Oral health-related quality of life and perceptions of patients following primary root canal treatment or non-surgical retreatment.

This retrospective cohort study compared the effect of primary root canal treatment (RCT) with root canal retreatment (Re-RCT) on patient-reported outcomes in Kuala Lumpur, Malaysia. Forty randomly selected adults participated (RCT n = 20; Re-RCT n = 20). The impact their dentition had on the Oral Health Impact Profile-14 (OHIP-14) was assessed by calculating the prevalence of oral health impact, and the severity score. Focus group discussions using a semi-structured guide were arranged through an online meeting platform. Qualitative content analysis identified common themes, and relevant quotes gathered. The impact on OHIP-14 was limited for both RCT and Re-RCT groups with no significant differences in the prevalence of oral health impact. Significant differences were found for functional limitation (RCT higher) and psychological discomfort (Re-RCT higher). Common themes from the discussions include the importance of retaining teeth, the significance of effective communication between clinicians and patients and that the respondents were satisfied with the treatment.

In-vitro evaluation of the effectiveness of polyphenols based strawberry extracts for dental bleaching.

To formulate a dental bleaching agent with strawberry extract that has potent bleaching properties and antimicrobial efficacy. Enamel specimens (3 × 3 × 2 mm3) were prepared. Quaternary Ammonium Silane (CaC2 enriched) was homogenized with fresh strawberries: Group 1: supernatant strawberry (10 g) extract < Group 2: supernatant strawberry (10 g) extract + 15%HA (Hydroxyapatite) < Group 3: supernatant strawberry (10 g) extract + 15% (HA-2%k21) < Group 4: supernatant strawberry (20 g) extract only (20 g strawberries) < Group 5: supernatant strawberry (20 g) extract + 15% HA < Group 6: supernatant strawberry (20 g) extract + 15% (HA-2%K21) < Group 7: In-office Opalescence Boost 35%. Single-colony lactobacillus was examined using confocal microscopy identifying bacterial growth and inhibition in presence of bleaching agents using 300 µL aliquot of each bacterial culture. Images were analysed by illuminating with a 488 nm argon/helium laser beam. Colour difference (∆E00) was calculated using an Excel spreadsheet implementation of the CIEDE2000 colour difference formula and colour change measured between after staining and after bleaching. Scanning electron microscope was used to image specimens. Raman spectra were collected, and enamel slices were used for STEM/TEM analysis. HPLC was used for strawberry extract analysis. Nano-indentation was performed and X-ray photoelectron spectroscopy. Antioxidant activity was determined along with molecular simulation. hDPSCs were expanded for Alamar Blue Analysis and SEM. Mean colour change was significantly reduced in group 1 compared to other groups (p < 0.05). CLSM showed detrimental effects of different strawberry extracts on bioflms, especially with antimicrobial (p < 0.05). Groups 1, 2 and 3 showed flatter/irregular surfaces with condensation of anti-microbial in group 3. In strawberry specimens, bands predominate at 960 cm-1. HPLC determined the strawberry extracts content. Molecular simulation verified interaction between calcium and polyphenol components. XPS peak-fitted high-resolution corresponding results of Ca2p3/2 and Ca2p1/2 for all k21 groups. Combination of 10 g strawberry extract supernatant and 15% (hydroxyapatite 2%k21) improved the whiteness and provided additional antimicrobial potential. The novel strawberry extract and antimicrobial based dental formulation had immediate bleaching effect without promoting significant changes in enamel morphology.

Pulpal and Periapical Status of the Vital Teeth Used as Abutment for Fixed Prosthesis-A Systematic Review and Meta-Analysis.

PURPOSE: This is a systematic review to identify the incidence of pulp necrosis and/or periapical changes among vital teeth which are used as an abutment for crown and fixed partial dentures (FPDs). MATERIALS AND METHODS: Two reviewers independently searched two electronic databases, PubMed and Scopus. The search was complemented from references of included studies and published reviews. Studies published in the English language through January 2021 that had assessed and documented the clinical and radiographic failure of crown or FPD in vital permanent teeth due to pulpal or periapical pathology with a follow-up of at least 12 months were selected. Data screening, data collection and extraction of data was performed. Quality of studies involved was analyzed using the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Meta-analysis was done using random effects model. Publication bias was assessed using funnel plots. RESULTS: Electronic searches provided 10,075 records among which 20 studies were selected for systematic review and 7 studies were selected for meta-analysis. With respect to quality assessment, all the studies involved were considered as high quality as the score in scale ranged between 6 and 9 as per the Newcastle-Ottawa Quality Assessment Scale for cohort studies. The meta-analyses showed that there was no statistically significant difference in the incidence of the loss of pulp vitality or pulp necrosis through clinical and radiographic examination with the follow up period of 5 years: p < 0.001, 95% CI: 0.96-1.00, I2 = 77.84%; 10 years: p < 0.001, 95% CI: 0.88-0.95, I2 = 93.59%; 15 years: p < 0.001, 95% CI: 0.92-0.96, I2 = 94.83%; and 20 years: p < 0.001, 95% CI: 0.94-0.96, I2 = 95.01%. CONCLUSIONS: The meta-analysis revealed clinical and radiographic success rate ranging between 92% to 98% at different follow up periods ranging between 5 years and 20 years. Future high-quality randomized clinical controlled trials with a larger population are required to confirm the evidence as only observational studies were considered in this paper.

Comparison of Apical Extrusion of Bacteria After Glide Path Preparation Between Manual K File, One G Rotary, and WaveOne Gold Glider Reciprocation Preparations.

OBJECTIVE: To compare the amount of apically extruded bacteria between hand-filed preparations, rotary and reciprocation glide path preparations in curved canals of extracted teeth infected with Enterococcus faecalis. METHODS: Forty mandibular first molar teeth were decoronated, fitted into rubber stoppers and fixed onto glass vials. The mesiobuccal canals from mandibular first molar teeth were infected with Enterococcus faecalis, then randomly assigned to one of five groups for glide path preparation: manual stainless-steel file (K-files), rotary file (One G), reciprocating file (WaveOne Gold Glider) and two control groups. After glide path preparation, 0.01 mL of saline was taken from the experimental vials. The solution was plated on tryptic soy agar and colonies of bacteria were counted as colony-forming units. The results were analysed statistically using Kruskal-Wallis and post hoc Mann-Whitney U tests. RESULTS: The manual K-file group was associated with significantly more bacteria extrusion compared to the rotary and reciprocating groups (P<0.05). However, no significant difference occurred between rotary and reciprocation instruments. CONCLUSION: All instrumentation techniques resulted in a measurable amount of apical extrusion of bacteria. Manual K-files extruded the highest quantity of bacteria compared to One G rotary file and WaveOne Gold Glider reciprocation file during glide path preparation.

Evaluation of usage-induced degradation of different endodontic file systems.

To evaluate structural profiles and mechanical behaviour of WaveOne Gold (WOG), Twisted File Adaptive (TFA) and XP-endo shaper (XPS) instruments after root canal preparation. Standardized in vitro shaping was performed in presence of 5.25% sodium hypochlorite. File morphology was analyzed using scanning electron microscopy; X-ray diffraction analysis was performed before and after use along with Raman spectroscopy. Nanoindentation was carried out to characterize surface topography. Ni2+ release was measured at 1, 3, 5 and 7 days. X-ray photoelectron spectroscopy (XPS) analysis was done before and after use. After allocating scan line shifts like in WOG, mechanical deformation was shown using first order polynomials. XPS file system showed minimal grooves on surface. SEM of WOG instrument showed scraping surface defects. Hardness varied from 8.11 ± 0.99 GPa in TFA system to 6.7 ± 1.27 GPa and 4.06 ± 4.1 GPa in XPS and WOG. Ni2+ concentration from WOG was 171.2 µg/L. Raman peak at 540-545 cm-1 is attributed to Cr2O3. High resolution of Ti 2p spectrum show distinctive peaks with binding energies dominating in WOG, XPS and TFA file system. XRD exhibited NiTi phases with diffraction peaks. WOG files showed more surface deterioration and less passive layer formation as compared to TFA and XPS systems.

Root canal morphology of permanent teeth in a Malaysian subpopulation using cone-beam computed tomography.

BACKGROUND: To determine the root canal morphology of human permanent maxillary and mandibular teeth in a Malaysian subpopulation using cone-beam computed tomography (CBCT). METHODS: A total of 208 CBCT images were examined retrospectively. Prevalence of an extra root/canal and internal morphology based on Vertucci's classification were observed in human maxillary and mandibular permanent teeth. Variations in the external and internal morphology were compared in relation to gender and tooth side (left vs right) using Pearson Chi-square and Fisher's exact tests with significance level set at p < 0.05. RESULTS: In the maxillary arch, the prevalence of three canals were observed in 0.3% of first premolars and two canals in 46.5% of second premolars. Males displayed significantly higher prevalence of two canals in maxillary second premolars than females (p < 0.05). The prevalence of a second mesiobuccal canal in maxillary first and second molars were 36.3 and 8.5%, respectively. Males displayed significantly higher prevalence of a second mesiobuccal canal in maxillary second molars than females (p < 0.05). The prevalence of a second palatal canal in maxillary first and second molars were 0.9 and 0.6%, respectively. In the mandibular arch, the prevalence of two canals were observed in 5.1% of central incisors, 12.3% of lateral incisors, 6.1% of canines, 18.7% of first premolars and 0.5% of second premolars. The prevalence of a middle mesial canal, second distal canal and extra root (radix entomolaris) were detected in 1.9, 19.5 and 21.4% of mandibular first molars, respectively. The prevalence of a C-shaped canal was observed in 48.7% of mandibular second molars. Females displayed significantly higher prevalence of a C-shaped canal in the right mandibular second molars than males (p < 0.05). No other statistically significant differences in root anatomy and root canal morphology were observed in relation to gender and tooth side. CONCLUSIONS: Wide variations in the root canal morphology exist among Malaysians. CBCT is a clinically useful tool in the identification of external and internal morphological variations in the human teeth.

Ozone- A Biological Therapy in Dentistry- Reality or Myth?????

The usage of ozone in dentistry has been proposed because of its antimicrobial, disinfectant, biocompatibility and healing properties. In the last decade a number of therapeutic protocols with ozone have been developed to address common dental infections associated with periodontal disease, RCT and caries. Despite these advantages, therapeutic ozone's application in dentistry is limited because of its possible side effects. Hence, dental practitioners need to know the proper usage of ozone therapy that can provide better patient care and considerably cut down the time and cost of the treatment.

Comparison of Dill Seed Oil Mouth Rinse and Chlorhexidine Mouth Rinse on Plaque Levels and Gingivitis - A Double Blind Randomized Clinical Trial.

INTRODUCTION: Mouthrinses have been in use for centuries as breath fresheners, medicaments, and antiseptics. Dill is said to be a good source of calcium, manganese and iron. It contains flavonoids known for their antioxidant, anti-inflammatory, and antiviral properties. Dill can help with microbial infections in the mouth; and its anti-oxidants minimize damage caused by free radicals to the gums and teeth. Being a good source of calcium, dill also helps with bone and dental health. AIMS AND OBJECTIVES: To compare the effectiveness of commercially available 0.2% chlorhexidine gluconate mouthrinse and dill seed oil mouthrinse on plaque levels and gingivitis. MATERIAL AND METHODS: A randomized controlled, double blind parallel arm study was conducted over 90 days on 90 subjects. The subjects were randomly divided into 2 groups and baseline data was collected using Loe and Silness gingival index and Quigley Hein plaque index and oral prophylaxis was performed on all the subjects. The mouthrinses included in the present study were dill seed oil and Hexodent (0.2% chlorhexidine gluconate). Intervention regarding the mouthrinsing was given to the subjects and were followed up for 45 days and 90 days, after this post intervention changes were assessed using the respective indices. RESULTS: It was observed that there is no significant difference in gingival & plaque scores among two mouthrinses from baseline to 45 days and 90 days. It was observed that there is statistical difference in gingival and plaque scores when compared with baseline to 45 days (p<0.001), baseline to 90 days (p<0.001) and 45 days to 90 days (p<0.001) when intergroup comparisons were done. CONCLUSION: It was concluded that dill seed oil and Hexodent (0.2% chlorhexidine gluconate) mouthrinse have similar antiplaque and antigingival effectiveness.

Letter to the Editor: Radiation Injuries: Reemphasizing the Usage of Radiation Protection Prosthesis.

Sir, I write in regard to Nayar S et al article 'The Effect of a Radiation Positioning Stent (RPS) in the Reduction of Radiation Dosage to the Opposing Jaw and Maintenance of Mouth opening after Radiation Therapy'. I wholeheartedly agree to that patients undergoing radio-therapy who had an Radiation Positioning Stent (RPS) would show a significant reduction in radiation dosage to the opposing jaw and maintained their mouth opening in the short-term. As we know that oral cancer has emerged to be one of most deadliest cancer nowadays.

A three-dimension finite element analysis to evaluate the stress distribution in tooth supported 5-unit intermediate abutment prosthesis with rigid and nonrigid connector.

OBJECTIVE: The aim of the study is to evaluate the stress distribution in tooth supported 5-unit fixed partial denture (FPD) having tooth as pier abutment using rigid and nonrigid connectors respectively, under simultaneous and progressive loading. MATERIAL AND METHODS: The three-dimensional (3D) finite element program (ANSYS software) was used to construct the mathematical model. Two 5-unit FPD'S were simulated, one with rigid connector and another one with nonrigid connector. For analysis, each of these models were subjected to axial and oblique forces under progressive loading (180, 180, 120, 120, 80 N force on first and second molars, premolars and canine respectively) and simultaneous loading (100, 100, 100, 100, 100 N force on first and second molars, premolars and canine respectively). RESULTS: The rigid and nonrigid connector design have effect on stress distribution in 5-unit FPDs with pier abutments. CONCLUSION: Oblique forces produce more stresses than vertical forces. Nonrigid connector resulted in decrease in stress at the level of prosthesis and increase in stress at the level of alveolar crest.

Patients awareness and attitude towards dental implants.

AIMS: The aim of the study was to assess the awareness of the patients regarding implant-retained prosthesis as an option for tooth replacement and the knowledge about tooth replacement as a whole including source of information and attitude towards it amongst Malaysian population. MATERIALS AND METHODS: Information on demographic characteristics, knowledge about implant as an option for missing tooth replacement, source of information and knowledge about other options of tooth replacement were obtained from patients visiting various dental outpatient departments of hospital and private dental clinics using nationwide self-explanatory survey. RESULTS: Amongst the 1013 response retrieved, 27% of respondents felt moderately well informed about the dental implant treatment. Only 9% of the respondents had dental implant treatment before and 17% felt well informed about different alternatives of replacing missing teeth. The dentists were the main source of information regarding dental implant treatment modality followed by friends and electronic media. 55.6% respondents felt implant to be as good as own teeth during function whereas high cost was the major limiting factor for implant treatment. CONCLUSION: 56% of Malaysian population was aware of dental implant as an alternative for replacing missing teeth. Necessary efforts and measures should be made to raise the awareness of dental implant treatment in the country.

Evaluation of the color durability of acrylic resin veneer materials after immersion in common beverages at different time intervals: A spectrophotometric study.

BACKGROUND: Proper function, esthetics, and cost are the prime factors to be considered while selecting bridge veneering materials. The purpose of the study is to evaluate color durability of acrylic veneer materials after immersion in common beverages at different time intervals. METHODS: Spectrophotometer was used for taking color measurements based on the transmission of light through the specimens made of the selected materials which were Tooth moulding powder (DPI) and Acrylux (Ruthinium). Thirty specimens of standardized dimensions were prepared from each material. The specimens were divided into three groups of 10 each. One group of each material was immersed in tea (TajMahal) and another group of each material in cola (Pepsi) as the staining solutions. The remaining group of 10 from each material served as control and was stored in distilled water. Color measurements were obtained pre-immersion, and after 1, 15, and 30 days of immersion. RESULTS: Tooth moulding powder displayed better color durability than Acrylux over the 1 month immersion period in both staining solutions. Tea resulted in more discoloration compared to cola (Pepsi). CONCLUSION: The difference in the color durability of Acrylux and Tooth moulding powder may be attributed to the differences in the composition of tested resin veneering materials, i.e. their polar properties, which contribute to the absorption of staining solution, and the different brands and the strengths of the solutions.

Effect of two different dentin desensitizers on shear bond strength of two different bonding agents to dentin: an in vitro study.

OBJECTIVE: The objective of the study was to compare the effect of two different desensitizers on shear bond strength of two different fifth-generation single-bottle adhesive agents on dentin surface. MATERIALS AND METHODS: Sixty human premolars were taken and divided into six groups of 10 samples each. The first two groups were the control groups and were not pretreated with any desensitizer; the remaining four groups were the experimental groups and were pretreated with either Denshield™ or Sensodent-K™ desensitizer. The specimens in each group were subjected to acid etching, application of adhesive (Single Bond or Prime and Bond NT), and application of hybrid composite resin (Z-100) according to the standard protocol. The specimens were subjected to shear bond strength testing, using a Lloyds universal testing machine (EZ20), followed by stereomicroscopic evaluation of the fracture mode at the debonded interface. RESULTS: Statistically significant difference existed between the two bonding agents in the control groups (group 1 and 2), with Prime and Bond NT showing higher bond strength than Single Bond. No statistically significant difference existed between either control or pretreated with any desensitizer when either of the adhesive systems was used. Prime and Bond NT showed statistically higher bond strength value when teeth were pretreated with Sensodent-K™ (groups 5 and 6). No statistically significant difference in bond strength values were observed between the bonding agents when pretreated with Denshield™ desensitizer.