Clinical studies on core-carrier obturation: a systematic review and meta-analysis.

BACKGROUND: This systematic review aimed to evaluate the clinical performance of core-carrier obturation in endodontic treatment. METHODS: Keywords of "(core carrier OR Thermafil) OR (cold lateral condensation OR lateral condensation) OR (warm vertical condensation OR vertical condensation) AND (obturation OR root canal filling) AND clinical study" were searched for all obtainable publications up to year 2017 in the databases of PubMed, ScienceDirect, EMBASE, Scopus and Web of Science. The success rate, short-term postoperative pain, overfilling and adaptation of core-carrier obturation from clinical studies were selected. Reviews, laboratory studies, animal studies and irrelevant reports were excluded. RESULTS: 1349 relevant articles were identified with 149 duplicated articles removed and 1173 irrelevant articles were excluded after screening. The titles and abstracts of the 19 identified articles were screened in the systematic review. The full texts of remaining articles were retrieved with data extracted for meta-analysis on the success rate, postoperative pain, overfilling and adaptation of obturation. The pooled success rate of core-carrier obturation was 83% (95% CI: 69%-91%). The pooled incidence of 1-day and 7-day short-term postoperative pain were 35% (95% CI: 15%-62%) and 6% (95% CI: 1-35%). The pooled proportion of teeth with overfilling and adequate adaptation of the obturation material were 31% (95% CI: 18%-50%) and 85% (95% CI: 75%-91%), respectively. CONCLUSIONS: The success rate of endodontic treatment using core-carrier obturation was 83%. Short-term postoperative pain was not uncommon (24%). Most teeth (85%) had adequate adaptation using core-carrier obturation material, but a considerable amount of teeth (31%) had overfilling.

Treatment outcomes of single-visit versus multiple-visit non-surgical endodontic therapy: a randomised clinical trial.

BACKGROUND: Clincians have been providing single-visit and multiple-visit endodontic treatments for their patients. This study aims to compare the success rate, prevalence of postoperative pain and chairside time of single-visit and multiple-visit endodontic treatments. METHOD: Patients who required primary endodontic treatment in a university dental clinic were randomly allocated to two general dentists for single-visit or multiple-visit treatments using the same materials and procedures. Ni-Ti rotary files were used to prepare the root canals, which were subsequently obturated with a core-carrier technique. The chairside time was recorded. The treated teeth were followed up every 6 months on clinically signs and symptoms including pain, tenderness to percussion, sinus tract, mobility and abscess. Periapical radiographs were taken to assess periapical pathology. Successful treatments were neither clinical signs/symptoms noted nor radiographic periapical pathology found postoperatively. RESULTS: A total of 220 teeth from patients aged 46.4 ± 14.1 were followed up for at least 18 months. The mean (±SD) follow-up period was 29.4 ± 9.3 months. The success rates of single-visit and multiple-visit treatments were 88.9 and 87.4 %, respectively (p = 0.729, effect size odds ratio = 1.156). Maxillary teeth had odds ratios of 3.16 (95 % CI: 1.33 to 7.46; p = 0.009) and absence of preoperative apical periodontitis had odds ratios of 4.35 (95 % CI: 1.43 to 13.24; p = 0.010) were identified from logistic regression as having a higher success rate. The average chairside times of single-visit and multiple-visit treatments were 62.0 and 92.9 min, respectively (mean difference = -30.9, 95 % CI: -39.4 to -22.4, p < 0.001, effect size odds ratio = -0.996). Single-visit and multiple-visit treatment had no significant difference in the prevalence of postoperative pain within 7 days (21 and 12 %, p = 0.055, effect size odds ratio = 2.061) and after at least 18 months (0.9 and 1.0 %, p > 0.999, effect size odds ratio = 0.879). CONCLUSIONS: The success rate and prevalence of postoperative pain of single-visit or multiple-visit treatment had no significant difference. The chairside time for single-visit treatment was shorter than multiple-visit treatment. TRIAL REGISTRATION: Clinical Trials (WHO) ChiCTR-IOR-15006117 registered on 20 March 2015.

Incidence of post-obturation pain after single-visit versus multiple-visit non-surgical endodontic treatments.

BACKGROUND: Post-obturation pain is frustrating to both patients and dentists. Its incidence may change with the use of contemporary endodontic techniques. This randomised clinical trial aims to compare the incidence of post-obturation pain at one and seven days after single-visit and multiple-visit non-surgical endodontic treatments. METHODS: Patients who required primary endodontic treatment in the two clinical trial centres in Hong Kong (HK) and in Beijing (PK) were recruited. Three HK dentists and three PK dentists performed endodontic treatments on 567 teeth using the same procedures and materials, either in a single visit or over multiple visits, using either core carrier or cold lateral condensation for obturation. RESULTS: The attrition rate was 5.1%, and a total of 538 teeth were evaluated. Among these teeth, 232 (43%) were operated in HK, 275 (51%) were treated in a single visit, and 234 (43%) were treated using core carrier obturation. Logistic regression analysis showed that teeth with apical periodontitis (OR = 0.35, 95% CI = 0.21-0.57, p < 0.01) and less pre-operative pain (OR = 1.10, 95% CI = 1.03-1.18, p < 0.01) had lower incidences of post-obturation pain after one day. The incidences of post-obturation pain after one day for single-visit and multiple-visit treatments were 24.7% (68 of 275) and 33.5% (88 of 263), respectively (p = 0.50). The incidences of post-obturation pain after seven days for single-visit and multiple-visit treatments were 4.0% (11 of 275) and 5.3% (14 of 263), respectively (p = 0.47). CONCLUSIONS: There was no significant difference in the incidences of post-obturation pain after one day and seven days with single-visit or multiple-visit endodontic treatments. TRIAL REGISTRATION: ChiCTR-IOR-15005989.

Treatment time for non-surgical endodontic therapy with or without a magnifying loupe.

BACKGROUND: Use of magnifying loupe may increase the efficiency of dental care. This clinical trial compared the time in performing non-surgical endodontic therapy with or without the use of a magnifying loupe. METHODS: Patients who required primary endodontic treatment in clinical trial centres at the University of Hong Kong (HKU) in Hong Kong and Peking University (PKU) in Beijing were invited to participate in this study. Two HKU dentists and 2 PKU dentists, forming 2 pairs of dentists with similar years of clinical experience, performed endodontic treatments according to the same procedures and used the same materials, either in single or multiple visits. They had no prior experience with the use of a magnifying loupe. One dentist from each pair was trained to use a magnifying loupe (x2.5). The treatment time was recorded. RESULTS: Eighty-four PKU patients with a mean age of 42.8 years and 98 HKU patients with a mean age of 46.0 years were recruited in this study. Ninety-six teeth were treated with a magnifying loupe and 86 teeth were treated without a magnifying loupe. The results showed that treatment time was not associated with age, gender, tooth vitality, or the presence of apical radiolucency or sinus tract. The results of ANCOVA revealed the treatment time was associated with the clinic (HKU or PKU), root canal system (single or multiple), presence of preoperative pain, treatment visit (single or multiple), the use of a magnifying loupe, and the experience of the operator. CONCLUSION: In this study, the use of a magnifying loupe could significantly reduce the endodontic treatment time. TRIAL REGISTRATION: Clinical Trials ChiCTR-IOR-15005988 registered 15 February 2015.

Challenge-Based Learning in Dental Education.

Challenge-based learning (CBL) is a novel learning framework for a collaborative and multidisciplinary learning experience. It allows students, teachers, stakeholders, researchers, families, and society to work together to identify and solve real-world challenges. CBL helps students develop a deeper knowledge of the subjects they are studying. The concepts of CBL originate from a variety of educational theories and approaches, such as problem-based learning and inquiry-based learning. The precursor to the CBL framework is problem-based learning. However, unlike in problem-based learning and other approaches, students formulate the challenges they will address in CBL. Furthermore, students need to create a solution resulting in concrete action. CBL takes into account the social impact of an idea rather than just the corporate benefits. Therefore, it can help students expand the scope and depth of learning, encourage teamwork capabilities, and raise their awareness about considering quality and ethics in decision-making. CBL is implemented in universities, schools, and institutions worldwide and its use is well-recognized in science, engineering, and medicine, but it has not been translated into dentistry. The aim of this paper is to describe the concept of inclusion, principles and design, implementation, and supervision of the CBL framework in a dental course for the adaption of this learning framework to dental education.

Update on Dental Luting Materials.

A dental luting material aids in the retention and stability of indirect restorations on the prepared tooth structure. In dentistry, clinicians are using a wide range of luting materials for the cementation of indirect restorations. Zinc oxide eugenol and non-eugenol cements, zinc phosphate cement, zinc polycarboxylate cement, glass ionomer cement and resin cements are common dental cements used in dentistry. Each luting material or cement possesses unique properties and clinical implications. An ideal luting cement should be biocompatible, insoluble, resistant to thermal and chemical assaults, antibacterial, aesthetic, simple and easy to use. It should have high strength properties under tension, shear and compression to resist stress at the restoration-tooth interface, as well as adequate working and setting times. So far, no luting material possesses all of these properties of an ideal cement. Scientists have been modifying the conventional luting cements to improve the material's clinical performance and developing novel materials for clinical use. To achieve the best clinical outcome, clinicians should update their knowledge and gain a good understanding of the luting materials so that they can make a wise clinical decision on the material selection and obtain an insight into the development of luting cements. Therefore, the objective of this study is to provide a discussion on the physical, chemical, adhesive and aesthetic properties of common luting materials. The clinical indications of these luting materials are suggested based on their properties. In addition, overviews of the modification of the conventional luting materials and the newly developed luting materials are provided.

Tunnel Restoration: A Minimally Invasive Dentistry Practice.

With advances in technology, dentists nowadays manage dental caries with the philosophy of minimally invasive dentistry. Dental restoration is now performed most conservatively with minimal destruction of tooth structure when operative dentistry is indicated. Some operative dentists suggested using tunnel restoration for treating proximal caries as a conservative alternative to the conventional box preparation. The main advantage of tunnel restoration over the conventional box or slot preparation includes being more conservative and increasing tooth integrity and strength by preserving the marginal ridge. However, tunnel restoration is technique sensitive and requires advanced operative skills. Tunnel restoration can be an option to restore proximal caries if the dentist selects the proper case and pays attention to the details of the restorative procedures. With the dentist's advanced training, advanced light-emitting diode handpieces, magnifying loupes, precise digital imaging and new generation restorative materials, good results can be obtained in selected cases. This study reviews the literature on tunnel restoration and provides updated techniques and clinical data that can be used in tunnel restoration to oversee its limitations and the perspective on restorative treatment.

Nonrestorative Management of Dental Caries.

The World Dental Federation (FDI) policy statement in 2016 advocated evidence-based caries-control measures for managing dental caries. The caries management philosophy has shifted from the traditional surgical manners to minimal intervention dentistry. Minimal intervention dentistry aims to extend the longevity of natural teeth. It places the nonrestorative approaches as a priority. The nonrestorative approaches for caries management aim to tackle the etiological factors of dental caries. Caries can be prevented or reversed by restricting the sugar intake and its frequency in the diet, improving oral hygiene practices, and using fluoride toothpaste. This article aims to present strategies for the nonrestorative management of dental caries, which are divided into four components to address the different etiological factors of dental caries. The first component is controlling dental plaque. Strategies for plaque control include oral hygiene instruction, motivational interviewing, mechanical plaque control, and chemical plaque control. The second component for nonrestorative management is reducing the risk of caries by identifying caries risk factors and protective factors, assessing personal caries risk, and customizing a treatment plan. Evidence-based measures for caries prevention include using fluoride, and dental sealants should be provided. The third component includes topical treatment to remineralise early carious lesions. The last component is long-term follow-up. Appropriate strategy adoption for the nonrestorative management of dental caries prolongs the life span of the teeth and sustains the good oral health of patients.

Use of Computer Simulation in Dental Training with Special Reference to Simodont.

Simulation-based dental education has been increasingly implemented in dental training. Virtual reality simulators are being explored as an adjunct to dental education. Simulation-based dental education could serve as a powerful aid to preclinical instruction. This article provides an overview of how dental simulators can be used in dental instruction and manual dexterity training, utilizing the Simodont dental trainer as a reference. The Simodont dental trainer provides a platform for students to hone their manual dexterity skills and practice repeatedly prior to conventional clinical simulations. Additionally, it can reduce resource wastage. However, the financial cost of setting up and maintaining the system can be high. The high cost would ultimately limit the number of devices each individual school could afford, as a potential drawback to meeting the training needs of many dental students at one time. The machine's force-feedback mechanism provides trainees with the tactile experience of drilling into various tissues. Students are empowered via self-learning and assessment, with guidance provided for diagnosis and treatment. From training students on basic operative skills to providing basic aptitude tests for entrance examinations, the Simodont dental trainer's functions and potential for further development may make it a valuable tool in the field of simulation-based dental education.

Improving Esthetics of Removable Partial Dentures Using Palatal Retentive Arms.

A well-designed removable partial denture can replace the loss of hard and soft tissues, restore masticatory function and maintain arch integrity. It is relatively simple, non-invasive and economical compared to other treatment options. Removable partial denture is therefore a common option among various treatment replacing missing teeth. A removable partial denture replacing anterior missing teeth can improve esthetics and hence the patient's quality of life. However, metal components of a removable partial denture may be visible and affects patient satisfaction. Esthetics of a removable partial denture can often be improved with some modifications to traditional designs. This article reported the use of a cobalt-chromium-based removable partial denture to replace a missing maxillary lateral incisor and molars. Palatal retentive arms were employed as the retentive components on the premolars to avoid the metal component being seen when speaking and smiling. The indications and design of the removable partial dentures with palatal retentive arms are also discussed.

Prosthodontic Rehabilitation and Follow-Up Using Maxillary Complete Conventional Immediate Denture.

Despite global efforts to improve individuals' oral health, a considerable proportion of patients still progress to the stage in which the extractions of all teeth in one arch or both are indicated. An immediate complete denture remains a relatively accessible treatment option, particularly for those patients who cannot afford or do not need implant treatment. It is often one of the best solutions when the complete extraction of the remaining teeth is unavoidable. The denture is fitted immediately after the surgical clearance of teeth. It acts as a splint for helping with haemostasis, preventing trauma, and promoting wound healing. More importantly, an immediate denture can copy the characteristics of the existing dentition and establishes the vertical dimension of occlusion. It offers immediate replacement of the missing teeth, thereby avoiding a period of edentulism and social embarrassment. These treatments help relieve patient anxiety and bring about patient satisfaction. This study used a case report to illustrate the clinical procedures required for the construction of an immediate complete maxillary denture with good retention, support, stability, and aesthetics.

Distal Extension Denture - Case Report and Overview.

Replacing missing teeth distal to the last standing teeth with removable partial dentures poses considerable challenge to dentists. However, the insertion of implants turns a free-end saddle into a bounded saddle. Still, patients may not be able to accept implant insertions due to financial reasons, systemic medical conditions, local anatomical factors or complicated treatments involving surgery. Hence, patients with missing teeth often prefer to use removable partial dentures to improve their dental aesthetics and to restore their oral function. In this article, we use a clinical case to illustrate the clinical procedures required for the fabrication of a distal extension denture with good retention, support, stability, aesthetics and masticatory function. We also review the design for a clasp assembly on the abutment adjacent to the distal edentulous ridge.

Perceptions of single-visit and multiple-visit endodontic treatment: a survey of endodontic specialists and general dentists in Hong Kong.

AIM: To study the preference of practice for single- and multiple-visit endodontic treatment by Hong Kong endodontists and general dental practitioners (GDPs), and to investigate their reasons for choosing single- or multiple-visit treatment in their practice. METHOD: An anonymous questionnaire was mailed to all 16 registered endodontists and 800 randomly selected GDPs in Hong Kong to explore their preference and reasons for selecting single- or multiple-visit endodontic treatment for their patients. Information on the use of magnifying loupes, microscopes and the number of years they have been in dental practice was also collected. RESULTS: Eight endodontists and 429 GDPs returned their questionnaires and the response rate was 50% and 53.6% respectively. Among the GDPs, 404 (94.2%) undertook endodontic treatment in their practices. For those performing endodontic treatment, the mean number of years of practice was 23.6 ± 4.8 for endodontists and 15.3 ± 9.1 for GDPs. Seven endodontists (87.5%) used a surgical microscope. For GDPs, only 25 (6.2%) used a surgical microscope and 123 (30.4%) used magnifying loupes during endodontic treatment. Seven endodontists (87.5%) and 375 GDPs (92.8%) predominantly performed multiple-visit treatment. The commonest reasons for choosing multiple-visit treatment for both endodontists and GDPs were the positive effects of interappointment medications (n = 3, 37.5%) and that the tooth to be treated had doubtful prognosis (n = 103, 25.5%). The commonest reason for choosing single-visit treatment for both endodontists and general dentists was that treatment could be completed in one visit (n = 4, 50%) and (n = 127, 31.4%). CONCLUSION: Most Hong Kong endodontists and GDPs preferred offering multiple-visit endodontic treatment.