Impact of Protracted War Crisis on Dental Students: A Comparative Multicountry Cross-sectional Study.

BACKGROUND: The impact of conflict and war crisis on dental students is poorly understood. Given the prolonged conflicts and political instability in the Arabic-speaking countries, it is crucial to investigate the effect of these conditions on dental students. This study aimed to assess the impact of protracted war on dental students by comparing the personal, university, and wider context challenges they face across war-affected and unaffected countries. METHODS: A cross-sectional study was conducted including a convenience sample of dental students from 13 universities in 12 Arabic-speaking countries. Respondents were those at entry and exit points of their undergraduate dental training. A self-administered paper questionnaire collected anonymized data on sociodemographics, and personal, university, and wider context challenges that students were facing. Multivariable Poisson regression analyses were carried out. RESULTS: The overall response rate was 64.8%. The mean age was 21.2 (standard deviation = 2.1) years, with 68% of participants being female. After adjusting for age and sex, dental students in Arabic-speaking countries affected by protracted war crisis were significantly more likely to report wider context challenges compared to their counterparts in unaffected countries (n = 2448; beta = 1.12; 95% confidence interval: 1.10-1.13; P < 0.001). DISCUSSION: Dental students in Arabic-speaking countries affected by protracted war crisis were more likely to suffer from wider context challenges such as difficulties in attendance due to the deterioration of security and lack of flexibility of teaching time to accommodate the different circumstances induced by the war crisis. Supporting dental students in areas affected by protracted war crises is needed and may include developing online dental education programs.

Dentists' Knowledge, Attitude and Practice of Root Canal Treatment Procedure: Survey-based Research.

AIM: The aim of this survey was to assess the dentists' knowledge, attitude and practice of endodontic treatment procedures and materials in Damascus city (capital of Syria), and the effect of endodontic specialty and years of experience on the survey findings. MATERIALS AND METHODS: Two hundred direct contacts (25 multiple-choice questions containing) questionnaires were distributed to randomly selected dentists practicing in Damascus city in 11 different areas, and a questionnaire contained questions regarding dentists' knowledge, attitude, and practice of root canal treatment procedure. The collected data were entered into a personal computer and analyzed using the statistical package for the social sciences (SPSS), 25 edition. RESULTS: One hundred eighty-eight questionnaires were collected with a 94% response rate. About 71.8% were general dental practitioners (GDPs), 25.5% were not practicing molar endodontics, and only 5.3% were referring difficult cases to endodontists. 32.4% and 21.8% of respondents were practicing vital and necrotic single visit root canal treatment, respectively. Only 6.9% were using rubber dam isolation, and more than half of the respondents used the standardized preparation technique. Non-setting calcium hydroxide was used 100% as an intra-canal medicament during necrotic root canal treatment sessions.96.3% of our respondents prefer delaying final restoration to next visit for symptoms disappearance. CONCLUSION: It was evident that more practicing experience does not improve treatment options selections of endodontic treatment. So the continuous educational programs are a very important way to change the old or wrong concepts in dental offices. CLINICAL SIGNIFICANCE: The sample covered a large number of dentists who are working in Damascus; the most developed place in Syria. It is also considered that for carrying out such kind of surveys as long as the dentists are familiar with this type of studies.

Effect of Intracanal Cryotherapy and Negative Irrigation Technique on Postendodontic Pain.

AIM: To evaluate the effect of intracanal cryotherapy with negative pressure irrigation (EndoVac) on postendodontic pain after vital single-visit root canal treatment (RCT). MATERIALS AND METHODS: A total of 75 single-rooted teeth with single root canal were treated endodontically. After root canal preparation with Protaper Universal rotary system and irrigation, teeth were divided randomly into three groups (n = 25) according to additional irrigation protocol as follows: Group I: No additional irrigation was applied (control); group II: A 20 mL of room temperature saline was irrigated during 5 minutes using EndoVac, and group III: A 20 mL of 2 to 4°C cold saline was irrigated during 5 minutes using EndoVac. Pain levels were assessed by visual analog scale (VAS) and verbal evaluation of pain questionnaire after 6, 12, 24, 48 hours, and 7 days of canal obturation. The data were then analyzed using Statistical Package for the Social Sciences (SPSS) 13.0 using Kruskal-Wallis and Mann-Whitney U tests at p-value of 0.05. RESULTS: The results showed that pain levels were high in groups I and II after 6 hours that decreased with time to almost diminish after 1 week, and on the other hand, group III showed no pain among different monitoring periods. Also pain levels in groups II were lower compared with group I after only 6 hours, with significance p < 0.05. CONCLUSION: Postendodontic pain presented with highest values after 6 hours of treatment and reduced to almost nil after 1 week. Intracanal cryotherapy eliminated postendodontic pain clinically. Negative pressure reduced postendodontic pain after 6 hours of treatment. CLINICAL SIGNIFICANCE: The outcome of this study indicates that the use of intracanal cryotherapy technique with negative pressure irrigation eliminates postendodontic pain after single-visit RCTs.

The Effect of Aloe vera and Chlorhexidine as Disinfectants on the Success of Selective Caries Removal Technique: A Randomized Controlled Trial.

This study aimed to evaluate the effect of Aloe vera and chlorhexidine "CHX" as disinfectants on the success of selective caries removal technique in deep carious lesions. A total of 60 patients with: (I) deep class II carious lesion diagnosed with reversible pulpitis; (II) good oral hygiene; (III) no gingival recession or periodontal diseases; (IV) no antibiotic or antifungal treatment in the last three months; and (V) no systematic disease or pregnancy were included in the study. Sixty patients were distributed randomly to three experimental groups (n = 20): Group 1: no disinfectant solution was applied (control group); group 2: the cavity was filled with 2% CHX for 5 mins and then dried with a sterilized cotton pellet; group 3: the cavity was filled with Aloe vera extract for 5 mins and then dried with sterilized cotton pellet. One week later, only teeth with vital pulp characteristics were restored definitely with resin composite. After 18 months, clinical and radiographic examination was performed by using a blinded separated evaluator. The data were tabulated and analyzed using the chi-square test by SPSS 13.0 with a significance level (p ≤ 0.05). It was observed that 13 teeth of the control group, 14 teeth of the CHX group, and 16 teeth of the Aloe vera group were diagnosed with healthy vital pulp after 18 months. There was no significant difference between the CHX and the control group; however, there was a significant difference between the Aloe vera and control group (p ≤ 0.007). Aloe vera extract as a cavity disinfectant increases the success rate of selective caries removal technique of deep carious lesions.

Endodontic Perforation Closure by Five Mineral Oxides Silicate-Based Cement with/without Collagen Sponge Matrix.

Endodontic perforations are common accidents that occasionally happen as a result of misuse or difficult anatomy of some teeth; it may lead to teeth loss unless a good management is provided. Bioceramic (silicate-based) cements like mineral trioxide aggregate have a big role in management of such accidents. This case report aimed to evaluate the ability of five mineral oxides cement "5MO" in sealing two root canal perforations (furcation and postdrill perforations) and inducing clinical and radiographic healing in the periodontal tissues with/without the use of collagen sponge matrix. A 58-year-old healthy female was referred to our dental office complaining of severe pain in the upper left premolars' region. Periapical radiographic examination revealed unsatisfactory root canal treatment of the teeth #24 and #25 with a furcation perforation and a postdrill perforation, respectively. Cone-beam computed tomography "CBCT" scans confirmed the findings of the periapical radiography and revealed the presence of radiolucent lesions surrounding the apex of both teeth #24 and #25. The treatment plan was a nonsurgical root canal retreatment by endodontic access through the full-ceramic crowns. After three years of follow-up, CBCT scans revealed a complete healing and bone formation on both premolars. This case report indicates the use of 5MO cement for endodontic perforations management.

Postendodontic pain in asymptomatic necrotic teeth prepared with different rotary instrumentation techniques.

OBJECTIVES: to investigate the postendodontic pain in asymptomatic necrotic teeth prepared with different rotary instrumentation techniques after single-visit root canal treatment. MATERIALS AND METHODS: A total of 60 single-rooted teeth with single root canal were treated endodontically. Teeth were divided randomly into four equaled groups (n = 15) according to instrumentation systems as follows: group I were shaped using ProTaper Universal (control group) (Dentsply/Maillefer, Ballaigues), group 2 were shaped with 2Shape (Micro-Mega) till TS2 (25.06), group 3 were shaped with XP-endo Shaper file (FKG Dentaire) till #30.04, and group 4 were shaped with Reciproc blue (VDW) till R25 (25.08). All groups were prepared according to manufacturer's instructions and obturated with lateral condensation technique. Pain levels were assessed by visual analog scale (VAS) and verbal evaluation of pain questionnaire after 6, 12, 24, 48 h, and 7 days of canal obturation. Data were then analyzed using Kruskal-Wallis and Mann-Whitney U tests at P value of 0.05. RESULTS: Postendodontic pain started after 6 h of treatment with highest values and then decreased gradually until almost vanished after 1 week of treatment, with no significant differences in VAS among studied groups (ProTaper, 2 shape, XP endo Shaper, and Reciproc Blue) after 6,12, and 48 h of treatment. On the other hand, XP endo Shaper group, showed the lowest pain values after 24 h of treatment, and the highest pain values were found in 2 shape group after 1 week with significance (P < 0.05). CONCLUSION: Root canals prepared with XP endo Shaper resulted in the lowest pain levels after 24 h of treatment. Root canal preparation with 2Sshape rotary system resulted in the highest pain levels after 1 week of treatment.

Root canal morphology of mandibular canines in the Syrian population: A CBCT Assessment.

INTRODUCTION: The recent study aimed to assess the root canal morphology of mandibular canines in the Syrian population depending on the cone beam computed tomography (CBCT) images. MATERIALS AND METHODS: A total of 418 fully developed mandibular canines in Syrian individuals aged between 16 and 60 years were included. The presence of at least one mandibular right or left canine with fully developed roots was recorded in each image. The root canal configurations were classified according to the method of Vertucci. The mandibular canines were examined in sagittal, coronal, and axial dimensions. The CBCT images were evaluated by three endodontists with at least 9 years of clinical experience in endodontics. Data were analyzed with descriptive analysis and Chi-square tests using the Statistical Package for the Social Sciences (SPSS) software version 25 (SPSS Inc, Chicago, IL, USA). RESULTS: Out of the 418 mandibular canines, 409 (97.85%) were single-rooted canines while only 9 (2.15%) were double-rooted canines. The most common type of Vertucci in single-rooted canines was Type I (1-1) in the percentage of 95.87% and the least type was Type V (1-2) in the percentage of (0.24%). The Chi-square tests showed no significant association between gender and number of roots (P = 0.64) and gender and root canal configuration in single-rooted canine (P = 0.194). CONCLUSION: Single-rooted with Type I canal configuration was the most common anatomy in mandibular canines in the Syrian population. Incidence of more than one root canal foramen at the end of the single root was detected in one case only.