Evaluation of Students' Proficiency in Removing Gutta-Percha Prior to Fiber Post Placement: A Retrospective Study.

INTRODUCTION: This retrospective study focuses on dental students' proficiency in removing gutta-percha during fiber post space preparation, which is important for maintaining apical seal integrity in endodontically treated teeth. Emphasizing the significance of preventing further reinfection. The primary objective of this study was to assess the proficiency of undergraduate dental students in the manipulation of gutta-percha during fiber post preparation, specifically focusing on the psychomotor skills involved. In addition, the study aims to determine the predictive value of these skills on the ultimate clinical outcomes of the procedure, with particular emphasis on variations attributable to tooth type. MATERIALS AND METHODS: The analysis encompassed 290 periapical radiographs obtained from endodontically treated teeth, all of which had undergone fiber post placement by undergraduate students at the College of Dentistry, Taibah University, Saudi Arabia. Postoperatively, the length of the remaining gutta-percha was measured by two experts in the field, and subsequent outcomes were classified into three categories: optimal, suboptimal, and inadequate, based on the extent of gutta-percha remaining. RESULTS: Students showed optimal removal rates ranging from 33.3% to 73.1%. Among the studied sample, upper anterior teeth were the highest included teeth (n=117, 40%). Remarkably, lower anterior teeth were more prone to suboptimal and inadequate gutta-percha remaining lengths (n=24, 33%). However, the chi-square test revealed no statistically significant difference in students' psychomotor skills while removing the gutta-percha and preparing the teeth to receive fiber posts across tooth types (p-value > 0.05). CONCLUSION: With the limitations of this study, more than half of the included cases show that undergraduate students of the College of Dentistry at Taibah University, Saudi Arabia, possess an optimum level of psychomotor skills in removing gutta-percha while preparing the teeth for receiving fiber posts. This study suggests enhancing the preclinical training of students by considering more training on different tooth types in relation to dental arches.

Longitudinal bond strength of a universal adhesive and chemical dentin characterization under different acid etching protocols.

OBJECTIVE: This study aimed to analyze the longitudinal bond strength of a universal adhesive and chemically characterize the dentin substrate under different acid etching protocols. METHODOLOGY: Dentin samples were etched with polyacrylic acid 25% (PAA) for 10 seconds (n=3) and phosphoric acid 32% (PA) for 15 seconds (n=3) and analyzed by Fourier transform infrared spectroscopy - attenuated total reflectance (FTIR-ATR) before and after treatment. For collagen degradation, samples (n=12) were divided into 3 groups: PAA, PA, and Deionized water (control), and analyzed by the quantity of solubilized type I collagen C-terminal cross-linked telopeptides and solubilized C-terminal peptide in relation to total protein concentration (ICTPtp and CTXtp) and by their ultimate tensile strength (UTS). For the adhesive interface analysis, dentin samples (n=72) were divided into 3 groups: PAA, PA, and Self-etch (SE), and subdivided into 2 groups: 24 h (baseline) and 1 year. The following tests were performed: microtensile bond strength (µTBS) (n=48), scanning electron microscopy (SEM) (n=12), and nanoleakage (n=12). RESULTS: The FTIR of PAA showed lower reduction of the peaks in the phosphate group when compared to PA. For ICTPtp, PA showed a significantly higher value. For CTXtp, PA and PAA groups failed to statically differ from each other. UTS was significantly lower for PA. For µTBS, storage time significantly affected bond strength. The results were unaffected by the etching protocol. For SEM, after 1 year, PA had little evidence of degradation in the upper third of the adhesive interface in comparison to the other groups. Nanoleakage showed no considerable silver impregnation after 1 year in the SE group. CONCLUSION: The use of PAA prior to a universal adhesive (when compared to PA) represents a less aggressive type of etching to dentin. However, self-etching still seems to be the best option for universal adhesive systems that have functional monomers in their composition.

Exploring the Perception and Awareness of Dental Students and Interns in Managing and Treating Pregnant Patients.

Background Undergraduate dental students and interns express reluctance to deal with pregnant women in the dental office due to the fear of medical consequences on the fetus. This study aims to explore the knowledge, attitudes, and practices of dental students and interns regarding the dental considerations of pregnant women in three dental schools in Saudi Arabia. Methodology This cross-sectional study was performed between October and December 2023 and targeted the clinical academic years of dental students and interns at three dental schools in Saudi Arabia, namely, Taibah University, Umm Al-Qura University, and Qassim University. Using the convenience sampling method, 223 students were invited to respond to a questionnaire constructed from previously published studies and reviewed by experts in the field. It consisted of 15 questions divided into four sections. Descriptive analysis and chi-square test were conducted to assess the difference between the different sociodemographic groups and students' educational levels with the significance level set at p-values <0.05. Results Overall, 223 complete responses were received, with a response rate of 97%. Demographics included 99 (44.40%) males and 124 (55.60%) females, with a reasonable distribution across academic years. Knowledge assessment findings revealed that 114 (51%) participants acquired adequate knowledge. Regarding participants' attitudes, 112 (50%) found the curriculum-centered information sufficient. In addition, 173 (77.6%) participants chose lectures/books as their preferred source of information. Almost 138 (61.9%) participants did not feel confident in managing pregnant women. The chi-square test revealed that educational level significantly impacts the knowledge and practice of the participants, regardless of their gender (p < 0.05). Conclusions Both students and dental interns showed adequate-to-good levels of knowledge and attitude. Both need more exposure to clinical situations with pregnant women during their undergraduate dental training programs to boost their confidence level and enhance their readiness to practice dental procedures with such a group of patients after graduation.

Longitudinal bond strength of a universal adhesive and chemical dentin characterization under different acid etching protocols

Abstract Objective This study aimed to analyze the longitudinal bond strength of a universal adhesive and chemically characterize the dentin substrate under different acid etching protocols. Methodology Dentin samples were etched with polyacrylic acid 25% (PAA) for 10 seconds (n=3) and phosphoric acid 32% (PA) for 15 seconds (n=3) and analyzed by Fourier transform infrared spectroscopy - attenuated total reflectance (FTIR-ATR) before and after treatment. For collagen degradation, samples (n=12) were divided into 3 groups: PAA, PA, and Deionized water (control), and analyzed by the quantity of solubilized type I collagen C-terminal cross-linked telopeptides and solubilized C-terminal peptide in relation to total protein concentration (ICTPtp and CTXtp) and by their ultimate tensile strength (UTS). For the adhesive interface analysis, dentin samples (n=72) were divided into 3 groups: PAA, PA, and Self-etch (SE), and subdivided into 2 groups: 24 h (baseline) and 1 year. The following tests were performed: microtensile bond strength (μTBS) (n=48), scanning electron microscopy (SEM) (n=12), and nanoleakage (n=12). Results The FTIR of PAA showed lower reduction of the peaks in the phosphate group when compared to PA. For ICTPtp, PA showed a significantly higher value. For CTXtp, PA and PAA groups failed to statically differ from each other. UTS was significantly lower for PA. For μTBS, storage time significantly affected bond strength. The results were unaffected by the etching protocol. For SEM, after 1 year, PA had little evidence of degradation in the upper third of the adhesive interface in comparison to the other groups. Nanoleakage showed no considerable silver impregnation after 1 year in the SE group. Conclusion The use of PAA prior to a universal adhesive (when compared to PA) represents a less aggressive type of etching to dentin. However, self-etching still seems to be the best option for universal adhesive systems that have functional monomers in their composition.

Assessment of Quality and Readability of Online Patient-Centered Arabic Web-Based Knowledge About Apicoectomy.

Background Endodontic microsurgery (apicectomy) can be considered in cases of persistent infection that is resistant to conventional root canal treatment. The aim of this study was to evaluate the quality and readability of the available online information regarding the apicectomy procedure in Arabic. Methods Online search on the three most commonly used websites (Google, Yahoo, and Bing) using one keyword. The first 100 websites from each search were analyzed for quality and readability using DISCERN instrument scores, the Journal of the American Medical Association (JAMA) benchmarks, the Health On the Net (HON) seal, Flesch Reading Ease Scores (FRES), Flesch-Kincaid Grade Level (FKGL), and the Simplified Measure of Gobbledygook (SMOG) Index. Results Searching using the Arabic translation for "root end resection surgery" revealed 349,900 websites. Following the inclusion criteria, 31 websites were selected and evaluated in this study. The selected websites belonged to either non-profit organizations or commercial websites. The quality of most of the selected websites received a moderate score (83.9%) using the DISCERN tool. None of the selected websites obtained the HON seal. Quality evaluation using the JAMA benchmarks revealed that currency was the most achieved item (45.2%), followed by authorship (22.6%). Evaluation of the readability of the selected websites using the FRES, FKGL, and SMOG showed that the included websites were considered readable. Conclusion Although the included websites were readable, the quality of the websites was moderate. There is an urgent need to create more trustworthy and readable websites explaining the different endodontic treatments.

Assessment of Pulp Stones Among Western Saudi Populations: A Cross-Sectional Study.

BACKGROUND: The term "pulp stones" refers to conditions of calcification that can appear in any area of the dental pulp. This study aims to assess the prevalence of pulp stones and examine whether there is any connection between their occurrence and factors such as patient age, gender, tooth location, presence of decay, or dental restorations in a western Saudi subpopulation based on cone-beam computed tomography (CBCT). METHODOLOGY: 500 patients were randomly selected from the College of Dentistry, Taibah University, Madinah, Saudi Arabia, database. The study involved evaluating 2998 teeth in coronal, axial, and sagittal planes by four dental peer examiners observing and recording data (sequentially and simultaneously) that included whether pulp stones were present or absent, the teeth group (anterior, premolars, and molars), tooth location (maxillary or mandibular), presence or absence of restoration, presence or absence of caries, and the patient's gender. Chi-square tests were utilized for statistical analysis, and a significance level of p-value ≤0.05 was established. RESULTS: Out of 500 individuals (250 females and 250 males), only 130 individuals (26%) and 278 teeth out of 2998 (9.2%) had pulp stones, with no significant statistical correlation identified between the presence of pulp stones and gender. (P = 0.459). Molars exhibited the greatest incidence of pulp stones (238; 85.6%), followed by anterior teeth (30; 10.8%), and premolars had the lowest prevalence (10; 3.6%). Teeth that showed a higher occurrence of pulp stones were associated with caries (74; 26.6%) and restorations (58; 20.9%). The association between pulpal stone and periodontal involvement was seldom significant (0.7%). A significant association was found between the presence of pulp stones and nonintact teeth (P<0.001). There was a statistically significant difference in the distribution of pulp stones between females and males in the maxillary and mandibular (74.7% and 57.3%, respectively) (P = 0.002). Additionally, the frequency of pulp stones was statistically significant when comparing the left and right sides (P<0.001) (48.9% and 51.1%, respectively). CONCLUSION: Understanding the prevalence and distribution of pulp stones is crucial for dentists and endodontists, as it assists practitioners in devising an appropriate treatment plan for affected teeth that require root canal therapy. One-fourth of the Madinah population was confirmed to have pulp stones, with a higher incidence in molars, caries, and restored teeth. No difference was found between its occurrence and gender. The high prevalence is exhibited in individuals between 45 and 54 years old. However, further studies with equal patient distribution are needed to confirm this observation.

Root Canal Morphology of Premolars in Saudis.

AIM: This study aimed to evaluate root number and morphological variations of the root canal system in maxillary and mandibular premolars among the Saudi subpopulation. METHODOLOGY: A total of 500 cone-beam computed tomography (CBCT) images were assessed, including 2442 maxillary and mandibular premolars. The evaluation encompassed the number of roots and canals and their configuration based on the Vertucci classification. Gender differences were considered, along with the position of premolars and unilateral or bilateral symmetry. RESULTS: Maxillary first premolars predominantly exhibited two roots (82.6%), followed by one root (16.3%) and three roots (0.97%), with a majority having two root canals (83.6%). Regarding maxillary second premolars, the most common morphology was one root (66.6%), with two root canals (40.5%) observed more frequently than one root canal (38.1%). Mandibular first and second premolars mainly featured one root (84.8% and 96.1%, respectively) with one root canal (70.8% and 90.2%, respectively), whereas two root canals were less prevalent (2.3% and 1.8%, respectively). Three canals and three roots were rarely found in mandibular premolars (0.3%). Regarding maxillary premolars, males exhibited significantly higher type IV and mandibular type I root configurations compared with females. Conversely, regarding mandibular premolars, females showed significant mandibular type V and higher type I root configurations compared with males. CONCLUSION: CBCT imaging facilitated precise assessment of root morphology and root canal configurations in maxillary and mandibular premolars. The present findings can aid dentists in diagnosing, evaluating case difficulty, and devising effective root canal treatments, particularly in patients from Saudi Arabia.

Effect of Odanacatib on the release of NTX (Amino Terminal Telopeptide) from LPS contaminated type I dentin collagen.

OBJECTIVE: To evaluated the Odanacatib inhibitor treatment on lipopolysaccharide (LPS) contamination effect on cathepsin-K mediated dentin degradation by analysis of type I collagen C- and N-termini telopeptides. METHODS: Pulverized and disks of human dentin were demineralized and LPS contaminated, or stored in deionized water (DW) for 12 h. Samples were challenged with lactic acid (LA). Aliquots of dentin powder were treated with 1 mL Odanacatib or stored in DW for 30 min. Dentin collagen degradation was determined by sub-product release of C-terminal (ICTP and CTX) and N-terminal (NTX) telopeptides, normalized to total protein (tp) concentration (n = 3). Dentin matrix was evaluated for gravimetric (n = 8) and ultrastructural changes. Data were analyzed by Student t-test, one-way ANOVA and Tukey's test (α = 5 %). RESULTS: LA incubation significantly increased telopeptide release compared with DW (p < 0.05). In untreated groups, significantly higher CTXtp, NTXtp telopeptide rates were observed for LA+LPS samples compared with DW (p < 0.01). Odanacatib significantly reduced ICTPtp, CTXtp, and NTXtp telopeptide release for LPS, LA, and LA+LPS conditions. In untreated groups, LPS and LA+LPS challenge significantly increased dentin weight loss (p = 0.02). Within each storage condition, Odanacatib treatment did not affect weight change (p > 0.05) of dentin disks. SIGNIFICANCE: This study showed that LPS contamination resulted in significantly higher rates of NTX than CTX from dentin matrix. Odanacatib significantly reduced telopeptide release rates of LPS contaminated dentin matrix.

Effect of protease inhibitor specificity on dentin matrix properties.

OBJECTIVE: To evaluate protease activity of dentin matrices subjected to treatment with non-specific (chlorhexidine - CHX), cysteine cathepsin specific (E-64), and cysteine cathepsin-K (CT-K) specific (Odanacatib - ODN) inhibitors. METHODS: Pulverized dentin powder obtained from human dentin disks (0.5 mm thickness) completely demineralized with 10% H3PO4 were challenged in 1 mL lactic acid (LA) (0.1M, pH 5.5) or stored in deionized water for 30 min. Aliquots of dentin powder were then immersed in 1 mL of CHX (2%), E-64 (10 µM and 20 µM) or Odanacatib (0.2 nM and 1 µM) for 30min. Degradation of dentin collagen was determined by telopeptide assays measuring the sub-product release of C-terminal cross-linked telopeptides (ICTP) and C-terminal peptide (CTX) in incubation media, which correlates with matrix metalloproteinases (MMP) and CT-K activities respectively (n = 3). The ICTP and CTX data were normalized to concentration of total protein (ICTPtp and CTXtp) in the media, measured by bicinchoninic acid assay. Dentin matrix properties were also measured by gravimetric change (n = 8) and ultimate tensile strength (UTS) (n = 10). Data were analyzed by one-way ANOVA followed by Tukey's post-hoc test and independent t-test (α = 5%). RESULTS: Telopeptide assays showed significantly lower CTXtp values after treatment with E-64 and Odanacatib. E-64 and Odanacatib at all tested concentrations significantly reduced the release of ICTPtp. Gravimetric analysis showed no significant difference between the tested inhibitors and control except for CHX after lactic acid challenge. UTS results showed significantly higher values for E-64 (20 µM) and Odanacatib (0.2 nM and 1 µM) groups in deionized water. SIGNIFICANCE: Dentin therapies targeting enzymes such as CT-K by specific inhibitors may provide superior pharmacokinetics and optimum efficacy due to precise protein binding, consequently limiting collagen degradation directly or indirectly by enzyme related pathways.

Functionalized epigallocatechin gallate copolymer inhibit dentin matrices degradation: Mechanical, solubilized telopeptide and proteomic assays.

OBJECTIVES: We investigated the biostability of dentin organic matrices treated with epigallocatechin gallate (EGCG) in comparison to chlorhexidine (CHX), both extracted from functionalized copolymers. METHODS: Copolymers were prepared with bis-GMA:TEGDMA and incorporated with 1% of EGCG or CHX (w/w). Blank copolymers were used as control. Copolymer samples were individually stored in 1mL deionized water to produce copolymer extracts. Dentin matrices were obtained by demineralization of dentin disks in 10% phosphoric acid solution. Matrices were individually treated with 1mL of the copolymer extracts or distilled water for 48h. Collected extracts were analyzed by high-performance liquid chromatography (HPLC) for the presence and quantification of EGCG, CHX, and copolymer by-products. Treated dentin matrices were tested for ultimate tensile strength, gravimetric changes, and swelling ratio. The treatment media were tested for total protein concentration, and dentin protease activity through solubilized telopeptide (ICTP- and CTX-ELISA) assays. The treatment media were also submitted to proteomic analysis. RESULTS: HPLC identified released unreacted copolymer species and showed higher release of CHX compared to EGCG from respective copolymer extracts. EGCG extract inhibited activity of dentin proteolytic enzymes and promoted collagen biomodification observed by the telopeptide assays and in the changes to dentin matrix properties. The proteomic results showed less collagenous peptide hits in the EGCG extract media compared to CHX, and suggest compound-specific dentin protein binding interactions. SIGNIFICANCE: This study demonstrates specific antiproteolytic effect and protein interactions of EGCG copolymer extract directly on dentin. This represents an advancement in dental materials which can impact the clinical procedures.

Effect of antibiotics on implant failure and postoperative infection.

DATA SOURCES: Medline and hand search of the British Journal of Oral and Maxillofacial Surgery, Clinical Implant Dentistry and Related Research, Clinical Oral Investigations, Clinical Oral Implants Research, European Journal of Oral Implantology, Implant Dentistry, International Journal of Oral and Maxillofacial Implants, International Journal of Oral and Maxillofacial Surgery, Journal of Clinical Periodontology, Journal of Oral Implantology, Journal of Oral and Maxillofacial Surgery, Journal of Periodontology Medicina Oral, Patologa Oral y Cirugía Bucal, and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology. STUDY SELECTION: Search of the literature was made to identify randomised controlled trials (RCTs) on the efficacy of antibiotics compared with a control group (not receiving antibiotics or receiving placebo. DATA EXTRACTION AND SYNTHESIS: All articles selected from the electronic and manual searches were independently assessed by the first and second authors of this study, in accordance with the established inclusion criteria. Two reviewers independently and in duplicate evaluated the quality of the included RCTs as part of the data extraction process. RESULTS: Four RCTs were included in the final review. These four RCTs grouped a total of 2063 implants and a total of 1002 patients. CONCLUSIONS: Antibiotic use significantly lowered the implant failure rate (P = 0.003), with an odds ratio of 0.331, implying that antibiotic treatment reduced the odds of failure by 66.9%. The number needed to treat (NNT) to prevent one patient from having an implant failure was 48 (95% confidence interval 31-109). In contrast, antibiotic use did not significantly reduce the incidence of postoperative infection (P = 0.754). Based on the results of this meta-analysis, and pending further research in the field, it can be concluded that there is evidence in favour of systematic antibiotic use in patients receiving dental implants, since such treatment significantly reduces implant failure. In contrast, antibiotic use does not exert a significant preventive effect against postoperative infection.