Comparison of the positional accuracy of robotic guided dental implant placement with static guided and dynamic navigation systems: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The development of robotic computer assisted implant surgery (r-CAIS) offers advantages, but how the positional accuracy of r-CAIS compares with other forms of guided implant surgery remains unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the positional accuracy of r-CAIS and to compare the positional accuracy of r-CAIS with s-CAIS and d-CAIS. MATERIAL AND METHODS: Five databases were systematically searched by 2 independent reviewers for articles published before May 2023. A manual search was also performed. Articles evaluating the positional accuracy of r-CAIS were included. The Cochrane risk of bias tool was used for the clinical studies, whereas the QUIN tool was used for the in vitro studies. A meta-analysis was performed to compare the positional accuracy of r-CAIS with d-CAIS. RESULTS: Thirteen studies were included, with 9 in vitro studies, 4 clinical studies, and a total of 920 dental implants. A high risk of bias was noted in 6 studies and low to moderate in 7 studies. R-CAIS showed greater accuracy for the coronal, apical, and angular deviations compared with d-CAIS. (-0.17 [-0.24, 0.09], (P<.001); -0.21 [-0.36, -0.06] (P=.006), and -1.41 [-1.56, -1.26] (P<.001)) CONCLUSIONS: R-CAIS can provide improved positional accuracy compared with d-CAIS when considering coronal, apical, and angular deviations. However, evidence to compare the positional accuracy of r-CAIS with s-CAIS was insufficient. These results should be interpreted with caution because of the limited data and the bias noted in several studies.

The role of bone ring technique for bone augmentation in implant surgery: A Narrative Review.

Bone grafting with simultaneous implant placement using the novel bone ring technique was a procedure introduced with the intention of three-dimensional bone augmentation with simultaneous implant placement in both maxilla and mandible. A ring-shaped bone is placed in the socket, which is secured by an implant placed through the ring. The current narrative review was planned to provide a concise summary of the core concepts surrounding bone augmentation, to provide context for understanding the bone ring technique, and to highlight the basics of bone grafting and the origin of the technique to its advancement and its importance in the light of current literature.

Tele-dentistry in COVID-19 era: A conduit for dental care in uncertain times.

Tele-dentistry encompasses all sorts of digital technologies that involve the exchange of patient's clinical data from a distant site for the provision of dental health care. Tele-dentistry has emerged from the concept of telemedicine, which has been in practice since the 19th century. In recent times, an upsurge in the digital technologies was noted, which has made the possibility of remote access to dental care. The outbreak of COVID- 19 pandemic has restricted the normal routine ways of clinical practice. In these challenging times, tele-dentistry serves as effective platform for providing dental health care. Tele-dentistry has vast applications across various disciplines of dentistry, including preventive dentistry, paediatric dentistry, oral medicine, and oral pathology etc. In these pandemic times, tele-dentistry can be efficiently used for identification of dental emergencies, allowing effective triage and subsequent management. There are different communication platforms available for tele-dentistry. The most common technologies used are web-based video conferencing and smart phone-based applications. As the clinicians are not aware of these digital technologies utilised in tele-dentistry, there are certain challenges associated with its use. In conclusion, tele-dentistry serves as an effective tool in providing health care in challenging times, but it has been underutilised by the dental fraternity. The legislative authorities should establish proper standard protocols to ensure the safety and confidentiality of patient information while using these digital platforms.

Diagnostic accuracy of artificial intelligence versus manual detection in marginal bone loss around fixed prosthesis. a systematic review.

Objectives: The aim of the review is to evaluate the existing precision of artificial intelligence (AI) in detecting Marginal Bone Loss (MBL) around prosthetic crowns using 2-Dimentional radiographs. It also summarises the recent advances and future challenges associated to their clinical application. Methodology: A literature survey of electronic databases was conducted in November 2023 to recognize the relevant articles. MeSH terms/keywords were used to search ("panoramic" OR "pantomogram" OR "orthopantomogram" OR "opg" OR "periapical") AND ("artificial intelligence" OR "deep" OR "machine" OR "automated" OR "learning") AND ("periodontal bone loss") AND ("prosthetic crown") in PubMed database, SCOPUS, COCHRANE library, EMBASE, CINAHL and Science Direct. RESULTS: The searches identified 49 relevant articles, of them 5 articles met the inclusion criteria were included. The outcomes measured were sensitivity, specificity and accuracy of AI models versus manual detection in panoramic and intraoral radiographs. Few studies reported no significant difference between AI and manual detection, whereas majority demonstrated the superior ability of AI in detecting MBL. CONCLUSIONS: AI models show promising accuracy in analysing complex datasets and generate accurate predictions in the MBL around fixed prosthesis. However, these models are still in the developmental phase. Therefore, it is crucial to assess the effectiveness and reliability of these models before recommending their use in clinical practice.

Nasopalatine canal cyst, a diagnostic twist.

We present a case of nasopalatine duct cyst in a 35-yearold female. The cyst was diagnosed based on the presence of only one clinical symptom and no obvious clinical signs, which is a relatively rare occurrence. However, the radiographic and histological presentation of this lesion was typical of a nasopalatine duct cyst. Therefore, this case report aims to highlight the variable presentations of the nasopalatine cyst, which is often misdiagnosed and treated as an endodontic infection.

Oral manifestations of Covid-19-A literature review.

Initially, it was reported that coronavirus 2019 disease (Covid-19) affects respiratory, gastrointestinal and neurological systems, but the oral, olfactory and integumentary systems are also involved. This review discusses various oral manifestations of Covid-19 reported in the literature along with possible underlying mechanisms. The reported manifestations include taste impairment, oral mucosal changes (petechiae, ulcers, plaque-like lesions, reactivation of herpes simplex virus 1(HSV1), geographical tongue and desquamative gingivitis) and dry mouth. The prominent location for mucosal lesions are tongue, palate and labial mucosa. The exact pathogenesis of these oral symptoms is not known. Angiotensin-converting enzyme 2 (ACE2) cell receptors are expressed in abundance on oral mucosa allowing severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) to infect them. Gustatory impairment along with olfactory changes is now listed as a symptom of Covid-19 by the World Health Organization, but further research is needed to confirm a link between reported additional oral symptoms and Covid-19. Dental professionals may encounter individuals with Covid-19 and be called upon to identify various oral manifestations of this disease.

The Implication of Stem Cells in Direct Pulp Capping: Where Do We Stand?

Direct pulp capping has been established as a more conservative alternative to root canal therapy, especially in case of an iatrogenic or traumatic exposure of the dental pulp. However, recent literature focuses on regeneration therapies to develop a physiological dentin barrier. The process of tissue regeneration through stem cell therapy involves a complex interaction between stem cells, growth factors and scaffolds known as the 'tissue engineering triad'. Recent advancements in stem cell therapy focus on the re programming of stem cells, development of scaffolds and enhancement of the regenerative potential of these stem cells, using appropriate growth factors and transfer media. This article provides a summary of the current evidence regarding the use of stem cell therapy in direct pulp capping. The sources of stem cells, types of scaffolds and growth factors have been described in detail along with the limitations and future prospects.

Evaluation of the Nasopalatine Canal (NPC) in a subset of Pakistani population, using Cone Beam Computed Tomography (CBCT).

OBJECTIVE: To evaluate variations in the shape, diameter, length and width of the nasopalatine canal along with the width of the buccal cortical bone anterior to it, using cone beam computed tomography imaging. METHODS: The retrospective, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from September to October 2020, and comprised pre-existing cone beam computed tomography scans taken between 2015 and 2020 of patients of either gender aged 18-60 years who had maxillary central incisors present. The shapes and dimensions of the nasopalatine canal were observed along with the buccal bone anterior to the nasopalatine canal. Data was compared with respect to age and gender. Data was analysed using SPSS 23. RESULTS: Of the 90 scans evaluated, 46(51.1%) belonged to females with a mean age of 37.85±18.19 years, and 44(48.9%) belonged to males with a mean age of 38.07±13.58 years. The mean length and width of the nasopalatine canal was 11.28±1.90mm and 2.62±0.91mm, respectively. The nasopalatine canal was significantly longer (p<0.01) and wider (p=0.02) in males than females. The mean diameter of foramen of Stenson was 2.99±1.17mm and incisive foramen was 6.09±1.80mm. The mean width of the buccal cortical bone at the most coronal, middle and most incisal levels was 7.20±1.70mm, 6.12±1.31mm and 6.12±1.31mm, respectively. Buccal bone width was wider in males than females, but the difference was significant only at the midpoint (p<0.05). CONCLUSIONS: There was a significant difference in the dimensions of the width and length of the NPC with respect to gender. No significant differences were observed with respect to age.

Clinical applications and novel approaches in stem cell: an insight to dental pulp regeneration.

Objectives: The aim of the review is to present the currently applied tissue regeneration through stem cells technology in regenerative endodontics. This review also summarises the various preclinical models used for the evaluation of stem cell-based therapies, their limitations, recent advances and challenges related to clinical applications of human stem cells. Methodology: A literature survey from 2010 to August 2022 was carried out in various electronic databases to identify the articles required for review on Pulp Regeneration through Stem Cells Technology. MeSH terms/keywords such as "Pulp regeneration," "Pulp Revascularization," "Pulp revitalization," "Regenerative Endodontics" were used to search in the electronic databases comprised of PubMed database, SCOPUS, COCHRANRE library, EMBASE, CINAHL, ICTRP, Science Direct and a manual search was also done using the cross references and textbooks. RESULTS: The searches revealed 299 articles. After reading the full text articles and applying the inclusion and exclusion criteria 15 articles were selected for the review fulfilling the criteria of the study. CONCLUSIONS: Currently in regenerative endodontics, there is a broad consent that the final tissue acquired is more likely to bone-like tissue mixed with connective tissue rather than the pulp-dentin complex. Moreover, re-innervation from sensory axons in regenerated tissue, is still to date, difficult to achieve.

Effect of Light Emitting Diode (LED) Curing Modes on Depth of Cure (DoC) in BulkFill Composite Resin: An invitro study.

Objectives: To evaluate the depth of cure in smart dentin replacement bulkfill composite resins polymerized by constant, pulse and ramped light-emitting diode curing modes. METHODS: The in vitro experimental study was conducted in November and December 2019 at the dental clinics of Aga Khan University Hospital, Karachi, and comprised of cylindrical composite specimens 8x4mm in size which were polymerised in Teflon moulds using light-emitting diode under constant mode in Group 1, pulse mode in Group 2 and ramped mode in Group 3. Once polymerised, each specimen was extruded from the mould and, using the International Organisation for Standardisation-4049 scrapping method, uncured resin was removed. Specimen lengths were measured with a Vernier calliper. Each specimen was measured thrice and the mean was taken as the depth of cure. Data was analysed using SPSS 24. RESULTS: Of the 33 specimens, there were 11(33.3%) in each of the 3 groups. Mean depth of cure in Group 1 was 2.92±0.29mm, in Group 2 it was 2.88±0.27mm, and it was 3.18±0.26mm in Group 3. The difference between Group 2 and Group 3 was statistically significant (p<0.05). Conclusion: Maximum depth of cure of smart dentin replacement bulkfill composite was achieved by ramped cure mode of light-emitting diode unit, followed by constant and pulse modes.

Cone Beam Computed Tomography based evaluation of position of mental foramen and its relation to apices of mandibular posterior teeth in a sample of Pakistani population.

OBJECTIVE: To radiographically determine the mental foramen position, its distance to the nearest apex and the prevalence of anterior loop of mandibular nerve using cone-beam computed tomography scans. METHODS: The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from January to June 2020, and comprised cone-beam computed tomography scans of males or females of Pakistani origin aged 15-65 years with intact mandibular dentition and fully formed roots with matured apex. The scans were analysed to determine the horizontal position of mental foramen and to classify it according to the Tebo and Telford classification. The vertical distance from mental foramen to the nearest tooth apex was measured and the mandibular nerve configuration was determined. Data was analysed using SPSS 23. RESULTS: Among the 96 scans, the most frequent location of mental foramen MF was along the long axis of 2nd premolars for both right 50(52.1%) and left 49(51%) sides, followed by between 1st and 2nd premolars for both right 28(29.2%) and left 38(39.6%) sides. The mean minimum distance from mental foramen to the nearest root apex was 3.75±2.59mm and 3.99±2.26mm on right and left sides, respectively. There was bilateral symmetry on both sides. The most frequent mandibular nerve configuration on the right 69(72.6%) and left 75(78.1%) sides, with anterior loop being the least common; right side 3(3.2%) and 5(5.2%) left side. Conclusion: The most common position of mental foramen was along the long axis of 2nd premolars while the anterior loop was the least common.

Knowledge and awareness regarding uses of extracted natural tooth in clinical practice.

Restoration of aesthetics is one the major patients' concern in dentistry which may be disrupted due to tooth-loss secondary to trauma, or as part of orthodontic treatment or periodontal problem. A number of treatment options are available for the replacement of teeth, but they may be expensive, and time-consuming, involving artificial teeth. For immediate tooth replacement, patient's own intentionally extracted or unintentionally avulsed tooth maybe used. The current narrative review was planned to discuss various techniques for the use of natural tooth pontic, which preserves the original contours, size and colour of the replaced tooth. Before using these teeth in a prosthesis, they need to be thoroughly disinfected and stored in appropriate medium according to the global guidelines. This reversible option would boost patient's confidence, preserve natural tooth anatomy and improve patient's acceptance.

Comparison of surface defects in Protaper Next and Hyflex EDM files after single clinical use: A stereoscopic evaluation.

OBJECTIVE: To compare the surface defects created on the ProTaper Next files versus HyFlex Electrical Discharge Machining files after single clinical use in molars. METHODS: The cross-sectional study was conducted in the dental department of the Aga Khan University Hospital, Karachi, from December 2018 to June 2019, and comprised Nickel-Titanium files belonging to HyFlex Electrical Discharge Machining and ProTaper Next to perform complete root canal treatment of molar teeth. The files were first visually examined and then analysed under 25.6x magnification using a stereomicroscope for the evaluation of surface defects. A photographic record was maintained and studied. Data was analysed using SPSS 23.0. RESULTS: Of the 114 files, 38(33.3%) each were ProTaper Next X1, ProTaper Next X2 and HyFlex Electrical Discharge Machining. The number of files showing defects under microscopic evaluation were 17(14.9%). Deformation of the cutting edge was the most frequently seen defect type, found in 9(7.9%) files. The frequency of fractured files was 4(3.5%). The odds of microscopic defects in HyFlex Electrical Discharge Machining files was 2.64 times that of ProTaper Next files. CONCLUSIONS: Even after single clinical use, HyFlex Electrical Discharge Machining files were more likely to get microscopic defects on their surface compared to ProTaper files.

Radiographic evaluation of the margins of clinically acceptable metal-ceramic crowns.

OBJECTIVE: To radiographically evaluate the proximal marginal fit of the clinically acceptable metal-ceramic crowns. METHODS: The prospective study was conducted at the dental clinics of Aga Khan University, Karachi, from July to December 2018, and comprised metal-ceramic crowns that were evaluated prior to the cementation. Clinical examinations were conducted by seating the crown on the tooth preparation and visual assessment was done using sharp explorer along the margins. Clinically acceptable crowns were then evaluated on the bite-wing radiograph. Any horizontal or vertical inaccuracy of >0.5mm at the proximal margins was recorded as 'discrepancy'. Data was analysed using SPSS 22. RESULTS: Of the 230 interproximal margins of 115 crowns evaluated, 113(49.1%) sites had marginal discrepancies; 44(19.1%) horizontal discrepancies, 58(25.2%) vertical discrepancies, and 11(4.8%) having both horizontal and vertical discrepancies. Horizontal crown margin discrepancies were most associated with the mesial site of the maxillary crowns, while vertical discrepancies were commonly associated with the distal aspect of all crowns (p<0.050). CONCLUSIONS: Almost half of the crowns that were considered clinically acceptable had some vertical or horizontal marginal discrepancy on radiographic evaluation.

Effect of different access cavity designs on fracture toughness of endodontically treated teeth: a systematic review and network meta-analysis.

Objective To compare the effect of different endodontic access cavities on fracture toughness of extracted endodontically treated human teeth.Data/sources An electronic literature search was performed in seven databases as well as hand search until September 2020. Risk-of-bias tool was used to evaluate the quality of included studies. Random effects frequentist network meta-analysis was performed, with mean difference (MD) and 95% confidence interval (CI) as the effect measure. Confidence in the documented evidence was assessed through the newly fuelled Confidence in Network Meta-analysis (CINeMA) framework based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.Study selection A total of 844 articles were obtained in the electronic and hand search. After the application of the eligibility criteria and duplicate removal, 14 studies were included in this systematic review. All included studies were in vitro that evaluated the influence of conservative endodontic cavities (CECs) on fracture toughness in extracted endodontically treated human teeth and compared to traditional endodontic cavities (TECs). In total, ten studies (n = 456) were included in the network meta-analysis for molars. The overall risk of bias was moderate.Results The results showed that when compared to intact teeth, the greatest reduction in fracture resistance was reported for TEC (MD: -927.52; 95% CI [-1304.80; -550.24]) and CEC showed least reduction in fracture resistance (MD: -365.59; 95% CI [-759.02; 27.83]). The surface under the cumulative ranking curve (SUCRA) value for intact teeth was highest (85.4% probability of being ranked as first), followed by CEC (51.4% probability of being ranked as second), with CEC presenting the highest probabilities to be the most effective access cavity design, according to the RANK (receptor activator of NF-kappaB) table. Level of confidence varied from low to moderate across all formulated comparisons.Conclusion Overall, based on the included in vitro studies in this systematic review, CEC was the most favourable access cavity design when compared to other (truss access cavities, TEC and ninja cavities) and TEC was the least favourable for fracture resistance; however, the level of evidence was moderate.

A CBCT based evaluation of root proximity of maxillary posterior teeth to sinus floor in a subset of Pakistani population.

OBJECTIVE: To evaluate the vertical relationship of the roots of maxillary posterior teeth with maxillary sinus floor, and its association with age, gender and bilateral jaw symmetry. METHODS: The cross-sectional study was conducted at a tertiary care hospital in Karachi from June to December 2018, and comprised patients who visited the dental clinics and underwent cone-beam computed tomography scans. The scans were evaluated in the axial, coronal and sagittal planes and roots were classified using Jungs classification for proximity to maxillary sinus floor. The distance between the sinus floor and the apices of maxillary posterior teeth was measured. Data was analysed using SPSS 23. RESULTS: There were 60 scans with 1066 roots. The most common maxillary tooth root in Type III group of Jung classification was the mesio-buccal root of the 2nd molar with the shortest mean distance of 0.44±3.05mm, followed by palatal roots of the 1st molar with the shortest mean distance of 1.58±4.01mm. The maxillary tooth root most frequent in Type I group was buccal root of 1st premolar with a mean distance of 8.15±6.65mm, and the 2nd premolar with a mean distance of 7.38±6.60mm. No significant difference was found in terms of gender and sides (p ≥0.05). CONCLUSIONS: The most common tooth root protruding in the sinus was found to be the mesio-buccal root of the 2nd molar, followed by palatal roots of the 1st molar. The most distant maxillary tooth root from the sinus was the buccal root of 1st and 2nd premolars.

Augmented reality in clinical dental training and education.

Dentistry is a profession that requires coordinated motor skills in addition to acquired knowledge for ideal execution of any treatment plan for patients. Learning experiences have been modified over a period of time for students as well as for the healthcare providers. Conventional pre-clinical training employed the use of cadavers, but financial, ethical and supervisory constraints have become a major shortcoming. With the adaptation of technology in dentistry, pre-clinical training has now employed simulation. It provides the opportunity for students to develop psychomotor skills for procedures by practising pre-clinical, standardised learning competencies before they engage in patient-management. Simulation involves computer-aided learning, augmented reality and virtual reality, which are largely taking over pre-clinical teaching. Augmented reality is commonly being employed in maxillofacial, restorative, tooth morphology learning and mastering technique for administering local anaesthesia in dentistry. Virtual reality is being employed particularly in pre-treatment implant planning and dental education for students. Use of haptic technology, like robotics, is also gaining popularity, and facilitates a two-way communication between the user and the environment to better simulate the clinical setting for learning purposes.

Inculcating research curriculum in Operative Dentistry - Endodontics residency programme: Experience and outcomes.

Incorporating research education and training in residency curriculum increases the understanding of evidence-based decision-making among doctors in training. Evidence suggests that the addition of research is linearly associated with improvement in clinical competence, and encourages the residents to shape their career as clinical investigators. The current paper was planned to share the experience of adding research into the core curriculum of Operative Dentistry-Endodontics residency programme at a tertiary care university hospital, and to evaluate the outcome achieved with that change.

Bio-active cements-Mineral Trioxide Aggregate based calcium silicate materials: a narrative review.

Recent advances in the field of endodontics have greatly improved the outcome and success rate of dental materials. For last three decades, there has been great interest in the development of bioactive dental material with the ability to interact and induce surrounding dental tissues to promote regeneration of pulpal and periradicular tissues. As these bioactive materials are mainly based on calcium silicates, they are also referred to as Calcium Silicate materials. The first material introduced was Mineral Tri-oxide Aggregate, which, due to its favourable biological properties, gained importance initially. However, later, due to its drawbacks, liked is colouration, long setting time and difficult manipulation, several modifications were done and newer bioactive materials, such as Biodentine, BioAggregate, Endosequence, Calcium-Enriched Mixture etc., were developed. The main applications of these materials are for pulp capping (direc t/indirec t), pulpotomy, perforation repair, resorption defects, apexogenesis and as retrograde filling materials, apexification and endodontic sealers. This review discusses the various types of bioactive materials, their composition, setting mechanism, and literature evidence for current applications.

Conventional and contemporary approaches of splinting traumatized teeth: A review article.

Trauma moves a tooth from its original position which needs to be repositioned for optimum healing and better outcomes. To stabilize the traumatically displaced teeth, splinting is specified as the gold standard. In this article we have discussed about various old and modern techniques based on the type of material to splint teeth with dentoalveolar trauma. As per recommendation of IADT, providing flexible splint is beneficial for good healing. A biologically favourable splint should not just be user friendly but also should be convenient in terms of removal. Every technique has its merits and demerits. Iatrogenic trauma to the teeth due to forceful removal of material should be avoided as it may result in post-operative sensitivity but sometimes it is inevitable. Metallic or wire based splints either secured with ligature wire or resin based material may show directly or through the cemented material and compromise aesthetics. This worsens the physiological impact which the patient is already facing after trauma. Recent advancement in splinting material with fiber reinforced material has brought a dramatic change in terms of strength and aesthetics, specifically after traumatic dental injuries. There are various other techniques discussed here which can be used for splinting teeth when the dentist has limited time in emergency or limited resources. The type and timing of the splinting span should be in accordance with the type of injury and as per IADT recommendation to follow standard of care.