emission scanning electron microscopy (FESEM) visualized morphology. Results: The polydopamine-based composite exhibited significantly superior sealing efficacy compared to MTA (P < 0.001). Radiopacity reached 3 mm aluminium equivalent, exceeding minimum clinical requirements. AFM analysis revealed a smooth surface topography, and FESEM confirmed successful composite synthesis. Conclusion: This study demonstrates promising properties of the polydopamine-based composite for root perforation repair, including superior sealing efficacy, clinically relevant radiopacity, and smooth surface topography. Further investigation is warranted to assess its clinical viability and potential translation to endodontic practice.

Dental trauma: assessment and acute management of fractures.

Acute dental trauma is unscheduled and presents infrequently to the majority of practitioners. Therefore, a consistent, logical and systematic process for examination, prioritisation and management is imperative for all sustained injuries to have an optimal outcome. Fractures are a frequent sequela to dental trauma and can involve any aspect of the tooth structure or supporting alveolar bone. While some minor crown fractures may initially seem inconsequential, they may be a subtle indication to a more serious underlying root fracture. Concomitant injuries and injuries that have been initially missed are generally associated with poorer outcomes. The time sensitive management of traumatic dental injuries aims to preserve pulpal and periodontal health where possible. The follow up period for tooth or alveolar fractures are important to allow for early intervention if pathology develops.

Assessment of artefacts produced by metal posts on CBCT images.

AIM: To evaluate artefact intensity in cone beam computed tomography (CBCT) images of two alloys used in metal posts scanned using different exposure parameters. METHODOLOGY: The sample consisted of 20 single-rooted teeth divided into two groups for use with either a NiCr post or AgPd post. All teeth were scanned with and without their corresponding metal posts and with and without the presence of an extra restored tooth in the arch. The samples were scanned using CS 9000 3D scanner with two exposure protocols: 85 kV 6.3 mA and 85 kV 10 mA. Voxel size and FOV were fixed at 0.100 mm and 5 cm × 3.75 cm. The presence of artefacts was assessed qualitatively by two calibrated observers using the CBCT volume and paired 2D images, and quantitatively by one trained observer, using ImageJ software. Wilcoxon's signed rank, Mann-Whitney, kappa and chi-square tests were used for qualitative analyses. Two-way anova and Tukey's tests were used for quantitative analyses. All analyses were conducted considering the 95% confidence level (α < 0.05). RESULTS: For the CBCT volume qualitative analysis, significant differences were observed between the metal alloys in the presence of an extra restored tooth, with higher artefact intensity for AgPd when assessing hypodense halos and lines (P = 0.006). Images with two restored teeth had significantly more hypodense and hyperdense lines (P = 0.033). When evaluating exposure parameters and number of restored teeth, the paired image quality analysis revealed significant disagreement between observers for diagnostic image quality (P = 0.001). Quantitative artefact analysis revealed higher artefact intensity for the AgPd posts in the presence of two restored teeth. CONCLUSION: Although the exposure parameters tested did not interfere with artefact intensity, post alloys with a higher atomic number and the presence of another metal structure in the arch increased artefact intensity and impaired the diagnostic quality of CBCT images.

Micro-CT assessment of dentinal micro-cracks after root canal filling procedures.

AIM: To evaluate the frequency of dentinal micro-cracks after root canal filling procedures with GuttaCore (GC), cold lateral compaction (CLC) and warm vertical compaction (WVC) techniques in mandibular molars using micro-computed tomographic analysis. METHODOLOGY: Thirty mesial roots of mandibular molars, with a type II Vertucci's canal configuration, were prepared to working length with a Reciproc R40 instrument and randomly assigned to one of the three experimental groups (n = 10), according to the technique used for root filling: GC, CLC or WVC. The GC group was filled with a size 40 GC obturator, whilst CLC and WVC groups used conventional gutta-percha cones. AH Plus sealer was used in all groups. The specimens were scanned at an isotropic resolution of 14.25 µm before and after root canal preparation and after root filling. Then, all pre- and postoperative cross-sectional images of the roots (n = 41 660) were screened to identify the presence of dentinal defects. RESULTS: Overall, 30.75% (n = 12 810) of the pre- + post-filling images displayed dentinal defects. In the GC, CLC and WVC groups, dentinal micro-cracks were observed in 18.68% (n = 2510), 15.99% (n = 2389) and 11.34% (n = 1506) of the cross-sectional images, respectively. All micro-cracks identified in the post-filling scans were also observed in the corresponding post-preparation images. CONCLUSION: Root fillings in all techniques did not induce the development of new dentinal micro-cracks.

Hybrid materials offer new perspectives.

Dental materials, especially in restorative dentistry, must not only be cost-effective, they must also meet many other requirements: biocompatibility, durability, excellent shade and light effects, abrasion resistance, hardness, mechanical strength under pressure, chemical resistance, surface density, ease of manufacture, and easy intraoral maintenance.

'The last post?': assessment of the failing post-retained crown.

Failure of a post-retained restoration can provide a challenge to the general dental practitioner (GDP) in terms of diagnosis, treatment planning and communication with the patient. The cause of failure must be identified, and a thorough assessment of the restoration, remaining tooth and its functional and aesthetic demands carried out in order to plan treatment to provide the most reliable result. Clinical Relevance: This article discusses the assessment of failing post-retained crowns, with discussion of reasons for failure, thereby assisting the GDP in decision-making and treatment planning for such teeth.

Time delays in treating dental trauma at a children's hospital and private pediatric dental practice.

PURPOSE: The purpose of this study was to compare the time interval between a child sustaining a dental injury and the rendering of treatment in a hospital setting and a private pediatric dental practice. METHODS: Data were collected from the patient records of children treated for dental trauma at a children's hospital emergency department, a children's hospital dental clinic, and a private pediatric dental practice. Data included demographics and the time, date, type of injury, and its treatment. RESULTS: Injuries were more severe, treatment was more complex, and the time interval between injury and treatment was longer for those children treated in the hospital setting versus private practice, regardless of distance traveled. Children treated at their dental home experienced fewer treatment delays. Insurance status, medical complexity, and associated injuries were not related to treatment delays. CONCLUSIONS: Children who seek emergency care for traumatic dental injuries in a hospital setting experience greater delays in treatment compared to those seeking care in a private practice setting. These findings might not be generalizable to other hospital settings or private practices due to the inherently unique characteristics of the sites used in this study.

[Cone beam computed tomography in endodontics: a review for daily clinical practice]. / Die digitale Volumentomographie in der Endodontologie. Eine Übersicht für den Praxisalltag.

Since the introduction of cone beam computed tomography (CBCT), this 3-dimensional diagnostic imaging technique has been established in a growing number of fields in dental medicine. It has become an important tool for both diagnosis and treatment planning, and is also able to support endodontic treatments. However, the higher effective dose of ionizing radiation compared to conventional 2-dimensional radiographs is not justifiable in every case. CBCT allows for a more precise diagnosis of periapical lesions, root fractures as well as external and internal resorptions. Concerning the utility of CBCT in treatment planning decisions, the gain of information through 3-dimensional imaging for any of these pathologies has to be evaluated carefully on an individual basis. Moreover, radioopaque materials such as root canal filling and posts often create artefacts, which may compromise diagnosis. The aim of this review is to summarize the possibilities and limits of CBCT imaging in endodontology as well as introduce guidelines for daily clinical practice. Furthermore, the article presents possible therapeutic advantages of preexisting CBCT scans for root canal treatments.

Contemporary management of horizontal root fractures to the permanent dentition: diagnosis--radiologic assessment to include cone-beam computed tomography.

Historically, obtaining several periapical radiographs has been recommended to diagnose horizontal root fractures. Assessing the 3-dimensional orientation of a fracture is correlated to treatment and outcome. However, conventional radiography yields only limited information for accurate diagnosis. Cone-beam computed tomography (CBCT) is a relatively new and useful technology, which provides an auxiliary imaging modality to supplement conventional radiography for evaluating horizontal root fractures. Despite the increasing application of this technology as well as a growing body of evidence supporting its value in diagnosing horizontal root fractures, there are no specific guidelines for its use. This article aimed to provide such preliminary guidelines for cases of suspected horizontal root fracture as a result of trauma. From a database search it was concluded that CBCT is most useful in cases in which conventional radiography yields inconclusive results or shows a fracture in the middle third of a root. In such cases CBCT may rule out false negatives, ie, a suspected root fracture not visualized with conventional radiography. For a root fracture in the middle third, CBCT may rule out or confirm an oblique course of fracture involving the cervical third in the labiolingual dimension. Although there are considerable advantages when CBCT is included in the assessment of horizontal root fracture and its possible sequelae, more experimental and clinical studies are warranted to determine the exact impact on outcomes.

Posts--when it all goes wrong! Part 1: case assessment and management options.

UNLABELLED: Posts have been used for many years to retain restorations or cores for extra-coronal restorations in endodontically treated teeth.This article discusses the variety of post systems that are available and the incidence and reasons for failure of teeth that have been restored with posts. The treatment options available for the management of such failures are considered, in addition to the indications for both non-surgical and surgical management of endodontic failures. The attitudes of dentists and the perceived complications of attempting post removal are reviewed, along with the evidence to support the prevalence of complications. CLINICAL RELEVANCE: Failure of post-retained restorations is a relatively frequent finding due to failure of the restoration itself or the endodontic treatment. It is therefore important to understand and be aware of the various treatment options available, their indications and associated risks.

Contemporary management of horizontal root fractures to the permanent dentition: diagnosis--radiologic assessment to include cone-beam computed tomography.

Historically, obtaining several periapical radiographs has been recommended to diagnose horizontal root fractures. Assessing the 3-dimensional orientation of a fracture is correlated to treatment and outcome. However, conventional radiography yields only limited information for accurate diagnosis. Cone-beam computed tomography (CBCT) is a relatively new and useful technology, which provides an auxiliary imaging modality to supplement conventional radiography for evaluating horizontal root fractures. Despite the increasing application of this technology as well as a growing body of evidence supporting its value in diagnosing horizontal root fractures, there are no specific guidelines for its use. This article aimed to provide such preliminary guidelines for cases of suspected horizontal root fracture as a result of trauma. From a database search it was concluded that CBCT is most useful in cases in which conventional radiography yields inconclusive results or shows a fracture in the middle third of a root. In such cases CBCT may rule out false negatives, ie, a suspected root fracture not visualized with conventional radiography. For a root fracture in the middle third, CBCT may rule out or confirm an oblique course of fracture involving the cervical third in the labiolingual dimension. Although there are considerable advantages when CBCT is included in the assessment of horizontal root fracture and its possible sequelae, more experimental and clinical studies are warranted to determine the exact impact on outcomes.

The status of mineral trioxide aggregate in endodontics education in dental schools in Turkey.

The aim of this study was to assess the current status of mineral trioxide aggregate (MTA) as an educational material in dental schools in Turkey. A survey was sent to senior members of the endodontic departments of seventeen dental schools; fourteen responded. All respondents reported that they used MTA in their clinical practice, with apexification, perforations, retrograde fillings, and root resorptions being the most frequently occurring treatment procedures. All reported that information was given to students regarding MTA mainly as part of the curriculum. The third and fourth years were the periods when MTA was introduced to students in most of the schools. Twelve schools reported that students had the opportunity to observe procedures in which MTA was used, but students had the chance to use the material in a very minor proportion of the schools, mainly under the supervision of clinical instructors. Ten schools agreed that MTA should be included in the regular endodontic curriculum. Financial constraints seemed to be the predominant reason for those who answered this question negatively, followed by difficult handling properties and low radiopacity of the material. Within the limitations of this study, it can be concluded that ways should be sought to prevent financial difficulties from depriving dental students of the opportunity to receive information about contemporary methodologies such as MTA utilization.

Assessment of vertical root fractures using three imaging modalities: cone beam CT, intraoral digital radiography and film.

OBJECTIVES: The aim of this study was to assess the accuracy of cone beam CT (CBCT) in detecting vertical root fractures and to compare the accuracy with images from an intraoral sensor and from conventional intraoral film. METHODS: 60 extracted, single-rooted human teeth were divided equally into two groups: a control group of 30 teeth and an induced fracture group of 30 teeth. All teeth were randomly placed into sockets in six dry mandibles. Each tooth was imaged by three modalities: CBCT, intraoral digital radiography and intraoral F-speed film. Three beam angulations (an orthogonal projection and additional projections with ± 20° horizontal shifts of the central ray) were used when radiographs were made using film and a digital sensor. Three oral and maxillofacial radiologists evaluated the presence of root fractures twice in each image modality using a five-point confidence rating scale. Areas under receiver operating characteristic curves (A(z)) were computed for each observer and modality and were tested for statistical differences using the Kruskal-Wallis test. RESULTS: There was no statistical difference in the performance of the three modalities (mean of A(z) values: CBCT = 0.811, film = 0.797 and sensor = 0.775; p = 0.771). CONCLUSIONS: There was no significant difference between intraoral film, a high-resolution complementary metal oxide semiconductor digital imaging system and CBCT in detecting vertical root fractures in mandibular single-rooted teeth.

Dysfunction prompts comprehensive oral health assessment.

A patient presented to the clinician's office as a result of discomfort from a fractured root. A systematic risk assessment revealed a combined periodontal/endodontic lesion associated with tooth No. 2, as well as the patient's history of orthodontic treatment, periodontal disease, and extensive restorative dentistry. It was also established that the patient was dissatisfied with her smile, which affected her self-esteem. Using a 10-step management system, the clinician was able to not only address the presenting complaint but also discover and treat the patient's cosmetic concerns. This case illustrates that through proper, comprehensive assessment of oral dysfunction dentists can do more than correct biomechanical and functional problems--they can also improve a patient's quality of life.

Endodontic prognosis assessment.

There are several variables which must be considered before initiating endodontic treatment, including assessing the feasibility of endodontic treatment, addressing past, present and future periodontal concerns, determining the restorability of the tooth, and detecting root fractures. If these parameters are not carefully evaluated, then short- or long-term endodontic success may be questionable. Endodontic prognosis assessment is often subjective, based on objective finding, but ultimately determined by the experience of the operator. Although dentists must rely upon evidence-based research to determine the best modality of treatment, good clinical judgment and experience may override the most objective findings. This article discusses the objective and subjective criteria which must be evaluated for determining the potential prognosis of endodontic treatment.

A comparative diagnostic assessment of anterior tooth and bone status using panoramic and periapical radiography.

AIMS: The aim of the present study was to compare diagnostic assessments of anterior tooth and bone status in a randomised cohort of pre-orthodontic patients using panoramic and periapical radiographs. METHOD: Four hundred and forty-four cases with matched periapical and panoramic radiographs were examined by three observers. Two were final-year postgraduate endodontic students and the other, a final-year Honours degree dental student. Multi-rater Kappa values were used to assess the reliability of the observers, with a value of 1 equating to complete agreement. RESULTS: With the exception of endodontic Class 1 and 2 palatal invaginations, reliability exceeded 0.95 for all three observers. An assessment of the graduate endodontic students revealed only a marginal increase in the kappa values. Statistical analysis (p < 0.05) determined that developmental anomalies or tooth/bone pathoses were more reliably detected by observers using periapical radiographs compared with panoramic films. This finding has relevance given the likelihood of anterior dental trauma among young children. CONCLUSION: While there have been considerable improvements in the quality of dental panoramic radiography, the present study indicated that a reliable pre-orthodontic or post-trauma diagnostic assessment should include both panoramic and intra-oral radiographs.

Dental implant tourism.

Access and affordability of dental care can be problematic for some in the Australian community. Therefore, dental tourism is increasingly becoming more attractive to some patients due to decreased expense, increased convenience and immediacy of treatment. However, there are significant issues for both clinician and patient in regards to dental tourism. Lack of accountability and regulation are the main issues and this is particularly evident when complications occur. This paper presents five cases where complications have arisen in the setting of dental tourism.