Global cone-beam computed tomography adoption, usage and scan interpretation preferences of dentists and endodontists.

AIM: This study investigated the adoption of cone-beam computed tomography (CBCT) by dentists and endodontists around the world, including their preferences in endodontic CBCT usage. METHODOLOGY: An online questionnaire surveyed dental association members in Australia and New Zealand, and endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA, about their CBCT training history, considerations in acquisition/interpretation, access to and usage of CBCT, preferred scan interpreter, and preferred endodontic scan settings. Data were analysed with Chi-squared, independent sample t-tests, Cochran's Q and McNemar's tests. RESULTS: Responses from 578 endodontic specialists or postgraduates (Group E) and 185 non-endodontic dentists (Group NE) were included. Continuing professional education (CPE) was the most common source of CBCT training (69.2%). Factors considered in CBCT acquisition/interpretation included beam hardening (75.4%), radiation exposure (61.1%) and patient movement (58.3%). Group E reported higher CBCT usage (90.8%) than Group NE (45.4%, p < .001) and greater workplace access to CBCT (81.1% vs. 25.9%, p < .001). Scans were interpreted by the respondent in most workplace scans (83.3%) and externally taken scans (60.5%); Group E were significantly more likely to interpret themselves than Group NE. Small field of view (83.6%) and high resolution (86.6%) were most preferred as settings for endodontic CBCTs; Group NE were less likely to choose these settings. There were some geographic variations within Group E. CONCLUSIONS: CBCT training was most commonly acquired via CPE. Endodontic respondents reported very high CBCT usage and access in the workplace. There are educational implications regarding CBCT limitations, appropriate applications and interpretation.

Global survey of endodontic practice and adoption of newer technologies.

AIM: To investigate current endodontic practices, adoption of technologies and continuing education attendance within specialist endodontic practice globally and to identify geographic trends. METHODOLOGY: A web-based survey of endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA on routine treatment preferences, armamentarium and education attendance was conducted. Chi-squared, independent sample t-tests, Cochran's Q test and McNemar's test were performed. RESULTS: The survey was completed by 543 endodontists or endodontic post-graduate students. Almost all respondents used the dental operating microscope (DOM, 91.3%), engine-driven nickel-titanium instruments (NiTi, 97.6%), electronic apex locators (EAL, 93.0%), cone-beam computed tomography (CBCT, 91.2%) and calcium silicate-based materials (CSBMs, 93.7%). Dental dam was always used by 99.1%. Over half used irrigation adjuncts (81.8%), warm vertical compaction (74.6%) and heat-treated NiTi (60.2%). Geographic comparison between AP (Asia-Pacific, n = 78), AM (Americas, n = 402) and EM (Europe and Middle East, n = 63) was performed. AM and EM preferred single-visit treatment more (p < .001) and used higher sodium hypochlorite concentrations than AP. AM had more access to CBCT in the workplace (86.6%) than AP (65.4%, p < .001) and used CBCT for routine preoperative assessment (39.6%) more than EM (7.3%, p < .001). Almost all of EM used irrigation adjuncts (95.2%), more than AM (78.1%, p = .001). AP used steroid/antibiotic medicaments most (p < .001) and had the highest attendance at continuing education programmes. CONCLUSION: Several endodontic-specific armamentaria have reached almost complete adoption within global specialist endodontic practice, whilst the continued uptake of newer technologies should be followed over time. Some practising philosophies varied significantly across different geographic regions.

Treatment of strip perforation using cold ceramic.

Root perforation may occur at any stage of endodontic treatment and is mostly due to iatrogenic injury and may compromise the outcome of endodontic treatment. Repairing a perforation is difficult and the prognosis depends on various factors such as time, site and size of perforation, and the patient's overall health status. Hence, choosing the most appropriate material can be critical for the dentist. In this case report of a strip-perforation repair, an mineral trioxide aggregate-like material (cold ceramic) that has been shown in previous studies to have favorable properties, was successfully used.

PROBE 2023 guidelines for reporting observational studies in endodontics: Explanation and elaboration.

Observational studies play a critical role in evaluating the prevalence and incidence of conditions or diseases in populations as well as in defining the benefits and potential hazards of health-related interventions. There are currently no reporting guidelines for observational studies in the field of Endodontics. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) team has developed and published new reporting guidelines for observational-based studies called the 'Preferred Reporting items for OBservational studies in Endodontics (PROBE) 2023' guidelines. The PROBE 2023 guidelines were developed exclusively for the speciality of Endodontics by integrating and adapting the 'STrengthening the Reporting of OBservational studies in Epidemiology (STROBE)' checklist and the 'Clinical and Laboratory Images in Publications (CLIP)' principles. The recommendations of the Guidance for Developers of Health Research Reporting Guidelines were adhered to throughout the process of developing the guidelines. The purpose of this document is to serve as a guide for authors by providing an explanation for each of the items in the PROBE 2023 checklist along with relevant examples from the literature. The document also offers advice to authors on how they can address each item in their manuscript before submission to a journal. The PROBE 2023 checklist is freely accessible and downloadable from the PRIDE website (http://pride-endodonticguidelines.org/probe/).

PROBE 2023 guidelines for reporting observational studies in Endodontics: A consensus-based development study.

Observational studies are non-interventional studies that establish the prevalence and incidence of conditions or diseases in populations or analyse the relationship between health status and other variables. They also facilitate the development of specific research questions for future randomized trials or to answer important scientific questions when trials are not possible to carry out. This article outlines the previously documented consensus-based approach by which the Preferred Reporting items for Observational studies in Endodontics (PROBE) 2023 guidelines were developed. A steering committee of nine members was formed, including the project leaders (PD, VN). The steering committee developed an initial checklist by combining and adapting items from the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding several new items specifically for the specialty of Endodontics. The steering committee then established a PROBE Delphi Group (PDG) and a PROBE Online Meeting Group (POMG) to obtain expert input and feedback on the preliminary draft checklist. The PDG members participated in an online Delphi process to reach consensus on the clarity and suitability of the items present in the PROBE checklist. The POMG then held detailed discussions on the PROBE checklist generated through the online Delphi process. This online meeting was held via the Zoom platform on 7th October 2022. Following this meeting, the steering committee revised the PROBE checklist, which was piloted by several authors when preparing a manuscript describing an observational study for publication. The PROBE 2023 checklist consists of 11 sections and 58 items. Authors are now encouraged to adopt the PROBE 2023 guidelines, which will improve the overall reporting quality of observational studies in Endodontics. The PROBE 2023 checklist is freely available and can be downloaded from the PRIDE website (https://pride-endodonticguidelines.org/probe/).

Mentoring of oral health professionals is crucial to improving access to care for people with special needs.

INTRODUCTION: Individuals with special health care needs continue to experience difficulties with accessing regular dental care. This has largely been due to clinicians feeling they lack the training and experience to manage their needs. The aim of this study was to determine whether working closely with specialists in special need dentistry influenced the willingness of clinicians to treat patients with special needs. MATERIALS AND METHODS: Semi-structured interviews were conducted with specialists and clinicians involved in these mentoring initiatives. Qualitative thematic analysis was used to determine perspectives towards how this additional support influenced their willingness to treat individuals with special needs. RESULTS: The views of all participants towards these supports were positive with clinicians feeling it not only offered them opportunities to learn from the specialists, but also increased their willingness to treat individuals with special needs and the timeliness and quality of care they were able to provide. Likewise, despite some concerns about the inappropriate use of specialist support, the specialists felt these mentoring relationships offered many benefits including improving timely access to care and ensuring individuals were able to receive appropriate care. CONCLUSIONS: Mentoring provided by specialists in special needs dentistry improved the willingness of clinicians to provide care for individuals with special health care needs. Supports such as these are likely to be crucial to overcoming concerns of clinicians about their ability to manage the needs of these individuals and begin to address a significant barrier to access of care for individuals with special health care needs.

Examination of canalis sinuosus using cone beam computed tomography in an Australian population.

BACKGROUND: Canalis sinuosus (CS) and its relationship with adjacent teeth is relevant for surgery in the anterior maxilla. Therefore, the aim of this study was to report the prevalence, characteristics and variations of CS. METHODS: Cone beam computed tomography (CBCT) scans of the anterior maxilla of 201 patients were reviewed. CS and the adjacent teeth were analysed by age, gender and scan resolution, using analysis of variance, Chi-squared and Fisher's exact tests. The widest and narrowest diameters of CS, and distance to tooth apex (DTA), were compared by quadrant, closest tooth and location, and the associations were examined statistically with P < 0.05. RESULTS: In the 201 scans, 412 CS were identified in 198 patients associated with 395 different teeth. Mean widest diameter was 1.08 ± 0.39 mm (range: 0.42-2.60 mm), while the narrowest diameter was 0.71 ± 0.26 mm (range: 0.25-1.59 mm); and mean DTA of 2.16 ± 1.25 mm (range: 0-6.22 mm). CS detection was significantly lower with CBCT taken at resolution size of 0.250 voxels (P = 0.02). CONCLUSIONS: CS was very common in the anterior maxilla. Clinicians would be well advised to identify this anatomical structure using CBCT before undertaking any surgery in the anterior maxilla. © 2022 Australian Dental Association.

Worldwide Assessment of the Mandibular First Molar Second Distal Root and Root Canal: A Cross-sectional Study with Meta-analysis.

INTRODUCTION: This study assessed the prevalence of radix entomolaris and 2 canals at the distal aspect of mandibular first molars among different geographic regions by means of cone-beam computed tomographic imaging. METHODS: Precalibrated observers from 23 worldwide geographic locations followed a standardized screening protocol to assess 5750 cone-beam computed tomographic images of mandibular first molars (250 per region), gathering demographic data and recording the presence of radix entomolaris and a second canal at the distal aspect of teeth. Intra- and interrater reliability tests were conducted and comparisons among groups were performed using proportions and odds ratio forest plots. The significance level was set at 5%. RESULTS: The results of intra- and interrater tests were above 0.79. The prevalence of radix entomolaris varied from 0.9% in Venezuela (95% confidence interval [CI], 0%-1.9%) to 22.4% in China (95% CI, 17.2%-27.6%). Regarding the proportion of a second distal canal, it ranged from 16.4% in Venezuela (95% CI, 11.8%-21.0%) to 60.0% in Egypt (95% CI, 53.9%-66.1%). The East Asia subgroup was associated with a significantly higher prevalence of an extra distolingual root, whereas the American subgroup, the American native ethnic group, and elderly patients were linked to significantly lower percentages of a second canal at the distal aspect of teeth. No significant differences were noted between male or female patients. CONCLUSIONS: The overall worldwide prevalence rates of radix entomolaris and a second canal at the distal aspect of the mandibular first molar were 5.6% and 36.9%, respectively. The East Asia geographic region and Asian ethnic group had a higher prevalence of a second distal root.

Mathematical validation of measurement of root fracture resistance: an in vitro study.

BACKGROUND: The aim of this study was to develop a mathematically valid method of assessing fracture resistance of roots. The model developed used mesial roots of lower molars instrumented using stainless steel hand files (SS) and two rotary nickel-titanium (NiTi) systems. METHODS: Eighty human lower molars were selected and randomly divided into four groups (n = 20). After instrumentation, the root canals were obturated using thermoplasticized gutta percha. The roots were covered with a simulated periodontal ligament and mounted vertically in autopolymerizing acrylic in PVC tubes. Using a universal testing machine, the force to fracture (N) was applied and the maximum load (FL) was recorded. Remaining dentine volume was calculated and the fracture resistance (FR) was recorded. The data were analyzed using SPSS version 22 with P < .05. RESULTS: There were no significant differences among the instrumentation methods for FL but in FR the roots instrumented using rotary NiTi showed significantly lower values than control groups and SS files (P < 0.001). CONCLUSIONS: Considering the effect of root length, volume of the root, and volume of the instrumented canal as well as the maximum failure load may be a more objective method of reporting fracture resistance of roots.

Comprehensive characterisation of flexural mechanical properties and a new classification for porosity of 11 contemporary ion-leaching dental restorative materials.

The objectives of this study were to evaluate 4 aspects of ion-leaching restorative materials (ILMs): 4-point bending flexural strength (4 PB-FS) and relative mechanical properties; biaxial flexural strength (B-FS) in relation to 4 PB-FS; porosity; and surface morphology. Eleven ILMs were used for the 4-point bending test. Bar-shaped (n = 15) samples were fabricated, stored in distilled water for 7 days. Then 4 PB-FS and the other mechanical properties were determined. Five ILMs were selected for the B-FS test using disk specimens (n = 15). The correlation between 4 PB-FS and B-FS was addressed. After the 4 PB test, 5 randomised fragments from each material were used to make 0.5 mm-thick sections for light microscopy to investigate the degree of porosity using reflected and transmitted lights. Eight ILMs were selected for quantitative analysis of the fractional % pore volume (PV%) due to their relative pore prominence using ImageJ software. One-way ANOVA/Dunnett's T3 was used to test for significance. Resin-based ILMs (RB-ILMs) were ranked first (p < 0.05) for 4 PB-FS values (53.3-110.2 MPa) followed by resin-modified glass-ionomer cements (RMGICs; 30.9-44.3 MPa) and high-viscosity glass-ionomer cements (HVGICs; 12.9-19.6 MPa), respectively. 'Flexural modulus' (4 PB-E) and 'flexural toughness' (4 PB-T) of ILMs varied even though similar 4 PB-FS values were observed. There was a positive correlation (p < 0.001) between 4PB-FS and B-FS (R2 = 0.992) with B-FS>4 PB-FS. There was no correlation between PV% and 4 PB-FS. In summary, material type played a major role in 4 PB-FS outcomes, whereas PV% seemed to have a minor effect when evaluating each material group of ILMs. Brittleness/ductility of ILMs was observed when determining 4 PB-E and 4 PB-T relative to 4 PB-FS. When selecting materials for posterior load-bearing dental restorations in high-caries risk patients, RB-ILMs or RMGICs would be more appropriate due to their superior flexural properties compared with recently introduced HVGICs. The decision for each situation will also be dependent on further evidence of the ion-leaching capacity.

Worldwide Prevalence of a Lingual Canal in Mandibular Premolars: A Multicenter Cross-sectional Study with Meta-analysis.

INTRODUCTION: The presence of multiple root canals is an important morphologic aspect of mandibular premolars. This study aimed to perform a worldwide analysis on the prevalence of a lingual canal in mandibular premolars and to evaluate its influence on patients' demographics in 23 countries using cone-beam computed tomographic images. METHODS: Observers from 23 countries were instructed to evaluate cone-beam computed tomographic images of 300 first and 300 second premolars (13,800 teeth) regarding the presence of a lingual canal, canal configuration, and data related to patients' ethnicity, age, and sex following a standardized screening methodology. Intra- and interrater evaluations were performed using the Cohen kappa test and intraclass correlation coefficient. Proportion and odds ratio forest plots were calculated in order to compare groups. Statistical significance was set at 5%. RESULTS: Both kappa and intraclass correlation coefficient values were above 0.60, and the percentage of agreement was 94.9% (first premolar) and 97.8% (second premolar). A significant statistical difference was observed between the worldwide proportion of a lingual canal in mandibular first (23.8%; range, 12.0%-32.7%) and second (5.3%; range, 1.0%-15.3%) premolars (P < .05). Asians and patients over 60 years old were associated with the lowest proportions of a lingual canal (P < .05), whereas Africans and younger groups were associated with the highest proportions (P < .05). The prevalence of a lingual canal in males (27.9%) was higher than females (20.0%) for the first premolar only (P < .05). Males were associated with 1.533 and 1.597 higher odds of presenting a lingual root canal in the first and second premolars, respectively. CONCLUSIONS: The worldwide proportion of a lingual root canal was 23.6% and 5.3% for the first and second premolars, respectively. Ethnicity, geographic region, age, and sex had an influence on the outcomes.

Revised guidelines for the endodontic education of dentistry students in Australia and New Zealand (FEBRUARY 2021).

These revised guidelines for contemporary endodontic education in Australia and New Zealand (version 2021) propose the minimum criteria for the training of dentistry students. The document contains a definition of endodontics and a description of the scope of endodontics. It proposes a general outline for education programmes in endodontics as part of general dental practice.

Perceived barriers encountered by oral health professionals in the Australian public dental system providing dental treatment to individuals with special needs.

AIMS: To investigate barriers experienced by clinicians treating individuals with special needs in the Australian public dental system. METHODS AND RESULTS: Oral health professionals working at primary care clinics in the public dental system were invited to participate in semi-structured interviews or focus groups to discuss the challenges they faced in managing patients with special needs. Qualitative methods, employing inductive thematic analysis, revealed two primary barriers: 1. clinicians lacked confidence in their ability to treat patients with special needs because of insufficient training and experience, and difficulties obtaining information about their patients, and 2. barriers within the public dental system, including inadequate funding, equipment and facilities, and productivity pressures prevented clinicians from being able to provide the care patients required. The priority and understanding of the oral health for these individuals within the public dental system and wider disability sector was also raised. CONCLUSION: A perceived lack of training and experience in managing individuals with special needs was a barrier to treating patients with special needs. Other significant barriers were under-resourcing of the public dental system and a lack of priority and understanding regarding oral health among carers of individuals with special needs and other health professionals.

Effect of benzalkonium chloride addition to EDTA on attachment and proliferation of dental pulp stem cells on dentin and on transforming growth factor-ß1 release.

To investigate the effect of benzalkonium chloride (BAC) addition to ethylenediaminetetraacetic acid (EDTA) on transforming growth factor-ß1 (TGF-ß1) release, as well as attachment and proliferation of dental pulp stem cells (DPSCs) on dentin. A total of standard 268 human dentin disks were prepared and immersed in 1.5% sodium hypochlorite (NaOCl) for 5 min. The disks were rinsed with distilled water and randomly divided into seven groups. In control group, the disks received no further treatment. The remaining disks were immersed in following solutions: 17% EDTA or 17% EDTA + 0.008% BAC for 1, 5 or 10 min and rinsed with distilled water. DPSCs were seeded in part of the disks since the TGF-ß1 release assay was performed with disks with and without cells. The attachment and proliferation of DPSCs on dentin disks were analyzed using lactate dehydrogenase activity and WST-1 assays, respectively. The cell morphology was observed by scanning electron microscopy. The release of TGF-ß1 was quantified using ELISA. Data were analyzed using three- and two-way analysis of variance with Bonferroni corrections. Both EDTA solutions increased the attachment and proliferation of DPSCs (p < .05) while there was no significant difference between them (p > .05). The exposure time of both EDTA solutions had no influence on cell attachment, proliferation and TGF-ß1 release (p > .05). There was no significant difference in TGF-ß1 release between the control and experimental groups (p > .05). The amount of released TGF-ß1 from dentin disks was similar whether or not they were seeded with cells (p > .05). Dentin treatment with either of the EDTA solutions had no effect on the amount of TGF-ß1 release while both EDTA solutions improved cell attachment and proliferation on dentin surface regardless of exposure time.

Revised guidelines for educational requirements for specialisation in endodontics in Australia and New Zealand (July 2020).

These revised guidelines developed by the Australian Society of Endodontology Inc. and the Australian and New Zealand Academy of Endodontists for educational requirements for specialisation in endodontics in Australia and New Zealand (version 2020) propose minimum criteria for training specialists in our field. The document contains a definition of endodontics and a description of the scope of endodontics. It proposes criteria for selection of the students and describes the proposed main features and a general outline of the education programme.

Evaluation of F, Ca, and P release and microhardness of eleven ion-leaching restorative materials and the recharge efficacy using a new Ca/P containing fluoride varnish.

OBJECTIVES: The objectives of this study were to evaluate fluoride (F), calcium (Ca), and phosphate (P) release of ion-leaching restorative materials (ILMs), their recharge efficacy with a Ca/P-containing F varnish, and relative microhardness. METHODS: Thirteen groups of materials were investigated. Cylindrical-shaped specimens were fabricated. Deionised water or lactic-acid solution were used as the storage media. Solutions were changed after 1d, 4d, 7d, and 14d of ion release and at the same periods after recharge with MI Varnish (7 -h storage). F, Ca, and P measurements were accomplished using a fluoride-ion selective electrode, atomic absorption spectrometry, and colourimetric method by spectrophotometer, respectively. Relative Vickers hardness was proceeded with similar specimens used in the F assay (4 periods). SEM/EDS was additionally performed. Statistical analyses were calculated in each parameter (p < 0.05). RESULT: Hardness of several ILMs immediately increased after recharge. After 28d, Ketac Universal [a high-viscosity glass-ionomer cement (HVGIC)] showed the highest hardness similar to the resin composite control. Although 2 HVGICs (Zirconomer and Equia Forte Fil) ranked as first and second for F release/re-release, some HVGICs had inferior or comparable F capacity to RMGICs (Fuji VIII and Fuji II LC) and a resin-based (RB) ILM (Cention N). Cention N, Activa-Restorative (RB-ILM), and Zirconomer were the top-3 ranking for Ca release/re-release. Activa-Restorative showed the highest P release, whereas Cention N displayed the greatest recharge ability for P. CONCLUSIONS: Zirconomer showed a versatile performance for ion-release/re-release, especially for F. Cention N had excellent capacity in relation to Ca release and recharge ability of Ca/P. CLINICAL SIGNIFICANCE: With the F varnish recharge protocol, Zirconomer, Equia Forte, and Fuji VIII seems to have an ability to inhibit initial caries initiation. Cention N is a promising resin-based material that could be an alternative for high caries risk patients due to the high Ca release/recharge with acceptable F release.

Management of dental pain in primary care.

Patients sometimes present to a medical practitioner with dental pain if they cannot see a dentist Doctors need to be aware of the common dental diseases that result in pain so they can help to manage the patient's symptoms until they are able to see a dentist Appropriate advice regarding analgesics for dental pain is important. Paracetamol and ibuprofen are more effective in combination than either of them alone, with or without opioids Antibiotics are only indicated as an adjunct to dental treatment when there are signs of systemic involvement, progressive and rapid spread of infection, or when the patient is immunocompromised

Adaptation of mineral trioxide aggregate to dentine walls compared with other root-end filling materials: A systematic review.

This systematic review analysed the literature comparing marginal adaptation of mineral trioxide aggregate (MTA) with other filling materials in root-end cavities. The PubMed, Ovid, Web of Science, SCOPUS, and Cochrane library databases were searched using appropriate keywords related to root-end filling materials and adaptation. Of 38 articles assessed, 20 met the inclusion criteria. No in vivo study was identified. In 10 studies, MTA gave the best marginal adaptation results, but no significant differences were found between MTA and any of the tested filling materials in seven studies. There was great variability in the study designs including analysed surface, unit of gap measurement and magnification amount during analysis. On the basis of available evidence, MTA presented good marginal adaptation to dentine walls. This review identified the need for the development of standardised methods to evaluate the adaptation property of root-end filling materials in ex vivo studies as well as in clinical studies evaluating outcome.

Worldwide Analyses of Maxillary First Molar Second Mesiobuccal Prevalence: A Multicenter Cone-beam Computed Tomographic Study.

INTRODUCTION: Maxillary first molar second mesiobuccal (MB2) root canal prevalence may change among different populations. The aim of this study was to analyze the worldwide prevalence of the MB2 root canal and understand its possible relation with sex, age, side, and root configuration using in vivo cone-beam computed tomographic (CBCT) assessment. METHODS: Observers from 21 regions were calibrated to achieve a similar CBCT assessment methodology and instructed to collect data from 250 maxillary first molars in previously existing examinations. Intra- and interrater reliability tests were performed. The sample size included 5250 molars and was defined by way of a preliminary trial. Data collected included MB2 presence, sex, age, side, number of roots per tooth, and mesiobuccal root configuration. The z test for proportions in independent groups was used to analyze the differences among subgroups. P < .05 was considered significant. RESULTS: The worldwide CBCT-assessed MB2 prevalence was 73.8%, ranging from 48.0% in Venezuela to 97.6% in Belgium. The prevalence in males and females was 76.3% and 71.8%, respectively (P < .05). Significantly higher MB2 proportions were found in younger patients and 3-rooted molar configurations. The group intraclass correlation coefficient and the percentage of agreement for the MB2 presence were 0.95 and 0.91, respectively. The intrarater Cohen kappa value was above 0.61 for all observers. CONCLUSIONS: MB2 prevalence in the analyzed regions varied widely. The differences may be associated with specificities within each region but also patient demographics. Males, younger patients, and 3-rooted configurations were associated with higher MB2 proportions.