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.

Comparison Of Centering Ability And Transportation Of The Protaper Next And Oneshape File Rotary Systems For Preparing Simulated Curved Canal.

BACKGROUND: To compare the effect of ProTaper Next and One Shape rotary files on canal transportation and centering abilities in resin block with simulated curved canal. METHODS: An in-vitro experimental study was carried out in Dental clinics. Sixty resin blocks (30 per group) having simulated curved canals prepared with ProTaper Next and One Shape and then filled with red and blue Indian ink, respectively. Photographs of resin blocks obtained using standardized manner were then transferred to the Adobe Photoshop 7.0. Centering abilities and amount of transportation were then calculated at coronal, middle and apical portion of canal for both the groups. Independent sample t-test was used to compare the transportation and centering ability of both file systems. Level of significance was kept at p-value ≤0.01. RESULTS: One Shape file resulted in more canal transportation at all the levels (apical, middle and coronal part) as compared to ProTaper Next file, however, difference was not statistically significant (p-value >0.01). Statistically significant difference was noted at the apical third between these two rotary files with One Shape file showing more centered preparation as opposed to ProTaper Next file (p-value <0.01). CONCLUSIONS: One Shape file system had more centered canal preparations specifically at the apical region as compared to ProTaper Next. One Shape also lead to more canal transportation in comparison to ProTaper Next, however the difference was not statistically significant.

Comparison of Two Different Methods in the Removal of Oil-Based Calcium Hydroxide From Root Canal System: A Triple-Blinded Randomised Clinical Trial.

OBJECTIVE: To compare the effectiveness of rotary master apical file (RMAF) with ultrasonic activation of endodontic file (UAF) in the removal of silicon oil-based calcium hydroxide (SOBCH) from the canal. METHODS: Ethical review committee approval and informed consent was obtained. 60 cases with necrotic teeth in which silicon oil-based intracanal medicament (Metapex) was to be placed were randomised in one of the two groups using sealed envelopes containing assignment codes for medicament removal: RMAF and UAF group. After standard protocol of coronal access, cleaning and shaping, silicon oil-based SOBCH was placed using a Lentulo spiral. A periapical radiograph was taken after SOBCH placement to check for adequate adaptation. On 7th day, after instrumentation and medicament removal according to respective group, a second radiograph was taken to evaluate the effectiveness. Effectiveness was calculated using a graded scale in which 0 and 1 are effective and 2 and 3 are ineffective cleaning. Teeth were statistically analyzed using the Mann Whitney U and Chi-square test. RESULTS: There was no statistically significant difference in the removal effectiveness of group RMAF and Group UAF at coronal (P=0.74) middle (P=0.71) and apical third (P=0.68). According to the graded score both techniques were equally effective in cleaning at all thirds of canal (RMAF=Apical: 1.09+-0.70, Middle: 0.61+-0.80, Coronal: 0.33+-0.48 and UAC=Apical: 1.00+-0.77, Middle: 0.52+-0.74, Coronal: 0.28+-0.46). Effectiveness of SOBCH removal using the two methods was not statistically significant between maxillary and mandibular teeth (P=0.35). CONCLUSION: Both the removal methods, Ultrasonic activation of file and Rotary master apical file, for SOBCH were equally effective in all the thirds of canal. And none of the techniques were able to completely remove the SOBCH. Effectiveness of SOBCH removal using the two methods was not statistically different between maxillary and mandibular teeth. (EEJ-2020-07-183).

Changes in canal width and angle in curved canals in the resin blocks: Pro taper next versus one shape instruments.

OBJECTIVE: To compare the effect of OneShape and ProTaper Next file on the change in canal width and angle of curvature in simulated curved canal in resin blocks. METHODS: The quasi-experimental study was conducted at the Aga Khan University, Karachi, from January to March 2018, and comprised endodontic resin blocks that had inbuilt curved canals. These were randomly divided into 2 equal groups and were subsequently prepared using OneShape in group A, and ProTaper Next rotary instrument in group B followed by staining with red and blue ink for comparison of pre- and post operative images of canals. Standardised photographs were taken along with reference measuring scale. Independent sample t-test and Paired sample t-test were used to compare the angle of curvature and canal width changes and pre and post instrumentation changes in resin block after using both the instruments, respectively. Intra class correlation was used to determine inter-examiner reliability. The level of significance was kept at p value < 0.01. SPSS 22 was used for data analysis. RESULTS: Of the 60 blocks, 30(50%) were in each of the two groups. The mean pre-instrumentation angle of curvature was 32.3±2.13 and 31.0±3.28 degrees for groups A and B. The mean degree of canal straightening post-intervention was 1.5±0.5 and 3.6±1.38 degrees in groups A and B (p<0.001). In terms of canal width changes, OneShape file removed more resin material from the canal walls compared to the ProTaper Next system (p<0.001). CONCLUSIONS: ProTaper Next file significantly altered the angle of curvature in the resin block compared to OneShape file, but the amount of material removed from the canal space was significantly higher with the OneShape file compared to ProTaper Next.

Comparative evaluation of Chlorhexidine, Metronidazole and combination gels on gingivitis: A randomized clinical trial.

INTRODUCTION: Dental plaque has been established as an etiological factor in the development of gingivitis and periodontitis. Several antimicrobials including Chlorhexidine and Metronidazole have been used as an adjuvant to mechanical plaque removal. OBJECTIVE: To compare 0.8% Metronidazole gel, 0.2% Chlorhexidine gel and alternate application of the two gels in reducing gingival inflammation when used for 14 days as an adjuvant with home based oral hygiene instructions. METHODS: The bleeding sites, probing depth and the gingival index score will be calculated. (Group A standard 0.2% Chlorhexidine gel applied on the marginal gingiva; Group B subjects will be instructed to apply 0.8% Metronidazole gel; Group C subjects 0.2% Chlorhexidine gel on the marginal gingiva after morning tooth brushing and 0.8% Metronidazole gel after evening tooth brushing). After 2 weeks second clinical examination will be carried out for bleeding sites, probing depth and the gingival index score. Scaling & polishing of teeth in all three groups and oral hygiene instructions will be reinforced. Subjects will be recalled at 6 weeks for evaluation of gingival and oral hygiene indices. Descriptive statistics for variables such as age, baseline clinical parameters including probing depth, bleeding sites, gingival index, and oral hygiene index will be computed. Generalized estimation equation (GEE) will be run to account for the correlated data for the comparison of study arms. Friedman test will be used to assess the bleeding sites among three study groups at the baseline and endpoint. Similarly, gingival index and oral hygiene index in the three groups at baseline, after 2 weeks and 4 weeks will be compared. The level of significance will be kept at 0.05.

Management of immature necrotic permanent teeth with regenerative endodontic procedures - a review of literature.

Immature necrotic permanent tooth presents a distinctive challenge for the endodontist. Various treatment modalities have been employed to create hard tissue barrier at the apex, which includes non-vital pulp therapy with calcium hydroxide, apexification with mineral trioxide aggregate, pulp revascularisation and regeneration. Regenerative endodontics is a novel modality which involves physiological replacement of the damaged structures of tooth like dentin, root and cells of the pulp-dentin complex. Numerous published case reports have revealed increased dentinal wall thickness, continued root development and apical closure, but there is still lack of sound scientific evidence regarding histological nature of the type of tissue. The current literature review was planned to summarise the evidence regarding the treatment of immature necrotic permanent teeth by regenerative endodontic procedures.

Assessment of iatrogenic damage to adjacent teeth during crown and bridge preparation.

INTRODUCTION: Iatrogenic damage to the adjacent tooth during crown preparation is a frequent disastrous effect. The aim of the study was, therefore, to determine the frequency of different types, degree and location of iatrogenic damage to the adjacent tooth during crown and bridge preparations in a tertiary care setting that lead towards the morbidity of tooth. MATERIALS AND METHODS: A prospective study was conducted in Aga Khan University dental laboratory in two months period in which a total of 150 dental casts fulfilling the inclusion criteria were analyzed using non-probability convenient sampling technique. The casts were examined using 3.5x magnifying loupes for the location, degree and type of damage to the proximal surface adjacent to the prepared tooth using Moonpar and Faulkner criteria. Data were analyzed by using SPSS version 22. Chi square test was used to assess the association between the experience of practitioner and degree of damage to adjacent tooth. It was also used to determine the association between location of tooth and degree of damage to adjacent tooth. Inter-examiner reliability was assessed by using kappa statistics. RESULTS: A high prevalence of damage to the proximal surface of adjacent teeth (78% on mesial tooth and 60.6% on distal tooth) was observed, with the majority (32.6%) belonging to the mild categories. There were statistically significant associations between the experience of practitioner and the damage to the surface mesial to the preparation. However, more severe damages occurred in mandibular teeth preparations as compared to maxillary teeth preparations. CONCLUSIONS: A high frequency of iatrogenic damage to the adjacent teeth had been found during crown and bridge work with the middle of the tooth as the most susceptible site. However, the majority of damages were of milder type including only abrasions.

Effectiveness of Hall Technique for Primary Carious Molars: A Systematic Review and Meta-analysis.

AIM: The objective of the present systematic review was to assess the outcomes of Hall technique (HT) on primary carious molars and compared it with the conventional dental restorations. MATERIALS AND METHODS: The systematic review was registered with Prospero registry (CRD42015020445) to answer the following research question: Is HT a better restorative option compared to other techniques for restoration of carious primary molars? In addition to exploring various health sciences databases, hand search was also done using following key terms in different permutations: (Hall technique OR Hall's technique OR preformed metal crown OR stainless steel crown) AND (caries OR carious molar OR deciduous tooth OR baby tooth OR milk tooth OR primary tooth). The outcome of interest was success of the restoration achieved with either method. RESULTS: Five studies were included (two RCTs, one quasi-experimental trial, and two retrospective). A total of 1775 teeth were assessed, of which 1325 teeth were restored using HT. The retrospective studies showed no difference between HT and other methods whereas the RCTs and quasi-experimental favored HT over other treatment modalities. Meta-analysis significantly favored HT over conventional restorations [risk ratio 5.55 (3.31-9.30)] (p value ≤ 0.001). CONCLUSION: HT appeared demonstrated higher success and significantly outperformed the conventional restorations. HOW TO CITE THIS ARTICLE: Badar SB, Tabassum S, Khan FR, et al. Effectiveness of Hall Technique for Primary Carious Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2019;12(5):445-452.

Prevalence of musculoskeletal disorders among dentists in teaching hospitals in Karachi, Pakistan.

Work-related musculoskeletal pain is common among healthcare professionals, including dentists. This cross-sectional study was conducted to determine the prevalence of work-related musculoskeletal disorders (MSDs) among dentists. This study was carried out from January to April 2016 at various teaching hospitals of Karachi, and comprised 230 dentists. A self-administered questionnaire, adapted from a validated Nordic questionnaire, was distributed among the participants. Descriptive statistics were computed and associations of interest were analysed using chi-square test. Of the 230 forms, 182(79.11%) were included after leaving out the incomplete ones. The overall prevalence of MSDs was 138(75.8%). The most frequent reasons for MSDs were lack of rest 21(15.2%) and having static postures for more than half-an-hour per procedure 38(27.5%).

Age estimation of a sample of Pakistani population using Coronal Pulp Cavity Index in molars and premolars on Orthopantomogram.

The aim of the present study was to assess the validity of tooth-coronal index (TCI) in the age estimation. This retrospective charts review was conducted at the Aga Khan University Hospital, Karachi from January 2016 to March 2016, and comprised 315 teeth of 80 individuals. The teeth were analysed on Orthopantomogram. TCI was calculated for unrestored mandibular premolars and molars. Pearson\\\'s correlation was applied to assess correlation between chronological age and TCI. Besides, 30(37.5%) subjects were male and 50(62.5%) female, and 140(44.4%) teeth were of male subjects and 175(55.6%) were of females. The mean correlation coefficient between chronological age and TCI was -0.27. The highest negative correlation was observed for tooth No.47 in males (r=-0.72) whereas among females the highest negative correlation was noted for tooth No.36 (r=-0.61).There was very weak correlation between age and TCI of a tooth. Therefore, TCI index could not be predictably used for age estimation in the studied population.