Latest Concepts in the Endodontic Management of Kidney Patients.

Doubtlessly, kidney patients present a common challenge in endodontic practice, so specialists in this field should know and follow several key points regarding this group of medically compromised patients. This review paper aims to explain kidney disease and its complications, as well as notify and discuss the latest concepts on anesthesia, pain management, antibiotic prophylaxis/stewardship, and the risk of viral diseases for these patients, and also the oral manifestations of kidney diseases that may guide endodontists to diagnose kidney intervention and prevent hazardous consequences that may happen during or following endodontic practice on these patients. For this purpose, relevant keywords were searched on Scopus, PubMed, Medline, and Web of Science to find published papers from 1980 to July 2023. Based on the quality, validity, and novelty 57 published articles were selected to provide this review to notify the most important concepts and considerations regarding endodontic management of kidney patients. Overall, it is concluded that training and education of general dentists, as well as endodontic specialists with strong technical, scientific, human, and moral knowledge about kidney patients, with emphasis on the philosophy of prevention of common dangerous systemic consequences originating from endodontic treatments, is the responsibility of dental schools in undergraduate as well as post-graduate programs.

Latest Concepts in Endodontic and Periodontal Management of Diabetic Patients.

The close interrelationship between chronic oral and dental inflammatory diseases, such as periodontal and apical abscesses (AA), with the patient's systemic condition, is one of the most interesting topics of study common between dentists and the medical staff. Chronic apical periodontitis and periodontal diseases are chronic infections of the oral cavity in which similar Gram-negative anaerobic microbiota are found and in both infectious diseases increased local inflammatory mediators, levels may influence overall systemic conditions. One of the most important systemic diseases linked to periodontal, as well as AA, is diabetes mellitus (DM); likewise, the prognosis of chronic apical periodontitis and endodontic treatment is also associated with how DM is controlled in the patient. periapical and periodontal diseases may also contribute to the quality of DM control. DM affects many systems in the body, the most important; cardiovascular and renal systems, and this necessitates obeying several keynotes to provide safe endodontic and periodontal disease control in these patients that is the aim of this article to clarify for clinicians.

Cone-Beam Computed Tomography Assessment of Prevalence of Procedural Errors in Maxillary Posterior Teeth.

A range of procedural errors can occur when performing endodontic treatment on posterior teeth. These errors may decrease the success rate in endodontic practice. This study assessed the prevalence of procedural errors and the quality of endodontic treatments in maxillary molars and premolars using cone-beam computed tomography (CBCT). CBCT scans from two private radiology centers were assessed retrospectively to ensure the same calculated sample size of 327 teeth for each of the four maxillary posterior tooth types (a total of 1,308 endodontically treated teeth). Image sets were evaluated for procedural errors categorized as follows: obturation length (overfilling or underfilling by >2 mm short of the root apex), missed canals, perforations, strip perforations (with extrusion of material into the furcation area), separated instruments in the root canal space, and root fracture. Data were analyzed with SPSS version 20 (SPSS Inc., Chicago, IL, USA), and frequency data was assessed using the Monte Carlo test at the 0.05 level of significance. The procedural errors most commonly reported in the present study were from most frequent to least frequent: underfilled canals (50.0%), missed canals (27.5%), overfilled canals (12.5%), apical perforations (5.0%), separated instruments (3.1%), and root fractures (1.9%). No strip perforations (with extrusion of material into the furcation area) were seen in the study (0%). Underfilled and missed root canals were the most frequent procedural errors identified in the present study. These findings underline the importance of more consideration of critical working length management during all stages of root canal treatment, greater awareness of root canal anatomy, and the use of imaging and diagnostic devices that enhance the ability to identify and treat root canals both safely and effectively.

Latest Concepts in Endodontic Management of Pregnant Patients.

Pregnant patients and how to manage their treatments is one of the most important challenges in endodontic practice. Endodontic treatment on pregnant women is sometimes an emergency condition to control toothache due to irreversible pulpitis and odontogenic infection. Tooth decay, oral health, local and general anesthesia, analgesics, antibiotic prescription, drug interactions, and X-ray radiation are the most important considerations that may impact treatment planning and endodontic practice in pregnancy. The aim of this article is to notify and explain the latest concepts in the endodontic management of pregnant patients.

Knowledge, Attitudes and Performance of Iranian Endodontists to Patients with Kidney Diseases.

OBJECTIVE: The high prevalence of chronic kidney disease in the community, especially in older patients, makes their management an important aspect of clinical practice. The aim of this study was to evaluate the knowledge attitudes and performance of Iranian endodontists regarding patients with chronic kidney disease (CKD). METHODS: This cross-sectional, descriptive-analytical study involved 100 Iranian endodontists (41 M, 59 F), who completed questionnaires with 21 items on CKD. Responses were analyzed by SPSS, using Chi-square or Fisher's exact tests. RESULTS: Overall levels of knowledge were rated as optimal in 55% of subjects, while attitudes to care were favourable in 83%. This cohort of specialist clinicians had strong scores for optimal attitude and performance. Awareness of issues around prescribed analgesics, antibiotic cover, bleeding risk and hypertension was high. Proximity to specialist training (younger specialists, and less years in practice) and female gender were associated with significantly higher scores across the three domains measured. CONCLUSION: Most specialists were aware of requirements for safe care of dental patients with CKD. Continuing professional education should target older clinicians who may have had less exposure to formal training in this topic during their clinical training. (EEJ-2022-04-059).

The Prevalence of Middle Mesial Canals in the Second Mandibular Molars of an Iranian Subpopulation: A Cross-Sectional CBCT Study.

Background Missed additional canals are a common reason for the failure of root canal treatments. The prevalence of additional canals in molar teeth can vary because of ethnic differences. Hence, this study aimed to determine the prevalence and distribution of middle mesial canals (MMCs) in the second mandibular molars using cone beam computed tomography (CBCT), for an adult population from Kerman in southeast Iran. Methodology De-identified retrospective provided CBCT scans from three private radiology centers in Kerman were reviewed (131 patients; 58 males (44.3%), 73 females (55.7%); age range: 13 to 54 years, mean age: 33). The presence of MMCs in mandibular second molars (222 teeth; 112 left and 110 right) was recorded, along with the morphology of the distal roots in the same teeth. Frequency data were analyzed using the Chi-square test and Fisher's exact test. Results The overall prevalence of MMC in the second mandibular molars was 2.3%. MMCs were found both unilaterally and bilaterally. More MMCs were found in females than males (2.7% vs. 1.7%), and on the left side (2.7% vs. 1.8%), but these differences were not statistically significant (p=1.0). There was no association between the existence of MMC in the mesial root and a second canal in the distal root of the same tooth. Conclusion Based on CBCT scans, the overall prevalence of MMC in mandibular second molars in this population was just below one in 44. Clinicians performing endodontic treatment on second molars should check for the presence of MMC so that this possible additional canal is not missed.

Comparison of Canal Transportation, Separation Rate, and Preparation Time between One Shape and Neoniti (Neolix): An In Vitro CBCT Study.

PURPOSE: This in vitro study compared root canal preparation in curved mesiobuccal canals of molar teeth using either the One Shape™ or the Neoniti (Neolix) rotary NiTi single-file systems, assessing canal transportation, instrument separation and time required for preparation. Methods. Extracted maxillary and mandibular human molar teeth with mesiobuccal canals having apical angles of curvature between 25 and 35o were selected and embedded in acrylic resin blocks, and an initial CBCT was taken. The teeth were divided into two equal groups (n = 20), and the canals were cleaned and shaped using either Neoniti™ or One Shape™ engine-driven NiTi rotary files. Each individual instrument was used to prepare 5 canals. The time required for the preparation of each canal was recorded. Postpreparation CBCT scans were taken and used to determine the extent of canal transportation at levels of 2, 4, 6, and 8 mm from the apex. The Kolmogorov-Smirnov test for normality was applied, and then, datasets were compared using independent t-tests, with a threshold of P < 0.05. RESULTS: Neoniti rotary files caused significantly less canal transportation of the curved canals (P=0.0001). On the other hand, the time required for canal preparation was significantly shorter for One Shape (P=0.0001). No instrument separation was recorded in both groups. CONCLUSION: Based on these results, the Neoniti™ rotary file system is preferred because it maintains the original shape of curved root canals better than One Shape™; even though this benefit comes at the cost of an increase in preparation time in clinical practice, the better technical performance may be more important than a difference in procedural time.

Prevalence and Distribution of the Middle Mesial Canal in Mandibular First Molar Teeth of the Kerman Population: A CBCT Study.

PURPOSE: Missed additional canals are one of the most important reasons for RCT failures in molar teeth. This study aimed to determine the prevalence and distribution of middle mesial canals in mandibular first molars of the Kerman population. MATERIALS AND METHODS: A retrospective study was performed on de-identified cone beam image sets from 3 private radiology centers in Kerman. A total of 100 mandibular first molars from 62 patients (mean age 32 years) were included. Information regarding the patient's age and gender, the location of teeth, and the presence or absence of a MMC and also a second distal canal in MMC cases was recorded in an Excel table. Data were analyzed using SPSS software (IBM-USA). RESULTS: The overall prevalence of MMCs in the mandibular first molars was 8.1% (10.0% in females and 6.3% in males). More cases of MMCs were seen on the right side (12.2%) than the left side (3.4%). One case of bilateral MMCs combined with bilateral second distal canals in the mandibular first molars was seen in a 26-year-old female. A further case of bilateral MMCs was found in a 32-year-old male but with single-canal distal roots on both sides. CONCLUSION: The overall prevalence of MMCs in the Kerman population (8.1%) is at the lower end of the reported range of the international literature (0.26% to 53.8%). In the cohort examined in this study, mid mesial canals were more prevalent in females and on the right side. There was no definite relationship between MMCs and second distal canals in the mandibular first molar teeth in the same subject. MMCs may be unilateral or bilateral. Careful exploration of the pulpal floor between canal orifices is essential to prevent missing the MMC, as this would cause undesirable clinical outcomes.

Prevalence and distribution of dilacerations in the permanent dentition of an Iranian population

A thorough knowledge of external dental root morphology is fundamental for having successful endodontic, orthodontic and surgical treatments in dentistry. The aim of this anatomical study was to determine the incidence of tooth dilacerations in Kerman, a province in the Southeastern Islamic Republic of Iran. A cross-sectional study was performed on a total of 3150 teeth from 800 PA radiographs; 100 radiographs from each 8 anatomic divisions of the dental arch, within a Kerman population. The numbers of radiographs were equal between 2 genders; 400 from females and 400 from males. Radiographs were studied by 3 specialists in this field in order to determine and record the prevalence and distribution of dilacerations in different teeth of this population. Amongst the total of 3150 teeth from 800 radiographs, 52 teeth (1.65%) showed dilacerations. The prevalence of this anomaly was 7.5% in males and 5% in females, and the distribution was almost equal between different teeth of the maxilla (2%-4%); meanwhile in the mandible, the maximum prevalence was in third molars (14%) and the rate was nil in anterior teeth (Spss and Excel softwares, IBM). The prevalence of tooth dilacerations was almost equal between genders in the Kerman population that was studied. The findings indicated that the presence of dilacerated roots was more prevalent in females in the mandibular arch, while this anomaly was more prevalent in males in the maxillary arch. Interestingly, none of the mandibular incisor teeth displayed this anomaly

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Latest Concepts in the Endodontic Management of Patients with Cardiovascular Disorders.

There are several cardiovascular interventions that need special considerations in the provision of treatments within the scope of endodontics. If these interventions are not carefully identified, diagnosed, and considered in the overall treatment plan for the patient, they may result in fatal conditions. These include hypertension that causes fatal cardiac disorders, such as angina pectoris, ischemic heart diseases, and myocardial infarction, and also cerebrovascular diseases; congestive heart failure; infective endocarditis, valvular diseases, and carrying pacemakers; and the use of antiplatelet and anticoagulant drugs that are commonly prescribed for patients who have experienced heart stroke. The aim of this article is to review the newest recommendations for patients with these disorders who require endodontic treatments.

Nickel-Titanium Rotary Instruments: Development of the Single-File Systems.

Over the past two decades, the nickel-titanium (NiTi) rotary instruments have highly improved the quality of the cleaning and shaping of the root canals. The superelasticity and shape memory of these instruments reduce the possibility of the canal transportation along with saving the time for both the patients and the clinicians. Several commercial types of these instruments, produced by different manufacturers, have currently become available by modifying the characteristics of the wonder NiTi alloy and also the cross-sectional shapes, cutting edges, tapering and numbers and distances of the flutes of the instruments. Up to this date, five generations for NiTi rotary instruments have been described according to the time of introduction, properties, and method of application. The aim of this article is to review the evolution of these five generations of NiTi rotary instruments since their inception.

Prevalence and Distribution of Radix Paramolaris in the Mandibular First and Second Molars of an Iranian Population.

OBJECTIVES: Inability to find supernumerary roots is one of the most important reasons for root canal therapy failures in molar teeth. This research aimed to determine the incidence and distribution of radix paramolaris in permanent mandibular molars of the population of Kerman. Iran over 2016-2017. MATERIALS AND METHODS: This study was performed on a collection of 500 extracted permanent mandibular first and second molars selected by random from different dental centers in Kerman without recording the sex and age of the patients as inclusion criteria. The incidence of additional mesiobuccal root (radix paramolaris), the average root length and morphology of this root was carefully determined following the Calberson and Alexanderson classification pattern. RESULTS: The incidence of radix paramolaris was 1.2% in mandibular first molars (0.8% Type A and 0.4% Type B) and 0.8% in mandibular second molars (0.4% Type A and 0.4% Type B) of this population. Fischer's Exact test showed that the difference in frequency of the radix paramolaris between first and second mandibular molars of this population was not statistically significant (two-sided P = 0.0001). The average length for radix paramolaris was 13.05 mms in mandibular first and second molars in this study. CONCLUSION: Radix paramolaris was found more frequently in mandibular first molars than in mandibular second molars in this sample of 500 mandibular molars. The rate of 1.2% in first molars seems to be higher than reported rates in European or Caucasian populations where the prevalence is typically <0.5%.

Pulp Stones, Prevalence and Distribution in an Iranian Population.

AIM: This study determined the prevalence and distribution of pulp stones in the permanent dentition of an adult population using their periapical radiographs. MATERIALS AND METHODS: The study followed a cross-sectional design. A total of 800 periapical radiographs collected from 412 patients attending dental clinics in Kerman, Islamic Republic of Iran, were examined using magnification. RESULTS: Pulp stones were present in 9.6% of all permanent teeth examined, being most common in maxillary first and second molars, followed by mandibular first and second molars. They were present in 31.5% of all adult patients, with a significantly increased prevalence in females compared with males (40.5 vs 23.9%, chi-squared test p < 0.001). There was also an increased prevalence with age. CONCLUSION: Based on the results of this study, clinicians should expect to encounter pulp stones most commonly in the pulp chambers of maxillary first and second molars, particularly in older female patients. CLINICAL SIGNIFICANCE: Pulp stones depending on their size and location can pose challenges to endodontic treatment. They obstruct access to the canal orifices and thus complicate endodontic treatment. Knowing where and when pulp stones are likely to occur improves the quality of root canal treatments.

Radix Entomolaris in the Mandibular Molar Teeth of an Iranian Population.

Purpose. Supernumerary roots in permanent mandibular molar teeth make endodontic treatment more complicated. The aim of this study was to determine the prevalence of Radix Entomolaris (RE) in permanent mandibular first and second molars in the population of Kerman, in the southeast of Iran. Materials and Methods. From a collection of 500 mandibular first and second molar teeth extracted over 2015-2016 at dental clinics in Kerman, teeth were scored for an additional distolingual root, and the average root length and root morphology of this extra root were determined using the De Moor classification scheme. Results. In this population, RE occurred in 6% of mandibular first molars (4% with a straight apex (Type I) and 2% with buccal apical curvature (Type III)). In all cases, RE was the shortest root, with an average root length of 18.37 mm. RE occurred in only 0.8% of mandibular second molars, with an average root length of 18.0 mm. All mandibular second molars with RE were of Type III. Fisher's exact test showed that the difference in frequency between first and second molars was statistically significant (two-sided P = 0.002). Conclusion. Radix Entomolaris occurs more frequently in mandibular first molars than in mandibular second molars in this sample of 500 mandibular molars. The reported rate of 6% in first molars is expected to be higher than reported rates in European or Caucasian populations where the prevalence is typically less than 2%.

Root and canal morphology of mandibular third molars in an Iranian population.

BACKGROUND AND AIMS: A through knowledge of the root canal morphology is required for successful endodontic ther-apy. The aim of this study was to investigate the root and canal morphology of mandibular third molars in Kerman, a prov-ince in southeast of Iran. MATERIALS AND METHODS: One-hundred-fifty extracted mandibular third molars were collected randomly from different dental clinics in Kerman. The root canal anatomy and morphology of each tooth was carefully studied using a clearing tech-nique. Root number and morphology, number of canals per root, root canal configuration according to Vertucci classifica-tion, and incidence of dilacerated roots and C-shaped canals in mandibular third molars were evaluated under stereomicro-scope with ×2 to ×3 magnifications. RESULTS: From the total of 150 mandibular third molars studied, 21% had one root. The majority of teeth (73%) had two roots. 5.5% of the teeth had three roots. The incidence of C-shaped canal was 3.5% in this study and 8% of the teeth had at least one dilacerated root. CONCLUSION: Although root canal anatomy and morphology of mandibular third molars is very variable having two roots seems to be the normal anatomy for these teeth.

Cytotoxic chemotherapy tooth ache following chemotherapy: a rare case report.

Currently, localized pulpalgia is listed as a rare manifestation of chemotherapy treatments in patients with malignant tumors. The neuropathy originated from neurotoxicity of anticancer drugs is usually described as a diffuse jaw pain or numbness in orofacial structures. This article reports localized tooth pain as a possible outcome of administrating high dosage chemotherapy drugs particularly in the last cycles of application.

Cleaning and shaping curved root canals: Mtwo vs ProTaper instruments, a lab comparison.

OBJECTIVES: The purpose of this study was to compare root canal preparation in curved canals in molar teeth with the rotary NiTi Mtwo and ProTaper systems in terms of canal shape and smear layer. MATERIALS AND METHODS: Mesiobuccal canals of 60 molar teeth with angles of curvature between 25 and 35 degrees were prepared with a torque controlled low speed engine; 30 canals for each system. Each individual instrument was used to prepare four root canals and the time required for preparation was recorded. Standardized radiographs were taken before and following instrumentation and used to determine changes in canal curvature. RESULTS: There was no significant difference in preparation time between the two systems. No instruments separated during use. The Mtwo system gave a statistically smaller change in canal curvature and thus was better for maintaining the original shape of the root canal, with less transportation (P less than 0.05). The greatest difference was seen for maxillary molar teeth. When prepared root canals were examined by SEM there was no difference between the two systems at the coronal, middle or apical thirds. CONCLUSION: Overall, the results of this study suggest that Mtwo instruments are preferable for situations where canals are curved, particularly for maxillary molars.

Quantitative analysis of KTP laser photodynamic bleaching of tetracycline-discolored teeth.

OBJECTIVE AND BACKGROUND DATA: Photodynamic bleaching is a recently developed method that may be suitable for photo-oxidation of difficult internal stains. This study examined the outcomes of photodynamic bleaching for treatment of confirmed cases of tetracycline discoloration, when used as a single-appointment procedure. MATERIALS AND METHODS: Digital analysis of standardized pre- and post-treatment digital photographs of a total of 90 maxillary incisors from 23 adult patients undergoing photodynamic bleaching was undertaken. The patients were treated by a visible green KTP laser (wavelength 532 nm) combined with a rhodamine-B photosensitizer gel (Smartbleach) applied to the teeth and activated for 30 sec. Each tooth underwent four cycles of 30 sec of laser exposure. Digital image analysis was undertaken in a blinded manner, and we examined changes in the four maxillary incisors in terms of blue pixel intensity (yellowness). RESULTS: Least squares linear regression analysis and a one-tailed paired t-test using the matched pairs of pre- and post-treatment data for mean blue pixel intensity showed that a significant lightening effect was achieved by the bleaching treatment. Significant increases in blue pixel intensity (reductions in yellowness) occurred in 78% of the teeth treated. CONCLUSIONS: In-office KTP laser photodynamic bleaching provides a clinically useful improvement in tooth shade in teeth with tetracycline discoloration.